Child and Adolescent Health and Development

Theme leader: Kathy Kahn with Shane NorrisKids in Somerset

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.

PEECHi (Programme for the Economic Evaluation for Maternal and Child Health interventions)
This is a three year project ( 2013-2016) funded by the SA MRC, in partnership with PRICELESS SA (Priority Cost Effective Lessons for System Strengthening), the Health Systems Trust and The MRC Burden of Disease Unit. The aim of the project is to evaluate the cost-effectiveness of interventions to reduce maternal and child mortality.  Open this information sheet comparing child mortality at home, in health care facilities and elsewhere.

Activating Treatment as Prevention through Community Mobilization in South Africa
Increasing the number of South Africans who get tested and linked to care for HIV is important for many reasons. Researchers have recently discovered that when someone who is HIV positive gets on treatment earlier, and then continues to stay on treatment, this person is much less likely to transmit the virus to another person. Using HIV treatment as a way of preventing HIV is called “Treatment as Prevention” (TasP).  We believe that “community mobilisation” will be the best way to address these barriers in order to improve testing, treatment and retention in care.  Through a partnership between the MRC/Wits Rural Public Health and Health Transitions Research Unit, the Universities of California, San Francisco and North Carolina and two local organizations, Sonke Gender Justice and Right to Care.  The community mobilization work will be implemented by Sonke Gender Justice over the next 3 years, from 2015 – 2018. At the end of the 3 years of intervention, we will look at the number of people who get tested, are linked to HIV care, and then remain in care in each village. To see if our intervention worked, will compare these numbers between the 8 intervention villages and the 8 control villages to see if there is a difference.

Feedback about this study was given to all of the communities in the Agincourt HDSS in the form of an informative, one-page fact sheet. To see the fact sheet, click here.

Innovations in HIV testing to enhance care for young women and their peers and partners
We propose to improve HIV prevention and care through expanding HIV testing options to include self-testing for young women, their peers and their sex partners, and by facilitating linkage to care.  In this study we propose two phases. The first phase is formative and will involve two parts: 1) conducting formative qualitative research to understand perceptions of HIV testing and HIV self-testing in the study population and 2) conducting observed HIV self-testing to better understand any challenges with self-testing and the materials needed to make the process clear.  The first phase started in October 2015.

Snacks at school

Snacks sold at schools in the AGincourt HDSS research site

Project Ntshembo: Improving the health and nutrition of adolescents and their infants to reduce the intergenerational risk of metabolic disease. June 2015
Collaboration with the MRC Developmental Pathways for Health Research Unit ; Oxford and Cambridge Universities, UK; Umea University, Sweden
Project Ntshembo: Improving the health and nutrition of adolescents and their infants to reduce the intergenerational risk of metabolic disease Collaboration with MRC Developmental Pathways for Health Research Unit (Wits); Oxford and Cambridge Universities, UK; Umea University, Sweden This initiative aims to promote adolescent health as a critical pathway to improve intrauterine and infant growth and thereby interrupt the intergenerational transfer of metabolic disease. 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 completed 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. 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. In 2012, funds were obtained from the British MRC to conduct a baseline survey – biometric, physical activity and dietary pattern data has been collected on a cross-sectional sample of approximately 600 young women between the ages of 18 and 21 years.  Concurrently, intervention mapping, including work with a local stakeholder group, has been completed. The study team is now poised to move to a Phase III cluster-randomised trial, which we anticipate to begin in 2016.

Optimising body composition in early childhood – The Ha Tlanga (We play) project
Collaboration with the UCT/MRC Research Unit for Exercise Science and Sports Medicine amd the MRC/Wits Developmental Pathways for Health Research Unit

Higher levels of physical activity, and lower levels of sedentary behaviour have been associated with favourable measures of body composition in early childhood. This is relevant in South Africa since obesity in this age group is becoming an increasing public health concern, although it exist

s alongside under-nutrition amongst young South African children, especially in rural areas.  There is evidence that interventions can increase physical activity and decrease sedentary behaviour in early childhood, and while many of these interventions have been implemented in low-income communities, the majority of interventions have been implemented in high-income countries. Very little research has been done on levels of physical activity and sedentary behaviour of young, preschool-aged children in South Africa, particularly in rural settings. This study has aimed to address this gap in the research.

In 2014 we have assessed physical activity (using accelerometry and direct observation) and gross motor skills of children from three independent preschools and two primary schools (Grade R learners) in Agincourt village. Focus groups were also conducted with teachers and parents from these schools, and we plan to collect data (via questionnaire) on parents’ perceptions of their preschool children’s physical activity behaviour early in 2015. Based on all of these findings, along with findings from similar work conducted in Cape Town, a theory- and evidence-based intervention to increase physical activity and decrease sedentary behaviour of preschool children in urban and rural settings will be developed. This intervention will involve capacity building of preschool teachers, and promote engagement with parents. Later in 2015, the feasibility, acceptability and fidelity of this intervention will be assessed, and the final intervention will be presented to stakeholders at the end of 2015.

Ha tlanga Page 1

Ha tlanga page 2

Child and Adolescent Growth Studies June 2015 
Collaboration with the MRC/Wits Developmental 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 kids with certificates

Kulani participants with certificates of participation

Kulani Child Health and Resilience Project  – evaluation of Soul Buddyz/SNOC Evaluation June 2015
Collaboration with Soul City and Oxford University, 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, and the report was provided to Soul City in March 2013.  In the second half of 2013, a research data feedback workshop will be held with the Department of Education in Mpumalanga Province.

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 is ongoing.

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, repeated in 2011, and the next round of data collection started in June 2013.


Young women being assisted to complete ACASI

Swa Koteka – Conditional Cash Transfer and Community Mobilisation Study – 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 is complemented by a community-level mobilization intervention (One Man Can) focused on young men and run by an NGO, Sonke Gender Justice. Recruitment was complete in June 2012, with 2533 young women and their caregivers recruited.  413 young women exited the study at the end of 2012, as they graduated from school.  The study is now in the process of year 1 and year 2 follow up visits.  An 89% retention rate is being achieved, 83% in the control arm and 98% in the intervention arm.  Read more about this study on the HPTN website

Feedback about this study was given to all of the communities in the Agincourt HDSS in the form of an informative, one-page fact sheet. To see the fact sheet, click here.

OMC mural

OMC mural in a village, painted by community members

The OMC intervention is well into its second year, working closely with CommunityAction Teams, Community Mobilisers and community leadership in 11 villages to conduct various activities to raise gender awareness. Read more about the work of Sonke Gender Justice on their website.

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