Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 12 num. 3 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>The new Road to Health Booklet demands a paradigm shift</b>]]> <![CDATA[<b>Ileosigmoid knotting in a child: Index case in Botswana and review of the literature</b>]]> Ileosigmoid knotting (ISK) is a rare form of complex intestinal obstruction where a loop of ileum wraps around the base of the sigmoid colon, or vice versa. We report the case of an ill-looking 8-year-old boy who presented with abdominal pain and vomiting. Abdominal examination revealed distension and features of diffuse peritonitis. Complicated appendicitis was at the top of the list of differential diagnoses. The patient was resuscitated and prepared for surgery. At laparotomy, haemorrhagic fluid with gangrenous ileum wrapping around gangrenous sigmoid colon was found. En bloc resection of the gangrenous ileum and sigmoid colon with primary ileo-ileal and descending colorectal anastomoses were done. The patient was discharged on the 10th postoperative day. Although extremely rare in this patient population, surgeons must be able to recognise and manage ISK in children. <![CDATA[<b>Double trouble: Addressing stunting and obesity via school nutrition</b>]]> BACKGROUND. South Africa (SA), as a middle-income country, faces the nutrition transition and associated double burden of undernutrition and obesity. School feeding programmes are one way of ensuring that malnutrition in children is addressed, but questions remain about whether they can address both undernutrition and obesity. OBJECTIVES. To compare the obesity and stunting outcomes for children receiving different combinations of school feeding programmes in a rural district of SA. METHODS. The evaluation involved a comparative design that compared the stunting and obesity levels of three groups of children. Group 1 received one lunch meal a day for a prolonged period, group 2 both lunch and breakfast, and group 3 had started receiving a daily lunch shortly before the commencement of the research. RESULTS. Group 1 had stunting levels in line with the national average. Group 2 had lower stunting levels than those receiving only the lunch meal. Children from group 3 had lower stunting levels than groups 1 and 2. Rates of obesity and overweight were markedly different between the groups. Group 3 had very high rates of overweight and obesity - above the national average of 28%. In contrast, group 1 had far lower rates of overweight and obesity, and group 2 exhibited the lowest levels. There was a significant decrease in the percentage of learners classified as overweight in group 3 over the 6-month period, from 26.1% to 19.2%. CONCLUSION. One lunch meal a day is associated with positive outcomes in relation to rates of stunting and obesity, and the lowest rates of obesity were measured when a breakfast meal was added. The addition of a breakfast meal to a lunch feeding programme shows promise, but this requires further investigation to understand whether causal linkages exist. <![CDATA[<b>Food insecurity, social welfare and low birth weight: Implications for childhood malnutrition in an urban Eastern Cape Province township</b>]]> BACKGROUND. Limited information is available regarding the impact of food insecurity, low birth weight (LBW) and the protective effect of the child support grant (CSG) on malnutrition in South Africa (SA). OBJECTIVES. To describe malnutrition in the context of food insecurity, CSG and LBW history among children younger than 24 months from an underprivileged urban settlement in the Eastern Cape Province of SA. METHODS. A descriptive study using a cross-sectional design was used to collect data from a non-probability sample of 400 young children from October 2015 to February 2016. Inferential statistics included t-tests to compare anthropometric data from different birth weight categories and analysis of covariance (ANCOVA) to allow for the effect of covariates. RESULTS. Of the sample, 9% were stunted, 1% were wasted, 16% were overweight, 23% were food secure, 47% were at risk of hunger, and 31% were classified as hungry. LBW history was significantly associated with stunting but not with wasting. CSG holders and 'hungry' households' children had significantly lower mean height-for-age z-scores (HAZ) than non-CSG holders and food-secure households. Despite these apparent associations, when LBW is considered as a covariate, it becomes apparent that neither the CSG nor CCHIP category is significantly related to any of the anthropometric indicators. CONCLUSION. The Department of Health has to recognise the significant impact of LBW on the prevalence of stunting and thus the need to prioritise antenatal care. Policymakers could aim to make the CSG available to mothers as close after birth as possible, or during pregnancy, in order to be more effective in reducing the long-term effects of LBW. <![CDATA[<b>Acceptance of an orange-fleshed sweet potato complementary food by infant caregivers in KwaZulu-Natal Province - a preliminary study</b>]]> BACKGROUND. Vitamin A deficiency (VAD) is a major public health problem that affects South African children and is a major contributor to the mortality of children under five years of age. VAD can result in visual impairment, diarrhoea and increased risk of severe measles and death. Orange-fleshed sweet potato (OFSP), a staple