Showing papers in "South African Journal of Child Health in 2012"
TL;DR: The mortality rates in South Africa, the rest of the world and Africa, is discussed, and causes and interventions that can be implemented to reduce these deaths are discussed.
Abstract: In the year 2000, 189 member countries of the United Nations committed themselves to eight goals towards the development and well-being of their nations. These goals are called Millenium Development Goals (MDGs). The fourth goal (MDG4) aims to reduce the mortality rate in children under the age of 5 years (U5MR) by two thirds between 1990 and 2015. Infants less than 1 month old account for about 40% of deaths of children under the age of 5 years globally. Achieving MDG4 will therefore need to include reducing deaths during the neonatal period. The goal of reducing U5MR by two thirds for neonatal deaths in South Africa meant reducing the neonatal mortality rate (NMR) from 21/1 000 live births in 1998 to 7/1 000 by 2015. In order to achieve this, all neonatal deaths need to be scrutinsed by focusing on mortality rates and pathological and health system causes of neonatal deaths. Of paramount importance, however, would be looking at interventions that could impact significantly on reducing these deaths. In this article we discuss the mortality rates in South Africa, the rest of the world and Africa, and discuss causes and interventions that can be implemented to reduce these deaths in South Africa.
46 citations
TL;DR: This report gives an overview of some of the key implementation and training issues identified by the group and recommendations emanating from the collaborative process.
Abstract: In the past three decades, kangaroo mother care (KMC) has been established as a safe and effective method of infant care, with the potential for improving the survival of low-birth-weight newborns, especially in low- and middle-income countries. Despite many implementation, education and training efforts, some countries are finding it difficult to increase their coverage of KMC, and individual institutions still struggle to get KMC institutionalised in a sustainable way. In the past decade a better understanding has emerged on the health system pathways followed in the implementation of KMC.
The initiative reported in this paper started out with a review of education and training practices in the implementation of KMC across the world. This was discussed at an international workshop and further inputs were derived from individuals’ experience, unpublished literature provided by colleagues, and published material. This report gives an overview of some of the key implementation and training issues identified by the group and recommendations emanating from the collaborative process.
A triangular change process that includes change agents and the choice of implementation and educational models is proposed. The different functions for change agents as drivers, trainers and implementers are discussed. The grassroots, policy and academic dimensions are presented as different pathways for initiating KMC. Educational models are developed locally and are determined by the context.
Education and training in KMC should be underpinned by the same basic understanding of the concept and should be accompanied by the creation of awareness, committed ‘champions’, multidisciplinary teamwork and continuous support from senior management. It should be based on the evidence produced by research, conducted according to current best practice in education, and locally appropriate and applicable.
34 citations
TL;DR: The mothers had better access to mobile phones than the Internet and were willing to receive SMS immunisation reminders, and future intervention strategies should explore payment mechanisms for SMS reminders, as there is an unwillingness to bear the cost by the respondents.
Abstract: Background. Effective communication is imperative for the delivery and receipt of adequate health care services.
Aim. To determine access to information technology and willingness to receive short message service (SMS) text message reminders for childhood immunisation services among mothers in Lagos, Nigeria.
Method. In this descriptive cross-sectional study, interviews using structured questionnaires were conducted with 399 mothers of children aged <5 years who brought their children to attend the immuno-prophylaxis and child welfare clinic of Lagos University Teaching Hospital during July and August 2011.
Results. The age of the respondents ranged from 16 to 51 years with a mean of 31.1±4.7 years. Almost all (98%) were current owners of mobile phones, 68% had computer access, 66% were current users of the Internet though most used it occasionally and 65% had e-mail addresses. About three-quarters (77%) were willing to receive future SMS reminders about childhood immunisations although 67% preferred telephonic reminders to SMS and only 53% were willing to pay for the reminders. Respondents who were currently married and had at least a post-secondary education were more willing to receive SMS reminders.
