Knowledge of Obstetric and Neonatal Danger Signs among Community Health Workers in the Rongo Sub-County of Migori County, Kenya: Results of a Community-based Cross-Sectional Survey

Sarah A. Heerboth, Cassandra Hennessey, Bernard Omondi, Meshak Wafula, Julius Mbeya, Ash Rogers, Daniele J. Ressler, Mario Davidson, Troy D. Moon


In efforts to reduce maternal and neonatal mortality, it is recommended that all pregnant women be counseled on signs of pregnancy related complications and neonatal illness. In resource limited settings, such counselling may be task-shifted to lay health workers. We conducted a community-based cross-sectional survey of community health workers/volunteers in North and East Kamagambo of the Rongo Sub- County of Migori County, Kenya, between January-April 2018. A survey tool was administered through face-to-face interviews to investigate the level of knowledge of obstetric and neonatal danger signs among community health workers in North Kamagambo after one year of participation in the Lwala program, as well as to evaluate baseline knowledge of community health volunteers in East Kamagambo at the beginning of Lwala’s expansion and prior to their receiving training from Lwala.  The North Kamagambo group identified more danger signs in each category. The percentage of participants with adequate knowledge in the pregnancy, postpartum, and neonatal categories was significantly higher in North Kamagambo than in East Kamagambo. Sixty percent of participants in North Kamagambo knew 3 or more danger signs in 3 or more categories, compared to 24% of participants in East Kamagambo. Location in North Kamagambo (OR 2.526, p=0.03) and a shorter time since most recent training (OR 2.291, p=0.025) were associated with increased knowledge. Our study revealed varying levels of knowledge among two populations of lay health workers. This study highlights the benefit of frequent trainings and placing greater emphasis on identified gaps in knowledge of the labor and postpartum periods. (Afr J Reprod Health 2020; 24[1]: 121-132).

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Transforming Our World: The 2030 Agenda for

Sustainable Development. The United Nations. 2015. Accessed 12 January 2019.

Trends in maternal mortality: 1990 to 2015: estimates by

WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization, UNICEF, United Nations, Department of Economic and Social Affairs, Population Division, World Bank. 2015. Accessed 12 January 2019.

Kagia JW. Maternal Mortality Causality a Kenyan

Experience. Linacre Q. 2011 May;78(2):211–5.

Summary Report of the Assessment of UNFPA's

Advocacy Campaign to End Preventable Maternal and New-Born Mortality in Kenya. UNFPA. 2016. Accessed 12 January 2019.

Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B,

Daniels J, Gulmezoglu AM, Temmerman A and Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun 1;2(6):e323–33.

Ronsmans C and Graham WJ. Lancet Maternal Survival

Series steering group. Maternal mortality: who, when, where, and why. Lancet Lond Engl. 2006 Sep 30;368(9542):1189–200.

WHO recommendations on antenatal care for a positive

pregnancy experience. WHO. 2016.;jsessionid=BE0FD56B410EE067602E384F372CC488?sequence=1. Accessed 12 January 2019.

Lehmann U and Sanders D. Community health workers:

What do we know about them? WHO. 2007. Accessed 12 January 2019.

Adam MB, Dillmann M, Chen M, Mbugua S, Ndung’u J,

Mumbi P, Waweru E and Meissner P. Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya. PLoS ONE 2014. 9(8).

Afework MF, Admassu K, Mekonnen A, Hagos S,

Asegid M and Ahmed S. Effect of an innovative community based health program on maternal health service utilization in north and south central Ethiopia: a community based cross sectional study. Reprod Health. 2014 Apr 4;11:28.

Lewin S, Munabi-Babigumira S, Glenton C, Daniels K,

Bosch-Capblanch X, van Wyk BE, Odgaard-Jensen J, Johansen M, Aja GN, Zwarenstein M and Scheel IB. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. The Cochrane database of systematic reviews. 2010(3):CD004015.

Kidane G and Morrow RH. Teaching mothers to provide

home treatment of malaria in Tigray, Ethiopia: a randomised trial. The Lancet. 2000 Aug 12;356(9229):550–5.

Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S,

Williams EK, Seraji HR, Mannan I, Rahman SM, Shah R, Shah SK, Syed U, Winch PJ, Lefevre A, Santosham M, Black RE and Projahnmo Study Group. Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. The Lancet. 2008 Jun 7;371(9628):1936–44.

