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
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
This is a list of supplementary files associated with this preprint. Click to download.
Posted 11 May, 2020
On 26 Apr, 2020
On 25 Apr, 2020
On 25 Apr, 2020
On 24 Apr, 2020
On 12 Feb, 2020
Invitations sent on 12 Feb, 2020
On 12 Feb, 2020
Received 12 Feb, 2020
On 11 Feb, 2020
On 11 Feb, 2020
On 10 Jan, 2020
Received 08 Jan, 2020
Received 03 Jan, 2020
On 18 Dec, 2019
On 13 Dec, 2019
Invitations sent on 30 Oct, 2019
On 15 Jul, 2019
On 15 Jul, 2019
On 12 Jul, 2019
On 24 Jun, 2019
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
Posted 11 May, 2020
On 26 Apr, 2020
On 25 Apr, 2020
On 25 Apr, 2020
On 24 Apr, 2020
On 12 Feb, 2020
Invitations sent on 12 Feb, 2020
On 12 Feb, 2020
Received 12 Feb, 2020
On 11 Feb, 2020
On 11 Feb, 2020
On 10 Jan, 2020
Received 08 Jan, 2020
Received 03 Jan, 2020
On 18 Dec, 2019
On 13 Dec, 2019
Invitations sent on 30 Oct, 2019
On 15 Jul, 2019
On 15 Jul, 2019
On 12 Jul, 2019
On 24 Jun, 2019
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