Abstract
BackgroundMore than 50% of Africa’s population lives in rural areas, which have few professional health workers. South Africa has adopted task shifting health care to Community Health Workers (CHWs) to achieve the Sustainable Development Goals, but little is known about CHWs’ efficacy in rural areas.MethodsIn this longitudinal prospective cohort study, almost all mothers giving birth (N = 470) in the Zithulele Hospital catchment area of the OR Tambo District were recruited and repeatedly assessed for 2 years after birth with 84.7–96% follow-up rates. During the cohort assessment we found that some mothers had received standard antenatal and HIV care (SC) (n = 313 mothers), while others had received SC, supplemented with home-visiting by CHWs before and after birth (HV) (n = 157 mothers, 37 CHWs). These visits were unrelated to the cohort study. Multiple linear and logistic regressions evaluated maternal comorbidities, maternal caretaking, and child development outcomes over time.ResultsCompared to mothers receiving SC, mothers who also received home visits by CHWs were more likely to attend the recommended four antenatal care visits, to exclusively breastfeed at 3 months, and were less likely to consult traditional healers at 3 months. Mothers in both groups were equally likely to secure the child grant, and infant growth and achievement of developmental milestones were similar over the first 2 years of life.ConclusionCHW home visits resulted in better maternal caretaking, but did not have direct benefits for infants in the domains assessed. The South African Government is planning broad implementation of CHW programmes, and this study examines a comprehensive, home-visiting model in a rural region.
Highlights
More than 50% of Africa’s population lives in rural areas, which have few professional health workers
At the time of the study, “Option A” Prevention of Mother-to-child-transmission (PMTCT) was in place, in which mothers living with Human Immunodeficiency Virus (HIV) that have a CD 4 count of less than 350 are started on lifelong highly active antiretroviral therapy (HAART) and those with a CD4 of over 350 receive Zidovudine (AZT) from 14 weeks gestation and a stat dose of nevirapine (NVP) during childbirth, and infants of mothers living with HIV are given NVP syrup
Of mothers living with HIV, we report on four PMTCT tasks: 1) taking appropriate ART before birth; 2) giving the child nevirapine as appropriate; 3) 6-weeks post-delivery PCR test done; and 4) whether PCR was done by 6-months post-delivery
Summary
More than 50% of Africa’s population lives in rural areas, which have few professional health workers. While there are 24.2 physicians per 10,000 people in the United States, there are only 7.6 in South Africa [1] This deficit is exaggerated in rural areas, where 43% of the South African population live [2], and where only 12% of doctors and 19% of nurses are based [3]. Patients face significant barriers to accessing rural healthcare facilities: transport is often unavailable; distances are vast; and geographical barriers such as rivers and mountains restrict mobility [4]. Given these challenges, health system administrators often focus on task shifting from professional to paraprofessional staff in order to meet the health needs of communities [5]. For maternal and child health in particular, there are many barriers that must be addressed by CHW
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