Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria

Mark M. Kabue, Lindsay Grenier, Stephanie Suhowatsky, Jaiyeola Oyetunji, Emmanuel Ugwa, Brenda Onguti, Eunice Omanga, Anthony Gichangi, Jonesmus Wambua, Charles Waka, Joseph Enne, Jennyfer Don-Aki, Mairo Ali, Maryam Buba, Jenipher Ang’aha, Daniel Iya, Elizabeth Washika, Diwakar Mohan, Jeffrey M. Smith

Research output: Contribution to journalArticle

Abstract

Background: Antenatal care (ANC) in many low-and middle-income countries is under-utilized and of sub-optimal quality. Group ANC (G-ANC) is an intervention designed to improve the experience and provision of ANC for groups of women (cohorts) at similar stages of pregnancy. Methods: A two-arm, two-phase, cluster randomized controlled trial (cRCT) (non-blinded) is being conducted in Kenya and Nigeria. Public health facilities were matched and randomized to either standard individual ANC (control) or G-ANC (intervention) prior to enrollment. Participants include pregnant women attending first ANC at gestational age <24 weeks, health care providers, and sub-national health managers. Enrollment ended in June 2017 for both countries. In the intervention arm, pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). After birth, the same cohorts meet four times over 12 months with their babies (Phase 2). Data collection was performed through surveys, clinical data extraction, focus group discussions, and in-depth interviews. Phase 1 data collection ended in January 2018 and Phase 2 concludes in November 2018. Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. Data analysis and reporting of results will be consistent with norms for cRCTs. General estimating equation models that account for clustering will be employed for primary outcome analyzes. Results: Overall 1,075 and 1,013 pregnant women were enrolled in Nigeria and Kenya, respectively. Final study results will be available in February 2019. Conclusions: This is the first cRCT on G-ANC in Africa. It is among the first to examine the effects of continuing group care through the first year postpartum.

Original languageEnglish (US)
Article number56
JournalGates Open Research
Volume2
DOIs
StatePublished - Jan 1 2018

Fingerprint

Postnatal Care
Prenatal Care
Kenya
Nigeria
Health care
Randomized Controlled Trials
Health
Public health
Pregnant Women
Managers
Health Facilities
Planning
Health Personnel
Postpartum Period
Public Facilities
Intention to Treat Analysis
Family Planning Services
Focus Groups
Gestational Age
Cluster Analysis

Keywords

  • Experience of care
  • Facility-based delivery
  • Group antenatal care
  • Health literacy
  • Kenya
  • Nigeria
  • Postpartum family planning
  • Self-efficacy

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Medicine (miscellaneous)
  • Biochemistry, Genetics and Molecular Biology (miscellaneous)
  • Immunology and Microbiology (miscellaneous)

Cite this

Group versus individual antenatal and first year postpartum care : Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria. / Kabue, Mark M.; Grenier, Lindsay; Suhowatsky, Stephanie; Oyetunji, Jaiyeola; Ugwa, Emmanuel; Onguti, Brenda; Omanga, Eunice; Gichangi, Anthony; Wambua, Jonesmus; Waka, Charles; Enne, Joseph; Don-Aki, Jennyfer; Ali, Mairo; Buba, Maryam; Ang’aha, Jenipher; Iya, Daniel; Washika, Elizabeth; Mohan, Diwakar; Smith, Jeffrey M.

In: Gates Open Research, Vol. 2, 56, 01.01.2018.

Research output: Contribution to journalArticle

Kabue, MM, Grenier, L, Suhowatsky, S, Oyetunji, J, Ugwa, E, Onguti, B, Omanga, E, Gichangi, A, Wambua, J, Waka, C, Enne, J, Don-Aki, J, Ali, M, Buba, M, Ang’aha, J, Iya, D, Washika, E, Mohan, D & Smith, JM 2018, 'Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria', Gates Open Research, vol. 2, 56. https://doi.org/10.12688/gatesopenres.12867.2
Kabue, Mark M. ; Grenier, Lindsay ; Suhowatsky, Stephanie ; Oyetunji, Jaiyeola ; Ugwa, Emmanuel ; Onguti, Brenda ; Omanga, Eunice ; Gichangi, Anthony ; Wambua, Jonesmus ; Waka, Charles ; Enne, Joseph ; Don-Aki, Jennyfer ; Ali, Mairo ; Buba, Maryam ; Ang’aha, Jenipher ; Iya, Daniel ; Washika, Elizabeth ; Mohan, Diwakar ; Smith, Jeffrey M. / Group versus individual antenatal and first year postpartum care : Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria. In: Gates Open Research. 2018 ; Vol. 2.
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abstract = "Background: Antenatal care (ANC) in many low-and middle-income countries is under-utilized and of sub-optimal quality. Group ANC (G-ANC) is an intervention designed to improve the experience and provision of ANC for groups of women (cohorts) at similar stages of pregnancy. Methods: A two-arm, two-phase, cluster randomized controlled trial (cRCT) (non-blinded) is being conducted in Kenya and Nigeria. Public health facilities were matched and randomized to either standard individual ANC (control) or G-ANC (intervention) prior to enrollment. Participants include pregnant women attending first ANC at gestational age <24 weeks, health care providers, and sub-national health managers. Enrollment ended in June 2017 for both countries. In the intervention arm, pregnant women are assigned to cohorts at first ANC visit and receive subsequent care together during five meetings facilitated by a health care provider (Phase 1). After birth, the same cohorts meet four times over 12 months with their babies (Phase 2). Data collection was performed through surveys, clinical data extraction, focus group discussions, and in-depth interviews. Phase 1 data collection ended in January 2018 and Phase 2 concludes in November 2018. Intention-to-treat analysis will be used to evaluate primary outcomes for Phases 1 and 2: health facility delivery and use of a modern method of family planning at 12 months postpartum, respectively. Data analysis and reporting of results will be consistent with norms for cRCTs. General estimating equation models that account for clustering will be employed for primary outcome analyzes. Results: Overall 1,075 and 1,013 pregnant women were enrolled in Nigeria and Kenya, respectively. Final study results will be available in February 2019. Conclusions: This is the first cRCT on G-ANC in Africa. It is among the first to examine the effects of continuing group care through the first year postpartum.",
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AU - Ugwa, Emmanuel

AU - Onguti, Brenda

AU - Omanga, Eunice

AU - Gichangi, Anthony

AU - Wambua, Jonesmus

AU - Waka, Charles

AU - Enne, Joseph

AU - Don-Aki, Jennyfer

AU - Ali, Mairo

AU - Buba, Maryam

AU - Ang’aha, Jenipher

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