title: A cluster randomised controlled effectiveness trial evaluating perinatal home visiting among South African mothers/infants.
abstract: BACKGROUND
  Interventions are needed to reduce poor perinatal health. We trained community health workers (CHWs) as home visitors to address maternal/infant risks.
  
  
  METHODS
  In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1) the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women), or 2) a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme), in addition to clinic care (n = 12 neighbourhoods; n = 644 women). Participants were assessed during pregnancy (2% refusal) and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received.
  
  
  RESULTS
  Benefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008); nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014), have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045), height-for-age measurements (OR = 1.13, p<0.001), breastfeed exclusively for six months (OR = 3.59; p<0.001), and breastfeed longer (OR = 3.08; p<0.001). Number of visits was positively associated with infant birth weight ≥2500 grams (OR = 1.07; p = 0.012), healthy head-circumference-for-age measurements at 6 months (OR = 1.09, p = 0.017), and improved cognitive development at 18 months (OR = 1.02, p = 0.048).
  
  
  CONCLUSIONS
  Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes. However, visits likely must extend over several years for persistent benefits.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00996528.
authors.affiliation: Department of Psychiatry and Biobehavioral Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.affiliation: Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: Mark
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: Philani Maternal, Child Health and Nutrition Programme, Elonwabeni, Cape Town, South Africa.
authors.forename: Ingrid M
authors.initials: IM
authors.lastname: le Roux
authors.affiliation: Department of Psychiatry and Biobehavioral Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Harwood
authors.affiliation: Department of Psychiatry and Biobehavioral Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Scott
authors.initials: S
authors.lastname: Comulada
authors.affiliation: Department of Psychiatry and Biobehavioral Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Connor
authors.affiliation: Department of Biostatistics, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Weiss
authors.affiliation: Department of Anthropology, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Carol M
authors.initials: CM
authors.lastname: Worthman
mesh_terms: D005260:Female; D006792:House Calls; D006801:Humans; D007223:Infant; D009035:Mothers; D017063:Outcome Assessment, Health Care; D011181:Postnatal Care; D011247:Pregnancy; D013019:South Africa