South African Journal of Child Health - Volume 1, Issue 3, 2007
Volume 1, Issue 3, 2007
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 1 (2007)More Less
Source: South African Journal of Child Health 1, pp 96 –97 (2007)More Less
Almost 70 delegates gathered in Stellenbosch in early September at the sixth biannual meeting of the South African Children's Cancer Study Group (SACCSG). Established in 1987, the organisation brings together paediatric oncologists, paediatric surgeons, radiation oncologists and pathologists. These meetings are an opportunity to share outcomes, discuss new treatments and enjoy the contributions of invited speakers.
Author Mariana KrugerSource: South African Journal of Child Health 1, pp 98 –100 (2007)More Less
The history of childhood cancer treatment is one of the major success stories of the second part of the 20th century, where cure rate improved from no survival in 1950 to more than 70% currently. This is due to the development of dedicated paediatric oncology units, prospective clinical trials, and improved supportive care. Challenges for the 21st century include finding therapies that will cure the other 30% of children and reduce the complications of treatment. Only about 20% of the world's children have access to this type of specialised care and a major focus area is how to ensure improved access to these treatment modalities for the other 80% of the world's children.
Source: South African Journal of Child Health 1, pp 102 –105 (2007)More Less
Unexplained fractures in infants and children often suggest abuse. Head injury with concomitant skull fracture is the leading cause of death in cases of child abuse. Fractures associated with child abuse vary from 11% to 55% in non-accidental injury (NAI) presentations. Distinguishing accidental from abusive fractures is vital; failure to recognise and prevent further abuse may result in unnecessary psychological trauma, injury or death of the child. The fracture patterns with high specificity for abuse are well documented; however, in practice, these patterns occur infrequently, and abused children may present with a wide spectrum of bony injuries. The majority of reports suggest that fractures of long bones are those most frequently seen in cases of abuse, although some studies have reported higher numbers of skull and rib fractures. Furthermore, socio-economic factors have been reported to influence the incidence and pattern of injuries in child abuse. The present study was a retrospective review of the Child Accident Prevention Foundation of South Africa (CAPFSA) database of children seen over a 14-year period at Red Cross War Memorial Children's Hospital (RXH), Cape Town, to identify those who had sustained fractures as a result of child abuse.
Source: South African Journal of Child Health 1, pp 106 –111 (2007)More Less
Background. The fourth Millennium Development Goal (MDG) aims at reducing childhood deaths in the developing world by 2015.
Objective. To examine the pattern of childhood deaths in a Nigerian tertiary hospital which served at least three states of the federation between 1996 and 2015.
Method. A retrospective study of paediatric deaths between January 1996 and December 2005. Subjects admitted in the pre-MDG period were compared with those admitted during the MDG period.
Results. Of 10 451 paediatric patients admitted, 1 320 (12.6%) died but only 1 225 were studied. The male-to-female ratio was 1.4:1. Although the yearly mortality rate ranged from 10.7% to 14.9%, the overall mortality rate for the pre-MDG period was similar to that for the MDG period (p=0.135). Most deaths (69.1%) occurred within 48 hours of hospitalisation. Of the 1 225 patients who died, 57.3% were neonates. These neonatal deaths were commonly due to prematurity (34.6%), perinatal asphyxia (30.8%) and septicaemia (24.8%), while severe anaemia was the most common cause of death among infants (20.1%) and toddlers (25.1%). Severe malaria, severe anaemia, and tetanus formed 33.3% of all deaths among children older than 5 years. There was no significant difference in the role of prematurity (p=0.298) and measles (p=0.927) as causes of death before and during the MDG periods. HIV/AIDS (p=0.046) became more common as a result of the HIV pandemic, while severe malaria (p=0.041) became less common as a cause of death during the same period.
Conclusion. The childhood mortality rate remained high over the 10-year study period. The deaths were mostly caused by infectious and other preventable conditions. The utilisation of specific target-orientated interventions, such as integrated management of childhood illnesses (IMCI), and primary health care may reduce the number of childhood deaths before 2015.
Source: South African Journal of Child Health 1, pp 112 –114 (2007)More Less
Atopy in the Gauteng and Free State provinces of South Africa has been reported previously. However, these studies reflect the allergy status of individuals living in Johannesburg and Bloemfontein. No study of this nature has ever been conducted in Pretoria. Pollen exposure is a well-recognised symptom trigger in allergic patients. In the former Transvaal (now Gauteng) pollen has been reported as present perennially, with grass pollen the most significant contributor in both absolute and relative terms. Furthermore, pollen and fungal counts frequently exceed levels of tolerance for allergy sufferers.
Probiotics in infectious diarrhoea : are they indicated? A review focusing on Saccharomyces boulardii : reviewSource: South African Journal of Child Health 1, pp 116 –119 (2007)More Less
Infectious gastroenteritis continues to be a leading cause of mortality and morbidity worldwide and, while rotavirus vaccination will certainly reduce the incidence, it is unlikely to make a significant impact on this condition. The cornerstone of treatment remains replacement of water and electrolyte losses with oral rehydration solution (ORS). In areas with low vitamin A status, supplementation of the latter may be of benefit and, in time, the addition of zinc may become routine.
A few years ago, probiotics were discussed primarily in the context of alternative medicine. Probiotics are now entering mainstream medical practice since they have been shown to decrease the severity and shorten the duration of infectious gastroenteritis by approximately 24 hours and are therefore a potent add-on therapy. Curtailing the duration of diarrhoea as well as reducing hospital stays, emphasises the social and economic benefits of probiotic treatment in adjunction to ORS in acute infectious gastroenteritis in children. Evidence in viral gastroenteritis is more convincing than in bacterial or parasitic infection. Mechanisms of action are strain specific, and only those probiotic strains for which there is evidence of clinical efficacy should be recommended. In acute gastroenteritis, there is evidence of efficacy of some strains of lactobacilli (Lactobacillus caseii GG and L. reuteri) and Saccharomyces boulardii. Although probiotics are 'generally regarded as safe', side-effects such as septicaemia have very rarely been reported.
Source: South African Journal of Child Health 1, pp 121 –128 (2007)More Less
Childhood empyema is an important complication of bacterial pneumonia. The incidence of empyema is increasing worldwide. Streptococcus pneumoniae and Staphylococcus aureus are the most common aetiologies in high- and low-income countries, respectively. The diagnosis is based on clinical, radiographic and pleural fluid examination. Tuberculosis (TB) is an important cause of a pleural effusion in high TB prevalence areas. There is controversy about the optimal treatment for empyema in children. Sepsis should be controlled with antibiotics and drainage of the pleural cavity. Intrapleural fibrinolysis and video-assisted thoracoscopic surgery (VATS) are modern interventions widely used in high-income countries, but mostly unavailable in the developing world. There are however few properly conducted studies that would support one therapeutic approach over the other. Despite this, the clinical outcome of paediatric empyema is usually good regardless of therapeutic approach. This review summarises aetiology, pathogenesis and clinical presentation of childhood empyema and discusses the various treatment modalities with an emphasis on clinical practice in developing countries.