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Babakazo P, Piripiri LM, Mukiese JM, Lobota N, Mafuta É. Breastfeeding practices and social norms in Kinshasa, Democratic Republic of the Congo: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0000957. [PMID: 38626214 PMCID: PMC11020689 DOI: 10.1371/journal.pgph.0000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/27/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION Breastfeeding has many benefits for both mothers and children. The World Health Organization recommends exclusive breastfeeding for the first six months of life. However, in the Democratic Republic of the Congo, slightly under half of children under six months are exclusively breastfed. This study aimed to describe breastfeeding practices and to explore perceived social norms regarding breastfeeding among mothers in Kinshasa. MATERIALS AND METHODS A qualitative descriptive study was conducted in Kinshasa from June to July 2013. This study purposively sampled 54 mothers of infants aged 6 to 12 months, who participated in six focus group discussions. Based on the Theory of Planned Behaviour, the discussion guide explored infant feeding in the first six months, knowledge of breastfeeding, perception of the feasibility of exclusive breastfeeding, and perception of the social norms with regard to exclusive breastfeeding. The content analysis approach was used to analyse data. RESULTS Mothers had good breastfeeding knowledge; however, few of them had practised exclusive breastfeeding as recommended during the first six months. Exclusive breastfeeding was considered unfeasible in their context. Barriers to exclusive breastfeeding were reported as baby's cries, social pressure, warm climate, and poor maternal diet. Social norms were supportive of breastfeeding but unfavourable to exclusive breastfeeding. CONCLUSION In Kinshasa, mothers have a good knowledge of breastfeeding. However, few practise exclusive breastfeeding. Social pressure plays an important role in the cessation of exclusive breastfeeding before six months. In order to improve the practice of exclusive breastfeeding in this context, social and behaviour change programmes should target the entire population rather than mothers only.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Lina M. Piripiri
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Marie Mukiese
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nelly Lobota
- Hôpital Général de Référence de Makala, Kinshasa, Democratic Republic of the Congo
| | - Éric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Mgongo M, Ickes SB, Leyaro BJ, Mboya IB, Grounds S, Seiger ER, Hashim TH, Conklin JL, Kimani-Murage EW, Martin SL. Early Infant Feeding Practices among Women Engaged in Paid Work in Africa: A Systematic Scoping Review. Adv Nutr 2024; 15:100179. [PMID: 38246350 PMCID: PMC10877690 DOI: 10.1016/j.advnut.2024.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/23/2024] Open
Abstract
Around the world, paid work without appropriate structural support is a key barrier to optimal breastfeeding practices. To better protect, promote, and support optimal breastfeeding practices among working women in Africa, this scoping review sought to understand how paid work influences infant feeding practices in the first 6 mo of life and what support women need to manage work and optimal infant feeding practices. We systematically searched PubMed, Scopus, Global Health, and CINAHL Plus, screened 2436 abstracts, and reviewed 322 full-text articles using Covidence for review and charting. We identified 203 articles that met the inclusion criteria. We identified 32 quantitative, 10 qualitative, 3 mixed-methods, and 2 review articles that focused on examining the relationship between work and breastfeeding, and 109 quantitative, 22 qualitative, 21 mixed-methods, and 4 review articles that included work as part of broader breastfeeding research but did not focus on work. Most studies reported a significant negative association between work and exclusive breastfeeding. Three major domains were reported in the qualitative studies: challenges to managing work and infant feeding, receiving support from employers and family members/caregivers, and strategies for feeding infants when the mother is working. Reviewed studies proposed recommendations to increase support for breastfeeding through changes to policies and support within worksites, the health system, and childcare; however, evidence of previously implemented policies or programs is limited. We recommend more consistent definitions and measurement of women's work. Future research is needed on the impact of implementing various strategies and benefits for breastfeeding at workplaces, as well as efforts to support breastfeeding among informal workers.
