Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1969
L Mfingwana, J Van Zyl, J Smith, M Rutherford, G T J Kali
Background. Neonatal hypoxic ischaemic encephalopathy (HIE) is a leading cause of term neonatal death worldwide, with a higherincidence in low- to middle-income settings.Objective. To investigate whether nucleated red blood cell (nRBC) counts could predict severity of HIE and outcomes in term neonatestreated with therapeutic hypothermia (TH).Methods. We conducted a retrospective sub-study at Tygerberg Hospital in Cape Town, South Africa. The review included all cooledneonates’ clinical records and blood samples from a National Health Laboratory Services database. One experienced neurodevelopmental expert assessed patients over a period of 12 months.Results. Twenty-five files out of a total of 100 were excluded owing to missing data. In accordance with the Thompson HIE score,the cohort was classified as mild (56%), moderate (27%), and severe (17%). All included patients (n=75) had full blood counts within6 hours of delivery. nRBC were detected in 52% of the samples. There was no correlation between nRBC category and HIE severity(p=0.265). Raised nRBCs (≥30 cells/100 white blood cells (WBCs)) were more frequent in infants who died than in those whosurvived (p=0.008). Infants with nRBC counts ≥30 cells/100 WBCs had an increased likelihood of having cerebral palsy or impairedneurodevelopment (p=0.013).Conclusion. The study demonstrated a significant association between an early increase in nRBC counts in HIE infants treated with TH,and both short- and long-term outcomes. A larger multicentre study is required to better understand the relationship between nRBCcounts and HIE in the era of cooling in our local setting.
{"title":"Nucleated red blood cells in neonates with hypoxic ischaemic encephalopathy treated with hypothermia: A worthwhile prognostic biomarker for clinicians in LMIC?","authors":"L Mfingwana, J Van Zyl, J Smith, M Rutherford, G T J Kali","doi":"10.7196/sajch.2023.v17i3.1969","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1969","url":null,"abstract":"Background. Neonatal hypoxic ischaemic encephalopathy (HIE) is a leading cause of term neonatal death worldwide, with a higherincidence in low- to middle-income settings.Objective. To investigate whether nucleated red blood cell (nRBC) counts could predict severity of HIE and outcomes in term neonatestreated with therapeutic hypothermia (TH).Methods. We conducted a retrospective sub-study at Tygerberg Hospital in Cape Town, South Africa. The review included all cooledneonates’ clinical records and blood samples from a National Health Laboratory Services database. One experienced neurodevelopmental expert assessed patients over a period of 12 months.Results. Twenty-five files out of a total of 100 were excluded owing to missing data. In accordance with the Thompson HIE score,the cohort was classified as mild (56%), moderate (27%), and severe (17%). All included patients (n=75) had full blood counts within6 hours of delivery. nRBC were detected in 52% of the samples. There was no correlation between nRBC category and HIE severity(p=0.265). Raised nRBCs (≥30 cells/100 white blood cells (WBCs)) were more frequent in infants who died than in those whosurvived (p=0.008). Infants with nRBC counts ≥30 cells/100 WBCs had an increased likelihood of having cerebral palsy or impairedneurodevelopment (p=0.013).Conclusion. The study demonstrated a significant association between an early increase in nRBC counts in HIE infants treated with TH,and both short- and long-term outcomes. A larger multicentre study is required to better understand the relationship between nRBCcounts and HIE in the era of cooling in our local setting.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1915
S C Hlako, L F Mushaphi, N S Mabapa, J Baumgartner
Background. Both iodine deficiency and excess may affect lactating women and their infants. In Limpopo Province, South Africa (SA), there are no data on the iodine status of individuals in these vulnerable groups.Objective. To determine the iodine status, including breastmilk iodine content, of lactating mothers and their infants aged 0 - 6 months in Vhembe and Mopani districts, Limpopo, SA.Methods. A cross-sectional descriptive study in the quantitative domain was undertaken in Vhembe and Mopani districts. Mother-infant pairs were randomly selected. Breastmilk iodine content (BMIC), urinary iodine content (UIC) of infants, UIC of mothers, household (HH) salt iodine content (SIC) and water iodine content (WIC). The iodine nutrition knowledge of mothers was determined.Results. The median (interquartile range (IQR)) of BMIC among lactating mothers in Vhembe and Mopani was 102 (62 - 179.7) μg/Land 150.4 (89.4 - 201.7) μg/L, respectively. The median (IQR) UIC of mothers in Vhembe and Mopani was 96.3 (54.8 - 154.8) μg/L and137.9 (72 - 212.4) μg/L, respectively. The median UIC of infants was 217.7 (107.1 - 409.9) and 339.8 (162.9 - 490.3) μg/L in Vhembe andMopani, respectively. There was a significant difference between SIC of coarse and fine salt in both districts. Lactating mothers in both areas had limited iodine nutrition knowledge.Conclusion. The results suggest that iodised salt is a major contributor to iodine status in lactating mothers and their infants. Our results also show that the salt iodisation programme in SA supplies sufficient iodine for children, women of reproductive age, lactating mothers and breastfed infants.
