Intention to Engage in Maternal and Child Health Home Visiting

Abstract Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3–0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

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Addressing maternal and child health equity through a community health worker home visiting intervention to reduce low birth weight: retrospective quasi-experimental study of the Arizona Health Start Programme

BMJ Open ◽

10.1136/bmjopen-2020-045014 ◽

2021 ◽

Vol 11 (6) ◽

pp. e045014

Author(s):

Samantha Sabo ◽

Patrick Wightman ◽

Kelly McCue ◽

Matthew Butler ◽

Vern Pilling ◽

...

Keyword(s):

Birth Weight ◽

Child Health ◽

American Indian ◽

Birth Outcomes ◽

Maternal And Child Health ◽

Home Visiting ◽

Birth Certificate ◽

Quasi Experimental ◽

Programme Participation ◽

And Child Health

ObjectiveTo test if participation in the Health Start Programme, an Arizona statewide Community Health Worker (CHW) maternal and child health (MCH) home visiting programme, reduced rates of low birth weight (LBW), very LBW (VLBW), extremely LBW (ELBW) and preterm birth (PTB).DesignQuasi-experimental retrospective study using propensity score matching of Health Start Programme enrolment data to state birth certificate records for years 2006–2016.SettingArizona is uniquely racially and ethnically diverse with comparatively higher proportions of Latino and American Indian residents and a smaller proportion of African Americans.Participants7212 Health Start Programme mothers matched to non-participants based on demographic, socioeconomic and geographic characteristics, health conditions and previous birth experiences.InterventionA statewide CHW MCH home visiting programme.Primary and secondary outcome measuresLBW, VLBW, ELBW and PTB.ResultsUsing Health Start Programme’s administrative data and birth certificate data from 2006 to 2016, we identified 7212 Health Start Programme participants and 53 948 matches. Programme participation is associated with decreases in adverse birth outcomes for most subgroups. Health Start participation is associated with statistically significant lower rates of LBW among American Indian women (38%; average treatment-on-the-treated effect (ATT): 2.30; 95% CI −4.07 to –0.53) and mothers with a pre-existing health risk (25%; ATT: -3.06; 95% CI −5.82 to –0.30). Among Latina mothers, Health Start Programme participation is associated with statistically significant lower rates of VLBW (36%; ATT: 0.35; 95% CI −0.69 to –0.01) and ELBW (62%; ATT: 0.31; 95% CI (−0.52 to –0.10)). Finally, Health Start Programme participation is associated with a statistically significant lower rate of PTB for teen mothers (30%; ATT: 2.81; 95% CI −4.71 to –0.91). Other results were not statistically significant.ConclusionA state health department-operated MCH home visiting intervention that employs CHWs as the primary interventionist may contribute to the reduction of LBW, VLBW, ELBW and PTB and could improve birth outcomes statewide, especially among women and children at increased risk for MCH inequity.

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Evaluation protocol to assess maternal and child health outcomes using administrative data: a community health worker home visiting programme

BMJ Open ◽

10.1136/bmjopen-2019-031780 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031780 ◽

Cited By ~ 1

Author(s):

Samantha Sabo ◽

Matthew Butler ◽

Kelly McCue ◽

Patrick Wightman ◽

Vern Pilling ◽

...

Keyword(s):

Child Health ◽

Health Outcomes ◽

Community Health ◽

Administrative Data ◽

Maternal And Child Health ◽

Home Visiting ◽

Health Workers ◽

Control Group ◽

And Child Health ◽

Start Program

IntroductionEmerging evidence suggests community health workers (CHWs) delivering preventive maternal and child health (MCH) interventions through home visiting improve several important health outcomes, including initiation of prenatal care, healthy birth weight and uptake of childhood immunisations.Methods and analysisThe Arizona Health Start Program is a behavioral-based home visiting intervention, which uses CHWs to improve MCH outcomes through health education, referral support, and advocacy services for at-risk pregnant and postpartum women with children up to 2 years of age. We aim to test our central hypothesis that mothers and children exposed to this intervention will experience positive health outcomes in the areas of (1) newborn health; (2) maternal health and healthcare utilisation; and (3) child health and development. This paper outlines our protocol to retrospectively evaluate Health Start Program administrative data from 2006 to 2015, equaling 15 576 enrollees. We will use propensity score matching to generate a statistically similar control group. Our analytic sample size is sufficient to detect meaningful programme effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunisation and hospitalisation rates.Ethics and disseminationThis work is supported through an inter-agency contract from the Arizona Department of Health Services and is approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802, approved 25 January 2017). Evaluation of the three proposed outcome areas will be completed by June 2020.

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