Health and educational achievement of school-aged children: The impact of anaemia and iron status on learning

Background: Anaemia is a common blood disorder in children and is known to cause complications such as lethargy and stress on bodily organs. Children from disadvantaged communities often fail to achieve their age-related potential with iron deficiency anaemia stated as a risk factor through causing inattentiveness and learning problems. Limited evidence exists for the adverse effects of iron deficiency anaemia on the developing child's brain from South African studies. Aim: The objective of this study was to determine the local prevalence of anaemia and iron deficiency and to examine their association with psychomotor development and school performance in school-aged children. Setting: This study was conducted in a peri-urban disadvantaged community from KwaZulu-Natal, South Africa. Methods: Children aged 6 to 8 years from KwaZulu-Natal were enrolled (n = 184). Three parameters of assessment were used: clinical data, biochemical data (haemoglobin levels and iron studies) and school performance (interviews with caregivers, teachers and the children). Anaemia presence and iron deficiency were the hypothesised mediating variables through which growth, development and school performance were influenced. Results: A high point prevalence of anaemia (23.4%), iron deficiency anaemia (4.9%) and helminth infection (27.1%) was identified. Impaired cognitive assessment scores (20.7%) were prevalent in the children sampled. Behavioural problems (4.3%), poor memory function (4.3%) and impaired attention (1.1%) were of low prevalence. Anaemia and iron deficiency were both associated with impaired fine motor skills (p < 0.05). Anaemia was significantly associated with low cognitive scores (p = 0.01). Neither anaemia, iron status nor helminth infection significantly predicted school performance in the children sampled. Conclusions: The point prevalence of anaemia and iron deficiency among the sampled children was higher than the national prevalence. The sample size was however inadequate for drawing statistical conclusions about psychomotor development and school performance because of the low prevalence of the different outcomes that were examined. Practical challenges faced in conducting this investigation in rural South African schools were discussed

Does the public antiretroviral treatment programme meet patients' needs? A study at four hospitals in eThekwini, KwaZulu-Natal, South Africa

Background: Patients play a major role in the success of any antiretroviral treatment (ART) programme. Hence, their needs should be articulated on a regular basis for interventional processes to promote adherence, retention and quality care.Aim: This study investigated whether patients' needs were being met, described which needs were met, which were not and how such needs could be met.Setting: The study took place at four ART clinics in eThekwini district public hospitals.Methods: This study formed part of a larger study that utilised a sequential mixed-methods design. However, only the qualitative component is documented herein. Twelve HIV-infected patients engaged in in-depth interviews (three patients from each of the four hospitals). A socio-ecological framework divided responses into four categories, namely, the individual, interpersonal, institutional and policy. Each category presented (1) patients' needs that are being met, (2) needs that are not being met, (3) recommendations on how they can be met and (4) researchers' observations.Results: All 12 patients reported that all their needs were not being met. They further shared their met needs, unmet needs and made recommendations for meeting their unmet needs. These needs varied per antiretroviral clinic because of unique processes at each institution.Conclusion: To adequately address the needs of HIV-infected patients, it is imperative for all stakeholders involved in the public ART programme to gain an understanding of what constitutes 'patients' needs'. The results reflect patients' willingness to be involved in their care, treatment and interventional strategies to adequately meet their needs

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal

Background: Adolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes. Aim: The aim of this study was to explore nurses' perceptions of the MDT approach in the continuum of care for adolescent mothers and their children. Setting: The study was conducted in a local district hospital in Ugu, KwaZulu-Natal. Methods: An explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses' perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis. Results: Six overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses' reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.Conclusion: In the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention

Prevalence and risk factors of repeat pregnancy among South African adolescent females

In the era of HIV/AIDS, repeat pregnancies among adolescents indicate the growing problem of high-risk sexual behavior and the status of reproductive health services. A cross sectional survey was conducted to establish the prevalence and risk factors of repeat pregnancies among South African adolescents. A total of 326 adolescents participated in this study at a district hospital in, KwaZulu-Natal, South Africa from June 2017 to November 2017. Data was analysed using R Software. Out of the 326 adolescents, 19.9% had experienced a repeat pregnancy. The risk factors associated with adolescent repeat pregnancy included a history of spontaneous abortion (p<0.001) and previous contraceptive use (p<0.001). A higher level of education (p<0.001) and emotional support from family (p=0.007) were found to be significant protective factors against adolescent repeat pregnancy. These findings have implications for future interventions aimed at reducing repeat pregnancy among adolescents

