SUNScholar - Browsing by Author "Rotheram-Borus, Mary Jane"

Browsing by Author "Rotheram-Borus, Mary Jane"

Now showing 1 - 12 of 12

Alcohol consumption among HIV-positive pregnant women in KwaZulu-Natal, South Africa : prevalence and correlates
(Elsevier, 2012) Desmond, Katherine; Milburn, Norweeta; Richter, Linda; Tomlinson, Mark; Greco, Erin; Van Heerden, Alastair; Van Rooyen, Heidi; Comulada, W. Scott; Rotheram-Borus, Mary Jane
Background: HIV-positive pregnant women who drink put their children at risk of both HIV and fetal alcohol spectrum disorders. The province of KwaZulu-Natal (KZN) has the highest prevalence of HIV in South Africa, but has not before been considered an area of high alcohol consumption among women. This paper analyzes a large sample of HIV+ pregnant women in KZN to examine alcohol consumption in that population. Methods: Data came from assessments of women enrolled in Prevention of Mother-To-Child Transmission programs at 8 clinics in KZN. Descriptive statistics and logistic regressions were used to examine the prevalence and correlates of alcohol consumption and binge drinking. Results: Of 1201 women assessed, 18% reported drinking during pregnancy, and 67% of drinkers usually binged when drinking (had 3+ drinks in one sitting). Over one-third of drinkers binged twice a month or more. Women living in urban and peri-urban locations were more likely to drink, as were those with indicators of higher economic status and greater social engagement. Married women were less likely to drink, while women who had poorer mental health, used tobacco, or had a greater history of sexual risk-taking were more likely to drink. Conclusion: Health care workers in KZN should be aware that pregnant women who drink are likely to do so at a level that is dangerous for their babies. Some factors associated with drinking indicate social/environmental influences that need to be counteracted by greater dissemination of information about the dangers of drinking, and greater support for abstinence or moderation.
Boring family routines reduce non-communicable diseases : a commentary and call for action
(BioMed Central, 2015-07) Rotheram-Borus, Mary Jane; Tomlinson, Mark; Davis, Emily
As global donors shift their efforts from infectious diseases to non-communicable diseases (NCD), it is critical to capitalize on our prior mistakes and successes. Policy makers and public health administrators are often looking for magic bullets: drugs or treatments to eradicate disease. Yet, each potential magic bullet requires consistent, daily implementation and adherence to a new set of habits to actually work. Families’ and communities’ daily, interlocking routines will be the battlefield on which scientific and technological breakthroughs will be implemented and succeed or not. Currently, there are many evidence-based interventions (EBI) which have been demonstrated to shift specific habits which account for most NCD (eating, drinking, moving, and smoking). Yet, securing sustained uptake of these programs is rare – suggesting different intervention strategies are needed. Structural changes, policy nudges, and partnerships with private enterprise may be able to shift the health behaviors of more citizens faster and at a lower cost than existing EBI. Addressing concurrent risk and protective factors at the community level and intervening to shape new cultural routines may be useful to reduce NCD.
A cluster randomised controlled effectiveness trial evaluating perinatal home visiting among South African mothers/infants
(PLoS, 2014-10-23) Rotheram-Borus, Mary Jane; Tomlinson, Mark; Le Roux, Ingrid M.; Harwood, Jessica M.; Comulada, Scott; O’Connor, Mary J.; Weiss, Robert E.; Worthman, Carol M.
