Philani- Cape Town

There are four intersecting epidemics among pregnant women in South Africa: hazardous alcohol use (30%), HIV (27%), TB (60% of HIV+), img_5313and malnutrition (24% of infants). Unless the prevention programs for these epidemics are horizontally integrated, there will never be adequate resources to address these challenges and stigma will dramatically reduce program utilization. Furthermore, while clinics are the typical sites for treating each of these health problems, the NIAAA-funded Philani study is examining a home-visiting prevention program delivered by neighborhood Mentor Mothers (MM) as an alternative to clinic-based interventions to reduce the consequences of hazardous alcohol use, HIV, TB, and poor nutrition. The intervention encourages mothers to care for their own health, parent well, maintain their mental health, and, if the mother is living with HIV (HIV+ MAR), reduce HIV transmission and/or reduce alcohol use and abuse. The results begin to inform the optimal delivery strategy for the next generation of preventive interventions in order to be feasible and sustainable for broad dissemination immediately following an efficacy trial.

Targeted Risk Group: 

Mothers at risk for hazardous alcohol use, HIV, TB, and malnutrition, as well as their infants

Published Journal Articles :

  1. The Philani Mentor Mothers Intervention neighbourhood wide impact on child growth in Cape Town’s peri-urban settlements (1 download)
  2. Thirty-Six-Month Outcomes of a Generalist Paraprofessional Perinatal Home Visiting Interventions (0 downloads)
  3. Adjustment of a Population of South African Children of Mothers (0 downloads)
  4. Food insufficiency depression and the modifying role of social support (0 downloads)
  5. Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum Population-Based Prospective Cohort Study (1 download)
  6. When can parents most influence their child's development Expert knowledge and perceived local realities (2 downloads)
  7. Community health workers can improve child growth (1 download)
  8. Re-engagement in HIV care among mothers living with HIV in South Africa over 36 months postbirth.html (0 downloads)
  9. Boring family routines reduce non-communicable diseases A commentary and call for action (0 downloads)
  10. Alcohol Use, Partner Violence, and Mental health Distress Among South African Township Mothers from Pregnancy to Three Years Post-birth- A Cluster Randomized Controlled Trial (0 downloads)
  11. Screening for Fetal Alcohol Spectrum Disorders by Nonmedical Community Workers (0 downloads)
  12. A Cluster Randomised Controlled Effectiveness Trial Evaluating Perinatal Home Visiting Among South African Mothers Infants (0 downloads)
  13. The impact of paraprofessional home visitors on infants growth and health at 18 months (1 download)
  14. Intervening on conflict, parental bonds and sexual risk acts among adolescent children of mothers LHIV (1 download)
  15. Antenatal depression case finding by CHWs in South Africa_feasibility of a mobile phone application_ONLINE (0 downloads)
  16. Leveraging paraprofessionals and family strengths to improve coverage and penetration of nutrition and early child development services (0 downloads)
  17. Multiple risk factors during pregnancy in South Africa_the need for a horizontal approach to perinatal care (1 download)
  18. Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa (0 downloads)
  19. Outcomes of home visits for pregnant township mothers and their infants_a cluster randomised controlled trial (0 downloads)
  20. Value of a mobile information system to improve quality of care by community health workers (0 downloads)
  21. An investigation into utilising Gestational Body Mass Index as a screening tool for adverse birth outcomes (0 downloads)
  22. Scaling up mHealth_Where is the evidence (0 downloads)
  23. An Investigation into the Influence of Socioeconomic Variables on gestational body mass index in pregnant women living in a peri-urban settlement_SA (0 downloads)
  24. Standardized functions for smartphone applications_examples from maternal and child health (0 downloads)
  25. Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa_prevalence and correlates (0 downloads)
  26. Philani Plus A Mentor Mother Community Health worker home visiting program to improve maternal and infants' outcomes (0 downloads)
  27. Immunisation coverage in the rural Eastern Cape-are we getting the basics of primary care right? Results from a longitudinal prospective cohort study. (0 downloads)

Interventions, Training Manuals, etc. : 

Surveys/Scales Used: 
  1. TWEAK - Tolerance, Worried, Eye-opener, Amnesia, Cut down (0 downloads)
  2. Social Support (1 download)
  3. Romantic Relationships (2 downloads)
  4. Reproductive Health (7 downloads)
  5. Traditional Medicines (0 downloads)
  6. Routines (0 downloads)
  7. Violence, Partner (1384 downloads)
  8. Household Characteristics and Composition (3 downloads)
  9. AIDS Knowledge and Attitude Survey for Pregnant Women (0 downloads)
  10. Edinburgh Postnatal Depression Score (EPDS) (1 download)
  11. Audit C - Alcohol Use Disorders Identification Test (0 downloads)
  12. Feeding Strategies to Prevent Transmission (1 download)
  13. Medication Adherence (5 downloads)
  14. Employment/Labor Experience (1 download)
  15. CDC Sexual Behavior Questions (CSBQ) (6 downloads)
  16. HIV Disclosure (0 downloads)
  17. Alcohol and Other Drug Abuse (AOD) (5 downloads)
  18. Pregnancy History (1 download)
  19. HIV Testing (0 downloads)
  20. General Medical History (0 downloads)
  21. General Health Questionnaire (1 download)

Intervention model:  

Mothers who are thriving in the community are chosen to act as role models, i.e. mentor mothers, for mothers at risk in the same community. This is based on the positive peer deviant model. Mentor mothers conduct home visits during the course of the study.

Research Methods: 

Twenty four neighborhoods were randomly assigned to the intervention (12 neighborhoods), i.e. a mentor mother home visiting program, or control condition (12 neighborhoods). There are two levels of nesting in the study. Mothers and their infants are nested within neighborhoods, and repeated observations over time are nested within individuals. Longitudinal random effect regression models will be used to account for the nesting and examine the efficacy of the intervention at improving the health of infants and their mothers over time.

Local Significance: 

The study is ongoing so it is too early to draw conclusions on the effectiveness of the intervention. Preliminary results are promising and suggest the mentor mother program may be an efficient mechanism to conduct healthcare-related home visits.

International Significance: 

If found to be efficacious, the home-visiting model that relies on paraprofessionals, i.e. trained mentor mothers, offers a viable alternative to clinic-based healthcare and or care that requires professional healthcare providers that may not be practical in poorer countries outside the U.S.