299. Geographic mediation of dose for PIERs On the Move (POM) in the Community Level Intervention for Preeclmpsia (CLIP) in Mozambique

Introduction Travel time and distance to health facilities are known barriers for accessing maternal health care, particularly in Mozambique. Community health workers (CHWs) are responsible for extending the reach of antenatal care to isolated communities. Less is known about the geographical barriers faced by CHWs that may hamper their access to these isolated communities. Objective This study aimed to evaluate the extent to which related to dose of CHW-led PIERS On the Move (POM) study visit, delivered as an intervention in the Community Level Intervention for Pre-eclampsia trial (NCT01911494) in six clusters in Maputo and Gaza provinces. Methods Access to care was measured by calculating the walking time from each community to the nearest PHC using ArcGIS software. Dose of the intervention was measured by the average number of POM visits during pregnancy. A spatial autocorrelation analysis using the Moran I statistic was used to identify regional clusters of communities with both high and low doses of POM visits and how this compared with access to PHCs. Results Regional clusters (Moran I p   0.001) of communities with poor access to PHCs had significantly lower doses of POM. The high dose areas had POM visits that were almost sevenfold higher than the POM visits in the low POM dose areas. The low dose areas required more that an additional hour of walking time to PHCs. Discussion Inequities in access to pregnancy related care persist, even when the reach of care through community health workers are implemented. Further strategies in addition to assigning community health workers are needed to counter the role of geography in mediating community interventions.