Role of community engagement in maternal health in rural Pakistan: Findings from the CLIP randomized trial

Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N Bone, Marianne Vidler, Sumedha Sharma, Beth A Payne, Laura A Magee, Peter von Dadelszen, Zulfiqar A Bhutta, CLIP Pakistan Working Group*, Amjad Hussain, Javed Memon, Farrukh Raza, Sharla K Drebit, Chirag Kariya, Mansun Lui, Diane Sawchuck, Ugochi V Ukah, Mai-Lei Woo Kinshella, Shafik Dharamsi, Guy A Dumont, Tabassum Firoz, Ana Pilar Betrán, Susheela M Engelbrecht, Veronique Filippi, William A Grobman, Marian Knight, Ana Langer, Simon A Lewin, Gwyneth Lewis, Craig Mitton, Nadine Schuurman, James G Thornton, France Donnay, Kelly Pickerill, Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N Bone, Marianne Vidler, Sumedha Sharma, Beth A Payne, Laura A Magee, Peter von Dadelszen, Zulfiqar A Bhutta, CLIP Pakistan Working Group*, Amjad Hussain, Javed Memon, Farrukh Raza, Sharla K Drebit, Chirag Kariya, Mansun Lui, Diane Sawchuck, Ugochi V Ukah, Mai-Lei Woo Kinshella, Shafik Dharamsi, Guy A Dumont, Tabassum Firoz, Ana Pilar Betrán, Susheela M Engelbrecht, Veronique Filippi, William A Grobman, Marian Knight, Ana Langer, Simon A Lewin, Gwyneth Lewis, Craig Mitton, Nadine Schuurman, James G Thornton, France Donnay, Kelly Pickerill

Abstract

Background: Community-based strategies to promote maternal health can help raise awareness of pregnancy danger signs and preparations for emergencies. The objective of this study was to assess change in birth preparedness and complication readiness (BPCR) and pregnant women's knowledge about pre-eclampsia as part of community engagement (CE) activities in rural Pakistan during the Community Level Interventions for Pre-eclampsia (CLIP) Trial.

Methods: The CLIP Trial was a cluster randomized controlled trial that aimed to reduce maternal and perinatal morbidity and mortality using CE strategies alongside mobile health-supported care by community health care providers. CE activities engaged pregnant women at their homes and male stakeholders through village meetings in Hyderabad and Matiari in Sindh, Pakistan. These sessions covered pregnancy complications, particularly pre-eclampsia/eclampsia, BPCR and details of the CLIP intervention package. BPCR was assessed using questions related to transport arrangement, permission for care, emergency funds, and choice of facility birth attendant for delivery during quarterly household surveys. Outcomes were assessed via multilevel logistic regression with adjustment for relevant confounders with effects summarized as odds ratios and 95% confidence intervals.

Results: There were 15 137 home-based CE sessions with pregnant women and families (n = 46 614) and 695 village meetings with male stakeholders (n = 7784) over two years. The composite outcomes for BPCR and pre-eclampsia knowledge did not differ significantly between trial arms. However, CE activities were associated with improved pre-eclampsia knowledge in some areas. Specifically, pregnant women in the intervention clusters were twice as likely to know that seizures could be a complication of pregnancy (odds ratio (OR) = 2.17, 95% confidence interval (CI) = 1.11, 4.23) and 2.5 times more likely to know that high blood pressure is potentially life-threatening during pregnancy (OR = 2.52, 95% CI = 1.31, 4.83) vs control clusters.

Conclusions: The findings suggested that a CE strategy for male and female community stakeholders increased some measures of knowledge regarding complications of pre-eclampsia in low-resource settings. However, the effect of this intervention on long-term health outcomes needs further study.

Trial registration: Clinical Trials.gov - INCT01911494.

Conflict of interest statement

Competing interests: The authors completed the ICMJE Unified Competing Interest form (available upon request from the corresponding author), and declare no conflicts of interest.

Copyright © 2021 by the Journal of Global Health. All rights reserved.

Figures

Figure 1
Figure 1
Community Engagement in the CLIP Trial. CLIP – Community Level Interventions for Pre-eclampsia, CE – community engagement, LHW – Lady Health Workers.
Figure 2
Figure 2
Birth preparedness and pre-eclampsia knowledge over the duration of the trial.
Figure 3
Figure 3
Composite birth preparedness and arranged transport by cluster.

References

    1. Lawn JE, Rohde J, Rifkin S, Were M, Paul VK, Chopra M.Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise. Lancet. 2008;372:917-27. 10.1016/S0140-6736(08)61402-6
    1. Rosato M, Laverack G, Grabman LH, Tripathy P, Nair N, Mwansambo C, et al. Community participation: lessons for maternal, newborn, and child health. Lancet. 2008;372:962-71. 10.1016/S0140-6736(08)61406-3
    1. Marston C, Hinton R, Kean S, Baral S, Ahuja A, Costello A, et al. Community participation for transformative action on women’s, children’s and adolescents’ health. Bull World Health Organ. 2016;94:376-82. 10.2471/BLT.15.168492
    1. Clinical and Translational Science Awards Consortium, Community Engagement Key Function Committee Task Force on the Principles of Community Engagement. Principles of community engagement: Second edition. Maryland: NIH Publication No. 11-7782; 2011.
    1. O’Rourke K, Howard-Grabman L, Seoane G.Impact of community organization of women on perinatal outcomes in rural Bolivia. Rev Panam Salud Publica. 1998;3:9-14. 10.1590/S1020-49891998000100002
    1. Morrison J, Tumbahangphe K, Sen A, Gram L, Budhathoki B, Neupane R, et al. Health management committee strengthening and community mobilisation through women’s groups to improve trained health worker attendance at birth in rural Nepal: A cluster randomised controlled trial. BMC Pregnancy Childbirth. 2020;20:268. 10.1186/s12884-020-02960-6
    1. Bhutta ZA, Soofi S, Cousens S, Mohammad S, Memon ZA, Ali I, et al. Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: A cluster-randomised effectiveness trial. Lancet. 2011;377:403-12. 10.1016/S0140-6736(10)62274-X
    1. Houweling TAJ, Looman CWN, Azad K, Das S, King C, Kuddus A, et al. The equity impact of community women’s groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials. Int J Epidemiol. 2019;48:168-82. 10.1093/ije/dyx160
    1. Alhassan RK, Nketiah-Amponsah E, Ayanore MA, Afaya A, Salia SM, Milipaak J, et al. Impact of a bottom-up community engagement intervention on maternal and child health services utilization in Ghana: A cluster randomised trial. BMC Public Health. 2019;19:791. 10.1186/s12889-019-7180-8
    1. Lee ACC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, et al. Linking families and facilities for care at birth: What works to avert intrapartum-related deaths? Int J Gynaecol Obstet. 2009;107 Suppl.1:S65. 10.1016/j.ijgo.2009.07.012
    1. Qureshi RN, Sheikh S, Hoodbhoy Z, Sharma S, Vidler M, Payne BA, et al. Community-level interventions for pre-eclampsia (CLIP) in Pakistan: A cluster randomised controlled trial. Pregnancy Hypertens. 2020;22:109-18.
    1. von Dadelszen P, Bhutta ZA, Sharma S, Bone J, Singer J, Wong H, et al. The Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials in Mozambique, Pakistan, and India: an individual participant-level meta-analysis. Lancet. 2020;396:553-63. 10.1016/S0140-6736(20)31128-4
    1. Sevene E, Sharma S, Munguambe K, Sacoor C, Vala A, Macuacua S, et al. Community-Level interventions for Pre-eclampsia (CLIP) in Mozambique: a cluster randomised controlled trial. Pregnancy Hypertens. 2020;21:96-105. 10.1016/j.preghy.2020.05.006
    1. Bellad MB, Goudar SS, Mallapur AA, Sharma S, Bone J, Charantimath US, et al. Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial. Pregnancy Hypertens. 2020;21:166-75. 10.1016/j.preghy.2020.05.008
    1. Schulz KF, Altman DG, Moher D.CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials. PLoS Med. 2010;7:e1000251. 10.1371/journal.pmed.1000251
    1. Payne B, von Dadelszen P, Bhutta Z, Magee L, Adetoro O, Sotunsa J, et al. Protocol 13PRT/9313: The Community Level Interventions for Pre-eclampsia (CLIP) Trials: four prospective cluster randomised controlled trials comparing a package of interventions directed towards improving maternal and perinatal outcomes related to pre-eclampsia with current standards of care. Available: . Accessed:8 June 2021.
    1. JHPIEGO. Monitoring birth preparedness and complication readiness: Rools and indicators for maternal and newborn health. Baltimore: JHPIEGO; 2004.
    1. Lavery JV, Tinadana PO, Scott TW, Harrington LC, Ramsey JM, Ytuarte-Nuñez C, et al. Towards a framework for community engagement in global health research. Trends Parasitol. 2010;26:279-83. 10.1016/j.pt.2010.02.009
    1. Team RC. A Language and Environment for Statistical Computing. Vienna, Austria; 2013.
