Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 11 num. 4 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Thoughts as we consider the legalisation of cannabis in South Africa</b>]]> <![CDATA[<b>Community feedback on the JustMilk Nipple Shield Delivery System in the Vhembe District of Limpopo Province, South Africa</b>]]> BACKGROUND. Infant medication administration is a major public-health challenge, especially in rural or low-resource areas. The JustMilk Nipple Shield Delivery System (NSDS) is a novel method of infant medication delivery designed to address some of these challenges. OBJECTIVE. To explore the acceptability of the JustMilk NSDS in selected communities in the Vhembe District of Limpopo, South Africa. METHODS. Data were collected through 39 semi-structured interviews and in five small groups (a total of 44 interviewees) with infant caretakers and health workers in the Vhembe District. Interviews were transcribed and coded into themes, which were verified by an independent coder. RESULTS. Four themes arose around the acceptability of the JustMilk NSDS: input on device design; perceived benefits of the device; perceived barriers to community acceptance; and suggested device applications. Participants expressed positivity about the NSDS concept. The potential for increased dosing accuracy was stated as the main positive attribute of the NSDS. Potential stigma was noted, and the need for an education programme on the device was discussed. No major community barriers to NSDS use were noted. Acetaminophen and deworming agents were suggested as potential applications for the device. CONCLUSION. Participants were enthusiastic about the potential benefits of the NSDS, and were interested in using the device to deliver medication to infants. Design suggestions, especially to combat the potential stigma of device use, will be thoroughly considered by the researchers. This study was a positive step forward in developing the NSDS as a novel method of medication delivery to breastfeeding infants, particularly in rural or low-resource areas. <![CDATA[<b>Predictors of obesity and cardiometabolic disease risk in South African children</b>]]> BACKGROUND. Obesity is a major public health problem in developed countries, and is also a growing concern in developing nations. This study assessed the predictors of overweight and obesity in South African (SA) children and adolescents, and examined the extent to which these dependent measures correlate with cardiometabolic disease (CMD) risk. OBJECTIVES. To assess the predictors of overweight and obesity in SA children and adolescents. METHODS. A total of 1 361 (boys, n=678; girls, n=683) children aged 9 - 11 (boys, n=455; girls, n=411) and adolescents aged &gt;12 - 13 (boys, n=288; girls n= 267) participated in the study. The children's anthropometric and physiological measurements were taken. Body mass index (BMI) was calculated and used to classify the children as underweight, of normal weight overweight or obese, as well as to screen them for CMD risk. RESULTS. Findings indicated that 81.2%, 17.4%, 0.9 and 0.5% ofthe children (<12 years old) were underweight, of normal weight, overweight, and obese, respectively. For adolescents (12 - 13 years old), 63.0%, 32.5%, 3.4% and 1.0% were underweight, of normal weight, overweight and obese, respectively. Provincial analysis of the results showed that the likelihood of a girl in Mpumalanga Province becoming overweight or obese was 0.33 times that of a female child in Limpopo Province. CONCLUSION. Periodic assessment of predictors of obesity and CMD disease risk in SA children is necessary. Intervention and prevention strategies are also needed to curb the rising tendency of CMD risk among the youths. <![CDATA[<b>Placental malaria and neonatal anti-tetanus antibody status: Any association?</b>]]> BACKGROUND. Neonatal tetanus (NT) has long remained an important cause of neonatal morbidity and mortality in the tropics, where it coexists with a high prevalence of placental malaria. The current strategy for the control of NT involves stimulating the production of a protective level of an anti-tetanus antibody in the mother, through tetanus toxoid immunisation, and transferring it through the placenta to the fetus. Placental malaria is known to alter the morphology and functions of the placenta, but the results of studies on the effect of the transfer of the anti-tetanus antibody, specifically, remain inconclusive. OBJECTIVE. To study the influence of placental malaria on the transplacental transfer of anti-tetanus antibodies among mother-infant pairs at the University of Maiduguri Teaching Hospital in north-eastern Nigeria. METHOD. Maternal and cord-blood samples were collected from 162 mother-infant pairs, and analysed for anti-tetanus antibody levels using the enzyme-linked immunosorbent assay technique. Placental biopsies were also taken from each mother-infant pair, and placental malaria diagnosed histologically. RESULTS. A total of 71.6% (n=116) of the 162 mother-infant pairs were positive for placental malaria, out ofwhom 50.9% (n=59) had chronic-active, 37.9% (n=44) acute and 11.2% (n=13) past placental malaria. In addition, 25.3% (n=41) babies were classified as seronegative for tetanus antibodies, of whom 72.7% (n=32) were delivered to mothers who were positive for placental malaria. A total of 34.5% (n=56) mother-infant pairs had poor placental transfer for tetanus antibodies, as signified by a cord-maternal ratio of <1.0 antibodies; of these, 24.7% (n=40) were positive for placental malaria. There was a statistically significant association between type of placental malaria and serostatus (p=0.0009), and efficiency of placental transfer (p=0.0340). Mothers with chronic-active