South African Journal of Child Health - Volume 8, Issue 2, 2014
Volume 8, Issue 2, 2014
Author D.F. WittenbergSource: South African Journal of Child Health 8 (2014) http://dx.doi.org/10.7196/SAJCH.773More Less
By common consensus, human breastmilk is not only the right food for optimal nutrition and growth for a newborn baby, but also a biological messenger system that influences future health. Breastmilk affects gut maturation, immunity and nutritional programming, and the maternal act of breastfeeding contributes to infant emotional bonding and sense of security. Rightly, therefore, the World Health Organization has repeatedly stressed the importance of breastfeeding as an essential requirement for child health, and it is an almost automatic expectation that all healthcare practitioners (doctors, nurses, dieticians, etc.) support and promote healthy breastfeeding.
Improving the quality of care for children with brain tumours in South Africa : a report from the 4th Paediatric Brain Tumour Workshop : congress reportSource: South African Journal of Child Health 8 (2014) http://dx.doi.org/10.7196/SAJCH.746More Less
The 4th annual Paediatric Brain Tumour Workshop was held on 16 and 17 November 2013 at the University of Cape Town (UCT), South Africa (SA). The focus of this workshop was the management of children with brain tumours in limited-resource settings.
Although brain tumours are the second-most common cancer in children, brain tumour awareness among the SA public and its physicians is low, with few centres being adequately equipped to manage affected children or having functioning multidisciplinary teams (MDTs). Currently, there are no national protocols or consensus agreements on how best to manage childhood brain tumours in SA.
Source: South African Journal of Child Health 8, pp 45 –49 (2014) http://dx.doi.org/10.7196/SAJCH.681More Less
Background. Babies born before arrival (BBAs) at hospital constitute a special group at risk of high morbidity and mortality.
Objective. We conducted a 12-month retrospective review to describe maternal and neonatal characteristics of BBAs, and their outcomes compared with babies born in the state health sector.
Methods. Using case-control sampling, all babies born outside a health facility and who presented to hospital within 24 hours of life were included and compared to the next in-hospital delivery occurring immediately after each BBA presented.
Results. During the period reviewed, 135 BBAs (prevalence 1.8%) presented; 71% after hours with most deliveries occurring at home (73.8%). There was no birth attendant present at 70.5% of deliveries. Average birth weights were similar (2.86 kg in the BBA group, 95% confidence interval (CI) 2.73 - 2.95; 2.94 kg in the control group, 95% CI 2.78 - 3.02), but significantly more preterm babies were found in the BBA group (23% v. 9%, respectively; p<0.0001). Admitted BBAs had significantly lower average weights than those who were not admitted (2.19 kg v. 2.96 kg, respectively; p<0.0001). No significant differences were found when maternal age, parity, co-morbidities and distance from the hospital were compared. There were significantly more unbooked mothers in the BBA group (23.0% v. 6.7%, respectively; p<0.0001). Only 54.40% of the admitted BBAs' mothers had booked antenatally, compared with 78.89% of mothers whose babies were discharged. Admission and complication rates were similar between the groups, but average length of stay was longer in admitted BBAs compared with controls.
Conclusion. The prevalence of BBAs in this study is comparable to that in other developing countries, and is associated with poor antenatal attendance, prematurity, delay in presentation to hospital and lengthier hospital stays. These factors have implications for prehospital care of newborns and access to maternal and child healthcare in general.
Infant feeding practices during the first 6 months of life in a low-income area of the Western Cape Province : researchSource: South African Journal of Child Health 8, pp 50 –54 (2014) http://dx.doi.org/10.7196/SAJCH.675More Less
Background. Exclusive breastfeeding during the first 6 months of life protects against infant morbidity and mortality. Few studies describe the infant feeding practices of mothers living in low-income areas of the Western Cape Province of South Africa (SA).
Objective. To describe the infant feeding practices of mothers of infants younger than 6 months in two low-income communities of SA.
Methods. A cross-sectional community-based study using a structured questionnaire, and seven focus group discussions were conducted from February to August 2011 in Avian Park and Zwelethemba in Worcester, an urban area in the Western Cape.
Results. Seventy-seven per cent of participants (n=108) had initiated breastfeeding. At the time of the study, 6% (n=8) breastfed exclusively. Ninety-four per cent (n=132) applied suboptimal breastfeeding practices: 36% (n=51) breastfed predominantly, 27% (n=38) breastfed partially and 31% (n=43) did not breastfeed. Ninety per cent (n=126) of the mothers had introduced water, of whom 83% (n=104) had done so before their infants were 1 month old. Forty-four per cent (n=61) of the mothers had introduced food or formula milk, of whom 75% (n=46) had done so before their infants were 3 months old. Qualitative findings indicated that gripe water, Lennon's Behoedmiddel and herbal medicines were also given to infants. Nutritive liquids and/or food most commonly given as supplementary feeds were formula milk and commercial infant cereal.