Conclusion. The mothers had better access to mobile phones than the Internet and were willing to receive SMS immunisation reminders. Future intervention strategies should explore payment mechanisms for SMS reminders, as there is an unwillingness to bear the cost by the respondents.
29 citations
TL;DR: While hygiene education alone resulted in meaningful reductions in gastrointestinal and respiratory illness and skin infections in children aged under 5 years across all communities, families with hygiene education plus consistent use of provided hygiene products had greater reductions.
Abstract: Background. Hygiene promotion has become increasingly important to public health policy makers as an illness reduction strategy. The primary aim of this study was to assess the differential effects of hygiene education alone compared with hygiene education plus hygiene products on the reduction of target illnesses/infections.
Aims and methods. We hypothesised that a participatory learning and action (PLA) family hygiene education approach plus the regular use of hygiene products could result in marked reduction of morbidity in children aged under 5 years. Population groups in two separate geographical areas were utilised (685 households). Each group consisted of a government (Reconstruction and Development Programme, RDP) housing community (indoor tap/flush toilet) and an informal (INF) housing community (communal tap/latrines). Illness data were gathered in both groups before hygiene education was introduced in June - November 2006 (study baseline) and for the same period in 2007 (study follow-up) after one group had received hygiene education only (control) and the other group hygiene education plus hygiene products (intervention). Facilitators from the communities monitored symptoms weekly and reinforced disease prevention behaviours, focusing on handwashing and bathing with soap, cleaning toilet/food surfaces, and treating skin problems with antiseptic.
Results. Children aged under 5 years in all communities had significant reductions in gastrointestinal and respiratory illnesses and skin infections over time. At study follow-up the control RDP community with hygiene education only was 2.46 times more likely to experience gastrointestinal illnesses (hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.17 - 4.91) and 4.56 times more likely to experience respiratory illnesses (HR 4.56, CI 1.97 - 10.54) at study follow-up than the intervention group. There was no statistical difference in the incidence of skin infections for children living in RDP housing. The INF community with hygiene education only was 1.64 times more likely to experience gastrointestinal illnesses (HR 1.64, CI 1.32 - 2.03), 4.62 times more likely to experience respiratory illnesses (HR 4.62, CI 4.19 - 5.09) and 1.29 times more likely to experience skin infections (HR 1.29, CI 1.26 - 1.32) than the intervention group.
Conclusion. While hygiene education alone resulted in meaningful reductions in gastrointestinal and respiratory illness and skin infections in children aged under 5 years across all communities, families with hygiene education plus consistent use of provided hygiene products had greater reductions.
16 citations
TL;DR: A 2-year-old boy who presented with swelling in the right inguino-scrotal region and Imaging showed migration of the peritoneal catheter into the right scrotum is reported on.
Abstract: Ventricular shunt is a well-established modality in the management of hydrocephalus. However, it can be associated with numerous complications and disastrous consequences. The reported incidence of intra-abdominal complications in infants and children after ventriculoperitoneal (VP) shunt procedures is about 24% and most of these patients present with abdominal signs and/or intracranial sepsis. In this article we report on a 2-year-old boy who presented with swelling in the right inguino-scrotal region. Imaging showed migration of the peritoneal catheter into the right scrotum.
12 citations
TL;DR: There was no difference in neurodevelopmental outcome at 18 months between the HEU and HUU groups and there were no significant differences between the groups with regard to the GMDS general quotient or other subscales.
Abstract: Introduction. HIV affects children both directly and indirectly, with evidence of increased infectious mortality and morbidity in the HIV-exposed but uninfected (HEU) infant. There is little published research on neurodevelopmental outcome of HEU infants in Africa. Following the introduction of successful prevention of mother-to-child transmission programmes, it has become important to determine whether differences exist between HEU infants and infants born to HIV-negative mothers (HUU) in order to guide current management policies of this rapidly growing group of infants.
Objectives. To compare the developmental outcome of infants exposed to HIV in utero who remained uninfected (HEU) with that of infants unexposed to HIV in utero (HUU).
