Normal ECG does not rule out heart disease, cardiologists warn

Medical services strongly urge mothers to commence exclusive breastfeeding for the first six months of a child's life to improve child survival rates and reduce malnutrition. Less than a quarter of infants in South Africa receive this nutrition during the first six months.

Health experts warn that the declining rate of breastfeeding in the country contributes to an increase in childhood malnutrition and preventable diseases. According to the National Food and Nutrition Survey, the exclusive breastfeeding rate in South Africa is 22.2%, while it is slightly higher in the Eastern Cape at around 25%. These figures are significantly below established global targets, as the country continues to grapple with high rates of child malnutrition and stunting.

In light of this situation, the Eastern Cape Department of Health visited the village of Nkondlo in the Ngcobo Municipality this week as part of Breastfeeding Week. There, department representatives urged mothers, families, and communities to support exclusive breastfeeding for the first six months of a child's life. Regional officials emphasized that this campaign aims to protect children from diseases that continue to claim young lives.

Officials reported that they approached the community to disseminate information about the importance of breastfeeding as a way to protect children from serious community-affecting illnesses, including diarrhea and other common childhood ailments. They noted that breast milk provides complete nutrition during the first six months of life.

The department also noted that it continues to record an alarming number of malnutrition cases among children aged zero to three years. Officials pointed to a slowing trend in breastfeeding, especially in communities where young mothers and HIV-positive mothers struggle with prolonged breastfeeding.

In response, the province is strengthening its Mother and Baby Friendly Initiative, supporting women throughout the period from pregnancy to childbirth, and establishing community support groups to boost breastfeeding rates. Department representatives stated that they aim to promote and support breastfeeding, considering it the gold standard, and wish to launch support groups for breastfeeding mothers who need assistance.

The National Department of Health has long identified exclusive breastfeeding as one of the most effective and accessible intervention methods for improving child survival, protecting infants from diarrheal diseases and respiratory infections, and reducing malnutrition. National guidelines recommend exclusive breastfeeding for the first six months of life, followed by continued feeding alongside complementary foods until two years of age or older.

Civil society organizations argue that the low breastfeeding rate in the country reflects a lack of support rather than a lack of desire among mothers. The maternal rights organization Embrace, as part of its Breastfeeding Week campaign, stated that breastfeeding should not be viewed solely as a mother's duty; it stressed that it is a collective responsibility.

This organization believes that for South Africa to reverse the declining trends, mothers require qualified medical support, paid maternity protection, family support, and workplaces that facilitate breastfeeding. The 'Grow Great' Foundation warned that improving breastfeeding is one of the most effective tools in combating child malnutrition. The organization stated that every child deserves the best start in life, and breastfeeding remains a powerful means of preventing stunting and improving long-term child health and development.

'Grow Great' has repeatedly called for increased investment in early childhood nutrition during the first thousand days of a child's life, calling this period critical for brain development and future health. The human rights organization Black Sash linked breastfeeding to broader issues of poverty and social protection, arguing that caregivers cannot be expected to make optimal nutritional decisions without adequate economic assistance. During a recent food security campaign, the organization stated: 'The right to food begins long before a child eats solid food,' calling for increased support for mothers and caregivers to combat hunger and malnutrition.

All agencies have called on governments to invest in sustainable breastfeeding support systems, warning that many mothers stop breastfeeding not by choice, but due to a lack of sufficient support from healthcare systems, communities, and employers.

Community members are also helping to reinforce this message. Nompendulo Peter, a traditional healer from the nearby village of Cvekweni, advised mothers, especially those newly diagnosed with HIV, to continue breastfeeding while receiving proper medical care. She shared that she refers her patients who test positive for HIV back to the clinic to encourage them to breastfeed their children and receive necessary support at the clinics.

Healthcare workers concluded that increasing breastfeeding rates will require collaboration between communities, healthcare professionals, traditional leaders, and families to ensure that mothers receive the necessary support during the critical first six months of their infants' lives.

Recently, there has been a growing interest in protein diets. Although doctors advise everyone to consume sufficient protein according to their weight, some people exceed the necessary amount and start taking dietary supplements. This raises the question of whether consuming such protein supplements can raise cholesterol levels and which groups of people are susceptible to these risks.

According to WHO recommendations, an average person should consume about 0.8–1.0 grams of protein per kilogram of body weight daily. For example, a person weighing 60 kilograms requires approximately 48 to 60 grams of protein per day. However, some people consume significantly more than this amount. Professor Dr. Tarun Kumar from the Cardiology Department of Medanta Mulchand Hospital commented on the effect of such consumption on heart health.

Dr. Tarun Kumar notes that when taken in the correct dosage, protein is safe for most healthy adults. Nevertheless, excessive consumption or taking supplements unnecessarily can cause problems in people with certain diseases. For instance, if a person consumes too much protein, they may experience symptoms such as bloating, flatulence, spasms, nausea, or diarrhea. Some people may also develop acne.

Furthermore, increased protein intake can increase the load on the kidneys during filtration. People with chronic kidney diseases should only determine protein dosage after consulting a doctor or dietitian, as excess protein increases the risk of progressive kidney pathology.

