Parenting for Lifelong Health for Infants

The PLH for Infants programme, also known as Thula Sana Mother-Infant programme, was developed by colleagues from Stellenbosch University and the University of Reading to improve maternal sensitivity and responsiveness and encourage secure attachment between mothers and their infants in low income settings. The programme targets early attachment, given the reliable relation between early insecure attachment and a plethora of later poor outcomes such as childhood behavioural problems, peer problems, and substance abuse problems in adolescence. PLH for Infants is designed to provide an emotionally supportive relationship to mothers in late pregnancy and through the early postpartum weeks and months. This home-visiting programme adopts a counselling approach, but combines this with methods for assessing the individual and interpersonal characteristics of the baby, as well as with strategies to facilitate good infant care and parent-infant relationships. A major aspect of the intervention is the use of items from the Neonatal Behavioural Assessment Schedule to sensitise the mother to her infant’s individual capacities and needs. The programme was implemented in Khayelitsha, a semi-urban impoverished community near Cape Town, South Africa.

The intervention was delivered by community health workers starting antenatally and continuing through the first six months of the child’s life. The programme includes two antenatal visits; weekly visits for first two months postnatally; fortnightly visits for the following two months; and monthly visits for two months. The intervention is designed to be deliverable by trained mothers in the local community. The programme is manualized with relevant materials translated into isiXhosa. Intervention staff are trained during a three-week training programme, with weekly group supervision throughout delivery of intervention.

PLH for Infants was implemented over the period 1999-2003 and evaluated in a randomised controlled trial in Khayelitsha, South Africa. The sample consisted of 449 mothers and their infants. At both 6 and 12 months post-partum, compared to control mothers, in directly observed, videotaped, interactions with their infants, mothers in the intervention group were significantly more sensitive and less intrusive. The intervention was also associated with a higher rate of secure infant attachments at 18 months. There was also a benefit of the intervention in terms of maternal depressed mood at six months. A similar set of findings has recently emerged from a small RCT of Thula Sana carried out by the Planned Parenting Federation in El Salvador.

In 2019 child participants from the original RCT, now 16-19 years of age, were re-randomised into the new intervention trial. Randomly selected adolescent boys and girls received the Zifune (Find Yourself) intervention, a group-based life skills programme with.a main focus on violence prevention, delivered over eight sessions by trained and supervised community health workers.

Tomlinson, M., Rabie, S., Skeen, S., Hunt, X., Murray, L., & Cooper, P.J. (in press). Improving mother-infant interaction during infant feeding: A Randomised Controlled Trial in a low-income community in South Africa. Infant Mental Health Journal. Link will be added when available

Fearon, R. P., Tomlinson, M., Kumsta, R., Skeen, S., Murray, L., Cooper, P. J., & Morgan, B. (2017). Poverty, early care, and stress reactivity in adolescence: Findings from a prospective, longitudinal study in South Africa. Development and psychopathology, 29(2), 449-464. Link

Murray, L., Cooper, P., Arteche, A., Stein, A., & Tomlinson, M. (2016). Randomized controlled trial of a home‐visiting intervention on infant cognitive development in peri‐urban South Africa. Developmental Medicine & Child Neurology, 58(3), 270-276. Link

Morgan, B., Kumsta, R., Fearon, P., Moser, D., Skeen, S., Cooper, P., ... & Tomlinson, M. (2017). Serotonin transporter gene (SLC6A4) polymorphism and susceptibility to a home-visiting maternal-infant attachment intervention delivered by community health workers in South Africa: Reanalysis of a randomized controlled trial. PLoS medicine, 14(2). Link

Cooper, P. J., Tomlinson, M., Swartz, L., Landman, M., Molteno, C., Stein, A., ... & Murray, L. (2009). Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: Randomised controlled trial. BMJ, 338, b974. Link