Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study.

backgroundMost women receive health education from healthcare workers. However, the same information can be delivered by non-health workers such as religious and traditional leaders, and peers, among others. The effectiveness of non-health worker-delivered health education on the uptake of hormonal contraceptives, however, remains uncertain. We compared the effectiveness of health worker and non-health worker-delivered health education on the uptake of modern contraceptives among women of reproductive age in two large districts in Malawi.

methodsWe designed a quasi-experimental study in two Malawian districts (Mangochi and Chikwawa). The intervention was health education delivered by either a health worker, such as a nurse (intervention group), while the comparator was health education delivered by a non-health worker, like a religious or traditional leader, peer, or the media, among others (comparison group). The main outcome was the uptake of modern contraceptives. To remove systematic differences between the two groups and achieve comparability on observed covariates, we used inverse probability of treatment weighting to emulate a randomized trial. After achieving covariate comparability, we performed a binary logistic regression to estimate the effect of health worker-delivered health education on contraceptive uptake, adjusting for the inverse probability of treatment weights. We reported the odds ratios (OR) and 95% confidence intervals (CI).

resultsWe studied 414 participants aged 15–49 years (median age 29 years, interquartile range 23–36). There were 316 participants in the intervention group, and 143 (45.3%) of them used modern contraceptives. The comparison group had 98 participants, and 41 (41.8%) of them used modern contraceptives (p = 0.552). Participants in the intervention group tended to have an increased modern contraceptive uptake compared to those in the comparison group, although the difference was statistically insignificant (OR 1.45, 95% CI 0.74–2.89).

conclusionsModern contraceptive uptake did not differ between health worker and non-health worker-delivered health education approaches in the two Malawian districts. Non-health worker-delivered health education could be an additional tool for reaching several women of reproductive age with modern contraceptive information. This would contribute to increasing the contraceptive prevalence rate and reducing maternal and neonatal morbidity and mortality in these districts and similar settings. CLINICAL TRIAL NUMBER: Not applicable.