Sociodemographic Characteristics
Table 2 provides selected sociodemographic characteristics of women 15-40 years who reported a delivery in the past 2 years; 3,037 in Cambodia, 2,805 in Kenya and 1,171 women in Zambia. More than 85% of households were headed by a male across all sites in both Cambodia and Kenya. In Zambia, less than 50% of households were headed by males in the intervention sites, compared to 70% in the comparison sites. In all three countries, most of the women were 20-36 years of age. More than 80% of the women were married in Cambodia and Kenya, while 70 to 75% of the women were married in Zambia.
Table 2: Sociodemographic characteristics of study population by country
Characteristics
|
Cambodia
N=3,037
|
Kenya
N=2,805
|
Zambia
N=1,171
|
|
I
N=1261
|
C
N=1776
|
p value
|
I
N=1590
|
C
N=1215
|
p value
|
I
N=634
|
C
N=537
|
p value
|
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
Male-headed household
|
1130 (89.8)
|
1584 (89.5)
|
0.815
|
1360 (86.4)
|
1076 (89.3)
|
0.022
|
288
(46.3)
|
368
(69.7)
|
0.001
|
Mean family size
|
5.1
|
4.8
|
0.001
|
4.9
|
4.8
|
0.021
|
5.3
|
5.2
|
0.173
|
Mother’s age (in years)
|
|
|
|
|
|
|
|
|
|
15-19
|
49
(3.9)
|
81 (4.6)
|
0.359
|
140 (8.8)
|
100 (8.2)
|
0.588
|
97 (15.3)
|
86 (16)
|
0.738
|
20-36
|
1113 (88.3)
|
1536 (86.5)
|
0.144
|
1334 (83.9)
|
1040 (85.6)
|
0.214
|
455 (71.8)
|
394 (73.4)
|
0.540
|
37-49
|
99
(7.8)
|
159 (8.9)
|
0.279
|
116 (7.3)
|
75 (6.2)
|
0.237
|
82 (12.9)
|
57 (10.6)
|
0.219
|
Marital status
|
|
|
|
|
|
|
|
|
|
Married
|
1239 (98.3)
|
1744 (98.2)
|
0.906
|
1321 (83.4)
|
1121 (92.6)
|
0.001
|
438 (69.4)
|
399 (74.3)
|
0.064
|
Single/divorced/widow-ed
|
22
(1.7)
|
32 (1.8)
|
0.906
|
263 (16.6)
|
90 (7.4)
|
0.001
|
193 (30.6)
|
138 (25.7)
|
0.064
|
Highest education
|
|
|
|
|
|
|
|
|
|
No education
|
191
(15.4)
|
453
(25.8)
|
0.001
|
19 (1.3)
|
52 (4.8)
|
0.001
|
44 (8.3)
|
68 (15.7)
|
0.001
|
Primary
|
675 (54.3)
|
764
(43.5)
|
0.001
|
1004 (69.2)
|
791 (72.7)
|
0.050
|
268
(49.8)
|
221 (50.9)
|
0.676
|
Secondary or more
|
377 (30.3)
|
539 (30.7)
|
0.831
|
429
(29.5)
|
244 (22.5)
|
0.001
|
225 (41.9)
|
145 (33.4)
|
0.004
|
Parity
|
|
|
|
|
|
|
|
|
|
Primiparous
|
504
(40.0)
|
674 (38.0)
|
0.262
|
422
(26.6)
|
337 (27.7)
|
0.205
|
161 (25.4)
|
179 (33.3)
|
0.006
|
Multiparous
|
756 (60.0)
|
1098 (62.0)
|
0.275
|
1160
(73.4)
|
871
(72.3)
|
0.210
|
465 (74.6)
|
336 (66.7)
|
0.001
|
Had prior miscarriage or stillbirth
|
264
(20.9)
|
454 (25.6)
|
0.003
|
63 (4.0)
|
65 (5.4)
|
0.165
|
40 (6.3)
|
24
(4.5)
|
0.165
|
Wealth quintile
|
|
|
|
|
|
|
|
|
Poorest (<20th percentile)
|
201 (15.9)
|
636 (35.8)
|
0.001
|
238 (15)
|
282 (23.3)
|
0.001
|
167 (26.1)
|
89 (16.6)
|
0.001
|
Poor (20th-39th percentile)
|
156 (12.4)
|
357 (20.1)
|
0.001
|
314 (19.7)
|
284 (23.4)
|
0.021
|
104 (16.4)
|
106 (19.7)
|
0.141
|
Middle (40th-59th percentile)
|
277 (22)
|
353 (19.9)
|
0.164
|
284 (17.9)
|
229 (18.8)
|
0.505
|
120 (18.9)
|
115 (21.4)
|
0.292
|
Rich (60th-79th percentile)
|
331 (26.2)
|
255 (14.4)
|
0.001
|
316 (19.9)
|
234 (19.2)
|
0.684
|
160 (25.2)
|
125 (23.2)
|
0.436
|
Richest (80th-99th percentile)
|
296 (23.5)
|
175 (9.8)
|
0.001
|
438 (27.5)
|
186 (15.3)
|
0.001
|
83 (13.1)
|
102 (18.9)
|
0.006
|
Has health insurance
|
333 (26.4)
|
536 (30.2)
|
0.022
|
--
|
--
|
--
|
--
|
--
|
--
|
I: Intervention; C: Comparison
In all three countries, more than 70% of the women had completed at least primary education, although this proportion was higher in Kenya compared to the other two countries. Approximately one-fourth of the women had access to health insurance in Cambodia, but this was not reported for Kenya or Zambia. Significant differences were evident between comparison and intervention sites for the following variables; male headed households (Kenya and Zambia), mean family size (Cambodia and Kenya), marital status (Kenya), education (Cambodia, Kenya and Zambia), health insurance (Cambodia) and wealth quintile (Cambodia, Kenya and Zambia).
Antenatal and Delivery Care
Characteristics of ANC and delivery care are shown in Table 3. The WHO standard of receiving at least 4 or more facility-based ANC visits was significantly higher in the intervention sites for Cambodia (81.2% vs 58%, p<0.001) and Kenya (70.5% vs 62.7%, p<0.001) but was significantly higher in the comparison sites in Zambia (59.6% vs 73.2%, p<0.001). In Cambodia, the mean month of women’s first ANC visit was the first trimester, whereas women in Kenya and Zambia tended to access ANC during the second trimester.
A composite ANC services index score (maximum score=12) was computed based on the quality of ANC services women received. The average score in all sites in all countries was above 9, except in the comparison site in Cambodia, where the average ANC index score was 7.8. In each country, women had significantly higher ANC services index scores in the intervention compared to the comparison sites. Table 3 shows the various individual ANC services received by women in each country, with significant differences between intervention and comparison sites for some services.
SBA during delivery was significantly higher in the intervention sites in Cambodia (99.1% vs 84.8, p<0.001). While over 90% of women reported SBA during delivery in Kenya and Zambia, there were no significant differences between the intervention and comparison sites. In Cambodia, most women reported SBA from a midwife, while in Kenya and Zambia, majority of women received SBA from a nurse. Among the women who did not have SBA during delivery, the majority had a traditional birth assistant at delivery for Cambodia, whereas in Kenya and Zambia, the majority of those without SBA at delivery obtained care from a relative, friend or neighbor.
