Effect of Community Health Strategy on Focused Antenatal Care Coverage: A Pretest-Posttest Experimental Study in Rural Mwingi West Sub-County; Kenya

Japheth Mativo Nzioki^1, , Rosebella Ogutu Onyango², James Ouma¹ and James H. Ombaka³

¹Department of Environmental Health, University of Kabianga, Kericho, Kenya

²Department of Public Health, Maseno University, Kisumu , Kenya

³Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya

Cite this paper:
Japheth Mativo Nzioki, Rosebella Ogutu Onyango, James Ouma and James H. Ombaka. Effect of Community Health Strategy on Focused Antenatal Care Coverage: A Pretest-Posttest Experimental Study in Rural Mwingi West Sub-County; Kenya. American Journal of Public Health Research. 2016; 4(6):213-221. doi: 10.12691/ajphr-4-6-4

Abstract

Globally, Maternal Mortality Rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100 000 live births in 2015 from MMR of 385 per 100 000 live births in 1990. Similarly, the number of under-five deaths worldwide has declined from 12.7 million in 1990 to 5.9 million in 2015. Despite these gains, sub-Saharan Africa remains the region with the highest MMR (99% of global maternal deaths) and under- five mortality rate (1 child in 12 die before their fifth birthday). In Kenya, maternal and child mortality rates are still high despite government efforts aimed at improving Maternal and Child Health (MCH). Studies have acknowledged that Focused Antenatal Care (FANC) is an important element of health care with the potential of reducing maternal and child mortality rates. Though the proportion of women in Kenya seeking ANC services from skilled attendants (for at least 1 visit) is high at 95.5%, FANC coverage remains low at 57.6%. This study sought to determine the effect of a community health worker led primary health care intervention (Community Health Strategy) on FANC in Mwingi West sub-county. A pretest -posttest experimental study design with 1 pretest and 2 post-test surveys in intervention and control sites was employed. Data was collected from a sample size of 422 households in each survey. Women with a child aged 9-12 months were main respondents. CHS significantly increased FANC coverage by 9.5% (Z=2.7528, P<005) within six months after implementation, and by 20.1% (Z= 5.7881, P<0.05) within 18 months of implementation. In intervention site, FANC coverage significantly increased to 59% from 38.9%. Women in intervention site were 1.7 times more likely to seek ANC services for at least 4 times compared to women in control site (95%CI: 1.464-2.014, P<0.0001). CHS was effective in increasing FANC coverage in intervention site. To improve MCH outcomes in Kenya the government should fast-track national implementation of CHS.

Keywords:
community health strategy community health workers focused antenatal care

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References:

[1]	World Health Organization, Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization, 2015.
[2]	UNICEF, WHO, World Bank, and UN-DESA Population Division, Levels and trends in child mortality 2015. New York: United Nations Children’s Fund, 2015.
[3]	Kenya National Bureau of Statistics (KNBS) and ICF Micro, Kenya Demographic and Health Survey, Key Indicators, 2014. Calverton, Maryland: KNBS and ICF Macro., 2014.
[4]	G. J. Hofmeyr and E. D. Hodnett, “Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Comentary: routine antenatal visits for healthy pregnant women do make a difference,” Reprod. Health, vol. 10, no. 20, pp. 1-2, 2013.
[5]	O. Lincetto, S. Mothebesoane-anoh, G. Patricia, and M. Stephen, Antenatal Care. Geneva: World Health Organization, 2013.
[6]	WHO and UNICEF, Antenatal care in Developing Countries; Promises, Achievements and Missed Opportunities. Geneva-Switzerland: World Health Organization, 2003.
[7]	WHO: Department of Health Statistics and Information Systems, State of Inequality Reproductive, maternal, newborn and child health. Geneva-Switzerland: WHO Department of Health Statistics and Information Systems, 2015.
[8]	World Health Organization, Provision of effective antenatal care. WHO Department of Making Pregnancy safer, 2006.
[9]	W. Jaskiewicz and K. Tulenko, “Increasing community health worker productivity and effectiveness: a review of the influence of the work environment.,” Hum. Resour. Health, vol. 10, no. 1, p. 38, Jan. 2012.
[10]	S. Chhetry, S. Clapham, and I. Basnett, “Community based maternal and child health care in Nepal: self-reported performance of Maternal and Child Health Workers.,” JNMA. J. Nepal Med. Assoc., vol. 44, no. 157, pp. 1-7, 2005.
[11]	Z. Quayyum, M. N. U. Khan, T. Quayyum, H. E. Nasreen, M. Chowdhury, and T. Ensor, “‘Can community level interventions have an impact on equity and utilization of maternal health care’ – Evidence from rural Bangladesh,” Int. J. Equity Health, vol. 12, no. 1, p. 22, 2013.
[12]	L. Mbuagbaw, N. Medley, A. J. Darzi, M. Richardson, K. Habiba Garga, and P. Ongolo-Zogo, “Health system and community level interventions for improving antenatal care coverage and health outcomes.,” Cochrane database Syst. Rev., vol. 12, no. 12, p. CD010994, 2015.
[13]	A. A. Charles A Uzondu, Henry V Doctor, Sally E Findley, Godwin Y Afenyadu, “Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria,” Glob. Heal. Sci. Pract., vol. 3, no. 1, pp. 97-108, 2015.
[14]	Ministry of Health, Taking the Kenya Essential Package for Health to the COMMUNITY A Strategy for the Delivery of level one services, no. June. Nairobi: Health Sector Reform Secretariat, Government of Kenya, 2006.
[15]	G. Wangalwa, B. Cudjoe, D. Wamalwa, Y. Machira, P. Ofware, M. Ndirangu, and F. Ilako, “Effectiveness of Kenya’s Community Health Strategy in delivering community-based maternal and newborn health care in Busia County, Kenya: non-randomized pre-test post test study.,” Pan Afr. Med. J., vol. 13 Suppl 1, no. Supp 1, p. 12, Jan. 2012.
[16]	J. M. Nzioki, R. O. Onyango, and J. H. Ombaka, “Efficiency and factors influencing efficiency of community health strategy in providing maternal and child health services in Mwingi district, Kenya: An expert opinion perspective,” Pan Afr. Med. J., vol. 20, pp. 1-7, 2015.
[17]	Kenya National Bureau of Statistics (KNBS) and ICF Micro, Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro., 2010.
[18]	County Government of Kitui, First County Integrated Development Plan; Planning for Sustainable Socio-Economic Growth and Development. Nairobi: County Government of Kitui, 2013.
[19]	T. J. W. Fisher A.A, Laing J.E, Stoeckel J.E., Handbook for Family Planning Operations Research, Second Edi. New York: Population Council, 1998.
[20]	R. Olayo, C. Wafula, E. Aseyo, C. Loum, and D. Kaseje, “A quasi-experimental assessment of the effectiveness of the Community Health Strategy on health outcomes in Kenya,” BMC Health Serv. Res., vol. 14, no. Suppl 1, p. S3, 2014.
[21]	M. Tavakol and R. Dennick, “Making sense of Cronbach’s alpha,” Int. J. Med. Educ., vol. 2, pp. 53-55, Jun. 2011.