Publication: Assessing the Influence of Community Health Workers on Uptake of Maternal Health Services in Musanze District, Northern Province, Rwanda
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2023-01
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Mount Kenya University
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Abstract
Background: Community-based initiatives are a worldwide policy that guarantees that key health services are available and accessible closer to the community. CHWs are an important element of healthcare services in Rwanda. Community health workers integrate individuals of their communities to provide preventive, habitual, and emergency maternity healthcare requirements. The aim of this research was to assess the influence of community health workers ' on the uptake of maternal health services in Musanze District. Methods: The study design used was an analytical cross-sectional study design utilizing both quantitative and qualitative methods. This research was cross-sectional because it examined the exposure and outcome at a time. In this study, a simple random sample approach was employed to choose 208 CHWs and 16 CHWs’ supervisors were interviewed for qualitative data (KII). The statistical tool for social sciences (SPSS) Version 26, was used to examine the data. Categorical variables were summarized with descriptive statistics for frequencies and percentages. Bivariate analysis with the Chi-square test of independence was used to check the association between both dependent and independent variables. Ordinal logistic regression was used as the most suitable inferential statistic because the predictor variables and the dependent were ordinal variables. Qualitative data were analyzed by NVIVO version 10. CHWs 208 participated in the study and all were female. Results: This study found that the uptake of maternal health services was regarded as very high. Among those services, deliveries at the Health Facility were at 73.6%, Antenatal care at 65.9%, Family planning at 54.3%, and the rate of Postnatal care was at 45.7%. The results also showed that Sending red Alert SMS by CHWs for pregnant mothers’ emergencies by CHWs towards maternal health services with chi-square test result p* =.001. CHWs' enrolment of girls and ladies of reproductive were significant with p* =.011. CHWs' follow-up to the pregnant has improved maternal health services with chi-square p* =.001). Health education has improved maternal health services where chi-square test was significant with p* =.014. This study assessed the influence of sociodemographic factors on uptake of maternal health services, level of education with p* <.001 , and working experience p* = .005 were associated with uptake of maternal health services. 85.1% of CHWs were knowledgeable on the warning signs of an emergency among pregnant mothers, and 89.4% reported that they would act based on these warning signs. CHWs had necessary training to provide care to pregnant mothers with p* =.001.Skills that CHWs have on administration of misoprostol to prevent post-partum hemorrhage was significant with p* <.001. Factors that influenced uptake of maternal health services were CHW’s regular supervision with p*=.001, provision of transportation p*=.001, regular refresher training p* =.002, and motivation/incentives p*=.001, as they were associated with the performance of CHWs towards uptake of Maternal Health care services. The research recommends improvement of maternal health services through access to contraception, antenatal care, and postnatal care, with particularly scale-up key motherly health services, regular training and supervision for CHWs, governmental support in terms of motivations of CHWs