Breastfeeding support practices in designated workplaces in the Breede Valley sub-district, Western Cape, South Africa

Background. Globally, mothers have identified employment as one of the leading barriers to exclusive and continued breastfeeding. The workplace and employment setting has been highlighted as one component of an enabling environment for breastfeeding.Objectives. To assess breastfeeding support practices in designated workplaces in the Breede Valley sub-district, Western Cape, South Africa.Methods. A quantitative, cross-sectional design study was used. An online survey was conducted amongst human resource managers and/or company managers to determine breastfeeding support practices in designated workplaces.Results. Fourteen participants completed the online survey. Breastfeeding support practices in designated workplaces were limited and inadequate, with few supportive breastfeeding practices. Onsite or nearby crèche facilities (n=2; 14.3%), breastfeeding counsellors (n=1; 7.1%), promotion of the benefits of breastfeeding to employees (n=2; 14.3%) and provision of private space for expressing (n=2; 14.3%) were not common practices. Workplace breastfeeding policies (n=4; 28.6%) were not common practice, and were mostly found in the public sector. Forty-three percent of workplaces (n=6; 42.9%) did not provide time for expressing at work.Conclusion. There is an urgent need to create advocacy regarding the benefits of breastfeeding support in the workplace for employers, employees and society as well as the breastfeeding rights of women in the workplace. The legislated breastfeeding break times need to be monitored to ensure better compliance in workplaces

What does an enabling environment for infant and young child nutrition look like at implementation level? Perspectives from a multi-stakeholder process in the Breede Valley Sub-District, Western Cape, South Africa.

BACKGROUND: Breede Valley is a sub-district of the Cape Winelands district, Western Cape Province, South Africa. The administrative capital of the district is situated in the semi-rural town Worcester. Findings of a baseline survey in Worcester revealed poor infant feeding practices and childhood under- and overnutrition, with particular concern over high levels of stunting and low dietary diversity. Maternal overweight and obesity was high. These characteristics made the site suitable to study multi-sectoral arrangements for infant and young child nutrition (IYCN). The purpose of this study was to explore elements of an enabling environment with key stakeholders aimed at improving IYCN at implementation level. METHODS: Focus group discussions and interviews were conducted with representatives from two vulnerable communities; local and district government; higher education institutions; business; and the media in the Breede Valley. Audio recordings were transcribed and data were analysed with the Atlas.TI software programme. RESULTS: The participants viewed knowledge and evidence about the first 1000 days of life as important to address IYCN. The impact of early, optimal nutrition on health and intellectual development resonated with them. The IYCN narrative in the Breede Valley could therefore be framed around nutrition's development impact in a well-structured advocacy campaign. Participants felt that capacity and resources were constrained by many competing agendas spreading public resources thinly, leaving limited scope for promotion and prevention activities. "People" were viewed as a resource, and building partnerships and relationships, could bridge some shortfalls in capacity. Conversations about politics and governance elicited strong opinions about what should be done through direct intervention, policy formulation and legislation. A lead government agency could not be identified for taking the IYCN agenda forward, due to its complexity. Participants proposed it should be referred to a local, informal, inter-governmental body where directors and senior managers meet to address issues of cross-cutting importance. CONCLUSION: The study illustrated that knowledge and evidence; politics and governance; and capacity and resources, elements of the international definition of an enabling environment, also apply at implementation level. In addition, our findings indicated that a people-centred approach is critical in shaping the enabling environment at this level.

Clinical features and outcome of lupus myocarditis in the Western Cape, South Africa.

