Commitment and capacity for the support of breastfeeding in South Africa: A paediatric food-based dietary guideline

This paper aims to summarise current evidence and highlight best  practices, in order to propose a paediatric food-based dietary guideline (FBDG) on exclusive breastfeeding for South Africa. A literature search was conducted to profile the current nutritional status of children and breastfeeding practices in South Africa, reflect on the commitment and capacity that has been pledged and built for exclusive and continued breastfeeding over the past five years, and highlight the action needed to improve infant and young child feeding practices in the country. From the review, it was clear that the nutritional status of children and breastfeeding practices in South Africa remain unsatisfactory. The evidence base supporting the importance of exclusive and continued breastfeeding on a global and local level has been broadened. There are comprehensive and practical international guidelines to guide the protection, promotion of, and support for breastfeeding. Comprehensive and sound national and provincial policies and guidelines have also been developed in South Africa. The political will to address infant and young child feeding has been advanced and demonstrated, and a supportive environment created through commitment and capacity building. There is a need for focused action addressing adequate monitoring and evaluation of processes during all stages of the implementation of evidencebased and theoretical planning. These actions should drastically improve exclusive and continued breastfeeding and advance the health and survival of children in South Africa. The recent momentum gained in support of improving infantand young child feeding could further be enhanced by the process of reviewing the preliminary South African paediatric FBDG and field testing the following proposed message: “Give only breast milk, and no other foods or liquids, to your baby for the first six months of life”

Field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines among mothers/caregivers of children between the ages of 3 and 5 years in the Northern Metropole, City of Cape Town, Western Cape province, South Africa

Objective: To assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary (SA-PFBDGs) among mothers/caregivers of children between the ages of 3 and 5 years. Exposure to similar messages, barriers and enablers were also assessed. Design: A qualitative, descriptive, cross-sectional study design was followed. Participants were purposively recruited to participate in 9 focus-group discussions (FGDs) conducted in isiXhosa, English and Afrikaans totalling 55 participants. Setting: Formal and informal urban communities along the West Coast, in the Northern Metropole, City of Cape Town, Western Cape, South Africa. Subjects: Mothers/caregivers older than 18 years who provided informed consent. Results: The majority of the participants mentioned previous exposure to messages similar to the revised, draft SA-PFBDGs mainly from healthcare workers, health facilities and the media. Cultural differences and taste preferences contributed to poor following of healthy eating guidelines, specifically regarding lean meats and chicken, dry beans, split peas, lentils and soya, salt, fat and sugar. With regard to dietary variety and fresh fruit and vegetables, availability and financial barriers existed. Understanding nutritional needs of children, supportive communities and education were strong enabling factors for following of the revised, draft SA-PFBDGs. Conclusion: Overall, the guidelines were familiar and understood. However, the comprehension of some guidelines must be clarified further, specifically those pertaining to sugar, salt and fat. The design of appropriate educational materials for the revised draft SA-PFBDGs, complementing national actions, could help to minimise inconsistent messages on young-child nutrition and create a supportive environment for improved nutritional health

Field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines among Siswati-speaking mothers/caregivers of children aged 0–36 months in Kabokweni, Mpumalanga province, South Africa

Objectives: To determine the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDG) among siSwati speaking mothers/caregivers of children aged 0–36 months. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: A descriptive, cross-sectional qualitative research approach was followed. Purposive and snowball sampling were used to recruit a total of 75 participants. Data were collected by means of focus-group discussions from 12 groups. Setting: Kabokweni, Mpumalanga, South Africa. Subjects: The study population included mothers/caregivers older than 18 years who provided informed consent. Results: The participants were generally aware of messages similar to those contained in the revised, draft SA-PFBDG. They reported exposure to these messages at clinics/hospitals, radio/television, and the Road-to-Health booklet. Participants showed good understanding of guidelines on breastfeeding, complementary feeding, inclusion of protein-rich and starchy foods as well as fruit and vegetables in the diets of young children as well as hygiene practices. The guidelines on avoiding tea, coffee and sugar drinks and high-sugar, high-fat salty snacks, being active and providing five small meals were less well understood. Enablers to following the guidelines were its perceived importance and positive impact on children’s health. Barriers included misinterpretation of the guidelines and lack of money and resources. Conclusion: The revised, draft SA-PFBDGs are appropriate for the age group 0–36 months. A degree of rewording is suggested to aid understanding. The guidelines can be used as an educational tool to improve the nutritional status of children in South Africa

Field testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines among mothers/caregivers of children aged 12–36 months in the Stellenbosch Municipality in the Western Cape province, South Africa

Objective: To assess the appropriateness and understanding of the revised, draft South African Paediatric Food-Based Dietary Guidelines (SA-PFBDGs) among mothers/caregivers of children aged 12–36 months. Exposure to guidelines with similar messages, barriers and enablers to following of the guidelines were also assessed. Design: A descriptive cross-sectional qualitative study was conducted. Data were collected from nine focus-group discussions (FGDs) conducted in isiXhosa, English and Afrikaans, resulting in 65 participants, 20 from formal areas and 45 from informal areas. Setting: Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) Subjects: The study population included mothers/caregivers older than 18 years, who consented to participate. Results: This study revealed that participants expressed a general understanding of the core messages contained in the revised, draft SA-PFBDGs. Misinterpretation arose regarding certain guidelines as a result of ambiguity. Participants were familiar with and recognised the majority of the concepts conveyed owing to previous exposure, mostly from healthcare facilities and the media. Financial constraints were identified as the biggest barrier to following the guidelines, while perceived enablers included receiving education on the guidelines as well as visual portrayal thereof. Conclusion: Following field-testing, it is clear that the draft, revised SA-PFBDGs for the age group 12–36 months are appropriate. Minor rewording is required to enhance understanding. Effective dissemination of the guidelines through multiple communication platforms is recommended

Ethical dilemmas and financial burdens faced by clinical dental students in a ‘quota-driven’ curriculum

Unprofessional behaviour, cheating or falsifying of information by undergraduate dental students is a serious problem, and may be a predictor of future professional board disciplinary actions against practitioners. In quota-driven curricula students have to complete a minimum number of procedures, many of which require laboratory services. In order to achieve this some students at the University of Limpopo had begun bribing technicians to complete their work preferentially, or to do part of it for them. A final-year dental student carried out an independent investigation to establish the extent of the problem so that school authorities could be alerted and requested to curb this practice. Anonymous questionnaires were given to all the clinical-year dental students, who were asked to answer as honestly as possible. Results showed that almost half of the 4th-year students (47%) and double that of 5th-years (86%) had paid technicians for special favours and services. Payment methods and amounts ranged from gifts to actual monetary reimbursement. Ninety-three per cent of students reported additional financial burdens owing to their having paid for patient treatment, transport costs, telephone calls or food, or for the actual prosthesis.Ethics courses are part of most dental curricula, but have no standard, universally accepted outline or structure. Bribery was investigated by a student who had experienced it as a problem himself, highlighting the point that students will be more engaged in ethics education when it addresses issues directly relevant to them. Faculties should therefore design dental ethics curricula that are practical and relevant to students’ experiences, and ensure these courses begin early in the dental education and span its entire duration. Faculties should also support and encourage consistent professional conduct in undergraduate students which they will hopefully continue to practise in their future professional lives as dentists.

Overview of field-testing of the revised, draft South African Paediatric Food-Based Dietary Guidelines amongst mothers/caregivers of children aged 0–5 years in the Western Cape and Mpumalanga, South Africa

Background: This paper provides an overview of a series of studies undertaken 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 0–5 years. Previous exposure to guidelines with similar messages, barriers and enablers to following the guidelines were also assessed. Design: Qualitative methods were used to collect data from 38 focus-group discussions (isiXhosa = 11, Afrikaans = 11, English =10 and siSwati = 6) resulting in 268 participants. Setting: Breede Valley sub-district (Worcester), Stellenbosch Municipality (Stellenbosch, Pniel and Franschhoek) and Northern Metropole (Atlantis, Witsand, Du Noon and Blouberg), City of Cape Town, Western Cape province, as well as Ehlanzeni District (Kabokweni) in Mpumalanga province. Subjects: Mothers/caregivers older than 18 years who provided informed consent to participate. Results: The majority of participants had previous exposure to guidelines with similar messages to the SA-PFBDGs. Information sources included nurses, local clinics, family, friends and media. Possible barriers to following the guidelines included limited physical and financial access to resources; cultural/family practices, poor social support and time constraints. Outdated information, misconceptions, inconsistent messages and contrasting beliefs were evident. The vocabulary of some messages was not well understood. Education on infant and young child feeding and visual portrayal of the guidelines could aid understanding. Conclusion: A degree of rewording should be considered for improved understanding of the revised, draft SA-PFBDGs. Once adopted, the guidelines can be used to educate various stakeholders, including parents, caregivers, healthcare providers and educators, on the correct nutritional advice for children aged 0–5 years ensuring the healthy growth and development of young children in South Africa

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

Assessing Inflammation in Acute Intracerebral Hemorrhage with PK11195 PET and Dynamic Contrast-Enhanced MRI

BACKGROUND AND PURPOSE: Studies in animal models suggest that inflammation is a major contributor to secondary injury after intracerebral hemorrhage (ICH). Direct, noninvasive monitoring of inflammation in the human brain after ICH will facilitate early-phase development of anti-inflammatory treatments. We sought to investigate the feasibility of multimodality brain imaging in subacute ICH. METHODS: Acute ICH patients were recruited to undergo multiparametric MRI (including dynamic contrast-enhanced measurement of blood-brain barrier transfer constant (Ktrans ) and PET with [11 C]-(R)-PK11195). [11 C]-(R)-PK11195 binds to the translocator protein 18 kDa (TSPO), which is rapidly upregulated in activated microglia. Circulating inflammatory markers were measured at the time of PET. RESULTS: Five patients were recruited to this feasibility study with imaging between 5 and 16 days after onset. Etiologies included hypertension-related small vessel disease, cerebral amyloid angiopathy (CAA), cavernoma, and arteriovenous malformation (AVM). [11 C]-(R)-PK11195 binding was low in all hematomas and 2 (patient 2 [probable CAA] and 4 [AVM]) cases showed widespread increase in binding in the perihematomal region versus contralateral. All had increased Ktrans in the perihematomal region (mean difference = 2.2 × 10-3 minute-1 ; SD = 1.6 × 10-3 minute-1 ) versus contralateral. Two cases (patients 1 [cavernoma] and 4 [AVM]) had delayed surgery (3 and 12 months post-onset, respectively) with biopsies showing intense microglial activation in perilesional tissue. CONCLUSIONS: Our study demonstrates for the first time the feasibility of performing complex multimodality brain imaging for noninvasive monitoring of neuroinflammation for this severe stroke subtype

Paternal obesity is associated with IGF2 hypomethylation in newborns: results from a Newborn Epigenetics Study (NEST) cohort

Data from epidemiological and animal model studies suggest that nutrition during pregnancy may affect the health status of subsequent generations. These transgenerational effects are now being explained by disruptions at the level of the epigenetic machinery. Besides in vitro environmental exposures, the possible impact on the reprogramming of methylation profiles at imprinted genes at a much earlier time point, such as during spermatogenesis or oogenesis, has not previously been considered. In this study, our aim was to determine associations between preconceptional obesity and DNA methylation profiles in the offspring, particularly at the differentially methylated regions (DMRs) of the imprinted Insulin-like Growth Factor 2 (IGF2) gene