# Effectiveness of trained religious leaders’ engagement in maternal health education on improving maternal health service utilizations: Protocol of cluster randomized controlled trial in Hadiya Zone, Southern Ethiopia

## TL;DR

This study tests if training religious leaders to promote maternal health education improves health service use in Ethiopia.

## Contribution

This is one of the first trials to evaluate the role of trained religious leaders in improving maternal health service utilization.

## Key findings

- A cluster-randomized trial will assess maternal health service use after religious leader engagement.
- Baseline and post-intervention data will evaluate knowledge of danger signs and service utilization.
- Qualitative analysis will explore perceptions and attitudes toward maternal health services.

## Abstract

Despite the many supply- and demand-side interventions aimed at increasing uptake of maternal health service utilizations, the maternal and new-born health service utilizations remains low. Religious leaders have the power to inhibit or facilitate effective adoption of maternal health service utilizations to promote maternal health. However, evidence on the roles of religious leaders in promoting maternal health in developing world is not fully known. Therefore this cluster-randomized trial is designed to evaluate the effects of trained religious leaders’ engagement in maternal health education in improving maternal health service utilization and knowledge of obstetric danger signs.

A community based cluster randomized control trial in which the study kebeles are randomly assigned into intervention and control groups will be conducted. The sample size is calculated using stata software. Three hundred six pregnant mothers will be enrolled in each group. A baseline study will be conducted before the intervention and post-intervention evaluation will be conducted after four months of intervention. Religious leaders will be selected and trained to lead participatory sessions on maternal health. Data on maternal health service utilizations, knowledge about obstetric danger signs, attitude towards skilled delivery service utilization and perception of pregnancy risk will be collected from a repeated cross sectional household survey. Effect of intervention will be assessed using multivariable logistic regression with generalized estimating equation model. Data will be analyzed using STATA software. For qualitative study, coded transcripts will be further analyzed and summarized in narratives for each theme and sub-themes.

This is one of the first trials to evaluate the effectiveness of trained religious leaders’ engagement in maternal health education and will provide much needed evidence to policy makers about aspects of functionality and the religious leaders engagement required as they scale-up this programme in Ethiopia.