Community midwifery model’s effect on availability, utilization and outcomes of maternal and newborn health services in hard-to-reach communities of Busia Kenya: a Quasi-experimental study

Abstract

Background Globally, poor women in hard-to-reach areas are least likely to receive healthcare and carry the burden of maternal and neonatal mortality related to complications of childbirth. Midwifery can avert 83% of all maternal & neonatal deaths and stillbirths. This study evaluated the effect of an enhanced community midwifery model (CMM) on skilled attendance during pregnancy and childbirth and maternal and perinatal outcomes against the background of protracted healthcare workers' strikes in rural Kenya. Methods A quasi-experimental (one-group pretest-posttest) designed. Six-months pretest period: December’2016-May’2017. Between Dec’2016-Feb’2017 (period 1) - a doctors’ strike and March-May’2017 (period 2), normal healthcare services resumed. An enhanced CMM (using 10 CMs linked to 6 health facilities) was implemented in the proceeding 5-months posttest period (period 3) – June-October’2017 during the national nurses/midwives’ strike. Differences in performance means for MNH variables of interest between the three periods were computed by ANOVA. Two-groups test of proportions for before and during/after the enhanced CMM computed. Results There were differences in mean monthly attendance for community midwifery services for the three periods: 1st ANC (1.8-2.3-9.9, P = 0.0087), 4th ANC (1.4-1.0-7.1, P = 0.0212), skilled births (1.5-1.7-13.1, P < 0.0001). Mean attendance at facility were: 1st ANC (55.7-70.8-4.0), 4th ANC (29.6-38.1-1.2) and skilled births (63.1-87.4-5.6), P ≤ 0.05. No differences in attendance between the doctors’ strike and normalcy period for both CMs and health facilities’ MNH services (P ≥ 0.05). However, significant increases for CMs MNH services during the nurses/midwives strike and significant reductions at the facility level during the same period (P ≤ 0.05). An increase of 68%, 74.5%, 67.8% and 33.3% in the proportion of 1st and 4th ANC, skilled births and PNC conducted by CMs during/after the CMM respectively (P ≤ 0.0001). A double and triple reduction in macerated stillbirths (0.70%-0.36%) and neonatal deaths (0.54%-0.18%) respectively and an increase in babies discharged alive (98.05%-100%) with no change in maternal deaths during/post intervention. Conclusions There was improvement in access/utilization of pregnancy and childbirth services from CMs. There is a golden opportunity to integrate the CMs to primary health care system to improve uptake of MNH care services through an enhanced CMM strategy in hard-to-reach communities.

Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model

“…As Kenya attempts to revitalise its primary healthcare delivery system to provide universal healthcare, leveraging past success is a good starting point. Evidence from studies conducted in Kenya shows that community midwives improved ANC attendance, family planning, HIV services, skilled birth attendance, postnatal care, and exclusive breastfeeding [33][34][35][36]. However, the continued success of community midwifery depends on their recognition as public health workers and adequate remuneration for services rendered by government insurance schemes.…”

“…As reported in pandemics in West Africa [ 1 , 43 ], crises exacerbate maternal and neonatal mortality. Lessons learned from previous crises in Kenya that impacted the healthcare system highlighted the need to prioritise maternal and newborn care [ 35 , 44 ]. Therefore, bold, long-term, and culturally acceptable measures are needed to address maternal and newborn care during this prolonged COVID-19 crisis.…”