Women's Health World Conference 2026

Abstract

Background: Maternal mortality in Sierra Leone remains exceptionally high. Causes include low utilization of antenatal care (ANC) and frequent home births particularly in rural areas. We assess the effect of the Masanga Outreach Maternity agents and ultrasound SCANning (MOMSCAN) intervention, a community-based intervention aiming to improve ANC in rural Sierra Leone, through training  of community Maternity Agents and antenatal outreach ultrasound services.

Methods: This single-armed pre-post study collected structured survey data at baseline (2023) and follow-up (2025) in 21 intervention villages, among women who had given birth within the past year. Primary outcomes were facility-based births, ANC attendance, and other ANC service indicators. Data was analyzed as both intention-to-treat and per-protocol using bivariate and multivariate logistic regression.

Results: 444 postpartum women were included at baseline and 432 at follow-up. Attendance of at least eight ANC visits (AOR: 3.35; 95% CI: 2.05-5.49), receiving at least one ultrasound scan (AOR: 6.08, 95% CI: 4.22-8.77), and identification of high-risk pregnancy (AOR: 2.04; 95% CI: 1.25-3.33) increased significantly in all applied models, while facility-based births only increased significantly per-protocol (AOR: 1.57; 95% CI: 1.09–2.25). Most participants (98.1%) would recommend other women to talk to Maternity Agents and 72.2% participated in at least one health talk provided by Maternity Agents.

Conclusion: MOMSCAN modestly increased utilization of facility-based births and substantially increased ANC attendance, ultrasound utilization, and identification of high-risk pregnancies. Results were stronger when analyzed per-protocol, supporting an intervention effect. While our findings call for prioritization of community-based interventions to improve maternal and neonatal health, there is an urgent need for political action to increase facility-based births.