Child Health In South Africa Research Articles

Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria

BackgroundSub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach.MethodsWe followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10–13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed.ResultsBased on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants.ConclusionsThrough dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.

Child exposure to organophosphate and pyrethroid insecticides measured in urine, wristbands, and household dust and its implications for child health in South Africa: A panel study.

Children in agricultural areas are exposed to organophosphate (OP) and pyrethroid (PYR) insecticides. This explorative study investigated child exposure to OPs and PYRs, comparing temporal and spatial exposure variability within and among urine, wristbands, and dust samples. During spraying season 2018, 38 South African children in two agricultural areas (Grabouw/Hex River Valley) and settings (farm/village) participated in a seven-day study. Child urine and household dust samples were collected on days 1 and 7. Children and their guardians were wearing silicone wristbands for seven days. Intraclass correlation coefficients (ICCs) evaluated temporal agreements between repeated urine and dust samples, Spearman rank correlations (Rs) evaluated the correlations among matrices, and linear mixed-effect models investigated spatial exposure predictors. A risk assessment was performed using reverse dosimetry. Eighteen OPs/PYRs were targeted in urine, wristbands, and dust. Levels of chlorpyrifos in dust (ICC = 0.92) and diethylphosphate biomarker in urine (ICC = 0.42) showed strong and moderate temporal agreement between day 1 and day 7, respectively. Weak agreements were observed for all others. There was mostly a weak correlation among the three matrices (Rs = -0.12 to 0.35), except for chlorpyrifos in dust and its biomarker 3,5,6-trichloro-2-pyridinol in urine (Rs = 0.44). No differences in exposure levels between living locations were observed. However, 21% of the urine biomarker levels exceeded the health-risk threshold for OP exposure. Observed high short-term variability in exposure levels during spraying season highlights the need for repeated sampling. The weak correlation between the exposure matrices points to different environmental and behavioral exposure pathways. Exceeding risk thresholds for OP should be further investigated.

Indirect effects of COVID-19 on maternal and child health in South Africa

ABSTRACT Background The unfinished burden of poor maternal and child health contributes to the quadruple burden of disease in South Africa with the direct and indirect effects of the COVID-19 pandemic yet to be fully documented. Objective To investigate the indirect effects of COVID-19 on maternal and child health in different geographical regions and relative wealth quintiles. Methods We estimated the effects of COVID-19 on maternal and child health from April 2020 to June 2021. We estimated this by calculating mean changes across facilities, relative wealth index (RWI) quintiles, geographical areas and provinces. To account for confounding by underlying seasonal or linear trends, we subsequently fitted a segmented fixed effect panel model. Results A total of 4956 public sector facilities were included in the analysis. Between April and September 2020, full immunisation and first dose of measles declined by 6.99% and 2.44%, respectively. In the follow-up months, measles first dose increased by 4.88% while full immunisation remained negative (−0.65%) especially in poorer quintiles. At facility level, the mean change in incidence and mortality due to pneumonia, diarrhoea and severe acute malnutrition was negative. Change in first antenatal visits, delivery by 15–19-year olds, delivery by C-section and maternal mortality was positive but not significant. Conclusion COVID-19 disrupted utilisation of child health services. While reduction in child health services at the start of the pandemic was followed by an increase in subsequent months, the recovery was not uniform across different quintiles and geographical areas. This study highlights the disproportionate impact of the pandemic and the need for targeted interventions to improve utilisation of health services.

"Must you make an app?" A qualitative exploration of socio-technical challenges and opportunities for designing digital maternal and child health solutions in Soweto, South Africa.

Participatory and digital health approaches have the potential to create solutions to health issues and related inequalities. A project called Co-Designing Community-based ICTs Interventions for Maternal and Child Health in South Africa (CoMaCH) is exploring such solutions in four different sites across South Africa. The present study captures initial qualitative research that was carried out in one of the urban research sites in Soweto. The aim was twofold: 1) to develop a situation analysis of existing services and the practices and preferences of intended end-users, and 2) to explore barriers and facilitators to utilising digital health for community-based solutions to maternal and child health from multiple perspectives. Semi-structured interviews were conducted with 28 participants, including mothers, other caregivers and community health workers. Four themes were developed using a framework method approach to thematic analysis: coping as a parent is a priority; existing services and initiatives lack consistency, coverage and effective communication; the promise of technology is limited by cost, accessibility and crime; and, information is key but difficult to navigate. Solutions proposed by participants included various digital-based and non-digital channels for accessing reliable health information or education; community engagement events and social support; and, community organisations and initiatives such as saving schemes or community gardens. This initial qualitative study informs later co-design phases, and raises ethical and practical questions about participatory intervention development, including the flexibility of researcher-driven endeavours to accommodate community views, and the limits of digital health solutions vis-à-vis material needs and structural barriers to health and wellbeing.

Housing and Child Health in South Africa: The Value of Longitudinal Research.

