Community health workers can improve child growth of antenatally-depressed, South African mothers: a cluster randomized controlled trial

Tomlinson, Mark; Rotheram-Borus, Mary Jane; Harwood, Jessica; le Roux, Ingrid M.; O’Connor, Mary; Worthman, Carol

doi:10.1186/s12888-015-0606-7

Cited by 80Maternal Mental Health During Pregnancy and PostpartumGlobal Maternal and Child HealthMaternal and Neonatal Healthcare

Community health workers can improve child growth of antenatally-depressed, South African mothers: a cluster randomized controlled trial

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Tomlinson, Mark, Rotheram-Borus, Mary Jane, Harwood, Jessica, le Roux, Ingrid M., O’Connor, Mary, Worthman, Carol·2015·BMC Psychiatry

DOI 10.1186/s12888-015-0606-7PMC PMC4581418

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Abstract

BACKGROUND: Maternal antenatal depression has long-term consequences for children's health. We examined if home visits by community health workers (CHW) can improve growth outcomes for children of mothers who are antenatally depressed. METHODS: A cluster randomized controlled trial of all pregnant, neighbourhood women in Cape Town, South Africa. Almost all pregnant women (98 %, N = 1238) were recruited and assessed during pregnancy, two weeks post-birth (92 %) and 6 months post-birth (88 %). Pregnant women were randomized to either: 1) Standard Care (SC), which provided routine antenatal care; or 2) an intervention, The Philani Intervention Program (PIP), which included SC and home visits by CHW trained as generalists (M = 11 visits). Child standardized weight, length, and weight by length over 6 months based on maternal antenatal depression and intervention condition. RESULTS: Depressed mood was similar across the PIP and SC conditions both antenatally (16.5 % rate) and at 6 months (16.7 %). The infants of depressed pregnant women in the PIP group were similar in height (height-for-age Z scores) to the children of non-depressed mothers in both the PIP and the SC conditions, but significantly taller at 6 months of age than the infants of pregnant depressed mothers in the SC condition. The intervention did not moderate children's growth. Depressed SC mothers tended to have infants less than two standard deviations in height on the World Health Organization's norms at two weeks post-birth compared to infants of depressed PIP mothers and non-depressed mothers in both conditions. CONCLUSIONS: A generalist, CHW-delivered home visiting program improved infant growth, even when mothers' depression was not reduced. Focusing on maternal caretaking of infants, even when mothers are depressed, is critical in future interventions. TRIAL REGISTRATION: ClinicalTrials.gov registration # NCT00996528 . October 15, 2009.

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Existing networks between providers facilitated referrals from task-sharing workers to specialists and other care providers.
“For instance, existing networks between providers facilitated referrals from task-sharing workers to specialists and other care providers [68]”
From Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks (2022) · cites this paper as [68]
The Discussion says Philani had longstanding relationships with Department of Health staff and clinics, supporting the existence of provider connections. It does not say those relationships facilitated referrals by community health workers to specialists or other care providers. The referrals mentioned under Methods > Intervention conditions concern standard clinic care, not referrals through Philani’s network. (LLM, conf=0.79)
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RESEARCH ARTICLE Open Access Community health workers can improve child growth of antenatally-depressed, South African mothers: a cluster randomized controlled trial
Tomlinson, M., Rotheram-borus, M. J., Harwood, J., Roux, I. M. L., & Worthman, C. M. (2009)
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Effects of a community health worker delivered intervention on maternal depressive symptoms in rural Tanzania
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Maternal patterns of antenatal and postnatal depressed mood and the impact on child health at 3-years postpartum.
Rotheram-Fuller, E. J., Tomlinson, M., Scheffler, A., Weichle, T. W., Rezvan, P. H., Comulada, W. S., & Rotheram‐Borus, M. J. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000281 · Cited by 59 · see citing works
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Perinatal depression treated by community health workers
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Authors: Tomlinson, M., Rotheram-Borus, M. J., Harwood, J., le Roux, I. M., O’Connor, M., & Worthman, C.
Affiliations: Stellenbosch University (ZA)
University of California, Los Angeles (US)
Emory University (US)
Corresponding author: Tomlinson, Mark
ORCID: Tomlinson, Mark
O’Connor, Mary
Worthman, Carol
Venue: BMC Psychiatry
Publisher: Springer Science and Business Media LLC
Published: 2015-09-23
Volume: 15
Issue: 1
Pages: 225-225
ISSN: 1471-244X (ISSN-L)
DOI: 10.1186/s12888-015-0606-7
PMC: PMC4581418
OpenAlex: W2152705939
Cited by: 80
References: 44
Citations by year: 2026: 3 · 2025: 4 · 2024: 1 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 34 · 2019: 6 · 2018: 5 · 2017: 7 · 2016: 2 · 2014: 1
FWCI: 5.00
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Psychiatry (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
eScholarship (California Digital Library) (submittedVersion)
SUNScholar (Stellenbosch University) (submittedVersion)
Funders: National Research Foundation
National Institutes of Health (UL1TR000124, MH58107, 5P30AI028697, and UL1TR000124, MH58107)
National Institute on Alcohol Abuse and Alcoholism (R01AA017104, R24AA022919)
National Institute of Mental Health (MH58107, P30MH058107)
National Institute of Allergy and Infectious Diseases (P30AI028697)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords: community health workers, home visiting, child growth, infant length, infant weight, maternal depression, infant care, Cape Town
MeSH terms: Body Height, Body Weight, Child, Community Health Workers, Counseling, Depressive Disorder, Female, Growth Disorders, House Calls, Humans, Infant, Male, Mothers, Pregnancy, Prenatal Care, Prenatal Exposure Delayed Effects, Puerperal Disorders, South Africa

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Community health workers can improve child growth of antenatally-depressed, South African mothers: a cluster randomized controlled trial

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