Is registrarship a different experience for women?

Objective. To detennine differences between male and female registrars in their subjective perceptions and experience of a paediatrics registrar training programme.Design. Cross-sectional survey.Setting. University-affiliated teaching hospitals.Participants. Thirty-nine paediatrics registrars.Results. Of the 39 respondents, 18 (46%) were women. Men were older than women (30A v. 29.1 years, p = 0.049). There were no gender differences in the number of hours worked per week (65.7 v. 67.8 hours, P = 0.384) or participation in the training programme. Success rates in postgraduate paediatrics examinations were also similar for the two groups (85% v. 76%, P = 0.486). Male registrars were more likely to have 'moonlighted' (43% v. 6%, P =0.011). FIfty-nine per cent of female registrars believed that they had been disadvantaged in their careers because of their gender, 28% felt that more was expected of a woman registrar and 22% of the female trainees claimed to have been subjected to sexual harassment. The majority (82%) of women registrars contemplated taking time off from practising clinical paediatrics in the Mure (postregistrarship), mainly for child-bearing purposes. Female respondents criticised both the academic department and the hospital authorities for discriminatory practices, such as the awarding of home loans to men and women who were breadwinners only. The findings suggest that women registrars do feel disadvantaged and discriminated against, and highlight the need for flexible, creative programmes that recognise the needs and aspirations of female registrars and, indeed, all women in academic medicine

Stress during internship at three Johannesburg hospitals

Background: There has been much recent attention paid to the excessive hours worked by interns, with a commitment by the health department to address this issue. However, there is still limited recognition of other stressors that influence the well-being and performance of interns. Methods: Cross-sectional study at three hospitals within the academic complex of the University of Witwatersrand, Johannesburg. Interns were randomly selected as respondents for an anonymous, self-administered, confidential questionnaire. Results: One hundred and ten questionnaires were distributed; 68 (62%) were returned and analysed. Twenty-seven participants (40%) rated internship as being “significantly” or “overwhelmingly” stressful. While the main stressors related to heavy workloads and excessive working hours, the risk of acquiring HIV and the frustration of working in inadequately resourced environments were the next most important stressors. Over two-thirds (69%) of responding interns had experienced accidental occupational exposure to HIV. Somatic manifestations of stress were universal with all interns reporting one or more stress-associated symptoms. More than one-half (54%) of interns admitted to being depressed, with over a third suffering from insomnia or appetite loss. Female interns were significantly more likely to report weight changes (OR 5.7 [95% CI 1.2-29.8], p=0.01) and crying (OR 3.8 [95% CI 1.1-14.4, p=0.02). Vacations and the support of family and friends served as the major stress relievers. Despite 93% of interns rating their stress to be “moderate” to “significant”, an overwhelming majority (91%) claimed to be coping with their internship. Conclusions: Internship in South Africa remains a stressful experience. HIV emerged as a significant stressor. Positively, and despite widespread somatic complaints, most interns believed they were coping. There is still inadequate acknowledgement of the extent of intern stress, and few systematic attempts by the health system to help interns cope and to alleviate the primary stressors

Can a new paediatric sub-specialty improve child health in South Africa?

Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the healthcare needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary healthcare will be limited by the skewed distribution of staff and the lack of suitable skills. A 'community' placement during specialist training, and the creation of a sub-specialty in Community Paediatrics and Child Health, could address the skills shortage and possibly attract health personnel to under-served areas through creating an appropriate career path. This proposal would also support the Department of Health's encouraging plans to re-engineer primary healthcare.DHE

Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial

Objective To investigate the effect of two different food supplements on body mass index (BMI) in wasted Malawian adults with HIV who were starting antiretroviral therapy

Community paediatrics and child health

TO THE EDITOR: In 2012, the Postgraduate Education Committee of the Health Professions Council of South Africa (HPCSA) supported the accreditation of Community Paediatrics and Child Health (CPCH) as a paediatric subspecialty; however, full HPCSA approval is outstanding. Consequently, by February 2015 there had been no visible progress towards implementation. Power and Heese and Swingler et al. highlighted the benefits of CPCH, rendering further debates about CPCH accreditation unnecessary, particularly in a country where: (i) progress towards the fourth Millennium Development Goal is slow; (ii) glaring gaps exist between hospital-based and community care, and between private and public sector care;[3] and (iii) current under- and postgraduate paediatric training emphasises clinical subspecialties (despite reduced public sector posts), yielding graduates with limited knowledge about priority child health conditions. Primary healthcare re-engineering and the establishment of district clinical specialist teams in South Africa have starkly revealed the urgency of CPCH training. CPCH locates child health within a sociocultural-economic-political-environmental-systemic paradigm. Successful community paediatricians share four characteristics: (i) academic collaboration; (ii) finding evidencebased local solutions; (iii) establishing strong community-based partnerships; and (iv) addressing disease outside traditional biomedical models. This suggests that our sometimes narrow approach to under- and postgraduate training needs significant adaptation. The British Association for Community Child Health, affiliated to the Royal College of Paediatricians, is a successful model we can adapt. This custodian of community paediatrics directs traineeships, stipulates requirements and outlines the scope of the discipline.DHE

Comparison of nuisance parameters in pediatric versus adult randomized trials: a meta-epidemiologic empirical evaluation

