South African Journal of Child Health - Volume 6, Issue 4, 2012
Volume 6, Issue 4, 2012
Author D.F. WittenbergSource: South African Journal of Child Health 6 (2012)More Less
In 1978 the Alma Ata Conference on Primary Health Care formulated many of the policies that form the cornerstone of public health programmes in numerous countries, including South Africa. In his 'Hot Topics' commentary on the proposed National Health Insurance (NHI) that was announced approximately 18 months ago, Saloojee stated that existing excellent child health policies had not been successfully transformed into measurable actions and outcomes so far. Despite much evidence of outstanding individual care for children able to access the health service, our national child health indicators remain appallingly poor in comparison with countries with equivalent resources.
Author Chris BatemanSource: South African Journal of Child Health 6, pp 100 –101 (2012)More Less
The legacy of suffering imposed by the discredited 'separate but equal' policy of successive apartheid governments has hit South Africa's children the hardest, and those living in former homelands remain the most deprived and least healthy. This emerges from the findings reported in the latest South African Child Gauge (2012).
Author P. SnymanSource: South African Journal of Child Health 6, pp 102 –105 (2012)More Less
Clinical photography is used in publications, teaching, lecture illustration and research. Nowadays virtually every medical doctor and medical student possesses a camera phone. The patient or the parent is often not asked for consent, or even aware that pictures have been taken with these devices. Medical colleagues may obtain photos we have taken, and use them without our consent. These new developments in digital media technology require a re-think of many ethical positions and legal implications.
Source: South African Journal of Child Health 6, pp 106 –108 (2012)More Less
Congenital rubella syndrome (CRS) is a rare but potentially debilitating disease with lifelong consequences. Although there is no cure, it is almost completely preventable by an effective immunisation programme. We present two confirmed cases of CRS diagnosed in the neonatal unit at Groote Schuur Hospital in 2011 and discuss aspects of the disease and its prevention.
Comprehensive family hygiene promotion in peri-urban Cape Town : gastrointestinal and respiratory illness and skin infection reduction in children aged under 5Source: South African Journal of Child Health 6, pp 109 –117 (2012)More Less
Background. Hygiene promotion has become increasingly important to public health policy makers as an illness reduction strategy. The primary aim of this study was to assess the differential effects of hygiene education alone compared with hygiene education plus hygiene products on the reduction of target illnesses/infections.
Aims and methods. We hypothesised that a participatory learning and action (PLA) family hygiene education approach plus the regular use of hygiene products could result in marked reduction of morbidity in children aged under 5 years. Population groups in two separate geographical areas were utilised (685 households). Each group consisted of a government (Reconstruction and Development Programme, RDP) housing community (indoor tap/flush toilet) and an informal (INF) housing community (communal tap/latrines). Illness data were gathered in both groups before hygiene education was introduced in June - November 2006 (study baseline) and for the same period in 2007 (study follow-up) after one group had received hygiene education only (control) and the other group hygiene education plus hygiene products (intervention). Facilitators from the communities monitored symptoms weekly and reinforced disease prevention behaviours, focusing on handwashing and bathing with soap, cleaning toilet/food surfaces, and treating skin problems with antiseptic.
Results. Children aged under 5 years in all communities had significant reductions in gastrointestinal and respiratory illnesses and skin infections over time. At study follow-up the control RDP community with hygiene education only was 2.46 times more likely to experience gastrointestinal illnesses (hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.17 - 4.91) and 4.56 times more likely to experience respiratory illnesses (HR 4.56, CI 1.97 - 10.54) at study follow-up than the intervention group. There was no statistical difference in the incidence of skin infections for children living in RDP housing. The INF community with hygiene education only was 1.64 times more likely to experience gastrointestinal illnesses (HR 1.64, CI 1.32 - 2.03), 4.62 times more likely to experience respiratory illnesses (HR 4.62, CI 4.19 - 5.09) and 1.29 times more likely to experience skin infections (HR 1.29, CI 1.26 - 1.32) than the intervention group.
Conclusion. While hygiene education alone resulted in meaningful reductions in gastrointestinal and respiratory illness and skin infections in children aged under 5 years across all communities, families with hygiene education plus consistent use of provided hygiene products had greater reductions.
Source: South African Journal of Child Health 6, pp 118 –122 (2012)More Less
Objectives. To report on the burden and outcome of episodes of acute otitis media (AOM) based on awareness of AOM and compliance to referral by community health workers (CHWs) in rural children aged under 2 in Bangladesh.
Study design. Retrospective population-based cohort study.
Method. Secondary data analysis on episodes of AOM, care-seeking pattern, compliance with referral, antibiotic use and duration of episodes from morbidity data collected by CHWs on 252 children aged under 2 who completed biweekly household surveillance starting from birth.
Results. A total of 375 episodes of AOM were observed in 45.6% (115/252) of the study subjects; 19.4% (49/252) experienced single and 26.2% (66/252) recurrent episodes. Just over 34% (129/375) of episodes were recognised by caregivers and reported to CHWs, and the remaining 246 episodes, unrecognised by caregivers, were detected by CHWs during home visits. CHWs referred all subjects with AOM to the study doctor. The caregivers complied with referral in all episodes they had recognised, but in only 21.5% (53/246) of episodes they had not recognised (p<0.0001). Compliance was best among caregivers of babies in the first 3 months of life. Resolution occurred in 95.0% (356/375) of acute episodes of AOM in ≤6 weeks, comprising 176/182 of antibiotic-treated and 180/193 of untreated episodes (p<0.13). Five per cent of episodes (19/375) progressed to chronic suppurative otitis media (CSOM). Doctor visits resulting in antibiotic use resulted in a 51% lower progression to CSOM (relative risk 0.49, 95% confidence interval 0.19 - 1.26).
