Impact of home-visit counselling on maternal and child health and nutrition by Barangay health workers: a quasi-experimental study from Eastern Visayas, Philippines.

Background: Maternal and child undernutrition and poor mental health remain public health concerns in the Philippines. We evaluated the impact of home visits with timed and targeted care for family (ttCF) strategies for maternal and child nutrition and mental health during the first 1000 days of life.

Methods: We designed a quasi-experimental study encompassing 12 municipalities (six intervention and six comparison) and enrolling 1518 pregnant women or mothers with children <12 months. Trained Barangay health workers (BHWs) conducted 12 scheduled home visits from pregnancy through child's second year in the intervention areas, while comparison areas received routine health services. We estimated the intervention's impact using multilevel mixed-effect models and generalised linear models, adjusting for socioeconomic covariates. The outcomes of interest included frequency of BHW's home visits, maternal message recall scores, possible depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS) score >9), maternal and child diet, and child nutritional status.

Results: We assessed 1313 women and children (655 in comparison; 658 in intervention) at 12-month follow-up. Women in the intervention areas received higher home visits during pregnancy (mean (x̄) = 3.2, standard deviation (SD) = 2.7 vs. x̄ = 1.7, SD = 2.0; P < 0.001) and postpartum (x̄ = 2.6, SD = 2.1 vs. x̄ = 1.3, SD = 1.4; P < 0.001), and they had higher recall of health and nutrition messages across the intervention period: prenatal care (adjusted mean difference (AMD) = 2.25; 95% CI = 1.57, 2.94), birth (AMD = 1.83; 95% CI = 1.24, 2.41), and postpartum care (AMD = 2.20; 95% CI = 1.43, 2.96). The intervention reduced maternal potential depressive symptoms by 9.16 percentage points (95% CI = -15.7, -2.62) and a reduction of 1.20 points in EPDS score (95% CI = -1.88, -0.52). There were no significant differences between intervention and comparison groups for maternal dietary diversity or child diet and nutrition indicators.

Conclusions: The ttCF strategy improved the frequency and quality of BHW home visits and demonstrated promising impacts on maternal mental health. However, additional enabling interventions are needed to improve maternal and child diet and nutrition outcomes.