Category: Paediatrics

Health and Economic Benefits of Breastfeeding Quantified

Among half a million Scottish infants, those exclusively breastfed were less likely to use healthcare services and incurred lower costs to the healthcare system

Photo by Wendy Wei

Breastmilk can promote equitable child health and save healthcare costs by reducing childhood illnesses and healthcare utilisation in the early years, according to a new study published this week in the open-access journal PLOS ONE by Tomi Ajetunmobi of the Glasgow Centre for Population Health, Scotland, and colleagues.

Breastfeeding has previously been found to promote development and prevent disease among infants. In Scotland – as well as other developed countries – low rates of breastfeeding in more economically deprived areas are thought to contribute to inequalities in early childhood health. However, government policies to promote child health have made little progress and more evidence on the effectiveness of interventions may be needed.

In the new study, researchers used administrative datasets on 502,948 babies born in Scotland between 1997 and 2009. Data were available on whether or not infants were breastfed during the first 6-8 weeks, the occurrence of ten common childhood conditions from birth to 27 months, and the details of hospital admissions, primary care consultations and prescriptions.

Among all infants included in the study, 27% were exclusively breastfed, 9% mixed fed and 64% formula fed during the first 6-8 weeks of life. The rates of exclusively breastfed infants ranged from 45% in the least deprived areas to 13% in the most deprived areas.

The researchers found that, within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed any formula milk. On average, breastfed infants had lower average costs of hospital care per admission (£42) compared to formula-fed infants (£79) in the first six months of life and fewer GP consultations (1.72, 95% CI: 1.66 – 1.79) than formula-fed infants (1.92 95% CI: 1.88 – 1.94). At least £10 million of healthcare costs could have been avoided if all formula-fed infants had instead been exclusively breastfed for the first 6-8 weeks of life, the researchers calculated.

The authors conclude that breastfeeding has a significant health and economic benefit and that increasing breastfeeding rates in the most deprived areas could contribute to the narrowing of inequalities in the early years.

Provided by PLOS

THC Lingers in Breastmilk with no Clear Peak or Decline

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The psychoactive component THC of cannabis showed up in breastmilk in a study published in the journal Breastfeeding Medicine. Unlike alcohol, when THC was detected in milk there was no consistent time when its concentration peaked and started to decline.

Importantly, the researchers discovered that the amount of THC they detected in milk was low – they estimated that infants received an average of 0.07mg of THC per day. For comparison, a common low-dose edible contains 2mg of THC. The research team stressed that it is unknown whether this amount has any impact on the infant.

“Breastfeeding parents need to be aware that if they use cannabis, their infants are likely consuming cannabinoids via the milk they produce, and we do not know whether this has any effect on the developing infant,” said Courtney Meehan, a WSU biological anthropologist who led the project and is the study’s corresponding author.

Since other research has shown that cannabis is one of the most widely used drugs during breastfeeding, the researchers aimed to uncover how long cannabinoids, like THC, persisted in breastmilk.

For this Washington State University-led study, the researchers analysed milk donated by 20 breastfeeding mothers who used cannabis. The participants, who all had infants younger than six months, provided detailed reports on their cannabis use. They collected milk after abstaining from using cannabis for at least 12 hours and then at regular intervals after use. All of this was done in their own homes, at a time of their choosing and with cannabis they purchased themselves.

The researchers then analyzed the milk for cannabinoids. They found that the milk produced by these women always had detectable amounts of THC, even when the mothers had abstained for 12 hours.

“Human milk has compounds called lipids, and cannabinoids are lipophilic, meaning they dissolve in those lipids. This may mean that cannabinoids like THC tend to accumulate in milk – and potentially in infants who drink it,” said Meehan.

The research also revealed that people had different peak THC concentrations in their milk. For participants who used cannabis only one time during the study, cannabinoids peaked approximately 30 minutes to 2.5 hours after use and then started to decline. For participants who used multiple times during the study, the majority showed a continual increase in concentrations across the day.

“There was such a range. If you’re trying to avoid breastfeeding when the concentration of THC peaks, you’re not going to know when THC is at its peak in the milk,” said lead author Elizabeth Holdsworth, who worked on this study while a WSU post-doctoral researcher and is now on the faculty of The Ohio State University.

