Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 15 num. 2 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>The South African 24-hour movement guidelines for birth to 5 years</b>]]> <![CDATA[<b>The age at which adult height is achieved during adolescence in the Birth to Twenty Cohort, Johannesburg, South Africa</b>]]> BACKGROUND: The core of the study involves comparing the secular trends in height among self-reported black and white racial groups in South Africa (SA). The white group represents that part of the population that has always been affluent and therefore has growth trends comparable with those of developed nations of the world. In comparing the groups, we wanted to see the extent to which the black population has caught up, if it all, since the introduction of democracy in 1994OBJECTIVES: To establish the age at which linear growth plateaus; to compare the age of growth cessation and the achieved adult height between sexes and racial groups in SA; and to compare data from the Bone Health Cohort with previous similar studies to ascertain the secular trendMETHODS: We analysed prospective data of 569 individuals who had annual anthropometric assessments from age nine until 20 years (1999 - 2010). The Superlmposition by Translation and Rotation (SITAR) statistical programme was used to model height and age at growth cessationRESULTS: There was a total of 183 black females, 93 white females, 205 black males and 88 white males. Black and white females achieved adult height at a similar age (15.1 and 15.3 years), but black females were 5.7 cm shorter. Black and white males achieved their adult height at 17.5 and 16.5 years, respectively, black males being 4.6 cm shorter. Mean adult black male height is currently 170.7 cm v. 166.9 cm in 1971, while there were no significant secular changes in the other groupsCONCLUSIONS: There has been a positive secular growth trend in height over 30 years among black males, but no changes in the other groups <![CDATA[<b>Individual and community-level factors associated with symptoms of acute lower respiratory infections among children under 5 years of age in Eswatini</b>]]> BACKGROUND: Despite initiatives and efforts implemented over the years that would impact positively on child health, acute lower respiratory infections (ALRIs) remain a serious challenge for under-5sOBJECTIVE: To investigate the individual- and community-level factors associated with child ALRIs in EswatiniMETHODS: Using the combined data for 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys, data for 4 265 children under 5 years of age were analysed. Univariable, bivariable and multivariable multilevel logistic regression analyses were conductedRESULTS: We found that the prevalence of ALRIs was 11.1% (95% confidence interval (CI) 10.0 - 12.4). Higher odds of ALRIs were observed among children who had reported diarrhoea in the same time period (adjusted odds ratio (aOR) 1.75; 95% CI 1.37 - 2.23) compared with those who did not report diarrhoea, and those born to women with no formal education (aOR 2.16; 95% CI 1.13 - 4.16) and those with primary education (aOR 2.60; 95% CI 1.34 - 5.04) compared with those born to women with tertiary education. Place of residence was a community-level variable associated with higher odds of ALRIs among children from urban areas (aOR 1.59; 95% CI 1.15 - 2.20) compared with rural residents. Those from Manzini (aOR 2.19; 95% CI 1.59 - 3.12), Shiselweni (aOR 1.73; 95% CI 1.23 - 2.44) and Lubombo (aOR 1.77; 95% CI 1.25 - 2.51) were more likely to be infected with ALRIs compared with those from the Hhohho region. In addition, higher odds of ALRIs were observed in children from communities with a low proportion of households with electricity (aOR 1.46; 95% CI 1.10 - 1.95) compared with those from communities with high access to electricityCONCLUSIONS: We found that individual- and community-level factors were associated with child ALRIs across communities in Eswatini. Programmes and policies that aim to mitigate child morbidity due to ALRIs should integrate the individual and community factors <![CDATA[<b>Retrospective study of sudden unexpected death of infants in the Garden Route and Central Karoo districts of South Africa: Causes of death and epidemiological factors</b>]]> BACKGROUND: Sudden unexpected death in infants (SUDI) is a major contributor to under-5 mortality rates. In attempts to better understand SUDI, an abundance of risk factors has previously been described. However, there is a lack of research pertaining to SUDI and risk factors in South Africa (SA), particularly in rural settingsOBJECTIVE: To describe the profile of SUDI in rural areas of the Western Cape, SAMETHODS: A retrospective analysis was