Showing papers in "South African Journal of Child Health in 2011"

Determinants of breastfeeding patterns among mothers in Anambra State, Nigeria

Abstract: Objectives. Exclusive breastfeeding for the first 6 months of life is still rare among nursing mothers. This study aimed to identify the factors influencing breastfeeding practices among mothers in Anambra State, Nigeria. Methods. A prospective cohort study was conducted in three comprehensive health centres of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Anambra State, between September 2006 and June 2007. The breastfeeding practices of 228 nursing mothers were assessed at enrolment when attending the maternal and child welfare clinics for BCG immunisation, and at follow-up visits at 6, 10, 14, 20 and 24 weeks. In addition, four focus group discussion sessions (one in each centre) were held, involving a total of 35 nursing mothers. Results. Most mothers 190 (83.3%) were aged between 20 and 34 years. The majority (208, 91.2%) had good or very good knowledge of breastfeeding. The main source of breastfeeding education was government health facilities (80.85%), but only 110 mothers (48.2%) initiated breastfeeding immediately (<1 hour) after delivery. The exclusive breastfeeding (EBF) rate fell from 143 (62.7%) at birth to 85 (37.3%) at 24 weeks. EBF was significantly associated with older maternal age, higher parity, delivery at a government facility, a positive family attitude towards EBF, and breastfeeding education from a government health facility (p<0.05). Focus group discussion showed that mothers believed that adequate nutrition and physical, financial and emotional support to them would increase EBF practice. Conclusion. The rate of EBF was low among the mothers, and the factors identified that may influence its practice have important implications for breastfeeding intervention programmes. Activities to promote EBF should be focused on specific groups of women and locations in which it is poorly practised. In addition, support to the mothers is necessary.

HIV co-infection with hepatitis B and C viruses among Nigerian children in an antiretroviral treatment programme

Abstract: Background. Nigeria has one of the world’s largest burdens of children living with HIV and is highly endemic for hepatitis B. This study set out to determine the prevalence of hepatitis B and C infections among HIV-infected children and to identify the factors associated with these co-infections. Method. We studied 155 HIV-infected children. Information on socio-demographics and history of exposure to risk factors such as scarification, blood transfusion, unsafe injections and circumcision were obtained. All the children were tested for the presence of hepatitis B surface antigen and antibodies to hepatitis C. Result. The prevalence of HIV/HBV co-infection was 7.7%, while that of HIV/HCV co-infection was 5.2%. No child was co-infected with all three viruses. Children who were co-infected with HCV were more likely to be older than 5 years. There was no significant association between co-infection with either of the hepatitis viruses and socio-economic status, gender, number of persons living in the household, World Health Organization clinical stage, route of acquisition of HIV, scarification, blood transfusion, unsafe injection or circumcision. Conclusion. The rate of HIV co-infection with hepatitis B and C in children is significant. HIV-infected children should be screened for these viruses. Those found to be negative and not immunised for hepatitis B should be immunised. Since the natural history of these co-infections in children is not known, it is imperative that affected patients be followed up adequately.

Patterns and risk factors for helminthiasis in rural children aged under 2 in Bangladesh

Abstract: Objectives. To obtain knowledge on the burden of infestation with soil-transmitted helminths (STHs) in rural children from birth to age 2 years. Methods. Household visits to enrolled children were made twice a week for 2 years, and stool samples were collected once a month. Stools were also collected during diarrhoeal episodes, and when STHs were identified, a single dose of pyrantel pamoate was administered to patients with diarrhoea. All stool samples were examined using the formalin-ether sedimentation technique. Results. About 70% of the children had had STH infestation by 2 years, and approximately 80% of these had STH ova identified on more than one occasion. The mean age at first acquisition was 14 months (standard deviation (SD) 4 months, range 1 - 24 months). Microscopic examination revealed ova of Ascaris lumbricoides (9%), Trichuris trichiura (0.6%), hookworm (0.06%) and mixed infestation (0.4%). In 41 of the 178 children with STH infestation, its first identification was associated with episodes of diarrhoea. Following pyrantel pamoate deworming, 66% of subjects were re-infested after a mean interval of 90 days (SD 79 days). Risk behaviours such as disposal of child faeces and defaecation by adult family members in open spaces and use of common source surface water for washing clothes and utensils were practised by 62%, 83% and 50% of the cohort families, respectively. Bivariate analysis shows that disposal of child faeces in a closed space resulted in a 35% reduction in helminth infestation (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.49 - 0.87), use of tube well water in a 48% reduction (OR 0.52, 95% CI 0.29 - 0.93, p<0.02) and breastfeeding in a 16% reduction (OR 0.84, 95% CI 0.64 - 1.10, p<0.2). Mutivariable analysis adjusted with risk variables shows a 5.06 times higher odds of recognising STH infestation during an episode of diarrhoea (OR 5.06, 95% CI 3.8 - 6.69, p<0.0001). Conclusion. Awareness building programmes and periodic deworming are crucial to prevent acquisition of, re-infestation with and spread of STH.

