Thula Sana

Thula Sana: The long term impact on cognitive and socio-emotional functioning of an intervention to enhance the mother-infant relationship

Department of Psychology, Stellenbosch University.

PI: Prof Mark Tomlinson

Stellenbosch University is conducting the Thula Sana study with the support of Grand Challenges Canada. It is one of several studies funded across various low and middle income countries under the Saving Brains grant programme.


There is emerging evidence that sensitive maternal care and associated secure infant attachment are strong predictors of a range of child developmental outcomes, including child growth and physical health status, child cognitive development, and socio-emotional functioning. In the context of poverty and high adversity, however, the capacity of parents to provide the kind of care that promotes good child developmental outcomes can be severely compromised.

A previous related study conducted by the research team in Khayelitsha, Cape Town, found that mother-infant relationships were characterized by insensitive and unresponsive parenting, and that there was a high rate of insecure infant attachment in this population. In response, a manualized home-based intervention was developed to promote mothers’ engagement in sensitive, responsive interactions with their infants. The intervention was designed for routine delivery by community health workers within low resource settings over a 6 month period. Between 1999 and 2003, the study team conducted a Randomized Controlled Trial (RCT) in Khayelitsha to assess the efficacy of this intervention. Compared to controls, at follow up, mothers in the intervention group were significantly more sensitive in interaction with their infants, and their infants were significantly more likely to be securely attached. Where social adversity was not extreme, there was also a significant benefit of the intervention in terms of child cognitive outcome.

The study

The present study aims to follow up the mothers and children enrolled in the previous RCT, now that the children are 12-13 years of age to assess the long-term outcomes of the intervention. We are conducting systematic standardized assessments of child cognitive functioning and school attainment, child emotional/behavioral functioning, the home environment, child health and growth, family functioning, as well as neural functions implicated in self-regulation (i.e. inhibitory control, self-monitoring, and working memory) and the stress response (allostatic load, and cortisol secretion). Data collection started in late 2012 and will continue until early 2014.