Skip to main content

Main menu

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Special Collections
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Tips for Writing About Programs in GHSP
      • Local Voices Webinar
      • Connecting Creators and Users of Knowledge
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Content
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • Special Collections
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Tips for Writing About Programs in GHSP
    • Submit Manuscript
    • Publish a Supplement
    • Promote Your Article
    • Resources for Writing Journal Articles
  • About
    • About GHSP
    • Editorial Team
    • Advisory Board
    • FAQs
    • Instructions for Reviewers
  • Alerts
  • Find GHSP on LinkedIn
  • Visit GHSP on Facebook
  • RSS
ORIGINAL ARTICLE
Open Access

Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India

Peter Smittenaar, B.M. Ramesh, Mokshada Jain, James Blanchard, Hannah Kemp, Elisabeth Engl, Shajy Isac, John Anthony, Ravi Prakash, Vikas Gothalwal, Vasanthakumar Namasivayam, Pankaj Kumar and Sema K. Sgaier
Global Health: Science and Practice September 2020, 8(3):358-371; https://doi.org/10.9745/GHSP-D-20-00027
Peter Smittenaar
aSurgo Foundation, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
B.M. Ramesh
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mokshada Jain
aSurgo Foundation, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
James Blanchard
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hannah Kemp
aSurgo Foundation, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elisabeth Engl
aSurgo Foundation, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shajy Isac
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
cIndia Health Action Trust, Lucknow, Uttar Pradesh, India.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John Anthony
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
cIndia Health Action Trust, Lucknow, Uttar Pradesh, India.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ravi Prakash
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
cIndia Health Action Trust, Lucknow, Uttar Pradesh, India.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Vikas Gothalwal
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
cIndia Health Action Trust, Lucknow, Uttar Pradesh, India.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Vasanthakumar Namasivayam
bCentre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Pankaj Kumar
dNational Health Mission, Government of Uttar Pradesh, Lucknow, Uttar Pradesh, India.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sema K. Sgaier
aSurgo Foundation, Washington, DC, USA.
eDepartment of Global Health & Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
fDepartment of Global Health, University of Washington, Seattle, WA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: semasgaier@surgofoundation.org
PreviousNext
  • Article
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • Additional Files
  • FIGURE 1.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1.

    (A) Number of CHW Home Visits to Each Womana; (B) Month of Pregnancy in Which First Visit Was Receivedb; (C) Rate of CHW Presence at Birthc; (D) Distribution of Hours Present Before and After Deliveryd; (E) Number of CHW Home Visits in the First Week After Deliverye

    Abbreviations: ANC, antenatal care; CHW, community health worker; PNC, postnatal care.Each y-axis represents the percentage of women receiving a particular level of service from their CHW, weighted to be representative of rural Uttar Pradesh.a N=5,469 women.b For the 84% of women that received at least 1 visit (n=4,541 women).c Dashed line shows the average across all births (n=5,469 women).d For the 57% of women that had the CHW present for any part of delivery, hours present as recollected by the woman (n=3,071).e n=5,383 women.

  • FIGURE 2.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2.

    Estimated Relationships Between Health Behaviors and (A) Number of CHW Home Visits and (B) Timing of First Home Visit

    Abbreviations: ANC, antenatal care; CHW, community health worker; IFA, iron and folic acid.Only significant associations are shown, see Table 1 for all associations. All means are estimated marginal proportions adjusted for covariates.a n=5,438 women.b n=4,541 women, excluding those who received no visit.

  • FIGURE 3.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3.

    (A) Increase in Health Behavior if Household Member Reported Having Talked to CHW About the Particular Behaviora; (B) Percentage of CHW Workforce That Has Ever Used Each Type of Message When Convincing Households to Attend Checkupsb; (C) Percentage of CHW Workforce That Has Ever Used Each Type of Message When Convincing Households to Deliver in Facilityc; (D) Predicting Whether a Woman Attended 3+ Checkups Based on the Preferred Behavior Change Message of the CHWd; (E) Predicting Whether a Woman Had an ID Based on the Preferred Behavior Change Message of the CHWe

    Abbreviations: ANC, antenatal care; CHW, community health worker; ID, institutional delivery; IFA, iron and folic acid; MIL, mother-in-law; VHND, village health nutrition day.All rates represent adjusted means, including covariates for several indicators of CHW quality and performance. * Indicates P<.05 compared to the reference.a Expressed as absolute increase with 95% confidence intervals (percentage points) based on regression. n=2,057 households that received CHW visit and had woman, husband, and MIL interviewed.b Self-reported in the CHW survey. n=1,318 CHWs that had at least 1 household receiving a visit from them in the data.c n=1,318 CHWs.d The most commonly preferred message is used as reference, and differences represent absolute changes in the rate of behavior. n=4,134 women.e N=4135 women.

  • FIGURE 4.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4.

    (A) Relationship Between Outcomes and CHW Presence at Birth Irrespective of Location of Deliverya; (B) Relationship Between Outcomes and CHW Presence at Birth by Location of Deliveryb; (C) Association of CHW’s Awareness of Delayed Bathing and Practice of Delayed Bathing When CHW Was Absent or Presentc; (D) Rate of Different Forms of Poor Treatment at Public Facility Deliveries When the CHW Was Absent or Presentd

    Abbreviations: BF, breastfeeding; CHW, community health worker.a N=5,240 women. * Indicates statistical significance at P<.05.b N=984 women at home, 1068 at private, 3123 at public.c N=4831 women.d N=3244 women. Error bars represent 95% CI.

  • FIGURE 5.
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 5.

    (A) Association of Number of PNC Visits With Rate of Exclusive Breastfeeding and Clean Cord Carea; (B) Increase in Health Behavior if Household Member Reported Having Talked to CHW About the Particular Behaviorb

    Abbreviations: BF, breastfeeding; CHW, community health worker; MIL, mother-in-law; PNC, postnatal care.a N=5,185 women.b N=2,057 households. Error bars represent 95% confidence interval.

Tables

  • Figures
  • Additional Files
    • View popup
    TABLE.

    Regression Results for CHW Actions in Uttar Pradesh, India.

    CHW actionAny Antenatal Home VisitNumber of Antenatal HomeVisitsaTiming of First Antenatal Home VisitaPresent for Any Part of DeliveryHours Present (Before + After)bPre- vs Postpartum Hours (After - Before)bAny Home Visit in First Week After DeliveryNumber of Home Visits in First Week After Deliveryc
    Adjusted Odds Ratiod (95% CI); P value
    Antenatal
    Received 3+ checkups2.22
    (1.90, 2.59)
    P<.001
    1.14
    (1.11, 1.17)
    P<.001
    1.10
    (1.06, 1.15)
    P<.001
    Consumed 100+ IFA1.11
    (0.9, 1.37)
    P=.35
    1.05
    (1.01, 1.09)
    P=.007
    1.07
    (1.01, 1.13)
    P=.03
    Delivery
    Delivered in facility2.20
    (1.85, 2.61)
    P<.001
    1.09
    (1.05, 1.14)
    P<.001
    1.05
    (0.99, 1.10)
    P=.08
    Respectful care1.55
    (1.14, 2.07)
    P=.004
    1.01
    (0.99, 1.03)
    P=.31
    1.01
    (0.99, 1.04)
    P=.29
    Stayed at
    facility for 24+ hours
    0.98
    (0.78, 1.23)
    P=.84
    1.01
    (0.97, 1.05)
    P=.72
    1.02
    (0.82, 1.27)
    P=.84
    Postnatal
    Early initiation breastfeeding1.21
    (1.00, 1.45)
    P=.04
    0.99
    (0.96, 1.02)
    P=.59
    1.32
    (1.12, 1.56)
    P=.001
    1.00
    (0.99, 1.01)
    P=.84
    1.00
    (0.98, 1.01)
    P=.60
    Delayed
    bathing 72+ hours
    1.55
    (1.30, 1.86)
    P<.001
    1.08
    (1.04, 1.11)
    P<.001
    0.95
    (0.81, 1.12)
    P=.57
    1.00
    (1.00, 1.01)
    P=.76
    1.01
    (0.99, 1.02)
    P=.31
    Exclusively breastfed0.99
    (0.84, 1.18)
    P=.95
    1.01
    (0.98, 1.05)
    P=.39
    1.24
    (1.06, 1.45)
    P=.008
    1.00
    (0.99, 1.00)
    P=.46
    1.01
    (0.99, 1.02)
    P=.37
    1.44
    (1.25, 1.66)
    P<.001
    1.21
    (1.08, 1.36)
    P=0.001
    Clean cord care1.00
    (0.78, 1.29)
    P=.99
    1.07
    (1.03, 1.12)
    P<.001
    1.19
    (0.96, 1.49)
    P=.11
    1.00
    (1.00, 1.01)
    P=.12
    0.99
    (0.98 1.01)
    P=.43
    1.40
    (1.14, 1.73)
    P=.002
    1.56
    (1.37, 1.77)
    P<.001
    • Abbreviations: CHW, community health worker; CI, confidence interval; IFA, iron and folic acid.