Uzondu CA, Doctor HV, Findley SE, Afenyadu GY and

Ager A. Female health workers at the doorstep: a pilot of community-based maternal, newborn, and child health service delivery in northern Nigeria. Glob Health Sci Pract. 2015 Mar;3(1):97–108.

Edmond KM, Yousufi K, Anwari Z, Sadat SM, Staniczai

SM, Higgins-Steele A, Bellows AL and Smith ER. Can community health worker home visiting improve care-seeking and maternal and newborn care practices in fragile states such as Afghanistan? A population-based intervention study. BMC Med. 2018 Jul 9;16(1):106.

Pembe AB, Urassa DP, Carlstedt A, Lindmark G,

Nyström L and Darj E. Rural Tanzanian women’s awareness of danger signs of obstetric complications. BMC Pregnancy Childbirth. 2009 Mar 26;9:12.

Maseresha N, Woldemichael K and Dube L. Knowledge

of obstetric danger signs and associated factors among pregnant women in Erer district, Somali region, Ethiopia. BMC Womens Health. 2016 Jun 6;16:30.

Desta FA, Shifa GT, Dagoye DW, Carr C, Van

Roosmalen J, Stekelenburg J, Nedi AB, Kols A and Kim YM. Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study. BMC health services research. 2017 Dec;17(1):839

Condo J, Mugeni C, Naughton B, Hall K, Tuazon MA,

Omwega A, Nwaigwe F, Drobac P, Hyder Z, Ngabo and Binagwaho A. Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives. Hum Resour Health. 2014 Dec 13;12:71.

Monitoring Birth Preparedness and Complication

Readiness: Tools and Indicators for Maternal and Newborn Health. JHPIEGO. 2004. Accessed 12 January 12, 2019.

Ayiasi RM, Criel B, Orach CG, Nabiwemba E and

Kolsteren P. Primary healthcare worker knowledge related to prenatal and immediate newborn care: a cross sectional study in Masindi, Uganda. BMC Health Serv Res. 2014 Feb 11;14:65.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N

and Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of biomedical informatics. 2009;42(2):377-81.

R Core Team R: A language and environment for

statistical computing. R Foundation for Statistical Computing 2017. Accessed 12 January 2019.

Agrawal PK, Agrawal S, Ahmed S, Darmstadt GL,

Williams EK, Rosen HE, Kumar V, Kiran U, Ahuja RC, Srivastava VK, Santosham M, Black RE and Baqui AH. Effect of knowledge of community health workers on essential newborn health care: a study from rural India. Health Policy Plan. 2012 Mar;27(2):115–26.

Medhanyie A, Spigt M, Dinant G and Blanco R.

Knowledge and performance of the Ethiopian health extension workers on antenatal and delivery care: a cross-sectional study. Hum Resour Health. 2012 Nov 21;10:44.

Sotunsa JO, Vidler M, Akeju DO, Osiberu MO, Orenuga

EO, Oladapo OT, Qureshi R, Sawchuck D, Adetoro OO, von Dadelszen P, Dada OA and CLIP Nigeria. Feasibility Working Group. Community health workers’ knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival. Reprod Health. 2016 Sep 30;13(2):108.

Kayemba NC, Guwatudde D, Waiswa P, Kiguli J,

Namazzi G, Namutumba S, Tomson G and Peterson

S. Community health workers - a resource for identification and referral of sick newborns in rural Uganda. Trop Med Int Health TM IH. 2013 Jul;18(7):898–906.

Kayemba NC, Naamala Sengendo H, Ssekitooleko J,

Kerber K, Källander K, Waiswa P, Aliganyira P, Guenther T, Gamache N, Strachan C, Ocan C, Magumba G, Counihan H, Mbonye AK and March DR. Introduction of newborn care within integrated community case management in Uganda. Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):46–53.

Than KK, Morgan A, Pham MD, Beeson JG and

Luchters S. Determinants of knowledge of critical danger signs, safe childbirth and immediate newborn care practices among auxiliary midwives: a cross sectional survey in Myanmar. BMJ Open. 2017 Jul 5;7(6):e017180.


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