Effect of personalized home-based support for pregnant women on pregnancy outcomes: a cluster randomized trial

Abstract

Background. Anemia during pregnancy has been linked to higher maternal and perinatal morbidity and mortality. The purpose of this study is to examine the impact of individualized home-based care for pregnant women on pregnancy outcomes.Methods: This was a cluster-randomized experiment done in Burkina Faso’s Sindou health area between 2015 and 2016. The intervention included a monthly home-based visit focused on nutritional counseling and pregnancy monitoring for pregnant women, and a training on nutrition for pregnant women, prevention of anemia in pregnancy, and management of anemia in pregnancy for health facility teams. In the control group, prenatal care was administered in accordance with national program guidelines. The primary outcome was the reported prevalence of anemia in pregnancy. The secondary outcomes of stillbirth, preterm birth, low birth weight, and abortion were evaluated using a difference in differences analysis and mixed models across the two groups. The sample consisted of 617 pregnant women, with 440 women assigned to the intervention group and 177 assigned to the control group. No maternal fatalities occurred in either group. The intervention decreased stillbirths by -1.6% (95% confidence interval: -3.1% to - 0.1%). It had no impact on the rates of low birth weight, premature birth, and abortion. Conclusion: In rural Burkina Faso, personalized support of pregnant women at home, in conjunction with appropriate prenatal care, reduced stillbirths, but not the rates of low birth weight, preterm birth, or abortion.

Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis

“…The 17 reports included were from studies conducted in 15 countries in SSA ( Table 1 ). Three studies each were from Malawi 23 , 37 , 39 and Burkina Faso, 26 , 27 , 30 and the rest were from 13 other countries. Two studies were conducted in two or more countries.…”

“… 26 , 32 There was at least one study from all four regions of SSA. Seven studies were from west Africa conducted in Nigeria, 29 , 33 Burkina Faso, 26 , 27 , 30 Ghana, 35 and Côte d’Ivoire. 28 Equally, east Africa had seven studies, from Malawi, 23 , 37 , 39 Tanzania, 24 Ethiopia, 21 Mozambique, 31 Uganda and Zambia.…”

“…Eight of the included studies were cluster Randomised Controlled Trials (cRCT), 21 , 23 , 24 , 25 , 26 , 27 , 28 , 39 four had pre-post design, 32 , 33 , 34 , 35 two were RCT, 29 , 30 while one each were non-randomised controlled trial (non-RCT), 31 cohort 36 and cross-sectional 37 [ Table 1 ]. Of the 17 studies, twelve were conducted solely in the community, four were conducted both in the communities and health facilities while one study had four arms comprising community only, community and health facility, health facility only and control.…”

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

“… Usual care Gambia, Burkina Faso and Benin cRCT Community only 1,2 Low risk 08 N/A Leight 2018 25 Provision of birth kits, health education using Community resource persons. Usual care Nigeria cRCT Community only 1,2 High risk 09 N/A Ilboudo 2022 26 Home visits, health worker training, iron and folic acid supplementation, Intermittent Preventive malaria therapy, nutrition counselling Usual care Burkina Faso cRCT Community and hospitals 1,2 Low risk 10 N/A Kone 2023 27 Home visits, nutritional counselling, micronutrient supplementation. Usual care Côte d’Ivoire cRCT Community only 1,2 Some concerns 11 N/A De Kok 2022 30 Provision of prenatal fortified balanced energy-protein supplement, iron and folic acid supplementation Usual care Burkina Faso RCT Community only 1,2 Low risk 12 N/A Alexander 2018 28 Provision of clean cook ethanol stoves, home visits and health education.…”

“…Ten studies were cRCTs, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 three were RCTs 28 , 29 , 30 and one was a non-randomised controlled trial. 31 Seven studies had a pre-post design, 32 , 33 , 34 , 35 , 36 , 37 , 38 three were cross sectional, 39 , 40 , 41 two were cohort studies, 42 , 43 and four were qualitative, 44 , 45 , 46 , 47 three were mixed method studies, 48 , 49 , 50 while one implementation report did provide sufficient detail on methods used 51 [ Table 1 ].…”