Conclusion. Exclusive breastfeeding (EBF) during the first 6 months of life was a rare practice in these low-income communities. Water, non-prescription medicines and formula milk and/or food were introduced at an early age.
The practice of breastfeeding by healthcare workers in the Federal Teaching Hospital, Abakaliki, southeastern Nigeria : researchSource: South African Journal of Child Health 8, pp 55 –58 (2014) http://dx.doi.org/10.7196/SAJCH.668More Less
Background. Optimal breastfeeding practices include exclusive breastfeeding (EBF) for the first 6 months of life, followed by continued breastfeeding with adequate complementary foods on to at least 2 years of age. This is expected to be well known and practised by healthcare workers (HCWs) who are in the position to educate the community.
Objective. To determine the actual breastfeeding practices of HCWs in a tertiary hospital in south-eastern Nigeria.
Methods. We conducted a cross-sectional, descriptive study among female HCWs at the Federal Teaching Hospital, Abakaliki, southeastern Nigeria, using a self-administered, semi-structured questionnaire.
Results. One hundred HCWs were recruited, including doctors, nurses, pharmacists and other HCWs. Only 3% practised EBF with all their children, their cited reasons being a busy work schedule (61.8%), EBF being too stressful (18.4%), ignorance of benefits of EBF (13.2%) and lack of family support (3.9%). Only 1% breastfed their babies up to 2 years. The reasons for failing to do so included refusal of the child to breastfeed (32.6%), another pregnancy (30.4%), feeling it was shameful (10.9%) and feeling that the baby was too old (8.7%).
Conclusion. There are obvious shortcomings in breastfeeding practices among HCWs. They need to be empowered and supported to promote and support breastfeeding among their patients in particular and society in general.
Source: South African Journal of Child Health 8, pp 59 –63 (2014) http://dx.doi.org/10.7196/SAJCH.658More Less
Objective. To determine the contribution of school lunchboxes to the daily food intake of adolescent girls in a school in an informal settlement in Durban, South Africa.
Methods. The study was conducted among a group of 61 secondary schoolgirls aged 13 - 18 years. Two 24-hour recall questionnaires were completed during an interview with participants to gather data on dietary patterns over a period of two consecutive days. The researcher weighed and recorded the contents of randomly selected lunchboxes.
Results. The lunchboxes contributed one-third of the daily nutrient intake of the children. The 24-hour recall and lunchbox content data revealed an energy-dense, carbohydrate-based diet. The contribution of total fat (34.04%) to the total energy intake of the girls was higher than the World Health Organization (WHO) recommendation of 15 - 30%. The daily fruit and vegetable intake (87.95 g and 83.97 g according to 24-hour recall and lunchbox analysis, respectively) was insufficient compared with the WHO-recommended intake of >400 g/day. Although the mean intake of most of the nutrients was sufficient, a large number of the girls did not receive the daily requirements for this age group.
Conclusion. The results of the study indicated a high-fat diet low in fruits and vegetables. The majority of respondents consumed carbohydrate-based food items and their lunchbox contents did not meet the basic requirements of a balanced diet. Although increased dietary needs are seldom met in adolescents, overweight is an emerging problem among young people in both low- and high-income countries. Nutrition education in this age group should concentrate on healthy food choices in school lunchboxes, as school children can spend up to 8 hours a day at school.
A strategy for scaling up vitamin A supplementation for young children in a remote rural setting in Zimbabwe : short reportSource: South African Journal of Child Health 8, pp 64 –67 (2014) http://dx.doi.org/10.7196/SAJCH.618More Less
Background. Vitamin A deficiency is a public health problem in Zimbabwe. Addressing vitamin A deficiency has the potential to enhance resistance to disease and reduce mortality, especially in children aged <5 years.
Objective. To describe a vitamin A supplementation outreach strategy implemented in one of the remote rural districts in Zimbabwe, which increased coverage after being implemented in difficult circumstances in a remote rural region.
Methods. We implemented and adapted a vitamin A supplementation outreach strategy within the national immunisation days (NIDs) and extended programme of immunisation in a remote rural district in Zimbabwe. The strategy involved supplementating children at prescheduled outreach points once per month for the whole year. Despite usual operational challenges faced at implementation, this approach enabled the district to increase delivery of vitamin A supplements to young children in the district.
