South African Journal of Child Health - Volume 7, Issue 3, 2013
Volume 7, Issue 3, 2013
Author D.F. WittenbergSource: South African Journal of Child Health 7 (2013)More Less
Diarrhoeal disease of infancy will remain one of the major causes of morbidity and mortality in the developing world until the scourges of poverty, unhygienic overcrowding and lack of sufficient safe water have been overcome. While this socio-political dimension of disease looms so large, human behaviour is also a major determinant, and caretakers can learn to lessen the risks inherent in an unhealthy environment. One of the major responsibilities of health services is to educate the public about effective preventive healthcare. This extends to learning how to deal with disease and recognising danger signals that necessitate health worker intervention. In the case of acute diarrhoea, the most important learned skill for mothers and caretakers is the application of appropriate oral rehydration therapy (ORT) and early adequate feeding.
Pre-hospital management and risk factors in children with acute diarrhoea admitted to a short-stay ward in an urban South African hospital with a high HIV burden : researchSource: South African Journal of Child Health 7, pp 84 –87 (2013)More Less
Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described.
Objectives. To document pre-hospital home and primary care management of diarrhoea, and certain risk factors and complications of diarrhoea.
Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital, Parow, Cape Town, between 1 February 2007 and 31 May 2008. Caregivers were interviewed, and demographic, clinical and laboratory variables were collected.
Results. We recruited 142 children, median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9%) were HIV-exposed, with 9 (6.3%) HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed, uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2% stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines.
Conclusions. Most caregivers do give ORT, but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition, and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies, pre-hospital management and nutritional rehabilitation.
Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa : researchSource: South African Journal of Child Health 7, pp 89 –94 (2013)More Less
Background. Perinatal asphyxia is a significant cause of death and disability.
Objective. To determine the outcomes (survival to discharge and morbidity after discharge) of neonates with perinatal asphyxia at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
Methods. This was a descriptive retrospective study. We reviewed information obtained from the computerised neonatal database on neonates born at CMJAH or admitted there within 24 hours of birth between 1 January 2006 and 31 December 2011, with a birth weight of >1 800 g and a 5-minute Apgar score <6.
Results. Four hundred and fifty infants were included in the study; 185 (41.1%) were females, the mean birth weight (± standard deviation) was 3 034.8±484.9 g, and the mean gestational age was 39.1±2.2 weeks. Most of the infants were born at CMJAH (391/450, 86.9%) and by normal vaginal delivery (270/450, 60.0%). The overall survival rate was 86.7% (390/450). Forty-two infants were admitted to the intensive care unit (ICU). The ICU survival rate was 88.1% (37/42). Significant predictors of survival were place of birth (p=0.006), mode of delivery (p=0.007) and bag-mask ventilation at birth (p=0.040). Duration of hospital stay (p=0.000) was significantly longer in survivors than in non-survivors (6.5±6.6 days v. 2.8±9.8 days). The remaining factors, namely gender, antenatal care, chest compressions, diagnosis of meconium aspiration syndrome or persistant pulmonary hypertension, did not differ significantly between the two groups. The rate of perinatal asphyxia (5-minute Apgar score <6) was 4.7/1 000 live births, and there was evidence of hypoxic ischaemic encephalopathy (HIE) in 3.6/1 000 live births. Of the 390 babies discharged from CMJAH, 113 (29.0%) had follow-up records to a mean corrected age of 5.9±5.0 months. The majority (90/113, 79.6%) had normal development.
Conclusions. (i) The high overall survival and survival after ICU admission provides a benchmark for further care; (ii) obtaining adequate data for long-term follow-up was not possible with the existing resources - surrogate early markers of outcome and/or more resources to ensure accurate follow-up are needed; and (iii) the high incidence of HIE suggests that a therapeutic hypothermia service, including a long-term follow-up component, would be beneficial.
Characteristics of children with pervasive developmental disorders attending a developmental clinic in the Western Cape Province, South Africa : researchSource: South African Journal of Child Health 7, pp 95 –99 (2013)More Less
Background. Little has been published on autism in Africa, and it is not known whether South African children present with the same characteristics and challenges as described internationally.