malaria were 7.4 times more likely to deliver a seronegative infant compared with mothers with acute malaria (p=0.0002; odds ratio (OR) 7.353; 95% confidence interval (CI) 2.327 - 23.234). Similarly, maternal-infant pairs with chronic-active malaria were 2.9 times more likely to have inefficient placental transfer (p=0.0221; OR 2.859; 95% CI 1.200 - 6.859). CONCLUSION. Placental malaria has remained a very common medical condition in Maiduguri among pregnant women, and may partly account for the high level of neonatal tetanus prevalent in the area. <![CDATA[<b>Assessing the utilisation of a child health monitoring tool</b>]]> BACKGROUND. The Road-to-Health booklet (RtHB), a standardised national tool for growth monitoring and the assessment of health among children from birth to five years of age, was introduced in South Africa in February 2011. OBJECTIVES. The study assessed the implementation of growth monitoring and promotion, immunisation, vitamin A supplementation, and deworming sections of the RtHB. Caregivers' (CGs) and healthcare workers' (HCWs') knowledge, attitudes and practices were investigated as well as HCWs' perceptions of barriers undermining implementation. METHODS. A cross-sectional descriptive study was conducted on a proportional sample of randomly selected primary healthcare facilities across six health districts (35%; n=143) in the Western Cape Province. HCWs involved in the implementation of the RtHB booklet, children (aged 0 - 36 months) and CGs were included. Information was obtained through scrutiny of the RtHB, observation of consultations and structured questionnaires. RESULTS. A total of 2 442 children, 2 481 CGs and 270 HCWs were recruited. Weight measurements (94.7%, n=2 251/2 378) were performed routinely. Less than half (40.2%; n=997/2 481) of CGs reported that their child's growth had been explained to them. Sixty-eight percent of HCWs (n=178/260) correctly identified criteria for underweight classification, whereas only 55% (n=134/245) and 39% (n=95/245) could do so for stunting and wasting, respectively. The RtHB sections were completed adequately for immunisation (89.3%; n=2 171/2 431) and vitamin A supplementation (94.6%; n=1 305/1 379) but not for deworming (48.8%; n=176/361). Most HCWs (93%; n=209/223) knew the correct regimens for vitamin A supplementation, but few CGs knew when treatment was due for vitamin A supplementation (16.4%, n=409/1 646) and deworming (26.2%; n=650/2 481). Potential barriers identified related to inadequate training, staff shortages and limited time. CONCLUSION. Focused efforts and resources should be channelled towards HCWs' training and monitoring regarding growth monitoring and promotion to optimise utilisation of the RtHB. Mobilisation of community health workers is needed to strengthen community awareness of preventive health interventions. <![CDATA[<b>Evaluation of culture-proven neonatal sepsis at a tertiary care hospital in Johannesburg, South Africa</b>]]> BACKGROUND. Organisms causing neonatal sepsis differ by region and the organisms causing sepsis change over time in the same area. The antibiotic susceptibility of microorganisms also changes with time, with emergence of multidrug resistant organisms. OBJECTIVE. This study aimed to review the causes of neonatal sepsis and antibiotic sensitivity of organisms causing neonatal sepsis at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) neonatal unit over a 12-month period. METHODS. This was a retrospective descriptive study. All blood cultures obtained from the neonatal unit at CMJAH between 1 January 2012 and 31 December 2012 were reviewed. This was followed by a review of the clinical data of patients with a positive culture. RESULTS. During the period under study, there were 196 patients with blood-culture-proven neonatal sepsis. This gave an incidence of 10.3 per 100 admissions. Late-onset sepsis accounted for 83.7% of cases of neonatal sepsis. The predominant isolates were Klebsiella pneumoniae (32.2%), coagulase-negative Staphylococcus (23.7%) and methicillin-resistant Staphylococcus aureus (13.1%). The majority of the isolated K. pneumoniae were extended-spectrum beta-lactamase (ESBL) producing bacteria with resistance to ampicillin and gentamicin. CONCLUSION. Neonatal sepsis is a common problem at the CMJAH neonatal unit. There has been an increase in the predominance of Gramnegative microorganisms as a cause of neonatal sepsis in the CMJAH neonatal unit over recent years, with ESBL-producing K. pneumoniae and Acinetobacter baumannii being the most prevalent Gram-negative causative agents of neonatal sepsis. Coagulase-negative Staphylococcus spp. remains an important cause of neonatal sepsis, and is the most prevalent Gram-positive organism isolated from the neonatal unit at CMJAH. Resistance to commonly used antibiotics regimens was noted to be high in the unit. <![CDATA[<b>Infant hearing screening in a developing-country context: Status in two South African provinces</b>]]> BACKGROUND. Newborn hearing screening (NHS) programmes are an important step toward early detection of hearing loss and require careful examination and planning within each context. The Health Professions Council of South Africa (HPCSA) has recommended specific contexts in which to actualise early hearing detection and intervention (EHDI) application. It is therefore imperative to explore if, and how, the current experience measures up to these recommendations. OBJECTIVE. To explore the feasibility and the current status of the implementation of NHS at various levels of healthcare within the South African context. METHODS. A non-experimental, descriptive, cross-sectional survey research design was employed, using a combination of questionnaires and