Ten years of major equestrian injury: are we addressing functional outcomes?

YesFunding provided by the Open Access Authors Fund

Effect of Duration and Intermittency of Rifampin on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis

In a systematic review of randomized controlled trials on tuberculosis treatment, Dick Menzies and colleagues find shorter courses of rifampin to be associated with poorer treatment outcomes

Report from the Annual Conference of the British Society of Echocardiography, November 2017, Edinburgh International Conference Centre, Edinburgh

No abstract available

Global Health Initiatives to Reduce Malaria Morbidity in School-aged Children

Background: To review global initiatives to reduce the burden of disease from malaria on school-aged children. The focus is on approaches with potential to reduce mortality and morbidity, improve the health and ability of children to attend school, avoid malaria impacting their potential academic achievement, and minimize the risk of short- and long-term cognitive impairment. Methods: Literature searches using defined terms related to malaria and education, and a scoping review of the key literature selected, to provide a narrative summary of the challenges and potential solutions identified. Results: There is robust evidence that school-aged children are particularly vulnerable to malaria, and need special measures to protect them; calls are widespread for better diagnostic approaches and program innovation because of current levels of malaria-related morbidity and mortality. School-based programs that educate children broadly on causation, prevention and care required can improve access to timely diagnosis and treatment; however, currently national malaria control interventions do not specifically target school-age children. The literature describes intervention strategies that include seasonal chemoprophylaxis, intermittent protective treatment and antimalarial therapy linked to mass drug administration for neglected tropical diseases. Recently, a community participatory intervention model based on WHO-endorsed diagnostic and treatment principles has taught teachers to screen all children sick at school using rapid point-of-care diagnostic testing and treat promptly with Artemesinin combination therapy; morbidity and absenteeism are significantly reduced. There is no consensus on the optimal intervention strategy; approaches will need to vary, but evidence of ‘what works and why’ exists to guide constructive implementation measures in each endemic region. Conclusion: Malaria exemplifies how health inequity negatively impacts a child’s health and ability to benefit from education, yet simple and effective school-based approaches exist that positively impact morbidity, provide access to WHO-endorsed diagnosis and treatment, are applicable worldwide and can increase the capacity of children to learn. Keywords: Absenteeism; Artemesinin Combination Therapy; Cognitive Impairment; Intermitient Protective Treatment; Rapid Diagnostic Testing; Seasonal Malaria Chemoprophylaxis; Teachers Received: 14 May 2020 Reviewed: 14 June 2020 Revised: 28 June 2020 Accepted: 28 June 2020 DOI: 10.35898/ghmj-41578

School-based initiatives to reduce malaria morbidity and promote academic achievement in children

CITATION: Macnab, A. J. 2020. School-based initiatives to reduce malaria morbidity and promote academic achievement in children, in Macnab, A., Daar, A. & Pauw, C. 2020. Health in transition : translating developmental origins of health and disease science to improve future health in Africa. Stellenbosch: SUN PReSS, doi:10.18820/9781928357759/14.The original publication is available at https://africansunmedia.store.it.si/zaIn sub-Saharan Africa, the challenge of addressing illnesses related to the developmental origins of health and disease (DOHaD) is compounded by other determinants of health, most notably the impact of poverty and infectious disease. Research has identified social factors to be the root cause of inequities in health that involve both non-communicable and infectious diseases, hence the calls for remedial action to involve social and treatment strategies. There is a recognised need for school programmes to educate the next generation about DOHaD, so that young people gain a measure of ‘health independence’ through learned knowledge, acquired skills and positive behaviours with the potential to improve the future health of their offspring. However, this goal is at risk when other adverse social determinants of health exist, and especially where infectious diseases are endemic, and morbidity from infection among school children is high. In sub-Saharan Africa, for example, malaria is the principal reason a child will be absent from school. How long a child is absent is a well-accepted measure of the severity of morbidity from malaria. Such absences can be of long duration, and associated residual cognitive compromise can compound the negative impact of malaria on a child’s ability to learn. For this reason, school-based strategies to advance knowledge about DOHaD in sub-Saharan Africa will benefit where school-based programmes addressing malaria are offered in parallel. A variety of educational approaches able to advance knowledge and provide practical skills related to DOHaD lend themselves to parallel programmes. For example, programmes can follow policies to advance the United Nations (UN)’ ‘Sustainable Development Goals’, adopt global strategies to promote the education of girls and implement the World Health Organization (WHO)’s ‘Health-Promoting School’ model. Malaria morbidity exemplifies how health inequity can negatively impact a child’s ability to benefit from education. However, simple and effective school-based approaches exist that can positively impact morbidity, provide access to diagnostic and treatment services, reduce absence due to illness and increase the capacity of large numbers of children to learn. This chapter reviews global efforts to reduce the impact of malaria on children's health, improve their ability to attend school, enhance their potential for academic achievement and minimise their risk of cognitive impairment. It also describes a successful and inexpensive community participatory intervention model based on WHO-endorsed diagnostic and treatment principles, that also follows the 2017 Lancet Commission’s current recommendations on the future of health in sub- Saharan Africa to use ‘non-traditional outlets’, ‘people-centred approaches’ and ‘improved tools’ to address health challenges. This model is suitable for use in schools worldwide where malaria is endemic and can be offered in parallel with school-based strategies to engage youth in the context of the DOHaD agenda.Publisher's versio