Objectives. To describe the demographics, history, clinical features, co-morbidity and yield of aetiological investigations in children diagnosed with a pervasive developmental disorder (PDD).
Methods. This was a retrospective review of medical records of children fulfilling Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) criteria for a PDD who attended a tertiary developmental clinic at Tygerberg Hospital, Western Cape, South Africa, over a 2-year period (2008 - 2010).
Results. Fifty-eight children were included. The median age at diagnosis was 42 months (range 15 - 106 months), and 45 (77.6%) were boys. Forty per cent had complex autism (dysmorphism with or without microcephaly), and 12.1% were macrocephalic. Most children (72.4%) were non-verbal (using fewer than 10 non-echoed words), and 89.0% had behavioural problems as reported by caregivers. The diagnostic yield of investigations was low.
Conclusion. The profile of children with PDD attending a tertiary hospital developmental clinic in the Western Cape revealed that a high proportion had severe language impairment, behavioural problems and complex autism.
The current pattern of gestational age-related anthropometric parameters of term Nigerian neonates : researchSource: South African Journal of Child Health 7, pp 100 –104 (2013)More Less
Background. Weight and length at birth reflect the quality of intra-uterine growth and exert a strong influence on postnatal survival.
Objective. To determine the current range of anthropometric measurements of term Nigerian neonates.
Methods. Consecutive term singleton mother-baby pairs were surveyed in the first 24 hours after birth. Weight, length, occipitofrontal circumference (OFC) and ponderal index were determined.
Results. A total of 825 babies (440 males and 385 females) were studied. The overall mean birth weight (± standard deviation (SD)) of the study subjects was 3 233±539 g, the mean ±SD length 49.0±2.5 cm, the mean ±SD OFC 34.6±1.4 cm, and the mean ±SD ponderal index 2.7±0.4 g/cm3.
Conclusion. The anthropometric parameters of the Nigerian infants studied were within the range previously reported for Africa and other developing countries, but lower than figures from some developed countries.
Source: South African Journal of Child Health 7, pp 105 –107 (2013)More Less
Background. Anthropometric parameters such as the distance between the nipples and the internipple index are important signs of some genetic disorders. Indian data on these measurements are scarce.
Objectives. To determine internipple distance and the internipple index and their correlation with gender, birth weight, length, chest circumference and gestational age in term Indian newborns.
Methods. Internipple distance was measured and the internipple index was calculated in 1 077 full-term newborn infants of both genders within 72 hours of birth at a tertiary care hospital in North India. The chest circumference was measured and the internipple index was calculated. Values for male and female infants were compared and correlated with weight, length, chest circumference and gestational age.
Results. The mean internipple distance (± standard deviation) was 8.5±1.4 cm and the mean internipple index was 27.04±3.5% in male and female infants taken together. The 3rd and 97th percentile values for internipple distances were 7.3 cm and 9.5 cm, respectively. Male infants had a larger mean internipple distance than females (p=0.03), but the two groups had a similar mean internipple index. Weight, length, chest circumference and gestation had a positive correlation with internipple distance and internipple index in both genders (p<0.05).
Conclusion. The mean internipple distance at birth in term Indian infants was 8.5 cm. Nipples can be considered widely spaced if >9.5 cm apart (>97th percentile) and narrowly spaced if <7.3 cm apart (<3rd percentile). Internipple distance tended to be significantly greater in male neonates than in females.
Source: South African Journal of Child Health 7, pp 108 –112 (2013)More Less
Background. Obesity in adolescence is common, and eating habits are a key determinant. Eating habits in adolescence often differ substantially from those in any other phase of life.
Objective. To assess the weight status and eating habits of adolescent urban secondary school girls in Benin City, Nigeria.
