title: The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial.
abstract: OBJECTIVE
  To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care (ANC) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania.
  
  
  METHODS
  Cluster randomised trial in Ngorongoro district, Arusha region, involving 16 health units (8 per arm). Nine hundred and five pregnant women at 24 weeks of gestation and above (404 in the intervention arm) were recruited and followed up to at least 1 month postpartum.
  
  
  RESULTS
  Skilled delivery care uptake was 16.8% higher in the intervention units than in the control [95% CI 2.6-31.0; P = 0.02]. Postnatal care utilisation in the first month of delivery was higher (difference in proportions: 30.0% [95% CI 1.3-47.7; P < 0.01]) and also initiated earlier (mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days, P < 0.01) in the intervention than in the control arm. Women's and providers' reports of care satisfaction (received or provided) did not differ greatly between the two arms of the study (difference in proportion: 12.1% [95% CI -6.3-30.5] P = 0.17 and 6.9% [95% CI -3.2-17.1] P = 0.15, respectively).
  
  
  CONCLUSIONS
  Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women's and providers' satisfaction with available ANC services. Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services.
authors: Department of Obstetrics and Gynaecology, Bugando Medical Centre and Teaching Hospital, Mwanza, Tanzania. drmagomasn@yahoo.com
authors: Moke
authors: M
authors: Magoma
authors: Jennifer
authors: J
authors: Requejo
authors: Oona
authors: O
authors: Campbell
authors: Simon
authors: S
authors: Cousens
authors: Mario
authors: M
authors: Merialdi
authors: Veronique
authors: V
authors: Filippi
mesh_terms: D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration*; D036801:Parturition / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011181:Postnatal Care / Q000379:methods* / Q000523:psychology / Q000592:standards; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology / Q000592:standards; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population; D013636:Tanzania; D014930:Women / Q000193:education / Q000523:psychology; D055815:Young Adult