Socio-Demographic Determinants of eCHIS Utilization for Maternal Health Services among Lactating Mothers in Muhoroni, Kisumu County, Kenya

Background: In Pakistan, poor antenatal and postnatal coverage, has accounted for nearly 70% of preventable maternal deaths. Interventions implemented to improve uptake of antenatal and postnatal care (PNC) services have not shown significant improvements. Recent increase in cellphone penetration has brought forward mHealth as a potential strategy to enhance antenatal care (ANC) and PNC uptake. The objective of this study was to explore if mHealth technology is a feasible strategy to improve uptake of preventive maternal healthcare services in peri-urban areas of Karachi. Methods: The study employed an exploratory qualitative research design using focus group discussions (FGDs) and key-informant interviews. FGDs were conducted with pregnant women, women in the postnatal period and lady health workers (LHWs) whereas key-informant interviews were conducted with maternal neonatal and child health experts and mHealth experts. The study data was analyzed using NVivo version 11. Results: This research found that women, healthcare providers and technology experts consider mHealth strategy has high potential to address barriers related to provision and utilization of ANC and PNC services. Healthcare providers and women understand the term mHealth and knew the benefits of mHealth services. Few of the women and healthcare providers are currently using mHealth for providing and receiving ANC and PNC services. Women and healthcare provider seemed ready for mHealth use however expressed challenges such as, illiteracy, cultural restrictions, lack of trustworthiness and misuse of technology. Conclusions: This study informs that mHealth is operationally feasible, culturally acceptable and technologically appropriate strategy. For successful integration of mHealth technology in to existing maternal neonatal and child health service delivery structure, it is considered imperative to build a sustainable model of mHealth by involving government, local communities, telecommunication personnel, health care providers and mHealth and maternal neonatal and child health experts and through tailoring the design of the mHealth solutions in such a way that it benefits majority of women.

<i>Background: </i>Maternal Mortality is a public health problem in Nepal, which was highest in 1990 among the South Asian countries. Associated factors of maternal mortality are various; among them maternal health services such as antenatal (ANC) and postnatal care (PNC) services are the main. <i>Methods: </i>A multivariate secondary data analysis out based on Nepal Demographic Health Surveys 2001 and 2006. Logistic regression models was performed to compare the utilization of the ANC and PNC services, with background characteristics of women aged between 15 to 49 years old. <i>Results: </i>A total of 8913 reproductive aged groups (15-49) women were taken for analysis and the mean age was 28.59±7.040 years. Logistic regression analysis revealed that health facility delivery (AOR=1.297, 95% CI=1.135-1.481), PNC check-up at health facility (AOD=4.442, 95% CI=2.815-7.011) and PNC service with a skilled health worker (AOD=4.533, 95% CI=2.753-7.465) utilized more in 2006 compared to 2001. This study also found that highly educated women had (AOD, 95% CI=10.823-22.968) more utilized the heath facility during pregnancy and (AOD, 95% CI=2.194-16.950) more likely during a PNC check-up, whereas, educated women were less (AOR=0.043, 95% CI=0.007-0.254) likely consult with a skilled professional. Similarly, antenatal care (ANC) visits (4 or more than four) and ANC visit in the first trimester were increased (95% CI=1.137-1.518) and (AOD=1.041, 95% CI=0.924-1.173) respectively. This study found that educated women, those who were living in urban areas, were more likely to use maternal health services compared to other regions. <i>Conclusion: </i>Increased in utilization of the ANC and PNC services through skilled health workers in a health facility among cohorts of educated women. However, the improvements were not equally distributed across the all regions in the country. This utilization of maternal health services is not sufficient to achieve the MDG goal. Because, health facility delivery is poor and counterpart home delivery is still high in Nepal.