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Affiliation(s)
- Melina Mgongo
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Better Health for the African Mother and Child, Moshi, Tanzania.
| | - Scott B Ickes
- Department of Biological and Health Sciences, Wheaton College, Wheaton, IL, United States; Kenya Medical Research Institute, Nairobi, Kenya; Program in Nutritional Sciences, and Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States; Department of Kinesiology and Health Sciences, William and Mary, WIlliamsburg, VA, United States
| | - Beatrice J Leyaro
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Innocent B Mboya
- Institute of Public Health, Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania; Department of Translational Medicine, Lund University, Malmo, Sweden
| | - Samantha Grounds
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily R Seiger
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara H Hashim
- Institute of Public Health, Department of Community and Global Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Jamie L Conklin
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Stephanie L Martin
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Prioreschi A, Pearson R, Richter L, Bennin F, Theunissen H, Cantrell SJ, Maduna D, Lawlor D, Norris SA. Protocol for the PLAY Study: a randomised controlled trial of an intervention to improve infant development by encouraging maternal self-efficacy using behavioural feedback. BMJ Open 2023; 13:e064976. [PMID: 36882258 PMCID: PMC10008478 DOI: 10.1136/bmjopen-2022-064976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION The early infant caregiving environment is crucial in the formation of parent-child relationships, neurobehavioural development and thus child outcomes. This protocol describes the Play Love And You (PLAY) Study, a phase 1 trial of an intervention designed to promote infant development through encouraging maternal self-efficacy using behavioural feedback, and supportive interventions. METHODS AND ANALYSIS 210 mother-infant pairs will be recruited at delivery from community clinics in Soweto, South Africa, and individually randomised (1:1) into two groups. The trial will consist of a standard of care arm and an intervention arm. The intervention will start at birth and end at 12 months, and outcome assessments will be made when the infants are 0, 6 and 12 months of age. The intervention will be delivered by community health helpers using an app with resource material, telephone calls, in person visits and behavioural feedback with individualised support. Every 4 months, mothers in the intervention group will receive rapid feedback via the app and in person on their infant's movement behaviours and on their interaction styles with their infant. At recruitment, and again at 4 months, mothers will be screened for mental health risk and women who score in the high-risk category will receive an individual counselling session from a licensed psychologist, followed by referral and continued support as necessary. The primary outcome is efficacy of the intervention in improving maternal self-efficacy, and the secondary outcomes are infant development at 12 months, and feasibility and acceptability of each component of the intervention. ETHICS AND DISSEMINATION The PLAY Study has received ethical approval from the Human Research Ethics Committee of the University of the Witwatersrand (M220217). Participants will be provided with an information sheet and required to provide written consent prior to being enrolled. Study results will be shared via publication in peer-reviewed journals, conference presentation and media engagement. TRIAL REGISTRATION NUMBER This trial was registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 10 February 2022 (identifier: PACTR202202747620052).
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Affiliation(s)
- Alessandra Prioreschi
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebecca Pearson
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Academic Mental Health, Addiction and Suicide Research, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona Bennin
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Helene Theunissen
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah J Cantrell
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Dumsile Maduna
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Deborah Lawlor
- Department of Social Medicine, MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Shane A Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Eldah TT, Mary M, Selina RN, Cecilia MT. Perceptions of Caregivers Regarding Malnutrition in Children under Five in Rural Areas, South Africa. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1784. [PMID: 36421232 PMCID: PMC9689243 DOI: 10.3390/children9111784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 09/25/2023]
Abstract
Children under five depend on the caregivers to provide them with nutritious food to combat malnutrition. Several studies have been conducted about malnutrition in children, yet limited attention has been paid to the caregivers. Thus, the study investigated the perceptions of caregivers with regard to non-nutritious foods in rural areas in South Africa. This study explored caregiver's perception regarding non-nutritious food in children below five. This was done in primary health care clinics of Tshilwavhusiku local areas of Makhado Municipality in Vhembe District, South Africa. A qualitative approach was adopted. Nine caregivers were sampled randomly. In-depth individual interviews were conducted, and Tesch's analytical approach was adopted to analyze the data measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. The study revealed that caregivers were lacking knowledge regarding nutritious food to be given to their children and signs of malnutrition were also not known. It is imperative to ensure the improvement of caregivers' knowledge regarding nutritious food and children's nutritional status in order to reduce the malnutrition rate.
