Impact of timed and targeted counselling on the maternal health continuum of care outcomes in Northern Uganda: A propensity score matched analysis

Objective: Improving maternal health is key to saving lives of women who would otherwise die due to pregnancy and childbirth related complications, especially in developing countries. The timed and targeted counseling (ttC) approach, delivered by community health workers, is a behavioural change counseling approach for improving maternal health. This approach focuses on giving stage appropriate messages to pregnant women regarding the timing of antenatal care visits, where to deliver and postnatal care. The purpose of this study therefore is to examine the impact of ttC on the maternal health continuum of care outcomes in Northern Uganda. Methods: A cross-sectional quasi-experimental design with propensity score matching (PSM) analysis was used with retrospective data collection comparing an intervention group(Aber subcounty) to a comparison group (Otwal subcounty) in Northern Uganda. PSM was done to determine the causal relation between ttC and the maternal health outcomes. The primary outcome measures were having four or more antenatal care visits(4+ ANC), delivery at the advised place of delivery(PoD) and having(at least one) postnatal care(PNC) visit. Results: The PSM analysis showed that participants receiving ttC were significantly more likely to have 4 + ANC attendance (OR = 15.61, 95 % CI 9.4–25.8), PoD (OR = 2.36, 95 % CI 1.4–4.1) and PNC (OR = 1.67, 95 % CI 1.0–2.7) than participants receiving care as usual. Conclusion: Implementation of ttC in similar low resource settings likely leads to improved maternal health continuum of care outcomes and therefore the government of Uganda should integrate ttC into its already existing health care system for more effective maternal health.