Improving maternal, newborn and child health outcomes through a community-based women’s health education program

A cluster randomised controlled trial in western Kenya

Bibliographic Data

ID21881375
AuthorsLauren Y Maldonado (0000-0002-8352-0815, Massachusetts General Hospital, corresponding author), Jeffrey N Bone (0000-0001-7704-1677, University of British Columbia), Michael L Scanlon (Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya), MICHAEL SCANLON (0000-0002-0334-5640, Mount Sinai Health System), Gertrude Anusu (AMPATH), Sheilah Chelagat (AMPATH), Anjellah Jumah (AMPATH), Justus E Ikemeri (AMPATH), Julia Songok (0000-0002-6431-0505, Moi University), Julia J Songok (Population Health, Academic Model Providing Access to Healthcare, Eldoret, Kenya), Astrid Christoffersen‐deb (0000-0002-3897-8907, University of British Columbia), Astrid Christoffersen-Deb (Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada), Laura J Ruhl (0000-0001-6646-9977, University School)
Year2020
Volume5
Issue12
Pagese003370
Publication date2020-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2020-003370
PMID33293295
OpenAlexW3112580914
LanguageEN
Citations received7
References cited24

INTRODUCTION: Community-based women's health education groups may improve maternal, newborn and child health (MNCH); however, evidence from sub-Saharan Africa is lacking. Chamas for Change (Chamas) is a community health volunteer (CHV)-led, group-based health education programme for pregnant and postpartum women in western Kenya. We evaluated Chamas' effect on facility-based deliveries and other MNCH outcomes. METHODS: We conducted a cluster randomised controlled trial involving 74 community health units in Trans Nzoia County. We included pregnant women who presented to health facilities for their first antenatal care visits by 32 weeks gestation. We randomised clusters 1:1 without stratification or matching; we masked data collectors, investigators and analysts to allocation. Intervention clusters were invited to bimonthly, group-based, CHV-led health lessons (Chamas); control clusters had monthly, individual CHV home visits (standard of care). The primary outcome was facility-based delivery at 12-month follow-up. We conducted an intention-to-treat approach with multilevel logistic regression models using individual-level data. RESULTS: Between 27 November 2017 and 8 March 2018, we enrolled 1920 participants from 37 intervention and 37 control clusters. A total of 1550 (80.7%) participants completed the study with 822 (82.5%) and 728 (78.8%) in the intervention and control arms, respectively. Facility-based deliveries improved in the intervention arm (80.9% vs 73.0%; risk difference (RD) 7.4%, 95% CI 3.0 to 12.5, OR=1.58, 95% CI 0.97 to 2.55, p=0.057). Chamas participants also demonstrated higher rates of 48 hours postpartum visits (RD 15.3%, 95% CI 12.0 to 19.6), exclusive breastfeeding (RD 11.9%, 95% CI 7.2 to 16.9), contraceptive adoption (RD 7.2%, 95% CI 2.6 to 12.9) and infant immunisation completion (RD 15.6%, 95% CI 11.5 to 20.9). CONCLUSION: Chamas participation was associated with significantly improved MNCH outcomes compared with the standard of care. This trial contributes robust data from sub-Saharan Africa to support community-based, women's health education groups for MNCH in resource-limited settings.Trial registration numberNCT03187873

Child health · Cluster randomised controlled trial · Community health · Environmental health · Family medicine · Public health · Randomized controlled trial · Global Health and Surgery · Global Maternal and Child Health · Medicine · Mobile Health and mHealth Applications · Nursing · Pediatrics