Atopic dermatitis (AD) is the most common, chronic, recurrent, inflammatory disorder of the skin, and it affects 5–30% of children worldwide. An analysis in the Journal of the European Academy of Dermatology & Venereologyof relevant published studies found that early application of emollients is an effective strategy for preventing AD in high-risk infants.
The analysis included 11 randomised controlled trials involving 3483 infants. Three types of emollients, including cream, emulsion, and mixed types were comparable in preventing AD; however, an additional analysis suggested that emollient emulsion may be the best option.
This analysis revealed a surface under the cumulative ranking curve (SUCRA) of 82.6%, 78.0% for high-risk infants and 79.2% for infants with food sensitisation. However, subjects receiving emollients more frequently experienced adverse events.
“The results of this systematic review and network meta-analysis show that early application of skin emollients can effectively prevent AD development in infants,” the authors wrote. “Moreover, among the available three types of emollients, the emollient emulsion is probably the optimal option in infancy to prevent AD development more effectively.”
“It was very, very critical to me. It was an albatross around my neck. It was something that caused a deep persistent anxiety in me…”
This is how a 61-year-old retired school teacher from a township on the East Rand describes the feelings he had around disclosing to his son that he (the child) was born with HIV.
The man, who taught life orientation skills and history, agreed to be interviewed on condition that their identities are protected.
Speaking to Spotlight he says, “With my son, it became late in his life because I didn’t know how to do it – how to tell him. So I postponed and postponed. It was becoming increasingly difficult.”
Three months after the boy was born in 2001 at the Far East Rand Hospital in Springs, the child’s mother passed away from an HIV-related illness. At the time, hospital staff referred the widowed father and baby boy to HIV and AIDS treatment non-profit organisation Right to Care where Dr Leon Levin diagnosed the child with HIV.
“My wife died three months after giving birth. I didn’t realise then that she had HIV and that I have HIV. I took my son to Dr Levin, who tested him. I started giving my son ARVs. I had to employ someone to look after the child while I was working, and this woman didn’t truly understand about adherence and at times did not give him all his medicine. So she defaulted, which is very bad. It was a time when not much information was available, the time of the president [Thabo Mbeki] denying that HIV causes AIDS.”
Also in 2001, young orphan Nkosi Johnson died of AIDS in Johannesburg at the age of 12. Johnson made headlines the previous year when he told the International AIDS Conference in Durban “care for us and accept us. We are all human beings”.
‘Taking medication as a team’
As the years went by, the man says, the burden in his heart grew bigger. “We would go to Dr Levin every six months for a check-up,” he says. “I would tell my son that he is sick, but I did not explain why.”
Eventually, the man felt comfortable allowing Levin to assist in sharing the news with his son. “Around the age of 16, Dr Levin did a full disclosure with my son. It was the heaviest weight off my shoulders. After that intervention, we could speak properly. We had a heart-to-heart, and we started taking medication as a team. This made it easy for me to explain to the child the advantages of adhering [to ARV treatment], the meaning of defaulting [failing to take ARV treatment regularly, as prescribed], and all these consequences. I could discuss with my son the importance of adherence because when you default, the medication becomes resistant. I told him if you take your medication, you can live a long life. You can get married and you can have children.”
Despite the substantial progress South Africa has made in fighting HIV over the last decade and a half, HIV in children is still quite common. According to the latest estimates from Thembisa – the leading mathematical model of HIV in South Africa – around 238 000 children (under the age of 15) were living with HIV in the country in 2021. There were just over 8 300 cases of mother-to-child transmission of HIV last year. While still a staggering problem, this is a significant improvement from the early 2000s when the number was around 74 000.
Disclosure – how to get it right
Sharing news of being born with HIV to a child (perinatal infection) is perhaps an often overlooked, deeply tender aspect of the country’s broader HIV response. The National Department of Health recommends “partial disclosure” from three years old and “full disclosure” from around 10 years old – ideally before a child is 13 or before their sexual debut.
Levin, who is based in Johannesburg, and Dr Julia Turner, who is based in White River, Mpumalanga – both are with Right to Care – spoke to Spotlight about how they assist parents and children in this regard.
“Parents are so scared to tell their child that they have HIV, so they delay and delay and delay,” says Turner. “If you ask a parent they’ll say, oh no, let’s wait until they’re 15. And then they say, oh no, let’s wait until they’re 18. Because it’s such a difficult thing for them to do. They’re scared that their child will be devastated and become depressed and blame them. So they delay and delay and eventually the child either googles it themselves or reads their own file while they’re waiting for the doctor at the clinic. Teenagers and children are generally much smarter than anyone ever thinks they are.”
Levin and Turner point out that it is unreasonable to expect a child or teenager to regularly take medicine when they don’t know what it is for.
“At some stage, the children will ask why do I need this?” says Turner. “Or they’re refusing to take it and then the parents don’t know what to say, so they end up making up something. So they’ll say, you’ve got TB, or you’ve got asthma, or you’ve got herpes, or they make up any excuse as to why the child must take treatment. Perhaps ‘you must take the treatment, otherwise, you’ll die’, which is a bit scary. None of these answers are satisfactory, plus the child might be angry later if they learn they were lied to.”
Levin has been treating children and adolescents with HIV for 26 years. When he started, there were no guidelines and he had to learn from his own mistakes.
“Leon has been a paediatrician for many years and he was dealing with children and teenagers,” says Turner. “And he had to just figure out a way to tell them. And initially, it ended in tears. The child was crying, the parents were crying, he was crying, everyone… So, he slowly developed this technique of doing it so that it was brought into a positive light. And that really worked.”
Turner has helped to refine the technique. They explain that partial disclosure is explaining to a child that they have to take their treatment – without telling the child untruths but without bringing up HIV. Full disclosure is naming the child’s condition as “HIV”.
“Unfortunately, schools use HIV for their own purposes,” says Levin. “They’re using it basically to encourage children not to be promiscuous. So they’re giving out the message that only bad people get HIV and that people die from HIV. So while this works to encourage children to not be promiscuous, the problem is that as soon as a child hears the word ‘HIV’ or that they’ve got HIV, they immediately think they’re going to die – there’s that bad connotation.”
The story of the ‘soldier cells’
Right to Care recommends providing the young child with full information about HIV, without actually naming the disease, to avoid stigma and fear. The crux of the method is to not use the word “HIV” until myths around HIV are dispelled. The organisation offers illustrated booklets, depicting their narrative where white blood cells are depicted as soldiers.
“So we basically tell them a little story that in their body they have white blood cells,” Turner explains. “We say white blood cells are like soldiers and they go around your body and they protect you from germs. But you weren’t born with enough soldiers in your body. So that’s why you can get sick very easily. But the tablets or the medicine you take can help to keep your soldiers strong, keep your immune system strong, and fight off all the germs. So at least that’s true, and it’s a good reason why they must take their medicine. And they are usually very satisfied with that.”
As the child gets older, the story is expanded.
“As they get older, we can say, okay, well, why don’t you have enough soldiers in your blood?” she says. “And then we tell them it’s because you have a virus. You were born with a virus that kills off your soldier cells. And then as they get older, eventually when they’re about 10 years old, you can then say do you want to know the name of that virus that you have? And that’s when we turn partial disclosure into full disclosure by telling them the name HIV.”
Questions and answers
News of the parent having HIV is shared in a similar manner by framing the virus in a positive light. No blame is placed on the parent ever. Instead, when speaking to the child about their HIV status, the doctors recommend that if any blame is apportioned, that it be on the medical fraternity “for not having better medicine available” at the time of the child’s birth.
“We ask the child what they know about HIV, just to try and find out what negative things they have been told,” says Turner. “Then we tell them no, it’s not true, actually, people with HIV live long and healthy lives… I always ask them, what they want to be when they grow up. And if they say they want to be a pilot or a doctor or a teacher, I say, do you think people with HIV can be a pilot? And they always say no. And then I say, of course, they can. People with HIV can do anything they want to do. They can be doctors, teachers, anything.”
Right to Care is set to bring out a disclosure flip chart to help healthcare workers and primary caregivers with this conversation, which might be rolled out by the health department nationally.
“The thing is, you have to think on your feet because you’re having a conversation with this young child and it’s not so straightforward. But the flip chart tells you exactly what to say, it makes it much easier,” says Levin.
Meanwhile, the retired teacher and his now 22-year-old son are together establishing a small business in their community.
“My advice to parents,” he says. “Sharing their HIV status with children might feel like a bombshell. They must ask for professional help – doctors have techniques to make it easier.”
