| dc.description.abstract | Background:
Improving maternal, newborn and child health (MNCH) remains an important
global health objective, particularly in developing countries with high rates of maternal and
neonatal mortality. In several countries in Africa, CHWs have played generalist health roles
and findings show that they have widened the coverage of many health services. Community
health workers (CHWs) enhance access, and increase the use of health care services (PHC)
acting as a conduit between patients in need and the required health care services
.
Objective:
To assess the contribution of community health workers to the utilization of
maternal health services among women in Bugangaizi West county, Kakumiro District,
Uganda
.
Methods:
The study was a cross sectional quantitative study supplemented with qualitative
inquiry, conducted among postpartum mothers in Kakindo sub-county, Bugangaizi West
county, Kakumiro District. Kakindo sub-county in Bugangaizi West county was purposively
selected. In the household sampling process, the researcher used the EPI “30x 7” cluster
sampling method to select them. Structured interviews were used to obtain primary data from
the post partum mothers. For the qualitative approach key informant interviews were
conducted to help to solicit for more in depth first hand information and opinions were,
Quantitative data was cleaned, edited, and entered onto Epidata version 3.2 and exported to
SPSS version 16 statistical software for analysis. The key informant data was then coded into
themes independently. They were then analyzed using Nvivo 7 software.
Results:
The results showed that ANC first visit attendance was universal (100%) but four
ANC visits were attended by less than half but most of them (n = 153, 39.8%).
As for delivery service utilization, majority of the women delivered in the health facility (n=
349, 90.9%). As for postnatal care service utilization, the greater proportion of the women
had not gone for postnatal care after child birth (n= 229, 59.6%). Overall, the level of
maternal health service utilization, was found to be 57% (n = 219).
Community health workers had educated more than half of the women on child birth and its
complications in the area, on the importance of giving birth in a health facility was
acknowledged by majority of the women (n = 201, 52.3%), and on antenatal care and its
importance (n = 224, 58.3%).
Exactly half of the women sampled in Kakindo sub county (n = 192, 50%) denied ever being
educated on how to prepare for birth by a community health worker. Majority of the mothers
disagreed with the statement that CHWs had come to their area and educated them about
postnatal care services available after child birth (n = 199, 51.8%) and the holding of general
health education sessions with all women and educating them about the advantages and
disadvantages of TBAs by CHWs (n = 208, 54.2%).
More than half of the women reported that they had been offered general counseling by the
community health workers on how to manage the pregnancy period in terms of health seeking
behavior (n = 288, 64.6%). About half of the women sampled mentioned that they had never
been registered and encouraged to go to health facilities for care during pregnancy by the
community health workers (n = 200, 52%), whereas the same proportion (n = 192, 50%)
agreed that CHWs had been to their area promoting healthy behaviors during pregnancy and
the postpartum period. More than three quarters of the women in Kakindo sub county
disagreed that CHWs in the area accompanied women in labor from their homes to the health
facility (n = 303, 78.9%), and still majority disagreed that CHWs in Kakindo sub county
visited mothers who had just given birth early enough to identify danger signs and refer them
to health facilities as needed (n = 249, 64.8%).Majority of the women in Kakindo Sub County
denied being immunized while pregnant with the tetanus vaccine when the CHW came to the
community (n = 224, 58.3%), and also disagreed to the statement that community health
workers carried out assessments of the women like weight and height (n = 257, 66.9%).
Seven community health worker activities had a statistically significant contribution to the
utilization of maternal health services. They are; education of women on antenatal care and
its importance (X2 = 18.290, p = 0.001), education of the women about postnatal care
services available after child birth (X2 = 10.835, p = 0.028), promotion of healthy behaviors
during pregnancy and the postpartum period (X2 = 10.092, p = 0.039), and the
accompaniment of women in labor from their homes to the health facility (X 2 = 13.220, p =
0.010), visits of mothers who have just gave birth early enough to identify danger signs and
refer them to health facilities as needed (X2 = 16.881, p = 0.002), holding of general health
education sessions with all women and educate them about the advantages and disadvantages
of TBAs (X2 = 11.001, p = 0.027), and assessments of pregnant women for example their
weights, heights (X2 = 15.514, p = 0.006).
Conclusion:
Generally, the measured level of maternal health service utilization in this study
is average however with approximately 6 out of every ten mother utilizing the three major
maternal health services (ANC, SBA, and PNC). There is very low utilization of the four
ANC visits and postnatal care services among the women in Kakindo Sub County. By and
large, community health worker activities have a significant but moderate contribution on the
utilization of maternal health services. It is only the activities related to reproductive health
education, health promotion, accompaniment to the facility for delivery and home visits and
assessment. | en_US |
