Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya
Abstract Background Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we...
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| Format: | Article |
| Language: | English |
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BMC
2020-05-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12884-020-02978-w |
| _version_ | 1819056968158937088 |
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| author | Lauren Y. Maldonado Julia J. Songok John W. Snelgrove Christian B. Ochieng Sheilah Chelagat Justus E. Ikemeri Monica A. Okwanyi Donald C. Cole Laura J. Ruhl Astrid Christoffersen-Deb |
| author_facet | Lauren Y. Maldonado Julia J. Songok John W. Snelgrove Christian B. Ochieng Sheilah Chelagat Justus E. Ikemeri Monica A. Okwanyi Donald C. Cole Laura J. Ruhl Astrid Christoffersen-Deb |
| author_sort | Lauren Y. Maldonado |
| collection | DOAJ |
| description | Abstract Background Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. Methods We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October–December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05. Results Compared to controls (n = 115), a significantly higher proportion of Chamas participants (n = 211) delivered in a health facility (84.4% vs. 50.4%, p < 0.001), attended at least four ANC visits (64.0% vs. 37.4%, p < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12–9.64, p < 0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Conclusions Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect. Trial registration ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017). |
| first_indexed | 2024-12-21T13:31:50Z |
| format | Article |
| id | doaj.art-362103374334410783ee637b6b4ae0d4 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-21T13:31:50Z |
| publishDate | 2020-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-362103374334410783ee637b6b4ae0d42022-12-21T19:02:17ZengBMCBMC Pregnancy and Childbirth1471-23932020-05-0120111410.1186/s12884-020-02978-wPromoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western KenyaLauren Y. Maldonado0Julia J. Songok1John W. Snelgrove2Christian B. Ochieng3Sheilah Chelagat4Justus E. Ikemeri5Monica A. Okwanyi6Donald C. Cole7Laura J. Ruhl8Astrid Christoffersen-Deb9Academic Model Providing Access to Healthcare (AMPATH)Academic Model Providing Access to Healthcare (AMPATH)Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of TorontoLVCT HealthAcademic Model Providing Access to Healthcare (AMPATH)Academic Model Providing Access to Healthcare (AMPATH)Kenya Red CrossDalla Lana School of Public Health, University of TorontoAcademic Model Providing Access to Healthcare (AMPATH)Academic Model Providing Access to Healthcare (AMPATH)Abstract Background Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors. Methods We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October–December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05. Results Compared to controls (n = 115), a significantly higher proportion of Chamas participants (n = 211) delivered in a health facility (84.4% vs. 50.4%, p < 0.001), attended at least four ANC visits (64.0% vs. 37.4%, p < 0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p < 0·001), and received a CHV home visit within 48 h postpartum (75.8% vs. 38.3%, p < 0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12–9.64, p < 0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls. Conclusions Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect. Trial registration ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017).http://link.springer.com/article/10.1186/s12884-020-02978-wPregnancyCommunity health volunteerMaternal healthNewborn or infant healthPeer supportHealth education |
| spellingShingle | Lauren Y. Maldonado Julia J. Songok John W. Snelgrove Christian B. Ochieng Sheilah Chelagat Justus E. Ikemeri Monica A. Okwanyi Donald C. Cole Laura J. Ruhl Astrid Christoffersen-Deb Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya BMC Pregnancy and Childbirth Pregnancy Community health volunteer Maternal health Newborn or infant health Peer support Health education |
| title | Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya |
| title_full | Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya |
| title_fullStr | Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya |
| title_full_unstemmed | Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya |
| title_short | Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya |
| title_sort | promoting positive maternal newborn and child health behaviors through a group based health education and microfinance program a prospective matched cohort study in western kenya |
| topic | Pregnancy Community health volunteer Maternal health Newborn or infant health Peer support Health education |
| url | http://link.springer.com/article/10.1186/s12884-020-02978-w |
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