Methods. In this school-based cross-sectional study, data were obtained on the subjects' eating habits via a structured anonymous self-administered questionnaire, while their weights and heights were obtained by direct measurements. The body mass index (BMI), calculated as weight/height (kg/m2), was used in assessing the weight status of the participants. The study sample was 2 097 adolescent urban public school girls, aged 12 - 19 years. Information was obtained on frequencies of skipping meals, reasons for skipping meals and food choices, as well as the socio-demographic characteristics of the participants. All the students at the two study schools were invited to participate.
Results. The mean age of the participants (± standard deviation) was 14.8±1.9 years (95% confidence interval (CI) 14.7 - 14.9). Slightly over half (52.6%) were from families of middle socio-economic status, and 84.7% of them lived with their parents. Of the 2 097 participants, 1 009 (48.1%) admitted to skipping at least one meal a fortnight. Of the three main meals, breakfast was the most frequently skipped (46.3%) and dinner the least frequently skipped (21.5%). With regard to age, the frequency of skipping meals was 30.1%, 50.4% and 58.5% among participants aged <14 years, 14 - 16 years and ≥17 years, respectively (p<0.001). The two leading reasons cited by participants for skipping breakfast were lack of appetite and time. Only 15.2% of the participants reported daily consumption of fruits and vegetables. Over half of the participants (60.2%) ate fast food at least once a week, with more than three-quarters of them (76.4%) consuming fast food along with soft drinks. The prevalences of both overweight (24.5% v. 13.2%) and obesity (2.5% v. 1.1%) were higher among girls who skipped meals compared with their peers who did not skip meals (odds ratio 0.4, 95% CI 0.32 - 0.50).
Conclusion. Meal skipping was associated with an increased prevalence of overweight and obesity among adolescent schoolgirls.
Dilemmas of telling bad news : paediatric palliative care providers' experiences in rural KwaZulu-Natal, South Africa : researchSource: South African Journal of Child Health 7, pp 113 –116 (2013)More Less
Background. In general, the principles of palliative care suggest that, at some stage, patients should be given 'bad news' about poor illness prognosis. The information is often important for care planning, especially when it involves disclosure to children. Although there are ongoing debates about whether to tell or not to tell children bad news, these debates have largely been informed by patients who live in a developed-world context. In contrast, this paper focuses on telling bad news to children and their families from a rural, developing-world context.
Objective. To analyse the experiences of providers of palliative care to children when they attempted to fulfil one of their roles as palliative caregivers, i.e. to prepare patients and families for a child's poor illness prognosis.
Method. This was an exploratory study that was approached qualitatively. Five nurses and eight home-based care workers who provided palliative care for children in rural areas of South Africa formed a purposive, information-rich, self-selected sample. Data were produced through discussions with participants, using photographs taken by the caregivers to stimulate and contextualise the discussions.
Results. Participants experienced four dilemmas with regard to telling bad news: when families did not want to be told any bad news; when participants felt uncomfortable about telling bad news; when participants and patients shared dissimilar values about telling bad news; and when participants were unsure about when to tell bad news.
Conclusion. In the rural areas where the study was conducted, children are not usually given bad news about their illness. Disclosing poor prognosis led to the dilemmas faced by caregivers. The result was that the emotionally charged work of caring for children reaching the end of their lives became more challenging for the caregivers because they were not prepared for cultural complexities. In view of the findings of this study, there is a need for ongoing research into paediatric palliative caregiving in context.
Source: South African Journal of Child Health 7, pp 117 –118 (2013)More Less
Desmoid tumours are a rare group of locally aggressive, non-malignant tumours of fibroblastic origin that can result in significant morbidity due to local invasion. Facial involvement in children with aggressive fibromatosis is uncommon. We present the case of a 14-month-old Rwandan child with an aggressive desmoid tumour involving the left mid-facial region. The patient presented with severe stertor due to massive nasal obstruction. After intensive supportive care the diagnosis was confirmed histopathologically. Treatment consisted of eight courses of chemotherapy with vincristine, actinomycin-D and cyclophosphamide, followed by surgical removal of the remaining mass. The outcome was impressive and encouraging.