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Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial

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Abstract

Objectives

In order to address South Africa’s maternal and infant mortality and morbidity rates, patient and community-level preventable factors need to be identified and addressed. However, there are few rigorously implemented and tested studies in low- and middle-income countries that evaluate the impact of community-level interventions on maternal and infant health outcomes. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on maternal depressive symptoms, maternal nutrition and intention to exclusively breastfeed.

Method

The intervention was tested using a pilot randomised controlled trial consisting of 72 (39 treatment and 33 control) adult women, implemented in a low-income, peri-urban area in Cape Town, South Africa. Data was collected using a baseline questionnaire conducted shortly after recruitment, and an end line questionnaire conducted a week after giving birth.

Results

The intervention resulted in a 0.928-point drop in the maternal depressive symptom scale (which ranges from 1 to 8). We find no evidence that the intervention has either a sizeable or precisely estimated impact on maternal nutrition, measured using middle-upper arm circumference. While the intervention has almost no effect on the infant feeding intention of women who own refrigerators, it has a very large positive effect of 3.349-points (on a scale ranging from 1 to 8) for women without refrigerators.

Conclusion

A package intervention consisting of psycho-social support, additional tailored health information, and an incentive to utilise public antenatal care services has the potential to increase exclusive breastfeeding intention and reduce maternal depressive symptoms among the economically vulnerable.

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Availability of Data and Material

The manuscript has associated data that is available in a data repository. https://figshare.com/s/b659902974d2fc2311bf.

Code Availability

The Stata code can be uploaded to the data repository.

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Funding

Funding was received from the Abdul Latif Jameel Poverty Action Lab (JPAL), Broadreach Healthcare and REDI3 × 3. Several smaller sponsorships were also obtained from Ackermanns, Agrimark SA and Jonsson.

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Authors and Affiliations

  1. School of Economics and Finance, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg, South Africa

    Laura Rossouw

  2. Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa

    Rulof Petrus Burger & Ronelle Burger

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  1. Laura Rossouw
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  2. Rulof Petrus Burger
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  3. Ronelle Burger
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Contributions

LR, RPB and RB all contributed to the study design. Implementation, fieldwork, project management and statistical analysis were performed by LR. Manuscript drafting was performed by LR, RB and RPB. All the authors read and approved the final manuscript.

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Correspondence to Laura Rossouw.

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Ethical approval was obtained from the research ethics committee of Stellenbosch University.

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Rossouw, L., Burger, R.P. & Burger, R. Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial. Matern Child Health J 25, 1913–1922 (2021). https://doi.org/10.1007/s10995-021-03229-w

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