title: Reaching the unreached through trained and skilled birth attendants in Ethiopia: a cluster randomized controlled trial study protocol.
abstract: Despite improvements since 1990 to 2014, maternal mortality ratio (MMR) remains high in Ethiopia. One of the key drivers of maternal mortality in Ethiopia is the very low coverage of Skilled Birth attendance (SBA) in rural Ethiopia. This cluster randomized trial piloted an innovative approach of deploying trained community reproductive nurses (CORN) to hard to reach/unreachable rural Ethiopia to improve the coverage of SBA.
  
  
  
  We used a three-arm cluster randomized trial to test the effect of deploying CORN in rural communities in South Ethiopia to improve SBA and other maternal health indicators. A total of 282 villages/clusters (94 from each arm) were randomly selected in the three districts of the zone for the study. The intervention was implemented in four consecutive phases that aimed at of provision of essential maternal, neonatal and child health (MNCH) services mainly focusing on SBA. The CORN were trained and deployed in health centres (arm 1) and in the community/health posts (arm2). A third arm (arm 3) consisting control villages without the intervention. A baseline and end line assessment was conducted to compare the difference in the proportion of SBA and other MNCH service uptake across the three arms Data was entered into computer, edited, cleaned, and analyzed using Epi-data statistical software. The presentation followed the Consolidated Standards of Reporting Trials (CONSORT) statement guidelines for cluster-randomized trials.
  
  
  
  This trial is designed to test the impact of an innovative and newly designed means of distribution for the national health extension program strategy with additional service package with no change to the target population. The focus is on effect of CORN in revitalizing the Health Extension Program (HEP) through improving SBA service uptake and other maternal health service uptake indicators. The study findings may guide national policy to strengthen and shape the already existing HEP that has certain limitations to improve maternal health indicators. The competency based training methodology could provide feedback for health science colleges to improve the national nursing or midwifery training curriculum.
  
  
  
  clinicaltrails.gov NCT02501252 dated on July 14, 2015.
authors.affiliation: Addis Ababa University, College of Natural Sciences, Centre for Food Sciences and Nutrition, Addis Ababa, Ethiopia. tadalzerfu@gmail.com.|Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA. tadalzerfu@gmail.com.|Dilla University, College of Medical Sciences, Dilla, Ethiopia. tadalzerfu@gmail.com.
authors.forename: Taddese Alemu
authors.initials: TA
authors.lastname: Zerfu
authors.affiliation: Dilla University, College of Medical Sciences, Dilla, Ethiopia.
authors.forename: Henok
authors.initials: H
authors.lastname: Taddese
authors.affiliation: University of Gondar, Institute of Public Heath, Gonder, Ethiopia.
authors.forename: Tariku
authors.initials: T
authors.lastname: Nigatu
authors.affiliation: Addis Ababa University, College of Health Sciences, School of Public Health, Addis Ababa, Ethiopia.
authors.forename: Girma
authors.initials: G
authors.lastname: Tenkolu
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, Switzerland.
authors.forename: Dina
authors.initials: D
authors.lastname: Khan-Neelofur
authors.affiliation: Public Health Research Consultant, Addis Ababa, Ethiopia.
authors.forename: Sibhatu
authors.initials: S
authors.lastname: Biadgilign
authors.affiliation: St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
authors.forename: Amare
authors.initials: A
authors.lastname: Deribew
mesh_terms: D000488:Allied Health Personnel; D016000:Cluster Analysis; D005002:Ethiopia; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health; D008427:Maternal Health Services / Q000592:standards; D008428:Maternal Mortality; D008880:Midwifery; D036801:Parturition; D011247:Pregnancy; D012424:Rural Population
keywords: CORN; Cluster randomized trial; Intervention; Skilled birth attendance