A related qualitative study by the research team revealed that many breastfeeding moms are using cannabis for therapeutic purposes: for the management of anxiety, other mental health issues or chronic pain. The mothers often chose cannabis over using other medications because they felt it was safer.

“Our results suggest that mothers who use cannabis are being thoughtful in their decisions,” said co-author Shelley McGuire, a University of Idaho professor who studies maternal-infant nutrition. “These women were mindful about their choices. This is far from a random lifestyle choice.”

While in most cases, the women were using cannabis as alternative treatment for a variety of conditions, McGuire pointed out that there is no evidence yet whether it is safer or more harmful. In fact, scientists know almost nothing about how many commonly used drugs may impact breastfeeding babies, partly because women, especially those who are breastfeeding, have historically been left out of clinical trials on medicines.

“This is an area that needs substantial, rigorous research for moms to know what’s best,” McGuire said.

Some research has been done regarding alcohol with guidelines for new mothers to wait at least two hours after consuming alcohol before breastfeeding. Nothing similar has been developed for cannabis, which has been growing in popularity.

The collaborative research team is currently working to address some of that knowledge gap with further research on cannabis use in breastfeeding moms, holistic composition of the milk they produce and its effects on infant development.

Source: Washington State University

Refurbished School for Paediatric Patients Bridges Critical Learning Gaps

Photo by Mary Taylor on Pexels

April 16 2024 – The Chris Hani Baragwanath Hospital School officially opened in its new location today, marking a key milestone in the partnership between Wits University and the academic hospital. The school caters for all learners in need of longer-term and chronic treatment for various paediatric conditions. Learners between Grades R and 12 are taught.  

“Sick children have multiple needs, and it’s our duty to ensure that they don’t miss out on any schooling. Everyone deserves the right to be educated and to contribute meaningfully to their communities as adults,” said Professor Shabir Madhi, Dean of the Wits Faculty of Health Sciences. 

Professor Madhi noted that the previous school building will be used as a campus for medical students and to grow the university’s teaching and learning footprint at Chris Hani Baragwanath Academic Hospital.  

The school district representative for Johannesburg Central, Ronica Ramdath, said that often sick children forfeit their education, which can be mitigated through the correct teaching approach and through supportive facilities. “When I first came to the school some years back, I was amazed at the teachers’ dedication. I remember seeing a teacher load all their educational resources in a bag and walk to the paediatric ward to teach sick children. Today, these children all benefit from such support,” she said.  

The Wits Faculty of Health Sciences heads of schools were present, together with hospital and teaching representatives.  

Meanwhile, Professor Madhi said that the university’s wifi is available at Chris Hani Baragwanath Hospital, underpinning Wits’ commitment to invest in a world-class academic hospital facility. “We are very proud of our footprint at the hospital and hope to continue to add value through research and clinical work,” he said. 

Source: University of the Witwatersrand – Faculty of Health Sciences

Bacteria Behind Meningitis in Babies Explains Resurgence

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A milestone study led by University of Queensland researchers has identified the main types of E. coli bacteria that cause neonatal meningitis, and revealed why some infections recur despite being treated with antibiotics.

The study, published in eLife, discovered that about 50% of neonatal meningitis infections are caused by two types of E. coli.

E. coli is the most common cause of meningitis in babies born pre-term, but knowing which types allows us to test for those strains and treat them appropriately,” said Professor Mark Schembri, who led the study along with Dr Nhu Nguyen and Associate Professor Adam Irwin.

The study was the largest of its type, examining the genomes of 58 different E. coli bacteria across four continents and using samples collected over 46 years. It found that two types of the bacteria were responsible for the majority of neonatal infections.

Rapid diagnosis and monitoring are key

Associate Professor Irwin, who is also a paediatric infectious disease specialist at the Queensland Children’s Hospital, said speed is of the essence to prevent lasting damage.

“While antibiotics can be effective in treating the infection, this relies on rapid diagnosis. Also, antibiotics don’t always eliminate the bacteria – some of the babies we tracked showed signs of a complete recovery before suffering repeated invasive E. coli infections,” he said.

