Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers

Women's Health, Volume 18, Year 2022

Interpretation

Objectives: To explore whether community health worker household-based maternal health visits improve antenatal care and skilled birth attendance among hard-to-reach fishing villages on Lake Victoria, Uganda. Methods: This quasi-experimental 18-month prospective study involved 486 consenting women aged 15–49 years, who were pregnant or had a pregnancy outcome in the past 6 months, from 6 island fishing communities. The community health worker household-based intervention (community health workers’ household visits to provide counseling, blood pressure measurement, anemia, and HIV testing) involved 243 women from three fishing communities. Random effects logistic regression was used to determine the association between the community health worker intervention and antenatal care and skilled birth attendance among women who had at least 5 months of pregnancy or childbirth at follow-up. Results: Almost all women accepted the community health worker intervention (90.9% (221/243)). Hypertension was at 12.5% (27/216) among those who accepted blood pressure measurements, a third (33.3% (9/27)) were pregnant. HIV prevalence was 23.5% (52/221). Over a third (34.2% (69/202)) of women tested had anemia (hemoglobin levels less than 11 g/dL). The community health worker intervention was associated with attendance of first antenatal care visit within 20 weeks of pregnancy (adjusted odd ratio = 2.1 (95% confidence interval 0.6–7.6)), attendance of at least four antenatal care visits (adjusted odd ratio = 0.9 (95% confidence interval 0.4–2.0)), and skilled birth attendance (adjusted odd ratio = 0.5 (95% confidence interval 0.1–1.5)), though not statistically significant. Conclusion: Community health workers have a crucial role in improving early antenatal care attendance, early community-based diagnosis of anemia, hypertensive disorders, and HIV among women in these hard-to-reach fishing communities. This was a quasi-experimental prospective study involving six islands FCs. Three communities were randomly selected for participants to receive the intervention: a CHW home visit package, consisting of household-based CHW HIV testing, anemia testing, BP measurement, and counseling by CHWs on prenatal, natal, and postnatal maternal–child health issues including skilled attendance. Participants from the other three control communities received standard facility-based maternal health services as provided by the Uganda Ministry of Health guidelines. 26 The study involved 486 consenting women aged 15–49 years, who were pregnant or had a pregnancy outcome in the past 6 months, half of the participants (243) were recruited from the intervention communities, while the other 243 were from the control communities. The study was conducted in six FCs of Kalangala district. Kalangala islands district is one of the hard-to-reach areas in Uganda, with the proportion of women in these islands who receive at least four ANC visits and those assisted by a SBA at birth being lower than the average for other regions in Uganda. 9 These FCs also have higher rates of HIV infection which may negatively impact on the elimination of mother-to-child transmission of HIV efforts.27–29 Selection of these islands has been described elsewhere. 13 Participants from intervention communities received the CHW home visit package (at least four household visits over 18 months, consisting of one-on-one standardized maternal health promotion messages on the importance of ANC, skilled childbirth, mother and newborn danger signs, PNC, exclusive breastfeeding within 6 months after birth, household-based BP measurement, HTC, and anemia testing by pre-trained CHWs. Through the existing active CHWs in the intervention communities, 11 CHWs were recruited. The CHWs received 10 days hands-on training in HIV counseling and testing, anemia testing, measurement of BP, counseling on maternal pregnancy, birth, newborn danger signs, documentation, and making referrals, based on national guidelines. 30 , 31 The training also included key messages that the CHW should provide to study participants and their spouses about birth preparedness, care-seeking for ANC, delivery, and newborn care. Training was conducted by the research team in collaboration with the Kalangala district health team. CHWs received supplies including calibrated automated BP machines, hemoglobin color scale kits, HIV testing kits per Uganda guidelines,31,32 quarterly support supervision, and refresher trainings. Each CHW was allocated an average of 22 participants, following up the same participants throughout the study. CHWs made household visits within their geographical area (village) to study participants at most once every month and at least four times during the 18 months project duration, documenting information collected at visits in structured notebooks (see supplemental material). The study team reviewed each CHW household visit notebook during field supervisions, with entry into open data kit (ODK) software designed screens done only after books were signed off as complete, without error. CHWs received a monthly field expenses reimbursement of €4.465 per woman they visited for project-related issues. The postulation was that CHW household visits would improve (1) ANC attendance, (2) skilled birth attendance, (3) uptake of household-based BP measurement, (4) anemia testing, and (5) HTC. To evaluate the relationship between CHW household visits and attendance to health facilities for ANC and skilled births, one-on-one standardized maternal health promotion messages on the importance of skilled ANC, delivery, and PNC services were provided by the trained CHWs to study participants in the intervention communities. To understand whether CHW visits improve uptake of household-based measurement of BP, household-based BP measurements were offered by CHWs to participants. BP was measured by a CHW with the participant seated after resting for at least 5 min, using validated OMRON® digital automatic BP machines. The left arm of the participant was placed on a chair or table with the palm facing upward. Three readings, 5 min apart, were then taken. 