Can people-centered community-oriented interventions improve skilled birth attendance? Evidence from a quasi-experimental study in rural communities of Cambodia, Kenya, and Zambia

Abstract Background Skilled attendance at delivery is a key marker for reducing maternal mortality. Effective community engagement strategies complemented by community health worker (CHW) services can improve access to maternal health services in areas with limited health infrastructure or workforce. Methods A quasi-experimental study with matched comparison groups was conducted in Cambodia, Kenya and Zambia to determine the effect of integrated community investments on SBA. In each country, communities in two districts/sub-districts received a package of community-oriented interventions comprised of timed CHW household health promotion for maternal, newborn and child health complemented by social accountability mechanisms using community scorecards. Two comparison districts/sub-districts received ongoing routine interventions. Data from the final evaluation were examined to determine the effect of community-oriented interventions including timed CHW services and SBA. Results Over 90% of the 3,037 women in Cambodia, 2,805 women in Kenya and 1,171 women in Zambia reported SBA. Women in intervention sites who received timely CHW health promotion and social accountability mechanisms in Cambodia and Kenya showed significantly higher odds of SBA (Cambodia, aOR=7.48; 95% CI: 3.87, 14.5, Kenya, aOR=0.60; 95% CI: 0.41, 0.85). The findings also indicated that older women (>24 years), in Cambodia, women with primary or secondary education in Cambodia and Kenya, women from higher wealth quintiles in Cambodia, and women with four or more ANC visits in all countries reported significantly higher odds of SBA. Inclusion of family members in pregnancy-related discussions (aOR=1.69; 95% CI: 0.92, 3.13 in Cambodia; aOR=2.12; 95% CI: 1.06, 4.26 in Kenya; aOR=6.78; 95% CI: 1.15, 13.9 in Zambia), follow up visits from the CHW following a referral or health facility visit (aOR=2.44; 95% CI: 1.30, 4.60 in Cambodia; aOR=2.17; 95% CI 1.25, 3.75 in Kenya; aOR=1.89; 95% CI: 1.05, 2.02 in Zambia) also showed significantly greater odds of SBA. Conclusions Enhancing people-centered care through culturally appropriate community-oriented strategies integrating timely CHW health promotion and social accountability mechanisms shows some evidence for improving SBA during delivery and accelerating the sustainable development goals for maternal child and newborn health.