{"title":"Iodine status, including breastmilk iodine content, of lactating mothers and their infants aged 0 to 6 months in Vhembe and Mopani districts of the Limpopo province, South Africa.","authors":"S C Hlako, L F Mushaphi, N S Mabapa, J Baumgartner","doi":"10.7196/sajch.2023.v17i3.1915","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1915","url":null,"abstract":"Background. Both iodine deficiency and excess may affect lactating women and their infants. In Limpopo Province, South Africa (SA), there are no data on the iodine status of individuals in these vulnerable groups.Objective. To determine the iodine status, including breastmilk iodine content, of lactating mothers and their infants aged 0 - 6 months in Vhembe and Mopani districts, Limpopo, SA.Methods. A cross-sectional descriptive study in the quantitative domain was undertaken in Vhembe and Mopani districts. Mother-infant pairs were randomly selected. Breastmilk iodine content (BMIC), urinary iodine content (UIC) of infants, UIC of mothers, household (HH) salt iodine content (SIC) and water iodine content (WIC). The iodine nutrition knowledge of mothers was determined.Results. The median (interquartile range (IQR)) of BMIC among lactating mothers in Vhembe and Mopani was 102 (62 - 179.7) μg/Land 150.4 (89.4 - 201.7) μg/L, respectively. The median (IQR) UIC of mothers in Vhembe and Mopani was 96.3 (54.8 - 154.8) μg/L and137.9 (72 - 212.4) μg/L, respectively. The median UIC of infants was 217.7 (107.1 - 409.9) and 339.8 (162.9 - 490.3) μg/L in Vhembe andMopani, respectively. There was a significant difference between SIC of coarse and fine salt in both districts. Lactating mothers in both areas had limited iodine nutrition knowledge.Conclusion. The results suggest that iodised salt is a major contributor to iodine status in lactating mothers and their infants. Our results also show that the salt iodisation programme in SA supplies sufficient iodine for children, women of reproductive age, lactating mothers and breastfed infants.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1911
E Chademana, U Maluleke, B Van Wyk
Background. More than 200 million children globally are at risk of not achieving the full developmental potential owing to multiple factors. HIV exposure is of particular concern as evidence suggests that children born to mothers who are HIV-positive are likely to experience developmental delays. Furthermore, the psychosocial and economic impacts of HIV, such as parental illness, poor mental health, poverty and malnutrition, also affect children’s development.
Objective. To assess and address the developmental challenges faced by children aged 2 - 5 years living in high-HIV prevalence settings through a toy-based rehabilitation intervention and to analyse the prevalence and nature of developmental delays observed in these children using the Ages and Stages Questionnaires (ASQ-3).
Methods. In response, the Bright Start programme was developed and implemented to target children living in high HIV-prevalence settings. In 2019, a pilot project was implemented with 90 caregiver-child dyads in Cape Town, South Africa. A baseline survey was conducted to assess developmental progression for all the children (N=141) in the care of the 90 caregivers using the Ages and Stages Questionnaires (ASQ-3) for children aged 24, 36, 48 and 60 months.
Results. Findings showed that 64% of children had delays in at least one domain and 37% had multiple delays. More than half of the children had developmental delays in fine motor skills (51%), while gross-motor and problem-solving delays were reported for 30% and 26% of children, respectively. Communication and personal-social domain delays were observed in 17% and 14% of children, respectively.
Conclusion. The prevalence of developmental delays among children in the programme was alarmingly high. These findings indicate that developmental delay is a serious concern for children living in high-HIV-prevalence settings. Early identification and timeous referrals of children with developmental delays are critical and may enable children to reach their full developmental potential.