Results. The strategy covered 63 outreach sites, with two sites being covered per day and visited once per month for the whole year. Coverage reached 71% in an area in which previous coverage rates were around <50%.
Conclusion. Implementing a vitamin A supplementation outreach strategy increased vitamin A supplementation coverage among children living in a remote rural region. This strategy can potentially be used by Scaling Up Nutrition (SUN) member states. However, we recommend further exploration of this strategy by others working in similar circumstances.
Clinical profile and outcome of D- haemolytic-uraemic syndrome in children from south India : short reportSource: South African Journal of Child Health 8, pp 68 –71 (2014) http://dx.doi.org/10.7196/SAJCH.635More Less
Background. Haemolytic-uraemic syndrome (HUS) occurring without a diarrhoeal prodrome is termed D- HUS and has a poorer prognosis than D+ HUS, with high mortality and potential for long-term renal and non-renal morbidity.
Methods. We studied nine children with D- HUS from the Pediatric Nephrology division of the Medical College, Trivandrum, India, over a period of 5 years. The clinical, haematological and renal profiles of all patients were recorded. All patients were treated with fresh-frozen plasma with or without dialysis.
Results. The aetiology of HUS was not apparent in any of the cases, except in one patient who had a history of ayurvedic treatment for chronic cough. The mean age of the patients was 7.5 years with a male:female ratio of 1:2. Hypertension (HT) was present in eight cases (88%). Plasmapheresis was performed in 22% of patients; 67% underwent dialysis. Renal biopsy was performed in six patients. Four patients (44%) had good renal recovery while two progressed to end-stage renal disease. One child died in the acute phase, and one had a relapse of HUS. HT persisted in 44% and proteinuria in 33% of patients.
Conclusion. Early comprehensive management including dialysis, plasma infusions, and aggressive management of HT yields a good outcome in D- HUS. Persistent HT and progressive, chronic kidney disease require long-term management.
Source: South African Journal of Child Health 8, pp 72 –74 (2014) http://dx.doi.org/10.7196/SAJCH.636More Less
We report nine cases of traumatic oral mucosal lesions (Riga-Fede disease or Cardarelli's aphthae) caused by natal teeth, and provide a brief review of the literature. Seven patients were treated with a conservative approach involving grinding of the sharp incisal edges, while extraction of the offending teeth was considered necessary in the other two cases. Triamcinolone was applied in all nine cases. At follow-up, all the lesions were healing and the infants had resumed painless feeding.
Source: South African Journal of Child Health 8, pp 75 –77 (2014) http://dx.doi.org/10.7196/SAJCH.664More Less
Reye's syndrome is characterised by acute non-inflammatory encephalopathy and fatty degeneration of the liver. The exact aetiology of the syndrome is unknown, but there is an association with viral infections and the use of aspirin. There has been a sharp decline in the incidence of Reye's syndrome; the reasons for this are unclear, but may be due, in part, to the declining use of aspirin in children and to improvements in the diagnosis of underlying inborn errors of metabolism. The use of the term 'Reye-like' has been advocated among experts in the field. We report the case of a child with Reye-like syndrome complicated by pancreatitis.
Abuse of antiretroviral drugs combined with addictive drugs by pregnant women is associated with adverse effects in infants and risk of resistance : case reportSource: South African Journal of Child Health 8, pp 78 –79 (2014) http://dx.doi.org/10.7196/SAJCH.734More Less
Reports of the use of antiretroviral drugs (ARVs) to produce a highly addictive drug called nyaope or whoonga are of major concern as ARVs are easily accessible in sub-Saharan Africa, including to pregnant women. Use of illicit drugs by pregnant women may result in serious adverse effects in their infants. We have noticed a sudden increase in the number of infants presenting with signs suggestive of neonatal abstinence in Chris Hani Baragwanath Academic Hospital. Here we report two neonates who were born to mothers addicted to nyaope. Both infants were growth restricted and presented with signs of neonatal abstinence syndrome that are likely due to nyaope or whoonga. We suggest that in growth-restricted infants born to mothers who are at high risk of substance abuse and/or are receiving ARVs, screening for substance abuse should be considered.
Source: South African Journal of Child Health 8, pp 80 –81 (2014) http://dx.doi.org/10.7196/SAJCH.673More Less
Hypertrophic osteoarthropathy (HOA) is an uncommon condition in children, consisting of a triad of digital clubbing, non-inflammatory joint effusions and radiographic evidence of periostitis affecting the hands, feet and distal long bones. HOA is classified as primary (idiopathic) or secondary to various diseases. In this case report, we present a patient with secondary HOA associated with biliary atresia and chronic liver disease.