Premium
Goodstart: a cluster randomised effectiveness trial of an integrated, community‐based package for maternal and newborn care, with prevention of mother‐to‐child transmission of HIV in a S outh A frican township
Author(s) -
Tomlinson Mark,
Doherty Tanya,
Ijumba Petrida,
Jackson Debra,
Lawn Joy,
Persson Lars Åke,
Lombard Carl,
Sanders David,
Daviaud Emmanuelle,
Nkonki Lungiswa,
Goga Ameena,
Rohde Sarah,
Sitrin Deborah,
Colvin Mark,
Chopra Mickey
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12257
Subject(s) - breastfeeding , medicine , pregnancy , cluster randomised controlled trial , infant mortality , pediatrics , randomized controlled trial , population , intervention (counseling) , breast feeding , transmission (telecommunications) , prenatal care , demography , environmental health , nursing , engineering , genetics , electrical engineering , biology , sociology
Background Progress towards MDG 4 for child survival in S outh A frica requires effective prevention of mother‐to‐child transmission ( PMTCT ) of HIV including increasing exclusive breastfeeding, as well as a new focus on reducing neonatal deaths. This necessitates increased focus on the pregnancy and early post‐natal periods, developing and scaling up appropriate models of community‐based care, especially to reach the peri‐urban poor. Methods We used a randomised controlled trial with 30 clusters (15 in each arm) to evaluate an integrated, scalable package providing two pregnancy visits and five post‐natal home visits delivered by community health workers in U mlazi, D urban, S outh A frica. Primary outcomes were exclusive and appropriate infant feeding at 12 weeks post‐natally and HIV ‐free infant survival. Results At 12 weeks of infant age, the intervention was effective in almost doubling the rate of exclusive breastfeeding (risk ratio 1.92; 95% CI : 1.59–2.33) and increasing infant weight and length‐for‐age z ‐scores (weight difference 0.09; 95% CI : 0.00–0.18, length difference 0.11; 95% CI : 0.03–0.19). No difference was seen between study arms in HIV ‐free survival. Women in the intervention arm were also more likely to take their infant to the clinic within the first week of life (risk ratio 1.10; 95% CI : 1.04–1.18). Conclusions The trial coincided with national scale up of ARV s for PMTCT , and this could have diluted the effect of the intervention on HIV ‐free survival. We have demonstrated that implementation of a pro‐poor integrated PMTCT and maternal, neonatal and child health home visiting model is feasible and effective. This trial could inform national primary healthcare reengineering strategies in favour of home visits. The dose effect on exclusive breastfeeding is notable as improving exclusive breastfeeding has been resistant to change in other studies targeting urban poor families.