Nutritional health of young children in South Africa over the first 16 years of democracy

Abstract: Objectives. Malnutrition among young children is a major health problem in post-apartheid South Africa. Despite implementation of numerous health and nutrition programmes, these extensive efforts to alleviate the situation have not been adequately reviewed. Methods. We provide an overview of various aspects of the current nutritional health status of young children. The reviewed data are from the time period 1994 - 2010, and were collected from literature databases and official reports, as well as our own experience with field research in various urban and rural parts of the country. Results. Both smaller province-based studies as well as three large nationwide surveys conclude that many young South African children have inadequate nutritional status. Rates of stunting, micronutrient deficiencies and hunger and food insecurity are all unacceptably high. Coexisting HIV/AIDS and tuberculosis add to this burden. A gradual transition to a westernised diet characterised by energy-dense food has led to a worrying increase in overweight and obesity. Conclusion. A major challenge for the South African health authorities is still the fight against childhood undernutrition and hunger, which in turn are rooted in poverty and social inequalities. The double burden of disease adds to the scale and complexity of this challenge.

Incidence and outcome of neonatal tetanus in Enugu over a 10-year period

Abstract: Background Tetanus is a preventable disease that can be eradicated by immunisation and improved obstetric practice Aim To study the trend and outcome of tetanus admissions among children in the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria Method All cases of tetanus admitted into the children’s ward of the UNTH over a 10-year period from July 1998 to June 2008 were analysed from the admission records Result A total of 9 361 patient admissions were reviewed Sixty-three (067%) of these patients had tetanus Forty-one (65%) were neonates Eighteen (286%) of the 63 patients with tetanus died, with mortality from neonatal tetanus (317%) not different from post-neonatal cases (227%) (p=045) Peaks of neonatal tetanus incidence were observed when immunisation of pregnant women was rejected by religious sects Conclusion From this study hospitalisation for tetanus over the period in review was generally low There was no definite trend and mortality was unacceptably high Indeed, there was no change in the mortality pattern from tetanus during the period under review Recommendations There is a need to strengthen immunisation against tetanus during antenatal care and by giving booster doses beyond infancy

Restraint use and seating position among children in motor vehicles in Bloemfontein

Abstract: Background. Most child deaths from motor vehicle accidents (MVAs) occur in low- and middle-income countries. Effective measures to protect children involved in MVAs include wearing age-appropriate child restraints and being seated in the rear of the vehicle. Methods. A descriptive study was used to assess use of child restraints, seating positions of children, driver restraint and vehicle overloading in Bloemfontein in 2007. Two pairs of observers stood at selected sites recording these findings. The study was done over a period of 1 month. Results. A total of 512 children in 374 vehicles were assessed. Just over a third of the children were seated on the front seat of the vehicle, and 14.1% were seated on other people’s laps (73.6% of these were on the front seat). Restraints were used by 8.8% of children and 17.4% of drivers; 10 times more children used restraints if the driver was restrained versus not restrained. Between 9.3% and 20.4% of vehicles were assessed as being overloaded with passengers. Conclusion. The safety of child passengers in Bloemfontein in the event of an MVA is threatened by poor adherence to basic safety measures. Enforcement of correct seating position and use of child restraints will prevent unnecessary deaths, disabilities and suffering of child passengers injured in the event of an MVA. Driver motivation and responsibility is important in achieving safer seating of children in motor vehicles.

