Barcelona 2013
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| Abstract #453 - Pregnancy and Childbearing | ||||
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Session: 34.3: Pregnancy and Childbearing (Parallel) on Tuesday @ 14.30-16.00 in Raval Chaired by Victorio Torres, Malega Kganakga Authors: Presenting Author: Professor Mark Tomlinson - Stellenbosch University, South Africa |
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| Additional Authors: Dr. Jordi Casabona, | ||||
| Aim: Progress towards MDG4 in South Africa requires sustainable interventions that shift prevention tasks from professional health providers to paraprofessionals and scaling-up effective prevention against mother-to-child transmission (PMTCT) of HIV, HIV care, maternal and child nutrition and fetal alcohol syndrome. We developed and evaluated two integrated home-visit package delivered by trained community health workers (CHWs) targeting pregnant and postnatal women and their newborns to provide essential maternal/newborn care. | ||||
| Method / Issue: We implemented two cluster randomized controlled trials - one in Cape Town and the other in Umlazi, KwaZulu Natal. The Cape Town based Philani mentor mother programme consisted of home visits to pregnant women by paraprofessional Mentor Mothers (MM) in 24 matched township neighborhoods. Mothers and their infants in each neighbourhood were monitored during pregnancy, at one week post-birth, and at six months post-birth. The Umlazi based Goodstart 3 study consisted of community health workers visiting women in 30 clusters (15 per randomized arm). Interviews were conducted at 12 weeks post-delivery. | ||||
| Results / Comments: In the Cape Town based Philani study, among all participants, intervention mothers were significantly more likely to consistently use condoms, breastfeed longer, and breastfeed exclusively for six months. Relative to the control condition, Mothers Living with HIV (MLH) in the intervention group were significantly more likely to adhere to the complete protocol for the prevention of maternal-to-child transmission; to take maternal anti-retroviral medication prior to and during delivery; to correctly administer infant anti-retroviral medication during and after birth; to use only one feeding method; to have fewer maternal birth complications and to have fewer infants 2 SD or more below the mean WHO standard for infant length-for-age at 6 months. In the Goodstart 3 trial, a significant effect was seen on exclusive breastfeeding, weight-for-age, and length-for-age. Improvements in coverage of care indicators, such as delivery preparations were also seen, but no difference in HIV-free survival was observed. | ||||
| Discussion: Paraprofessional/community health workers can be trained as generalists in maternal and child health, improve neighbourhood outcomes in early infancy. Our findings will be discussed in terms of the lessons they provide for HIV programming at scale. | ||||
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