Background: Interventions are needed to reduce poor perinatal health. We trained community health workers (CHWs) as home visitors to address maternal/infant risks. Methods: In a cluster randomised controlled trial in Cape Town townships, neighbourhoods were randomised within matched pairs to 1) the control, healthcare at clinics (n = 12 neighbourhoods; n = 594 women), or 2) a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks (by the Philani Maternal, Child Health and Nutrition Programme), in addition to clinic care (n = 12 neighbourhoods; n = 644 women). Participants were assessed during pregnancy (2% refusal) and 92% were reassessed at two weeks post-birth, 88% at six months and 84% at 18 months later. We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal random effects regressions. A binomial test for correlated outcomes evaluated overall effectiveness over time. The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received. Results: Benefits were found on 7 of 32 measures of outcomes, resulting in significant overall benefits for the intervention compared to the control when using the binomial test (p = 0.008); nevertheless, no effects were observed when only the 18 month outcomes were analyzed. Benefits on individual outcomes were related to the number of home visits received. Among women living with HIV, intervention mothers were more likely to implement the PMTCT regimens, use condoms during all sexual episodes (OR = 1.25; p = 0.014), have infants with healthy weight-for-age measurements (OR = 1.42; p = 0.045), height-for-age measurements (OR = 1.13, p<0.001), breastfeed exclusively for six months (OR = 3.59; p<0.001), and breastfeed longer (OR = 3.08; p<0.001). Number of visits was positively associated with infant birth weight ≥2500 grams (OR = 1.07; p = 0.012), healthy head-circumference-for-age measurements at 6 months (OR = 1.09, p = 0.017), and improved cognitive development at 18 months (OR = 1.02, p = 0.048). Conclusions: Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes. However, visits likely must extend over several years for persistent benefits.
A cluster randomized controlled trial evaluating the efficacy of peer mentors to support South African women living with HIV and their infants
(PLoS, 2014-01-22) Rotheram-Borus, Mary Jane; Richter, Linda M.; Van Heerden, Alastair; Van Rooyen, Heidi; Tomlinson, Mark; Harwood, Jessica M.; Comulada, W. Scott; Stein, Alan
Objective: We evaluate the effect of clinic-based support by HIV-positive Peer Mentors, in addition to standard clinic care, on maternal and infant well-being among Women Living with HIV (WLH) from pregnancy through the infant's first year of life. Methods: In a cluster randomized controlled trial in KwaZulu-Natal, South Africa, eight clinics were randomized for pregnant WLH to receive either: a Standard Care condition (SC; 4 clinics; n = 656 WLH); or an Enhanced Intervention (EI; 4 clinics; n = 544 WLH). WLH in the EI were invited to attend four antenatal and four postnatal meetings led by HIV-positive Peer Mentors, in addition to SC. WLH were recruited during pregnancy, and at least two post-birth assessment interviews were completed by 57% of WLH at 1.5, 6 or 12 months. EI's effect was ascertained on 19 measures of maternal and infant well-being using random effects regressions to control for clinic clustering. A binomial test for correlated outcomes evaluated EI's overall efficacy. Findings: WLH attended an average of 4.1 sessions (SD = 2.0); 13% did not attend any sessions. Significant overall benefits were found in EI compared to SC using the binomial test. Secondarily, over time, WLH in the EI reported significantly fewer depressive symptoms and fewer underweight infants than WLH in the SC condition. EI WLH were significantly more likely to use one feeding method for six months and exclusively breastfeed their infants for at least 6 months. Conclusions: WLH benefit by support from HIV-positive Peer Mentors, even though EI participation was partial, with incomplete follow-up rates from 6–12 months.
Community context and individual factors associated with arrests among young men in a South African township
(Public Library of Science, 2019) Christodoulou, Joan; Stokes, Lynissa R.; Bantjes, Jason; Tomlinson, Mark; Stewart, Jackie; Rabie, Stephan; Gordon, Sarah; Mayekiso, Andile; Rotheram-Borus, Mary Jane
Background: In high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town. Methods: Data were collected from a stratified community sample of 906 young men aged 18–29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests. Results: Significant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests. Conclusions: When considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men.