32 The average of the last two readings (calculated in ODK at data entry) was taken as the final BP reading. Hypertension was defined as an average systolic BP ⩾ 140 mm Hg and/or average diastolic BP ⩾ 90 mm Hg, or currently taking medication for hypertension. 33 The measurements were recorded in the CHW’s notebook (see supplementary material) for each participant and entered in ODK designed data entry forms on computer tablets. Participants with hypertension were referred by CHWs to a health facility level III, IV, or V, of their choice for appropriate management. To understand whether CHW visits improve household-based anemia testing, anemia testing by CHWs was done using the hemoglobin color scale. 34 Hemoglobin color scale levels less than 11 g/dL were regarded as anemia.34,35 CHWs were trained to refer participants with anemia to the health facilities for further evaluation. CHWs offered household-based HTC to participants who have voluntarily accepted to be tested, using the finger stick technique in accordance with the national HTC algorithm. 31 The serial HIV testing algorithm was used; where the participant was first tested using the Determine® (Alere Medical Co. Ltd, Chiba, Japan) HIV rapid test kit, if it was negative, the result was reported as negative, and if Determine was positive, STAT-PAK® (Chemo Bio Diagnostic Systems Inc. Medford, NY, USA) HIV rapid test kit was immediately used. If both Determine and STAT-PAK were positive, the result was reported as HIV positive (HIV infected). If the retesting on STAT-PAK showed a negative result, a third tie breaker test, SD Bioline® (Standard Diagnostics Inc. Borahagal-ro, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea, South), was immediately used. If SD Bioline result was negative, the result was reported as negative. If SD Bioline indicated a positive result, the eventual result would be indicated as inconclusive, and a repeat testing would be requested after 14 days. 31 Participants found to be HIV positive were referred to health facilities for further evaluation and management. Participants from the three control communities received standard maternal health services in any health facility of their choice. There was no training offered to CHWs in the control communities. The study was conducted over 23 months (January 2018 to December 2019); enrollment took 5 months with a follow-up period of 18 months. Calculation was based on individual participant analysis with a two-sided alpha, at 95% confidence level, an 80% power to detect a minimum difference of 14% in the proportion of participants attended to by an SBA during ANC (at least four visits) or childbirth at 18 months, between the intervention and control arms, assuming equal numbers of participants recruited for either arms and a cumulative 24% loss to follow-up, the estimated total sample size was 486 (243 per arm). Women were eligible if aged 15–49 completed years at enrolment, were pregnant, or had a pregnancy outcome (live birth, still birth, or abortion) in the 6 months prior to enrolment. Detailed screening and enrolment procedures have been documented elsewhere. 12 Follow-up procedures at 12 and 18 months involved administration of a semi-structured face-to-face questionnaire designed in ODK software, 36 on computer tablets to all participants. The questionnaires were designed using validated tools. 37 Intervention participants were also visited by CHWs during follow-up, measuring their BP, conducting HTC, anemia testing, and counseling on skilled ANC, skilled births, postnatal danger signs, and exclusive breastfeeding during the first 6 months after birth. Direct electronic data capture using ODK software on computer tablets was done, with real-time data review for completeness, accuracy, and subsequent uploading to a cloud-based server. Data were downloaded and aggregated into a data set, re-checked for completeness and accuracy. This analysis aimed at answering the following research questions: Participants’ baseline and follow-up characteristics were described using counts, percentages, proportions, frequencies, medians, and ranges. Tables were used to make comparisons across intervention and control groups at baseline and at follow-up. The chi-square and Fisher’s exact tests were used to evaluate associations across intervention and control groups in respect to a given characteristic. Random effects logistic regression was used to determine the association between the intervention (CHW household visits) and attendance of first ANC visit within 20 weeks of being pregnant among those who had an at least 5 months of pregnancy, at least four ANC visit attendance and delivery in the presence of a skilled birthing team as outcomes among women with a childbirth during follow-up. The resulting adjusted odd ratio (AOR) indicates the direction of association, whether the intervention was associated with increased or decreased likelihood of the outcome. Choice of co-variates was based on the measured variables’ relation to the outcomes and intervention from previous literature. These included women’s age groups (15–24 and 25–49 years), highest years of education attained [0 (none), 1–7 years (primary), or 8 or more years (post-primary)], baseline marital status (married and unmarried), main occupation at baseline, duration of community residence (up to 5 years and over 5 years), lifetime births, history of pregnancy loss, presence of a public health (government) facility within the participant community (present or absent), and receipt of components of ANC at attendance. During estimation of pregnancy incidence, woman years of observation were calculated as reported date of pregnancy by a woman, minus date of enrolment, divided by 365.25. All analyses were done using STATA® version 17 (StataCorp, College Station, TX, USA) software. 38

