Scielo RSS <![CDATA[South African Journal of Child Health]]> vol. 15 num. 4 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b>Children caught in the long shadow of COVID-19</b>]]> Despite the more transmissible delta variant being associated with higher rates of COVID-19 in unvaccinated adolescents, children have remained relatively spared from severe disease. Nevertheless, children are indirectly affected by the COVID-19 pandemic, which threatens to have far-reaching consequences. The effect of disruptions of seasonal patterns of circulation of respiratory pathogens on future immunity against such pathogens, childhood immunisation programmes, and HIV and tuberculosis treatment programmes poses a threat to the future wellbeing of children. Furthermore, the economic devastation caused by the pandemic, including an increase in unemployment, gives rise to numerous challenges, such as food insecurity, which is likely to worsen childhood nutritional status. Also, COVID-19 has ongoing effects on the mental wellbeing of children, driven in part by the interruption of schooling and other opportunities to socialise. An increase in psychological illnesses has manifested in children consequent to the stresses of the pandemic, lockdowns, caregiver deaths. In this article, we highlight the indirect effects of COVID-19 on children, and suggest solutions to mitigate against the long-term sequelae. A focused health, nutrition, education and child protection response is required from government and healthcare practitioners to safeguard the health and wellbeing of South African children. <![CDATA[<b>Utilisation of paediatric surgical theatresat the Chris Hani Baragwanath Academic Hospital, Johannesburg</b>]]> BACKGROUND. Optimal theatre utilisation is essential to reduce long waiting lists for elective surgeries and to increase cost-effective theatre operation. Utilisation rates well below the global benchmark of 80% have been reported for government hospitals in Johannesburg, South Africa (SA). OBJECTIVE. To investigate utilisation of three paediatric theatres at the Chris Hani Baragwanath Academic Hospital (CHBAH) in Johannesburg. METHODS. Surgery lists of the three theatres were reviewed for three one-week periods over a four-month study period. Preoperative, intraoperative and postoperative data were collected to create a timeline for each theatre and each surgical case, including reasons for cancellations, delays or expedited times. RESULTS. A total of 152 surgeries were scheduled during the reviewed study period, of which 44 cases were cancelled. The utilisation rate was 59.8% across the three theatres combined, with individual rates calculated as 62.7%, 58.2% and 57.0% in the burns, general and neonatal theatres, respectively. The primary factor contributing to under-utilisation was early completion of the scheduled list. Surgery delays were mainly due to delays in transferring the patient to the theatre and between anaesthetic induction and the start of surgery. CONCLUSION. Utilisation of the paediatric theatres at CHBAH is below the ideal benchmark of 80%; however, utilisation was better than expected when compared with findings from other public-sector hospitals in SA. However, theatre efficiency was found to be very low and perhaps better explains the reasons for backlogs in paediatric surgeries at CHBAH. <![CDATA[<b>Complications associated with central venous lines for paediatric oncology patients at Univers Academic Hospital, Bloemfontein, from 1992 to 2018</b>]]> BACKGROUND. Central venous access devices are associated with complications such as central-line infections and systemic sepsis. OBJECTIVE. To determine the complication rates associated with central venous lines used to administer chemotherapy at the Paediatric Haematology Oncology Unit, Universitas Academic Hospital, Bloemfontein, from January 1992 to March 2018. METHODS. A retrospective descriptive analysis of paediatric oncology patients who received intravenous catheterisation and were treated at the unit. Cases with incomplete data, age >16 years and treatment after 31 March 2018 were excluded. RESULTS. Records of 293 Hickman lines were analysed. The median patient age was 64.7 months. Sepsis was noted in 13.3% of the cases; no in situ local complications were found in 62.5% of the lines. Of the 39 cases that presented with line sepsis, 23.1% showed no signs of systemic sepsis, whereas 61.5% were neutropenic and septic. In total, 190 patients had symptoms of systemic sepsis and accompanying neutropenia. Of these, 67.4% did not develop in situ line complications. Lines were removed mostly because the end of treatment had been reached (44.7%); line sepsis was noted as the reason for removal in only 16.3% of cases. CONCLUSION. Despite the study population having a high risk for infections because of a young age, a large proportion of haematological malignancies and surgical placement of Hickman lines, there was a low incidence of line sepsis complications. The special care taken intraoperatively and meticulous aseptic postoperative handling and maintenance are suggested as contributing to limited infective complications. <![CDATA[<b>Incidence, types and outcomes of congenital anomalies in babies born at a public, tertiary hospital in South Africa</b>]]> BACKGROUND. Limited information is available on the incidence of major congenital abnormalities (MCAs) in low- and middle-income countries (LMICs). OBJECTIVE. To determine the incidence and types of MCA and associated all-cause mortality from a facility with a large delivery service in an LMIC. METHODS. Births and neonatal admission registers of live inborn births between 1 January 2012 and 31 December 2013 at the Chris Hani Baragwanath Academic Hospital, South Africa, were reviewed for diagnosis of MCA. RESULTS. A total of 201 infants were admitted with