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1.
BMJ Open ; 10(10): e034770, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109638

RESUMO

OBJECTIVES: We report the effectiveness of a mentoring approach to improve health workers' (HWs') knowledge, attitudes and confidence with counselling on HIV and infant feeding. DESIGN: Quasi-experimental controlled before-after study. SETTING: Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa. PARTICIPANTS: All HWs providing infant feeding counselling in selected facilities were invited. INTERVENTIONS: Three 1-2 hours, on-site workshops over 3-6 weeks. PRIMARY OUTCOME MEASURES: Knowledge (22 binary questions), attitude (21 questions-5-point Likert Scale) and confidence (19 questions-3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison groups postintervention, adjusting for the mean score difference between them at baseline. Analyses were adjusted for participant baseline characteristics and clustering at health facility level. RESULTS: In intervention and comparison sites, respectively: 289 and 131 baseline and 253 and 114 follow-up interviews were conducted (August-December 2017). At baseline there was no difference in mean number of correctly answered knowledge questions; this differed significantly at follow-up (15.2 in comparison; 17.2 in intervention sites (p<0.001)). At follow-up, the mean attitude and confidence scores towards breast feeding were better in intervention versus comparison sites (p<0.001 and p=0.05, respectively). Controlling for confounders, interactions between time and intervention group and preintervention values, the attitude score was 5.1 points significantly higher in intervention versus comparison groups. CONCLUSION: A participatory, low-intensity on-site mentoring approach to disseminating updated infant feeding guidelines improved HWs' knowledge, attitudes and confidence more than standard dissemination via a circular. Further research is required to evaluate the effectiveness, feasibility and sustainability of this approach at scale.


Assuntos
Infecções por HIV , Tutoria , Estudos Controlados Antes e Depois , Aconselhamento , Feminino , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , África do Sul
2.
BMJ Open ; 6(9): e012154, 2016 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-27633638

RESUMO

INTRODUCTION: Lower respiratory infections (LRIs) and pneumonia are among the leading causes of death worldwide, especially in children aged under 5 years, and these patterns are reflected in the South African population. Local epidemiological data for LRIs and pneumonia are required to inform the Second National Burden of Disease Study underway in South Africa. The aim of this systematic review is to identify published studies reporting the prevalence, incidence, case fatality, duration or severity of LRI and pneumonia in adults and children in South Africa. METHODS AND ANALYSIS: Electronic database searches will be conducted to obtain studies reporting on the prevalence, incidence, case fatality, duration and severity of LRI and pneumonia in South Africa between January 1997 and December 2015. Studies that are assessed to have moderate or low risk of bias will be included in a meta-analysis, if appropriate. Where meta-analysis is not possible, the articles will be described narratively. Subgroup analysis (eg, age groups) will also be conducted where enough information is available. ETHICS AND DISSEMINATION: This systematic review will only include published data with no linked patient-level information; thus, no ethics approval is required. The findings will be used to calculate the burden of disease attributed to LRI and pneumonia in South Africa and will highlight the type of epidemiological data available in the country. The article will be disseminated in a peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42016036520.


Assuntos
Pneumonia/epidemiologia , Infecções Respiratórias/epidemiologia , Humanos , Incidência , Pneumonia/mortalidade , Prevalência , Projetos de Pesquisa , Infecções Respiratórias/mortalidade , África do Sul/epidemiologia , Revisões Sistemáticas como Assunto
3.
Trop Med Int Health ; 21(9): 1060-70, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27314457

RESUMO

OBJECTIVE: To present evidence from available reliable published data on the prevalence, incidence and severity of diarrhoea in children aged under five years in South Africa. METHODS: We searched seven electronic databases. Two reviewers assessed the studies independently and extracted outcome data. The heterogeneity of the studies did not allow for a meta-analysis. RESULTS: We found only one nationally representative study conducted in 1998 reporting a diarrhoea prevalence of 13% in children under five. Other studies were conducted in smaller settings across the country. Diarrhoea incidence was 10.13 per 1000 person years in children admitted to a tertiary hospital. Three studies reported severity of diarrhoea; however, they differed across study settings and time period. CONCLUSION: The paucity of nationally representative prevalence data for SA necessitates more national surveys with standardised data-collection methods to allow for more effective comparisons.


