Integrating immunization services into nutrition sites to improve immunization status of internally displaced persons' children living in Bentiu protection of civilian site, South Sudan

Introduction: the protracted war in South Sudan has led to severe humanitarian crisis with high level of malnutrition and disruption of the health systems with continuous displacement of the population and low immunization coverage predisposing the population to vaccine preventable diseases. The study aimed at evaluating the effect of integrating immunization services with already established nutrition services on immunization coverage in resource-constrained humanitarian response.Methods: a community and health facility based interventional study involving integration of immunization into nutrition services in two Outpatient Therapeutic Program(OTP)centers in Bentiu PoC between January-December 2017. The main hypothesis was that inclusion of immunization services during nutrition services both at the OTP and community outreaches be an effective strategy for reducing missed opportunity for immunizing all eligible children accessing nutrition services. Data analyzed using STATA version 15 and bivariate analysis using logistic regression was conducted to identify predictor of missed vaccinations.Results: integration of immunization into the nutrition services through the OTP centres increased the number of children immunized with various antigens and the dropout rate was much lower and statistically significant among children who received immunization at the OTP centers than those in the Primary Health Care Centers (PHC Centers) in the study sites. Children who were vaccinated at the OTP centre in sector 2 were 45% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.45; 95%CI:0.36- 0.55), p<0.05 while those vaccinated at the OTP sector in sector 5 were 27% less likely to miss vaccination than those vaccinated at the PHCC (OR: 0.27; 95%CI: 0.20 -0.35) p<0.05).Conclusion: this study indicated that immunization coverage improved effectively with integration with nutrition services as a model of an integrated immunization programme for child health in line with the Integrated Management of Childhood Illnesses (IMCI) and the Global Immunization Vision and Strategy (GIV)

Evaluation of Selected Aspects of the Nutrition Therapeutic Programme offered to HIV-Positive Women of Child-Bearing Age in Western Cape Province; South Africa

Background: The Nutrition Therapeutic Programme (NTP) involves the provision of food supplements at primary health clinics (PHCs) to correct nutritional deficiencies in vulnerable groups. Although previous studies have identified problems with implementing the programme at PHCs; assessments of its efficiency have been scarce.Objective: To evaluate implementation of the NTP at PHCs that provide antiretroviral therapy.Methods: A cross-sectional; descriptive study was conducted at 17 PHCs located within 3 districts of Western Cape Province. Two target groups were chosen: 32 staff members working at the sites and 21 women of child-bearing age enrolled in the NTP. Questionnaires were used to obtain data.Results: Only 2 women (10%) lived in food-secure households; the rest were either at risk of hunger (29%) or classified as hungry (61%). Most of the women knew they had to take the supplements to improve their nutritional status; but the majority only recalled receiving basic nutritional advice; and the information was mainly given verbally. Ten of the women had shared their supplements with others; mostly with their children. The study identified lack of clearly defined NTP responsibilities at the PHCs; causing confusion amongst the staff. Although many staff members expressed problems with the NTP; only 38% of them reported having routine evaluations regarding the programme.Conclusion: Several aspects compromised the effectiveness of the NTP; including socio- economic factors leading to clients' non-compliance. The strategic organisation and implementation of the NTP varied between different PHCs offering antiretroviral therapy; and staff experienced difficulties with the logistics of the programme

Nutritional Management of the Burn Patient

The incidence of burn injuries is on the increase in Africa due to migration to urban areas and the development of slum areas; but there is a paucity of such data on the African continent. The South African Medical Research Council has indicated that 3.2of the South African population is burned annually; with 50of individuals who suffer burns being younger than 20 years. The Red Cross Children's Hospital admits 650 to 900 children with burn injuries annually.1 Burn injury; the most severe type of injury from a metabolic point of view; is characterised by the most profound alterations in basal metabolic rate and urinary nitrogen excretion. In addition; requirements for and/or metabolism of macro- and micronutrients are altered or increased. The major improvement in burn survival can be attributed to many factors; one being the development and implementation of improved methods of nutritional support that optimise host defences; enhance wound healing and support the metabolic response to stress.2 The greatest threats to survival from burns are still infection/sepsis; with burn wound sepsis and nosocomial pneumonia; including ventilatorassociated pneumonia (VAP); being the leading causes of death.2;3 Effective medical nutrition therapy in patients with burn injuries requires an understanding of the physiologic and metabolic alterations that accompany the burn injury; alterations in the immune system and the role of reactive oxygen species (ROS)