South African Journal of Child Health - Volume 4, Issue 2, 2010
Volume 4, Issue 2, 2010
Author D.F. WittenbergSource: South African Journal of Child Health 4 (2010)More Less
With this edition the South African Journal of Child Health is entering a new stage of its development. To speak in paediatric terms, the founding editor, Professor Nonhlanhla Khumalo, mothered the new publication in its infancy in a most impressive way. Now that the baby is weaned Professor Khumalo has decided to move on, and has handed over stewardship of its further growth and development.
Author D.L. WoodsSource: South African Journal of Child Health 4, pp 28 –30 (2010)More Less
The Integrated Management of Childhood Illness (IMCI) project was presented by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) in 1996 as the principal strategy to improve child health, especially in poor communities. IMCI addresses the comprehensive health and development needs of children under the age of 5 years in an integrated way and concentrates on the accurate identification and management, in outpatient and home settings, of the medical conditions that most frequently cause morbidity and mortality. It also focuses on preventive measures, immunisation, good nutrition and health promotion by improving the performance of health workers and community care practices, as well as the provision of careful counselling of caregivers and appropriate referral of seriously ill children. Recently IMCI has been expanded to include the care of newborn and young infants and children infected with HIV. The IMCI philosophy has also been used in the Integrated Management of Adult and Adolescent Illness (IMAI) project.
Using community-based interventions to improve disease prevention practices of caregivers of under-5s in Ile-Ife, south-western NigeriaAuthor O.M. EbuehiSource: South African Journal of Child Health 4, pp 32 –36 (2010)More Less
Objectives. To compare caregivers' knowledge and practice of key disease prevention household and community practices in two local government areas (LGAs), in one of which Community-Integrated Management of Childhood Illness (C-IMCI) had been implemented.
Design. A cross-sectional design.
Setting. Osun State, Nigeria, between August and September 2007.
Subjects. Mothers or caregivers of children 0 - 59 months of age and their index children.
Results. The IMCI key disease prevention practices were generally better applied in the C-IMCI-compliant LGA than in the non-compliant LGA. Significant differences were observed in the proportion of caregivers who would wash their hands with soap after using the toilet (p=0.0445), after attending to a child who has passed stool (p=0.000), before feeding a child (p=0.000), before preparing food (p=0.000), and before eating (p=0.0385). More caregivers from the compliant than the non-compliant LGA had ever used a method to prevent malaria. More than a quarter of caregivers from the non-compliant LGA did not use any method to prevent malaria. More caregivers from the non-compliant LGA showed deficiencies in their knowledge base of HIV/AIDS infection. Knowledge was particularly poor with respect to mother-to-child transmission of HIV. Only 39% of caregivers from the non-compliant LGA believed that a child can be infected with HIV/AIDS.
Recorded incidence and management of dysphagia in an outpatient paediatric neurodevelopmental clinicAuthor Joanne BarrattSource: South African Journal of Child Health 4, pp 38 –41 (2010)More Less
In recent years there has been an increase in the number of children diagnosed with neurodevelopmental disorders. Dysphagia is believed to be a co-morbid condition in up to 90% of children with neurodevelopmental disorders, and is potentially life threatening.
Objectives. To describe the medical diagnoses of children attending a state outpatient neurodevelopmental clinic; to determine the involvement of allied health professionals in the management of children with neurodevelopmental impairments; and to compare the reported incidence of feeding difficulties with the number of referrals made for feeding assessments.
Setting. State hospital outpatient neurodevelopmental clinic in South Africa.
Subjects and methods. Retrospective audit of a systematic sample of 100 files from 1 472 patients aged 0 - 14 years attending the clinic between June 2008 and April 2009. Data were tabulated and analysed quantitatively using descriptive statistics.
Results. Diagnoses recorded in the files included developmental delay (32%), genetic syndrome (24%), cerebral palsy (19%), autism spectrum disorder (15%), learning disability (4%), microcephaly (1%), hydrocephalus (1%), dysmorphic features (1%), neuropathy (1%), traumatic brain injury (1%) and specific language impairment (1%). Of the sample 79% had been referred for at least one type of therapeutic intervention including speech and language therapy. Feeding difficulties were mentioned in only 29% of files, and less than half of these children (14% of the total sample) had been referred for a feeding assessment.
Conclusion. A minority of children with neurodevelopmental disorders and recorded feeding difficulties are referred for feeding assessments. This supports the suggestion of mandatory dysphagia screening in clinics and regular follow-up feeding assessments, as well as improved multidisciplinary teamwork.
Source: South African Journal of Child Health 4, pp 42 –45 (2010)More Less
Objectives. To describe blood pressure and its relationship to weight and height in healthy newly enrolled school entrants in Jos, Plateau State, Nigeria.
