title: Home-based social support for socially disadvantaged mothers.
abstract: BACKGROUND
  Epidemiologic studies indicate that babies born to socio-economically disadvantaged mothers are at higher risk of injury, abuse and neglect, health problems in infancy, and are less likely to have regular well-child care. Home visitation programs have long been advocated as a strategy for improving the health of disadvantaged children. Over the past two decades, a number of randomised trials have examined the effect of home visitation programs on a range of maternal and child health outcomes. The studies in this review evaluate programs which offer additional home based support for socially disadvantaged mothers and their children.
  
  
  OBJECTIVE
  Babies born in socio-economic disadvantage are likely to be at higher risk of injury, abuse and neglect, and to have health problems in infancy. The objective of this review was to assess the effects of programs offering additional home-based support for women who have recently given birth and who are socially disadvantaged.
  
  
  METHODS
  We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: 26 October 1998.
  
  
  METHODS
  Randomised and quasi-randomised trials of one or more post-natal home visits with the aim of providing additional home based support for socially disadvantaged women who had recently given birth, compared to usual care.
  
  
  METHODS
  Trial quality was assessed. Study authors were contacted for additional information.
  
  
  RESULTS
  Eleven studies, involving 2992 families, were included. Most of the trials had important methodological limitations. Seven trial reports are awaiting further assessment. There was a trend towards reduced child injury rates with additional support, although this was not statistically significant (odds ratio 0.74, 95% confidence interval 0.54 to 1.03). There appeared to be no difference for child abuse and neglect (odds ratio 1.12, 95% confidence interval 0.80 to 1.57), although differential surveillance between visited and non-visited families is an important methodological consideration. Babies in the additional support groups were more likely to have complete well-child immunizations. Based on the results of two trials, there was a trend towards reduced hospitalization, although this was not statistically significant.
  
  
  CONCLUSIONS
  Postnatal home-based support programs appear to have no risks and may have benefits for socially disadvantaged mothers and their children, possibly including reduced rates of child injury. Differential surveillance does not allow easy interpretation of the child abuse and neglect findings.
authors.affiliation: Maternal, Infant and Reproductive Health Research Unit, 790 Bay Street, Suite 715, Toronto, Canada, M5G 1N8. ellen.hodnett@utoronto.ca
authors.forename: E D
authors.initials: ED
authors.lastname: Hodnett
authors.forename: I
authors.initials: I
authors.lastname: Roberts
mesh_terms: D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D005260:Female; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008427:Maternal Health Services; D008429:Maternal Welfare; D008430:Maternal-Child Health Centers; D011203:Poverty; D012944:Social Support