Ocular changes in multi-transfused children with β-thalassaemia receiving desferrioxamine: A case-control study

Abstract: Objectives. This study was planned to determine the prevalence of ocular abnormalities in multi-transfused children with β-thalassaemia receiving desferrioxamine and to determine the association of abnormalities with the patients’ age, serum ferritin level, haemoglobin concentration, and dosage and duration of treatment with desferrioxamine. Methods. Twenty-five thalassaemic children receiving desferrioxamine and attending the day-care centre of a tertiary care hospital in Delhi, India, and 25 healthy age-matched controls were examined to determine the prevalence and pattern of ocular abnormalities. A refraction test, the visual evoked response and fluorescein angiography were done where applicable. Ocular changes were correlated with serum ferritin levels, the dosage and duration of chelation with desferrioxamine, and pre-transfusion haemoglobin levels. Results. None of the children reported any visual symptoms. The prevalence of ocular abnormalities in the thalassaemic group was 36% (9/25). Ocular changes seen included cataract (5/25), blurred optic disc margins (6/25) and dilatation and tortuosity of retinal vessels (2/25). The thalassaemic children had a significantly higher prevalence of cataract than the controls ( p <0.05). Prevalence of cataract was associated with serum ferritin values above 4500 ng/ml ( p <0.05), and blurring of disc margins was significantly associated with increased duration ((5 years) and frequency ((5 times/week) of desferrioxamine administration. A positive correlation was seen between the incidence of cataract and blurred disc margins. Conclusions. Children with thalassaemia should be screened periodically for ocular abnormalities. Rational usage of desferrioxamine and use of newer chelating agents will reduce the prevalence of these abnormalities.

Prevalence of the molecular marker of chloroquine resistance ( pfcrt 76 ) in Nigeria 5 years after withdrawal of the drug as first-line antimalarial: A cross-sectional study

Abstract: Background. In line with the World Health Organization (WHO) guideline on chloroquine (CQ) resistance, CQ was withdrawn as the first-line antimalarial drug in Nigeria in 2005 as a result of widespread resistance. It was expected that its sensitivity and clinical usefulness ould be restored with time. This study therefore aimed to determine the level of CQ resistance in Nigerian children aged less than 60 months. Methods. We monitored the resistance pattern 5 years after withdrawal of CQ, using the pfcrt K76T mutation as a molecular marker for CQ resistance. Results. Of 98 Plasmodium falciparum -positive blood samples, 95 (96.9%) showed the K76T mutation. Twenty-seven (27.6%) of the children had been treated with CQ at home before presentation at the clinic, while 50 (51.0%) had taken other antimalarials. Conclusion. Our results indicate that there is an urgent need to re-evaluate antimalarial drug policy in Nigeria, especially when 27.6% of our study population still use CQ at home despite its withdrawal as first-line antimalarial. This may require effective legislation against the manufacture, importation and use of CQ in Nigeria, if the purpose behind its withdrawal is to be achieved.

Uncommon presentation of neurocysticercosis : : case report

Abstract: Non-epileptic manifestations of neurocysticercosis (NCC) include intellectual deterioration, dementia and parkinsonian behaviour. We report on a child with NCC presenting with abnormal choreiform movement. The case report highlights an uncommon presentation of NCC, and also draws attention to an unusual cause of chorea in children from tropical regions.

Predictors of paediatric injury mortality

Abstract: Background. Childhood injury is a major public health issue in many parts of the world, contributing significantly to paediatric morbidity and mortality. World Health Organization recently projected that with the current trends, trauma and infectious diseases will account for equal numbers of year of potential life lost worldwide by the year 2020. Aim. This study aimed to investigate factors predictive of childhood injury mortality. Design. A prospective hospital-based cross-sectional study. Methods. All attendances and admissions to the Children’s Emergency Room at the Wesley Guild Hospital, Ilesa, Osun State, Nigeria, over a period of 2 years (1 June 2007 - 30 May 2009) were serially documented and all patients with injury were recruited into the study. The socio-demographic variables, injury characteristics, Pediatric Trauma Score (PTS) and Glasgow Coma Score (GCS) were tested against outcome by binary logistic regression analysis. Results. Five hundred and seventy-six children presented with injury during the study period with 22 deaths, giving an injury mortality rate of 3.8%. Logistic regression modelling found infancy (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.04 - 0.37), head injury (OR 2.51, 95% CI 0.10 - 0.61), low PTS (≤8) (OR 8.95, 95% CI 0.86 - 0.94) and low GCS (<9) (OR 5.22, 95% CI 0.40 - 0.69) to be significant independent predictors of childhood injury mortality. Conclusion. Prompt identification of the above factors in children with injury may prevent many deaths.

