Effect of Community Health Worker Interventions on Antenatal Care Utilization and Facility-Based Delivery in East Africa: A Systematic Review and Meta-Analysis
Abstract:
Local health
workers are often used in low- and middle-income settings to boost maternal
health care, especially in remote settings. But evidence on their effectiveness
in enhancing service use is mixed. This study sought to assess the effect of
community-based approaches on antenatal service utilization and institutional
birth in Kenya, Tanzania, and Uganda. This study used the methodology of
systematic reviews and meta-analysis in line with PRISMA 2020 guidelines. Articles
published between 2015 and 2025 were found via searching PubMed, Scopus, Web of
Science, and Google Scholar, complemented by grey literature. Studies reviewed
assessed the effect of community-based programs on uptake of antenatal care or
giving birth in health facilities. Random-effects models were used to calculate
effect sizes, and the I² statistic was calculated to assess heterogeneity. Fourteen
studies fitted the inclusion criteria (including randomized or
quasi-experimental studies and cohorts). In general, the interventions
exhibited a modest increase in the uptake of antenatal care services, but not
to a statistically significant extent (OR 1.16, 95% CI 0.86 – 1.56; I² = 58.8%).
A similar non-substantial positive trend was observed for facility-based
childbirth (OR 1.56, 95% CI 0.55 – 4.46; I² = 91.7%). The diversity of study
results was likely due to differences in the design and implementation. The
results suggest that community-based strategies likely increase maternal health
service use, especially during pregnancy. But improvements in facility-based
delivery seem to rely on the health system factors. This suggests that a
combination of strategies to improve community-based approaches with better
service accessibility and quality may result in better outcomes in East Africa.
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