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BMC Medicine
Published in: BMC Medicine 1/2018

Open Access 01-12-2018 | Research article

Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study

Authors: Karen M. Edmond, Khaksar Yousufi, Zelaikha Anwari, Sayed Masoud Sadat, Shah Mansoor Staniczai, Ariel Higgins-Steele, Alexandra L. Bellows, Emily R. Smith

Published in: BMC Medicine | Issue 1/2018

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Abstract

Background

The effects of community health worker (CHW) home visiting during the antenatal and postnatal periods in fragile- and conflicted-affected countries such as Afghanistan are not known.

Methods

We conducted a non-randomised population-based intervention study from March 2015 to February 2016. Two intervention and two control districts were selected.
All female CHWs in the intervention districts were trained to provide eight home visits and behaviour change communication messages from pregnancy to 28 days postpartum. The primary outcome was the proportion of women who reported delivering in a health facility. Secondary outcomes were the proportion of women who reported attending a health facility for at least one antenatal and one postnatal visit. Outcomes were analysed at 12 months using multivariable difference-in-difference linear regression models adjusted for clustering.

Results

Overall, 289 female CHWs in the intervention districts performed home visits and 1407 eligible women (less than 12 months postpartum) at baseline and 1320 endline women provided outcome data (94% response rate). Facility delivery increased in intervention villages by 8.2% and decreased in the control villages by 6.3% (adjusted mean difference (AMD) 11.0%, 95% confidence interval (CI) 4.0–18.0%, p = 0.002). Attendance for at least one antenatal care visit (AMD 10.5%, 95% CI 4.2–16.9%, p = 0.001) and postnatal care visit (AMD 7.2%, 95% CI 0.2–14.2%, p = 0.040) increased in the intervention compared to the control districts.

Conclusions

CHW home visiting during the antenatal and postnatal periods can improve health service use in fragile- and conflict-affected countries. Commitment to scale-up from Ministries and donors is now needed.

Trial registration

This trial was retrospectively registered at the Australian and New Zealand Clinical Trial Registry (ACTRN12618000609​257).
Appendix
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Metadata
Title
Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study
Authors
Karen M. Edmond
Khaksar Yousufi
Zelaikha Anwari
Sayed Masoud Sadat
Shah Mansoor Staniczai
Ariel Higgins-Steele
Alexandra L. Bellows
Emily R. Smith
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2018
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-018-1092-9

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