Teach your children well

This perspective looks at the importance of providing parents with the information they need to make informed decisions about their children’s health, and particularly of encouraging parents to teach their children health-related practices that help prevent illness and injury; it is the viewpoint of a grandparent who is also a children’s doctor. Keywords: Perspectives, Parents, Children's Health, Health Practices Received: 7 May 2019; Reviewed: 13 June 2019; Revised: 14 June 2019; Accepted: 19 June 2019 DOI: 10.35898/ghmj-32547

PROMOTING FUTURE HEALTH. Why are our children and what they learn in school so important?

This conference celebrates advances in applied science and health research intended to benefit all sections of society, from the very young to the very old. This is the nature and strength of research inquiry. Each of us brings our own interests, expertise and experience to the research we do, and as a children’s doctor my focus in naturally on the health and future wellbeing of children. However, there are compelling practical and scientific reasons why children should be the focus for much health sciences research. And one of these is the strong economic argument that governments should invest in children as they are the future of our society, and the benefits from initiatives that improve their health will last throughout their lifetime. Often a strong economic argument is the best way to translate your research into a practical reality. Some of the best examples come from injury prevention where, because of an intervention, the cost to society of long term handicap is avoided. And now research indicates that intervening with children and young people to prevent chronic non-communicable diseases (NCDs), like Type 2 diabetes, coronary artery disease, high blood pressure and stroke, can have strong health and economic benefits. Treatment of NCDs in adult life is placing a huge financial burden on most countries. This area of research is called the Developmental Origins of Health and Disease (DOHaD); and it provides compelling evidence that fetal wellbeing in utero and growth and nutrition during infancy determine in large part, whether or not an individual goes on to develop a NCD in adult life. However, an obvious challenge for intervening with DOHaD-derived prevention strategies is how to engage and educate the ‘at risk’ population in a way that promotes healthy behaviors. Because effective intervention requires that fetal micronutrient provision and growth throughout pregnancy are optimal, and care and nutrition during infancy sustains normal growth, there is an implicit requirement that young people are engaged. Traditionally, youth are not a sub-set of the population who prioritize or even seriously consider their future health or that of their potential partners, let alone their offspring. Yet to reduce the burden of NCDs, children need to learn the facts necessary to adopt healthy behaviors before they become pregnant and give birth to children of their own.  The WHO Health Promoting School (HPS) model has proven success engaging youth in the context of improving health, disseminating knowledge effectively and positively impacting future behaviors, particularly in low resource settings. The HPS model is flexible, based on a process of community engagement, and represents an avenue for health promotion aimed at impacting a range of health and lifestyle issues; so it is promising as a way to begin youth engagement regarding the DOHaD agenda. Schools provide the most efficient and effective way to reach large portions of the population, and WHO now recommends HPS strategies in low and middle income countries, as the burden of disease, disability and premature death is disproportionately high, and many of the causes are preventable. There  are many examples of how imaginative school-based programs have successfully improved health issues that range from poor oral health, through loss of school due to malaria, to promoting condom use and knowledge about HIV. Challenges exist worldwide over how to educate the next generation in the context of health. Using school-based programs offers a flexible and inexpensive avenue. With informed political action, broad participation and inspired advocacy, initiatives that share ‘knowledge’ and teach ‘healthy practices’ using the WHO HPS model have great potential to offer

The World Health Organization's 'Health-promoting School' model: a potential avenue for developmental origins of health and disease education in Africa