The researchers discovered the bacteria causing subsequent infections were the same as in the initial infection.

“It’s most likely that bacteria hide out in the intestinal microbiome,” Professor Schembri said. “This tells us we need to keep monitoring these babies after their first infection, as they are at a high risk of subsequent infection.”

Professor Schembri said the E. coli that can lead to meningitis also cause urinary tract infections and colonise the intestinal tract. “There is something about these types of E. coli that equips them to cause both infections,” he said.

“Our next step is to examine the bacteria’s pathway from the intestinal tract or urinary tract into the bloodstream, and then to the brain, so we can consider new ways to stop them.”

Source: University of Queensland

Specific Nasal Cells Protect against COVID in Children

Legend of spirals: This image highlights the appearance of nasal cultures from older adults, revealing distinct spiral-like patterns that were absent in cultures grown from children. Credit: University College London

Important differences in how the nasal cells of young and elderly people respond to the SARS-CoV-2 virus, could explain why children typically experience milder COVID symptoms, finds a new study led by researchers at UCL and the Wellcome Sanger Institute.

The study, published in Nature Microbiology, focused on the early effects of SARS-CoV-2 infection on the cells first targeted by the viruses, the human nasal epithelial cells (NECs).

These cells were donated from healthy participants, including children (0–11 years), adults (30–50 years) and, for the first time, the elderly (over 70 years).

The cells were then cultured to regrow into the different types of nasal cells. Using single-cell RNA sequencing techniques that enable scientists to identify the unique genetic networks and functions of thousands of individual cells, the team identified 24 distinct epithelial cell types. Cultures from each age group were then either mock-infected or infected with SARS-CoV-2.

After three days, the NECs of children responded quickly to SARS-CoV-2 by increasing interferon (the first line of anti-viral defence), restricting viral replication. However, this early anti-viral effect became less pronounced with age.

The researchers also found that NECs from elderly individuals not only produced more infectious virus particles, but also experienced increased cell shedding and damage.

The strong antiviral response in the NECs of children could explain why younger people typically experience milder symptoms. In contrast, the increased damage and higher viral replication found in NECs from elderly individuals could be linked to the greater severity of disease observed in older adults.

Project lead, Dr Claire Smith (Associate Professor at UCL Great Ormond Street Institute of Child Health), said: “Our research reveals how the type of cells we have in our nose changes with age, and how this affects our ability to combat SARS-CoV-2 infection. This could be crucial in developing effective anti-viral treatments tailored to different age groups, especially for the elderly who are at higher risk of severe COVID-19.”

Co-Senior author, Dr Kerstin Meyer (Wellcome Sanger Institute), said: “By carrying out SARS-CoV-2 infections of epithelial cells in vitro and studying the responses with single cell sequencing, we get a much more detailed understanding of the viral infection kinetics and see big differences in the innate immune response between cell types.”

Children infected with SARS-CoV-2 rarely progress to respiratory failure, but the risk of mortality in infected people over the age of 85 remains high, despite vaccination and improving treatment options.

The research underscores the importance of considering age as a critical factor in both research and treatment of infectious diseases.

Co-senior author, Dr Marko Nikolic (UCL Division of Medicine), said: “It is fascinating that when we take away immune cells from nasal samples, and are only left with nasal epithelial cells grown in a dish, we are still able to identify age-specific differences in our body’s response to the SARS-CoV-2 between the young and elderly to explain why children are generally protected from severe COVID-19.”

Dr Smith added: “Understanding the cellular differences at the initiation of infection is just the beginning. We now hope to investigate the long-term implications of these cellular changes and test therapeutic interventions using our unique cell culture model. This ‘gold-standard’ system is only possible with the support of our funders and the willingness of participants to provide their samples.”

The team suggest that future research should consider how ageing impacts the body’s response to other viral infections.

Source: University College London

Giving Fizzy Drinks to Toddlers Increases Adult Obesity Risk

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Consuming sugar-sweetened drinks in the first few years of childhood can be linked to poor diet patterns that increase the risk of obesity in later life, according to a new study by the School of Psychology at Swansea University.

