Improving maternal and child health outcomes through a community involvement strategy in Kabula location, Bungoma County, Kenya

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Abstract

Background

Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under five children health indicators, more rapid progress is needed to meet the targets including the Sustainable Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain these goals.

Objective

To facilitate innovative partnerships in health care provision and to assess trends in access, utilization and quality of Maternal and Child Health care through the health systems approach using community owned initiatives including use of community owned resourse persons (CORPs), establishment of Community Based Organisations (CBOs) and Income Generating Activities(IGAs).

Study site

This was implemented in Kabula location, Bungoma County, Kenya between January 2016 and April 2019.

Study population

Pregnant women, newborns and under-five children living in Kabula location identified by Community Owned Resource Persons (CORPs).

Methods

A prospective study to show trends in maternal, neonatal and infant outcomes through the implementation of community owned initiatives.

Findings

General, under five and antenatal clinic attendance increased four fold in 2016,2017 and 2018. There was a 76% full immunization coverage with 97% BCG and 84% Polio coverage respectively among children studied. There was an 87% facility delivery rate among the pregnant women enrolled in the study.

Conclusions

Trends in Maternal and under-five health indicators in Kabula showed improvements over the study period following the implementation of the community owned initiatives and community participation.

Recommendations

The community owned initiatives as implemented in this study is useful in primary care and universal health coverage programs in health care delivery systems in LMICs.

Related collections

Most cited references 12

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Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

Imran Ahmed, Said Mohammed Ali, Seeba Amenga-Etego … (2018)

Summary Background Modelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa. Methods In this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, we conducted population-based surveillance of women of reproductive age (15–49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. We used standard operating procedures, data collection instruments, training, and standardisation to harmonise study implementation across sites. Verbal autopsies were done for deaths of all women of reproductive age, neonatal deaths, and stillbirths. Physicians used standardised methods for cause of death assignment. Site-specific rates and proportions were pooled at the regional level using a meta-analysis approach. Findings We identified 278 186 pregnancies and 263 563 births across the study sites, with outcomes ascertained for 269 630 (96·9%) pregnancies, including 8761 (3·2%) that ended in miscarriage or abortion. Maternal mortality ratios in sub-Saharan Africa (351 per 100 000 livebirths, 95% CI 168–732) were similar to those in south Asia (336 per 100 000 livebirths, 247–458), with far greater variability within sites in sub-Saharan Africa. Stillbirth and neonatal mortality rates were approximately two times higher in sites in south Asia than in sub-Saharan Africa (stillbirths: 35·1 per 1000 births, 95% CI 28·5–43·1 vs 17·1 per 1000 births, 12·5–25·8; neonatal mortality: 43·0 per 1000 livebirths, 39·0–47·3 vs 20·1 per 1000 livebirths, 14·6–27·6). 40–45% of pregnancy-related deaths, stillbirths, and neonatal deaths occurred during labour, delivery, and the 24 h postpartum period in both regions. Obstetric haemorrhage, non-obstetric complications, hypertensive disorders of pregnancy, and pregnancy-related infections accounted for more than three-quarters of maternal deaths and stillbirths. The most common causes of neonatal deaths were perinatal asphyxia (40%, 95% CI 39–42, in south Asia; 34%, 32–36, in sub-Saharan Africa) and severe neonatal infections (35%, 34–36, in south Asia; 37%, 34–39 in sub-Saharan Africa), followed by complications of preterm birth (19%, 18–20, in south Asia; 24%, 22–26 in sub-Saharan Africa). Interpretation These results will contribute to improved global estimates of rates, timing, and causes of maternal and newborn deaths and stillbirths. Our findings imply that programmes in sub-Saharan Africa and south Asia need to further intensify their efforts to reduce mortality rates, which continue to be high. The focus on improving the quality of maternal intrapartum care and immediate newborn care must be further enhanced. Efforts to address perinatal asphyxia and newborn infections, as well as preterm birth, are critical to achieving survival goals in the Sustainable Development Goals era. Funding Bill & Melinda Gates Foundation.

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The Maternal and Newborn Health Registry Study of the Global Network for Women's and Children's Health Research.

