Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 11 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>The Nelson Mandela Children's Hospital</b>]]> <![CDATA[<b>The new Nelson Mandela Children's Hospital -a white elephant or an essential development for paediatric care in Johannesburg?</b>]]> <![CDATA[<b>Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa</b>]]> BACKGROUND. Paediatric patients are particularly prone to medication errors as they are classified as the most fragile population in a hospital setting. Paediatric medication errors in the South African healthcare setting are comparatively understudied. OBJECTIVES. To determine the incidence of medication errors in neonatal and paediatric inpatients, investigate the origin of medication errors that occurred and describe and categorise the types of medication errors made in both the neonatal intensive care unit (NICU) and paediatric wards. METHODS. The study followed a prospective, quantitative design with a descriptive approach. A prospective record review of inpatients' medication charts was undertaken to determine what was prescribed by the physician, dispensed by the pharmacy and administered by the nurses. The researcher also directly observed the preparation and administration techniques as performed by the nurses. A medication error checklist was used to collect the data. RESULTS. A total of 663 medication errors were detected in 227 patients over the study period of 16 weeks, of which 177 (78%) patients had one or more error(s). There were 338 (51%) administration errors and 309 (47%) prescribing errors. Incorrect dosing was the most frequent type of error (34%), followed by omission of medication (18.5%) and medication given at the incorrect time (12%). The causes of these medication errors were mostly due to miscalculation (26%), failure to monitor (15%) and procedures not followed (15%). Anti-infectives (43%) and analgesics (25%) had the most errors. In 118 (67%) patients the errors resulted in no harm to the patient, whereas in 59 (33%) patients the medication error resulted in some level of harm. CONCLUSION. The incidence of medication errors in the NICU and paediatric wards at the teaching hospital was higher than values reported elsewhere globally. Most errors occur during prescribing and administration of medication. Dosing errors are a common problem in paediatrics. Therefore, a formalised system to record these errors should be introduced alongside regular discussions on preventive measures among the multidisciplinary team. <![CDATA[<b>Nutritional status of children on the National School Nutrition Programme in Capricorn District, Limpopo Province, South Africa</b>]]> BACKGROUND. School feeding programmes are intended to alleviate short-term hunger, improve nutrition and cognition of children, and provide incomes to families. OBJECTIVES. To assess the nutritional status of children receiving meals provided by the National School Nutrition Programme (NSNP) in Capricorn Municipality, Limpopo Province, South Africa. METHODS. The setting was 18 randomly selected schools on the NSNP in Capricorn District. The total sample comprised 602 randomly selected schoolchildren from grades 4 to 7, aged 10 (26.6%), 11 (35.4%) and 12 (35.4%). Socioeconomic characteristics, anthropometric measurements, dietary patterns and school attendance were determined. Children were interviewed to assess their nutritional status using a validated questionnaire. Descriptive statistics such as means, standard deviations (SDs) and ranges were used for socioeconomic parameters and dietary patterns, and z-scores for anthropometric data. RESULTS. The results showed that boys (9.5%) and girls (7.8% ) were underweight. The prevalence of stunting in the sample was 11.3% for boys and 7.4% for girls, whereas boys (3.6%) and girls (4.2%) were wasted, with a z-score of -2 SD. School attendance was good. CONCLUSION. The nutritional status of most subjects in the study was within the acceptable range as indicated by the assessment of growth using anthropometric measurements. <![CDATA[<b>The promotion of oral health in health-promoting schools in KwaZulu-Natal Province, South Africa</b>]]> BACKGROUND. Oral health promotion is a cost-effective strategy that can be implemented at schools for the prevention of oral diseases. The importance and value of school-based interventions in children has been identified in South Africa (SA). Although oral health strategies include integrated school-based interventions, there is a lack of published evidence on whether these strategies have been translated into practice and whether these programmes have been evaluated. OBJECTIVE. To assess the efficiency and sustainability of the toothbrushing programme implemented at health-promoting schools in KwaZulu-Natal Province, SA. METHODS. A mixed-methods approach was used for this study, conducted at 23 health-promoting schools in KwaZulu-Natal using focus group discussions. Triangulation was used for evaluation. RESULTS. The intervention implemented had created awareness of oral health for learners, educators and parents. Findings in this study indicate that although there were benefits obtained from this school-based intervention, many challenges, such as time constraints, large classes and a lack of adequate resources and funding, affected the sustainability of the programme. CONCLUSION. The school setting has the potential to deliver integrated preventive and promotive programmes provided they are supported by adequate funding and resources. <![CDATA[<b>Serum selenium status of HIV-infected children on care and treatment in Enugu, Nigeria</b>]]> OBJECTIVE. To compare the selenium status of HIV-infected and HIV-uninfected children. METHODS. This was a hospital-based comparative study using a structured questionnaire in the quantitative research domain at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria. Seventy-four HIV-infected children were compared with 74 non-HIV-infected children (35 males and 39 females in each group). The outcome measure was the selenium status of the study participants. RESULTS. The mean (standard deviation (SD)) weight-for-height z-score among the subjects was -0.18 (1.53) compared with 0.05 (1.68) among the controls (p=0.457). The mean (SD) height-for-age z-score among the subjects was -1.16 (1.44) compared with 0.06 (1.06) among the controls (p<0.001). Eighteen subjects (24.3%) compared with eight controls (11.4%) were selenium deficient (odds ratio 2.49; 95% confidence interval 1.00 - 6.18; p=0.044). Median CD4 counts of selenium-deficient and non-deficient subjects were 765.5 (range 409 -1 489) and 694.0 (range 85 - 2 196) cells/L, respectively (p=0.321). The proportions of selenium deficiency were 26.4% and 22.2% in the highly active antiretroviral therapy (HAART) and pre-HAART groups, respectively (p=0.565). CONCLUSION. There was a significant difference in the proportion of HIV-infected children who were selenium deficient compared with their uninfected counterparts. <![CDATA[<b>Individual v. community-level measures of women's decision-making involvement and child survival in Nigeria</b>]]> BACKGROUND. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. OBJECTIVES. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. METHODS. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. RESULTS. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. CONCLUSION. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities. <![CDATA[<b>Pubertal breast development in primary school girls in Sokoto, North-Western Nigeria</b>]]> BACKGROUND. There is wide variation in normal pubertal timing among various populations. OBJECTIVES. To determine the mean age of pubertal stages of breast development and menarche, and the influence of nutrition and ethnicity on pubertal onset in primary school girls in Sokoto, North-Western Nigeria. METHODS. A cross-sectional study using a multistage random sampling design was conducted on 994 primary school girls in grades 3 - 6. Weight and height measurements and Tanner breast staging were done. Body mass index (BMI) was calculated, and a BMI-for-age percentile was used to categorise nutritional status. There were four major ethnic groups. P<0.05 was taken as showing statistical significance. RESULTS. The participants' mean age was 10.23 years (standard deviation (SD) 1.70, range 6 - 15 years). Of the 994 girls, 628 (63.2%) were pre-pubertal, and 366 (36.8%) were pubertal. Of the latter, 158 (15.9%) were in breast stage 2, while 112 (11.3%), 70 (7.0%) and 26 (2.6%) were in breast stages 3, 4 and 5, respectively. The mean ages (SD; range) of pubertal onset and menarche were 10.50 (1.33; 8 - 13), and 12.67 (1.65; 11 - 15), years, respectively. The overnourished (overweight/obese) and Igbo ethnic group girls had early-normal pubertal onset (p=0.006 and p=0.001, respectively). CONCLUSION. The mean ages of Tanner breast stages 1 - 5 and menarcheal age of girls in Sokoto, North-Western Nigeria, were within the age ranges reported worldwide. Pubertal onset was influenced by nutrition. <![CDATA[<b>Short-term and sustained effects of a health system strengthening intervention to improve mortality trends for paediatric severe malnutrition in rural South African hospitals</b>]]> BACKGROUND. Case fatality rates for childhood severe acute malnutrition (SAM) remain high in some resource-limited facilities in South Africa (SA), despite the widespread availability of the World Health Organization treatment guidelines. There is a need to develop reproducible interventions that reinforce the implementation of these guidelines and assess their effect and sustainability. OBJECTIVES. To assess the short-term and sustained effects of a health system strengthening intervention on mortality attributable to SAM in two hospitals located in the Eastern Cape Province of SA. METHODS. This was a theory-driven evaluation conducted in two rural hospitals in SA over a 69-month period (2009 - 2014). In both facilities, a health system strengthening intervention was implemented within the first 32 months, and thereafter discontinued. Sixty-nine monthly data series were collected on: (i) monthly total SAM case fatality rate (CFR); (ii) monthly SAM CFR within 24 hours of admission; and (iii) monthly SAM CFR among HIV-positive cases, to determine the intervention's effect within the first 32 months and sustainability over the remaining 37 months. The data were analysed using Linden's method for analysing interrupted time series data. RESULTS. The study revealed that the intervention was associated with a statistically significant decrease of up to 0.4% in monthly total SAM CFR, a non-statistically significant decrease of up to 0.09% in monthly SAM CFR within 24 hours of admission and a non-statistically significant decrease of up to 0.11% in monthly SAM CFR among HIV-positive cases. The decrease in mortality trends for both outcomes was only slightly reversed upon the discontinuation of the intervention. No autocorrelation was detected in the regression models generated during data analyses. CONCLUSION. The study findings suggest that although the intervention was designed to be self-sustaining, this may not have been the case. A qualitative enquiry into the moderating factors responsible for failure to sustain such an intervention, as well as the process of care, would add value to the findings presented in this study. <![CDATA[<b>Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severe malnutrition in rural South Africa: A retrospective multicohort study</b>]]> BACKGROUND. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization (WHO) recommended treatment modality. OBJECTIVES. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. METHODS. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients' clinical characteristics. Kaplan-Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. RESULTS. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001). CONCLUSION. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to ensure that mechanisms for effective treatment of HIV comorbidity in SAM are in place. However, a much more rigorous study is warranted to verify this conclusion. <![CDATA[<b>Parental satisfaction in the traditional system of neonatal intensive care unit services in a public sector hospital in North India</b>]]> BACKGROUND. Traditional systems of neonatal intensive care unit (NICU) care predispose parents to increased levels of stress and anxiety due to parental separation from their infant. Parental satisfaction, an indicator of the quality of care, is significantly compromised during prolonged NICU stay. The research is limited in developing countries. OBJECTIVES. To assess the parental satisfaction with traditional systems of NICU care in a public sector hospital and to identify the areas that need improvement and can be worked upon. METHODS. A semi-structured questionnaire was used to interview the parents of the neonates on the day of discharge. Fifteen questions were categorised into four domains, namely interpersonal relationships with staff, parents' involvement, staff competence and services offered by the health system. Parental satisfaction level was marked on a three-point Likert scale, 0 corresponding to highly dissatisfied, and 2 to completely satisfied for each of the 15 questions. RESULTS. Out of 100 patients interviewed, communication was the chief determinant of their satisfaction. Parents expressed fair satisfaction levels with regard to the emotional support and encouragement received, but discontent at being unable to look after their own baby and breastfeed the baby. They were satisfied with the competence of the staff. CONCLUSION. The traditional system of NICU care was not satisfying for the parents in many aspects and changes in the form of family-centred care should be tried for greater parental satisfaction.