Childhood motorcycle-related injuries in a Nigerian city - prevalence, spectrum and strategies for control

Abstract: The use of motorcycles is becoming increasingly popular in Nigeria because of poor public and private transportation systems Motorcycle crashes account for a disproportionate share of the deaths and disabilities that result from road traffic accidents We undertook a prospective descriptive study of all children aged 15 years or under with motorcycle-related injuries (MCRIs) who presented at the emergency room of the University of Ilorin Teaching Hospital over a period of 3 years Children with ophthalmic injuries and those who died before reaching the hospital were excluded Over the study period, 40 of a total of 440 patients admitted with MCRIs were children (90%) Twenty-seven children (675%) were injured as pedestrians, 11 (275%) as passengers and 2 (5%, young adolescents) as riders One 3-year-old child was admitted to the intensive care unit with severe head injury and died Prevention of MCRIs in children should be a priority in our setting Public campaigns should clearly highlight the risk of injury to this age group, and poor safety practices with regard to children should be specifically targeted With the motorcycle gaining popularity as a mode of transportation in our cities and communities, the importance of teaching our youth about correct safety behaviour such as helmet use, and parents on the danger of letting their children cross roads alone, cannot be over-emphasised

Splenic rupture in a neonate - a rare complication

Abstract: Birth trauma is well described in the neonatal literature, but intra-abdominal injuries occur infrequently and are often forgotten in the differential diagnosis of a hypovolaemic shocked infant with an abdominal mass. The symptoms of splenic rupture are nonspecific, creating a diagnostic dilemma for the clinician. As splenic rupture denotes a surgical emergency, increased awareness of this complication may decrease the delay in diagnosis, therefore increasing the infant’s chances of survival. This applies not only to paediatricians but to every midwife, intern or medical officer who attends to deliveries and is involved with the care of the newborn.

Tissue factor pathway inhibitor in paediatric patients with nephrotic syndrome.

Abstract: Background Tissue factor pathway inhibitor (TFPI) is an endogenous protease inhibitor that regulates the initiation of the extrinsic coagulation pathway by producing factor Xa-mediated feedback inhibition of the tissue factor/factor VIIa (TF/VIIA) catalytic complex Objectives To evaluate plasma TFPI levels in paediatric patients with nephrotic syndrome (NS) and its correlation with disease activity Subjects and methods Fifteen nephrotic patients in relapse (proteinuria >40 mg/m2/h, hypo-albuminaemia and oedema) before initiating steroid therapy (group I) and another 15 nephrotic patients in remission after withdrawal of steroid therapy (group II) were compared with 15 age- and sex-matched healthy children (group III) Besides clinical evaluation and routine laboratory investigations of NS, tissue factor pathway inhibitor levels in plasma were measured by enzyme-linked immunosorbent assay (ELISA) Results The plasma TFPI level was higher in nephrotic patients during relapse (group I) and during remission (group II) (mean 10253 (standard deviation (SD) 1423) and 8293 (SD 383) ng/ml, respectively) compared with that in the control group (6240 (SD 753) ng/ml) (p<00001) In children with NS the plasma TFPI level was higher during relapse (group I) compared with the level in remission (group II) (p<00001) There was a negative correlation between the plasma TFPI level and total protein and serum albumin, and a positive correlation between the plasma TFPI level and the urinary protein/creatinine ratio (p<005) Conclusion NS was associated with increased level of plasma TFPI in comparison with the control group, and the increase was more apparent in patients with active disease

Ambient solar UV radiation and seasonal trends in potential sunburn risk among schoolchildren in South Africa

