title: Community health workers to improve antenatal care and PMTCT uptake in Dar es Salaam, Tanzania: a quantitative performance evaluation.
abstract: BACKGROUND
  Home visits by community health workers (CHW) could be effective in identifying pregnant women in the community before they have presented to the health system. CHW could thus improve the uptake of antenatal care (ANC), HIV testing, and prevention of mother-to-child transmission (PMTCT) services.
  
  
  METHODS
  Over a 16-month period, we carried out a quantitative evaluation of the performance of CHW in reaching women early in pregnancy and before they have attended ANC in Dar es Salaam, Tanzania.
  
  
  RESULTS
  As part of the intervention, 213 CHW conducted more than 45,000 home visits to about 43,000 pregnant women. More than 75% of the pregnant women identified through home visits had not yet attended ANC at the time of the first contact with a CHW and about 40% of those who had not yet attended ANC were in the first trimester of pregnancy. Over time, the number of pregnant women the CHW identified each month increased, as did the proportion of women who had not yet attended ANC. The median gestational age of pregnant women contacted for the first time by a CHW decreased steadily and significantly over time (from 21/22 to 16 weeks, P-value for test of trend <0.0001).
  
  
  CONCLUSIONS
  A large-scale CHW intervention was effective in identifying pregnant women in their homes early in pregnancy and before they had attended ANC. The intervention thus fulfills some of the conditions that are necessary for CHW to improve timely ANC uptake and early HIV testing and PMTCT enrollment in pregnancy.
authors.affiliation: *Familia Salama Trial Unit, Management and Development for Health, Dar es Salaam, Tanzania; †Department of Global Health and Population, and Departments of Epidemiology and Biostatistics (D.S.), Harvard School of Public Health, Huntington Avenue, Boston, MA; ‡PMTCT Department, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania; §Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; ‖Department of Infectious Diseases, Karolinska University Hospital, Karolinskavägen, Solna, Stockholm, Sweden; and ¶Wellcome Trust Africa Centre for Health and Population Studies, Mtubatuba, South Africa.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Lema
authors.forename: David
authors.initials: D
authors.lastname: Sando
authors.forename: Lucy
authors.initials: L
authors.lastname: Magesa
authors.forename: Lameck
authors.initials: L
authors.lastname: Machumi
authors.forename: Esther
authors.initials: E
authors.lastname: Mungure
authors.forename: Mary
authors.initials: M
authors.lastname: Mwanyika Sando
authors.forename: Pascal
authors.initials: P
authors.lastname: Geldsetzer
authors.forename: Dawn
authors.initials: D
authors.lastname: Foster
authors.forename: Deborah
authors.initials: D
authors.lastname: Kajoka
authors.forename: Helga
authors.initials: H
authors.lastname: Naburi
authors.forename: Anna M
authors.initials: AM
authors.lastname: Ekström
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Nan
authors.initials: N
authors.lastname: Li
authors.forename: Guerino
authors.initials: G
authors.lastname: Chalamilla
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D005069:Evaluation Studies as Topic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011295:Prenatal Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013636:Tanzania / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents