Shuaib Kauchali | University of KwaZulu-Natal (original) (raw)

Papers by Shuaib Kauchali

South African Medical Journal, 2018

Data on the number of admissions and deaths in children aged under 5 years from diarrhoea, pneumo... more Data on the number of admissions and deaths in children aged under 5 years from diarrhoea, pneumonia and severe acute malnutrition are routinely collected through the District Health Information System. These data, and the associated case fatality rates, are available for all public sector hospitals in South Africa (SA), and can be compared over time, as well as across different settings. This article presents these data for the period 2011/12 - 2016/17. It reflects on the remarkable improvements in these case fatality rates, and the likely reasons for their declines across all provinces. The article concludes by identifying the actions that need to be taken to ensure that SA achieves the Sustainable Development Goal aim of ending preventable child deaths by 2030.

South African Journal of Clinical Nutrition, 2019

Background: The Asenze study has the long-term goal of promoting better physical, cognitive and p... more Background: The Asenze study has the long-term goal of promoting better physical, cognitive and psychosocial functioning of children in a rural area in KwaZulu-Natal, 50 km from Durban, with a view to planning interventions to promote growth and development for very young children. The specific objective in this paper was to provide information for the Child Health and Development project of the Valley Trust to assist with intervention planning. The broader goal was to assess developmental delays in communities ravaged by the HIV epidemic. The Asenze study was designed in two phases from 2008 and 2012. The current paper reports on 1 581 4-6-year-old children in the baseline phase (2008-2010) in the five adjacent tribal areas in the study area. Method: The participants included all the 4-6-year-olds whose parents had consented to inclusion in the project and their caregivers. Data were derived from a brief questionnaire administered in the homes of participants, and subsequently from medical and psychological assessments of the children and their caregivers at the Asenze clinic. The association between child factors and other factors (geographic area, socioeconomic status (SES), parental level of education, the child's preschool education) on the one hand, and the child's cognitive performance (as measured by the Grover Counter and subtests of the KABC-11) were analysed. Linear regression models were employed to determine which predictor variables of interest in a model were associated with the children's cognitive scores as the dependent variables. Results: Based on the data, the principal factors associated with children's cognitive outcomes were height-forage z-score (HAZ), preschool education and the area of residence. Generally children who had low cognitive scores were more often stunted (as defined by the WHO anthropometric tables), had not had preschool education, and came from areas less favourable in terms of local infrastructure and access to employment opportunities and arable land. Conclusion: The finding from this cross-sectional analysis of baseline data showed that in addition to height for age and preschool education, which are commonly thought to impact on cognition, the local authority area where the children lived was associated with their scores on cognitive tests. This has implications for intervention planning. The functioning of local government in promoting the type of community development that will protect the rights of children should be taken into account.

South African Medical Journal, 2018

In 2005, about 4 million newborns died worldwide, [1] with more than 80% of the deaths occurring ... more In 2005, about 4 million newborns died worldwide, [1] with more than 80% of the deaths occurring in lower-middle-income countries in sub-Saharan Africa and South Asia. [2] Since the Millennium Development Goals project ended in 2015, the annual reduction rate in mortality was noted to be slower during the neonatal period than in the post-neonatal period (1-59 months): 3.1% v. 4.7%, with a subsequent increase in the proportion of neonatal deaths accounting for 45% of the global under-5 mortality rate. [3] The United Nations Inter-agency group for child mortality reported that the global neonatal mortality rate (NMR) fell from 36 per 1 000 live births to 19 per 1 000 live births. This translates to a 47% reduction in neonatal deaths, to 2.7 million deaths per year, for the 2005-2015 period. [4] Many lower-middle-income countries have unreliable measurements and estimates of neonatal mortality. In-country vital statistics data that counts every birth and death, coupled with an accurate cause of death, is necessary for decision-making, planning and resource allocation. In most African countries, fewer than 25% of deaths are registered, with only 2% of African and Asian countries having complete data. [5] South Africa (SA) is an exception, and it is one of the few sub-Saharan African countries that has varied and rich sources of mortality data for children. These are shown in Table 1. This article reviews recent estimates of the NMR and causes of neonatal deaths in SA. It also reviews the strategies that are being used to reduce the NMR. In order to reach and surpass the sustainable development target for the NMR, we propose approaches to accelerate the rate of reduction of neonatal mortality resulting from preventable causes of death. Methods The NMRs for the period 2012-2015 were analysed using a number of data sources. Routine data were extracted from the District Health This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

International Journal of Epidemiology, 2015

South African Medical Journal, 2018

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Health Policy and Planning, 2019

There is a gap in understanding of how national commitments to child nutrition are translated int... more There is a gap in understanding of how national commitments to child nutrition are translated into sub-national implementation. This article is a mixed methods case study of a rural South African health district which achieved accelerated declines in morbidity and mortality from severe acute malnutrition (SAM) in young children, following a district health system strengthening (HSS) initiative centred on real-time death reporting, analysis and response. Drawing on routine audit data, the declining trends in under-five admissions and in-hospital mortality for SAM over a 5-year period are presented, comparing the district with two others in the same province. Adapting Gillespie et al.’s typology of ‘enabling environments’ for Maternal and Child Nutrition, and based on 41 in-depth interviews and a follow-up workshop, the article then presents an analysis of how an enabling local health system environment for maternal-child health was established, creating the conditions for achievement...

BMC Health Services Research

Background Despite progress, maternal and neonatal mortality and still births remain high in Sout... more Background Despite progress, maternal and neonatal mortality and still births remain high in South Africa. The South African National Department of Health implemented a quality improvement (QI) programme, called Mphatlalatsane, to reduce maternal and neonatal mortality and still births. It was implemented in 21 public health facilities, seven per participating province, between 2018 and 2022. Methods We conducted a qualitative process evaluation of the contextual and implementation process factors’ influence on implementation uptake amongst the QI teams in 15 purposively selected facilities. Data collection included three interview rounds with the leaders and members of the QI teams in each facility; intermittent interviews with the QI advisors; programme documentation review; observation of programme management meetings; and keeping a fieldwork journal. All data were thematically analysed in Atlas.ti. Implementation uptake varied across the three provinces and between facilities wi...

BJOG : an international journal of obstetrics and gynaecology, 2014

The Perinatal Problem Identification Programme (PPIP) was designed and developed in South Africa ... more The Perinatal Problem Identification Programme (PPIP) was designed and developed in South Africa as a facility audit tool for perinatal deaths. It has been used by only a few hospitals since the late 1990s, but since the country's commitment to achieve Millennium Development Goal 4-the use of PPIP is now mandatory for all facilities delivering pregnant mothers and caring for newborns. To date 588 sites, representing 73% of the deliveries captured by the District Health Information System for South Africa, provide data to the national database at the Medical Research Council Unit for Maternal and Infant Health Care Strategies in Pretoria.

Health Systems Trust, Mar 1, 2019

Global Health: Science and Practice, 2022

We report our "how-to" approaches and lessons learned from scaling up implementation of the World... more We report our "how-to" approaches and lessons learned from scaling up implementation of the World Health Organization (WHO) guidelines on inpatient treatment of severe acute malnutrition within routine health services in 4 countries. n Substantial improvements in survival were evident within a few months of guideline implementation, but it took many years to improve treatment practices at scale. n We show that the WHO guidelines are scalable to a national level, and their effectiveness in improving survival appears to be retained at scale. Key features for success include collaborations to build capacity and undertake operational research and advocacy for guideline adoption; specialist teams to mentor and build confidence and competency through supportive supervision; and political commitment and administrative policies for sustainability. Key Implications n Policy makers, health professionals, and their national societies should bring together all the talent available and establish alliances such as communities of practice to implement and scale up WHO malnutrition treatment guidelines and use new opportunities such as eLearning to build workforce capacity. n Health educators should review medical and nursing curricula and realign pre-service training so that it is fit-for-purpose and competency-based for effective practice. Resumen en español al final del artículo.

South African Health Review, 2013

In its commitment to the Millennium Development Goals, South Africa has embarked on significant h... more In its commitment to the Millennium Development Goals, South Africa has embarked on significant health reforms to reach the targets set. Integral to achieving the targets has been the adoption of a three-stream approach to primary health care (PHC) re-engineering, which includes municipal ward-based outreach teams, integrated school health teams, and district clinical specialist teams.The authors describe the developments and progress in the implementation of the District Clinical Specialist Team (DCST) stream of PHC re-engineering. The concept of a DCST being responsible for supporting health service delivery at district level, through the provision of clinical leadership and mentoring, and through facilitating health system strengthening for quality care, is new in South Africa. This chapter is thus largely descriptive, outlining the policy and strategic background underpinning the DCST stream; describing the DCST composition, roles and responsibilities; providing an update on DCS...

Global Health: Science and Practice

South African Medical Journal, 2018

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Epidemiology and Health

Purpose: The Asenze cohort is set in South Africa, a middle-income country impacted by one of the... more Purpose: The Asenze cohort is set in South Africa, a middle-income country impacted by one of the highest global rates of people living with HIV/AIDS and high levels of socioeconomic inequality. This longitudinal population-based cohort of children and their primary caregivers assesses household and caregiver functioning, child health, social well-being, and neuro-development from childhood through adolescence. Methods: Almost 1600 children born at the peak of the HIV epidemic (2003-2005) were followed (with their primary caregivers) in three waves, between 2008 and 2021, at average ages five, seven, and 16. Wave 3 is currently underway having assessed over 1100 of the original Wave 1 children. Wave 4 begins in 2022. Results: The study, with a dyadic structure, uses a broad range of measures, validated in South Africa or recommended for global use, that address physical, social and neuro-development in childhood and adolescence, and the social, health and psychological status of their primary caregivers. Conclusion: The Asenze study deepens understanding of childhood physical, cognitive, and social abilities and/or disabilities, including risk-taking behaviors, and biological, environmental, and social determinants of health. We anticipate the findings will contribute to the development of community-informed interventions to promote wellbeing in this South African population and elsewhere.

Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) ... more Objectives We report the effectiveness of a mentoring approach to improve health workers’ (HWs’) knowledge, attitudes and confidence with counselling on HIV and infant feeding. Design Quasi-experimental controlled before–after study. Setting Randomly selected primary healthcare clinics (n=24 intervention, n=12 comparison); two districts, South Africa. Participants All HWs providing infant feeding counselling in selected facilities were invited. Interventions Three 1–2 hours, on-site workshops over 3–6 weeks. Primary outcome measures Knowledge (22 binary questions), attitude (21 questions—5-point Likert Scale) and confidence (19 questions—3-point Likert Scale). Individual item responses were added within each of the attitude and confidence domains. The respective sums were taken to be the domain composite index and used as a dependent variable to evaluate intervention effect. Linear regression models were used to estimate the mean score difference between intervention and comparison ...

International Journal of Epidemiology, 2006

Child: Care, Health and Development, 2022

BACKGROUND Adverse childhood events (ACEs) are associated with negative health effects in adultho... more BACKGROUND Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behavior in low- and middle-income countries (LMIC). METHODS The population-based Asenze cohort study was implemented in a peri-rural area of KwaZulu-Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5 years old and child behavior problems (Strengths and Difficulties Questionnaire (SDQ)) approximately two years later (average age 7 years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. RESULTS A significant relationship between increased ACEs exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. CONCLUSIONS There is an association between exposure to ACEs and later child behavior problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behavior problems that may be a part of the mechanism through which later health effects arise.

Indian pediatrics, 2006

This study describes the clinical characteristics and co-infections in infants born to HIV infect... more This study describes the clinical characteristics and co-infections in infants born to HIV infected women being followed up in a high risk clinic of South Africa Sixty three percent (302 out of 476) of mothers attended clinic for varying periods during follow-up. Sixty four per cent of babies had physical clinical signs suggestive of HIV infection. In the majority of babies, persistent signs resolved by 9 months of age. In those with persistent signs, 20 percent tested positive for HIV infection. Among the HIV exposed infants, co-infections with TB, CMV, syphilis and Herpes zoster were diagnosed which appeared independent of their ultimate seroconversion status.

We are pleased to re-submit the revised manuscript entitled "Compliance with Referrals for Child ... more We are pleased to re-submit the revised manuscript entitled "Compliance with Referrals for Child Health Services: Evidence from the Longitudinal ASENZE Study in KwaZulu Natal, South Africa" for consideration for publication in BMC Health Services Research). We have included a point by point response to the comments posed by each reviewer on the following pages. In this paper, we report the relationship between compliance with referrals to child health services for sub-acute, chronic conditions and socio-demographic factors within the ASENZE study, a longitudinal study conducted in Kwa.Zulu Natal, South Africa. Within sub-Saharan Africa, there has been a notable increase in the burden of chronic conditions among pediatric populations. An effective referral system is an integral component to ensuring improved health outcomes for these conditions. While many studies have evaluated factors associated with referral compliance for acute, life threatening conditions affecting young children in sub-Saharan Africa, no studies, to our knowledge, have evaluated referral compliance for sub-acute chronic conditions in this population. This is of great importance, since management of chronic conditions is heavily reliant on well-functioning referral systems that allow a child to move from screening to treatment with ease, thereby resulting in improved quality of care, decreased healthcare expenditures and most importantly, better health outcomes. In this study, referral compliance was high for HIV infection and anemia, but lower for vision problems, hearing or ear problems, anemia and developmental delay. After controlling for significant socio-demographic factors, referral compliance increased with higher household educational attainment and stable caregiving. The BMC Health Services Research audience will benefit greatly from these findings and may be able to integrate this information to support further research investigating other potential determinants of compliance with child health services, such as caregiver attitudes about the health system and infrastructure of the health system. This study may also highlight possible at-risk groups for poor compliance with referrals in disadvantaged African communities, although further research is needed to explore these relationships. The contents of this research are the sole responsibility of the authors and do not represent the official views of the funding agency. This research study was approved by the

South African Medical Journal, 2018

South African Journal of Clinical Nutrition, 2019

South African Medical Journal, 2018

International Journal of Epidemiology, 2015

South African Medical Journal, 2018

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Health Policy and Planning, 2019

BMC Health Services Research

BJOG : an international journal of obstetrics and gynaecology, 2014

Health Systems Trust, Mar 1, 2019

Global Health: Science and Practice, 2022

South African Health Review, 2013

Global Health: Science and Practice

South African Medical Journal, 2018

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Epidemiology and Health

International Journal of Epidemiology, 2006

Child: Care, Health and Development, 2022

Indian pediatrics, 2006