Effect of Traditional Birth Attendants-Led Health Education Intervention on Selected Maternal and Child Health Promotion Strategies in West Pokot County, Kenya

Abstract

Despite global progress in maternal and child health, disparities persist in resource-limited settings. Between 2000 and 2017, the global maternal mortality ratio declined by 38%, yet sub-Saharan Africa continues to bear a disproportionate burden. In West Pokot County, Kenya, a region characterized by poor infrastructure, challenging terrain, and high fertility rates, over half of all deliveries are managed by traditional birth attendants (TBAs). Skilled birth care (SBC), exclusive breastfeeding (EBF), postpartum family planning (PPFP), and infant vaccination coverage (IVC), which are maternal, newborn and child health (MNCH) strategies remain critically low, contributing to maternal and child morbidity and mortality. This study evaluated the effect of a TBA-led health education intervention on promoting SBC, EBF, PPFP and IVC in West Pokot County, Kenya. A quasi-experimental design was employed with an intervention group (Pokot South Sub-County) and a control group (North Pokot Sub-County). Baseline and end-line surveys were conducted among 408 expectant mothers, who were followed until their infants reached above nine months of age. In the intervention site, 24 TBAs were recruited, trained using an adapted Ministry of Health (MOH) curriculum, and assigned to expectant mothers to provide health education and advocacy for SBC, EBF, PPFP, and IVC. The control group received standard MOH care. Attrition was 13.2% (n=27) in the intervention group and 21.1% (n=43) in the control group, with a total of 338 participants (177 control, 161 intervention) completing the end-line survey. Analysis progressed from bivariate (Pearson's chi-square) to multivariate (binary logistic regression with three hierarchical models). The intervention group demonstrated significantly better outcomes across all four MNCH strategies. For SBC, 81.4% of intervention mothers delivered in a health facility versus 58.2% in the control group (p<0.001). Bivariate analysis yielded an unadjusted odds ratio (UOR) of 3.137 (95% CI: 1.909–5.155), and after controlling for confounders, the adjusted odds ratio (AOR) was 3.180 (95% CI: 1.790–5.651; p<0.001). For EBF, 95.0% of intervention mothers practiced exclusive breastfeeding for six months compared to only 23.3% in the control group (p<0.001). The effect was very large (UOR=62.561; 95% CI: 28.330 138.152; AOR=71.423; 95% CI: 30.247–168.651; p<0.001). For PPFP, 50.3% of intervention mothers were on modern family planning methods versus 13.0% in the control group (p<0.001), with consistent effects (UOR=6.779; 95% CI: 3.966–11.588; AOR=6.514; 95% CI: 3.543–11.976; p<0.001). For IVC, 92.3% of intervention group children were fully immunized per KEPI schedules compared to 37.3% in the control group (p<0.001), with strong effects (UOR=20.200; 95% CI: 10.337–39.474; AOR=13.935; 95% CI: 2.708–71.699; p=0.002). The overall model explained 55.2% of the variance in combined outcomes (R²=0.552, p<0.001). In conclusion, the TBA-led health education intervention significantly improved the utilization of SBC, practice of EBF, use of modern PPFP, and IVC in West Pokot County. The effects ranged from moderate to very large (3-fold for SBC to 71-fold for EBF) and remained significant after controlling for potential confounders. These findings demonstrate that TBAs, when properly trained and recognized, can serve as effective community champions for MNCH strategies (SBC, EBF, PPFP & IVC) in remote, under-resourced settings. The study recommends that the MOH and county governments recognize the role of TBAs as MNCH champions and referral agents rather than birth attendants. Policy reforms should also address barriers such as distance to facilities, low maternal literacy, and male involvement in family planning decisions. Future longitudinal research is warranted to assess the sustainability of these gains over time.