Field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines amongst mothers/caregivers of children aged 0–12 months in the Breede Valley sub-district, Western Cape province, South Africa

Objectives: To assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–12 months. Exposure to guidelines with similar messages, barriers and enablers to following of the guidelines were also assessed. Design: Qualitative data were collected from 14 focus-group discussions (FGDs), conducted in isiXhosa (n = 5), English (n = 4) and Afrikaans (n = 5), totalling 73 mother/caregiver participants. Setting: Worcester, Breede Valley sub-district, Western Cape province. Subjects: The study population included mothers/caregivers who were older than 18 years. Results: The majority of participants had previous exposure to variations of messages similar to the revised, draft SA-PFBDGs. Health platforms and practitioners (community health centres, antenatal classes, nurses, doctors) and social networks and platforms (family, magazines, radio) were mentioned as primary sources of information. Barriers to following the messages included: inconsistent messages (mainly communicated by healthcare workers), contrasting beliefs and cultural/family practices, limited physical and financial access to resources, poor social support structures and the psycho-social and physical demands of raising a child. Conclusion: The revised, draft SA-PFBDGs for the age range 0–12 months have been field-tested in English, Afrikaans and isiXhosa. The messages in some of the revised, draft SA-PFBDGs were not understood by the participants, indicating that a degree of rewording should be considered to facilitate understanding of the guidelines by the public. The National Department of Health should consider the findings of this study, and use these standardised message/s to optimise infant and young child feeding

Field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines amongst mothers/caregivers of children aged 0–12 months in the Breede Valley sub-district, Western Cape province, South Africa

Objectives: To assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) amongst mothers/caregivers of children aged 0–12 months. Exposure to guidelines with similar messages, barriers and enablers to following of the guidelines were also assessed. Design: Qualitative data were collected from 14 focus-group discussions (FGDs), conducted in isiXhosa (n = 5), English (n = 4) and Afrikaans (n = 5), totalling 73 mother/caregiver participants. Setting: Worcester, Breede Valley sub-district, Western Cape province. Subjects: The study population included mothers/caregivers who were older than 18 years. Results: The majority of participants had previous exposure to variations of messages similar to the revised, draft SA-PFBDGs. Health platforms and practitioners (community health centres, antenatal classes, nurses, doctors) and social networks and platforms (family, magazines, radio) were mentioned as primary sources of information. Barriers to following the messages included: inconsistent messages (mainly communicated by healthcare workers), contrasting beliefs and cultural/family practices, limited physical and financial access to resources, poor social support structures and the psycho-social and physical demands of raising a child. Conclusion: The revised, draft SA-PFBDGs for the age range 0–12 months have been field-tested in English, Afrikaans and isiXhosa. The messages in some of the revised, draft SA-PFBDGs were not understood by the participants, indicating that a degree of rewording should be considered to facilitate understanding of the guidelines by the public. The National Department of Health should consider the findings of this study, and use these standardised messages to optimise infant and young child feeding

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa