South African Journal of Child Health - Volume 3, Issue 2, 2009
Volume 3, Issue 2, 2009
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 3 (2009)More Less
This winter season has been associated with coughs and colds like any other. However, these symptoms are causing a lot more worry than usual. The pandemic caused by the H1N1 virus, otherwise known as swine flu, and the highly publicised deaths of infected patients have led to panic, with tour groups being quarantined and not allowed to enter countries and schools being closed down.
Author Heather J. ZarSource: South African Journal of Child Health 3, pp 35 –37 (2009)More Less
Influenza, caused by influenza A or B virus, produces a spectrum of disease ranging from mild to severe illness. Seasonal influenza is common; in South Africa, the influenza season usually lasts from April until August. The World Health Organization estimates that 3 - 5 million cases of seasonal influenza occur every year, with around 250 000 - 500 000 deaths. The annual attack rate in developed countries is estimated at between 10% and 20% of adults but is higher in children, with approximately 1 in 3 children infected annually. In South Africa, seasonal influenza is estimated to cause 6 000 - 10 000 deaths every winter.
Pandemic influenza occurs at regular periods when a circulating influenza strain or strains undergoes genetic reassortment or antigenic shift. This has recently occurred, leading to the current pandemic from influenza A H1N1 virus or swine flu. The causative virus, a novel influenza A H1N1 virus, seems to have originated in pigs; however, spread is predominantly between people. A pandemic has occurred because humans have little or no immunity to the new virus and it is easily transmitted from human to human.
Source: South African Journal of Child Health 3, pp 40 –43 (2009)More Less
Objectives. In view of the high rate of paediatric trauma in South Africa, we investigated how much attention - and of what nature - was given in printed media to these incidents, and to the broader subject of child safety.
Methods. Over 4 months, every article in the Cape Argus and Weekend Argus that pertained to either : (i) a traumatic incident involving at least one child under the age of 13; or (ii) other issues involving child safety, was collected. With each article, the number of columns and pictures published was recorded and used as a gauge of media attention. Traumatic incidents were categorised by cause, and the media attention dedicated to each of these was compared with actual admission figures to the Trauma Unit at the Red Cross War Memorial Children's Hospital, the only dedicated unit for children in Cape Town.
Results. Ninety-five articles met the inclusion criteria : 61 (64%) reported incidents involving paediatric trauma, 29 (31%) were related to child safety, and 5 (5%) covered both. Of the articles that reported specific incidents, non-accidental injuries were the most frequently published (68%), and of these sexual assault was by far the most written-about cause (52% of total incidents published). However, non-accidental injuries accounted for only 4% of total trauma admissions at Red Cross Hospital, behind almost every other cause of paediatric trauma including motor vehicle accidents (15% of admissions).
Conclusions. Media attention given to different causes of paediatric trauma is significantly skewed. From a prevention perspective, it would be more appropriate to give greater emphasis to motor vehicle accidents, in line with actual figures for paediatric trauma admissions.
Comparative study of different brands of stavudine capsules for the off-label 'opened capsule' dosing method recommended for HIV-infected infants and children in resource-limited settingsSource: South African Journal of Child Health 3, pp 44 –47 (2009)More Less
Introduction. If a caregiver does not have access to a refrigerator, the South African National Department of Health advises that stavudine adult capsule formulations be employed using the off-label 'opened capsule' dosing method. The accuracy of this dosing method has not previously been validated.
Aim. To assess the accuracy of the off-label opened capsule method for stavudine dosing in infants and children. In addition, we assessed the relative ease of dispersion of generic and original capsule preparations in water to determine which preparations, if any, are suitable for the off-label opened capsule dosing method.
Method. We evaluated 10 Zerit (Bristol-Myers Squibb), 5 Stavudine (Aspen), and 5 Stavir (Cipla) capsules. Each capsule was dispersed in 30 ml water, creating 20 separate solutions. Timed dispersion of each generic was compared with that of the original (Zerit). Each solution was then centrifuged to remove sediment, and the concentration of active drug (mg/ml) was analysed by high-performance liquid chromatography.
Results. The ease of dispersion of the contents of Aspen Stavudine capsules was equivalent to that of Zerit, and resulted in a mean recovery of active drug from solution of over 97%, confirming the accuracy of this dosing method. The contents of Stavir capsules, however, were extremely difficult to disperse in water despite prolonged agitation; consequently, the recovery of active drug from the solution was reduced.
Conclusion. The accuracy of the off-label opened capsule dosing method for stavudine is acceptable. There is no need to instruct caregivers to include sediment in the aliquot given to the infant. However, studies that confirm adequate bioavailability and efficacy are needed. In addition, it is important to avoid supplying generic capsules the contents of which do not disperse easily in water, as this may lead to a significant reduction in the amount of active drug that a child receives.
Early surfactant therapy and nasal continuous positive airways pressure for mild respiratory distress syndrome - a pilot studySource: South African Journal of Child Health 3, pp 48 –54 (2009)More Less
Objectives. To determine if the administration of porcine surfactant 100 mg/kg within 24 hours after birth, to infants with respiratory distress syndrome (RDS) receiving nasal continuous positive airways pressure (NCPAP) and inspired oxygen (FiO2) 0.3 - 0.4, decreased the need for mechanical ventilation (MV) during the first week of life compared with infants in whom the required FiO2 was allowed to rise above 0.4 before surfactant was administered.
