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01-10-2019 | Human Immunodeficiency Virus

Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis

Authors: Katharine D. Shelley, Rose Mpembeni, Gasto Frumence, Elizabeth A. Stuart, Japhet Killewo, Abdullah H. Baqui, David H. Peters

Published in: Maternal and Child Health Journal | Issue 10/2019

Abstract

Objectives

Despite renewed interest in expansion of multi-tasked community health workers (CHWs) there is limited research on HIV and maternal health integration at the community-level. This study assessed the impact of integrating CHW roles for HIV and maternal health promotion on facility delivery utilization in rural Tanzania.

Methods

A 36-month time series data set (2014–2016) of reported facility deliveries from 68 health facilities in two districts of Tanzania was constructed. Interrupted time series analyses evaluated population-averaged longitudinal trends in facility delivery at intervention and comparison facilities. Analyses were stratified by district, controlling for secular trends, seasonality, and type of facility.

Results

There was no significant change from baseline in the average number of facility deliveries observed at intervention health centers/dispensaries relative to comparison sites. However, there was a significant 16% increase (p < 0.001) in average monthly deliveries in hospitals, from an average of 202–234 in Iringa Rural and from 167 to 194 in Kilolo. While total facility deliveries were relatively stable over time at the district-level, during intervention the relative change in the proportion of hospital deliveries out of total facility deliveries increased by 17.2% in Iringa Rural (p < 0.001) and 14.7% in Kilolo (p < 0.001).

Conclusions for Practice

Results suggest community-delivered outreach by dual role CHWs was successful at mobilizing pregnant women to deliver at facilities and may be effective at reaching previously under-served pregnant women. More research is necessary to understand the effect of dual role CHWs on patterns of service utilization, including decisions to use referral level facilities for obstetric care.

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Title: Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis
Authors: Katharine D. Shelley
Rose Mpembeni
Gasto Frumence
Elizabeth A. Stuart
Japhet Killewo
Abdullah H. Baqui
David H. Peters
Publication date: 01-10-2019
Publisher: Springer US
Keyword: Human Immunodeficiency Virus
Published in: Maternal and Child Health Journal / Issue 10/2019
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-019-02783-8

At a glance: The STEP trials

Springer Medicine

Integrating Community Health Worker Roles to Improve Facility Delivery Utilization in Tanzania: Evidence from an Interrupted Time Series Analysis

Abstract

Objectives

Methods

Results

Conclusions for Practice

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions for Practice

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