Community-led health model improves maternal and child health outcomes in Kenya

In partnership with Lwala Community Alliance (Lwala), VIGH faculty member Troy Moon, M.D., MPH, provided mentorship to Vanderbilt medical student Sarah Heerboth to conduct a study assessing the level of knowledge of obstetric and neonatal danger signs among Community Health Workers (CHW) in rural western Kenya. Lwala centers on a community led health model, transforming traditional birth attendants into CHWs. As shown in this study, Lwala’s model of care and education has connected many mothers to formal health systems, allowing them to be treated throughout their pregnancy and postpartum periods. 

Lwala operates a clinic and hospital in Migori County, Kenya. Their innovative CHW program has connected traditional birth attendants with government health facilities to improve quality of care. By intentionally recruiting all traditional birth attendants regardless of their level of knowledge to their program, Lwala has been able to have a wide-reaching impact on the region. Lwala provides extensive training, supervision and compensation to their workers, to ensure that they can provide high quality care to every mother. Equipped with a mobile device, CHWs can track pregnancies, encourage facility deliveries, ensure on-time immunizations, test and treat common childhood illnesses, provide family planning services, and connect clients to health systems. CHWs continue to provide care and education to mothers and their children until they reach the age of 5 years, as the first 5 years of a child’s life is when they are at greatest risk.  

Sarah Heerboth, under Dr. Moon´s supervision, conducted interviews with CHWs in the North Kamagambo subregion of Migori County, if they had participated in the Lwala program for one year. Additionally, she interviewed CHWs in the East Kamagambo subregion at the beginning of their Lwala training to assess and compare their knowledge of danger signs surrounding pregnancy. They found that CHWs in North Kamagambo, who had already received training from Lwala, were much more knowledgeable at identifying signs of danger during pregnancy, labor and delivery and the post-partum period compared to CHWs in East Kamagambo who had not yet received training from Lwala. Being able to recognize risks in a mother and child not only decreases their chances of dying from childbirth, but also increases knowledge in mothers as they rely on CHWs for health education. 

This study was significant in verifying the impact that Lwala has had on maternal and child health in Kenya. These results suggest that the structure of the Lwala program has led to increased knowledge across the region, which will translate to lower maternal and infant mortality rates. The community led health model fostered by Lwala is a key part of the innovative solutions needed to address this global health issue.  

Knowledge of Obstetric and Neonatal Danger Signs among Community Health Workers in the Rongo Sub-County of Migori County, Kenya: Results of a Community-based Cross-Sectional Survey

DOI: 10.29063/ajrh2020/v24i1.13
Sarah A. Heerboth1 , Cassandra Hennessey2 , Bernard Omondi3 , Meshak Wafula3 , Julius Mbeya3, Ash Rogers4 , Daniele J. Ressler3 , Mario Davidson5 , Troy D. Moon6

Vanderbilt University Medical School, 1161 21st Avenue, Nashville, TN 37232
Vanderbilt University Medical Center, Department of Biostatistics, 2525 West End Avenue Suite 1100, Nashville, TN 372032
Lwala Community Alliance Box 24 Rongo 40404, Kenya
Lwala Community Alliance, PO Box 60688, Nashville, TN 372064
Vanderbilt University Medical Center, Department of Biostatistics, 2525 West End Avenue Suite 1100, Nashville, TN 372035
Vanderbilt Institute for Global Health, Department of Pediatrics, 2525 West End Avenue Suite 750, Nashville, TN 372036 

Photo credit: Sarah Heerboth