Abstract: Background. The detrimental effects of excess personal solar ultraviolet (UV) radiation exposure include sunburn, immunosuppression and skin cancer. In South Africa, individuals with minimum natural protection from melanin, including fair-skinned individuals and African albinos, and people spending extended unprotected periods outdoors are at risk of sunburn, a risk factor for skin cancer. Sunburn becomes increasingly likely during the high solar UV radiation hours around midday, and previous studies have shown that children are exposed to potentially high, sunburn-causing solar UV radiation levels while at school. Method. To estimate national potential child sunburn risk patterns, monitored ambient solar UV radiation levels at six sites in South Africa were converted into possible schoolchild solar UV radiation exposures by calculating the theoretical child exposure to 5% of the total daily ambient solar UV radiation as derived from personal child exposure studies. Results. Schoolgoing children with skin types I, II and III were identified as being at greatest risk of sunburn. There were 44 and 99 days in a year when schoolchildren with skin type III (moderately sensitive) living in Durban and De Aar, respectively, would be likely to experience sunburn. Schoolchildren with skin type I (extremely sensitive) were at risk of experiencing sunburn on 166 days in De Aar, and those with skin types I and II were at risk on at least 1 day per year at all six locations. Conclusion. Seasonal patterns show that schoolchildren with sensitive skin types may experience sunburn in spring, summer and autumn months. Differences in child sunburn risk were evident, mainly due to latitude and atmospheric aerosols. Additional factors affecting sunburn risk include schoolchildren’s use of sun protection, sun-exposed activity, and timing and duration of exposure. Understanding risk patterns and obtaining locally relevant information will assist South African skin cancer prevention and sun protection awareness

Multidisciplinary management of paediatric dysphagia in government hospitals in Gauteng, South Africa: A pilot study

Abstract: A team approach allows for case co-ordination and gives a holistic view of the patient's difficulties and needs. Core team members for the investigation and management of paediatric dysphagia include paediatrician, dietician, occupational therapist (OT), nurse, social worker, physiotherapist (PT), speech therapist (ST) and caregiver.

Indications, medical conditions and services related to gastrostomy placement in infants and children at a tertiary hospital in South Africa

Abstract: Objectives. To describe South African infants and children requiring gastrostomies in a tertiary hospital, including the indications, medical conditions and health services, during a 5-year period (2005 - 2009). Design. The research design was a retrospective descriptive survey of medical records. Setting. A tertiary paediatric state hospital in South Africa. Subjects. One hundred and forty-two patients between the ages of 0 and 17 years. Results. Dysphagia (N=80, 56%), aspiration (N=70, 49%) and need for nutritional support (N=63, 44%) were the most common indicators for gastrostomy placement. Most participants (N=85, 75% of the subset of 114 with feeding and swallowing difficulties) presented with multiple medical conditions, and neurological impairment (N=94, 82%) and gastro-intestinal problems (N=96, 84%) were the most prominent. Services were required from a variety of health care professionals for a period ranging from 6 to 103 months (mean 18 months). The speech-language therapist was consulted most frequently before gastrostomy placement (85%), while the stoma sister (97%) and dietician (97%) were consulted after placement. Conclusions. South African infants and children requiring gastrostomies frequently present with multiple medical conditions and dysphagia. These children are likely to benefit from extended services provided by a specialised team of health care professionals.

National health insurance and health system restructuring - does it offer anything to children? : hot topics

Abstract: The paediatricians and doctors I usually associate with, including colleagues who work in the public and the private sectors, seem to hold one of three views about the imminent introduction of national health insurance (NHI) in South Africa.

Thoraco-abdominal neuroenteric cyst: A case report and review of the literature

Abstract: Neuroenteric cysts are rare congenital anonalies, presenting in infancy or childhood. Only a few cases of posterior mediastinal neuroenteric cysts have been reported. A 12-year-old girl presented to our hospital with a neglected mildly painful cyst in the posterior mediastinum and retroperitoneum. Magnetic resonance imaging revelealed scoliosis of the thoracic spine, hemivertebrae T6 - 7, and a large hyperintense (on T2-weighted images) cystic lesion in the posterior mediastinum. The lesion had no intraspinal communication, but extended into the abdomen between the liver and kidney. Despite the long history and spatial extent of the lesion, it was excised uneventfully through a right thoracotomy. Microscopy of the cyst wall revealed partially disrupted cuboidal epithelium, muscle fibres, inflammatory cells, and, bony and cartilaginous elements. Enterogenous duplication cysts of foregut origin with vertebral anomalies are referred to as neuroenteric cysts. This is a probably only the second reported case of thoraco-abdominal neurogenic cyst originating in the posterior mediastinum.

