Tanya Doherty

University of the Western Cape, Kaapstad, Western Cape, South Africa

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Publications (62)277.32 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Cash transfer (CT) programmes are increasingly being used as policy instruments to address child poverty and child health outcomes in developing countries. As the largest cash-transfer programme in Africa, the South African Child Support Grant (CSG) provides an important opportunity to further understand how a CT of its kind works in a developing country context. We explored the experiences and views of CSG recipients and non-recipients from four diverse settings in South Africa. Four major themes emerged from the data: barriers to accessing the CSG; how the CSG is utilised and the ways in which it makes a difference; the mechanisms for supplementing the CSG; and the impact of not receiving the grant. Findings show that administrative factors continue to be the greatest barrier to CSG receipt, pointing to the need for further improvements in managing queues, waiting times and coordination between departments for applicants trying to submit their applications. Many recipients, especially those where the grant was the only source of income, acknowledged the importance of the CSG, while also emphasising its inadequacy. To maximise their impact, CT programmes such as the CSG need to be fully funded and form part of a broader basket of poverty alleviation strategies.
    Global Public Health 02/2015; · 0.92 Impact Factor
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    ABSTRACT: To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth. Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items. A township near Durban, South Africa. Pregnant women (1894 intervention and 2243 control) aged 17 years or more. Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels. A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
    Public Health Nutrition 02/2015; · 2.48 Impact Factor
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    ABSTRACT: Services to diagnose early infant HIV infection should be offered at the six-week immunisation visit. Despite high six-week immunisation attendance, the coverage of early infant diagnosis (EID) is low in many sub-Saharan countries. We explored reasons for such missed opportunities at six-week immunisation visits. We used data from two cross-sectional surveys conducted in 2010 in South Africa. A national assessment was undertaken among randomly selected public facilities (n=625) to ascertain procedures for EID. A sub-sample of these facilities (n=565) were re-visited to assess the HIV-status of 4-8 week old infants receiving six-week immunisation. We examined potential missed opportunities for EID. We used logistic regression to assess factors influencing maternal intention to report for EID at six-week immunisation visits. EID services were available in >95% of facilities, and 72% of immunisation service points (ISPs). The majority (68%) of ISPs provide EID for infants with reported or documented (on infant's Road-to-Health Chart/booklet - iRtHC) HIV-exposure. Only 9% of ISPs offered provider-initiated counselling and testing (PICT) for infants of undocumented/unknown HIV-exposure. Interviews with self-reported HIV-positive mothers at ISPs revealed only 55% had their HIV-status documented on their iRtHC and 35% intended to request EID during six-week immunisation. Maternal non-reporting for EID was associated with fear of discrimination, poor adherence to antiretrovirals, and inadequate knowledge about mother-to-child HIV transmission (MTCT). Missed opportunities for EID were attributed to poor documentation of HIV-status on iRtHC, inadequate maternal knowledge about MTCT, fear of discrimination, and the lack of PICT service for undocumented, unknown, or undeclared HIV-exposed infants.
    Journal of acquired immune deficiency syndromes (1999). 12/2014;
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    ABSTRACT: Objective: Assess coverage of selected case management and care-seeking indicators of diarrhoea, malaria and pneumonia, after an integrated health system strengthening (IHSS) intervention in six African countries – Ethiopia, Ghana, Malawi, Mali, Mozambique and Niger. Methods: Fixed mixed-methods evaluation were utilised. Baseline data and secular trends from large, population-based household surveys (DHS, MICS, LQAS conducted from 2005 to 2013) for key indicators were examined to assess changes in coverage during the IHSS intervention. Contextual factors were described using data from document reviews and databases. Contextual data were also collected during key informant interviews with national stakeholders, district personnel, community health workers, supervisors, and beneficiaries. Data were analysed and triangulated. Results: There was large variation in coverage post IHSS for case management interventions: with ORS coverage ranging from 24% in rural Ethiopia to 52% in Malawi; care-seeking for fever 50% in rural Ethiopia to 74% in Malawi, care-seeking for pneumonia 25% in rural Ethiopia to 72% in Malawi, and malaria treatment 32% in rural Mozambique to 37% in 3 Northern Regions of Ghana. Coverage generally increased from baseline to endline, ranging from a 12 percentage point increase in ORS coverage in 3 Northern Regions of Ghana to a 35 percentage point increase in fever care-seeking in Ethiopia. Qualitative data highlighted the contextual influences impacting on intervention receipt and implementation. Conclusion: Across these six African countries IHSS supports to facility-based and community-based case management contributed to improved care-seeking and treatment coverage for pneumonia, diarrhoea and malaria, however substantial barriers to implementation remain.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: There is a paucity of data on the national population-level effectiveness of preventing mother-to-child transmission (PMTCT) programmes in high-HIV-prevalence, resource-limited settings. We assessed national PMTCT impact in South Africa (SA), 2010.
