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

Abstract

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.

Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

“…The interventions provided mixed results. When undertaken in a peri-urban area in which participants received visits from community health workers, the intervention was found to reduce maternal depression at 6-month follow-up when compared standard available care [79]. However, a similar intervention, undertaken in a rural area, found no significant differences regarding maternal depression scores between groups in the first 2 years postpartum [80].…”

An integrated parenting intervention for maternal depression and child development in a low‐resource setting: Cluster randomized controlled trial

“…CHWs or lay healthcare workers are typically community members who are trusted and respected, and able to provide a link between people's homes and formal government primary healthcare clinics (Olaniran et al, 2017). Clinical trials and longitudinal observational studies of visits by CHWs have shown to improve maternal well‐being (including symptoms of maternal depression) and child development in low‐resource settings (Kumar et al, 2020; le Roux et al, 2020).…”

The Role and Impact of Female Health Workers on the Well-Being of Global South Communities: A Call for Gender-Transformative Action

“…After completion of training, FCHVs are provided a certificate from the Ministry of Health, and a medicine kit that includes oral rehydration solution packets and oral supplements such as vitamin A and iron. They are provided an identity card and a register with 30 to 40 indicators to be recorded, including maternal, infant, and child deaths, and details of vertical programmes in their areas [7,39].…”

“…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 [39,40]. Local communities and Non-Governmental Organizations (NGOs) responded to overwhelming care and social needs in the HIV-affected countries of southern Africa and provided home-based care and support that emerged organically.…”