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Affiliation(s)
| | - Maluleke Mary
- Department of Advanced Nursing Science, University of Venda, Private Bag X 5050, Thohoyandou 0950, South Africa
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Babakazo P, Bosonkie M, Mafuta E, Mvuama N, Mapatano MA. Common breastfeeding problems experienced by lactating mothers during the first six months in Kinshasa. PLoS One 2022; 17:e0275477. [PMID: 36223384 PMCID: PMC9555666 DOI: 10.1371/journal.pone.0275477] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/18/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Breastfeeding has numerous advantages for infant, mother and society. However, many mothers discontinue breastfeeding due to problems they encounter. This study aimed to identify problems commonly experienced by breastfeeding mothers during the first six months in Kinshasa. METHODS A prospective cohort study was carried out in Kinshasa from October 2012 to July 2013. A total of 422 mother-infant couples were recruited shortly after being discharged from twelve maternity facilities in Kinshasa and followed-up for six months. Interviews were conducted at the mother's house during the first week after birth, and thereafter at monthly intervals for six months. Data included mother's sociodemographic characteristics, the breastfeeding problems she experienced and information on child's feeding. Incidences of breastfeeding problems encountered during different periods were calculated as well as their confidence intervals. RESULTS Cracked or sore nipples, insufficient production of milk and breast engorgement were the most commonly experienced problems by lactating mothers. The problems occurred mainly during the first week (17.1%; CI95% 13.7-21.1) and the rest of the first month (16.2%; CI95% 12.8-20.3). CONCLUSIONS The first month after birth presents the most risk for the occurrence of breastfeeding problems. Mothers should be supported as soon as possible after delivery, to improve their breastfeeding performance and to be informed on how to maintain breast milk supply.
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Affiliation(s)
- Pélagie Babakazo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- * E-mail: ,
| | - Marc Bosonkie
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nono Mvuama
- Centre Mère et Enfant Barumbu, Kinshasa, Democratic Republic of the Congo
| | - Mala-Ali Mapatano
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Till S, Mkhize M, Farao J, Shandu LD, Muthelo L, Coleman TL, Mbombi M, Bopape M, Klingberg S, van Heerden A, Mothiba T, Densmore M, Verdezoto Dias NX. Digital Health Technologies for Maternal and Child Health in African and other LMICs: A Cross-disciplinary Scoping Review with Stakeholder Consultation (Preprint). J Med Internet Res 2022; 25:e42161. [PMID: 37027199 PMCID: PMC10131761 DOI: 10.2196/42161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/16/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. OBJECTIVE This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. METHODS We conducted a scoping review using the 6-stage framework by Arksey and O'Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. RESULTS During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. CONCLUSIONS Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy.
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Affiliation(s)
- Sarina Till
- School of Information Technology, Independent Institute of Education, Durban, South Africa
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Mirriam Mkhize
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
| | - Jaydon Farao
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - Londiwe Deborah Shandu
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
| | - Livhuwani Muthelo
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | | | - Masenyani Mbombi
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Mamara Bopape
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Sonja Klingberg
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Alastair van Heerden
- Human Sciences Research Council, Centre for Community Based Research, Sweet Waters, South Africa
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tebogo Mothiba
- Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Melissa Densmore
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
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Hunter-Adams J, Strebel A, Corrigall J, Zweigenthal V. Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work. BMC Public Health 2022; 22:16. [PMID: 34991552 PMCID: PMC8734352 DOI: 10.1186/s12889-021-12435-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many low-and-middle-income countries, including South Africa, have high rates of teenage pregnancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa's education department, in the interest of learners, promotes adolescents' early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. METHODS Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staff who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. RESULTS Informants from both sectors expressed discomfort at pregnant learners remaining in school late in pregnancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefits of extended breastfeeding for infants and mothers, they recognised the potential conflict between the need for the mother to return to school and the recommendation for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. CONCLUSIONS Our findings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6 weeks postpartum, followed by guided support of formula-feeding. We encourage the active engagement of adolescents' mothers and extended families who are often involved in infant feeding and care decisions. Education and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mother.
