South African Journal of Child Health - Volume 5, Issue 1, 2011
Volume 5, Issue 1, 2011
Author D.F. WittenbergSource: South African Journal of Child Health 5 (2011)More Less
In tertiary education, students are exhorted to become lifelong learners so as to be able to adapt and function successfully in an ever-changing environment. It stands to reason that the script for lifelong learning must also change continually in line with developments in knowledge or technology and changes in interpretation and focus.
Author Anthony T. WestwoodSource: South African Journal of Child Health 5, pp 3 –4 (2011)More Less
Acute gastro-enteritis (AGE) is a leading post-neonatal cause of death among South Africa's children. Almost all these deaths are caused by the consequences of dehydration. Many of these deaths occur in hospitals. AGE is also a significant nutritional insult at a critical time of growth.
Source: South African Journal of Child Health 5, pp 5 –6 (2011)More Less
To the Editor: Dehydration due to diarrhoeal disease is one of the major contributors to mortality in early childhood. In South Africa it contributes significantly to in-hospital mortality, often within the first 24 hours of admission. Rehydrating a dehydrated child over 4 - 6 hours (rapid rehydration (RR)) is widely recommended, as it has resulted in earlier discharge and is considered safe. Where oral rehydration cannot be used, nasogastric (NG) rehydration has been shown to be at least as effective as intravenous (IV) rehydration and is probably safer.
Author Chris Rainier-PopeSource: South African Journal of Child Health 5 (2011)More Less
To the Editor: It was with interest I read the article on the DRESS syndrome in the December issue of SAJCH. The toxicology of Spirostachys africana is well recognised. Commonly known as tamboti, it produces copious milky latex which was apparently used in the treatment of the patient.
HIV co-infection with hepatitis B and C viruses among Nigerian children in an antiretroviral treatment programmeSource: South African Journal of Child Health 5, pp 7 –10 (2011)More Less
Background. Nigeria has one of the world's largest burdens of children living with HIV and is highly endemic for hepatitis B. This study set out to determine the prevalence of hepatitis B and C infections among HIV-infected children and to identify the factors associated with these co-infections.
Method. We studied 155 HIV-infected children. Information on socio-demographics and history of exposure to risk factors such as scarification, blood transfusion, unsafe injections and circumcision were obtained. All the children were tested for the presence of hepatitis B surface antigen and antibodies to hepatitis C.
Result. The prevalence of HIV/HBV co-infection was 7.7%, while that of HIV/HCV co-infection was 5.2%. No child was co-infected with all three viruses. Children who were co-infected with HCV were more likely to be older than 5 years. There was no significant association between co-infection with either of the hepatitis viruses and socio-economic status, gender, number of persons living in the household, World Health Organization clinical stage, route of acquisition of HIV, scarification, blood transfusion, unsafe injection or circumcision.
Conclusion. The rate of HIV co-infection with hepatitis B and C in children is significant. HIV-infected children should be screened for these viruses. Those found to be negative and not immunised for hepatitis B should be immunised. Since the natural history of these co-infections in children is not known, it is imperative that affected patients be followed up adequately.
Ocular changes in multi-transfused children with β-thalassaemia receiving desferrioxamine : a case-control studySource: South African Journal of Child Health 5, pp 11 –14 (2011)More Less
Objectives. This study was planned to determine the prevalence of ocular abnormalities in multi-transfused children with β-thalassaemia receiving desferrioxamine and to determine the association of abnormalities with the patients' age, serum ferritin level, haemoglobin concentration, and dosage and duration of treatment with desferrioxamine.
Methods. Twenty-five thalassaemic children receiving desferrioxamine and attending the day-care centre of a tertiary care hospital in Delhi, India, and 25 healthy age-matched controls were examined to determine the prevalence and pattern of ocular abnormalities. A refraction test, the visual evoked response and fluorescein angiography were done where applicable. Ocular changes were correlated with serum ferritin levels, the dosage and duration of chelation with desferrioxamine, and pre-transfusion haemoglobin levels.
