Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 11 num. 3 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<b>Reflexivity: Parent of a child with ASD</b>]]> <![CDATA[<b>Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique</b>]]> BACKGROUND. The need for healthcare in paediatric patients is often due to respiratory diseases, acute diarrhoea and viral fever, which suggests a limited need for the use of antibiotics. OBJECTIVES. To identify the determinants of antibiotic prescription in hospitalised paediatric patients in Mozambique. METHODS. A cross-sectional study was conducted between January and June 2015. A total of 454 medical prescriptions and clinical records of children aged 0 - 14 years from Hospital Central de Maputo (HCM) and Hospital Geral de Mavalane (HGM) were analysed. RESULTS. Antibiotics were used in 97.6% of the patients, with no significant differences (p&gt;0.05) in the prescription rates of the hospitals. The most commonly used antibiotics were beta-lactams (57.3%), aminoglycosides (28.3%) and co-trimoxazole (9.4%). Antibiotics were prescribed in all cases of bronchopneumonia, fever, sepsis and acute gastroenteritis. For malaria and undefined diagnoses, antibiotics were prescribed 97.8% and 99.3% of cases, respectively. It was clear that most severe clinical conditions (odds ratio (OR) 9.06; 1.13 - 12.14) and age <5 years (OR 5.47; 1.54 - 7.60) were treated with antibiotics. CONCLUSION. The prescription of antibiotics for paediatric patients at both HCM and HGM was largely influenced by patients' clinical condition and age. It showed that physicians used an empirical approach, in the absence of laboratory tests, often leading to unnecessary antibiotic treatments with negative causative effects. Physicians should be encouraged to use an evidence-based approach for managing the cases correctly. <![CDATA[<b>Factors associated with the severity of motor impairment in children with cerebral palsy seen in Enugu, Nigeria</b>]]> BACKGROUND. Cerebral palsy (CP) is a heterogeneous condition that is well known to cause impairments with varying degrees of severity. The gross motor function classification system (GMFCS) is widely used to assess ambulatory function in CP, but little is known about the factors that account for the variations in gross motor function in children. The purpose of this study was to assess the relation between the severity of gross motor dysfunction (GMD) and certain factors such as the type of CP, aetiology of CP, nutrition, socioeconomic class (SEC), and the frequency of these accompanying impairments like visual, auditory, cognitive and speech impairments. METHODS. This was a cross-sectional observational study of 100 consecutively recruited CP patients aged 9-96 months, who attended the paediatric neurology clinics (PNCs) in Enugu between April and October 2010. Each patient's clinical history was recorded, a neurological examination conducted and GMFCS level ascertained. Statistical analyses were done to determine the association between the categorical variables. RESULTS. The type of CP (p=0.000), aetiological factors (p=0.016), the presence of malnutrition (p=0.004) and the frequency of accompanying impairments (p=0.001) were significantly associated with the severity of GMD, while SEC (p=0.649) had no significant association. CONCLUSION. The type of CP, aetiological factors, the presence of malnutrition and the number of accompanying physical, mental or physiological impairments, were positively associated with the severity of GMD and walking ability in children with CP. <![CDATA[<b>The views and knowledge of parents of children with autism spectrum disorder on a range of treatments</b>]]> BACKGROUND. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that appears before the age of 3 years. Symptoms reflect delayed or abnormal social interaction and communication skills, with restricted or repetitive behaviour warranting the need for early intensive treatment. METHODS. The aim of the study was to investigate the knowledge and views of parents regarding treatments for their children, aged between 5 and 9 years old with ASD, in eThekwini Metropolitan Municipality, South Africa. An embedded mixed methods research design was utilised. Non-random purposive sampling was used to select 46 parents of children with ASD. A 42-item questionnaire was used and the data were interpreted using descriptive statistics and thematic analysis. RESULTS. More than half of the parents (53%) were unfamiliar with or had only heard of treatments in question, while 13.4% had a practical understanding of the treatments. Of all the treatments, parents rated their knowledge of speech-language therapy (SLT) most highly. The