South African Journal of Child Health - Volume 5, Issue 3, 2011
Volume 5, Issue 3, 2011
Author D.F. WittenbergSource: South African Journal of Child Health 5 (2011)More Less
As these lines are being written, sports-loving South Africans are following their national World Cup rugby team's performance with considerable enthusiasm and fervent hope. Our hope is that our dream of World Cup glory will be fulfilled despite realistic doubts and evident problems.
National health insurance and health system restructuring - does it offer anything to children? : hot topicsAuthor Haroon SaloojeeSource: South African Journal of Child Health 5, pp 67 –70 (2011)More Less
Source: South African Journal of Child Health 5, pp 72 –77 (2011)More Less
Objectives. Malnutrition among young children is a major health problem in post-apartheid South Africa. Despite implementation of numerous health and nutrition programmes, these extensive efforts to alleviate the situation have not been adequately reviewed.
Methods. We provide an overview of various aspects of the current nutritional health status of young children. The reviewed data are from the time period 1994 - 2010, and were collected from literature databases and official reports, as well as our own experience with field research in various urban and rural parts of the country.
Results. Both smaller province-based studies as well as three large nationwide surveys conclude that many young South African children have inadequate nutritional status. Rates of stunting, micronutrient deficiencies and hunger and food insecurity are all unacceptably high. Coexisting HIV / AIDS and tuberculosis add to this burden. A gradual transition to a westernised diet characterised by energy-dense food has led to a worrying increase in overweight and obesity.
Conclusion. A major challenge for the South African health authorities is still the fight against childhood undernutrition and hunger, which in turn are rooted in poverty and social inequalities. The double burden of disease adds to the scale and complexity of this challenge.
Source: South African Journal of Child Health 5, pp 78 –84 (2011)More Less
Objectives. To obtain knowledge on the burden of infestation with soil-transmitted helminths (STHs) in rural children from birth to age 2 years.
Methods. Household visits to enrolled children were made twice a week for 2 years, and stool samples were collected once a month. Stools were also collected during diarrhoeal episodes, and when STHs were identified, a single dose of pyrantel pamoate was administered to patients with diarrhoea. All stool samples were examined using the formalin-ether sedimentation technique.
Results. About 70% of the children had had STH infestation by 2 years, and approximately 80% of these had STH ova identified on more than one occasion. The mean age at first acquisition was 14 months (standard deviation (SD) 4 months, range 1 - 24 months). Microscopic examination revealed ova of Ascaris lumbricoides (9%), Trichuris trichiura (0.6%), hookworm (0.06%) and mixed infestation (0.4%). In 41 of the 178 children with STH infestation, its first identification was associated with episodes of diarrhoea. Following pyrantel pamoate deworming, 66% of subjects were re-infested after a mean interval of 90 days (SD 79 days).
Risk behaviours such as disposal of child faeces and defaecation by adult family members in open spaces and use of common source surface water for washing clothes and utensils were practised by 62%, 83% and 50% of the cohort families, respectively. Bivariate analysis shows that disposal of child faeces in a closed space resulted in a 35% reduction in helminth infestation (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.49 - 0.87), use of tube well water in a 48% reduction (OR 0.52, 95% CI 0.29 - 0.93, p<0.02) and breastfeeding in a 16% reduction (OR 0.84, 95% CI 0.64 - 1.10, p<0.2).
Mutivariable analysis adjusted with risk variables shows a 5.06 times higher odds of recognising STH infestation during an episode of diarrhoea (OR 5.06, 95% CI 3.8 - 6.69, p<0.0001).
Conclusion. Awareness building programmes and periodic deworming are crucial to prevent acquisition of, re-infestation with and spread of STH.
Indications, medical conditions and services related to gastrostomy placement in infants and children at a tertiary hospital in South AfricaSource: South African Journal of Child Health 5, pp 86 –89 (2011)More Less
Objectives. To describe South African infants and children requiring gastrostomies in a tertiary hospital, including the indications, medical conditions and health services, during a 5-year period (2005 - 2009).
Design. The research design was a retrospective descriptive survey of medical records.
Setting. A tertiary paediatric state hospital in South Africa.
Subjects. One hundred and forty-two patients between the ages of 0 and 17 years.
Results. Dysphagia (N=80, 56%), aspiration (N=70, 49%) and need for nutritional support (N=63, 44%) were the most common indicators for gastrostomy placement. Most participants (N=85, 75% of the subset of 114 with feeding and swallowing difficulties) presented with multiple medical conditions, and neurological impairment (N=94, 82%) and gastro-intestinal problems (N=96, 84%) were the most prominent. Services were required from a variety of health care professionals for a period ranging from 6 to 103 months (mean 18 months). The speech-language therapist was consulted most frequently before gastrostomy placement (85%), while the stoma sister (97%) and dietician (97%) were consulted after placement.
Conclusions. South African infants and children requiring gastrostomies frequently present with multiple medical conditions and dysphagia. These children are likely to benefit from extended services provided by a specialised team of health care professionals.
Inner ear malformations in siblings presenting with vestibular symptoms in early childhood : case reportSource: South African Journal of Child Health 5, pp 90 –92 (2011)More Less
Introduction. Although the association between inner ear abnormalities and progressive sensorineural hearing loss is well known, vestibular signs or loss of vestibular function in these patients are often unrecognised by medical practitioners.
Case report. We report on two siblings with identical inner ear malformations, with special reference to the vestibular symptoms they displayed, as well as the rapid decline in hearing they both experienced in early childhood. We provide a brief overview of the latest classification of these inner ear defects as well as a review of the literature pertaining to children with inner ear malformations presenting with vestibular symptoms.
Conclusion. Gross anatomical defects of the inner ear are present in approximately 20% of cases of congenital hearing loss. These defects may result in a rapidly progressive hearing loss. Any child presenting with vestibular symptoms should be referred for an audiological assessment.
Author Lizel G. LloydSource: South African Journal of Child Health 5, pp 94 –96 (2011)More Less
Birth trauma is well described in the neonatal literature, but intra-abdominal injuries occur infrequently and are often forgotten in the differential diagnosis of a hypovolaemic shocked infant with an abdominal mass. The symptoms of splenic rupture are nonspecific, creating a diagnostic dilemma for the clinician. As splenic rupture denotes a surgical emergency, increased awareness of this complication may decrease the delay in diagnosis, therefore increasing the infant's chances of survival. This applies not only to paediatricians but to every midwife, intern or medical officer who attends to deliveries and is involved with the care of the newborn.
Multidisciplinary management of paediatric dysphagia in government hospitals in Gauteng, South Africa : a pilot study : scientific letterSource: South African Journal of Child Health 5, pp 97 –98 (2011)More Less
A team approach allows for case co-ordination and gives a holistic view of the patient's difficulties and needs. Core team members for the investigation and management of paediatric dysphagia include paediatrician, dietician, occupational therapist (OT), nurse, social worker, physiotherapist (PT), speech therapist (ST) and caregiver.
Source: South African Journal of Child Health 5, pp 99 –103 (2011)More Less