Community Health Worker Impact on Maternal and Child Health in Displaced Populations: A Prospective Cohort Study

Abstract

Abstract:

Abstract (Expanded Version):

Background:
Internally displaced populations (IDPs) face disproportionate maternal and child health challenges due to disrupted services, poor environmental hygiene, and limited health system access. This study aimed to evaluate the impact of a Community Health Worker (CHW) intervention on maternal and neonatal health outcomes in humanitarian settings across Chad, Sudan, and Somalia.

Methods:
A prospective cohort study was conducted among 1,200 pregnant women in six IDP camps from January 2022 to December 2023. Baseline data were compared with post-intervention outcomes over 12 months. CHWs were deployed with a coverage ratio of 1:50 households, delivering antenatal education, referral services, immunization support, and home-based care. Key indicators included antenatal care (ANC) attendance, institutional deliveries, immunization rates, neonatal mortality, and patient satisfaction. Data were analyzed using chi-square tests and logistic regression models.

Results:
Antenatal care (ANC) attendance improved significantly from 41.2% (95% CI: 38.1–44.3%) at baseline to 96.4% (95% CI: 94.2–98.1%) post-intervention (p < 0.001). Institutional delivery rates increased from 29.3% to 67.1% (p = 0.002). Full immunization coverage among infants under 12 months rose from 52.7% to 98.9% (p < 0.001). Neonatal mortality declined from 32.1 per 1,000 live births to 18.0 per 1,000, reflecting a 43.9% reduction (p = 0.004). The CHW intervention also significantly increased patient satisfaction, with 84.3% of mothers reporting high satisfaction scores, up from 48.5% pre-intervention (p < 0.001).

Despite these gains, structural barriers remained: only 63.5% of CHWs received formal medical training, and 41.1% reported insufficient medical supplies, limiting service effectiveness in some zones. Multivariate logistic regression indicated that CHW exposure was independently associated with increased ANC attendance (Adjusted Odds Ratio [AOR]: 4.82; 95% CI: 3.44–6.75; p < 0.001) and reduced neonatal mortality (AOR: 0.48; 95% CI: 0.29–0.78; p = 0.005).

Conclusion:
CHW-led maternal and child health programs in humanitarian contexts can significantly improve access to essential services and reduce neonatal mortality by over 40%, even in low-resource, crisis-affected settings. The study underscores the urgency of scaling and institutionalizing CHW interventions into national emergency response frameworks to improve health outcomes in displaced populations.