Browsing by Author "Hendricks, Michael"

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    A descriptive study of the community-based follow-up and outcomes of very low birth weight babies discharged from a regional hospital
    (2022) Gondwana de Wit, Thandi Maya; Hendricks, Michael
    Background Neonatal mortality continues to be a significant global health concern, especially in low/middle income countries. In South Africa, neonatal deaths contribute to 32% of the under-five mortality rate, with 48% of these deaths attributed to prematurity. One of the components aimed at reducing neonatal deaths in the Western Cape, is the Home and Community-Based Services (HCBS) for very low birth weight (VLBW) babies. This intervention could reduce neonatal deaths by 25%. This study aimed to describe a VLBW baby cohort discharged from a regional hospital in Cape Town over a year; the HCBS referral process; their follow-up; their outcomes and caregivers' perceptions of the service. Methods This was a retrospective descriptive mixed methods study. Quantitative data from an accredited database were used to describe the VLBW cohort. Meetings with stakeholders and referral form analyses were used to assess the referral pathway and follow-up. Telephonic interviews were held with VLBW babies' caregivers to obtain further quantitative and qualitative data about the HCBS programme. Results During 2018, 169 VLBW babies were included in the population with a mean (SD) gestational age of 30 (±2.21) weeks and median (IQR) birthweight of 1210g (1045-1390g). At delivery, 84.6% had respiratory distress with 60% requiring continuous positive airway pressure; 64% had presumed and 15.3% had suspected or proven nosocomial sepsis. Caregiver characteristics included unbooked pregnancies (10%), primigravida deliveries (15%), smoking (11%), maternal alcohol use (9%), teenage pregnancy (5%), drug addiction (3%) and babies born before hospital arrival (4%) with 14% being referred to a social worker. Folder review showed plans for HCBS referral in only 49 (43.4%) of the cohort, however only 20 (17.7%) referral forms were received by HCBS. Learning about the VLBW HCBS programme identified several challenges relating to the referral process from both the hospital and HCBS side. Overall, the caregivers interviewed had positive perceptions of the HCBS. Those not visited by HCBS felt they would have benefitted from a visit. Conclusion The burden of this medically and socially vulnerable VLBW cohort, who are at high risk of neonatal mortality and morbidity, remains large at this regional hospital - constituting nearly 15% of all their neonatal discharges. Despite the identified challenges, the caregivers' interviewed remained positive about the HCBS. HCBS can play an essential role in providing education, counselling and support following hospital discharge. However, for the HCBS to be fully effective, further promotion, strengthening and monitoring of the referral system is required.
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    Estimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000
    (2007) Nannan, Nadine; Norman, Rosana; Hendricks, Michael; Dhansay, Muhammad A; Bradshaw, Debbie; South African Comparative Risk Assessment Collaborating Group
    Objectives. To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Children under 5 years of age and pregnant women. Outcome measures. Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other nonHIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW. Results. Among children under 5 years, 11.8% were underweight. In the same age group, 11 808 deaths (95% uncertainty interval 11 100 - 12 642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5. Conclusions. The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health.
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    An evaluation of the nutritional status of preschool chldren living in a rural health district : implications for a community based nutrition programme in the Northern Province
    (1999) Saitowitz, Romy; Shung King, Maylene; Hendricks, Michael
    The study aimed to evaluate the nutritional status of pre-school children (0-6 years), and the activities of a local CBNP serving these children, in the Ngwaritsi health district of the Northern Province. The following objectives were identified: o To determine the anthropometric status of children 0-6 years o To determine the dietary intake of children 0-6 years o To evaluate the nutrition services offered to these children by a local CBNP o To make recommendations, based on these findings, for improving existing strategies to address malnutrition in the area.
