Testing Interventions to Improve Maternal and Neonatal Health
This project was aimed at improving maternal and child health outcomes in South Africa. South Africa’s health outcomes do not compare well to that of our peers. For instance, the maternal mortality ratio for South Africa’s upper middle income peers is 60 per 100 000 live births, while South Africa’s ratio was 300 per 100 000 live births in 2010. South Africa’s infant and child mortality rates have begun to decline, but still includes deaths due to causes that could have easily been avoided.
According to data from the District Health Information System (DHIS) of 2012, only 40.5% of South African women attended antenatal clinics before 20 weeks gestation. Earlier and frequent antenatal care access has been associated with lower maternal mortality rates (Pattinson et al., 2012) as it increases the probability of identifying problematic pregnancies earlier and decreases the probability of death during childbirth related to HIV factors. Earlier access also decreases the probability of transmission of HIV from mother to child (amongst HIV positive mothers).
This intervention was aimed at identifying women early in their pregnancy and motivating them to seek antenatal care early and frequently. It provided psycho-social support and informed women of how they can care for themselves and their unborn child during the pregnancy and make them aware of the danger signs that require immediate action.
The intervention was implemented in Lwandle, Nomzamo and Zola in the Eastern Health District of the Western Cape. These are feeding areas of primary care facilities with low early access rates. The intervention was implemented in January 2015 and concluded in December 2015.
Based on the literature showing that disappointing maternal and infant health outcomes may be due to multiple constraints, it involved support to pregnant women using three strategies:
- Providing easy access to early pregnancy testing.
- Encouraging pregnant women to visit clinics by providing a reward for early and frequent clinic attendance. This reward was a mother starter kit known as the Thula Baba Box. The plastic box contains various products, such as clothing, maternity pads and other sanitary products for the infant. The box itself can be used as storage or a small bath. The idea is modelled on the Finnish baby box which significantly decreased maternal mortality in Finland in the first half of the twentieth century. The idea was proposed by two South African social entrepreneurs to the South African context, while Stellenbosch researchers adapted it to a South African setting.
- Providing pregnant women with the required psycho-social support and health information via (at least four) visits by a community health volunteer (CHV) from the community with training in antenatal care. This intervention is modelled on a programme by Philani health and nutrition project, a NGO based in Khayelitsha. The NGO has had phenomenal success in improving maternal and infant health.
The intention of these three interventions is to promote earlier and frequent antenatal care visits, decrease antenatal anxiety, and enhance knowledge of pregnancy and neonatal danger signs. Results will be released in 2016.
The funding for the project was provided by the Abdul Latif Jameel Poverty Action Lab (J-PAL), and Broadreach Healthcare, with smaller product sponsorships from Ackermans and Agrimark South Africa.