Universal home visits improve male knowledge and attitudes about maternal and child health in Bauchi State, Nigeria: Secondary outcome analysis of a stepped wedge cluster randomised controlled trial

Abstract

Background The World Health Organization recommends increased male involvement to improve maternal and newborn health in low- and middle-income countries, but few studies have measured the impact of male-engagement interventions on targeted men. A trial of universal home visits to pregnant women and their spouses in Nigeria improved maternal and child health outcomes. This analysis examines the impact of the visits on male spouses. Methods In Toro Local Government Area in Bauchi State, Nigeria, we randomly allocated eight wards into four waves, beginning the intervention at one-year intervals. The intervention comprised two-monthly evidence-based home visits to discuss local risk factors for maternal and child health with all pregnant women and their male spouses. Measured secondary outcomes of the intervention in the men included knowledge about danger signs in pregnancy and childbirth, beliefs about heavy work in pregnancy, discussion with their wives about pregnancy and childbirth, knowledge about causes and intentions about management of childhood diarrhoea, and views about childhood immunisation. The analysis compared outcomes between men in visited wards (intervention group) and pre-intervention wards (control group), using a cluster t test. Generalised linear mixed modelling accounted for the effect of socio-economic differences on the measured impact. Results The analysis included 6931 men in the intervention group and 9434 in the control group. More men in the intervention group knew four or more danger signs in pregnancy (risk difference (RD) = 0.186, 95% confidence interval (CI) = 0.044 to 0.327), and three danger signs in childbirth (RD = 0.091, 95%CI = 0.013 to 0.170), thought pregnant women should reduce heavy work before the third trimester (RD = 0.088, 95% CI = 0.015 to 0.162), and had discussed pregnancy and childbirth with their spouse (RD = 0.157, 95% CI = 0.026 to 0.288). More knew correct management of childhood diarrhoea with fluids and feeding (RD = 0.300, 95% CI = 0.203 to 0.397) and less would give a child medicine to stop diarrhoea (RD = 0.206, 95% CI = 0.125 to 0.287). Socio-economic differences did not explain the effect of the intervention on any of the outcomes. Conclusion Universal home visits improved knowledge of male spouses about maternal and child health, which could contribute to improved maternal and child outcomes. Trial registration ISRCTN, ISRCTN82954580. 11 August 2017. Retrospectively registered. http://www.isrctn.com/ISRCTN82954580

Gender-Based Violence Interventions in Low- and Middle-Income Countries: A Systematic Review of Interventions at Structural, Community, Interpersonal, Individual, and Multiple Levels

“…The interventions at interpersonal level were implemented and evaluated in South (i.e., Zambia, South Africa), East (i.e., Rwanda, Ethiopia), and West African countries (i.e., Nigeria). The GBV risk reduction component was integrated with HIV/STI risk reduction (Chaudhury et al, 2016; Jones et al, 2014; Minnis et al, 2015; Sharma et al, 2020), antenatal and postnatal care (Cockcroft et al, 2019), and substance use (Jones et al, 2014; Minnis et al, 2015) components. One study included a component on men’s engagement in promotion of reproductive and maternal health (Doyle et al, 2018).…”

“…Target populations included men and women, heterosexual couples (e.g., HIV seroconcordant and serodiscordant couples), and families (i.e., one HIV positive caregiver and one child between ages 7 and 17). Trained community members (i.e., men and women) commonly facilitated sessions within participants’ homes (e.g., Chaudhury et al, 2016; Cockcroft et al, 2019), community health centers (Jones et al, 2014), local schools or administrative offices (Doyle et al, 2018), or other settings. In one study, the intervention was delivered in an individual format (i.e., gender-separate sessions for partners) (Cockcroft et al, 2019), while the formats and length of sessions varied in other interventions.…”

Receiving antenatal care via mobile clinic: Lived experiences of Jordanian mothers

“…Cockcroft et al. (2019) advise applying home visits in settings where pregnant women are physically unable to attend a clinic or hospital for antenatal care, as it reduces maternal risk and improves pregnancy outcomes [ 22 ]. A Japanese study examined the extent to which home visits to high-risk pregnant women after 28 weeks’ gestation improved birth outcomes.…”

“…The organizers of these campaigns should increase their frequency in remote areas to ensure that the World Health Organization (WHO) standards for the care of pregnant women are achieved. The 2016 WHO guidelines for antenatal care recommended eight visits as a minimum number of antenatal care contacts, the first contact to occur during the first trimester of pregnancy [ 22 ].…”

Participatory health research under COVID-19 restrictions in Bauchi State, Nigeria: Feasibility of cellular teleconferencing for virtual discussions with community groups in a low-resource setting

“…18 The home visits took place between 2016 and 2019. In early 2020, we met face to face with groups of community leaders to present and discuss with them the quantitative research findings about impact of the home visits [19][20][21] and plan with them follow-up actions they could implement in their communities. In May and June 2020, we intended to hold follow-up meetings with community leaders to discuss their progress with action plans.…”