Men’s accompaniment in antenatal care for positive outcome

This project aimed to explore the effect of improving men’s limited understanding of the need for maternal health services which improve health literacy, quality of care experience, perinatal outcomes, immunization for women and newborns, and reduce cultural malpractices. 

According to the World Health Organization (WHO), interventions to promote the involvement of men during pregnancy, childbirth, and after birth are recommended to facilitate and support improved use of skilled care during the maternal continuum of care, self-care, and home care practices for the woman and newborn. This also calls for an understanding of the joint responsibilities of men and women, so that they become equal partners in public and private lives and encouraging and enabling men to take responsibility for their sexual and reproductive behavior. The problem of low maternal continuum of care in resource settings relying heavily on contextual, socio-cultural, environmental, and intersectional aspects continues to hinder antenatal care access.

Title: The effect of men’s accompaniment in antenatal health education services on improving health literacy, quality of care experience, and perinatal health outcomes at primary health facilities in Ethiopia

Background information

ANC aims to provide the safety of pregnant women and fetuses through a range of medical, educational, nutritional, and health systems (1). Emerging evidence and program experience indicate that engaging men in maternal and newborn health with the provision of information about informed decision-making have a promising positive effect on reducing mortalities and morbidities (2). Men’s involvement showed that an increasing emotional support, improved birth preparedness, couple communication, enhanced men’s knowledge about danger signs, use of skilled birth attendants, giving birth at health facilities, and decreasing the likelihood of maternal postpartum depression (3–7).

However, in Ethiopia, there was high perinatal mortality, no change in healthcare-seeking during the perinatal periods for complications or illness, and dropping out before finishing the full course of maternity continuum of care remains a bottleneck to achieving the global goals (8). In this context, about 295,000 women died from pregnancy and childbirth-related complications in 2017 Globally [14]. Despite the current sustainable development goal (i.e. SDG 3) period where the great emphasis has been given to maternal and neonatal health, ensuring the optimal health of both the mother and newborns is the foremost challenge in Sub-Saharan Africa (SSA) (10,11). Seven out of ten women died from SSA (9). In addition, Ethiopian institutional birth is one of the lowest in the world. Fifty-two percent of women gave birth at home, indicating a significant number of deliveries continue to take place at home. Moreover, there is a disparity in service utilization between urban (72%) and rural (43%) (12). Since no healthcare system allows professionals to attend labor at home, homebirth in Ethiopia is unattended, unless by Traditional Birth Attendants (TBA) (13). According to the Ethiopian Health Sector Transformation Plan II report, the maternal mortality ratio (MMR) was 401per100,000 live births in 2017. In addition, infant mortality per 1000 live births reduced from 77 in 2005 to 47 in 2019 (14). However, over the years, there have been no significant reductions in neonatal mortality (12).

According to the World Health Organization (WHO), interventions to promote the involvement of men during pregnancy, childbirth, and after birth are recommended to facilitate and support improved use of skilled care during the maternal continuum of care, self-care, and home care practices for the woman and newborn (2). This also calls for an understanding of the joint responsibilities of men and women, so that they become equal partners in public and private lives and encouraging and enabling men to take responsibility for their sexual and reproductive behavior. The problem of the low maternal continuum of care in resource settings relying heavily on contextual, socio-cultural, environmental, and intersectional aspects continues to hinder antenatal care access (15).

The time to act is now unless we accelerate our progress, more than 30 million women do not give birth in a health facility each year in developing countries; more than 45 million receive insufficiently or no ANC, and limited direct evidence of the effectiveness male partner accompaniment for mortality and morbidity outcomes (16–18).

Even though men have decisive power related to maternal and child health issues, they have been traditionally excluded from maternal healthcare services due to maternal and child health is viewed as a woman’s affair (5,19). Inherited factors in husbands' sociodemographic and cultural factors, poor attitude toward maternal health, and lack of knowledge about reproductive and maternal health are the barriers to male involvement in maternal and child health and attributes to the practice of male dominance, often called “patriarchy (6).

This health education and promotion during ANC interventions are aimed to improve care-seeking and home care practices across the continuum of care (5,20). Therefore, this interventional research will explore the effect of male partner accompaniment in antenatal health education services in improving perinatal health outcomes, fill gaps in factors affecting care-seeking and care practices, and use them as baseline data for healthcare policymakers.

Clinical significance

Sustainable development goal 3.1 sets a target for all global nations to decrease the maternal mortality ratio to less than 70 by 2030 (18). Furthermore, The WHO recommendations set forth will help countries to establish if the single intervention should be part of a broader package to reach the objectives to increase individual, family, and community capacity to contribute to maternal and newborn health improvements and to increase the use of skilled care during pregnancy, for childbirth and after birth (2).

This study helps to explore the effect of improving men’s limited understanding of the need for maternal health services and harmful cultural gender norms pose obstacles to women’s healthcare service utilization, which is an opportunity to acquire health education and understand the possible complication of pregnancy and childbirth. This enables them to consider calling men to be available with their wives and have appropriate education/information. Thus, male partner accompaniment in antenatal health education services helps to improve the maternal continuum of care (i.e. birth preparedness and complication readiness, skilled birth service utilization, and postnatal care service utilization), maternal/obstetric outcomes (antepartum hemorrhage, postpartum hemorrhage, anemia during pregnancy, pre-labor rupture of membrane, preterm labor, uterine rupture, admission to intensive care unit, oligohydramnios, gestational diabetes, obstructed labor, and maternal death), perinatal outcomes (i.e. stillbirth, low birth weight, macrosomia, meconium aspiration syndrome, congenital malformation, need for resuscitation, and low APGAR score), immunization for women and newborns, reduce cultural malpractice during pregnancy, intrapartum, and postpartum periods. In turn, this will contribute to achieving SDG 3.

Objectives

General objective

The effect of men’s accompaniment in antenatal health education services on improving health literacy, quality of care experience, and perinatal health outcomes at primary health facilities in Ethiopia

2.2 Specific objectives

Sub-theme 1: The effect of men’s accompaniment in antenatal health education services on maternal continuum of care in North Shewa zone, Ethiopia

1.1 To evaluate the effect of men’s accompaniment in antenatal health education services on birth preparedness and complication readiness in Ethiopia

1.2 To evaluate the effect of men’s accompaniment in antenatal health education services on the utilization of skilled birth attendants in Ethiopia 

1.3 To evaluate the effect of men’s accompaniment in antenatal health education services on utilization of postpartum care in Ethiopia

Sub-theme 2: The effect of men’s accompaniment in antenatal health education services on improving perinatal health outcomes at primary health facilities in Ethiopia

2.1 The effect of men’s accompaniment in antenatal health education services on improving fetal health outcomes at primary health facilities in Ethiopia

2.2 The effect of men’s accompaniment in antenatal health education services on improving maternal health outcomes at primary health facilities in Ethiopia

Sub-theme 3: The effect of men’s accompaniment in antenatal health education services on improving cultural malpractice during labour, childbirth and postpartum in Ethiopia

Hypothesis

Health promotion intervention on men accompaniment in antenatal health education services can improve health literacy, quality of care experience, and perinatal health outcomes in Ethiopia.

Study design

Two arms of cluster-randomized control trials will be conducted in Ethiopia. The intervention will be done at health centers and hospitals (clusters), and will be assigned to the intervention or control groups randomly. The intervention group comprised an invitation letter delivered to the spouses of new antenatal attendees (Group A—men and women received health education together at two clusters (health centers and hospitals) and the control group (Group B—women will receive health education alone) in another two clusters. We will include 858 eligible pregnant women in each group. The intervention consisted of two 50-min sessions administered in a private room in the hospital with pregnant women and their partners. Session 1: Pregnancy Care and Birth Preparedness (Importance of weight gain, ANC, nutrition, anemia– symptoms, prevention, treatment, supplementations, rest, harmful substances, Sexual transmitted diseases & HIV, Tetanus diphtheria immunization, danger signs, birth preparedness -- Need for preparation for birth: a place of delivery, skilled attendant at delivery, finances, transport, blood donor, and emergency plan, emotional support & communication). Session 2: Labor & Delivery/Postpartum Period (Signs of labor, risk factors for complicated deliveries, danger signs, complications during labor and postpartum for mother and newborn, safe delivery kit and practice, importance of postpartum visits, early & exclusive breastfeeding, feeding of colostrum, family planning methods; birth spacing & limiting, maternal & infant care needs and emotional support). The first health education session will be between 12-16th weeks of gestation and will be asked to return to the hospital at the 34-36th week of gestation for the second health education session. Midwives who were working in maternity units and supervisors collected data after they were trained for five days. Both data collectors and supervisors had bachelor's degree in Midwives and master's degree in public health and had immense experience in data collection. Data will be collected in 2 phases: at labor and delivery, immediate postpartum, and 7 weeks postpartum. 

