South African Journal of Child Health - Volume 8, Issue 3, 2014
Volume 8, Issue 3, 2014
Author D.F. WittenbergSource: South African Journal of Child Health 8 (2014) http://dx.doi.org/10.7196/SAJCH.810More Less
Can South Africa (SA)'s re-engineered primary healthcare service deliver the Youth-friendly Health Services (YFHS) package? The thrust of the Department of Health's new shift towards preventive health services relies heavily on community health workers (CHWs) as members of ward-based outreach teams that form the basis for health promotion activities, problem recognition, referral and home-based care.
Considerations for linking South Africa's Youth-friendly Services to its community health worker programme : hot topicSource: South African Journal of Child Health 8, pp 85 –87 (2014) http://dx.doi.org/10.7196/SAJCH.677More Less
In this article, we open the debate on whether or not South Africa's Youth-friendly Services (YFS) programmes should be linked to community health worker (CHW) programmes. Both are important in South Africa's efforts to re-engineer primary healthcare in the country. This article presents the pros and cons of linking the two programmes by incorporating YFS into the current list of CHW competencies. Also, we explore the alternative of training specialist CHWs to deliver YFS. We argue that regardless of which approach is adopted, research is required. Furthermore, efforts should be made for policy-makers, researchers and practitioners to join together and channel research findings into the design of people-centred health policies.
Added sugar and dietary sodium intake from purchased fast food, confectionery, sweetened beverages and snacks among Sowetan adolescents : researchSource: South African Journal of Child Health 8, pp 88 –91 (2014) http://dx.doi.org/10.7196/SAJCH.678More Less
Background. Greater availability and accessibility of fast foods, sugar-sweetened beverages and snacks in urban South Africa may be contributing to the burgeoning obesity epidemic in adolescents.
Objectives. To determine the consumption of purchased foods and drinks among a cohort of urban adolescents, and to estimate the added sugar and dietary sodium intake from these foods and beverages.
Methods. Participants (N=1 451, 49.6% male, mean 17.7 years of age) completed interviewer-assisted questionnaires on dietary intake practices pertaining to food choices in the home, school and community. The consumption of fast foods, sugar-sweetened beverages and snacks was determined and the average added sugar and sodium intakes were estimated.
Results. The median (interquartile range) intake of fast foods was 11 (7 - 16) items/week in both sexes. Sweetened beverages were consumed 8 (5 - 11) and 10 (6 - 11) times/week by males and females, respectively (p<0.02). Females consumed confectionery more often than males (13 (9 - 17) and 11 (8 - 15) items/week, respectively; p<0.01). Seven (5 - 10) salty snack items/week were consumed by both sexes. Overall, mean added sugar intake from these purchased food items was estimated at 561.6 g/week for males and 485.3 g/week for females, respectively (p=0.02), and dietary salt at 4 803 mg/week for males and 4 761 mg/week for females, respectively (p>0.05).
Conclusion. In this study, males and females consumed on average three times the recommended daily intake of added sugar, and more than half of the recommended daily salt intake from these purchased foods alone. These dietary patterns during adolescence may exacerbate the risk of obesity and hypertension in later adult life.
Source: South African Journal of Child Health 8, pp 92 –95 (2014) http://dx.doi.org/10.7196/SAJCH.687More Less
Background. Intensive diabetes management requires the use of multiple daily injections. Inappropriate insulin injection technique, inadvertent intramuscular (IM) injections, needle phobia and insulin omission negatively affect glucose control.
Objectives. To document skin and skin plus subcutaneous skin thickness using high resolution ultrasound (US) in a group of children and adolescents with type 1 diabetes. In addition, injection technique, needle re-use and injection site analysis was performed.
Methods. Commonly recommended injection sites were examined using high-resolution US. Patient characteristics such as age, body mass index, frequency of injections and favoured sites were analysed.
Results. A total of 40 paediatric and adolescent children aged 4 years 3 months to 18 years were examined. The maximum skin thickness at any site was 2.93 mm. A high rate of IM injection was predicted with the standard 8 mm needle and was reduced but not eliminated with the use of the shortest available 4 mm needle. As the subcutaneous skin thickness increased across injection sites in the following order: arm, thigh, abdomen and buttocks, the risk of IM injection declined.
Conclusion. Choice of needle length, injection site and injection technique are important considerations in diabetes management in the paediatric population and are likely to affect quality of glycaemic control. Shorter needles are more acceptable and reduce the risk of IM injections.
Fluoroscopic guided benign oesophageal stricture dilatation in children : 12 years' experience : researchSource: South African Journal of Child Health 8, pp 96 –100 (2014) http://dx.doi.org/10.7196/SAJCH.695More Less
Background. Benign oesophageal strictures (BOSs) are a debilitating health concern in the paediatric populations of developing countries, which lead to impaired weight gain. Various non-surgical methods may be used to address these strictures.
Objectives. To compare the success and complications of fluoroscopically guided Savary-Gilliard bougienage (SGB) with balloon dilatation and the combination of both methods for the treatment of BOSs in children at Universitas Hospital, Bloemfontein, South Africa.
