An Assessment of Maternal Health Issues in Two Villages in the Eastern Cape Province of South Africa

Siruma, Amanda; Hornby, D. Brock; Srinivas, S.

doi:10.3390/ijerph110909871

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…In 2011, the South African (SA) National Department of Health (NDOH) launched 'The Re-engineering of Primary Health Care' policy, which relies heavily on CHWs, to reduce maternal and child mortality and improve access to health care [8][9][10][11]. Successful CHW programs have provided services to over 200 million people over the past 2 decades in Brazil, Bangladesh and Nepal [12].…”

Section: Introductionmentioning

confidence: 99%

Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

et al. 2020

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Background Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3–0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

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Section: Introductionmentioning

confidence: 99%

Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

et al. 2020

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“…Moreover, even if they could get to call ambulances, the supply is always outnumbered by the demand. For instance, for the need of about 70 ambulances, only 25 ambulances will be operational [2] [4]. Fig.…”

Section: Background Informationmentioning

confidence: 99%

Mobile-Based Medical Emergency Ambulance Scheduling System

Isong¹,

Dladlu²,

Magogodi³

2016

IJCNIS

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Effective and efficient public service delivery like healthcare services are very important in today's society, especially in the rural areas. People in rural areas are expected to have access to public facilities at all times. However, these services are not always available when they are needed. This paper discusses the problems faced by rural areas of Mafikeng in South Africa (SA) when public and basic healthcare facilities like medical ambulance transports are needed during emergency situation. The challenges ranges from poor communication, poor road network and unstructured address to non-arrival of ambulances leading loss of lives that are preventable. This paper designed and implemented a system prototype using mobile application technologies to offer cost-effective services to patients during emergencies. It is intended to reduce long queues in hospitals and long waiting periods for an ambulance via location-based services. By using this application, lives in the rural areas can be made easier and loss of lives prevented by providing timely response from the appropriate healthcare providers during emergencies.

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“…South Africa has 55,000 CHWs [ 12 ], and these CHWs are seen as a key component of the government’s plans to “Re-engineer Primary Health Care” [ 13 – 16 ]. In 2011, more than 33,000 of the 55,000 CHWs were reassigned from being based mostly at clinics to performing home visits [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of supervision on community health workers’ effectiveness with households in rural South Africa: A cluster randomized controlled trial

Rotheram¹,

Roux

Norwood³

et al. 2023

PLoS Med

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Background Community health workers (CHWs) can supplement professional medical providers, especially in rural settings where resources are particularly scarce. Yet, outcomes of studies evaluating CHWs effectiveness have been highly variable and lack impact when scaled nationally. This study examines if child and maternal outcomes are better when existing government CHWs, who are perinatal home visitors, receive ongoing enhanced supervision and monitoring, compared to standard care. Methods and findings A cluster randomized controlled effectiveness trial was conducted comparing outcomes over 2 years when different supervision and support are provided. Primary health clinics were randomized by clinic to receive monitoring and supervision from either (1) existing supervisors (Standard Care (SC); n = 4 clinics, 23 CHWs, 392 mothers); or (2) supervisors from a nongovernmental organization that provided enhanced monitoring and supervision (Accountable Care [AC]; n = 4 clinic areas, 20 CHWs, 423 mothers). Assessments were conducted during pregnancy and at 3, 6, 15, and 24 months post-birth with high retention rates (76% to 86%). The primary outcome was the number of statistically significant intervention effects among 13 outcomes of interest; this approach allowed us to evaluate the intervention holistically while accounting for correlation among the 13 outcomes and considering multiple comparisons. The observed benefits were not statistically significant and did not show the AC’s efficacy over the SC. Only the antiretroviral (ARV) adherence effect met the significance threshold established a priori (SC mean 2.3, AC mean 2.9, p < 0.025; 95% CI = [0.157, 1.576]). However, for 11 of the 13 outcomes, we observed an improvement in the AC compared to the SC. While the observed outcomes were not statistically significant, benefits were observed for 4 outcomes: increasing breastfeeding for 6 months, reducing malnutrition, increasing ARV adherence, and improving developmental milestones. The major study limitation was utilizing existing CHWs and being limited to a sample of 8 clinics. There were no major study-related adverse events. Conclusions Supervision and monitoring were insufficient to improve CHWs’ impact on maternal and child outcomes. Alternative strategies for staff recruitment and narrowing the intervention outcomes to the specific local community problems are needed for consistently high impact. Trial registration Clinicaltrials.gov, NCT02957799.

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An Assessment of Maternal Health Issues in Two Villages in the Eastern Cape Province of South Africa

Cited by 5 publications

References 5 publications

Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

Community health workers impact on maternal and child health outcomes in rural South Africa – a non-randomized two-group comparison study

Mobile-Based Medical Emergency Ambulance Scheduling System

The effect of supervision on community health workers’ effectiveness with households in rural South Africa: A cluster randomized controlled trial

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