To document factors that hinder or enable strategies to reduce the first and second delays of the Three Delays in rural and pastoralist areas in Ethiopia. A key informant study was conducted with 44 Health Extension Workers in Afar Region, Kafa Zone (Southern Nation, Nationalities and Peoples' Region), and Adwa Woreda (Tigray Region). Health Extension Workers were trained to interview women and ask for stories about their recent experiences of birth. We interviewed the Health Extension Workers about their experiences referring women for Skilled Birth Attendance and Emergency Obstetric and Newborn Care. Data were analysed using thematic analysis. Themes related to reducing the first delay, such as the tradition of home birth, decision-making, distance and unavailability of transport, did not differ between the three locations. Themes related to reducing the second delay differed substantially. Health Extension Workers in Adwa Woreda were more likely to call ambulances due to support from the Health Development Army and a functioning referral system. In Kafa Zone, some Health Extension Workers were discouraged from calling ambulances as they were used for other purposes. In Afar Region, few Health Extension Workers were called to assist women as most women give birth at home with Traditional Birth Attendants unless they need to travel to health facilities for Emergency Obstetric and Newborn Care. Initiatives to reduce delays can improve access to maternal health services, especially when Health Extension Workers are supported by the Health Development Army and a functioning referral system, but district (woreda) health offices should ensure that ambulances are used as intended.

Skilled maternal health services, including antenatal care (ANC)services, childbirth services and postnatal care (PNC)services, can save the lives of women and newborns. However, women in resource-limited countries, such as Ethiopia, tend to have a relatively lower uptake, partly because current services may not align with their preferences. This study assessed thestated preferences ofwomen formaternal health servicesintheSidama region, Ethiopia. A multi-stage sampling technique was used to select reproductive-aged women (15-49 years) from the Central Sidama Zone,Sidama region, Ethiopia. A D-efficient discrete choice experiment (DCE) with two blocks of 24 choice tasks was designed. Six attributes, including healthcare provider attitude, availability of medication and supplies, distance to the health facility, privacy, waiting times, and service cost, were identified through literature reviews, focus group discussions and in-depth interviews with women and other stakeholders. Respondents were randomly assigned to one of the three interrelated but distinct maternal health services (ANC, childbirth and PNC). A latent class analysis (LCA) model was used to estimate preferences and estimate the relative importance of attributes, uptake probability, and willingness-to-pay (WTP). The association between individual sociodemographic characteristics and latent classes was examined using a class membership model. A total of 1558 women, including 526 for ANC services, 537 for childbirth services and 495 for PNC services, were included in the analysis. For each service, three classes were identified, and notable differences in preferences were observed across the classes within each maternal health service. For ANC services, Class 1 was a medication-sensitive group (34.3%) that prioritised the availability of essential medications. In contrast, Class 2 was a price-sensitive group (21.9%), exhibiting high disutility for costly services (7500 ETB ≈ US$137). For childbirth services, Class 1 was a time-sensitive group (21.1%) exhibiting strong aversion to long waiting times (24 hours), while Class 2 was a price-sensitive group (19.3%). For PNC services, Class 1 was a medication-sensitive group (48%), whereas Class 3 was a price-sensitive group (25%). The predicted uptake probability in ideal conditions was above 96% across all maternal health services; however, it ranged from 60% for class 2 PNC services to 99% for class 2 childbirth services in average conditions. Overall, women showed a higher willingness to pay (WTP) approximately 8604 ETB (US$159) and 5118 ETB (US$95 ), to avoid childbirth services that lacked medications and supplies or had long waiting times, respectively. Sociodemographic factors, including age, residence, and education level, significantly shaped women's preferences for maternal health services. The cost of service, availability of medication and supplies, and waiting time were the most important attributes influencing maternal health service preferences for most of the classes of all services, while privacy and distance to the health facility were frequently the least important. Maternal health services should address the specific needs of women, such as subsidising costs, ensuring sustainable medication supply, and optimising service efficiency to enhance maternal healthcare uptake and outcomes in resource-limited settings, including Ethiopia and similar contexts. The findings will provide policymakers with valuable insights and inform future research on maternal health services in other contexts, including the Afar and Somali regions, where nomadic lifestyles are common, and data are sparse.

BackgroundSeveral studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being.MethodsThis study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe.ResultsOverall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)].ConclusionDecomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

BackgroundAntenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia.MethodsData were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis.ResultsThirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women’s autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people.ConclusionMaternal health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.