a diagnosis of MCA, of which 114 were inborn. This translated to an incidence of 2.60 per 1 000 live births. The cardiovascular (43.9%), gastrointestinal (21%), musculoskeletal (13.2%) and central nervous system (12.3%) were commonly affected systems. Most MCAs were single defects (75.4%), followed by trisomies (19.3%). A significant number of infants with trisomies were born to multigravid women older than 35 years (p<0.001). A significant number of infants with single defects were preterm (p<0.002) and of low birth weight (p<0.002). One third (34%) required surgical intervention before hospital discharge. All-cause mortality at hospital discharge was 20.2%, with more deaths among patients with trisomy 13 (50%) and trisomy 18 (40%) compared with patients with single defects (19.8%) or trisomy 21 (7.8%) (p<0.05). CONCLUSION. The incidence of MCAs found in this study is much lower than what has been reported from HICs but similar to findings from other LMICs. MCAs in LMIC settings are associated with high mortality rates. <![CDATA[<b>Correlation between pulse oximetry and the clinical profile of children with acute lower respiratory tract infection</b>]]> BACKGROUND. Hypoxaemia is a common predictor of mortality and a potent marker of severe illness in children with acute lower respiratory tract infection (ALRTI). OBJECTIVE. To determine the mean oxygen saturation (SpO2) in children with ALRTI and its correlation with selected clinical and anthropometric variables. METHODS. A cross-sectional study of 178 children, aged between 2 months and 5 years, treated in two teaching hospitals in southeast Nigeria. All patients were assessed for ALRTI, focusing on their clinical profile and sociodemographic risk factors. Student's t-test was used to compare means of discrete variables. Pearson correlation was used to express association between discrete variables and multiple regression was used to predict dependent variables. RESULTS. Patients with severe ALRTI had significantly lower oxygen saturation (SpO2=89%) than those with mild disease (SpO2=95%) (p=0.001). A negative correlation was found between oxygen saturation and respiratory rate. Multiple regression analysis showed respiratory rate to be the only variable predicting oxygen saturation in children with ALRTI, with a negative association between the two variables. CONCLUSION. Low oxygen saturation is associated with decreased respiratory rate in children with ALRTI. Oxygen supplementation should always be considered in children with ALRTI, especially those with severe disease. <![CDATA[<b>Physical activity and sedentary behaviours during pregnancy are associated with neonatal size at birth</b>]]> BACKGROUND. Pregnancy is a crucial time to examine modifiable maternal behaviours associated with neonatal outcomes so that preventative measures can be taken against childhood obesity. OBJECTIVES. This study aimed to examine the pathways through which maternal physical activity impacted neonatal size and body composition. Methods. A subsample of participants who had objectively measured physical activity data were included from a pregnancy cohort study. Sociodemographic data were collected at the first visit during pregnancy. Gestational weight gain (GWG) was calculated at each visit, and the presence of gestational diabetes, hypertension and HIV were assessed. Physical activity was measured using a hip-worn triaxial accelerometer, at 14 - 18 weeks' and 29 - 33 weeks' gestation. At delivery, gestational age, birthweight and length were measured and neonatal body composition was analysed. A structural equation model (SEM) was run with either weight-to-length ratio (WLR) or fat mass index (FMI) as the outcome. RESULTS. A total of 84 participants were included in this study, and a subsample of neonates (n=45) also had FMI data. Most (66%) mothers presented as overweight or obese at their first visit, and gained on average 0.35 (19) kg per week. The SEM showed that only gestational age at delivery and sedentary time were positively associated with WLR. Step count was directly associated with GWG (β=-0.02, p=0.01), and with gestational age (β=0.16, p=0.04), and was therefore indirectly associated with decreased fetal abdominal circumference. CONCLUSION. This study showed that increasing daily step count and decreasing sedentary behaviour could have beneficial effects on maternal health as well as delivery outcomes and neonatal size. <![CDATA[<b>Early language development in children with autism (ages 3 - 5 years) in Bloemfontein, South Africa: A comparative study</b>]]> BACKGROUND. Autism is a developmental disorder, which presents during the childhood years, with social communication difficulties and signs of delay in early language development. OBJECTIVES. The aim of the study was to compare the early language development of children aged 3 - 5 years with a Diagnostic and Statistical Manual of Mental Disorders (DSM) V diagnosis of autism with that of children of the same age with typical early language development. The secondary aim was to determine if certain children with autism have better language development in the language to which they are exposed on television (English) than in their home language (Afrikaans). METHODS. The Language Development Survey was translated into Afrikaans, modified and used as a questionnaire. For the control group, questionnaires were distributed at preschools and completed by the parents. For the sample group, questionnaires were distributed at the practice of a developmental paediatrician. RESULTS. The median percentages of Afrikaans words used in all the categories were lower in the sample group than in the control group. More children in the sample group tended to speak English the best, use words not spoken at home, and imitate words and sounds in the incorrect context. Most of the parents of