Evaluation of a Community Health Worker Home Visit Intervention to Improve Child Development in South Africa: A Cluster-Randomized Controlled Trial

A strong body of evidence demonstrates that the negative impacts of early adversity on child development in low- and middle-income countries (LMICs) can be mitigated through appropriate early-life interventions. Regular home visits by trained staff who support and counsel caregivers on topics including child health, nutrition and play-based stimulation have proven to be particularly effective. However, important questions remain around how to effectively integrate home-based interventions for children into existing service platforms to deliver them at scale.
 
In a new journal article published in PLOS Medicine, Peter Rockers and coauthors share findings from a home visit intervention they designed and integrated into community health worker (CHW) operations in South Africa. CHWs in the intervention group were trained on a job aid that included content on child health, nutrition, developmental milestones and encouragement to engage in developmentally appropriate play-based activities for use during regular monthly home visits with caregivers of children under two years of age. Control CHWs provided the local standard of care, while household surveys were administered to the full study sample at baseline in 2018 and endline in late 2020 through mid-2021.

Main findings:

• At the end of the first year of the intervention period, 43 percent of CHWs adhered to monthly home visits. 
• The home visit intervention had no significant impact on children’s height-for-age scores, growth stunting, motor skills, language skills or social-emotional skills.
• The children in the intervention group did see significant improvements in saccadic reaction time (SRT), an eye-tracking measure of visual processing speed. 
• However, while the effect on SRT was observed during the first two lab assessments, it was no longer present at the third assessment, which took place after the intervention had ended.

The authors note that the study had important limitations. Due to the COVID-19 pandemic, they were not able to assess outcomes until one year after the intervention period had ended and also were not able to thoroughly document key aspects of implementation. Nevertheless, the study contributes to a growing literature documenting the positive effects of home visit interventions on child development in LMICs. The study also demonstrates the feasibility of collecting markers of neural function like SRT in low-resource settings.