Study setting

The study will be conducted at public health facilities in the North Shewa zone, northeast Ethiopia. The zone comprises 439 kebeles and 24 districts with an estimated total population of 3.5 million with a fifty-fifty numerical split between the sexes. There are 95 health centers, 12 primary Hospitals (of which two are private Hospitals), and one comprehensive specialized hospital. These hospitals are staffed by professionals of various disciplines. See evidence images from the study setting; Fig 1. Men are traditionally excluded from maternal healthcare services due to maternal and child health is viewed as a woman’s affair. Fig 2. A significant number of deliveries continue to take place at home in Ethiopia and seek care after catastrophic complications arose.

Study duration: The study will be completed within 12 months.

Study population: Women living with their partners for at least six months in the study area, and those who initiated ANC service in the selected health institutions before or during the study period will be recruited. Those women with known medical illnesses and high-risk pregnancies will be excluded.

Ethical consideration: Ethical clearance will be obtained from the Debre Berhan University and informed consent of each participant will be obtained at the start of this study.

Project cost and justification  

Calculated costs, specified

Personnel cost (training fees, refreshment, data clerk, advocacy)

USD9100

Material and supply (data collection equipment, stationary cost, etc)

USD4000

Travel cost (fuel, drivers per diem, and car rent) 

USD6000

Data collection cost (data collectors, supervisors fees, etc)

USD17500

Cost for policy brief and dissemination of result  

USD2400

For stationery, printing, and duplication

USD600

For phone calls, internet cost, COVID-19 prevention

USD1500 

Total

USD 411000 

Declaration

We the undersigned, declare that this proposal entitled “The effect of men’s accompaniment in antenatal health education services on improving health literacy, quality of care experience, and perinatal health outcomes at primary health facilities in Ethiopia”, is our original work, and all the resources and materials used for the proposal development are recognized and cited.

Further, we will accept the responsibilities for the scientific ethical, and technical conduct of the research and the provision of required progress reports as per terms and conditions.

Conflict of interest

The authors declare no conflict of interest for this work.

Reference

1.        World Health Organization (WHO). WHO reccommendations on antenatal care for a positive pregnancy experience. 2016. 172 p.

2.        World Health Organization (WHO). WHO recommendations on health promotion interventions for maternal and newborn health. 2015. 1–27 p.

3.        Aguiar C, Jennings L. Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries : A Systematic Literature Review. Matern Child Heal J. 2015;19(9):2012–9.

4.        Yargawa J, Leonardi-bee J. Male involvement and maternal health outcomes : systematic review and meta-analysis. J Epidemiol Community Heal. 2015;69(6):604–12.

5.        Smith HJ, Portela AG, Marston C. Improving implementation of health promotion interventions for maternal and newborn health. BMC Pregnancy Childbirth. 2017;17:2–7.

6.        Ghanotakis E, Hoke T, Wilcher R, Field S, Mercer S, Bobrow EA, et al. Evaluation of a male engagement intervention to transform gender norms and improve family planning and HIV service uptake in Kabale , Uganda. Glob Public Health. 2016;19(June):19.

7.        Daniele MAS, Ganaba R, Sarrassat S, Cousens S, Rossier C, Drabo S. Involving male partners in maternity care in Burkina Faso : a randomized controlled trial. Bull World Heal Organ. 2018;96(June):450–61.

8.        Teklesilasie W, Deressa W. Husbands ’ involvement in antenatal care and its association with women ’ s utilization of skilled birth attendants in Sidama zone , Ethiopia : a prospective cohort study. BMC Pregnancy Childbirth. 2018;18:315.

9.        WHO, UNICEF U. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019: Licence: CC BY-NC-SA 3.0 IGO.; 2017.

10.      Kinney M V, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H. Sub-Saharan Africa ’ s Mothers , Newborns , and Children : Where and Why Do They Die ? PLOS Med. 2010;7(6):1–9.

11.      Federal Democratic Republic of Ethiopia Ministry of Health. Reproductive Health Strategic Plan 2021-2025. 2021. 143 p.

12.      Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. Ethiopia Mini Demographic and Health Survey 2019: Key Indicators. Rockville, Maryland, USA: 2019. 207 p.

