Effect of Community Health Strategy on Focused Antenatal Care Coverage: A Pretest-Posttest Experimental Study in Rural Mwingi West Sub-County; Kenya

Abstract

Globally, Maternal Mortality Rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100 000 live births in 2015 from MMR of 385 per 100 000 live births in 1990. Similarly, the number of under-five deaths worldwide has declined from 12.7 million in 1990 to 5.9 million in 2015. Despite these gains, sub-Saharan Africa remains the region with the highest MMR (99% of global maternal deaths) and under- five mortality rate (1 child in 12 die before their fifth birthday). In Kenya, maternal and child mortality rates are still high despite government efforts aimed at improving Maternal and Child Health (MCH). Studies have acknowledged that Focused Antenatal Care (FANC) is an important element of health care with the potential of reducing maternal and child mortality rates. Though the proportion of women in Kenya seeking ANC services from skilled attendants (for at least 1 visit) is high at 95.5%, FANC coverage remains low at 57.6%. This study sought to determine the effect of a community health worker led primary health care intervention (Community Health Strategy) on FANC in Mwingi West sub-county. A pretest -posttest experimental study design with 1 pretest and 2 post-test surveys in intervention and control sites was employed. Data was collected from a sample size of 422 households in each survey. Women with a child aged 9-12 months were main respondents. CHS significantly increased FANC coverage by 9.5% (Z=2.7528, P<005) within six months after implementation, and by 20.1% (Z= 5.7881, P<0.05) within 18 months of implementation. In intervention site, FANC coverage significantly increased to 59% from 38.9%. Women in intervention site were 1.7 times more likely to seek ANC services for at least 4 times compared to women in control site (95%CI: 1.464-2.014, P<0.0001). CHS was effective in increasing FANC coverage in intervention site. To improve MCH outcomes in Kenya the government should fast-track national implementation of CHS.