    Journal of Epidemiology &amp Community Health 11/2014; 69(3). · 3.29 Impact Factor
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    ABSTRACT: Background: Cash transfers (CTs) are increasingly used as a strategy to alleviate poverty and improve child health outcomes in low- and middle-income countries. The Child Support Grant (CSG) is the largest CT programme in South Africa, and on the continent, targeting poor children from birth until the age of 18 with a monthly sum of R300 (USD30). Evidence on the CSG shows that early receipt of the grant is associated with improved child health outcomes. Since its implementation, one of the major concerns about the grant has been take-up rates, particularly for younger children. This paper reports results on take-up rates for 12-week-old infants residing in an urban township in South Africa. Methods: This is a descriptive study utilising data from a community-based, cluster-randomised trial which evaluated a programme providing pregnancy and post-natal home visits by community health workers to 3,494 mothers in Umlazi township, South Africa. Results: At the 12-week visit, half (52%) of the mothers who had enrolled in the study had applied for the CSG on behalf of their children, while 85% of the mothers who had not applied were still planning to apply. Only 38% (1,327) of all children had received the CSG. Conclusions: In this study, many mothers had not applied for the CSG in the first few months after delivery, and only a third of children had accessed the grant. Further research is needed to understand what the current barriers are that prevent mothers from applying for this important form of social protection in the early months after delivery.
    Global Health Action 08/2014; 7:25310. · 1.65 Impact Factor
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    ABSTRACT: Objective To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa.Methods South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother–infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate.ResultsSeventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2–5.1) and low birthweight (HR 2.4; 95% CI 1.3–4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1–0.7).ConclusionsA strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.
    Tropical Medicine & International Health 07/2014; · 2.30 Impact Factor
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    ABSTRACT: In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities.
    BMC Public Health 06/2014; 14(1):633. · 2.32 Impact Factor
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    The Lancet Global Health. 04/2014; 2(4):e199.
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    ABSTRACT: Progress towards MDG4 for child survival in South Africa requires effective prevention of mother-to-child transmission (PMTCT) of HIV including increasing exclusive breastfeeding, as well as a new focus on reducing neonatal deaths. This necessitates increased focus on the pregnancy and early post-natal periods, developing and scaling up appropriate models of community-based care, especially to reach the peri-urban poor. We used a randomised controlled trial with 30 clusters (15 in each arm) to evaluate an integrated, scalable package providing two pregnancy visits and five post-natal home visits delivered by community health workers in Umlazi, Durban, South Africa. Primary outcomes were exclusive and appropriate infant feeding at 12 weeks post-natally and HIV-free infant survival. At 12 weeks of infant age, the intervention was effective in almost doubling the rate of exclusive breastfeeding (risk ratio 1.92; 95% CI: 1.59-2.33) and increasing infant weight and length-for-age z-scores (weight difference 0.09; 95% CI: 0.00-0.18, length difference 0.11; 95% CI: 0.03-0.19). No difference was seen between study arms in HIV-free survival. Women in the intervention arm were also more likely to take their infant to the clinic within the first week of life (risk ratio 1.10; 95% CI: 1.04-1.18). The trial coincided with national scale up of ARVs for PMTCT, and this could have diluted the effect of the intervention on HIV-free survival. We have demonstrated that implementation of a pro-poor integrated PMTCT and maternal, neonatal and child health home visiting model is feasible and effective. This trial could inform national primary healthcare reengineering strategies in favour of home visits. The dose effect on exclusive breastfeeding is notable as improving exclusive breastfeeding has been resistant to change in other studies targeting urban poor families.
