Scielo RSS <![CDATA[South African Journal of Child Health]]> http://www.scielo.org.za/rss.php?pid=1999-767120180002&lang=pt vol. 12 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Jellyfish envenomation: A chilling toxidrome of seizures and cyanosis - a case report</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200001&lng=pt&nrm=iso&tlng=pt Jellyfish envenomation is a common incident in coastal areas all over the world. While the majority of reported cases are self-limiting with few lasting complications, a few deadly species can cause life-threatening and debilitating illnesses with a prolonged recovery time. Chrysaora spp. have been known to cause a diverse spectrum of manifestations. We report the case of a 7-year-old boy with jellyfish envenomation presenting with cyanosis, seizures, and hypertension not previously described in association with the Chrysaora spp. <![CDATA[<b>The role of kidney injury molecule-1, interleukin-18 and glutathione-S-transferase-</b><b>π</b><b> in paediatric HIV-associated nephropathy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200002&lng=pt&nrm=iso&tlng=pt BACKGROUND. HIV-associated nephropathy (HIVAN) in sub-Saharan Africa remains a significant cause of morbidity and mortality in children. Early detection of kidney injury is essential for injury-specific interventions that may avert permanent kidney damage and delay progression of kidney injury. Kidney biopsy is presently the gold standard for diagnosis of related kidney disease; however, it is pervasive with attendant complications, and may not be representative owing to sampling error. Serum creatinine is an insensitive and non-specific marker for the diagnosis of various kidney diseases, particularly in HIV-infected patients, who usually have varying degrees of muscle wasting. Therefore, a non-invasive approach using additional biomarkers for early detection of HIV-related kidney diseases, particularly HIV-associated nephropathy (HIVAN), is urgently needed. OBJECTIVE. To determine the urinary concentrations of kidney injury molecule-1 (KIM-1), interleukin-18 (IL-18) and glutathione-S-transferase-π (GST-π) in children with idiopathic focal segmental glomerulosclerosis (FSGS) and HIVAN. Methods. The study group comprised 34 children: 13 with HIVAN and 21 with idiopathic FSGS. The control groups were 19 HIV-positive and 16 HIV-negative children with no kidney disease. Urine samples collected from these 69 children were stored at -80°C. Urinary concentrations of KIM-1, IL-18 and GST-π were quantified using Bio-Plex assay. RESULTS. A significant increase in urinary KIM-1 levels was observed in the HIVAN group compared with the HIV-positive (p=0.0039) and HIV-negative (p=0.0438) control groups. There was no significant increase in KIM-1 levels on comparison of the idiopathic FSGS group with the control groups (HIV-positive and HIV-negative children) (p=0.0737 and p=0.1757, respectively). No statistically significant differences were noted in urinary IL-18 and GST-π levels across all study groups. CONCLUSION. Urinary KIM-1 levels are significantly elevated in children with HIVAN and may be a useful biomarker to detect kidney disease in HIV-1-infected children. <![CDATA[<b>Monitoring well-baby visits in primary healthcare facilities in a middle-income country</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200003&lng=pt&nrm=iso&tlng=pt BACKGROUND. Globally, child health services are a priority, but are most acutely felt in underdeveloped and developing countries. Most of the children who live in such countries die from a disease or combination of diseases that could easily have been prevented through immunisations, or treated at a primary healthcare level. Undernutrition contributes to over a third of these deaths. Preventive measures are important to proactively prevent such disease and mortality burdens. Well-baby visits are for babies who come to the clinic for preventive and promotive health, and who are not sick. One of the goals in the National Core Standards is to reduce waiting time in health establishments. However, it is imperative that all necessary assessments are conducted during a well-baby visit. The Road to Health booklet (RtHB) contains the baby's health record, and is issued to all caregivers, usually on discharge post-delivery. It also contains lists of appropriate assessments that should be performed during each well-baby visit according to age, including immunisations and health promotion messages for caregivers. In South Africa, infant morbidity and mortality rates are decreasing very slowly, requiring effective use of the RtHB to address important applied and