title: A randomised controlled trial on the Four Pillars Approach in managing pregnant women with anaemia in Yogyakarta-Indonesia: a study protocol.
abstract: BACKGROUND
  Anaemia is a common health problem among pregnant women and a contributing factor with a major influence on maternal mortality in Indonesia. The Four Pillars Approach is a new approach to anaemia in pregnancy, combining four strategies to improve antenatal and delivery care. The primary objective of this study is to measure the effectiveness of the Four Pillars Approach. The barriers, the facilitators, and the patients' as well as the midwives' satisfaction with the Four Pillars Approach will also be measured.
  
  
  METHODS
  This study will use a cluster randomised controlled trial. This intervention study will be conducted in the Public Health Centres with basic emergency obstetric care in Yogyakarta Special Province and in Central Java Province. We will involve all the Public Health Centres (24) with emergency obstetric care in Yogyakarta Special Province. Another 24 Public Health Centres with emergency obstetric care in Central Java Province which have similarities in their demographic, population characteristics, and facilities will also be involved. Each Public Health Centre will be asked to choose two or three nurse-midwives to participate in this study. For the intervention group, the Public Health Centres in Yogyakarta Special Province, training on the Four Pillars Approach will be held prior to the model's implementation. Consecutively, we will recruit 360 pregnant women with anaemia to take part in part in the study to measure the effectiveness of the intervention. The outcome measurements are the differences in haemoglobin levels between the intervention and control groups in the third trimester of pregnancy, the frequency of antenatal care attendance, and the presence of a nurse-midwife during labour. Qualitative data will be used to investigate the barriers and facilitating factors, as to nurse-midwives' satisfaction with the implementation of the Four Pillars Approach.
  
  
  CONCLUSIONS
  If the Four Pillars Approach is effective in improving the outcome for pregnant women with anaemia, this approach could be implemented nationwide and be taken into consideration to improve the outcome for other conditions in pregnancy, after further research.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN35822126.
authors.affiliation: School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia. A.Widyawati@radboudumc.nl.
authors.forename: Widyawati
authors.initials: W
authors.lastname: Widyawati
authors.forename: Suze
authors.initials: S
authors.lastname: Jans
authors.forename: Hans
authors.initials: H
authors.lastname: Bor
authors.forename: Rukmono
authors.initials: R
authors.lastname: Siswishanto
authors.forename: Jeroen
authors.initials: J
authors.lastname: van Dillen
authors.forename: Antoine L M
authors.initials: AL
authors.lastname: Lagro-Janssen
mesh_terms: D000740:Anemia / Q000097:blood / Q000628:therapy*; D001291:Attitude of Health Personnel; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004505:Education, Nonprofessional; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007214:Indonesia; D008297:Male; D009721:Nurse Midwives / Q000193:education / Q000523:psychology; D016487:Parenting; D017060:Patient Satisfaction; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000628:therapy*; D011263:Pregnancy Trimester, Third / Q000097:blood; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D012107:Research Design
chemical_list: D006454:Hemoglobins