conducted on SUDI cases admitted to the seven mortuaries in the Garden Route and Central Karoo districts (Western Cape) between 1 January 2012 and 31 December 2016RESULTS: SUDI contributed to 38.56% of all infant deaths and the rate of SUDI was 7.95/1 000 live recorded births. Of the total 5 323 case load, 401 (7.53%) were admitted as SUDI cases. In accordance with other studies, more infant deaths occurred during winter (30.7%) than other seasons and almost all infants demised while sleeping (97.7%). Contrary to other studies, there was a slight female preponderance (54.6%). Symptoms (often mild) of illness prior to demise were reported in 70.2% of infants, but only one-third of these infants' parents/ caregivers sought medical attention. Following postmortem investigation, the majority of deaths were due to explained natural causes (93.7%), of which respiratory tract infection was the leading cause of death (74.1% of SUDI admissions). The most prevalent risk factors were: bed-sharing (especially with a smoker), side sleeping, prematurity, exposure to cigarette smoke, maternal alcohol use, unsatisfactory infant weight gain and socioeconomic indicators of deprivationCONCLUSIONS: Overall, the risk factors observed in the rural setting were highly prevalent and were similar to those described in urban areas (both in SA and internationally). Many of these are modifiable and ample opportunity for risk factor intervention was identified, as well as future research opportunities. Most importantly, parents should be educated to not underestimate seemingly mild symptoms in their infants <![CDATA[<b>The outcome of newborns admitted to kangaroo mother care units at regional hospitals in KwaZulu-Natal, South Africa</b>]]> BACKGROUND: Kangaroo mother care (KMC) is a common modality of care for low birthweight and preterm newborns, with good long-term outcomes at low cost. However, little is known about the short-term outcomes of babies during their stay in a KMC unit.OBJECTIVE: To describe the profile and outcome of newborn babies admitted to KMC unitsMETHOD: A retrospective chart review was undertaken of babies admitted to the KMC units of two Durban hospitals over a two-year period. All babies with birthweights below 2 000 g admitted to the KMC units for the first time during this period were included. Poor outcome was defined as a death in the KMC unit or need for readmission to the neonatal nurseryRESULT: Two hundred and twenty-four newborns were included in the study. The median maternal age was 25 years. The newborns had a median gestational age of 32 weeks, median birthweight of 1 500 g, median KMC unit admission weight of 1 600 g, and median age on admission to the KMC units of 9.5 days. Twenty-six percent of babies had a poor outcome, including seven deaths. Significant factors associated with a poor outcome included a birth or admission weight to KMC units below 1 500 g, HIV-negative mothers; and abnormal temperature or blood glucose levelsCONCLUSION: Seventy-four percent of babies admitted to KMC were discharged home after an uneventful stay. Poor outcomes were associated with a birth or KMC admission weight below 1 500 g and an abnormal temperature or blood glucose level while admitted to the KMC unit <![CDATA[<b>Effect of school-based interventions on body composition of grade-4 children from lower socioeconomic communities in Gqeberha, South Africa</b>]]> BACKGROUND: South African (SA) children from disadvantaged communities are plagued by a double burden of under- and over-nutrition. The resulting overweight and obesity on the one hand, and stunting on the other, are risk factors for chronic diseases in adulthoodOBJECTIVE: To determine the effect of school-based interventions on body composition of grade-4 children from lower socioeconomic communities in the Gqeberha region, SAMETHODS: A cluster-randomised controlled trial was carried out with children from 8 schools. Schools were randomly assigned, either to a 10-week school-based intervention (4 schools) or a control condition (4 schools). The intervention comprised several arms, with each intervention school receiving a different combination of the following measures: physical activity, health and hygiene education, and nutrition education with supplementation. Effects on children's body composition were evaluated using standardised, quality-controlled methods. Height and weight were assessed to calculate body mass index (BMI), and percentage body fat was measured via thickness of skinfolds (triceps and subscapularRESULTS: Overall, 898 children (458 boys and 440 girls) aged 8 - 11 years participated in the trial. Children's BMI, BMI-for-age and percentage body fat increased significantly over time. Increases were similar