Doctoral thesis
Background: It is widely accepted that community-based interventions are vital strategies towards reduction of maternal and neonatal mortalities in developing countries. This study has aimed at finding the effectiveness of a Community-Based Continuous Training (CBCT) project, on improving birth preparedness, male involvement and maternal services utilization in rural Tanzania.
Method: The quasi-experimental study design with control was adopted to determine the effectiveness of CBCT project. The study was conducted from June 2017 until March 2018.
A multi-stage sampling technique was employed to obtain 561 couples. Pre-test and end-line information were collected using semi-structured questionnaires. The effectiveness of the intervention was determined by using independent t-test and paired t-test. The effect size was calculated using Cohen’s d. Linear and logistic regression models were used to test the predictors of change.
Results: At the end-line, knowledge mean scores were significantly higher in the intervention group among both pregnant women and their male partners as compared to control group. The predictors of change in knowledge scores among pregnant women were the CBCT project (β=0.346, p<0.000) and the ethnic group [Mambwe (β=-0.524, p=0.001)] while male partners were the CBCT project (β=1.058, p<0.001) and the walking distance [more than five kilometers (β=-0.55, p< 0.05)].
The predictor of change in attitudes and subjective norms towards birth preparedness scores, was the CBCT project (β=0.065, p<0.05) and (β=0.112, p=0.001) respectively while in perceived behavior control towards male involvement were the
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intention to accompany (β=-0.099, p=0.001), ethnic group (others, β=-0.063, p<0.05) and the CBCT project (β=0.067, p<0.05).
There was a significant increase in mean scores in birth preparedness and maternal services utilization among couples in the intervention group as compared to control group. The CBCT project significantly predicted birth preparedness ((AOR=2.138; p<0.001), male involvement (AOR=1.638; p<0.05) and maternal services utilization (AOR= 3.368; p<0.001).
Conclusion: This project which focused on knowledge empowerment and behavior change among the couples was both feasible and effective on improving knowledge, attitudes and subjective norms towards birth preparedness, perceived behavior control towards male involvements, birth preparedness and maternal services utilization. The project has potential to make a positive impact on maternal and newborn health.