Associations between birth kit use and maternal and neonatal health outcomes in rural Jigawa state, Nigeria: A secondary analysis of data from a cluster randomized controlled trial

Abstract

BackgroundThe burden of maternal and neonatal mortality remains persistently high in Nigeria. Sepsis contributes significantly to both maternal and newborn mortality, and safe delivery kits have long been promoted as a cost-effective intervention to ensure hygienic delivery practices and reduce sepsis. However, there is limited evidence on the effectiveness of home birth kit distribution by community health workers, and particularly the impact of this intervention on health outcomes. This paper reports a secondary analysis of data from a cluster randomized trial in rural northern Nigeria in which birth kits were distributed by community health workers to pregnant women in their homes, analyzing non-experimental variation in receipt and use of birth kits. More specifically, associations between pregnant women’s baseline characteristics and receipt and use of birth kits, and associations between birth kit use, care utilization and maternal and newborn outcomes were assessed.Methods and findingsBaseline, post-birth and endline data related to 3,317 births observed over a period of three years in 72 intervention communities in Jigawa state, Nigeria, were analyzed using hierarchical, logistic regression models. In total, 140 women received birth kits, and 72 women used the kits. There were no associations between baseline demographic characteristics, health history, and knowledge and attitudes and receipt of a kit, suggesting that community health workers did not systematically target the distribution of birth kits. However, women who used the kit reported reduced odds of past pregnancy complications (OR = 0.44, 95% CI: 0.19-1.00) as well as significantly higher odds of feeling generally healthy at baseline (OR = 2.00, 95% CI: 1.06-3.76), of exposure to radio media (OR = 1.97, 95% CI: 1.21-3.22), and of perceiving themselves as having a low-risk pregnancy (OR = 3.05, 95% CI:1.39-6.68). While there were no significant associations between birth kit use and facility based delivery, skilled birth attendance or post-natal care, women who used a kit exhibited significantly lower odds of completing four or more ANC visits (adjusted OR = 0.39, 95% CI: 0.18-0.85) and significantly higher odds of reporting prolonged labor (adjusted OR = 4.75, 95% CI: 1.36-16.59), and post-partum bleeding (adjusted OR = 3.25, 95% CI: 1.11-9.52).ConclusionsThis evidence suggests that use of birth kits is low in a rural population characterized by minimal baseline utilization of maternal and neonatal health services, and the use of birth kits was not associated with reductions in maternal or neonatal morbidity. While further research is required to understand how the effectiveness of birth kits may be shaped by the mechanism through which women access and utilize the kits, our findings suggest that the provision of kits to women outside of the formal health system may be associated with increased risk of adverse outcomes.

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

“… Usual care DRC cRCT Community only 1,2 Some concerns 07 Community scheduled Malaria screening and treatment (CSST) Scott 2019 20 Malaria screening and treatment, home visits. Usual care Gambia, Burkina Faso and Benin cRCT Community only 1,2 Low risk 08 N/A Leight 2018 25 Provision of birth kits, health education using Community resource persons. Usual care Nigeria cRCT Community only 1,2 High risk 09 N/A Ilboudo 2022 26 Home visits, health worker training, iron and folic acid supplementation, Intermittent Preventive malaria therapy, nutrition counselling Usual care Burkina Faso cRCT Community and hospitals 1,2 Low risk 10 N/A Kone 2023 27 Home visits, nutritional counselling, micronutrient supplementation.…”

“…Ten studies were cRCTs, 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 three were RCTs 28 , 29 , 30 and one was a non-randomised controlled trial. 31 Seven studies had a pre-post design, 32 , 33 , 34 , 35 , 36 , 37 , 38 three were cross sectional, 39 , 40 , 41 two were cohort studies, 42 , 43 and four were qualitative, 44 , 45 , 46 , 47 three were mixed method studies, 48 , 49 , 50 while one implementation report did provide sufficient detail on methods used 51 [ Table 1 ].…”

Scoping review of maternal and newborn health interventions and programmes in Nigeria

“…An additional 28 articles were retrieved from citations, and the full texts were assessed and included in the review. A total of 80 publications were included in the final review 24–103. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews flow diagram in figure 2 summarises the search results and screening processes for this study.…”

“…Nearly half (45%, n=33) had outcomes related to improving the demand, access, coverage, quality and utilisation of essential MNH services, interventions or both. Other outcomes include reducing maternal or newborn deaths or both;24 26 27 32 34 49 60 62 64 67–69 72 78 102 improving knowledge of preventive practices and self-management;30 38 39 50 51 55 65 71 73 74 93 95 improving community participation in MNH including male members of the community;28 45 92 99 capacity building of the health workforce44 77 79 86 88 and the prevention and management of pregnancy or newborn-related diseases and complications, or both 31 35 37 40 41 57 61 66 96 103…”

“…The most common facilitators reported were community engagement and participation (50%, n=23) 24 25 27 28 31 39 41 42 45 51 53 54 63 65 77 85 91 92 98 100–102. Others included an integrated approach to implementation of interventions;31 48 85 89 98 communication of adequate (and culturally appropriate) knowledge about the programme or intervention54 65 69 103 and demand creation activities 52 53…”