{"title":"A baseline assessment of developmental delays among children under 5 years in a high-HIV- prevalence setting in the Cape Metropole","authors":"E Chademana, U Maluleke, B Van Wyk","doi":"10.7196/sajch.2023.v17i3.1911","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1911","url":null,"abstract":"
 
 
 
 Background. More than 200 million children globally are at risk of not achieving the full developmental potential owing to multiple factors. HIV exposure is of particular concern as evidence suggests that children born to mothers who are HIV-positive are likely to experience developmental delays. Furthermore, the psychosocial and economic impacts of HIV, such as parental illness, poor mental health, poverty and malnutrition, also affect children’s development.
 Objective. To assess and address the developmental challenges faced by children aged 2 - 5 years living in high-HIV prevalence settings through a toy-based rehabilitation intervention and to analyse the prevalence and nature of developmental delays observed in these children using the Ages and Stages Questionnaires (ASQ-3).
 Methods. In response, the Bright Start programme was developed and implemented to target children living in high HIV-prevalence settings. In 2019, a pilot project was implemented with 90 caregiver-child dyads in Cape Town, South Africa. A baseline survey was conducted to assess developmental progression for all the children (N=141) in the care of the 90 caregivers using the Ages and Stages Questionnaires (ASQ-3) for children aged 24, 36, 48 and 60 months.
 Results. Findings showed that 64% of children had delays in at least one domain and 37% had multiple delays. More than half of the children had developmental delays in fine motor skills (51%), while gross-motor and problem-solving delays were reported for 30% and 26% of children, respectively. Communication and personal-social domain delays were observed in 17% and 14% of children, respectively.
 Conclusion. The prevalence of developmental delays among children in the programme was alarmingly high. These findings indicate that developmental delay is a serious concern for children living in high-HIV-prevalence settings. Early identification and timeous referrals of children with developmental delays are critical and may enable children to reach their full developmental potential.
 
 
 
","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1964
C Gabriels, D M Le Roux
Background. Neonatal mortality (death in the first 28 days of life) is a major contributor to under-5 mortality in South Africa. Many advances in neonatal care have been introduced, but the impact of these interventions has not been studied outside of tertiary academic centres.Objective. To describe neonatal mortality in the neonatal high care unit at New Somerset Hospital in Cape Town, South Africa, over an8-year period.Methods. Records of neonatal deaths were captured and entered into a database; deaths were coded according to Perinatal ProblemIdentification Program categories.Results. Neonatal deaths from 2011 to 2018 were analysed, excluding 2014. There were 296 neonatal deaths; median (interquartile range (IQR)) birthweight of neonatal deaths was 1 140 (790 – 2 420) g; median (IQR) gestation was 29 (25 - 38) weeks. Immaturity (132/296, 45%) was the most common cause of death, followed by hypoxia (67/296, 23%) and infections (61/296, 21%). There were 250 (84%) neonatal deaths in the first week of life. There was a trend towards a decreasing number of neonatal deaths (from 48 in 2011 to 34 in 2018), and rate of deaths (from 45.2 per 1 000 admissions to 28.2 per 1 000 admissions). This was driven by decreased deaths due to immaturity; number of deaths due to other causes remained approximately constant.Conclusion. We observed a decreasing number of neonatal deaths and rate of deaths per 1 000 admissions, with the largest decreasein deaths due to prematurity. Advances in respiratory care for preterm neonates may have contributed to decreased mortality due toimmaturity. Upstream obstetric interventions will be required to address hypoxia-related causes of neonatal mortality.
