Impact of a Community Health Worker-Led Programme on Maternal and Child Nutrition Outcomes in South Africa: A Retrospective Chart Review
1
Grow Great, Midrand, South Africa
2
The DG Murray Trust, Cape Town, South Africa
3
University of Cape Town, Cape Town, South Africa
4
The ELMA Philanthropies, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2282
ABSTRACT
BACKGROUND:
Stunting remains a major public health challenge in South Africa, affecting one in three children under two. Community Health Workers (CHWs) play a critical role through growth monitoring, nutrition counselling, early identification of growth faltering and linkage to health and social services. The Grow Great Champions (GGC) programme was implemented to strengthen CHW capacity through structured tools, training and routine household follow-up to prevent and respond to stunting. This study assessed maternal and child outcomes associated with participation in the programme.
METHODS:
A retrospective chart review was conducted using GGC client folders completed between 2018 and 2023. Data from 2 757 child-caregiver records across 183 clinics in Gauteng, Limpopo, Mpumalanga, and the Western Cape were analysed. Anthropometric indicators were calculated using WHO growth standards. Associations between nutritional outcomes and CHW visit frequency were examined using chi-squared tests, and mixed-effects logistic regression. Growth-curve modelling assessed catch-up growth.
RESULTS:
Overall, 34% of children under two years were stunted, with prevalence declining from 38% at six months to 30% at 24 months within the cohort. Children receiving more than four CHW visits were significantly less likely to be stunted at 24 months compared to those receiving fewer visits (27% vs 36%; OR = 0.63, 95% CI 0.47–0.85). Growth-curve modelling demonstrated sustained catch-up growth among children receiving four or more visits. Exclusive breastfeeding at six months reached 80%, while vitamin A supplementation and deworming coverage exceeded 95%. Alongside undernutrition, an emerging double burden of malnutrition was observed, with overweight and obesity increasing to 15% by 24 months.
CONCLUSIONS:
Consistent CHW household engagement is strongly associated with reducing stunting and improved catch-up growth in children under two. Findings support scaling the GGC model within existing ward-based outreach teams, prioritising four to seven CHW visits per child to accelerate progress toward halving stunting by 2030.
Stunting remains a major public health challenge in South Africa, affecting one in three children under two. Community Health Workers (CHWs) play a critical role through growth monitoring, nutrition counselling, early identification of growth faltering and linkage to health and social services. The Grow Great Champions (GGC) programme was implemented to strengthen CHW capacity through structured tools, training and routine household follow-up to prevent and respond to stunting. This study assessed maternal and child outcomes associated with participation in the programme.
METHODS:
A retrospective chart review was conducted using GGC client folders completed between 2018 and 2023. Data from 2 757 child-caregiver records across 183 clinics in Gauteng, Limpopo, Mpumalanga, and the Western Cape were analysed. Anthropometric indicators were calculated using WHO growth standards. Associations between nutritional outcomes and CHW visit frequency were examined using chi-squared tests, and mixed-effects logistic regression. Growth-curve modelling assessed catch-up growth.
RESULTS:
Overall, 34% of children under two years were stunted, with prevalence declining from 38% at six months to 30% at 24 months within the cohort. Children receiving more than four CHW visits were significantly less likely to be stunted at 24 months compared to those receiving fewer visits (27% vs 36%; OR = 0.63, 95% CI 0.47–0.85). Growth-curve modelling demonstrated sustained catch-up growth among children receiving four or more visits. Exclusive breastfeeding at six months reached 80%, while vitamin A supplementation and deworming coverage exceeded 95%. Alongside undernutrition, an emerging double burden of malnutrition was observed, with overweight and obesity increasing to 15% by 24 months.
CONCLUSIONS:
Consistent CHW household engagement is strongly associated with reducing stunting and improved catch-up growth in children under two. Findings support scaling the GGC model within existing ward-based outreach teams, prioritising four to seven CHW visits per child to accelerate progress toward halving stunting by 2030.
| eISSN: | 2654-1459 |
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