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While it is well-accepted that mothers play a key role in child health outcomes, the role of the father is less well understood. This study, the first of two investigations of the relationship between the social environment and child health, growth and development, was nested in a child nutrition programme carried out in Kwale County. At present child health services are largely administered through government Mother and Child Health programmes. Previous community consultations have raised the need to include all family members, particularly fathers, in the process of addressing child health and development issues. To provide a background to planning for inclusion of the wider family this study investigated local attitudes and beliefs towards parenting and how these may influence child health outcomes. In this study, we used qualitative in-depth interviews of 61 co-habiting couples with fathers and mothers interviewed separately, analysed using NVivo 10 software, to look for patterns of responses with regards to attitudes and behaviours relevant to child health. The study findings suggested that both mothers and fathers overall valued their status as parents and were willing to be involved in promoting the well-being of their children. Fathers and mothers saw that they carried out a different role, and drew on different influences in their decision making and role definition. The main barrier to direct paternal involvement in the health care of their children was reported to be the cost of attendance at clinics, both in terms of time and money. Innovation in how medical services engage with families is required to increase the supportive role that fathers can provide by using opportunities such as community meetings where men gather to explain child health risks and preventative measures.

Early educators' perceptions of play and learning influence whether they adopt responsive roles to facilitate learning in play. While studies have investigated perceptions of play as pedagogical practice and its perceived relevance for learning, few have also interrogated educator learning perceptions, and hence compared these perceptions. This study explored perceptions among South African early educators by contrasting their interview and questionnaire responses. Findings revealed play perceptions encompassing structured, adult-led activities alongside child-managed play. While play was highlighted as active, joyful and chosen, participants emphasised appropriate, real-world play over children's self-directed explorations and make-believe. Learning perceptions presented a span that primarily centred on correctness, followed by children understanding and applying lessons. Surprisingly, less nuance emerged for learning in play: rather than viewing play as a context for practicing and improving, respondents saw play as a 'stage' where children could demonstrate proficiency. Finally, patterns in play and learning perceptions came out more clearly in interviews than the questionnaire. These findings point to a need for alternative at-scale methods when eliciting educator perceptions, and for supporting educators to develop reflected, nuanced notions of play as practice and children's learning in play.

Perinatal HIV infection is associated with delayed neurocognitive development, but less is known about children perinatally HIV-exposed but uninfected (CHEU). We compared cognitive and language outcomes in 4-6-year old CHEU versus children HIV-unexposed and uninfected (CHUU) and children living with HIV (CLHIV). We enrolled 1,581 children (77% of the child population) in five communities in KwaZulu-Natal, South Africa. Children completed: Grover-Counter Scale of cognitive development, sub-scales of the Kaufman Assessment Battery for Children, Reynell Developmental Language Scales. HIV status of children and primary caregivers was determined by repeated rapid tests or report of prior testing. We conducted a cross-sectional multivariable linear regression on 922 dyads with complete data (257 CHEU, 627 CHUU, 38 CLHIV). On all outcome measures, CHEU and CHUU groups had comparable scores; CLHIV scored significantly lower. Emerging global progress toward the elimination of vertical HIV transmission may not only reduce mortality, but also positively impact child development.

Background: The Southern Africa Development Community (SADC) has a shortage of critical healthcare skills. Aims: To identify the causes and consequences of shortages and make policy recommendations. Methods: A literature search was conducted using eight electronic databases and the World Health Organization and SADC Websites. Results: From the studies reviewed the causes included mismatch between demand and supply, and loss of personnel to developed countries. Underlying factors included poorly functioning education systems and poor working conditions. Of the 16 SADC countries only five met the minimum requirements for nurses and midwives, and four for physicians. These factors exacerbate the population’s poor health, and clinical outcomes. Conclusion: Internal reforms to the health and education sectors are necessary to progress towards geographic and demographic equity in health provision. The SADC should set regional targets and monitor the size and composition of the workforce to enable evaluation of progress towards targets. [ABSTRACT FROM AUTHOR]

Background and Objectives Alcohol abuse, a significant health problem in South Africa, affects the ability of adults to care for children. Little is known regarding risky alcohol use among child caregivers there. A large population-based study examined the prevalence of, and factors associated with, risky drinking among caregivers of young children in KwaZulu-Natal, South Africa comparing the use of the Alcohol Use Disorders Identification Test (AUDIT) and the AUDIT-C screens for hazardous or harmful drinking (referred to here as risky drinking). Methods 83 % of child caregivers from five tribal areas were interviewed using the 10-question AUDIT to screen for risky drinking. The AUDIT-C screen, a subset of AUDIT questions, targets alcohol consumption and binge drinking. Factors associated with risky drinking were investigated using logistic regression. Results 1434 caregivers participated, 98 % female. Sixteen percent reported ever drinking alcohol. Based on AUDIT criteria for risky drinking, 13 % of the sample scored as moderate drinkers, 2 % as hazardous users, and 1 % as harmful or dependent users (identifying 3 % as risky drinkers). Using AUDIT-C criteria to identify risky drinking significantly increased the proportion of caregivers identified as risky drinkers to 9 %. In multivariate analyses, factors associated with risky drinking were similar in both screens: partner violence, smoking, HIV-infection, caring for a child with disabilities. Conclusions for Practice Since the AUDIT-C identified risky alcohol use not otherwise detected with the full AUDIT, and since resources for screening in health care settings is limited, the AUDIT-C may be a more appropriate screen in populations where binge drinking is common., Author(s): Myra Taylor[sup.1] , Justin Knox[sup.2] , Meera K. Chhagan[sup.1] [sup.3] , Shuaib Kauchali[sup.1] , Jane Kvalsvig[sup.1] , Claude Ann Mellins[sup.4] , Stephen M. Arpadi[sup.2] [sup.5] , Murray H. Craib[sup.1] [...]

Given the existing evidence linking parental depression with infant and early child development, our aim was to describe the burden of mental health disorders among caregivers of young children aged 4-6 years living in an environment of poverty and high HIV seroprevalence. We analyzed baseline data from an epidemiologic study of the health and psychosocial needs of preschool-aged children. Primary caregivers of index children recruited from a household survey were screened for common mental disorders using the Client Diagnostic Questionnaire (CDQ). Sociodemographic, HIV and general health surveys were also conducted. Many caregivers (449/1,434; 31.3 %) screened positive for at least one psychiatric disorder on the CDQ, with post-traumatic-stress-disorder being the most common. Caregivers who screened positive for any disorder were more likely to be older, to have no individual sources of income and to have less formal education. Presence of a disorder was also significantly associated with lower employment levels within the household and death of a young child within the household. Known HIV-infected caregivers were more likely to have any mood disorder than caregivers who previously tested negative. The data support the need for mental health treatment interventions in South Africa, particularly interventions directed at PTSD and depression, and that take into account the high burden of poverty, HIV and childhood mortality. Given the limited formal mental health structure in South Africa to address these highly prevalent disorders; community-based mental health supports, available through decentralized health systems many be critical to delivering accessible interventions., Author(s): Meera K. Chhagan [sup.1] , Claude A. Mellins [sup.2] , Shuaib Kauchali [sup.1] , Murray H. Craib [sup.1] , Myra Taylor [sup.3] , Jane D. Kvalsvig [sup.3] , Leslie [...]

Background: Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behaviour in low‐ and middle‐income countries (LMIC). Methods: The population‐based Asenze cohort study was implemented in a peri‐rural area of KwaZulu‐Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5 years old and child behaviour problems (Strengths and Difficulties Questionnaire [SDQ]) approximately 2 years later (average age 7 years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. Results: A significant relationship between increased ACE exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. Conclusions: There is an association between exposure to ACEs and later child behaviour problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behaviour problems that may be a part of the mechanism through which later health effects arise. [ABSTRACT FROM AUTHOR]

Abstract Background Schistosomiasis is one of the major health problems in tropical and sub-tropical countries, with school age children usually being the most affected group. In 1998 the Department of Health of the province of KwaZulu-Natal established a pilot programme for helminth control that aimed at regularly treating primary school children for schistosome and intestinal helminth infections. This article describes the baseline situation and the impact of treatment on S. haematobium infection in a cohort of schoolchildren attending grade 3 in a rural part of the province. Methods Primary schoolchildren from Maputaland in northern KwaZulu-Natal were examined for Schistosoma haematobium infection, treated with praziquantel and re-examined four times over one year after treatment in order to assess the impact of treatment and patterns of infection and re-infection. Results Praziquantel treatment was highly efficacious at three weeks after treatment when judged by egg reduction rate (95.3%) and cure rate of heavy infections (94.1%). The apparent overall cure rate three weeks after treatment (57.9%) was much lower but improved to 80.7% at 41 weeks after treatment. Re-infection with S. haematobium was low and appeared to be limited to the hot and rainy summer. Analysis of only one urine specimen per child considerably underestimated prevalence when compared to the analysis of two specimens, but both approaches provided similar estimates of the proportion of heavy infections and of average infection intensity in the population. Conclusion According to WHO guidelines the high prevalence and intensity of S. haematobium infection necessitate regular treatment of schoolchildren in the area. The seasonal transmission pattern together with the slow pace of re-infection suggest that one treatment per year, applied after the end of summer, is sufficient to keep S. haematobium infection in the area at low levels.

Abstract Background Geohelminth infection is a major health problem of children from rural areas of developing countries. In an attempt to reduce this burden, the Department of Health of the province of KwaZulu-Natal (KZN) established in 1998 a programme for helminth control that aimed at regularly treating primary school children for schistosomiasis and intestinal helminths. This article describes the baseline situation and the effect of treatment on geohelminth infection in a rural part of the province. Methods Grade 3 schoolchildren from Maputaland in northern KZN were examined for infections with hookworm, Ascaris lumbricoides, and Trichuris trichiura, treated twice with 400 mg albendazole and re-examined several times over one year after the first treatment in order to assess the impact of treatment and patterns of infection and re-infection. Results The hookworm prevalence in the study population (83.2%) was considerably higher than in other parts of the province whereas T. trichiura and especially A. lumbricoides prevalences (57.2 and 19.4%, respectively) were much lower than elsewhere on the KZN coastal plain. Single dose treatment with albendazole was very effective against hookworm and A. lumbricoides with cure rates (CR) of 78.8 and 96.4% and egg reduction rates (ERR) of 93.2 and 97.7%, respectively. It was exceptionally ineffective against T. trichiura (CR = 12.7%, ERR = 24.8%). Re-infection with hookworm and A. lumbricoides over 29 weeks after treatment was considerable but still well below pre-treatment levels. Conclusion High geohelminth prevalences and re-infection rates in the study population confirm the need for regular treatment of primary school children in the area. The low effectiveness of single course albendazole treatment against T. trichiura infection however demands consideration of alternative treatment approaches.