Study reveals effectiveness of CHW-led initiatives on maternal health outcomes – State of Reform


A study published by BMJ Open found that pregnant women served by community health workers are less likely to have low birth weight and preterm deliveries compared to those who did not receive these supports.

The ten-year study, conducted by the University of Arizona and Northern Arizona University, examined whether participation in the Arizona Health Start program reduced rates of low birth weight and premature births compared to the same groups of people who haven’t.

Arizona Health Start Program is a community health intervention program designed to reach mothers facing specific social determinants of health, including racial discrimination, poverty, and previous adverse birth experiences. The program helps members access education and health programs and offers health and developmental screenings for mothers and children up to the age of two.

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The researchers noted that inequalities in maternal and child health (MCH) are associated with a variety of social and structural determinants beyond the control of individual community members. Their research found that racial discrimination, economic status and access to quality health care ‘consistently track’ rates of low birth weight (LBW), very low birth weight (VLBW), d ‘extremely low at birth (ELBW) and premature birth.

“It is widely accepted that societal influences, including exposure to discrimination, living in disadvantaged neighborhoods, having low socioeconomic status (SES) and not having access to health insurance, all contribute to cumulative physiological damage to the body caused by environmental stressors. ”

To test the impact of community health workers (CHWs) on improving these outcomes, the researchers compared 7,212 mothers in the Health Start program with 53,948 mothers who were not enrolled. Arizona’s diverse population allowed researchers to follow a wide range of participants, including Native American and Latin populations with a proportionately smaller African American population.

The study found a “statistically significant” improvement in almost all subgroups.

“In accordance with our hypothesis, the women registered [sic] in the Health Start program before giving birth during the 2006 to 2016 study period had improved childbirth outcomes, with the most statistically significant effects in Native American women, women at preexisting risks for childbirth. health, Latin women and adolescent mothers.

Native American mothers experienced the most significant improvement in almost all subgroups. The NPF among this group was 38% lower than in the control group and 25% lower for those with pre-existing conditions. Some other subgroups noticed very little statistical improvement. Teenage mothers giving birth preterm saw an improvement of only 0.21%.

Although the statistical result appeared low, the researchers say the impact of this improvement is significant. The cost savings to the state alone can run into the millions.

“The early health care costs associated with a surviving ELBW infant are approximately $ 202,700, compared to $ 1,100 for a healthy infant. [A] -0.2% effect translates to about 16 fewer ELBW cases, resulting in estimated cost savings of $ 3.2 million.

Researchers believe this is the largest study of its kind. These results provide evidence for the effectiveness of home community health worker interventions, particularly with respect to the social determinants of health.

“These findings provide important evidence supporting the effectiveness of CHW-led home visiting interventions in general, and in particular the ability of CHWs to address MCH equity in ethnoracially maternal and child populations. and geographically diverse and socio-economically disadvantaged. ”

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