    Tropical Medicine & International Health 01/2014; · 2.30 Impact Factor
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    ABSTRACT: Background: Community-based peer support has been shown to be effective in improving exclusive breastfeeding rates in a variety of settings.
    PLoS ONE 01/2014; 9(1). · 3.53 Impact Factor
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    ABSTRACT: Introduction: Lack of universal, annual testing for human immunodeficiency virus (HIV) in health facilities suggests that expansion of HIV testing and counselling (HTC) to non-clinical settings is critical to the achievement of national goals for prevention, care and treatment. Consideration should be given to the ability of lay counsellors to perform home-based HTC in community settings. Methods: We implemented a community cluster randomized controlled trial of home-based HTC in Sisonke District, South Africa. Trained lay counsellors conducted door-to-door HIV testing using the same rapid tests used by the local health department at the time of the study (SD Bioline and Sensa). To monitor testing quality and counsellor skill, additional dry blood spots were taken and sent for laboratory-based enzyme-linked immunosorbent assay (ELISA) testing. Sensitivity and specificity were calculated using the laboratory result as the gold standard. Results and discussion: From 3986 samples, the counsellor and laboratory results matched in all but 23 cases. In 18 cases, the counsellor judged the result as indeterminate, whereas the laboratory judged 10 positive, eight negative and three indeterminate, indicating that the counsellor may have erred on the side of caution. Sensitivity was 98.0% (95% CI: 96.3-98.9%), and specificity 99.6% (95% CI: 99.4-99.7%), for the lay counsellor field-based rapid tests. Both measures are high, and the lower confidence bound for specificity meets the international standard for assessing HIV rapid tests. Conclusions: These findings indicate that adequately trained lay counsellors are capable of safely conducting high-quality rapid HIV tests and interpreting the results as per the kit guidelines. These findings are important given the likely expansion of community and home-based testing models and the shortage of clinically trained professional staff.
    Journal of the International AIDS Society 11/2013; 16(1):18744. · 4.21 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: Data from a prospective multisite cohort study were used to examine the effect of HIV exposure, untreated HIV infection, and single-dose nevirapine on infant growth velocity. The 2009 WHO growth velocity standards constitute a new tool for this type of investigation and are in need of functional validation. In period 1 (3-24 wk), 65 HIV-infected, 502 HIV-exposed uninfected (HEU), and 216 HIV-unexposed infants were included. In period 2 (25-36 wk), 31 infants moved from the HEU group to the HIV-infected group. We compared weight velocity Z-scores (WVZ) and length velocity Z-scores (LVZ) by HIV group and assessed their independent influences. In period 1, mean WVZ (95% CI) was significantly (P < 0.001) lower in infected [-0.87 (-1.77, 0.04)] than HEU [0.81 (0.67, 0.94)] and unexposed [0.55 (0.33, 0.78)] infants. LVZ showed similar associations. In both periods, sick infants and those exposed to higher maternal viral loads had lower WVZ. Higher mean LVZ was associated with low birth weight. Infants that had received nevirapine had higher LVZ. In conclusion, HIV infection and not exposure was associated with low WVZ and LVZ in period 1. Eliminating infant HIV infection is a critical component in averting HIV-related poor growth patterns in infants in the first 6 mo of life.
