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

Kirsten Fagerli Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Katherine O'Connor Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Sunkyung Kim Biostatistics and Information Management Office, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Maureen Kelley Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.

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Aloyce Odhiambo Safe Water and AIDS Project, Kisumu, Kenya.

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Sitnah Faith Safe Water and AIDS Project, Kisumu, Kenya.

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Ronald Otieno Safe Water and AIDS Project, Kisumu, Kenya.

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Benjamin Nygren Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Mary Kamb Division of Sexually Transmitted Infections, Centers for Disease Control and Prevention, Atlanta, Georgia.

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Robert Quick Waterborne Diseases Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

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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.

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

Financial support: 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.

Authors' addresses: Kirsten Fagerli, Katherine O'Connor, Sunkyung Kim, Benjamin Nygren, Mary Kamb, and Robert Quick, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: kfagerli@cdc.gov, ioy6@cdc.gov, wox0@cdc.gov, ghz8@cdc.gov, mlk5@cdc.gov, and rxq1@cdc.gov. Maureen Kelley, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, E-mail: makelle@emory.edu. Aloyce Odhiambo, Sitnah Faith, and Ronald Otieno, Safe Water and AIDS Project, Kisumu, Kenya, E-mails: racksalomex@yahoo.com, sitnahfaith@yahoo.com, and ronotien0@yahoo.com.

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