Sometimes “a little” can mean “a lot” in the daily lives of long ignored, underserved communities.
In under-developed countries the rates of maternal and newborn morbidity and mortality are scandalously high in spite of longstanding intervention by the public and private agencies, especially in the Sub-Saharan countries. The critical factor is to engage the pregnant women at the point of care entry. The lack of adequate supplies of medical kits is of humongous importance.
Pilar Betrán, Bergel et al. designed a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten prenatal care clinics in Mozambique that followed at least 200 pregnant women per year and had specialized nurses. The Public Health interventions were composed of these components:
- Component 1: provision of prenatal care kits with basic medicines laboratory supplies and materials approved by the Health Ministry
- Component 2: a place to store the kits was provided at each clinic
- Component 3: a login sheet was used to register the usage
- Component 4: a training session and refresher course for the nurses
Ten practices were chosen initially for primary and secondary outcomes:
- Screening for proteinuria
- Screening for anemia
- Treatment of parasitic women with mebendazole
- Screening for high blood pressure
- Screening for syphilis
- Preventive treatment for malaria
- Screening for HIV
- Treatment for syphilis
For the three primary outcomes—proteinuria, anemia and parasites—the interventions produced clinically and statistically significant improvements. “5519 (14.6%) of 37826 women were screened for anemia in the control period, compared with 30,057 (97.7%) of 30,772 women in the intervention period…3739 (9.99%) of 37,826 women were screened for proteinuria in the control period compared with 29,874 (97.1%) of 30,772 women in the intervention period…17,926 (51.4%) of 34,842 women received mebendaazole for treatment of parasitic worms in the control period compared with 24, 960 (88.2%) of 28,924 women in the intervention period.” In four of the six secondary outcomes there were also clinically and statistically significant improvements; a small improvement was measured in HIV screening and treatment but it was not statistically significant.
The design and implementation of a woman-centered prenatal supply-chain made a big difference in Mozambique, which sets an example for the rest of Africa.
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