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01 November 2024 | Story André Damons | Photo Supplied
Dr Nomakhuwa Tabane
Dr Nomakhuwa Tabane is the Head of the Department of Paediatrics and Child Health at the University of the Free State.

The first 1 000 days of a baby’s life, from conception to the age of two, constitute a critical period during which children’s brains form as many as 1 000 neural connections every second – a pace that will not be repeated in their lifetime.

These connections are the building blocks of every child’s future, which makes the role of a campaign like the First 1 000 Days vitally important. It highlights the importance of stimulation and learning from the earliest possible moments, good nutrition for expectant mothers, prevention of malnutrition of children, and early diagnosis of chronic, life-threatening illnesses and developmental disorders.

This is according to Dr Nomakhuwa Tabane, Head of the Department of Paediatrics and Child Health at the University of the Free State (UFS). The campaign was promoted by Dr Tabane’s department in partnership with the Mother and Child Academic Hospital (MACAH) Foundation.  The annual campaign kicks off on 1 November each year.

“There are certain factors that can interfere with this process and result in irreversible damage to children’s brain development, poor growth, and compromised immunity. Those conditions include prematurity, ischaemic brain damage, and infections. These are also the top contributors to the neonatal mortality.

“In the one-month to 49-month-old period, the causes of mortality and morbidity that affect brain development and growth include respiratory illnesses like pneumonia, diarrhoeal diseases, and malnutrition,” says Dr Tabane. 

Aims of the campaign

The First 1 000 Days initiative promotes excellent mother, infant, and child healthcare by supporting community-based programmes that drive the message of the importance of the first 1 000 days of life to teenagers, young adults, healthcare workers, and the public. This initiative aims to bring about interventions that can address the Under-5 Mortality Rates (U5MR), including Neonatal Mortality Rates (NMR), Infant Mortality Rates (IMR), and Perinatal Mortality Rates (PMR).

“The campaign also aims to improve the growth and development of children in their first 1 000 days of life from conception until they are two years old. It also aims to improve expectant mothers’ health and prevent and decrease maternal mortality in the Free State, as well as to prevent unwanted pregnancies, focusing on decreasing teenage pregnancies.”

According to Dr Tabane, the 2020 South African UN Inter-agency Group for Child Mortality Estimation (UNIGME) estimate for U5MR was 32 deaths per 1 000 live births, NMR of 11 per 1 000 live births, and infant mortality rate (IMR) of 26 per 1 000 live births as compared to the Medical Research Council (MRC) estimate of U5MR of 28 per 1 000 live births, NMR of 12 per 1 000 live births and IMR of 21 per 1 000 live births (15).

South Africa behind other BRICS countries

Based on the 2020 UNIGME report, says Dr Tabane, South Africa has achieved the Sustainable Development Goals (SDG) goals of NMR and the U5MR. South Africa’s indicators were much better than the UNIGME and the MRC 2020 estimates, but it still falls behind other BRICS countries.

“In contrast to other BRICS countries (Brazil, Russia, India, China, and South Africa), UNIGME reports that in the same reporting period of 2020, China’s U5MR was seven per 1 000 live births, Brazil's 15 per 1 000 live births, and Russia's five per 1 000 live births (16). In 2020, the South African national in-hospital neonatal mortality rate (NMR) based on DHIS data was 12,0 per 1 000 live births; the infant mortality rate (IMR) was 15.1 per 1 000 live births, and the under-5 mortality (U5 MR) rate was 16.9 per 1 000 live births, with differences amongst provinces,” says Dr Tabane.

The first 1 000 days campaign’s interventions include education to prevent illnesses and deaths and promote good health, growth, and development. While many training programmes on child survival strategies have been rolled out (e.g., MSSN, HBB, ETAT, AANC, ESMOE, and IMCI), in-service training still has significant gaps.

Other interventions include preventing unwanted and unplanned pregnancies, providing healthcare support for therapeutic and interventional care, strengthening the implementation of the existing strategies developed by the Department of Health to reduce Maternal and Child Mortalities, and monitoring and evaluating the interventions.

News Archive

Emotional health of vulnerable children needs urgent intervention
2014-02-04



In South Africa, thousands of children under the age of 18 are orphaned as a result of HIV/Aids. Experts are worried that these orphans and vulnerable children will experience serious socio-emotional problems and behaviour disorders, should urgent intervention programmes not be implemented urgently.

A study was undertaken by the Centre for Development Support at the UFS, in conjunction with Stellenbosch University and the Houston University in America. The research found that in the Free State province alone, about 15% of orphans and vulnerable children showed signs of psychiatric disorders. Almost half of the children in the study showed signs of abnormal or maladjusted behavioural functioning.

The research team believes that the South African government and the numerous non-governmental organisations put too much emphasis on the physical needs of orphaned and vulnerable children and that their socio-emotional or mental wellbeing receives very little attention.

The nominal financial grant is a welcome relief for some of the needs of this risk group. Researchers are worried, though, that the lack of reliable and culturally-sensitive diagnostic methods for the early detection of psychiatric disorders may pose a challenge when the children reach puberty.

The current study is focusing on the detection of emotional behavioural problems even before adolescence. Questionnaires were distributed across the Free State at clinics, schools and non-governmental organisations dealing with these children. The questionnaires enabled researchers to establish the children's socio-emotional needs.

"Overcrowding in houses where orphans and vulnerable children often live is directly linked to poor socio-emotional health in children," says Prof Lochner Marais from the Centre for Development Support. "The state institutions offering programmes for orphans and vulnerable children overemphasise the physical and/or financial needs of these children. The programme provides, for example, food for the children, grants for the [foster] parents, assistance with school clothes and ensures clinic visits for the children. Of these, only the supply of food has a direct impact on the improved mental health of children."

The study provides, for the first time, a profile of the state of mind of this group, as well as the emotional impact of HIV/Aids – an "urgent matter" according to Dr Carla Sharp from the University of Houston's Department of Psychology. According to Dr Sharp, much more could be done to assist foster parents in addressing the emotional needs of these children. The early detection of behavioural disorders should be the key in intervention programmes.

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