Paul Kiprono Chelule

Child health remains a critical global public health concern, with malnutrition, diarrhea and pneumonia consistently driving high morbidity and mortality rates among children under the age of five. The World Health Organization (WHO) estimates that malnutrition accounts for approximately 3.1 million child deaths annually. In South Africa, persistent challenges such as stunting, micronutrient deficiencies, and food insecurity remain prevalent, particularly in rural communities, despite the existing interventions. Fermented foods present a culturally acceptable, affordable, and sustainable strategy to address malnutrition and improve gut health, potentially reducing stunting and diarrheal diseases. This article presents a protocol for a future four-phase mixed-method study that will be conducted to develop and validate strategies to promote the integration of fermented foods into children’s daily diets. The researchers will employ an exploratory sequential mixed methods design in three phases for the purpose of the envisaged study: bibliometric analysis, qualitative inquiry through in-depth interviews with caregivers and nurses, and a quantitative survey developed from qualitative findings. By combining qualitative and quantitative data, the study seeks to generate evidence-based, context-specific strategies for policy and programmatic integration. The anticipated outcome is a framework to support the inclusion of fermented foods in child nutrition programs to ensure the improved child health and progress toward the United Nations Sustainable Development Goals (UN SDGs).

Background: Foundational learning spaces in South Africa, designed to nurture growth and development, continue to grapple with malnutrition, a persistent barrier to the health, cognitive potential, and wellbeing of preschool-aged children, amidst a nutrition transition. Aim: This study assessed dietary diversity, nutritional status, and their associations among children aged 2–5 years attending funded Early Learning Centres (ELCs) in Johannesburg (Region C). Methods: Using systematic random sampling across 33 nutrition-funded ELCs in Region C, we assessed the nutritional status of children aged 2–5 years with WHO Anthro software (z-score cut-offs for undernutrition: stunting, underweight, thinness; overnutrition: overweight, obesity). Dietary diversity scores (DDSs) were derived from a 24 h recall of 16 food groups, classified by primary nutrient contributions (some groups spanning multiple classes), and categorized as low (≤8) or normal (≥9). Associations between DDS and nutritional indicators were analyzed using Poisson regression to estimate adjusted prevalence ratios (aPRs). Results: Despite structured feeding practices, all ELCs reported inadequate nutritional funding, prompting calls for dietitian support. While 27% sourced groceries from wholesalers, most relied on supermarkets and spaza shops; all had cooking infrastructure, but only 12% had food gardens, and 88% expressed interest in establishing them to improve dietary diversity. The mean DDS was 9.47 (±1.07), and 83% of children had a normal DDS (≥9), with common consumption of cereals (100%), vitamin A-rich vegetables (100%), oils (100%), and leafy greens (96%), but limited intake of protein-rich foods like eggs (7%), legumes (19%), and fish (37%). A dual burden of malnutrition was observed: 31% of children were stunted and 30% were overweight or obese. Multivariable analysis showed that boys had significantly lower odds of stunting compared to girls (aPR = 0.38; 95%CI: 0.01–0.74), while younger age (aPR = 0.61; 95%CI: 0.37–0.85) and low DDS (aPR = −0.15; 95%CI: −0.29–−0.06) were independently associated with increased risk of stunting. Age was positively associated with underweight (aPR = 1.27; 95%CI: 0.58–1.96), and thinness was strongly associated with boys (aPR = 17.00; 95%CI: 15.12–18.74), with a marginal association with age. Conclusions: Integrated nutrition strategies are critical to addressing the dual burden of stunting and being overweight in urban ELCs. Strengthening funding, professional dietetic support, and promoting food gardens can enhance dietary diversity and child health outcomes.

Background: In 2024, type 2 diabetes mellitus (T2DM) – a public health challenge – affected 589 million adults worldwide. In South Africa, the prevalence is estimated at 15%, contributing to approximately 3.4 million deaths. Achieving optimal glycaemic control in patients is challenging, resulting in preventable complications and deaths. Systemic reforms and targeted interventions are urgently required. Aim: To identify barriers faced by healthcare professionals (HCPs) to effectively manage patients with T2DM. Setting: A survey was conducted in the Tshwane Metropolitan Municipality, Gauteng province, South Africa. Methods: The study involved 205 HCPs across 22 clinics and 6 community health centres from May 2022 to June 2022. Data were analysed descriptively. Categorical variables were compared using Fisher’s exact test and a p-value of < 0.05 was considered significant. Results: Most participants were nurses (84%), < 50 years (65%), female (87%), black people (64.7%), and > 10 years experience (65%) and had academic and in-house training on T2DM (38.5%). Key barriers faced by HCPs in managing patients with T2DM included workload making it difficult monitor patients (53%) and screen for complications (57%), time pressures to deliver quality care (59%) and educate patients (69%), inadequate insulin initiation knowledge (68%) and lack of continuity of care (62%). Conclusion: Excessive workloads, insufficient staffing, time pressures, insulin inertia, and knowledge gaps – impede the delivery of personalised care, patient education and monitoring. Contribution: Addressing these challenges will require collaborative care models, workforce optimisation, targeted training, better resource allocation and health technology and can significantly improve patient outcomes and alleviate burden among HCPs.