Environmental factors influencing the distribution and prevalence of Schistosoma haematobium in school attenders of ILembe and uThungulu Health Districts, KwaZulu-Natal Province, South Africa

Schistosoma haematobium infection is reported to facilitate the development of urogenital diseases. Its symptoms include haematuria, dysuria and tiredness, and it may cause cognitive decline in children. The prevalence of S. haematobium infection needs to be known in endemic areas and a mass treatment programme against the disease implemented. The aim of this study was to investigate the prevalence and intensity of S. haematobium infection in ILembe and uThungulu health districts, using the major symptom, haematuria, as an indicator. A total of 6 265 urine samples, from 96 rural schools, was collected for analysis using dipsticks. The prevalence of haematuria in the ILembe health district was 37% (95% CI, 35­39%) for boys and 39% (95% CI, 37­41%) for girls. The prevalence of haematuria in the uThungulu health district was 56% (95% CI, 53­59%) and 53% (95% CI, 50­56%) for girls and boys, respectively. Light-intensity infection was the most common infection level in both health districts. A negative relationship was observed between prevalence and altitude (r = −0.262, p = 0.009); whereas, we found a slight, though significant, positive association with mid-summer temperatures (r = 0.234, p = 0.021). Associations between prevalence and distance of school to the nearest river were non-significant

The willingness of private-sector doctors to manage public-sector HIV/AIDS patients in the eThekwini metropolitan region of KwaZulu-Natal

Background: South Africa is severely affected by the AIDS pandemic and this has resulted in an already under-resourced public sector being placed under further stress, while there remains a vibrant private sector. To address some of the resource and personnel shortages facing the public sector in South Africa, partnerships between the public and private sectors are slowly being forged. However, little is known about the willingness of private-sector doctors in the eThekwini Metropolitan (Metro) region of KwaZulu-Natal, South Africa to manage public-sector HIV and AIDS patients. Objectives: To gauge the willingness of private-sector doctor to manage public-sector HIV and AIDS patients and to describe factors that may influence their responses. Method: A descriptive cross-sectional study was undertaken among private-sector doctors, both general practitioners (GPs) and specialists, working in the eThekwini Metro, using an anonymous, structured questionnaire to investigate their willingness to manage public-sector HIV and AIDS patients and the factors associated with their responses. Chi-square and independent t-tests were used to evaluate associations. Odds ratios were determined using a binary logistic regression model. A p value < 0.05 was considered statistically significant. Results: Most of the doctors were male GPs aged 30­50 years who had been in practice for more than 10 years. Of these, 133 (77.8%) were willing to manage public-sector HIV and AIDS patients, with 105 (78.9%) reporting adequate knowledge, 99 (74.4%) adequate time, and 83 (62.4%) adequate infrastructure. Of the 38 (22.2%) that were unwilling to manage these patients, more than 80% cited a lack of time, knowledge and infrastructure to manage them. Another reason cited by five doctors (3.8%) who were unwilling, was the distance from public-sector facilities. Of the 33 specialist doctors, 14 (42.4%) indicated that they would not be willing to manage public-sector HIV and AIDS patients, compared with only 24 (17.4%) of the 138 GPs (p < 0.01). Conclusion: Many private-sector doctors are willing to manage public-sector HIV and AIDS patients in the eThekwini Metro, potentially removing some of the current burden on the public health sector

Schistosomiasis and Water-Related Practices in School Girls in Rural Kwazulu-Natal; South Africa

Abstract:There is increasing evidence of an association between female genital Schistosoma haematobium infection and HIV. In KwaZulu-Natal; we aimed to explore girls' water contact practice and to determine whether a study exclusively on girls would be manageable and welcomed. Three primary schools that had participated in a parasite control programme eight years prior were approached. Subject to consent; girls aged 9 to 12 years were interviewed on water-body contact; symptoms and household composition. Urine samples were analysed for S. haematobium infection eggs. Good dialogue was achieved in all schools and 95 consented to had an S. haematobium infection; geometric mean intensity 10.5 ova per 10 ml urine. Only 12participation; 43 had ever been treated for S. haematobium. Water-body contact was significantly associated with S. haematobium (OR 2.8; 95 CI 1.3-5.9; p= 0.008); however; S. haematobium was also found in 20 of girls who claimed to never have had water-body contact. Sixty-four percent thought they had no choice but to use unprotected water; 21 had no mother in the household; and being an orphan increased the risk of having S. haematobium. The community welcomed the study. Prevalence levels in South Africa are so high that some communities are eligible for WHO-recommended regular mass treatment