Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

Abstract

Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ≥ 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ≤ 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing ( = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.

Integrating nutrition into health systems: What the evidence advocates

“…Search results: We identified 13,843 titles in our search and after abstract and full‐text screening and cross referencing; we included 45 papers that met the inclusion criteria. Studies ranged from randomized, controlled trials to qualitative studies (Aguayo et al, ; Amadi et al, ; Anand, Luman, & O'Connor, ; Arifeen et al, ; Armstrong et al, ; Baqui et al, ; Berti, Mildon, Siekmans, Main, & MacDonald, ; Bhandari, Mazumder, Taneja, Sommerfelt, & Strand, ; Brits et al, ; Bryce et al, ; Ching, Birmingham, Goodman, Sutter, & Loevinsohn, ; Deconinck et al, ; Doherty et al, ; El Arifeen et al, ; Fagerli et al, ; Fernandez‐Rao et al, ; Friedman & WoLFheim, ; Gowani, Yousafzai, Armstrong, & Bhutta, ; Grellety et al, ; Grossmann et al, ; Guyon et al, ; Hodges et al, ; Klemm, Villate, Tuazon‐Lopez, & Ramos, ; Kouam et al, ; Masanja et al, ; Mazumder et al, ; Miller et al, ; Nguyen et al, ; Palmer, Diaz, Noordam, & Dalmiya, ; Parikh et al, ; Puett, Alderman, Sadler, & Coates, ; Puett, Coates, Alderman, & Sadler, ; Rasanathan et al, ; Ropero‐Álvarez, Kurtis, Danovaro‐Holliday, Ruiz‐Matus, & Tambini, ; Sadler, Puett, Mothabbir, & Myatt, ; Saiyed & Seshadri, ; Schellenberg et al, ; Singh et al, ; Sivanesan, Kumar, Kulkarni, Kamath, & Shetty, ; Tadesse et al, ; Tandon, ; Taneja et al, ; Yousafzai, Rasheed, Rizvi, Armstrong, & Bhutta, ). Data S1, Figure S1 depicts the search flow diagram, and the quality of the included studies are described in Data S1, Figure S2.…”

“…For integrated nutrition and other programmes (programmes that could not be categorized in the above categories and integrated nutrition‐specific interventions, including promotion of breastfeeding and appropriate complementary feeding, feeding practices, growth monitoring, supplementary nutrition, vitamin A supplementation, home fortification, screening and management for malnutrition into existing community health setups, and maternal, newborn, and child health centres and clinics), we could not pool any of the outcomes. Among nutrition‐specific outcomes, the India programme showed significantly improved early initiation of breastfeeding (OR: 2.04, 95% CI [1.20, 3.45]) and exclusive breastfeeding (OR: 0.61, 95% CI [0.36, 1.03]; Singh et al, ), and programmes for Kenya and Bangladesh suggested significantly higher intervention coverage for vitamin A supplementation, paediatric iron folic acid supplementation, and supplementary nutrition (Fagerli et al, ; Nguyen et al, ). The Kenya programme also reported significant increase in the exclusive breastfeeding rates from baseline to end line, as well as improved antenatal visits, health facility delivery, and postnatal visits (Fagerli et al, ).…”

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

“…If it is a boy, mothers are more likely to practice cord-care-related behaviours that, while posing a health risk, respond to their heightened desire to nurture [50] Two studies provided information on the determinants of use of maternal health services in Kenya and India. In these studies, clean birthing practices are measured as outcomes associated with accessing maternal health services; however, the mechanisms through which this occurs are not articulated [52,53].…”

“…This intervention design implies that the barriers to adoption of clean birthing practices are insufficient knowledge and inadequate access to necessary materials. One intervention distributed materials (including soap and clean delivery kits) at ANC visits, and these products were found to successfully incentivise mothers to obtain ANC, suggesting the importance of motivational determinants [52]. Four studies (4/15) described interventions that included a community engagement component in addition to the standard educational messaging to mother or TBA.…”

The Impact of Supply-side and Demand-side Interventions on Use of Antenatal and Maternal Services in Western Kenya: A Qualitative Study

“…Supply-side determinants include the availability of healthcare providers, staff training, and medical supplies [7][8][9][10][11]. Demand-side determinants include cost, household wealth levels, maternal education, previous experience of obstetric complications, previous experiences at health care facilities, physical access to healthcare facilities, infectious disease testing, and cultural beliefs on pregnancy [9][10][11][12][13][14][15][16]. In western Kenya, monitoring fetal position, offering vaccinations, and providing medications were found to be major facilitators for ANC visits while clinic staff's negative attitudes and behaviors, long waiting times for services, and cost were identi ed as barriers [13].…”