{"title":"In-hospital neonatal mortality in a level-2 hospital in Cape Town, South Africa","authors":"C Gabriels, D M Le Roux","doi":"10.7196/sajch.2023.v17i3.1964","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1964","url":null,"abstract":"Background. Neonatal mortality (death in the first 28 days of life) is a major contributor to under-5 mortality in South Africa. Many advances in neonatal care have been introduced, but the impact of these interventions has not been studied outside of tertiary academic centres.Objective. To describe neonatal mortality in the neonatal high care unit at New Somerset Hospital in Cape Town, South Africa, over an8-year period.Methods. Records of neonatal deaths were captured and entered into a database; deaths were coded according to Perinatal ProblemIdentification Program categories.Results. Neonatal deaths from 2011 to 2018 were analysed, excluding 2014. There were 296 neonatal deaths; median (interquartile range (IQR)) birthweight of neonatal deaths was 1 140 (790 – 2 420) g; median (IQR) gestation was 29 (25 - 38) weeks. Immaturity (132/296, 45%) was the most common cause of death, followed by hypoxia (67/296, 23%) and infections (61/296, 21%). There were 250 (84%) neonatal deaths in the first week of life. There was a trend towards a decreasing number of neonatal deaths (from 48 in 2011 to 34 in 2018), and rate of deaths (from 45.2 per 1 000 admissions to 28.2 per 1 000 admissions). This was driven by decreased deaths due to immaturity; number of deaths due to other causes remained approximately constant.Conclusion. We observed a decreasing number of neonatal deaths and rate of deaths per 1 000 admissions, with the largest decreasein deaths due to prematurity. Advances in respiratory care for preterm neonates may have contributed to decreased mortality due toimmaturity. Upstream obstetric interventions will be required to address hypoxia-related causes of neonatal mortality.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1992
A E Strode, Z Essack, C M Slack
South African law provides that children under 18 years old can self-consent to medical treatments and terminations of pregnancy.An article published by van Heerden et al. in the South African Journal of Child Health in 2020 found that children 12 years and olderwere able to give informed consent to medical procedures because they were able to make a treatment choice, comprehend information, weigh options and provide reasons for their decision. However, only children older than 14 years possessed actual understanding of more abstract concepts. This paper considers whether the law is consistent with empirical data on child capacity. It does so by examining the evolution of laws regarding child capacity, interrogating current legal standards on capacity and ultimately evaluating whether the law reflects current empirical knowledge. We conclude that the law on medical treatment is not in conflict with the findings of van Heerden et al. However, there is less synergy between law and empirical data regarding terminations of pregnancy for children under 14 years old.Parliament placed an emphasis on access to health services and did not want age or parental consent to act as a barrier to adolescentsgetting medical assistance; however, data show that children younger than 14 years old struggle with more complex and abstract medical choices. We suggest that the recommendations in the Choice Act for counselling in terminations of pregnancy by children under the age of 14 years need to be more fully operationalised through the issuing of regulations or a national policy.Keywords. consent; medical treatment; capacity; law.
{"title":"Adolescent self-consent to medical interventions in South Africa","authors":"A E Strode, Z Essack, C M Slack","doi":"10.7196/sajch.2023.v17i3.1992","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1992","url":null,"abstract":"South African law provides that children under 18 years old can self-consent to medical treatments and terminations of pregnancy.An article published by van Heerden et al. in the South African Journal of Child Health in 2020 found that children 12 years and olderwere able to give informed consent to medical procedures because they were able to make a treatment choice, comprehend information, weigh options and provide reasons for their decision. However, only children older than 14 years possessed actual understanding of more abstract concepts. This paper considers whether the law is consistent with empirical data on child capacity. It does so by examining the evolution of laws regarding child capacity, interrogating current legal standards on capacity and ultimately evaluating whether the law reflects current empirical knowledge. We conclude that the law on medical treatment is not in conflict with the findings of van Heerden et al. However, there is less synergy between law and empirical data regarding terminations of pregnancy for children under 14 years old.Parliament placed an emphasis on access to health services and did not want age or parental consent to act as a barrier to adolescentsgetting medical assistance; however, data show that children younger than 14 years old struggle with more complex and abstract medical choices. We suggest that the recommendations in the Choice Act for counselling in terminations of pregnancy by children under the age of 14 years need to be more fully operationalised through the issuing of regulations or a national policy.Keywords. consent; medical treatment; capacity; law.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1967
T S Ntuli, M P A Mashego, M H K Hamese
Background. Despite numerous interventions to prevent neonatal heat loss, preventing hypothermia after delivery continues to be aconcern in developing countries.Objective. To determine the prevalence of hypothermia and its risk factors among preterm very-low-birthweight infants admitted to the neonatal care unit (NCU) of a tertiary hospital in Limpopo Province, South Africa.Method. A retrospective study (January - July 2015) was undertaken to analyse data from the medical records of infants admitted tothe NCU of Mankweng Hospital. Hypothermia at admission was the major outcome and was defined as an axillary body temperature<36.5°C. Maternal data collected were age, parity, use of antenatal corticosteroids, and mode of delivery, while neonatal data included sex, birthweight, gestational age, Apgar score, resuscitation at delivery, admission and discharge dates, length of stay, morbidity, interventions and infant outcomes.Results. A total of 252 neonate-and-mother pairs were included in the study, with hypothermia on admission being present in 35%of infants. Factors associated with hypothermia on admission include being born in the winter season, resuscitation at delivery, use ofsynchronised inspiratory positive airway pressure (SiPAP), respiratory distress syndrome and mortality.Conclusion. Hypothermia on admission in our study is relatively high and is associated with resuscitation in the delivery room, respiratory distress syndrome, use of SiPAP, winter season and neonatal mortality. Therefore maintaining infant temperature in the desired range of 36.5°C to 37.5°C after delivery, during transport and on NCU admission might improve neonatal outcomes.
