The effect of the community midwifery model on maternal and newborn health service utilization and outcomes in Busia County of Kenya: a quasi-experimental study

Abstract

Background Poor women in hard-to-reach areas are least likely to receive healthcare and thus carry the burden of maternal and perinatal mortality from complications of childbirth. This study evaluated the effect of an enhanced community midwifery model on skilled attendance during pregnancy/childbirth as well as on maternal and perinatal outcomes against the backdrop of protracted healthcare workers’ strikes in rural Kenya. Methods The study used a quasi-experimental (one-group pretest-posttest) design. The study spanned three time periods: December 2016-February 2017 when doctors were on strike (P1), March-May 2017 when no healthcare providers were on strike (P2), and June-October 2017 when nurses/midwives were on strike (P3), which was also the period when the project enhanced the capacity of community midwives (CMs) to provide services at the community level. Analysis entailed comparison of frequencies/means of maternal and newborn health service utilization data across the three periods. Results The monthly average number of clients obtaining services from CMs across the three time periods was: first antenatal care (ANC) (P1-1.8, P2-2.3, P3-9.9), fourth ANC (P1-1.4, P2-1.0, P3-7.1), skilled birth (P1-1.5, P2-1.7, P3-13.1) and the differences in means were statistically significant (p < 0.05). Over the period, the monthly average number of clients obtaining services from health facilities was: first ANC (P1-55.7, P2-70.8, P3-4.0), fourth ANC (P1-29.6, P2-38.1, P3-1.2) and skilled birth (P1-63.1, P2-87.4, P3-5.6), p < 0.05. There were no statistically significant differences in the average number of clients obtaining services from CMs or health facilities between P1 and P2 (p > 0.05). There was, however, a statistically significant increase in the average number of clients obtaining services from CMs in P3 accompanied by a statistically significant decline in the average number of clients obtaining services from health facilities (p < 0.05). First ANC increased by 68%, fourth ANC by 75%, skilled births by 68%, and postnatal care by 33% in P3 (p < 0.0001). There was a non-significant decline in macerated stillbirths and neonatal deaths in P3. Conclusions The findings underscore the importance of integrating community-level health service providers (CMs and health volunteers) into the primary health care system to complement service delivery according to their level of expertise, especially in low-resource settings.

Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis

“…Statistical heterogeneity across studies was moderate (I 2 = 57%, p = 0.0057). A sensitivity analysis excluding the study with high risk of bias 34 did not materially change the results (OR 0.97; 95% CI 0.79–1.19, n = 60,615).

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“…Eight of the included studies were cluster Randomised Controlled Trials (cRCT), 21 , 23 , 24 , 25 , 26 , 27 , 28 , 39 four had pre-post design, 32 , 33 , 34 , 35 two were RCT, 29 , 30 while one each were non-randomised controlled trial (non-RCT), 31 cohort 36 and cross-sectional 37 [ Table 1 ]. Of the 17 studies, twelve were conducted solely in the community, four were conducted both in the communities and health facilities while one study had four arms comprising community only, community and health facility, health facility only and control.…”

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

“… N/A Burkina Faso Pre-post Community and hospitals 1,2 poor 18 N/A Sloan 2018 34 Community mobilisation, TBA training, referral linkages, and supply of essential medications. N/A Nigeria Pre-post Community and hospitals 1,2 Good 19 Boresha Shikuku 2020 36 Community midwifery, training and deployment of health workers to hard to reach areas. N/A Kenya Pre-post Community only 1,2 Poor 20 N/A Seim 2014 35 Evacuation of women in obstructed labour from their home to a midwife, health centre, or hospital.…”

“…Ten studies were cRCTs, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 three were RCTs 28 , 29 , 30 and one was a non-randomised controlled trial. 31 Seven studies had a pre-post design, 32 , 33 , 34 , 35 , 36 , 37 , 38 three were cross sectional, 39 , 40 , 41 two were cohort studies, 42 , 43 and four were qualitative, 44 , 45 , 46 , 47 three were mixed method studies, 48 , 49 , 50 while one implementation report did provide sufficient detail on methods used 51 [ Table 1 ].…”

“…Of the 34 studies included, 25 were conducted solely in the community, 18 , 19 , 20 , 22 , 23 , 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 39 , 41 , 42 , 43 , 46 , 47 , 49 , 51 while nine had some element of health facility implementation including purchasing equipment, employing adjunct medical staff, and training health workers. 21 , 26 , 34 , 38 , 40 , 50 , 52 , 53 Most studies were conducted in one country, while three studies were conducted in two or more countries 20 , 24 , 52 [ Table 1 ].…”