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Pregnancy Testing in Northern Uganda

Last registered on August 02, 2018

Pre-Trial

Trial Information

General Information

Title
Resolution of Uncertainty through Testing: The Impact of Pregnancy Tests on Reproductive and Maternal Health Beliefs and Behaviors
RCT ID
AEARCTR-0003187
Initial registration date
July 29, 2018

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
August 02, 2018, 1:34 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Primary Investigator

Affiliation
University of Chicago

Other Primary Investigator(s)

PI Affiliation
University of Illinois at Urbana-Champaign

Additional Trial Information

Status
In development
Start date
2018-08-22
End date
2018-12-31
Secondary IDs
Abstract
Given the high rate of delayed adoption of antenatal care (ANC), and high rates of unintended pregnancy and unsafe abortion in Uganda, research on the period of time before confirmation of pregnancy is critical to understand underlying beliefs that guide behaviors ultimately important for maternal and neonatal health.

Home pregnancy tests - which now cost less than 10 cents each - have the potential to facilitate FP uptake and significantly improve reproductive, maternal and child health outcomes in sub-Saharan Africa, including Uganda. These tests are easy to administer, disposable, inexpensive, and have a low false positive rate. Yet, for women living in rural areas in sub-Saharan countries, these tests are typically unavailable outside of health centers or they are prohibitively expensive.

This study will investigate women's underlying beliefs about pregnancy status and examine how providing access to home-based pregnancy tests - thus facilitating earlier resolution of uncertainty of pregnancy status - influences such beliefs and decisions to take up family planning (FP).

The results will inform the design of a larger study in the future.
External Link(s)

Registration Citation

Citation
Kamei, Akito and Rebecca Thornton. 2018. "Resolution of Uncertainty through Testing: The Impact of Pregnancy Tests on Reproductive and Maternal Health Beliefs and Behaviors." AEA RCT Registry. August 02. https://doi.org/10.1257/rct.3187-1.0
Former Citation
Kamei, Akito and Rebecca Thornton. 2018. "Resolution of Uncertainty through Testing: The Impact of Pregnancy Tests on Reproductive and Maternal Health Beliefs and Behaviors." AEA RCT Registry. August 02. https://www.socialscienceregistry.org/trials/3187/history/32468
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2018-08-22
Intervention End Date
2018-12-31

Primary Outcomes

Primary Outcomes (end points)
Use of any modern family planning method, perceived pregnancy status or degree of uncertainty about pregnancy status, and the value of pregnancy test (Willingness to pay).
Primary Outcomes (explanation)
We will construct measures for the following FP-related outcomes: use of any short-acting method and use of long-acting reversible method. Demand for pregnancy test kit is computed by Take it or leave it (TIOLI) method. We will also conduct sub-analyses among women who are not using modern family planning at baseline and women who are using modern family planning at baseline.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Following baseline data collection, around 60% of the sample will be provided with a home pregnancy test to assess how resolving uncertainty about pregnancy status affects beliefs and behaviors.
Experimental Design Details
We will conduct two interventions:
1. First, following baseline data collection, approximately 60% of the sample (720 of the 1200 women uncertain of pregnancy status at baseline) will be provided with a home pregnancy test to assess how resolving uncertainty about pregnancy status affects beliefs and behaviors. The pregnancy test consists of a simple dip-strip pregnancy test (dipped into a receptacle of urine) and an informational pamphlet explaining how and when to use the test and interpret the results. By randomly allocating access to free home pregnancy tests at baseline, we will be able to compare how access to and experience with home pregnancy tests affects a) beliefs about pregnancy status, b) willingness to pay and value of additional pregnancy tests at baseline and endline, and c) use of FP services or ANC services. We hypothesize that access can affect behavior through both experience and acquiring information.

2. Second, we will randomly select about half of the women in the treatment group (ie those who received a test) to receive a free home pregnancy test at the end of the baseline for use in the future. Women who receive a test for free will be able to test for pregnancy in their home if they experience a period of uncertainty or suspect a pregnancy.

Follow-up data collection will occur approximately one month after baseline to measure instances of suspected pregnancy, reproductive behavior, sexual activity, signs of pregnancy, family planning use and beliefs, and maternal health care-seeking.
We will give money as a token of appreciation for their participation in the study, which they can choose to use towards purchasing the home pregnancy tests. Pregnancy tests will then be offered to women for a randomly assigned price ranging from free to a moderate subsidy to elicit willingness to pay for pregnancy tests. We will use the price indicated as an outcome measure.
Randomization Method
Random number generator done in office by a computer
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
No culster
Sample size: planned number of observations
1200 women - not pregnant or uncertain of pregnancy status, at risk of pregnancy.
Sample size (or number of clusters) by treatment arms
360 women, offer free pregnancy test at baseline and to keep for the future.
360 women, offer free pregnancy test at baseline.
480 women, control group. No intervention.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
According to the DHS 2016 in Uganda, 21.43% of people use modern short-term contraceptive (Injectable and Pills) in Ankole region (sample weighted). Following the power calculation of two proportion test, the treatment group has to have 29.57% take up of family planning with power set at 0.9. This is the 8.14 percentage points increase from the baseline.
IRB

Institutional Review Boards (IRBs)

IRB Name
Office for the Protection of Research Subjects, University of Illinois
IRB Approval Date
2017-06-05
IRB Approval Number
17418

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials