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- Volume 10, Issue 2, 2016
South African Journal of Child Health - Volume 10, Issue 2, 2016
Volume 10, Issue 2, 2016
Source: South African Journal of Child Health 10, pp 103 –104 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1144More Less
Kidney disease affects millions of adults and children worldwide. The 11th World Kidney Day was celebrated on 10 March 2016, and was dedicated to childhood kidney diseases. Many children may be at risk of developing kidney disease at an early age, and this year, World Kidney Day aimed to increase awareness around the fact that many adults have had kidney disease since early childhood. The spectrum of kidney disease in children ranges from treatable disorders without long-term sequelae to life-threatening conditions. Children with acute kidney injury (AKI) may develop long-term consequences leading to chronic kidney disease (CKD) later in life. Worldwide, epidemiological information on the incidence and prevalence of paediatric AKI and CKD is limited, often imprecise, and flawed by methodological differences between the various data sources, although increasing in scope. This is particularly pertinent in Africa, where the focus is on communicable diseases with lack of proper documentation and renal registries. As a result there are insufficient data to guide the authorities responsible for resource allocation. This increases the challenges of providing care for children with kidney disease in a resource-limited environment. The rising incidence of kidney diseases in children highlights the need for early detection and healthy lifestyle, starting at birth and continuing into adult life. The main aim of World Kidney Day 2016 was to inform parents, caregivers, young patients, the general public, and policymakers of the importance of the early detection and appropriate management of childhood kidney disease.
Exploring South African adolescents' knowledge of abortion legislation and attitudes to abortion : sexual status and gender differences : short reportSource: South African Journal of Child Health 10, pp 105 –106 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1137More Less
This study explored adolescents' knowledge of the Choice on Termination of Pregnancy Act (No 92 of 1996) and attitudes toward abortion. A sample of 150 secondary school learners (aged 15 - 19 years), from a low socioeconomic area in Durban, KwaZulu-Natal Province, South Africa was surveyed. Twenty percent of the sample indicated that they found abortion acceptable. The sexually active (have had sex) respondents had more positive attitudes toward abortion for elective reasons than the sexually inactive (have not had sex) sample. On traumatic reasons the gender difference was found to be a function of sexual status. Sexually active females showed greater support than males. While the majority of those sampled were aware of the legal status of abortion in this country, they demonstrated a lack of knowledge on specific aspects of the Act. Recognition of adolescents' right to information is central to responsible decision-making among the youth about sexual and reproductive health issues.
Source: South African Journal of Child Health 10 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1178More Less
The 6th Child Health Priorities Conference was convened by the South African Child Health Priorities Association at the University of KwaZulu-Natal in Pietermaritzburg from 3 to 5 December 2015. The theme of the conference, 'Walk the Talk', tackled the challenges of implementing the recommendations from the reports of two child health-related ministerial committees.
Source: South African Journal of Child Health 10, pp 108 –110 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.717More Less
Background. There has been a growing recognition of the challenge of Nigerian adolescents' health issues and the need to address it. Adolescent preventive services (APS) constitute an effective mechanism to reduce adolescent morbidities.
Objective. To evaluate the current practice of APS among Nigerian paediatric residents.
Methods. For this cross-sectional survey, we designed an anonymous questionnaire based on Guidelines of APS of the American Medical Association to elicit information on residents' current practice regarding screening adolescents for specific morbidities.
Results. A total of 103 residents participated in the study; nearly 60% were from federal teaching hospitals. The majority (78.6%) attended to adolescents at least once a week. In the last month, the adolescent medicine service most commonly provided by respondents was general health guidance (66.7%). Altogether, less than one-fifth of the residents have recently asked at least two specific questions to screen adolescents for eating disorders, violence, safety issues, depression, substance or sexual abuse. Senior registrars were more likely than registrars to screen adolescents for hypertension (75.0% v. 29.1%, p=0.032), depression (50.0% v. 16.5%, p=0.043) and abuse (62.5% v. 22.1%, p=0.023). Also, residents with <5 years in practice were more likely to screen for relationship issues (p=0.045).