Community health workers can improve child growth of antenatally-depressed, South African mothers : a cluster randomized controlled trial
(BioMed Central, 2015-09-23) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Harwood, Jessica; Le Roux, Ingrid M.; O’Connor, Mary; Worthman, Carol
Background: Maternal antenatal depression has long-term consequences for children’s health. We examined if home visits by community health workers (CHW) can improve growth outcomes for children of mothers who are antenatally depressed. Methods: A cluster randomized controlled trial of all pregnant, neighbourhood women in Cape Town, South Africa. Almost all pregnant women (98 %, N = 1238) were recruited and assessed during pregnancy, two weeks post-birth (92 %) and 6 months post-birth (88 %). Pregnant women were randomized to either: 1) Standard Care (SC), which provided routine antenatal care; or 2) an intervention, The Philani Intervention Program (PIP), which included SC and home visits by CHW trained as generalists (M = 11 visits). Child standardized weight, length, and weight by length over 6 months based on maternal antenatal depression and intervention condition. Results: Depressed mood was similar across the PIP and SC conditions both antenatally (16.5 % rate) and at 6 months (16.7 %). The infants of depressed pregnant women in the PIP group were similar in height (height-forage Z scores) to the children of non-depressed mothers in both the PIP and the SC conditions, but significantly taller at 6 months of age than the infants of pregnant depressed mothers in the SC condition. The intervention did not moderate children’s growth. Depressed SC mothers tended to have infants less than two standard deviations in height on the World Health Organization’s norms at two weeks post-birth compared to infants of depressed PIP mothers and non-depressed mothers in both conditions. Conclusions: A generalist, CHW-delivered home visiting program improved infant growth, even when mothers’ depression was not reduced. Focusing on maternal caretaking of infants, even when mothers are depressed, is critical in future interventions.
Depressed mood in pregnancy : prevalence and correlates in two Cape Town peri-urban settlements
(BioMed Central, 2011-05) Hartley, Mary; Tomlinson, Mark; Greco, Erin; Comulada, W. Scott; Stewart, Jacqueline; Le Roux, Ingrid; Mbewu, Nokwanele; Rotheram-Borus, Mary Jane
Abstract. Background. The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data on antenatal depression in South Africa. The purpose of this study was to determine the prevalence and correlates of depressed mood in pregnancy in Cape Town peri-urban settlements. Methods. This study reports on baseline data collected from the Philani Mentor Mothers Project (PMMP), a community-based, cluster-randomized controlled trial on the outskirts of Cape Town, South Africa. The PMMP aims to evaluate the effectiveness of a home-based intervention for preventing and managing illnesses related to HIV, TB, alcohol use and malnutrition in pregnant mothers and their infants. Participants were 1062 pregnant women from Khayelitsha and Mfuleni, Cape Town. Measures included the Edinburgh Postnatal Depression Scale (EPDS), the Derived AUDIT-C, indices for social support with regards to partner and parents, and questions concerning socio-demographics, intimate partner violence, and the current pregnancy. Data were analysed using bivariate analyses followed by logistic regression. Results. Depressed mood in pregnancy was reported by 39% of mothers. The strongest predictors of depressed mood were lack of partner support, intimate partner violence, having a household income below R2000 per month, and younger age. Conclusions. The high prevalence of depressed mood in pregnancy necessitates early screening and intervention in primary health care and antenatal settings for depression. The effectiveness and scalability of community-based interventions for maternal depression must be developed for pregnant women in peri-urban settlements. Trial registration ClinicalTrials.gov: NCT00972699.
Emerging opportunities provided by technology to advance research in child health globally
(SAGE, 2020-05-17) van Heerden, Alastair; Leppanen, Jukka; Rotheram-Borus, Mary Jane; Worthman, Carol M.; Kohrt, Brandon A.; Skeen, Sarah; Giese, Sonja; Hughes, Rob; Bohmer, Lisa; Tomlinson, Mark, (Mark R.)
Current approaches to longitudinal assessment of children’s developmental and psychological well-being, as mandated in the United Nations Sustainable Development Goals, are expensive and time consuming. Substantive understanding of global progress toward these goals will require a suite of new robust, cost-effective research tools designed to assess key developmental processes in diverse settings. While first steps have been taken toward this end through efforts such as the National Institutes of Health’s Toolbox, experience-near approaches including naturalistic observation have remained too costly and time consuming to scale to the population level. This perspective presents 4 emerging technologies with high potential for advancing the field of child health and development research, namely (1) affective computing, (2) ubiquitous computing, (3) eye tracking, and (4) machine learning. By drawing attention of scientists, policy makers, investors/funders, and the media to the applications and potential risks of these emerging opportunities, we hope to inspire a fresh wave of innovation and new solutions to the global challenges faced by children and their families.
