Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review

Scharff, Darcell P.; Enard, Kimberly R.; Tao, Donghua; Strand, Gretta; Yakubu, Rauta Aver; Cope, Victoria

doi:10.1007/s10995-021-03299-w

Cited by 11 publications

(9 citation statements)

References 42 publications

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“…This study adds to the evidence supporting the role of CHWs facilitating access to care for underserved populations facing disparities and contributing to improved care, health, and equity . Three HV studies of CHWs plus licensed professionals in combined models have shown improvements in selected birth outcomes for all or subgroup participants, although these studies have somewhat limited comparability with our findings due to participant characteristics, exclusion criteria, and methodology shortcomings, including limited baseline covariates used for addressing selection bias.…”

Section: Discussionmentioning

confidence: 76%

“…CHW-provided HV, partnering with licensed professionals, could increase reach to high-risk populations and improve maternal and infant health and service utilization. However, there is limited evidence that the combination of these health care and licensed professionals can improve birth outcomes or address disparities . This retrospective population-based cohort study compared risks of adverse birth outcomes and the prenatal and postnatal maternal care of Medicaid-eligible individuals who received prenatal HV by CHWs working with nurses and social workers vs usual care.…”

Section: Introductionmentioning

confidence: 99%

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Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

et al. 2023

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ImportanceHome visiting is recommended to address maternal and infant health disparities but is underused with mixed impacts on birth outcomes. Community health workers, working with nurses and social workers in a combined model, may be a strategy to reach high-risk individuals, improve care and outcomes, and address inequities.ObjectiveTo assess the association of participation in a home visiting program provided by community health workers working with nurses and social workers (Strong Beginnings) with adverse birth outcomes and maternal care vs usual care among birthing individuals with Medicaid.Design, Setting, and ParticipantsThis retrospective, population-based, propensity score matching cohort study used an administrative linked database, including birth records and Medicaid claims, linked to program participation. The Strong Beginnings program exposure took place in 1 county that includes the second largest metropolitan area in Michigan. Study participants included primarily non-Hispanic Black and Hispanic Strong Beginnings participants and all mother-infant dyads with a Medicaid-insured birth in the other Michigan counties (2016 through 2019) as potential matching nonparticipants. The data were analyzed between 2021 and 2023.ExposureParticipation in Strong Beginnings or usual care.Main Outcomes and MeasuresPreterm birth (less than 37 weeks’ gestation at birth), very preterm birth (less than 32 weeks’ gestation), low birth weight (less than 2500 g at birth), very low birth weight (less than 1500 g), adequate prenatal care, and postnatal care (3 weeks and 60 days).ResultsA total of 125 252 linked Medicaid-eligible mother-infant dyads (mean age [SD], 26.6 [5.6] years; 27.1% non-Hispanic Black) were included in the analytical sample (1086 in Strong Beginnings [mean age (SD), 25.5 (5.8) years]; 124 166 in usual prenatal care [mean age (SD), 26.6 (5.5) years]). Of the participants, 144 of 1086 (13.3%) in the SB group and 14 984 of 124 166 (12.1%) in the usual care group had a preterm birth. Compared with usual prenatal care, participation in the Strong Beginnings program was significantly associated with reduced risk of preterm birth (−2.2%; 95% CI, −4.1 to −0.3), very preterm birth (−1.2%; 95% CI, −2.0 to −0.4), very low birth weight (−0.8%; 95% CI, −1.3 to −0.3), and more prevalent adequate prenatal care (3.1%; 95% CI, 0.6-5.6), postpartum care in the first 3 weeks after birth (21%; 95% CI, 8.5-33.5]), and the first 60 days after birth (23.8%; 95% CI, 9.7-37.9]).Conclusions and RelevanceParticipation in a home visiting program provided by community health workers working with nurses and social workers, compared with usual care, was associated with reduced risk for adverse birth outcomes, improved prenatal and postnatal care, and reductions in disparities, among birthing individuals with Medicaid. The risk reductions in adverse birth outcomes were greater among Black individuals.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

et al. 2023

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“…Studies have consistently demonstrated that CHW interventions significantly increase the percentage of women attending ANC visits, and the number of visits. 38 It is imperative to bolster these demand-side interventions to ensure that expectant mothers receive the care they require.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis

Aguilar‐Rodríguez,

Castro‐Porras

2023

Birth

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BackgroundOften marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID‐19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID‐19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico.MethodsWe conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits.ResultsDuring the COVID‐19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre‐pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference.ConclusionsAccording to our results, Indigenous women's ANC adequacy was negatively affected by the COVID‐19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.

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“…An aspect of the intervention that was not captured by the MRB was the counseling on the benefits of ANC by the CHW to the pregnant woman prior to administering the referral, which likely was a key motivator for ANC attendance. A recent meta-analysis reported that CHW interventions, including counseling, increased knowledge and ANC utilization amongst pregnant women [ 26 ]. For future research, it would be beneficial to capture the counseling component in addition to the referral, to examine the role of counseling by CHWs and whether there it results in a difference in ANC attendance and IPTp uptake.…”

Section: Discussionmentioning

confidence: 99%

Retrospective evaluation of referral by community health workers on the uptake of intermittent preventive treatment of Malaria in pregnancy in Ohaukwu, Ebonyi State, Nigeria

Orji¹,

Bryce

Odio³

et al. 2022

BMC Pregnancy Childbirth

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Background The World Health Organization recommends a minimum of three doses of quality-assured sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria during pregnancy (IPTp), in moderate to high malaria transmission areas in sub-Saharan Africa. Currently, coverage of IPTp lags behind coverage of antenatal care (ANC) visits; in Nigeria, 57% of women attended four or more ANC visits, whereas only 17% received the recommended three or more doses of IPTp. The innovative program aimed to close this gap by providing counseling on the benefits of comprehensive ANC, referral to ANC and community distribution of IPTp (C-IPTp), complementing IPTp at ANC. The study aimed to examine whether CHW referral to ANC improved the likelihood of receiving three or more doses of IPTp. Methods The data for this study were extracted from the maternity record books of 1437 pregnant women seen at 25 public health facilities in Ebonyi State, Nigeria. The outcome of interest was defined as the receipt of three or more doses of IPTp (IPTp3) and the independent variable was referral to ANC by a community health worker for any visit. Descriptive statistics were reported and the results from the multi-level regressions are reported as adjusted odds and prevalence ratios with corresponding 95% confidence intervals. Results Of the 936 women included in the analysis, 24.47% received the recommended three or more IPTp doses and 61.32% were referred by a community health worker (CHW) for at least one ANC visit. There was no difference in the mean number of ANC visits between women who received C-IPTp and those who received IPTp exclusively at a facility (2.40 vs 2.52; p = 0.374). There were no maternal characteristics associated with CHW referral. Women who were referred by a CHW had 60% greater odds (95% CI, 1.08–2.38) of receiving IPTp3 than those who were never referred. Conclusion The results indicate that CHW referrals conducted within a C-IPTp program are associated with higher IPTp uptake but not fewer ANC visits and that CHWs applied the referral process equally. This strengthens the evidence base for C-IPTp scale-up, which could have a large impact in sub-Saharan Africa in mitigating existing health systems issues.

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Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review

Cited by 11 publications

References 42 publications

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance

COVID‐19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis

Retrospective evaluation of referral by community health workers on the uptake of intermittent preventive treatment of Malaria in pregnancy in Ohaukwu, Ebonyi State, Nigeria

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