Effects of a gender-responsive maternal, newborn and child health program on health and economic outcomes during COVID-19 in Kenya: a mixed-methods study
Notice bibliographique
Résumé
BACKGROUND: The COVID-19 pandemic worsened health and economic disparities for women in resource-limited settings. Chamas for Change (Chamas, Swahili for 'groups with a purpose') is a gender-responsive maternal, newborn and child health program that combines health education with social support and microfinance activities to address systematic disparities in maternal and infant health outcomes. This study evaluated the program's effectiveness in mitigating pandemic-related health and economic inequities in Trans-Nzoia County, Kenya, a region with significant pre-existing vulnerabilities. METHODS: We conducted a mixed-methods study using an explanatory sequential design from March to December 2023. We collected quantitative data from 609 women in 3 cohorts: continuous Chamas participants (n = 128), discontinued (drop-out) participants (n = 240), and women without Chamas exposure (n = 241). We measured maternal health indicators and the Poverty Probability Index (PPI) score as primary outcomes. Quantitative analysis included linear mixed-effects models (unadjusted and adjusted). Qualitative data from focus group discussions and key informant interviews (n = 57) were analyzed using the Gender and COVID-19 Matrix. RESULTS: Continuous Chamas participants achieved significantly higher rates of postpartum visits (OR = 19.54; 95% CI:3.76-101.57) and exclusive breastfeeding (OR = 8.04; 95% CI:1.52-42.43), demonstrating reduced disparities in essential maternal health services. They showed lower health insurance uptake (OR = 0.43; 95% CI:0.22-0.83) and minimal improvements in PPI scores. Qualitative findings revealed that while the pandemic disrupted health services, Chamas membership provided continuity of care through adapted CHW services. However, pandemic-related restrictions limited the program's economic benefits, potentially due to the program's shifted focus toward health service delivery during the crisis, intensifying existing economic inequities. CONCLUSION: The Chamas program effectively sustained maternal and child health practices during the COVID-19 pandemic through adapted CHW support but showed limited ability to protect members from economic hardship. This demonstrates both the resilience and limitations of community-based interventions during widespread crises. Our results highlight the need for robust governmental support and social protection measures to address underlying economic vulnerabilities for women. Future pandemic preparedness should integrate CHWs into formal health systems and focus on strengthening linkages with formal financial systems while supporting CHWs' role in reducing inequities in maternal and newborn health service delivery during crises.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».