TY - JOUR
T1 - The impact of a community health worker intervention on uptake of antenatal care
T2 - A cluster-randomized pragmatic trial in Dar es Salaam
AU - Regan, Mathilda
AU - Cheng, Chao
AU - Mboggo, Eric
AU - Larson, Elysia
AU - Lema, Irene Andrew
AU - Magesa, Lucy
AU - Machumi, Lameck
AU - Ulenga, Nzovu
AU - Sando, David
AU - Mwanyika-Sando, Mary
AU - Barnhart, Dale A.
AU - Hong, Biling
AU - Mungure, Ester
AU - Li, Nan
AU - Siril, Hellen
AU - Mujinja, Phares
AU - Naburi, Helga
AU - Kilewo, Charles
AU - Ekstrom, Anna Mia
AU - Geldsetzer, Pascal
AU - Fawzi, Wafaie
AU - Barnighausen, Till
AU - Sudfeld, Christopher R.
AU - Spiegelman, Donna
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - The provision of high-quality antenatal care (ANC) is important for preventing maternal and newborn mortality and morbidity, but only around half of pregnant women in Tanzania attended four or more ANC visits in 2019. Although there is emerging evidence on the benefit of community health worker (CHW) interventions on ANC uptake, few large-scale pragmatic trials have been conducted. This pragmatic cluster-randomized trial, implemented directly through the public sector health system, assessed the impact of an intervention that trained public sector CHWs to promote the uptake of ANC. We randomized 60 administrative wards in Dar es Salaam to either a targeted CHW intervention or a standard of care. The impact of the intervention was assessed using generalized estimating equations with an independent working correlation matrix to account for clustering within wards. A total of 243 908 women were included in the analysis of our primary outcome of four or more ANC visits. The intervention significantly increased the likelihood of attending four or more ANC visits [relative risk (RR): 1.42; 95% confidence interval (CI): 1.05, 1.92] and had a modest beneficial effect on the total number of ANC visits (percent change: 7.7%; 95% CI: 0.2%, 15.5%). While slightly more women in the intervention arm attended ANC in their first trimester compared with the standard-of-care arm (19% vs 18.7%), the difference was not significant (RR: 1.02; 95% CI: 0.84, 1.22). Our findings suggest that trained CHWs can increase attendance of ANC visits in Dar es Salaam and similar settings. However, additional interventions appear necessary to promote the early initiation of ANC. This study demonstrates that routine health system data can be leveraged for outcome assessment in trials and programme evaluation and that the results are likely superior, both in terms of bias and precision, to data that are collected specifically for science.
AB - The provision of high-quality antenatal care (ANC) is important for preventing maternal and newborn mortality and morbidity, but only around half of pregnant women in Tanzania attended four or more ANC visits in 2019. Although there is emerging evidence on the benefit of community health worker (CHW) interventions on ANC uptake, few large-scale pragmatic trials have been conducted. This pragmatic cluster-randomized trial, implemented directly through the public sector health system, assessed the impact of an intervention that trained public sector CHWs to promote the uptake of ANC. We randomized 60 administrative wards in Dar es Salaam to either a targeted CHW intervention or a standard of care. The impact of the intervention was assessed using generalized estimating equations with an independent working correlation matrix to account for clustering within wards. A total of 243 908 women were included in the analysis of our primary outcome of four or more ANC visits. The intervention significantly increased the likelihood of attending four or more ANC visits [relative risk (RR): 1.42; 95% confidence interval (CI): 1.05, 1.92] and had a modest beneficial effect on the total number of ANC visits (percent change: 7.7%; 95% CI: 0.2%, 15.5%). While slightly more women in the intervention arm attended ANC in their first trimester compared with the standard-of-care arm (19% vs 18.7%), the difference was not significant (RR: 1.02; 95% CI: 0.84, 1.22). Our findings suggest that trained CHWs can increase attendance of ANC visits in Dar es Salaam and similar settings. However, additional interventions appear necessary to promote the early initiation of ANC. This study demonstrates that routine health system data can be leveraged for outcome assessment in trials and programme evaluation and that the results are likely superior, both in terms of bias and precision, to data that are collected specifically for science.
KW - antenatal care
KW - health promotion
KW - health services research
KW - Maternal and child health
KW - randomized controlled trial
UR - https://www.scopus.com/pages/publications/85150666464
U2 - 10.1093/heapol/czac100
DO - 10.1093/heapol/czac100
M3 - Article
C2 - 36377764
AN - SCOPUS:85150666464
SN - 0268-1080
VL - 38
SP - 279
EP - 288
JO - Health Policy and Planning
JF - Health Policy and Planning
IS - 3
ER -