Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Intervention in South Africa on Maternal Health and Child Health and Development

Abstract

Almost all pregnant women (98%) in 24 Cape Town neighborhoods were randomized by neighborhood to: 1) the standard care (SC) condition (n=12 neighborhoods; n=594 pregnant women), or 2) the Philani Intervention Program (PIP) in which home visits by Community Health Workers (CHW) were conducted (n=12 neighborhoods; n=644 pregnant women). At 36 months post-birth (84.6% follow-up) PIP mothers were significantly less depressed at compared to the SC mothers. Children in PIP are significantly less likely to be stunted (24.3% vs 18.1%, p=0.013), to have better vocabularies and are less likely to be hospitalized than children in the SC condition. These data suggest home visits may need to continue for several years post-birth. Sustainable, scalable perinatal intervention models are needed in LMIC.

Fresh Perspectives on the Alcohol and HIV Nexus: A Call for Action in an Era of Increased Opportunities and Challenges

“…This could prevent many new infections, add thousands of quality-adjusted life years (QALYs), and yield an incrementally favorable cost-effectiveness ratio averting new infections [8]. Similar findings have emerged in randomized controlled trials with pregnant women in South Africa [9, 10]; Rotheram-Borus et al [11]. Specifically, seropositive mothers reduce alcohol use and problematic drinking when visited by paraprofessional home visitors and increase their completion of tasks to Prevent Mother to Child Transmission (PMTCT) of HIV by 50%.…”

Diffusing and scaling evidence‐based interventions: eight lessons for early child development from the implementation of perinatal home visiting in South Africa

“…This is reflected in Philani's selection strategy. Further, underlying the philosophy is a belief in the value of transferring back to intervention communities the capacity to solve every day health challenges to improve ECD . The actual process of selection is a multistage strategy: Potential CHWs are sourced using three strategies—community stakeholders and leaders put forward names; open advertising on community networks; and word of mouth using existing mentor mothers Interviews of prospective CHWs are conducted by individuals from every rung of the organization—including the director, middle management, supervisors, mentor mothers, and cleaning staff; analog simulation tasks (Dooley) facilitate observations by program staff.…”

“…Further, underlying the philosophy is a belief in the value of transferring back to intervention communities the capacity to solve every day health challenges to improve ECD. 22,23,26,33 The actual process of selection is a multistage strategy:…”

Adapting Current Strategies to Implement Evidence-Based Prevention Programs for Paraprofessional Home Visiting

“…With these innovations, significant benefits were observed in a cluster randomized controlled trial (RCT) for mothers receiving home visits by MM in the first three years of life (Tomlinson et al, in revision). Benefits occurred for both mothers living with HIV (50% improvement in tasks to prevent perinatal HIV transmission, longer duration of breastfeeding and a single feeding method; higher condom use and partner HIV testing, heavier and longer infants in the first 6 months, fewer child hospitalizations) and mothers in the same neighborhoods without HIV (less alcohol use and abuse during pregnancy, less maternal depression at three years post-birth, less alcohol use and abuse at five years, children who are better behaved and with better language skills at three and better behaved at five years).…”