Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial.
OBJECTIVE
To assess the efficacy of an intervention designed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances.


METHODS
Randomised controlled trial.


METHODS
Khayelitsha, a peri-urban settlement in South Africa.


METHODS
449 pregnant women.


METHODS
The intervention was delivered from late pregnancy and for six months postpartum. Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting. The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother. Women in the control group received no therapeutic input from the research team.


METHODS



METHODS
quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months. Secondary outcome: maternal depression at six and 12 months.


RESULTS
The intervention was associated with significant benefit to the mother-infant relationship. At both six and 12 months, compared with control mothers, mothers in the intervention group were significantly more sensitive (6 months: mean difference=0.77 (SD 0.37), t=2.10, P<0.05, d=0.24; 12 months: mean difference=0.42 (0.18), t=-2.04 , P<0.05, d=0.26) and less intrusive (6 months: mean difference=0.68 (0.36), t=2.28, P<0.05, d=0.26; 12 months: mean difference=-1.76 (0.86), t=2.28 , P<0.05, d=0.24) in their interactions with their infants. The intervention was also associated with a higher rate of secure infant attachments at 18 months (116/156 (74%) v 102/162 (63%); Wald=4.74, odds ratio=1.70, P<0.05). Although the prevalence of maternal depressive disorder was not significantly reduced, the intervention had a benefit in terms of maternal depressed mood at six months (z=2.05, P=0.04) on the Edinburgh postnatal depression scale).


CONCLUSIONS
The intervention, delivered by local lay women, had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment, factors known to predict favourable child development. If these effects persist, and if they are replicated, this intervention holds considerable promise for use in the developing world.


BACKGROUND
Current Controlled Trials ISRCTN25664149.
Cooper
Peter J
PJ
School of Psychology, University of Reading, Reading RG6 6AL. p.j.cooper@rdg.ac.uk
Tomlinson
Mark
M
Swartz
Leslie
L
Landman
Mireille
M
Molteno
Chris
C
Stein
Alan
A
McPherson
Klim
K
Murray
Lynne
L
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006701:Home Nursing; D006801:Humans; D009034:Mother-Child Relations; D009769:Object Attachment; D011181:Postnatal Care / Q000379:methods; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014504:Urban Health; D055815:Young Adult