Health Systems TrustHST General
Comparing a paper based monitoring and evaluation system to a mHealth system to support the national community health worker programme, South Africa: an evaluationBioMed CentralNon HST
Department of Health (South Africa)Non HST
Key Findings from an Evaluation of the mothers2mothers Program in KwaZulu-Natal, South Africa
The program achieved substantial coverage of both pregnant and postpartum women, with almost 60 percent of women reporting that a mentor mother talked with them at least once while the women were pregnant or during their last pregnancy. Nearly half of all pregnant and postpartum women interviewed reported two or more interactions with a mentor mother.
The sociodemographic characteristics of participants (women who had two or more contacts with the program) versus non-participants (women who had no contact with m2m were similar. With respect to MTCT knowledge, overall respondents knew more basic information about how and when MTCT occurs than how to prevent it. Comparing the two groups, m2m participants had greater MTCT knowledge than non-participants, but most differences were not statistically significant.
There were high rates of disclosure in the study population. Among postpartum women, m2m participants were significantly more likely to have disclosed to someone than non-participants (97 percent vs. 85 percent p < 0.01), and to have done so prior to delivery. The person HIV-positive women, regardless of program exposure, disclosed most often to was their partner or husband. There was no difference in Nevirapine receipt by program exposure for pregnant women. But m2m program participants interviewed postpartum were more likely to report receipt and ingestion of Nevirapine, and receipt of the infant dose than non-participants, with about 9 out of 10 participants reporting as such.
Formula feeding was the most common method of infant feeding mentioned, although neither the facility nor the program distributed formula. Pregnant and postpartum program participants were more likely to report intending or actually giving infant formula exclusively than their counterparts who had no exposure to the program.
The vast majority (70 percent) of postpartum program participants (412 weeks after delivery) reported using contraception, with injection mentioned as the most common method. They were more likely to use contraception than non-participants.
Program participants interviewed postpartum reported significantly higher rates of having undergone CD4 testing during their last pregnancy (79 percent vs. 57 percent p < 0.01) and knowing their CD4 count after testing (88 percent vs. 72 percent p < 0.01) than non-participants.
With respect to psychosocial well-being, pregnant participants were significantly more likely to report feeling they could do things to help themselves, cope with taking care of the baby, and live positively in comparison to non-participants. Postpartum participants reported feeling less alone in the world, overwhelmed by problems, and hopeless about the future compared to non-participants. The multivariate analysis controlled for age, existence of partner, education, employment, number of live births, number of antenatal care visits, and site. With these controls, program participation continued to be positively and significantly related to key PMTCT knowledge and behaviors, or there was a positive association that was not statistically significant.
The data were also analyzed to assess whether the changes associated with program participation among postpartum women occurred between baseline and follow up data collection. Most findings were in the same direction, suggesting that the program contributed to positive changes at the site level after one year of implementation.