Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

Abstract

Background: Skilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce. Methods: A quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on skilled birth attendance (SBA). In each country, communities in two districts/sub-districts received a package of community-oriented interventions comprised of timed CHW household health promotion for maternal, newborn and child health complemented by social accountability mechanisms using community scorecards. Two matched comparison districts/sub-districts received ongoing routine interventions. Data from the final evaluation were examined to determine the effect of timed CHW services and community-oriented interventions on SBA. Results: Over 80% of the 3037 women in Cambodia, 2805 women in Kenya and 1171 women in Zambia reported SBA. Women in intervention sites who received timely CHW health promotion and social accountability mechanisms in Cambodia showed significantly higher odds of SBA (aOR = 7.48; 95% CI: 3.87, 14.5). The findings also indicated that women over the age of 24 in Cambodia, women with primary or secondary education in Cambodia and secondary education in Kenya, women from higher wealth quintiles in Cambodia, and women with four or more antenatal care (ANC) visits in all countries reported significantly higher odds of SBA. Inclusion of family members in pregnancy-related discussions in Kenya (aOR = 2.12; 95% CI: 1.06, 4.26) and Zambia (aOR = 6.78; 95% CI: 1.15, 13.9) and follow up CHW visits after a referral or health facility visit (aOR = 2.44; 95% CI: 1.30, 4.60 in Cambodia; aOR = 2.17; 95% CI 1.25, 3.75 in Kenya; aOR = 1.89; 95% CI: 1.05, 2.02 in Zambia) also showed significantly greater odds of SBA.

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey

“…This may be attributed to the fact that regular contact with health workers during ANC, accords more opportunities for education and counselling about the need to seek for health care services during and after pregnancy [ 28 , 31 , 38 ]. Mothers who had at least one visit by a health field worker had higher odds of PNC utilisation, a finding similar to that of other studies done in similar contexts [ 39 , 40 ]. The repeated contact with health workers during pregnancy through ANC services and visits by health field workers promote confidence and familiarity with the health system leading to increased trust in the health system [ 36 ].…”

Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey

“…In addition to their roles of providing basic primary health care services, CHAs ensure increased modern contraceptive utilization through health promotion and behavioral change sessions and providing basic reproductive, maternal and newborn health (RMNH) interventions were including contraceptive counselling and administration of injectable contraceptives within the communities [ 46 , 48 ]. Being visited by field health workers has been shown to be associated with increased utilization of SRH services in several other studies [ 12 , 50 – 52 ].…”

Intimate partner violence and its association with skilled birth attendance among women in Nigeria: evidence from the Nigeria Demographic and Health Surveys

“…The presence of a skilled health professional, such as a doctor, nurse or midwife who is trained to manage pregnancies, childbirth and the immediate postnatal period is one of the central elements in reducing maternal and child deaths [8][9][10]. Previous studies have shown that socioeconomic, cultural and other related factors influence SBA utilisation [11][12][13][14]. In addition, cultural and institutional norms like maleheaded households and gender-based power inequalities, through gender-based violence adversely affect women's sexual and reproductive health [15,16].…”