# Enhancing maternal and newborn outcomes in Ghana: a comprehensive randomized controlled trial evaluation of obstetric triage effectiveness and midwives training

## TL;DR

This study evaluates a program in Ghana to improve maternal and newborn health through triage protocols and midwife training.

## Contribution

The study introduces a novel midwife-led peer training model within a resource-limited setting to improve obstetric care.

## Key findings

- OTIP aims to improve maternal and neonatal outcomes through triage protocols and midwife training.
- The study will assess the effectiveness of OTIP using a cluster randomized controlled trial and regression discontinuity analysis.
- Findings will inform the scalability of the training model to other regions and contribute to global maternal health literature.

## Abstract

Ghana has made progress in maternal and newborn health, but significant challenges remain, with maternal mortality at 263 per 100,000 live births and neonatal mortality at 22.8 per 1,000 live births. The Obstetric Triage Implementation Package (OTIP), which includes rapid triage protocols and midwife-led peer training, aims to improve the quality of care in a context of scarce resources. This study evaluates the effectiveness of OTIP in improving maternal and neonatal outcomes and assesses the mechanisms behind the observed effects.

A cluster randomized controlled trial will assess the impact of OTIP in 25 high-volume hospitals across Ghana during the final phase of its national roll-out. Hospitals will be randomized into early and late intervention groups. A complementary regression discontinuity analysis will assess the impact of OTIP at the national level. Primary outcomes include process improvements and maternal and neonatal outcomes. Secondary outcomes will assess midwives’ knowledge and attitudes. Data sources include primary surveys of 1,250 mother-newborn pairs and 750 midwives, and administrative records from the Ghana Health Service, Ministry of Health.

A rigorous evaluation of OTIP would be crucial, not only to assess the effectiveness of a program in which the Government of Ghana is already investing, but also to assess the potential applicability of this training model to other areas, and to contribute to the academic literature by filling gaps in our understanding of how different training methods can overcome barriers to the diffusion of new practices.

Study protocols have been approved by the Ghana Health Service (GHS) Ethics Review Committee (GHS-ERC: 022/05/24). Trial registration number: ISRCTN15629047. Registered on 04/11/2024 while participant enrollment was ongoing, 10.1186/ISRCTN15629047. The study is hence retrospectively registered.

The online version contains supplementary material available at 10.1186/s12913-025-13132-7.