Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya

Abstract

Background: Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. Methods: We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.

Improving maternal, newborn and child health outcomes through a community-based women’s health education program: a cluster randomised controlled trial in western Kenya

“…Our findings strengthen evidence from an earlier Chamas pilot that similarly demonstrated increased odds of achieving these outcomes compared with the standard of care in rural western Kenya. 15 Collectively, these findings highlight our intervention's potential to improve MNCH outcomes by leveraging existing community health resources and infrastructure in settings like Kenya. This work has several limitations.…”

“…Intervention clusters participated in the Chamas programme (programme details are published elsewhere). 15 Briefly, Chamas is a group-based, CHV-led health education programme that supports women during the first 1000 days of their child’s life. Women randomised to the intervention arm participated in Chamas in lieu of receiving individual home visits (standard of care).…”

“…We estimated sample size using methods described by Rutterford et al for a proposed mixed effects regression analysis 23 using derived baseline estimates. 1 15 Assuming a mean cluster size of 20 individuals, 77 clusters (equally allocated between arms), intracluster correlation coefficient (ICC) of 0.44 (based on pilot data) 15 and 20% attrition, we calculated that a total of 1280 individuals would be needed to detect a 4.7% risk difference (RD) (difference in the rate of facility-based birth at the county vs national-level 1 with 80% power at a (two-tailed) significance level of 0.05). To determine our recruitment timeline, we assumed 6.3% of all women of reproductive age would be pregnant at any given time (or roughly 50 women per CU annually).…”

“…A pilot study investigating first-year Chamas participation demonstrated significant associations between participation and the likelihood of practising positive MNCH behaviours such as delivering in a health facility with a skilled birth attendant. 15 To validate whether first-year Chamas participation is positively associated with health facility delivery and the practice of other key MNCH interventions, we conducted a large-scale cluster randomised controlled trial in rural western Kenya. We hypothesised women participating in Chamas would be more likely to deliver in health facilities than those receiving individual, home-based visits (standard of care).…”

Participation in a Community-Based Women's Health Education Program and At-Risk Child Development in Rural Kenya: Developmental Screening Questionnaire Results Analysis

“…A pilot study evaluating the first year of this program demonstrated significant associations between participation and the likelihood of practicing positive MNCH behaviors, including attending adequate antenatal care and exclusively breastfeeding. 14,15 To test our hypothesis that maternal participation in Chamas improved MNCH outcomes, including ECD, we conducted a cluster-randomized controlled trial in Trans Nzoia County, Kenya. In this article, we report results from developmental screening questionnaires (DSQ) completed on children born during the trial at 1-year follow-up.…”