Effectiveness of the electronic Community Health Information System on maternal continuum of care completion in rural East Shewa Zone, Eastern Ethiopia: A prospective controlled quasi-experimental study.

Abstract

Maternal mortality in Ethiopia remains high, and strengthening the continuum of maternal care is essential for reducing preventable deaths. The electronic Community Health Information System was introduced to improve service delivery through decision support, client tracking, and electronic referrals, but evidence of its effect in routine settings is limited. This study assessed the effect of the eCHIS's Reproductive, Maternal, Newborn, Child Health and Nutrition module intervention on completion of the maternal continuum of care. A prospective controlled pre-post quasi-experimental study design was conducted in Primary Health Care Units. Baseline data were collected from January 5 to February 5, 2025, enrolling pregnant women with twenty six weeks of gestation or earlier. Participants were followed for nine months, and end-line data collected that year. Maternal care outcomes came from antenatal, delivery, and postnatal registers, with verification interviews when records were incomplete. The primary outcome was completion of the maternal continuum of care. Intervention effects were estimated using a Difference in Differences fixed effects model with cluster robust standard errors. Follow-up was completed for 409 women in each group (97.5%). Baseline continuum of care completion was comparable across groups. By endline, completion increased from 19.6% to 47.7% in the intervention group versus 19.1% to 23.7% in controls. The eCHIS-RMNCHN intervention produced a 23.5% point improvement in full continuum of care completion (β = 0.235; 95% CI: [0.155-0.314]), with significant gains in ANC4+ and ANC4 + combined with SBA. Implementation of the eCHIS-RMNCHN module intervention was associated with substantial improvements in maternal continuum-of-care completion and key intermediate indicators. Strategies guided by the CFIR ERIC framework helped address local barriers to digital system use. Sustained implementation, leadership engagement, technical support, community involvement, and continuous performance monitoring are essential for maintaining these improvements and informing scale up efforts.