Neonatal Health Outcomes Before and After Introduction of a Midwifery‐Led Care Model in Embu County, Kenya: A Randomized Controlled Trial

INTRODUCTION: Neonatal health is a global concern, particularly in Sub-Saharan Africa where the neonatal mortality ratio exceeds Sustainable Development Goals targets. To address this, midwifery-led care models have been proposed as safe and cost-effective solutions. However, their use and impact in Kenya remain under-researched. This study aimed to evaluate the effects of one of these models on neonatal health outcomes. METHODS: Two hospitals, Siakago and Runyenjes, were chosen for a Randomized Controlled Trial involving 164 mothers and 60 midwives. Data were collected using questionnaires, observation, and record reviews. Data were analyzed using descriptive statistics and chi-square tests to determine relationships between study variables. At the time of the baseline survey, poor neonatal health outcomes were observed. Midwives in the intervention group then received education on the midwifery-led care model, whereas the control group received no education. After 6 months of monitoring the model's implementation, a post-intervention survey was conducted. RESULTS: Findings showed a 24.0% reduction in neonatal asphyxia in the intervention group, compared to a 6.6% reduction in the control group. The non-complication rate increased by 12.7% in the intervention group and by 1.4% in the control group. Both groups experienced an increase in preterm and low birth weight babies by 7.6% and 7.9%, respectively. A chi-square test indicated a significant association between the intervention and improved neonatal health outcomes. CONCLUSION: Implementing a midwifery-led care model had a positive impact on some neonatal health outcomes, but not all. County policymakers should use these findings to develop standardized policy guidelines for midwifery-led care models, aiming to enhance neonatal health outcomes across the county. These findings can also inform policy decisions at national and international levels in developing evidence-based frameworks to enhance neonatal care.