Abstract:
|
BACKGROUND: There is a need for studies evaluating maternal
health interventions in low-income countries. This paper
evaluates one such intervention designed to promote maternal
health among rural women in Nepal. METHODS AND RESULTS: This was
a five-year controlled, non-randomised, repeated cross-sectional
study (2007, 2010, 2012) of a participatory community-based
maternal health promotion intervention focusing on women's
groups to improve maternal health services uptake. In total
1,236 women of childbearing age, who had their last child =
two years ago, were interviewed. Difference-in-Difference
estimation assessed the effects of the intervention on selected
outcome variables while controlling for a constructed wealth
index and women's characteristics. In the first three years
(from 2007 to the 2010), the intervention increased women's
likelihood of attending for antenatal care at least once during
pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of
taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2;
7.8)], and of seeking four or more antenatal care visits of two
times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)].
Over five years, women were more likely to seek antenatal care
at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic
acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal
care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on
attending antenatal care in the first trimester, birthing at an
institution or with a skilled birth attendant. CONCLUSION:
Community-based health promotion has a much stronger effect on
the uptake of antenatal care and less on delivery care. Other
factors not easily resolved through health promotion
interventions may influence these outcomes, such as costs or
geographical constraints. The evaluation has implications for
policy and practice in public health, especially maternal health
promotion. |