Added Value of Video Edutainment on Android Handsets in Home Visits to Improve Maternal and Child Health in Bauchi State, Nigeria: Secondary Analysis from a Cluster Randomised Controlled Trial

"The videos help the pregnant women understand the risk factors and take action more than if I had just explained. People don't forget easily what they see." (Female home visitor)

Maternal mortality and morbidity are very high in Nigeria, and there is limited access to effective maternal care services. A cluster randomised controlled trial (RCT) of evidence-based health promotion home visits to pregnant women and their spouses in northern Nigeria found significant improvements in maternal and child health outcomes. The objective of the study described here was to measure whether adding video edutainment to support the discussion about risk factors in the home visits produced any additional impact on the measured outcomes, over and above that of the visits themselves.

As part of the RCT's intervention, detailed at Related Summaries, below, female and male home visitors visited pregnant women and their male spouses in Bauchi State and discussed with them evidence about risk factors for maternal and child health actionable by households. The visitor shared the evidence either verbally alone or with added videos about the risk factors. Using android handsets, they showed 3 videos about maternal health at each visit during the pregnancy and added 2 videos about child health in their visits late in pregnancy and immediately after the birth.

The 5 short videos, each about 4 minutes long, took the form of soap opera dramas popular in the area. They depicted people's attitudes and beliefs about the maternal and child health risk factors, illustrated the impacts of these risk factors, and showed how actions by households could protect the health of pregnant women and small children. Each video concluded with a summary and advice from an actor in the role of a local community leader. A local production team filmed the videos in a rural community in Bauchi State. Local actors played the roles of characters in the dramas, speaking in the Hausa language. The videos are available with English subtitles here; see one example, below.

In total, 19,718 households in 3 randomly allocated video wards (administrative areas) received home visits including short videos; 16,751 households in three non-video wards received visits with only verbal discussion about risk factors. The researchers compared outcomes between wards with and without videos in the visits, calculating the odds ratio (OR) and 95% confidence interval (95% CI) of differences, in bivariate and then multivariate analysis adjusting for socio-economic differences between the video and non-video wards.

Pregnant women from video wards were more likely than those from non-video wards to have discussed pregnancy and childbirth often with their husbands (OR 2.22, 95% CI 1.07-4.59). Male spouses in video wards were more likely to know to give more fluids and continued feeding to a child with diarrhoea (OR 1.61, 95% CI 1.21-2.13). However, for most outcomes, there was no significant difference between video and non-video wards. The home visitors valued the videos and felt they helped sustain people's interest and increased their understanding about the risk factors. They said the Hausa soap opera style meant people enjoyed and could relate to the videos. Studies of the use of videos in community interventions report that videos work well when people can identify with characters and story lines.

In reflecting on the findings, the researchers explain that the careful training of home visitors in non-video wards helped them engage households in a comprehensive discussion about the maternal and child health risk factors addressed in the visits. For this reason, adding the video might not have had as much as an impact as it would in a wider rollout of the home visits in a service context, where such intensive training and support for home visitors will probably not be available. In this context, the video edutainment docudramas might be useful and add value.