Rehydration in acute gastro-enteritis - the value of going rapid and enteral

Abstract: Acute gastro-enteritis (AGE) is a leading post-neonatal cause of death among South Africa’s children. Almost all these deaths are caused by the consequences of dehydration. Many of these deaths occur in hospitals. AGE is also a significant nutritional insult at a critical time of growth. When the literature on therapy for AGE is reviewed, only four interventions recommend themselves for universal application for uncomplicated disease: rapid rehydration within 4 - 6 hours with hypotonic solutions, preferably via the gut; continuation of breastfeeding throughout the episode; early re-introduction of full-strength feeds; and zinc therapy. This article explores the first of these, but will show how its application enhances the positive effects of feeding on the diarrhoea as well as the child’s nutritional status.

An unusual presentation of an intra-abdominal rhabdomyosarcoma

Abstract: Rhabdomyosarcoma (RMS) is a common neoplasm, representing 5 - 10% of malignant solid tumours in childhood, and is the commonest soft-tissue sarcoma in the paediatric age group. Even though the tumour usually arises from striated muscle, it frequently originates from sites devoid of striated muscle such as the urinary bladder, prostate gland and gallbladder. We present an unusual case of a large intra-abdominal embryonal RMS which demonstrated a mesenteric cleft inferolaterally with feeding vessels entering the mass. This unique presentation of embryonal RMS proved to be a diagnostic challenge.

From audit to action

Abstract: The 'Hot Topic' article in this issue originates from the latest 'Saving Children' Report, published in May 2011. It summarises some of the important findings of the Child Healthcare Problem Identification Programme (PIP), which was developed for the Medical Research Council's Unit for Maternal and Infant Health Care Strategies. In this programme, careful auditing of each child death allows conclusions to be drawn about quality of care and possible modifiable factors in that death. From a small beginning at a few hospitals, Child PIP has been gathering momentum and is now being implemented at nearly a third of all public hospitals in South Africa. The full report and more detail is available on-line at www.childpip.org.za, and is an important resource.

Umbilical cord ulceration and jejunal atresia

Abstract: The association between umbilical cord ulceration and congenital intestinal atresia is being increasingly reported and carries a high mortality. We report on a case of jejunal atresia associated with massive fetal haemorrhage from an umbilical cord ulcer. Fetal distress noted on continuous fetal heart monitoring allowed for delivery by emergency caesarean section followed by appropriate neonatal resuscitation and intact survival. This and other reported cases highlight the need for identification of high-risk fetuses with congenital intestinal atresia. Close fetal monitoring during labour is imperative in order to improve outcomes.

Inner ear malformations in siblings presenting with vestibular symptoms in early childhood

Abstract: Introduction. Although the association between inner ear abnormalities and progressive sensorineural hearing loss is well known, vestibular signs or loss of vestibular function in these patients are often unrecognised by medical practitioners. Case report. We report on two siblings with identical inner ear malformations, with special reference to the vestibular symptoms they displayed, as well as the rapid decline in hearing they both experienced in early childhood. We provide a brief overview of the latest classification of these inner ear defects as well as a review of the literature pertaining to children with inner ear malformations presenting with vestibular symptoms. Conclusion. Gross anatomical defects of the inner ear are present in approximately 20% of cases of congenital hearing loss. These defects may result in a rapidly progressive hearing loss. Any child presenting with vestibular symptoms should be referred for an audiological assessment.

The doughnut sign : clinical images

Abstract: Chest radiographs remain the imaging modality of choice for diagnosing diseases such as tuberculosis (TB) in children in developing countries. Despite chest radiographs not being sensitive or specific enough to detect lymphadenopathy in children with suspected pulmonary TB, there are specific radiographic findings that are unequivocal.

