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.
BACKGROUND
The 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.


METHODS
In 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.


RESULTS
A 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); p<0.001], cord care [aOR: 3.05(95%CI: 1.81-5.12); p<0.001] thermal care [aOR: 7.58(95%CI: 2.52-22.82); p<0.001], and timely care-seeking for newborn illness [aOR: 4.93(95%CI: 1.59-15.31); p = 0.006].


CONCLUSIONS
VHTs 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.


BACKGROUND
ClinicalTrials.gov NCT02084680.
Makerere University, School of Public Health, College of Health Sciences, P.O Box 7072, Kampala, Uganda.
Richard
R
Mangwi Ayiasi
Institute of Tropical Medicine, Nationalestraat 150, B 2000 Antwerp, Belgium.
Patrick
P
Kolsteren
Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
Vincent
V
Batwala
Institute of Tropical Medicine, Nationalestraat 150, B 2000 Antwerp, Belgium.
Bart
B
Criel
Makerere University, School of Public Health, College of Health Sciences, P.O Box 7072, Kampala, Uganda.
Christopher Garimoi
CG
Orach
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding; D040421:Cell Phone; D036861:Delivery, Obstetric / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006792:House Calls; D006801:Humans; D007231:Infant, Newborn; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care; D019035:Rural Health Services; D014454:Uganda; D055815:Young Adult