Home-visits before and after birth can benefit caregiving in low- and middle-income settings
A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that home-visiting by trained community workers during and after pregnancy can improve mother-child interactions in the first years of life. However, this benefit was not found for mothers who experienced depressive symptoms during pregnancy.
"The quality of close relationships early in life has a lasting impact on children's development," said lead author Joan Christodoulou, a postdoctoral scholar at University of California, Los Angeles's Global Center for Children and Families in Los Angeles, CA, USA. "Caregiving that is sensitive, or responsive to a child's needs and engages the child, with limited hostility, may be a particularly important factor in mediating the adverse effects on development for children growing up in poverty."
The findings are based on the results of a cluster randomized controlled trial, jointly-investigated by researchers at UCLA and South Africa's Stellenbosch University. Evaluating the Philani Program in Cape Town, South Africa, pregnant mothers in 24 local township neighborhoods were recruited into the study; 98 percent were enrolled and followed from pregnancy through to five-years post-birth. A representative cohort of 1,239 pregnant township mothers were studied.
Mothers in the intervention received home visits by community workers trained by the Philani Program from May 2009 to September 2010. Over the next five years, researchers tracked data related to maternal- and child-health including depression, HIV, food security, caregiving, as well as the quality of mother-child interactions.
The authors found that mothers who received home visits displayed more maternal sensitivity, talked to the infant more and had more harmonious interactions with their children. They also have children who paid more attention and were happier than their peers at three years post-birth. However, mothers who had depressive symptoms during pregnancy did not experience these benefits.
Home-visiting by trained community health workers resulted in a better quality of caregiving for mothers without depressive symptoms in a low and middle income country. Future maternal and child health interventions need to specifically target maternal depression during and after pregnancy.