Abstract:
Background: Over 43% of children living in low- and middle-
income countries are at risk for developmental delays; however,
access to protective interventions in these settings is limited. We
evaluated the effect of maternal participation in Chamas for
Change (Chamas)—a community-based women’s health educa-
tion program during pregnancy and postpartum—and risk of de-
velopmental delay among their children in rural Kenya.
Methods: We analyzed developmental screening questionnaire
(DSQ) data from a cluster randomized controlled trial in Trans Nzoia
County, Kenya (ClinicalTrials.gov, NCT03187873). Intervention
clusters (Chamas) participated in community health volunteer-led,
group-based health lessons twice a month during pregnancy and
postpartum; controls had monthly home visits (standard of care). We
screened all children born during the trial who were alive at 1-year
follow-up. We labeled children with any positive item on the DSQ as
“at-risk development.” We analyzed data using descriptive statistics
and multilevel regression models (
a=.05); analyses were intention-to-
treat using individual-level data.
Results: Between November 2017 and March 2018, we enrolled
1,920 pregnant women to participate in the parent trial. At
1-year follow-up, we screened 1,273 (689 intervention, 584 con-
trol) children born during the trial with the DSQ. Intervention
mothers had lower education levels and higher poverty likelihood
scores than controls (P<.001 and P=.007, respectively). The
overall rate of at-risk development was 3.5%. Children in
Chamas clusters demonstrated significantly lower rates of at-risk
development than controls (2.5% vs. 4.8%, P=.025). Adjusted
analyses revealed lower odds for at-risk development in the inter-
vention arm (OR=0.50; 95% confidence interval=0.27, 0.94).
Conclusions: Maternal participation in a community-based
women’s health education program was associated with lower
rates of at-risk development compared to the standard of care.
Overall, rates of at-risk development were lower than expected
for this population, warranting further investigation. Chamas
may help protect children from developmental delay in rural
Kenya and other resource-limited settings.