Factors influencing early development
Hendricks, G., Malcolm-Smith, S., Stein, D. J., Zar, H. J., Wedderburn, C. J., Nhapi, R. T., Chivese, T., Adnams, C. M., & Donald, K. A. (2020). Prenatal alcohol exposure is associated with early motor, but not language development in a South African cohort. Acta neuropsychiatrica, 32(3), 1–8. Advance online publication. https://doi.org/10.1017/neu.2019.51
PAE has potentially important consequences for motor development in the first 2 years of life, a period during which the most rapid growth and maturation occur. These findings highlight the importance of identifying high-risk families in order to provide preventive interventions, particularly in antenatal clinics and early intervention services.
Community Health Worker Programs
le Roux, K. W., Almirol, E., Rezvan, P. H., le Roux, I. M., Mbewu, N., Dippenaar, E., Stansert-Katzen, L., Baker, V., Tomlinson, M., & Rotheram-Borus, M. J. (2020). Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. BMC public health, 20(1), 1404. https://doi.org/10.1186/s12889-020-09468-w
This study shows limited but important effects of a CHW home-visiting program in a deeply rural area of South Africa. It appears that the positive impact of CHWs on health outcomes is more difficult to achieve in the rural context than in more densely populated urban and peri-urban areas [18]. This needs to be considered when implementing rural CHW programs and greater investments in transport and support of CHWs may be required to ensure the effectiveness of the intervention. It is important to recognise that the CHWs assessed in this study had only been established in the area for 12–18 months and that assessments of other CHW programs occurred after these programs had embedded themselves into communities over many years [18]. Nevertheless, mothers who were visited by CHWs before and for up to a 6 months after delivery exclusively breastfed for longer, attended antenatal care more often, had lower levels of depressive symptoms and higher trust in government healthcare services. Their children were also significantly less likely be wasted at 6-months. In conclusion, CHWs have an important role to play in the provision of PHC services in rural areas, but need to be managed in the light of the rural context and supported accordingly.
le Roux, K., le Roux, I., Mbewu, N., & Davis, E. (2015). The Role of Community Health Workers in the Re-Engineering of Primary Health Care in Rural Eastern Cape. South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 57(2), 116–120. https://doi.org/10.1080/20786190.2014.977063
CHWs, especially in rural settings, can find and refer new TB/HIV cases, ill children and at-risk pregnant women; rehabilitate malnourished children at home; support TB and HIV treatment adherence; treat diarrhoea, worm infestation and skin problems; and, distribute Vitamin A. CHWs provide follow-up after clinic and hospital care, support families to apply health information, problem-solve the health and social challenges of daily living, and assist in accessing social grants. Case examples of how this model functions are provided.
Perinatal depression and development
Christodoulou, J., Le Roux, K., Tomlinson, M., Le Roux, I. M., Katzen, L. S., & Rotheram-Borus, M. J. (2019). Perinatal maternal depression in rural South Africa: Child outcomes over the first two years. Journal of affective disorders, 247, 168–174. https://doi.org/10.1016/j.jad.2019.01.019
Mothers with perinatal depressed mood are significantly less likely to live with the child's father or their in-laws (23% vs 35%), have household incomes above 2000 ZAR (154 USD) (31% vs 51%), and significantly more likely to have experienced IPV prior (19% vs 9%) and during (32% vs 20%) pregnancy compared to mothers without depressed mood. There are no differences in age, education, primipara, HIV status (29% seropositive), or alcohol use. Growth and developmental delays and motor and speech milestones through 24 months post-birth are similar for mothers with and without perinatal depressed mood.
Conclusions: Despite increased economic and partner difficulties associated with perinatal depressed mood, infant outcomes are similar in mothers with and without depressed mood in rural South Africa.