Background: This study assessed the effect of HIV-integrated care delivered within routine primary health care (PHC) in Kano, Nigeria, on the uptake of maternal health and routine childhood immunization services. Methods: A retrospective cohort design was used to review and collect anonymized data from medical records of women and children who accessed health care from the PHC facility between January 2009 and December 2016. Data were analyzed using SPSS version 22. Interrupted time series analysis (ITS) was performed to estimate changes in maternal and childhood immunization service usage over time following the delivery of the integrated care. Results: Uptake of maternal health services increased over time: antenatal care attendance (effect/month [95% confidence interval (CI)]: 6.6 [44.55–8.65], P = 0.0001), family planning (effect/month [95% CI]: 1.3 [0.26–2.26], P = 0.014), and delivery (effect/month [95% CI]: 0.9 [0.39–1.45], P = 0.0009). Uptake of routine immunization also increased over time with the integrated care: Bacille Calmette Guerin (BCG) (Effect/month [95% CI]: 1.8 [0.64–2.88], P = 0.002), and diphtheria, tetanus, and pertussis 1 (DPT1)/Penta 1 vaccinations (Effect/month [95% CI]: 1.0 [0.20–1.73], P = 0.013) also showed a moderate increase over time, but DPT3/Penta 3 vaccination dropped gradually over time (Effect/month [95% CI]: −0.1 [−0.74–0.46], P = 0.649). Conclusion: The integrated care resulted in increased uptake of both maternal health and childhood routine immunization services. This suggests that the reorganization and restructuring of the HIV-integrated care in the Kumbotso Comprehensive Health Centre has had a positive impact on non-HIV services provided at the center. There are still opportunities for further research to refine and elaborate on the novel findings of this study.

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Gombe State in North Eastern Nigeria is one of the states in the region that records the highest maternal and newborn death rates in the world. Poverty incidence is 72.2% in the state and a great deal of women in the villages don't have tangible means of livelihood and heavily rely on their husbands. Empowering these women through formation of women groups saving schemes, literacy, maternal health and vocational training, will improve their economic power and enhance their utilization of these vital maternal services. The study was a quasi-experimental one with non-equivalent experimental and comparison groups. Data for this study were collected using quantitative and qualitative methods through household survey and focus group discussions (FDGs) in two purposively selected intervention Local Government Areas (LGAs) of the state at baseline and 6 months after intervention. Iterative bidding technique was employed to determine the women's willingness to pay. The main outcome variables are willingness to pay (WTP) and utilization of antenatal care (ANC), facility delivery and post-natal care (PNC) of the women. An association between women's characteristics and their WTP and utilization of maternal health care services was analysed. The findings show statistically significant changes in the income (z=-6.983, p &lt; 0.001) and the willingness to pay for delivery (z=-2.623, p = 0.009) and PNC (z =-2.465, p = 0.014) services. The correlations between WTP and income with all the services were found. Decision of women independently or jointly with husbands on their health care, religion, ability to read and write local languages were factors found to be associated with WTP for maternal services. Utilization of maternal services was found to be associated with age, current pregnancy, decision on health care, and prices for ANC and PNC services. The FGDs revealed that the groups understand empowerment as a combination of economic power, literacy and ability to take decisions independently. Willingness to pay for maternal care is associated with higher income, autonomy in taking decision for health care needs. Empowering women economically and educationally has potential for improving their willingness to pay for maternal health care needs. Government needs to look at the feasibility of aiding the proliferation of women savings groups especially in rural areas, which are the abodes of women without the ability and willingness to access health care services.

