1. Maternal depression, alcohol use, and transient effects of perinatal paraprofessional home visiting in South Africa: Eight-year follow-up of a cluster randomized controlled trial
- Author
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Rotheram-Borus, Mary Jane, Tomlinson, Mark, Worthman, Carol M, Norwood, Peter, le Roux, Ingrid, and O'Connor, Mary J
- Subjects
Midwifery ,Public Health ,Health Sciences ,Health Disparities ,Substance Misuse ,Behavioral and Social Science ,Brain Disorders ,Maternal Health ,Clinical Trials and Supportive Activities ,Clinical Research ,Women's Health ,Mental Health ,Social Determinants of Health ,Depression ,Infectious Diseases ,Alcoholism ,Alcohol Use and Health ,Pediatric ,Mental Illness ,Prevention ,Sexually Transmitted Infections ,HIV/AIDS ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Reproductive health and childbirth ,Good Health and Well Being ,Child ,Female ,Pregnancy ,Humans ,South Africa ,Acquired Immunodeficiency Syndrome ,Bayes Theorem ,Follow-Up Studies ,Mothers ,House Calls ,Maternal depression ,Alcohol use ,Problematic alcohol abuse ,HIV ,AIDS ,Home visiting ,Community health worker ,Cultural beliefs ,Cultural values ,Medical and Health Sciences ,Economics ,Studies in Human Society ,Health sciences ,Human society - Abstract
BackgroundSouth African mothers confront synergistic challenges from depression, alcohol use, and HIV/AIDS. The importance of maternal functioning for child development motivates interventions, yet long-term outcomes seldom are tracked. Furthermore, little is known about trajectories and the role of social-cultural factors in maternal depression and alcohol use across parenthood in low- and middle-income countries.MethodsWe examined maternal outcomes at 5- and 8-years' post-birth, from the Philani Intervention Program (PIP), a randomized controlled trial of a prenatally-initiated home visiting intervention lasting through 6 months' post-birth which yielded some benefits for children and mothers through 3 years. Longitudinal Bayesian mixed-effects models assessed intervention effects for maternal depression and alcohol use from pre-birth through 8 years post-birth. We plotted trajectories of depression and alcohol use and analyzed their relationship over time.ResultsMaternal benefits appeared limited and intervention outcomes differed at 5 and 8 years. Reduced depression in PIP versus standard care (SC) mothers at 3 years disappeared by 5 and 8 years. Depression prevalence declined from 35.1% prenatally to 5.5% at 8 years, independent of intervention or alcohol use. Alcohol use in both groups rebounded from a post-birth nadir; fewer PIP than SC mothers drank alcohol and reported problematic use at 5 but not 8 years. HIV+ prevalence did not differ by condition and increased from 26% to 45% over the reported period.ConclusionsDissipation of early child benefits from home visiting by age 8 years likely reflects lack of durable change in maternal behaviors compounded by social-cultural factors and cumulative effects of community deprivation. High prenatal rates warrant screening and treatment for depression in standard antenatal care. Low-and-middle income countries may need sustained interventions, including alcohol use reduction, to capitalize on initial gains from targeted interventions and address community social-cultural factors. HIV/AIDS continues to spread in this population. more...
- Published
- 2023