AI Digest

Study Justification:

The study aimed to improve access to maternal health services among rural hard-to-reach fishing communities in Uganda, specifically focusing on the role of community health workers (CHWs). This was justified by the fact that these communities face challenges in accessing adequate maternal health care, resulting in lower rates of antenatal care (ANC) attendance, skilled birth attendance, and higher rates of HIV infection. The study aimed to explore whether CHW household-based visits could improve these outcomes.

Highlights:

– The study involved 486 consenting women aged 15-49 years from 6 island fishing communities in Uganda.
– The intervention group consisted of 243 women from 3 fishing communities who received CHW household visits, including counseling, blood pressure measurement, anemia testing, and HIV testing.
– Almost all women (90.9%) accepted the CHW intervention.
– The CHW intervention was associated with improved attendance of the first ANC visit within 20 weeks of pregnancy.
– The CHW intervention showed potential for improving early community-based diagnosis of anemia, hypertensive disorders, and HIV among women in hard-to-reach fishing communities.

Recommendations:

Based on the study findings, the following recommendations can be made:

1. Scaling up the use of CHWs in rural hard-to-reach fishing communities to improve access to maternal health services.
2. Providing training and support to CHWs in conducting household-based visits, including counseling, testing, and measurement of vital signs.
3. Strengthening referral systems to ensure that women with identified health issues are appropriately managed at health facilities.
4. Promoting community awareness and education on the importance of ANC, skilled birth attendance, and maternal health issues.

Key Role Players:

To address the recommendations, the following key role players are needed:

1. Community Health Workers (CHWs): They play a crucial role in conducting household-based visits and providing counseling and testing services.
2. Ministry of Health: They provide guidance and support in implementing and scaling up CHW programs.
3. District Health Team: They collaborate with the research team in training and supervising CHWs and ensuring the quality of services.
4. Health Facilities: They receive referrals from CHWs and provide appropriate management for women with identified health issues.
5. Community Leaders: They play a role in promoting community awareness and education on maternal health issues.

Cost Items for Planning Recommendations:

While the actual cost is not provided, the following cost items should be considered in planning the recommendations:

1. Training and capacity building for CHWs, including training materials, trainers’ fees, and transportation.
2. Supplies and equipment for CHWs, such as calibrated automated blood pressure machines, hemoglobin color scale kits, and HIV testing kits.
3. Support supervision and refresher trainings for CHWs.
4. Field expenses reimbursement for CHWs to cover project-related issues.
5. Communication and awareness materials for community education.
6. Monitoring and evaluation activities to assess the impact of the interventions.
Please note that the actual cost will depend on various factors, including the scale of implementation and local context.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is quasi-experimental, which limits the ability to establish causality. Additionally, the sample size is relatively small, which may affect the generalizability of the findings. To improve the strength of the evidence, future studies could consider using a randomized controlled trial design and increasing the sample size to enhance statistical power. Additionally, including a control group that receives a different intervention or no intervention at all would help to better assess the effectiveness of the community health worker intervention. Finally, conducting a longer follow-up period would allow for a more comprehensive evaluation of the intervention’s impact on maternal health outcomes.