Gorlin syndrome : case report

Abstract: Naevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, is an autosomal dominant syndrome of developmental anomalies associated with an increased risk of malignancies. Patients have multiple lesions, which may be subtle, and the diagnosis can easily be missed, leading to sub-optimal follow-up. Despite its infrequency clinicians may benefit from familiarity with the syndrome, as these patients are hypersensitive to radiation and prone to develop multiple malignancies. Patients can present to paediatricians, oncologists, maxillofacial surgeons, radiation oncologists and dermatologists, and it will be to the benefit of the patient with this syndrome for these specialists to have a working knowledge of this rare but fascinating disorder.

'Saving Children 2009' : evaluating quality of care through mortality auditing

Abstract: The Child Healthcare Problem Identification Programme (Child PIP) has contributed to both improving knowledge regarding child deaths and efforts to reduce these deaths since its introduction in 2004 Child PIP is a voluntary mortality audit process designed to ascertain the quality of care children receive in the South African health system It provides structure and tools for conducting mortality reviews or audits of in-hospital deaths of children by : ensuring that all deaths are identified determining the social, nutritional and HIV context of each child who dies assigning a cause to each death determining modifiable factors that identify instances where failure to meet specific standards of care have, or may have, contributed to the child's death Child PIP encourages and enables teams of health care workers to reflect on the quality of health care children receive, to identify gaps or deficiencies in this care, and to find solutions that will improve care in the future Child PIP was developed and initially implemented primarily by paediatricians (who are usually based at regional or tertiary levels), but has since been taken up by general doctors and professional nurses working in district hospitals

The safety of rapid rehydration in dehydrating diarrhoea in a busy rehydration unit : letter

Abstract: To the Editor: Dehydration due to diarrhoeal disease is one of the major contributors to mortality in early childhood. In South Africa it contributes significantly to in-hospital mortality, often within the first 24 hours of admission. Rehydrating a dehydrated child over 4 - 6 hours (rapid rehydration (RR)) is widely recommended, as it has resulted in earlier discharge and is considered safe. Where oral rehydration cannot be used, nasogastric (NG) rehydration has been shown to be at least as effective as intravenous (IV) rehydration and is probably safer.

Pericarditis as initial clinical manifestation of systemic lupus erythematosus in a girl

Abstract: The most common diagnostic features of systemic lupus erythematosus (SLE) include mucocutaneous lesions, nephritis, arthritis and haematological disorder. Serositis in the form of pericarditis is an uncommon first-line clinical manifestation. We report on an 11-year-old Nigerian girl who presented recurrently with pericarditis as the initial clinical manifestation of SLE. Other diagnostic clinical features, namely malar rash and polyarthritis, evolved sequentially over time. Diagnostic laboratory features were lymphopenic leukopenia, a positive lupus erythematosus cell preparation and positive lupus anticoagulant tests. She responded well to non-steroidal anti-inflammatory and immunosuppressive therapy. Unexplained pericarditis in any child should warrant immediate screening for SLE.

Spinal cord disease in children with malignancies : clinical cases and literature review

Abstract: Spinal cord disease in children with known or suspected malignancy is an oncological emergency because it commonly implies malignant spinal cord compression (SCC). Since the outcome of SCC is primarily determined by the patient’s neurological status at treatment initiation, the goal must be to establish the underlying diagnosis before development of irreversible spinal cord damage. A high index of suspicion is key to early diagnosis; it is therefore mandatory that all health care workers involved in the care of children should have a basic acquaintance with this potentially catastrophic condition. Four cases of children with malignancies and spinal cord pathology are presented. Current knowledge of this condition is reviewed.

Morgagni hernia presenting with lung consolidation unresponsive to antibiotics

Abstract: Congenital diaphragmatic hernia (CDH) is a congenital malformation of the diaphragm that allows the abdominal organs to push into the chest cavity We report the case of a 15-month-old patient who presented with a non-resolving opacity on a chest radiograph despite extensive antibiotic treatment A large anterior mediastinal mass was seen on the chest radiograph with effacement of the right cardiac border and accompanying diminution of the liver shadow, suggesting intrathoracic herniation of abdominal contents A computed tomography (CT) scan confirmed the presence of abdominal contents in the right hemithorax Congenital diaphragmatic hernias can cause uncertainty in diagnosis and difficulty in subsequent treatment Non-resolving chest opacities warrant further investigation by cross-sectional imaging such as a CT scan