in boys and girls. Body fat remained unchanged in underweight children, whereas increases occurred in normal weight and (particularly) overweight/obese peers. In normal-weight children, the physical activity intervention (either alone or combined with health education) mitigated increments in body fat levels. A similar pattern was observed in overweight/obese children, but only in the physical activity intervention cohort aloneCONCLUSION: Our study shows that normal-weight children are at risk of becoming overweight and children who are already overweight/ obese are at even greater risk of gaining weight. The physical activity intervention (alone or in combination with health education) can mitigate increases in body fat in normal-weight children as well as in overweight/obese children. Our findings reveal that school-based physical activity, nutrition and health and hygiene interventions can have beneficial effects on children's body composition. Further analyses are needed to examine how (school-based) physical activity interventions should be designed to improve children's health in lower socioeconomic areas <![CDATA[<b>Kangaroo mother care: Lived experiences of mothers in three hospitals of Limpopo Province, South Africa</b>]]> BACKGROUND: Kangaroo mother care (KMC) is a low-expense, highly effective management plan for preterm babies in low-to middle-income countries. Limpopo Province initiated KMC as part of the Limpopo Initiative for New-born Care in their district hospitals. We explored the experiences of mothers during KMC in the hospitals in Vhembe DistrictOBJECTIVE: To document lived-in experiences of mothers providing KMC in Vhembe District of Limpopo Province, South AfricaMETHODS: Using a phenomenological design, 13 mothers who provided KMC were interviewed from the three hospitals in the Vhembe District. Following a phenomenological analysis of each transcript, three main themes emerged. All relevant ethical protocols were observed during the researchRESULTS: The mothers' experience was characterised by three main themes and nine sub-themes. The mothers understood the practice, rationale and benefits of KMC. Despite this knowledge, mothers reported challenges: strained family relationships, fatigue associated with the practice of KMC, inadequate hospital amenities, and ineffective instrumental support and disruption of academic progress for the student mothers. Mothers received emotional support from their relatives, spouses and professional nursesCONCLUSION: This is the first known study to report on the shortage of amenities regarding KMC. It is important for the Limpopo Department of Health to improve the provision of basic amenities in the unit to sustain the objectives of the Limpopo Initiative for New-born Care <![CDATA[<b>Prevalence and outcomes of persistent pulmonary hypertension of the newborn in a neonatal unit, Mankweng Hospital, Limpopo Province, South Africa</b>]]> BACKGROUND: Persistent pulmonary hypertension of the newborn (PPHN) is a condition of high pulmonary arterial pressures leading to hypoxaemia and continued shunting of blood across fetal channels as a result of failure of circulatory transition at birthOBJECTIVE: To determine the prevalence and outcomes of PPHN at Mankweng Hospital, Limpopo Province, South AfricaMETHODS: A retrospective descriptive review of patients' files from January 2015 to December 2017 was conducted. PPHN was diagnosed on echocardiogramRESULTS: During the 3-year period of the study, a total of 6 776 neonates were admitted to the neonatal unit, of whom 0.76% (n=52) were diagnosed with PPHN. Of these, 98% (n=51) had complete information in their medical records and were further analysed. Slightly more than half (53%) were males, 59% were delivered by caesarean section, 94% had gestational age &gt;37 weeks, and 39% and 14% had Apgar scores of <6 at 1 minute and 5 minutes, respectively. Most neonates (72%) had meconium aspiration as the single risk factor or in combination with other conditions. Nearly half (45.1%) of the neonates with PPHN did not survive. Gender, mode of delivery, and Apgar score were each correlated with PPHN mortality and they all showed no statistically significant association. A significantly higher proportion of non-survivors received inotropic support than survivors (p<0.05CONCLUSIONS: The prevalence of PPHN was found to be lower than in other low- and middle-income countries; nonetheless, the all-cause mortality rate is significantly high. The commonest aetiology of PPHN is meconium aspiration syndrome as a single underlying risk factor, and in combination with other conditions. Most neonates who needed inotropic support died <![CDATA[<b>Muscle strength in young children perinatally