Abstract

This was a quasi-experimental prospective study involving six islands FCs. Three communities were randomly selected for participants to receive the intervention: a CHW home visit package, consisting of household-based CHW HIV testing, anemia testing, BP measurement, and counseling by CHWs on prenatal, natal, and postnatal maternal–child health issues including skilled attendance. Participants from the other three control communities received standard facility-based maternal health services as provided by the Uganda Ministry of Health guidelines. 26 The study involved 486 consenting women aged 15–49 years, who were pregnant or had a pregnancy outcome in the past 6 months, half of the participants (243) were recruited from the intervention communities, while the other 243 were from the control communities. The study was conducted in six FCs of Kalangala district. Kalangala islands district is one of the hard-to-reach areas in Uganda, with the proportion of women in these islands who receive at least four ANC visits and those assisted by a SBA at birth being lower than the average for other regions in Uganda. 9 These FCs also have higher rates of HIV infection which may negatively impact on the elimination of mother-to-child transmission of HIV efforts.27–29 Selection of these islands has been described elsewhere. 13 Participants from intervention communities received the CHW home visit package (at least four household visits over 18 months, consisting of one-on-one standardized maternal health promotion messages on the importance of ANC, skilled childbirth, mother and newborn danger signs, PNC, exclusive breastfeeding within 6 months after birth, household-based BP measurement, HTC, and anemia testing by pre-trained CHWs. Through the existing active CHWs in the intervention communities, 11 CHWs were recruited. The CHWs received 10 days hands-on training in HIV counseling and testing, anemia testing, measurement of BP, counseling on maternal pregnancy, birth, newborn danger signs, documentation, and making referrals, based on national guidelines. 30 , 31 The training also included key messages that the CHW should provide to study participants and their spouses about birth preparedness, care-seeking for ANC, delivery, and newborn care. Training was conducted by the research team in collaboration with the Kalangala district health team. CHWs received supplies including calibrated automated BP machines, hemoglobin color scale kits, HIV testing kits per Uganda guidelines,31,32 quarterly support supervision, and refresher trainings. Each CHW was allocated an average of 22 participants, following up the same participants throughout the study. CHWs made household visits within their geographical area (village) to study participants at most once every month and at least four times during the 18 months project duration, documenting information collected at visits in structured notebooks (see supplemental material). The study team reviewed each CHW household visit notebook during field supervisions, with entry into open data kit (ODK) software designed screens done only after books were signed off as complete, without error. CHWs received a monthly field expenses reimbursement of €4.465 per woman they visited for project-related issues. The postulation was that CHW household visits would improve (1) ANC attendance, (2) skilled birth attendance, (3) uptake of household-based BP measurement, (4) anemia testing, and (5) HTC. To evaluate the relationship between CHW household visits and attendance to health facilities for ANC and skilled births, one-on-one standardized maternal health promotion messages on the importance of skilled ANC, delivery, and PNC services were provided by the trained CHWs to study participants in the intervention communities. To understand whether CHW visits improve uptake of household-based measurement of BP, household-based BP measurements were offered by CHWs to participants. BP was measured by a CHW with the participant seated after resting for at least 5 min, using validated OMRON® digital automatic BP machines. The left arm of the participant was placed on a chair or table with the palm facing upward. Three readings, 5 min apart, were then taken. 32 The average of the last two readings (calculated in ODK at data entry) was taken as the final BP reading. Hypertension was defined as an average systolic BP ⩾ 140 mm Hg and/or average diastolic BP ⩾ 90 mm Hg, or currently taking medication for hypertension. 33 The measurements were recorded in the CHW’s notebook (see supplementary material) for each participant and entered in ODK designed data entry forms on computer tablets. Participants with hypertension were referred by CHWs to a health facility level III, IV, or V, of their choice for appropriate management. To understand whether CHW visits improve household-based anemia testing, anemia testing by CHWs was done using the hemoglobin color scale. 