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Affiliation(s)
- Jo Hunter-Adams
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Anna Strebel
- Women's and Gender Studies, Faculty of Arts, University of the Western Cape, Bellville, 7535, South Africa
| | - Joanne Corrigall
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Virginia Zweigenthal
- Division of Public Health Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
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Mugware A, Motadi SA, Mushaphi LF. Feeding practices and micronutrient status of children aged 0-36 months in Thulamela Municipality, Limpopo province. Health SA 2022; 27:1973. [PMID: 36337439 PMCID: PMC9634681 DOI: 10.4102/hsag.v27i0.1973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/12/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Micronutrient deficiency continues to be a major public health problem affecting infants and young children under 5 years of age worldwide. AIM The study aims to investigate feeding practices and micronutrient status of children aged 0-36 months. SETTING The study was conducted at government clinics located in Thulamela Municipality, which is one of the local municipalities in Vhembe District, Limpopo province. METHODS A cross-sectional survey was conducted. A total of 250 mothers with children aged 0-36 months were enrolled. A structured questionnaire was used to interview the mothers. Biochemical measurements of children were assessed using standard procedures. RESULTS Only 7.6% of children were exclusively breastfed for 6 months. Majority (87.5%) of the children were introduced to complementary foods before 6 months and 98.8% of the children had a low dietary diversity score of less than four, while 9.2% had a dietary diversity score of more than four. The prevalence of vitamin A deficiency, anaemia and iron deficiency was 21.7%, 53.6% and 13.1%, respectively. For mothers who initiated breastfeeding immediately after delivery, the odds of children having low ferritin were 0.11 times, as compared to children who were initiated breastfeeding a day after delivery (odds ratio = 0.11; 95% confidence interval = 0.015-0.812). CONCLUSION Most of the children were introduced to complementary foods earlier than 6 months of age. Infant feeding practices were associated with micronutrients status. CONTRIBUTION The study contributes to the body of literature on feeding practices and the micronutrient status of children.
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Affiliation(s)
- Anzani Mugware
- Department of Nutrition, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Selekane A. Motadi
- Department of Nutrition, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Lindelani F. Mushaphi
- Department of Nutrition, Faculty of Health Sciences, University of Venda, Thohoyandou, South Africa
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Vitalis D, Vilar-Compte M, Nyhan K, Pérez-Escamilla R. Breastfeeding inequities in South Africa: Can enforcement of the WHO Code help address them? - A systematic scoping review. Int J Equity Health 2021; 20:114. [PMID: 33947401 PMCID: PMC8097970 DOI: 10.1186/s12939-021-01441-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Suboptimal breastfeeding rates in South Africa have been attributed to the relatively easy access that women and families have had to infant formula, in part as a result of programs to prevent maternal-to-child transmission (MTCT) of HIV. This policy may have had an undesirable spill-over effect on HIV-negative women as well. Thus, the aims of this scoping review were to: (a) describe EBF practices in South Africa, (b) determine how EBF has been affected by the WHO HIV infant feeding policies followed since 2006, and (c) assess if the renewed interest in The Code has had any impact on breastfeeding practices in South Africa. METHODS We applied the Joanna Briggs Institute guidelines for scoping reviews and reported our work in compliance with the PRISMA Extension (PRISMA-ScR). Twelve databases and platforms were searched. We included all study designs (no language restrictions) from South Africa published between 2006 and 2020. Eligible participants were women in South Africa who delivered a healthy live newborn who was between birth and 24 months of age at the time of study, and with known infant feeding practices. RESULTS A total of 5431 citations were retrieved. Duplicates were removed in EndNote and by Covidence. Of the 1588 unique records processed in Covidence, 179 records met the criteria for full-text screening and 83 were included in the review. It was common for HIV-positive women who initiated breastfeeding to stop doing so prior to 6 months after birth (1-3 months). EBF rates rapidly declined after birth. School and work commitments were also reasons for discontinuation of EBF. HIV-positive women expressed fear of HIV MTCT transmission as a reason for not breastfeeding. CONCLUSION The Review found that while enforcing the most recent WHO HIV infant feeding guidelines and the WHO Code may be necessary to improve breastfeeding outcomes in South Africa, they may not be sufficient because there are additional barriers that impact breastfeeding outcomes. Mixed-methods research, including in-depth interviews with key informants representing different government sectors and civil society is needed to prioritize actions and strategies to improve breastfeeding outcomes in South Africa.
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Affiliation(s)
- Debbie Vitalis
- Yale University School of Public Health, New Haven, CT, 06510, USA.
| | | | - Kate Nyhan
- Yale University, Cushing/Whitney Medical Library, 333 Cedar St., New Haven, CT, 06510, USA
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Richard SA, McCormick BJJ, Murray-Kolb LE, Patil CL, Chandyo RK, Mahopo C, Maciel BL, Bose A, Mahfuz M, Ambikapathi R, Olortegui MP, Caulfield LE. Characteristics associated with the transition to partial breastfeeding prior to 6 months of age: Data from seven sites in a birth cohort study. MATERNAL AND CHILD NUTRITION 2021; 17:e13166. [PMID: 33660928 PMCID: PMC8189203 DOI: 10.1111/mcn.13166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites of a birth cohort study in which twice weekly information on infant feeding practices was collected. Infant (size, sex, illness and temperament), maternal (age, education, parity and depressive symptoms), breastfeeding initiation practices (time of initiation, colostrum and pre‐lacteal feeding) and household factors (food security, crowding, assets, income and resources) were considered. Three consecutive caregiver reports of feeding animal milks and/or solids (over a 10‐day period) were characterized as a transition to partial breastfeeding, and Cox proportional hazard models with time (in days) to partial breastfeeding were used to evaluate associations with both fixed and time‐varying characteristics. Overall, 1470 infants were included in this analysis. Median age of transition to partial breastfeeding ranged from 59 days (South Africa and Tanzania) to 178 days (Bangladesh). Overall, higher weight‐for‐length z‐scores were associated with later transitions to partial breastfeeding, as were food insecurity, and infant cough in the past 30 days. Maternal depressive symptoms (evaluated amongst 1227 infants from six sites) were associated with an earlier transition to partial breastfeeding. Relative thinness or heaviness within each site was related to breastfeeding transitions, as opposed to absolute z‐scores. Further research is needed to understand relationships between local perceptions of infant body size and decisions about breastfeeding.
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Affiliation(s)
- Stephanie A Richard
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Infectious Disease Clinical Research Program, Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Benjamin J J McCormick
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Science Fish Limited, Insch, UK
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
| | - Crystal L Patil
- Department of Human Development and Nursing Science, University of Illinois, Chicago, Illinois, USA
| | | | - Cloupas Mahopo
- Department of Nutrition, University of Venda, Thohoyandou, South Africa
| | - Bruna L Maciel
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Anuradha Bose
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Ramya Ambikapathi
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, USA.,Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | | | - Laura E Caulfield
- The Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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11
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Goon DT, Ajayi AI, Adeniyi OV. Reasons for the Early Introduction of Complementary Feeding to HIV-Exposed Infants in the Eastern Cape, South Africa: An Exploratory Qualitative Study. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E703. [PMID: 33339140 PMCID: PMC7765566 DOI: 10.3390/medicina56120703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
Exclusive breastfeeding has many health benefits for the baby and the mother. This study explored the reasons for the early introduction of supplementary feeding before six months, and the issues faced by parturient women in practicing exclusive breast feeding (EBF) for their HIV-exposed infants in the Eastern Cape, South Africa. Narratives from 319 parturient women with HIV (aged 18 years and above) were collected at three hospitals in the Eastern Cape through semi-structured interviews over a period of five months. Qualitative data were analysed using thematic content analysis. The maternal perception of HIV transmission from breast milk influenced the decision for the immediate introduction of formula feeding. Breast sores, lumps, surgery and perceived insufficiency of milk influenced the decision of mothers to initiate formula feeding within the first two months. However, mothers who initiated complementary feeding after two months were driven by factors common among newborns (refusal of breast milk, baby crying inconsolably and fear of losing weight) and social factors (economic or financial hardships and work-related challenges). Additionally, advice from family members weighed heavily in the decision to switch to complementary feeding, contrary to the healthcare providers' recommendations. Early complementary feeding for HIV-exposed infants is influenced by maternal perceptions of breast milk transmission, breast and infant factors and socio-economic and cultural practices in the region. Thus, behavioural interventions tailored towards promoting exclusive breastfeeding practices in this population, starting from the pre-natal and continuing during the post-partum period, should also target the immediate family members. National policy should focus on creating an EBF-friendly environment at the workplace for women.
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Affiliation(s)
- Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5201, South Africa; or
| | - Anthony Idowu Ajayi
- Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Centre, APHRC Campus, Manga Close, Nairobi 00100, Kenya; or
- Sociology Department, University of Fort Hare, East London 5201, South Africa
| | - Oladele Vincent Adeniyi
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5201, South Africa; or
- Department of Family Medicine, East London Hospital Complex, Cecilia Makiwane Hospital, East London 5206, South Africa
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12
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Abstract
OBJECTIVE To (i) describe the infant feeding practices of South African women living in Soweto and (ii) understand from the mothers' perspective what influences feeding practices. DESIGN Semi-structured focus group discussions (FGD) and in-depth interviews (IDI) were conducted, and data were analysed using thematic analysis. SETTING Soweto, South Africa. PARTICIPANTS Nineteen mothers were stratified into three FGD according to their baby's age as follows: 0-6-month-olds, 7-14-month-olds and 15-24-month-olds. Four mothers from each FGD then attended an IDI. RESULTS Although mothers understood that breast-feeding was beneficial, they reported short durations of exclusive breast-feeding. The diversity and quality of weaning foods were low, and 'junk' food items were commonly given. Infants were fed using bottles or spoons and feeding commonly occurred separately to family meal times. Feeding practices were influenced by mothers' beliefs that what babies eat is important for their health and that an unwillingness to eat is a sign of ill health. As such, mothers often force-fed their babies. In addition, mothers believed that feeding solid food to babies before 6 months of age was necessary. Family matriarchs were highly influential to mothers' feeding practices; however, their advice often contradicted that of health professionals. CONCLUSIONS In South Africa, interventions aimed at establishing healthier appetites and eating behaviours in early life should focus on: (i) fostering maternal self-efficacy around exclusive breast-feeding; (ii) challenging mixed feeding practices and encouraging more responsive feeding approaches and (iii) engaging family members to promote supportive household and community structures around infant feeding.
