An integrated approach to improve maternal and perinatal outcomes in rural Guatemala: A stepped-wedge cluster randomized trial.

International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics
Edgar KestlerDilys Walker

Abstract

To evaluate the impact of an intervention package on maternal and newborn health indicators. A randomized stepped-wedge non-blind trial was conducted across six subdistricts within two districts in Guatemala from January 2014 to January 2017. Data on outcomes were collected on all deliveries in all 33 health centers. The intervention package included distribution of promotional materials encouraging health center delivery; education for traditional birth attendants about the importance of health center delivery; and provider capacity building using simulation training. Main outcomes were number of health center deliveries, maternal morbidity, and perinatal morbidity and mortality. Overall, there were 24 412 deliveries. Health center deliveries per 1000 live births showed an overall increase, although after adjustment for secular trends and clustering, the relative risk for the treatment effect was not statistically significant (aRR, 1.04; 95% confidence interval [CI], 0.97-1.11, P=0.242). Although not statistically significant, maternal morbidity (aRR, 0.78; 95% CI, 0.60-1.02; P=0.068) and perinatal morbidity (aRR, 0.84; 95% CI, 0.68-1.05; P=0.133) showed a tendency toward a decrease. The present study represents one of the few...Continue Reading

Associated Clinical Trials

References

Jun 1, 1995·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·A AlisjahbanaM Koblinsky
Jan 25, 2005·BJOG : an International Journal of Obstetrics and Gynaecology·Mattias RööstBirgitta Essén
Mar 12, 2005·Annual Review of Public Health·Sonya Grier, Carol A Bryant
May 20, 2006·BMJ : British Medical Journal·W Douglas Evans
Jul 27, 2012·International Perspectives on Sexual and Reproductive Health·Kanako IshidaEvelyn Espinoza
Oct 1, 2014·PloS One·Ernestina CoastSamantha R Lattof
Jun 13, 2015·Reproductive Health·Ana GarcesRobert L Goldenberg
Aug 28, 2015·Simulation in Healthcare : Journal of the Society for Simulation in Healthcare·Dilys M WalkerHéctor Lamadrid-Figueroa
Jan 23, 2016·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·Anna WaltonDilys Walker
Apr 11, 2017·Clinical Trials : Journal of the Society for Clinical Trials·Monica TaljaardCharles Weijer
Nov 17, 2017·Maternal Health, Neonatology and Perinatology·Tadele Girum, Abebaw Wasie

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Citations

Apr 26, 2021·Acta Obstetricia Et Gynecologica Scandinavica·Albaro J Nieto-CalvacheUNKNOWN Latin American group for the study of placenta accreta spectrum

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