Key lessons from a mixed-method evaluation of a postnatal home visit programme in the humanitarian setting of Gaza

Background: The World Health Organization recommends postnatal home visits to improve maternal and newborn health. Evidence of postnatal home visit effectiveness in humanitarian settings is limited. Aims: To evaluate postnatal home visits implemented in the constrained humanitarian context of Gaza. Methods: Qualitative data were obtained through key informant interviews, in-depth interviews and/or focus group discussions with women targeted by the programme, nontargeted women, husbands, and home visitors. These data were complemented by a secondary analysis of quantitative data from existing household surveys and project monitoring data. Qualitative data were analysed using thematic analysis, and quantitative data were analysed to describe trends over time. Results: Women in the programme demonstrated improved breastfeeding practices and increased uptake of breastfeeding, and behavioural changes reduced harmful traditional norms and practices. The programme increased mutual understanding and respect between health providers and women, allowed for a more personalized approach and increased self-esteem among the women. To improve postnatal care throughout the population, interventions should focus not only on home visits but also address immediate postnatal care in maternity, postnatal follow-up in clinics, and improvements in the coordination and communication between the different levels of care. Conclusion: Implementation of postnatal home visits in a constrained humanitarian context such as Gaza is feasible and positively contributes to breastfeeding and newborn care practices, as well as to improved interactions between health providers and their clients. Positive effects could be leveraged if postnatal care were strengthened throughout the continuum of care.

Does routine home visiting improve the return rate and outcome of DOTS patients who delay treatment?

Over a period of 6 months the effect of home visits on compliance with directly observed therapy, short course [DOTS], was studied on 480 new smear-positive tuberculosis patients who had delayed collecting their drugs on one occasion. Patients registered at 15 tuberculosis treatment centers in Baghdad, Iraq, were randomized to an intervention group [receiving home visits from trained personnel] or a control group. Home visits were highly effective in improving the return to treatment of patients who were late for treatment [231/240, 96.3%]. The intervention group showed a higher treatment success rate [94.2% versus 76.7%], lower default rate [0.8% versus 10.0%] and higher smear conversion rate after the end of treatment [92.9% versus 75.0%] than controls. Home visiting by trained personnel significantly improves patient compliance with DOTS