South African Journal of Child Health 2019-02-26T11:42:19+00:00 Dankwart Wittenberg Open Journal Systems The SAJCH is a quarterly, peer reviewed, medical child health journal. <p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> Editorial: Children’s oral health in South Africa: Time for action 2019-02-26T11:42:09+00:00 M Molete No Abstract 2019-02-26T00:00:00+00:00 Copyright (c) Non-ketotic hyperglycaemia and the hemichoreahemiballismus syndrome – a rare paediatric presentation 2019-02-26T11:42:10+00:00 M.P.K. Hauptfleisch J.L. Rodda <p>Hemichorea-hemiballismus may be due to non-ketotic hyperglycaemia, but this condition has rarely been described in paediatrics. We describe the case of a 13-year-old girl with newly diagnosed type 1 diabetes and acute onset of left-sided choreoathetoid movements. Neuroimaging revealed an area of hyperintensity in the right basal ganglia. Her blood glucose level at the time was 19 mmol/L, and there was no ketonuria. The hemiballismus improved with risperidone and glycaemic control. Repeat neuroimaging 4 months later showed complete resolution of the hyperintensities seen.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Impact of atopic dermatitis on the quality of life of Nigerian children: A hospital-based cross-sectional study 2019-02-26T11:42:11+00:00 O.T. Puddicombe O.A. Odusote F.E.A. Lesi A.O. Ayanlowo <p><strong>Background.</strong> Atopic dermatitis (AD) is the most common inflammatory skin disease in childhood. A skin disorder with a relapsing course, AD exerts a significant disease burden on affected children. However, there is a dearth of knowledge about the impact of AD on the quality of life (QOL) of affected children in Nigeria.</p><p><strong>Objectives.</strong> To examine the impact of AD on QOL in children of various age groups, and to identify the relationship between patient variables (age, gender, socioeconomic status), disease severity and QOL in AD.</p><p><strong>Method.</strong> This was a cross-sectional descriptive study of children with AD attending the dermatology clinic of Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. AD cases were recruited from new paediatric patients ≤16 years who attended the clinic over a 6-month period. English and Yoruba versions of the Infants’ Dermatitis Quality of Life Index (IDQOL) and the Children’s Dermatology Life Quality Index (CDLQI) were used to determine the QOL of the subjects. AD severity was evaluated using the Objective SCORing of Atopic Dermatitis (obj-SCORAD) index.</p><p><strong>Results.</strong> Forty-seven subjects with AD were identified. Their ages ranged from newborn to 16 years. The median(interquartile range (IQR)) IDQOL score was 6.0 (3.0 - 15.5;<em> n</em>=25), and the median (IQR) CDLQI score was 9.5 (7.75 - 17.75; <em>n</em>=22). The mean (standard deviation) obj-SCORAD score was 34.4 (17.2). The question on itching was the highest-scoring question in both QOL questionnaires. There was no significant difference in QOL across age, gender and socioeconomic status groups. However, greater QOL scores were significantly correlated with higher AD severity scores.</p><p><strong>Conclusion.</strong> The study confirms that AD impairs the QOL of affected children in all age groups. QOL assessments are relevant tools which provide a patient’s perspective, thus improving the understanding of the impact of AD on afflicted individuals.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Factors underlying the changing of antibiotics in a paediatric intensive care unit in Pietermaritzburg, KwaZulu-Natal 2019-02-26T11:42:12+00:00 A Vather N.H. McKerrow M.E. Morgan <p><strong>Background.</strong> Antibiotics are among the most commonly used drugs in a paediatric intensive care unit (PICU). Despite guidelines and protocols for the use of antibiotics, inappropriate use may contribute to an increase in antibiotic resistance. The factors behind changes in antibiotic prescriptions in the PICU at Grey’s Hospital are unknown.</p><p><strong>Objective.</strong> To establish the frequency, process and rationale behind antibiotic prescription changes in the PICU.</p><p><strong>Methods.</strong> A retrospective descriptive study of all eligible patients admitted to the PICU during a 6-month period.</p><p><strong>Results.</strong> Three-quarters of patients admitted to the PICU received antibiotics during their stay. The antibiotic prescription was changed in 80 (58%) of the138 patients, with most changes (63.4%) occurring within 3 days of admission. Patients younger than 1 year and those who were malnourished accounted for 57% of the changes. The majority (65%) of the changes entailed the escalation of antibiotics and 89% of these were empiric therapy. De-escalation accounted for 35% of the changes. The rationale for a prescription change was not documented in 80% of cases.</p><p><strong>Conclusion.</strong> Antibiotic use in this PICU and changes to prescriptions were common. Changes were generally made on an empirical basis soon after admission and were more likely to occur in young malnourished children and patients admitted for a medical reason or surgical emergency.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Family environment, socioeconomic conditions and childhood health and wellbeing in informal settlements in Mozambique 2019-02-26T11:42:13+00:00 B.M. Cau <p><strong>Background.</strong> A possible relationship between slum residence and children’s health and wellbeing in sub-Saharan Africa has been relatively under-researched.</p><p><strong>Objective.