South African Journal of Child Health - Volume 5, Issue 2, 2011
Volume 5, Issue 2, 2011
Author D.F. WittenbergSource: South African Journal of Child Health 5 (2011)More Less
The 'Hot Topic' article in this issue originates from the latest 'Saving Children' Report, published in May 2011. It summarises some of the important findings of the Child Healthcare Problem Identification Programme (PIP), which was developed for the Medical Research Council's Unit for Maternal and Infant Health Care Strategies. In this programme, careful auditing of each child death allows conclusions to be drawn about quality of care and possible modifiable factors in that death. From a small beginning at a few hospitals, Child PIP has been gathering momentum and is now being implemented at nearly a third of all public hospitals in South Africa. The full report and more detail is available on-line at www.childpip.org.za, and is an important resource.
Source: South African Journal of Child Health 5, pp 28 –32 (2011)More Less
The Child Healthcare Problem Identification Programme (Child PIP) has contributed to both improving knowledge regarding child deaths and efforts to reduce these deaths since its introduction in 2004. Child PIP is a voluntary mortality audit process designed to ascertain the quality of care children receive in the South African health system. It provides structure and tools for conducting mortality reviews or audits of in-hospital deaths of children by :
- ensuring that all deaths are identified
- determining the social, nutritional and HIV context of each child who dies
- assigning a cause to each death
- determining modifiable factors that identify instances where failure to meet specific standards of care have, or may have, contributed to the child's death.
Ambient solar UV radiation and seasonal trends in potential sunburn risk among schoolchildren in South AfricaSource: South African Journal of Child Health 5, pp 33 –38 (2011)More Less
Background. The detrimental effects of excess personal solar ultraviolet (UV) radiation exposure include sunburn, immunosuppression and skin cancer. In South Africa, individuals with minimum natural protection from melanin, including fair-skinned individuals and African albinos, and people spending extended unprotected periods outdoors are at risk of sunburn, a risk factor for skin cancer. Sunburn becomes increasingly likely during the high solar UV radiation hours around midday, and previous studies have shown that children are exposed to potentially high, sunburn-causing solar UV radiation levels while at school.
Method. To estimate national potential child sunburn risk patterns, monitored ambient solar UV radiation levels at six sites in South Africa were converted into possible schoolchild solar UV radiation exposures by calculating the theoretical child exposure to 5% of the total daily ambient solar UV radiation as derived from personal child exposure studies.
Results. Schoolgoing children with skin types I, II and III were identified as being at greatest risk of sunburn. There were 44 and 99 days in a year when schoolchildren with skin type III (moderately sensitive) living in Durban and De Aar, respectively, would be likely to experience sunburn. Schoolchildren with skin type I (extremely sensitive) were at risk of experiencing sunburn on 166 days in De Aar, and those with skin types I and II were at risk on at least 1 day per year at all six locations.
Conclusion. Seasonal patterns show that schoolchildren with sensitive skin types may experience sunburn in spring, summer and autumn months. Differences in child sunburn risk were evident, mainly due to latitude and atmospheric aerosols. Additional factors affecting sunburn risk include schoolchildren's use of sun protection, sun-exposed activity, and timing and duration of exposure. Understanding risk patterns and obtaining locally relevant information will assist South African skin cancer prevention and sun protection awareness campaigns.
Prevalence of the molecular marker of chloroquine resistance (pfcrt 76) in Nigeria 5 years after withdrawal of the drug as first-line antimalarial : a cross-sectional studySource: South African Journal of Child Health 5, pp 39 –42 (2011)More Less
Background. In line with the World Health Organization (WHO) guideline on chloroquine (CQ) resistance, CQ was withdrawn as the first-line antimalarial drug in Nigeria in 2005 as a result of widespread resistance. It was expected that its sensitivity and clinical usefulness would be restored with time. This study therefore aimed to determine the level of CQ resistance in Nigerian children aged less than 60 months.
Methods. We monitored the resistance pattern 5 years after withdrawal of CQ, using the pfcrt K76T mutation as a molecular marker for CQ resistance.
Results. Of 98 Plasmodium falciparum-positive blood samples, 95 (96.9%) showed the K76T mutation. Twenty-seven (27.6%) of the children had been treated with CQ at home before presentation at the clinic, while 50 (51.0%) had taken other antimalarials.
Conclusion. Our results indicate that there is an urgent need to re-evaluate antimalarial drug policy in Nigeria, especially when 27.6% of our study population still use CQ at home despite its withdrawal as first-line antimalarial. This may require effective legislation against the manufacture, importation and use of CQ in Nigeria, if the purpose behind its withdrawal is to be achieved.
Source: South African Journal of Child Health 5, pp 43 –47 (2011)More Less
Background. Most child deaths from motor vehicle accidents (MVAs) occur in low- and middle-income countries. Effective measures to protect children involved in MVAs include wearing age-appropriate child restraints and being seated in the rear of the vehicle.
