Secondary Outcomes (end points)
8. Quality of care for management of maternal and neonatal complications, measured by delivery observation
A continuous variable based on essential actions providers should perform to manage maternal and neonatal complications, including postpartum hemorrhage, pre-eclampsia/eclampsia, neonatal resuscitation, and shoulder dystocia. Score is calculated as the fraction of total items applicable to each case, with higher scores indicating better quality of care.
[Time Frame: assessed from patient admission to up to 1 hour post the delivery of the placenta approximately 6 months after intervention initiation]
9. Quality of care for infection prevention, measured by delivery observation
A continuous variable based on a series of questions that measure whether infection prevention and control procedures are performed during labor and delivery. Individual item is assigned a score equal to 1 if an action is done.
[Time Frame: assessed from patient admission to up to 1 hour post the delivery of the placenta approximately 6 months after intervention initiation]
10. Quality of care for partograph completion, measured by delivery observation
A continuous variable based on a series of questions that measure whether progress of labor is plotted appropriately on the partograph. Individual item is assigned a score equal to 1 if an action is done.
[Time Frame: assessed from patient admission to up to 1 hour post the delivery of the placenta approximately 6 months after intervention initiation]
11. Provider motivation and satisfaction, measured by provider survey
A continuous variable based on 11 questions that measure health workers’ motivation adapted from a scale validated in Kenya (Mbindyo et al, 2009). Individual questions are scored using a 1-to-5 LIkert scale. The total score is calculated as the sum of all items (with a few items reverse coded).
[Time Frame: assessed approximately 6 months after intervention initiation]
12. Patient treatment during labor and delivery, measured by delivery observation
A continuous variable based on a series of questions that measure aspects of mistreatment during labor and delivery: interpersonal abuse scale, exams & procedures index, and unsupportive birth environment (Berger et al., 2021). Individual items are scored to 1 if observed.
[Time Frame: assessed from patient admission to up to 1 hour post the delivery of the placenta approximately 6 months after intervention initiation]
13. Respectful maternity care during last antenatal care visit, measured by patient survey
A binary variable equal to one if a patient felt she was treated with respect during her last antenatal care visit.
[Time Frame: assessed in the last month of pregnancy]
14. Disrespect in care during delivery, measured by patient survey
An ordinal variable based on to what extent a patient was abused or treated in a way that made her feel humiliated/disrespected during her delivery.
[Time Frame: assessed between 7 - 8 weeks postpartum]
15. Severe morbidity and mortality, measured by delivery observation and document review
A binary variable that measures whether a woman or her baby had any severe maternal complication (including severe postpartum hemorrhage, severe pre-eclampsia, eclampsia, severe systemic infection or sepsis, and uterine rupture), neonatal complication (including asphyxia), maternal mortality, and perinatal mortality (including stillbirth and newborn death)
[Time Frame: assessed at approximately 6 months after intervention initiation]
16. Medical advice/treatment seeking during pregnancy, measured by patient survey
A binary variable that measures whether a participant sought advice or treatment from a healthcare professional in the past month
[Time Frame: assessed during the last month of pregnancy]
17. Medical advice/treatment seeking for baby's health postpartum, measured by patient survey
A binary variable that measures whether a participant sought advice or treatment from a healthcare professional since she left the hospital after delivery for her baby’s health
[Time Frame: assessed between 7 - 8 weeks postpartum]
18. Medical advice/treatment seeking for mom's health postpartum, measured by patient survey
A binary variable that measures whether a participant sought advice or treatment from a healthcare professional since she left the hospital after delivery for her own health
[Time Frame: assessed between 7 - 8 weeks postpartum]
19. Care seeking in response to severe antenatal danger signs, measured by patient survey
A binary variable based on a series of questions that measure whether a respondent sought any medical advice or treatment for a healthcare provider in response to severe prenatal danger signs.The variable is coded to one if respondent sought advice or treatment for at least one danger sign.
[Time Frame: assessed in the last month of pregnancy]
20. Care seeking in response to severe postnatal danger signs, measured by patient survey
A binary variable based on a series of questions that measure whether a respondent sought any medical advice or treatment for a healthcare provider in response to severe postnatal danger signs. The variable is coded to one if respondent sought advice or treatment for at least one danger sign.