Table 3: Characteristics of Antenatal Care and Skilled Birth Attendance of Study Population by Country
Maternal careseeking characteristics
|
Cambodia N= 3,037
|
Kenya N= 2,805
|
Zambia N= 1,171
|
I
N=1261
|
C
N=1776
|
p value
|
I
N=1590
|
C
N=1215
|
p value
|
I
N=634
|
C
N=537
|
p value
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
Antenatal care (ANC)
|
|
|
|
|
|
|
|
|
|
Received ≥4 facility ANC visits
|
997 (81.2)
|
949 (58)
|
0.001
|
1048 (70.5)
|
645 (62.7)
|
0.001
|
321 (59.6)
|
254 (73.2)
|
0.001
|
Month of 1st ANC visit (mean)
|
2.4
|
2.7
|
0.001
|
4.4
|
4.3
|
0.014
|
4.2
|
3.8
|
0.001
|
1st trimester
|
994 (81.4)
|
1187 (73.3)
|
0.001
|
419 (28.8)
|
302 (29.9)
|
0.595
|
165 (30.8)
|
177 (51.1)
|
0.001
|
2nd trimester
|
212 (17.4)
|
391 (24.2)
|
0.001
|
942 (64.7)
|
654 (64.8)
|
0.908
|
356 (66.4)
|
167 (48.3)
|
0.001
|
3rd trimester
|
15 (1.2)
|
40 (2.5)
|
0.013
|
95 (6.5)
|
54 (5.3)
|
0.210
|
15 (2.8)
|
2 (0.6)
|
0.007
|
ANC services received
|
|
|
|
|
|
|
|
|
|
ANC Services Index Score b
|
9.2
|
7.8
|
0.001
|
10.0
|
9.8
|
0.001
|
9.9
|
9.2
|
0.001
|
2 tetanus toxoid vaccination
|
533 (42.5)
|
715 (42.1)
|
0.826
|
420 (27.2)
|
249 (23.6)
|
0.043
|
83 (14.1)
|
95 (18.9)
|
0.034
|
Iron and folic acid
|
1242 (99.1)
|
1638 (96.4)
|
0.001
|
1436 (94.1)
|
776 (71.1)
|
0.001
|
567 (97.4)
|
474 (97.5)
|
0.006
|
Antimalarials
|
19 (1.5)
|
17 (1.0)
|
0.222
|
1094 (71)
|
783 (74.4)
|
0.053
|
568 (96.4)
|
480 (95.8)
|
0.595
|
Weight measurement
|
1172 (93.7)
|
1468 (90.1)
|
0.001
|
1506 (99.3)
|
938 (90.2)
|
0.001
|
577 (99.5)
|
396 (99)
|
0.001
|
Blood pressure measured
|
1222 (97.5)
|
1481 (87.2)
|
0.001
|
1468 (96.8)
|
825 (79.3)
|
0.001
|
539 (92.9)
|
386 (96.5)
|
0.001
|
Urine test
|
671 (53.6)
|
396 (23.3)
|
0.001
|
1355 (89.4)
|
712 (68.4)
|
0.001
|
177 (30.5)
|
175 (43.8)
|
0.651
|
Blood test
|
1072 (85.6)
|
995 (58.6)
|
0.001
|
1327 (87.5)
|
664
(63.8)
|
0.001
|
560 (96.6)
|
383 (95.6)
|
0.001
|
Nutrition advice
|
1184 (94.7)
|
1466 (90)
|
0.001
|
1240 (81.6)
|
809 (78.6)
|
0.063
|
552 (95.3)
|
366 (92)
|
0.038
|
Counseling on pregnancy complications and danger signs
|
1144 (91.3)
|
1359 (80.4)
|
0.001
|
1331 (86.6)
|
813 (77.1)
|
0.001
|
546 (93.5)
|
451 (91.5)
|
0.215
|
Informed about where to go if pregnancy-related complications develop
|
1133 (99.1)
|
1341 (98.1)
|
0.019
|
1328 (99.5)
|
796 (98.2)
|
0.006
|
548 (99.3)
|
453 (99.1)
|
0.790
|
Informed about PMTCTc
|
1048 (84)
|
1260 (74.7)
|
0.001
|
1511 (98.1)
|
1004 (95.8)
|
0.002
|
560 (94.4)
|
490 (98)
|
0.002
|
Offered HIV test
|
1061 (84.7)
|
1139 (67.0)
|
0.001
|
1522 (98.7)
|
1033 (98.1)
|
0.318
|
591 (100)
|
491 (98.4)
|
0.083
|
Delivery care
|
|
|
|
|
|
|
|
|
|
Skilled birth attendance
|
1249 (99.1)
|
1505 (84.8)
|
0.001
|
1460 (92.8)
|
1082 (91.7)
|
0.348
|
593 (94.1)
|
510 (95.3)
|
0.288
|
Doctor
|
157 (12.5)
|
143 (8.1)
|
0.001
|
241 (15.3)
|
215 (18.2)
|
0.043
|
14 (2.2)
|
48 (9.0)
|
0.001
|
Clinical officer
|
0
(0)
|
1 (0.06)
|
0.317
|
245 (15.6)
|
103 (8.7)
|
0.001
|
23 (3.6)
|
66 (12.4)
|
0.001
|
Nurse
|
3 (0.24)
|
6 (0.33)
|
0.608
|
900 (57.2)
|
714 (60.7)
|
0.073
|
490 (77.8)
|
280 (52.2)
|
0.001
|
Midwife
|
1089 (86.4)
|
1355 (76.3)
|
0.001
|
74 (4.7)
|
50 (4.2)
|
0.563
|
66 (10.5)
|
116 (21.7)
|
0.001
|
Unskilled birth attendance
|
12 (0.9)
|
271 (15.2)
|
0.001
|
122 (7.2)
|
107 (8.3)
|
0.348
|
41 (5.9)
|
27 (4.7)
|
0.288
|
Community health worker
|
0
(0)
|
20 (1.1)
|
0.001
|
24 (1.5)
|
10 (0.8)
|
0.098
|
6
(0.9)
|
