Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Shikuku, Duncan N.; Masavah, Leakey K.; Muganda, Maxwell; Otieno, Felix; Magolo, George; Njoki, Lilian; Odhong, Tom Otieno; Sisimwo, Kenneth; Matete, Thomas; Orero, Solomon; Kisia, Paul

doi:10.21203/rs.3.rs-75610/v1

Cited by 2 publications

(1 citation statement)

References 31 publications

(57 reference statements)

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“…There is a need to address issues such as the age and education levels of CHVs, core competencies and remuneration. As already seen in the case of iCCM [23], there is no doubt that CHVs can generate greater demand for and access to health services. This can only be sustained if CHVs are trained, motivated, and supervised to work within a supportive environment that guarantees sufficient backstopping and operational efficiencies [24].…”

Section: Discussionmentioning

confidence: 81%

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

Wambui,

Wilunda,

Donfouet

et al. 2024

PLOS Glob Public Health

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Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

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Section: Discussionmentioning

confidence: 81%

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

Wambui,

Wilunda,

Donfouet

et al. 2024

PLOS Glob Public Health

View full text Add to dashboard Cite

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Four antenatal care visits by four months of pregnancy and four vital tests for pregnant mothers: impact of a community-facility health systems strengthening intervention in Migori County, Kenya

Alhassan,

Otiso,

Okoth

et al. 2024

BMC Pregnancy Childbirth

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Background Early attendance at antenatal care (ANC), coupled with good-quality care, is essential for improving maternal and child health outcomes. However, achieving these outcomes in sub-Saharan Africa remains a challenge. This study examines the effects of a community-facility health system strengthening model (known as 4byFour) on early ANC attendance, testing for four conditions by four months of pregnancy, and four ANC clinic visits in Migori county, western Kenya. Methods We conducted a mixed methods quasi-experimental study with a before-after interventional design to assess the impact of the 4byFour model on ANC attendance. Data were collected between August 2019 and December 2020 from two ANC hospitals. Using quantitative data obtained from facility ANC registers, we analysed 707 baseline and 894 endline unique ANC numbers (attendances) based on negative binomial regression. Logistic regression models were used to determine the impact of patient factors on outcomes with Akaike Information Criterion (AIC) and likelihood ratio testing used to compare models. Regular facility stock checks were undertaken at the study sites to assess the availability of ANC profile tests. Analysis of the quantitative data was conducted in R v4.1.1 software. Additionally, qualitative in-depth interviews were conducted with 37 purposively sampled participants, including pregnant mothers, community health volunteers, facility staff, and senior county health officials to explore outcomes of the intervention. The interview data were audio-recorded, transcribed, and coded; and thematic analysis was conducted in NVivo. Results There was a significant 26% increase in overall ANC uptake in both facilities following the intervention. Early ANC attendance improved for all age groups, including adolescents, from 22% (baseline) to 33% (endline, p = 0.002). Logistic regression models predicting early booking were a better fit to data when patient factors were included (age, parity, and distance to clinic, p = 0.004 on likelihood ratio testing), suggesting that patient factors were associated with early booking.The proportion of women receiving all four tests by four months increased to 3% (27/894), with haemoglobin and malaria testing rates rising to 8% and 4%, respectively. Despite statistical significance (p < 0.001), the rates of testing remained low. Testing uptake in ANC was hampered by frequent shortage of profile commodities not covered by buffer stock and low ANC attendance during the first trimester. Qualitative data highlighted how community health volunteer-enhanced health education improved understanding and motivated early ANC-seeking. Community pregnancy testing facilitated early detection and referral, particularly for adolescent mothers. Challenges to optimal ANC attendance included insufficient knowledge about the ideal timing for ANC initiation, financial constraints, and long distances to facilities. Conclusion The 4byFour model of community-facility health system strengthening has the potential to improve early uptake of ANC and testing in pregnancy. Sustained improvement in ANC attendance requires concerted efforts to improve care quality, consistent availability of ANC commodities, understand motivating factors, and addressing barriers to ANC. Research involving randomised control trials is needed to strengthen the evidence on the model’s effectiveness and inform potential scale up.

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Effect of Integrated Community Case Management on Access and Utilization of Maternal, Newborn and Child Health and Immunization Services in Hard-to-Reach Communities in Migori County, Kenya: A Quasi-Experimental Study

Cited by 2 publications

References 31 publications

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

Four antenatal care visits by four months of pregnancy and four vital tests for pregnant mothers: impact of a community-facility health systems strengthening intervention in Migori County, Kenya

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