Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 10 num. 1 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>A global consensus on the prevention and management of nutritional rickets: How does this change policy in South Africa?</b>]]> <![CDATA[<b>Mothers' reasons for refusing to give consent to HIV testing and the outcome in the children</b>]]> BACKGROUND: HIV/AIDS is one of the most common underlying causes of death in children between the ages of 3 months and 5 years in sub-Saharan Africa. In Limpopo Province, South Africa, the prevention of mother-to-child transmission (PMTCT) programme introduced in early 2000 and paediatric ARV roll-out have had a poor uptake due to various factors. OBJECTIVE: To establish the reasons why mothers decline HIV testing for their children. METHODS: A cross-sectional descriptive study was conducted at the paediatric ward, Mankweng Hospital, Limpopo, for a period of 1 year (June 2009 - June 2010). All mothers who had declined HIV testing on their children were requested to participate. All the participants gave informed consent. RESULTS: A total of 30 mothers participated. All women had attended antenatal care, 28 (93%) stated that their HIV results were negative and 2 (8%) had undergone PMTCT. The reasons mothers refused HIV testing on their children included the following: did not want to be stressed with a positive result (67%), did not want to know their status (7%) and could not consent as their partners had declined tests on both baby and mother (7%); 20% had other reasons including fear of HIV stigma. The median age of the children was 13 months (interquartile range 2 months - 10 years). Twenty-one (70%) of children were discharged home after treatment without HIV testing, five (16%) mothers signed refusal of hospital treatment, three (12%) started ARV after the mother reconsidered and signed consent, with good response to highly active antiretroviral treatment (HAART) and one child died after a month in the hospital. CONCLUSION: Fear of being stressed by a positive result was the main reason mothers refused an HIV test on their children. Better education about HIV transmission, prevention and the good response to HAART is needed to increase the uptake of HIV testing and antiretroviral therapy. <![CDATA[<b>A comparison of clinician and caregiver assessment of functioning in patients attending a child and adolescent mental health clinic in Nigeria</b>]]> OBJECTIVE: To compare clinician and caregiver assessments of functioning and impairment among children attending a specialist mental health facility. METHODS: Caregivers of patients attending the Harvey Road Child and Adolescent Centre (N=155) were consecutively recruited over a 1-month period. The caregivers were requested to fill in a sociodemographic questionnaire, the Columbia Impairment Scale (CIS), the 12-item version of the General Health Questionnaire (GHQ-12) and the Zarit Burden Interview. Scoring on the Children's Global Assessment Scale (CGAS) was done by clinicians. RESULTS: The mean (standard deviation (SD)) age of patients and caregivers was 12.3 (4.9) years and 41.5 (8.9), respectively. Mean (SD) scores on the CGAS and CIS were 55.3 (22.8) and 16.4 (14.3), respectively, while mean scores on the Zarit Burden Interview and the GHQ were 27.9 (17.2) and 2.5 (2.6), respectively. Poorer clinician-rated functioning was associated with lower educational level of the child, a main diagnosis other than seizure disorder, longer duration of illness, and presence of comorbidity. Worse caregiver rating of impairment was equally associated with lower child education, and main diagnosis other than seizure disorder. Both CGAS and CIS scores showed significant correlation with Zarit and GHQ scores. Finally, a significant correlation was found between CGAS and CIS scores (r=-0.388, p<0.001). CONCLUSION: Children attending specialist neuropsychiatric services have functional impairment which may be associated with lower child education, and which is linked with increased caregiver burden and psychiatric morbidity. <![CDATA[<b>Prevalence of positive coeliac serology in a cohort of South African children with type 1 diabetes mellitus</b>]]> BACKGROUND: Coeliac disease (CD) is characterised by immune-mediated damage to the mucosa of the small intestine. Both CD and type 1 diabetes (T1D) have common auto-immune origins. Many patients with CD and T1D are asymptomatic or present with only mild symptoms; hence early diagnosis may only be facilitated by serological screening. Distal duodenal biopsy remains the gold standard for confirming the diagnosis. OBJECTIVE: To describe the prevalence of CD in T1D patients presenting to the paediatric endocrine service at Inkosi Albert Luthuli Central hospital (IALCH) in Durban and document the relationship between positive coeliac serology and small-bowel biopsy results. METHODS: A retrospective chart review was done at IALCH, the paediatric tertiary referral centre for KwaZulu-Natal (KZN) Province. The study sample included all patients with newly diagnosed T1D diagnosed between January 2008 and December 2011. RESULTS: A total of 120 newly diagnosed T1D patients were included in the study, of whom 49 (40.8%) were coeliac serology positive and 61 (50.8%) serology negative. There was no significant difference between the two groups regarding mean age of presentation with diabetes, race, sex, urban v. rural origin and baseline anthropometric measurements. Of patients in the serology-positive group, 97.6% had no symptoms suggestive of CD. Of the 49 patients who were coeliac serology positive, 8 (16%) were biopsied: 3 (37.5%) were positive, 1 (12.5%) had intra-epithelial lymphocytes and 4 (50%) were negative. There was a strong positive correlation between biopsy results and titres of endomysial antibody results (p=0.047). CONCLUSION: There is a high prevalence of coeliac serology positivity in newly diagnosed T1D patients in KZN. This study provides evidence for screening of children with T1D for CD, and also confirms the low prevalence of symptoms. <![CDATA[<b>Effect of community integrated management of childhood illness on mothers' healthcare-seeking behaviour and home management of childhood illness in Ile-Ife, South-West Nigeria: A household survey</b>]]> BACKGROUND: Care-seeking interventions, as part of community integrated management of childhood illness (CIMCI), have the potential to substantially reduce child mortality in countries where common childhood illnesses are a major problem. Prompt and appropriate care-seeking practices are important to avoid many deaths attributed to delays in or not seeking care, particularly in developing countries such as Nigeria. OBJECTIVE: To assess the effect of community-level intervention on mothers' care-seeking behaviour for common childhood illnesses and related influencing factors. METHODS: The study had a comparative cross-sectional design and was conducted in two local government areas (LGAs) of Osun State, South-West Nigeria. A total of 722 mothers of index children aged <5 years were selected through a multistage cluster sampling technique. Data were collected and analysed using SPSS version 16.0. Descriptive, bivariate and multivariate analyses were performed. RESULTS: Care-seeking for children who reported illness was higher in the CIMCI-implementing LGA (90.2%) compared with 74.8% in the non-implementing LGA (p=0.002). Care was sought within the first 48 hours of perceived onset of illness for 83.2% and 57.9% of sick children in the CIMCI-implementing and non-implementing LGAs, respectively. Residing in a CIMCI-implementing area (odds ratio (OR) 2.54, 95% confidence interval (CI) 1.24 - 5.45) and maternal education level (OR 1.50, 95% CI 1.06 - 3.03) were identified as predictors of healthcare-seeking practices among mothers. CONCLUSION: The study concluded that a high level of care-seeking behaviour exists where community-level intervention was operating. Therefore the CIMCI programme should be strengthened further and also scaled up to include non-implementing communities. <![CDATA[<b>Audiological findings in a group of neurologically compromised children: A retrospective study</b>]]> BACKGROUND: Hearing loss is more prevalent in developing countries. Later diagnosis ofhearing loss will result in delayed access to rehabilitation. It is typically more difficult to obtain subjective information required in a hearing test from neurocompromised children, causing audiologists to frequently turn to objective measures such as the auditory brainstem response (ABR) measure to obtain this information. OBJECTIVE: To describe the ABR results in a group of neurologically compromised children and to establish a relationship between ABR findings and behavioural audiometry results, where these existed. METHODS: A retrospective review was conducted on 40 ABR patient records of neurologically compromised participants aged 5 months to 10 years. Behavioural audiometry results were sought where these existed. Hearing status was described per ear for objective and behavioural results, and descriptive statistics were conducted. RESULTS: Behavioural audiometry results were obtained in 72.5% of ears. Results correlated between ABR and behavioural audiometry for only 7.5% of ears, which were all diagnosed with normal hearing. About12.5% of ears were misdiagnosed with behavioural audiometry. Premature infants were most likely to cope with behavioural audiometry. Hearing loss was highest in participants with cerebral palsy, Down syndrome, prematurity and retroviral disease. CONCLUSIONS: Behavioural audiometry appears to be a largely unreliable method of testing the hearing of children diagnosed with neurological disorders, as results were obtained in only 27.5% of the study sample; however, it remains the gold standard in paediatric hearing testing to evaluate the entire auditory system and provides information on how a child processes sound. Hearing thresholds should be