Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya

Authors: Margaret McConnell, Allison Ettenger, Claire Watt Rothschild, Faith Muigai, Jessica Cohen

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Login to get access

Abstract

Background

Since the 2009 WHO and UNICEF recommendation that women receive home-based postnatal care within the first three days after birth, a growing number of low-income countries have explored integrating postnatal home visit interventions into their maternal and newborn health strategies. This randomized trial evaluates a pilot program in which community health workers (CHWs) visit or call new mothers three days after delivery in peri-urban Kiambu County, Kenya.

Methods

Participants were individually randomized to one of three groups: 1) early postnatal care three days after delivery provided in-person with a CHW using a simple checklist, 2) care provided by phone with a CHW using the same checklist, or 3) a standard of care group. Surveys were conducted ten days and nine weeks postnatal to measure outcomes related to compliance with referrals, self-reported health problems for mother and baby, care-seeking behaviors, and postnatal knowledge and practices around the recognition of danger signs, feeding, nutrition, infant care and family planning.

Results

The home visit administration of the checklist increased the likelihood that women recognized postnatal problems for themselves and their babies and increased the likelihood that they sought care to address those problems identified for the child. In both the home visit and mobile phone implementation of the checklist, actions taken for postnatal problems happened earlier, particularly for infants. Knowledge was found to be high across all groups, with limited evidence that the checklist impacted knowledge and postnatal practices around the recognition of danger signs, feeding, nutrition, infant care and family planning.

Conclusion

We find evidence that CHW-administered postnatal checklists can lead to better recognition of postnatal problems and more timely care-seeking. Furthermore, our results suggest that CHWs can affordably deliver many of the benefits of postnatal checklists.

Trial registration

ClinicalTrials.gov NCT02104635; registered April 2, 2014.
Appendix
Available only for authorised users
Footnotes
1
In order to avoid the possibility that patients responded to the phone call with more health seeking behaviors because of reciprocity, we include a phone call for the standard of care group that focused exclusively on customer service. Patients reported appreciating receiving any phone call so, to the extent that this call may have influenced behavior in the standard of care group, some estimates of program impacts may be underestimates.
 
2
While our assessment guidelines are consistent with the WHO guidelines from 2014, our postnatal checklist was developed in 2013, prior to the release of these guidelines and was therefore not specifically based on these guidelines.
 
3
Referrals were made to the nearest facility (not to Jacaranda) since Jacaranda was not offering emergency comprehensive pediatric care at the time of the intervention.
 
4
We find highest uptake of the hormonal implant in both the standard of care and home visit arms (comprising 60% (3/5) and 50 % (4/8) of participants reporting contraceptive use assigned to these arms, respectively). In the phone-administered checklist arm, the most common method was oral contraceptives (comprising 50 % of participants in this arm). In both the phone- and home visit-administered checklist arms, injectables were the second most common method (comprising 29 % (4/14) and 25 % (2/8) of participants reporting contraceptive use in these arms, respectively).
 
