Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Office 4009, 4th Floor, Education Building, Francie van Zijl Drive, Tygerberg, South Africa.
School of Nursing and Midwifery, Queens University, Belfast, UK.
BMC Health Serv Res. 2020 Jun 29;20(1):594. doi: 10.1186/s12913-020-05436-7.
More 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.
In 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.
Compared 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.
CHW 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.
超过 50%的非洲人口居住在农村地区，那里只有很少的专业卫生工作者。南非已经将医疗保健工作转移到社区卫生工作者（CHW），以实现可持续发展目标，但对于农村地区 CHW 的效果知之甚少。
在这项纵向前瞻性队列研究中，Zithulele 医院集水区的几乎所有产妇（N=470）都被招募，并在出生后 2 年内进行了多次评估，随访率为 84.7-96%。在队列评估期间，我们发现一些产妇接受了标准的产前和艾滋病毒护理（SC）（n=313 名母亲），而另一些产妇则接受了 SC，并在产前和产后由 CHW 进行家访（HV）（n=157 名母亲，37 名 CHW）。这些访问与队列研究无关。多元线性和逻辑回归评估了产妇合并症、产妇护理和儿童发育结果随时间的变化。
与接受 SC 的母亲相比，同时接受 CHW 家访的母亲更有可能接受推荐的四次产前保健访问，在 3 个月时进行纯母乳喂养，在 3 个月时较少咨询传统治疗师。两组母亲获得儿童津贴的可能性相同，婴儿在头 2 年的生长和发育里程碑的实现情况相似。
CHW 家访导致更好的产妇护理，但在评估的领域对婴儿没有直接益处。南非政府正在计划广泛实施 CHW 计划，本研究在农村地区检验了一种全面的家访模式。
