South African Journal of Child Health – December 2022 - Vol 16 no 4

Introduction

Sociodemographic factors associated with mixed-feeding practices among a cohort of mothers with infants aged 4 - 14 weeks in Tlokwe subdistrict, North West Province, South Africa

The evidence documented in the 2016 Lancet series on breastfeeding (BF) has without a doubt proven that it is very beneficial, contributing to a smarter, healthier and more thriving future for the world. BF has short- and long-term benefits, including reduced morbidity caused by infectious and respiratory diseases in childhood, and a diminished risk of childhood obesity and diabetes. In spite of these well-established advantages, global exclusive BF (EBF) rates remain far below target.

Food provision in early childhood development centres in Harare, Zimbabwe

Optimal nutritional status is achieved when there is access to affordable, diverse and nutritious food, appropriate care practices, and good hygiene. Poor dietary intake leads to malnutrition, a health problem that severely affects vulnerable groups such as infants and children. Globally, nearly half of all deaths in children under-5 are attributable to malnutrition. Africa is the second-most-affected country after Asia, and malnutrition statistics in sub-Saharan Africa showed a pooled prevalence of 39% stunting, 27% wasting and 25% overweight. Factors contributing to malnutrition in Zimbabwe include insufficient dietary knowledge among mothers and ECD caregivers; incoherent nutrition interventions; and limited execution of appropriate hygiene and sanitation practices.

Children and adolescents with diabetes at Tygerberg Hospital – at risk of cardiovascular complications?

Studies have reported that there has been an increase of 2 - 5% in the annual incidence of type 1 diabetes (T1D) worldwide. In the Western Cape Province of South Africa (SA), the incidence of T1D is unknown, but is likely to be 5 new cases per 100 000. The worldwide incidence of type 2 diabetes (T2D) in children and adolescents ranges from 1 to 51 per 1 000. There is no estimate for SA, but its prevalence is likely to be on the increase

Exchange blood transfusion for hyperbilirubinaemia: Neonatal characteristics and short-term outcomes

Neonatal jaundice due to unconjugated hyperbilirubinaemia remains one of the common clinical conditions that clinicians working with neonates encounter on a daily basis. It is the leading cause of hospital readmissions during the neonatal period. Hyperbilirubinaemia at levels requiring exchange blood transfusion (EBT), which is often called severe hyperbilirubinaemia (SHB), is associated with serious morbidity and mortality if left untreated or if treatment is delayed. Unconjugated hyperbilirubinaemia is known to be a neurotoxin that can lead to significant neuronal damage. Clinically it can present acutely with signs of acute bilirubin encephalopathy (ABE) characterised by lethargy, abnormal tone, poor feeding, a high-pitched cry, seizures, opisthotonus and apnoea, with a mortality risk of 7 - 10%.

Coverage of vitamin A supplementation, deworming and immunisations: Associations with nutritional status among urban children younger than 5 years in Nelson Mandela Bay, Eastern Cape Province, South Africa

Sub-Saharan Africa accounts for one-third of all undernourished children globally, with ~39% stunted, 10% wasted and 25%  underweight children <5 years of age. Despite a decline in the global prevalence of stunting, the absolute number of stunted children in the African region has increased from 46.3 million in 1990 to 57.4 million in 2020 Conventional approaches to understanding the causes of childhood malnutrition have focused on infant- and young child-feeding practices and food security, with stunting perceived to be a result of  chronic undernutrition. Raiten and Bremer have challenged this  conventional approach, and recently more attention has been paid  to wider contextual factors that result in childhood malnutrition,  including intrauterine growth restriction, poor nutritional status among pregnant and breastfeeding women and factors related to women’s empowerment, including education and access to resources. Furthermore, there is increasing interest in environmental enteric dysfunction in the aetiology of stunting. Environmental enteric dysfunction refers to a subclinical state of intestinal inflammation, which results in poor nutrient absorption. Budge et al. suggest that poor sanitation and stunting may be causally linked via environmental enteric dysfunction. Vitamin A deficiency results in poor epithelial cell differentiation, which has an impact on gut mucosal integrity and nutrient absorption. Vitamin A deficiency and rotavirus infection are among the leading causes of diarrhoea in children. Soil-transmitted helminth infestation, which may cause anaemia, diarrhoea and reduced appetite, can negatively affect the nutritional intake, growth and development of children, even in urban areas.

Association between physical fitness and anthropometric, cardiovascular and socioeconomic risk factors in primary schoolchildren in KwaZulu Natal Province, South Africa

Physical fitness (PF) levels in children have been shown to indicate their cardiometabolic health profile and their way of life. Moreover, PF has been identified as a predictor of chronic disease risk factors such as obesity, cardiovascular disease, skeletal issues and mental health. Poor PF levels in childhood have been linked with various non-communicable diseases (NCDs) and an increased risk of premature death in adulthood. Since PF includes elements that allow us to perform physical activities and activities of daily living, desired levels have been associated with reduction in disease risk and a better quality of life.

Magnetic resonance imaging findings and the clinical characteristics of children with cerebral palsy at a public sector hospital in Gauteng Province, South Africa

Cerebral palsy (CP) is one of the most common causes of significant physical impairment in children worldwide, with an estimated prevalence of 2 - 10 per 1 000 live births in Africa. To date, CP remains a clinical diagnosis. Although neuro-imaging is not a prerequisite for the diagnosis of CP, it assists in determining the onset of the brain insult and possible aetiology. Both the American Academy of Neurology (AAN) and the 2017 NICE guidelines recommend that neuro-imaging should be done if the aetiology of CP is unknown. Magnetic resonance imaging (MRI) is the preferred diagnostic modality. MRI at term gestation has also proven to be useful in predicting CP in high-risk patients such as premature infants, with a sensitivity range of 86 - 100% and specificity range of 87 - 97%.

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Meconium aspiration syndrome (MAS) is characterised by early onset of respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAF) with poor lung compliance and clinical hypoxaemia presenting radiographically as patchy opacification and hyperinflation. Few studies from Africa have investigated MAS, with most seeming to focus on risk factors for mortality and maternal factors associated with MSAF.  This is the first study from Africa looking at predictors of risk factors associated with disease severity of MAS. A complete understanding of the epidemiology of MAS has been hampered by the lack of population-based studies and the lack of large numbers of neonates with confirmed disease. The incidence of MAS varies from country to country, based on available resources. Incidence has decreased over the years owing to better fetal monitoring of term and post-term babies and dealing with a neonate born through MSAF.