Methodology. This was a prospective, blinded, hospital-based study. Infants aged between 17 and 19 months were assessed on the Griffiths Mental Developmental Scales (GMDS). Birth history, previous hospitalisation, maternal and infant characteristics, antiretroviral exposure, anthropometric measurements and abnormal clinical findings were documented.
Results. Of the original 55 infants enrolled at 2 weeks of age, 37 (17 HEU and 20 HUU) underwent neurological and developmental assessment. There were no significant differences between the groups with regard to the GMDS general quotient or other subscales, apart from the Personal/social subscale, where the HEU group performed significantly more poorly than the HUU participants (p=0.026). This difference is probably a result of cultural differences between the groups, as 76% of HEU and only 15% of HUU participants were of Xhosa origin.
Discussion. There was no difference in neurodevelopmental outcome at 18 months between the HEU and HUU groups.
11 citations
TL;DR: This review critically surveys the available evidence to generate a comparison between arterial and capillary blood gas sampling, focusing on their relative accuracy and complications, as well as briefly mentioning the management of such complications.
Abstract: Blood gas sampling is part of everyday practice in the care of babies admitted to the neonatal intensive care unit, particularly for those receiving respiratory support. There is little published guidance that systematically evaluates the different methods of neonatal blood gas sampling, where each method has its individual benefits and risks. This review critically surveys the available evidence to generate a comparison between arterial and capillary blood gas sampling, focusing on their relative accuracy and complications, as well as briefly mentioning the management of such complications. This evidence-based summary and guidance should help inform best practice in the neonatal intensive care unit, and minimise the exposure of babies to unnecessary and potentially serious risk.
The most accurate and non-invasive method of measuring oxygenation is oxygen saturation monitoring. Indwelling arterial catheters are a practical, reliable and accurate method of measuring acid-base parameters, provided they are inserted and maintained with the proper care. Capillary blood gas sampling is accurate, and a good substitute for radial ‘stab’ arterial puncture avoiding many of the complications of repeated arterial puncture.
10 citations
TL;DR: Oedematous undernutrition was common and 73% of the children presented with severe wasting and in order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms ofUndernutrition is crucial.
Abstract: Background. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana. Purpose. To determine the clinical profile and the severity of anthropometric failure of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Francistown. Method. Data were collected from 113 caregiver-child pairs using a researcher-administered questionnaire targeting caregivers together with the children’s hospital records. The children’s anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Proportions were then calculated. Results. The median age of the children was 14 months and 55% were boys. The majority of the caregivers were single, younger than 30 years and lived in rural villages. The most common symptoms on admission were oedema (50%) and coughing (35%). Ten per cent of the children were HIV-infected and the HIV status of half the children was unknown. The majority (87%) did not present with secondary diagnoses. Severe wasting (<-3 standard deviations (SD)) (73%) was found in all age groups. Stunting (<-2 SD) was prevalent in 68% of the boys, and 95% of the children were severely underweight (<-3 SD). Conclusion. Oedematous undernutrition was common and 73% of the children presented with severe wasting (<-3 SD). In order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms of undernutrition is crucial.
9 citations
TL;DR: New developments in digital media technology require a re-think of many ethical positions and legal implications in clinical photography.
Abstract: Clinical photography is used in publications, teaching, lecture illustration and research. Nowadays virtually every medical doctor and medical student possesses a camera phone. The patient or the parent is often not asked for consent, or even aware that pictures have been taken with these devices. Medical colleagues may obtain photos we have taken, and use them without our consent. These new developments in digital media technology require a re-think of many ethical positions and legal implications.
7 citations
TL;DR: There is a need to develop standards for the maximum sound output of toys, and compulsory introduction of warnings about the noise levels of toys on the packaging and adherence to ASTM International standards for toy manufacturers are recommended.
