Recent advances in the human microbiome - review

The human gut microbiome can be considered a 'new' internal organ, with a metabolic capacity exceeding that of the liver, or our primary connection to the environment, linking us to the world's ecology. The density of microbes within the colon is one of the highest in nature, and it is estimated that the number of microbes within our gut match or exceed that of our host human cell count, whilst their genetic machinery outnumbers our own by 100:1. This helps explain the remarkable new findings that show our microbiome not only affects the health and function of our intestines, but also has a strong influence on general body health through its close interaction with the gut immune system and through its production of bioactive metabolites that are absorbed and affect distant organ function. A state of dysbiosis can occur when its food source, fiberrich foods, becomes depleted and when oral antibiotics are used. Dysbiosis has been linked to an increasing list of human diseases, and in particular to 'westernized' diseases, such as colon cancer, allergy, diabetes, obesity, inflammatory bowel disease, and atherosclerosis, which pose the major threat to healthcare in the USA today

Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa

Background: Age-specific health promotion messages appear in the Road-to-Health-Booklet, an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit.Objective: This investigation, part of a larger Road-to-Health-Booklet survey, assessed the implementation of health promotion messages and identified barriers to its successful implementation.Methods: A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary health care facilities. Information was obtained through questionnaires; direct observation of consultations and recording of health promotion material in facilities.Results: In total, 2442 children (0-36 months; mean age 6.26 ± 6.24 months.); 2481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% completing Grade 12. Healthcare workers had a median of five years (0.5 - 37.0 years) work experience in primary health care. All healthcare workers indicated that health promotion messages are important, however, messages were only conveyed in 51% of consultations observed. If communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers.Various forms of health promotion material were available in facilities.Conclusions: Sub-optimal implementation of the health promotion messages in the Road-to-Health-Booklet are apparent despite healthcare workers realising the importance of health promotion.Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and supported by society to promote child health and care

Assessing the utilization of a child health monitoring tool

Objective: The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the Road-to-Health Booklet. Caregivers and health care workers knowledge, attitudes and practices were investigated as well as health care workers perceptions of barriers undermining implementation.Methods: A cross-sectional descriptive study was conducted on a proportional sample of randomly selected Primary Health Care facilities across six health districts (35%; n=143) in the Western Cape Province. Health care workers involved in the implementation of the Road-to-Health Booklet, children (0-36 months) and CGs were included. Information was obtained through scrutiny of the Road-to-Health Booklet, observation of consultations and structured questionnaires.Results: A total of 2442 children, 2481 caregivers and 270 health care workers were recruited. Weight (94.7%) measurements were performed routinely. Less than half (40.2%) of caregivers reported that their child's growth was explained. Sixty-eight percent of health care workers correctly identified criteria for underweight, whereas only 55% and 39% could do so for stunting and wasting respectively. Road-to-Health Booklet sections were completed adequately for immunization (89.3%), vitamin A supplementation (94.6%) but not for deworming (48.8%). Most health care workers (94%) knew the correct regimes for vitamin A supplementation and deworming, but few caregivers knew when treatment was due for vitamin A supplementation (16.4%) and deworming (26.2%). Potential barriers identified related to inadequate training, staff shortages and limited time.Conclusion: Focussed effort and resources should be channelled towards health care workers training and monitoring regarding growth monitoring and promotion to optimize utilization of the Road-to-Health Booklet. Mobilisation of community health workers is needed to strengthen community awareness of preventative health interventions

Probiotics; with Special Emphasis on their Role in the Management of Irritable Bowel Syndrome

Probiotics are live microorganisms; and when administered in adequate amounts; bestow beneficial effects on the host. The therapeutic and preventative application of probiotics in several disorders is receiving increasing attention; and this is especially true when gastrointestinal microbiota is thought to be involved in their pathogenesis; as in irritable bowel syndrome (IBS). Given the increasingly widespread use of probiotics; a thorough understanding of their risks and benefits is important. The purpose of this review is to update healthcare professionals on current probiotic information; and provide an overview of probiotic treatment approaches; with special emphasis on IBS

Malabsorption: Causes; Consequences; Diagnosis and Treatment

Malabsorption generally refers to the alterations of the gastrointestinal tract affecting the digestion; absorption and transport of nutrients across the bowel wall. In this article the causes; diagnostic tests and appropriate treatment options will be discussed by differentiating between premucosal; mucosal and postmucosal aberrations