established via objective testing. Conditioning should continue for a behavioural audiological test battery, with adaptations for the child's developmental ability. <![CDATA[<b>Risks for communication delays and disorders in infants in an urban primary healthcare clinic</b>]]> BACKGROUND: Many risk factors may result in a communication delay. Reliable identification methods are essential to identify infants at risk of communication difficulties in the primary healthcare context. Literature on identifying both at-risk and established risk factors associated with communication disorders in South Africa is limited. OBJECTIVE: To identify and describe risk factors for communication delays in infants 0 - 12 months of age at Daspoort Polyclinic in Gauteng. METHODS: A structured interview schedule was utilised to conduct an interview with the caregiver participants. Convenience sampling was used to select 96 caregiver participants. RESULTS: The results obtained indicated that all infant participants presented with exposure to one or more risk factors that may possibly impact communication development. High frequencies of risk factors included colds and/or flu during pregnancy, previous miscarriages, maternal smoking, low educational levels and unemployment. CONCLUSION: The high frequency of at-risk conditions within the Daspoort population justifies the importance of implementation of early communication intervention services in primary healthcare. <![CDATA[<b>Haemophilia: A disease of women as well</b>]]> BACKGROUND: While haemophilia is a disease phenotype in males only, it has an effect on females too. In South Africa, there is no documentation on the views and experiences of haemophilia carrier mothers regarding the disease, or about their response to carrier testing for daughters or other female members of their families. The burden of child care may fall entirely on the mother in some cultures, and having a son with haemophilia may make coping difficult. Knowing their carrier status would allow daughters of carrier mothers to be aware of the chances of themselves having a son with haemophilia. Knowing their own factor levels may also be useful in understanding possible excessive bleeding in themselves. OBJECTIVES: To record the experiences of haemophilia carrier mothers in KwaZulu-Natal and their attitudes and opinions on carrier testing for female members of their families. METHODS: Forty mothers ofhaemophiliac sons were interviewed using a structured questionnaire specifically designed and tested for this study. RESULTS: From this cohort, there were 21 potential carrier daughters and 25 potential carrier sisters who would be eligible for further testing and counselling. All the study participants expressed their desire to have carrier testing available for female family members. They also expressed their concerns regarding raising a son with haemophilia, including some culture-specific issues. CONCLUSION: A diagnosis of haemophilia carriership is seen by mothers of haemophiliac sons as important for female members of their families. A protocol for the care of haemophilia carrier women is therefore necessary. <![CDATA[<b>Serious bacterial infections in febrile young children: Lack of value of biomarkers</b>]]> BACKGROUND: Serious infections in children are difficult to determine from symptoms and signs alone. Fever is both a marker of insignificant viral infection, as well as more serious bacterial sepsis. Therefore, seeking markers of invasive disease, as well as culture positivity for organisms, has been a goal of paediatricians for many years. In addition, the avoidance of unnecessary antibiotics is important in this time of emerging multiresistant micro-organisms. OBJECTIVE: To ascertain whether acute-phase reactant tests predict positive culture results. METHODS: A prospective, cross-sectional study over a 1-year period included all documented febrile children under the age of 5 years (with an axillary temperature >38°C) who presented to Steve Biko Academic Hospital, Pretoria, with signs and symptoms of pneumonia, meningitis and/or generalised sepsis. Every child had clinical signs, chest radiograph findings, urine culture, blood testing (full blood count, C-reactive protein, procalcitonin) and blood culture results recorded. RESULTS: A total of 63 patients were enrolled, all of whom had an axillary temperature >38°C. C-reactive protein, procalcitonin and white cell count did not predict the presence of positive blood culture or cerebrospinal fluid culture results, nor infiltrates on chest radiographs. No statistically significant correlations were found between the duration of hospital stay and the degree of fever (p=0.123), white cell count (p=0.611), C-reactive protein (p=0.863) or procalcitonin (p=0.392). CONCLUSION: Biomarkers do not seem to predict severity of infection, source of infection, or duration of hospitalisation in children presenting to hospital with fever. The sample size is however too small to