Abstract: Objectives . To describe the noise levels of popular hand-held, tabletop, crib and close-to-the-ear toys for children between the ages of birth and 3 years in South Africa. Design . A quantitative, non-experimental, descriptive research design was employed for this study. Subjects . Twenty toys, 5 from each of 4 categories, were chosen from a popular toy store in South Africa. The noise levels of these toys were measured using a sound level meter in a quiet room. The frequency spectra of the noise were analysed and compared with current international standards relating to toy safety. Results . The majority of toys adhere to the current American Society for Testing and Materials (ASTM) International standards for toy noise. Frequency spectra analysis revealed that the loudest continuous noise levels for all toys were recorded at the frequencies that are the most important for hearing speech. Conclusions . There is a need to develop standards for the maximum sound output of toys, and compulsory introduction of warnings about the noise levels of toys on the packaging and adherence to ASTM International standards for toy manufacturers are recommended.
7 citations
TL;DR: This work presents two confirmed cases of CRS diagnosed in the neonatal unit at Groote Schuur Hospital in 2011 and discusses aspects of the disease and its prevention.
Abstract: Congenital rubella syndrome (CRS) is a rare but potentially debilitating disease with lifelong consequences. Although there is no cure, it is almost completely preventable by an effective immunisation programme. We present two confirmed cases of CRS diagnosed in the neonatal unit at Groote Schuur Hospital in 2011 and discuss aspects of the disease and its prevention.
TL;DR: While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised.
Abstract: A point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2007 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised.
TL;DR: There were increased numbers of admissions for diarrhoea at the ages of 7 months and 12 months, during the dry season and together with diagnosed infection, particularly malaria, however, further study on causes of childhood diarrhoeA, given the identified risk factors, may better explain the epidemiology of diarrhea in Morogoro.
Abstract: Objectives. To describe the diarrhoea admissions and the influencing factors in six - 60-month-old children at Morogoro Regional Hospital.
Design. A retrospective descriptive study of the type of diarrhoea, patient age, home address, nutritional status, diagnosed infection, month of admission, admission duration and outcome.
Setting. A hospital-based study: paediatric admissions at Morogoro Regional Hospital.
Subjects. All children aged 6 - 60 months admitted to the infectious diseases ward over the 60-month period from May 2006 to April 2011.
Results. A total of 4 988 records were extracted, among which the prevalence of diarrhoea was 2 855 (57.2%). Among the 2 855 children with diarrhoea, the majority (2 536 (88.8%)), were 6 - 24 months old, with peak admissions at 7 months and 12 months. District of residence, season, undernutrition and infection were the factors significantly associated (p<0.001) with the age at which children were admitted with diarrhoea.
Conclusions. There were increased numbers of admissions for diarrhoea at the ages of 7 months and 12 months, during the dry season and together with diagnosed infection, particularly malaria. However, further study on causes of childhood diarrhoea, given the identified risk factors, may better explain the epidemiology of diarrhoea in Morogoro.
TL;DR: Early assessment, community awareness of AOM intensified by motivational activities, and increased compliance with referral to the doctor in caregiver-unreported cases may help to decrease morbidity and burden from the disease.
Abstract: Objectives. To report on the burden and outcome of episodes of acute otitis media (AOM) based on awareness of AOM and compliance to referral by community health workers (CHWs) in rural children aged under 2 in Bangladesh.
Study design. Retrospective population-based cohort study.
Method. Secondary data analysis on episodes of AOM, care-seeking pattern, compliance with referral, antibiotic use and duration of episodes from morbidity data collected by CHWs on 252 children aged under 2 who completed biweekly household surveillance starting from birth.
Results. A total of 375 episodes of AOM were observed in 45.6% (115/252) of the study subjects; 19.4% (49/252) experienced single and 26.2% (66/252) recurrent episodes. Just over 34% (129/375) of episodes were recognised by caregivers and reported to CHWs, and the remaining 246 episodes, unrecognised by caregivers, were detected by CHWs during home visits. CHWs referred all subjects with AOM to the study doctor. The caregivers complied with referral in all episodes they had recognised, but in only 21.5% (53/246) of episodes they had not recognised (p<0.0001). Compliance was best among caregivers of babies in the first 3 months of life. Resolution occurred in 95.0% (356/375) of acute episodes of AOM in ≤6 weeks, comprising 176/182 of antibiotic-treated and 180/193 of untreated episodes (p<0.13). Five per cent of episodes (19/375) progressed to chronic suppurative otitis media (CSOM). Doctor visits resulting in antibiotic use resulted in a 51% lower progression to CSOM (relative risk 0.49, 95% confidence interval 0.19 - 1.26).
