South African Journal of Child Health - Volume 4, Issue 1, 2010
Volume 4, Issue 1, 2010
Author Nonhlanhla P. KhumaloSource: South African Journal of Child Health 4 (2010)More Less
The South African Journal of Child Health is starting its fourth year of existence this year. The first three years were eventful and full of the usual surprises - and scary moments - of early childhood. Starting a new journal in the current plethora of both print and digital medical journals is certainly intimidating, but SAJCH has achieved significant milestones. We now have an established peer-reviewed medical journal in the field of paediatrics and child health - the first in South Africa. In addition, the journal is attracting both submissions and readers from beyond this country and even beyond the continent. Up to 25% of published articles are from authors working outside South Africa!
Author D.F. WittenbergSource: South African Journal of Child Health 4, pp 3 –4 (2010)More Less
After the large-scale introduction of oral rehydration therapy (ORT) in the early 1980s, it was hoped that we now had a simple, cost-effective management strategy that was implementable in primary care as well as at home and that would also solve the forbidding mortality rate from childhood diarrhoea in the developing world. This was premised on the fact that severe acute diarrhoea causes dehydration that can kill unless adequately managed, and the demonstration that providing extra water with sugar and salt can prevent and treat dehydration. ORT was therefore strongly promoted, and occasionally it was forgotten that oral rehydration solution (ORS) treats the water and electrolyte loss but not the diarrhoea, and that ORT certainly does not lessen the predisposition to and incidence of diarrhoea.
Author Sebastian Van AsSource: South African Journal of Child Health 4, pp 5 –6 (2010)More Less
Evaluation of the Integrated Management of Childhood Illness strategy implementation in Bulawayo City, Zimbabwe, 2006Source: South African Journal of Child Health 4, pp 7 –10 (2010)More Less
Introduction. Bulawayo City reported an age-specific death rate for under-5s of 5.9/1 000 in 2004, and this figure rose to 6.8/1 000 in 2005. Nurses were trained in implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 2005. We evaluated the programme in order to establish the level of implementation and the quality of care given to children aged under 5 years.
Methods. We conducted a cross-sectional study on a population of sick children aged between 2 months and 5 years, health care workers and caregivers. Data were collected using a structured observation checklist of the case management of sick children, exit interviews with caregivers, and a structured inventory checklist for equipment, drugs and supplies at each health facility.
Results. Nine facilities, 17 nurses and 72 children were observed during the study. Seventeen children (24%) were assessed for the three general danger signs (failure to drink or breastfeed, vomiting everything ingested, and convulsions), 31 (43%) were correctly prescribed an oral antibiotic, and 11% received the first dose of treatment at the health facility. Thirty-two per cent of caregivers who received a prescription for an oral medication were able to report correctly how to give the treatment. Drugs were below minimum stock levels in all 9 facilities. Only 19 (20%) of the 94 nurses were trained in IMCI.
Conclusion. IMCI implementation in Bulawayo failed to meet the accepted standard protocol requirements. The main deficiencies noted were the low number of IMCI-trained health workers and the lack of availability of essential drugs at health facilities. However, it was noteworthy that only two case assessment parameters differed statistically between IMCI-trained and non-trained nurses. Larger studies are needed to confirm or refute these findings.
Evaluation of sexual maturity among adolescent male sickle cell anaemia patients : the usefulness of testicular volume estimationSource: South African Journal of Child Health 4, pp 11 –15 (2010)More Less
Background. The use of Tanner stages (i.e. sexual maturity rating (SMR)) in evaluating sexual maturity has gained widespread acceptance. Tanner staging assesses pubic hair growth and increase in genital size, the latter factor being best reflected by increase in testicle size. Testicular volume increases are thought to be the most sensitive clinical indication of onset and progress of puberty. It has been suggested that the initial stage of sexual development may be missed if testicular volume is not assessed. We explored the usefulness of testicular volume (TV) for assessing sexual maturity among adolescent male sickle cell anaemia (SCA) patients.
Methods. We conducted a cross-sectional case-control study evaluating sexual maturation of male patients with sickle cell anaemia and those with the HbAA genotype. Tanner staging and testicular volume assessment were both used as models for evaluating stages of sexual maturation among SCA patients and their normal counterparts matched for age and socioeconomic status.
Results. SCA patients showed delayed onset and completion of sexual maturation. TV of subjects was smaller than those of controls but, when related to stages of sexual maturity, there was no statistically significant difference between the groups. The correlation coefficients between various stages of sexual maturity and TV suggest strong associations.
Conclusion. The increase in testicular volume was found to be a good predictor of onset and progression of sexual maturity in both SCA subjects and their healthy controls.
Author Wilson E. SadohSource: South African Journal of Child Health 4, pp 16 –19 (2010)More Less
Introduction. Ventricular septal defect (VSD) is a common congenital heart disease (CHD). Spontaneous closure of the VSD may occur, depending on the type and size of defects. This study was conducted to determine the natural history of VSD in a group of Nigerian children.
Subjects and methods. Sixty-one children diagnosed with VSD were prospectively studied at a tertiary centre in Nigeria until they were 2 years old. They had regular two-dimensional (2D) and Doppler echocardiography evaluations for the VSD size and closure.
Results. Most (35 - 57.4%) of the patients were female, their mean age at presentation was 11.2±5.2 months, and the most common type of VSD was the perimembranous (39 - 63.9%). Almost half (28 - 45.9%) of the patients had spontaneous closure. The spontaneous closure rate was highest in muscular VSD (82.4%) and in small defects (95.0%). Incidental presence of a murmur, absence of heart failure and bronchopneumonia were good clinical predictors of closure. Only 3 (4.9%) patients had surgery abroad. There were 2 (3.3%) deaths from bronchopneumonia and bacterial endocarditis.
Conclusion. Spontaneous closure readily occurs in small-sized defects and muscular VSDs. However, most patients withmoderate to large VSDs are confined to long-term medical management, highlighting the need for indigenous surgical capacityin Nigeria.
Source: South African Journal of Child Health 4, pp 20 –21 (2010)More Less
Thymolipomas are rare benign tumours, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumours may run an indolent, asymptomatic course, often achieving massive dimensions before presentation. Once symptomatic, respiratory symptoms predominate. Diagnosis should be confirmed radiologically during the pre-operative work-up, with pathognomonic features demonstrated on both computed tomography (CT) scan and magnetic resonance imaging (MRI). Open surgical resection remains the treatment of choice for lesions of a significant size, and sternotomy is well tolerated in the paediatric population.
Prolapse of the small intestine through the peritoneal opening - an unusual cause of post-shunt intestinal obstruction : case reportSource: South African Journal of Child Health 4, pp 22 –23 (2010)More Less
Ventriculoperitoneal (VP) shunt is the most widely used procedure for the management of hydrocephalus. Various complications, including disconnection, breaking, kinking and tip occlusion of the tube, cerebrospinal fluid loculation, shunt infection, intestinal obstruction, migration of the shunt and perforation of the internal organs, have been described with this invasive procedure. We report a case in which bowel prolapsed through the peritoneal opening and caused intestinal obstruction in a female baby.
Author Andrew RedfernSource: South African Journal of Child Health 4 (2010)More Less
The latest edition of Coovadia's Paediatrics and Child Health now includes his name in the title, testimony to his involvement in the book since the first edition was published 25 years ago. This 6th edition improves on an already excellent book. It is similar in length and format to the previous edition, but subtle design changes such as more prominent headings make the layout of chapters easier to follow, and highlighted text boxes stress important points or core information.