Background. Measles kills about 2 million children annually, and there is no specific therapy for the disease. It has been suggested that vitamin A may be of benefit in the treatment of measles. Methods. We conducted a randomized, double-blind trial involving 189 children who were hospitalized at a regional center in South Africa because of measles complicated by pneumonia, diarrhea, or croup. The children (median age, 10 months) were assigned to receive either vitamin A (total dose, 400,000 IU of retinyl palmitate, given orally; n = 92) or placebo (n = 97), beginning within five days of the onset of the rash. At base line, the characteristics of the two groups were similar. Results. Although clinically apparent vitamin A deficiency is rare in this population, the children's serum retinol levels were markedly depressed (mean [±SEM], 0.405±0.021 μmol per liter [11.6±0.6 /μg per deciliter]), and 92 percent of them had hyporetinemia (serum retinol level <0.7 μmol per liter [20 μg per deciliter]). Se...

A randomized, controlled trial of vitamin a in children with severe measles

Objectives. Malnutrition among young children is a major health problem in post-apartheid South Africa. Despite implementation of numerous health and nutrition programmes, these extensive efforts to alleviate the situation have not been adequately reviewed. Methods. We provide an overview of various aspects of the current nutritional health status of young children. The reviewed data are from the time period 1994 - 2010, and were collected from literature databases and official reports, as well as our own experience with field research in various urban and rural parts of the country. Results. Both smaller province-based studies as well as three large nationwide surveys conclude that many young South African children have inadequate nutritional status. Rates of stunting, micronutrient deficiencies and hunger and food insecurity are all unacceptably high. Coexisting HIV/AIDS and tuberculosis add to this burden. A gradual transition to a westernised diet characterised by energy-dense food has led to a worrying increase in overweight and obesity. Conclusion. A major challenge for the South African health authorities is still the fight against childhood undernutrition and hunger, which in turn are rooted in poverty and social inequalities. The double burden of disease adds to the scale and complexity of this challenge.

/pdf/nutritional-health-of-young-children-in-south-africa-over-2vpicwxl1x.pdf

Nutritional health of young children in South Africa over the first 16 years of democracy

Vitamin A and anthropometric status of South African preschool children from four areas with known distinct eating patterns.

OBJECTIVE: Nutritional status has remained inadequate among disadvantaged mothers and small children in South Africa. Several supplementation programmes are administered through primary health clinics (PHC). The present study examined the perceptions of mothers who attend PHC and of the PHC staff on the purpose management and eligibility of the vitamin A and nutritional supplementation components of the Nutrition Supplementation Programme (NSP). DESIGN: Observational study based on anthropometry and questionnaires. SETTING: Random selection of ten urban and ten rural PHC from the Western Cape Province of South Africa. SUBJECTS: Mothers (n 176) and their children (n 179) aged <5 years and various PHC staff categories. RESULTS: Half (56 %) of the households were classified as food insecure and about one-third of the children were malnourished as evidenced by stunting wasting or underweight. A majority of mothers complained about poor information related to the programmes. More than half of the children who were eligible for NSP were not included. In contrast the staff felt that they managed both programmes well and problems with implementation were mostly attributed to clients. CONCLUSIONS: In general the mothers expressed more dissatisfaction and ignorance about the vitamin A programme and the NSP than was perceived by the staff. This apparent discrepancy might at least in part explain why these programmes do not work optimally.

/pdf/diverging-opinions-of-supplementation-programmes-between-kfeau5wyzd.pdf

Diverging opinions of supplementation programmes between mothers of small children and staff at primary health clinics in the Western Cape Province of South Africa.

Protein iron and zinc content and bioaccessibility of a ready-to-eat sorghum and cowpea meal developed for 2-to 5-year old African children

Objective: To assess the implementation of the vitamin A supplementation programme in primary health care
(PHC) clinics in a rural area of the Western Cape Province.

Material and methods: A study was conducted at 14 randomly selected PHC clinics. All children aged 6 - 60
months attending on the day of surveying with their mothers/caregivers were selected by purposive sampling,
after they had been seen by a PHC nurse in the clinic. A structured exit interview was conducted with the
mother/caregiver of each child. The information from 56 such interviews could be utilised for data analysis. The
manager of each clinic was also interviewed.

Results: Seventy-seven per cent of the study population (N=40) was eligible for high-dose vitamin A
supplementation on the day of the study, based on the criteria of the vitamin A supplementation protocol.
However, 25% of these children (N=10) did not receive vitamin A, even though there was an indication to
administer it. Only 39% of mothers (N=22) reported that they were aware of the supplementation programme. All
the health facility managers of the clinics had received training in the programme. Staffing problems and stock
shortages appeared to play a role in inadequate implementation of the programme at some clinics. In addition, health facility managers reported that many children failed to receive their vitamin A dose because parents did not bring them regularly to clinics.

Conclusions: The vitamin A supplementation programme appears to be reasonably successfully implemented in
the Boland/Overberg region. Informing mothers about the importance of vitamin A supplementation and regular
clinic attendance, as well as improving the availability of human and material resources and logistic support at
PHC facilities, may further enhance the implementation and success of the programme.

/pdf/evaluation-of-the-implementation-of-the-vitamin-a-113i37c69g.pdf

Evaluation of the implementation of the vitamin A supplementation programme in the Boland/Overberg region of the Western Cape Province

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Evaluation of the implementation of the vitamin A supplementation programme in the Boland/Overberg region of the Western Cape Province