Factors associated with facility childbirth and skilled birth attendance in Migori County, Kenya and the effect of Lwala Community Alliance intervention: a cross-sectional assessment from the 2019 and 2021 Lwala household surveys.

IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Frontiers in global women's health Pub Date : 2024-09-19 eCollection Date: 2024-01-01 DOI:10.3389/fgwh.2024.1426264
Christina Hope Lefebvre, Joseph R Starnes, Aleksandra Jakubowski, Alyn Omondi, Janet Manyala, Jane Wamae, Ash Rogers, Sandra Mudhune, Vincent Okoth, Vincent Were, Julius Mbeya, Samantha V Yap, Philip Omondi, Willys Ochieng, Tom Odhong, Carren Siele, Richard Wamai
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Abstract

Background: Despite evidence of the beneficial effects of skilled birth attendance (SBA) on maternal health and childbirth outcomes, there are disparities in access across counties in Kenya. These include Migori County which has historically recorded high maternal mortality rates. In 2007, the Lwala Community Alliance was founded to improve health outcomes in this county. The objective of this study is to provide a baseline status of facility childbirth and SBA in Migori and to characterize the effect of Lwala intervention on these outcomes.

Methods: A cross-sectional household survey was designed for a 10-year study to evaluate the effectiveness of Lwala initiatives. The 2019 and 2021 household surveys were conducted in Lwala intervention wards and in comparison wards with sample sizes of 3,846 and 5,928 mothers, respectively. The survey captured demographic, health, and socioeconomic data at each household, data on SBA and facility childbirth, and explanatory variables. A generalized linear model was used to determine factors associated with SBA. A secondary trend analysis was conducted to determine change over time in the explanatory variables and SBA. To determine the change in SBA rate due to Lwala intervention, controlling for background temporal trends, a difference-in-differences (DiD) model compared SBA rates in intervention wards and comparison wards.

Results: SBA increased in all surveyed wards and across all explanatory variables from 2019 to 2021. The DiD analysis showed that the SBA rate increased more in Lwala intervention wards than in comparison wards (Adjusted Prevalence Rate Ratio 1.05, p < 0.001, 95%CI 1.03-1.08). The 2021 survey found the highest rates of both facility childbirths (97.9%, 95%CI 96.5-98.7) and SBA (98.2%, 95%CI 97.0-99.0) in North Kamagambo, the oldest ward of Lwala intervention. Higher educational status, four or more ANC visits, marriage/cohabitation, and wealth were significantly associated with increased SBA.

Conclusions: We provide the first quasi-experimental evidence that Lwala interventions are significantly improving SBA which may inform related initiatives in similar settings. The household-survey data provides a baseline for continued evaluation of Lwala programs, and the breakdown by ward allows for development of specific programmatic targets.

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肯尼亚米戈里县设施分娩和熟练助产护理的相关因素以及 Lwala 社区联盟干预措施的效果:2019 年和 2021 年 Lwala 家庭调查的横断面评估。
背景:尽管有证据表明熟练助产护理(SBA)对孕产妇健康和分娩结果有益处,但肯尼亚各县在助产护理方面仍存在差距。其中,米戈里县的孕产妇死亡率一直居高不下。2007 年,Lwala 社区联盟成立,旨在改善该县的健康状况。本研究的目的是提供米戈里的设施分娩和SBA的基线状况,并描述Lwala干预对这些结果的影响:方法:为评估 Lwala 计划的效果,设计了一项为期 10 年的横断面家庭调查。2019年和2021年的家庭调查分别在Lwala干预区和对比区进行,样本量分别为3846名和5928名母亲。调查收集了每个家庭的人口、健康和社会经济数据、SBA 和设施分娩数据以及解释变量。采用广义线性模型来确定与 SBA 相关的因素。为确定解释变量和 SBA 随时间的变化,进行了二次趋势分析。为确定 Lwala 干预措施对 SBA 发病率的影响,在控制背景时间趋势的情况下,采用差分(DiD)模型比较了干预病房和对比病房的 SBA 发病率:从 2019 年到 2021 年,在所有调查病房和所有解释变量中,SBA 都有所增加。DiD 分析表明,Lwala 干预病房的 SBA 患病率高于对比病房(调整患病率比值为 1.05,p 结论:我们提供了第一份关于 SBA 患病率的准前瞻性分析:我们提供了第一个准实验证据,证明 Lwala 干预措施正在显著改善 SBA,这可能会为类似环境中的相关举措提供参考。家庭调查数据为继续评估 Lwala 计划提供了基线,而按选区分列的数据则有助于制定具体的计划目标。
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