Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal and Child Health

Background:

• Pregnancy hypertension is a leading cause of maternal and fetal mortality in Mozambique.
• Existing healthcare systems face challenges in timely triage, transport, and treatment for hypertensive disorders of pregnancy.

Purpose of the Study:

• To evaluate the effectiveness of task-sharing care through the Community-Level Interventions for Pre-eclampsia (CLIP) intervention.
• To assess if the CLIP intervention could reduce adverse pregnancy outcomes, including maternal, fetal, and newborn mortality and morbidity.

Main Methods:

• A cluster randomized controlled trial involving 15,013 women across 12 administrative posts in Mozambique.
• The CLIP intervention involved community engagement, community health worker assessments, initial treatment, and algorithm-guided referral.
• Outcomes were analyzed using multi-level logistic regression, comparing intervention and control clusters.

Main Results:

• The primary outcome did not significantly differ between intervention and control clusters (aOR 1.31, p=0.40).
• Women with at least 8 contacts with the CLIP intervention experienced fewer primary adverse outcomes (aOR 0.79, p=0.041).
• Improved maternal outcomes were observed in women with higher CLIP contact intensity (aOR 0.72, p=0.033).

Conclusions:

• The general implementation of the CLIP intervention did not significantly improve overall pregnancy outcomes.
• Increased engagement with the CLIP intervention, particularly achieving the WHO's eight-contact model, may be beneficial for maternal health.