BackgroundDespite improvement in the coverage of most maternal, newborn, and child health services, inequality in the uptake of services still remains the challenge of health systems in most developing countries. This study was conducted to examine the degree of inequities and potential predictors of inequity in reproductive and maternal health services utilization in the Oromia region, Ethiopia.MethodsThe 2016 Ethiopian demographic and health survey data set was used. Utilization rate of four maternal health service categories (family planning, antenatal care, facility based delivery and postnatal care) was considered in the analysis. Equity in each of these indicators was assessed by residence (urban/rural), wealth index, and educational status. Inequality in service utilization was estimated using rate ratios, concentration curve, and concentration indices.ResultsOverall data of 5701 women were used in this analysis. The concentration index to all of the maternal health service utilization indicators showed significance. The concentration index of family planning, antenatal care, facility based delivery, and postnatal care was 0.136 (95% CI=0.099–0.173), 0.106 (95% CI=0.035–0.177), 0.348 (95% CI=0.279–0.418), and 0.348 (95% CI=0.279–0.418), respectively. Maternal age and all of the three socio-demographic factors (residence, education, and wealth) showed inequitable distribution of maternal health service utilization in the Oromia region. The majority of women who were in the favored groups utilized the key reproductive and maternal health services.ConclusionThe utilization of maternal health services in the study area is grossly skewed to those who are well off, educated, and live in urban areas. Any action intended to improve utilization of maternal and child health services should aim to reduce the unnecessary and avoidable disparity demonstrated in our analysis. This of course demands multisectoral intervention to impact on the determinants.

BackgroundThe progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005–11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities.MethodsData for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services.ResultsIn this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor.ConclusionThe challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus, addressing socioeconomic inequalities in accessing maternal health services is central to resolving challenges of maternal health. Furthermore, as Ethiopia moves forward with the sustainable development agenda, socioeconomic inequalities in uptake of maternal health services should also be continuously monitored.

BackgroundNepal has improved access and utilisation of routine maternal and newborn health (MNH) services. Despite improved access to routine MNH services such as antenatal care (ANC), and delivery and postnatal care (PNC) services, the burden of maternal and neonatal deaths in Nepal remains high. Most of those deaths could be prevented by improving utilisation of evidence-informed clinical MNH interventions. However, little is known on determinants of utilisation of such clinical MNH interventions in health facilities (HFs). This study investigated the determinants of utilisation of technical quality MNH services in Nepal.MethodsThis study used data from the 2015 Nepal Services Provision Assessment. A total of 523 pregnant and 309 postpartum women were included for the analysis of utilisation of technical quality of ANC, and delivery and PNC services, respectively. Outcome variables were utilisation of better quality i) ANC services, and ii) delivery and PNC services while independent variables included features of HFs and health workers, and demographic characteristics of pregnant and postpartum women. Binomial logistic regression was conducted to identify the determinants associated with utilisation of quality MNH services. The odds ratio with 95% confidence interval (CIs) were reported at the significance level of p < 0.05 (two-tailed).ResultsWomen utilised quality ANC services if they attended facilities with better HF capacity (aOR = 2.12;95% CI: 1.03, 4.35). Women utilised better quality delivery and PNC services from private HFs compared to public HFs (aOR = 2.63; 95% CI: 1.14, 6.08). Women utilised better technical quality ANC provided by nursing staff compared to physicians (adjusted odds ratio (aOR) =2.89; 95% CI: 1.33, 6.29), and from staff supervised by a higher authority compared to those not supervised (aOR = 1.71; 95% CI: 1.01, 2.92). However, compared to province one, women utilised poor quality delivery and PNC services from HFs in province two (aOR = 0.15; 95% CI: 0.03, 0.63).ConclusionsWomen utilised quality MNH services at facilities with better HF capacity, service provided by nursing staff, and attended at supervised HFs/health workers. Provincial and municipal governments require strengthening HF capacities (e.g., supply equipment, medicines, supplies), recruiting trained nurse-midwives, and supervising health workers.

Background: Community health workers integrate individuals of their communities to provide preventive, habitual, and emergency maternity healthcare requirements. The aim of this study was to assess Community Health Workers social demographic factors and roles influencing uptake of Maternal Health services in Musanze District, Northern Province, Rwanda.&#x0D; Methods: The study design used was analytical cross-sectional study design utilizing both quantitative and qualitative methods. In this study, a simple random sample approach was employed to choose 208 CHWs and 16 CHW’s supervisors were interviewed for qualitative data (KII). The statistical tool for social sciences (SPSS) Version 26, was utilized to examine the data. Bivariate analysis with Chi-square test of independence was used to check the relationship between the dependent and independent variables. Ordinal logistic regression was used as the most suitable inferential statistic because the predictor variables and the dependent were ordinal variables. Qualitative data were analyzed by INVIVO version 10. Community health workers 208 participated in the study and all were female.&#x0D; Results: This study found that the uptake of maternal health services was regarded as very high. Among those services, deliveries at the Health Facility were at 73.6%, Antenatal care at 65.9%, Family planning at 54.3%, and the rate of Postnatal care was at 45.7%.This study assessed the influence of social demographic factors on uptake of maternal health services, level of education with p* &lt;.001, and working experience p* = .005 were associated with uptake of maternal health services. The study recommends improvement of maternal health services through family planning, health care during pregnancy, post-partum care, with particularly scaling up key motherly health services, regular training and supervision for CHWs. This will help to achieve third goal of SDG 2030 as Good Health and well-being for all People and end up reducing mortality rates in the community unit. The findings of the study will be helpful to Ministry of Health (at District and national level) in taking strategic steps towards reducing mortality rates in the unit and country at large.

