Increasing Access to Malaria in Pregnancy Services through Community Health Units and Enhanced Supportive Supervision of Community Health Volunteers

Donald Apat and colleagues address the importance of community health workers and appropriate supervision in their study from Kenya. This was presented today at the 69th Annual Meeting of American Society of Tropical Medicine and Hygiene which is virtual. See their findings below.

According to the 2018 Kenya malaria program review, the uptake of malaria in pregnancy interventions by rural communities in Kenya remains low due to late first presentation to antenatal care (ANC), leading to sub-optimal intermittent preventive treatment in pregnancy (IPTp) coverage. Poor healthcare provider-client communication and low investment in advocacy, communication, and social mobilization contribute to late ANC presentation.

Kenya is using community health volunteers (CHVs) supervised by community health assistants (CHAs) in community health units (CHUs) to increase demand for ANC services and uptake of IPTp but tracking of progress is hampered by a lack of accurate data on the number of estimated pregnancies at the sub-national level and poor household coverage by CHVs at the community level.

In July 2019, Impact Malaria supported malaria-endemic Teso South sub-county of Busia county with the reorientation of 354 CHVs (92%) and 14 CHAs (100%), to identify and track pregnant women at the household level within the government established CHUs, provide social and behavior change communication messages, and enhance monthly supervision and reporting by CHAs.

CHVs identified and tracked 917 pregnant women from 32,758 (89.6%) households and identified and referred 273 ANC defaulters. We compared the uptake of IPTp before intervention (January to June 2019) and during the intervention (July to December 2019) using programmatic and Kenya health information system (KHIS) data.

At pre-intervention, 32,898 (90%) households were visited, with 2,160 new ANC visits and 5,342 ANC revisits. During the intervention period, 35,910 (98.3%) households were visited with 1,934 new ANC visits and 5,904 ANC revisits. Uptake of IPTp1 increased from 83.6% to 92.6%; IPTp2 from 73.5% to 87%; and IPTp3 from 51.9% to 75.4%.

Enhanced supervision of CHVs by CHAs to conduct and improve household visits enabled identification and referral of ANC defaulters and contributed to increased IPTp uptake. Supportive supervision and optimal CHU coverage in tracking pregnant women if conducted routinely may provide accurate denominators to track IPTp coverage and inform targeted interventions.

Authors and Affiliations

Donald Apat1, Willis Akhwale1, Moses Kidi1, Edwin Onyango2, James Andati1, Hellen Gatakaa1, Augustine Ngindu1, Lolade Oseni3, Gladys Tetteh3, Daniel Wacira4
1PMI-Impact Malaria, Nairobi, Kenya, 2Department of Health, Busia County, Kenya, 3Jhpiego, Baltimore, MD, United States, 4PMI, Nairobi, Kenya

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