Community health workers can improve emotional wellbeing of mothers in a high HIV prevalence setting

Alcohol use, partner violence, and depression: a cluster randomized controlled trial among urban South African mothers over 3 years.

Rotheram-Borus MJ, Tomlinson M, Roux IL, Stein JA. Am J Prev Med. 2015 Jul 28. pii: S0749-3797(15)00225-1. doi: 10.1016/j.amepre.2015.05.004. [Epub ahead of print]

Introduction: Pregnant South African women with histories of drinking alcohol, abuse by violent partners, depression, and living with HIV are likely to have their post-birth trajectories over 36 months significantly influenced by these risks.

Design: All pregnant women in 24 Cape Town neighborhoods were recruited into a cluster RCT by neighborhood to either: (1) a standard care condition (n=12 neighborhoods, n=594 mothers); or (2) a home-visiting intervention condition (n=12 neighborhoods, n=644 mothers).

Setting/participants: Pregnant women residing in urban, low-income neighborhoods in Cape Town, South Africa.

Intervention: Home visiting included prenatal and postnatal visits by community health workers (Mentor Mothers) focusing on general maternal and child health, HIV/tuberculosis, alcohol use, and nutrition.

Main outcome measures: Mothers were assessed in pregnancy and at 18 and 36 months post birth: 80.6% of mothers completed all assessments between 2009 and 2014 and were included in these analyses performed in 2014. Longitudinal structural equation modeling examined alcohol use, partner violence, and depression at the baseline and 18-month interviews as predictors of maternal outcomes at 36 months post birth.

Results: Relative to standard care, intervention mothers were significantly less likely to report depressive symptoms and more positive quality of life at 36 months. Alcohol use was significantly related to use over time, but was also related to depression and HIV status at each assessment and partner violence at 36 months.

Conclusions: Alcohol, partner violence, and depression are significantly related over time. A home-visiting intervention improved the emotional health of low-income mothers even when depression was not initially targeted.

Abstract [1]  Full-text [free] access [2]

Editor’s notes: This study evaluates the use of community health workers (CHW) to implement a programme to improve maternal wellbeing among low-income mothers in Cape Town, South Africa from pregnancy until 36 months after birth. This is a setting with high prevalence of HIV (about 30% of pregnant women are HIV positive in the Western Cape), and the programme followed a behaviour-change model focused on alcohol and HIV (but not intimate partner violence [IPV] or depression). The programme was associated with improved maternal emotional health at 36 months. However, there was relatively little change in alcohol use or IPV.  Overall, the study underlines the inter-relationships between alcohol use, intimate partner violence, HIV and depression. Further, it suggests that future programmes should train CHWs to expand their activities to depression and IPV as well as HIV, and alcohol.

Africa [8]
South Africa [9]
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