A Research Protocol for a Comparative Study of Maternal Health Interventions in Guinea-Bissau: An African Regional Perspective

Maternal mortality remains high in sub-Saharan Africa, with disparities in intervention effectiveness. Guinea-Bissau faces specific challenges in maternal healthcare delivery. A context-specific comparison of key interventions is needed to inform regional policy and practice. This protocol outlines a study to compare the effectiveness and acceptability of two maternal health interventions in Guinea-Bissau: community-based antenatal care programmes and facility-based delivery initiatives. The primary objective is to determine which model, or combination, is most strongly associated with improved maternal outcomes and increased skilled birth attendance in this setting. A mixed-methods, comparative study will be conducted across three rural districts. Quantitative data on birth outcomes and service utilisation will be collected retrospectively from health facility records. Qualitative data will be gathered via focus group discussions with service users and semi-structured interviews with healthcare providers to explore perceptions and barriers. Data will be analysed thematically and using comparative statistical tests. As this is a research protocol, no empirical findings are available. The anticipated analysis will compare outcomes, such as the proportion of skilled births attended, between the two intervention models and identify key thematic barriers to access. The study is expected to delineate the relative strengths and limitations of each intervention model within the Guinean-Bissau context, contributing to the evidence base for optimising maternal healthcare in similar regions. Recommendations will be directed at national and district health authorities, focusing on practical strategies for scaling effective intervention components and addressing identified systemic barriers. Maternal health, comparative study, health interventions, Guinea-Bissau, antenatal care, skilled birth attendance, sub-Saharan Africa This protocol provides a structured framework for generating context-specific evidence to guide maternal health programming in Guinea-Bissau and similar African regions.