Published in the European Journal of Clinical Nutrition, the study tracked the influence of diet on 14 000 British children from birth to adulthood and is believed to be the longest of its kind ever reported.

Using the Avon Longitudinal Study of Parents and Children, the research team found:

  • Children who drank fizzy drinks such as cola or sugar-sweetened fruit cordials before the age of two gained more weight when they were 24 years old. Girls who had pure fruit juice gained less weight, while the weight of boys remained the same.
  • At three years of age, toddlers who drank cola consumed more calories, fat, protein, and sugar but less fibre. In contrast, those given pure apple juice consumed less fat and sugar but higher amounts of fibre.

The study also highlighted corresponding differences in food choices.

Children who consumed pure apple juice often followed a diet with more fish, fruit, green vegetables, and salad, whereas those drinking cola ate more burgers, sausages, pizza, french fries, meat, chocolate, and sweets.

Additionally, the team discovered a link between sugar-sweetened drinks and social deprivation, with children from affluent backgrounds more likely to have access to pure fruit juice.

Lead researcher Professor David Benton said: “The early diet establishes a food pattern that influences, throughout life, whether weight increases. The important challenge is to ensure that a child develops a good dietary habit: one that offers less fat and sugar, although pure fruit juice, one of your five a day, adds vitamin C, potassium, folate, and plant polyphenols.”

Dr Hayley Young added: “Obesity is a serious health concern, one that increases the risk of many other conditions. Our study shows that the dietary causes of adult obesity begin in early childhood and that if we are to control it, more attention needs to be given to our diet in the first years of life.”

Source: Swansea University

Landmark Study Supports Use of Cystic Fibrosis Drug in Infants from Four Weeks of Age

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A cystic fibrosis drug targeting the basic defect that causes the condition has been shown to be safe and effective in newborns aged four weeks and above, new research involving RCSI University of Medicine and Health Sciences and Children’s Health Ireland has found.

The finding is described as a “huge moment” for cystic fibrosis by one of the lead researchers. The study included the first baby in the world with cystic fibrosis to be diagnosed from birth and enrolled directly onto a trial of this sort.

The drug, ivacaftor (Kalydeko), is the first drug designed to treat the basic defect in cystic fibrosis. It was originally approved for adults, then sequentially over several years for older and younger children. Currently, it is approved for babies aged four months and older, however, this new research suggests that it is safe and effective for babies as young as four weeks of age.

Cystic fibrosis experts predict that the earlier treatments can begin, the more likely that progression of the condition can be slowed down or halted in children, and this is the focus of several international research studies led by RCSI and Children’s Health Ireland. The findings of this study could pave the way for eligible newborns to start treatment on the medicine at the time of diagnosis (typically at newborn screening) rather than having to wait until they are four months old.

“This is a huge moment in cystic fibrosis,” said Paul McNally, Associate Professor of Paediatrics at RCSI and Consultant in Respiratory Medicine at CHI. McNally is one of the authors of the new study which was published in the Journal of Cystic Fibrosis.

“Over the years ivacaftor, or Kalydeko, has been put through clinical trials in younger and younger children. Now, through this study, it has been shown to be safe and effective all the way down to four weeks of age,” he said.

“This is an important development because almost all children are diagnosed through newborn screening at around this time. The availability of a treatment that targets the underlying cause of the disease in newborns and can be started immediately at diagnosis will provide a huge sense of reassurance and hope for families.”

Cystic fibrosis is an inherited disease that mainly affects the lungs and digestive system. Ireland has the highest incidence of the condition in the world: approximately 1400 children and adults in Ireland live with the condition and more than 30 new cases of cystic fibrosis are diagnosed here each year, typically around four weeks of age through the newborn screening programme.

In recent years, new medicines have emerged that target the basic defect that causes cystic fibrosis. Ivacaftor (Kalydeko) is one such treatment. It targets a genetic change seen in around 4% of people with cystic fibrosis worldwide, and around 10% in Ireland.

Siblings Kara (aged 5) and Isaac Moss (aged 2) both participated in the study through Children’s Health Ireland. Kara was part of an earlier phase of the study that paved the approval of the drug in older infants and led to the latest trial that Isaac took part in.