[Time Frame: assessed between 7 - 8 weeks postpartum]
21. Care seeking in response to severe neonatal danger signs, measured by patient survey
A binary variable based on a series of questions that measure whether a respondent sought any medical advice or treatment for a healthcare provider in response to severe neonatal danger signs. The variable is coded to one if respondent sought advice or treatment for at least one danger sign.
[Time Frame: assessed between 7 - 8 weeks postpartum]
22. Patient knowledge on prenatal danger signs, measured by patient survey
A ratio based on questions that ask whether a respondent would seek medical care immediately in response to serious prenatal danger signs. Each question is scored according to whether a participant chooses the correct response (i.e., whether to visit a hospital or not in response to a health condition). The total score is calculated as the share of the times the respondent correctly identifies the need to seek medical care immediately..
[Time Frame: assessed in the last month of pregnancy]
23. Patient knowledge on postnatal danger signs, measured by patient survey
A ratio based on questions that ask whether a respondent would seek medical care immediately in response to serious postpartum danger signs. Each question is scored according to whether a participant chooses the correct response (i.e., whether to visit a hospital or not in response to a health condition). The total score is calculated as the share of the times the respondent correctly identifies the need to seek medical care immediately.
[Time Frame: assessed between 7 - 8 weeks postpartum]
24. Patient knowledge on neonatal danger signs, measured by patient survey
A ratio based on questions that ask whether a respondent would seek medical care immediately in response to serious neonatal danger signs. Each question is scored according to whether a participant chooses the correct response (i.e., whether to visit a hospital or not in response to a health condition). The total score is calculated as the share of the times the respondent correctly identifies the need to seek medical care immediately.
[Time Frame: assessed between 7 - 8 weeks postpartum]
25. Patient knowledge on signs of labor, measured by patient survey
A count variable that measures the number of signs of labor a woman lists without being prompted.
[Time Frame: assessed in the last month of pregnancy]
26. Patient knowledge on breastfeeding, measured by patient survey
A binary variable that measures whether a woman correctly identifies the best time to start breastfeeding after delivery
[Time Frame: assessed in the last month of pregnancy]
27. Use of prenatal supplements, measured by patient survey
a binary variable that measures whether a woman is taking IFAS tablets or prenatal supplement that contains iron and folic during her pregnancy
[Time Frame: assessed in the last month of pregnancy]
28. Birth preparation, measured by patient survey
a count variable that measures the total number of things a woman has done to prepare for her delivery
[Time Frame: assessed in the last month of pregnancy]
29. Institutional delivery, measured by patient survey
a binary variable that measures whether a woman delivered her baby in a hospital or health clinic/center
[Time Frame: assessed between 7 - 8 weeks postpartum]
30. Exclusive breastfeeding, measured by patient survey
a binary variable that measures whether a baby is exclusively fed with breast milk
[Time Frame: assessed between 7 - 8 weeks postpartum]
31. Sleep safety, measured by patient survey
A binary variable that measures weather a woman puts her baby to sleep in the safest position at night
[Time Frame: assessed between 7- to 8-week postpartum]
32. Interaction with newborn, measured by patient survey
A binary variable that measures weather a woman spoke or sang to the baby in the past 24 hours
[Time Frame: assessed between 7- to 8-week postpartum]
33. Patient self-efficacy in care-seeking during last antenatal care visit, measured by patient survey
a binary variable that measures whether a woman feels that she could ask healthcare workers at her last antenatal care visit any question she had about her pregnancy.
[Time Frame: assessed in the last month of pregnancy]
34. Patient self-efficacy in care-seeking during pregnancy and delivery, measured by patient survey
an ordinal variable that measures to what extent a woman feels she can get her questions about her health answered during pregnancy and delivery.
[Time Frame: assessed between 7- to 8-week postpartum]
35. Timeliness of care, measured by delivery observation
[Time Frame: assessed from patient arrival to up to 1 hour post the delivery of the placenta 6 months after intervention start]