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Table 4 List of outcomes and definition of outcome indicators

From: Impact of the Maternal and Child Health handbook in Angola for improving continuum of care and other maternal and child health indicators: study protocol for a cluster randomised controlled trial

Outcome Definition Type Indicators Details
Primary outcome
 Complete CoC (maternal behaviour-based) Time-dependent composite outcome. Complete CoC is the minimum number of ANC visits + facility-based delivery + PNC for mother and newborn + child vaccinations at two time points—at birth and at 2~3 months. Includes women who attended ANC and other MCNH services only.
Complete CoC = 1 when all indicators = 1
Binary First ANC timing Timeline divided into ≤ 20, 21~30, 31~37 and 38 weeks~ ga
No. of ANC services < 4 = 0, ≥ 4 = 1 (≤ 20 weeks); < 3 = 0, ≥ 3 = 1 (21–30 weeks); < 2 = 0, ≥ 2 = 1 (31~37 weeks); < 1 = 0, ≥ 1 = 1 (38 weeks)
Facility delivery No = 0; yes = 1
PNC_mother No HBR record = 0; HBR record = 1
PNC_child No HBR record = 0; HBR record = 1
Vaccinations at birth and at 2 months infant age < 2 vacc clinic visits = 0; 2 vacc visits = 1
Secondary outcomes
 Rate of MNCH service utilisation Total no. of actual MCH service used per person per arm compared with an expected minimum number of service utilisation.
Estimate means for each arm
Continuous No. of ANC services No. of women with a minimum number of ANC in each arm
Facility delivery No of women with facility delivery in each arm
PNC_mother No. of women with mother PNC record in each arm
PNC_child No. of women with child PNC record in each arm
Vaccination No. of women with child vacc record in each arm
 Complete CoC (service-based) Time-dependent composite outcome. Composite outcome including ≥ 4 ANC visits + facility-based delivery + PNC of mother and newborn + complete child immunisation up to 2~3 months.
Complete CoC = 1 when all indicators = 1
Binary First ANC timing Timeline divided into ≤ 20, 21~30, 31~37 and 38 weeks~ ga
No. of ANC services < 4 = 0, ≥ 4 = 1 (≤ 20 weeks); < 3 = 0, ≥ 3 = 1 (21–30 weeks); < 2 = 0, ≥ 2 = 1 (31~37 weeks); < 1 = 0, ≥ 1 = 1 (38 weeks)
Facility delivery No = 0; yes = 1
PNC_mother No HBR record = 0; HBR record = 1
PNC_child No HBR record = 0; HBR record = 1
Vaccination < 7 records = 0; 7 records = 1
 Neonatal mortality No. of deaths within the first 28 days of life compared to the total number of deliveries in each study arm.
NM = 1 when all indicators = 1
Binary Live birth No = 0; yes = 1
Infant death No = 0; yes = 1
Date of death Death within 28 days of birth = 1
ANC service utilisation No. of women who receive ≥ 4 ANC visits in each arm regardless of the timing of first ANC.
Adequate ANC = 1 if no. of ANC services = 1
Binary First ANC timing 1st trimester, 2nd trimester, 3rd trimester
Received ANC No = 0; yes = 1
No. of ANC services < 4 = 0; ≥ 4 = 1
No. of women who receive ≥ 8 ANC visits in each arm regardless of the timing of first ANC.
Adequate ANC = 1 if no. of ANC services = 1
Binary First ANC timing 1st trimester, 2nd trimester, 3rd trimester
Received ANC No = 0; yes = 1
No. of ANC services < 8 = 0; ≥ 8 = 1
 Facility-based delivery No. of facility-based deliveries in each arm. Binary Facility delivery No = 0; yes = 1
 Infant health check-up Presence of at least one HBR entry from baby-well clinic attendance. Binary Record entry for any of current wgt, polio1, pentavalent, pneumo1 or rota1 No HBR record = 0; HBR record (for any of current wgt, polio1, pentavalent, pneumo1 or rota1) = 1
 Maternal morbidity and pregnancy complication detection rate No. of cases of specified disease conditions and pregnancy complications diagnosed by an HCP in each arm.
Maternal morbidity = 1 if any indicator = 1
Binary High blood pressure No HBR record = 0; HBR record = 1
Preeclampsia No HBR record = 0; HBR record = 1
Miscarriage No HBR record = 0; HBR record = 1
Stillbirth No HBR record = 0; HBR record = 1
Vaginal bleeding No HBR record = 0; HBR record = 1
Anaemia No HBR record = 0; HBR record = 1
Malaria No HBR record = 0; HBR record = 1
TB No HBR record = 0; HBR record = 1
HIV No HBR record = 0; HBR record = 1
Diabetes No HBR record = 0; HBR record = 1
 Infant morbidity rate Total no. of disease cases attended by an HCP.
Infant morbidity = 1 if all indicators = 1
Binary Past month sickness No = 0; yes = 1
Sought treatment No = 0; yes = 1
Treatment from HP No = 0; yes = 1
 Infant mortality No of deaths of infants < 1 year old compared to the total number of deliveries in each study arm.
IM = 1 when if both indicators = 1
Binary Livebirth No = 0; yes = 1
Infant death No = 0; yes = 1
 Maternal health behaviour Prevalence of maternal health behaviour between arms with regard to tobacco use, alcohol use, PMTCT, malaria prevention, use of ITNs and family planning. Prevalence of each indicator will be compared between the intervention and control arms. Binary Current alcohol use No = 0; yes = 1
Current tobacco use No = 0; yes = 1
PMTCT No = 0; yes = 1
Family planning use No = 0; yes = 1
Knowledge change tobacco use No = 0; yes = 1
Knowledge change alcohol use No = 0; yes = 1
 Malaria prevention   Binary ITN possession No = 0; yes = 1
ITN use No = 0; yes = 1
Malaria prophylaxis use No = 0; yes = 1
 Maternal depression No. of cases of maternal postnatal depressive symptoms in each arm. Binary EPDS < 10 = 0; ≥ 10 = 1
 Infant feeding practices Appropriate infant feeding practices including EIBF, EBF and absence of pre-lacteal feeding.
Adequate if all indicators = 1
Binary EIBF After 1 h = 0; within 1 h = 1
Pre-lacteal feeding Yes = 0; no = 1
Current BF No = 0; yes = 1
 Child vaccination Composite outcome for the no. of complete fully vaccinated children at 3 months in each study arm.
Vaccination = 1 if all indicators = 1
Binary Polio0 No HBR record = 0; HBR record = 1
BCG No HBR record = 0; HBR record = 1
Hepatitis B N HBR record = 0; HBR record = 1
Polio1 No HBR record = 0; HBR record = 1
Pentavalent No HBR record = 0; HBR record = 1
Pneumo1 No HBR record = 0; HBR record = 1
Rotavirus1 No HBR record = 0; HBR record = 1
  1. CoC continuum of care, ANC antenatal care, PNC postnatal care, HBR home-based record, MNCH maternal, newborn and child health, NM neonatal mortality, IM infant mortality, PMTCT prevention of mother-to-child transmission, ITN insecticide-treated net, EIBF early initiation of breastfeeding, EBF exclusive breastfeeding