Hodnett E D, Roberts I
Cochrane Database Syst Rev. 2007 Jul 18(3):CD000107. doi: 10.1002/14651858.CD000107.
Epidemiologic studies indicate that babies born to socio-economically disadvantaged mothers are at higher risk of injury, abuse and neglect, health problems in infancy, and are less likely to have regular well-child care. Home visitation programs have long been advocated as a strategy for improving the health of disadvantaged children. Over the past two decades, a number of randomised trials have examined the effect of home visitation programs on a range of maternal and child health outcomes. The studies in this review evaluate programs which offer additional home based support for socially disadvantaged mothers and their children.
Babies born in socio-economic disadvantage are likely to be at higher risk of injury, abuse and neglect, and to have health problems in infancy. The objective of this review was to assess the effects of programs offering additional home-based support for women who have recently given birth and who are socially disadvantaged.
We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: 26 October 1998.
Randomised and quasi-randomised trials of one or more post-natal home visits with the aim of providing additional home based support for socially disadvantaged women who had recently given birth, compared to usual care.
Trial quality was assessed. Study authors were contacted for additional information.
Eleven studies, involving 2992 families, were included. Most of the trials had important methodological limitations. Seven trial reports are awaiting further assessment. There was a trend towards reduced child injury rates with additional support, although this was not statistically significant (odds ratio 0.74, 95% confidence interval 0.54 to 1.03). There appeared to be no difference for child abuse and neglect (odds ratio 1.12, 95% confidence interval 0.80 to 1.57), although differential surveillance between visited and non-visited families is an important methodological consideration. Babies in the additional support groups were more likely to have complete well-child immunizations. Based on the results of two trials, there was a trend towards reduced hospitalization, although this was not statistically significant.
AUTHORS' CONCLUSIONS: Postnatal home-based support programs appear to have no risks and may have benefits for socially disadvantaged mothers and their children, possibly including reduced rates of child injury. Differential surveillance does not allow easy interpretation of the child abuse and neglect findings.
流行病学研究表明，社会经济条件不利的母亲所生的婴儿遭受伤害、虐待和忽视的风险更高，在婴儿期存在健康问题，而且获得定期儿童健康护理的可能性较小。长期以来，家庭访视计划一直被倡导为改善弱势儿童健康状况的一项策略。在过去二十年中，多项随机试验研究了家庭访视计划对一系列母婴健康结局的影响。本综述中的研究评估了为社会弱势母亲及其子女提供额外家庭支持的计划。
社会经济条件不利的母亲所生的婴儿遭受伤害、虐待和忽视的风险可能更高，且在婴儿期存在健康问题。本综述的目的是评估为近期分娩且社会经济条件不利的妇女提供额外家庭支持的计划的效果。
我们检索了Cochrane妊娠与分娩组试验注册库和Cochrane对照试验注册库。最后检索日期：1998年10月26日。
一项或多项产后家庭访视的随机和半随机试验，旨在为近期分娩的社会弱势妇女提供额外的家庭支持，并与常规护理进行比较。
评估试验质量。与研究作者联系以获取更多信息。
纳入了11项研究，涉及2992个家庭。大多数试验存在重要的方法学局限性。7份试验报告有待进一步评估。获得额外支持后儿童受伤率有降低的趋势，尽管这在统计学上不显著（优势比0.74，95%置信区间0.54至1.03）。在虐待和忽视儿童方面似乎没有差异（优势比1.12，95%置信区间0.80至1.57），不过访视家庭和未访视家庭之间的差异监测是一个重要的方法学考量因素。额外支持组中的婴儿更有可能完成儿童全程免疫接种。基于两项试验的结果，住院率有降低的趋势，尽管这在统计学上不显著。
产后家庭支持计划似乎没有风险，可能对社会弱势母亲及其子女有益，可能包括降低儿童受伤率。差异监测使得对虐待和忽视儿童的研究结果难以进行解读。
