Evaluating Community Health Worker-Led Maternal Nutrition Counseling in Rural Ghana: Effectiveness and Cost-Efficiency
DOI:
https://doi.org/10.54536/ajmhc.v1i2.7547Keywords:
Community Health Workers, Cost-Efficiency, Dietary Diversity, Maternal Nutrition, Neonatal OutcomesAbstract
In rural Ghana, maternal undernutrition continues to be a crucial issue with adverse pregnancy and neonatal outcomes. This study examines the effectiveness and cost-efficiency of Community Health Worker (CHW)-led maternal nutrition counseling versus facility-based counseling in Talensi and East Mamprusi districts. A quasi-experimental mixed-methods design enrolled 420 pregnant women. Participants in the intervention received culturally adapted, structured counseling at the household and community levels, and comparators received standard antenatal care counseling. Data were quantitative, including maternal dietary diversity (MDD-W), birth weight, and gestational age. Cost-efficiency was evaluated using activity-based costing, as well as incremental cost-effectiveness ratios (ICERs). Focus groups and interviews were conducted for qualitative data collection. By the third trimester, the mean MDD-W scores had increased to 5.8 food groups in the CHW group and 4.6 in the comparator (p < 0.001). The proportion that met minimum dietary diversity reached 71%, as opposed to 52%. Neonatal outcomes were better: average birth weight was 3.1 kg compared with 2.8 kg (p < 0.05), and the incidence of low birth weight decreased to 7% from 15%. Cost per mother counseled decreased (GHS 48 vs. GHS 72) and ICERs favored CHW-led counseling. The qualitative research supported these findings: “The CHW came to my home and taught me how to mix beans with maize,” and “We saw babies born stronger when mothers followed the advice.” CHW-led counseling was shown to be effective and cost-efficient, providing an evidence-based solution to consolidate Ghana’s CHPS model and improve maternal and neonatal health outcomes.
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