South African Journal of Child Health - Volume 6, Issue 3, 2012
Volume 6, Issue 3, 2012
Author D.F. WittenbergSource: South African Journal of Child Health 6 (2012)More Less
In this issue's 'Hot Topics' contribution, Velaphi and Rhoda review the poor outcomes of South African neonatal care. They point out that South Africa, as one of only 8 countries globally, sadly finds itself in the company of African countries such as Cameroon, Chad, Congo and Zimbabwe in having shown no improvement in neonatal outcomes over the past 20 years, despite having arguably the most advanced economy on the continent.
Source: South African Journal of Child Health 6, pp 67 –71 (2012)More Less
In the year 2000, 189 member countries of the United Nations committed themselves to eight goals towards the development and well-being of their nations. These goals are called Millenium Development Goals (MDGs). The fourth goal (MDG4) aims to reduce the mortality rate in children under the age of 5 years (U5MR) by two thirds between 1990 and 2015. Infants less than 1 month old account for about 40% of deaths of children under the age of 5 years globally. Achieving MDG4 will therefore need to include reducing deaths during the neonatal period. The goal of reducing U5MR by two thirds for neonatal deaths in South Africa meant reducing the neonatal mortality rate (NMR) from 21/1 000 live births in 1998 to 7/1 000 by 2015. In order to achieve this, all neonatal deaths need to be scrutinsed by focusing on mortality rates and pathological and health system causes of neonatal deaths. Of paramount importance, however, would be looking at interventions that could impact significantly on reducing these deaths. In this article we discuss the mortality rates in South Africa, the rest of the world and Africa, and discuss causes and interventions that can be implemented to reduce these deaths in South Africa.
Incorrectly diagnosing children as HIV-infected : experiences from a large paediatric antiretroviral therapy site in South AfricaSource: South African Journal of Child Health 6, pp 72 –75 (2012)More Less
Objective. To assess the extent to which children may be falsely diagnosed as HIV-infected, using data from an antiretroviral therapy (ART) site in Pretoria, South Africa.
Methods. This was a retrospective patient record review of all ART-naïve children referred to Kalafong hospital's paediatric HIV clinic between April 2004 and March 2010, with detailed review of those found to be HIV-uninfected.
Results. There were 1 526 patient files analysed, with a male-to-female ratio of 1.01:1 and median age at first visit of 20 months (range 26 days - 17.5 years). Nearly half (n=715; 47%) of the children were aged <18 months. Fifty-one children were found to be HIV-uninfected after repeated diagnostic tests. Incorrect laboratory results for children aged <18 months included false-positive HIV DNA PCR tests (40), detectable HIV viral loads (4) and a false-positive HIV p24Ag test (1). One child above 18 months had false-positive HIV ELISA results. An additional 4 children were inappropriately referred after being incorrectly labelled as HIV-infected and 1 child aged <18 months was referred after an inappropriate diagnostic test for age was used. In summary, 1 in every 30 (3.3%) children was discharged HIV-uninfected, and below age 18 months, 1 in 16 children (6.3%) had false-positive HIV virological tests.
Conclusions. Urgency in ART initiation in HIV-infected children is life-saving, especially in infants. However, HIV tests may produce false-positive results leading to misdiagnosis of children as HIV-infected, which has serious consequences. Meticulous checking of HIV-positive status is of utmost importance before committing any child to lifelong ART.
Access to information technology and willingness to receive text message reminders for childhood immunisation among mothers attending a tertiary facility in Lagos, NigeriaSource: South African Journal of Child Health 6, pp 76 –80 (2012)More Less
Background. Effective communication is imperative for the delivery and receipt of adequate health care services.
Aim. To determine access to information technology and willingness to receive short message service (SMS) text message reminders for childhood immunisation services among mothers in Lagos, Nigeria.
Method. In this descriptive cross-sectional study, interviews using structured questionnaires were conducted with 399 mothers of children aged <5 years who brought their children to attend the immuno-prophylaxis and child welfare clinic of Lagos University Teaching Hospital during July and August 2011.