</strong> To investigate the relationship between the type of area of residence and children’s and adolescents’ health and wellbeing in urban Mozambique.</p><p><strong>Methods.</strong> Descriptive and logistic regression techniques were employed on data from 1 913 children and 798 adolescents, to analyse several key outcomes.</p><p><strong>Results.</strong> The descriptive findings indicate that children in slum areas are the most disadvantaged, followed by those in quasi-slum areas, in terms of school enrolment, health and the type of care received in the home. Similar descriptive results were found for the adolescents’ outcomes. Multivariate analyses showed that compared with children in slum areas, those in non-slum areas were more likely to be attending school (odds ratio (OR) 4.22; confidence interval (CI) 1.73 - 10.31), less likely to be typically sick (OR 0.26; CI 0.14 - 0.47) and less likely to be left alone in the household (OR 0.29; CI 0.18 - 0.48). Adolescents in non-slum areas tended to have completed ≥6 years of education (OR 3.01; CI 1.78 - 5.07), to be aware of HIV/AIDS programmes (OR 4.29; CI 2.43 - 7.55), to believe that HIV/AIDS may be transmitted through unprotected sex (OR 13.01; CI 3.76 - 45.02) and to have parents or caregivers who had ever talked to them about matters related to sex (OR 3.15; CI 1.76 - 5.65). Family structure and sowcioeconomic characteristics, together, account for most of the differences between slum and quasi-slum areas, particularly for children’s outcomes.</p><p><strong>Conclusion.</strong> The health and the wellbeing of children and adolescents in slums is negatively affected, compared with other urban places in Mozambique. However, for children, family structure and other socioeconomic factors remove most slum/quasi-slum effects.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Feeding patterns of infants admitted with lower respiratory tract infections in an HIV-endemic area 2019-02-26T11:42:14+00:00 S Muhomud K.L. Naidoo V Naidoo R Masekela <p><strong>Background.</strong> Lower respiratory tract infections (LRTIs) remain a major cause of mortality and morbidity in infants in South Africa (SA). Exclusive breastfeeding has been shown to decrease mortality and morbidity in infants with LRTIs, especially in the context of HIV/AIDS. Major effort has been put into educating HIV-positive mothers on the benefits of exclusive breastfeeding within effective prevention of mother-to-child transmission (PMTCT) programmes.</p><p><strong>Objectives.</strong> To determine the feeding practices among infants admitted with LRTIs in an HIV-endemic area.</p><p><strong>Methodology.</strong> The study was a retrospective chart review of all infants admitted with a diagnosis of LRTI between 1 January 2015 and 31 December 2015 at King Edward VIII Hospital, Durban, SA. Data on feeding patterns, socioeconomic status, maternal HIV status and clinical outcomes of LRTI admissions were collected.</p><p><strong>Results.</strong> Of the 308 infants enrolled, 63% were male. Exclusive breastfeeding rates of those aged &lt;6 months with LRTIs were higher than those found in previous studies; however, these feeding patterns were significantly associated with the HIV status of the mother (<em>p</em>=0.003). Mothers who were HIV-negative were twice as likely to breastfeed as those who were HIV-positive (odds ratio 2.25; 95% confidence interval 1.32- 3.88). There was no association between the type of feeding and the clinical outcomes for LRTIs.</p><p><strong>Conclusion.</strong> Maternal HIV status influenced the feeding patterns of infants admitted with LRTIs with lower exclusive breastfeeding rates in the HIV-exposed group. Despite extensive efforts to promote breastfeeding within effective PMTCT programmes, HIV-positive mothers are still not harnessing the benefits that exclusive breastfeeding provides.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Universal newborn hearing screening in public healthcare in South Africa: Challenges to implementation 2019-02-26T11:42:15+00:00 J.K. Bezuidenhout K Khoza-Shangase T de Maayer R Strehlau <p><strong>Background.</strong> The implementation of early hearing detection and intervention (EHDI) remains a challenge in developing countries, despite the known benefits.</p><p><strong>Objectives.</strong> To investigate challenges encountered during implementation of universal newborn hearing screening (UNHS) at a secondary level public hospital in Johannesburg, South Africa. </p><p><strong>Methods.</strong> A prospective cohort study design that assessed the feasibility of conducting UNHS was adopted. This feasibility assessment was conducted during a 3-month period, and all challenges encountered were identified and documented. Screening time was also recorded for each neonate. Data were entered into Excel, and later analysed using Stata version 11.</p><p><strong>Results.</strong> Of 2 740 neonates born during the study period, 490 (17.9%) were identified for screening, and distortion product otoacoustic emissions screening was conducted on 121 (4.4%). The majority (74.4%) were screened in the first 24 hours of life. Repeat screening was required in 57 (47.1%) neonates, but only 20 returned for follow-up. The most important challenges to the feasibility of UNHS implementation were the insufficient number of audiologists available to provide screening, the high rate of false positive test results and the unacceptably high rates of loss to follow-up. Two modifiable factors, namely the presence of vernix caseosa in the external ear canal and high ambient noise levels, were found to have significantly influenced the screening process.