Methods. A retrospective review of the patient notes on all children ≤12 years who underwent oesophageal dilatation for benign strictures from January 2001 to June 2012 was performed. Interventional radiologists performed the dilatations on children under general anaesthesia either by angioplasty balloon, SGB or a combination of both. Postdilatation contrast swallows were done to confirm the absence of perforation.
Results. A total of 432 oesophageal dilatations was performed on 63 children aged ≤12 years. Of these, 36 were males (57%), and 71% were exclusive balloon dilatation, 19% exclusive SGB and 10% utilised both techniques. Five dilatations failed (1.2%) and no complications were documented. Average follow-up dilatations needed per procedure were 8.3 after SGB, 7.2 after balloon dilatation, and 4.2 after a combined method (p<0.05). Strictures due to caustic ingestion required, on average, more dilatations (n=11) compared with those in oesophageal atresia (n=6).
Conclusion. Fluoroscopically guided dilatation of benign oesophageal strictures by either balloon catheter dilatation or SGB or a combination of the two methods is a safe and effective treatment in our paediatric population.
Blood pressure profile in children aged 3 - 5 years : relationship to age, weight, height, gender and body mass index : researchSource: South African Journal of Child Health 8, pp 100 –103 (2014) http://dx.doi.org/10.7196/SAJCH.711More Less
Background. Blood pressure measurement is not commonly done in children. Most of the studies done in Nigeria so far on blood pressure and hypertension are in older children.
Objectives. To determine the blood pressure profile in children aged 3 - 5 years, establish the relationship between their blood pressure and age, body mass index (BMI), height, weight and gender, and compare the results with available values.
Methods. A total of 603 apparently healthy nursery school children aged 3 - 5 years were randomly recruited from three nursery schools: two in Abakaliki, Ebonyi State, and one in Asaba, Delta State. Their blood pressure, height and weight were measured and their BMI calculated.
Results. Of the 603 pupils, 311 (51.6%) were males and 292 (48.4%) were females. Blood pressure ranged from 70/40 to 120/90, with mean (standard deviation) systolic values for pupils aged 3 years 87.5 (8.3) mmHg, aged 4 years 93.5 (8.5) mmHg and aged 5 years 93.5 (8.4) mmHg, and mean diastolic values for pupils aged 3 years 55.1 (9.1) mmHg, aged 4 years 61.2 (8.3) mmHg and aged 5 years 61.5 (7.8) mmHg. No gender difference was found, but age, height and weight all correlated positively with blood pressure. The values found in this study were similar to those in the literature.
Conclusion. The mean systolic and diastolic blood pressures of the age group studied were 91.3 (8.9) mmHg and 59.0 (9.0) mmHg. The blood pressure values obtained in this study were similar to published values in the literature.
Comparative weight gain with ready-to-use therapeutic food in stunted HIV-infected and -uninfected children in a Nigerian Hospital : researchSource: South African Journal of Child Health 8, pp 104 –107 (2014) http://dx.doi.org/10.7196/SAJCH.723More Less
Objective. To bridge the management gap between nutritional rehabilitation for severe acute malnutrition (SAM) and chronic malnutrition, this study investigated to what extent ready-to-use therapeutic food (RUTF) promotes growth in children with long-term nutrition deficit with superimposed SAM.
Methods. A total of 225 (164 HIV-negative and 61 HIV-positive) chronically malnourished children (aged 6 - 60 months) with superimposed SAM were enrolled. Children were provided 92 g packets of an RUTF, Plumpy'Nut, based on an estimated requirement of 200 kcal/kg body weight (BW)/day. Children were fed Plumpy'Nut over a 2-week period, and weight was assessed weekly. Weight gain was compared for HIV-positive children and HIV-negative children.
Results. On day 15, the HIV-positive group had a median weight gain of 645 g compared with 670 g in the HIV-negative group (difference 25 g, p=0.784). Similarly, rate of weight gain per kilogram BW per day was comparable for both groups of children (13.2 g/kg BW per day for HIV-negative children v. 11.9 g/kg BW per day for HIV-positive children, p=0.353). On day 15, the proportions of HIV-positive and HIV-negative children who had sustained weight gain were not significantly different.
Conclusion. Chronically malnourished children with superimposed SAM benefit from the use of RUTF as much as children without chronic nutritional deprivation, regardless of HIV status.
Hypoglycaemia in children aged 1 month to 10 years admitted to the Children's Emergency Centre of Lagos University Teaching Hospital, Nigeria : researchSource: South African Journal of Child Health 8, pp 107 –111 (2014) http://dx.doi.org/10.7196/SAJCH.737More Less
Background. Hypoglycaemia occurs in many disease states common in the tropics, and may also complicate treatment of malaria. It may contribute significantly to morbidity and mortality.
Objectives. To determine the prevalence of and clinical conditions associated with hypoglycaemia.
