Journal of Advances in Medicine and Medical Research

Background: Maternal and neonatal mortality remains high in arid and semi-arid regions of Kenya, with Isiolo County reporting maternal mortality of 790 per 100,000 live births. Weak community referral systems and health system constraints limit timely access to skilled care. Frontline health workers (FHWs) are critical in linking communities to facilities, yet evidence on effective referral strategies and health system factors remains limited.

Methodology: The study employed a pretest–posttest quasi-experimental mixed-methods design involving 260 frontline health workers, with 130 participants in the intervention arm and 130 in the control arm, followed from baseline to end line. The intervention consisted of a structured training package focused on maternal and neonatal danger sign recognition, referral protocols, emergency preparedness, and the use of digital and feedback-based referral tools. Quantitative data were collected using structured questionnaires at baseline and endline, while qualitative data were obtained through key informant interviews and focus group discussions. Data was analysed using SPSS version 26 with descriptive statistics, Chi-square, Fisher’s exact tests, logistic regression, and McNemar tests.

Results: At baseline, high referral knowledge was reported by 28.0% of control and 20.8% of intervention respondents. At endline, this increased to 28.5% and 40.4%, respectively. Significant associations with referral uptake in the intervention group included establishment of web portals and inventory systems (p=0.046), reception of counter-referral feedback (p=0.024), and training on preparedness and response to maternal and neonatal emergencies (p=0.017). Significant health system factors included integrated emergency preparedness (p=0.047), emergency care training (p=0.027), and availability of client rights complaint registers (p=0.043). Transport infrastructure was significant in the control group (p=0.018). Training FHWs increased referral uptake (OR=1.377, p=0.031).

Conclusion: Training FHWs improves referral knowledge and utilisation. Strengthening digital tools, feedback mechanisms, emergency preparedness, and supportive health systems is essential for reducing preventable deaths.