A large-scale study published in JAMA Network has found no link between benzodiazepines use in pregnancy and subsequent autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) diagnoses in offspring. When comparing siblings, benzodiazepines use had no effect on ASD or ADHD risk, indicating that the mother’s genetics partly explained the increased risk.
Some 10–30% of pregnant women experience mental disorders, including mood or anxiety spectrum disorders, for which benzodiazepine agents are sometimes prescribed; this occurs in an estimated 1.9% of pregnancies globally.
The safety of these agents to the developing foetus and newborn has been called into question, since benzodiazepines are able to cross the placenta and have been found to be present in amniotic fluid and breast milk. The US FDA includes in the category of possible harm to the foetus.
While rodents studies have tested benzodiazepine exposure during the first trimester of pregnancy, investigations of neurodevelopmental outcomes in humans, such as ASD and ADHD, have been lacking.
One study found no significantly increased risks of ADHD symptoms or fine or greater motor deficits. Those researchers suggested the disorder resulting in benzodiazepine use might partly explain the increased risks. Maternal depressive and anxiety symptoms in pregnancy have also been linked to increased ADHD risk in children.
From the Taiwanese national health database, of over 1 .5 million children born full term who were younger than 14 years of age and followed up to 2017; 5.0% had been exposed to benzodiazepines in utero.
However, no differences were found with unexposed sibling controls during the same time frame for ADHD or ASD.
The researchers concluded that their results “challenge current assumptions of a potential association of neurodevelopmental disorders with maternal benzodiazepine use before or during pregnancy. Better identification of maternal mental health concerns, as well as possible interventions or provisions of guidance to build better nurturing and raising environments for newborns at risk, may be relevant to the prevention of adverse outcomes of neurodevelopmental disorders.”
WHO today launched new guidelines to improve survival and health outcomes for babies born preterm (< 37 weeks) or small (< 2.5kg). In a significant departure from common clinical practice, the guidelines advise that caregiver skin to skin contact with a caregiver – aka kangaroo mother care – should start immediately after birth, without incubator stabilisation. This reflects the immense health benefits of ensuring caregivers and their preterm babies can stay close, without being separated, after birth.
The guidelines also provide recommendations to ensure emotional, financial and workplace support for families of very small and preterm babies, who can face extraordinary stress and hardship because of intensive caregiving demands and anxieties around their babies’ health.
“Preterm babies can survive, thrive, and change the world – but each baby must be given that chance,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “These guidelines show that improving outcomes for these tiny babies is not always about providing the most high-tech solutions, but rather ensuring access to essential healthcare that is centred around the needs of families.”
Depending on where they are born, there remain significant disparities in a preterm baby’s chances of surviving. While most born at or after 28 weeks in high-income countries go on to survive, in poorer countries survival rates can be as low as 10%.
Most preterm babies can be saved through feasible, cost-effective measures including quality care before, during and after childbirth, prevention and management of common infections, and kangaroo mother care – combining skin to skin contact in a special sling or wrap for as many hours as possible with a primary caregiver, usually the mother, and exclusive breastfeeding.
Previous recommendations for preterm babies were for an initial period of separation from their primary caregiver, with 3–7 days of initial stabilisation in an incubator or warmer. However, research has now shown that starting kangaroo mother care immediately after birth reduces mortality, infections and hypothermia, and improves feeding.
Breastfeeding is also strongly recommended to improve health outcomes for preterm and low birthweight babies, with evidence showing it reduces infection risks compared to infant formula. Where mother’s milk is not available, donor human milk is the best alternative, though fortified ‘preterm formula’ may be used if there are no donor milk banks.
Integrating feedback from families gathered through over 200 studies, the guidelines also advocate for increased emotional and financial support for caregivers. Parental leave is needed to help families care for the infant, the guidelines state, while government and regulatory policies and entitlements should ensure families of preterm and low birthweight babies receive sufficient financial and workplace support.
Earlier this year, WHO released related recommendations on antenatal treatments for women with a high likelihood of a preterm birth. These include antenatal corticosteroids, which can prevent breathing difficulties and reduce health risks for preterm babies, as well as tocolytic treatments to delay labour and allow time for a course of corticosteroids to be completed. Together, these are the first updates to WHO’s preterm and low birth weight guidelines since 2015.
The guidelines were released ahead of World Prematurity Day, which is marked every year on 17th November.
Figure 1. The epidemiological curve of measles outbreak cases, Greater Sekhukhune and Mopani Districts, Limpopo province, September to November 2022 (*Two sporadic cases in Vhembe District are not included). Source: NICD
As of 10 November, the National Institute of Communicable Diseases reported 35 laboratory-confirmed measles cases in Limpopo, with 14 new cases on 8 and 9 November, all in Mopani district. Thus far, most of the laboratory-confirmed cases (25 of 35) fall within the 13 month to 9 year age range.
With these new cases, the Mopani district with 19 cases has overtaken the Greater Sekhukhune district which remains at 16 (see Figure 1). Only seven cases are known to be vaccinated; eight are either unvaccinated or partially vaccinated; vaccination status of the remaining 20 is unknown.
According to a recent study published in BMC Public Health, measles has been experiencing a resurgence in South Africa. Over 2015–16, measles had remained largely under the elimination target of under one case per million in South Africa, but rose above this threshold from 2017–2019. Cases fell below the threshold in 2020 with the onset of COVID, but the pandemic also saw normal vaccination efforts slipping. The article authors also noted a measles vaccine effectiveness of only 80% among 1–4 year olds, compared to the 95% rate found in large datasets.
Those cases reported in the Mopani district were in the Greater Giyani, Ba-Phalaborwa, and Ga-Kgapane sub-districts. Epidemiological investigations showed that in the Mopani district, two siblings with measles infection had contact with cases in the Greater Sekhukhune district when they travelled there for a family funeral.
While two cases were reported in Vhembe District, they were considered sporadic as they had not links to the other cases and are not included in the outbreak tally.
The laboratory-confirmed measles infections have been identified in 19 males and 16 females ranging in age from 6 months and 24 years in the Greater Sekhukhune district, while cases range from 2 to 42 years in the Mopani district (Table 1), with increasing cases in the 5–9 year age range. Two children were hospitalised but no deaths or other complications from measles have been reported.
According to the NICD, the affected districts are continuing with the public health response activities and tracing and vaccinating contacts. Measles catch-up doses are also being given to children who have missed vaccinations.
Watching violent TV during the preschool years can lead to later risks of psychological and academic impairment by the end of primary school according to a new study published in the Journal of Developmental and Behavioral Pediatrics.
According to study leader Professor Linda Pagani, a professor at Université de Montréal’s School of Psycho-Education, it was previously “unclear to what extent exposure to typical violent screen content in early childhood – a particularly critical time in brain development – can predict later psychological distress and academic risks,” said Pagani.
“The detection of early modifiable factors that influence a child’s later well-being is an important target for individual and community health initiatives, and psychological adjustment and academic motivation are essential elements in the successful transition to adolescence,” she added.
“So, we wanted to see the long-term effect of typical violent screen exposure in preschoolers on normal development, based on several key indicators of youth adjustment at age 12.”
To do this, Pagani and her team examined the violent screen content that parents reported their children viewing between ages three-and-a-half and four-and-a-half, and then conducted a follow-up when the children reached 12.
Follow-up at age 12
At the follow-up, two reports were taken: first, of what teachers said they observed, and second, of what the children themselves, now at the end of Grade 6, described as their psychological and academic progress.
“Compared to their same-sex peers who were not exposed to violent screen content, boys and girls who were exposed to typical violent content on television were more likely to experience subsequent increases in emotional distress,” said Pagani.
“They also experienced decreases in classroom engagement, academic achievement and academic motivation by the end of the sixth grade,” she added.
“For youth, transition to middle school already represents a crucial stage in their development as adolescents. Feeling sadness and anxiety and being at risk academically tends to complicate their situation.”
Pagani and co-authors Jessica Bernard and Caroline Fitzpatrick came to their conclusions after examining data from a cohort of children born in 1997 or 1998 who are part of the Quebec Longitudinal Study of Child Development, coordinated by the Institut de la statistique du Québec.
Close to 2000 children studied
In all, the parents of 978 girls and 998 boys participated in the study of violent TV viewing at the preschool age. At age 12 years, the children and their teachers rated the children’s psychosocial and academic achievement, motivation and participation in classroom activities.
Pagani’s team then analysed the data to identify any significant link between problems with those aspects and violent content they were exposed to at preschool, while trying to account for as many possible biases and confounding influences as possible.
“Our goal was to eliminate any pre-existing conditions of the children or families that could have provided an alternative explanation or throw a different light on our results,” Pagani said.
Watching TV is a common early childhood pastime, and some of the children in the study were exposed to violence and some were not.
Psychological and academic impairment in children is of increasing concern for education and public-health sector workers. According to Pagani, problems starting middle school (ages 13 to 15) are rooted in early childhood.
Identifying with fictional characters
“Preschool children tend to identify with characters on TV and treat everything they see as real,” she said. “They are especially vulnerable to humorous depictions of glorified heroes and villains who use violence as a justified means to solve problems.
“Repeated exposure,” she added, “to rapidly paced, adrenaline-inducing action sequences and captivating special effects could reinforce beliefs, attitudes and impressions that habitual violence in social interactions is ‘ normal’. Mislearning essential social skills can make it difficult to fit in at school.”
Added Bernard: “Just like witnessing violence in real life, being repeatedly exposed to a hostile and violent world populated by sometimes grotesque-looking creatures could trigger fear and stress and lead these children to perceive society as dangerous and frightening.
“And this can lead to habitually overreacting in ambiguous social situations.”
She continued: “In the preschool years, the number of hours in a day is limited, and the more children get exposed to aggressive interactions (on screens) the more they might think it normal to behave that way.”
Pagani added: “Being exposed to more appropriate social situations, however, can help them develop essential social skills that will later be useful and ultimately play a key role in their personal and economic success.”
A population-based observational study has shown that babies suffering oxygen-deficiency complications at birth are almost twice as likely to develop cardiovascular disease in childhood or early adulthood, though such conditions are rare in youth. The findings are published in the journal The Lancet Regional Health – Europe.
According to the Karolinska Institutet researchers, the study could be the first of its kind to examine how complications related to asphyxiation at birth, which affects four million babies annually, affects the risk of cardiovascular disease later in life. Previous research has mostly concentrated on the association between asphyxia in the neonatal period and brain development.
Despite the relatively high risk, the absolute number of babies who suffer from cardiovascular disease despite asphyxiation at birth is very low. After the 30-year follow-up period, only 0.3% of those with asphyxia-related complications had a cardiovascular diagnosis, compared with 0.15% of those without complications.
Since the study was observational, the researchers are unable to establish any causality or propose any underlying mechanisms.
Largest risk increase for stroke and heart failure
The study followed over 2.8 million individuals born in Sweden between 1988 and 2018, of whom 31 419 suffered asphyxia-related complications at birth. A total of 4165 cases of cardiovascular disease were identified during the follow-up period. The increase in risk was particularly salient for stroke and heart failure, as well as for atrial fibrillation. The researchers took into account potential confounders such as birth weight and maternal lifestyle.
“Even if the absolute risk of cardiovascular disease is low at a young age, our study shows that asphyxia-related complications at birth are associated with a higher risk of cardiovascular disease later in life,” says the study’s corresponding author Neda Razaz, assistant professor at the Department of Medicine, Solna, Karolinska Institutet.
A study published in the Journal of Pediatric Hematology/Oncologyfound that blood transfusion is associated with adverse outcomes, including infection and higher rates of tumour recurrence — in paediatric solid tumour oncology patients following surgical removal of the tumour.
“Blood transfusion is obviously hugely important when used in the appropriate clinical scenario, but there are some downsides,” said study author Shannon Acker, MD, an assistant professor of paediatric surgery in the University of Colorado School of Medicine. “It’s pro-inflammatory and suppresses the immune system because your body reacts to foreign tissue. It can be a vital intervention, but I think we’re starting to be a little more thoughtful about giving patients blood products.”
Understanding paediatric blood transfusion
Dr Acker and colleagues pursued this research, in part, because while the effects of packed red blood cell (PRBC) transfusion in adult populations have been widely studied, data are sparser for paediatric patients.
“It’s fairly well-documented that in adult patients, perioperative blood transfusion for solid tumour resection is associated with certain adverse outcomes,” Dr Acker explained. “But paediatric cancers are more rare, so they’re more challenging to study. We need more data to understand whether what we know to be true in adult cancers is also true in paediatric cancers.”
Using retrospective data on more than 260 paediatric patients over 11 years, the researchers included malignant solid tumours removed by surgeons across all surgical disciplines. Dr Acker acknowledges that grouping different types of cancer into one study lessens the validity of the research because different cancers have different outcomes, “but we needed a place to start so we can begin working toward more collaborative, multi-centre paediatric oncology research,” she said.