    • ↵a Women with 1+ antenatal home visit only.

    • ↵b Women with community health worker presence only.

    • ↵c Women with 1+ postnatal home visit within first week after birth only.

    • ↵d An adjusted odds ratio (aOR) greater than 1 means the household behavior was more likely. Each aOR is from a separate regression with appropriate covariates depending on the relationship being estimated, including corrections for demographics, parity, location of delivery, and other CHW actions.

Additional Files

  • Figures
  • Tables
  • Supplemental material

    • Supplement 1 -

      Supplement 1

    • Supplement 2 -

      Supplement 2

    • Supplement 3 -

      Supplement 3

    • Supplement 4 -

      Supplement 4

    • Supplement 5 -

      Supplement 5

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 8 (3)
Global Health: Science and Practice
Vol. 8, No. 3
September 30, 2020
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India
Peter Smittenaar, B.M. Ramesh, Mokshada Jain, James Blanchard, Hannah Kemp, Elisabeth Engl, Shajy Isac, John Anthony, Ravi Prakash, Vikas Gothalwal, Vasanthakumar Namasivayam, Pankaj Kumar, Sema K. Sgaier
Global Health: Science and Practice Sep 2020, 8 (3) 358-371; DOI: 10.9745/GHSP-D-20-00027

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Bringing Greater Precision to Interactions Between Community Health Workers and Households to Improve Maternal and Newborn Health Outcomes in India
Peter Smittenaar, B.M. Ramesh, Mokshada Jain, James Blanchard, Hannah Kemp, Elisabeth Engl, Shajy Isac, John Anthony, Ravi Prakash, Vikas Gothalwal, Vasanthakumar Namasivayam, Pankaj Kumar, Sema K. Sgaier
Global Health: Science and Practice Sep 2020, 8 (3) 358-371; DOI: 10.9745/GHSP-D-20-00027
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • ABSTRACT
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSION
    • Acknowledgments
    • Funding
    • Competing interests
    • Notes
    • REFERENCES
  • Figures & Tables
  • Supplements
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • How do psychobehavioural variables shed light on heterogeneity in COVID-19 vaccine acceptance? Evidence from United States general population surveys on a probability panel and social media
  • Improving Community Health Worker Compensation: A Case Study From India Using Quantitative Projection Modeling and Incentive Design Principles
  • [We] learned how to speak with love: a qualitative exploration of accredited social health activist (ASHA) community health worker experiences of the Mobile Academy refresher training in Rajasthan, India
  • Google Scholar

More in this TOC Section

  • People that Deliver Theory of Change for Building Human Resources for Supply Chain Management: Applications in sub-Saharan Africa and Southeast Asia
  • Exploring the Role of Gender in the Public Health Supply Chain Workforce in Low- and Middle-Income Countries
  • Applying a Theory of Change for Human Resources Development in Public Health Supply Chains in Rwanda
Show more ORIGINAL ARTICLE

Similar Articles

Subjects

  • Cross-Cutting Topics
    • Health Workers
  • Health Topics
    • Maternal, Newborn, and Child Health
Johns Hopkins Center for Communication Programs

Follow Us On

  • LinkedIn
  • Facebook
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers

About

  • About GHSP
  • Advisory Board
  • FAQs
  • Privacy Policy
  • Contact Us

© 2025 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire