title: Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use.
abstract: AbstractReducing 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.
authors.affiliation: Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Fagerli
authors.affiliation: Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Katherine
authors.initials: K
authors.lastname: O'Connor
authors.affiliation: Biostatistics and Information Management Office, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Kim
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Maureen
authors.initials: M
authors.lastname: Kelley
authors.affiliation: Safe Water and AIDS Project, Kisumu, Kenya.
authors.forename: Aloyce
authors.initials: A
authors.lastname: Odhiambo
authors.affiliation: Safe Water and AIDS Project, Kisumu, Kenya.
authors.forename: Sitnah
authors.initials: S
authors.lastname: Faith
authors.affiliation: Safe Water and AIDS Project, Kisumu, Kenya.
authors.forename: Ronald
authors.initials: R
authors.lastname: Otieno
authors.affiliation: Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nygren
authors.affiliation: Division of Sexually Transmitted Infections, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Mary
authors.initials: M
authors.lastname: Kamb
authors.affiliation: Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Quick
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene / Q000193:education*; D007630:Kenya; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D009752:Nutritional Status; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012424:Rural Population; D011795:Surveys and Questionnaires; D018508:Water Purification / Q000941:ethics*