{"title":"Hypothermia in preterm very-low-birthweight infants in a neonatal care unit of a tertiary hospital in Limpopo Province, South Africa","authors":"T S Ntuli, M P A Mashego, M H K Hamese","doi":"10.7196/sajch.2023.v17i3.1967","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1967","url":null,"abstract":"Background. Despite numerous interventions to prevent neonatal heat loss, preventing hypothermia after delivery continues to be aconcern in developing countries.Objective. To determine the prevalence of hypothermia and its risk factors among preterm very-low-birthweight infants admitted to the neonatal care unit (NCU) of a tertiary hospital in Limpopo Province, South Africa.Method. A retrospective study (January - July 2015) was undertaken to analyse data from the medical records of infants admitted tothe NCU of Mankweng Hospital. Hypothermia at admission was the major outcome and was defined as an axillary body temperature<36.5°C. Maternal data collected were age, parity, use of antenatal corticosteroids, and mode of delivery, while neonatal data included sex, birthweight, gestational age, Apgar score, resuscitation at delivery, admission and discharge dates, length of stay, morbidity, interventions and infant outcomes.Results. A total of 252 neonate-and-mother pairs were included in the study, with hypothermia on admission being present in 35%of infants. Factors associated with hypothermia on admission include being born in the winter season, resuscitation at delivery, use ofsynchronised inspiratory positive airway pressure (SiPAP), respiratory distress syndrome and mortality.Conclusion. Hypothermia on admission in our study is relatively high and is associated with resuscitation in the delivery room, respiratory distress syndrome, use of SiPAP, winter season and neonatal mortality. Therefore maintaining infant temperature in the desired range of 36.5°C to 37.5°C after delivery, during transport and on NCU admission might improve neonatal outcomes.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.2022
M Botes, D W Swanepoel, M Graham, J Van der Linde
Background. Regular developmental surveillance using structured developmental screening tools is a proven way to effectively identify developmental delays and disabilities. Most screening tools are developed and standardised in high-income countries and then adapted and translated for low-and middle-income countries. However, cultural differences and viewpoints make it challenging to translate and adapt developmental screening tools for low-income communities.Objectives. To determine caregivers’ perspectives on linguistic and cultural appropriateness of the Parents’ Evaluation of Developmental Status (PEDS) and the PEDS: Developmental Milestones (DM) as a first step in the adaptation process for low-income communities in South Africa.Method. Participants (N=102) were selected using convenience sampling at an immunisation clinic. We employed a survey researchdesign. Quantitative data were analysed using descriptive statistics and qualitative survey feedback survey was analysed using data-driven inductive methodology.Results. On the PEDS questionnaire, 38.2% of participants indicated the term ‘development’ on question 1 was not suitable; and 51%preferred the phrase ‘sometimes worry’ more than the phrase ‘have any concerns’ for questions 2 - 9. On the PEDS:DM, 58 of the 124questions were deemed difficult. Most questions were problematic owing to cultural or linguistic differences (49 questions), while 9questions were too difficult for the child’s age. The expressive language developmental domain had the most challenges.Conclusion. The present study relied on robust community participation, enabling community-led adaptation of the PEDS tools. Items on the tools were viewed solely from a community perspective, empowering the community to be ‘experts’ in this process, ensuring greater contextual relevance and applicability of the tools, as well as generalisability to similar low-income communities.