Conclusion. AOM in rural children aged under 2 in Bangladesh is a disease of public health importance. Early assessment, community awareness of AOM intensified by motivational activities, and increased compliance with referral to the doctor in caregiver-unreported cases may help to decrease morbidity and burden from the disease.
TL;DR: Poor academic performance is common among adolescents with epilepsy and is associated with early onset, poor seizure control and missing school, and efforts should be made to control seizures and educate society about the illness.
Abstract: Adolescents with epilepsy experience significant academic difficulties. However, little is known about the effects of epilepsy on the academic performance of adolescents with the disorder in Northern Nigeria.
Objective. To assess the academic performance of adolescents with epilepsy and factors associated with poor performance in this population in a Northern Nigerian setting.
Methods. The socio-demographic/clinical characteristics of 77 consecutive adolescents (aged 12 - 17 years) with epilepsy attending the Child and Adolescent Clinic of Federal Neuropsychiatric Hospital, Kaduna, North-West, between March 2008 and September 2010 and the socio-demographic characteristics of 76 controls (matched for age and sex) were recorded. Information concerning school attendance and academic performance of the subjects and the controls were obtained from the adolescents and their parents or caregivers.
Results. The mean ages of the subjects and the controls were 15.1 (standard deviation (SD) 2.1) and 14.7 (SD 1.7) years, respectively (p>0.05), the mean duration of illness was 6.1 (SD 4.6) years, the mean seizure-free period was 16.8 (SD15.6) weeks, and 64.9% of the subjects and 57.9% of the controls were males. Forty-six subjects (59.7%) and 12 controls (15.8%) had poor academic performance (p<0.001). Long duration of illness, short seizure-free periods and irregular school attendance were significantly associated with poor academic performance (p<0.05).
Conclusions. Poor academic performance is common among adolescents with epilepsy and is associated with early onset, poor seizure control and missing school. Efforts should be made to control seizures and educate society about the illness.
TL;DR: A case of isolated hydatid cyst of the lung in a 5-year-old boy from a nomadic cattle-rearing tribe is presented and it is shown that boys are affected more commonly than girls.
Abstract: Cystic echinococcosis is the larval cystic stage (echinococcal cysts) of a small taeniid-type tapeworm (Echinococcus granulosus) that may cause illness in intermediate hosts, generally herbivorous animals and people who are infected accidentally Pulmonary hydatid cysts are typical, involving one lobe in 72% of cases, usually at the lung base In the paediatric age group, boys are affected more commonly than girls We present a case of isolated hydatid cyst of the lung in a 5-year-old boy from a nomadic cattle-rearing tribe
TL;DR: A case in which child abuse was wrongly diagnosed and the correct diagnosis made in time to re-unite the child with his parents is reported.
Abstract: The differential diagnosis of child abuse or non-accidental injury is extensive and includes rare metabolic disorders. We report a case in which child abuse was wrongly diagnosed. Fortunately the correct diagnosis made in time to re-unite the child with his parents.
TL;DR: In neonatal and paediatric units, where the volume of blood available is limited and turnaround time critical, an appropriately quality-assured HemoCue can replace standard haematology analysers in the measurement of Hb.
Abstract: Objective. The HemoCue is a point-of-care analytical system for haemoglobin concentration (Hb) measurement. Point-of-care testing has been validated in hospitals and outpatient departments to assist with urgent patient management by providing rapid laboratory test results.
Method. In this prospective study we compared the analytical performance of the HemoCue with that of the Advia 120 haematology analyser with regard to accuracy, precision and linearity in the measurement of Hb in neonates and infants.
