Wakobo-ti-Kodro: Improving Identification of Pregnancy At Risk of Obstetric Complications At Community Level

Wakobo Ti Kodro: a Quasi-experimental Study to Improve 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 project aims to improve maternal health indicators in a national context where the maternal mortality rate is one of the highest in the world. Our hypothesis is that an intervention combining (i) the training of traditional birth attendant in the identification and monitoring of high-risk pregnancies, (ii) their integration into the health system and (iii) the use of a digital decision-support application installed on a smartphone and adapted to their profile, could strengthen the identification and monitoring of high-risk pregnancies, increase attendance at facilities and thus the rate of assisted deliveries in health facilities, in Bimbo district around the capital Bangui in the Central African republic.

Study Overview

• Status: Completed
• Conditions: Pregnancy Complications; Maternal Health
• Intervention / Treatment: Other: Wakobotikodro

Detailed Description

This is a quasi-experimental study with a before (baseline measurement) and after (final measurement) approach combined with 2) an exploratory prospective observational cohort study and 3) a sub-study using a mixed methodology.

The main objective is to assess a composite intervention implementation combining the integration of Traditional Birth Attendants (TBAs) into the health system through a strengthened collaboration with health facilities with the support of a numeric application aiming at registering pregnant women & identifying those at high risk of obstetric complications.

The secondary objectives are to:

1. Describe the characteristics of antenatal care, pregnancy outcomes, postnatal care, maternal and neonatal mortality, and changes in the use of health facilities by pregnant women.
2. To assess the acceptability and feasibility of this intervention with matrons, community health workers, community representatives, women who have already given birth in the study area and health staff involved in the study, in order to understand the potential levers and barriers to the implementation of the intervention.

• Study Type: Observational
• Enrollment (Actual): 1857

Contacts and Locations

Study Locations

• Central African Republic
  • Bangui
    • Bimbo, Bangui, Central African Republic
      • Bimbo health center,

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

The main study population is pregnant women attending the health facilities included in the study.

Secondary population are beneficiaries of the intervention tested: traditional birth attendants, health workers, community health workers, community representatives, women who have already given birth or pregnant women or their husbands living in the study area.

Description

Inclusion Criteria for the main study (quasi-experimental study with a before-after approach)

• Aggregated data of pregnant women, regardless of the age of their pregnancy, and
• attending the health facilities included in the study

Inclusion Criteria for participating in the observational cohort:

• Being a pregnant woman residing in the study area and
• attending the health facilities included in the study and
• with a given individual consent.

Inclusion Criteria for participating in the sub-study on intervention's acceptability and feasibility:

• traditional birth attendants (TBAs) or
• health workers working in health facilities or
• community health workers or
• community representatives or
• women who have already given birth or pregnant women or their husbands AND
• All with a given individual consent AND
• All being part of the study area.

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Deliveries in health facilities of women with complicated pregnancies	Proportion of deliveries by pregnant women at risk of obstetric complications among all women who give birth in the health facilities included in the study, after 10 months of intervention	Comparison between baseline and endline data after 10 months of intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Antenatal consultancies (ANCs)	Evolution of monthly number of ANCs at health facilities	after 10 months of intervention
Delivery	Evolution of monthly number of delivery at health facilities	after 10 months of intervention
Post-partum consultancies	Evolution of monthly number of Post-partum consultancies at health facilities	after 10 months of intervention
Pregnant women at risk of obstetrical complication, screened by traditional birth attendants in the community	Evolution of monthly number of Pregnant women at risk, screened by traditional birth attendants in the community	after 10 months of intervention
Pregnant women at risk of obstetrical complication, monitored at health facilities	Evolution of monthly number of Pregnant women at risk of obstetrical complication, monitored at health facilities	after 10 months of intervention
Maternal mortality rate	Number of death of women while pregnant or within 42 days of termination of pregnancy	after 10 months of intervention
Neonatal mortality rate	Death of a live born infant, regardless of gestational age at birth, within the first 28 completed days of life	after 10 months of intervention

Collaborators and Investigators

• Sponsor: Alliance for International Medical Action
• Collaborators: Institut National de la Santé Et de la Recherche Médicale, France; Elrha; PACCI Program
• Investigators: Principal Investigator: Richard Ngbale, Pr, Faculté des sciences de la santé, Bangui; Principal Investigator: Renaud Becquet, Institut National de la Santé Et de la Recherche Médicale, France

Publications and helpful links

Helpful Links

• web page of Inserm website
• page web of ELRHA website

Study record dates

Study Major Dates

• Study Start (Actual): July 17, 2023
• Primary Completion (Actual): December 31, 2024
• Study Completion (Actual): December 31, 2024

Study Registration Dates

• First Submitted: September 19, 2024
• First Submitted That Met QC Criteria: September 23, 2024
• First Posted (Actual): September 26, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 11, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Africa; Digital health; Traditional birth attendant; Pregnancy at risk of complications identification; Collaboration with traditional birth attendant; Central African Republic
• Additional Relevant MeSH Terms: Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Pregnancy Complications
• Other Study ID Numbers: Wakobo ti Kodro

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No