{"title":"Cultural and linguistic applicability of the English PEDS tools in a low-income community: A caregiver perspective","authors":"M Botes, D W Swanepoel, M Graham, J Van der Linde","doi":"10.7196/sajch.2023.v17i3.2022","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.2022","url":null,"abstract":"Background. Regular developmental surveillance using structured developmental screening tools is a proven way to effectively identify developmental delays and disabilities. Most screening tools are developed and standardised in high-income countries and then adapted and translated for low-and middle-income countries. However, cultural differences and viewpoints make it challenging to translate and adapt developmental screening tools for low-income communities.Objectives. To determine caregivers’ perspectives on linguistic and cultural appropriateness of the Parents’ Evaluation of Developmental Status (PEDS) and the PEDS: Developmental Milestones (DM) as a first step in the adaptation process for low-income communities in South Africa.Method. Participants (N=102) were selected using convenience sampling at an immunisation clinic. We employed a survey researchdesign. Quantitative data were analysed using descriptive statistics and qualitative survey feedback survey was analysed using data-driven inductive methodology.Results. On the PEDS questionnaire, 38.2% of participants indicated the term ‘development’ on question 1 was not suitable; and 51%preferred the phrase ‘sometimes worry’ more than the phrase ‘have any concerns’ for questions 2 - 9. On the PEDS:DM, 58 of the 124questions were deemed difficult. Most questions were problematic owing to cultural or linguistic differences (49 questions), while 9questions were too difficult for the child’s age. The expressive language developmental domain had the most challenges.Conclusion. The present study relied on robust community participation, enabling community-led adaptation of the PEDS tools. Items on the tools were viewed solely from a community perspective, empowering the community to be ‘experts’ in this process, ensuring greater contextual relevance and applicability of the tools, as well as generalisability to similar low-income communities.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1997
D N Pillay, P Moodley
Background. Myelomeningocele (MMC) is a common neural tube defect with significant sequelae. There are limited recent data on the mortality and morbidity of MMC in South Africa (SA).
Objective. To describe the outcomes and characteristics of patients with MMC admitted to the neonatal unit at Universitas Academic Hospital (UAH) in Bloemfontein, SA.
Methods. A retrospective, descriptive study which included 53 patients with MMC admitted to the neonatal unit between 1 January 2017 and 31 December 2019 was conducted. Electronic patient records were reviewed. Data included outcomes, length of stay, complications and maternal and infant characteristics.
Results. The inpatient mortality rate was 11.3% (n=6/53). The median length of stay was 18 days. Notable MMC complications included hydrocephalus (88.7%; n=47/53), Chiari malformation type II (44.7%; n=21/47), lower-limb paralysis (84.9%; n=45/53), lower-limb deformities (60.4%; n=32/53), meningitis (52.8%; n=28/53), neuropathic bladder (37.7%; n=20/53) and loss of anal tone (41.5%; n=22/53). MMC repair was performed in 62.2% (n=33/53) and 27.3% (n=9/33) developed complications. Wound sepsis and breakdown were the most common complications (18.2%, n=6/33), with a median 8 days to complications. Antenatal sonar was not performed in 62% (n=31/50) of cases. MMC was detected antenatally in 20% of cases.
Conclusion. The inpatient mortality rate in thisstudy was lower than the mortality rates reported in other low- and middle-income countries although significant morbidity was identified. A lack of quality antenatal care and access to antenatal sonars were barriers to early detection of MMC. Other healthcare system infrastructural failures may be contributory, which highlights the need for ongoing inter- sectoral collaboration for prevention, early detection and management of MMC to improve patient outcomes.
{"title":"Profiles of patients with myelomeningocele admitted to the neonatal unit at Universitas Academic Hospital in Bloemfontein, South Africa","authors":"D N Pillay, P Moodley","doi":"10.7196/sajch.2023.v17i3.1997","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1997","url":null,"abstract":"
 
 
 
 Background. Myelomeningocele (MMC) is a common neural tube defect with significant sequelae. There are limited recent data on the mortality and morbidity of MMC in South Africa (SA).
 Objective. To describe the outcomes and characteristics of patients with MMC admitted to the neonatal unit at Universitas Academic Hospital (UAH) in Bloemfontein, SA.
 Methods. A retrospective, descriptive study which included 53 patients with MMC admitted to the neonatal unit between 1 January 2017 and 31 December 2019 was conducted. Electronic patient records were reviewed. Data included outcomes, length of stay, complications and maternal and infant characteristics.
