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The impact of universal home visits with pregnant women and their spouses on maternal outcomes: a cluster randomised controlled trial in Bauchi State, Nigeria
  1. Anne Cockcroft1,
  2. Khalid Omer2,
  3. Yagana Gidado3,
  4. Muhammad Chadi Baba3,
  5. Amar Aziz2,
  6. Umaira Ansari2,
  7. Adamu Ibrahim Gamawa4,
  8. Yahaya Yarima5,
  9. Neil Andersson1,2
  1. 1 CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
  2. 2 Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
  3. 3 Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi Chapter, Bauchi, Nigeria
  4. 4 Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
  5. 5 Bauchi State Ministry of Health, Bauchi, Nigeria
  1. Correspondence to Dr Anne Cockcroft; anne.cockcroft{at}mcgill.ca

Abstract

Introduction Maternal mortality in Nigeria is extremely high. Access to quality antenatal and obstetric care is limited. In Bauchi State, we found maternal morbidity was associated with domestic violence, heavy work in pregnancy, ignorance of danger signs, and lack of spousal communication. This cluster randomized controlled trial tested the impact of universal home visits that discussed these upstream risk factors with pregnant women and their spouses, to precipitate household actions protecting pregnant women.

Methods We randomly allocated four wards in Toro Local Government Authority to immediate or delayed intervention. Female and male home visitors visited all pregnant women and their spouses in the two intervention wards every 2 months. We compared completed pregnancies between intervention and pre-intervention wards after 1 year. Primary outcomes were pregnancy, delivery, and postnatal complications, analysed with intention to treat using a cluster t-test. Ancillary analysis examined the influence of baseline and health service use differences.

Results Among 1837 women in intervention wards and 1853 women in pre-intervention wards, the intervention reduced problems in pregnancy and post partum: raised blood pressure (relative risk reduction (RRR) 0.120, cluster-adjusted 95% CI (CIca) 0.045 to 0.194; risk difference (RD) 0.116, 95% CIca 0.042 to 0.190) and swelling of face or hands (RRR 0.271, 95% CIca 0.201 to 0.340; RD 0.264, 95% CIca 0.194 to 0.333) and postpartum sepsis (RRR 0.399, 95% CIca 0.220 to 0.577; RD 0.324, 95% CIca 0.155 to 0.493). The intervention reduced the targeted upstream risk factors such as heavy work during pregnancy (RRR 0.234, 95% CIca 0.085 to 0.383; RD 0.222, 95% CIca 0.073 to 0.370). It did not increase use of antenatal care, institutional delivery or skilled birth attendance.

Conclusion Home visits reduced upstream maternal risks, improving maternal outcomes without increased use of health services. This could have implications in other settings with poor access to quality antenatal and delivery care services.

Trial registration ISRCTN82954580.

  • Home visits
  • antenatal care
  • maternal care services
  • maternal morbidity
  • post-partum sepsis
  • Nigeria
  • cluster randomized controlled trial

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Contributors AC contributed to design of the study, led implementation, contributed to the analysis and co-drafted the manuscript. KO and YG contributed to design of the study, led the implementation in Nigeria, and contributed to the analysis and drafting of the manuscript. AA designed the database, supported data management and reviewed the manuscript. MCB, UA, AIG and YY supported the implementation in Nigeria and reviewed the manuscript. NA conceived and designed the study, conducted the analysis and co-drafted the manuscript.

  • Funding This work was carried out with the aid of a grant from the Innovating for Maternal and Child Health in Africa initiative, a partnership of Global Affairs Canada (GAC), the Canadian Institutes of Health Research (CIHR) and Canada’s International Development Research Centre (IDRC). The Quebec Population Health Research Network (QPHRN) and the International Development Research Centre (IDRC) contributed to the financing of this publication.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The Bauchi State Health Research Ethics Committee approved the trial on 12 May 2015 (NREC/12/05/2015/12), as did the McGill Faculty of Medicine IRB on 23 June 2015 (A06-B35-15A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised participant data for the findings reported in this article will be available only after completion of the whole stepped-wedge trial and publication of the findings. Researchers wishing to have access to the data should submit a request to AC (anne.cockcroft@mcgill.ca).

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