Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study

Karl W. Le Roux, Ellen Almirol, Panteha Hayati Rezvan, Ingrid M. Le Roux, Nokwanele Mbewu, Elaine Dippenaar, Linnea Stansert-Katzen, Venetia Baker, Mark Tomlinson, M. J. Rotheram-Borus*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)
2 Downloads (Pure)


Background: Home visits by paraprofessional community health workers (CHWs) has been shown to improve maternal and child health outcomes in research studies in many countries. Yet, when these are scaled or replicated, efficacy disappears. An effective CHW home visiting program in peri-urban Cape Town found maternal and child health benefits over the 5 years point but this study examines if these benefits occur in deeply rural communities. Methods: A non-randomized, two-group comparison study evaluated the impact of CHW in the rural Eastern Cape from August 2014 to May 2017, with 1310 mother-infant pairs recruited in pregnancy and 89% were reassessed at 6 months post-birth. Results: Home visiting had limited, but important effects on child health, maternal wellbeing and health behaviors. Mothers reported fewer depressive symptoms, attended more antenatal visits and had better baby-feeding practices. Intervention mothers were significantly more likely to exclusively breastfeed for 6 months (OR: 1.8; 95% CI: 1.1, 2.9), had lower odds of mixing formula with baby porridge (regarded as detrimental) (OR: 0.4; 95% CI: 0.2, 0.8) and were less likely to consult traditional healers. Mothers living with HIV were more adherent with co-trimoxazole prophylaxis (p < 0.01). Intervention-group children were significantly less likely to be wasted (OR: 0.5; 95% CI 0.3-0.9) and had significantly fewer symptoms of common childhood illnesses in the preceding two weeks (OR: 0.8; 95% CI: 0.7,0.9). Conclusion: The impact of CHWs in a rural area was less pronounced than in peri-urban areas. CHWs are likely to need enhanced support and supervision in the challenging rural context.

Original languageEnglish
Article number1404
JournalBMC Public Health
Issue number1
Publication statusPublished - 17 Sep 2020

Bibliographical note

Funding Information:
This study was funded by the National Institute of Mental Health (NIMH; R01MH111391), the ELMA Foundation and the Church of Sweden. None of the funders were involved in the design of the study, nor were they involved in the collection, analysis, and interpretation of data and in writing the manuscript.

Publisher Copyright:
© 2020 The Author(s).


  • Community health workers
  • Depression
  • Eastern cape
  • Rural
  • South Africa
  • Wasting

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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