Methods. A descriptive study was used to assess use of child restraints, seating positions of children, driver restraint and vehicle overloading in Bloemfontein in 2007. Two pairs of observers stood at selected sites recording these findings. The study was done over a period of 1 month.
Results. A total of 512 children in 374 vehicles were assessed. Just over a third of the children were seated on the front seat of the vehicle, and 14.1% were seated on other people's laps (73.6% of these were on the front seat). Restraints were used by 8.8% of children and 17.4% of drivers; 10 times more children used restraints if the driver was restrained versus not restrained. Between 9.3% and 20.4% of vehicles were assessed as being overloaded with passengers.
Conclusion. The safety of child passengers in Bloemfontein in the event of an MVA is threatened by poor adherence to basic safety measures. Enforcement of correct seating position and use of child restraints will prevent unnecessary deaths, disabilities and suffering of child passengers injured in the event of an MVA. Driver motivation and responsibility is important in achieving safer seating of children in motor vehicles.
Childhood motorcycle-related injuries in a Nigerian city - prevalence, spectrum and strategies for control : short reportSource: South African Journal of Child Health 5, pp 48 –50 (2011)More Less
The use of motorcycles is becoming increasingly popular in Nigeria because of poor public and private transportation systems. Motorcycle crashes account for a disproportionate share of the deaths and disabilities that result from road traffic accidents.
We undertook a prospective descriptive study of all children aged 15 years or under with motorcycle-related injuries (MCRIs) who presented at the emergency room of the University of Ilorin Teaching Hospital over a period of 3 years. Children with ophthalmic injuries and those who died before reaching the hospital were excluded. Over the study period, 40 of a total of 440 patients admitted with MCRIs were children (9.0%). Twenty-seven children (67.5%) were injured as pedestrians, 11 (27.5%) as passengers and 2 (5%, young adolescents) as riders. One 3-year-old child was admitted to the intensive care unit with severe head injury and died.
Prevention of MCRIs in children should be a priority in our setting. Public campaigns should clearly highlight the risk of injury to this age group, and poor safety practices with regard to children should be specifically targeted. With the motorcycle gaining popularity as a mode of transportation in our cities and communities, the importance of teaching our youth about correct safety behaviour such as helmet use, and parents on the danger of letting their children cross roads alone, cannot be over-emphasised.
Spinal cord disease in children with malignancies : clinical cases and literature review : case reportSource: South African Journal of Child Health 5, pp 51 –54 (2011)More Less
Spinal cord disease in children with known or suspected malignancy is an oncological emergency because it commonly implies malignant spinal cord compression (SCC). Since the outcome of SCC is primarily determined by the patient's neurological status at treatment initiation, the goal must be to establish the underlying diagnosis before development of irreversible spinal cord damage. A high index of suspicion is key to early diagnosis; it is therefore mandatory that all health care workers involved in the care of children should have a basic acquaintance with this potentially catastrophic condition. Four cases of children with malignancies and spinal cord pathology are presented. Current knowledge of this condition is reviewed.
Source: South African Journal of Child Health 5, pp 55 –57 (2011)More Less
Neuroenteric cysts are rare congenital anonalies, presenting in infancy or childhood. Only a few cases of posterior mediastinal neuroenteric cysts have been reported.
A 12-year-old girl presented to our hospital with a neglected mildly painful cyst in the posterior mediastinum and retroperitoneum. Magnetic resonance imaging revelealed scoliosis of the thoracic spine, hemivertebrae T6 - 7, and a large hyperintense (on T2-weighted images) cystic lesion in the posterior mediastinum. The lesion had no intraspinal communication, but extended into the abdomen between the liver and kidney. Despite the long history and spatial extent of the lesion, it was excised uneventfully through a right thoracotomy. Microscopy of the cyst wall revealed partially disrupted cuboidal epithelium, muscle fibres, inflammatory cells, and, bony and cartilaginous elements.
Enterogenous duplication cysts of foregut origin with vertebral anomalies are referred to as neuroenteric cysts. This is a probably only the second reported case of thoraco-abdominal neurogenic cyst originating in the posterior mediastinum.
Source: South African Journal of Child Health 5, pp 58 –59 (2011)More Less
Non-epileptic manifestations of neurocysticercosis (NCC) include intellectual deterioration, dementia and parkinsonian behaviour. We report on a child with NCC presenting with abnormal choreiform movement. The case report highlights an uncommon presentation of NCC, and also draws attention to an unusual cause of chorea in children from tropical regions.
Source: South African Journal of Child Health 5, pp 60 –62 (2011)More Less
Rhabdomyosarcoma (RMS) is a common neoplasm, representing 5 - 10% of malignant solid tumours in childhood, and is the commonest soft-tissue sarcoma in the paediatric age group. Even though the tumour usually arises from striated muscle, it frequently originates from sites devoid of striated muscle such as the urinary bladder, prostate gland and gallbladder.
We present an unusual case of a large intra-abdominal embryonal RMS which demonstrated a mesenteric cleft inferolaterally with feeding vessels entering the mass. This unique presentation of embryonal RMS proved to be a diagnostic challenge.