Home visits for preterm/low birthweight infants in South Africa: Qualitative evidence synthesis.

Background: Prematurity and low birth weight (LBW) are the main causes of neonatal mortality in South Africa (SA). Home visits by lay health workers (LHWs) may be effective in addressing this. Aim: To inform a national guideline on LHW home visits as part of the Global Evidence, Local Adaptation (GELA) project, we conducted a rapid qualitative evidence synthesis exploring the acceptability, feasibility and equitability of this intervention for preterm and LBW babies. Setting: We included studies conducted in SA. Methods: We searched PubMed and Embase until 15 September 2023 and identified eligible studies independently and in duplicate. We synthesised evidence using thematic analysis, assessed study quality using an adaptation of the Critical Appraisal Skills Programme tool and assessed confidence in the review findings using GRADE-CERQual. Results: The 16 eligible studies included diverse settings and populations in SA. Factors facilitating mothers' acceptance included the knowledge and skills gained, the psychosocial support offered and improved healthcare access and relationships with facility staff. Distrust in LHWs and stigma associated with home visits were barriers to acceptance. Lay health workers' acceptance was facilitated by them feeling empowered. The emotional burden of home visits for LHWs, coupled with insufficient training and support, undermined the feasibility of home visits. Conclusion: A complex range of interacting contextual factors may impact on the implementation of home visit programmes for preterm and LBW infants in SA. Contribution: This country profile provides insights into how home visits for preterm and LBW infants in SA might be contextually tailored to increase local relevance and in turn effectiveness, with potential relevance for other African countries.