Improving Uptake of Antenatal Care Services in Rural Côte d'Ivoire
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexFemale
Age15+
SponsorSwiss Tropical & Public Health Institute
About this trial
The past two decades have brought significant increases in the availability of maternal health care services in many low- and middle-income countries, with a large increase in the number of health facilities that provide these services. However, many women still do not receive the basic services recommended by the World Health Organization. In many settings, antenatal care is associated with substantial financial cost, which means that obtaining high quality care can involve complex intrahousehold bargaining and decision-making. Women have more access to information about these services, but men generally make the financial decisions. If men are unaware of the magnitude and timing of financial needs, securing adequate financial resources may be difficult.
The investigators plan to conduct a randomized-controlled experiment of supply- and demand-side solutions to increase uptake of recommended antenatal care services in rural Côte d'Ivoire, where there are currently substantial gaps in service coverage. Despite Côte d'Ivoire's "free maternity care" policy, many recommended services - including ultrasounds and laboratory tests - continue to carry costs for patients. On the supply side, the study will evaluate the impact of providing key services (including ultrasounds, laboratory testing, and iron and folic acid supplements) for free to pregnant women (in line with Côte d'Ivoire's policy of free provision). On the demand side, the study will evaluate the impact of providing information about antenatal care recommendations to pregnant women (alone or with their partners), and of providing a financial planning session to pregnant women or their partners, or both together. The study will evaluate the impacts of these interventions on the uptake of recommended antenatal care services.
Eligibility criteria
This trial does not accept healthy volunteersQualifiers
Currently pregnant
Aged 15 years or older
Live in the area served by the Taabo Health & Demographic Surveillance System
Estimated gestational age of less than 6 completed months of pregnancy
Disqualifiers
None
Trial design
Design model
Parallel
Treatments tested in this trial
Information video
BehavioralParticipants will be shown a short video that describes key recommendations for antenatal care and health during pregnancy, based on national guidelines in Côte d'Ivoire. In arms (1a-1b) and (2a-2b), this video will be shown only to the pregnant woman. In arms (3a-3b), this video will be shown to the pregnant woman together with her partner.
Financial planning session
BehavioralIn this intervention, a member of the study team will facilitate a structured discussion about planning for the expenses of health care services and related transportation costs over the course of pregnancy. The discussion will follow a series of questions and prompts set up as a survey form in ODK (attached to this protocol). The study team member will also share a list of the local prices of recommended antenatal care services. In arms (2a-2b), this intervention is delivered only to pregnant women. In arms (3a-3b), this intervention is delivered to pregnant women together with their partners.
Vouchers
Other interventionThis intervention consists of vouchers for a pre-defined set of antenatal care services. Pregnant women who are randomized to receive this intervention will be given vouchers for one ultrasound, one "bilan prenatal" (a recommended set of prenatal laboratory tests in Côte d'Ivoire), and a 6-month supply of iron \& folic acid supplements (with dosage based on their health care provider's recommendation). The study team will establish agreements with local health facilities to provide services in exchange for these vouchers, with reimbursement by the study team.
Treatment groups
1,290 Participants
are divided into 6 treatment groups6
Treatment groupsSee each treatment group below.
Group A: 1a) Information video onlyExperimental treatment 1 intervention
Group B: 1b) Information video + VouchersExperimental treatment 2 interventions
Group C: 2a) Information video + financial planningExperimental treatment 2 interventions
Group D: 2b) Information video + financial planning + vouchersExperimental treatment 3 interventions
Group E: 3a) Information video + financial planning with partnersExperimental treatment 2 interventions
Group F: 3b) Information video + financial planning with partners + vouchersExperimental treatment 3 interventions
Trial outcomes
Primary outcomes
1
Proportion of women receiving recommended antenatal care services
The primary endpoint is the proportion of women receiving the following recommended antenatal care services during their pregnancy, as measured through recall during endline surveys with pregnant women: * At least four antenatal care visits with a skilled provider AND * At least one ultrasound AND * At least one laboratory assessment.
Time frame
During pregnancy (measured 4-8 weeks after the end of pregnancy)Secondary outcomes
1
Proportion of participants receiving the recommended number of malaria chemoprophylaxis doses during pregnancy
Proportion of participants who receive at least three doses of malaria chemoprophylaxis during pregnancy as reported by study participants during endline interviews
Time frame
During pregnancy (measured 4-8 weeks after the end of pregnancy)2
Proportion of participants receiving high-quality antenatal care measured using antenatal care booklets
High-quality antenatal care (defined as at least 4 antenatal care visits with a skilled provider, at least one ultrasound, and at least one laboratory assessment) as measured through review of antenatal care booklets (as opposed to measurement by maternal recall). This secondary endpoint will only be measured in cases when women have an ANC book available at the time of the endline interview.
Time frame
During pregnancy (measured 4-8 weeks after the end of pregnancy)3
Average antenatal care knowledge scores among pregnant women and their partners
Average scores (among pregnant women and among their partners) on assessments of knowledge of antenatal care recommendations, as measured using the following questions during endline surveys with pregnant women and their partners: 1. During antenatal care visits, health care providers conduct some examinations and tests. Can you tell me which examinations and tests they should conduct? 2. During antenatal care visits, health care providers also sometimes give medications or treatments. Can you tell me which medications they should provide to all pregnant women? Participants receive 1 point for each correct test or examination they mention in response to Q1 and 1 point for each correct medication or treatment they mention in response to Q2.
Time frame
Measured 4-8 weeks after the end of pregnancy4
Proportion of women who delayed or missed care for financial reasons
Proportion of women who respond "yes" to one or both of the following questions during endline surveys: * During your most recent pregnancy, did you ever delay your visit to the hospital because of financial issues? * During your most recent pregnancy, did you ever skip recommended care - like an ultrasound or a blood test - because of money problems?
Time frame
Measured 4-8 weeks after the end of pregnancySponsors and contacts
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Swiss Tropical & Public Health Institute
Lead sponsor
Centre Suisse de Recherches Scientifiques en Cote d'Ivoire
Collaborator
Swiss National Science Foundation
Collaborator
Source ClinicalTrials.gov