Okoh-Owusu, Marion (2022) Using community health workers and nurses for home visits to pregnant women to improve maternal and newborn health in rural Ghana : a systematic review and cluster-randomised controlled trial. PhD thesis, University of Warwick.

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Abstract

Introduction: Most maternal deaths which occur in the world are recorded in Low and Middle-Income Countries (LMICs). Home visits offer opportunities to educate pregnant women on care practices and safer delivery options.
Objective: To review and synthesise the evidence on the effects of home visits to pregnant women, and to investigate CHW/CHN partnerships for home visits, for improved skilled attendant at birth and other health outcomes for mother and baby. Methods: First a systematic review and meta-analysis was conducted. Medline, Embase, Cochrane databases were searched for published data on trials, which assessed the effects of home visits. Then a clusterrandomised controlled trial was conducted where, after an intensive community mobilization, CHWs provided three follow-up visits to pregnant women enrolled in ten intervention zones. Women in control zones had usual care. Independent assessors collected data on health outcomes after delivery, for the intention to treat analysis.
Results: The systematic review did not find a study where CHWs partnered with other cadres to conduct home visits. The results showed that home visits to pregnant women led to improvement in SAB (OR1.5 (95% CI: 1.2, 2.0) and other care practices. However, the pooled data in a meta-analysis did not show a statistically significant difference in overall neonatal mortality among intervention and control arms (Pooled RR: 1.002 (95% CI 0.922, 1.089). The field trial had widespread acceptance among community members with 952 women participating. CHW-CHN partnerships led to high Skilled Attendant at Birth among intervention arm, 98 percent, and controls, 89 percent. There was a statistically significant difference on the effect of home visits on SAB among intervention arm, compared to the controls (Odds Ratio, OR: 5.24, 95% Confidence Interval, CI: 2.70 to 10.17), and with a statistically significant p-value of <0.001. Regarding neonatal indicators, breastfeeding initiation was significantly affected by the home visits (OR 2.89 (95% CI 1.21, 6.90), p=0.001) as well as BCG vaccination statuses at month 1; OR 3.10 (95% CI 1.73, 5.56), P=0.001.
Conclusion: CHW/CHN home visits to pregnant women led to improvements in some care practices for mothers and babies. Innovative approaches where trained health staff and clinically oriented cadres such as CHNs partner with CHWs during home visits, could lead to better health outcomes in LMICs. Community mobilization was identified as an essential contributor to the successful field work. Further research on cost effectiveness of these partnerships is needed.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics R Medicine > RT Nursing
Library of Congress Subject Headings (LCSH):	Visiting nurses -- Ghana, Prenatal care -- Ghana, Maternal health services -- Ghana, Pregnant women -- Health and hygiene -- Ghana, Pregnant women -- Services for -- Ghana, Community health aides -- Ghana, Community health nurses -- Ghana
Official Date:	19 July 2022
Dates:	Date Event 19 July 2022 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Brown, Celia A. ; Gill, Paramjit
Sponsors:	Commonwealth Scholarship Commission in the United Kingdom ; University of Warwick
Format of File:	pdf
Extent:	223 leaves : illustrations, photographs
Language:	eng

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