Isaac was the first baby with cystic fibrosis in the world to be diagnosed from birth and enrolled directly onto a trial of these ground-breaking treatments.

“Both Kara and Isaac are doing really well and remarkably are not experiencing any of the typical symptoms of cystic fibrosis at the moment,” said their mother Debbie.

“Research studies like this one are so important to ensuring that children get access to the right treatments as early as possible. With the right medications, they can enjoy a healthy childhood and look forward to a brighter future”

Ivacaftor is manufactured by pharmaceutical company Vertex Pharmaceuticals, who are currently applying to the European Medicines Agency for an extension to the marketing authorization for Ivacaftor down to one month of age.

The study involved researchers from RCSI, Children’s Health Ireland, the U.S. and the UK.

Source: RCSI

Obese and Overweight Children at Risk of Iron Deficiency

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Children and young people who are overweight or obese are at significantly higher risk of iron deficiency, according to a study by nutritional scientists at the University of Leeds.

Researchers from the School of Food Science and Nutrition examined thousands of medical studies from 44 countries involving people under the age of 25 where levels of iron and other vitamins and minerals had been recorded alongside weight. They found that iron deficiency was associated with both underweight and overweight children and adolescents.

By contrast, zinc and vitamin A deficiencies were only observed in children who were undernourished, leading researchers to conclude that iron deficiency in overweight children is probably due to inflammation disrupting the mechanisms that regulate iron absorption.

The results of the research appear in the journal BMJ Global Health.

Iron deficiency in children has a negative effect on brain function, including attention, concentration and memory, and can increase the risk of conditions, such as autism and ADHD.

It is already recognised as a problem in adults living with obesity, but this research is the first to look at the association in children.

Lead author Xiaomian Tan, a Doctoral Researcher in the University of Leeds’ School of Food Science and Nutrition said: “The relationship between undernutrition and critical micronutrients for childhood growth and development is well established, but less is known about the risk of deficiencies in iron, vitamin A and zinc in children and adolescents who are overweight or obese, making this a hidden form of malnutrition.

“Our research is hugely important given the high prevalence of obesity in children. We hope it will lead to increased recognition of the problem by healthcare practitioners and improvements in clinical practice and care.”

Hidden hunger

Historically the problem has been linked to malnutrition and is a particular concern for lower- and middle-income countries where hunger may be the leading cause of mortality for young children.

Increasingly though it is being recognised that vitamin and mineral deficiencies can also occur in people who are overweight and obese and who have a nutrient-poor but energy-dense diet, something which has been described as ‘hidden hunger’.

In high-income countries it is associated with ultra-processed foods that are high in fat, sugar, salt, and energy but in lower- and middle-income countries obesity is often associated with poverty and monotonous diets with limited choices of staples such as corn, wheat, rice, and potatoes.

Many developing countries are now facing a double burden of malnutrition alongside overnutrition due to the rapid increase in the global prevalence of obesity in recent decades, especially in children aged between five and 19.

Undernutrition versus overnutrition

The research also highlights differences in focus between higher income countries and developing nations, with most studies in Africa and Asia focusing on undernutrition and those from North America and Europe focusing entirely on overnutrition.

The researchers say this is particularly concerning as both Africa and Asia are experiencing the highest double burden of malnutrition due to economic growth and the transition to a western-style high-sugar, high-fat diet.

Between the years 2000 and 2017, the number of overweight children under the age of five in Africa increased from 6.6 to 9.7 million, and in Asia that figure rose from 13.9 to 17.5 million. At the same time, there was an increase in the number of stunted children under 5, from 50.6 to 58.7 million in Africa.

Research supervisor Bernadette Moore, Professor of Nutritional Sciences in Leeds’ School of Food Science and Nutrition, said: “These stark figures underscore the fact that the investigation of micronutrient deficiencies in relation to the double burden of malnutrition remains critically important for child health.

“By the age of 11 here in the UK, one in three children are living with overweight or obesity, and our data suggests that even in overweight children inflammation leading to iron deficiency can be an issue.

“Iron status may be the canary in the coalmine, but the real issue is that prolonged inflammation leads to heart disease, diabetes and fatty liver.”

