Using community health workers to refer pregnant women and young children to health care facilities in rural West Bengal, India: A prospective cohort study

Abram L Wagner,Lu Xia,Uddip Nandi,Sujay Santra,Bhramar Mukherjee,Aparna Ghosh,Sucheta Joshi,Tanusree Mazumder,Joyojeet Pal,Sandip Datta,Sharmila Chattopadhyay,Priyamvada Pandey,Stephen D Ginsberg

doi:10.1371/journal.pone.0199607

Abstract

BackgroundCommunity health workers (CHWs) have been placed in many rural areas in India to increase villagers’ connections to basic preventive health care. In this study, we describe how pregnant women and mothers of young children react when CHWs inform them that they, or their child, are at high risk of pregnancy-related complications or early childhood developmental delays, and further screening and health care from a physician is recommended.MethodsIn this longitudinal study in rural villages in West Bengal, India, pregnant mothers, as well as mothers of children aged 12–24 months, were screened for high risk complications. They were re-contacted and asked questions regarding how and to what extent did visits by the CHWs improve their household’s overall health behavior, along with details about what additional care, if any, they sought. These responses are presented by different demographic and medical characteristics.ResultsOf the 231 pregnant women, all said they had sought additional care in response to the CHW visit, and all stated that feedback from the CHW resulted in improvement to their health behaviors. Most (90%) pregnant women gave birth at an institution. Among the 213 mothers of young children who were followed up, all sought additional care in response to the CHW’s visit. Most (67%) mentioned that they had a significant improvement in their health behaviors following feedback from the CHW, and the rest stated that they had some improvement.ConclusionsWith the proper training, CHWs can be partners in health care to improve the health of vulnerable populations, not only in rural areas of India, but also in other developing countries. CHWs can promote positive health outcomes in their villages of residence.

Highlights

Community health workers (CHWs) have been an integral part of the health care system throughout the world since the 1970s, especially in low- and middle-income countries [1]
Of the 231 pregnant women, all said they had sought additional care in response to the CHW visit, and all stated that feedback from the CHW resulted in improvement to their health behaviors
CHWs can be partners in health care to improve the health of vulnerable populations, in rural areas of India, and in other developing countries

Summary

Introduction

Community health workers (CHWs) have been an integral part of the health care system throughout the world since the 1970s, especially in low- and middle-income countries [1]. They often work with marginalized populations in medically underserved areas that lack consistent access to health care services. Up to 50% of women may experience pregnancy-related complications [3], and around 10% of children globally may experience developmental disabilities [4] These numbers appear to be increasing [5], and the World Health Organization (WHO) has established guidelines to help curb this phenomenon [6]. We describe how pregnant women and mothers of young children react when CHWs inform them that they, or their child, are at high risk of pregnancy-related complications or early childhood developmental delays, and further screening and health care from a physician is recommended

Methods

Results

Conclusion