Effect of Village Health Team Home Visits and Mobile Phone Consultations on Maternal and Newborn Care Practices in Masindi and Kiryandongo, Uganda: A Community-Intervention Trial

IntroductionThe World Health Organisation recommends home visits conducted by Community Health Workers (in Uganda known as Village Health Teams—VHTs) in order to improve maternal and newborn health. This study measured the effect of home visits combined with mobile phone consultations on maternal and newborn care practices.MethodIn a community intervention trial design 16 health centres in Masindi and Kiryandongo districts, Uganda were randomly and equally allocated to one of two arms: control and intervention arms. Eight control health centres received the usual maternal and newborn educational messages offered by professional health workers and eight intervention health centres that received an intervention package for maternal care and essential newborn care practices. In the intervention arm VHTs made two prenatal and one postnatal home visit to households. VHTs were provided with mobile phones to enable them make regular telephone consultations with health workers at the health centre serving the catchment area. The primary outcome was health facility delivery. Other outcomes included antenatal attendances, birth preparedness, cord and thermal care and breastfeeding practices. Analysis was by intention-to-treat.ResultsA total of 1385 pregnant women were analysed: 758 and 627 in the control and intervention arms respectively. Significant post-intervention differences were: delivery place [adjusted Odds Ratio aOR: 17.94(95%CI: 6.26–51.37); pppp = 0.006].ConclusionVHTs can have an effect in promoting proper cord and thermal care for the newborn and improve timely care-seeking for health facility delivery and newborn illness, because they could answer questions and refer patients correctly. However, VHTs should be supported by professional health workers through the use of mobile phones.Trial RegistrationClinicalTrials.gov NCT02084680引言 世界卫生组织（World Health Organisation）推荐由社区卫生工作者（在乌干达称为村卫生团队（Village Health Teams，简称VHTs））开展家庭访视，以改善孕产妇与新生儿健康状况。本研究评估了家庭访视结合手机咨询对孕产妇及新生儿护理行为的影响。 方法 本研究采用社区干预试验设计，将乌干达马辛迪（Masindi）和基扬东戈（Kiryandongo）地区的16个卫生中心随机平均分为两组：对照组与干预组。8个对照卫生中心接受专业卫生人员提供的常规孕产妇及新生儿健康教育信息，8个干预卫生中心则获得针对孕产妇护理与新生儿基本护理行为的干预方案。在干预组中，VHTs为受访家庭开展2次产前家庭访视与1次产后家庭访视，并为VHTs配备手机，以便其与服务辖区卫生中心的专业卫生人员开展常规电话咨询。本研究的主要结局指标为医疗机构分娩率，其他结局指标包括产前检查次数、分娩准备情况、脐带护理与保暖护理行为，以及母乳喂养习惯。分析采用意向性治疗（intention-to-treat）原则。 结果 本研究共纳入1385名孕妇进行分析，对照组与干预组分别为758例与627例。干预后出现的显著差异包括：分娩地点[校正比值比（adjusted Odds Ratio，简称aOR）：17.94（95%CI：6.26–51.37）；p<0.001]、分娩准备评分[aOR：1.80（95%CI：1.13–2.87）；p=0.013]、新生儿正确脐带护理行为[aOR：3.07（95%CI：1.39–6.77）；p=0.006]。 结论 VHTs可有效推广新生儿正确脐带护理与保暖护理行为，并改善孕产妇寻求医疗机构分娩及新生儿疾病及时诊疗的行为，原因在于其能够正确解答疑问并为患者提供合规转诊指引。但VHTs的工作需要专业卫生人员通过手机通讯提供持续支持。 试验注册 ClinicalTrials.gov NCT02084680