definitively confirm this viewpoint. This study suggests that clinical suspicion of serious infection and appropriate action are as valuable as extensive testing. <![CDATA[<b>Selected facets of nutrition during the first 1 000 days of life in vulnerable South African communities</b>]]> BACKGROUND: Optimal nutrition during the first 1 000 days of life can reap lasting benefits throughout life OBJECTIVES: To assess infant and young child-feeding (IYCF) practices and mother/caregiver-child anthropometry in two vulnerable Breede Valley communities, Western Cape. METHODS: Mothers of children aged 0 - 23 months (N=322) were interviewed to assess IYCF practices. Anthropometric measurements of mothers/caregivers and children were performed according to standard procedures. RESULTS: Mothers reported early breastfeeding (BF) initiation in 75.2% (242/322) of cases. Of infants <6 months old, 38.5% (45/117) were recorded as exclusively breastfed (EBF). Cross-checking this figure with other research from the area, however, suggests significant over-reporting of EBF. One in five infants <6 months were exclusively bottle fed (19.7%; 23/117) and 48.4% (156/322) aged 0 - 23 months had received bottle feeding in the preceding 24 hours. Eighty-four percent (36/43) of 6 - 8-month-old infants were receiving complementary foods. BF was continued in 32.5% (13/40) of children 12 - 15 months old. In children 6 - 23 months, 44.0% (90/205) received foods from four or more food groups, 71.0% (145/205) received complementary foods the recommended minimum number of times or more, and 44.4% (91/205) received a minimum acceptable diet. The prevalence of stunting and overweight in children was 28.9% and 21.8%, respectively. The prevalence of overweight in mothers/caregivers was 28.9%, and 33.7% were obese, with a mean waist circumference of 88.6 cm CONCLUSION: Indicators showed sub-optimal IYCF practices with child under- and overnutrition coexisting with maternal/caregiver overnutrition. This profile signals a need for urgent and appropriate interventions focusing on the first 1 000 days of life. <![CDATA[<b>A 3-year survey of acute poisoning exposures in infants reported in telephone calls made to the Tygerberg Poison Information Centre, South Africa</b>]]> BACKGROUND: Infants undergo rapid development changes and are particularly vulnerable to toxic chemicals. Identifying and evaluating the toxic risks that exist in this age group could be very valuable when making recommendations on how to prevent specific types of poisoning. OBJECTIVES: This study analysed the toxic substances responsible for acute poisoning exposures in infants (<1 year of age) as well as the severity of the exposures. METHODS: A retrospective analysis of the Tygerberg Poison Information Centre (TPIC) database was conducted over a 3-year period (1 January 2011 to 31 December 2013). Descriptive statistics are provided for the entire study population as well as for the neonatal subgroup (<30 days old). RESULTS: The TPIC handled 17 434 consultations during the 3-year study period. Infants were involved in 1 101 cases (6.3%), of which 46 cases (4.2%) were neonates. Most enquiries about infants were associated with non-drug chemicals (n=824, 74.8%). Pharmaceuticals were involved in 185 cases (16.8%) followed by biological exposures (e.g. snake and spider bites, scorpion stings, plant and mushroom poisonings) (n=109, 9.9%). Most infants (n=987, 89.6%) presented with no or only minor symptoms. In neonates, 17 (37.0%) presented with moderate to severe toxicity. Six of these (35.3%) were poisoned by complementary and alternative medicines. CONCLUSION: Most poisoning exposures in infants are not serious and can be safely managed at home after contacting a poison centre. Identification and documentation of poisoning in this special population is of great importance. <![CDATA[<b>Exploring sibling attitudes towards participation when the younger sibling has a severe speech and language disability</b>]]> BACKGROUND: Typically developing children who have a younger sibling with a disability often feel inadequately supported and excluded from family interactions. However, early intervention programmes often use family activities and routines as intervention settings. Siblings' negative attitudes towards participation in such activities may therefore hamper intercession efforts. OBJECTIVE: To determine the attitudes of typically developing children toward their younger siblings with severe speech and language disabilities in four everyday life situations identified by the World Health Organization's International Classification of Functioning, Disability and Health: Children and Youth Version, namely communication, domestic life, interpersonal interaction and relationships, and major life areas. METHODS: An adapted structured interview format was used to determine the attitude of the 27 participants, 6- to 10-year-old typically developing South Africans. RESULTS: Typically developing peers were