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13
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Fuls N, Krüger E, van der Linde J. Feeding characteristics of infants in a lower-middle-income country. J Paediatr Child Health 2020; 56:1083-1089. [PMID: 32073196 DOI: 10.1111/jpc.14823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/27/2020] [Accepted: 02/02/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe feeding characteristics (such as breast feeding and complementary feeding) and determine the nature of feeding difficulties of infants in a primary health-care clinic (PHC) in South Africa. METHODS A total of 200 infants aged 6-12 months (mean = 8.54, standard deviation = 2.18) received a feeding screening by a speech-language therapist at a PHC in a semi-urban area using the Montreal Children's Hospital-Feeding Scale (MCH-FS). Children who failed screening underwent further clinical feeding evaluation using the Schedule of Oral Motor Assessment. RESULTS The sample consisted of 200 participants, and most participants (n = 174; 87%) received breastfeeding, irrespective of their mothers' human immunodeficiency virus status. The longer the breastfeeding period, the less likely parents were to show concern about infants' feeding (P = 0.035). Complementary feeding was introduced between 6 and 8 months (n = 122; 82%). The MCH-FS identified 13 participants with feeding difficulties (6.5%), of which 11 were diagnosed with oral motor dysfunction (OMD) using the Schedule of Oral Motor Assessment. The 6.5% (n = 13) that failed had mild (n = 8; 61.5%), moderate (n = 2; 15.4%) and severe (n = 3; 23.1%) feeding difficulties, as reported by care givers using the MCH-FS. The MCH-FS showed that distraction during meals/following infants (n = 42; 21%); food refusal (n = 31; 15.5%); care giver unease about feeding (n = 29; 14.5%); and problems with vomiting, gagging or spitting (n = 28; 14%) were characteristics of feeding in this sample. Participants in the age groups 6 (n = 3; 27.3%) and 10 months (n = 3; 27.3%) were prone to OMD. CONCLUSIONS This study is the first of its kind to describe the feeding characteristics of a group of infants during the transitional feeding stage in late infancy in South Africa. Important findings were the existence of OMD in 11 infants and feeding difficulties during transitional feeding in 13 infants. The study's findings may be used as a starting point for larger-scale studies in a similar setting, investigating the development of future care giver education and health-care professional training programmes regarding transitional feeding. Research endeavours by speech-language therapists need to prioritise late infancy and transitional feeding in order to prevent possible difficulties arising from sub-optimal care giver feeding practices. The study may be valuable to all health-care providers in PHC.
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Affiliation(s)
- Nichole Fuls
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Esedra Krüger
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - Jeannie van der Linde
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
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14
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Daniele MAS, Martinez-Alvarez M, Etyang AK, Vidler M, Salisbury T, Makanga PT, Musitia P, Flint-O'Kane M, Brown TW, Diallo BA, Boene H, Stones W, von Dadelszen P, Magee LA, Sandall J. The contribution of qualitative research within the PRECISE study in sub-Saharan Africa. Reprod Health 2020; 17:58. [PMID: 32354359 PMCID: PMC7191675 DOI: 10.1186/s12978-020-0875-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The PRECISE Network is a cohort study established to investigate hypertension, fetal growth restriction and stillbirth (described as "placental disorders") in Kenya, Mozambique and The Gambia. Several pregnancy or birth cohorts have been set up in low- and middle-income countries, focussed on maternal and child health. Qualitative research methods are sometimes used alongside quantitative data collection from these cohorts. Researchers affiliated with PRECISE are also planning to use qualitative methods, from the perspective of multiple subject areas. This paper provides an overview of the different ways in which qualitative research methods can contribute to achieving PRECISE's objectives, and discusses the combination of qualitative methods with quantitative cohort studies more generally.We present planned qualitative work in six subject areas (health systems, health geography, mental health, community engagement, the implementation of the TraCer tool, and respectful maternity care). Based on these plans, with reference to other cohort studies on maternal and child health, and in the context of the methodological literature on mixed methods approaches, we find that qualitative work may have several different functions in relation to cohort studies, including informing the quantitative data collection or interpretation. Researchers may also conduct qualitative work in pursuit of a complementary research agenda. The degree to which integration between qualitative and quantitative methods will be sought and achieved within PRECISE remains to be seen. Overall, we conclude that the synergies resulting from the combination of cohort studies with qualitative research are an asset to the field of maternal and child health.