face-to-face semi-structured interviews. Participants comprised 30 primary healthcare (PHC) nursing managers across two provinces (Gauteng and North West) and 24 speech-language therapists and/or audiologists directly involved with NHS in secondary and tertiary levels of care within Gauteng. RESULTS. Our findings indicated that there was a lack of formal, standardised, and systematic EHDI implementation at all three levels of health care (primary, secondary and tertiary) with valuable reasons such as insufficient knowledge, lack of equipment, budgetary constraints, and human resource challenges being provided for this. Regardless of the level of care and varied resource allocations and levels of specialisation,EHDI implementation as advocated by the HPCSA in its 2007 position statement currently does not seem feasible, unless the number of barriers identified are addressed, and NHS becomes mandated. CONCLUSION. Our findings have highlighted the need to ensure that context-specific studies in EHDI are conducted to ensure that national position statements are sensitive to contextual challenges and therefore allow for evidence-based practice, particularly in developing countries where resource constraints dictate success and/or failure of any well-intended programme. <![CDATA[<b>Association between HIV and proven viral lower respiratory tract infection in paediatric intensive care unit patients at Inkosi Albert Luthuli Central Hospital, Durban, South Africa</b>]]> BACKGROUND. Acute viral respiratory infections are common within the paediatric population. Nucleic acid amplification tests can identify a wide range of respiratory viruses. Virally infected patients can now be diagnosed early and more accurately in the acute phase of illness. OBJECTIVES. To examine the association between HIV status and mortality in children with viral lower respiratory tract infection (LRTI) and to delineate the profile of identified viruses. METHODS. We conducted a retrospective review of charts of children aged from birth to 10 years of age who were admitted to the paediatric intensive care unit at Inkosi Albert Luthuli Central Hospital with a viral LRTI between December 2010 and May 2015. Only patients who had a positive respiratory viral multiplex test were eligible for entry into the study. Patients were grouped according to their HIV status and mortality was assessed. RESULTS. A total of 338 records were analysed in this study. Sixty-five patients tested HIV-positive (19.2%) and 80.8% were HIV-negative (n=273). There were 55 mortalities: 12 were among the 65 HIV-positive patients (18.5%) and 43 among the 273 HIV-negative patients (15.8%). The difference in mortality according to HIV status was not statistically significant (p=0.595). Respiratory syncytial virus was the most prevalent virus identified overall, with adenovirus being most prevalent in the HIV-positive group. CONCLUSION. The results showed that patients with viral LRTIs who required respiratory support had a similar mortality regardless of HIV status. <![CDATA[<b>Implementation of the Road-to-Health-Booklet health promotion messages at primary health care facilities, Western Cape Province, South Africa</b>]]> BACKGROUND. Age-specific health promotion messages appear in the Road-to-Health booklet (RtHB), an assessment and monitoring tool for child health in South Africa. Healthcare workers should communicate health promotion messages to caregivers at each clinic visit. This investigation was part of a larger RtHB survey. OBJECTIVE. To assess the implementation of health promotion messages and identify barriers to its successful implementation. METHODS. A cross-sectional descriptive study with analytical components was conducted in the Western Cape Province. Knowledge and practices of caregivers and healthcare workers were assessed at 143 randomly selected primary healthcare facilities. Information was obtained through questionnaires, direct observation of consultations and recording of health promotion material in facilities. RESULTS. In total, 2 442 children (0 - 36 months; mean (standard deviation) age 5.10 (6.24) months), 2 481 caregivers and 270 healthcare workers were included. Caregivers' educational level varied, with only 24.3% having completed Grade 12. Healthcare workers had a median of 5 (range 0.5 - 37.0) years' work experience in primary healthcare. All healthcare workers indicated that health promotion messages were important, however, messages were only conveyed in 51% of observed consultations. When it was communicated, health promotion messages were age-appropriate in 97% of cases. Barriers to the implementation of health promotion messages hinged on time and staff constraints, workload and language barriers. Various forms of health promotion material were available in facilities. CONCLUSIONS. Suboptimal implementation of the health promotion messages in the RtHB are apparent despite healthcare workers realising the importance of health promotion. Barriers to optimal implementation must be urgently addressed by the National Department of Health and healthcare workers in partnership with caregivers and with support from society to promote child health and care. <![CDATA[<b>Diandric triploidy in a liveborn infant with 3-4 syndactyly and a neural tube defect</b>]]> Triploidy is a chromosomal abnormality caused by an additional set of haploid chromosomes. It is a common cause of early first-trimester miscarriages. Only very rarely are babies with triploidy born alive and even more rarely do they survive beyond the first few days of life. We present here a case of a term baby with confirmed paternal (diandric) triploidy and some unusual features, who survived for 50 days, and review the literature on those who survived.