Results. None of the children reported any visual symptoms. The prevalence of ocular abnormalities in the thalassaemic group was 36% (9/25). Ocular changes seen included cataract (5/25), blurred optic disc margins (6/25) and dilatation and tortuosity of retinal vessels (2/25). The thalassaemic children had a significantly higher prevalence of cataract than the controls (p<0.05). Prevalence of cataract was associated with serum ferritin values above 4500 ng/ml (p<0.05), and blurring of disc margins was significantly associated with increased duration ((5 years) and frequency ((5 times/week) of desferrioxamine administration. A positive correlation was seen between the incidence of cataract and blurred disc margins.
Conclusions. Children with thalassaemia should be screened periodically for ocular abnormalities. Rational usage of desferrioxamine and use of newer chelating agents will reduce the prevalence of these abnormalities.
Source: South African Journal of Child Health 5, pp 15 –18 (2011)More Less
Background. Childhood injury is a major public health issue in many parts of the world, contributing significantly to paediatric morbidity and mortality. World Health Organization recently projected that with the current trends, trauma and infectious diseases will account for equal numbers of year of potential life lost worldwide by the year 2020.
Aim. This study aimed to investigate factors predictive of childhood injury mortality.
Design. A prospective hospital-based cross-sectional study.
Methods. All attendances and admissions to the Children's Emergency Room at the Wesley Guild Hospital, Ilesa, Osun State, Nigeria, over a period of 2 years (1 June 2007 - 30 May 2009) were serially documented and all patients with injury were recruited into the study. The socio-demographic variables, injury characteristics, Pediatric Trauma Score (PTS) and Glasgow Coma Score (GCS) were tested against outcome by binary logistic regression analysis.
Results. Five hundred and seventy-six children presented with injury during the study period with 22 deaths, giving an injury mortality rate of 3.8%. Logistic regression modelling found infancy (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.04 - 0.37), head injury (OR 2.51, 95% CI 0.10 - 0.61), low PTS (≤8) (OR 8.95, 95% CI 0.86 - 0.94) and low GCS (<9) (OR 5.22, 95% CI 0.40 - 0.69) to be significant independent predictors of childhood injury mortality.
Conclusion. Prompt identification of the above factors in children with injury may prevent many deaths.
Source: South African Journal of Child Health 5, pp 19 –20 (2011)More Less
The association between umbilical cord ulceration and congenital intestinal atresia is being increasingly reported and carries a high mortality. We report on a case of jejunal atresia associated with massive fetal haemorrhage from an umbilical cord ulcer. Fetal distress noted on continuous fetal heart monitoring allowed for delivery by emergency caesarean section followed by appropriate neonatal resuscitation and intact survival. This and other reported cases highlight the need for identification of high-risk fetuses with congenital intestinal atresia. Close fetal monitoring during labour is imperative in order to improve outcomes.
Source: South African Journal of Child Health 5, pp 21 –22 (2011)More Less
Naevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin syndrome, is an autosomal dominant syndrome of developmental anomalies associated with an increased risk of malignancies. Patients have multiple lesions, which may be subtle, and the diagnosis can easily be missed, leading to sub-optimal follow-up. Despite its infrequency clinicians may benefit from familiarity with the syndrome, as these patients are hypersensitive to radiation and prone to develop multiple malignancies. Patients can present to paediatricians, oncologists, maxillofacial surgeons, radiation oncologists and dermatologists, and it will be to the benefit of the patient with this syndrome for these specialists to have a working knowledge of this rare but fascinating disorder.
Source: South African Journal of Child Health 5 (2011)More Less
Reviewing this excellent pocket handbook for the practice of paediatrics was a bitter-sweet experience. The editor, Professor Cas Motala, passed away towards the end of last year, shortly after publication of the book. I was working with Cas on another project at the time and I know how delighted he was with this book. I want to pay tribute to Cas by mentioning that he was a busy doctor with a prolific output in activities relating to paediatrics. He was a highly respected allergist and busy paediatrician. Cas, my friend, I will miss you. We all will.