Literature
1.
Requejo JH, Bryce J, Barros AJD, Berman P, Bhutta Z, Chopra M, et al. Countdown to 2015 and beyond: fulfilling the health agenda for women and children. Lancet. 2014; doi: 10.​1016/​S0140-6736(14)60925-9.
2.
Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007;370:1358–69.CrossRefPubMed
3.
4.
5.
Kenya National Bureau of Statistics (KNBS) and ICF Macro. Kenya Demographic and Health Survey: Key Indicators 2014. Rockville, MD: KNBS and ICF Macro; 2015.
6.
Beguy D, Elung’ata P, Mberu B, Oduor C, Wamukoya M, Nganyi B, Ezeh A. HDSS Profile: The Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Int J Epidemiol. 2015; doi:10.​1093/​ije/​dyu25.
7.
Nalwadda CK, Waiswa P, Kiguli J, Namazzi G, Namutamba S, et al. High Compliance with Newborn Community-to-Facility Referral in Eastern Uganda: An Opportunity to Improve Newborn Survival. PLoS ONE. 2013; doi:10.​1371/​journal.​pone.​0081610.
8.
Rotheram-Borus MJ, Tomlinson M, le Roux IM, Harwood JM, Comulada S, et al. A Cluster Randomised Controlled Effectiveness Trial Evaluating Perinatal Home Visiting among South African Mothers/Infants. PLoS One. 2014; doi:10.​1371/​journal.​pone.​0105934.
9.
Gogia S, Sachdev HS. Home visits by CHWs to prevent neonatal deaths in developing countries: a systematic review. Bull World Health Organ. 2010;88:658–6B.CrossRefPubMedPubMedCentral
10.
Baqui AH, Ahmed S, El Arfeen S, Darmstdat G, Rosecrans A, Mannan I, Shman SM, Begum N, Mahmud AB, Seraji HR, Williams EK, Winch PJ, Santosham M, Black RE. Effect of timing of first postnatal care home visit on neonatal mortality on Bangladesh: a observational cohort study. BMJ. 2009;339:2826.CrossRef
11.
Zimba E, Kinney MV, Kachale F, Watensperger KZ, Blencowe H, et al. Newborn survival in Malawi: a decade of change and future implications. Health Policy Plann. 2012;27 Suppl 3:iii88–103.
12.
13.
Kirkwood BR, Manu A, ten Asbroek AH, Soremekun S, Weobong B, Gyan T, Danso S, Amenga-Etego S, Tawiah-Agyemang C, Owusu-Agyei S, Hill Z. Effect of the Newhints home-visits intervention on neonatal mortality rate and care practices in Ghana: a cluster randomized controlled trial. Lancet. 2013; doi:10.​1016/​S0140-6736(13)60095-1
14.
Haider R, Ashworth A, Kabir I, Huttly SRA. Effect of community-based peer counselors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomized controlled trail. Lancet. 2000;356:1643–47.CrossRefPubMed
15.
Penfold S, Manzi F, Mkumbo E, Temu S, Jaribu J, Shamba DD, et al. Effect of home-based counseling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial. BMC Pediatrics. 2014;14:187.CrossRefPubMedPubMedCentral
16.
Duysburgh E, Kerstens B, Kouanda S, Kabore CP, Belemsaga Yugbara D, et al. Opportunities to improve postnatal care for mothers and infants: design of context-specific packages of postnatal interventions in rural districts in four sub-Saharan African countries. BMC Pregnancy Childbirth 2015; doi:10.​1186/​s12884-015-0562-8
17.
18.
Kenya National Bureau of Statistics (KNBS). The 2009 Population and Housing Census Nairobi, Kenya. Calverton, Maryland: KNBS and ICF Macro; 2010.
19.
Oliver M, Geniets A, Winters N, Rega I, Mbae S. What do community health workers have to say about their work and how can this inform improved programme design? A case studies with CHWs within Kenya. Global Health Action. 2015; doi:10.​3402/​gha.​v8.​27168.
20.
21.
22.
O’Brien P. Procedures for comparing samples with multiple endpoints. Biometrics. 1984;40:1079–87.CrossRefPubMed
23.
Kling JR, Liebman JB, Katz LF. Experimental analysis of neighborhood effects. Econometrica. 2007;75:83–119.CrossRef
24.
Darmstadt GL, Choi Y, Arifeen SE, Bari S, Rahman SM, Mannan I, et al. Evaluation of a Cluster-Randomized Controlled Trial of a Package of Community-Based Maternal and Newborn Interventions in Mirzapur, Bangladesh. PLoS ONE 2010; doi:10.​1371/​journal.​pone.​0009696.
25.
Sitrin D, Guenther T, Murray J, Pilgrim N, Rubayet S, et al. Reaching Mothers and Babies with Early Postnatal Home Visits: The Implementation Realities of Achieving High Coverage in Large-Scale Programs. PLoS ONE. 2013; doi:10.​1371/​journal.​pone.​0068930
26.
27.
Mehl G, Labrique A. Prioritizing integrated mHealth strategies for universal health coverage. Science. 2014;345:1284.CrossRefPubMed
28.
Mitchell M, Hedt B, Msellemu D, Mkaka M, Lesh N. Improvement in Integrated Management of Childhood Illness (IMCI) Implementation through use of Mobile Technology: Evidence from a Pilot Study in Tanzania. BMC Med Inform Decis Mak. 2013;13:95.CrossRefPubMedPubMedCentral
29.
Warren C, Abuya T, Kanya L, Obare F, Njuki R, Tennerman M. A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya. BMC Pregnancy Childbirth. 2015;15:153.
30.
Essendi H, Mills S, Fotso JC. Barriers to Formal Emergency Obstetric Care Services’ Utilization. J Urban Health. 2011;88:356-369.
31.
32.
Watt C, Abuya T, Warren C, Kanya, L., Bellows, B. Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s Safe Motherhood voucher scheme. PLoS ONE. 2015;10(4):e0122828.
33.
34.
Metadata
Title
Can a community health worker administered postnatal checklist increase health-seeking behaviors and knowledge?: evidence from a randomized trial with a private maternity facility in Kiambu County, Kenya
Authors
Margaret McConnell
Allison Ettenger
Claire Watt Rothschild
Faith Muigai
Jessica Cohen
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-0914-z

Other articles of this Issue 1/2016

BMC Pregnancy and Childbirth 1/2016 Go to the issue

Research article

Socioeconomic and demographic determinants of birth weight in southern rural Ghana: evidence from Dodowa Health and Demographic Surveillance System

Research article

The influence of physical activity during pregnancy on maternal, fetal or infant heart rate variability: a systematic review

Case report

Management of ureteral stenting for postrenal failure during pregnancy after ureteral reimplantation: a case report

Research article

Maternal nutrition, inadequate gestational weight gain and birth weight: results from a prospective birth cohort

Research article

A mixed method study exploring adherence to and acceptability of small quantity lipid-based nutrient supplements (SQ-LNS) among pregnant and lactating women in Ghana and Malawi

Research article

Effect of L-arginine and sildenafil citrate on intrauterine growth restriction fetuses: a meta-analysis