Increasing physical activity and improving diet have been shown to reduce inflammation and improve iron status in children and the researchers are now calling for further studies into the effectiveness of these interventions.

They also believe that more research is needed into micronutrient deficiencies and the double burden of malnutrition and overnutrition in countries where there are currently gaps in data.

Source: University of Leeds

Focus on Children, Urges President of SA Society of Psychiatrists

Dr Anusha Lachman is the first child psychiatrist to hold the position as president of the SA Society of Psychiatrists. Photo supplied to Spotlight

By Sue Segar for Spotlight

There are serious gaps in psychiatry regarding treatment, prevention and care for children and adolescents in South Africa. Offering solutions, Dr Anusha Lachman tells Spotlight psychiatric services should be offered in ways that are Afro-centric and culturally sensitive.

“There’s a mental health crisis in South Africa and yet, today, there are fewer than 40 registered child psychiatrists in the country,” Dr Anusha Lachman tells Spotlight.

She is the first child psychiatrist to hold the position as president of the SA Society of Psychiatrists (SASOP) and she hopes to prioritise the “grossly under-represented and under-resourced” field of child and adolescent health in the country. While the field is certainly neglected, Lachman is not alone in trying to draw more attention to it – the 2020/2021 edition of the Children’s Institute’s excellent Child Gauge also concentrated on the mental health of children in South Africa.

Lack of data

One of the biggest issues in child and adolescent psychiatry, Lachman laments, is the lack of reliable data. She explains that most of the current research, literature and thinking about infant mental health is focused on Western, high-income settings but her focus is on the African context and in limited-resource settings. “We don’t have many figures on how many young people are suffering from the various mental health disorders,” she says.

While it is a struggle to get concrete, reliable statistics, Lachman adds there are some data to work with but South Africa lacks a collective data base that ties it all together.

Insight into the country’s mental health crisis, she says, is partly gauged from the number of referrals to primary health care centres for mental health support and evidenced by the long waiting lists for children to be assessed at specialist mental health clinics and at hospitals. “All we have, across our public hospitals, is the waiting list data which only tell us the duration that children with severe mental illness wait to get into secondary and tertiary level hospitals to access hospital-based care,” she says. The problem is that this type of data tells us little about the vast majority of adolescents with mental health issues who do not require hospitalisation.

Lachman is also head of the Clinical Unit Child Psychiatry at Tygerberg Hospital. The unit is the Western Cape’s only tertiary hospital based assessment unit for adolescents aged from 13 to 18 years with complex psychiatric presentations and severe mental illness. The young people they help often face not only mental health issues, but the full range of psychosocial challenges – from poverty to exposure to violence, substance abuse, and HIV.

“We know, for example,” she says, “what substance-use disorder looks like in children under twelve, and in young people under 21 because we get that from substance-use centres and rehabilitation centres. We know what proportion of children have HIV and TB and some infectious diseases, which by extension have psychosocial consequences and comorbidities, and we know about neurodevelopmental delays because we track things like school attendance and requests for access to support in special needs.

“We do have statistics on issues which affect children in South Africa disproportionately,” she says, “on food insecurity, intimate partner violence, instability in terms of accommodation etc. There are huge occurrences of abuse but there are inadequate services for children to be removed from those abusive homes, because we don’t have sufficient children’s homes or safety placements for example. So these are children who are disproportionally disadvantaged and that in itself is hard to quantify – and the psychosocial support structures are just not there.”

Lachman says the Western Cape department of Health and Wellness is making inroads into the lack of data by tracking and digitising child mental health statistics, through its Child and Adolescent Mental Health Strengthening Project. “This will give us some important data across emergency rooms throughout the Western Cape. Hopefully that can roll out to the rest of the country so that we can understand what children are presenting with.”

Hard to categorise

Asked which mental illnesses South African children and adolescents mainly suffer from, Lachman says child mental health is a function of multiple psycho-social stressors, structural problems, and fundamental relational challenges  –  and that’s hard to categorise.