A longitudinal cohort study of rural adolescent vs adult South African mothers and their children from birth to 24 months
(BMC (part of Springer Nature), 2019-01-11) Le Roux, Karl; Christodoulou, Joan; Stansert-Katzen, Linnea; Dippenaar, Elaine; Laurenzi, Christina; Le Roux, Ingrid M.; Tomlinson, Mark; Rotheram-Borus, Mary Jane
Background: Adolescent motherhood has been repeatedly linked to poor child outcomes in high income countries and urban areas in low- and middle-income countries. We examine the structural, personal, and caretaking challenges of adolescent mothers and their children in rural South Africa compared to adult mothers over the first 24 months post-birth. Methods: A cohort of sequential births (n = 470/493) in the rural OR Tambo District was recruited and reassessed at 3, 6, 9, 12, and at 24 months post-birth, with a retention rate above 84% at all timepoints. Maternal and child outcomes were examined over time using multiple linear and logistic regressions. Results: Adolescent mothers reflect 17% of births (n = 76/458). Adolescent mothers were more likely to have water in their households, but less likely to live with a partner and to be seropositive for HIV than adult mothers. Risks posed by mental health symptoms, alcohol, and partner violence were similar. Adolescents exclusively breastfed for shorter time and it took longer for them to secure a child grant compared to adult mothers. Although obtaining immunizations was similar, growth was significantly slower for infants of adolescent mothers compared to adult mothers over time. Conclusions: In rural South Africa, almost one in five pregnant women is an adolescent. Caretaking tasks influencing child growth, especially breastfeeding and securing the child grant appear as the greatest problems for adolescent compared to adult mothers.
The pull of soccer and the push of Xhosa boys in an HIV and drug abuse intervention in the Western Cape, South Africa
(Taylor & Francis Open, 2018-11-14) Medich, Melissa; Mindry, Deborah; Tomlinson, Mark; Rotheram-Borus, Mary Jane; Bantjes, Jason; Swendeman, Dallas
ENGLISH ABSTRACT: There is growing interest in engaging men and boys in health and development programmes targeting the intersection of HIV risk, substance abuse, and violence. Understanding the conceptualisations of masculinities or masculine identities that shape both behaviours and opportunities for intervention is central to advancing the global agenda to engage men in health and development interventions. This paper examines an intervention using soccer and job training to engage and deliver activities for HIV prevention, substance abuse, and gender-based violence in a South African township. A literature review provides theoretical, historical and social context for the intersection of gender, masculinity, soccer, violence, and sexual relationships. Qualitative data from in-depth interviews and focus groups is analysed using theoretical and contextual frames to elucidate the negotiation of shifting, contradictory, and conflicting masculine roles. Results highlight how changing risky, normative behaviours among young men is a negotiated process entailing men's relationships with women and with other men.
Scaling up mHealth : where is the evidence?
(Public Library of Science, 2013-02-12) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Swartz, Leslie; Tsai, Alexander C.
Despite hundreds of mHealth pilot studies, there has been insufficient programmatic evidence to inform implementation and scale-up of mHealth. We discuss what constitutes appropriate research evidence to inform scale up. Potential innovative research designs such as multi-factorial strategies, randomized controlled trials, and data farming may provide this evidence base. We make a number of recommendations about evidence, interoperability, and the role of governments, private enterprise, and researchers in relation to the scale up of mHealth.
Value of a mobile information system to improve quality of care by community health workers
(AOSIS Publishing, 2013) Tomlinson, Mark; Rotheram-Borus, Mary Jane; Doherty, Tanya; Swendeman, Dallas; Tsai, Alexander C.; Ijumba, Petrida; Le Roux, Ingrid; Jackson, Debra; Stewart, Jackie; Friedman, Andi; Colvin, Mark; Chopra, Mickey
Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC), where the penetration rate approaches 100%. Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa. Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs. Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field. Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.

Browsing by Author "Rotheram-Borus, Mary Jane"

Results Per Page

Sort Options