Impact of universal home visits on child health in Bauchi State, Nigeria: a stepped wedge cluster randomised controlled trial

Abstract

Background Nigeria is the second biggest contributor to global child mortality. Infectious diseases continue to be major killers. In Bauchi State, Nigeria, a stepped wedge cluster randomised controlled trial tested the health impacts of universal home visits to pregnant women and their spouses. We present here the findings related to early child health. Methods The home visits took place in eight wards in Toro Local Government Authority, randomly allocated into four waves with a delay of 1 year between waves. Female and male home visitors visited all pregnant women and their spouses every 2 months during pregnancy, with a follow up visit 12–18 months after the birth. They presented and discussed evidence about household prevention and management of diarrhoea and immunisation. We compared outcomes among children 12–18 months old born to mothers visited during the first year of intervention in each wave (intervention group) with those among children 12–18 months old pre-intervention in subsequent waves (control group). Primary outcomes included prevalence and management of childhood diarrhoea and immunisation status, with intermediate outcomes of household knowledge and actions. Generalised Estimating Equations (GEE), with an exchangeable correlation matrix and ward as cluster, tested the significance of differences in outcomes. Results The analysis included 1796 intervention and 5109 control children. In GEE models including other characteristics of the children, intervention children were less likely to have suffered diarrhoea in the last 15 days (Odds Ratio (OR) 0.40, 95% confidence interval (CI) 0.30–0.53) and more likely to have received increased fluids and continued feeding in their last episode of diarrhoea (OR 6.06, 95% CI 2.58–14.20). Mothers of intervention children were more likely to identify lack of hygiene as a cause of diarrhoea (OR 2.24, 95% CI 1.27–3.95) and their households had better observed hygiene (OR 3.29, 95% CI 1.45–7.45). Intervention children were only slightly more likely to be fully immunised (OR 1.67, 95% CI 0.78–3.57). Conclusions Evidence-based home visits to both parents stimulated household actions that improved prevention and management of childhood diarrhoea. Such visits could help to improve child health even in settings with poor access to quality health services. Trial registration ISRCTN82954580. Date: 11/08/2017. Retrospectively registered.

“I had to change my attitude”: narratives of most significant change explore the experience of universal home visits to pregnant women and their spouses in Bauchi State, Nigeria

“…This is a recognised feature of the most significant change technique [61] and authors have recommended confirmation of reported benefits by other means [62]. In our case, we confirmed the impact of the home visits on knowledge, views and health outcomes using quantitative methods in the context of a cluster randomised controlled trial [31][32][33]. The changes described in the stories are likely to be context-specific and may not apply in other settings, but the approach of sharing evidence to allow households to take preventive actions is more widely relevant.…”

“…Taken together with the quantitative evidence of impact of the home visits on maternal and child health outcomes [31][32][33], the narratives of change described here reinforce the idea that home visits to share evidence with pregnant women and their spouses can empower households to take action to improve their own situation. The Bauchi State Primary Health Care Development Agency has already committed to extending such home visits throughout the State, as funding permits.…”

“…For child health, they shared evidence about the benefits of childhood immunizations, about breastfeeding (including use of colostrum), and about prevention and management of childhood diarrhoea, including information from surveys in Bauchi [30]. Quantitative analysis of questionnaire responses in the trial revealed significant impacts of the home visits intervention: reduced complications of pregnancy and delivery and improved targeted risk factors [31]; improvements in child health outcomes [32]; and improved male knowledge and behaviour [33].…”

Universal home visits improve male knowledge and attitudes about maternal and child health in Bauchi State, Nigeria: Secondary outcome analysis of a stepped wedge cluster randomised controlled trial

“…Less than half the included studies were randomised controlled trials, and study outcomes did not include maternal and child health indicators. Our trial showed an impact of the home visits on men’s knowledge and attitudes, as well as improvements in both maternal and child health outcomes [ 15 , 16 ].…”

“…A recent stepped wedge cluster randomized controlled trial of home visits to pregnant women and their spouses in Bauchi State, Nigeria [ 14 ] reported large and significant impacts on maternal health outcomes [ 15 ] and on child health outcomes [ 16 ]. The visits targeted upstream actionable risk factors for maternal health, based on the findings from a previous survey in the state [ 17 ].…”