most positive towards participation in play activities with their sibling with a disability. They were also positive towards participation in household tasks. They were less positive towards communication participation and least positive about participation in interpersonal relationships. A significant difference between certain components of attitudes was reported for three of the four domains. CONCLUSION: The attitudes of typically developing children are generally positive towards participating with their younger siblings with severe speech and language disabilities. These results can be used to select activities for activity-based interventions and to guide interventions aimed at supporting the siblings of children with disabilities. <![CDATA[<b>Childhood and adolescent fatalities at the Pretoria Medico-Legal Laboratory: 2005 - 2009</b>]]> BACKGROUND: Children and young adults are particularly vulnerable to intentional and accidental fatal injuries. The majority of deaths in Africa in children <5 years of age are due to infectious diseases. Road traffic fatalities constitute a large proportion of deaths in children and young adults worldwide. OBJECTIVE: To evaluate the demographic details, external cause/circumstance of death and manner of death in children and young adults admitted to the Pretoria Medico-Legal Laboratory (PMLL). METHODS: A retrospective case audit was conducted on all persons aged 1 - 20 years admitted to the PMLL from January 2005 through December 2009. RESULTS: A total of 965 cases were identified. Childhood deaths constituted 7 - 9% of all cases admitted. The majority were aged between 16 and 20 years (42%), followed by children aged between 1 and 5 years (33%). The most common cause of death was injury due to road traffic accidents (this was present in all age groups). CONCLUSION: Children and young adults contribute a relatively large number of admissions to the medico-legal mortuary. The majority of these deaths are accidental. Many of the accidents could have been prevented with stricter legislation with regard to transportation of children and safety surrounding swimming pools. <![CDATA[<b>Factors present on admission associated with increased mortality in children admitted to a paediatric intensive care unit (PICU)</b>]]> BACKGROUND: The admission of children to an intensive care unit (ICU) necessitates the selection of children who will benefit most from scarce ICU resources. Decisions should be based on objective data available on outcomes related to particular conditions and resource availability. OBJECTIVE: To determine which sociodemographic factors and paediatric scoring systems can be used on admission to identify patients who would derive the most benefit. METHODS: A retrospective review was undertaken of the charts of children admitted to a paediatric ICU (PICU) over a 6-month period. Charts were analysed according to health status, biographical and demographic data, as well as Pediatric Risk of Mortality (PRISM), Pediatric Logistic Organ Dysfunction (PELOD) and Paediatric Index of Mortality 3 (PIM3) scores to determine which factors were associated with an increased mortality risk. RESULTS: Two hundred and two children were admitted during the study period. Ninety-six children were included in the study, 79 files were not found and 27 children were ineligible. The median age was 14 months and the mortality rate was 15.6%. The significant factor associated with mortality was severe malnutrition. In total 88% of required data were available for the calculation of both the PRISM and PELOD scores and 95% for PIM3 score. The PRISM, PELOD and PIM3 standardised mortality ratios were 2.5, 4.8 and 2.9, respectively. P-values for PRISM, PELOD and PIM3 were <0.05. CONCLUSION: Severe malnutrition is a statistically significant factor in predicting mortality. This possibly reflects the social context in which the children live. PRISM, PELOD and PIM3 underpredict mortality in our setting. A larger sample is required to verify these outcomes and to determine whether other factors play a role. <![CDATA[<b>The association between chronic undernutrition and malaria among Ethiopian children aged 6 - 59 months: A facility-based case-control study</b>]]> BACKGROUND: Malaria and undernutrition remain two major causes of childhood mortality in sub-Saharan Africa, including Ethiopia. The synergetic relationship between undernutrition and infection is widely documented but the relationship with malaria remains controversial. More studies are needed to address this and provide information to develop effective strategies for malaria control and prevention of undernutrition. OBJECTIVE: To assess the relationship between malaria and chronic undernutrition in children aged 6 - 59 months at Bahir-Dar special zone, Ethiopia. METHODS: A facility-based case-control study was employed to assess the relationship between malaria and chronic undernutrition at Bahir-Dar. A total of 621 children aged between 6 and 59 