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document
Goodstart : a cluster randomised effectiveness trial of an integrated , community-based package for maternal and newborn care , with prevention of mother-to-child transmission of HIV in a South African township . BACKGROUND Progress towards MDG4 for child survival in South Africa requires effective prevention of mother-to-child transmission ( PMTCT ) of HIV including increasing exclusive breastfeeding , as well as a new focus on reducing neonatal deaths . This necessitates increased focus on the pregnancy and early post-natal periods , developing and scaling up appropriate models of community-based care , especially to reach the peri-urban poor . METHODS We used a randomised controlled trial with 30 clusters ( 15 in each arm ) to evaluate an integrated , scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers in Umlazi , Durban , South Africa . Primary outcomes were exclusive and appropriate infant feeding at 12 weeks post-natally and HIV-free infant survival . RESULTS At 12 weeks of infant age , the intervention was effective in almost doubling the rate of exclusive breastfeeding ( risk ratio 1.92 ; 95 % CI : 1.59-2.33 ) and increasing infant weight and length-for-age z-scores ( weight difference 0.09 ; 95 % CI : 0.00-0.18 , length difference 0.11 ; 95 % CI : 0.03-0.19 ) . No difference was seen between study arms in HIV-free survival . Women in the intervention arm were also more likely to take their infant to the clinic within the first week of life ( risk ratio 1.10 ; 95 % CI : 1.04-1.18 ) . CONCLUSIONS The trial coincided with national scale up of ARVs for PMTCT , and this could have diluted the effect of the intervention on HIV-free survival . We have demonstrated that implementation of a pro-poor integrated PMTCT and maternal , neonatal and child health home visiting model is feasible and effective . This trial could inform national primary healthcare reengineering strategies in favour of home visits . The dose effect on exclusive breastfeeding is notable as improving exclusive breastfeeding has been resistant to change in other studies targeting urban poor families .
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Intervention_Psychological
integrated , community-based package for maternal and newborn care , with prevention of mother-to-child transmission of HIV
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Intervention_Psychological
integrated , scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers
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Outcome_Other
effectiveness
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Outcome_Physical
exclusive and appropriate infant feeding at 12 weeks post-natally and
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Outcome_Mortality
HIV-free infant survival
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Outcome_Physical
rate of exclusive breastfeeding
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Outcome_Physical
infant weight and length-for-age z-scores
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Outcome_Mortality
HIV-free survival
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Outcome_Physical
take their infant to the clinic within the first week of life
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Outcome_Physical
HIV-free survival
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Participant_Condition
maternal and newborn care , with prevention of mother-to-child transmission of HIV in a South African township
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Participant_Sample-size
peri-urban poor
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Participant_Sample-size
30 clusters ( 15 in each arm ) to evaluate an integrated , scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers in Umlazi , Durban , South Africa .
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Participant_Condition
12 weeks post-natally and HIV-free infant survival
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Participant_Age
12 weeks of infant age