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Acceptability of a Community-based Maternal and Neonatal health program in rural Somalia: Perspectives of Women beneficiaries and Household decision-makers

Year: 2026
Type: preprint
Abstract: Background Somalia faces one of the highest maternal and neonatal mortality rates globally, and it remains significantly higher in rural areas compared to urban areas. To address this concern, the International Rescue Committee is implementing a Community-Based Maternal and Newborn Care (CBMNC) program in the Galmudug region, Somalia. This study examines the acceptability of the CBMNC program among women who enrolled in the program and household decision-makers in their households in the community where the program was implemented. Given the limited understanding of its relevance in communities with limited health facilities, this paper explores how the program is perceived as appropriate, relevant, and adoptable by its users. Methods We conducted a cross-sectional qualitative descriptive study using the Theoretical Framework of Acceptability (TFA) between November and December 2024. The TFA was used to guide the development of data collection tools. We conducted 32 in-depth interviews (IDIs) and 14 Focus Group Discussions (FGDs) (84 participants). All data collection was conducted in Somali, audio-recorded, and later translated contemporaneously into English for analysis. Analysis of interview data identified recurring subthemes across the seven domains of TFA Findings The findings demonstrate substantial community support for the CBMNC program, primarily due to its home-visiting strategy, cultural and religious appropriateness, and relevance to community needs. Participants appreciated that services were delivered at home, that health education was practical and adaptable, and that key supplies—such as iron tablets, mosquito nets, and water-purification tablets—were useful. Although male involvement in the program was limited, they strongly supported it due to its cost-effectiveness. The program’s acceptability was further strengthened by the trust Community Health Workers (CHWs) had earned through common cultural, religious, and neighborhood ties Conclusion The results of this study highlighted the value of home visiting strategies, cultural, and religious appropriateness, and the relevance of commodities to the community's needs. Consistent community awareness, supportive male engagement that promotes shared decision-making, and the involvement of other household decision-makers can maximize the impact of CBMNC. Future programs should consider engaging men, who are the primary household decision-makers in Maternal and Newborn Health (MNH) and in mother-to-mother groups, to address persistent cultural beliefs.
DOI: 10.21203/rs.3.rs-10783577/v1
Author: Asia Mohamud
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W7204170056
Cites: 33
Cited by:
Related to: 10