Conclusion. The current level of practice of APS is low among paediatric residents in Nigeria. There is a need to restructure their ongoing practice and training to emphasise preventive paediatrics and other issues pertinent to adolescent care.
The effects of iron deficiency and anaemia on primary school learners' scholastic performance : researchSource: South African Journal of Child Health 10, pp 111 –115 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.887More Less
Background. Iron deficiency anaemia (IDA) is a preventable cause of cognitive impairment and other negative effects on the academic potential of learners.
Objectives. To determine the local prevalence of IDA among grade 2 learners in a resource-poor community and to evaluate the association between IDA and the learners' scholastic performance.
Methods. This was a case-control observational design study. Data were collected using a stadiometer and an electronic scale, HemoCue Hb 201+ system and official grade 1 school reports.
Results. The point prevalence of IDA was found to be 9.8% (n=19), with a higher prevalence among girls (58%). There was no statistically significant difference between the performances of the two groups (p=0.511) in mathematics. There was a statistically significant difference for life skills (p=0.00017), and the difference between the groups in literacy or languages approached statistical significance (p=0.071).
Conclusions. The results of this study suggest that IDA is prevalent and may have negative effects on learners' scholastic performances. Such negative effects warrant early preventive measures so as to avoid the possibilities of school failure, drop-out and poor productivity in adulthood.
Barriers, facilitators and recommendations for the early infant diagnosis and treatment (EIDT) cascade : a qualitative study in Malawi : researchSource: South African Journal of Child Health 10, pp 116 –120 (2016) http://dx.doi.org/10.7196/SAJCH.2016v10i2.982More Less
Background. Identifying and testing all HIV-exposed infants (HEIs) by 2 months of age with rapid antiretroviral therapy (ART) initiation for those infected is critical to survival. Yet in 2009 only 29% of HEIs in need of ART received treatment in Malawi.
Objectives. To understand barriers, facilitators and recommendations for five key steps in the early infant diagnosis and treatment (EIDT) cascade: (1) identification of HEIs; (2) infant testing; (3) sample processing and transport; (4) reporting results to mothers; (5) ART initiation for HEI.
Methods. Semistructured interviews were conducted through convenience sampling with mothers of infants eligible for EIDT (n=47) and with healthcare workers (HCWs) providing EIDT (n=20) in five facilities, in April 2013.
Results. (1) Reliance on the health passport to identify HEIs is both barrier, as women may not attend appointments with their passports, and facilitator, for documentation of HIV-exposure status. Use of trained health surveillance assistants in EIDT enhances cascade steps 1 and 2, but requires increased supervision. (2) Women struggle to accept their own HIV status, yet test results for an HEI is a motivator. Sensitisation through local leadership facilitates EIDT. (3) A reliable transport system is needed. (4) Maintaining appointments to report results to women motivates them. (5) Mothers were reluctant to give ART to young, apparently healthy infants.
Conclusion. Both women and healthcare workers are motivated by test results for HEIs. The inclusion of community education can improve all steps in the EIDT cascade, including information that HEIs need ART.
The prevalence of paediatric skin conditions at a dermatology clinic in KwaZulu-Natal Province over a 3-month period : researchSource: South African Journal of Child Health 10, pp 121 –125 (2016) http://dx.doi.org/10.7196/SAJCH.2016v106i7.985More Less
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.
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 : researchSource: South African Journal of Child Health 10, pp 126 –129 (2016) http://dx.doi.org/10.7196/SAJCH.2016v106i7.1049More Less
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.
Risk profiles of infants ≤32 weeks' gestational age with oropharyngeal and oesophageal dysphagia in neonatal care : researchSource: South African Journal of Child Health 10, pp 130 –133 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1051More Less
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 impact of a change in referral pathway on a paediatric short-stay ward in Cape Town, South Africa : researchSource: South African Journal of Child Health 10, pp 134 –138 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1054More Less
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.
Infant hearing screening at primary healthcare immunisation clinics in South Africa : the current status : researchSource: South African Journal of Child Health 10, pp 139 –143 (2016) http://dx.doi.org/10.7196/SAJCH.2016.v10i2.1114More Less
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.