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

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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 compared to the SC mothers. Children in PIP were significantly less likely to be stunted (24.3 vs 18.1 %, p = 0.013), to have better vocabularies, and were 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.

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References

  • Aboud, F. E., & Akhter, S. (2011). A cluster-randomized evaluation of a responsive stimulation and feeding intervention in Bangladesh. Pediatrics, 127, e1191–e1197. doi:10.1542/peds.2010-2160.

    Article  PubMed  Google Scholar 

  • Aracena, M., Krause, M., Pérez, C., Méndez, M. J., Salvatierra, L., Soto, M., & Altimir, C. (2009). A cost-effectiveness evaluation of a home visit program for adolescent mothers. Journal of Health Psychology, 14, 878. doi:10.1177/1359105309340988.

    Article  PubMed  Google Scholar 

  • Black, M. M., & Aboud, F. E. (2011). Response feeding is embedded in a theoretical framework of responsive parenting. Journal of Nutrition, 141, 490–494.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bolles, K., Speraw, C., Berggren, G., & Lafontant, J. G. (2002). Ti Foyer (hearth) community-based nutrition activities informed by the positive deviance approach in Leogane, Haiti: A programmatic description. Food & Nutrition Bulletin, 23, 9.

    Article  Google Scholar 

  • Bruner, J. (1985). Child’s talk: Learning to use language. Child Language Teaching and Therapy, 1, 111–114.

    Article  Google Scholar 

  • Campbell, C., & Scott, K. (2011). Retreat from Alma Ata? The WHO’s report on Task Shifting to community health workers for AIDS care in poor countries. Global Public Health, 6, 125.

    Article  CAS  PubMed  Google Scholar 

  • Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression—Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.

    Article  CAS  PubMed  Google Scholar 

  • Dawson, D. A., Grant, B. F., & Stinson, F. S. (2005). The AUDIT-C: Screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders. Comprehensive Psychiatry, 46, 405–416.

    Article  PubMed  Google Scholar 

  • de Onis, M., & Blossner, M. (2003). The World Health Organization Global Database on Child Growth and Malnutrition: Methodology and applications. International Journal of Epidemiology, 32, 518–526.

    Article  PubMed  Google Scholar 

  • Deane, F. P., Leathem, J., & Spicer, J. (1992). Clinical norms, reliability and validity for the Hopkins Symptom Checklist-21. Australian Journal of Psychology, 44, 21–25. doi:10.1080/00049539208260158.

    Article  Google Scholar 

  • Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19, 1–15.

    Article  CAS  PubMed  Google Scholar 

  • Dunn, L. M. (1965). Peabody Picture Vocabulary Test. Circle Pines: American Guidance Service.

    Google Scholar 

  • Engle, P. L., & Black, M. M. (2008). The effect of poverty on child development and educational outcomes. Annals of the New York Academy of Sciences, 1136, 243–256. doi:10.1196/annals.1425.023.

  • Flay, B. R., Biglan, A., Boruch, R. F., Castro, F. G., Gottfredson, D., Kellam, S., . . . Ji, P. (2005). Standards of evidence: Criteria for efficacy, effectiveness and dissemination. Prevention Science, 6, 151–175. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16365954.

  • Gertler, P., Heckman, J., Pinto, R., Zanolini, A., Vermeersch, C., Walker, S., . . . Grantham-McGregor, S. (2014). Labor market returns to an early childhood stimulation intervention in Jamaica. Science, 344, 998–1001. doi:10.1126/science.1251178.

  • Grantham-McGregor, S. M., Powell, C. A., Walker, S. P., & Himes, J. H. (1991). Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: The Jamaican Study. The Lancet, 338, 1. doi:10.1016/0140-6736(91)90001-6.

    Article  CAS  Google Scholar 

  • Heckman, J. J. (1995). Lessons from the Bell Curve. Journal of Political Economy, 103, 1091–1120. doi:10.1086/262014.

    Article  Google Scholar 

  • Heckman, J. J. (2006). Skill formation and the economics of investing in disadvantaged children. Science, 312, 1900–1902. doi:10.1126/science.1128898.

