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首页> 外文期刊>Trials >Conditional cash transfers to retain rural Kenyan women in the continuum of care during pregnancy, birth and the postnatal period: protocol for a cluster randomized controlled trial
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Conditional cash transfers to retain rural Kenyan women in the continuum of care during pregnancy, birth and the postnatal period: protocol for a cluster randomized controlled trial

机译：有条件的现金转移以在怀孕，分娩和产后期间留住肯尼亚农村妇女的连续照护：一项整群随机对照试验的方案

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Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1?year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5–10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial’s primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48?h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable contexts. ClinicalTrials.gov, NCT03021070 . Registered on 13 January 2017.
机译：事实证明，在高负担的环境中，产前保健（ANC），分娩设施和产后保健（PNC）可以降低母婴死亡率和发病率。但是，很少有农村孕妇充分利用这些服务。这项研究旨在评估有条件现金转移的影响，成本效益和可扩展性，以促进孕妇或刚分娩的妇女与肯尼亚的正规医疗系统之间的接触增加。测试的干预措施是有条件的现金转移给妇女进行ANC健康检查，分娩和PNC检查，直到她们的新生婴儿达到1岁。这项研究是在肯尼亚Siaya县进行的一项整群随机对照试验。试验组是48个随机选择的公共初级卫生机构，其中24个在研究的干预部门，而24个在控制部门。随机单位是卫生设施。目标样本为7200名研究参与者，其中包括在12个月的招募期间首次ANC访问时识别并招募的孕妇以及其后的新生儿。在招募期间，所有参加其中一个选定的试验设施进行首次ANC访问的孕妇都有资格参加试验并被邀请参加。在怀孕期间，分娩时以及分娩后的多次访视中，对已登记的母亲进行所有健康检查。参加研究后，还会在另外三个时间点与他们联系：入学后5-10天，预期分娩日期后6个月和出生后12月27日。如果他们还没有在工厂交货，则在预期的到期日之后再进行2次随访。有条件现金转移对孕产妇保健服务和利用的影响将通过试验的主要结果来衡量：怀孕期间所有合格的ANC访视，在医疗机构分娩的比例，所有合格的PNC访视的比例，怀孕和产后转诊的比例，以及参加合格的儿童免疫接种的比例。次要结果包括：健康检查和感染控制，活产，分娩后48小时的母婴存活，纯母乳喂养，产后避孕药的使用以及母婴发病率。衡量结果的数据源包括常规健康记录，电子读卡器系统，电话调查和焦点小组讨论。将进行全面的经济评估，以评估干预措施的交付成本和成本效益，以及试验活动和结果的收益发生率和公平影响。这项试验将为有条件现金转移在便利就诊和促进肯尼亚农村地区以及其他类似情况下的妇幼保健方面的有效性和成本效益提供证据。 ClinicalTrials.gov，NCT03021070。 2017年1月13日注册。

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