 Results. The inpatient mortality rate was 11.3% (n=6/53). The median length of stay was 18 days. Notable MMC complications included hydrocephalus (88.7%; n=47/53), Chiari malformation type II (44.7%; n=21/47), lower-limb paralysis (84.9%; n=45/53), lower-limb deformities (60.4%; n=32/53), meningitis (52.8%; n=28/53), neuropathic bladder (37.7%; n=20/53) and loss of anal tone (41.5%; n=22/53). MMC repair was performed in 62.2% (n=33/53) and 27.3% (n=9/33) developed complications. Wound sepsis and breakdown were the most common complications (18.2%, n=6/33), with a median 8 days to complications. Antenatal sonar was not performed in 62% (n=31/50) of cases. MMC was detected antenatally in 20% of cases.
 Conclusion. The inpatient mortality rate in thisstudy was lower than the mortality rates reported in other low- and middle-income countries although significant morbidity was identified. A lack of quality antenatal care and access to antenatal sonars were barriers to early detection of MMC. Other healthcare system infrastructural failures may be contributory, which highlights the need for ongoing inter- sectoral collaboration for prevention, early detection and management of MMC to improve patient outcomes.
 
 
 
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Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1984
TS Cleak, DE Ballot, NM Moshesh, L Chirwa, T Thomas, DA White
Background. Respiratory syncytial virus (RSV) is the most common cause of severe bronchiolitis in children worldwide.Objectives. To describe clinical characteristics and outcomes of children hospitalised with bronchiolitis and to compare those with RSVbronchiolitis with children with other viral causes of bronchiolitis.Methods. A retrospective study of children admitted with virally screened bronchiolitis to Charlotte Maxeke Johannesburg AcademicHospital (CMJAH) and Nelson Mandela Children’s Hospital (NMCH) from 1 February to 31 August 2018 was conducted, where RSVpositive and -negative children were compared. These children were identified by the National Health Laboratory Service as havingundergone respiratory viral multiplex molecular assay analysis and hospital charts were retrospectively reviewed.Results. A total of 131 children admitted with bronchiolitis from CMJAH and NMCH were compared in this study, 58 from CMJAHand 73 from NMCH. In the sample group, 65 (49.6%) children had RSV in comparison with 66 (50.4%) children without RSV. Childrenwith RSV comprised 55 (42%) children with RSV only and 10 (7.6%) children with RSV in combination with another respiratory virus.Rhinovirus was the second most common virus detected in this cohort of children (n=17, 12.9%) followed by adenovirus (n=12, 9.2%)and coronavirus (n=9, 6.9%). A statistically significant risk factor noted in children requiring hospitalisation for RSV bronchiolitis wasage less than six months (p<0.001).Conclusions. Bronchiolitis is a common disease in children. Respiratory syncytial virus is the most common cause of severe bronchiolitis in hospitalised infants less than six months of age.
{"title":"RSV bronchiolitis in 2018: A descriptive study of children admitted to two Johannesburg tertiary hospitals","authors":"TS Cleak, DE Ballot, NM Moshesh, L Chirwa, T Thomas, DA White","doi":"10.7196/sajch.2023.v17i3.1984","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1984","url":null,"abstract":"Background. Respiratory syncytial virus (RSV) is the most common cause of severe bronchiolitis in children worldwide.Objectives. To describe clinical characteristics and outcomes of children hospitalised with bronchiolitis and to compare those with RSVbronchiolitis with children with other viral causes of bronchiolitis.Methods. A retrospective study of children admitted with virally screened bronchiolitis to Charlotte Maxeke Johannesburg AcademicHospital (CMJAH) and Nelson Mandela Children’s Hospital (NMCH) from 1 February to 31 August 2018 was conducted, where RSVpositive and -negative children were compared. These children were identified by the National Health Laboratory Service as havingundergone respiratory viral multiplex molecular assay analysis and hospital charts were retrospectively reviewed.Results. A total of 131 children admitted with bronchiolitis from CMJAH and NMCH were compared in this study, 58 from CMJAHand 73 from NMCH. In the sample group, 65 (49.6%) children had RSV in comparison with 66 (50.4%) children without RSV. Childrenwith RSV comprised 55 (42%) children with RSV only and 10 (7.6%) children with RSV in combination with another respiratory virus.Rhinovirus was the second most common virus detected in this cohort of children (n=17, 12.9%) followed by adenovirus (n=12, 9.2%)and coronavirus (n=9, 6.9%). A statistically significant risk factor noted in children requiring hospitalisation for RSV bronchiolitis wasage less than six months (p<0.001).Conclusions. Bronchiolitis is a common disease in children. Respiratory syncytial virus is the most common cause of severe bronchiolitis in hospitalised infants less than six months of age.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.1962