Higher rates of complications
Of the 360 paediatric patients who underwent tumour resection, 194 received a blood transfusion within 30 days of surgery.
Analysing the data, they saw that children who received a blood transfusion had higher rates of post-surgery infectious complications, a shorter disease-free interval, and higher rates of tumour recurrence. They also adjusted for receiving pre-operative chemotherapy and still found that blood transfusion was associated with higher rates of post-operative infectious complications and a shorter disease-free interval.
No relationship was seen between tumour type and rate of infectious complications or disease-free interval.
Providing the best patient care
An aim of the research and its findings is to continue supporting and facilitating conversations and practices about patient care. “Packed red blood cells carry oxygen to the body and help tissues get the oxygen that they need,” Acker says. “They’re essential. It used to be common practice that if a surgeon was taking out a tumour and the patient was losing blood, they would immediately get two units.”
She added that blood transfusion now is recognised as “not a totally benign intervention, so instead of immediately giving a patient two units, we start with one and see if that leads to an appropriate response. Our research shows that each additional unit increases risk of adverse outcomes, so we want to continue being thoughtful in using this intervention.”
Acker adds that a further goal of the research is to work with members of paediatric oncology surgical consortiums to draw data from national and international centres. “The data we have are good, but I don’t think they’re enough to convince people to change institutional protocols. If we can get more validated, multi-centre data, we can begin to look at a more granular level at timing of transfusions and types of cancers so we can continue providing the best patient care.”
Diarrhoea remains one of the leading causes of death, ill health and disability among children under five years of age in developing countries,1 accounting for 19% of deaths of under-fives in South Africa and for 46% on the African continent.1 Globally, diarrhoea is the second leading infectious cause of death, accounting for 9.2% of deaths in under-fives.1
The high incidence of malnutrition in South Africa2 adds to this toll. The relationship between diarrhoea and malnutrition is bidirectional: diarrhoea may lead to malnutrition, while malnutrition may aggravate the course of diarrhoea.3 Diarrhoea is more common and more severe in children with malnutrition (ie, undernutrition), and malnourished children often have persistent or repeated diarrhoea.4 In addition, malnourished children are more likely to develop severe diarrhoea and die from it.4 Vulnerable groups such as pregnant women and children under five years of age are the most affected by malnutrition, especially in rural areas.5
Identifying children at risk
The Centres for Disease Control advises that caregivers should be trained to recognise signs of illness or treatment failure that necessitate medical intervention.6 Infants with acute diarrhoea are more prone to becoming dehydrated than older children,6 and healthcare workers or parents of infants with diarrhoea should promptly seek medical evaluation as soon as the child appears to be in distress. Reports of changing mental status in the child are of particular concern.6
When the child’s condition is in doubt, immediate evaluation by a healthcare professional is recommended.6 Clinical examination of the child provides an opportunity for physical assessment, including vital signs, degree of dehydration, and a more detailed history, and for providing better instructions to the caregivers.6
Treatment
The treatment emphasis for acute diarrhoea in children is the prevention and management of dehydration, electrolyte abnormalities and comorbid conditions.3 The objectives of diarrhoeal disease management are to prevent weight loss, encourage catch-up growth during recovery, shorten the duration and decrease the impact of the diarrhoea on the child’s health.3
A number of studies have shown that probiotics shorten the duration of diarrhoea and prevent recurrence of other episodes.7 Furthermore, probiotics can prevent diarrhoea from infection in infants with malnutrition.7
Momeena Omarjee, Consumer Healthcare Country Head: Scientific Affairs, at Sanofi South Africa says: “Good gut health is crucial for one’s wellbeing – and healthcare professionals should encourage parents to give children a daily, regular probiotic which could go a long way in preventing diarrhoea and illness.”
How can the risk of diarrhoea be reduced?
Breastfeeding, a clean safe water supply, appropriate hand-washing and good sanitation will prevent most cases of diarrhoea.8
Research shows that diarrhoea is closely linked to socioeconomic status and has the most adverse effects in South Africa’s impoverished communities.9 South African children living in poverty are approximately 10 times more likely to die from diarrhoea than their more privileged counterparts.9
Says Omarjee: “Many of these under-privileged children in South Africa do not have adequate access to clean, potable water and quality early childcare and development, and they experience limited access to health and nutrition services. KwaZulu-Natal (KZN), for example, is experiencing outbreaks of diarrhoea and other water-borne diseases due to the recent floods.”