5 (1.0)
|
0.978
|
Relative/friend/neighbor
|
1 (0.08)
|
5 (0.28)
|
0.174
|
34 (2.2)
|
40 (3.5)
|
0.055
|
19
(3)
|
8 (1.6)
|
0.078
|
Traditional birth assistant (TBA)
|
9 (0.7)
|
235 (13.3)
|
0.001
|
5
(0.3)
|
9 (0.8)
|
0.125
|
9
(1.5)
|
10 (1.9)
|
0.556
|
No one
|
1 (0.08)
|
11 (0.62)
|
0.008
|
50 (3.2)
|
37 (3.1)
|
0.955
|
3
(0.5)
|
1 (0.2)
|
0.385
|
I:Intervention; C: Comparison
a. Facility-based ANC includes: Private or Government facility, clinic, or hospital
b. ANC Services Index calculated by summing the total number of services (out of 12) each woman received during her last pregnancy, giving equal weight to each of the 12 services. Minimum score=0; Maximum score=12.
c. PMTCT: prevention of mother to child transmission of HIV
Community health worker services
In all three countries, a significantly greater proportion of women in the intervention sites compared to comparison sites received at least one visit from a CHW during their last pregnancy (Table 4). The mean number of CHW visits varied between countries. In Zambia, more than 75% of women did not receive any visit from a CHW (76% in intervention sites and 89.9% in comparison sites, p<0.001), while in Cambodia, 70% of the women in intervention sites reported at least 1-2 CHW visits, and 65.5% reported no CHW visits in the comparison sites. In all three countries regardless of treatment site, less than one-fourth of women received 3-4 CHW visits, and less than 5% of women received more than 4 CHW visits during their last pregnancy, except for the intervention sites in Kenya (10.5%). Across all countries, about one third of the CHW visits occurred during the 1st trimester.
Table 4: Components of community health worker (CHW) visits and services by country
|
Cambodia
|
Kenya
|
Zambia
|
Reported CHW Services
|
I
N=1261
|
C
N=1776
|
p value
|
I
N=1590
|
C
N=1215
|
p value
|
I
N=634
|
C
N=537
|
p value
|
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
n(%)
|
n(%)
|
|
CHW visited during last pregnancy
|
896 (71.8)
|
613 (35)
|
0.001
|
864 (55.1)
|
367 (31)
|
0.001
|
157 (24.8)
|
59 (11)
|
0.001
|
Mean Number of CHW visits
|
2.4
|
2.5
|
0.081
|
3.5
|
2.9
|
0.001
|
2.5
|
2.9
|
0.131
|
None
|
364
(29.2)
|
1146 (65.5)
|
0.001
|
769 (49.1)
|
835 (70.5)
|
0.001
|
477 (76)
|
478 (89.9)
|
0.001
|
1-2 visits
|
526 (42.1)
|
352 (20.1)
|
0.001
|
259 (16.6)
|
164 (13.9)
|
0.001
|
76 (12)
|
25 (4.7)
|
0.001
|
3-4 visits
|
321 (25.0)
|
202 (11.5)
|
0.001
|
373 (23.8)
|
144 (12.2)
|
0.001
|
69 (11)
|
22 (4.1)
|
0.001
|
>4 visits
|
46 (3.7)
|
50 (2.9)
|
0.001
|
164 (10.5)
|
40 (3.4)
|
0.001
|
6 (1.0)
|
7 (1.3)
|
0.001
|
Mean month of 1st CHW visit
|
4.6
|
4.1
|
0.001
|
4.4
|
5.0
|
0.001
|
4.9
|
4.5
|
0.213
|
1st trimester
|
295 (33.9)
|
277 (46.6)
|
0.001
|
305 (35.4)
|
81 (22.1)
|
0.001
|
31 (20.1)
|
19 (33.9)
|
0.057
|
2nd trimester
|
422 (48.6)
|
233 (39.2)
|
0.001
|
446 (51.6)
|
214 (58.3)
|
0.032
|
97 (63)
|
26 (46.4)
|
0.036
|
3rd trimester
|
152 (17.5)
|
85
(14.2)
|
0.097
|
112 (13.0)
|
72 (19.6)
|
0.127
|
26
(16.9)
|
11 (19.7)
|
0.419
|
CHW was courteous and respectful
|
888 (99.1)
|
602 (98.7)
|
0.453
|
847 (98.4)
|
358 (98.4)
|
0.978
|
143 (96.6)
|
48 (96)
|
0.845
|
Satisfied with CHW services
|
884 (99)
|
601 (98.4)
|
0.305
|
844 (97.9)
|
339 (93.6)
|
0.002
|
141 (95.9)
|
45 (90)
|
0.202
|
CHW provided counseling during home visits
|
843 (94.9)
|
418 (69.8)
|
0.001
|
813 (97.7)
|
339 (97.4)
|
0.762
|
144 (99.3)
|
47 (88.7)
|
0.020
|
CHW used counseling aids/ storybooks
