Innovating for Maternal and Child Health in Africa
Toro doorstep antenatal edutainment
IMCHA (Innovating for Maternal and Child Health in Africa) seeks to improve maternal, newborn and child health outcomes by
strengthening health systems, using primary healthcare as an entry point. Under IMCHA, Implementation Research Teams of African and
Canadian researchers and policy-makers are developing practical solutions to improve support for women and children in their communities
and in the health facilities that serve them.
Maternal health in Bauchi
Maternal, infant, and childhood mortality and morbidity remain far too high in Bauchi State. A large state-wide household survey in 2010,
conducted by CIET, found that women more likely to have complications in
pregnancy or childbirth if they:
* Did not talk to their partners about pregnancy and childbirth
* Continued heavy work during pregnancy
* Experienced violence during pregnancy
* Did not know danger signs during pregnancy and childbirth
People in communities, especially men, can reduce these pregnancy and
Universal home visits
Female home visitors go to every household in their catchment of about 300 households. They
register all pregnant women, and revisit them every two months during their pregnancy.
In each visit, they note the woman’s answers to questions about her health on a cellular
handset, sending the record to a central server, and then they share and discuss video-clips
about the pregnancy risks.
Male home visitors speak with the partners of these pregnant women to share the same information
with them and to discuss the videos.
Measured impact of the home visits on maternal outcomes
In 2016, home visits began in two randomly selected wards of Toro local government authority, with two more wards added in 2017, and two
more in 2018. Female home visitors have registered more than 50,000 CBAs in more than 30,000 houses. The study follows some 22,000
pregnancies and compares pregnancy outcomes in wards with visits and wards not yet visited, to identify the impact of the visits
A recently published paper in BMJ Global Health (https://gh.bmj.com/content/4/1/e001172) compares maternal outcomes after one year in the two first-wave wards (with home visits) with outcomes in the two second-wave wards (without home visits). It confirms a reduction in complications of pregnancy and in post-partum sepsis in the visited wards, of 20% or more, as well as big improvements in the targeted risk factors. However, there was no significant difference in use of health facilities for antenatal care or delivery between the visited and non-visited wards.
The findings support our idea that the improvement in maternal outcomes is due to changes in the actionable “upstream” risk factors.
What people think about the visits
Households value the home visits and describe how they have benefited from them.
I might have also lost my fifth pregnancy due to ignorance if I had not met her
[the home visitor]. 25 year old woman
My understanding … has changed my beliefs. I no longer allow my wife to do heavy work
during pregnancy. 27 year old man
Sustainability and rollout
Government counterparts from state and local government authorities are active members of the team supervising and monitoring the home
visits. From November 2018, the Bauchi State government took over the technical and financial management of the home visits programme
in the first two wards. The Bauchi State government has included a rollout of home visits across all the LGAs in the State in its plan for health
services, with an associated budget. A Technical Group convened by the PHCDA is working on the details of the home visits scheme to be rolled
out across Bauchi State. The home visits to be rolled out across Bauchi will be similar to those tested in Toro LGA, with some additional issues
added to the contents.
Rollout of the home visits program across the state requires a cadre of government officers trained in the management and technical monitoring of the program. The Bauchi IMCHA team are providing formal training for government counterparts in training, supervising and monitoring the home visitors; data quality monitoring; and data analysis/interpretation. The training courses are housed in the Bauchi State College of Nursing and Midwifery; six courses will take place during the project.
Dissemination of the project methods and results
A Bauchi State-level dissemination one-day workshop in December 2018 was attended by over 100 people: government planners and policy makers and civil society and media representatives. A dissemination workshop for the northern zone LGAs took place in January 2019 and central and southern zonal workshops will follow.
Dr Andersson gave a presentation about the project in the IDRC Symposium on maternal and child health in fragile contexts at the Canadian Conference on Global Health, Ottawa, in October 2017. Dr Cockcroft gave a presentation about the project as an invited Research Seminar in the department of Family Medicine, McGill University, in December 2017.
The study protocol published in BMC Health Services Research
(https://doi.org/10.1186/018-3319-z) allows interested researchers and policy makers to see the details of the approach and measurement methods.
Too short a gap between childbirth and the next pregnancy (kunika in the Hausa language) can be bad for the health of the mother and both
the children. A linked project explores kunika with stakeholders in communities in Toro and at
state level, asking about their views of the causes of kunika, and culturally acceptable ways to
discuss kunika with women and their partners in home visits.
Community focus groups of men and women in 2018 discussed the consequences of kunika. A
systematic literature review is looking at factors associated with short birth interval in the
international literature. We used fuzzy cognitive mapping in 2018 to describe the knowledge about
causes and prevention of kunika of women and men in communities, and government officers at
LGA and state level. In early 2019, dialogue groups in communities and wards of Toro LGA reviewed
evidence from the maps and discussed how to include the topic of kunika into home visits.
The team in Bauchi State, Nigeria
The Bauchi team is a collaboration between:
Federation of Muslim Women Association in Nigeria (FOMWAN),
Bauchi State Primary Health Care Development Agency (SPHCDA), and
CIET/PRAM in the department of Family Medicine, McGill University, Montreal, Canada.
Md Chadi Baba
Project State Coordinator
Phone: 0803 604 9628
Dr Anne Cockcroft
Associate Professor, Family Medicine,
McGill University, Montreal, Canada