Comparison of high- versus low-intensity community health worker intervention to promote newborn and child health in Northern Nigeria

Figures & data

Table 1 Background characteristics of respondents, Northern Nigeria, 2009 versus 2011

Background characteristic	BHS 2009 n (%)	FHS 2011 n (%)
Age group (years)
15–19	344 (4.7)	179 (7.8)
20–24	820 (11.1)	529 (22.9)
25–29	1,417 (19.2)	608 (26.3)
30–34	1,618 (22.0)	526 (22.8)
35–39	1,176 (16.0)	281 (12.2)
40–44	1,015 (13.8)	147 (6.4)
45–49	982 (13.3)	29 (1.3)
Marital status
Married	6,664 (97.2)	2,288 (99.1)
Widowed	78 (1.1)	11 (0.5)
Divorced or separated	115 (1.7)	10 (0.4)
Rank of wife
1st	5,401 (80.6)	1746 (76.6)
2nd	1,128 (16.8)	427 (18.7)
3rd+	175 (2.7)	101 (4.7)
Formal education
Yes	1,293 (18.8)	501 (16.5)
No	5,593 (81.2)	1,358 (83.5)
Level of formal education
Primary	713 (53.0)	317 (63.5)
Secondary	466 (34.7)	72 (14.4)
Post-secondary	166 (12.3)	110 (22.1)
Reading and writing in Hausa
Not at all	5,373 (78.1)	2,045 (88.5)
With difficulty	644 (9.4)	131 (5.9)
Easily	864 (12.6)	112 (4.7)
Occupation
Food processing	2,480 (36.2)	664 (28.7)
Agricultural processing	310 (4.5)	132 (5.7)
Farming	249 (3.6)	230 (10.0)
Trading/selling	1,200 (17.5)	655 (28.3)
Housewife	2,079 (30.3)	1,105 (47.8)
Other	534 (7.8)	149 (6.4)
Cellphone ownership
Yes	543 (7.9)	667 (28.9)
No	6,363 (92.1)	1,643 (71.1)
Total	6,906	2,310

Abbreviations: BHS, baseline household survey; FHS, follow-up household survey.

Figure 1 Newborn care activities (%) by intervention intensity, Northern Nigeria 2009 and 2011.

Note: Differences in newborn care activities are statistically significant for the baseline and follow-up household survey categories (χ² = 88.46, P = 0.000).

Table 2 Newborn care for the most recent birth, by intervention intensity, Northern Nigeria, 2009 versus 2011

Characteristic	BHS 2009, % (n)	Control 2011, % (n)	Low intensitya 2011, % (n)	High intensityb 2011, % (n)	F (P) Control vs low intensity vs high intensity	t (P) BHS vs FHS
Mother had anti-tetanus vaccine	69.2 (1,335)	81.1 (132)	84.6 (494)	87.6 (250)	1.018 (0.339)	50.1 (0.000)
First breastfeeding within 24 hours	42.9 (1,335)	56.1 (399)	59.1 (1,122)	61.1 (416)	0.138 (0.830)	14.3 (0.000)
First postnatal check within 48 hours	16.8 (1,335)	15.5 (71)	25.6 (258)	28.0 (143)	1.164 (0.328)	4.90 (0.000)
Person checking newborn					3.433 (0.015)	42.1 (0.000)
Nurse/midwife	34.5	59.6	41.0	35.7
CHW – health post	4.7	19.2	29.1	48.2
CHW – outreach	NA	9.6	13.4	4.8
TBA	40.8	–c	–c	NA
Other	20.0 (1,335)	11.8 (94)	16.6 (337)	11.3 (168)
Care provided to the newborn					4.972 (0.019)	24.7 (0.000)
No special newborn care	NA	3.6	0.9	0.0
Cord care	7.0	5.7	29.8	34.9
Washed baby	39.1	39.6	58.5	58.1
Kept baby warm (kangaroo)	16.8	13.2	21.3	21.7
Breastfed immediately	15.6	28.3	45.7	50.9
Watched for danger signs	20.0	15.1	20.6	19.8
Registered the birth	NA	3.8	5.1	5.7
Newborn vaccination	3.1	24.5	22.5	22.6
Weighed baby	15.1	3.8	3.8	3.8
Watched for high fever	NA (1,441)	11.3 (404)	24.3 (1,126)	23.4 (418)
Source of information about newborn cared					1.330 (0.281)	4.93 (0.000)
No one	31.9	25.7	31.6	18.9
Nurse/midwife	25.0	6.0	7.1	7.9
CHW in health post	6.8	3.5	8.4	14.4
CHW in outreach	NA	3.7	4.0	5.0
TBA	48.4	15.2	8.7	5.5
Family/friends	NA	39.4	21.5	19.4
Drug vendor/chemist	NA	3.2	1.1	0.0
Other	1.8	0.3	0.5	0.0
Total	6,208	404	1,126	418

Notes: F-statistic is comparable to the chi-square statistic, but is corrected for the design effect of clustering used in the household survey sample design.

a Community volunteer only

b community volunteer plus CHW

c not computed due to too few cases

d the person checking the newborn and counseling the mother after delivery.