BACKGROUND: African American ethnicity is independently associated with lupus myocarditis compared with other ethnic groups. In the mixed racial population of the Western Cape, South Africa, no data exists on the clinical features/outcome of lupus myocarditis. OBJECTIVES: The objective of this study was to give a comprehensive description of the clinical features and outcome of acute lupus myocarditis in a mixed racial population. METHODS: Clinical records (between 2008 and 2014) of adult systemic lupus erythematosus (SLE) patients at a tertiary referral centre were retrospectively screened for a clinical and echocardiographic diagnosis of lupus myocarditis. Clinical features, laboratory results, management and outcome were described. Echocardiographic images stored in a digital archive were reanalysed including global and regional left ventricular function. A poor outcome was defined as lupus myocarditis related mortality or final left ventricular ejection fraction (LVEF) <40%. RESULTS: Twenty-eight of 457 lupus patients (6.1%) met inclusion criteria: 92.9% were female and 89.3% were of mixed racial origin. Fifty-three per cent of patients presented within three months after being diagnosed with SLE. Seventy-five per cent had severely active disease (SLE disease activity index ≥ 12) and 67.9% of patients had concomitant lupus nephritis. Laboratory results included: lymphopenia (69%) and an increased aRNP (61.5%). Treatment included corticosteroids (96%) and cyclophosphamide (75%); 14% of patients required additional immunosuppression including rituximab. Diastolic dysfunction and regional wall motion abnormalities occurred in > 90% of patients. LVEF improved from 35% to 47% (p = 0.023) and wall motion score from 1.88 to 1.5 (p = 0.017) following treatment. Overall mortality was high (12/28): five patients (17.9%) died due to lupus myocarditis (bimodal pattern). Patients who died of lupus myocarditis had a longer duration of SLE (p = 0.045) and a lower absolute lymphocyte count (p = 0.041) at diagnosis. LVEF at diagnosis was lower in patients who died of lupus myocarditis (p = 0.099) and in those with a persistent LVEF < 40% (n = 5; p = 0.046). CONCLUSIONS: This is the largest reported series on lupus myocarditis. The mixed racial population had a similar prevalence, but higher mortality compared with other ethnic groups (internationally published literature). Patients typically presented with high SLE disease activity and the majority had concomitant lupus nephritis. Lymphopenia and low LVEF at presentation were of prognostic significance, associated with lupus myocarditis related mortality or a persistent LVEF < 40%.

Body composition of rheumatoid arthritis patients in the City of Cape Town, South Africa.

Patients with rheumatoid arthritis (RA) tend to have a poor nutritional status. This study aimed to gather information on body composition in patients with RA in private and public health settings in the City of Cape Town, South Africa (SA). This cross-sectional study evaluated adults with RA. Information on demographics, comorbidities and medication was gathered. Anthropometrical measurements included weight, height, waist circumference and skinfolds and were used to calculate, interpret and classify body mass index (BMI), percentage body fat, waist circumference, fat mass index (FMI) and fat-free mass index (FFMI). Ethics approval for the execution of the study was obtained from the Health Research Ethics Committee of Stellenbosch University. The study included 251 participants [mean age, 54.7 years; ±standard deviation (SD) 13.6]. The mean BMI was 30.3 kg/m(2) (±SD 6.7) and 26.6 kg/m(2) (±SD 6.1) for women and men, respectively. BMI was used to classify obesity (45.9 %), overweight (26.8 %), normal weight (25.6 %) and underweight (1.6 %). Waist circumference classifications showed a substantially increased risk for metabolic complications in 127 participants (51.8 %) and an increased risk in 52 participants (21.2 %). Low fat-free mass (FFMI of <10th percentile) was seen in 24 participants (21 %), and obesity (FMI of >90th percentile) was seen in 31 (27 %). Rheumatoid cachexia was identified in 12 participants (10.3 %). Results indicate suboptimal nutritional status in patients with RA in the current setting. It highlights the importance of involving dietitians in the management of RA, with a view to reduce symptoms, improve quality of life, prevent cardiovascular disease and decrease overall medical costs.

Isomerization of the double bonds of a conjugated fatty acid during beta-oxidation.

The beta-oxidation of an unsaturated fatty acid containing conjugated double bonds at odd-numbered carbon atoms has not previously been studied. It is, therefore, not clear whether, during the beta-oxidation of such an acid, the double bonds will be isomerized by enoyl-CoA isomerase (delta 3 - delta 2-enoyl-CoA isomerase) with the loss or retention of its conjugated nature. To investigate the problem, (E,E)-3,5-octadienoyl-CoA was synthesized for use as a model substrate, and enoyl-CoA isomerase was partially purified from bovine liver. The isomerization was followed by spectrophotometric and gas liquid chromatographic methods, and the results suggested that the isomerization of the model substrate proceeded with retention of a conjugated double bond system. It is, therefore, proposed that the beta-oxidation intermediate of alpha-eleostearic acid (delta 9,11,13 fatty acid) will also isomerize with retention of the conjugated double bond system.