Editorial Releases: 2003

THE FATHERHOOD PROJECT - PROMOTING MEN S CARE AND PROTECTION OF CHILDREN: December 2, 2003

South Africa has unacceptably high levels of child abuse, including sexual abuse, much of which is perpetrated by men. Fathers are also absent from a large number of families in the country. Despite this, very few programmes to protect children and build family and community life focus on or include men. These factors prompted the development of an action research project to promote fatherhood.

The Birth to Twenty research programme at Wits University, based in Soweto-Johannesburg, in partnership with the Child, Youth and Family Development (CYFD) research programme at the Human Sciences Research Council, started the Fatherhood Project. The Fatherhood Project aims to promote men?s care and protection by providing information about the importance of father-child relationships, and how they benefit children, men and families.

Professor Linda Richter, Executive Director of CYFD and Principal Investigator of Birth to Twenty says, ?fatherhood is a mental concept; it consists of the ideas and images we have of men, who protect, encourage and guide us. In a country where so many fathers are absent from homes and from the lives of their children, fathers nonetheless feature strongly in the minds and yearnings of young people?

Within the Birth to Twenty study, only a fifth (20%) of the 2500 children have contact with their biological fathers. However, fathers do not only have to be biological fathers ? we talk of Nelson Mandela as the father of our nation, we speak of father-figures, and so on. For many South African children, their father is in fact a grandfather, a step-father, an uncle, an older brother, a teacher, a religious leader and, sometimes, even their mother.

Part of the Project included asking boys and girls between 10 and 12 years of age in urban and rural areas to write about their fathers. One young girl in rural KwaZulu-Natal wrote of her father, ??He is not working. It is only my mother who is working. My father stays at home and he does house chores every day. He cleans the house. He cooks the food and washes clothes. My mother doesn?t have to come back from work and do the house. He is a caring father who teaches me to pray and to respect other people. I love him so much.?

There is much research on the critical role that men in general, and fathers in particular, play in promoting children?s development and adjustment. Findings from community interventions in the USA, suggest that promoting the involvement of, especially young, fathers in their children?s development may inhibit the development of antisocial behaviour in high-risk environments, and may promote positive values and civic engagement among men.

Birth To Twenty is the largest and longest running study of children?s health and development in Africa, and one of the few large-scale longitudinal studies in the world. For seven weeks between March and June, following Nelson Mandela?s release from prison in 1990, 5500 children were born in the metropolitan area of Soweto - Johannesburg. The study has maintained contact with over 75% of the cohort.

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ANGLOAMERICAN?S CHAIRMAN FUND IN PARTNERSHIP WITH BIRTH TO TWENTY: December 1, 2003

Birth To Twenty, at the University of the Witwatersrand, is the largest and longest running study of child health and development in Africa. With the view of tracking the lives of children for ten years, the study was conceptualised to begin in 1990, under the name Birth To Ten. For seven weeks between March and June 1990, less than a month after Nelson Mandela?s release, more than 5000 children were born in the Johannesburg Metropolitan area and were enrolled in the study. Because of its importance and it enormous success, the study has since been extended for another decade, and is now called Birth To Twenty.

The Birth To Twenty study encompasses research based on growth and bone mass acquisition, nutrition, health and illness, psycho social development, child care and education, social context, environment and health, sexual maturity and teen parenthood methodological issues, social risks and vulnerability of young people to contract Sexually Transmitted Infections.

To date, more than100 scientific documents on the findings of the study have been published at national and international conferences and in journals. The Birth To Twenty findings have impacted on the following:

Improvements have been made to the way routine data about children?s births are collected in hospitals and clinics, so that accurate and complete information can be collected on children at risk.
Children?s perceptions and experiences of smoking at five years and seven years of age were presented to the Minister and the Parliamentary standing committee on Health, and contributed to the tobacco control legislation passed in 2000.
Birth to Twenty researchers developed a policy brief on the consequences of high rates of lead in the blood of children living in Johannesburg linked to fuel emissions and other sources.
A report addressing schools as social environments for learning and health promotion has been circulated to all the schools in Soweto ?Johannesburg area.
Information on the early age, at which some children were being admitted to school (15%)of BTT went to school before they were five years old, contributed to the mandatory school enrolment age being introduced by the minister of education in 2000.
Young adolescents have to contend with both sexual and lifestyle risk. Both psychological and social changes occur during the ages of 10 and 14 years. Some of the changes which occur in this age range are directly related to puberty, an example of which is sexual behaviour. Studies show that sexual behaviour starts around 13 years of age around boys in South Africa and around 15 years around girls. This behaviour could predisposes one to the risk of unwanted pregnancy, abortion, and contracting STIs.
Some of the changes are, however, indirectly associated with puberty, for example, the rapid growth during puberty, together with hormonal modifications and changes in diet and activity levels may lead to weight gain. ɳ°ÍÌåÓý¹ÙÍø_2024Å·ÖÞ±­²©²Êapp@ 7 % of South African children are overweight, which is twice the average percentage overweight for Africa and the US. There is evidence that variations in pubertal development may be related to adult diseases such as cardiovascular disease and diabetes.