</p><p><strong>Conclusion.</strong> The identified challenges are important considerations for any successful implementation of universal screening protocols. Careful planning to mitigate the challenges will have a positive impact on EHDI initiatives in these contexts.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Red blood cell concentrate transfusion strategies utilised at a tertiary-level paediatric intensive care unit: A descriptive study on impact and cost 2019-02-26T11:42:16+00:00 P.B.S. Radebe P.M. Jeena <p><strong>Background.</strong> Optimal haemoglobin threshold for red blood cell (RBC) transfusions in critically ill anaemic children in a paediatric intensive care unit (PICU) is uncertain.</p><p><strong>Objective.</strong> To describe outcomes and costs associated with different RBC transfusion strategies in anaemic patients admitted to a tertiary PICU in Durban, South Africa.</p><p><strong>Methods.</strong> Transfusion data gathered over a 1-year period were analysed retrospectively. RBC transfusion strategies were classified as restrictive, ‘modified liberal’ or mixed. The ‘modified liberal’ group was subdivided into haemodynamically stable or unstable clusters. Transfusion-related effects, comorbidities and mortality were described. Costs associated with RBC transfusions in the various strategy groups were analysed.</p><p><strong>Results.</strong> Over the 118 transfusion records analysed, a restrictive strategy was adopted in 27 cases (22.9%) and a modified liberal strategy was used in 68 cases (57.6%). A mixed strategy was followed in 23 (19.5%) cases. Although mortality was higher in the modified liberal group than in the restrictive group (27.9% v. 11.1%), the difference was not statistically different (<em>p</em>=0.09). There were no differences in the duration of intermittent positive pressure ventilation, length of PICU stay or post-transfusion effects between the restrictive and modified liberal transfusion strategies. A saving of R155 280.15 could have been realised if a restrictive transfusion strategy had been used for haemodynamically stable patients assigned to the modified liberal group. A further R28 988.67 was spent on avoidable after-hours transfusions levies.</p><p><strong>Conclusion.</strong> Adopting a restrictive daytime strategy for RBC transfusions at a PICU could introduce considerable cost savings without affecting outcomes.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Enteric pathogen co-infections in the paediatric population from rural communities in the Vhembe District, South Africa 2019-02-26T11:42:17+00:00 S.E. Ledwaba J.P. Kabue T.G. Barnard A.N. Traore N Potgieter <p><strong>Background.</strong> Enteric pathogens co-infections are a serious health risk in children under the age of 5 years.</p><p><strong>Objective.</strong> The study aimed to determine the prevalence of diarrhoea-causing pathogens in children suffering from diarrhoea in rural communities of the Vhembe District.</p><p><strong>Methods.</strong> A cross-sectional study was conducted from July 2014 to June 2015. Diarrhoeal stool specimens (N=237) were collected from children attending primary healthcare facilities in rural communities of the Vhembe District. Stools were screened for enteric viral adenovirus 40/41, rotavirus and norovirus pathogens by means of enzyme immuno-assay (EIA) and enteric bacterial <em>Escherichia coli</em> spp. (diarrhoeagenic pathotypes),<em> Shigella</em> spp., <em>Salmonella</em> spp. and <em>Vibrio</em> spp. pathogens by means of multiplex polymerase chain reaction.</p><p><strong>Results.</strong> A total of 59.1% (140/237) were positive for at least one or more enteric pathogens. Enterotoxigenic <em>E. coli</em> (ETEC) (27.9%), enteroaggregative<em> E. coli</em> (EAEC) (26.8%) and atypical enteropathogenic <em>E. coli</em> (EPEC) (17.9%) were frequently detected in children less than 2 years of age. Bacterial-bacteria co-infections were detected in 24.5% (<em>n</em>=58) and bacterial-viral co-infections in 14.3% (<em>n</em>=34) of the stool specimens.</p><p><strong>Conclusion.</strong> The findings indicated that enteric pathogen co-infections are major causes of diarrhoea in children less than 2 years of age in the Vhembe District.</p> 2019-02-26T00:00:00+00:00 Copyright (c) Hypoxic-ischaemic encephalopathy: Identifying newborns who will benefit from therapeutic hypothermia in developing countries 2019-02-26T11:42:18+00:00 M Coetzee <p>Hypoxic-ischaemic encephalopathy (HIE) is only one of the many causes of neonatal encephalopathy, with no definitive test to make the diagnosis and very little available in terms of neuroprotective strategies, except for the use of therapeutic hypothermia (TH). TH improves survival and neurodevelopmental outcome at 18 months of age in neonates with moderate or severe encephalopathy. Based on this evidence, the International Liaison Committee on Resuscitation has recommended TH as standard of care since 2010. Low-cost methods of administering TH in low- and middle-income countries are effective as long as intensive care facilities are available, and provided that a TH guideline based on published international trials is in place. A local guideline, taking into consideration the care capable at different hospital levels, would be valuable in a developing country with resource constraints and increasing litigation.</p> 2019-02-26T00:00:00+00:00 Copyright (c)