Clinical NeuroscienceInvestigating the psychosocial determinants of child health in Africa: The Drakenstein Child Health Study
Section snippets
Background
There is growing evidence that early life events have a profound impact on later health outcomes (Gluckman et al., 2008, Heim et al., 2010). The first few years of life constitute a critical period, during which psychobiological and psychosocial factors may influence not only developmental outcomes, but also lifelong health trajectories (Anda et al., 2006, Maggi et al., 2010). Examples of psychosocial risk factors include low socioeconomic status (SES) during childhood; psychological distress
Design
The birth cohort design recruits pregnant women attending one of two primary health care clinics in the Drakenstein sub-district of the Cape Winelands, Western Cape, South Africa – Mbekweni (serving a black African population) and TC Newman (serving a mixed race population). Consenting mothers are enrolled during pregnancy, and mother–infant dyads are followed longitudinally until children reach 5 years of age. Mothers are asked to request that the father of the index pregnancy attend a single
Measures
After providing consent, participants are asked to complete a battery of self-report and clinician-administered measures at a number of antenatal and postnatal study visits (see Fig. 1), as described below. These measures aim to assess maternal psychosocial risk factors over time, paternal psychosocial risk factors antenatally, and infant development. This combination of methods will allow the exploration of a range of risk factors and their underlying mechanisms, and will enable a comparison
Results
Enrolment into the DCHS cohort began in March 2012, with approximately 950 women enrolled to date. As fewer than 40% of participants report that they are currently in a stable relationship, the number of fathers enrolled in the study is far lower (less than 10% of the total number of mothers enrolled). Complete baseline psychosocial data is available and presented below for 634 mothers, and 75 fathers.
Discussion
Several aspects of the methods outlined here deserve further consideration, and several findings from these baseline data warrant further discussion.
First, these data reinforce the point that in many parts of the globe, pregnant mothers and their infants face considerable health challenges. This cohort has low levels of educational attainment and employment, and unplanned pregnancy is common. There is a high prevalence of antenatal psychological distress and depression, consistent with previous
Acknowledgments
We thank the study staff and the staff at Paarl Hospital, and at Mbekweni and TC Newman clinics for their support of the study. We thank the families and children who participated in this study. Support for this study was provided by the Bill and Melinda Gates Foundation [OPP 1017641] and by the National Institute of Mental Health (NIMH) Brain Disorders in the Developing World: Research Across the Lifespan program (grant number R21 MH098662). DJS, NK, AR and HJZ are supported by the Medical
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