The results of the Birth To Twenty study show that children at 11 and 12 years of age appear to be at low expressed risk with regard to sexual behaviour and substance use. However, a small group of children show multiple dangerous behaviours, including carrying a weapon. Without appropriate services, these youngsters are likely to encounter difficulties with the law, with their parents and school, and risk contracting sexually transmitted infections and becoming victims of violence.

The value of a longitudinal perspective, as gained in a study such as Birth To Twenty, is that changes can be studied during different life course stages and may impact government policy. Anglo-American, who is renowned for fighting the AIDS epidemic head-on with their workplace policy, has recognised this. Anglo-American?s pioneering work in the field of policy and advocacy on HIV/AIDS was recognised in 2001 by a Commonwealth award. The Anglo American Chairman?s Fund has supported the Birth To Twenty study since its inception in 1990, and is an example of a partnership that can make a difference to the lives of South African children.

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OSTEOPOROSISAWARENESS WEEK: 20 OCTOBER - 26 OCTOBER 2003

Factors That Influence Bone Health in Children

Collaboration between the MRC Mineral Metabolism Research Unit and Birth To Twenty has set forth to investigate the factors that influence children?s bone health with the idea to develop strategies that may optimise bone health in young adults and decrease the risk of developing osteoporosis in later life.

Birth To Twenty is the largest and longest running study of children?s health and development in Africa, and one of the few large-scale longitudinal studies in the world. Current research at Birth To Twenty is taking place under two umbrellas - bone health and the youth maturity study. The bone health component encompasses a study on growth and bone mass acquisition.

The MRC Mineral Metabolism Research Unit has been conducting research in mineral and bone metabolism for the past 30 years and has made a huge contribution to the understanding and eradication of rickets in South Africa.

Unpublished data from the initiative exploring factors that influence bone health in children have found that the most important factors influencing bone strength at the spine and hip in prepubertal children are maternal bone mass, birth weight, ethnicity and current height.

It is important to understand factors that influence bone mass accretion between childhood and adolescence so as to optimise peak bone mass in early adulthood. The greater one?s peak bone mass, the less risk one is at in developing a disabilitating disease like osteoporosis in later life.

To find out more about these exciting findings and its implications, please contact us. Both Birth To Twenty and the MRC Mineral Metabolism Research Unit are actively involved in research that makes a difference.

Contacts:

Shane Norris
Birth To Twenty: Project Manager
Tel: (011) 488 3609
082 928 2381
E-mail: san@global.co.za

Carmen Basson
Tel: (011) 488 3246
Fax: (011) 488 3593
083 724 6480
E-mail: bassoncd@medicine.wits.ac.za

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THE EFFECTS OF BIRTH WEIGHT AND SUBSEQUENT GROWTH ON GLUCOSE TOLERANCE IN CHILDREN: 09 October 2003

Studies from all over the world have shown that children with low birth weight, and who later become obese as adults, are more susceptible to developing type 2 (insulin dependent) diabetes mellitus and other chronic diseases in adult life.

According to the thrifty phenotype hypothesis, low birth weight, possibly resulting from poor maternal intake, leads to a reduction in the number of insulin secreting B-cells in the pancreas, which becomes detrimental only if the individual becomes overweight.

Studies have confirmed that there is an inverse relationship between birth weight and blood glucose levels. In particular, a study at the Wits University?s Department of Pediatrics demonstrated that neonatal blood glucose levels soon after birth are related to birth weight. The Birth To Twenty Study has collected growth data on more than 2000 children from birth to 10 years of age and has provided the ideal opportunity to measure the effects of both birth weight and glucose metabolism in urban children living in a population that is increasingly exposed to a more westernized diet. Data gathered from the Birth To Twenty Research shows that low birth weight does predispose to higher glucose levels at 7 years of age. Further analysis of the data has been done: birth weights were divided into three equal groups, group 1 being the lowest birth weights, group2 the medium birth weights and 3 the highest birth weights. Children in the lowest group, who also had a low weight at 7 years, had the highest glucose levels and the worst B-cell insulin secretory function. These are characteristics of type 2 diabetes, and these data suggest that such children maybe be at an increased risk developing this disease later in life, especially if they become obese.

Other studies carried out in developing countries have produced very similar results. Therefore children with the worst glucose tolerance are those born with low birth weight, who are relatively obese at 8 years of age. Childhood obesity is thus an important factor in predisposing to type 2 diabetes, especially if it occurs in conjunction with low birth weight.