For most people, protein supplements themselves are not a direct cause of heart disease. When assessing the impact, the total calorie content of the product, its nutritional quality, and the necessity of taking the supplement if the diet does not provide enough protein are taken into account. If the daily diet already contains sufficient protein, additional supplementation usually provides no significant benefit.

Dr. Tarun emphasizes that excessive reliance on protein powders is undesirable. Protein deficiency can be replenished through a balanced diet. The diet should include legumes, nuts, and dairy products. Those who eat meat can obtain protein from eggs and meat.

This April, the Durban beach area will be transformed into a sea of colorful hats thanks to the third annual charity run, #HatsOn4CPC, taking place on Sunday, October 11th. The event is organized by Palliative Care for Children South Africa (PatchSA) in collaboration with Umduduzi Hospice Care for Children.

As part of this 5-kilometer event, local families, schools, and businesses are invited to wear their brightest hats to raise necessary funds and draw attention to the issues facing youth suffering from life-threatening illnesses.

The event will be held at the Amphitheatre on the North Beach Promenade, opposite the Southern Sun Elangeni and Maharani hotels in Durban. However, behind the festive, family-oriented atmosphere lies a serious issue concerning access to pediatric care in South Africa.

A study conducted by UNICEF and the International Children's Palliative Care Network (ICPCN) showed that over 300,000 children in South Africa live with severe illnesses requiring specialized palliative care. PatchSA estimates that only about 5% of them can receive the necessary support.

For the remaining 95%, a diagnosis often means uncontrolled physical discomfort, and families are forced to cope with a heavy emotional burden alone. Events like the #HatsOn4CPC Fun Walk, timed for Children's Palliative Care Day on October 9th, help break the silence surrounding childhood diseases.

The 2025 run saw participation from over 250 individuals who raised funds and increased awareness about palliative care for children in KwaZulu-Natal and across South Africa.

What is palliative care for children?

Pediatric Palliative Care (CPC) is a comprehensive and active approach to treatment aimed at relieving the medical, emotional, social, and spiritual suffering of children with life-limiting or life-threatening conditions. This approach provides holistic support to the entire family, helping them maintain the best possible quality of life despite a difficult diagnosis.

A common misconception is that palliative care is intended exclusively for the final days of life. Dr. Julia Ambler, Medical Director and Co-founder of Umduduzi, explains: 'Pediatric palliative care is about helping children live as well and as long as possible. It is not just for end-of-life care.'

She adds that it should be provided alongside curative treatment, starting from the moment of diagnosis or recognition of a life-threatening condition.

Who is eligible for pediatric palliative care?

Pediatric palliative care covers newborns, children, and adolescents facing a wide range of medical problems. Eligibility criteria are not limited to terminal diagnoses. They include:

• Oncological and non-infectious diseases: Serious cancer conditions or severe organ failure.

• Congenital and genetic conditions: Complex chromosomal abnormalities, severe cerebral palsy, or metabolic disorders.

• Infectious diseases: Progressive or complicated cases of HIV, AIDS, or drug-resistant tuberculosis.

• Rare and undiagnosed diseases: Conditions without known treatment or formal names, causing progressive neurological or physical deterioration.

When should palliative care be considered?

Parents are advised to seek palliative care for their children immediately after a diagnosis of a serious, life-threatening, or life-limiting illness, rather than waiting until curative treatments are finished. Palliative care works alongside primary medical methods from day one, managing agonizing physical symptoms such as pain, nausea, and fatigue, thereby ensuring maximum comfort and activity for the child.

In addition to physical relief, it provides an invaluable extra layer of support during frequent hospitalizations or complex treatment decisions, helping families weigh options and align care with their goals. It also extends necessary emotional, practical, and spiritual support to the whole family, offering counseling for siblings, respite for exhausted caregivers, and assistance with daily healthcare matters.

Ultimately, early access to palliative care ensures that no family has to cope alone with the immense difficulties associated with a child's serious illness. There is no need to wait for a doctor to suggest palliative care. If your child has a serious illness and your family requires additional support, you can request a referral for palliative care from your primary pediatrician, oncologist, or hospital team at any point in the journey.

The situation in South Africa

The gap between the number of children in South Africa needing palliative support (over 300,000) and those receiving it (about 5%) highlights a critical healthcare problem. Organizations like PatchSA and Umduduzi Hospice Care for Children are working directly to change this situation by training healthcare workers, advocating for policy integration, and providing direct care services to vulnerable families.

Sue Bosher, Program Manager at PatchSA, notes that healthcare workers are overburdened and often lack the time to provide holistic palliative care to the child and family. She states: 'These are very unequal circumstances given the many situations in South Africa.'

She also points out that even in the best circumstances, the misconception persists that palliative care equals 'end-of-life care' and implies 'giving up' on fighting for a cure, which prevents many doctors and specialists from referring patients to existing institutions and organizations capable of providing pediatric palliative care. Furthermore, many families perceive palliative care as 'surrender,' so they may resist it.

How you can help

Every hat, whether a sun hat or a sports cap, or an intricate handmade item worn on October 11th, opens vital discussions about the right of children to compassionate and dignified care. All funds raised go towards supporting the current activities of PatchSA and Umduduzi Hospice Care for Children. For more information, please visit the website.