majority (68%) stated that they had difficulties accessing ASD treatment facilities and healthcare professionals, and perceived treatments as being costly. Even so, 74% of parents reported that they had a good relationship with their healthcare professional. CONCLUSION. The above findings should be viewed as motivation for health professionals to share information regarding the range of ASD treatments. They can assist parents in accessing appropriate facilities, recommend treatments that are supported by research, and update their knowledge on advances in ASD treatment. <![CDATA[<b>Toilet training practices in Nigerian children</b>]]> BACKGROUND. This study reports on toilet training with a focus on the effect of age, methods used, and factors that can affect urinary incontinence in Nigerian children. METHODS. This was a cross-sectional hospital-based study carried out in public and private hospitals in South-Western Nigeria. A questionnaire was used to obtain information about toilet training practices from 350 adults, who toilet trained 474 children. RESULTS. The adults had previously toilet trained children 1-18 years old. In this study, toilet training commenced at <12 months, during the day and night in 40.6% and 33.4% of children, respectively. Of the 350 parents/guardians, 141 (47.7%) commenced toilet training by waking children from their afternoon nap. The most common method was allowing the child to urinate at fixed time intervals, while the least common was a reward/punishment system. Furthermore, age was considered as the most common indicator to commence toilet training. For 36.9% of the children, training lasted 1-6 months. Daytime continence was achieved by 33.4% of children at <12 months old, and night-time continence was achieved in 29.7% of children between 12 and 18 months old. By 30 months, 91.1% and 86.9% had attained day- and night-time continence, respectively, and only 8.6% of the children were incontinent at night. CONCLUSION. Assisted infant toilet training is still practised among Nigerian parents despite the influence and the trends in the developed countries. The age at initiation and completion of toilet training was lower than those reported for developed countries. <![CDATA[<b>The barriers that women face when choosing food for their primary school children: A case study in the Western Cape Province, South Africa</b>]]> BACKGROUND. Unhealthy food choices made by mothers can impact negatively on child health and may lead to unhealthy eating behaviours that persist into adulthood. Choosing food is a complex process influenced by many factors. OBJECTIVES. To determine the factors that influence mothers' food choices and to investigate barriers to purchasing healthy food. METHODS. A cross-sectional, descriptive study, with an analytical component, was conducted. Mothers (N=476) were recruited from three randomly selected primary schools, from a low, middle and high quintile. A self-administered questionnaire was used to collect data on demographics, knowledge, attitude and practices of mothers. Six focus groups (FG) (two per school) were conducted to investigate the factors that prevent mothers from making healthy dietary decisions. RESULTS. The mean nutrition knowledge score for the group was 68.6%. Nutrition knowledge was significantly lower (p<0.01) in mothers from the lower quintile school (64.0%). Primary factors influencing food purchases were cost (60%), nutritional value (37%) and time constraints (29%). Primary sources of nutrition information included magazines and health professionals at 62% and 44%, respectively. Time constraints resulted in mothers purchasing convenience foods more often (p=0.001). The main barriers identified were mixed media messages, the school environments and supermarket layouts. CONCLUSION. Nutrition education campaigns should include practical advice, e.g. the preparation of economical, wholesome meals. Policymakers should monitor increasing prices of healthy foods. School and supermarket environments, as well as the food industry, can play a pivotal role in facilitating mothers to make healthy food choices. <![CDATA[<b>The clinical profile and outcome of children with West syndrome in KwaZulu-Natal Province, South Africa: A 10-year retrospective review</b>]]> BACKGROUND. West syndrome (WS) is a rare epileptic encephalopathy of infancy. There is currently no research on the incidence or prevalence of WS in Africa. METHODS. We aimed to describe the outcome of children with WS at a quaternary-level hospital in KwaZulu-Natal, South Africa (SA). This was a retrospective chart review conducted on patients diagnosed with WS over a 10-year period. Eight children (males, n=7; African, n=6; Asian, n=2) identified