South African Journal of Child Health
Published by Health and Medical Publishing Group. The SAJCH is a medical child health journal. It carries research articles and letters, editorials, clinical practice and other child health articles and personal opinion, South Africa health-related news, obituaries, general correspondence, and classified advertisements.
|Publisher||Health and Medical Publishing Group (HMPG)|
|Coverage||Vol 1 Issue 1 2007 - current|
Infant hearing screening at primary healthcare immunisation clinics in South Africa : the current status : research
Background. In the developing world, it is critical that the acceptable principle that early hearing detection and intervention (EHDI) programmes be contextually useful, given the extensive level of difficulties faced by these regions. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise EHDI application. One of these contexts relates to hearing screening at immunisation clinics within the first 6 weeks of life.
Objective. To explore the current status of the implementation of the HPCSA's 2007 guidelines for clinic-based hearing screening within the South African primary healthcare clinic (PHC) setting.
Methods. Within a qualitative research design, 30 PHC nurses representing 30 PHC clinics in the North West and Gauteng Provinces were interviewed using a structured questionnaire. Qualitative as well as thematic content analysis strategies were adopted in analysing data.
Results. There is a lack of formal EHDI implementation at PHC clinics in both provinces. Lack of equipment, budgetary constraints and human resource challenges are the reasons for this. Regardless of the province's socioeconomic development based on the deprivation index, EHDI implementation at clinic level is not feasible unless the barriers are addressed.
Conclusion. There is a need to ensure that context-specific studies in EHDI are conducted. This will ensure that national position statements are sensitive to contextual challenges and that they allow for evidence-based practice. This is particularly relevant in developing countries where resource constraints dictate the success or failure of any well-intentioned programme. The HPCSA's 2007 position statement needs to be reviewed taking careful cognisance of feasibility study findings such as the current one. Findings have implications for nurses training, future studies, and policy formulation, as well as clinical plans for EHDI in developing contexts.
The impact of a change in referral pathway on a paediatric short-stay ward in Cape Town, South Africa : research
Background. The opening of the new Khayelitsha District Hospital in April 2012 coincided with a change in referral pathway to Tygerberg Hospital (TBH) for children requiring specialist care.
Objective. To determine the disease burden impact of the referral pathway change on paediatric short-stay ward admissions at TBH.
Methods. A retrospective cohort study, analysing routine health information as captured in ward admissions registers over two similar seasonal periods: 1 April - 30 September 2011 (prior to referral change) and 1 April - 30 September 2012 (post referral change).
Results. Paediatric short-stay ward admissions remained similar, but a statistically significant increase in the number of admissions from Khayelitsha sub-district (SD) (p<0.001) was seen. The median age was 13 months over the two time periods. Children from Khayelitsha (median age 9.49 months for 2011 and 5.2 months for 2012) were, however, significantly younger than those from other SDs (median age 26.31 months in 2011 and 26.44 months in 2012) (p=0.001). Khayelitsha children were more likely to require admission to a TBH paediatric ward (p<0.001, adjusted odds ratio (aOR) 0.57), while children from other SDs were more likely to be discharged home or transferred to a district hospital (p<0.001, aOR 1.75). Respiratory illnesses accounted for the majority of admissions during both time periods (54% in 2011 and 51% in 2012).
Conclusion. Children from Khayelitsha were significantly younger and more likely to be admitted to a TBH inpatient ward compared with other SDs. These findings necessitate a review of current health service resource allocation.
Risk profiles of infants ≤32 weeks' gestational age with oropharyngeal and oesophageal dysphagia in neonatal care : research
Background. Infants in neonatal intensive care are at risk of swallowing difficulties, in particular oropharyngeal dysphagia (OPD) and oesophageal dysphagia (OD). OPD is treated by speech-language therapists while OD is managed by doctors. Diagnosis of dysphagia is a challenge as equipment for instrumental evaluations is not readily available. Additional information to guide clinical assessment may be valuable.