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Affiliation(s)
- Marina A S Daniele
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Angela Koech Etyang
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Marianne Vidler
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Tatiana Salisbury
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience,, King's College London, London, UK
| | - Prestige Tatenda Makanga
- Department of Surveying and Geomatics, Faculty of Science and Technology, Midlands State University, Gweru, Zimbabwe
| | - Peris Musitia
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University in East Africa, Nairobi, Kenya
| | - Meriel Flint-O'Kane
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Tanya Wells Brown
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Brahima Amara Diallo
- Medical Research Council Unit in The Gambia, the London School of Hygiene & Tropical Medicine, London, UK
| | - Helena Boene
- Centro de Investigação em Saúde de Manhiça, Manhiça, Maputo Province, Mozambique
| | - William Stones
- Department of Public Health and Department of Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Science, Faculty of Life Sciences and Medicine, King's College London, 5th Floor, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
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15
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Nieuwoudt SJ, Ngandu CB, Manderson L, Norris SA. Exclusive breastfeeding policy, practice and influences in South Africa, 1980 to 2018: A mixed-methods systematic review. PLoS One 2019; 14:e0224029. [PMID: 31626658 PMCID: PMC6799928 DOI: 10.1371/journal.pone.0224029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In 2011, South Africa committed to promoting exclusive breastfeeding (EBF) for six months for all mothers, regardless of HIV status, in line with World Health Organization recommendations. This was a marked shift from earlier policies, and with it, average EBF rates increased from less than 10% in 2011 to 32% by 2016. OBJECTIVES The aim of this mixed-methods systematic review was to describe EBF practices in South Africa and their multi-level influences over four policy periods. METHODS We applied PRISMA guidelines according to a published protocol (Prospero: CRD42014010512). We searched seven databases [Africa-Wide, PubMed, Popline, PsychINFO, CINAHL, Global Health, and The Cochrane Library] and conducted hand searches for eligible articles (all study designs, conducted in South Africa and published between 1980-2018). The quality of articles was assessed using published tools, as appropriate. Separate policy analysis was conducted to delineate four distinct policy periods. We compared EBF rates by these periods. Then, applying a three-level ecological framework, we analysed EBF influences concurrently by method. Finally, the findings were synthesized to compare breastfeeding influences by policy period, maintaining an ecological framework. RESULTS From an initial sample of 20,226 articles, 72 unique articles were reviewed, three of which contributed to both quantitative and qualitative analysis. Despite the large sample, several provinces were poorly represented (if at all) and many studies were assessed as low to moderate quality. Despite these limitations, our historical lens enabled us to explore why South African progress on increasing EBF practices has been slow. The review reflects a context that increasingly supports EBF, but falls short in accounting for family, community, and workplace influences. The findings also highlight the unintended damage caused by rapidly adopting and introducing global guidelines to an unsupported health workforce. CONCLUSIONS From a South African perspective, we identified geographic and methodological biases, as well as gaps in our understanding and potential explanations of inequities in EBF. Our recommendations relate to policy, programming, and research to inform changes that would be required to further improve EBF practice rates in South Africa. While our review is South Africa-specific, our findings have broader implications for investing in multi-level interventions and limiting how often infant feeding guidelines are changed.
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Affiliation(s)
- Sara Jewett Nieuwoudt
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Christian B. Ngandu
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
| | - Lenore Manderson
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- Institute at Brown for Environment and Society, Brown University, Providence, RI, United States of America
- School of Social Sciences, Menzies Building, Clayton Campus, Monash University, Melbourne, Australia
| | - Shane A. Norris
- SAMRC Developmental Pathways Health and Research Unit, University of the Witwatersrand, Braamfontein, Johannesburg, South Africa
- School of Human Development and Health, and NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
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Webb C, Cabada MM. A Review on Prevention Interventions to Decrease Diarrheal Diseases’ Burden in Children. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0134-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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