South African Journal of Child Health

Maternal vaccination to prevent pertussis in infants

Aetiology and risk factors for neonatal sepsis at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria

BACKGROUND. Neonatal sepsis is a significant cause of morbidity and mortality in developing countries, accounting for a large proportion of neonatal deaths annually. Every year, 4 million neonates die, and one-third of these deaths is attributed directly to neonatal sepsis. OBJECTIVES. To determine the prevalence of neonatal sepsis, characterise and identify causative organisms and identify possible risk factors. Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis. METHODS. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD, USA) bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A structured questionnaire was used to collect data for risk factors, which were analysed with the SPSS version 17. RESULTS. Of 250 neonates who were sampled, 85 (34%) had pathogens recovered from their bloodstream, with Klebsiella pneumoniae the predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01), and by frequent changes in antibiotics (p=0.00). CONCLUSION. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this.

Pregnancy and death: An examination of pregnancy-related deaths among adolescents in South Africa

BACKGROUND. South Africa (SA)'s high adolescent fertility has been extensively studied. A pregnancy outcome that has not received sufficient attention in research is the causes of death among pregnant adolescents. OBJECTIVES. To examine levels and causes of adolescent maternal mortality in SA. METHODS. A secondary data analysis of Death Notification Forms from 2006 to 2012 was carried out. SA General Household Surveys from 2006 to 2012 were used to ascertain the number of female adolescents in the population. Frequency distributions and life table techniques were employed. RESULTS. An estimated 1 164 deaths have been recorded among pregnant adolescents between 2006 and 2012. Adolescent maternal and pregnancy-related mortality is lower than adult maternal and pregnancy-related mortality. The main causes of death among adolescents were hypertension (55.6% of all direct causes), abortion (17.6% of all indirect causes) and injuries (48.9% of all indirect causes). The probability of adolescents dying while pregnant without these causes is practically non-existent (range 0.002 - 0.150%). CONCLUSION. Policies and programmes should prioritise these pregnancy-related causes of death in order to further reduce such deaths among adolescents in SA.

Outcome of children admitted to a general high-care unit in a regional hospital in the Western Cape, South Africa

BACKGROUND. Critically ill children are often managed in non-tertiary general intensive care units admitting both adults and children, but few data are currently available regarding paediatric outcomes in these general units. OBJECTIVE. To determine the outcome of critically ill neonates and children admitted to a general high-care unit in a large regional hospital in the Western Cape, South Africa. METHODS. This was a retrospective descriptive analysis of outcome of all neonatal and paediatric (<13 years of age) patients admitted with non-surgical disease, during a 1-year period, to a general high-care unit at a large regional hospital in Worcester, South Africa. Data included demography, admission time, length of stay, diagnoses, HIV status, therapeutic interventions and outcome. The primary outcome was defined as successful discharge, transfer to a central hospital or death. RESULTS. There were 185 admissions, with the majority (83%) <12 months of age (median age 3.7 months; range 0 - 151 months) and a male:female ratio of 1.3:1. The majority (70%) were successfully discharged, while 24% were transferred to a tertiary paediatric intensive care unit (PICU) and only 6% died. Causes of death included acute lower respiratory tract infections (33%), acute gastroenteritis (33%), birth asphyxia (16%) and complications of prematurity (16%). Nasal continuous positive airway pressure (p<0.001), ventilation (p<0.001) and HIV infection (p=0.010) were associated with transfer to a PICU in a central hospital or death. CONCLUSION. The majority of children (70%) requiring admission to a general high-care unit in a regional hospital were successfully treated and discharged. These good outcomes were only achievable with a good transfer system and supportive tertiary healthcare system.

A review of chronic lung disease in neonates at Charlotte Maxeke Johannesburg Academic Hospital from 1 January 2013 to 31 December 2014

