Community health worker home visiting in deeply rural South Africa: 12-month outcomes

ABSTRACT

Home visiting by community health workers (CHW) improves child outcomes in efficacy trials, there is however limited evidence of impact evaluating CHW programmes when operating outside of a research project. A CHW programme, previously demonstrated efficacious in a peri-urban township, was evaluated in a deeply rural context in a non-randomised comparative cohort study. Two non-contiguous, rural areas in the Eastern Cape of South Africa of about equal size and density were identified and 1469 mother-infant pairs were recruited over 33 months. In one area, CHWs conducted perinatal home visits (intervention group). Mothers in the comparison group received standard clinic care. Maternal and child outcomes were compared between the groups at one year. Mothers in the intervention group had significantly fewer depressive symptoms than mothers in the comparison group. Children of intervention mothers attained a higher proportion of their developmental milestones, compared to children in the comparison group. There were no other significant differences between mothers and children in the two groups. It is important to establish key parameters for implementing efficacious CHW programmes, especially as the numbers of CHWs are rapidly increased and are becoming critical components of task-shifting strategies of health departments in low and middle income countries (LMIC).

KEYWORDS:

• Community health workers
• home visiting programmes
• HIV
• malnutrition
• maternal depression

Acknowledgements

Thank you to all mothers and CHWs who participated in this study and to ELMA Philanthropies and the Church of Sweden who funded this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the sensitivity and the availability of geographic data, we are not making the data broadly available publicly. We do have anonymous data sets which are available upon request for specific purposes.

Additional information

Funding

This work was supported by ELMA Foundation. The study was partly funded by a grant from the Church of Sweden.