Methods. We measured the blood pressures of 650 healthy, randomly selected pupils after a complete physical examination at the start of school in the morning, using standard procedures.
Results. There were 301 male and 349 female children (male/female ratio 0.9:1). Their ages ranged from 5 to 12 years, with a mean of 6.6 (standard deviation (SD) 1.3) years. Mean systolic and diastolic blood pressures were 102.5 (SD 9.43) and 73.0 (SD 10.0) mmHg, respectively, and were significantly higher in private school pupils compared with public school pupils (97.1 (SD 9.17) and 70.1 (SD 9.65) mmHg, respectively, p<0.05). Blood pressure did not differ significantly between the genders. Mean systolic and diastolic blood pressures increased with age, weight and height in both genders. Anthropometric indices had a positive correlation with systolic and diastolic blood pressures (r=0.26 - 1.22, p<0.05). Two children (0.3%) had persistently elevated blood pressure.
Conclusion. Blood pressures were higher in private school pupils compared with public school pupils of the same age, while height and weight had a direct relationship to the systolic and diastolic blood pressures. Routine blood pressure monitoring of schoolchildren should be encouraged, starting at school entry to serve as a baseline assessment, with follow-up when indicated. In addition, blood pressure measurement should be a part of the routine clinical examination of children.
Author Olusegun J. AdebamiSource: South African Journal of Child Health 4, pp 46 –49 (2010)More Less
Objectives. A study to determine the pattern and outcome of neonatal seizures.
Design. A prospective descriptive study.
Setting. Special Care Baby Unit, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
Subjects. All newborn infants with observed seizures admitted between January 2006 and December 2008.
Results. Of 866 neonates admitted, 59 (6.8%) had seizures; of these 43 (72.9%) had been born outside our health facility (outborn). Babies with seizures had a higher birth weight than babies without seizures (p=0.008), and the incidence of seizures had a linear relationship increasing with the weights of the babies and inverse to their ages. Of the 59 babies with seizures, 37 (62.7%) were considered to have had birth asphyxia. Meningitis, hypoglycaemia, and hypocalcaemia occurred in 7 (11.9%), 6 (10.2%) and 2 (3.4%) of cases, respectively, and 7 (11.9%) had undiagnosed causes. Forty-two (71.2%) of the 59 babies had both subtle and generalised seizures. Twenty-seven babies with seizures died (45.8%) compared with 131 of 807 babies without seizures (16.2%, p=0.0001). Babies with seizures and asphyxia or who had been outborn had the highest risk of death (59.5% and 48.8%, respectively).
Recommendations. The major causes of neonatal seizures and death are potentially preventable. Comprehensive and vigorous efforts are needed to achieve safe delivery, prevent birth asphyxia and improve care and transport of sick neonates at the primary care level. In view of the high prevalence of seizures among severely asphyxiated neonates and those with meningitis, anticonvulsant chemoprophylaxis is recommended in these groups.
Thymic size at birth in preterm infants with severe respiratory distress syndrome can be used to predict the likelihood of survival : a retrospective cohort studySource: South African Journal of Child Health 4, pp 50 –53 (2010)More Less
Objective. To determine whether the thymic size in preterm infants with severe respiratory distress syndrome (RDS) can be used to predict survival. We also set out to determine which antenatal and postnatal factors have an influence on, or correlation with, thymic size.
Methods. A retrospective study was conducted on 55 consecutive preterm infants who were ventilated for RDS. A chest X-ray (CXR) was taken within the first 24 hours, and the cardiothymic/thoracic ratio (CT/T ratio) calculated. This ratio was then correlated with outcome, as well as antenatal maternal and postnatal factors.
Results. Of the 49 infants included in the study (6 were excluded), 15 died and 34 survived. There was a statistically significant correlation between the CT/T ratio and survival (p=0.029). In those infants above 1 030 g, the CT/T ratio was more significant (p=0.038) than birth weight in predicting survival. The severity of RDS did not influence the CT/T ratio. The only maternal and postnatal factors influencing CT/T ratio were the presence of pre-eclamptic toxaemia (PET) and birth by caesarean section (CS), but these factors did not influence likelihood of survival. Factors found to be not associated with thymic size were antenatal steroid administration, maternal HIV status, clinical chorio-amnionitis, gender, gestational age (small or appropriate weight) and lymphocyte count.
Conclusions. A small thymus measured in the first 24 hours can be used to predict likelihood of survival in infants weighing more than 1 030 g, but not in smaller infants. Prenatal stress associated with PET and indication for CS may cause the thymus to shrink.