“It’s a complex relationship between environmental stressors and vulnerabilities to mental illnesses.” She explains that environments that are high risk – with violence, poverty, untreated mental illness in caregivers, food insecurity and economic burdens – predispose children to mental illness expressed commonly in mood disorders, anxiety and trauma responses. “These take the form of poor functioning at school, learning challenges, suicide and self-harming attempts, drug-seeking behaviours and, in some instances, expressions of severe mental illnesses. ADHD is also commonly seen in this context.”

Lack of relevant research

Lachman bemoans what she calls the “distaste” for research that originates from the global South. “The biggest problem we face is the inability to publish and compete in international journals, not because our research is inadequate but because there’s a distrust of information originating from the lower-middle income countries or the global South.”

In terms of publication bias, she says the huge issue is that editorial boards and funders of journals consist largely of privileged white men.

“They don’t represent people of colour and ethnic majorities outside of the industrialised northern hemisphere countries. When we aren’t able to publish, we aren’t able to get the data out there, and when you don’t get the data out, there’s a vacuum of information and evidence-based treatment – and interventions are often  coloured by information that doesn’t represent the lower-income communities and population groups.”

Lachman says research published a few years ago, by Stellenbosch University academic Mark Tomlinson, showed that less than three percent of all articles published in peer reviewed literature include data from low- and middle-income countries, where 90 percent of children live.

Low number of child psychiatrists

Turning to the shockingly low number of registered child psychiatrists in the country, Lachman notes that in the last three years, South Africa has lost five child psychiatrists to New Zealand. “This is about the brain drain, where there is targeted recruitment of qualified people [by] first-world or industrialised regions who can offer incentivised work opportunities which we, in South Africa, cannot compete with.”

She adds: “One child psychiatrist is trained only every two years. And only from a university that can train them. There are only four universities that can  do that here – Stellenbosch, Wits, UCT and Pretoria. It depends after two years if the student passes the exam or not so that is why there are so few.” (Prior to training in child psychiatry candidates first have to complete the normal training to become a medical doctor.)

“So far there were two that qualified 2022 and one that qualified in 2023. And at the beginning of 2023, we had lost five child psychiatrists to New Zealand and Australia. It’s dire,” she emphasises. People remain registered with the Health Professions Council of South Africa (HPCSA) but that doesn’t mean they are physically in the country, Lachman adds. “Recent stats show that we have under 40 [child] psychiatrists in working environments, including those who have retired.

“We still sit with provinces that have zero representation for child psychiatry. We recently deployed one to the Eastern Cape, but, currently North West, Limpopo, Mpumalanga, don’t have any qualified [child] psychiatrists.”

‘Everybody’s business’

Yet, Lachman does not believe the only answer is to train more child psychiatrists. “The answer is more nuanced. It’s about upskilling and task shifting, and an openness to the idea that child and adolescent psychiatry is everybody’s business.”

“If you’re an adult psychiatrist, a physician a paediatrician, or a nurse, or even somebody treating adults, it’s your job to be aware of mental health problems in children,” Lachman adds. “I feel strongly about changing the narrative and moving away from the idea that it’s a specialist realm, because mental health is everybody’s business and child mental health should be pervasive in terms of focus, across various sectors.”

She also feels strongly that psychiatric services should be offered in ways that are Afro-centric and culturally sensitive. Such an “Afro-centric approach”, she says, “must include a diverse spectrum of input – so not just the mental health care providers who punt a specific model of medication and therapy – but partnerships with the educators, community workers, caregivers and allied health professionals to be able to effectively attempt to support and re-think models that can work in our setting.”

She suggests exploring opportunities for children to be screened early, recognised, and offered treatment. For instance, Lachman says, nurses at Well Baby clinics – where babies get immunised – can be trained in child mental health. “Whilst checking the child’s growth and immunisations, they could also look at whether the child is making eye contact, or engaging in reciprocal contact. If this is not happening, they need to know what further questions to ask and what to do next.”

Similarly, mental health awareness and screening should be in schools. Why do we offer sexual education, but not address mental health issues, she asks. “Just as we have so easily incorporated into school curriculums how people can get condoms, we need to ask them how they’re feeling, whether they feel isolated, want to harm themselves or want to die.”

Republished from Spotlight under a Creative Commons licence.

