Research Shows Positive Impact of Groups for Pregnant Mothers

AMPATH’s community-based health education program for expectant mothers significantly improved maternal, newborn and child health (MNCH) outcomes according to a new research study from AMPATH investigators published in BMJ Global Health.

Women in Chamas for Change (Chamas) groups participate in bi-monthly, group-based health lessons led by a community health volunteer (CHV). The published study of Chamas groups in Trans Nzoia County showed higher rates of facility-based deliveries than a similar control group of mothers that had the standard monthly individual visit from a CHV. Participation in Chamas also showed a significant association between program participation and postpartum visits, exclusive breastfeeding, contraceptive uptake and completion of infant immunizations.

“Chamas offer an innovative approach that leverages existing community infrastructure to improve maternal, newborn and child health in rural, resource-limited settings,” said Laura Ruhl, MD, MPH, executive field director of AMPATH and one of the leaders of AMPATH’s population health effort.

“This trial and other earlier studies support community-based women’s health education groups as an effective strategy for improving facility-based deliveries and other life-saving MNCH practices,” added Dr. Julia Songok, associate Dean, School of Medicine, Moi University.

AMPATH developed the Chamas model for expectant mothers in 2012 and there are now more than 4,300 women active in 341 groups throughout western Kenya. They are an important component of AMPATH’s population health strategy and in addition to health education also include an optional microfinance component to empower women in both health and wealth. The groups typically form during pregnancy and stay to together for 3-4 years. This study included more than 1500 participants randomized to intervention and control groups and was completed prior to the pandemic.

The World Health Organization (WHO) recommends lay health works such as CHVs promote MNCH in resource-limited settings, but data to support the impact of group-based interventions in sub-Saharan Africa is sparse. “Many low- and middle-income countries still face high levels of maternal and infant deaths, despite an overall decline globally over the last three decades,” said Michael Scanlon, assistant director of research for the IU Center for Global Health. “Women in poorer, rural areas in particular have worse outcomes, so it is encouraging that Chamas groups can have a positive impact in these communities,” he added.

Social distancing and other hygiene practices related to the pandemic have posed a significant challenge to our Chamas groups over the last year,” said Justus Elung’at, Chamas program manager at AMPATH. “But despite these challenges, we are supporting pregnant mothers with health messages delivered via text and many groups have developed innovative ways to conduct their business in COVID-safe ways.”

A Chamas staff member from Trans Nzoia added, “I am grateful to our program for the mental health and psycho-social support trainings offered to the staff through Zoom which are crucial in handling the pressure that comes with the current crisis and to support our Chama women.”

This trial was made possible through the generous support of the Saving Lives at Birth (SL@B) partnership. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the SL@B partners or the institutions with which they are affiliated.

AMPATH’s longtime partner AbbVie Foundation provides ongoing support to grow the Chamas program.

Citation: Maldonado LY, Bone J, Scanlon ML, et al. Improving maternal, newborn and child health outcomes through a community-based women’s health education program: a cluster randomised controlled trial in western Kenya. BMJ Global Health 2020;5:e003370. https://gh.bmj.com/content/5/12/e003370.long