1. Author: Taddese Alemu Zerfu(PhD) Post doctoral Fellow
Is deployment of trained nurses to rural villages a remedy for the low skilled birth attendance in Ethiopia?
a cluster-randomized controlled community trial .
Author: Taddese Alemu Zerfu(PhD) Post doctoral Fellow

2. Conclusions Methods Results & Discussion
Introduction
Methods
Results & Discussion
Conclusions
Maternal and neonatal mortality remains unacceptably high in SSA & SA
Most could have been prevented with simple inexpensive, low-technology measures
The single most critical intervention is the presence of a skilled provider during childbirth and the immediate postpartum/newborn period.
Thursday, January 17, 2019

3. HEP and emerging limitations
Introduction
Methods
Results & Discussion
Conclusions
HEP and emerging limitations
HEW
Contributed for ANC, PNC and FP
But, often lack the time and skills to provide SBA and other essential skilled care services.
The competency of HEW ?
< 50% of the HEW knew signs of obstructed labor (Aray M.et.at)
HEW are overwhelmed by 16 packages
Thursday, January 17, 2019

4. Conclusions Methods Results & Discussion
Introduction
Methods
Results & Discussion
Conclusions
Cultural, social and economic problems.
Very low SBA &institutional delivery ;
27.7 % Vs 26% (National)
21% Vs 19% (Rural)
A novel and culturally sensitive approach is urgently needed?
 Could CORN fill this gap?
Thursday, January 17, 2019

5. To determine the effect of CORN on SBA services utilization
Introduction
Objectives
Methods
Results & Discussion
Conclusions
To determine the effect of CORN on SBA services utilization
To examine the programmatic and socio-cultural acceptability of home based delivery of SBA services
Thursday, January 17, 2019

6. Study Area and period Introduction Methods
Results & Discussion
Conclusions
Study Area and period
The study was conducted in Gedeo zone of the SNNPR.
SNNPR region makes 20% of national population.
The study lasted for 18 months (from pre-implementation to final evaluation)
Thursday, January 17, 2019

7. 94 villages per arm = 282 villages randomly selected from 18 Kebeles
Introduction
Methods
Results & Discussion
Conclusions
Study design
A Three Arms Cluster Randomized Controlled Community Trial conducted in four phases.
Arm one : CORNs based at HP and living with the community providing SBA.
Arm two : CORNs based at HC level providing SBA and other RH services to households on an outreach bases.
Arm three : randomly selected comparable controls clusters .
Sample size :
94 villages per arm = 282 villages randomly selected from 18 Kebeles
Thursday, January 17, 2019

8. RCT Intervention
Home visit (CORN with HEW): Educate and Counsels pregnant/lactating mother (with the husband) on the need for health facility SBA /MNH services utilization and other related issues
Mother (with husband) decided to use facility based institutional SBA services?
Yes No
Assess for Risk pregnancy that necessitates Hospitalized delivery ? E. g: Previous C/S scar, mother with cardiac problem...etc
Facilitate Referral to HC/Hospital for ANC and SBA services + Counsels on birth preparedness
Yes No
Follow up visit every month (ANC visit time) to confirm use
Re-counsel and reinforce mother for Hospitalized SBA
Mother stick to the counseling decision and started facility level service utilization
Counsel mother( and husband), they decided to use SBA/MNH services at home/health post level?
Yes No
Yes No
STUDY INTERVENTION
Encourage and honor mother/family for subsequent use
Counsel mother on clean & Safe Delivery
Close follow up
CORN provides SBA and immediate post partum care at HH or HP level
Thursday, January 17, 2019
Figure 1 : CORN Activities (INTERVENTION) Algorithm

9. Who are CORNs? Introduction Methods Results & Discussion Conclusions
Female diploma nursing (midwifery) graduates from accredited HLI in Ethiopia.
Passed intake exam
Successfully completed a four months intensive skill oriented training on RH and Community health care activities.
Recruited from both government health facilities and from the market after proper evaluation
The trained CORN were deployed to work with rural HEW
Thursday, January 17, 2019

10. Data Collection and Analysis
Introduction
Methods
Results & Discussion
Conclusions
Data Collection and Analysis
Data were collected at baseline, and end line of the project both (intervention and control) sites.
Analyzed using SPSS V- 16 and EPI INFO V- 7 statistical software.
Intention to treat analysis
Proportions
DID calculated
Thursday, January 17, 2019

11. Introduction Methods Results & Discussion Conclusions
Table 3.1. Utilization of SBA services and home delivery at baseline and end of the study in rural Gedeo, Southern Ethiopia
Variable
Control
n ( %)
CORN HP
DID P
CORN HC PP
SBA at home
Baseline
End line
16 (3.1)
8 (1.7)
21 (3.8)
22 (5.2)
2.8
0.035*
34 (5.4)
6 (1.3)
-2.7
0.078*
SBA at HP
0 (0)
0(0)
179 (24.8)
24.8
0.001**
55 (7.8)
7.8
0.01*
SBA at HI†
193 (26.9)
198 (27.7)
154 (21.7)
121 (16.8)
-5.7
0.065
84 (11.7)
197 (27.9)
15.4
0.02*
SBA Total
209 (30)
206 (29.4)
175 (25.5)
322 (46.8)
21.9
118 (17.1)
258 (37)
20.5
0.001
Non-SBA (Home)delivery
508 (70)
515 (72.3)
536 (74.5)
400 (53.2)
-23.6
601(82.9)
474 (66.7)
-18.5
0.03*

12. Introduction Methods Results & Discussion Conclusions
Figure 3.1 : Proportion of skilled deliveries and non-skilled home deliveries at baseline and end line of the study in rural Gedeo, Southern Ethiopia

13. Introduction
Methods
Results & Discussion
Conclusions
CORN significantly contributed for SBA in general and HP & Home based in particular
Compared to control, significant decline in home delivery at intervention sites
Distance, perceived high quality, good approach of health workers and other unspecified reasons

14. Revitalize HEP for excellent and exemplary PHC services !!!
Together ! Integrated! Diversified!