Research investigating the link between housing and health often produces mixed results. It does not always prove that good housing improves health. The results suggest a complex set of factors play a role, and the findings are sometimes contradictory. Two ways of addressing these concerns are longitudinal research, where the relationship between housing and health is measured in the short and medium terms, and a focus on children. We use the children’s housing and health data from the five waves of the National Income and Distribution Survey (NIDS) survey in South Africa, 2008 to 2017. We investigate the effect that continued living in informal housing over the five waves has had on these children’s health. Our results show a statistically significant relationship between prolonged residence in poor housing and poor health outcomes for some health indicators. The results call for a closer understanding of health issues in housing policy in South Africa.

District Governance and Improved Maternal, Neonatal and Child Health in South Africa: Pathways of Change

ABSTRACT District-level initiatives to improve maternal, neonatal and child health (MNCH) generally do not take governance as their primary lens on health system strengthening. This paper is a case study of a district and sub-district governance mechanism, the Monitoring and Response Unit (MRU), which aimed to improve MNCH outcomes in two districts of South Africa. The MRU was introduced as a decision-making and accountability structure, and constituted of a “triangle” of managers, clinicians and information officers. An independent evaluation of the MRU initiative was conducted, three years after establishment, involving interviews with 89 district actors. Interviewees reported extensive changes in the scope, quality and organization of MNCH services, attributing these to the introduction of the MRU and enhanced support from district clinicians. We describe both the formal and informal aspects of the MRU as a governance mechanism, and then consider the pathways through which the MRU plausibly acted as a catalyst for change, using the institutional constructs of credible commitment, coordination and cooperation. In particular, the MRU promoted the formation of non-hierarchical collaborative networks; improved coordination between community, PHC and hospital services; and shaped collective sense-making in positive ways. We conclude that innovations in governance could add significant value to the district health system strengthening for improved MNCH. However, this requires a shift in focus from strengthening the front-line of service delivery, to change at the meso-level of sub-district and district decision-making; and from purely technical, data-driven to more holistic approaches that engage collective mindsets, widen participation in decision-making and nurture political leadership skills.

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future.

Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016 - 2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990 - 2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.

A Dynamic Analysis of Maternal Fertility Choices and Child Health in South Africa

The relationship between household size and future health outcomes for children is of immense interest to economists, demographers and policy-makers especially in developing countries. One reason for this is that child health is a key determinant of future human capital. This is particularly important in South Africa with high levels of unemployment, poverty and gross income inequality. Moreover, the quantity-quality model of fertility indicates a trade-off of children’s welfare with increasing family size. However, despite the forgoing, relatively little empirical research has been done regarding this nexus, especially in developing countries. Furthermore, while the few studies have mainly relied on cross-sectional data, this study takes advantage of the availability of the recent National Income Dynamic Study (NIDS) panel data set to empirically assess this link. We make use of both the Generalized Method of Moments (GMM) and the Control Function (CF) approaches to account for econometric issues such as heterogeneity and endogeneity. These results suggest fertility choices has a significant association with child health. Moreover, younger children are more likely to be affected by increased household size. These results are concordant with theoretical expectations. From a policy perspective, these findings indicate that intensified child support is likely to improve child health outcomes in South Africa, particularly among the black racial group where fertility is comparatively higher. Moreover, family planning programs especially in the rural areas of the country, should be promoted. In addition, the empowerment of women through provision of funding for schooling and skills development could also contribute to better child health outcomes.

Tobacco, nicotine and e-cigarettes: Protecting children in South Africa

A piece of health legislation that is pivotal for the health of children in South Africa (SA) is currently before parliament: the draft Control of Tobacco Products and Electronic Delivery Systems Bill 2018.[1] We outline why further control of tobacco and nicotine is important for the health of children in SA, and why the legislation deserves the strong support of all those who seek to promote the best interests of children in this country.

‘We are the advocates for the babies’ - understanding interactions between patients and health care providers during the prevention of mother-to-child transmission of HIV in South Africa: a qualitative study

ABSTRACTBackground: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved.Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa.Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward.Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child’s health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs.Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.

Thyroid Function in Pregnant Women With Moderate to Severe Alcohol Consumption Is Related to Infant Developmental Outcomes.

