This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya
Lauren Y. Maldonado
Academic Model Providing Access to Healthcare
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8352-0815
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors.
Methods: We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.
Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a health facility (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12-9.64, p<0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls.
Conclusions: Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.
Trial Registration: ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017)
Keywords
Pregnancy, community health volunteer, maternal health, newborn or infant health, peer support, health education, microfinance, financial inclusion, low- and middle-income country (LMIC), Kenya
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 11 May, 2020
No community comments so far
Editor assigned
On 26 Apr, 2020
Submission checks complete
On 25 Apr, 2020
Editor invited
On 25 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 24 Apr, 2020
Editor assigned
On 12 Feb, 2020
Reviewers invited
Invitations sent on 12 Feb, 2020
Reviewer #1 agreed
On 12 Feb, 2020
Review #1 received
Received 12 Feb, 2020
Submission checks complete
On 11 Feb, 2020
Editor invited
On 11 Feb, 2020
No comments provided
Editorial decision: Major revision
On 10 Jan, 2020
Review #2 received
Received 08 Jan, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #2 agreed
On 18 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 30 Oct, 2019
Editor invited
On 15 Jul, 2019
Editor assigned
On 15 Jul, 2019
Submission checks complete
On 12 Jul, 2019
First submitted
On 24 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
This preprint is under consideration at BMC Pregnancy and Childbirth. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: a prospective matched cohort study in western Kenya
Lauren Y. Maldonado
Academic Model Providing Access to Healthcare
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8352-0815
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 11 May, 2020
No community comments so far
Editor assigned
On 26 Apr, 2020
Submission checks complete
On 25 Apr, 2020
Editor invited
On 25 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 24 Apr, 2020
Editor assigned
On 12 Feb, 2020
Reviewers invited
Invitations sent on 12 Feb, 2020
Reviewer #1 agreed
On 12 Feb, 2020
Review #1 received
Received 12 Feb, 2020
Submission checks complete
On 11 Feb, 2020
Editor invited
On 11 Feb, 2020
No comments provided
Editorial decision: Major revision
On 10 Jan, 2020
Review #2 received
Received 08 Jan, 2020
Review #1 received
Received 03 Jan, 2020
Reviewer #2 agreed
On 18 Dec, 2019
Reviewer #1 agreed
On 13 Dec, 2019
Reviewers invited
Invitations sent on 30 Oct, 2019
Editor invited
On 15 Jul, 2019
Editor assigned
On 15 Jul, 2019
Submission checks complete
On 12 Jul, 2019
First submitted
On 24 Jun, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Chamas for Change (Chamas) is a group-based health education and microfinance program for pregnant and postpartum women that aims to address inequities contributing to high rates of maternal and infant mortality in rural western Kenya. In this prospective matched cohort study, we evaluated the association between Chamas participation and facility-based delivery. We additionally explored the effect of participation on promoting other positive maternal, newborn and child health (MNCH) behaviors.
Methods: We prospectively compared outcomes between a cohort of Chamas participants and controls matched for age, parity, and prenatal care location. Between October-December 2012, government-sponsored community health volunteers (CHV) recruited pregnant women attending their first antenatal care (ANC) visits at rural health facilities in Busia County to participate in Chamas. Women enrolled in Chamas agreed to attend group-based health education and microfinance sessions for one year; controls received the standard of care. We used descriptive analyses, multivariable logistic regression models, and random effect models to compare outcomes across cohorts 12 months following enrollment, with α set to 0.05.
Results: Compared to controls (n=115), a significantly higher proportion of Chamas participants (n=211) delivered in a health facility (84.4% vs. 50.4%, p<0.001), attended at least four ANC visits (64.0% vs. 37.4%, p<0·001), exclusively breastfed to six months (82.0% vs. 47.0%, p<0·001), and received a CHV home visit within 48 hours postpartum (75.8% vs. 38.3%, p<0·001). In multivariable models, Chamas participants were over five times as likely as controls to deliver in a health facility (OR 5.49, 95% CI 3.12-9.64, p<0.001). Though not significant, Chamas participants experienced a lower proportion of stillbirths (0.9% vs. 5.2%), miscarriages (5.2% vs. 7.8%), infant deaths (2.8% vs. 3.4%), and maternal deaths (0.9% vs. 1.7%) compared to controls.
Conclusions: Chamas participation was associated with increased odds of facility-based delivery compared to the standard of care in rural western Kenya. Larger proportions of program participants also practiced other positive MNCH behaviors. Our findings demonstrate Chamas’ potential to achieve population-level MNCH benefits; however, a larger study is needed to validate this observed effect.
Trial Registration: ClinicalTrials.gov, NCT03188250 (retrospectively registered 31 May 2017)
Figure 1