Objective. To determine whether risk profiles of infants (≤32 weeks' gestation) in a neonatal intensive care unit (NICU) and diagnosed with OPD or OD were distinctly different from one another.
Methods. Non-probability convenience sampling was used to select 49 participants. Based on modified barium swallow (MBS) examinations, three groups of participants were identified: no dysphagia (n=11), OPD (n=13) and OD (n=25). Clinical data were collected to investigate associations between risk profiles and type of dysphagia.
Results. Factors such as gestational age, birth weight, poor weight gain and Apgar scores showed no association with either type of dysphagia in the sample of infants with a mean gestational age of 35.53 weeks. Increased NICU stay, increased chronological age, problematic breastfeeding and use of tube feeding showed an association with OPD. Three risk factors, namely intrauterine growth restriction, premature rupture of membranes and nutritive sucking difficulties were associated with OD.
Conclusion. Risk profiles associated with the two types of dysphagia may guide NICU personnel and speech-language therapists, especially in settings where no MBS equipment is available.
The long-term concerns post cochlear implantation as experienced by parents/caregivers of prelingually deaf children between the ages of 3 and 5 years in Gauteng Province, South Africa : research
Background. Cochlear implantation aims to provide an effective means of spoken communication for prelingually deaf children. However, studies in this field are mostly clinically orientated, with little focus on the experiences and long-term concerns of families post cochlear implantation (CI).
Objective. To describe the long-term concerns post CI as experienced by parents/caregivers of prelingually deaf children between the ages of 3 and 5 years, and to determine the role of support groups with regard to effective intervention and coping post CI.
Methods. A phenomenological, non-experimental research design was conducted through semi-structured, indepth, one-on-one interviews with five parents/caregivers.
Results. Caregivers reported concerns with changes in family support, financial difficulties, poor communication, and schooling and vocational prospects for their children.
Conclusion. The findings of this study highlight a need for continued support for parents and families with children who have been fitted with cochlear implants. This should be through the use of a family systems perspective model that takes into account the impact on the quality of life of families with children who have a hearing loss or who are fitted with cochlear implants. There is a need for a contextualised longitudinal study where, based on previous observations and experiences, parents/caregivers are reminded about the continual long-term expenses associated with CI. This includes maintenance costs, hospital visits and school placement when the children reach school-going age.
The prevalence of paediatric skin conditions at a dermatology clinic in KwaZulu-Natal Province over a 3-month period : research
Background. Skin conditions are common in children, and studying their spectrum in a tertiary dermatology clinic will assist in quantifying skin diseases associated with greatest burden.
Objective. To investigate the spectrum and characteristics of paediatric skin disorders referred to a tertiary dermatology clinic in Durban, KwaZulu-Natal (KZN) Province, South Africa.
Methods. A cross-sectional study of children attending the dermatology clinic at King Edward VIII Hospital, KZN, was carried out over 3 months. Relevant demographic information and clinical history pertaining to the skin conditions were recorded and diagnoses were made by specialist dermatologists. Data were analysed with EPI Info 2007 (USA).
Results. There were 419 children included in the study; 222 (53%) were males and 197 (47%) were females. A total of 64 diagnosed skin conditions were classified into 16 categories. The most prevalent conditions by category were dermatitis (67.8%), infections (16.7%) and pigmentary disorders (5.5%). For the specific skin diseases, 60.1% were atopic dermatitis (AD), 7.2% were viral warts, 6% seborrhoeic dermatitis and 4.1% vitiligo. Dermatitis was significantly more common in males (p<0.05). AD was the most common condition below 12 years of age, while the presence of viral warts was the most prevalent disorder among HIV-infected children. Approximately one-third (37.5%) of the disorders referred by other medical practitioners were misdiagnosed.
Conclusions. AD constituted the highest burden both numerically and economically. Viral infections were a major contribution from HIV infection. The diverse spectrum and characteristics of skin diseases referred will assist in modifying the dermatology educational curriculum and bridge knowledge gaps among healthcare providers treating children.