34 Hemoglobin color scale levels less than 11 g/dL were regarded as anemia.34,35 CHWs were trained to refer participants with anemia to the health facilities for further evaluation. CHWs offered household-based HTC to participants who have voluntarily accepted to be tested, using the finger stick technique in accordance with the national HTC algorithm. 31 The serial HIV testing algorithm was used; where the participant was first tested using the Determine® (Alere Medical Co. Ltd, Chiba, Japan) HIV rapid test kit, if it was negative, the result was reported as negative, and if Determine was positive, STAT-PAK® (Chemo Bio Diagnostic Systems Inc. Medford, NY, USA) HIV rapid test kit was immediately used. If both Determine and STAT-PAK were positive, the result was reported as HIV positive (HIV infected). If the retesting on STAT-PAK showed a negative result, a third tie breaker test, SD Bioline® (Standard Diagnostics Inc. Borahagal-ro, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea, South), was immediately used. If SD Bioline result was negative, the result was reported as negative. If SD Bioline indicated a positive result, the eventual result would be indicated as inconclusive, and a repeat testing would be requested after 14 days. 31 Participants found to be HIV positive were referred to health facilities for further evaluation and management. Participants from the three control communities received standard maternal health services in any health facility of their choice. There was no training offered to CHWs in the control communities. The study was conducted over 23 months (January 2018 to December 2019); enrollment took 5 months with a follow-up period of 18 months. Calculation was based on individual participant analysis with a two-sided alpha, at 95% confidence level, an 80% power to detect a minimum difference of 14% in the proportion of participants attended to by an SBA during ANC (at least four visits) or childbirth at 18 months, between the intervention and control arms, assuming equal numbers of participants recruited for either arms and a cumulative 24% loss to follow-up, the estimated total sample size was 486 (243 per arm). Women were eligible if aged 15–49 completed years at enrolment, were pregnant, or had a pregnancy outcome (live birth, still birth, or abortion) in the 6 months prior to enrolment. Detailed screening and enrolment procedures have been documented elsewhere. 12 Follow-up procedures at 12 and 18 months involved administration of a semi-structured face-to-face questionnaire designed in ODK software, 36 on computer tablets to all participants. The questionnaires were designed using validated tools. 37 Intervention participants were also visited by CHWs during follow-up, measuring their BP, conducting HTC, anemia testing, and counseling on skilled ANC, skilled births, postnatal danger signs, and exclusive breastfeeding during the first 6 months after birth. Direct electronic data capture using ODK software on computer tablets was done, with real-time data review for completeness, accuracy, and subsequent uploading to a cloud-based server. Data were downloaded and aggregated into a data set, re-checked for completeness and accuracy. This analysis aimed at answering the following research questions: Participants’ baseline and follow-up characteristics were described using counts, percentages, proportions, frequencies, medians, and ranges. Tables were used to make comparisons across intervention and control groups at baseline and at follow-up. The chi-square and Fisher’s exact tests were used to evaluate associations across intervention and control groups in respect to a given characteristic. Random effects logistic regression was used to determine the association between the intervention (CHW household visits) and attendance of first ANC visit within 20 weeks of being pregnant among those who had an at least 5 months of pregnancy, at least four ANC visit attendance and delivery in the presence of a skilled birthing team as outcomes among women with a childbirth during follow-up. The resulting adjusted odd ratio (AOR) indicates the direction of association, whether the intervention was associated with increased or decreased likelihood of the outcome. Choice of co-variates was based on the measured variables’ relation to the outcomes and intervention from previous literature. These included women’s age groups (15–24 and 25–49 years), highest years of education attained [0 (none), 1–7 years (primary), or 8 or more years (post-primary)], baseline marital status (married and unmarried), main occupation at baseline, duration of community residence (up to 5 years and over 5 years), lifetime births, history of pregnancy loss, presence of a public health (government) facility within the participant community (present or absent), and receipt of components of ANC at attendance. During estimation of pregnancy incidence, woman years of observation were calculated as reported date of pregnancy by a woman, minus date of enrolment, divided by 365.25. All analyses were done using STATA® version 17 (StataCorp, College Station, TX, USA) software. 38