K Reddy, A Van Zyl, R Uys, M Kruger
Background. Nephroblastoma is a common childhood solid tumour in South Africa.Objective. The aim was to determine outcomes of patients diagnosed with nephroblastoma between 1990 and 2018 and compare outcomes of two cohorts treated with consecutive International Society of Paediatric Oncology (SIOP) nephroblastoma protocols.Methods. This was a retrospective, descriptive study of two cohorts in Tygerberg Hospital. Cohort 1 (1990 - 2007) was treated with theSIOP 9 and SIOP 93-01 protocols, and Cohort 2 (2008 - 2018) with the SIOP 2001 protocol. Data included demographic data (age atdiagnosis, sex), HIV status, pre- and postoperative staging, surgical complications, histological types, lymph node sampling, overallsurvival (OS) and event-free survival (EFS) with the end point two years after diagnosis.Results. There were 60 children (M:F ratio 1:1.14) in Cohort 1 with an older mean age of 42 months (interquartile range (IQR)16.25 - 56.5 months) v. 45 children (M:F ratio 1:0.8) in Cohort 2 with a mean age of 37 months (IQR 22 - 45.5 months). Cohort 2 hadmore patients with localised disease (76%) than Cohort 1 (55%) (trend towards significance p=0.076). Both cohorts had a good OS(respectively 88% and 93%) and EFS (respectively 82% and 80%). Half of Cohort 1 (50%; n=30/60) did not have lymph nodes sampledwith four subsequent relapses, significantly associated with OS (p<0.001) and EFS (p=0.006). There was a significant associationbetween OS and EFS and underlying histology (respectively p=0.006 and p=0.015) for Cohort 1, but only for EFS and histology (p=0.02)for Cohort 2.Conclusion. There was good OS for children with nephroblastoma treated with consecutive SIOP protocols in a single institution inSouth Africa.
{"title":"Outcome of two cohorts with nephroblastoma treated with consecutive International Society of Paediatric Oncology protocols in a South African paediatric oncology unit","authors":"K Reddy, A Van Zyl, R Uys, M Kruger","doi":"10.7196/sajch.2023.v17i3.1962","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.1962","url":null,"abstract":"Background. Nephroblastoma is a common childhood solid tumour in South Africa.Objective. The aim was to determine outcomes of patients diagnosed with nephroblastoma between 1990 and 2018 and compare outcomes of two cohorts treated with consecutive International Society of Paediatric Oncology (SIOP) nephroblastoma protocols.Methods. This was a retrospective, descriptive study of two cohorts in Tygerberg Hospital. Cohort 1 (1990 - 2007) was treated with theSIOP 9 and SIOP 93-01 protocols, and Cohort 2 (2008 - 2018) with the SIOP 2001 protocol. Data included demographic data (age atdiagnosis, sex), HIV status, pre- and postoperative staging, surgical complications, histological types, lymph node sampling, overallsurvival (OS) and event-free survival (EFS) with the end point two years after diagnosis.Results. There were 60 children (M:F ratio 1:1.14) in Cohort 1 with an older mean age of 42 months (interquartile range (IQR)16.25 - 56.5 months) v. 45 children (M:F ratio 1:0.8) in Cohort 2 with a mean age of 37 months (IQR 22 - 45.5 months). Cohort 2 hadmore patients with localised disease (76%) than Cohort 1 (55%) (trend towards significance p=0.076). Both cohorts had a good OS(respectively 88% and 93%) and EFS (respectively 82% and 80%). Half of Cohort 1 (50%; n=30/60) did not have lymph nodes sampledwith four subsequent relapses, significantly associated with OS (p<0.001) and EFS (p=0.006). There was a significant associationbetween OS and EFS and underlying histology (respectively p=0.006 and p=0.015) for Cohort 1, but only for EFS and histology (p=0.02)for Cohort 2.Conclusion. There was good OS for children with nephroblastoma treated with consecutive SIOP protocols in a single institution inSouth Africa.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135780924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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