Children caught in the long shadow of COVID-19

Despite the more transmissible delta variant being associated with higher rates of COVID-19 in unvaccinated adolescents, children have remained relatively spared from severe disease. Nevertheless, children are indirectly affected by the COVID-19 pandemic, which threatens to have far-reaching consequences. The effect of disruptions of seasonal patterns of circulation of respiratory pathogens on future immunity against such pathogens, childhood immunization programmes, and HIV and tuberculosis treatment programmes poses a threat to the future wellbeing of children. Furthermore, the economic devastation caused by the pandemic, including an increase in unemployment, gives rise to numerous challenges, such as food insecurity, which is likely to worsen childhood nutritional status. Also, COVID-19 has ongoing effects on the mental wellbeing of children, driven in part by the interruption of schooling and other opportunities to socialize. An increase in psychological illnesses has manifested in children consequent to the stresses of the pandemic, lockdowns, caregiver deaths. In this article, we highlight the indirect effects of COVID-19 on children, and suggest solutions to mitigate against the long-term sequelae. A focused health, nutrition, education and child protection response is required from government and healthcare practitioners to safeguard the health and wellbeing of South African children.

Infant Feeding Practices in a High HIV Prevalence Rural District of KwaZulu-Natal; South Africa

Aim: To describe infant feeding practices at birth and at 14 weeks post-partum in the Ugu-North Health District; KwaZulu-Natal; South Africa. Methods: A prospective; cohort study design was used. Mothers who delivered over a one-month period were interviewed at birth and 14 weeks later. Results: Initially; 168 mothers were interviewed within 24 hours of delivery; of whom 117 (70) were contactable at 14 weeks post-partum. The vast majority (96) initiated breast-feeding at birth. At birth; less than one-third (55/168 [32.7]) of mothers declared an intention to both breast and formula (mix) feed in the next 14 weeks; but by the 14th week post-partum over three-quarters (89/117 [76.1]) actually practised mixed feeding. At 14 weeks; the prevalence of exclusive breast-feeding was 18: 52of infants were offered water and 73solids. The majority (20/23 [87]) of HIV infected mothers chose to breastfeed their infants at birth. Nevertheless; they were significantly more likely to formula feed their infants compared to HIV negative mothers (3/23 [13.0] vs 2/145 [1.4]; OR 10.73; 95CI 1.34 - 99.16; p = 0.02). By 14 weeks; only 11of HIV positive mothers were still exclusively breast-feeding; while almost two-thirds (12/19 [63]) practised mixed feeding. This change was mainly ascribed to their need to return to school (40) or to work (20). Conclusions: Most infants were fed inappropriately by 14 weeks of age. The failure to maintain exclusive breast-feeding; despite high initiation rates; is of greatest concern. Routine prevention of mother-to-child transmission of HIV services was ineffective in influencing mothers to follow any feeding regimen exclusively