Materials

Innovations

Title: Improving Access to Maternal Health Services in Rural Fishing Communities in Uganda: The Role of Community Health Workers

Description: This study aimed to assess the effectiveness of a community health worker (CHW) household-based intervention in improving access to maternal health services in hard-to-reach fishing communities in Uganda. The intervention involved CHWs making regular household visits to provide counseling, blood pressure measurement, anemia testing, and HIV testing to pregnant women. The study found that the CHW intervention was associated with improved attendance of the first antenatal care visit within 20 weeks of pregnancy and early community-based diagnosis of anemia, hypertensive disorders, and HIV.

The CHWs in the intervention communities received training in maternal health promotion, HIV counseling and testing, anemia testing, and blood pressure measurement. They made regular household visits to provide education and support to pregnant women, as well as conduct necessary tests. The CHWs were equipped with supplies such as blood pressure machines, hemoglobin color scale kits, and HIV testing kits.

The study showed that almost all women accepted the CHW intervention, and it had a positive impact on early antenatal care attendance and the detection of health conditions such as anemia, hypertension, and HIV. However, the association with attendance of at least four antenatal care visits and skilled birth attendance was not statistically significant.

Implementing this recommendation would involve training and deploying CHWs to the targeted fishing communities. They would provide household-based maternal health services, including counseling, testing, and monitoring. Regular supervision and support would be provided to the CHWs to ensure the quality of care. Collaboration with local health authorities and facilities would be essential to ensure referrals and continuity of care.

By improving access to maternal health services through the CHW intervention, it is expected that more women in these hard-to-reach fishing communities would receive timely and appropriate care during pregnancy and childbirth. This could contribute to reducing maternal and neonatal morbidity and mortality in the area.

AI Innovations Description

The recommendation from the study is to implement a community health worker (CHW) household-based intervention to improve access to maternal health services among rural hard-to-reach fishing communities in Uganda. The intervention involves CHWs making household visits to provide counseling, blood pressure measurement, anemia testing, and HIV testing to pregnant women. The study found that the CHW intervention was associated with improved attendance of the first antenatal care visit within 20 weeks of pregnancy and early community-based diagnosis of anemia, hypertensive disorders, and HIV.

The CHWs in the intervention communities received training in maternal health promotion, HIV counseling and testing, anemia testing, and measurement of blood pressure. They made regular household visits to provide education and support to pregnant women, as well as conduct necessary tests. The CHWs were equipped with supplies such as BP machines, hemoglobin color scale kits, and HIV testing kits.

The study showed that almost all women accepted the CHW intervention, and it had a positive impact on early antenatal care attendance and the detection of health conditions such as anemia, hypertension, and HIV. However, the association with attendance of at least four antenatal care visits and skilled birth attendance was not statistically significant.

Implementing this recommendation would involve training and deploying CHWs to the targeted fishing communities. They would provide household-based maternal health services, including counseling, testing, and monitoring. Regular supervision and support would be provided to the CHWs to ensure the quality of care. Collaboration with the local health authorities and facilities would be essential to ensure referrals and continuity of care.

By improving access to maternal health services through the CHW intervention, it is expected that more women in these hard-to-reach fishing communities would receive timely and appropriate care during pregnancy and childbirth. This could contribute to reducing maternal and neonatal morbidity and mortality in the area.

AI Innovations Methodology

The methodology used in the study to simulate the impact of the recommendations on improving access to maternal health services in rural hard-to-reach fishing communities in Uganda involved a quasi-experimental prospective design. Here is a summary of the methodology:

1. Study Population: The study included 486 consenting women aged 15-49 years who were pregnant or had a pregnancy outcome in the past 6 months from 6 island fishing communities in Uganda.

2. Intervention and Control Groups: Three communities were randomly selected to receive the community health worker (CHW) household-based intervention, while the other three communities served as the control group and received standard facility-based maternal health services.

3. CHW Intervention: The CHW intervention involved CHWs making regular household visits to provide counseling, blood pressure measurement, anemia testing, and HIV testing to pregnant women. CHWs received training in maternal health promotion, HIV counseling and testing, anemia testing, and blood pressure measurement. They were equipped with necessary supplies and received regular supervision and support.

4. Data Collection: Data was collected through face-to-face questionnaires administered at baseline and follow-up (12 and 18 months). CHWs also collected data during their household visits using electronic data capture on computer tablets.

5. Outcome Measures: The study assessed the association between the CHW intervention and attendance of the first antenatal care (ANC) visit within 20 weeks of pregnancy, attendance of at least four ANC visits, and skilled birth attendance.

6. Data Analysis: Random effects logistic regression was used to determine the association between the CHW intervention and the outcome measures. Adjusted odds ratios (AOR) were calculated to assess the direction of association.

7. Statistical Software: STATA® version 17 was used for data analysis.

8. Ethical Considerations: The study obtained informed consent from participants and followed ethical guidelines for research involving human subjects.

The findings of the study showed that the CHW intervention was associated with improved attendance of the first ANC visit within 20 weeks of pregnancy and early community-based diagnosis of anemia, hypertensive disorders, and HIV. However, the association with attendance of at least four ANC visits and skilled birth attendance was not statistically significant.

The publication of this study can be found in the Women’s Health journal, Volume 18, Year 2022.

Authors & Co-Authors

Statistics:

Authors: 10

Identifiers:

DOI: 10.1177/17455057221103993

ISSN: 17455057

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Uganda

Study Design:

Cohort Study, Cross Sectional Study, Quasi Experimental Study, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Female