Results. Samples from 44 patients were analysed by both instruments and the results compared using difference plots. The mean Hb value for the HemoCue (11.8 g/dl; range 4.8 - 18.7) was comparable to that for the Advia (11.8 g/dl; range 5.2 - 19.2). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was small and the imprecision was within acceptable limits. Hb measurement was linear in the range 4.8 - 20 g/dl.
Conclusion. In neonates and infants, the diagnostic accuracy of the HemoCue point of care device is comparable to that of the Advia 120 analyser. In neonatal and paediatric units, where the volume of blood available is limited and turnaround time critical, an appropriately quality-assured HemoCue can replace standard haematology analysers in the measurement of Hb.
TL;DR: This case highlights the importance of an adequate history, clinical examination combined with correct imaging in accurate, early diagnosis of Sinding-Larsen- Johansson syndrome, a rare but important course of patellofemoral pain.
Abstract: A spectrum of entities is involved in injury to the inferior aspect of the patella and the proximal patella tendon, including Sinding-Larsen- Johansson syndrome, patellar sleeve avulsion and jumper’s knee. The patellar tendon is usually only a few centimetres long, arising from the inferior patella and inserting distally into the tibial tuberosity. Sinding-Larsen-Johansson syndrome is an osteochondrosis of the inferior pole of the patella and is often bilateral. It is not osteonecrosis, epiphysitis or osteochondritis as previously described in the literature. Sinding- Larsen-Johansson is commonly seen in active adolescents aged between 10 and 14 years, as described in our patient. Our case highlights the importance of an adequate history, clinical examination combined with correct imaging in accurate, early diagnosis of Sinding-Larsen- Johansson syndrome, a rare but important course of patellofemoral pain.
TL;DR: A retrospective patient record review of all ART-naive children referred to Kalafong hospital’s paediatric HIV clinic between April 2004 and March 2010 found that 1 in every 30 children was discharged HIV-uninfected, and below age 18 months, 1 in 16 children had false-positive HIV virological tests.
Abstract: Objective. To assess the extent to which children may be falsely diagnosed as HIV-infected, using data from an antiretroviral therapy (ART) site in Pretoria, South Africa.
Methods. This was a retrospective patient record review of all ART-naive children referred to Kalafong hospital’s paediatric HIV clinic between April 2004 and March 2010, with detailed review of those found to be HIV-uninfected.
Results. There were 1 526 patient files analysed, with a male-to-female ratio of 1.01:1 and median age at first visit of 20 months (range 26 days - 17.5 years). Nearly half (n=715; 47%) of the children were aged <18 months. Fifty-one children were found to be HIV-uninfected after repeated diagnostic tests. Incorrect laboratory results for children aged <18 months included false-positive HIV DNA PCR tests (40), detectable HIV viral loads (4) and a false-positive HIV p24Ag test (1). One child above 18 months had false-positive HIV ELISA results. An additional 4 children were inappropriately referred after being incorrectly labelled as HIV-infected and 1 child aged <18 months was referred after an inappropriate diagnostic test for age was used. In summary, 1 in every 30 (3.3%) children was discharged HIV-uninfected, and below age 18 months, 1 in 16 children (6.3%) had false-positive HIV virological tests.
Conclusions. Urgency in ART initiation in HIV-infected children is life-saving, especially in infants. However, HIV tests may produce false-positive results leading to misdiagnosis of children as HIV-infected, which has serious consequences. Meticulous checking of HIV-positive status is of utmost importance before committing any child to lifelong ART.
TL;DR: A case of hyperimmunoglobulin E syndrome associated with Sjogren’s syndrome in a 10-year-old boy is described and a brief review of the literature is provided.
Abstract: We describe a case of hyperimmunoglobulin E syndrome associated with Sjogren’s syndrome in a 10-year-old boy and provide a brief review of the literature. Although seen in adults, Sjogren’s syndrome occurring after a primary immunodeficiency disease such as hyperimmunoglobulin E has not previously been reported in a child.