Conclusion. AOM is a disease of public health importance in rural children aged under 2 in Bangladesh. Early assessment, community awareness of AOM intensified by motivational activities, and increased compliance with referral to the doctor in caregiver-unreported cases may help to decrease morbidity and burden from the disease.
The clinical and anthropometric profile of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in BotswanaSource: South African Journal of Child Health 6, pp 123 –127 (2012)More Less
Background. Although Botswana is a middle-income country, undernutrition among children younger than 5 years of age is still seen in various parts of the country. There is little information on the clinical and anthropometric profile of undernourished children in this age group admitted to hospitals in Francistown, Botswana.
Purpose. To determine the clinical profile and the severity of anthropometric failure of undernourished children aged under 5 admitted to Nyangabgwe Referral Hospital in Francistown.
Method. Data were collected from 113 caregiver-child pairs using a researcher-administered questionnaire targeting caregivers together with the children's hospital records. The children's anthropometric measurements were taken. Data were analysed using the WHO Anthro 2006 software and Stata 10. Proportions were then calculated.
Results. The median age of the children was 14 months and 55% were boys. The majority of the caregivers were single, younger than 30 years and lived in rural villages. The most common symptoms on admission were oedema (50%) and coughing (35%). Ten per cent of the children were HIV-infected and the HIV status of half the children was unknown. The majority (87%) did not present with secondary diagnoses. Severe wasting (<-3 standard deviations (SD)) (73%) was found in all age groups. Stunting (<-2 SD) was prevalent in 68% of the boys, and 95% of the children were severely underweight (<-3 SD).
Conclusion. Oedematous undernutrition was common and 73% of the children presented with severe wasting (<-3 SD). In order to prevent severe forms of undernutrition, avoid the necessity for complicated care and improve the chances of survival, health education to caregivers on various forms of undernutrition is crucial.
Source: South African Journal of Child Health 6, pp 128 –131 (2012)More Less
Background. Cranial radiation is part of a treatment protocol for childhood acute lymphoblastic leukaemia (ALL) in South Africa. Radiation is known to disrupt the myelination and integrity of white matter tracts in the brain. Associated cognitive impairment has been well documented in other countries, but not to the same extent in the multicultural and multilingual South African context.
Objectives. The current study focused on the assessment of memory and learning, two imperative cognitive functions. A quantitative evaluation of verbal and visuospatial memory performance in a cohort of ALL patients was done in order to establish whether there was a difference in performance between verbal and visuospatial tasks.
Methods. Eight patients with a low socio-economic background and being educated in their second language were included in the cognitive evaluation. All had received 18 Gy of radiation as part of their treatment protocol and were on maintenance treatment at the time of the study.
Results. In all the patients, primary cognitive impairment was demonstrated in ostensibly right hemisphere visuospatial tasks in comparison with ostensibly left hemisphere verbal tasks. Because deficits in visuospatial attention and working memory were identified, qualitative analysis of the results suggested that the white matter tracts in the right frontoparietal region and prefrontal cortex may be particularly vulnerable to radiation injury.
Conclusion. The study findings support vulnerability of the right hemisphere, particularly the right frontoparietal region and prefrontal cortex, to radiation injury. The decline in visuospatial cognitive abilities has major implications for second-language learners, as visuospatial learning is particularly important for them.
Poor academic performance among adolescents with epilepsy in Kaduna, Northern Nigeria : a case-control studySource: South African Journal of Child Health 6, pp 132 –134 (2012)More Less
Background. Adolescents with epilepsy experience significant academic difficulties. However, little is known about the effects of epilepsy on the academic performance of adolescents with the disorder in Northern Nigeria.
Objective. To assess the academic performance of adolescents with epilepsy and factors associated with poor performance in this population in a Northern Nigerian setting.
Methods. The socio-demographic/clinical characteristics of 77 consecutive adolescents (aged 12 - 17 years) with epilepsy attending the Child and Adolescent Clinic of Federal Neuropsychiatric Hospital, Kaduna, North-West, between March 2008 and September 2010 and the socio-demographic characteristics of 76 controls (matched for age and sex) were recorded. Information concerning school attendance and academic performance of the subjects and the controls were obtained from the adolescents and their parents or caregivers.
Results. The mean ages of the subjects and the controls were 15.1 (standard deviation (SD) 2.1) and 14.7 (SD 1.7) years, respectively (p>0.05), the mean duration of illness was 6.1 (SD 4.6) years, the mean seizure-free period was 16.8 (SD 15.6) weeks, and 64.9% of the subjects and 57.9% of the controls were males. Forty-six subjects (59.7%) and 12 controls (15.8%) had poor academic performance (p<0.001). Long duration of illness, short seizure-free periods and irregular school attendance were significantly associated with poor academic performance (p<0.05).
Conclusions. Poor academic performance is common among adolescents with epilepsy and is associated with early onset, poor seizure control and missing school. Efforts should be made to control seizures and educate society about the illness.
Source: South African Journal of Child Health 6 (2012)More Less
We welcome the comprehensive review on neonatal mortality in South Africa by Rhoda and Velaphi, and strongly agree with their recommendation to implement therapeutic hypothermia where appropriate infrastructure and equipment exist. In the light of that recommendation and the inherent limitations of the budget constraints common to all public hospitals, we wish to discuss their statement regarding appropriate cooling methodology.