Excessive or inadequate weight gain in low birth weight children has negative effects on glucose tolerance. Therefore maternal nutrition during pregnancy and postnatal nutrition of both mother and child may be important factors that contribute toward childhood and adult glucose tolerance. Children born into poor socio-economic environments may be subjected to poor nutrient intake both in utero and postnatally and the influence of this on childhood glucose tolerance needs to be investigated in detail. Such studies are underway in India and South Africa and will provide very important information on the effect of diet during these periods of development on glucose metabolism and insulin secretory response.

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PHYSICALACTIVITY LEVELS AND SOCIOECONOMIC VARIABLES ARE CLOSELY RELATED IN SOUTH AFRICAN CHILDREN: September 25, 2003

• Physical activity minimizes the development of chronic diseases of lifestyle, aids in injury prevention by decreasing fall propensity, contributes to quality of life, and improves psychological health.
• Even though physical activity is assumed to be a normal part of childhood, it appears that levels of physical activity are much lower than expected in South African children. Among other factors, this can be attributed to the socio-economic status of the children.
• A study based at the University of the Witwatersrand has found that there is a significant relationship between socio-economic status and physical activity.

The relationship between Socio Economic Status (SES) and physical activity

• Children and adolescents in developing countries are often very inactive.
• Socio economic factors have been identified as an important factor influencing physical activity
• Children in the highest SES group had the highest physical activity scores
• The number of children partaking in Physical education lessons trebled from the lowest SES group to the highest SES group
• There was a strong relationship between mother?s marital status, education level and the child?s physical activity and vice versa.
• The study has also revealed that adolescents with a healthy participation in physical activity are more likely to continue being active into adulthood. Birth to Twenty has been examining physical activity levels since the children were 5 years old, and results from studies were analyzed when children were 9 years old. Physical activity was measured using questionnaires and bone density scans were performed.

Some of the other findings of the study:

• White children were found to be taller than black children at age 9.
• Less than one third of black children were offered Physical Education lessons at school
• Hip bone mass in black children is higher than in white children
• Spine bone mass is higher in black than in white girls.
• White children slept more than black children
• Black children spent double the time walking to and from school than white children
• White children spent double the amount of time per week playing sport than black children
• White children watch half the amount of television over a week than black children.

Of all the causes of chronic diseases, physical activity is the most modifiable. Promotion of physical activity should be placed high on health promotions and school health agenda. Skill development should start as early as possible, if we encourage a love for physical activity early on, the benefits will certainly continue to adulthood.

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BLACKAND INDIAN CHILDREN HAVE THE LOWEST INTAKE OF MICRONUTRIENTS, AS COMPARED TO WHITES AND COLOUREDS: 12 September 2003

A study based at the University of Witwatersrand, within the Department of Pediatrics, has revealed that the most significant micronutrients contributing towards healthy growth from birth are: calcium, iron, zinc, ascorbic acid and biotin. All these were found to be deficient, or below the recommended daily allowance, in diets of black children between the following age groups: at 1 year, and again at 2 years. It has been found that these deficiencies retard growth, may make children susceptible to illness, but can be prevented by modifications in dietary intake and fortification of basic foods.

This study has been following growth and development of more than 2000 children born in Johannesburg ? Soweto.

It was found that breastfeeding plays a significant and positive role in growth and weight during the first six months of life. Poor weaning foods, infections and low levels of stimulation, however counter act this once breastfeeding stops, that by 2 years of age 22% of the children were stunted, (lower than expected height for growth)and 7% were wasted (much less than expected height for growth). Feeding methods play a contributory role in nutrient absorption- feeding should take place in a stable and affectionate relationship. Malnutrition occurs more frequently in households that are disorganized, and in which there is a change of care givers, and in which care givers fail to express affection towards the child.

During adolescence there is:

1. Increased demand for macro and micro nutrients
2. Changes in lifestyle
3. Special needs comes with participation in sports, adolescent pregnancy,
4. Western beauty ideal- contributes to prevalence of eating disorders
5. Young athletes are especially vulnerable to nutritional misinformation that promises enhanced performance.

The following were cited as learning points:

• Preventive measures to reduce diet related disease should begin early in life; however, improvements in diets, eating habits and physical activity can benefit health regardless of age.
• It is not only important that we increase the access poor people have to food, but also that we influence the kinds of food they choose to buy and eat once discretionary income becomes available. Developing countries like South Africa seems destined to take on the problems of the West before entirely solving the problems of poverty, with concomitant increases in obesity, nutrition transition, and sedentary lifestyle. This is commonly referred to as the health transition.
• Policy makers and the media should engage with researchers to effectively communicate important nutritional messages and practices to the public, particularly caregivers.

The researchers gave the following recommendations:

- It is recommended that nutrition information be communicated to children, empowering them to take an active role in food choice and intake. Foods rich in calcium, vitamin A, ascorbic acid, and biotin should be encouraged to prevent micronutrient deficiencies. A food choice plan to optimize macro and micro nutrient intake should be present, especially in scenarios where there is less disposable food.

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Contact person: Carmen Basson
Phone: 011 4883246
e-mail: bassoncd@medicine.wits.ac.za