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    Health service utilisation prior to out-of-hospital natural deaths among children under five in Metro West, Cape Town in 2018: a retrospective analysis of data from the Child Death Review
    (2022) Jacobs, Solomon M; Mathews, Shanaaz; Hendricks, Michael; Phillips, Tammy
    Background In the Metro West geographical service area within the City of Cape Town district the under-five mortality rate in the Metro West GSA decreased from 25 per 1000 live births in 2010 to 22 deaths per 1000 live births in 2013, but the rate of decrease slowed down in part because of the amount of child deaths outside of health facilities. Fifty-five percent of under-five deaths occur out-of-hospital in South Africa, with a similar percentage in the Metro West (49-52% in 2010 to 2015). Describing factors that enable or prevent health service usage among natural under-five deaths is an important precursor for effective interventions. Objectives and Methods A retrospective cross-sectional design utilised secondary, routinely collected data from 1 January to 31 December 2018 on under-five out-of-hospital natural deaths reported to Salt River Mortuary. We used the data, which included routine interviews with the caregivers, together with social and medical data collated by the Child Death Review, to describe the cause of death, the socio-demographic profile, and the routine and prior-to-death health service usage. Dimensions of health service access according to the WHO and Anderson, respectively, were used as a heuristic lens to describe the applicable variables and to formulate a priori multivariable logistic regression models to compare those who did and did not seek care before death. These dimensions include physical accessibility, financial affordability, the health needs of the child as well as the existing health behaviour of the caregiver. Results Of the 187 cases described, 68% died of lower respiratory tract infections and 8% of diarrhoea. Fifty four percent of cases were younger than 3 months, and 40% were born prematurely. In terms of the residential health sub-district, 37% resided in Mitchells Plain, 29% in Klipfontein, 18% in Western and 14% in Southern; 52% resided in needy or very needy areas. Mothers were single (69%), unemployed (73%) and lived in informal housing (46%). Of the cases who were alive at the time, immunisation coverage was 79%, 70% and 68% at the 6-, 10- and 14-week visits. However, only 23% of mothers sought health care prior to the child's death. Overall, 51% of the mothers recognised symptoms of illness prior to death and symptoms were recognised in 95% of the mothers who sought health care compared to 37% of the mothers who did not seek health care (p-value < 0.001). Multivariable logistic regression models showed the importance in recognising symptoms in seeking health care (aOR 18.28, 95% CI 3.67-90.93), and that, while not statistically significant, the recognition of symptoms was less likely at younger ages (aOR 0.28, 95% CI 0.07-1.14 for cases younger than 3 months compared to those older than 6 months) Conclusion The study identified key risk factors implicated in the out-of-hospital deaths in Metro West and the need for mothers to identify and seek health care when their child is symptomatic. There should be focused support during the first 1000 days for mothers identified as being at-risk, namely: those who are single, unemployed, lack social support and abuse substances, and for babies with prematurity and HIV-exposure. Counselling should emphasise the recognition of LRTI symptoms and health care seeking to prevent child deaths and reduce the under-five mortality. Further research is needed to consolidate which provincial geographical areas should be prioritized for targeted interventions that impact on health care seeking behaviour, as well as the most effective child health education and messaging. Data paucity on medical history may be addressed by data augmentation from the Provincial Health Data Centre and improvements should be made for capturing children's anthropometry.
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    How do Swazi mothers respond when their children develop diarrhoea and what factors may underlie such responses? : a study on the home management of diarrhoea among mothers in the Manzini Region of Swaziland
    (2007) Kaleta, Tshikaya; Muwanga, Fred; Hendricks, Michael
    The aim of this study was to determine how Swazi mothers initially respond when their children develop diarrhoea and the factors that could influence their response.
