BMJ 1996;312:29-33 (6 January)

General practice

Does home visiting prevent childhood injury? A systematic review of randomised controlled trials

Ian Roberts, overseas fellow,a Michael S Kramer, professor,b Samy Suissa, director c

a Department of Community Paediatric Research, Montreal Children's Hospital, McGill University Faculty of Medicine, Montreal, Quebec, Canada, b Departments of Pediatrics and of Epidemiology and Biostatistics, McGill University Faculty of Medicine, c Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal

Correspondence to: Dr Ian Roberts, Department of Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH.

Abstract

Objective: To quantify the effectiveness of home visiting programmes in the prevention of child injury and child abuse.
Design: Systematic review of 11 randomised controlled trials of home visiting programmes. Pooled odds ratios were estimated as an inverse variance weighted average of the study specific odds ratios.
Setting: Randomised trials that were available by April 1995.
Subjects: The trials comprised 3433 participants.
Results: Eight trials examined the effectiveness of home visiting in the prevention of childhood injury. The pooled odds ratio for the eight trials was 0.74 (95% confidence interval 0.60 to 0.92). Four studies examined the effect of home visiting on injury in the first year of life. The pooled odds ratio was 0.98 (0.62 to 1.53). Nine trials examined the effect of home visiting on the occurrence of suspected abuse, reported abuse, or out of home placement for child abuse. Because of the potential for bias in outcome reporting in these studies, pooled effect estimates were not calculated.
Conclusions: Home visiting programmes have the potential to reduce significantly the rates of childhood injury. The problem of differential surveillance for child abuse between intervention and control groups precludes the use of reported abuse as a valid outcome measure in controlled trials of home visiting.

Key messages

  • Key messages

  • Home visiting has been proposed as a prevention strategy, but the results from randomised trials are conflicting

  • This systematic review of randomised trials shows that home visiting can substantially reduce rates of child injury

  • No consistent effect on child abuse was found, but differential surveillance for child abuse between visited groups and control groups is an important weakness in many trials

  • The role of health visitors and non-professionals in the prevention of child injury deserves further attention


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