A randomized control trial in Nigeria

J-PAL has gotten a lot of attention for its unique approach to development interventions. They use the scientific randomized control trial (RCT) to test behavioral and community-based solutions and thus far have implemented or are in the process of implementing 280 of them. The group is known for their work on school attendance and teacher attendance. They have also covered such interventions as providing free eyeglasses to children in China and evaluating primary school performance (it helps) and providing microcredit in Morocco (it helped expand livestock but did not translate into enterprises).

J-PAL is now bringing their RCT methodology to maternal health, specifically to an area of Nigeria with some of the highest maternal mortality rates in the world. In the North East and North West parts of Nigeria the maternal mortality ratio is estimated to be between 1000-1500 maternal deaths per 100,000 live births. The Abdul Latif Jameel Poverty Action Lab (JPAL) will collaborate with the Planned Parenthood Federation Nigeria (PPFN) to evaluate community-based programs addressing maternal mortality in 96 villages in Nigeria.

What will they look at? In short, "the trial will evaluate PPFN's efforts to work at the community level in communities where the MSS has been implemented." The study is "working in villages where the MSS scheme has already been implemented in primary health centers and where PPFN's programs will serve as a complement to the MSS scheme by aiming to strengthen maternal health through community based interventions." Three groups will be compared:

1) Voluntary health workers alone (spreading birth preparedness and hygiene messages)
2) Voluntary health workers with a birth kit (our understanding is that this is a clean birth kit)
3) Voluntary health workers with community folk media

The primary outcomes of the study are maternal and neonatal mortality and morbidity. Additional outcomes include health knowledge and behavior as well as anthropometric indicators of infants.

We'll be watching this trial closely. Too often pilot projects implement just one of these initiatives or implement all three without knowing which of the initiatives really worked and which was most cost-effective. Knowing what we know about maternal mortality and the causes of death, we certainly wish that there were a way to include a fourth track-- and that is equipping voluntary health workers with the means addressing postpartum hemorrhage, the leading cause of death for women. But perhaps that can be a next phase.

The field really needs to hone in on the leading cause of death-- postpartum hemmorhage. Did any of these interventions reduce the amount of blood lost, the number of maternal complications, the number of deaths? What if another trial could be developed to compare iron folate supplementation, misoprostol administration in the community, measurement of blood loss and use of new technologies to STOP postpartum hemorrhage.

To be continued.
http://maternova.net/blog/randomized-control-trial-nigeria