A randomized controlled trial of home visits by neighborhood mentor mothers to improve children's nutrition in South Africa

Abstract

Malnourished children and babies with birth weights under 2500 g are at high risk for negative outcomes over their lifespans. Philani, a paraprofessional home visiting program, was developed to improve nutritional outcomes for young children in South Africa. One “mentor mother” was recruited from each of 37 neighborhoods in Cape Town, South Africa. Mentor mothers were trained to conduct home visits to weigh children under six years old and to support mothers to problem-solve life challenges, especially around nutrition. Households with underweight children were assigned randomly on a 2:1 ratio to the Philani program (n = 500) or to a standard care condition (n = 179); selection effects occurred and children in the intervention households weighed less at recruitment. Children were evaluated over a one-year period (n = 679 at recruitment and n = 638 with at least one follow-up; 94%). Longitudinal random effects models indicated that, over 12 months, the children in the intervention condition gained significantly more weight than children in the control condition. Mentor mothers who are positive peer deviants may be a viable strategy that is efficacious and can build community, and the use of mentor mothers for other problems in South Africa is discussed.

Keywords:

• mentoring
• motherhood
• nutrition
• positive deviant
• South Africa

Acknowledgements

This research was supported by funding from the Centre for Health and Wellbeing through Professor Christina Paxon at the Woodrow Wilson School, Princeton University. We thank Professor Anne Case and Dr. Alicia Menendez from the Center for Health and Wellbeing for their contribution to the original design of the study and their advice and support throughout. We thank the Philani staff for their work with the families and assistance in collecting the data and the families in Khayelitsha for their participation. Drs I. M and K. leRoux and Dr. Rotheram-Borus supervised the study. Drs leRoux supervised the intervention and the acquisition of data. Dr. Comulada designed and conducted the statistical analyses and interpreted the results. All authors contributed to the writing of the paper.