|
703 (79)
|
153 (25.2)
|
0.001
|
766 (89.1)
|
259 (71.2)
|
0.001
|
136 (90.1)
|
34 (64.2)
|
0.001
|
CHW discussed pregnancy complications
|
692 (77.8)
|
339 (55.6)
|
0.001
|
813 (94.4)
|
322 (88.7)
|
0.002
|
137 (91.3)
|
28 (54.9)
|
0.001
|
CHW provided solutions and
recommendations for woman’s
concerns
|
625 (70.2)
|
336 (55.1)
|
0.001
|
801 (93.3)
|
317 (87.8)
|
0.007
|
136 (90.1)
|
34 (69.4)
|
0.005
|
CHW included influential family
members in pregnancy-related
discussions
|
614 (69.6)
|
342 (56.6)
|
0.001
|
734 (85.7)
|
244 (67.4)
|
0.001
|
138 (91.4)
|
29 (56.9)
|
0.001
|
CHW facilitated woman’s access to ANC
|
551 (92.8)
|
218 (89)
|
0.097
|
711 (95.7)
|
270 (92.8)
|
0.086
|
82 (54.3)
|
22 (84.6)
|
0.751
|
CHW conducted a follow-up visit after referral or visit to a health center
|
600 (77.2)
|
194 (59.1)
|
0.001
|
429 (90.7)
|
260 (89.7)
|
0.641
|
68 (72.3)
|
17 (48.6)
|
0.018
|
I:Intervention; C: Comparison
Over 95% of women in all sites reported that the CHW was courteous and respectful and were satisfied with the CHW services. There were no significant differences between intervention and comparison sites, except in Kenya in terms of CHW service satisfaction, where women from intervention sites reported slightly higher levels of satisfaction (97.9% vs 93.6%, p=0.002). In all three countries, most women reported that CHWs provided counseling during home visits with significant differences between intervention and comparison sites for Cambodia (94.9% vs 69.8%, p<0.001) and Zambia (99.3% vs. 88.7%, p<0.02). CHWs in intervention sites were significantly more likely to use counseling aids and storybooks during their visits, discuss pregnancy complications and danger signs with the woman, and include influential family members in the discussions compared to comparison sites in all three countries. For Cambodia and Kenya, over 90% of women reported that CHWs facilitated their access to ANC, in contrast to Zambia (53.3% in intervention sites and 84.6% in comparison sites). Approximately 90% of the women in the intervention and comparison sites in Kenya reported that CHWs made a follow-up visit after they were referred to or visited a health center, whereas in Cambodia and Zambia, it was lower, 75% and 50% in the intervention and comparison sites.
Regression Analysis
Table 5 shows results from the univariate and multivariate logistic regression analysis. Controlling for other factors, women 24 years or older had significantly greater odds (aOR=1.65; 95% CI: 1.14, 2.39, p<0.01) of receiving SBA in Cambodia. There was no significant association between age and SBA in Kenya and Zambia. Women with primary or secondary education had greater odds of receiving SBA compared to women with no education in Cambodia. Multiparous women compared to primiparous women and those in the wealth quintile equal to or above the 40th percentile compared to women whose wealth was less than the 40th percentile, who were otherwise similar on controlled factors, were significantly more likely to receive SBA. Women in the intervention sites in Cambodia had 7.5 times greater odds (aOR=7.48; 95% CI: 3.87, 14.5) of receiving SBA compared to women in the comparison sites. The reverse was true for Kenya, where women had lower odds of having SBA at delivery in the intervention sites compared to the comparison sites (aOR=0.60; 95% CI: 0.41, 0.85). There was no significant association between the study sites for SBA in Zambia.
