Early life risks and child development

A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand in fulfilment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 2017.Background Exposure to biological and psychosocial risks, particularly during the first three years of life, affects brain development and compromises the short- and long-term health and development of children, as well as their educational achievement and long-term productivity. This study sought to determine the effects of maternal and child environmental and psychosocial exposures during pregnancy and the first two years of the child’s life on growth and development outcomes in early childhood (up to 5 years) in an urban South African birth cohort. Methods Data used for this study was from the Birth to Twenty Plus (Bt20+) longitudinal birth cohort study, initiated in 1990 in the greater Johannesburg metropolitan area, South Africa. First, the associations between exposure to nine maternal risks, assessed in 1228 women, and subsequent infant birth weight was assessed. Second, the study examined the effects of risk exposure to the mother (and child) during pregnancy and the first year of a child’s life on stunting at age 2 years in 1098 mother–child pairs. Finally, the associations between ten demographic and psychosocial exposures occurring during the third trimester of pregnancy and the first two years of a child’s life and child development age 5 were examined in 636 mother-child pairs. Multivariable regression analyses were used to investigate associations between exposures and outcomes. Further analysis was undertaken to assess whether early life growth mediated the associations between maternal and household exposures and child development outcome at age 5. Results Unwanted pregnancy (or ambivalence) was associated with a ~156 g reduction in infant birth weight (β = −0.32, 95% confidence interval (CI): −0.51, −0.14). Tobacco use during pregnancy was negatively associated with BWZ (β = −0.32, 95% CI: −0.59, −0.05). Exposure to both these risks was associated with cumulative reductions in birth weight. Approximately 1 in 5 children were stunted at age 2 years, with males at greater risk than females. Higher maternal education was protective for females (adjusted odds ratio (AOR) = 0.35; 95% CI: 0.14, 0.87), while higher household SES was protective for males (AOR for richest SES group = 0.39; 95% CI: 0.16, 0.92). Males scored significantly lower than females on the developmental measure at age 5. Improved child developmental outcome was associated with higher birthweight for both sexes and superior linear growth in males. R-DPDQ scores increased by 0.84 units for every 1 SD increase in relative linear growth between birth and two years (β = 0.84 [95% CI 0.30, 1.39]). Socio-economic status (for both sexes) and maternal education for males were significant predictors of better child development. Growth status did not mediate the effects of socio-economic status (either sex) or maternal education (males) on developmental outcome. Conclusion Social factors, especially social determinants such as household SES and maternal education, were associated with early childhood growth and development in this context. Prenatal (using birthweight as a proxy) and postnatal growth were important for child development. Males were particularly vulnerable to poor growth and development in this cohort. The effects of household SES and maternal education on child development at 5 years were not mediated by linear growth between birth and 4 years.LG201

School health in South Africa : reflections on the past and prospects for the future

This in-depth report examines the South African school health service, and considers its design and intentions against international models. Across countries of all income levels, the dual role of school health in contributing to both the health and education status of children has been recognised. The paper provides an overview of school health services and the integrated school health policy (ISHP) in particular: its evolution and current implementation progress. The review emphasises need for close collaboration between health and education, regardless of which department leads. It also highlights challenges with modes of delivery, resource constraints, and inter- and intra-sectoral relationships

Improving the early development of children through quality health care

Ensuring that the package of services provided during the first 1 000 days is more comprehensive, and includes the services envisaged in the Nurturing Care Framework and the ECD Policy, will require substantial changes in how services are organised, delivered and monitored.http://www.journals.co.za/content/journal/healthram2020School of Health Systems and Public Health (SHSPH

What the science of child and adolescent development contributes to understanding the impacts of COVID-19

CITATION: Tomlinson, M., Richter, L. & Slemming, W. 2021. What the science of child and adolescent development contributes to understanding the impacts of COVID-19. South African Journal of Science, 117(1/2):8876, doi:10.17159/sajs.2021/8876.The original publication is available at https://sajs.co.za/articleAs of 8 September 2020, there were 27 236 916 confirmed cases of COVID-19, including 891 031 deaths reported to the World Health Organization.1 The direct effects of SARS-CoV-2 (the virus) and COVID-19 (the disease caused by the virus) are infection (of which ~80% of people will have no or mild symptoms), serious illness (~15% requiring hospitalisation and ~5% ventilation) and death (<1%). Of all age groups, children (0–18 years of age) have the lowest risk of the direct effects of the virus and the disease. Understandably, because of this, much of the global focus has been on protecting the elderly and adults with co-morbidities and using country lockdowns to prevent community transmission. What has often been forgotten, however, is that children have the highest risk of all age groups of experiencing the indirect adverse effects of the pandemic and the effects to contain it. As ~20% of deaths occur amongst people over 65 years of age, many children will lose beloved grandparents and older relatives, and many will lose their primary caregiver. Newborn and young children may be separated from their mothers – an experience that can have long-term effects on children’s development.2 Other indirect effects result from actions and the knock-on effects of actions taken to prevent, control and treat the virus. These include societal lockdowns, isolation and quarantine with follow-on negative effects on income and food security, fear and panic, anxiety and depression, altered family and social relations, stigma and, in extreme cases, post-traumatic stresshttps://sajs.co.za/article/view/8876Publisher's versio

Measurement for Change: From Idea to Approach

Measurement for Change proposes an integration of monitoring, evaluation, and learning into decision-making systems that support sustainable transition of interventions to scale. It was developed using a cyclical, interactive 1-year dialogue between early childhood development (ECD) practitioners and academics from across the globe. Details are presented in Krapels et al. (1) as part of this special issue in Frontiers. In this paper, we trace the developments that inspired Measurement for Change and the novel ways in which the approach and the special issue was developed. The experience, and the reflections on this experience, are intended to inform those implementing initiatives that similarly seek to integrate practitioner- and academic experiences in support of sustainable transitions of interventions to scale

Health Pregnancy, Healthy Baby:Testing the added benefits of pregnancy ultrasound scan for child development in a randomised control trial

BACKGROUND:The 2016 World Health Organization Antenatal Guidelines and the 2015 South African Maternal and Child Health Guidelines recommend one early antenatal ultrasound scan to establish gestational age and to detect multiple pregnancies and fetal abnormalities. Prior research indicates that ultrasound scan can also increase parental-fetal attachment. We aim to establish whether, compared to routine care, messages to promote parental attachment and healthy child development, conducted during one or two pregnancy ultrasound scans, improve early child development and growth, exclusive breastfeeding, parental-child interactions and prenatal and postnatal clinic attendance. METHODS:The effect of messages to sensitise mothers and fathers to fetal development will be tested in a three-armed randomised trial with 100 mothers and their partners from Soweto, Johannesburg in each arm. The primary outcome is child development at 6&#x2009;months postnatally. Secondary outcomes include infant feeding, parental attachment and interaction, parental mental health and infant growth, assessed at 6&#x2009;weeks and 6&#x2009;months. Parents in Arm 1 receive a fetal ultrasound scan &lt;&#x2009;25&#x2009;weeks during routine antenatal care at tertiary hospitals, and a second standard ultrasound scan at the research site within 2&#x2009;weeks. Arm 2 participants receive the routine antenatal ultrasound scan and an additional ultrasound scan &lt;&#x2009;25&#x2009;weeks at the research site, together with messages to promote parental attachment and healthy child development. Arm 3 participants receive the routine ultrasound scan and two additional ultrasound scans at the research site, &lt;&#x2009;25&#x2009;weeks and&#x2009;&lt;&#x2009;36&#x2009;weeks, together with messages to promote parental attachment and healthy child development. DISCUSSION:Evidence from high-income countries suggests that first-time prospective mothers and fathers enjoy seeing their fetus during ultrasound scan and that it is an emotional experience. A number of studies have found that ultrasound scan increases maternal attachment during pregnancy, a predictor of positive parent-infant interactions which, in turn, promotes healthy infant development. It is generally agreed that studies are needed which follow up parental-child behaviour and healthy child development postnatally, include fathers and examine the construct in a wider diversity of settings, especially in low and middle-income countries. Testing the added benefits of pregnancy ultrasound scan for child development is a gap that the proposed trial in South Africa seeks to address. TRIAL REGISTRATION:Pan African Clinical Trials Registry, PACTR201808107241133. Registered on 15 August 2018

Maternal perspectives on infant feeding practices in Soweto, South Africa

Objective: To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers' perspective what influences feeding practices. Design: Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis. Setting: Soweto, South Africa. Participants: Nineteen mothers were stratified into three FGD according to their baby's age as follows: 0-6-month-olds, 7-14-month-olds and 15-24-month-olds. Four mothers from each FGD then attended an IDI. Results: Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and 'junk' food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers' beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers' feeding practices; however, their advice often contradicted that of health professionals. Conclusions: In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding. </p

Measurement for Change: From Idea to Approach

Measurement for Change proposes an integration of monitoring, evaluation, and learning into decision-making systems that support sustainable transition of interventions to scale. It was developed using a cyclical, interactive 1-year dialogue between early childhood development (ECD) practitioners and academics from across the globe. Details are presented in Krapels et al. (1) as part of this special issue in Frontiers. In this paper, we trace the developments that inspired Measurement for Change and the novel ways in which the approach and the special issue was developed. The experience, and the reflections on this experience, are intended to inform those implementing initiatives that similarly seek to integrate practitioner- and academic experiences in support of sustainable transitions of interventions to scale

The Aspirations of Measurement for Change

This Perspective presents the five key aspirations of an approach to data use, decision making and monitoring, evaluation, and learning (MEL) in Early Childhood Development (ECD) referred to as Measurement for Change. The core ideas of Measurement for Change gave rise to this series, and many of the papers submitted in this series speak to this approach, whether directly or indirectly. The five aspirations describe interconnected concepts that advocate for practitioners and researchers within ECD to build the capacity to use data in their decision making, by establishing a monitoring, evaluation, and learning system that strives to be: Dynamic; Inclusive; Informative; Interactive; and People-centered

The Aspirations of Measurement for Change

This Perspective presents the five key aspirations of an approach to data use, decision making and monitoring, evaluation, and learning (MEL) in Early Childhood Development (ECD) referred to as Measurement for Change. The core ideas of Measurement for Change gave rise to this series, and many of the papers submitted in this series speak to this approach, whether directly or indirectly. The five aspirations describe interconnected concepts that advocate for practitioners and researchers within ECD to build the capacity to use data in their decision making, by establishing a monitoring, evaluation, and learning system that strives to be: Dynamic; Inclusive; Informative; Interactive; and People-centered