The impact of universal home visits with pregnant women and their spouses on maternal outcomes: a cluster randomised controlled trial in Bauchi State, Nigeria.

INTRODUCTION: Maternal mortality in Nigeria is extremely high. Access to quality antenatal and obstetric care is limited. In Bauchi State, we found maternal morbidity was associated with domestic violence, heavy work in pregnancy, ignorance of danger signs, and lack of spousal communication. This cluster randomized controlled trial tested the impact of universal home visits that discussed these upstream risk factors with pregnant women and their spouses, to precipitate household actions protecting pregnant women. METHODS: We randomly allocated four wards in Toro Local Government Authority to immediate or delayed intervention. Female and male home visitors visited all pregnant women and their spouses in the two intervention wards every 2 months. We compared completed pregnancies between intervention and pre-intervention wards after 1 year. Primary outcomes were pregnancy, delivery, and postnatal complications, analysed with intention to treat using a cluster t-test. Ancillary analysis examined the influence of baseline and health service use differences. RESULTS: Among 1837 women in intervention wards and 1853 women in pre-intervention wards, the intervention reduced problems in pregnancy and post partum: raised blood pressure (relative risk reduction (RRR) 0.120, cluster-adjusted 95% CI (CIca) 0.045 to 0.194; risk difference (RD) 0.116, 95% CIca 0.042 to 0.190) and swelling of face or hands (RRR 0.271, 95% CIca 0.201 to 0.340; RD 0.264, 95% CIca 0.194 to 0.333) and postpartum sepsis (RRR 0.399, 95% CIca 0.220 to 0.577; RD 0.324, 95% CIca 0.155 to 0.493). The intervention reduced the targeted upstream risk factors such as heavy work during pregnancy (RRR 0.234, 95% CIca 0.085 to 0.383; RD 0.222, 95% CIca 0.073 to 0.370). It did not increase use of antenatal care, institutional delivery or skilled birth attendance. CONCLUSION: Home visits reduced upstream maternal risks, improving maternal outcomes without increased use of health services. This could have implications in other settings with poor access to quality antenatal and delivery care services. TRIAL REGISTRATION: ISRCTN82954580.

Childhood Malnutrition is Associated with Maternal Care During Pregnancy and Childbirth: A Cross-Sectional Study in Bauchi and Cross River States, Nigeria.

BACKGROUND: Malnutrition remains an important cause of childhood morbidity and mortality; the levels of childhood malnutrition in Nigeria are among the highest in the world. The literature supports many direct and indirect causes of malnutrition, but few studies have examined the link between maternal care during pregnancy and childbirth and childhood malnutrition. This study examines this potential link in Bauchi and Cross River states in Nigeria. DESIGN AND METHODS: In 2011, a household survey collected information about children under four years old and their mothers' last pregnancy. Trained fieldworkers measured mid-upper arm circumference (MUAC) of children aged 6-47 months. We examined associations with childhood malnutrition in bivariate and multivariate analysis. RESULTS: Some 4.4% of 3643 children in Cross River, and 14.7% of 2706 in Bauchi were malnourished (MUAC z-score). In both states, a child whose mother had fewer than four government antenatal care visits was more likely to be malnourished (Cross River: OR 1.85, 95%CIca 1.33-2.55; Bauchi: OR 1.29, 95%CIca 1.02-1.63). In Bauchi, a child whose mother who rarely or never discussed pregnancy and childbirth with her husband (OR 1.34, 95%CIca 1.07-1.68), and who did not have her last delivery attended by a skilled health worker was more likely to be malnourished (OR 1.50, 95%CIca 1.09-2.07). CONCLUSIONS: These findings, if confirmed in other studies, suggest that poor care of women in pregnancy and childbirth could pose a longer term risk to the health of the child, as well as increasing immediate risks for both mother and child. Significance for public healthChildhood malnutrition is a public health priority, accounting for almost 1/5 of global disease burden among children under five years old. Many studies have examined risk factors for childhood malnutrition, but few have examined the link between maternal care during pregnancy and childbirth and childhood malnutrition. This study, albeit a cross-sectional design, provides evidence of a link between poor care during pregnancy and childbirth and childhood malnutrition in two states of Nigeria. This is important for public health because it suggests another benefit of caring for women during pregnancy and childbirth. This could not only reduce maternal and child perinatal mortality, but also have benefits for the longer-term health and development of children. This finding could be useful for paternal advocacy; it may motivate men to support their wives during pregnancy and childbirth since through this support, fathers can also protect the future development of their children.