Although government and NGOs have been working tirelessly to distribute clean, potable water to affected areas in the province, many communities continue to face challenges and intervention is needed to not only provide clean water to the communities, but also to manage the high risk of diarrhoea and related water-borne diseases.
“Sanofi has therefore embarked on an ambitious campaign, in partnership with a non-profit organisation, Save the Children South Africa, from October 2022 to assist these areas in need, and to impact over 2,000,000 lives through hygiene education and access to water,” says Omarjee.
Sanofi, working together with Save the children South Africa, will donate water tanks to Early Childhood Care and Development (ECCD) centres in the communities identified, based on Save the Children’s baseline assessment, and will ensure access to clean, potable water.
The provision of information, counselling, education and support to children and their caregivers is also limited, which translates into low use of services and uptake of practices promoting good health. Education campaigns on healthy hygiene habits will be rolled out to children and their caregivers and will be run through the Child Health Awareness Days (CHAD) events, training of ECCD centres practitioners, and community health workers.
Sanofi is committed to ensuring that no child dies of a preventable disease, especially when there are effective treatments available. Says Omarjee: “Healthcare professionals need to encourage parents and caregivers to act promptly and seek assistance when instances of diarrhoea in children under age five do not abate swiftly.”
Awotione, O.F., et al. 2016. Systematic review: Diarrhoea in children under five years of age in South Africa (1997-2014). Tropical Medicine and International Health, 21(9), 1060-1070.
Cleary, K. 2020. In-depth: The long shadow of malnutrition in South Africa. Available from: https://www.spotlightnsp.co.za, accessed 29 September 2022.
Nel, E. 2010. Diarrhoea and malnutrition. South African Journal of Clinical Nutrition, 23, suppl 1, 15-18.
Child Healthcare. n.d. What is the relationship between diarrhoea and malnutrition? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
Govender, L., et al. 2021. Assessment of the nutritional status of four selected rural communities in KwaZulu-Natal, South Africa. Nutrients, 13(9), 2920.
Centers for Disease Control. 2003. Managing acute gastro-enteritis among children. MMWR, 52(RR16), 1-16.
Solis, B. et al. 2002. Probiotics as a help in children suffering from malnutrition and diarrhoea. European Journal of Clinical Nutrition, 56, S57-59.
Child Healthcare. n.d. How can the risk of diarrhoea be reduced? Available from: https://childhealthcare.co.za, accessed 29 September 2022.
Chola, L., et al. 2015. Reducing diarrhoea deaths in South Africa: costs and effects of scaling up essential interventions to prevent and treat diarrhoea in under five children. BMC Public Health, 15, 394.
Even months after being critical ill with sepsis, children are at risk for new or worsening medical conditions, suggests a study in JAMA Pediatrics. The researchers found that a fifth of children in a nationwide US cohort either developed or experienced progressing disease within six months of leaving the intensive care unit for sepsis.
Researchers compared data from 5150 children who received ICU care for sepsis to 96 361 who experienced critical illness from other conditions. Those with sepsis were more likely to later experience chronic respiratory failure, problems requiring nutritional dependence and chronic kidney disease. Both groups also had a risk of developing a seizure disorder.
“Children who survive severe sepsis are at risk of long-term health consequences that impact their quality of life and future health needs,” said lead author Erin Carlton, MD, MSc, a paediatric intensivist at University of Michigan Health C.S. Mott Children’s Hospital.
Not all children who recover from critical illness from sepsis are impacted equally, the study suggests. Those with pre-existing illnesses were three times more likely to experience new or worsening disease.
Meanwhile, younger children, especially under twelve months old, were twice as likely to require supplemental nutrition, such as needing a feeding tube, or develop a new seizure condition such as epilepsy, than older children.
Sepsis, where an out-of-control immune response to infection damages vital organs, is a leading cause of death among children and newborns. In the US, 70 000 children in the are hospitalised with sepsis annually.
“Many children who require critical care for sepsis have debilitating physical, cognitive or emotional challenges long after recovery,” Dr Carlton said. “Our findings suggest a need for improved follow up care focused on identifying and treating new or worsening medical conditions.”
