Our Impact

Tangible gains in maternal & child health

2020 Annual Report

A peer-reviewed study of under-five mortality was published in 2018 in the journal PLOS One. Results show that prior to Lwala’s intervention 105 children under 5 died for every 1,000 live births. From 2012 to 2017 that rate dropped to 29.5 deaths per 1,000 live births.1

Lwala’s rates outperformed the most recently reported under-5 mortality rates for our region, Nyanza Province (82 per 1,000) and for Kenya as a whole (52 per 1,000). Lwala is within reach of the Sustainable Development Goal of 25 deaths per 1,000 live births.

To build on this study, we are partnering with Vanderbilt Institute of Global Health to conduct a quasi-experimental program evaluation. We are collecting repetitive cross-sectional survey data across ~7,000 households, tracking key indicators, including under 5 mortality.

¹ Starnes JR, et al. Under-five mortality in Rongo Sub-County of Migori County, Kenya: Experience of the Lwala Community Alliance 2007-17 with evidence from a cross-sectional survey. Public Library of Science. 2018-13(9)

A recently published peer-reviewed study compared Lwala professionalized CHW’s to status quo CHW’s.1 It found that the professionalized cadre was:

  • Trained twice as frequently
  • Retained 40% longer
  • 5 times more likely to be knowledgeable of health danger signs

Importantly, formal education level was not a predictor of CHW knowledge. Lwala is leveraging this and other evidence to support policymakers to design more effective community health systems in Kenya and beyond.

1 Heerboth, S., Hennessy, C., Omondi, B., et al. (2020). Knowledge of obstetric and neonatal danger signs among community health workers in Rongo sub-county of Migori County, Kenya: Results of a community-based cross-sectional survey. African Journal of Reproductive Health, 24(1), 121-132.


A peer-reviewed study of contraceptive prevalence used regression analysis to identify factors associated with increased contraceptive use.1 The study compared Lwala communities alongside four similar locations and found that living in a Lwala community significantly increased the odds of using a contraceptive method. Importantly, this study also gives Lwala and the Kenya Ministry of Health more insight on how to target our most vulnerable populations, especially younger people.

1.  Moon, T., Okoth, V., Starnes, J., Opiyo, E., Ressler, D., Mbeya, J., & Rogers, A. (2020). Determinants of modern contraceptive prevalence and unplanned pregnancies in Migori County, Kenya: results of a cross-sectional household survey. (submitted manuscript)

Alice is a mother of five who was accustomed to delivering her children at home. During one of her deliveries a complication arose, and by the time she reached a health facility, she had lost her baby. Then, a traditional midwife in her village, named Rose, became a Lwala Community Health Worker. Rose identified Alice early in her next pregnancy and accompanied her to ensure she received prenatal visits, vitamin supplements, and skilled delivery. After a successful delivery of twins, Rose visited Alice to check for postpartum warning signs, offer breastfeeding advice, and share information on contraceptive options. Now, Rose will continue to check on Alice’s family until the twins reach the age of 5. Alice is grateful saying, “I felt confident knowing clinicians, nurses, and my Community Health Worker are there to support and care for me and my newborn twins.”