    1. World Health Organization. An evidence map of social, behavioural and community engagement interventions for reproductive, maternal, newborn and child health. Geneva: WHO; 2017.
    1. Sabzwari SR.Health literacy in Pakistan: Exploring new ways of addressing an old challenge. J Pak Med Assoc. 2017;67:1901-4.
    1. Habib MA, Soofi S, Cousens S, Anwar S, Haque N, Ahmed I, et al. Community engagement and integrated health and polio immunisation campaigns in conflict-affected areas of Pakistan: a cluster randomised controlled trial. Lancet Glob Health. 2017;5:e593-603. 10.1016/S2214-109X(17)30184-5
    1. Sadruddin S.Khan I ul H, Bari A, Khan A, Ahmad I, Qazi SA. Effect of community mobilization on appropriate care seeking for pneumonia in Haripur, Pakistan. J Glob Health. 2015;5:010405. 10.7189/jogh.05.010405
    1. Khowaja AR, Qureshi RN, Sheikh S, Zaidi S, Salam R, Sawchuck D, et al. Community’s perceptions of pre-eclampsia and eclampsia in Sindh Pakistan: A qualitative study. Reprod Health. 2016;13:36. 10.1186/s12978-016-0136-x
    1. Vidler M, Charantimath U, Katageri G, Ramadurg U, Karadiguddi C, Sawchuck D, et al. Community perceptions of pre-eclampsia in rural Karnataka State, India: A qualitative study. Reprod Health. 2016;13:35. 10.1186/s12978-016-0137-9
    1. August F, Pembe AB, Mpembeni R, Axemo P, Darj E.Effectiveness of the Home Based Life Saving Skills training by community health workers on knowledge of danger signs, birth preparedness, complication readiness and facility delivery, among women in Rural Tanzania. BMC Pregnancy Childbirth. 2016;16:129. 10.1186/s12884-016-0916-x
    1. Soubeiga D, Gauvin L, Hatem MA, Johri M.Birth Preparedness and Complication Readiness (BPCR) interventions to reduce maternal and neonatal mortality in developing countries: Systematic review and meta-analysis. BMC Pregnancy Childbirth. 2014;14:129. 10.1186/1471-2393-14-129
    1. Marston C, Renedo A, McGowan CR, Portela A.Effects of Community Participation on Improving Uptake of Skilled Care for Maternal and Newborn Health: A Systematic Review. PLoS One. 2013;8:e55012. 10.1371/journal.pone.0055012
    1. Bitew Y, Awoke W, Chekol S.Birth Preparedness and Complication Readiness Practice and Associated Factors among Pregnant Women, Northwest Ethiopia. Int Sch Res Notices. 2016;2016:8727365. 10.1155/2016/8727365
    1. Sumankuuro J, Crockett J, Wang S.Factors influencing knowledge and practice of birth preparedness and complication readiness in sub-saharan Africa: a narrative review of cross-sectional studies. Int J Community Med Public Health. 2016;3:3297-307. 10.18203/2394-6040.ijcmph20164251
    1. Stephenson R, Elfstrom KM.Community influences on antenatal and delivery care in Bangladesh, Egypt, and Rwanda. Public Health Rep. 2012;127:96-106. 10.1177/003335491212700111
    1. Pratley P.Associations between quantitative measures of women’s empowerment and access to care and health status for mothers and their children: A systematic review of evidence from the developing world. Soc Sci Med. 2016;169:119-31. 10.1016/j.socscimed.2016.08.001
    1. Qureshi RN, Sheikh S, Khowaja AR, Hoodbhoy Z, Zaidi S, Sawchuck D, et al. Health care seeking behaviours in pregnancy in rural Sindh, Pakistan: A qualitative study. Reprod Health. 2016;13:34. 10.1186/s12978-016-0140-1
    1. Sheikh S, Qureshi RN, Khowaja AR, Salam R, Vidler M, Sawchuck D, et al. Health care provider knowledge and routine management of pre-eclampsia in Pakistan. Reprod Health. 2016;13 Suppl 2:104. 10.1186/s12978-016-0215-z
    1. Kilpatrick S.Multi-level rural community engagement in health. Aust J Rural Health. 2009;17:39-44. 10.1111/j.1440-1584.2008.01035.x
    1. Hafeez A, Mohamud B, Shiekh M, Shah S, Jooma R.Lady health workers programme in Pakistan: challenges, achievements and the way forward. J Pak Med Assoc. 2011;61:210.
    1. Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. van Wouwe JP, editor. PLoS One. 2018;13:e0191620.
    1. Mohammed BH, Johnston JM, Vackova D, Hassen SM, Yi H.The role of male partner in utilization of maternal health care services in Ethiopia: A community-based couple study. BMC Pregnancy Childbirth. 2019;19:28. 10.1186/s12884-019-2176-z
    1. MacQueen KM, Bhan A, Frohlich J, Holzer J, Sugarman J.Evaluating community engagement in global health research: The need for metrics Ethics in Biomedical Research. BMC Med Ethics. 2015;16:44. 10.1186/s12910-015-0033-9

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