TL;DR: Doctors may underestimate mothers’ capacity to cope with handicapped children, and the opinion and perspectives of mothers are therefore important factors in NICU decision making.
Abstract: Objectives . In neonatal intensive care units (NICUs), difficult decisions about care and withdrawal of treatment sometimes have to be taken by parents and healthcare workers, especially when the infant will probably have a poor developmental outcome. Only one previous study conducted in South Africa investigated whether preferences in this regard differ between these groups. We aimed to acquire more information on the issue. Design . A comparative cohort study comprising separate groups. Setting . Neonatal units of Universitas Academic and Pelonomi Regional hospitals. Subjects . Mothers of very low-birth-weight (VLBW) babies and children with multiple disabilities; paediatricians (including registrars) and nurses working in these units. Outcome measures . The preferences for developmental outcomes were compared between four groups: nurses, paediatricians, mothers of VLBW infants, and mothers of babies with multiple disabilities. Different scenarios were illustrated, and questionnaires were used to obtain the opinions on active treatment for babies with a poor developmental outcome. Results . When asked whether doctors should attempt to save premature babies, even with a more than 50% chance of being handicapped, 100% of mothers agreed, as opposed to 23% of paediatricians. Similar results were obtained when respondents were asked whether they would prefer to have a severely handicapped child rather than no children at all. Seventy per cent of mothers of VLBW babies indicated that parents are the most important stakeholders in NICU decision making. Conclusions . Doctors may underestimate mothers’ capacity to cope with handicapped children. The opinion and perspectives of mothers are therefore important factors in NICU decision making.
TL;DR: The case of a 6-year-old boy presenting only with cervical lymphadenopathy as a manifestation of kala-azar without evidence of any other visceral involvement is described.
Abstract: We describe the case of a 6-year-old boy presenting only with cervical lymphadenopathy as a manifestation of kala-azar without evidence of any other visceral involvement. Involvement of lymph nodes in Indian kala-azar is quite rare with only a few case reports in published literature. The boy was known to be HIV-positive for 1 year before presentation. Immunodeficiency due to HIV infection could have resulted in unusual manifestation of kala-azar.
TL;DR: The study findings support vulnerability of the right hemisphere, particularly the right frontoparietal region and prefrontal cortex, to radiation injury, which has major implications for second-language learners, as visuospatial learning is particularly important for them.
Abstract: Background . Cranial radiation is part of a treatment protocol for childhood acute lymphoblastic leukaemia (ALL) in South Africa. Radiation is known to disrupt the myelination and integrity of white matter tracts in the brain. Associated cognitive impairment has been well documented in other countries, but not to the same extent in the multicultural and multilingual South African context. Objectives . The current study focused on the assessment of memory and learning, two imperative cognitive functions. A quantitative evaluation of verbal and visuospatial memory performance in a cohort of ALL patients was done in order to establish whether there was a difference in performance between verbal and visuospatial tasks. Methods . Eight patients with a low socio-economic background and being educated in their second language were included in the cognitive evaluation. All had received 18 Gy of radiation as part of their treatment protocol and were on maintenance treatment at the time of the study. Results . In all the patients, primary cognitive impairment was demonstrated in ostensibly right hemisphere visuospatial tasks in comparison with ostensibly left hemisphere verbal tasks. Because deficits in visuospatial attention and working memory were identified, qualitative analysis of the results suggested that the white matter tracts in the right frontoparietal region and prefrontal cortex may be particularly vulnerable to radiation injury. Conclusion . The study findings support vulnerability of the right hemisphere, particularly the right frontoparietal region and prefrontal cortex, to radiation injury. The decline in visuospatial cognitive abilities has major implications for second-language learners, as visuospatial learning is particularly important for them.
TL;DR: The South African Child Gauge serves as an annual barometer of the situation of South Africa’s children.
Abstract: Now in its seventh year, the South African Child Gauge serves as an annual barometer of the situation of South Africa’s children.
