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. 2025 Apr 27;53(1):61.
doi: 10.1186/s41182-025-00730-8.

Effect of trust in village health workers on the use of facility-based follow-up postnatal care services in two districts in the Lao People's Democratic Republic

Noudéhouénou Credo Adelphe Ahissou  1 , Manami Uehara  2 , Daisuke Nonaka  2 , Inthanomchanh Vongphoumy  3 , Tiengkham Pongvongsa  3 , Khamtoun Ounlienvongsack  4 , Khampheng Phongluxa  5 , Sengchanh Kounnavong  5 , Jun Kobayashi  2
Affiliations

Effect of trust in village health workers on the use of facility-based follow-up postnatal care services in two districts in the Lao People's Democratic Republic

Noudéhouénou Credo Adelphe Ahissou et al. Trop Med Health. .

Abstract

Background: Despite high coverage of antenatal care services (89.8%) and facility-based deliveries (79.8%), delayed initiation or lack of follow-up postnatal care (PNC) visits remains a challenge in the Lao People's Democratic Republic (Lao PDR). Follow-up PNC encourages healthy lifestyles and monitoring mothers' and newborns' health to decrease postpartum complications and hospital readmissions. While village health volunteers and workers (VHVs/VHWs) are essential for health promotion in Lao PDR, the extent to which mothers' trust in VHVs/VHWs helps promote better service utilization has not been studied.

Objectives: We investigated the trust levels in VHVs/VHWs among ethnic minority mothers and the influence on the use of facility-based follow-up PNC.

Methods: We utilized cross-sectional data from July and August 2024, collected as a baseline survey for a quasi-experimental study conducted in 35 villages across the Sepone and Vilabuly districts. We compared the respondents' PNC usage and characteristics using chi-square tests and Fisher's exact tests. Standard binary logistic regression analyses were conducted to estimate the effects of various factors on the utilization of facility-based follow-up PNC. Trust in VHVs/VHWs was a construct variable based on their provision of emotional support, relevant information, adequate discussion time, effective care, and the likelihood of future pregnancy-related care.

Results: The study enrolled 241 mothers (mean age 24 years, SD 5.7), including 110 from Sepone and 131 from Vilabuly. Overall, the follow-up PNC coverage rate was 19.0%, and there was no significant difference between Sepone and Vilabuly, despite variations in access to healthcare and engagement with VHVs/VHWs. High trust in VHVs/VHWs was linked to 12.25 times higher odds of utilizing follow-up PNC than low trust (95% CI 2.2-67.8). In addition, having an older child (9-12 months) and immediate PNC utilization were beneficial for subsequent PNC use. Unexpectedly, contact with VHVs/VHWs during prenatal and/or postnatal periods decreased the odds of utilizing follow-up PNC, with distance to health facilities and adherence to traditional gender norms also having a similar negative effect.

Conclusions: Facility-based follow-up postnatal care was critically low among respondents; however, increasing trust in VHVs/VHWs may foster improvements. Along with increasing contact frequency, offering quality support to mothers through VHVs/VHWs while emphasizing the complementary nature of community-based and facility-based care could be beneficial. Effective interventions may also include enhancing immediate PNC and tackling physical accessibility challenges, as well as restrictive gender norms through male involvement.

Keywords: Follow-up postnatal care; Lao PDR; Trust; Village health volunteers.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The present study obtained ethical approval from the "Ethics Committee of the University of the Ryukyus for Medical and Health Research Involving Human Subjects" (approval no: 24-2329-00-00-00) and the Lao Tropical Medicine and Public Health Institute (approval no: 31/NECHR). Participants were provided with comprehensive information sheets and consent forms outlining the purpose of the study; for participants of 15–17 years of age, signed assent was requested in addition to obtaining permission from their legal guardians. All the data from the respondents were handled anonymously. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentages of responses to question items on trust in VHVs/VHWs
See this image and copyright information in PMC

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