Development of a COVID-19 Protocol for Frontline CHWs in Rural Guatemala

Volume 9, Issue 1, February 2024     |     PP. 93-114      |     PDF (3231 K)    |     Pub. Date: March 1, 2021
DOI: 10.54647/cm32425    180 Downloads     1519 Views  


Jessica Oliveira, DMS, MSPA, Florida International University Herbert Wertheim College of Medicine, United States; Saving Mothers, United States
Daniel Hu, Brown University, United States
Eleanor Lawrence, MPH, Saving Mothers, United States
Taraneh Shirazian, MD, NYU Langone Health, United States; Saving Mothers, United States

COVID-19 will negatively impact maternal health outcomes in low-resource, rural communities. The indirect effects of the pandemic on the health of women and girls are significant and concerning. Many factors contribute to poor maternal health outcomes during the COVID-19 pandemic, including travel restrictions, limited financial agency, hindered education, domestic violence, and shifting familial and societal roles. Furthermore, misinformation regarding the virus may spread in communities, resulting in distrust of healthcare providers and the services offered. WHO, UNICEF, and other major organizations have emphasized the need for community-based health services in low resource settings to mitigate the expected rise in maternal mortality and pregnancy-related complications. In Guatemala, Saving Mothers works with community health workers (CHWs) in the rural region of Sololá to deliver maternal health services to the local indigenous women. Saving Mothers has developed a home-visit COVID-19 protocol to ensure their safety, protection, and adherence to healthcare guidelines as front-line workers. Feedback from local community elders informed development of this protocol and it was adapted into a checklist and infographic to facilitate the CHW training process. Following implementation of the protocol, both CHWs and patients reported ease with protocol-uptake and satisfaction with the health services rendered.

maternal health care, COVID protocols, CHW training

Cite this paper
Jessica Oliveira, DMS, MSPA, Daniel Hu, Eleanor Lawrence, MPH, Taraneh Shirazian, MD, Development of a COVID-19 Protocol for Frontline CHWs in Rural Guatemala , SCIREA Journal of Clinical Medicine. Volume 9, Issue 1, February 2024 | PP. 93-114. 10.54647/cm32425


