Child Health and Development

Theme leader: Kathy Kahn with John Pettifor; Theme officer: Rhian Twine

In rural South Africa, morbidity, mortality and growth failure associated with undernutrition exist alongside female obesity and emerging cardiovascular disease. By tackling proximal issues of infant growth and nutrition, and social/emotional development, we aim to impact more distal outcomes including cognitive development, educational attainment, HIV infection, adult vascular risk and economic productivity.

Project Ntshembo: Improving the health and nutrition of adolescents and their infants to reduce the intergenerational risk of metabolic disease - Collaboration with Birth-to-Twenty; Oxford and Cambridge Universities, UK; Umea University, Sweden

 This five year project aims to promote adolescent health as a critical pathway to improve intrauterine and infant growth and thereby interrupt the intergenerational transfer of metabolic disease and HIV/AIDS. This will be achieved by innovative community-based interventions targeting female adolescents prior to and during pregnancy, and in the postnatal period. In 2009, several sub-studies were done to understand adolescent female dietary and physical activity practices, interactions of social risk factors with obesity risk and body image, and to examine the macronutrient composition and availability of fast foods. In 2010, funds were obtained from the British MRC to conduct the baseline survey in 2012, as well as follow up assessments over 5 years. Pilot work in May/June 2011 focused on physical activity, beliefs and practices regarding childbirth and the postpartum period, and the availability and distribution of food vendors.

Child and adolescent growth studies - Collaboration with Birth-to-Twenty now the MRC/Wits Deveopmental Pathways to Health Research Unit (DPHRU)

 Studies seek to document and understand the double burden of undernutrition in children (particularly stunting) and overweight/obesity in adolescents, particularly girls. In 2009, fieldwork was completed on 600 adolescents, to examine the association of nutrition on body composition and metabolic disease risk. One PhD was completed in 2010; another, on the association of nutrition on body composition and metabolic disease risk, is ongoing.

Kulani Child Health and Resilience Project  - evaluation of Soul Buddyz/SNOC Evaluation - Collaboration with Soul City and Oxford Univ, UK 

School-based, cluster-randomised trial to evaluate an established school-based intervention by an NGO, Soul City, to provide emotional and social support to pupils 10-12 years. Aims to enhance learners' ability to cope and learn in an environment of chronic adversity. Baseline study in 2009 examined rates of anxiety, depression and post-traumatic stress disorder, and environmental factors (parental death or migration, poverty) associated with these symptoms. During 2010 there was ongoing monitoring of NGO intervention and the end-of-intervention survey took place in October 2010. Data entry is almost complete. Analysis of baseline data has commenced, and analysis of qualitative data on school management systems is complete.

SARI/ROTA - Severe Acute Respiratory Infection (SARI) and Rotavirus diarrhoea surveillance - Collaboration with National Institute for Communicable Diseases and the Respiratory and Meningeal Pathogens Research Unit, Wits

Aims to describe trends in numbers of SARI and diarrhoeal cases at 4 sentinel surveillance sites. Data will inform health policy on SARI and diarrhoeal disease management, prevention and control, and assist in planning for future influenza pandemics. Project will contribute to assessment of influenza, pneumococcal conjugate and rotavirus vaccine strategies, reflecting on recent introduction of rotavirus & pneumococcal vaccines into the national Expanded Programme on Immunisation. Surveillance system in two district hospitals in Bushbuckridge was set up in 2009 and data collection continued throughout 2010.

PCV - Pneumococcal Conjugate Vaccine Introduction - Collaboration with Respiratory and Meningeal Pathogens Research Unit, Wits

Study to examine the effect of pneumococcal conjugate vaccine immunization upon nasopharyngeal ecology of Streptococcus pneumonia in vaccinated and non-vaccinated individuals at household level. In 2009, nasopharyngeal swabs were taken, and questionnaires completed, in 600 households.

Conditional Cash Transfer Study and Pilot - HPTN 068 - Collaboration with University of North Carolina, USA and Wits Institute for Sexual and Reproductive Health, HIV & Related Diseases (WRHI) 

Study to determine effects of a multi-level HIV prevention intervention to jointly address structural and social factors contributing to young women’s increased vulnerability to HIV, through providing cash transfers to families of young women conditional on her attending school. Goal is to reduce young women’s HIV risk by keeping her in school through improving her family’s economic resources. This intervention will be complemented by a community-level mobilization intervention focused on young men. In 2010, there were pilots of the young woman questionnaire, household and community mobilization surveys. A “hope scale” was developed and a community mapping exercise in all 24 study villages undertaken. The ACASI and CAPI systems were refined and tested. All staff were recruited and trained. Ethics clearance was obtained from UNC and Wits.