    Article  CAS  PubMed  Google Scholar 

  • Kalembo, F. W., & Zgambo, M. (2012). Loss to followup: A major challenge to successful implementation of prevention of mother-to-child transmission of HIV-1 programs in Sub-Saharan Africa. ISRN AIDS, 2012, 598817. doi:10.5402/2012/589817.

    Article  Google Scholar 

  • Lawrie, T. A., Hofmeyr, G. J., de Jager, M., & Berk, M. (1998). Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. The South African Medical Journal, 88, 1340–1344.

    CAS  PubMed  Google Scholar 

  • le Roux, I. M., Tomlinson, M., Harwood, J. M., O’Connor, M., Worthman, C. M., Mbewu, N., & Rotheram-Borus, M. J. (2013). Outcomes of home visits for pregnant mothers and their infants: A cluster randomised controlled trial. Aids, 27, 1461. doi:10.1097/QAD.0b013e3283601b53.

    Article  PubMed  Google Scholar 

  • Marmot, M., Friel, S., Bell, R., Houweling, T. A., Taylor, S., & Health, C. o. S. D. o. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Lancet, 372, 1661–1669. doi:10.1016/S0140-6736(08)61690-6.

    Article  PubMed  Google Scholar 

  • Maselko, J., Sikander, S., Bhalotra, S., Bangash, O., Ganga, N., Mukherjee, S., . . . Rahman, A. (2015). Effect of an early perinatal depression intervention on long-term child development outcomes: Follow-up of the Thinking Healthy Programme randomised controlled trial. Lancet Psychiatry, 2, 609–617. doi:10.1016/S2215-0366(15)00109-1.

  • Michalopoulos, C., Lee, H., Duggan, A., Lundquist, E., Tso, A., Crowne, S. S., . . . Knox, V. (2015). The mother and infant home visiting program evaluation: Early findings on the maternal, infant, and early childhood home visiting program. ACF Web Report. Retrieved from http://www.acf.hhs.gov/sites/default/files/opre/mihope_report_to_congress_final_1.pdf.

  • Nahar, B., Hossain, M. I., Hamadani, J. D., Ahmed, T., Grantham-McGregor, S., & Persson, L. A. (2012). Effects of psychosocial stimulation on improving home environment and child-rearing practices: Results from a community-based trial among severely malnourished children in Bangladesh. BMC Public Health, 12, 622. doi:10.1186/1471-2458-12-622.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics, 168, 800. doi:10.1001/jamapediatrics.2014.472.

    Article  PubMed  PubMed Central  Google Scholar 

  • One Million Community Health Worker’s Campaign. (2015). Financing community health worker systems at scale in sub-Saharan Africa: Workshop report. Retrieved from http://1millionhealthworkers.org/files/2015/09/1mCHW_SSC_Workshop_Report_External_2015-09-10_Final.compressed-1.pdf.

  • Pakendorf, C., & Alant, E. (1996). Culturally valid assessment tools: Northern Sotho translation of the Peabody Picture Vocabulary Test-Revised. The South African Journal of Communication Disorders, 44, 3–12.

    Google Scholar 

  • Panter-Brick, C., Eggerman, M., & Tomlinson, M. (2014). How might global health master deadly sins and strive for greater virtues? Global Health Action, 7, 23411. doi:10.3402/gha.v7.23411.

    Article  PubMed  Google Scholar 

  • Peacock, S., Konrad, S., Watson, E., Nickel, D., & Muhajarine, N. (2013). Effectiveness of home visiting programs on child outcomes: A systematic review. BMC Public Health, 13, 17. doi:10.1186/1471-2458-13-17.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rahman, A., Iqbal, Z., Roberts, C., & Husain, N. (2009). Cluster randomized trial of a parent-based intervention to support early development of children in a low-income country. Child: Care, Health and Development, 35, 56. doi:10.1111/j.1365-2214.2008.00897.x.

    CAS  Google Scholar 

  • Rotheram-Borus, M. J., le Roux, I. M., Tomlinson, M., Mbewu, N., Comulada, W. S., le Roux, K., & Swendeman, D. (2011). Philani Plus (+): A Mentor Mother community health worker home visiting program to improve maternal and infants’ outcomes. Prevention Science, 12, 372. doi:10.1007/s11121-011-0238-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rotheram-Borus, M. J., Richter, L. M., van Heerden, A., van Rooyen, H., Tomlinson, M., Harwood, J. M., . . . Stein, A. (2014). A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants. PLoS One, 9, e84867. doi:10.1371/journal.pone.0084867.

  • Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption. Addiction, 88, 791. doi:10.1111/j.1360-0443.1993.tb02093.x.

    Article  CAS  PubMed  Google Scholar 

  • Singh, P., & Sachs, J. D. (2013). 1 million community health workers in sub-Saharan Africa by 2015. Lancet, 382, 363–365. doi:10.1016/S0140-6736(12)62002-9.

    Article  PubMed  Google Scholar 

  • Super, C. M., Herrera, M. G., & Mora, J. O. (1990). Long-term effects of food supplementation and psychosocial intervention on the physical growth of Colombian infants at risk of malnutrition. Child Development, 61, 29–49. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2307045.

  • Tomlinson, M., Cooper, P. J., Stein, A., Swartz, L., & Molteno, C. (2006). Post-partum depression and infant growth in a South African peri-urban settlement. Child: Care, Health and Development, 32, 81–86. doi:10.1111/j.1365-2214.2006.00598.x.

    CAS  Google Scholar 

  • Tomlinson, M., Rotheram-Borus, M. J., Harwood, J., le Roux, I. M., O’Connor, M., & Worthman, C. (2015). Community health workers can improve child growth of antenatally-depressed, South African mothers: A cluster randomized controlled trial. BMC Psychiatry, 15, Artn 225. doi:10.1186/S12888-015-0606-7.

    Article  Google Scholar 

  • Vally, Z., Murray, L., Tomlinson, M., & Cooper, P. J. (2015). The impact of dialogic book-sharing training on infant language and attention: A randomized controlled trial in a deprived South African community. Journal of Child Psychology and Psychiatry, 56, 865–873. doi:10.1111/jcpp.12352.

    Article  PubMed  Google Scholar 

  • Victora, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L., . . . Child Undernutrition Study, G. (2008). Maternal and child undernutrition: Consequences for adult health and human capital. Lancet, 371, 340–357. doi:10.1016/S0140-6736(07)61692-4.

  • Waber, D. P., Vuori-Christiansen, L., Ortiz, N., Clement, J. R., Christiansen, N. E., Mora, J. O., . . . Herrera, M. G. (1981). Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. The American Journal of Clinical Nutrition, 34, 807–813. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7223696.

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Acknowledgments

We would like to acknowledge all the women and children who participated in our study.

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Authors and Affiliations

  1. Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa

    Mark Tomlinson

  2. Department of Psychiatry and Biobehavioral Sciences, Semel Institute, University of California at Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA, 90024, USA

    Mary Jane Rotheram-Borus, Maryann Youssef, Sandahl H. Nelson, Aaron Scheffler & Mary O’Connor

  3. Philani Maternal, Child Health and Nutrition Trust, PO Box 40188, Elonwabeni, Cape Town, 7791, South Africa

    Ingrid M. le Roux

  4. Department of Biostatistics, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, 90095, USA

    Robert E. Weiss

  5. Department of Anthropology, Emory University, 1557 Dickey Drive, Atlanta, GA, 30322, USA

    Carol M. Worthman

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  1. Mark Tomlinson
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Corresponding author

Correspondence to Mary Jane Rotheram-Borus.

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Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism (R01AA017104, R24AA022919), National Institute of Mental Health (P30MH058107), Ilifa Labantwana, National Institute of Allergy and Infectious Diseases (AI028697), and the National Center for Advancing Translational Science (UL1TR000124). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. MT is supported by the National Research Foundation (South Africa) and is a lead investigator with the Centre of Excellence, University of Witwatersrand, South Africa.

Conflict of Interest

The authors disclose that they have no conflict of interest.

Ethical Approval

The Institutional Review Boards of University of California Los Angeles (UCLA), Stellenbosch University, and Emory University approved the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Appendix

Table 5 Web Appendix: summary statistics for outcomes and reliability between time points
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Tomlinson, M., Rotheram-Borus, M.J., le Roux, I.M. et al. Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Intervention in South Africa on Maternal Health and Child Health and Development. Prev Sci 17, 937–948 (2016). https://doi.org/10.1007/s11121-016-0676-x

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