infected with HIV who were initiated on antiretroviral therapy early</b>]]> BACKGROUND: As children with perinatally acquired HIV (PHIV) are living longer, long-term physical sequelae of the disease are becoming more pertinent. Muscle strength is known to be adversely affected in adults infected with HIV but little is known about the muscle strength of children with PHIVOBJECTIVES: To determine the muscle strength of children perinatally infected with HIV compared with an uninfected control group. Associations between clinical and anthropometric variables and muscle strength were investigatedMETHODS: In this cross-sectional descriptive study, 175 children who acquired HIV perinatally and 171 children who were HIV-uninfected had their muscle strength assessed by hand-held dynamometry and the 'make test'. Clinical data were extracted from the children's clinic files. Height and weight were assessed using a stadiometer and a digital scale, respectively. Children were between the ages of 5 and 11 years of age at assessment. The children living with HIV had all been initiated on antiretroviral treatment (ART) at a young age (mean (standard deviation (SD)) 8.7 (6.7) months) and their disease was well controlledRESULTS: Despite the children with HIV presenting with significantly lower height, weight and body mass index (BMI) for age z-scores, there was no statistical difference in muscle strength between the two groups. BMI and Tanner staging were associated with muscle strength in both groupsCONCLUSIONS: Children who are initiated on ART at an early age and whose disease is well controlled are able to attain near-normal muscle strength. Longitudinal follow-up of these children as they go through puberty is warranted <![CDATA[<b>Prevalence of prelacteal feeding and its associated factors among mothers of under-24-month-old children at Arba Minch Zuria District, Ethiopia: A cross-sectional study</b>]]> BACKGROUND: Introduction of prelacteal feeds to newborn babies negates the recommendation of the World Health Organization that breastfeeding should be initiated within an hour after childbirth. As a result, many known health benefits of breastfeeding for infants, children and mothers are precluded. Therefore, to obviate the harmful effects of prelacteal feeding, it remains of paramount concern to identify the current status of prelacteal feeding and its contributing factorsOBJECTIVE: To assess the prevalence of prelacteal feeding and associated factors among mothers of under-24-month-old children in Arba Minch Zuria District, EthiopiaMETHODS: A community-based cross-sectional study was conducted among 400 mother/caregiver-child pairs. A structured and pretested questionnaire uploaded on mobile devices pre-installed with open data kit software was used for data collection. Factors associated with prelacteal feeding practices were explored using multivariable logistic regression analysis. The Hosmer-Lemeshow goodness-of-fit test was used to determine whether the model adequately described the data or notRESULTS: A total of 400 mothers/caregivers participated in the study, of whom 67 (16.8%) practised prelacteal feeding. Mothers who had poor knowledge of breastfeeding were nearly four times more likely to practise prelacteal feeding than those who had good knowledge (adjusted odds ratio (aOR) 3.95; 95% confidence interval (CI) 1.82 - 8.54). Mothers who did not receive counselling on breastfeeding during antenatal care (ANC) follow-up were 4.1 times more likely to provide prelacteal feeds than those who received counselling (aOR 4.1; 95% CI 1.70 - 9.76). Furthermore, mothers who did not receive immediate postnatal care were 6.46 times more likely to give prelacteal feeding than those who received immediate postnatal care (aOR 6.46; 95% CI 2.85 - 14.63CONCLUSIONS: One out of six neonates was given prelacteal feeds in the study area. Poor knowledge among mothers about breastfeeding, lack of counselling on optimal breastfeeding during ANC visits, and lack of immediate postnatal care mainly led to prelacteal feeding. Therefore, attention should be given to improving maternal knowledge of breastfeeding through the refining of skilled counseling during ANC and immediate postnatal care <![CDATA[<b>Acute necrotising encephalopathy: A rare but important differential diagnosis</b>]]> We describe a patient with the classic clinical and radiological findings of acute necrotising encephalopathy and present a review of the current literature. Although it is a rare condition, we believe it should always be considered in an encephalopathic child when the specific radiological findings are seen. This is of particular importance given that early treatment has been reported to result in better outcomes.