CITATION: Macnab, A. J. 2020. The World Health Organization's 'Health-promoting School' model: a potential avenue for developmental origins of health and disease education in Africa, in Macnab, A., Daar, A. & Pauw, C. 2020. Health in transition : translating developmental origins of health and disease science to improve future health in Africa. Stellenbosch: SUN PReSS, doi:10.18820/9781928357759/12.The original publication is available at https://africansunmedia.store.it.si/zaTraditional health care strategies to manage illness are based on the tenets of prevention and cure. Health promotion is an urgent matter from both a health and economic standpoint, as most non-communicable diseases cannot be cured, and the future costs of management are prohibitive. Hence, a new focus on prevention involving youth has been widely called for, including by the Cape Town Manifesto.2 This chapter reviews the challenge and opportunities of engaging youth in health promotion related to the developmental origins of health and disease (DOHaD) agenda. It explores the potential for using the World Health Organization (WHO)’s ‘Health-Promoting School’ model as part of health initiatives in Africa to promote the adoption of a DOHaD related health agenda. At a societal level, effective disease prevention must often rely on the application of new science and technological innovation, plus legislation to dictate change. However, at an individual level, alterations in health behaviours are required to contain the epidemic of DOHaD-related non-communicable diseases, which can only be achieved through learning and increased awareness driving attitudinal change. The challenge facing DOHaD related health promotion is how we, as a society, can disseminate valid information widely and frame compelling arguments to engage and motivate individuals to improve their health and change their behaviours. The nature of DOHaD also predicates that the most fertile place to invest in prevention and health improvement strategies is the next generation. The WHO estimates are that school-based health promotion has the potential to reach one billion children worldwide. Health-Promoting School programmes are a proven means of providing children with the knowledge and practical ways to improve their health and have been shown to positively impact a range of specific health issues and health behaviours. Importantly in the context of Africa, the integrated educational approach used in Health-Promoting School has proved to be applicable and beneficial even in low- and middle-income settings. Significantly in the context of prevention, children who participate in good Health-Promoting School programmes have been shown to develop improved resilience, self-esteem and self-efficacy; traits recognised to engender a greater desire and increased ability to exercise control over their lives, and characteristics all likely relevant to advancing the DOHaD agenda.Publisher's versio

Celebrity health promotion messaging : novel opportunities to engage youth in the developmental origins of health and disease

CITATION: Macnab, A. J. & Mukisa, R. 2020. Celebrity health promotion messaging : novel opportunities to engage youth in the developmental origins of health and disease, in Macnab, A., Daar, A. & Pauw, C. 2020. Health in transition : translating developmental origins of health and disease science to improve future health in Africa. Stellenbosch: SUN PReSS, doi:10.18820/9781928357759/16.The original publication is available at https://africansunmedia.store.it.si/zaThis chapter is a personal view seen from disparate viewpoints of age and culture. Two proponents of health promotion, one a Ugandan youth with firsthand experience of the burden of illness among African children and the other a Canadian academic with a lifetime spent treating sick children, speak to the place and potential of celebrity in the promotion of health among youth. Since 2011, school-based health promotion programmes conceived at the Stellenbosch Institute for Advanced Study (STIAS) have been introduced into many communities in Uganda. These initiatives are seen as an example of innovative health promotion with the potential to give the next generation health knowledge and skills that will translate into an important measure of ‘health independence’ for them in their future lives. A regular component of these programmes enables schools to introduce new topics through teacher-guided in-class discussions about health; in this way, pupils were introduced to elements of the developmental origins of health and disease (DOHaD) agenda, and then asked to discuss which ‘messages’ they saw as most relevant to them, and which ‘messengers’ could deliver these messages with the greatest impact. Amongst the messengers, celebrities were identified as particularly influential; young people said they would listen to what a celebrity said about health, lifestyle and behaviour. Expanding on these discussions, pupils quoted health and lifestyle messaging that they already knew from listening to celebrity-recorded music videos. Here we describe examples, from a Ugandan perspective, of this form of celebrityendorsed health messaging contained in music videos; these are the songs young people told us they listened to and knew the promotional messages they contain. National music celebrities, whom these young people identify with, have recorded a variety of videos with content advocating specific health behaviours, endorsing physical, emotional or spiritual health and calling for individual and collective action to address challenges such as maternal deaths related to childbirth and infant mortality. Some artists even raise awareness of difficult but very important social issues such as gender inequity, sexual harassment and domestic violence through their music. Music videos resonate with youth, and celebrity recordings appeal as they combine young people’s love of music with their fascination of the aura of celebrity. We review the production concepts, content and messaging that make these celebrity music videos particularly powerful, and also suggest future directions where the engagement of celebrity messengers could offer a conduit for innovative delivery of DOHaD-related messages, and an effective way to impart knowledge and impact health behaviours among youth.Publisher's versio