research problems. OBJECTIVE. To investigate how 'well babies' were monitored in primary healthcare facilities. METHODS. A descriptive quantitative cross-sectional survey design was used for retrospective review of 300 babies' RtHBs, using a checklist developed directly from the assessment page of this booklet. The clinical microsystem model was used to guide the study. Data were analysed using SPSS version 22.0. RESULTS. Babies were shown to have been immunised in 100% of records, while discussion of side-effects and the management thereof were only recorded in 9.7% (n=20) charts. Records indicated that 98.7% (n=296) of babies were weighed, but only 71% (n=213) of weights were 'plotted' and 56.3% (n=169) classified according to the integrated management of childhood illnesses norms. CONCLUSION. Based on the findings, this research was able to make a contribution to the body of knowledge about baby monitoring practices in primary healthcare settings. <![CDATA[<b>Pulmonary hydatidosis: Still unrecognised in endemic regions - a 10-year review</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200004&lng=pt&nrm=iso&tlng=pt BACKGROUND. Echinococcus disease in still endemic in many low-middle-income countries, with 1 million people infected at any one time. Surgery, the mainstay of its treatment, is costly. OBJECTIVES. To describe the presentation, clinical features and outcomes of children referred with pulmonary hydatid disease at Inkosi Albert Luthuli Central Hospital in Durban, South Africa. METHODS. A 10-year review of children with pulmonary hydatid disease at Inkosi Albert Luthuli Hospital was carried out. The data collected were demographic, clinical, laboratory and radiological. Cases were mapped geographically to analyse for clustering of cases. Spearman's correlation was used to assess for correlations between laboratory markers. RESULTS. A total of 24 subjects, 75% of whom were male, were included. The mean (standard deviation) age at diagnosis was 8.9 (3.4) years. The mean delay in diagnosis was 5.8 (5.7) months. Of the subjects, 15 (71.4%) were from the Eastern Cape and 9 from KwaZulu-Natal provinces. Seventy-nine percent of the patients had been exposed to dogs, while 8% reported exposure to either sheep or cattle. There was right-sided preponderance, with 11 right- and 7 left-sided cysts; 6 patients had bilateral cysts, and 4 associated extrapulmonary cysts. Indirect haemagglutination assay was positive in 70%, and blood eosinophilia was present in 45% of the subjects, with no correlation between the two markers (p=0.22). Surgery was the only modality of treatment in 18 (75%) subjects, while 5 had had prior medical therapy for disseminated disease. The mean intensive care stay postoperatively was 2 (2) days with no mortality. CONCLUSION. Despite exposure to known risk factors and living in endemic regions, there is often a significant delay in diagnosis of pulmonary hydatid disease at Inkosi Albert Luthuli Hospital. <![CDATA[<b>How do we survive and grow to support South African and African paediatrics in the future?</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200005&lng=pt&nrm=iso&tlng=pt BACKGROUND. Echinococcus disease in still endemic in many low-middle-income countries, with 1 million people infected at any one time. Surgery, the mainstay of its treatment, is costly. OBJECTIVES. To describe the presentation, clinical features and outcomes of children referred with pulmonary hydatid disease at Inkosi Albert Luthuli Central Hospital in Durban, South Africa. METHODS. A 10-year review of children with pulmonary hydatid disease at Inkosi Albert Luthuli Hospital was carried out. The data collected were demographic, clinical, laboratory and radiological. Cases were mapped geographically to analyse for clustering of cases. Spearman's correlation was used to assess for correlations between laboratory markers. RESULTS. A total of 24 subjects, 75% of whom were male, were included. The mean (standard deviation) age at diagnosis was 8.9 (3.4) years. The mean delay in diagnosis was 5.8 (5.7) months. Of the subjects, 15 (71.4%) were from the Eastern Cape and 9 from KwaZulu-Natal provinces. Seventy-nine percent of the patients had been exposed to dogs, while 8% reported exposure to either sheep or cattle. There was right-sided preponderance, with 11 right- and 7 left-sided cysts; 6 patients had bilateral cysts, and 4 associated extrapulmonary cysts. Indirect haemagglutination assay was positive in 70%, and blood eosinophilia was present in 45% of the subjects, with no correlation between the two markers (p=0.22). Surgery was the only modality of treatment in 18 (75%) subjects, while 