South African Journal of Child Health - Volume 4, Issue 3, 2010
Volume 4, Issue 3, 2010
Author D.F. WittenbergSource: South African Journal of Child Health 4 (2010)More Less
For South Africans it has been a momentous year so far. After hectic preparations, the joyful noise of the vuvuzelas loudly proclaimed the achievements of the 'African' football World Cup, and the mood was one of national euphoria. We were in the limelight again. We had done what sceptics had doubted we could do. There was the hope and perhaps even a promise of a better life for all.
The new WHO recommendations on HIV and infant feeding - bridging the gap between training, learning and doing : hot topicsSource: South African Journal of Child Health 4, pp 62 –64 (2010)More Less
The new WHO recommendations on HIV and infant feeding - care for the mother, and in resource-limited settings let breastmilk care for the baby : hot topicsSource: South African Journal of Child Health 4, pp 66 –69 (2010)More Less
Until 2009 the role of breastmilk in feeding HIV-exposed infants was fraught with international and national controversy. The general benefits of breastmilk and breastfeeding were differentially weighted against the risk of HIV transmission through breastmilk, and this splintered HIV and child health policy makers, implementers and activists. Ramdhial and Coovadia summarise the seven Key Recommendations in Infant Feeding in the new World Health Organization guidelines and highlight the training implications of these guidelines. This paper discusses recent research findings that led to the development of these new guidelines and the implications of the guidelines for HIV-positive mothers, their infants and the South African prevention of mother-to-child transmission (PMTCT) programme.
Factors influencing choice of paediatrics as a career among medical students at the University of Nairobi, KenyaSource: South African Journal of Child Health 4, pp 70 –72 (2010)More Less
Objective. We aimed to determine factors influencing choice of a career in paediatrics by medical students in Kenya.
Methods. A cross-sectional survey of 450 medical students from the University of Nairobi, Kenya, was undertaken using a questionnaire designed to assess their preferences with regard to future specialisation, and timing of and factors influencing this choice. The data were analysed using the Statistical Package for Social Sciences.
Results. The response rate was 385/450 (85.6%). Paediatrics was the second most preferred specialty after surgery, and was chosen by 50 students (13.0%). Female students were five times more likely than males to select paediatrics. Choice of paediatrics as a career was mainly determined by perceived intellectual challenge, presence of a role model, and ease of combining a career with raising a family. Those who had completed a clerkship in the specialty reported that they were encouraged by the teaching and clinical staff (p=0.006), but found the specialty less prestigious than others (p=0.030). None of the male students but 12 of the female students (30%) considered gender distribution to be a factor influencing their career choice (p=0.046).
Conclusion. This study indicates that paediatrics is popular among female students and that several factors influence choice of this specialty. Understanding these factors may help medical school administrators and faculty plan future recruitment strategies.
Source: South African Journal of Child Health 4, pp 73 –77 (2010)More Less
Objective. To assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg, South Africa.
Design. Observational study conducted at 16 PHC clinics. A researcher-developed structured checklist, based on national guidelines and protocols, was utilised.
Results. The majority of facilities were adequately equipped and well stocked with drugs. A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean 135 (standard deviation 72) minutes). Many routine examination procedures were poorly performed, with an adequate diagnosis established in 108 of 141 consultations (77%), even though health professionals were experienced and well trained. Triage and attention to danger signs were poor. An antibiotic was prescribed in almost half (65/141) of the consultations, but antibiotic use was unwarranted in one-third of these cases. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. HIV status was seldom asked about or investigated, for the mother or for the child. Growth monitoring and nutritional counselling at well child visits was generally inadequate, with not one of 11 children who qualified for food supplementation receiving it.
Conclusion. The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers to address children's health needs meaningfully. A deliberate and radical restructuring of PHC for children, with clearly defined and monitored standard clinical practice routines and norms, is required to change the status quo.
Magnitude of and driving factors for female genital cutting in schoolgirls in Addis Ababa, Ethiopia : a cross-sectional studySource: South African Journal of Child Health 4, pp 78 –82 (2010)More Less
Background. Female genital cutting (FGC) is practised throughout the world, and is common in many Asian and African countries. Although FGC in Ethiopia has decreased, the practice is still very widespread.
Methods. A cross-sectional study design with an analytical component was used to study girls attending randomly sampled primary schools in Addis Ababa between August and June 2008. A total of 407 girls, selected from four primary schools, and their respective families were recruited. Data were collected through self-administered and open-ended questionnaires and analysed using bivariate and multivariate models.
Results. In this group of schoolgirls, 26.0% had undergone FGC at a median age of 4 years. FGC had most commonly been performed at age 1 - 5 years, when 50.9% of the total group had been circumcised. Of the girls attending government schools, 36.6% had undergone FGC. The majority of the procedures had been performed by traditional circumcisers (62.3%), followed by health workers (22.6%). The decision to subject the girl to FGC was most frequently made by mothers (38.7% of the FGC group), the remainder of the decisions being made by fathers (24.5%), both parents (22.6%) and relatives (14.2%). There was a significantly higher prevalence of FGC among girls attending government schools, girls of Guraghe ethnicity, and girls whose mothers had no knowledge about the harm of FGC. A smaller proportion of girls living with both parents than of those living with relatives had undergone FGC.
Conclusions. FGC is prevalent in primary schoolgirls in the capital city of Ethiopia, despite improved availability of health information. This situation underscores the need to reinforce the national law against FGC. Creation of awareness should be focused on parents of Guraghe ethnicity and on government schools. Parental education should be promoted, and empowerment of women is required to fight FGC.
Source: South African Journal of Child Health 4, pp 83 –87 (2010)More Less
Objective. To evaluate the usefulness of cranial ultrasound (CU) at a rural hospital in a developing country setting and to analyse how indications, results and therapeutic consequences differ from those in developed countries.
Methods. All CU scans performed over a 32-month period at Haydom Lutheran Hospital, Tanzania, were retrospectively analysed. The patients' presenting signs and symptoms were categorised into nine groups: 1. birth asphyxia; 2. congenital syndromes; 3. neural tube defects/spina bifida; 4. macrocephalus; 5. post-meningitis; 6. seizures; 7. developmental / neuromuscular abnormalities; 8. head trauma; and 9. miscellaneous. The information derived from the scans was then analysed with regard to underlying pathology and possible influence on the child's future management.
Results. 420 scans were performed in 293 patients, of whom 34 were older than 1 year. In 155 cases no abnormal result was obtained. When results of the abnormal scans were related to their impact on patient management, the pathological findings were found to have provided useful information in groups 1 (45%), 3 (100%), 4 (87%), 6 (57%), 6 (31%) and 7 (45%).
Conclusions. CU is a highly feasible technique even in resource-poor settings and provides valuable additional information in patients with neural tube defects/spina bifida, macrocephalus, post-meningitis, birth asphyxia, developmental/neuromuscular abnormalities and seizures.