Shivaprasad Goudar, Waldemar A Carlo, Elizabeth McClure … (2012)

To implement a vital statistics registry system to register pregnant women and document birth outcomes in the Global Network for Women's and Children's Health Research sites in Asia, Africa, and Latin America. The Global Network sites began a prospective population-based pregnancy registry to identify all pregnant women and record pregnancy outcomes up to 42 days post-delivery in more than 100 defined low-resource geographic areas (clusters). Pregnant women were registered during pregnancy, with 42-day maternal and neonatal follow-up recorded-including care received during the pregnancy and postpartum periods. Recorded outcomes included stillbirth, neonatal mortality, and maternal mortality rates. In 2010, 72848 pregnant women were enrolled and 6-week follow-up was obtained for 97.8%. Across sites, 40.7%, 24.8%, and 34.5% of births occurred in a hospital, health center, and home setting, respectively. The mean neonatal mortality rate was 23 per 1000 live births, ranging from 8.2 to 48.5 per 1000 live births. The mean stillbirth rate ranged from 13.7 to 54.4 per 1000 births. The registry is an ongoing study to assess the impact of interventions and trends regarding pregnancy outcomes and measures of care to inform public health. ClinicalTrial.gov NCT01073475. Copyright © 2012 International Federation of Gynecology and Obstetrics. All rights reserved.

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Maternal mortality, stillbirth and measures of obstetric care in developing and developed countries.

Zoë E. McClure, C Bann, Elizabeth Goldenberg (2007)

Maternal mortality and stillbirths are important adverse pregnancy outcomes, especially in developing countries. Because underlying causes of both outcomes appeared similar, the relationship between maternal mortality, stillbirth and three measures of obstetrical care were studied. Using data provided by the World Health Organization from 188 developed and developing countries, correlations and linear regression analyses between maternal mortality and stillbirth rates and cesarean section rates, skilled delivery attendance, and >or=4 prenatal visits) were developed. Stillbirth and maternal mortality rates were strongly correlated, with about 5 stillbirths for each maternal death. However, the ratio increased from about 2 to 1 in least developed countries to 50 to 1 in the most developed countries. In developing countries, as the cesarean section rates increased from 0 to about 10%, both maternal mortality and stillbirth rates decreased sharply. Skilled delivery attendance was not associated with significant reductions in maternal mortality or stillbirth rates until coverage rates of about 40% were achieved. Four or more antenatal visits were not associated with significant reductions in maternal deaths until about 60% coverage was achieved. The same measure was associated with only modest decreases in stillbirth. Across countries, stillbirth was significantly associated with maternal mortality. Both stillbirth and maternal mortality were similarly related to all three measures of obstetric care. An increase in cesarean section rates from 0 to 10% was associated with sharp decreases in both maternal mortality and stillbirths.

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Author and article information

Contributors

Fabian Esamai

Journal

Journal ID (nlm-ta): Dialogues Health

Journal ID (iso-abbrev): Dialogues Health

Title: Dialogues in Health

Publisher: Elsevier

ISSN (Electronic): 2772-6533

Publication date PMC-release: 02 July 2022

Publication date Collection: December 2022

Publication date (Electronic): 02 July 2022

Volume: 1

Electronic Location Identifier: 100026

Affiliations

[a ]Dept of Child Health and Paediatrics, School of Medicine College of health Sciences Moi University, Kenya

[b ]Dept of Behavioural Sciences, School of Medicine College of Health Sciences Moi University, P. O Box 4606, 30100 Eldoret, Kenya

[c ]Dept of health management and Health Policy, School of Public Health, College of health Sciences, Moi University, P. O Box 4606, 30100 Eldoret, Kenya

[d ]Senior Lecturer, Dept of Disaster Risk Management, School of Public health, College of Health Sciences, Moi University, P. O Box 4606, 30100 Eldoret, Kenya

[e ]Clinical Psychology, Dept of behavioural Sciences, School of Medicine College of Health Sciences Moi University, P. O Box 4606, 30100 Eldoret, Kenya

[f ]Dept of Reproductive Health, School of Medicine College of health Sciences Moi University, P. O Box 4606, 30100 Eldoret, Kenya

Author notes

[* ]Corresponding author. fesamai2007@ 123456gmail.com

Article

Publisher Item ID: S2772-6533(22)00026-0 Publisher ID: 100026

DOI: 10.1016/j.dialog.2022.100026

PMC ID: 10954023

PubMed ID: 38515927

SO-VID: 2fb2af7d-96cf-4fe0-ad19-b4f67faff86f

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 23 March 2022

Date revision received : 17 April 2022

Date accepted : 28 June 2022

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