Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda

Solomon T Wafula; Aisha Nalugya; Rornald M Kananura; Richard K Mugambe; Moses Kyangwa; John B Isunju; Betty Kyobe; Tonny Ssekamatte; Sarah Namutamba; Gertrude Namazzi; Elizabeth K Ekirapa; David Musoke; Florian Walter; Peter Waiswa

doi:10.1080/16549716.2022.2141312

Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda

Glob Health Action. 2022 Dec 31;15(1):2141312. doi: 10.1080/16549716.2022.2141312.

Authors

Affiliations

¹ Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
² School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
³ Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Global Health Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background: Early Initiation of antenatal care (ANC) and at least four visits during pregnancy allow screening and support for a healthy lifestyle and self-care during pregnancy however, community-directed interventions to improve access to these services are rarely explored.

Objective: To assess the effect of community health worker (CHW) involvement on utilisation of antenatal services during pregnancy in resource-constrained rural settings in Uganda.

Methods: We conducted a quasi-experimental evaluation study among mothers from Eastern Uganda. We used Difference in Differences (DiD) analysis to assess the effect of CHW intervention on ANC attendance. Components of the intervention included community dialogues and empowering CHWs to educate pregnant women about using maternal health services. The primary endpoints were early initiation of ANC and completion of at least 4 ANC visits.

Results: Overall, the intervention significantly improved attendance of ≥ 4 ANC visits (DiD = 5.5%). The increase was significant in both intervention and comparison areas (46.2-64.4% vs. 54.1-66.8%, respectively), with slightly greater gains in the intervention area. Other elements that predicted ≥4 ANC attendance besides the intervention were post-primary education (PR1.14, 95%CI 1.02-1.30), higher wealth quintile (PR1.17, 95%CI 1.06-1.30), and early initiation of ANC (PR1.58, 95%CI 1.49-1.68). The intervention did not significantly improve early initiation of ANC (DiD =-1.3%). Instead, early initiation of ANC was associated with higher husband education (PR1.19,95%CI 1.02-1.39), larger household size (PR = 0.81, 95%CI 0.70-0.95), and higher wealth index (PR1.19,95%CI 1.03-1.37).

Conclusions: The CHW intervention improved attendance of at least 4 ANC visits but not early initiation of ANC. There is need to promote CHW-led health education to increase attendance at 4+ ANC visits, but other approaches to promote early initiation are urgently required.

Keywords: Community health workers; Eastern Uganda; Training and supervsion; antenatal care; community mobilization; early ANC initiation.

MeSH terms

Female
Humans
Maternal Health Services*
Postpartum Period
Pregnancy
Pregnant Women
Prenatal Care*
Uganda

Grants and funding

This study was made possible with funding from the World Health Organization (WHO) and Department for International Development (DFID). The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.