The impact of strengthened ward development committees on utilisation of reproductive maternal and child health services in Bayelsa State, Nigeria.

INTRODUCTION

Maternal and Child Health (MCH) conditions continue to be a major public health concern in low- and middle-income countries (LMICs), which account for 94% of maternal deaths worldwide. Despite documented successes from government interventions at all levels, maternal and child mortality remains high in Nigeria. The purpose of this study is to assess the impact of strengthened Ward Development Committees (WDCs) on the use of reproductive and maternal and child health services in a specific local government area (LGA) in Bayelsa State, Nigeria.

METHODS

A quasi-experimental study design without a control group was used, with data collected at the baseline, midline and endline using a pre-posttest questionnaire. This was collected to determine the outcome of the impact of strengthened WDC in Bayelsa State's Kolokuma/Opokuma LGA. Existing WDCs were strengthened by providing funding, Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCH + N) commodities, outreach, human resource support, and technical assistance. Caregivers of children between the ages of 0 and 59 months were randomly selected to participate in the study. The Cochrane and Friedman test were used to analyse changes over time in key indicators, with statistical significance set at P < 0.05, while logistic regression was used to examine the influence of socio-demographic factors on maternal health service utilisation.

RESULTS

Following the intervention, significant improvements were observed in key reproductive, maternal, and child health (RMCH) indicators. Family planning utilisation increased markedly from 0% at baseline to 62% at endline (P < 0.001). Similarly, the proportion of health facility deliveries rose from 46 to 72% (P < 0.001), while antenatal care (ANC) attendance with four or more visits improved from 78 to 92% (P < 0.001). Postnatal care (PNC) attendance also showed a significant increase, from 52% at baseline to 93% at endline (P < 0.001). Logistic regression analysis further revealed that women aged 31-40 years were significantly more likely to utilise family planning services compared to those aged 15-20 years (OR = 5.29; 95% CI: 1.61-17.36; P = 0.0059). Marital status also had a strong influence, with single women demonstrating significantly higher odds of using family planning services compared to married women (OR = 6.39; 95% CI: 2.81-14.50; P < 0.001).

CONCLUSION

The WDC strengthening intervention led to significant improvements in maternal health service utilisation, family planning uptake, and postnatal care attendance. Socio-demographic factors such as age and marital status were important determinants of family planning uptake, with older and single women more likely to use these services. However, declines in caregivers' knowledge of child health interventions and the acceptability of key health interventions, particularly vaccines, highlight the need for targeted health education and communication strategies. Getting communities more involved and using effective ways to share health information are recommended to maintain and improve health outcomes in similar settings.