TL;DR: A 10-year-old girl with typhoid fever who presented with motor aphasia during the first week of illness is reported, a complication that has not been reported previously.
Abstract: Typhoid (enteric) fever is an endemic disease in many tropical countries, with diverse modes of presentation. The classic clinical manifestations are rarely seen nowadays owing to early diagnosis and institution of antibiotic therapy. Moreover, the epidemiology of the disease is constantly shifting, with some cases presenting with complications in the early part of the illness. Of all the complications reported in enteric fever, the neurological manifestations constitute an important but often under-diagnosed group. We report a 10-year-old girl with typhoid fever who presented with motor aphasia during the first week of illness, a complication that has not been reported previously.
TL;DR: Because of considerable clinical overlap between diarrhoea patients with and without HIV infection, HIV co-infection cannot be reliably predicted on clinical features alone and must be actively excluded.
Abstract: or urinary infection. Patients with diarrhoea were more likely to be tested for HIV if they were severely malnourished or clinically wasted, if they had hyponatraemia or hypokalaemia, and if they had hepatomegaly or lymphadenopathy. The presence of shock or severe dehydration on admission, or of comorbid pneumonia, did not differentiate between those who were tested for HIV and those who were not. There were statistically significant differences between those tested for HIV and those not tested in respect of outcome. Among the children tested for HIV, 24.2% of survivors had a prolonged hospital stay (more than 10 days), compared with 1.4% among those not tested (p<0.005). While more children in the group tested for HIV died in hospital (6.1% v. 2.6%), this did not reach statistical significance (p=0.466). Conclusion. In this study, HIV testing was found to be predominantly based on clinical grounds at the time of admission. Because of considerable clinical overlap between diarrhoea patients with and without HIV infection, HIV co-infection cannot be reliably predicted on clinical features alone and must be actively excluded. Effective ART is now available. All patients with diarrhoea must therefore be offered HIV testing to provide earlier access to appropriate management.
TL;DR: A 2-year-old boy presenting with persistent fever and splenomegaly who fulfilled the diagnostic criteria for haemophagocytic lymphohistiocytosis (HLH) remains well and in remission (from HLH) a year later with residual tricuspid regurgitation awaiting tric Suspid valve replacement.
Abstract: We report a case of a 2-year-old boy presenting with persistent fever and splenomegaly who fulfilled the diagnostic criteria for haemophagocytic lymphohistiocytosis (HLH) according to the Histiocyte Society (2004). The persistence of a cardiac murmur despite multiple transfusions, and therapy which rendered him afebrile, led us to do an echocardiogram as part of surveillance for sepsis. This revealed tricuspid vegetation and a small ventricular septal defect. Blood culture and postoperative histology of the anterior leaflet of the tricuspid valve confirmed Streptococcus pneumoniae infection. The patient was successfully treated with intravenous antibiotic therapy for 6 weeks and dexamethasone for 8 weeks and remains well and in remission (from HLH) a year later with residual tricuspid regurgitation awaiting tricuspid valve replacement.
TL;DR: The Division of Human Genetics (National Health Laboratory Service and University of the Witwatersrand) recently hosted the second annual Achondroplasia Day in Johannesburg, with the main aim to bring individuals with achondro Plasia and their families together and to facilitate improved interaction between families and the healthcare professionals involved in their care.
Abstract: The Division of Human Genetics (National Health Laboratory Service and University of the Witwatersrand) recently hosted the second annual Achondroplasia Day in Johannesburg. Participation in the meeting increased from 4 families in 2011 to 17 families in 2012. The main aim of the meeting was to bring individuals with achondroplasia and their families together and to facilitate improved interaction between families and the healthcare professionals involved in their care. This short report briefly describes the events of the day, and the immense benefit such activities have for families with rare genetic conditions. Additionally, we provide an overview of the basic genetics of achondroplasia and specific health needs of affected individuals. It is hoped that other centres around South Africa will be inspired to organise similar events in their respective areas to benefit their patients.