South African Journal of Child Health - Volume 2, Issue 3, 2008
Volume 2, Issue 3, 2008
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 2 (2008)More Less
This issue of the South African Journal of Child Health (SAJCH) is characterised by variety. Variety is also typical of childhood ailments and captures our endeavour to serve the whole child health care community. The birth of a new baby is supposed to be an amazing and happy time, filled with wonderful warm emotions. If the new arrival has a deformity, the parents suddenly have to cope with major emotional turmoil. Coping is made more difficult in children with cleft lip / palate because of the difficulty in feeding with all its consequences. As health care providers attempting to help parents through this difficult time, we need mechanisms to evaluate what we do and how well we do it - in addition to assessing the effectiveness of the tools we use. The finding by Bellardie and Harris that the 'Cleft Lip and Palate Parent Information Leaflet' is such a tool may encourage its use in other centres. Similarly, the study by Ogunlesi and co-authors describes in their setting the profile of patients with cerebral palsy, another 'all too common' yet 'too little studied' condition. It is hoped that this study will encourage well-designed prospective studies that will not only identify disease determinants but make recommendations for prevention.
Source: South African Journal of Child Health 2, pp 94 –95 (2008)More Less
Pneumococcal disease caused by Streptococcus pneumoniae is a major cause of death, hospitalisation and morbidity in children in South Africa and Africa. Paediatric pneumococcal disease manifests most commonly as otitis media, pneumonia or meningitis. Otitis media is commonest, occurring approximately 10 times more frequently than pneumonia and 100 times more than meningitis. However, pneumonia or meningitis are severe forms of disease, responsible for a large proportion of childhood mortality and morbidity. S. pneumoniae is the most important bacterial cause of pneumonia in children, responsible for 1 - 4 million episodes of pneumonia in Africa annually.
Author Prakash JeenaSource: South African Journal of Child Health 2, pp 96 –101 (2008)More Less
Aspects of immunisation of the HIV-infected person that need to be considered include safety, efficacy with or without highly active antiretroviral therapy (HAART), convenience and relevance to public health. Live attenuated vaccines have been associated with an increased risk of disseminated disease, while killed and subunit vaccines have been shown to be safe. HIV-infected individuals have suboptimal immunological responses to primary vaccination, including memory and protection, and a faster rate of immunological decline of primary vaccine responses. Despite this, there is clear evidence to support vaccination of these individuals as they have a high burden of vaccine-preventable diseases. Immunisation schedules should be universal for all children. Surveillance and monitoring of the vaccinated HIV-infected individual are essential to evaluate responses to and risks associated with vaccination. HAART has a positive effect on rates of response to vaccination.
Source: South African Journal of Child Health 2, pp 102 –106 (2008)More Less
Background. Low measles vaccine coverage has been a characteristic of child health indices in Uganda. A countrywide mass measles vaccination of children from 6 months to 15 years old was undertaken in October 2003 and again in October 2006.
Objective. To describe the effect of mass measles vaccination on the number of measles cases admitted to Mulago Hospital, Kampala, Uganda.
Methods. The study involved a review of documents including ward admission books, patients' case notes, discharge summaries, measles surveillance records, and laboratory reports. Measles cases admitted during the study period were identified by using the World Health Organization (WHO) clinical case definition of measles during epidemic times but, during non-epidemic periods, the case definition had to be supported by positive testing for measles antibodies. The number of measles cases admitted before and after each mass vaccination was documented.
Results. Prior to mass measles campaigns, the mean number of measles cases admitted to Mulago Hospital was 120 per month. Seventy-three per cent of the patients were between 9 and 60 months of age. Two weeks after a campaign, the number of measles cases started falling. Four months after each of the mass campaigns, only a few mild measles cases presented; and, for 2 years subsequently, there were no cases severe enough to warrant hospital admission. The number of measles deaths dropped by 54% and 62%, after the first and second mass immunisations, respectively.
Conclusion. Mass measles vaccinations appear to significantly reduce the number of measles cases admitted to Mulago Hospital. However, the retrospective nature of the study and the lack of serological confirmation of the diagnosis of measles might have introduced bias. The results need confirmation by means of prospective studies.
Neurological and neurocognitive function of HIV-infected children commenced on antiretroviral therapySource: South African Journal of Child Health 2, pp 108 –113 (2008)More Less
Aim : To describe neurological and neurocognitive deficits in HIV-infected children and the short-term effect of highly active antiretroviral therapy (HAART) on the observed deficits.
Methods : In this prospective study, 39 children (15 females) were evaluated before the start of HAART and 30 reassessed 6 months later. The subjects were evaluated with a range of cognitive tests used in everyday clinical practice.
Results : At enrolment, the mean (±SD) age was 60±46 months, 17 (44%) and 22 (56%) had Centers for Disease Control (CDC) clinical category B and C disease respectively, and 36 (92%) had severe immunosuppression. At the start of HAART no child had cranial nerve or cerebellar dysfunction, but 13/29 (33.3%) had evidence of motor dysfunction. By 6 months 1 child had developed cerebellar dysfunction, but there was no statistically significant change in the frequency of motor dysfunction. Mean baseline performances on cognitive testing were generally subnormal. Between 33% and 81% of the children recorded subnormal intelligence quotients on various cognitive tests. Mean performances did not change significantly after 6 months of HAART.
Conclusion : Neurological and neurocognitive deficits are frequent in HIV-infected children. The prevalence and extent of deficits did not change significantly in response to short-term HAART, indicating neither spontaneous improvement nor deterioration during early treatment.
