DOI: 10.6084/m9.figshare.30600590.v1
title: Empowering Community Health Workers to Transform Maternal Care in Uganda’s Lake Victoria Fishing Communities.

description: <br>Uganda is still having a high number of women dying from pregnancy and childbirth-related complications despite reductions over the past two decades. Most of these deaths are due to preventable causes, including excessive bleeding after childbirth, hypertensive disease complications, infections following childbirth or termination of pregnancy, obstructed labor, complications following cesarean section births, and HIV/AIDS related complications, among others.<br>Innovative context-specific maternal health improvement strategies are still urgently needed to reduce the number of women dying from pregnancy and childbirth-related complications to the UN SDG 3 target of less than 70 per 100,000 live births within the subsequent eight years.<br>There are maternal health improvement strategies that have already proven to be effective in reducing maternal deaths elsewhere, including access to skilled ANC, skilled childbirth attendance and post-natal care, and access to contraceptive services.<br>However, there are still a lot of contextual factors hampering access to women’s skilled attendance at ANC, birth, and postnatal care. These multiple interrelated factors include poor health infrastructure, limited awareness, demand for skilled attendance during childbirth, limited funding for maternal health care, and shortages of professional personnel at health facilities.<br>Access to skilled maternal health personnel is still a serious challenge in Uganda, more so in the rural, hard-to-reach maternal health personnel is still a serious challenge in Uganda, more so in the rural, hard to reach<br>locations, which affects women’s access to skilled maternal health providers. There are only 14.2 SBAs (Doctor, Nurse, and Midwife), per 10,000 people, far below the WHO’s sustainable development recommendation of 44.5 per 10,000 people.<br>There is also a mal-distribution of the few SBAs, with more numbers working in health facilities serving urban populations than in rural, hard-to-reach fishing communities. Fishing communities on Lake Victoria, Uganda, being rural, hard-to-reach, have a shortage of SBAs, with 16.4 SBAs per 10,000 people, still low compared to the WHO target for sustainable development. The shortage of skilled health workers contributes to the high number of women dying from pregnancy and childbirth complications, though estimates for these communities are not available.<br>Primary health care improvement is one of the most cost-effective ways of reducing maternal morbidity and mortality, if appropriately linked to higher levels of care, through the health care system. Intensified involvement of CHWs who are part of Uganda’s health care system and have already shown a positive impact on maternal health behaviors in hard-to-reach areas was postulated to improve fishing communities’ maternal health risk perception and behavior.<br>The use of CHWs to promote behaviors and services for maternal and child health was found to be effective in reducing health inequalities, improving access to maternal-child health, and helping extend care to underserved populations.<br>The project's overall aim was to examine the role of a CHWs intervention in improving ANC, skilled<br>birth attendance, uptake of household-based HTC, anemia testing, and blood pressure monitoring among women, amidst the shortage of skilled birth attendants that Lake Victoria, Uganda, fishing communities are facing.<br>Reproductive age women (243 in the intervention, 243 in the control group) from six island fishing communities reporting childbirth or pregnancy outcomes during the past six months were enrolled in a quasi-experimental prospective observational cohort over 18 months to evaluate the effect of the intervention (CHWs counseling on maternal health, household-based measurement of blood pressure, testing for anemia, and HIV) on ANC and childbirth attendance. I used quantitative survey data collection tools to achieve the study objectives. The study was conducted from 2018 to 2020.<br><br>