BACKGROUND By 2015, Malawi had not achieved Millennium Development Goal 4, reducing maternal mortality by about 35% from 675 to 439 deaths per 100,000 livebirths. Hypothesised reasons included low uptake of antenatal care (ANC), intrapartum care, and postnatal care. Involving community health workers (CHWs) in identification of pregnant women and linking them to perinatal services is a key strategy to reinforce uptake of perinatal care in Neno, Malawi. We evaluated changes in uptake after deployment of CHWs between March 2014 and June 2016. METHODS A CHW intervention was implemented in Neno District, Malawi in a designated catchment area of about 3100 women of childbearing age. The pre-intervention period was March 2014 to February 2015, and the post-intervention period was March 2015 to June 2016. A 5-day maternal health training package was delivered to 211 paid and supervised CHWs. CHWs were deployed to identify pregnant women and escort them to perinatal care visits. A synthetic control method, in which a "counterfactual site" was created from six available control facilities in Neno District, was used to evaluate the intervention. Outcomes of interest included uptake of first-time ANC, ANC within the first trimester, four or more ANC visits, intrapartum care, and postnatal care follow-up. RESULTS Women enrolled in ANC increased by 18% (95% Credible Interval (CrI): 8, 29%) from an average of 83 to 98 per month, the proportion of pregnant women starting ANC in the first trimester increased by 200% (95% CrI: 162, 234%) from 10 to 29% per month, the proportion of women completing four or more ANC visits increased by 37% (95% CrI: 31, 43%) from 28 to 39%, and monthly utilisation of intrapartum care increased by 20% (95% CrI: 13, 28%) from 85 to 102 women per month. There was little evidence that the CHW intervention changed utilisation of postnatal care (- 37, 95% CrI: - 224, 170%). CONCLUSIONS In a rural district in Malawi, uptake of ANC and intrapartum care increased considerably following an intervention using CHWs to identify pregnant women and link them to care.

中文翻译：

---

越来越多地利用围产期服务：估计马拉维内诺的社区卫生工作者计划的影响。

背景技术到2015年，马拉维尚未实现千年发展目标4，将产妇死亡率从每100,000个活产儿中的675例死亡减少35％到439例死亡。假设不足的原因包括对产前护理（ANC），产时护理和产后护理的摄取不足。在马拉维的内诺，让社区卫生工作者（CHW）参与识别孕妇并将其与围产期服务联系起来是加强对围产期保健服务的一项重要战略。我们评估了2014年3月至2016年6月期间部署CHW的摄入量变化。方法在马拉维Neno区指定的约3100名育龄妇女的集水区实施了CHW干预措施。干预前的时期为2014年3月至2015年2月，干预后的时期为2015年3月至2016年6月。为211名付费和受监督的CHW提供了为期5天的孕产妇保健培训包。部署了CHW来识别孕妇并护送他们进行围产期保健访问。使用一种综合控制方法来评估干预措施，在该方法中，从Neno区的六个可用控制设施中创建了一个“模拟场所”。感兴趣的结果包括初次使用ANC，在头三个月内使用ANC，进行四次或更多次ANC访视，产时护理和产后护理随访。结果参加ANC的女性从每月83例平均增加到98例，增加了18％（95％可信区间（CrI）：8、29％），在孕早期开始ANC的孕妇比例增加了200％（95 CrI百分比：162，234％）从每月10％增至29％，完成四次或更多ANC访问的女性比例增加了37％（95％CrI：31％，43％）从28％增至39％，并且每月使用产时护理的人数从85位女性增加到102位女性，增加了20％（95％CrI：13，28％）。几乎没有证据表明，CHW干预改变了产后护理的利用（-37，95％CrI：-224，170％）。结论在马拉维的一个农村地区，在使用CHW进行识别孕妇并将其与护理联系起来的干预措施之后，ANC和产期护理的摄入量大大增加。