13.      Roro MA, Hassen EM, Lemma AM, Gebreyesus SH, Afework MF. Why do women not deliver in health facilities: A qualitative study of the community perspectives in south central Ethiopia? BMC Res Notes [Internet]. 2014;7(1):1–7. Available from: 10.1186/1756-0500-7-556

14.      Ethiopian Ministry of Health. Health Sector Transformation Plan II 2020/2021-2024/2025. Vol. 25. 2021. 1–128 p.

15.      Gamberini C, Angeli F, Ambrosino E. Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation. BMC Pregnancy Childbirth [Internet]. 2022;22(1):1–11. Available from: https://doi.org/10.1186/s12884...

16.      Ministry of Health-Ethiopia. Reproductive Health Strategic Plan 2021-2025. Vol. 4. 2021. 1–23 p.

17.      Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich M, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLoS One. 2018;13(1):1–16.

18.      United Nations. Transforming our world: the 2030 agenda for sustainable development. 2016. 36 p.

19.      Report of the UN Inter-agency Group for Child Mortality Estimation. A Neglected Tragedy The global burden of stillbirths. 2020. 90 p.

20.      Esopo K, Derby L, Haushofer J. Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: A systematic review. BMC Pregnancy Childbirth [Internet]. 2020;20(1):1–12. Available from: 10.1186/s12884-020-02992-y

Women living with their partners for at least six months in the study area, and those who initiated ANC service in the selected health institutions before or during the study period will be recruited.

Two arms of cluster-randomized control trials will be conducted in Ethiopia. The intervention will be done at health centers and hospitals (clusters) and will be assigned to the intervention or control groups randomly. The intervention group comprised an invitation letter delivered to the spouses of new antenatal attendees (Group A—men and women received health education together at two clusters of (health centers and hospitals) and the control group (Group B—women will receive health education alone) in another two clusters. We will include 858 eligible pregnant women in each group. The intervention consisted of two 50-min sessions administered in a private room in the hospital with pregnant women and their partners. 

The time to act is now unless we accelerate our progress, more than 30 million women do not give birth in a health facility each year in developing countries; more than 45 million receive insufficiently or no antenatal care, and limited direct evidence of the effectiveness male partner accompaniment for mortality and morbidity outcomes.

Even though men have decisive power related to maternal and child health issues, they have been traditionally excluded from maternal healthcare services due to maternal and child health is viewed as a woman’s affair. Inherited factors in husbands' sociodemographic and cultural factors, poor attitude toward maternal health, and lack of knowledge about reproductive and maternal health are the barriers to male involvement in maternal and child health and attributes to the practice of male dominance, often called “patriarchy.

This health education and promotion during ANC interventions are aimed to improve care-seeking and home care practices across the continuum of care. Therefore, this interventional research will explore the effect of male partner accompaniment in antenatal health education services in improving perinatal health outcomes, fill gaps in factors affecting care-seeking and care practices, and use them as baseline data for healthcare policymakers.

Our team comprises both MSc and PhD midwives in different universities who understand, promote and facilitate the physiological processes of pregnancy and childbirth, identify complications that may arise in mother and baby, accesses appropriate medical assistance, and implements emergency measures as necessary. 

A midwife is a person who has successfully completed a midwifery education program that is based on the ICM Essential Competencies for Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education.

This work involves antenatal education and preparation for parenthood and may extend to women's health, sexual or reproductive health and child care. A midwife may practise in any setting including the home, community, hospitals, clinics or health units.

Investigators

Birhan Tsegaw Taye (Lecturer in Clinical Midwifery, Debre Berhan University),

Muhabaw Shumye (Assistant professor in Clinical Midwifery, PhD fellow, University of Gondar),

Azmeraw Ambachew (Lecturer in Clinical Midwifery, University of Gondar),

Addisu Andualem (Lecturer in Clinical Midwifery, Debre Markos University),

Dr. Solomon Hailemeskel (PhD in Midwifery and women’s health, Debre Berhan University)

We would like to make an application for £411000 from the Bill and Melinda Gates Foundation fund. We are a group of local people in Ethiopia, and we have recently set up to provide health education activities for men/husbands with pregnant women during antenatal care entitled ''The effect of men’s accompaniment in antenatal health education services on improving health literacy, quality of care experience, and perinatal health outcomes at primary health facilities in Ethiopia.'' 

We were mainly inspired to start this health education and promotion because, in Ethiopia, there was high perinatal mortality, no change in healthcare-seeking during the perinatal periods for complications or illness, and dropping out before finishing the full course of maternity continuum of care remains a bottleneck to achieving the global goals. Thus, without proper funding, we will strive to get the right outcome and will be very hard to accomplish our objectives set. 

Different programs have directed efforts to harness the support and active involvement of men for improved health literacy, quality of care experiencematernal and newborn health outcomes. There are different models and rationales for seeking to involve men, including a view of men as gatekeepers and decision-makers for prompt access to maternal and child health services both at the household and community levels; men as responsible partners of women, and as an important sub-population within the community; the need to address men’s own sexual and reproductive health needs. 

Therefore, this study involves men to improve their limited understanding of the need for maternal health services and harmful cultural gender norms that pose obstacles to women’s healthcare service utilization, which is an opportunity to acquire health education and understand the possible complication of pregnancy and childbirth. This enables them to consider calling husbands to be avail with their wives and have got appropriate education/information in all regards. Thus, male partner accompaniment in antenatal health education services may improve the maternal continuum of care.   

Improved men’s understanding of the need for maternal health services and harmful cultural gender norms that pose obstacles to women’s healthcare service utilization through health education and understand the possible complication of pregnancy and childbirth. 

                       >>>>>>>>>

This enables them to consider calling husbands to be avail with their wives and have got appropriate education/information in all regards. Thus, increase male partner accompaniment in maternal and child healthcare services to improve the maternal continuum of care (i.e. birth preparedness and complication readiness, skilled birth service utilization, and postnatal care service utilization). 

                    >>>>>>>>>>

Reduce maternal/obstetric adverse outcomes (antepartum hemorrhage, postpartum hemorrhage, anemia during pregnancy, pre-labor rupture of membrane, preterm labor, uterine rupture, admission to intensive care unit, gestational diabetes, obstructed labor, and maternal death), reduce advers perinatal outcomes (i.e. stillbirth, low birth weight, macrosomia, meconium aspiration syndrome, congenital malformation, need for resuscitation, and low APGAR score), immunization for women and newborns.

                  >>>>>>>>>

Reduce cultural malpractice during pregnancy, intrapartum, and postpartum periods. 

                 >>>>>>>>>

In turn, increasing the health literacy of the community and quality of care experience; will contribute to achieving SDG 3.

We can measure the progress of Men involvement in antenatal care health education through outcome and effect measures. 

In order to ensure this, rigorous monitoring and evaluation of the implementation towards our predetermined goals; 1) assess the coverage of men's involvement in the maternal continuum of care, 2) assess the positive impact on the uptake of maternal health services and/or experience of care. 3) assess the impact of men's involvement on maternal/obstetric and perinatal outcomes.  

Provide health education on Pregnancy Care and Birth Preparedness (i.e. Importance of weight gain, ANC, nutrition, anemia– symptoms, prevention, treatment, supplementations, rest, harmful substances, Sexual transmitted diseases & HIV, Tetanus diphtheria immunization, danger signs, birth preparedness -- Need for preparation for birth: a place of delivery, skilled attendant at delivery, finances, transport, blood donor, and emergency plan, emotional support & communication).  Labor & Delivery/Postpartum Period (i.e. Signs of labor, risk factors for complicated deliveries, danger signs, complications during labor and postpartum for mother and newborn, safe delivery kit and practice, importance of postpartum visits, early & exclusive breastfeeding, feeding of colostrum, family planning methods; birth spacing & limiting, maternal & infant care needs and emotional support).                                   >>>>>>>>>

Improved men’s limited understanding of the need for maternal health services and harmful cultural gender norms pose obstacles to women’s healthcare service utilization.

                             >>>>>>>>>

Thus, male partner accompaniment in antenatal health education services helps to improve the maternal continuum of care (i.e. birth preparedness and complication readiness, skilled birth service utilization, and postnatal care service utilization), maternal/obstetric outcomes (antepartum hemorrhage, postpartum hemorrhage, anemia during pregnancy, pre-labor rupture of membrane, preterm labor, uterine rupture, admission to intensive care unit, oligohydramnios, gestational diabetes, obstructed labor, and maternal death), perinatal outcomes (i.e. stillbirth, low birth weight, macrosomia, meconium aspiration syndrome, congenital malformation, need for resuscitation, and low APGAR score), immunization for women and newborns, reduce cultural malpractice during pregnancy, intrapartum, and postpartum periods.

                       >>>>>>>>>>

In turn, this will contribute to achieving SDG 3.

3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

3.2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births.

Summary 

Background: Involvement of men during pregnancy, childbirth, and after birth is recommended to facilitate improved use of skilled care for positive pregnancy outcomes. Men’s involvement showed improved birth preparedness, couple communication, enhancing men’s knowledge of danger signs, use of skilled attendants, giving birth at health facilities, and decreasing maternal postpartum depression.

