Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 13 num. 1 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Consideration of molecular autopsies in forensic cases of sudden unexpected death in infants and children in South Africa</b>]]> <![CDATA[<b>Tobacco, nicotine and e-cigarettes: Protecting children in South Africa</b>]]> <![CDATA[<b>Comparison of the demographic and diagnostic profile of new patients attending a neurodevelopmental clinic in 2008/2009 and 2016</b>]]> BACKGROUND: Literature suggests an increasing prevalence of developmental disabilities, and specifically of conditions such as autism and attention deficit/hyperactivity disorder. Lhe resulting burden on paediatric neurodevelopmental services has not been described in the South African setting OBJECTIVE: Lo compare the demographic and diagnostic profile of new patients attending a neurodevelopmental service across two 12-month periods, after a change in referral pathway and the introduction of a secondary clinic METHODS: We conducted a retrospective, descriptive cross-sectional folder review of new patients seen in the neurodevelopmental service at Lygerberg Hospital in 2008/2009 and 2016 RESULTS: Lhe number of new patients increased from 84 in 2008/2009 to 240 in 2016. In both periods the majority of patients were male. Lhe median (IQR) age decreased from 62 (31 - 92) months in 2008/2009 to 53 (37 - 67) months in 2016 (£=0.17). In 2008/2009 only one patient was from the Khayelitsha health subdistrict compared with 49 (20.4%) in 2016, following the subdistrict's addition to the hospitals drainage area in 2011. Lhe number of patients referred by allied health professionals increased between the two periods (30.4% in 2016 v. 16.4% in 2008/2009). Cases of autism spectrum disorder (ASD) increased notably: from 10 (8.4%) in 2008/2009 to 84 (35%) in 2016 CONCLUSION: Lhe notable increase in neurodevelopmental referrals over the past 8 years cannot be fully explained by a regional population increase or a change in referral pathway. Lhe number of ASD cases has increased disproportionately, with important implications for health and educational service planning <![CDATA[<b>The impact of a diabetes care team on the glycaemic control of paediatric and adolescent patients with type 1 diabetes mellitus at Tygerberg Children's Hospital</b>]]> BACKGROUND: A diabetes care team (DCT) may contribute to improved glycaemic control in type 1 diabetes mellitus (T1DM) patients. Hence a DCT was introduced at Tygerberg Children's Hospital (TCH) in 2009 HYPOTHESIS: A DCT for T1DM patients improves HbAlc, reduces admission and diabetic ketoacidosis (DKA) rates and insulin dose, and decreases the prevalence of complications METHODS: In this retrospective cohort study, records of 190 T1DM patients attending the paediatric diabetic clinic at TCH between August 2004 and July 2011 were reviewed. Data extracted include: glycated haemoglobin (HbAlc) levels; total number of admissions; DKA and recurrent DKA (rDKA) admissions; insulin regimen and dose; and presence of complications. Four periods, in which specific changes to team composition occurred, were compared RESULTS: HbAlc levels increased from 9.0% (7.85 -10.15) in PI to 10.9% (9.6 - 12.2) in P2, but decreased to 9.3% (8.75 - 9.75) in P4 (p=0.02). The number of admissions decreased from 0.79 (0.46 - 1.12) to 0.18 (0.02 - 0.34) (p=0.01). The DKA rate decreased from 32.5/100 patient years to 23.5/100 patient years. The rDKA rate decreased from 18.8% in PI to 9.6% in P4. Daily insulin injections increased from 2.97 (2.85 - 3.01) to 3.06 (3.06 - 3.23) (p=0.01). The mean insulin dose decreased from 1.19 (1.08 - 1.31) to 0.93 (0.87 - 1.00) units/kg/day (p=0.00 CONCLUSION: After the introduction of the DCT, HbAlc levels were less variable and hospital admission and DKA rates decreased. Improvements were achieved with a multiple injection regimen at a lower daily insulin dose <![CDATA[<b>Women's position in the household as a determinant of neonatal mortality in sub-Saharan Africa</b>]]> BACKGROUND: The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the neonatal period, with over 40% of cases occurring during the first month of life. There is a paucity of evidence on the influence of women's household position on neonatal survival in SSA OBJECTIVE: To assess the influence of women's household position on neonatal survival in SSA METHODS: We analysed pooled data (N=191 514) from the demographic and health surveys of 18 countries in SSA. Cox proportional hazards regression analysis was used to explore statistically significant relationships RESULTS: Findings support the hypothesis that a