    Journal of Nutrition 11/2013; 144(1). · 4.23 Impact Factor
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    ABSTRACT: We will be unable to achieve sustained impact on health outcomes with maternal and child health (MCH) interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support monitoring and evaluation of MCH interventions and conduct large scale MCH research are central to bridging the gap. Inexpensive and easy to use, mobile phones are broadly available, particularly in LMIC, where penetration approaches 100%. This technology represents an effective option for MCH monitoring, evaluation and research. Our South African team has successfully used mobile (mHealth) technology to support and evaluate MCH health interventions for the past 6 years. In partnership with a mobile technology company we developed a system to use mobile phones in the field (communities and health facilities) with a web-based interface utilized by supervisors. Computerized algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of field work and collection of research data. Our work has included management and evaluation of two community cluster randomized trials and national facility-based surveillance of the South African National PMTCT program. The latter system manages data from over 10,000 infants from every region of the country. We are able to monitor enrolment data daily, track progress, and manage field staff. Analytical screens monitor field worker performance and measure health outcomes. Results are readily available for feedback to stakeholders and program managers. The system has proved useful for both cross-sectional and cohort tracking, data collection and data management.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Sohni Dean and colleagues report their CHNRI exercise that developed health research priorities for effective pre-conception care in low- and middle-income countries. Please see later in the article for the Editors' Summary.
    PLoS Medicine 09/2013; 10(9):e1001508. · 14.00 Impact Factor
  • The Lancet 07/2013; 382(9889):307-8. · 39.21 Impact Factor
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    ABSTRACT: We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention. This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples. Learning about each other's status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised. Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women's vulnerability and their lack of decision-making power.
    PLoS ONE 06/2013; 8(6):e66390. · 3.53 Impact Factor
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    ABSTRACT: To assess the effect of home based HIV counselling and testing on the prevalence of HIV testing and reported behavioural changes in a rural subdistrict of South Africa. Cluster randomised controlled trial. 16 communities (clusters) in uMzimkhulu subdistrict, KwaZulu-Natal province, South Africa. 4154 people aged 14 years or more who participated in a community survey. Lay counsellors conducted door to door outreach and offered home based HIV counselling and testing to all consenting adults and adolescents aged 14-17 years with guardian consent. Control clusters received standard care, which consisted of HIV counselling and testing services at local clinics. Primary outcome measure was prevalence of testing for HIV. Other outcomes were HIV awareness, stigma, sexual behaviour, vulnerability to violence, and access to care. Overall, 69% of participants in the home based HIV counselling and testing arm versus 47% in the control arm were tested for HIV during the study period (prevalence ratio 1.54, 95% confidence interval 1.32 to 1.81). More couples in the intervention arm had counselling and testing together than in the control arm (2.24, 1.49 to 3.03). The intervention had broader effects beyond HIV testing, with a 55% reduction in multiple partners (0.45, 0.33 to 0.62) and a stronger effect among those who had an HIV test (0.37, 0.24 to 0.58) and a 45% reduction in casual sexual partners (0.55, 0.42 to 0.73). Home based HIV counselling and testing increased the prevalence of HIV testing in a rural setting with high levels of stigma. Benefits also included higher uptake of couple counselling and testing and reduced sexual risk behaviour. Current Controlled Trials ISRCTN31271935.
    BMJ (online) 06/2013; 346:f3481. · 16.38 Impact Factor
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    ABSTRACT: 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's), where the penetration rate approaches 100%. In this article we describe how mobile phones may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.
    South African journal of information management. 02/2013; 15(1).
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    ABSTRACT: BACKGROUND: Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context. METHODS: The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu-Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers' health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers. RESULTS: Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW. CONCLUSIONS: We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs.Trial registration number: ISRCTN41046462.
    BMC Health Services Research 02/2013; 13(1):47. · 1.66 Impact Factor

Publication Stats

798 Citations
277.32 Total Impact Points


  • 2011–2015
    • University of the Western Cape
      • School of Public Health
      Kaapstad, Western Cape, South Africa
  • 2011–2012
    • Stellenbosch University
      • Department of Psychology
      Stellenbosch, Province of the Western Cape, South Africa
  • 2008–2009
    • South African Medical Research Council
      • Health Systems Research Unit (HSRU)
      Cape Town, Province of the Western Cape, South Africa
  • 2005–2007
    • Health Systems Trust
      Port Natal, KwaZulu-Natal, South Africa
  • 2006
    • Uppsala University
      • Department of Women's and Children's Health
      Uppsala, Uppsala, Sweden