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    Neonatal Mortality in the Cape Town Metro West Geographical Service Area 2014-2017
    (2020) Nelson, Candice Afonso; Hendricks, Michael; Rhoda, Natasha; Masu, Adelaide
    Background Each neonatal death counts, as recognised by the Every Newborn Action Plan (ENAP). This is an important aspect in attaining the third Sustainable Development Goal by 2030. Accurate neonatal mortality data as well as an understanding of the causality and context is essential to plan interventions to reduce neonatal deaths and attain the third Sustainable Development Goals (SDG) of a neonatal mortality rate of less than 12 per 1000 livebirths by 2035. Objectives The objectives of this study were: (i) to determine neonatal mortality occurring in and out of health facilities in the Metro West GSA using the three audit programmes; Perinatal Problem Identification Programme (PPIP), Child Healthcare Problem Identification Programme (Child PIP) and Forensic Pathology Services (ii) to ascertain the cause of death specific neonatal mortality (iii) to describe the avoidable factors in each death as coded by the three audit programmes (iv) to make recommendations for the alignment of existing audit databases to obtain accurate neonatal statistics for the Metro West GSA. Methods This was a retrospective descriptive study of neonatal deaths undertaken in the public healthcare setting in the Cape Town Metro West GSA from January 2014 till December 2017. Existing data from PPIP, Child PIP and the CDR/FPS was used. Neonatal deaths were defined as in the first 28 days of life where there had been signs of life at delivery and a birthweight greater than 500g. Neonatal deaths were excluded where birth had occurred outside of the GSA or in the private health care setting. The audit data with regards to cause of death and avoidable or modifiable factors was obtained for each death. Results From a total of 134843 live deliveries, 1243 neonatal deaths were identified: 976(78%) from PPIP, 58(5%) from Child PIP and 209 (17%) from CDR/FPS. Sixteen per cent of the deaths occurred outside of healthcare facilities. The neonatal mortality rate (NMR) for PPIP was 7.2, Child PIP 0.43 and CDR 1,6 per 1000 livebirths. When the audit systems were combined, the annual NMR over the study period varied from 8.05 to 10.1 with a mean of 9.2 per 1000 livebirths over the entire period. Seventy-eight per cent of the deaths occurred in the early neonatal period with a mean early neonatal mortality rate of 7.2 per 1000 livebirths. The mean late NMR was 2 per 1000 livebirths. Where all neonatal deaths were considered for those more than 500g, the main cause of death was immaturity related, then infection related followed by congenital disorders and then hypoxia related. Seventy-four per cent of deaths occurred in those less than 2500g at birth and 41% were less than 1000g and defined as extremely low birthweight. In the group of neonates greater than 1000g, the main cause of death was infection related deaths, closely followed by congenital disorders and then hypoxia, followed by immaturity. Most of infection related deaths were collected by the CDR and Child PIP. A third of Child PIP and PPIP deaths and half of the CDR deaths were coded as avoidable. The prevalence of deaths due to abandonment either by passive or active neonaticide contributed towards the higher proportion of preventable deaths in the CDR group. Conclusions The burden of deaths due to immaturity is high and may be attributed to the finding that 41% of neonatal deaths were in the ELBW group. Current viability criteria that aim at optimum use of resources may improve survival amongst this group. Infection related deaths were shown by this study to have a greater burden than recorded from PPIP data; most of these deaths were derived from Child PIP and CDR data. Also, where 10% of neonatal deaths were sudden unexpected deaths (SUDIs), a better understanding and definition of this group is urgently required as many of these deaths were subsequently found to be secondary to lower respiratory infections. It is further relevant that where 20% of CDR deaths or 3% of all the study deaths were due to active and passive neonaticide, this entity should be monitored and investigated. The study showed that the GSA has achieved the SDG for NMR of less than 12 per 1000 livebirth. However, a mean NMR of 9.2 per 1000 livebirths is not comparable to other upper middle-income countries. As 38% of the deaths were coded as avoidable, appropriate programmes to address these factors could reduce the NMR to 5.7 per 1000 livebirths. A strong recommendation from this study would be to use all three audit systems to calculate the NMR, understand the causes of neonatal deaths and plan programmes to improve neonatal survival in this GSA.