Browsing by Author "Laurenzi, Christina"

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    Exploring the implementation of a community health worker programme for maternal and child health in the rural Eastern Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2020-12) Laurenzi, Christina; Tomlinson, Mark; Coetzee, Bronwyne; Skeen, Sarah; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT:Community health worker (CHW) programmes are regarded as important solutions for improving health care services and outcomes for mothers and children globally. In low- and middle-income countries (LMICs), CHWs may be able to bridge widening gaps between limited human resource capacity and population health needs. However, despite the expansion of CHW programmes, we lack evidence for their effectiveness at scale. Even well-researched evidence-based programmes, when broughtto scale, tend to lose some of their effectiveness. Implementation science methods have emerged as one way to investigate why programmes succeed or fail, by providing researchers with frameworks to examine processes related to delivery, quality, and context. In this dissertation, I explore the processes underpinning the delivery of a CHWprogramme in rural South Africa. This study addressed four related research questions, focused on CHW fidelity to training, client responses to and engagement with the programme, and contextual aspects that affect the programme’s delivery. I utilised a combination of data sources, including transcripts from audio recordings of CHW home visits (n=84), interviews with clients of the programme (n=26), and interviews with CHWs themselves (n=10). The findings of this study identify programmatic strengths, with high levels of fidelity to training in communication skills; instructive and mutually supportive relationships between CHWs and their clients; and dedicated CHWs who regularly prioritise their clients’ needs. These findings also echo persistent challenges in programme implementation, including occupational burdens and pressures for CHWs, and barriers for clients in linking to health care within an under-functioning health system. This dissertation points to the importance of continued training, client and community consultation, and identification of contextual challenges to make programme implementation more effective before they are able to be scaled. It also emphasises the need to adopt a human-centred approach to designing and implementing CHW programmes, shifting away from a technical, vertical mode of providing much-needed services.
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    Home visits by community health workers in rural South Africa have a limited, but important impact on maternal and child health in the first two years of life
    (BMC (part of Springer Nature), 2020-06-29) Katzen, Linnea Stansert; Tomlinson, Mark; Christodoulou, Joan; Laurenzi, Christina; Le Roux, Ingrid; Baker, Venetia; Mbewu, Nokwanele; Le Roux, Karl W.; Borus, Mary Jane Rotheram
    Background: 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. Methods: 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. Results: 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. Conclusion: 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.
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    A longitudinal cohort study of rural adolescent vs adult South African mothers and their children from birth to 24 months
    (BMC (part of Springer Nature), 2019-01-11) Le Roux, Karl; Christodoulou, Joan; Stansert-Katzen, Linnea; Dippenaar, Elaine; Laurenzi, Christina; Le Roux, Ingrid M.; Tomlinson, Mark; Rotheram-Borus, Mary Jane
    Background: Adolescent motherhood has been repeatedly linked to poor child outcomes in high income countries and urban areas in low- and middle-income countries. We examine the structural, personal, and caretaking challenges of adolescent mothers and their children in rural South Africa compared to adult mothers over the first 24 months post-birth. Methods: A cohort of sequential births (n = 470/493) in the rural OR Tambo District was recruited and reassessed at 3, 6, 9, 12, and at 24 months post-birth, with a retention rate above 84% at all timepoints. Maternal and child outcomes were examined over time using multiple linear and logistic regressions. Results: Adolescent mothers reflect 17% of births (n = 76/458). Adolescent mothers were more likely to have water in their households, but less likely to live with a partner and to be seropositive for HIV than adult mothers. Risks posed by mental health symptoms, alcohol, and partner violence were similar. Adolescents exclusively breastfed for shorter time and it took longer for them to secure a child grant compared to adult mothers. Although obtaining immunizations was similar, growth was significantly slower for infants of adolescent mothers compared to adult mothers over time. Conclusions: In rural South Africa, almost one in five pregnant women is an adolescent. Caretaking tasks influencing child growth, especially breastfeeding and securing the child grant appear as the greatest problems for adolescent compared to adult mothers.
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    To evaluate if increased supervision and support of South African Government health workers’ home visits improves maternal and child outcomes : study protocol for a randomized control trial
    (Biomed Central, 2017-08) Rotheram-Borus, Mary J.; Le Roux, Karl; Le Roux, Ingrid M.; Christodoulou, Joan; Laurenzi, Christina; Mbewu, Nokwanele; Tomlinson, Mark
    Background: Concurrent epidemics of HIV, depression, alcohol abuse, and partner violence threaten maternal and child health (MCH) in South Africa. Although home visiting has been repeatedly demonstrated efficacious in research evaluations, efficacy disappears when programs are scaled broadly. In this cluster randomized controlled trial (RCT), we examine whether the benefits of ongoing accountability and supervision within an existing government funded and implemented community health workers (CHW) home visiting program ensure the effectiveness of home visiting. Methods/Design: In the deeply rural, Eastern Cape of South Africa, CHW will be hired by the government and will be initially trained by the Philani Programme to conduct home visits with all pregnant mothers and their children until the children are 2 years old. Eight clinics will be randomized to receive either (1) the Accountable Care Condition in which additional monitoring and accountability systems that Philani routinely uses are implemented (4 clinics, 16 CHW, 450 households); or (2) a Standard Care Condition of initial Philani training, but with supervision and monitoring being delivered by local government structures and systems (4 clinics, 21 CHW, 450 households). In the Accountable Care Condition areas, the CHW’s mobile phone reports, which are time-location stamped, will be monitored and data-informed supervision will be provided, as well as monitoring growth, medical adherence, mental health, and alcohol use outcomes. Interviewers will independently assess outcomes at pregnancy at 3, 6, 15, and 24 months post-birth. The primary outcome will be a composite score of documenting maternal HIV/TB testing, linkage to care, treatment adherence and retention, as well as child physical growth, cognitive functioning, and child behavior and developmental milestones. Discussion: The proposed cluster RCT will evaluate whether routinely implementing supervision and accountability procedures and monitoring CHWs’ over time will improve MCH outcomes over the first 2 years of life.