low position of a woman in the household is significantly associated with high neonatal mortality, as children of women who experienced a high position in the household had a significantly lower risk of neonatal mortality (hazard ratio 0.85, confidence interval 0.76 - 0.95; p<0.05) than those whose mothers experienced a low household position CONCLUSION: This study concludes that improving women's household position through enhanced socioeconomic status could substantially contribute to reducing neonatal mortality in SSA <![CDATA[<b>A study of self-reported handwashing practices of caregivers in relation to acute respiratory infections and gastroenteritis in infants in a peri-urban community in KwaZulu-Natal Province, South Africa</b>]]> BACKGROUND: Handwashing is a recognised cost-effective intervention for the prevention of common childhood infections, including pneumonia and diarrhoeal disease. Globally, handwashing practices may be poor and little is known about handwashing practices in South Africa OBJECTIVES: To describe and compare handwashing practises of caregivers whose infants are admitted with acute gastroenteritis and acute lower respiratory tract infection with those of healthy infants who are attending primary healthcare clinics for routine immunisation METHODS: A cross-sectional study of self-reported handwashing practices was conducted among caregivers of infants from the Vulindlela area, Pietermaritzburg. Respondents were interviewed regarding household structure, services and handwashing practices RESULTS: During the 3-month study period, 137 respondents were interviewed. Of these, 41 (30%) had infants with pneumonia, 41 (30%) with diarrhoea and 55 (40%) had healthy infants. A high rate of handwashing with soap and water (81.8%) was found in this study, with 58.4% of the respondents using running rather than stagnant water. Logistic regression identified some variables associated with higher odds of having a healthy infant, namely: a monthly household income >ZAR2 000 (odds ratio (OR) 4.74; 95% confidence interval (CI) 1.99 - 11.25); washing hands with soap and running water (OR 3.88; 95% CI 1.55 - 9.76); washing hands before eating (OR 7.41; 95% CI 0.79 - 68.76), and washing hands after household chores (OR 9.24; 95% CI 1.85 - 46.25 CONCLUSION: A higher than anticipated number of participants washed their hands with soap and running water and at critical moments <![CDATA[<b>Waist circumference percentiles of black South African children aged 10-14 years from different study sites</b>]]> BACKGROUND: Waist circumference (WC) is a useful predictor of cardiometabolic risk in children. Published data on WC percentiles of children from African countries are limited OBJECTIVES: To describe age- and sex-specific WC percentiles in black South African (SA) children from different study sites, and compare these percentiles with median WC percentiles of African-American (AA) children METHODS: Secondary data on WC for 10 - 14-year-old black SA children (N=4 954; 2 406 boys and 2 548 girls) were extracted from the data sets of six studies. Smoothed WC percentile curves for boys and girls were constructed using the LMS method. The 50th percentile for age- and sex-specific WC measurements was compared across study sites and with AA counterparts RESULTS: Girls had higher WC values than boys from the 50th to 95th percentiles at all ages. The 50th WC percentiles of all groups of SA children combined were lower than those of AA children. When SA groups were considered separately, Western Cape children had median WC values similar to AA children, while rural Limpopo children had the lowest WC values. The 95th percentiles for Western Cape girls exceeded the adult cutoff point for metabolic syndrome (WC >80 cm) from age 11 years CONCLUSIONS: The differences in WC values for 10 - 14-year-old children across the six study sites highlight the need for nationally representative data to develop age-, sex- and ethnic-specific WC percentiles for black SA children. The results raise concerns about high WC among Western Cape girls <![CDATA[<b>Tracking progress on the health status and service delivery outcomes for neonates and children in the Metro West geographic service area of the Cape Metropole, 2010-2015</b>]]> BACKGROUND: Monitoring the health status of populations of children is one of the building blocks of the health system. The provision of an indicator dashboard with disaggregated data that are collected over time can be used to gauge the performance of the health system, guide the allocation of resources and prioritise health interventions within districts OBJECTIVES: To determine