Outcome of a home-visiting intervention to improve social withdrawal assessed with the m-ADBB in six-month old infants in Khayelitsha, Cape Town : a cluster randomised controlled trial

Durandt, Nicola Estelle (2014-12)

Thesis (MSc)--Stellenbosch University, 2014.

Thesis

ENGLISH ABSTRACT: Pregnant women living in South African peri-urban settlements face many challenges for their health and the health of their infants. Current health care services face many constraints and are not able to meet all the needs of pregnant mothers. Home-visiting programmes implemented by community health workers can alleviate these constraints. The current RCT assessed the effectiveness of the Philani Plus Intervention Program that addressed HIV, alcohol, maternal and child nutrition and mental health. The effectiveness of the intervention was assessed by measuring infant social withdrawal behaviour using the modified Alarm Distress Baby Scale (m- ADBB). A total of 681 cases were randomised into control (N=330) and intervention groups (N=351) and assessed using the m-ADBB. A cut-off score of two and above was used to determined significant social withdrawal behaviour. Data was analysed using descriptive statistics and cross-tabulation initially, followed by analysis of variance and multilevel modelling. Results indicated a prevalence of 46.7% of social withdrawal behaviour; however, no significant differences between groups were found. The current prevalence was substantially higher in comparison to the only other published study using the m-ADBB. Furthermore, the prevalence rate was also significantly higher compared to the majority of other studies using the original Alarm distress Baby Scale (ADBB). The high prevalence of social withdrawal behaviour found in this study indicates an increased risk for suboptimal infant development. Further research regarding social withdrawal behaviour and the casual mechanisms associated with the development of such behaviour is needed. Furthermore, validation of the m-ADBB in different settings is needed.

AFRIKAANSE OPSOMMING: Swanger vroue wat in Suid-Afrikaanse buitestedelike nedersettings woon staar baie uitdagings in die gesig met betrekking tot hul gesondheid en die gesondheid van hul babas. Huidige gesondheidsdienste is baie beperk en is nie in staat om in al die behoeftes van swanger moeders te voorsien nie. Huis-besoek programme wat deur gemeenskaplike gesondheidswerkers geïmplementeer word, kan hierdie beperkings verlig. Die huidige RCT het die effektiwiteit van die Philani Plus Intervensie Program wat MIV, alkohol, voeding en geestelike gesondheid aanspreek, geassesseer. Die effektiwiteit van die intervensie is geassesseer deur sosiale onttrekkingsgedrag met behulp van die gewysigde Alarm Nood Baba Skaal (m-ADBB) te meet. ‘n Totaal van 681 gevalle is lukraak in kontrole (N = 330) en intervensie groepe (N = 351) verdeel en geëvalueer volgens die m-ADBB. 'n Afsnypunt van twee en hoër is gebruik om beduidende sosiale onttrekkingsgedrag te bepaal. Data is aanvanklik ontleed met behulp van beskrywende statistiek en kruis-tabulering, gevolg deur analise van variansie en multi-modelle. Resultate toon 'n 46,7%-voorkoms van sosiale onttrekkingsgedrag, maar het egter geen beduidende verskille tussen groepe getoon nie. Die huidige voorkoms was aansienlik hoër in vergelyking met die enigste ander gepubliseerde studie wat gebruik gemaak het van die m- ADBB. Verder was die voorkomssyfer ook aansienlik hoër in vergelyking met die meerderheid van die ander studies wat gebruik gemaak het van die oorspronklike Alarm Nood Baba Skaal (ADBB). Die hoë voorkoms van sosiale onttrekkingsgedrag dui op 'n verhoogde risiko vir suboptimale baba ontwikkeling. Verdere navorsing oor sosiale onttrekkingsgedrag en die meganismes wat verband hou met die ontwikkeling van sulke gedrag, is nodig. Verder word die bekragtiging van die m-ADBB in verskillende instellings benodig.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/96009
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