Assuntos
Diarreia/epidemiologia , Pré-Escolar , Desidratação/epidemiologia , Desidratação/etiologia , Diarreia/complicações , Humanos , Lactente , Índice de Gravidade de Doença , África do Sul/epidemiologia
4.
Public Health Nutr ; 13(9): 1314-8, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20338085

RESUMO

OBJECTIVE: To obtain baseline pre-intervention prevalence levels of iodine deficiency and parasitic and helminth infections in school-going children in Bie Province, Angola. DESIGN: A cross-sectional study conducted in randomly selected schools. The target population was children aged 6-10 years. SETTING: Bie Province, Angola. SUBJECTS: A total of 1029 children sampled, with 791 stool samples and 826 urine samples collected from twenty-four schools. RESULTS: Widespread severe and moderate deficiencies in iodine. Children in five schools were severely iodine deficient. All sampled schoolchildren were iodine deficient to a greater or lesser extent. In all, 80 % of all children across the twenty-four schools were infected with one or a combination of intestinal helminths and intestinal protozoa. CONCLUSIONS: These findings have serious implications for the cognitive development of Angolan children, as well as for Angola's development in terms of productivity and economic potential. It is strongly recommended that the provincial and national Ministries of Health, in collaboration with international health agencies, immediately plan and implement a strategy to provide sufficient iodine through iodised oil capsules and iodised salt to the iodine-deficient population. National coalitions need to be strengthened among the government, partners and salt producers. It is also recommended that all the children in schools be de-wormed for multiple helminth species at least twice a year.


Assuntos
Anti-Helmínticos/administração & dosagem , Helmintíase/epidemiologia , Enteropatias Parasitárias/epidemiologia , Iodo/administração & dosagem , Iodo/deficiência , Angola/epidemiologia , Criança , Fenômenos Fisiológicos da Nutrição Infantil/fisiologia , Estudos Transversais , Suplementos Nutricionais , Fezes/parasitologia , Feminino , Helmintíase/prevenção & controle , Humanos , Enteropatias Parasitárias/prevenção & controle , Iodo/urina , Óleo Iodado/administração & dosagem , Masculino , Saúde Pública , Cloreto de Sódio na Dieta/administração & dosagem , Urina/química
5.
Matern Child Nutr ; 3(4): 251-8, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17824853

RESUMO

Existing dietary recommendations and nutrition counselling provided to mothers/caregivers at primary healthcare (PHC) facilities are reviewed and analysed to be consistent with food-based dietary guidelines (FBDGs) that are being developed for preschool children. Recommendations provided by the Integrated Management of Childhood Illness and the provincial Paediatric Case Management Guidelines, which are currently implemented at PHC facilities were reviewed. For FBDGs to be consistent with nutrition counselling that is provided to mothers/caregivers at these facilities, various principles need to be promoted. These include among others, exclusive and on-demand breastfeeding in the HIV-negative mother; exclusive breastfeeding with abrupt cessation preferably at 6 months or exclusive, safe and adequate formula feeding in the HIV-infected mother; the introduction of complementary feeds in all infants at 6 months; the provision of energy-dense and micronutrient-enriched (particularly, iron, zinc, calcium and vitamin A) complementary feeds; frequent visits to the healthcare facility; and physical activity aimed at encouraging a healthy lifestyle and preventing overweight and obesity in childhood. The FBDGs should be incorporated into nutrition and child health programmes and be reviewed and modified regularly.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Ciências da Nutrição Infantil/educação , Promoção da Saúde/métodos , Política Nutricional , Desmame , Aleitamento Materno , Cuidadores/educação , Cuidadores/psicologia , Criança , Transtornos da Nutrição Infantil/terapia , Pré-Escolar , Qualidade de Produtos para o Consumidor , Feminino , Humanos , Lactente , Masculino , Mães/educação , Mães/psicologia , Valor Nutritivo , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , África do Sul
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