[ 1 ] Akseer, N., Kandru, G., Keats, E. C., & Bhutta, Z. A. (2020). COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. The American Journal of Clinical Nutrition, 112(2), 251-256. doi:10.1093/ajcn/nqaa171
[ 2 ] Atty, M. (2020). Surge in Violence Against Girls and Women in Latin America and Caribbean. Retrieved from
[ 3 ] Berry, N. S. (2010). Unsafe motherhood: Mayan maternal mortality and subjectivity in post-war Guatemala (Vol. 21): Berghahn books.
[ 4 ] Boyce, M. R., & Katz, R. (2019). Community Health Workers and Pandemic Preparedness: Current and Prospective Roles. Front Public Health, 7, 62. doi:10.3389/fpubh.2019.00062
[ 5 ] Dashraath, P., Wong, J. L. J., Lim, M. X. K., Lim, L. M., Li, S., Biswas, A., . . . Su, L. L. (2020). Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol, 222(6), 521-531. doi:10.1016/j.ajog.2020.03.021
[ 6 ] Encuesta Nacional de Salud Materno Infantil: Informe Interno Priliminario. (2017). Guatemala City, Guatemala
[ 7 ] Estudio Nacional de Mortalidad Materna. (2011). Guatemala City, Guatemala Retrieved from
[ 8 ] Evans, D. (2020). How Will COVID-19 Affect Women and Girls in Low- And Middle-Income Countries.
[ 9 ] Guatemala, I. N. d. E. (2015). Republica de Guatemala: Estadisticas demograficas y Vitales 2014. Retrieved from
[ 10 ] Healthcare Facility Guidance. (2020). Centers for Disease Control and Prevention
[ 11 ] Hernandez, S., Oliveira, J. B., Mendoza Sosof, C., Lawrence, E., & Shirazian, T. Adapting antenatal care in a rural LMIC during COVID-19: A low literacy checklist to mitigate risk for community health workers. International Journal of Gynecology & Obstetrics, n/a(n/a). doi:10.1002/ijgo.13332
[ 12 ] Hernandez, S., Oliveira, J. B., & Shirazian, T. (2017). How a training program is transforming the role of traditional birth attendants from cultural practitioners to unique health-care providers: a community case study in rural Guatemala. Frontiers in Public Health, 5, 111.
[ 13 ] Li, Y., Zhao, R., Zheng, S., Chen, X., Wang, J., Sheng, X., . . . Sheng, J. (2020). Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Disease journal, 26(6), 1335. doi:10.3201/eid2606.200287
[ 14 ] Lopez, M. L. M., & Mejia, L. (2011). Indigenous women and governance in Guatemala: FOCAL.
[ 15 ] Ma, X., Vervoort, D., Reddy, C. L., Park, K. B., & Makasa, E. (2020). Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective. International Journal of Surgery, 79, 43-46. doi:
[ 16 ] Medhanyie, A., Spigt, M., Kifle, Y., Schaay, N., Sanders, D., Blanco, R., . . . Berhane, Y. (2012). The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study. BMC Health Services Research, 12(1), 352. doi:10.1186/1472-6963-12-352
[ 17 ] Orellana, M. S., Rodríguez, A. L. C., & Benini, G. La Asociación de Ginecología y Obstetricia de Guatemala-AGOG.
[ 18 ] Organization, W. H. (2019). Maternal mortality: Levels and trends: 2000 to 2017. Sexual and reproductive health.
[ 19 ] Organization, W. H. (2020a). Rational use of personal protective equipment for coronavirus disease (‎‎‎‎‎‎COVID-19)‎‎‎‎‎‎ and considerations during severe shortages: interim guidance, 6 April 2020. Retrieved from Geneva:
[ 20 ] Organization, W. H. (2020b). Strengthening preparedness for COVID-19 in cities and urban settings: interim guidance for local authorities. Retrieved from Geneva:
[ 21 ] Outpatient assessment and management for pregnant women with suspected or confirmed novel coronavirus (COVID-19). (2020). In. The American College of Obstetricians and Gynecologists.
[ 22 ] Phone Advice Line Tools: Guidelines for Children (2-17 years) or Adults (>18 years) with Possible COVID-19. (2020). U.S. Department of Health and Human Services Retrieved from
[ 23 ] Practice Advisory for the Novel Coronavirus 2019 (COVID-19). (2020). Novel Coronavirus 2019 (COVID-19).
[ 24 ] Prata, N., Passano, P., Sreenivas, A., & Gerdts, C. E. (2010). Maternal mortality in developing countries: challenges in scaling-up priority interventions. Women’s Health, 6(2), 311-327.
[ 25 ] Rasmussen, S. A., & Jamieson, D. J. (2020). Coronavirus Disease 2019 (COVID-19) and Pregnancy: Responding to a Rapidly Evolving Situation. Obstetrics and gynecology, 135(5), 999-1002. doi:10.1097/AOG.0000000000003873
[ 26 ] Rasmussen, S. A., Jamieson, D. J., & Uyeki, T. M. (2012). Effects of influenza on pregnant women and infants. Am J Obstet Gynecol, 207(3 Suppl), S3-8. doi:10.1016/j.ajog.2012.06.068
[ 27 ] Riley, T., Sully, E., Ahmed, Z., & Biddlecom, A. (2020). Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low-and middle-income countries. Int Perspect Sex Reprod Health, 46, 46.
[ 28 ] Roberton, T., Carter, E. D., Chou, V. B., Stegmuller, A. R., Jackson, B. D., Tam, Y., . . . Walker, N. (2020). Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study. Lancet Glob Health. doi:10.1016/s2214-109x(20)30229-1
[ 29 ] Rodriguez-Morales, A. J., Gallego, V., Escalera-Antezana, J. P., Méndez, C. A., Zambrano, L. I., Franco-Paredes, C., . . . Cimerman, S. (2020). COVID-19 in Latin America: The implications of the first confirmed case in Brazil. Travel medicine and infectious disease, 101613-101613. doi:10.1016/j.tmaid.2020.101613
[ 30 ] Schwartz, D. A. (2020). An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med. doi:10.5858/arpa.2020-0901-SA
[ 31 ] Silasi, M., Cardenas, I., Kwon, J.-Y., Racicot, K., Aldo, P., & Mor, G. (2015). Viral infections during pregnancy. American journal of reproductive immunology (New York, N.Y. : 1989), 73(3), 199-213. doi:10.1111/aji.12355
[ 32 ] Stollak, I., Valdez, M., Rivas, K., & Perry, H. (2016). Casas Maternas in the rural highlands of Guatemala: a mixed-methods case study of the introduction and utilization of birthing facilities by an indigenous population. Global Health: Science and Practice, 4(1), 114-131.
[ 33 ] Wenham, C., Smith, J., Morgan, R., Gender, & Group, C.-W. (2020). COVID-19: the gendered impacts of the outbreak. Lancet, 395(10227), 846-848. doi:10.1016/S0140-6736(20)30526-2
[ 34 ] World Health, O. (2020). Clinical management of COVID-19: interim guidance, 27 May 2020. Retrieved from Geneva:
[ 35 ] World Health Organization, & Fund, U. N. C. s. (2020). Community-based health care, including outreach and campaigns, in the context of the COVID-19 pandemic: interim guidance, May 2020. Retrieved from Geneva: