Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 9 num. 3 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Preventing invasive Group B <i>Streptococcus </i>(GBS) disease in South African infants: Time for change</b>]]> <![CDATA[<b>The 5th South African Child Health Priorities Conference</b>]]> <![CDATA[<b>Clinical features and lung function in HIV-infected children with chronic lung disease</b>]]> BACKGROUND: Although chronic lung disease (CLD) is commonly seen in children with advanced HIV disease, it is poorly studied. OBJECTIVES: To report on the clinical manifestations and lung function tests in children with advanced HIV disease at a tertiary care centre, and determine clinical predictors of poor lung function. METHODS: We undertook a cross-sectional study of children with advanced HIV disease in whom CLD was suspected. We undertook clinical evaluation and lung function tests, accompanied by a retrospective chart review. RESULTS: In 56 children identified, the median age was 5 (interquartile range (IQR) 2 - 8) years with equal gender ratio. The majority (93%) had been previously treated for tuberculosis and/or pneumonia (71%). The most common CLD identified was lymphocytic interstitial pneumonitis (54%). The median nadir CD4 percentage was 13% (IQR 8.5 - 16%) and the median highest reported viral load was log5.8 (IQR log5.0 - log6.5). The median duration of antiretroviral therapy was 9.8 (IQR 1.1 - 19.5) months. Lung function tests were performed in 27 (48%) children. The median forced expiratory volume in 1 second (FEV1) was 60% (IQR 45.3 - 86.3%) predicted. Previous hospitalisation, respiratory rate, digital clubbing, chest hyperinflation and hyperpigmented skin lesions were associated with a decreased FEV1 in a univariate relationship. In a multiple linear regression analysis, hyperinflation, increased respiratory rate and hyperpigmented skin lesions were associated with poor lung function (percentage FEV1. CONCLUSION: We identified useful clinical signs predictive of poor lung function in HIV-infected children with CLD, especially in resource-limited settings. <![CDATA[<b>Severe pneumonia in HIV-infected and exposed infants in a paediatric ICU</b>]]> BACKGROUND: Pneumocystis jiroveci pneumonia is still a common cause of severe disease in HIV-infected infants <5 months of age. Despite attention to the prevention of mother-to-child transmission programme in South Africa (SA), HIV testing remains incomplete and infants are still at risk. The management of Pneumocystis pneumonia requires ventilation strategies and combination antibiotics. METHODS: A prospective but open intervention was performed on all HIV-exposed patients admitted with severe pneumonia to the paediatric intensive care unit (PICU) at Steve Biko Academic Hospital, SA, during a 3-year period from January 2009 to December 2011. All patients were treated with ampicillin, amikacin, co-trimoxazole, prednisone and intravenous gancilovir. Highly active antiretroviral therapy (HAART) was initiated in the PICU as soon as tuberculosis was excluded and HIV status confirmed with an HIV viral load (VL). Routine blood and tracheal specimens were cultured for bacteria and tested by direct fluorescent antigen testing for P jiroveci. Cytomegalovirus (CMV) VL was tested. All infants were ventilated in a standard fashion and none were oscillated. RESULTS: A total of 87 patients were admitted during the 3-year period. Of these, 29 patients were excluded from the study because they were HIV-unexposed. Ten patients died during the 3-year period. In a multivariate analysis of the presence or absence of P jiroveci, HIV VL, CD4 count, timing of HAART initiation and CMV VL, no single factor was documented to influence mortality. CONCLUSION: Mortality from Pneumocystis pneumonia continues to decrease in this PICU. No single factor is responsible and yet all therapeutic strategies contribute to survival. A national policy and guideline is urgently required. <![CDATA[<b>Parents' journey into the world of autism</b>]]> BACKGROUND: Autism Spectrum Disorder (ASD) is a developmental disability that results in an impairment in an individual's social interaction and communication, as well as restricted, repetitive and stereotyped patterns of behaviour. Children with ASD display difficulties in the areas of social as well as communicative behaviour. Parents, caregivers and family members are the main communication partners of children with ASD. Living with a child with ASD can result in changes within a family system. OBJECTIVE: To describe the challenges and experiences faced by families in their interaction with their child with ASD, caregiver coping strategies and the success of these strategies, and the generalisation and carryover of therapeutic strategies provided by a speech language pathologist (SLP). METHODS: A qualitative descriptive research design was selected to explore the objectives of the study. Ten participants were recruited; all participants were parents of a child with ASD attending Learners with Special Educational Needs School in Gauteng, South Africa. Data were collected through a semistructured face-to-face interview survey comprising open- and closed-ended questions, and were analysed using thematic content analysis. RESULTS: The results revealed five main themes, namely communicative challenges, family experiences, communicative coping strategies, speech and language therapy services and strategies provided by the SLPs. Communicative challenges were experienced by parents of one child with ASD. The communication and behaviour of children with ASD were found to affect the daily functioning of the family. The majority of parents reported not learning a new mode of communication, but rather adapting and adjusting to the communication of their child. Communicative coping strategies were required for novel social settings. There were mixed responses with respect to parent's abilities to access and learn new communicative coping strategies. Speech and language therapy assisted in improving the child's communication skills, while strategies provided by SLPs were explained to be effective even though generalisation of strategies was limited. CONCLUSION: This study concluded that parents and children with ASD experience challenges in communication and interaction. The family systems approach as well as the World Health Organization's International Classification of Impairments, Disabilities and Handicaps are two functional frameworks that can assist SLPs to provide intervention to children with ASD. <![CDATA[<b>Current practices around HIV disclosure to children on highly active antiretroviral therapy</b>]]> BACKGROUND: The introduction of antiretroviral therapy (ART) for children has resulted in survival into adolescence. This is associated with the challenge of disclosing HIV status to infected children. OBJECTIVES: To establish whether HIV disclosure had occurred, the process of disclosure or reasons for non-disclosure, and the effect of disclosure on the child's understanding of their disease and adherence. METHODS: Interviews were conducted with the caregivers of 100 HIV-positive children, aged 8 - 14 years, who were on ART for >1 year to determine if disclosure had occurred. Where disclosure had occurred, these children were interviewed. RESULTS: Disclosure had occurred in only 27 patients. The age and gender of the caregiver and their relationship to the child did not influence the likelihood of disclosure. The educational level of the caregiver and the number of admissions of the child were both associated with disclosure. Disclosure did not improve adherence, as reflected by an increased CD4 count or reduced viral load. CONCLUSION: HIV disclosure to children on ART remains less than optimal despite the presence of both national and international guidelines. Caregivers cited fear on the part of the child and fear of being blamed for their illness as the main reasons that they do not disclose. Of the children who knew their status, 76.9% had already suspected that they had HIV. <![CDATA[<b>Adherence to case management guidelines of Integrated Management of Childhood Illness (IMCI) by healthcare workers in Tshwane, South Africa</b>]]> BACKGROUND: Integrated Management of Childhood Illness (IMCI) is an essential strategy known to deliver childhood interventions that reduce the under-five mortality rate. OBJECTIVE: To evaluate the adherence to the IMCI case management guidelines by primary healthcare workers in the Tshwane area, South Africa. METHODS: The study was conducted between July and December 2012 on children referred from clinics to Kalafong Hospital. Data on IMCI clinical symptoms and signs, classification and treatment given at the clinics before referral to the hospital were collected from patients' referral letters. An interview with the caregiver on counselling received at the clinic was done using an adapted World Health Organization health facility survey tool. RESULTS: Eighty children between 2 and 60 months referred from 12 local clinics were included in the study. IMCI classification was done in just over half (52.9%) of 34 children with cough and 73% of 15 children with diarrhoea. Only 18% of children with chest indrawing and fast breathing were classified correctly. Prereferral treatment for all children with severe dehydration had been given correctly but not so for children with severe pneumonia and severe malnutrition. None of the children with severe disease had been checked for glucose levels before referral. CONCLUSIONS: The IMCI guidelines had not been adhered to in all children referred to the hospital. Children, particularly those with severe disease, had been incorrectly classified, leading to inadequate prereferral treatment. Healthcare workers had not given the expected treatment at the clinic before referral. <![CDATA[<b>Viability in delivering oral health promotion activities within the Health Promoting Schools Initiative in KwaZulu-Natal</b>]]> BACKGROUND: The Health Promoting Schools Initiative can provide a platform to explore integration of oral health promotion activities within the broader context of healthcare delivery. OBJECTIVES: To understand the contextualised delivery of oral health service provision within Health Promoting Schools, to conduct a situational analysis of existing services provided at these schools and to review current health and education policies. METHODS: The explorative study design used a mixed methods approach. Twenty-three schools of a total sample of 154 were selected using multistage cluster sampling. Data collection comprised policy reviews, a self-administered questionnaire, a data capture sheet and an interview schedule. The study was approved by the Humanities and Social Sciences Research Ethics Committee of the University of KwaZulu-Natal (HSS/0509/013D. RESULTS: Although policies included statements on oral health promotion, this was not translated into practice at school level. Barriers and challenges identified for successful implementation of an oral health promotion programme included lack of funds, human resources, knowledge and ownership, as well as high workloads and time constraints. CONCLUSION: Current delivery of oral health promotion services within the Health Promoting Schools Initiative will not reap the desired oral health outcomes owing to the inherent mismatch between policy planning and implementation. More research needs to be conducted to address opportunities and challenges facing educators and other oral healthcare providers working in the school environment. <![CDATA[<b>Effect of a nutrition education programme on nutritional status of children aged 3 - 5 years in Limpopo Province, South Africa</b>]]> BACKGROUND: Globally, the prevalence of chronic and acute malnutrition and micronutrient deficiency is high in young children, especially in developing countries. Nutrition education is an important intervention to address these challenges. OBJECTIVE: To determine the nutritional (anthropometric and micronutrient) status of children aged 3 - 5 years at baseline and post intervention. METHODS: A pre-test-post-test control group design was chosen, which included eight villages (four villages in the experimental group (E); four villages in the control group (C)). The Nutrition Education Intervention Programme (NEIP) comprised ten topics emphasising healthy eating, hygiene and sanitation. RESULTS: At baseline, 15% (E) - 22.4% (C) of children were stunted. Very few children were underweight in both groups (E = 2.5%; C = 8.2%) and only 2.5% of children were wasted in the E group at baseline. At baseline, about a third of children in both groups (E = 38.5%; C = 30.8%) had marginal vitamin A status (100 - 199.9 μg/L), while <10% in the E group (E = 7.7%) had vitamin A deficiency (<100 μg/L). According to the categories for indicators of iron status, the number of children who were in the 'adequate' category for serum iron, serum ferritin, serum transferrin and percentage transferrin saturation did not change in both groups at postintervention assessment. In both groups, nutritional status of children (both anthropometric and blood variables) did not change significantly following intervention. CONCLUSION: The nutrition intervention did not have a significant effect on indicators of nutritional status, possibly owing to its short duration (12 months) and the fact that food supplementation was not included. <![CDATA[<b>Food allergy: Two case reports and management challenges in a resource-limited setting</b>]]> BACKGROUND: Food allergy has been well described in white children, and cow's milk protein allergy (CMPA) still remains the most common allergy in these children. Information on the same subject in developing countries is very limited, and management of this condition remains challenging. CASE PRESENTATION: We report on two cases of children with multiple food allergies. The first patient presented with chronic diarrhoea following the introduction and use of several infant formulas, while the second patient had more severe allergic reactions following ingestion of milk, egg and wheat. Elimination of identified triggers from the diet resulted in significant clinical recovery in both cases. CONCLUSION: Food allergy, especially CMPA, should be considered more frequently in infants and children from developing countries, especially when there is a significant reaction to the introduction of cow's milk. A high index of suspicion and appropriate laboratory support are also needed in the diagnosis and management of other food allergies in the African setting.