Abbreviations: BHS, baseline household survey; CHW, community health worker; FHS, follow-up household survey; NA, not applicable (response item not collected in the survey); TBA, traditional birth attendant; vs, versus.

Table 3 Knowledge of and response to newborn danger signs and illness episodes of children under 5 years of age by intervention intensity, Northern Nigeria, 2011

Newborn danger sign knowledge and response type	Control 2011 (%)	Low intensitya	High intensityb	F (P) Control vs low intensity vs high intensity
Knowledge of each newborn danger sign
None known	9.8	8.8	11.5	0.543 (0.561)
Known
High fever	83.2	83.4	84.7	0.182 (0.825)
Stiff neck, fitting, or convulsions	14.6	31.6	23.3	2.827 (0.091)
Jaundice	6.7	15.5	18.9	3.081 (0.066)
Difficult/fast breathing	5.6	25.3	19.3	5.404 (0.021)
Not able to suckle/refusal to feed	6.3	17.9	14.6	3.408 (0.051)
Diarrhea/dehydration/sunken soft spot	21.6	26.7	33.2	0.647 (0.512)
n	297	771	339
Observation of specific danger signs in newborns (<6 weeks old)
High fever	25.4	29.6	30.9	1.126 (0.337)
Stiff neck, fitting, or convulsions	4.5	4.5	5.8	0.279 (0.757)
Swollen stomach	16.5	17.9	14.2	0.612 (0.550)
Diarrhea	14.5	18.0	19.7	0.830 (0.426)
Difficult/fast breathing	5.0	6.4	9.4	1.634 (0.223)
Not able to suckle/refusal to feed	6.5	6.0	7.2	0.216 (0.759)
n	401	1,125	417
Source of advice on care of sick children				1.872 (0.111)
Nurse/midwife	8.0	8.0	7.9
CHW in health post	6.0	14.7	24.5
CHW in outreach	4.7	4.5	3.4
TBA	6.7	5.0	0.7
Family/friends	35.7	27.3	23.6
Drug vendor/chemist	3.2	1.1	0.0
Traditional healer/other	0.3	0.5	0.0
No one mentioned	28.2	28.8	21.6
n	401	1,124	416
Specific acute illness episodes in past month, children <5 years
Fever only	24.9	24.5	28.1	0.273 (0.698)
Diarrhea	15.0	15.4	21.3	0.467 (0.592)
Cough only	13.2	12.2	15.6	0.281 (0.693)
Malnutrition (weight loss)	14.0	12.3	16.6	0.308 (0.732)
Fever and cough	37.8	30.7	32.5	0.256 (0.663)
Diarrhea and malnutrition	19.7	18.9	23.7	1.187 (0.311)
n	401	1,125	417

Notes:F-statistic is comparable to the chi-square statistic, but is corrected for the design effect of clustering used in the household survey sample design.

a Community volunteer only

b community volunteer plus CHW.

Abbreviations: CHW, community health worker; TBA, traditional birth attendant; vs, versus.

Table 4 Type of care given to sick child in the month preceding the survey by intervention intensity, Northern Nigeria, 2009 and 2011

Type of care (%) (n with any care)	2009 Fever/cough n = 1,205	2011 Fever/cough n = 533			F (P) C vs L vs H	2009 Diarrhea n = 1,335	2011 Diarrhea n = 348			F (P) C vs L vs H
		C	L	H			C	L	H
Home care
Gave more fluids	NA	2.8	14.7	17.6	3.410 (0.076)	NA	14.5	18.0	19.8	1.456 (0.255)
Gave ORS	6.6	2.8	3.7	10.2	5.593 (0.024)	18.2	4.7	6.7	13.9	3.400 (0.077)
Gave cough medicine	NA	9.9	13.7	13.6	1.122 (0.337)	NA	14.0	12.3	12.3	0.144 (0.813)
Traditional edicine/herbs	13.2	18.3	26.5	23.9	0.596 (0.531)	11.6	18.6	29.5	24.6	1.164 (0.326)
Did nothing	35.2	32.7	26.5	32.3	1.311 (0.284)	40.0	28.3	29.5	27.0	0.114 (0.871)
Medication use
Analgesics	39.0	61.9	58.3	44.4	1.869 (0.182)	29.9	57.1	51.4	42.3	0.902 (0.404)
Antibiotics	35.9	48.8	37.5	49.0	2.108 (0.156)	36.2	44.0	45.0	54.2	0.643 (0.518)
Antimalarials	57.5	34.6	40.5	37.0	0.332 (0.659)	55.8	33.3	33.3	37.1	0.096 (0.851)
Total sick	2,910	105	298	130		1,415	60	173	89

Notes:F-statistic is comparable to the chi-square statistic, but is corrected for the design effect of clustering used in the household survey sample design. Bolded values in the 2009 columns indicate that the differences between the BHS and FHS (high- and low-intensity intervention areas only) are significant at the 0.05 significance level or lower, according to the t-test. Percentages do not sum to 100% because multiple care activities may have been used per episode.

Abbreviations: C, control; H, high intensity (community volunteer and community health worker); L, low intensity (community volunteer only); NA, not applicable or data item not collected in the survey; vs, versus; ORS, oral rehydration salts.