Centro de Investigación de EnfermedadesTropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico.
Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi, Nigeria.
BMC Health Serv Res. 2021 Oct 12;21(1):1085. doi: 10.1186/s12913-021-07000-3.
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.
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.
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).
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.
ISRCTN82954580 . Date: 11/08/2017. Retrospectively registered.
尼日利亚是全球儿童死亡率第二高的国家。传染病仍是主要死因。在尼日利亚包奇州，一项阶梯式楔形群随机对照试验测试了向孕妇及其配偶提供普遍家访对其健康的影响。我们在此介绍与早期儿童健康相关的发现。
家访在 Toro 地方政府区的八个病房进行，这些病房被随机分配到四波，每波之间间隔 1 年。女家访员和男家访员在妊娠期间每两个月访问一次所有孕妇及其配偶，在分娩后 12-18 个月进行一次随访。他们介绍并讨论了有关家庭预防和管理腹泻和免疫的证据。我们比较了在每个波次的第一年接受干预的母亲所生的 12-18 个月大的儿童（干预组）与随后波次中干预前的 12-18 个月大的儿童（对照组）的结果。主要结果包括儿童腹泻的患病率和管理以及免疫状况，中间结果包括家庭知识和行为。采用广义估计方程（GEE），使用可交换相关矩阵和病房作为聚类，检验了结果差异的显著性。
分析包括 1796 名干预组儿童和 5109 名对照组儿童。在包括儿童其他特征的 GEE 模型中，干预组儿童腹泻的比例较低（优势比（OR）0.40，95%置信区间（CI）0.30-0.53），且在最后一次腹泻发作时更有可能增加液体摄入并继续喂食（OR 6.06，95% CI 2.58-14.20）。干预组儿童的母亲更有可能将缺乏卫生视为腹泻的原因（OR 2.24，95% CI 1.27-3.95），其家庭的卫生状况更好（OR 3.29，95% CI 1.45-7.45）。干预组儿童完全免疫的比例略高（OR 1.67，95% CI 0.78-3.57）。
向父母双方提供基于证据的家访可以激发家庭采取行动，从而改善儿童腹泻的预防和管理。即使在获得优质卫生服务机会有限的情况下，这种家访也可以帮助改善儿童健康。
ISRCTN82954580。日期：2017 年 8 月 11 日。回顾性注册。
