Projects |

ENABLE: Reducing mortality and morbidity in under-5s in Eastern Cape Province, South Africa

Examining whether a comprehensive, home-based care and support for child and maternal health integrated with the local primary health care system and offered within the first 5 years of life, can reduce mortality and morbidity and substantially improve outcomes for vulnerable mothers and children in the O R Tambo district in the Eastern Cape province of South Africa.

WHAT ENABLE: Reducing mortality and morbidity in under-5s in Eastern Cape Province, South Africa
WHERE OR Tambo District, Eastern Cape

Background

In South Africa, for every 1,000 live births, up to 44 children die before their fifth birthday. More than a third die in the first month of life (You et al., 2015). South Africa is one of a few countries in the world where the Millennium Development Goal indicators for child and maternal mortality have worsened between 1990 and 2009.

Currently, more than 1 in 3 child deaths in South Africa occur within the first month of life, illustrating the urgent need for improvements in care of the mother before, during and after giving birth. The first 1,000 days of life is a particularly sensitive and rapid period of development. Healthy brain development largely depends on the quality of the environment before birth and in the first 24 months. Poverty, ill health, poor nutrition and a lack of stimulation during this crucial period can undermine educational foundations, restricting what children are able to accomplish.

HIV prevalence, maternal depression, low immunisation rates, inadequate nutrition and failure to focus on maternal mental health and early childhood development are key obstacles to child survival. For the most vulnerable children, low educational attainment, low incomes and few positive parenting models compound and amplify their disadvantage. All too often, the most vulnerable children fall through the net.

What we are doing

We are interested in whether a comprehensive, home-based care and support for child and maternal health, delivered by Mentor Mothers, and integrated with the local primary health care system and offered within the first 5 years of life, can reduce mortality and morbidity and substantially improve outcomes for vulnerable mothers and children in the O R Tambo district in the Eastern Cape province of South Africa.

We are also interested in how certain facets of intervention implementation, including fidelity, quality, dosage, and contextual influences (for e.g. community support, values, and power relations in the implementation teams), ultimately affect child outcomes.

This cross-sectional 12month post-partum data collection point, and in-depth longitudinal process evaluation of the implementation of the intervention, will begin early 2017.