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
- cluster randomized controlled trial
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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 (firstname.lastname@example.org).
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