neonatal and child mortality, morbidity and health service outcomes over a 6-year period in the Metro West geographic service area (GSA) of the Cape Town metropole METHODS: A dashboard with key indicators was developed using existing data RESULTS: From 2010 to 2015, there was a decrease in the perinatal mortality rate from 31.7 to 24.8 per 1 000 deliveries, and the early neonatal and neonatal mortality rates from 7.8 and 8.6 to 7.0 and 8.2 per 1 000 live births, respectively. The main obstetric causes of early neonatal deaths were antepartum haemorrhage (22 - 24%) and unexplained intrauterine death (13 - 16%); the main neonatal causes were immaturity (17 - 34%), congenital abnormalities (23 - 29%) and hypoxia (23 - 26%). Under-five mortality decreased in 2013 from 25 to 22 per 1 000 live births, with the main causes being neonatal conditions (32%), pneumonia (25%), congenital abnormalities (9%), injuries (8%) and diarrhoea (8%). Fifty percent of child deaths were out of hospital, with pneumonia and diarrhoea accounting for more than half of these. There was an improvement in health service coverage rates in 2015: immunisation <1 year old (99%); measles second dose (85%), pneumococcal third dose (100%) and rotavirus second dose (100%); maternal antiretroviral coverage (90%); HIV testing in mothers (93%); HIV DNA polymerase chain reaction testing in babies (97%); and a decrease in HIV transmission (2%). Exclusive breastfeeding coverage rates at 14 weeks, and vitamin A supplementation at 12 - 59 months, were only 30% and 44%, respectively, across the GSA CONCLUSION: There was a decrease in perinatal, early neonatal, infant and under-five mortality in Metro West over the 6 years. Further reductions in under-five mortality will require focusing on interventions to reduce neonatal and out-of-hospital deaths across the service delivery platform. Home visits to at-risk mothers and infants by community health workers could prevent out-of-hospital deaths and improve exclusive breastfeeding and vitamin A coverage. This will require increasing the number of community health workers and broadening their scope of practice <![CDATA[<b>Severe hypertension in children at a central referral hospital in KwaZulu-Natal Province, South Africa</b>]]> BACKGROUND: Hypertension (HPT) is often underdiagnosed in children, although significant morbidity and mortality arises from hypertensive target organ damage and hypertensive crises OBJECTIVES: To determine the prevalence, complications and causes of severe HPT in children <12 years old at a central hospital METHODS: Hospital records of children < 12 years old with severe HPT (stage 2 and higher) from 2005 to 2014 were reviewed. Demographics, nutritional status, causes, HIV status, presence of target organ damage and treatment were analysed RESULTS: Of 821 children admitted to the paediatric nephrology unit, 152 (18.5%) children had severe HPT, with a mean age of 6.3 years; 86 (57%) were boys. A total of 28 (19%) were HIV-positive, and 19 (68%) were treatment naive. Kidney disease accounted for 82% of cases, 46 (30%) having steroid-resistant nephrotic syndrome, 22 (14%) HIV-associated nephropathy, 19 (13%) glomerulonephritis, 21 (14%) congenital urinary tract abnormalities and 17 (11%) other renal causes. Renovascular causes accounted for 12 (8%) cases. Of these 12,7 (58%) had left ventricular hypertrophy (LVH), compared with 10/125 (8%) who had other forms of kidney disease (jkO.023). Hypertensive crises occurred in 28 (18%) patients, and were significantly more common in children with HPT secondary to renovascular causes than renal causes (p=0.001 CONCLUSION: Renal diseases were the most common cause of severe HPT in children. Hypertensive crises, retinopathy and LVH are common in renovascular HPT <![CDATA[<b>Splenic abscess: Conservative management in children</b>]]> Isolated splenic abscess is rare in children, and occurs predominantly in the immunocompromised, with high rates of mortality and morbidity. We reviewed seven cases of splenic abscess managed at our centre. Six out of seven children (aged 7 months - 15 years, four male and three female) had multiple abscesses. Fever, abdominal pain, hepatosplenomegaly and leukocytosis were the predominant clinical manifestations. Burkholderia pseudomallei and coagulase-negative Staphylococcus aureus were isolated as the causative agents in two children. Five children were successfully managed conservatively, and two with ultrasonography-guided aspiration. Early institution of parenteral antibiotics and ultrasonography-/computed tomography-guided aspiration can help in preventing splenectomy in such children.