Table 5: Multivariate Logistic Regression of Factors Associated with Skilled Birth Attendance by Country
Characteristics
|
Cambodia
|
Kenya
|
Zambia
|
SLR
|
MR
|
SLR
|
MR
|
SLR
|
MR
|
|
OR
|
95%CI
|
aOR
|
95%CI
|
OR
|
95%CI
|
aOR
|
95%CI
|
OR
|
95%CI
|
aOR
|
95%CI
|
Age
|
|
|
|
|
|
|
|
|
|
|
|
|
< 24 yrs (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
>= 24 yrs
|
1.10
|
0.84, 1.45
|
1.65 **
|
1.14, 2.39
|
0.80
|
0.60, 1.08
|
0.94
|
0.65, 1.36
|
0.48 *
|
0.28, 0.84
|
0.75
|
0.32, 1.77
|
Education
|
|
|
|
|
|
|
|
|
|
|
|
|
None (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Primary
|
2.88 ***
|
2.19, 3.79
|
1.96 ***
|
1.44, 2.69
|
1.64
|
0.85, 3.19
|
1.37
|
0.63, 2.97
|
1.78
|
0.86, 3.70
|
1.46
|
0.60, 3.53
|
Secondary +
|
5.02 ***
|
3.48, 7.24
|
2.96 ***
|
1.95, 4.47
|
5.38 ***
|
2.49, 11.63
|
3.61 **
|
1.48, 8.79
|
1.8
|
0.84, 3.85
|
1.31
|
0.49, 3.50
|
Parity
|
|
|
|
|
|
|
|
|
|
|
|
|
Primi (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Multi
|
2.23 ***
|
1.68, 2.97
|
2.31 ***
|
1.59, 3.34
|
1.78 ***
|
1.25, 2.52
|
1.49
|
0.96, 2.32
|
2.20 *
|
1.14, 4.27
|
2.21
|
0.78, 6.26
|
Wealth
|
|
|
|
|
|
|
|
|
|
|
|
|
<40th percentile (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
>= 40th percentile
|
4.70 ***
|
3.52, 6.26
|
2.12 ***
|
1.53, 2.94
|
1.38 *
|
1.05, 1.81
|
1.16
|
0.84, 1.59
|
1.06
|
0.65, 1.75
|
1.08
|
0.57, 2.03
|
Study Arm
|
|
|
|
|
|
|
|
|
|
|
|
|
Comparison (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Intervention
|
18.74 ***
|
10.5, 33.6
|
7.48 ***
|
3.87, 14.5
|
1.18
|
0.90, 1.55
|
0.60 **
|
0.41, 0.85
|
0.76
|
0.46, 1.26
|
0.82
|
0.42, 1.59
|
Facility-based ANC
|
|
|
|
|
|
|
|
|
|
|
|
|
< 4 visits (ref)
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
Ref
|
--
|
>= 4 visits
|
4.48 ***
|
3.52, 5.96
|
1.66 **
|
1.20, 2.29
|
2.88 ***
|
2.18, 3.80
|
1.91 ***
|
1.36, 2.67
|
2.40 ***
|
1.43, 4.00
|
2.53 **
|
1.33, 4.81
|
ANC Indexa (1-12)
|
1.30 ***
|
1.25, 1.35
|
1.13 ***
|
1.08, 1.19
|
1.21 ***
|
1.17, 1.26
|
1.19 ***
|
1.13, 1.24
|
1.16 **
|
1.06, 1.28
|
1.08
|
0.94, 1.23
|
CHW Visits and Services
|
|
|
|
|
|
|
|
|
|
|
|
|
Number of CHW visits
|
1.39 ***
|
1.25, 1.55
|
0.96
|
0.82, 1.12
|
1.08 *
|
1.01, 1.17
|
1.06
|
0.92, 1.21
|
0.93
|
0.77, 1.11
|
0.73
|
0.44, 1.20
|
CHW was courteous
|
2.70 ***
|
2.06, 3.54
|
2.91
|
0.32, 26.7
|
1.22 *
|
1.01, 1.76
|
3.00
|
0.75, 12.1
|
0.74
|
0.40, 1.36
|
5.19
|
0.17, 15.8
|
Satisfied with CHW
|
2.65 ***
|
2.02, 3.47
|
0.31
|
0.03, 2.96
|
1.28
|
0.97, 1.69
|
0.99
|
0.19, 5.13
|
0.73
|
0.40, 1.34
|
0.27
|
0.01, 8.18
|
CHW provided counseling during home visits
|
3.23 ***
|
2.38, 4.38
|
1.06
|
0.61, 1.86
|
1.25
