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Home nurse visitation reduced maternal, child mortality
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Prenatal, infant and toddler home visitation by nurses reduced mortality of mothers and their first-born children living in disadvantaged settings.
David L. Olds, PhD, of the University of Colorado in Aurora, Colo., and colleagues conducted a randomized study of 1,138 women, enrolled at less than 29 weeks gestation, to receive one of four treatment interventions. Women in group one (n=166) received free transportation to prenatal care appointments; those in group two (n=514) received transportation for prenatal care, developmental screening and referral services when their children were aged 6, 12 and 24 months; women in group three (n=230) received free transportation and nurse home visits during pregnancy and two postpartum visits. Those in group four (n=228) were provided the same services as group three, in addition to home visits until the child was aged 2 years and developmental screening and referrals for children.
Researchers enrolled primarily African American women who reported no previous live births, and had at least two of the following sociodemographic risk characteristics: unmarried, fewer than 12 years of education, or unemployed. Most of the study cohort was African American (92.1%) and unmarried (98.1%); 85.1% came from households with annual incomes below the United States federal poverty guidelines; 64.1% were aged younger than 18 years at study enrollment.
Groups one and two served as the control group.
Regarding maternal mortality, there were 27 all-cause deaths in group one and two, one in group three, and five in group four overall. There were 11 deaths in groups one and two, none in group three, and one in group four related to external causes.
At 21 years following randomization, the mean all-cause mortality rate was 3.7% in groups one and two; 0.4% in group three; and 2.2% in group four. There was a significant contrast of survival between groups one and two and group three (P=0.007) and between groups one and two combined and groups three and four combined (P=0.008).
Regarding child mortality, there were 14 deaths in group two and two deaths in group four for all causes. Five of the deaths in group two and two in group four were due to natural causes. Nine deaths in group two were due to preventable causes. No deaths in group four were associated with preventable causes, according to the study findings.
When children were aged 20 years, all-cause mortality rate was 2.7% in group two and 0.9% in group four. Survival contrast between groups was not significant. The preventable mortality rate was 1.6% in group two, compared with 0% in group four.
“The relatively lower rates of death found among nurse-visited mothers and children compared with those in the control group are consistent with the effect of the program on earlier aspects of maternal and child health. These findings suggest that this intervention may have longer-term effects on health and mortality as the mothers and their children grow older,” the researchers concluded.
Disclosure: The researchers have financial ties with the Nurse-Family Partnership.
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