Wakobo ti Kodro: A quasi-experimental study aimed at strengthening the identification and follow-up of pregnant women at risk of obstetric complications in the community by traditional birth attendants in the Central African Republic

This quasi-experimental study in the Central African Republic evaluates whether training and digitally supporting traditional birth attendants, and integrating them into the health system, can improve the identification of high-risk pregnancies and increase safe deliveries in health facilities.

République Centre Africaine

Axis: Global Health inequities

Coordinating investigators:

– Pr Richard Ngbale, Université de Bangui, République Centrafricaine
– Dr Renaud Becquet, Université de Bordeaux, France
– Dr Cécile Cazes, ALIMA, Sénégal

Teams:

– Department of Gynaecology-Obstetrics, Université de Bangui, République Centrafricaine
– GHiGS, UB
– Ministère de la Santé, République Centrafricaine
– PACCI, Abidjan, Côte d’Ivoire
– ALIMA, Dakar, Sénégal

Funder: Research for Health in Humanitarian Crises (ELRHA/R2HC)

Status: accepted

Impact:

1 doctoral fellowship is associated to the project)
– Name of doctoral student : Jérémie Sansan Hien
– Title: Évaluation d’une intervention visant à renforcer l’identification et le suivi des femmes enceintes à risque de complications obstétricales en communauté par les accoucheuses traditionnelles

Justification

This project aims to improve maternal health indicators in a national context where the maternal mortality rate is among the highest in the world. Our hypothesis is that an intervention combining (i) training traditional birth attendants on the identification and follow-up of high-risk pregnancies, (ii) their integration into the health system, and (iii) the use of a digital decision support application installed on smartphones and tailored to their profile, could strengthen the identification and follow-up of high-risk pregnancies, increase the attendance at health facilities, and thus the rate of deliveries assisted in health care facilities.

Objective

To assess whether an intervention targeted at midwives, combining multiple components (training, use of a digital application, collaboration with the health system), increases the proportion of births by pregnant women at risk of obstetric complications in the health facilities included in this study after 10 months of intervention.

Methods

The project involves conducting: – a quasi-experimental pilot study with a before/after intervention approach that takes into account aggregated data on deliveries in the health facilities included in the study (primary objective); – a prospective observational cohort study with an exploratory purpose, including pregnant women of any age of pregnancy who reside in the health areas included in the study, having given their informed consent (secondary objective 1); – a sub-study with a mixed methodology, combining qualitative and quantitative data from the various stakeholders (secondary objective 2).

Expected Outcomes

If the research yields positive results, we expect the evidence produced to assist the Central African Ministry of Health in renewing its community health policy by integrating community midwives. This could also influence other humanitarian actors to include this community component in their maternal health programs in the country and progressively improve communication between traditional birth attendants and health facilities. If our experience with the digital application used by midwives to identify high-risk pregnancies is positive, we assume that it could be expanded by the Ministry of Health to other districts, by the health ministries of other countries, or by ALIMA or other humanitarian actors in various humanitarian contexts. In this sense, if the results of this pilot study justify it, we commit to providing free access to the final version of the application to these stakeholders.