crop biofortified with provitamin A, has the potential to improve vitamin A intake in infants, especially when used as a complementary food. OBJECTIVE. To assess the acceptance of an OFSP complementary food by infant caregivers. METHODS. This study was conducted at the Newtown Community Health Centre, Inanda, in the eThekwini District of KwaZulu-Natal (KZN). Sixty-three infant caregivers assessed the acceptance of complementary foods made from OFSP and white-fleshed sweet potato (WFSP) (control), using a five-point hedonic rating test. In addition, ten caregivers participated in two focus group discussions, using pre-determined questions. RESULTS. There were no statistically significant differences in the sensory attribute ratings of complementary foods made from WFSP and OFSP. The OFSP complementary food was well-accepted, especially its colour and soft texture. None of the focus group discussion participants had seen or tasted the OFSP before. Caregivers were willing to buy the OFSP, if it were available and cheaper than the WFSP. CONCLUSION. The complementary food made from the OFSP was highly acceptable to infant caregivers attending the Newtown Community Health Centre in KZN. It has the potential to be used in complementary feeding and to improve the vitamin A status of infants. <![CDATA[<b>Blood pressure pattern and the relationship with body mass index among apparently healthy secondary-school students in Sokoto metropolis, Nigeria</b>]]> BACKGROUND. Childhood obesity may result in the premature onset of cardiovascular risk factors, particularly hypertension, hence the need for proper screening. However, blood pressure (BP) is measured only once in most studies in Nigeria, probably because of difficulties in returning to the study areas for repeat measurement. OBJECTIVE. To determine the BP pattern and assess its relationship with body mass index (BMI) in apparently healthy secondary-school students aged 10 - 18 years in Sokoto metropolis, Nigeria. METHODS. This study was descriptive and cross-sectional, and carried out between 13 October 2014 and 30 January 2015. In total, 800 students from 6 schools were selected through multistage sampling. BP was measured on three separate days according to the National High Blood Pressure Education Program charts. BMI was categorised according to the Centers for Disease Control charts. The relationship of BP level with BMI was determined. RESULTS. There were 424 (53.0%) males and 376 (47.0%) females, with a ratio of approximately 1:1. BP increased with age. The mean systolic and diastolic BP was significantly higher in females than males (systolic 113.1 mmHg v. 110.5 mmHg, and diastolic 69.0 mmHg v. 66.5 mmHg, respectively; p=0.01). Females had a higher mean BMI than males (18.7 kg/m² v. 17.9 kg/m², respectively; p<0.01). BP increased as the BMI percentile increased (p<0.001). The prevalence rates of hypertension were 6.1%, 3.5% and 3.1% at the first, second and third screenings, respectively, while the corresponding prevalence rates of prehypertension were 14.3%, 8.4% and 7.1%. The prevalence of obesity and overweight was 0.3% and 5.9%, respectively. CONCLUSION. The prevalence rate of prehypertension and hypertension reduced with subsequent measurements, and the prevalence rates of overweight and obesity were low. However, higher BP levels were associated with higher BMI, supporting its predictive significance for elevated BP. <![CDATA[<b>Ownership of mobile phones and willingness to receive childhood immunisation reminder messages among caregivers of infants in Ondo State, south-western Nigeria</b>]]> BACKGROUND. The timely completion of the childhood immunisation schedule for children under the age of 1 year by caregivers is key to reducing the high morbidity and mortality of vaccine-preventable diseases among infants globally. OBJECTIVE. To determine the ownership of mobile phones among caregivers of children under the age of 1 year, their knowledge about immunisation service delivery and willingness to receive childhood immunisation schedule reminder messages in Ondo State, south-western Nigeria. METHOD. A descriptive cross-sectional study using semi-structured interviewer-administered questionnaires was conducted with 615 caregivers of infants, who brought their children to clinics conducting immunisation in 24 health facilities in rural, semi-urban and urban settlements in Ondo State in December 2014. RESULTS. The mean (standard deviation, SD) age of respondents was 28.49 (6.01) years, 76.7% were Yoruba, 91.4% were married and living with their spouses and 4.2% were single. Mobile phone ownership was 74.5% among rural-based respondents, and 95.8% among urban-based. Forty-six percent of the respondents had good knowledge of immunisation, vaccine-preventable diseases and vaccination schedules, while 27.5% had poor knowledge. The majority of the respondents (99.7%) were willing to receive childhood immunisation reminder messages on their mobile phones. About 50% of the respondents preferred to receive reminder messages at any time, rather than specific times. The most preferred language for reminders was English (54.5%). Residing in an urban area and having post-secondary education were predictors of mobile phone ownership. CONCLUSION. The high mobile phone ownership level, and the willingness of caregivers of infants in this study area to receive immunisation schedule reminder messages, is encouraging, and should be optimised to improve routine immunisation uptake. However, caregivers of infants in rural areas need to be provided with mobile phone support, and trained in their usage in order to benefit from such an intervention in childhood immunisation. <![CDATA[<b>Improving survival of preterm babies in low- to middle-income countries - what can we do?