Group Antenatal Care in Ghana: Protocol for a Cluster Randomized Controlled Trial

Area of Science:

• Global Health
• Maternal and Child Health
• Health Services Research

Background:

• Group antenatal care (ANC) is established in high-income countries but novel in sub-Saharan Africa.
• Generalizing findings from high-resource settings to low-resource contexts with low literacy and high maternal/newborn mortality is challenging.
• The Group Antenatal Care Delivery Project (GRAND) is a cluster RCT in Ghana comparing group ANC to individual ANC.

Purpose of the Study:

• To enhance health literacy among pregnant women in rural Ghana.
• To increase birth preparedness and complication readiness.
• To optimize maternal and newborn health outcomes through group ANC.

Main Methods:

• A cluster randomized controlled trial (RCT) involving seven rural health facilities.
• Quantitative data collection at four time points via a secure web application.
• Intention-to-treat analysis comparing group ANC and routine individual ANC, supplemented by a process evaluation.

Main Results:

• Participant enrollment completed (n=1761) in November 2021.
• Third-trimester data collection completed (n=1284) in May 2022.
• Postpartum data collection (6 weeks, 6 months, 1 year) is ongoing.

Conclusions:

• This is one of the first RCTs evaluating group ANC in low-literacy populations.
• Study findings could significantly impact clinical care delivery for low-literacy populations globally.
• The research has the potential to improve maternal and newborn outcomes in underserved communities.