Psychosocial and economic determinants of infant feeding intent by pregnant HIV-infected women in Tshwane / PretoriaSource: South African Journal of Child Health 2, pp 114 –118 (2008)More Less
Objectives. To determine the extent to which stigma, disclosure, coping and socio-economic factors would affect infant feeding choices made antenatally by pregnant HIV-positive women after the routine prevention of mother-to-child transmission counselling process.
Patients and methods. The antenatal feeding choices and determinants of these choices of HIV-infected women were studied at four antenatal clinics in two Tshwane townships, between June 2003 and December 2005.
Results. Seventy-four per cent of the 293 study participants intended to formula feed their babies, while 26% planned to breastfeed or mixed feed. The women who intended to breastfeed had lower active coping ability (adjusted odds ratio (AOR) 0.88, 95% confidence interval (CI) 0.82 - 0.94), were less likely to have disclosed their status to partners or husbands (AOR 0.54, 95% CI 0.30 - 0.99), were twice as likely to be married (AOR 2.06, 95% CI 1.03 - 4.12) and were twice as knowledgeable about HIV transmission through breastfeeding (AOR 2.11, 95% CI 1.14 - 3.90).
Conclusion. Counselling on infant feeding choices among HIV-infected women should be sensitive to the numerous internal and external factors that influence the decision. The support that HIV-infected women need in making their infant feeding decisions will entail psychosocial, community-wide interventions, and frequent counselling sessions to assist them in coping with and disclosing their status.
Source: South African Journal of Child Health 2, pp 120 –124 (2008)More Less
Background. Cerebral palsy (CP) is a common neurological disorder of childhood with significant implications.
Objective. To determine the socio-clinical characteristics of children with CP at a paediatric neurology clinic in Sagamu, Nigeria.
Methods. Hospital records of 92 children attending the clinic between 2000 and 2006 were reviewed. Demographic data were extracted and a validated socio-economic classification of parents was used.
Results. The majority of babies had been delivered by primary health workers and traditional birth attendants. The prevalence of CP at the paediatric neurology clinic was 50.3%. Most subjects were aged 1 - 3 years (77.2%), were malnourished (80.4%) and belonged to the lower socio-economic groups (70.6%). The clinical types of CP were spastic (80.4%), hypotonic (12.0%), extrapyramidal (4.3%) and mixed (3.3%). Quadriplegia was the commonest type of spastic CP (66.2%). Asphyxia (57.6%), kernicterus (36.9%) and CNS infections (21.7%) were the leading identified causes. Co-morbidities such as seizures, microcephaly and speech and auditory deficits were present in 90.2% of the subjects. Seizures and microcephaly were commoner among CP cases associated with asphyxia than those associated with kernicterus (p = 0.026 and p = 0.005, respectively).
Limitations. The rarity of prenatal causes of CP in this study may reflect our inability to investigate high-risk pregnancies adequately, particularly for intra-uterine infections. This also emphasises the inability of retrospective studies to adequately identify risk factors.
Conclusion. Most patients with CP in this study were of low socio-economic status and had had perinatal problems. Improved perinatal care may reduce the burden of CP. Continuing training of health workers and traditional birth attendants is essential. It is hoped that this study will stimulate well-designed prospective studies.
Source: South African Journal of Child Health 2, pp 125 –128 (2008)More Less
Objectives. This study was undertaken to ascertain information about parents' attitudes to the Cleft Lip and Palate Parent Information Leaflet (PIL) used at Red Cross War Memorial Children's Hospital, Cape Town, and to assess the readability of the English version of this PIL.
Design. A descriptive study for the PIL combined with a questionnaire for parents of children born 5 months - 16 years previously.
Subjects. Participants were 36 parents of children with cleft lip and / or palate (CLP) who attended appointments at Red Cross Hospital. They had been given the PIL, and were telephoned 2 weeks later and asked 15 questions.
Outcome measures. The reading statistics, design elements, grading and readability of the PIL were assessed. Parental experiences were recorded on the questionnaire.
Results. The PIL is well designed and easy to read. Most parents were informed of their children's clefts at birth by a physician, gynaecologist or nurse, but felt that health professionals' knowledge of CLP was lacking. Inadequate information about feeding was common.
Conclusions. The Cleft Lip and Palate PIL can be read and understood by the average 14-year-old. There is parental dissatisfaction with aspects of CLP care, and the PIL is useful to improve parents' understanding of this condition.
Source: South African Journal of Child Health 2, pp 130 –131 (2008)More Less
We present the case of an 11-year-old boy with an elongated neck and chest. Both the cervical and the thoracic spine carried one supernumerary vertebra. This was accompanied by symmetrical polythelia (i.e.additional nipples). To our knowledge this is first publication of a case presenting with this collection of features.
Source: South African Journal of Child Health 2, pp 132 –133 (2008)More Less
Varicella is a common, contagious infection caused by herpes-virus 3. It is usually benign but rarely can be associated with potentially serious complications, requiring hospitalisation.
In a study conducted in Spain, 64 (5.4%) of 1 177 children attending the emergency room with varicella required admission for complications. The median age was 3.2 years. The most common complications were skin / soft-tissue infections (33 patients) and the most common organisms were Streptococcus pyogenes (N = 13) and Staphylococcus aureus (N = 10). Other complications were pneumonia and neurological, haematological and osteoarticular disorders. One patient died of multi-organ failure.
A case report on a child with ulcerative chickenpox, a serious cutaneous complication, is presented.
Source: South African Journal of Child Health 2, pp 134 –135 (2008)More Less
A healthy 5½-year-old child was assessed together with her parents for an immigration medical. A thorough clinical examination was done and the child's height and weight were plotted on growth charts. All findings were unremarkable. As part of the medical a urine dipstick test was routinely performed.