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

• Authors: Kirsten Fagerli, Centers for Disease Control and Prevention; Katherine O'Connor, Centers for Disease Control and Prevention; Sunkyung Kim, Centers for Disease Control and Prevention; Maureen Kelley, Emory University; Aloyce Odhiambo, Safe Water and AIDS Project; Sitnah Faith, Safe Water and AIDS Project; Ronald Otieno, Safe Water and AIDS Project; Benjamin Nygren, Centers for Disease Control and Prevention; Mary L. Kamb, Emory University; Robert Quick, Centers for Disease Control and Prevention
• Journal Title: American Journal of Tropical Medicine and Hygiene
• Volume: Volume 96, Number 5
• Publisher: American Society of Tropical Medicine and Hygiene | 2017-05-03, Pages 1253-1260
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4269/ajtmh.16-0709
• Subjects: Health Sciences, Hygiene; Health Sciences, Nutrition; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Tropical Medicine; QUALITY-OF-CARE; ANTENATAL CARE; DRINKING-WATER; WESTERN KENYA; RURAL KENYA; MOTHERS; MALAWI; WOMEN; INCENTIVES; PRODUCTS

Abstract

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.