Fetal alcohol spectrum disorders (FASD) have an estimated global prevalence of 2-5% of births, but prevalence is reported to be as high as 15.5% for FASD in certain high-risk communities in South Africa. Preclinical studies demonstrate that alcohol consumption during pregnancy interferes with thyroid hormone availability and function and negatively impacts exposed offspring. Very little is currently reported on this phenomenon in humans. This pilot study was embedded in the Drakenstein Child Health Study, a multi-disciplinary longitudinal birth cohort study investigating the early biological and psychosocial determinants of child health in South Africa. Twenty one mothers and their children with moderate-severe prenatal alcohol exposure (PAE) and 19 mothers and their children with no alcohol exposure were investigated. Maternal exposure history and blood samples were collected in mid-pregnancy and analyzed for serum-free thyroxin (FT4), free triiodothyronine (FT3), and thyroid stimulating hormone (TSH). Children were assessed with formally measured growth parameters and development was evaluated using the Bayley III Scales of Infant and Toddler Development (BSID III) at 6 and 24 months of age. While there were no significant differences in serum TSH and FT4 between groups, FT3 levels were significantly higher in mothers with moderate-severe prenatal alcohol use. In abstinent pregnant women, levels of FT4 were significantly correlated with infants' scores on cognitive measures at 6 and 24 months of age and with levels of gross motor skills at 24 months. However, in mothers with alcohol use, FT4 levels were not correlated with any cognitive or motor skills, but FT3 levels were significantly associated with scores on children's social-emotional development at 24 months of age. Thyroid function in PAE is sufficiently disrupted to lead to alterations in serum FT3 levels. The contrast in findings between PAE and abstinent dyads in their association of maternal thyroid function and infant development further suggests that such disruption is present and may contribute to adverse neurodevelopment. Further work is needed to determine the relationship between peripheral thyroid indices during pregnancy and neurodevelopmental outcomes in the context of PAE.

Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa

Background: Age-specific health promotion messages appear in the Road-to-Health-Booklet, an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit. Objective: This investigation, part of a larger Road-to-Health-Booklet survey, assessed the implementation of health promotion messages and identified barriers to its successful implementation. Methods: A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary health care facilities. Information was obtained through questionnaires; direct observation of consultations and recording of health promotion material in facilities. Results: In total, 2442 children (0-36 months; mean age 6.26 ± 6.24 months.); 2481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% completing Grade 12. Healthcare workers had a median of five years (0.5 - 37.0 years) work experience in primary health care. All healthcare workers indicated that health promotion messages are important, however, messages were only conveyed in 51% of consultations observed. If communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers. Various forms of health promotion material were available in facilities. Conclusions: Sub-optimal implementation of the health promotion messages in the Road-to-Health-Booklet are apparent despite healthcare workers realising the importance of health promotion. Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and supported by society to promote child health and care.

Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries

Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries

Safeguarding maternal and child health in South Africa by starting the child support grant before birth: Design lessons from pregnancy support programmes in 27 countries

Background. Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants. Objectives. To review design and operational features of pregnancy support programmes, highlighting features that promote their effectiveness and efficiency, and implications thereof for SA. Methods. Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries. Results. Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support. Conclusions. Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.

Safeguarding maternal and child health in South Africa by starting the Child Support Grant before birth: Design lessons from pregnancy support programmes in 27 countries.

Deprivation during pregnancy and the neonatal period increases maternal morbidity, reduces birth weight and impairs child development, with lifelong consequences. Many poor countries provide grants to mitigate the impact of poverty during pregnancy. South Africa (SA) offers a post-delivery Child Support Grant (CSG), which could encompass support during pregnancy, informed by lessons learnt from similar grants. To review design and operational features of pregnancy support programmes, highlighting features that promote their effectiveness and efficiency, and implications thereof for SA. Systematic review of programmes providing cash or other support during pregnancy in low- and middle-income countries. Thirty-two programmes were identified, across 27 countries. Programmes aimed to influence health service utilisation, but also longer-term health and social outcomes. Half included conditionalities around service utilisation. Multifaceted support, such as cash and vouchers, necessitated complex parallel administrative procedures. Five included design features to diminish perverse incentives. These and other complex features were often abandoned over time. Operational barriers and administrative costs were lowest in programmes with simplified procedures and that were integrated within child support. Pregnancy support in SA would be feasible and effective if integrated within existing social support programmes and operationally simple. This requires uncomplicated enrolment procedures (e.g. an antenatal card), cash-only support, and few or no conditionalities. To overcome political barriers to implementation, the design might initially need to include features that discourage pregnancy incentives. Support could incentivise service utilisation, without difficult-to-measure conditionalities. Beginning the CSG in pregnancy would be operationally simple and could substantially transform maternal and child health.

The 5th South African Child Health Priorities Conference

The 4th South African (SA) Child Health Priorities Conference was convened by the SA Child Health Priorities Association at Wits Medical School in Johannesburg on 31 October - 2 November 2013. Its aim was to review progress in child health in South Africa, reflect on recent achievements, and set priorities for the forthcoming year.

Quo vadis child health in South Africa?

The World Health Organization's definition of health as a state of physical, mental and social well-being implies for children the opportunity to grow and develop to a state of optimal functioning in adulthood. It is clear that this is not possible under circumstances of poverty, deprivation of access to resources of food, housing and education, existential insecurity, natural disasters and human conflict.

Can a new paediatric subspecialty improve child health in South Africa?

Can a new paediatric subspecialty improve child health in South Africa?

Can a new paediatric sub-specialty improve child health in South Africa?

Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the health care needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary health care will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary health care.

Early intervention in child health in South Africa : editorial

The World Health Organization's definition of health as a state of physical, mental and social well-being implies for each person the ability and opportunity to function optimally within their individual context. By international consensus, children have a right to be helped to achieve such optimal functioning.