Source: Spotlight

Autism and ADHD are Linked to Gut Flora Disturbance in First Year of Life

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Disturbed gut flora during the first years of life is associated with diagnoses such as autism and ADHD later in life. One explanation for this disturbance could be from antibiotic treatment. This is according to a study led by researchers at the University of Florida and Linköping University and published in the journal Cell.

The study is the first prospective study to examine gut flora composition and a large variety of other factors in infants, in relation to the development of the children’s nervous system. The researchers have found many biological markers that seem to be associated with future neurological development disorders, such as autism spectrum disorder, ADHD, communication disorder and intellectual disability.

“The remarkable aspect of the work is that these biomarkers are found at birth in cord blood or in the child’s stool at one year of age over a decade prior to the diagnosis,” says Eric W Triplett, professor at the Department of Microbiology and Cell Science at the University of Florida, USA, one of the study leaders.

Antibiotic treatment could be involved

The study is part of the ABIS (All Babies in Southeast Sweden) study led by Johnny Ludvigsson at Linköping University. More than 16 000 children born in 1997–1999, representing the general population, have been followed from birth into their twenties. Of these, 1197 children (7.3%), have been diagnosed with autism spectrum disorder, ADHD, communication disorder or intellectual disability. Many lifestyle and environmental factors have been identified through surveys conducted on several occasions during the children’s upbringing. For some of the children, the researchers have analysed substances in umbilical cord blood and bacteria in their stool at the age of one.

“We can see in the study that there are clear differences in the intestinal flora already during the first year of life between those who develop autism or ADHD and those who don’t. We’ve found associations with some factors that affect gut bacteria, such as antibiotic treatment during the child’s first year, which is linked to an increased risk of these diseases,” says Johnny Ludvigsson, senior professor at the Department of Biomedical and Clinical Sciences at Linköping University, who led the study together with Eric W. Triplett.

Children who had repeated ear infections before one year of age had a higher risk of a developmental neurological disorder diagnosis later in life. It is probably not the infection itself that is the culprit, but the researchers suspect a link to antibiotic treatment. They found that the presence of Citrobacter bacteria or the absence of Coprococcus bacteria increased the risk of future diagnosis. One possible explanation may be that antibiotic treatment has disturbed the composition of the gut flora in a way that contributes to neurodevelopmental disorders. The risk of antibiotic treatment damaging the gut flora and increasing the risk of diseases linked to the immune system, such as type 1 diabetes and childhood rheumatism, has been shown in previous studies.

Coprococcus and Akkermansia muciniphila have potential protective effects. These bacteria were correlated with important substances in the stool, such as vitamin B and precursors to neurotransmitters which play vital roles orchestrating signalling in the brain. Overall, we saw deficits in these bacteria in children who later received a developmental neurological diagnosis,” says study first author Angelica Ahrens, Assistant Scientist in Eric Triplett’s research group at the University of Florida.

The present study also confirms that the risk of developmental neurological diagnosis in the child increases if the parents smoke. Conversely, breastfeeding has a protective effect, according to the study.

Differences at birth

In cord blood taken at the birth of children, the researchers measured substances such as fatty acids and amino acids, as well as exogenous ones such as nicotine and environmental toxins. They compared substances in the umbilical cord blood of 27 children diagnosed with autism with the same number of children without a diagnosis.

It turned out that children who were later diagnosed had low levels of several important fats in the umbilical cord blood. One of these was linolenic acid, which is needed for the formation of omega 3 fatty acids with anti-inflammatory properties and other effects in the brain. The same group also had higher levels than the control group of a PFAS substance, used as flame retardants and shown to negatively affect the immune system in several different ways. PFAS substances can enter the body via drinking water, food and the air we breathe.

Opens up new possibilities

As the relationships found in the Swedish children may not be generalisable to other populations, studies in other populations are needed. Another question is whether gut flora imbalance is a triggering factor or whether it has occurred as a result of underlying factors, such as diet or antibiotics. Yet even accounting for risk factors that might affect the gut flora, they found that the link between future diagnosis remained for many of the bacteria.

The research is at an early stage and more studies are needed, but the discovery that many biomarkers for future developmental neurological disorders can be observed at an early age opens up the possibility of developing screening protocols and preventive measures in the long term.

Source: Linköping University