Cockcroft Anne, Omer Khalid, Gidado Yagana, Gamawa Adamu Ibrahim, Andersson Neil
CIET/PRAM, Department of Family Medicine, McGill University, 5858 Cote des Neiges, Montreal, Canada.
CIET in Nigeria, Federal Low Cost, Near Police Station, Bauchi, Bauchi State, Nigeria.
BMC Health Serv Res. 2018 Jul 3;18(1):510. doi: 10.1186/s12913-018-3319-z.
Maternal mortality in Nigeria is one of the highest in the world. Access to antenatal care is limited and the quality of services is poor in much of the country. Previous research in Bauchi State found associations between maternal morbidity and domestic violence, heavy work in pregnancy, lack of knowledge about danger signs, and lack of spousal communication about pregnancy and childbirth. This cluster randomized controlled stepped-wedge trial will test the impact of universal home visits to pregnant women and their partners, and the added value of video edutainment.
The trial will take place in six wards of Toro Local Government Area in Bauchi State, Nigeria, randomly allocated into three waves of two wards each. Home visits will begin in wave 1 wards immediately; in wave 2 wards after one year; and in wave 3 wards after a further year. In each wave, one ward, randomly allocated, will receive video edutainment during the home visits. Female home visitors will contact all households in their catchment areas of about 300 households, register all pregnant women, and visit them every two months during pregnancy, after delivery and one year later. They will use android handsets to collect information on pregnancy progress, send this to a central server, and discuss with the women the evidence about household factors associated with higher maternal risks, using video clips in the edutainment wards. Male home visitors will contact the partners of the pregnant women and discuss with them the same evidence. We will compare outcomes between wave 1 and wave 2 wards at about one year, between wave 2 and wave 3 wards at about two years, and finally between wards with and without added edutainment. Primary outcomes will be complications in pregnancy and delivery, and child health at one year. Secondary outcomes include knowledge and attitudes, use of health services, knowledge of danger signs, and household care of pregnant women.
Demonstrating an impact of home visits and understanding potential mechanisms could have important implications for reducing maternal morbidity and mortality in other settings with poor access to quality antenatal care services.
Registration number: ISRCTN82954580 . Registry: ISRCTN. Date of registration: 11 August 2017. Retrospectively registered.
尼日利亚的孕产妇死亡率位居世界前列。该国大部分地区获得产前护理的机会有限，服务质量也很差。此前在包奇州的研究发现，孕产妇发病率与家庭暴力、孕期繁重工作、对危险信号缺乏了解以及夫妻之间缺乏关于怀孕和分娩的沟通之间存在关联。这项整群随机对照阶梯式楔形试验将测试对孕妇及其伴侣进行普遍家访的影响，以及视频教育娱乐的附加价值。
该试验将在尼日利亚包奇州托罗地方政府辖区的六个病房进行，随机分为三组，每组两个病房。家访将立即在第一组病房开始；一年后在第二组病房开始；再过一年在第三组病房开始。在每组中，随机分配的一个病房将在家访期间接受视频教育娱乐。女性家访员将联系其辖区内约300户家庭中的所有家庭，登记所有孕妇，并在孕期、分娩后及一年后每两个月对她们进行一次家访。她们将使用安卓手机收集怀孕进展信息，发送至中央服务器，并在教育娱乐病房使用视频片段与女性讨论与较高孕产妇风险相关的家庭因素证据。男性家访员将联系孕妇的伴侣，并与他们讨论相同的证据。我们将在大约一年时比较第一组和第二组病房的结果，在大约两年时比较第二组和第三组病房的结果，最后比较有和没有附加教育娱乐的病房的结果。主要结局将是怀孕和分娩期间的并发症以及一岁时儿童的健康状况。次要结局包括知识和态度、卫生服务的使用、危险信号的知晓情况以及对孕妇的家庭护理。
证明家访的影响并了解潜在机制可能对在其他难以获得优质产前护理服务的地区降低孕产妇发病率和死亡率具有重要意义。
注册号：ISRCTN82954580。注册机构：ISRCTN。注册日期：2017年8月11日。追溯注册。
