Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya

Abstract

BackgroundVolunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance.MethodsThe study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women’s children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas.ResultsMean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%.ConclusionThe delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.

Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study

“…The study results confirm the importance of community interventions in promoting birth preparedness and knowledge of obstetric danger signs in rural communities [10,25]. The study results also indicate existing gaps in birth preparedness practice in rural communities.…”

“…In addition, the interaction between study area and VHT home visits indicated that the odds of obstetric danger signs’ knowledge and birth preparedness were higher among intervention residents who were visited by the VHTs. Other studies have also indicated the importance of community health workers in improving the knowledge of obstetric danger signs as well as birth preparedness among women [25,29,30]. …”

Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

“…Other authors have emphasized the scope of the intervention, implementation efficiency, availability of resources, leadership and local contextual issues as key factors that influence the successful implementation of interventions [6,28]. Local contextual cultural factors were noted to be vital in changing newborn care practices.…”

“…Community-based strategies that involve the training of CHWs and traditional birth attendants have resulted in increased awareness of maternal and newborn health and newborn danger signs, increased utilization of antenatal care (ANC) and facility delivery [1,17,20,27,28], and increased newborn care practices such as clean cord care, immediate breastfeeding, thermal care and delayed bathing [19,21]. Community mobilization and the use of community support groups have also resulted in increased awareness and knowledge about maternal and newborn health and increased facility deliveries [6].…”

Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial

“…Globally, given the limited human resources in the health sector, a community-based approach has been promoted as a cost-effective and pro-poor intervention to improve the accessibility of health care [5, 6]. Community health workers (CHWs) are often employed as a key element of the community-based approach to the rural population of low- and middle-income countries [7].…”