Effectiveness of Student-Led vs. Midwife-Led Group Antenatal Education on Maternal Knowledge and Birth Preparedness: A Cluster Randomised Trial in Primary Health Centres in Kaduna State, Nigeria

Abstract

Objective: This study compared student-led and midwife-led antenatal education on maternal knowledge of obstetric danger signs, birth preparedness and complication readiness, and maternal satisfaction among pregnant women attending primary health centres in Jema’a Local Government Area, Kaduna State, Nigeria. Methods: A parallel, two-arm cluster randomised controlled trial was conducted in 14 primary health centres. Facilities were allocated in a 1:1 ratio to student-led or midwife-led education, stratified by facility type and urban or rural location. Eligible pregnant women aged 18 years or older received a structured four-session antenatal education curriculum. The primary outcome was adequate knowledge of obstetric danger signs at follow-up, defined as spontaneous recall of at least three danger signs for pregnancy, labour or childbirth, and the postpartum period. Secondary outcomes included adequate birth preparedness and complication readiness, maternal satisfaction, and perceived usefulness. Analyses used generalised linear mixed models accounting for clustering. Results: Of 872 enrolled women, 438 were assigned to the student-led arm and 434 to the midwife-led arm. Follow-up data were available for 796 women (91.3%). Adequate knowledge at follow-up was higher in the student-led arm than in the midwife-led arm (68.2% versus 58.5%; adjusted odds ratio 1.52, 95% confidence interval 1.12–2.06). Adequate birth preparedness and complication readiness was also higher in the student-led arm (64.8% versus 57.0%; adjusted odds ratio 1.38, 95% confidence interval 1.01–1.89). Maternal satisfaction was high in both arms. Conclusion: Student-led antenatal education improved maternal knowledge and birth preparedness compared with midwife-led education while maintaining high participant satisfaction.