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South African mothers confront synergistic challenges from depression, alcohol use, and HIV/AIDS. The importance of maternal functioning for child development motivates interventions, yet long-term outcomes seldom are tracked. Furthermore, little is known about trajectories and the role of social-cultural factors in maternal depression and alcohol use across parenthood in low- and middle-income countries. We examined maternal outcomes at 5- and 8-years' post-birth, from the Philani Intervention Program (PIP), a randomized controlled trial of a prenatally-initiated home visiting intervention lasting through 6 months' post-birth which yielded some benefits for children and mothers through 3 years. Longitudinal Bayesian mixed-effects models assessed intervention effects for maternal depression and alcohol use from pre-birth through 8 years post-birth. We plotted trajectories of depression and alcohol use and analyzed their relationship over time. Maternal benefits appeared limited and intervention outcomes differed at 5 and 8 years. Reduced depression in PIP versus standard care (SC) mothers at 3 years disappeared by 5 and 8 years. Depression prevalence declined from 35.1% prenatally to 5.5% at 8 years, independent of intervention or alcohol use. Alcohol use in both groups rebounded from a post-birth nadir; fewer PIP than SC mothers drank alcohol and reported problematic use at 5 but not 8 years. HIV+ prevalence did not differ by condition and increased from 26% to 45% over the reported period. Dissipation of early child benefits from home visiting by age 8 years likely reflects lack of durable change in maternal behaviors compounded by social-cultural factors and cumulative effects of community deprivation. High prenatal rates warrant screening and treatment for depression in standard antenatal care. Low-and-middle income countries may need sustained interventions, including alcohol use reduction, to capitalize on initial gains from targeted interventions and address community social-cultural factors. HIV/AIDS continues to spread in this population. • Home visiting yields early mother-child benefits that erode without sustained intervention. • High rates of maternal depression in pregnancy decline systematically over time. • Pregnancy appears a teachable moment for reducing alcohol mis/use but risk recurs with time. • Perinatal alcohol intervention can slow resumption of use but benefits disappear by 8 years. [ABSTRACT FROM AUTHOR]

Compelling evidence for the long-term impact of conditions in gestation and early childhood on both physical and psychosocial functioning and productivity has stimulated a focus in global health policy and social services on the “first 1000 days”. Consequently, related initiatives may assume that rationale for this orientation and the agency of parents during this period is self-evident and widely shared among parents and communities. In 2012, we tested this assumption among a sample of 38 township-dwelling caregivers in Cape Town, by asking a question identified during a study of cultural models of parenting, namely: At what age or stage can a parent or caregiver have the most influence on a child's development? Formal cultural consensus analysis of responses met criteria for strong agreement that the period for greatest impact of parenting on a child's development occurs at adolescence, at a median age of 12 years. In follow-up focus groups and structured interviews, caregivers articulated clear ecological and developmental reasons for this view, related to protection both of developmental potential and against powerful, context-specific ecological risks (early pregnancy, substance ab/use, violence and gangs) that emerge during adolescence. Such risks threaten educational attainment, reproductive health, and social derailment with enduring consequences for lifetime well-being that caregivers are highly motivated to prevent. Developmental needs in pregnancy and early childhood, by contrast, were considered more manageable. These findings resonate with emerging evidence for multiple sensitive periods with corresponding developmental needs, and urge the value of complementing efforts to optimize early development with those to sustain and enhance it during later windows of developmental opportunity such as adolescence. Our results also indicate the need to consult local views of developmental risk and parenting practice in communicating with caregivers and planning interventions, and the value of using available methodological tools to do so. [ABSTRACT FROM AUTHOR]

Research suggests that parenting behaviours are negatively affected by parental trauma. However, thus far, the evidence base has provided limited insight into why this occurs. Further, the available evidence has focused largely on high income contexts (HICs), and we know much less about the experiences of parents in low- and middle-income countries (LMICs) who are frequently coping with multiple adversities. The current qualitative study aimed to gain a more in-depth understanding from the parent's perspective about whether and how their trauma impacted themselves and their parenting behaviours. We conducted interviews with 30 trauma-exposed, Xhosa speaking parents (28 mothers) from Khayelitsha, a township outside Cape Town in South Africa, 66% of whom reported experiencing moderate to severe posttraumatic stress symptoms. Five key themes were identified: consequences for parents as individuals (in terms of mental and physical health); the centrality of community and cultural context to parental experiences; consequences in terms of parenting capacity; trauma related effects on the child and how these may influence parental coping; and mechanisms of coping and achieving recovery. Findings highlight the difficult nature of parenting following trauma due to impacts on multiple areas of life, and suggest potential avenues for the development of parenting interventions in order to support parents and families more effectively following trauma. • Trauma exposure and posttraumatic distress present many challenges to LMIC parents. • Posttrauma anger, threat perceptions, poor coping may particularly affect parenting. • Physical consequences (e.g., loss of income) are also crucial for LMIC parents. • Perceived negative impacts for their children can compound parental distress. • Despite these challenges, parental bonds with their children may be retained. [ABSTRACT FROM AUTHOR]