Results. The age of the respondents ranged from 16 to 51 years with a mean of 31.1±4.7 years. Almost all (98%) were current owners of mobile phones, 68% had computer access, 66% were current users of the Internet though most used it occasionally and 65% had e-mail addresses. About three-quarters (77%) were willing to receive future SMS reminders about childhood immunisations although 67% preferred telephonic reminders to SMS and only 53% were willing to pay for the reminders. Respondents who were currently married and had at least a post-secondary education were more willing to receive SMS reminders.
Conclusion. The mothers had better access to mobile phones than the Internet and were willing to receive SMS immunisation reminders. Future intervention strategies should explore payment mechanisms for SMS reminders, as there is an unwillingness to bear the cost by the respondents.
Epidemiological factors in admissions for diarrhoea in 6 - 60-month-old children admitted to Morogoro Regional Hospital, TanzaniaSource: South African Journal of Child Health 6, pp 81 –84 (2012)More Less
Objectives. To describe the diarrhoea admissions and the influencing factors in 6 - 60-month-old children at Morogoro Regional Hospital.
Design. A retrospective descriptive study of the type of diarrhoea, patient age, home address, nutritional status, diagnosed infection, month of admission, admission duration and outcome.
Setting. A hospital-based study: paediatric admissions at Morogoro Regional Hospital.
Subjects. All children aged 6 - 60 months admitted to the infectious diseases ward over the 60-month period from May 2006 to April 2011.
Results. A total of 4 988 records were extracted, among which the prevalence of diarrhoea was 2 855 (57.2%). Among the 2 855 children with diarrhoea, the majority (2 536 (88.8%)), were 6 - 24 months old, with peak admissions at 7 months and 12 months. District of residence, season, undernutrition and infection were the factors significantly associated (p<0.001) with the age at which children were admitted with diarrhoea.
Conclusions. There were increased numbers of admissions for diarrhoea at the ages of 7 months and 12 months, during the dry season and together with diagnosed infection, particularly malaria. However, further study on causes of childhood diarrhoea, given the identified risk factors, may better explain the epidemiology of diarrhoea in Morogoro.
Source: South African Journal of Child Health 6, pp 88 –89 (2012)More Less
We describe the case of a 6-year-old boy presenting only with cervical lymphadenopathy as a manifestation of kala-azar without evidence of any other visceral involvement. Involvement of lymph nodes in Indian kala-azar is quite rare with only a few case reports in published literature. The boy was known to be HIV-positive for 1 year before presentation. Immunodeficiency due to HIV infection could have resulted in unusual manifestation of kala-azar.
Source: South African Journal of Child Health 6, pp 90 –92 (2012)More Less
A spectrum of entities is involved in injury to the inferior aspect of the patella and the proximal patella tendon, including Sinding-Larsen-Johansson syndrome, patellar sleeve avulsion and jumper's knee. The patellar tendon is usually only a few centimetres long, arising from the inferior patella and inserting distally into the tibial tuberosity. Sinding-Larsen-Johansson syndrome is an osteochondrosis of the inferior pole of the patella and is often bilateral. It is not osteonecrosis, epiphysitis or osteochondritis as previously described in the literature. Sinding-Larsen-Johansson is commonly seen in active adolescents aged between 10 and 14 years, as described in our patient. Our case highlights the importance of an adequate history, clinical examination combined with correct imaging in accurate, early diagnosis of Sinding-Larsen-Johansson syndrome, a rare but important course of patellofemoral pain.
Source: South African Journal of Child Health 6, pp 93 –94 (2012)More Less
Ventricular shunt is a well-established modality in the management of hydrocephalus. However, it can be associated with numerous complications and disastrous consequences. The reported incidence of intra-abdominal complications in infants and children after ventriculoperitoneal (VP) shunt procedures is about 24% and most of these patients present with abdominal signs and/or intracranial sepsis. In this article we report on a 2-year-old boy who presented with swelling in the right inguino-scrotal region. Imaging showed migration of the peritoneal catheter into the right scrotum.