months, with a 1:3 ratio of confirmed malaria cases to controls, were enrolled. Clinical data and anthropometric measurements were taken, and blood film taken and examined. Anthropometric data were converted into nutritional indices using World Health Organization Anthro software version 3.2.2 and exported to SPSS for cleaning and analysis. RESULTS: Prevalence of stunting and underweight was 50.3% and 34.2% among cases, respectively. Stunting and underweight were significantly associated with confirmed cases of malaria after sociodemographic and other variables were controlled. Other important predictors were rural residence, sleeping under long-lasting impregnated nets, and using indoor residual spray. CONCLUSION: Chronic undernutrition was closely associated with malaria infection. Major predictors for contracting malaria were stunting, underweight, rural residence, not using long-lasting impregnated nets and indoor residual spray, male sex and low educational status of mother/caregiver. Integrated actions targeting these factors are necessary to reduce the prevailing problem. <![CDATA[<b>Epidemiology of paediatric poisoning reporting to a tertiary hospital in Ghana</b>]]> BACKGROUND: Childhood poisoning is an important cause of morbidity in both developed and developing countries. Epidemiological studies on accidental poisoning in children show a consistent pattern regarding age and gender. Childhood poisoning is predominant in children <6 years of age and has a male preponderance, as boys are more active with a drive to explore the environment. OBJECTIVE: To document the epidemiology of home poisonings in Kumasi and its environs. METHODS: We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana RESULTS: Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61-month period, with an average of four cases per month. The male to female ratio was 1.58:1. The median age of the children was 24 months (interquartile range 24 - 48 months). Kerosene was the leading cause of poisoning (39.5%). CONCLUSION: Paediatric poisoning is a major health hazard in children living in Kumasi and its environs. This can possibly be attributed to a lack of adequate supervision of children and poor storage of harmful substances in homes. Multidisciplinary interventions are needed to reduce the occurrence of the condition in the population at risk. <![CDATA[<b>An exploratory study of the implementation of early intervention workshops for primary caregivers in Johannesburg</b>]]> BACKGROUND: If primary caregivers are able to stimulate their children's development effectively, then the prevalence of children at risk of cognitive and language developmental delays could decrease and the shortage of available services for the identified children could be addressed, as hopefully fewer children would require extensive early intervention (EI) services later on in life. OBJECTIVE: To develop and implement an EI workshop with primary caregivers on how to provide language and cognitive stimulation through daily living activities (DLAs). METHODS: Two workshops were conducted at two daycare centres, focusing on daily language stimulation, with the primary caregivers of children aged between 0 and 3 years. A pre-workshop, semi-structured group interview was conducted to gain insight into the participants' knowledge and expectations. This was followed with a post-workshop, semi-structured group interview to gain insight into and feedback on how the participants were able to carry over the techniques in order to stimulate their children in DLAs. The data were analysed using thematic data analysis. RESULTS: It was found that although participants demonstrated the basic understanding of the concept of EI, their knowledge improved with the workshop. The participants reported that they were able to implement the techniques gained from the workshop and noticed a change in their children's behaviour and communication within the space of 1 week. The participants also reported on the ease of stimulating their children through DLAs and that no additional time had to be scheduled for stimulation. CONCLUSION: The workshops have the potential to target populations regardless of their socioeconomic status, cultural beliefs, linguistic differences, and access to medical institutions. <![CDATA[<b>Usefulness of ultrasonography and biochemical features in the diagnosis of cholestatic jaundice in infants</b>]]> BACKGROUND: Biliary atresia is a common cause of cholestasis. In our experience, patients with biliary atresia are referred late, with the diagnosis based on an absent gall bladder at ultrasonography. Such late referrals may render patients inoperable and not acceptable for formal intraoperative diagnosis. OBJECTIVES: To determine the usefulness of an absent gall bladder on ultrasonography, and of biochemical features, in differentiating biliary atresia from other causes of cholestasis, using liver needle biopsy as a gold standard. METHODS: A retrospective file review