5 had had prior medical therapy for disseminated disease. The mean intensive care stay postoperatively was 2 (2) days with no mortality. CONCLUSION. Despite exposure to known risk factors and living in endemic regions, there is often a significant delay in diagnosis of pulmonary hydatid disease at Inkosi Albert Luthuli Hospital. <![CDATA[<b>Pattern of cerebral palsy seen in children attending the outpatient paediatric physiotherapy clinics in Osun State tertiary hospitals in Nigeria</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200006&lng=pt&nrm=iso&tlng=pt BACKGROUND. Cerebral palsy (CP) is a major cause of disability in children and the most commonly encountered neurologic condition by paediatric physiotherapists in Nigeria. Local data on the pattern of presentation of CP and standardised management protocols are lacking. OBJECTIVES. To assess the pattern of CP seen in children attending paediatric physiotherapy clinics in Osun State tertiary hospitals. METHODS. A hospital-based cross-sectional study was conducted in three tertiary hospitals within Osun State, Nigeria. Data were collected using caregiver questionnaires, medical records and physical assessment (Gross Motor Function Measure-88) and were recorded on a standardised case record form. Data were analysed using appropriate statistical tests with alpha set at p<0.05. RESULTS. A total of 187 children with CP were seen during the six-month period. The male to female ratio was 1.2:1 and the children were aged 12 months to 12 years. The majority of the mothers (63.6%) were primiparous and, at the time of delivery, most mothers were aged between 28 and 33 years. Spastic (72.7%) and quadriplegic (69.5%) presentations were the leading sub-types of CP, with 76.5% of children having one or more associated problems. Birth asphyxia (57.2%) was the leading aetiology of CP while speech impairment was common in 63.6% of cases. One hundred and fourteen (61%) children were classified as being severely disabled and 53.5% had a gross motor function measure score of less than 40.9%. CONCLUSION. Severe CP is commonly encountered in the region, with children most frequently presenting with spastic quadriplegia and speech impairment. A good knowledge of the pattern of CP seen in south-western Nigeria is one of the first steps in developing a standardised protocol. <![CDATA[<b>Health-related quality of life in children and adolescents with end-stage renal disease receiving dialysis in Johannesburg</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200007&lng=pt&nrm=iso&tlng=pt BACKGROUND. Limitations in daily activities can have a major impact on the quality of life in children and adolescents. Long-term dialysis tends to restrict children from carrying out similar activities to those of their peers. OBJECTIVE. To analyse the health-related quality of life of children and adolescents with end-stage renal disease on dialysis in Johannesburg. METHODS. A hospital-based, cross-sectional study which assessed the health-related quality of life (HRQOL) of patients undergoing haemodialysis (HD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) using the Pediatric Quality of Life Inventory (PedsQL 3.0) and end-stage renal disease (ESRD) module as the instrument. The instrument is a questionnaire comprising 7 domains with a total of 34 questions/items. Child reports as well as parent proxy reports were obtained. Questionnaires were administered to all patients and parents/caregivers of children on all forms of chronic dialysis. RESULTS. Twenty-seven children and adolescents were studied. The mean (standard deviation (SD)) age of the study participants was 14.4 (4.8) years (range 5 - 25). Fourteen patients were on HD while 13 were on peritoneal dialysis (8 on APD and 5 on CAPD). Those on HD were significantly older, with a mean (SD) age of 16.6 (3.2) years, compared with the mean (SD) age of those on PD, which was 12.1 (5.3) years (p=0.007). Moreover, those on HD had been on dialysis for a longer period of time, with a mean (SD) period of 4.5 (3.3) years, compared with those on PD who had been on dialysis for a mean (SD) duration of 1.7 (0.8) years (p=0.006). The HRQOL was lower in most domains in the HD group compared with the PD group. Among the patients on PD, the HRQOL scores were lower in the APD group compared with the CAPD group (p>0.05). The ratings by the parent proxies were higher than those reported by the children themselves in most domains. When compared with the population mean HRQOL scores derived from a healthy paediatric population, the mean HRQOL scores of the children with ESRD on dialysis were significantly lower for both child (t=-11.1; p=0.001) and parent proxy reports (t=-7.2; p=0.001). CONCLUSION. HRQOL is low in children with ESRD receiving chronic dialysis. It tends to be much lower in children on HD when compared with those on PD. PD appears to be more acceptable to children and parents/caregivers than HD. <![CDATA[<b>The use of the Road-to-Health card by doctors in a tertiary paediatric hospital setting</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200008&lng=pt&nrm=iso&tlng=pt BACKGROUND. Low possession of the Road-to-Health card (RTHC) by parents, as well as inadequate use of the RTHC by health professionals, have reduced its efficacy. OBJECTIVES. To describe the level of possession of the RTHC by a sample of patients admitted to the Red Cross War Memorial Children's Hospital (RCWMCH), and to determine the extent and accuracy of doctors' transfer of clinical information between the RTHC and hospital records. METHODS. A cross-sectional analytical study conducted in four general paediatric wards over six weeks, during which data were extracted from participants' RTHC and hospital record. The presence or absence of selected items of information on the RTHC and the hospital record was recorded; the primary outcome was the transfer of the specified items of information between records. RESULTS. A total of 133 (81%) eligible caregivers had the RTHC on their person. Variables including perinatal information, immunisation record and weight-for-age chart were well-documented on the RTHC prior to hospital admission, and mostly well-transferred to the hospital record. In general, new information in the hospital record was poorly transferred to the RTHC on discharge; for example, weight (31%), diagnosis (63%) and treatment (48%). CONCLUSIONS. The possession rate of RTHCs within the study sample was within an acceptable range. Although doctors generally made use of the RTHC as a reference source, their recording of new clinical information on the RTHC was poor, missing the opportunity to use it as a communication tool for continuity of care. <![CDATA[<b>Sphenoid mucocoele - an unusual cause for headaches in a teenage boy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200009&lng=pt&nrm=iso&tlng=pt Isolated sphenoid sinus disease in childhood is uncommon and sphenoid mucocoeles (histologically benign, epithelium-lined, mucus-containing sacs) are rare. They are thought to arise as a result of obstruction of the sinus ostium due to previous surgery, inflammation, trauma or irradiation, but may be idiopathic. We present a case of a sphenoid sinus mucocoele in a young boy and highlight the fact that headache may be the only symptom, therefore diagnosis may require a combination of imaging and exploratory surgery. <![CDATA[<b>The immigration of anaemia - presentation of sickle cell disease in children admitted to a district hospital in Johannesburg: A case series</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200010&lng=pt&nrm=iso&tlng=pt Sickle cell disease (SCD) is the most common monogenic disorder and haemoglobinopathy worldwide and is unique in its distribution to tropical, malaria-endemic regions. SCD is typically rare in South Africa (SA) but the increasing immigration of foreign nationals over the last 20 years has the potential to alter the epidemiology of this life-threatening disease. With recent data from the Western Cape showing an increase in disease frequency, more evidence needs to be collected to determine the changes in the disease profile locally. This case series reviews the presentation and outcome of three patients diagnosed with SCD at a district hospital in Johannesburg, Gauteng. <![CDATA[<b>Neonatal haemolytic anaemia - a diagnostic approach to red cell membrane disorders</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S1999-76712018000200011&lng=pt&nrm=iso&tlng=pt In neonates presenting with a non-immune haemolytic anaemia, a high index of suspicion is raised for hereditary red cell membrane disorders. The distinction between red cell membrane disorders, however, is often difficult in neonates in the absence of a complete family history. We describe a case of a 26-day-old female twin who presented with jaundice and severe haemolysis, which required multiple red cell transfusions. Laboratory investigations revealed a non-immune haemolysis. Red cell membrane extraction and sodium dodecyl sulphate-polyacrylamide gel electrophoresis analysis, including spectrin analysis, revealed the presence of mutant spectrin αI/74. A diagnosis of hereditary elliptocytosis with transient infantile poikilocytosis was favoured. On follow-up at 4 months, a decline in haemolysis was observed.