According to the World Health Organization (WHO), interventions to promote the involvement of men during pregnancy, childbirth, and after birth are recommended to facilitate and support improved use of skilled care during the maternal continuum of care, self-care, and home care practices for the woman and newborn. This also calls for an understanding of the joint responsibilities of men and women, so that they become equal partners in public and private lives and encouraging and enabling men to take responsibility for their sexual and reproductive behaviour.

However, in Ethiopia, there was high perinatal mortality, no change in healthcare-seeking of men during the perinatal periods for complications or illness, and finishing the full course of maternity continuum of care remains a bottleneck to achieving the global goals.

Clinical Significance of Preliminary Studies: This project aimed to explore the effect of improving men’s limited understanding of the need for maternal health services which improve health literacy, quality of care experience andperinatal outcomes, immunization for women and newborns, and reduce cultural malpractices.

Experimental Design: Two arms of cluster-randomized control trials will be conducted in the North Shewa zone, Ethiopia. The intervention will be done at hospitals (clusters), and will be assigned to the intervention or control groups randomly. The intervention group (men and women received health education together in two clusters and the control group (women will be received health education alone) is another two clusters. We will include 858 eligible pregnant women in each group (12th weeks of gestation onwards). The first health education session will be between 12-16th weeks of gestation and will be asked to return to the hospital at the 34-36th week of gestation for the second health education session. Data will be collected in 2 phases: at labor and delivery, immediate postpartum, and 7 weeks postpartum. Midwives who were working in maternity units and supervisors collected data after they were trained for five days.

Duration of Study: The study will be completed within 12 months (October 1/2022 to September 1/2023).

Required budget: to accomplish this project $41100 is required.

Midwives who were working in maternity units and supervisors collected data after they were trained for five days. Both data collectors and supervisors had bachelor's degree in Midwives and master's degree in public health and had immense experience in data collection. Data will be collected in 2 phases: at labor and delivery, immediate postpartum, and 7 weeks postpartum.  

Respect is a very important foundational factor in the development and maintenance of a healthy learning environment. Respect opens space for the development of trust and learning. So, we will respect the cultural traditions, norms, and beliefs of the community and involve the community and religious leaders, stakeholders, and supports community positive health outcomes. Because several elements can influence health communication—including behaviors, language, customs, beliefs, and perspectives—cultural respect is also critical for achieving accuracy in medical research.

We will provide health education and promotion during antenatal care interventions aimed to improve care-seeking and home care practices across the continuum of care. Therefore, this interventional research will explore the effect of male partner accompaniment in antenatal health education services in improving perinatal health outcomes, fill gaps in factors affecting care-seeking and care practices, and use them as baseline data for healthcare policymakers.

We will bring in money to fund our work through a grants to complete our activity.

Project cost and justification  

Calculated costs, specified

Personnel cost (training fees, refreshment, data clerk, advocacy)

USD9100

Material and supply (data collection equipment, stationary cost, etc)

USD4000

Travel cost (fuel, drivers per diem, and car rent) 

USD6000

Data collection cost (data collectors, supervisors fees, etc)

USD17500

Cost for policy brief and dissemination of result  

USD2400

For stationery, printing, and duplication

USD600

For phone calls, internet cost, COVID-19 prevention

USD1500 

Total

USD 411000 

We have won the following grats 

2019 a 5200 Ethiopian Birr small mega project at Debre Berhan University, Ethiopia

2020 17800 Ethiopian Birr domestic grant at Debre Markos University, Ethiopia 

2020 University of Gondar Mega project grant, the effect of COVID-19 pandemic on maternity and neonatal continuum of care services utilization, readiness, maternal and perinatal outcomes 250,000 Ethiopian Birr 

2019 UNFPA maternal supported project grant, predictors of failure to obstetric fistula surgical repair 35,000 Ethiopia Birr 

2019 UNFPA maternal supported project grant, the effect of women’s body mass index on pelvic organ prolapse: 35,000 Ethiopian Birr

2022 International Institute for Primary Health Care-Ethiopia (IPHC-E) small grant for research, 10,000 USD. (The trial is registered at PACTR with a unique Identification number for the registry of PACTR202203807835401.

2019 Effectiveness of Midwife-led continuum of care intervention for improving maternal and newborn health in Ethiopia at Laerdal Foundation.