South African Journal of Child Health - Volume 6, Issue 2, 2012
Volume 6, Issue 2, 2012
Author D.F. WittenbergSource: South African Journal of Child Health 6 (2012)More Less
For a long time, health service planners have grappled with the vexed question of how to provide care of optimal quality for patients in the most cost-effective way. When the large majority of healthcare-seeking customers suffer from conditions that are easily managed without expensive drugs or equipment by personnel without high levels of training or skill, it seems not to be cost-effective to place the highest level of skill and resources at the gateway. Accordingly, in a primary care-based model, patient services at the entry point into the healthcare system are planned at a relatively low level of sophistication and cost.
Source: South African Journal of Child Health 6, pp 31 –37 (2012)More Less
A point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2008 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down / home care provision were deficient or inefficiently utilised.
Source: South African Journal of Child Health 6, pp 38 –45 (2012)More Less
In the past three decades, kangaroo mother care (KMC) has been established as a safe and effective method of infant care, with the potential for improving the survival of low-birth-weight newborns, especially in low- and middle-income countries. Despite many implementation, education and training efforts, some countries are finding it difficult to increase their coverage of KMC, and individual institutions still struggle to get KMC institutionalised in a sustainable way. In the past decade a better understanding has emerged on the health system pathways followed in the implementation of KMC.
The initiative reported in this paper started out with a review of education and training practices in the implementation of KMC across the world. This was discussed at an international workshop and further inputs were derived from individuals' experience, unpublished literature provided by colleagues, and published material. This report gives an overview of some of the key implementation and training issues identified by the group and recommendations emanating from the collaborative process.
A triangular change process that includes change agents and the choice of implementation and educational models is proposed. The different functions for change agents as drivers, trainers and implementers are discussed. The grassroots, policy and academic dimensions are presented as different pathways for initiating KMC. Educational models are developed locally and are determined by the context.
Education and training in KMC should be underpinned by the same basic understanding of the concept and should be accompanied by the creation of awareness, committed 'champions', multidisciplinary teamwork and continuous support from senior management. It should be based on the evidence produced by research, conducted according to current best practice in education, and locally appropriate and applicable.
Attitudes of mothers and staff towards treatment and possible outcomes of very low-birth-weight (VLBW) infants in BloemfonteinSource: South African Journal of Child Health 6, pp 46 –50 (2012)More Less
Objectives. In neonatal intensive care units (NICUs), difficult decisions about care and withdrawal of treatment sometimes have to be taken by parents and healthcare workers, especially when the infant will probably have a poor developmental outcome. Only one previous study conducted in South Africa investigated whether preferences in this regard differ between these groups. We aimed to acquire more information on the issue.
Design. A comparative cohort study comprising separate groups.
Setting. Neonatal units of Universitas Academic and Pelonomi Regional hospitals.
Subjects. Mothers of very low-birth-weight (VLBW) babies and children with multiple disabilities; paediatricians (including registrars) and nurses working in these units.
Outcome measures. The preferences for developmental outcomes were compared between four groups: nurses, paediatricians, mothers of VLBW infants, and mothers of babies with multiple disabilities. Different scenarios were illustrated, and questionnaires were used to obtain the opinions on active treatment for babies with a poor developmental outcome.
Results. When asked whether doctors should attempt to save premature babies, even with a more than 50% chance of being handicapped, 100% of mothers agreed, as opposed to 23% of paediatricians. Similar results were obtained when respondents were asked whether they would prefer to have a severely handicapped child rather than no children at all. Seventy per cent of mothers of VLBW babies indicated that parents are the most important stakeholders in NICU decision making.
Conclusions. Doctors may underestimate mothers' capacity to cope with handicapped children. The opinion and perspectives of mothers are therefore important factors in NICU decision making.
Source: South African Journal of Child Health 6, pp 51 –55 (2012)More Less
Introduction. HIV affects children both directly and indirectly, with evidence of increased infectious mortality and morbidity in the HIV-exposed but uninfected (HEU) infant. There is little published research on neurodevelopmental outcome of HEU infants in Africa. Following the introduction of successful prevention of mother-to-child transmission programmes, it has become important to determine whether differences exist between HEU infants and infants born to HIV-negative mothers in order to guide current management policies of this rapidly growing group of infants.
Objectives. To compare the developmental outcome of infants exposed to HIV in utero who remained uninfected (HEU) with that of infants unexposed to HIV in utero (HUU).
Methodology. This was a prospective, blinded, hospital-based study. Infants aged between 17 and 19 months were assessed on the Griffiths Mental Developmental Scales (GMDS). Birth history, previous hospitalisation, maternal and infant characteristics, antiretroviral exposure, anthropometric measurements and abnormal clinical findings were documented.
Results. Of the original 55 infants enrolled at 2 weeks of age, 37 (17 HEU and 20 HUU) underwent neurological and developmental assessment. There were no significant differences between the groups with regard to the GMDS general quotient or other subscales, apart from the Personal/social subscale, where the HEU group performed significantly more poorly than the HUU participants (p=0.026). This difference is probably a result of cultural differences between the groups, as 76% of HEU and only 15% of HUU participants were of Xhosa origin.
Discussion. There was no difference in neurodevelopmental outcome at 18 months between the HEU and HUU groups.
Author Elsa LubbeSource: South African Journal of Child Health 6, pp 56 –59 (2012)More Less
The differential diagnosis of child abuse or non-accidental injury is extensive and includes rare metabolic disorders. We report a case in which child abuse was wrongly diagnosed. Fortunately the correct diagnosis could be made in time to re-unite the child with his parents.
Author Shahida MoosaSource: South African Journal of Child Health 6, pp 60 –61 (2012)More Less
The Division of Human Genetics (National Health Laboratory Service and University of the Witwatersrand) recently hosted the second annual Achondroplasia Day in Johannesburg. Participation in the meeting increased from 4 families in 2011 to 17 families in 2012. The main aim of the meeting was to bring individuals with achondroplasia and their families together and to facilitate improved interaction between families and the healthcare professionals involved in their care. This short report briefly describes the events of the day, and the immense benefit such activities have for families with rare genetic conditions. Additionally, we provide an overview of the basic genetics of achondroplasia and specific health needs of affected individuals. It is hoped that other centres around South Africa will be inspired to organise similar events in their respective areas to benefit their patients.
Source: South African Journal of Child Health 6, pp 62 –63 (2012)More Less