EDITORIAL

Discussion and debate

Can South Africa (SA)'s re-engineered primary health-care service deliver the Youth-friendly Health Services (YFHS) package? The thrust of the Department of Health's new shift towards preventive health services relies heavily on community health workers (CHWs) as members of ward-based outreach teams that form the basis for health promotion activities, problem recognition, referral and home-based care.^[1]

The YFHS model, previously adopted by the SA Department of Health, aims to deliver effective, appropriate and accessible services to adolescents and young people, who are a recognised high-risk group and who have very specific health needs, but who are notoriously difficult to reach through the established health system.

A community-based approach using community members rather than professionals seems to be ideally suited to help deliver YFHS, but is it?

In their Hot Topic article in this issue, Koon et al.^[2] discuss the possibilities of involving CHWs in the YFHS package. They point out advantages and drawbacks, and motivate for continued informed debate and further research. In this, their contribution extends beyond the question at hand; it reminds us that many policies and strategies are subject to multifactorial inputs that may effect success or failure, and that review, research, discussion and debate are continually needed to confirm or modify health service decisions.

A few other articles in this issue contribute to discussion and debate. Feeley and Norris^[3] estimate the extra energy and sodium intake from fast foods that urban adolescents might consume, and suggest that this might be a contributing factor to the rising epidemic of obesity and hypertension in transitional societies. Marran and Segal^[4] measured the skin thickness of their diabetic patients and calculated the potential frequency of insulin being injected intramuscularly rather than subcutaneously with specific needle lengths. Their study supports the use of shorter needles, but a clinically important consequence of this has not yet been shown.

The other articles in this issue cover a range of research topics. Nutritional research topics rightly still demand a high priority in an African context. Ige et al.^[5] show that ready-to-use therapeutic food helps children to gain weight in the short term even if they are chronically malnourished or HIV-infected. Oyenusi et al.^[6] draw attention to the frequency of hypoglycaemia as a marker of serious illness in children arriving in hospital. Brink and co-workers'^7-show the high frequency of stunting in hospitalised children, and also confirm empirical experience that many length/height measurements recorded in hospitalised children are incorrect. This has a significant impact on weight-for-height calculations, with potentially large errors in diagnostic categories based on weight-for-height z-scores such as severe acute malnutrition.

As this is being written, FIFA World Cup television coverage has been going on for some weeks. The prior protest actions in Brazil's cities highlighted the stark contrast between the financial extravagance and investment for the tournament and daily life in the favelas of the poor. These were pushed aside by television focus on the stadiums. And yet, after the World Cup, life will go on in Brazil as it did in SA, with very little to show for it in the daily life of millions, despite all the investments and opportunities.

After 4 years as Editor of this Journal, the time has come for me to hand over the baton. I am happy to have seen positive progress; the Journal has become well established. I have enjoyed my tenure.

I am delighted to be able to welcome Prof. John Pettifor as new Editor. He brings with him impeccable qualifications as long-time clinician, researcher, author, teacher and publisher in paediatrics. As erstwhile chief paediatrician at Africa's largest hospital, the Chris Hani Baragwanath Academic

Hospital, and as previous Head of Department of Paediatrics of the University of the Witwatersrand in Johannesburg, he is eminently poised to strengthen both the quality and the reputation of the Journal. Thank you, John, for taking this on.

DF Wittenberg
MD, FCP (Paed) (SA)
Editor

References

1. Saloojee H. National health insurance and health system restructuring: Does it offer anything to children? South African Journal of Child Health 2011;5(3):68-70.         [ Links ]

2. Koon AD, Goudge J, Norris SA. Considerations for linking South Africa's Youth-friendly Services to its community health worker programme. South African Journal of Child Health 2014;8(3):85-87. [http://dx.doi.org/10.7196/SAJCH.677]

3. Feeley AB, Norris SA. Added sugar and dietary sodium intake from purchased fast food, confectionery, sweetened beverages and snacks among Sowetan adolescents. South African Journal of Child Health 2014;8(3):88-91. [http://dx.doi.org/10.7196/SAJCH.678]

4. Marran K, Segal D. SKINNY - SKIN thickness and Needles in the Young. South African Journal of Child Health 2014;8(3):92-95. [http://dx.doi.org/10.7196/SAJCH.687]

5. Ige OK, Oladokun RE, Kikelomo O. Comparative weight gain with ready-to-use therapeutic food in stunted HIV-infected and -uninfected children in a Nigerian Hospital. South African Journal of Child Health 2014;8(3):104-107. [http://dx.doi.org/10.7196/SAJCH.723]

6. Oyenusi EE, Oduwole AO, Oladipo OO, Njokanma OF, Esezobor CI. Hypoglycaemia in children aged 1 month to 10 years admitted to the Children's Emergency Centre of Lagos University Teaching Hospital, Nigeria. South African Journal of Child Health 2014;8(3)107-111. [http://dx.doi.org/10.7196/SAJCH.737]

7. Brink J, Pettifor JM, Lala SG. The prevalence of malnutrition in children admitted to a general paediatric ward at the Chris Hani Baragwanath Academic Hospital: A cross-sectional survey. South African Journal of Child Health 2014;8(3):112-116. [http://dx.doi.org/10.7196/SAJCH.787]