children in the sample group considered their child's language development poor. Children in both groups watched television for long periods of time. CONCLUSIONS. Afrikaans-speaking children with autism have a poorer vocabulary in Afrikaans and used more English words than in the control group. The television exposure of children under the age of two years is high. <![CDATA[<b>Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a tertiary hospital in South Africa</b>]]> BACKGROUND. International literature has shown the prevalence of coeliac disease (CD) in children and adolescents with diabetes to range from 1 - 10%. Prevalence rates in African countries are limited or unknown. OBJECTIVE. The objective was to describe the prevalence of CD in all children and adolescents with type 1 diabetes mellitus presenting to the paediatric and adult diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. METHOD. A retrospective review of the files of all children and adolescents in the paediatric and adult diabetic clinic with type 1 diabetes mellitus between August 2016 and June 2019 was conducted. Children requiring screening and/or intestinal biopsies were also prospectively included during this period. The setting of this study was Steve Biko Academic Hospital, a tertiary referral centre, in Pretoria, South Africa. Coeliac screening included anti-deaminated gliadin antibodies and anti-tissue transglutaminase antibodies (both IgA and IgG). All biopsies were obtained by a paediatric gastroenterologist or an experienced paediatric surgeon. RESULTS. A total of 184 files were screened; 132 met inclusion criteria but only 108 patients in total had coeliac screening. Positive antibody screening for CD was found in 11 out of 108 patients (10.2%). Nine of the 11 serology-positive patients had biopsies performed. Out of the nine biopsies, two (22.2%) were positive for CD based on the Marsh-Oberhuber classification. CONCLUSION. This study found a prevalence of serology-positive CD in our local population of South African children with type 1 diabetes mellitus of 10.2%, while the prevalence of biopsy-confirmed CD was found to be 1.9%. <![CDATA[<b>A scoping review to identify the type and effect of hand hygiene interventions on the reduction of infectious diseases (including COVID-19) in pre-school children</b>]]> BACKGROUND. Proper handwashing can reduce the burden of diseases related to hand hygiene (HH) and so contribute reducing under-5 mortality. Preschoolers can benefit from HH interventions by the burden of disease and absenteeism being reduced. OBJECTIVE. To perform a scoping review of literature to assess the types and effectiveness of HH interventions at preschools, with a view to providing a guideline for appropriate interventions for South African facilities. METHODS. A literature search was conducted through the PubMed database to identify relevant studies. An iterative screening process to focus the review allowed for information on the type and effectiveness of interventions to be collated. An updated PubMed search was conducted to determine whether any interventions related to COVID-19 at preschools could be included. RESULTS. No additional studies relating to COVID-19 were found. Of the 305 studies identified during the initial search, only 12 fitted the specific search criteria. Of these, 10 studies showed improvements in HH-related indicators following the interventions. Only two studies used health education as an intervention, whereas the others included the supply of HH products (to varying extents) as part of the intervention. CONCLUSION. HH interventions appear successful in reducing diseases spread by poor HH, improving general HH practices and reducing absenteeism among preschoolers. Studies using innovative, entertaining methods of educating children have shown to be successful in improving handwashing techniques and decreasing microbial growth on children's hands. HH interventions are suggested as an effective measure to improve HH during the COVID-19 pandemic. <![CDATA[<b>Sirenomelia with major cardiac anomalies</b>]]> Sirenomelia is a rare and serious congenital anomaly characterised by fusion of the lower limbs, usually a single umbilical artery and malformations of the genitourinary and gastrointestinal tracts. In this report, we present clinical and radiological features, as well as autopsy findings, in a patient with sirenomelia diagnosed at the time of delivery. Major cardiac defects were observed, namely transposition of the great vessels and a hypoplastic left ventricle. <![CDATA[<b>Orchiepididymitis in a 14-year-old boy with concurrent SARS-CoV-2 infection</b>]]> The symptoms of SARS-CoV-2 infection and COVID-19 provoked by this virus are poorly described in children. Here we analyse a case of orchiepididymitis associated with COVID-19 in a 14-year-old boy. We discuss the possibility of SARS-CoV-2-associated testicular inflammation. This report strengthens the necessity for more in-depth study of the clinical presentation of paediatric COVID-19 and the potential association with non-respiratory symptoms. <![CDATA[<b>Choreoathetosis and dystonia in a child with COVID-19 and multisystem inflammatory syndrome</b>]]> Neurological complications of COVID-19 or multisystem inflammatory syndrome in children (MIS-C) are well described. We report an unusual presentation in a 9-year-old girl presenting with status epilepticus, who thereafter developed choreoathetosis and dystonia. She was initially managed with intravenous immunoglobulins and methylprednisolone for presumed autoimmune encephalitis. However, she tested positive for SARS-CoV-2 and met the clinical and laboratory criteria for MIS-C. She remained encephalopathic with abnormal movements and dystonia for 8 days from presentation but was discharged home with complete clinical recovery after 2 weeks.