of 150 infants presenting with cholestasis to Steve Biko Academic Hospital Paediatric Gastroenterology and Hepatology Unit from January 2008 to August 2014 was undertaken. Clinical, serum biochemical, abdominal ultrasonography and liver histology findings were analysed. Three groups were compared, based on liver histology findings, consisting of patients with biliary atresia, neonatal hepatitis, and other diagnoses, respectively RESULTS: A total of 66/150 patients had biliary atresia, based on liver histology findings of extrahepatic obstruction. Their mean age was 4.7 (2.9) months, higher than in the other groups. In those with biliary atresia, the age at diagnosis, splenomegaly, and gamma glutamyl transferase (GGT), aspartate transaminase (AST) and GGT/AST ratio values were significantly different from the other groups. Total and conjugated bilirubin levels were similar among the groups. Ultrasonography was 69.7% sensitive, 98.8% specific and had a positive predictive value of 97.9% for biliary atresia. Ultrasonography missed 30.3% of patients with biliary atresia. CONCLUSION: Ultrasonography has poor sensitivity but good specificity in screening for biliary atresia; however, other investigations are necessary to confirm the diagnosis. <![CDATA[<b>An evaluation of the screening for retinopathy of prematurity in very-low-birth-weight babies at a tertiary hospital in Johannesburg, South Africa</b>]]> BACKGROUND: Retinopathy of prematurity (ROP) is a leading cause of blindness for very-low-birth-weight (VLBW, <1 500 g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment. OBJECTIVES: To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines, the grades of ROP found and the treatment modality received. METHODS: This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH, whether inborn or transferred in. The babies were divided into two groups based on age at final outcome. Final outcome was defined as death, discharge or transfer out of the unit. The 'early' outcome group had their final outcome before day 28 oflife. The 'late' outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening. RESULTS: There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1 127 (standard deviation (SD) 244.75) g and gestational age of 29 (2.743) weeks. The mean duration of stay was 29 (21.66) days and there were 309 female babies. Of these 572 babies, 304 comprised the early outcome group and 268 comprised the late outcome group. In the early outcome group babies who were transferred out of the unit or died were excluded; therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included five babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal antivascular endothelial growth factor (VEGF) and three babies required surgery CONCLUSIONS: More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one-third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented; therefore prevalence cannot be established. <![CDATA[<b>Perceptions of community-based human milk banks before and after training in a resource-limited South African setting</b>]]> BACKGROUND: Human breastmilk provides gold standard nutrition and immunological support to infants. For low birth weight, HIV-infected, HIV-exposed or otherwise vulnerable babies, it can mean the difference between life and death. When a mother's own milk is not available, safe, donated human breastmilk is an excellent alternative. High rates of under-5 mortality have prompted the South African (SA) Ministry of Health to commit to scaling up human milk banks in key health facilities. Community-based human milk banks (CBHMBs) have the potential to complement these efforts, but there is little research on the feasibility and acceptability of this approach. OBJECTIVE: To determine mothers' perceptions of breastfeeding and CBHMBs, and to ascertain how training could affect those perceptions. METHODS: A total of 40 black mothers in KwaZulu-Natal, SA, participated in a survey on breastfeeding and human milk banks (HMBs) prior to commencing a breastfeeding peer-counselling training course that included information on HMBs. The survey was re-administered following the completion of the module on HMBs. The questionnaire was repeated ~4 months later. RESULTS: Following training, significant changes were observed in mothers' knowledge and perceptions around donor milk and safety. No significant changes were observed in reports of what these mothers presumed the community's perceptions around donor milk banking were. CONCLUSION: Education of mothers can play an important role in supporting CBHMBs by improving mothers' perceptions and acceptance of breastfeeding, donor milk, and milk banking. Changing community concerns around HMBs will require more than just changing the perceptions of mothers. <![CDATA[<b>Prevalence and nature of communication delays in a South African primary healthcare context</b>]]> BACKGROUND: Communication delays are the most common impairment in early childhood and have a negative effect on long-term academic, psychological and social development. Baseline prevalence of communication delays or disorders enables adequate planning of service delivery and successful implementation of intervention strategies, to reduce disorder prevalence. OBJECTIVE: To determine the prevalence and describe the nature of communication delays in infants aged 6 - 12 months in underserved communities in South Africa (SA). METHOD: A parent interview and the Rossetti Infant-Toddler Language Scale (RITLS) were used to collect data from the caregivers of 201 infants aged 6 - 12 months by means of convenience sampling at primary healthcare facilities in the Tshwane district, SA. RESULTS: Thirteen percent (n=26) of infants were diagnosed with communication delay. Associations affecting language delays were established for three risk factors (i.e. housing status, age of mother and number of siblings). The effect of combined risk factors on language development revealed that an infant was at greatest risk (27% probability) of developing a language delay when: (i) mothers were between the ages of 19 and 34 years; (ii) parents owned their own home; and (in) there were three or more children in the household. CONCLUSION: The prevalence of communication delays in the sample population was high, possibly because the majority of infants were exposed to risk factors. The implementation of preventive measures such as awareness campaigns and developmental screening and surveillance should be considered in the SA primary healthcare context. <![CDATA[<b>An analysis of national data on care-seeking behaviour by parents of children with suspected pneumonia in Nigeria</b>]]> BACKGROUND: Pneumonia is responsible for 940 000 under-5 deaths annually. Most of these deaths result from delays in instituting effective treatment. OBJECTIVES: To determine care-seeking behaviour by parents of children with pneumonia and sociodemographic factors that influence decisions to seek appropriate care. METHODS: The study was an analysis of the Nigeria Demographic and Health Survey 2013, which was a nationwide cross-sectional survey using a stratified cluster design of 40 680 households. All children under-5 living in the surveyed households with suspected pneumonia in the preceding 2 weeks were recruited along with their mothers. Sociodemographic characteristics of the parents and where they sought care for their child were obtained. Binomial logistic regression analysis was used to determine the contribution of various sociodemographic variables to the decision on seeking appropriate medical care RESULTS: Of the 28 950 children surveyed, 565 had suspected pneumonia, which equates to an occurrence rate of 19.5 per 1 000 children. About 36% of parents were judged to have sought appropriate care when their children had pneumonia. High paternal education, health decision-making by both husband and wife, and belonging to the higher quintiles on a wealth index were factors that positively influenced care-seeking behaviour CONCLUSION: Care-seeking behaviour for pneumonia is poor. Paternal education and joint decision-making are key determinants of parents seeking appropriate care for their children with suspected pneumonia in Nigeria. <![CDATA[<b>Too much diarrhoea, too many infections, and too few neutrophils</b>]]> Neutropenia is a common finding in ill paediatric patients and can be conveniently subdivided into that due to decreased production or increased destruction. Intrinsic defects in granulocytes or their progenitors or extrinsic factors such as infection, drugs and autoimmune phenomena are the main causes. Our case focuses on cyclic neutropenia presenting with severe chronic diarrhoea lasting 17 weeks, multiple recurrent bacterial infections and pulmonary tuberculosis (TB). To our knowledge this is the first case of pulmonary TB described in association with cyclic neutropenia and chronic diarrhoea in Africa. <![CDATA[<b>Ecthyma gangrenosum caused by <i>Stenotrophomonas maltophilia </i>in a neutropenic leukaemic infant: A case report</b>]]> Ecthyma gangrenosum (EG) is a cutaneous lesion, mostly caused by pseudomonas in immunocompromised patients. Other bacterial and fungal pathogens have also been reported. It can occasionally affect previously healthy children. The cutaneous findings are characterised by small indurated papulovesicles, progressing rapidly to necrotic ulcers with surrounding erythema and a central black eschar. Sites most commonly involved are the buttocks, perineum, limbs and axillae; the face is less commonly involved. We are presenting a rare case of EG in a neutropenic infant who had just completed the induction phase of chemotherapy for acute lymphoblastic leukaemia. The gangrenous lesion was on the face involving the tip of the nose, which is an uncommon location. Blood and pus cultures grew Stenotrophomonas maltophilia, which is a rare cause of EG. The patient was treated with IV antibiotics (colistin for 14 days) and improved.