Design and subjects. A study of 102 infants was planned, but terminated early due to slow recruitment, and is presented as pilot data. Twenty-seven preterm infants were randomised into either a low- or a high-threshold group. The low-threshold group received surfactant immediately and the high-threshold group received surfactant if their FiO2 rose above 0.4. Infants who received surfactant were returned to NCPAP if respiratory effort was adequate.
Setting. The Neonatal Intensive Care Unit, Groote Schuur Hospital, Cape Town.
Results. The mean gestational age for the entire cohort was 31±2 weeks. There were no significant differences between the groups with regard to the need for MV in the first week of life. However, the duration of any form of assisted ventilation (NCPAP and MV) was less in the low-threshold group (p=0.042), and this group had a lower mean PaCO2 at 24 hours (p=0.015).
Conclusions. In this pilot study, the administration of 100 mg/kg porcine surfactant to preterm infants with RDS requiring NCPAP at a threshold FiO2 of 0.3 - 0.4 improved alveolar ventilation and reduced the duration of any form of assisted ventilation compared with waiting until the FiO2 was >0.4. There was no significant reduction in the need for MV.
Source: South African Journal of Child Health 3, pp 55 –59 (2009)More Less
Aim. To describe the impact of HIV infection and tuberculosis on the workload of a general paediatric ward at Red Cross War Memorial Children's Hospital in 2007.
Methods. Prospective descriptive surveillance of the patient composition of a general paediatric ward over a 1-year period.
Results. Median bed occupancy was 96.4%, and 66.7% of all patients hospitalised to the ward were less than 12 months old. Of all the admitted children, 27.6% had HIV infection, and 16.7% had tuberculosis (TB). Dual HIV and TB infection was present in 10.3% of all patients. Of all the children requiring high care, 23.1% were HIV infected. Approximately 50% of all children with HIV infection were on antiretroviral therapy. The annualised nurse-to-patient ratios were 1 registered nurse per 2.7 patients, and 1 professional nurse per 5.0 high-care patients. Fifty-six children died while in hospital, of whom 34 (60.7%) were HIV infected. Pneumonia was the main cause of death in both HIV-infected and uninfected children.
Conclusion. Despite prevention of mother-to-child-transmission intervention and paediatric antiretroviral treatment programmes, HIV infection and TB contribute substantially to the general paediatric workload at the hospital. Work associated with specific nursing functions should be quantified so that patient / nurse ratios may be optimised.
Source: South African Journal of Child Health 3, pp 60 –63 (2009)More Less
Background. Urinalysis as a part of medical examination of fitness in schoolchildren is useful in detecting abnormalities that could identify early disease conditions.
Objective. To describe the urine examination findings in apparently healthy newly enrolled primary school entrants in Jos, Plateau.
Methods. Through a multistage stratified randomisation procedure, 650 apparently healthy pupils were selected to have a complete physical examination in the morning with mid-stream urine samples collection. The urine samples were examined for abnormalities using dipsticks.
Results. There were 301 boys and 349 girls (ratio 0.9:1). Their mean age was 6.6±1.3 years (range 5 - 12 years). Urinary abnormalities were present in 63 (9.6%) of the subjects, with most in the 6 - 8-year age group. Proteinuria was the most common abnormality, detected in 23 (3.5%), and next, urobilinogen in 12 (1.8%) subjects. The latter was significantly greater in male and private school subjects (p=0.03). Haematuria and nitrituria were present in 10 (1.5%) subjects, while 11 (1.7%) had bilirubinuria. Four (0.6%) subjects had ketones in their urine but none had glycosuria. Two pupils (0.2%) had both haematuria and proteinuria but no associated elevated blood pressure.
Conclusion. Urine abnormalities are not uncommon in new school entrants; this study underscores the importance of urine examination in children at the point of school entry.
Source: South African Journal of Child Health 3, pp 64 –67 (2009)More Less
Background. Children with nasal foreign bodies are commonly seen in everyday practice. The aim of this study was to document the pattern of foreign bodies in the nose, their treatment and outcome.
Methods. This was a prospective audit of all children seen in the ear, nose and throat clinic, accident and emergency unit and emergency paediatric unit at the University of Ilorin Teaching Hospital, Nigeria, from August 2005 to July 2006.
Results. Of a total of 173 patients with ear, nose and throat foreign bodies seen during the study period, 71 patients had foreign bodies in the nose. The male / female ratio was 1.5:1 and the mean age was 2.5 years (range 1 - 15 years), under-5s comprising 72% of the patients. The most common foreign bodies were grains and seeds (35%). Presentation was within 24 hours in 45% of cases, between 1 and 5 days in 27%, and longer in the rest. Of the patients 51% had inserted the foreign body into the nose themselves, and in 39% of cases this had happened at school. In most cases (68%) the foreign body had been inserted into the right nostril. Most children had an offensive nasal discharge (45%) or were asymptomatic (27%). Parents were the first to make the diagnosis in 63% of cases, and in 32% of cases removal had been attempted before presentation. Most of the foreign bodies (89%) were mechanically extracted with a Jobson-Horne probe. In 61% of cases removal was done by a senior registrar. General anaesthesia was needed in a minority of cases. Minimal epistaxis after removal occurred in 50.7%, and only 1 patient had septal perforation.
Conclusion. Nasal foreign bodies are still a challenge among under-5s. Public health education is needed to make parents and caregivers aware that it is hazardous for a child to insert a foreign body into the nose. Consistent with published guidelines, the majority of cases can be managed safely with direct extraction in the office setting. With adequate training, primary health care practitioners can manage most cases successfully and will know when to refer complicated ones.