with WS out of 2 206 admitted with epilepsy. The median age (range) at diagnosis was 7.5 (1 - 9) months. The average time between onset of epileptic spasms and diagnosis was 3.1 months. RESULTS. Six patients had abnormal neuroimaging (atrophy (n=2); corpus callosum agenesis (n=2); tuberous sclerosis (n=1); focal dysplasia (n=1)). Drug management included sodium valproate (n=8), topiramate (n=7) and levetiracetam (n=3). Subsequent definitive treatment was intramuscular adrenocorticotrophic hormone (n=3), vigabatrin (n=2) and oral prednisone (n=4). Four (50%) patients had complete seizure remission (neuromigratory disorder (n=2); tuberous sclerosis (n=1); and idiopathic (n=1)) and 4 had partial remission (neonatal complications (n=3); idiopathic (n=1)). DISCUSSION. Most of our patients had symptomatic WS, with 50% remission on treatment. Outcomes were poorer in our study when compared with those in published data. CONCLUSION. Further collaborative studies are still needed to evaluate the true impact and prevalence of WS in SA. <![CDATA[<b>Fanconi anaemia in South African patients with Afrikaner ancestry</b>]]> BACKGROUND. Fanconi anaemia (FA) is a rare genetic disorder of impaired DNA repair that results in physical and haematological consequences in affected individuals. In South Africa (SA), individuals with Afrikaner ancestry are at an increased risk of inheriting disease-causing FA mutations, owing to the three common FANCA (FA, complementation group A) founder mutations present in this population subgroup. OBJECTIVES. To describe the physical phenotype of SA patients with FANCA mutations for the purpose of recommending appropriate care for affected individuals. METHODS. A structured clinical examination and file-based review were used to evaluate the physical phenotype of 7 patients with compound heterozygous and homozygous FANCA founder mutations, and 1 patient with confirmed FANCA complementation analysis. Descriptive statistical analysis was used to determine the frequency of physical anomalies in Afrikaner patients and to compare the described phenotype to other FA cohorts, including a previously clinically characterised black SA FA cohort. RESULTS. An earlier age of diagnosis of FA in Afrikaner patients, a high frequency of somatic anomalies and a higher-than-expected incidence of the VACTERL/H phenotype were noted. CONCLUSIONS. Based on our findings, recommendations for the care of FA patients with Afrikaner ancestry are made, including renal ultrasound evaluation at diagnosis and hearing screening. <![CDATA[<b>Soaps and cleansers for atopic eczema, friends or foes? What every South African paediatrician should know about their pH</b>]]> BACKGROUND. Knowledge of the pH level of soaps and cleansers used by patients with atopic eczema and sensitive skin is crucial, as high-alkalinity products are irritants and impair the normal skin barrier, so interfering with the adequate control of atopic eczema. OBJECTIVES. The aim of this study was to assess the pH of various bar soaps and cleansers that are usually recommended and used by patients with atopic diseases and dry, sensitive skin in South Africa. METHODS. Forty-nine commercial soap bars and cleansers were randomly selected for pH analysis. The samples were prepared as 8% emulsions in tap water. Nine undiluted liquid facial cleansers were also evaluated. Deionised water was used as a negative control. The pH of each emulsion or liquid cleanser was recorded in duplicate using a Metrohm pH meter model 827 (Metrohm, Herisau, Switzerland). RESULTS. Of the 49 samples analysed, 34 (69.4%) were alkaline with a pH ranging from 9.3 - 10.7. Two samples (4.1%) were within the acceptable range of (5.4 - 5.9), and 2 samples (4.1%) had pH levels of below 5. In total, 5 samples (10.2 %) had a pH of 4 - 6. CONCLUSION. The majority of soaps and cleansers analysed in this study were alkaline, with only 2 falling in the acceptable pH range of 5.4 - 5.9 and 5 within the pH range of 4 - 6, thus raising concerns regarding the optimal management of atopic eczema patients. <![CDATA[<b>Acute poisoning in children from <i>Jatropha curcas </i>seeds</b>]]> The semi-evergreen shrub, Jatropha curcas is native to Central and South America, but now occurs worldwide. Four children suffered severe symptoms of abdominal pain, nausea and vomiting after ingesting the seeds of J. curcas. These cases support the listing of J. curcas as a noxious weed. As a result of this, and a few other incidents, municipal authorities are urged to discourage the use of highly toxic plants such as J. curcas for hedges and garden plants, and to monitor the occurrence of such species. We present a case report about J. curcas poisoning.