BACKGROUND. Chronic lung disease (CLD) remains a significant morbidity in preterm babies despite advances in neonatal care. The use of postnatal corticosteroids (PNCSs) to treat CLD remains controversial. OBJECTIVES. To describe the clinical characteristics of babies with CLD at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to explore the use of PNCSs for the prevention and treatment of CLD. METHODS. This was a 2-year retrospective review of neonates admitted to CMJAH. Neonates who were in hospital for >28 days were included. Comparisons were made between neonates with evolving CLD and those with no CLD. RESULTS. A total of 485 neonates were analysed: 237 had evolving CLD and 245 did not have CLD. Overall incidence of evolving CLD was 5%. More neonates with CLD than those without CLD needed resuscitation at birth (48.5% v. 39.8%; p=0.02) and had low 5-minute Apgar scores (17.2% v. 10.6%; p=0.001). Neonates with CLD had increased prevalence of patent ductus arteriosus (30.4% v. 7.7%; p=0.001) and late-onset sepsis (56.5% v. 23.6%; p=0.001). The mortality rate was also higher in CLD babies (10.2 v. 2.4%; p=0.001). Necrotising enterocolitis (NEC) (29.2% v. 8%; p=0.005) and sepsis (83.3% v. 53.8%; p=0.008) were associated with increased mortality. The use of PNCSs was associated with less NEC (3.5% v. 17.2%; p=0.001) and improved survival (95.6% v. 81.7%; p=0.001). CONCLUSIONS. CLD remains a common morbidity in neonates despite advances in neonatal care. The use of PNCSs was shown to have short-term benefits. To get the most out of PNCS use for CLD, further studies need to be conducted to determine the safest type of steroid, safe doses and the duration of treatment.

Pattern and practice of psychoactive substance abuse and risky behaviours among street children in Cameroon

BACKGROUND. Cameroon is among other developing countries reported to be facing an increasing problem of street children involved in drug abuse and other harmful behaviours. Although there are some government efforts to intervene, little is known about the extent of psychoactive substance abuse and the related behaviours among street children in Cameroon. The information is critical to support policy formulation and the implementation of interventions to tackle this problem. OBJECTIVE. To document the pattern and practice of psychoactive substance abuse and the related risky behaviours among street children in three cities in Cameroon. METHODS. This study was an analytical cross-sectional survey conducted by the administration of questionnaires to 399 street children who had been homeless for at least a month in three cities of Cameroon during 2015. RESULTS. All 399 participants reported that they were using some psychoactive substance at the time of the survey. The preferred substances were alcohol (45.9%), tobacco (28.8%), volatiles (11.5%) and cannabis (10.3%). Girls were more predisposed to sex work for survival than boys (p<0.000), with the majority of the participants reporting to have had unprotected sex after using any drug or consuming alcohol (93.98%). In most cases, the pattern and practice of psychoactive substance abuse were higher in the cities of Douala and Yaoundé than in Bamenda. The participants reported that the substances were readily available from street vendors. CONCLUSION. The results revealed that the level of psychoactive substance abuse is very high among street children, especially boys, in all three cities. Efforts to prevent and rehabilitate street children from abusing psychoactive substances are required. The government, role-players, decision-makers, the ministry of trade and industry and all stakeholders working with street children should consider working together in order to improve the quality of life for street children in Cameroon.

The existence of policies, practices and perceptions regarding children as visitors to public hospitals in uMgungundlovu, KwaZulu-Natal Province

BACKGROUND. Current policies and practices regarding child visitors in hospitals in uMgungundlovu, KwaZulu-Natal Province, South Africa, are unknown. Existing literature focuses on provision for child visitors in specialised units in well-resourced countries. OBJECTIVE. To identify policies, describe current practices and determine the perceptions of healthcare workers to child visitors. METHODS. Interviews were conducted with 7 nursing managers regarding the existence and content of a hospital visitors' policy, 12 operational managers (OMs) to describe ward practices regarding child visitors, and 12 professional nurses and 11 doctors to determine their attitudes towards children as visitors in all four general state hospitals in uMgungundlovu between October 2013 and July 2015. RESULTS. Five out of seven nursing managers were aware of a visitors' policy in their hospital. These policies allowed children to visit family or parents in adult wards, but only 2 would allow children to visit a family member and only 1 would allow visits to a friend in the children's wards. According to the nursing managers, policy was that the visitor must be over 5 years of age to visit in an adult ward while 2 out of 3 nursing managers allowed only children over 12 years of age to visit in children's wards. Visits must occur during prescribed visiting times and the visitor must be accompanied by an adult. In practice, 7 out of 12 OMs allow child visitors in their wards. Only 2 out of 7 OMs allow unrestricted visitation by children and only to non-infectious patients in children's wards - this is subject to variable age restrictions in adult wards and an age limit of 12 years in children's wards. In all wards, visits by children are restricted to prescribed visiting times and conditional on an adult escort. Three out of seven OMs allow 2 visitors only, although most (5 out of 7) allow visits of unlimited duration. Staff who favoured child visitors were more likely to be younger, male and employed as health professionals for <5 years. More doctors than nurses believed that children should be allowed to visit family and/or friends in hospital. Justifications for not allowing children to visit centred on infection risks and the emotional trauma of visiting a sick loved one. The child, patient and health professional were seen to benefit socially from child visitors, although there are positive and negative emotional consequences for the patient and the child. CONCLUSION. Hospitals do make provisions for visitors, but most exclude young children, particularly those who are most vulnerable to the negative consequences of separation from a parent or family member. While policies do exist to guide child visitation in uMgungundlovu, such policies are restrictive, inconsistent and do not necessarily reflect day-to-day practices.

Clinical presentation of infants hospitalised with pertussis

BACKGROUND. Despite the widespread use of pertussis vaccine, there has been a resurgence of pertussis cases in developed and developing countries. South Africa lacks data regarding clinical presentation and healthcare impact of pertussis. OBJECTIVES. To describe the clinical presentation and healthcare impact in hospitalised infants with confirmed pertussis. METHODS. This was a retrospective cohort study, conducted in Bloemfontein between April 2008 and September 2012. Infants with laboratory-confirmed pertussis (group 1; N=102), were compared with infants with a negative pertussis result (group 2; N=104) and infants with a lower respiratory tract infection of unspecified aetiology (group 3; N=104). The following data were extracted from the clinical records: demographics, presenting symptoms, paediatric intensive care unit (PICU) admission, length of stay in the general ward and PICU, overall hospital stay and outcome. RESULTS. There were no significant demographic differences between the groups. A larger percentage of infants in group 1 (n=41, 40%) required PICU admission compared with group 2 (n=37, 36%) and group 3 (n=20, 19%). The median PICU stay of group 1 was longer (11 days) compared with group 2 (6 days) and group 3 (5 days). The presence of cough and post-tussive vomiting was significantly higher in group 1 than groups 2 and 3. There was no significant difference in mortality between the groups. CONCLUSION. Pertussis results in significant morbidity in infants. Measures to identify and manage this vaccine-preventable disease should be considered at a national level.

Characteristic of monosymptomatic and non-monosymptomatic childhood nocturnal enuresis in Benin City, Nigeria

BACKGROUND. In recent years, nocturnal enuresis (NE) has been classified into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE) on the basis of the absence or presence of daytime voiding symptoms. Identifying clinical features that differentiate MNE from NMNE would aid in quick diagnosis, which would foster the introduction of early and appropriate therapeutic care options. OBJECTIVE. To identify distinguishing characteristics of MNE and NMNE in Nigerian children. METHODS. The parents of children in public primary and secondary schools in Egor local government area, Edo State, were interviewed using a semi-structured questionnaire. RESULTS. The total studied population included 1 221 parent/child pairs. Of the children studied, 228 were enuretic. There were 149 (65.4%) MNE and 79 (34.6%) NMNE children. Enuretic children with a history of multiple wetting per night or whose parents observed difficulty awakening them from sleep were significantly more likely to be in the NMNE group. CONCLUSION. MNE is twice as common as NMNE and the main distinguishing features between the two groups of enuretic children are multiple wetting at night and difficulty awakening the child from sleep. These were significantly more commonly observed among the NMNE group of children.

Congenital infantile fibrosarcoma mimicking sacrococcygeal teratoma in a Ghanaian infant: A case report and review of the literature

Congenital infantile fibrosarcoma (CIFS) is a rare tumour of childhood accounting for less than 1% of malignant tumours in children. Reports from sub-Saharan Africa are particularly rare and the occurrence in the sacral region mimicking a sacrococcygeal teratoma has not been reported in Africa to the best of our knowledge. The poor predilection of the tumour for distant metastases may contribute to its above average prognosis, but the rarity of systemic antenatal detection of congenital conditions in most parts of Africa may mitigate this good fortune. We report the very rare case of a 9-month-old female infant who presented with a progressively increasing painless sacral mass from birth which was thought to be a sacrococcygeal teratoma clinically but histopathological assessment revealed a CIFS.

Acute cholecystitis in a child with scarlet fever: A rare association

Group A streptococcal infection is common in children; however, scarlet fever is now considered rare except for isolated outbreaks. One of the rarest complications of scarlet fever is acute cholecystitis - very few cases have been reported in the literature. A 5-year-old boy was admitted with scarlet fever complicated by acute cholecystitis. Clinical examination along with ultrasound of the abdomen confirmed the diagnosis of acute cholecystitis associated with scarlet fever. The patient was managed conservatively with broad-spectrum antibiotics and was discharged home successfully. Acute cholecystitis should be suspected as a rare complication of scarlet fever presenting with an acute abdomen.