Effectiveness Of a Community Health Worker-Led Education Intervention on Knowledge, Attitude, and Antenatal Care Attendance of Pregnant Women in Eastern Uganda. A Quasi- Experimental Study

Abstract Background Uganda experiences high maternal mortality ratios, with suboptimal utilization of maternal health services like antenatal care (ANC), especially in rural areas. Community Health Workers (CHWs), known as Village Health Teams (VHTs), have shown the potential to enhance maternal and child health (MCH) outcomes in Uganda by educating pregnant women in the community. However, their training models need to be refined to boost their performance.Objective We evaluated the effectiveness of a contextually tailored educational intervention delivered by VHTs on the knowledge, attitudes, and antenatal care attendance of pregnant women in Eastern Uganda.Methods We performed a quasi-experimental study using a pre-post-intervention evaluation conducted over six months in Eastern Uganda. We included pregnant women in their first trimester who consented to participate and excluded those in later trimesters. We performed multistage sampling with villages randomly selected and participants enrolled by trained VHTs. The VHTs were trained using a Maternal Newborn Child Health curriculum developed by a multidisciplinary team of healthcare professionals. The VHTs delivered educational sessions to the participants during home visits throughout their pregnancy. Data was collected on pregnant women's knowledge, attitudes, and antenatal care attendance before and after the intervention. A score of ≥ 75% was considered sufficient knowledge. The Chi-square test was used to test the difference in the proportional change in knowledge and attitude of pregnant women. A paired two-sample t-test assessed changes in ANC attendance pre- and post-intervention. A p < 0.05 was considered statistically significant.Results 228 participants were included, with a mean age of 27 ± 5.90 years and gravidity of 2.92 ± 1.47. There was a significant improvement in participant proportions with sufficient MCH knowledge (post-intervention: 80.3% versus pre-intervention: 19.6%, p < 0.001). Attitudes towards healthy MCH behaviors improved post-intervention; 98.7% of women agreed that attending eight or more ANC visits is crucial, compared to 88.1% before intervention (p < 0.001). Additionally, 99.6% of participants recognized a health facility as the best place for ANC post-intervention, compared to 89.9% pre-intervention (p < 0.001). The average number of ANC visits significantly increased from 1.22 to 6.38 (p < 0.001).Conclusion Contextually tailored education delivered by trained CHWS significantly improved maternal health knowledge, attitudes, and ANC attendance among pregnant women in rural Uganda.