Community-based health education led by women’s groups significantly improved maternal health service utilization in southern Ethiopia: A cluster randomized controlled trial

Abstract

Abstract Introduction: Maternal health service utilization (MHSU) is cost-effective to reduce maternal mortality. One of the methods to increase its utilization is via health education intervention (HEI). Yet, the impact of HEI on MHSU had not been comprehensively investigated, and previous studies reported controversial findings. Thus, this study aimed to evaluate the effect of HEI on MHSU in southern Ethiopia. Methods: From January 10 to August 1, 2023, a community-based, two-arm, parallel-group cRCT was conducted among pregnant mothers in the Northern Zone of Sidama National Regional State, Ethiopia. Pregnant mothers < 12 weeks of gestation were eligible for this study. The pregnant women in treatment clusters (kebeles) received standard and pre-prepared audio-based HEI led by women development team leaders, whereas comparator clusters received routine HEI for six months. Six months later, MHSU was assessed in both groups by data collectors who were masked from treatment allocation. The results of the two groups were compared using the intention-to-treat analysis. We utilized multilevel mixed-effects modified Poisson regression with robust variance to control for the effects of clustering and potential confounders. The level of significance was adjusted for multiple comparisons. Results: The overall utilization of at least one antenatal care (ANC) visit was 90.2% in the treatment group and 59.5% in the comparator group (c2 = 89.22, df =1, p < 0.001). Health facility delivery (HFD) utilization was considerably different between the treatment group (74.3%) and the comparator group (50.8%) (c2 = 70.50, df =1, p < 0.001). HEI significantly increased ANC utilization (adjusted risk ratio [ARR]: 1.32; 99% CI: 1.12-1.56) and HFD utilization (ARR: 1.24; 99% CI: 1.06-1.46). The utilization of at least one postnatal care (PNC) was 65.4% in the treatment group and 52.1% in the comparator group (c2 = 19.51, df =1, p = 0.01). However, after controlling for the effects of confounders and clustering, the impact of HEI on PNC utilization was insignificant between the two groups (ARR: 1.15; 99% CI: 0.89-1.48). Conclusion: A community-based HEI significantly increased ANC and HFD utilization but did not increase PNC utilization. Expanding the HEI with certain modifications will have a superior effect on improving MHSU. Trial registration number: NCT05865873.