Background: Musculoskeletal disorders (MSD) are, to this day, considered one of the major occupational health risks, especially among healthcare workers. Poor working conditions, such as awkward postures, are associated with the development of MSD. This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of nurses at a public tertiary hospital in Botswana relating to ergonomic principles. Methods: The researchers conducted a cross-sectional survey, using a self-administered questionnaire to collect the data. The researchers employed Stata v18 (StataCorp, USA) to perform descriptive and inferential statistics. The chi-square test was used to determine the association between knowledge levels and sociodemographic variables. p-values ≤ 0.05 were deemed statistically significant. Results: In total, 306 nurses participated in the study, and a response rate of 88.4% was achieved. The mean age was 35.5 (SD± 8.79) years. Most (69%) participants were female nurses. About 99.3% (95%CI: 97.7–99.9) of the participants were familiar with the concept of ergonomics. Only a small proportion of participants (26%) possessed high levels of knowledge, exhibited positive attitudes, and demonstrated good practices in relation to ergonomic principles, following the composite analysis. A statistically significant relationship was found to exist between sex and practice (p = 0.030) and between length of work and practice (p = 0.013). Conclusions: The KAP analysis indicated that most nurses had poor practices regarding essential ergonomic principles. These findings could inform policy development and enable employers to design prevention strategies, especially those aimed at preventing lower back pain (LBP).

Health SA Gesondheid promotes communication, collaboration and teamwork between professions and disciplines within the health sciences to address problems that cross and affect disciplinary boundaries.

Background: Evidence on the prevalence of lower back pain (LBP) among nurses is widespread in the literature, with several risk factors being reported. These include manual handling of patients, repetitive bending and twisting movements, and long working hours. It is reported that LBP has negative health outcomes and causes poor work performance among healthcare workers (HCWs). The magnitude of ergonomic risks associated with these healthcare activities has not been adequately investigated in Botswana. Thus, this study aimed to investigate the ergonomic risk levels associated with the manual handling of patients and its association with the prevalence of LBP among nurses in Botswana. Methods: This was an observational cross-sectional hospital-based study conducted in a Botswana public tertiary hospital from March to April 2023. The Movement and Assistance of Hospital Patients (MAPO) tool was used to collect data on ergonomic risk levels. Data on the demographic characteristics of participants were collected using a tool adapted from the Nordic Musculoskeletal Questionnaire (NMQ). Odds ratios and 95% confidence intervals were estimated to determine the association between ergonomic risk levels and the prevalence of LBP. Results: A total of 256 nurses participated and completed the study. The self-reported prevalence of LBP in this study was 76.6%. The risk of acquiring LBP was high (90.5%) based on the MAPO index. Although the frequencies of self-reported LBP were high among nurses, these did not show any significant association with the MAPO index data. This could be partly due to the small sample size. Conclusions: There was a high prevalence of LBP in this study, which was corroborated by the MAPO index data. This has demonstrated the value of the MAPO index in forecasting the risk of patient manual handling. The findings might help Botswana formulate policies intended to address ergonomic preventive measures, directed towards reducing the MAPO index score by addressing the single risk determinants.

Background: Poor dietary habits are major contributors to malnutrition globally, particularly in children living in African countries. The widespread transition from African diet of healthy indigenous foods to a nutrient-poor Western-style diet is well-documented in global societal culture. Aim: This study aimed to assess the dietary habits and their nutritional implications among learners in public primary schools. Setting: City of Tshwane, located in the Gauteng province of South Africa. Methods: This was a quantitative cross-sectional study where researcher-administered questionnaire was used to collect data from 814 primary school learners in grades 4–7. Anthropometric data were also collected. The study was conducted in 10 primary schools in the City of Tshwane. Results: Unhealthy dietary practices were observed where consumption of refined carbohydrates, sugar-filled beverages and limited protein was prevalent. The prevalence rates for overweight and obesity were 15.1% and 11.3%, respectively. Most learners (77.4%) purchased foods from street vendors and tuckshops. Also, learners who knew about healthy eating were less likely to be underweight than those who did not (OR: 0.35; 95% CI: 0.14–0.85; p = 0.020). Conclusion: Poor dietary habits are demonstrated in this study and may be associated with the rising levels of overweight and obesity among the learners. The findings also showed that the school environment is the main source of exposure to unhealthy diet. Contribution: Intervention strategies, such as amendment of the national school nutrition policy, need to be implemented.

Background: Type 2 diabetes mellitus (T2D) is a public health challenge, affecting 90% of all patients with diabetes, globally. Compliance to treatment guidelines among healthcare professionals (HCPs) is low, thus resulting in inadequate quality of patient care and poor health outcomes among patients. Aim: To examine the availability of equipment, guidelines, screening and education offered to patients with T2D and compare between clinics and community health centres (CHCs). Setting: Tshwane Metropolitan Municipality, Gauteng Province, South Africa. Methods: A cross-sectional descriptive study utilised a self-administered questionnaire to collect data from nurses and doctors responsible for treating patients with T2D, from May to June 2022. About 250 eligible HCPs were recruited during routine morning meetings in 22 clinics and six CHCs. Results: More than 80% of HCPs reported having basic equipment except for ophthalmoscopes, Snellen charts (67%), tuning forks (64%), electrocardiograms (ECG) (46%) and monofilaments (12%). SEMDSA guidelines were reported by 16% of the participants, Diabetic Foot Care Guidelines were reported by 54% and Dietary Guidelines for Diabetic Patients by 55%. Furthermore, 91%, 71% and 69% of HCPs reported that ECG, microalbumin-creatinine and foot examinations were not always performed, respectively. About 66% and 17% always offered individual educational and group sessions, respectively. Conclusion: Equipment availability and compliance with treatment guidelines, patient education and screening of chronic complications are inadequate. Contribution: The study highlights the poor adherence to treatment guidelines and inadequate equipment in health facilities. These shortcomings could lead to missed opportunities for early diagnosis of complications and ultimately poorer patient outcomes.