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BACKGROUND: The under-five mortality rates of children in South Africa (SA) remain high despite successful HIV prevention and treatment programs. The in-hospital mortality of children with severe acute malnutrition remains a key obstacle. This study identifies and describes changes in the mortality of under-five children with severe acute malnutrition (SAM) following the implementation of HIV and malnutrition prevention and treatment programmes. METHODS: This was a retrospective review of in-hospital mortality records and databases. The study was based at a large referral hospital in KwaZulu-Natal (KZN), where HIV and malnutrition rates are high, and SAM children are managed with standard WHO guidelines. Records of children under five years old who died from 2009 to 2018 were analysed. RESULTS: Of the 698 under-five children who died in this period, 285 (40, 8% of all under-5 deaths) were classified as having SAM. The number of HIV-infected SAM deaths dropped significantly, especially those below six months of age, mirroring the expansion of HIV treatment and prevention programmes. Despite this and a significant drop in the proportion of SAM admissions identified, there was no change in SAM case fatality rates over the ten years. Septicaemia remained the most common cause of death in children with SAM. CONCLUSIONS: Despite significant decreases in HIV-related malnutrition deaths over ten years, the lack of change in SAM case fatality rates is a concern at this referral hospital. Standardised WHO inpatient management protocols, may require review, especially where underlying medical conditions may contribute to SAM deaths in HIV-negative children.
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Background. Lower respiratory tract infections (LRTIs) remain a major cause of mortality and morbidity in infants in South Africa (SA).Exclusive breastfeeding has been shown to decrease mortality and morbidity in infants with LRTIs, especially in the context of HIV/AIDS.Major effort has been put into educating HIV-positive mothers on the benefits of exclusive breastfeeding within effective prevention of mother-to-child transmission (PMTCT) programmes.Objectives. To determine the feeding practices among infants admitted with LRTIs in an HIV-endemic area.Methodology. The study was a retrospective chart review of all infants admitted with a diagnosis of LRTI between 1 January 2015 and 31December 2015 at King Edward VIII Hospital, Durban, SA. Data on feeding patterns, socioeconomic status, maternal HIV status and clinical outcomes of LRTI admissions were collected.Results. Of the 308 infants enrolled, 63% were male. Exclusive breastfeeding rates of those aged <6 months with LRTIs were higher thant hose found in previous studies; however, these feeding patterns were significantly associated with the HIV status of the mother(p=0.003).Mothers who were HIV-negative were twice as likely to breastfeed as those who were HIV-positive (odds ratio 2.25; 95% confidence interval 1.32- 3.88). There was no association between the type of feeding and the clinical outcomes for LRTIs.Conclusion. Maternal HIV status influenced the feeding patterns of infants admitted with LRTIs with lower exclusive breastfeeding rates in the HIV-exposed group. Despite extensive efforts to promote breastfeeding within effective PMTCT programmes, HIV-positive mothers are still not harnessing the benefits that exclusive breastfeeding provides
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Comportamento Alimentar , Lactente , Infecções Respiratórias , África do SulRESUMO
Objectives: The objective of this study was to assess the dietary intake and metabolic control of children with type 1 diabetes. Design: A cross-sectional observational study was carried out. Subjects: A total of 30 subjects whose ages ranged from six to ten years were included in the study. Setting: The study was conducted at the Paediatric Diabetic Clinics at Grey's Hospital; Pietermaritzburg and Inkosi Albert Luthuli Central Hospital (IALCH); Durban; in KwaZulu-Natal. Outcome measures: Dietary intake was assessed using a three-day dietary record. Metabolic control was assessed using glycosylated haemoglobin (HbA1c). Results: The mean percentage contributions of macronutrients to total energy as determined by the three-day dietary records were as follows: carbohydrate - 52; added sucrose - 2; protein - 16; fat - 32. The mean intakes were similar to the recommendations of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines (2002). Micronutrient intake was generally adequate. The mean latest glycosylated haemoglobin (HbA1c) for the sample as at the time of the study was 9.7. Five of the thirty subjects had HbA1c values that were within the recommended levels for children with type 1 diabetes. Conclusions: The macronutrient intake in this sample was found to be similar to the ISPAD Consensus Guidelines (2002) while micronutrient intake was adequate in most cases. Overall the sample had poor metabolic control