</b>]]> Surviving prematurity poses the greatest challenge in neonatal care in low- to middle-income countries (LMICs). South Africa has not made much progress in improving the survival of preterm babies. Neonatal survival of preterm infants has become a national priority since the serious failure to reach the Millennium Development Goal targets in 2015. High rates of prevention are particularly relevant in LMICs, where the neonatal mortality rate is at its highest owing to a lack of simple and effective measures. Preventing prematurity and related complications begins with a healthy pregnancy. Antenatal care and maternal corticosteroids are antenatal interventions that could improve the survival of preterm babies. Postnatal interventions include: the management of neonatal sepsis, meningitis and pneumonia; prevention of hypothermia after delivery, for example, the plastic bag/wrap and cap, which has been extensively researched and is found to be an effective, low-cost method for reducing hypothermia in preterm infants; the use of continuous positive airway pressure (CPAP), including the low-cost CPAP device, which is a cost-effective strategy for providing respiratory support for premature neonates with respiratory distress syndrome; exogenous surfactant; early feeding with breastmilk; and kangaroo mother care. The use of cost-effective, evidence-based interventions can be implemented in LMICs to reduce neonatal mortality. <![CDATA[<b>Traditional red cell indices are not suggestive of iron deficiency in children with chronic kidney disease</b>]]> BACKGROUND. Iron deficiency (ID) contributes significantly to the chronic anaemia seen in chronic kidney disease (CKD). The use of traditional red cell indices such as mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RCDW) in screening for ID has been recommended, because they are inexpensive and widely available, especially in low-income settings. OBJECTIVES. To determine the prevalence of anaemia and ID, and the role of traditional red cell indices in screening for ID in children with CKD. METHODS. A sample of 130 children (aged 5 - 18 years) with various stages of CKD was recruited. Blood samples were taken and assessed for traditional red cell indices (MCV, MCH, MCHC and RCDW), serum haemoglobin, creatinine, C-reactive protein, iron, transferrin, transferrin saturation (TSAT) and ferritin. RESULTS. The mean (standard deviation) age was 10.7 (3.6) years, with a male-to-female ratio of 1.8:1. There was a high prevalence (32%) of anaemia among the patients. The median TSAT and ferritin were 19 (range 13 - 26)% and 50 (28 - 102) ng/mL, respectively. The prevalence of ID and ID with anaemia (IDA) was 43% and 11%, respectively. The majority of the patients (110/130; 85%) were iron deplete, and serum ferritin and RCDW were found to be independent predictors for anaemia, ID and IDA. There was no significant difference in the traditional red cell indices in iron-deplete and iron-replete patients. CONCLUSION. The routine use of traditional red cell indices alone in screening for ID in children with CKD should be discouraged. <![CDATA[<b>Demographics and predictors of mortality in children undergoing resuscitation at Khayelitsha Hospital, Western Cape, South Africa</b>]]> BACKGROUND. The clinical outcomes of paediatric patients requiring resuscitation depend on physicians with specialised knowledge, equipment and resources owing to their unique anatomy, physiology and pathology. Khayelitsha Hospital (KH) is a government hospital located near Cape Town, South Africa, that sees ~44 000 casualty unit patients per year and regularly functions at more than 130% of the bed occupancy. Many of these patients are children requiring resuscitation. OBJECTIVES. We sought to describe characteristics of children under the age of 12 who required resuscitation upon presentation to KH, determine predictors of mortality, and compare paediatric volume to specialist physician presence in the unit. METHODS. A retrospective chart review was performed on patients younger than 12 years who were treated in the resuscitation area of KH during the six-month period from 1 November 2014 to 30 April 2015. RESULTS. A total 317 patients were enrolled in the study with a median age of 14 months. The top 5 diagnoses were: pneumonia (n=58/317); neonatal sepsis (n=40/317); seizures (n=37/317); polytrauma (n=32/317); and acute gastroenteritis complicated by septic shock (n=28/317). Overall mortality was 7% (n=21/317) and mortality in children less than 1 month of age was 12% (n=5/42). Premature birth was associated with a mortality odds ratio of 8.44 (p=0.002). More than two-thirds (73%; n=231/317) of paediatric resuscitations occurred when specialist physicians were not physically present in the unit. CONCLUSION. The study findings indicate that children under one month of age with a history of prematurity are at high risk and may benefit most from paediatric-specific expertise and rapid transfer to a higher level of care.