Methods. A total of 430 patients aged 1 month to 10 years were recruited consecutively from the Children's Emergency Centre of Lagos University Teaching Hospital. Clinical and demographic data were entered into a predesigned study proforma. Blood glucose was determined in the laboratory using the glucose oxidase method. Hypoglycaemia was defined as plasma glucose <2.5 mmol/L.
Results. The median age of the study subjects was 24 months, with a range of 1.5 - 120 months. A total of 248 patients (57.6%) were <24 months old. The mean (standard deviation) blood glucose of all the study subjects was 5.19 (2.05) mmol/L (median 4.9 mmol/L). Twenty-four patients (5.6%) were hypoglycaemic. The predominant disease conditions in which hypoglycaemia occurred were severe malaria, multisystemic infections, marasmus, malignancies and gastroenteritis. Mortality was higher in hypoglycaemic patients than in those without hypoglycaemia (33.3% v. 5.4%, p<0.01).
Conclusion. Hypoglycaemia complicates many common childhood illnesses seen in the emergency room and is associated with significant mortality. Hypoglycaemia should be suspected in severely ill children with severe malaria, multisystemic infections, marasmus, malignancies and gastroenteritis.
The prevalence of malnutrition in children admitted to a general paediatric ward at the Chris Hani Baragwanath Academic Hospital : a cross-sectional survey : researchSource: South African Journal of Child Health 8, pp 112 –116 (2014) http://dx.doi.org/10.7196/SAJCH.787More Less
Background. The prevalence of malnutrition, an important contributor to childhood mortality, is poorly described in hospitalised South African (SA) children, many of whom are HIV-exposed or HIV-infected.
Objectives. To describe the prevalence of malnutrition in infants and children <14 years of age admitted to a general paediatric ward at the Chris Hani Baragwanath Academic Hospital in Soweto, SA, and to compare the nutritional status of infants <18 months of age who were HIV-unexposed, HIV-exposed but uninfected (HEU) or HIV-infected.
Methods. A cross-sectional nutritional survey was conducted on 222 admitted children. A total of 139 infants were <18 months of age.
Results. Stunting was the most common form of malnutrition (40.5%), followed by underweight-for-age (33.3%) and wasting (23.4%). Of 175 children aged <5 years, 22 (12.6%) were severely wasted. Twenty-four (10.8%) children were HIV-infected: 6 children were <18 months, 3 were ≥18 months but < 5 years and 15 children were ≥5 years. For children ≤18 months, HEU children (n=56) were significantly more underweight and stunted than their HIV-unexposed peers (n=77); weight-for-age and height-for-age median z-scores for these groups were -1.81 v. -0.63 (p=0.0038) and -2.51 v. -0.51 (p=0.004), respectively.
Conclusion. Malnutrition is prevalent in hospitalised children, with stunting being the most common form. The prevalence of HIV-infection is decreasing in younger children, but HEU children, who constitute a large proportion of total hospital admissions, have high rates of malnutrition, especially stunting.
Source: South African Journal of Child Health 8, pp 117 –118 (2014) http://dx.doi.org/10.7196/SAJCH.637More Less
Isolated left ventricular non-compaction (LVNC) is a rare congenital disorder caused by failure of normal embryogenesis of the endocardium and myocardium in utero, resulting in prominent ventricular trabeculations with deep intertrabecular recesses. Patients may be asymptomatic or may present with refractory cardiac failure. The best modality of diagnosis is based on echocardiographic diagnostic criteria. Prognosis remains poor for patients with impaired systolic left ventricular function, as treatment options are very limited. We report the case of 2-month-old infant presenting with congestive cardiac failure diagnosed as isolated LVNC on echocardiography.
Source: South African Journal of Child Health 8, pp 119 –121 (2014) http://dx.doi.org/10.7196/SAJCH.646More Less
Background. Oral and nappy Candida infections are common in neonates and infants, but candidaemia and its consequences are more often seen in children with risk factors for immunosuppression. This case presentation illustrates that exposure to HIV, without infection, should be considered one of those risk factors.
Objectives. To determine whether HIV-exposed, but uninfected, children have immune dysfunction that could alter their disease profile, and to elucidate the interactions of the gastrointestinal tract (GIT) with Candida infections.
Methods. Keywords/key phrases searched on databases were: candidiasis; GIT and Candida; HIV-exposed infants; immunity and HIV-exposed neonates.
Results. Several detailed original studies confirm an impaired immunological response in neonates and infants born to HIV-infected mothers. Impairment extends to children born to mothers on antiretroviral medication. The duration of immune dysfunction is unclear, but it appears to persist for several years. Homeostasis of the GIT is essential in order to prevent the translocation of Candida into the bloodstream. GIT immunity plays a critical role in the clearance of fungi. The HI virus interferes negatively with this ability.
Conclusion. If HIV-exposed but uninfected children have a degree of immunodeficiency, then the risk of opportunistic infections is higher than in HIV-unexposed uninfected children. The clinician should bear this in mind when these patients present, in order to decrease the morbidity and mortality associated with delayed diagnosis and treatment of candidaemia.