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Author Notes:

Address correspondence to Robert Quick, Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329-4018. E-mail: rxq1@cdc.gov

We are grateful to the implementation and research teams of the Safe Water and AIDS Project, and especially to the women who participated in this project with grace and good nature.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.


Research Funding:

This study was made possible by financial support from the Centers for Disease Control and Prevention, the P & G Fund, and the U.S. Agency for International Development.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Public, Environmental & Occupational Health
  • Tropical Medicine

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use


Journal Title:

American Journal of Tropical Medicine and Hygiene


Volume 96, Number 5


, Pages 1253-1260

Type of Work:

Article | Final Publisher PDF


Reducing barriers associated with maternal health service use, household water treatment, and improved hygiene is important for maternal and neonatal health outcomes. We surveyed a sample of 201 pregnant women who participated in a clinic-based intervention in Kenya to increase maternal health service use and improve household hygiene and nutrition through the distribution of water treatment products, soap, protein-fortified flour, and clean delivery kits. From multivariable logistic regression analyses, the adjusted odds of ? 4 antenatal care (ANC4+) visits (odds ratio [OR] = 3.0, 95% confidence interval [CI] = 1.9-4.5), health facility delivery (OR = 5.3, 95% CI = 3.4-8.3), and any postnatal care visit (OR = 2.8, 95% CI = 1.9-4.2) were higher at follow-up than at baseline, adjusting for demographic factors. Women who completed primary school had higher odds of ANC4+ visits (OR = 1.8, 95% CI = 1.1-2.9) and health facility delivery (OR = 4.2, 95% CI = 2.5-7.1) than women with less education. For women who lived ? 2.5 km from the health facility, the estimated odds of health facility delivery (OR = 2.4, 95% CI = 1.5-4.1) and postnatal care visit (OR = 1.6, 95% CI = 1.0-2.6) were higher than for those who lived > 2.5 km away. Compared with baseline, a higher percentage of survey participants at follow-up were able to demonstrate proper handwashing (P = 0.001); water treatment behavior did not change. This evaluation suggested that hygiene, nutritional, clean delivery incentives, higher education level, and geographical contiguity to health facility were associated with increased use of maternal health services by pregnant women.

Copyright information:

© 2017 by The American Society of Tropical Medicine and Hygiene.

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