BACKGROUND We wished to compare the nuisance parameters of pediatric vs. adult randomized-trials (RCTs) and determine if the latter can be used in sample size computations of the former. METHODS In this meta-epidemiologic empirical evaluation we examined meta-analyses from the Cochrane Database of Systematic-Reviews, with at least one pediatric-RCT and at least one adult-RCT. Within each meta-analysis of binary efficacy-outcomes, we calculated the pooled-control-group event-rate (CER) across separately all pediatric and adult-trials, using random-effect models and subsequently calculated the control-group event-rate risk-ratio (CER-RR) of the pooled-pediatric-CERs vs. adult-CERs. Within each meta-analysis with continuous outcomes we calculated the pooled-control-group effect standard deviation (CE-SD) across separately all pediatric and adult-trials and subsequently calculated the CE-SD-ratio of the pooled-pediatric-CE-SDs vs. adult-CE-SDs. We then calculated across all meta-analyses the pooled-CER-RRs and pooled-CE-SD-ratios (primary endpoints) and the pooled-magnitude of effect-sizes of CER-RRs and CE-SD-ratios using REMs. A ratio < 1 indicates that pediatric trials have smaller nuisance parameters than adult trials. RESULTS We analyzed 208 meta-analyses (135 for binary-outcomes, 73 for continuous-outcomes). For binary outcomes, pediatric-RCTs had on average 10% smaller CERs than adult-RCTs (summary-CE-RR: 0.90; 95% CI: 0.83, 0.98). For mortality outcomes the summary-CE-RR was 0.48 (95% CIs: 0.31, 0.74). For continuous outcomes, pediatric-RCTs had on average 26% smaller CE-SDs than adult-RCTs (summary-CE-SD-ratio: 0.74). CONCLUSIONS Clinically relevant differences in nuisance parameters between pediatric and adult trials were detected. These differences have implications for design of future studies. Extrapolation of nuisance parameters for sample-sizes calculations from adult-trials to pediatric-trials should be cautiously done

Child health, infant formula funding and South African health professionals : eliminating conflict of interest

Lake et al. refer to the Allergy Society of South Africa (ALLSA) as an example of a professional body that may be fostering transgressions of regulation R991 (R991) of the Regulations Relating to Foodstuffs for Infants and Young Children. They also infer that the low breastfeeding rate (BFR) in South Africa (SA) is a direct result of aggressive breastmilk substitute (BMS) marketing and transgressions of R991 and call for a total dissociation between BMS suppliers and healthcare professionals.The South African Medical Research Councilhttp://www.samj.org.zaam2021ImmunologyPaediatrics and Child Healt

Ensuring Quality in AFRINEST and SATT: Clinical Standardization and Monitoring

Background: Three randomized open-label clinical trials [Simplified Antibiotic Therapy Trial (SATT) Bangladesh, SATT Pakistan and African Neonatal Sepsis Trial (AFRINEST)] were developed to test the equivalence of simplified antibiotic regimens compared with the standard regimen of 7 days of parenteral antibiotics. These trials were originally conceived and designed separately; subsequently, significant efforts were made to develop and implement a common protocol and approach. Previous articles in this supplement briefly describe the specific quality control methods used in the individual trials; this article presents additional information about the systematic approaches used to minimize threats to validity and ensure quality across the trials. Methods: A critical component of quality control for AFRINEST and SATT was striving to eliminate variation in clinical assessments and decisions regarding eligibility, enrollment and treatment outcomes. Ensuring appropriate and consistent clinical judgment was accomplished through standardized approaches applied across the trials, including training, assessment of clinical skills and refresher training. Standardized monitoring procedures were also applied across the trials, including routine (day-to-day) internal monitoring of performance and adherence to protocols, systematic external monitoring by funding agencies and external monitoring by experienced, independent trial monitors. A group of independent experts (Technical Steering Committee/Technical Advisory Group) provided regular monitoring and technical oversight for the trials. Conclusions: Harmonization of AFRINEST and SATT have helped to ensure consistency and quality of implementation, both internally and across the trials as a whole, thereby minimizing potential threats to the validity of the trials’ results

Conflicts of interest are harming maternal and child health : time for scientific journals to end relationships with manufacturers of breast-milk substitutes

► Forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes, inappropriate marketing of breast-milk substitutes persists and puts infants and young chil- dren at risk of malnutrition, illness and death. ► The formula industry is large and powerful and has used various ‘medical marketing’ strategies to influ- ence scientists and health professionals as to the purported benefit of breast-milk substitutes. ► The examples provided in this commentary show how a manufacturer is using a leading scientific journal to market breast-milk substitutes through paid advertisements and advertisement features. ► By receiving funding from breast-milk substitute manufacturers, journals create a conflict of interest, whereby the publisher and readers of the journal may favour corporations consciously or unconsciously in ways that undermine scientific integrity, editorial in- dependence and clinical judgement. ► Conflicts of interest have previously been identified in infant and young child nutrition science and in journal advertising policies and have been criticised by public health experts, yet the practice continues. ► All scientific journals and publishers should stop ac- cepting funding from manufacturers and distributors of breast-milk substitutes, in accordance with global public health guidance. Public health must come be- fore profit.The DSI/NRF Centre of Excellence in Food Security.https://gh.bmj.comhj2022Paediatrics and Child Healt