Background and objectives: Maternal as well as infant mortality is high in Bangladesh. Utilization of post natal care (PNC) services is important to reduce maternal and infant mortality. Considering this matter, this study attempted to find out the level of PNC utilization by women living in slum areas of Dhaka city as well as to identify the factors associated with the utilization of PNC services.&#x0D; Methods: This study was conducted in Khilgaon and Rampura slums of Dhaka city. In each slum, women aged between 15-49 years who had given birth to at least one child were enrolled in the study by random sampling technique. Participants were interviewed with a semi-structured questionnaire which included information on socio-economic, demographic, cultural status as well as information on PNC service utilization.&#x0D; Results: Out of total 360 enrolled women in both slums, 58.6% utilized PNC services. The rate of utilization of PNC services was 55% and 62.2% in Khilgaon and Rampura slum respectively. Compared to 40-49 years age group, significantly (p&lt;0.01) higher percentage of women aged &lt;20, 20-29 and 30-39 years utilized PNC services (69.6%, 67.0% and 56.4% respectively). The significant associates of receiver of PNC were respondent’s education, number of antenatal care (ANC) received, level of tetanus vaccination, place of delivery, distance between home and clinic, mass media exposure, male participation and autonomy.&#x0D; Conclusion: Local socioeconomic and cultural aspects should be considered while planning intervention program to improve the utilization of PNC service.&#x0D; Ibrahim Med. Coll. J. 2019; 13(2): 53-58

Background: Community-based initiatives are a worldwide policy that guarantees that key health services are available and accessible closer to the community. CHWs are an important element of healthcare services in Rwanda. Community health workers integrate individuals of their communities to provide preventive, habitual, and emergency maternity healthcare requirements. Maternal health is still a challenge to the achievement of SDGs by 2030 in the health-care sector compared with the effort provided by CHWs. The aim of study was to assess the influence of community health workers' role on uptake of maternal health services in Musanze District. Methods: The study design used was an analytical cross-sectional study design utilizing both quantitative and qualitative methods. Simple random sample approach was employed to choose 208 CHWs and 16 CHWs’ supervisors were interviewed for qualitative data (KII). The statistical tool for social sciences (SPSS) Version 26, was used to examine the data. Categorical variables were summarized with descriptive statistics for frequencies and percentages. Bivariate analysis with the Chi-square test of independence was used to check the association between both dependent and independent variables. Ordinal logistic regression was used as the most suitable inferential statistic. Qualitative data were analyzed by NVIVO version 10. Results: This study found that the uptake of maternal health services was regarded as very high. 85.1% of CHWs were knowledgeable on the warning signs of an emergency among pregnant mothers, and 89.4% reported that they would act based on these warning signs. CHWs had necessary training to provide care to pregnant mothers with p* =. 001. Skills that CHWs have on the administration of misoprostol to prevent post-partum hemorrhage was significant with p* &lt;.001. Factors that influenced uptake of maternal health services were CHW’s regular supervision with p*=.001, provision of transportation p*=.001, regular refresher training p* =.002, and motivation/incentives p*=.001, as they were associated with the performance of CHWs towards the uptake of Maternal Health care services. The research recommends improvement of maternal health services through access to contraception, antenatal care, and postnatal care, with particularly scale-up key motherly health services, regular supervision should be done at least every month and training for CHWs quarterly, governmental support in terms of motivations of CHWs.