|
0.94, 1.67
|
0.95
|
0.29, 3.31
|
0.80
|
0.43, 1.50
|
0.65
|
0.04, 10.1
|
CHW used counseling aids/story books
|
5.77 ***
|
3.63, 9.15
|
1.58
|
0.79, 3.17
|
1.24
|
0.93, 1.66
|
0.95
|
0.41, 2.19
|
0.78
|
0.41, 1.48
|
0.26
|
0.03, 2.63
|
CHW discussed pregnancy complications
|
3.57 ***
|
2.52, 5.05
|
1.10
|
0.51, 2.35
|
1.23
|
0.93, 1.63
|
0.66
|
0.16, 2.71
|
0.84
|
0.43, 1.63
|
0.17
|
0.01, 3.46
|
CHW provided solutions to concerns
|
2.98 ***
|
2.12, 4.18
|
0.65
|
0.30, 1.41
|
1.23
|
0.93, 1.63
|
0.28
|
0.06, 1.32
|
0.98
|
0.49, 1.96
|
10.5
|
0.72, 15.3
|
CHW included influential family in discussions
|
3.25 ***
|
2.29, 4.62
|
1.69
|
0.92, 3.13
|
1.52 **
|
1.12, 2.06
|
2.12 *
|
1.06, 4.26
|
0.96
|
0.48, 1.92
|
6.78 *
|
1.15,13.9
|
CHW facilitated access to ANC
|
3.23 ***
|
2.18, 4.78
|
0.66
|
0.37, 1.18
|
1.29
|
0.96, 1.74
|
0.70
|
0.33, 1.49
|
1.01
|
0.42, 2.39
|
4.01
|
0.68, 24.8
|
CHW follow up after referral /facility visit
|
6.58 ***
|
3.94, 10.97
|
2.44 ***
|
1.30, 4.60
|
1.85 ***
|
1.28, 2.67
|
2.17 **
|
1.25, 3.75
|
0.56
|
0.26, 1.22
|
1.89 *
|
1.05, 2.02
|
SLR= simple logistic regression; MLR= multivariate logistic regression; OR=odds ratio; aOR=adjusted odds ratio.
ANC Index calculated by summing the total number of services (out of 12) each woman received during her last pregnancy, giving equal weight to each of the 12 services. Minimum score=0; Maximum score=12.
*p<0.05; **p<0.01; ***p<0.001
The odds of SBA were significantly higher for women who received four or more facility-based ANC visits for all three countries controlling for other factors. For Cambodia and Kenya, for every additional ANC service received (i.e., a one-point increase in the ANC Index Score), women were 1.13 times (95% CI: 1.08, 1.19) and 1.19 times (95% CI: 1.13, 1.24) more likely to receive SBA.
Though there was a significant positive dose-effect between the number of CHW visits and delivery with SBA in the univariate analysis for Cambodia and Kenya, this significance was no longer evident in the multivariate analysis. Controlling for other factors, women in Kenya and Zambia had a greater odds of SBA at delivery if the CHW included influential family members in discussions (Kenya aOR=2.12; 95% CI: 1.06, 4.26; Zambia, aOR=6.78; 95% CI: 1.15, 13.9), and in all three countries, if the CHW conducted a follow up visit after a referral to a health care center (Cambodia, aOR=2.44; 95% CI: 1.30, 4.60; Kenya, aOR=2.17; 95% CI 1.25, 3.75; Zambia, aOR=1.89; 95% CI: 1.05, 2.02). Other components of CHW pregnancy-related services were not significantly associated with presence of SBA at delivery in the multivariate analyses.