Pub Date : 2023-10-19DOI: 10.7196/sajch.2023.v17i3.2002
MJ Rotheram-Borus, J Christodoulou, E Rotheram-Fuller, M Tomlinson
About 250 million children under the age of 5 years in low- and middle-income countries (LMICs) lose lifelong cognitive potential. However, the primary focus of interventions has been to increase survival and promote growth. All pregnant women in 24 non-contiguous, low-income areas in Cape Town, South Africa (N=1 238) were recruited between 2009 and 2010 and reassessed six times over 8 years post birth. Mothers in half of the 24 areas were randomised to receive home visits by community health workers, concentrated during the pregnancy and the first 6 months of life. At 18 months, the children’s cognitive development was at the global norm, i.e a mean standard deviation (SD) value of 100 (15). By 5 years of age, the mean cognitive development fell to one SD below the global norm (<85; mean = 83) and 60% of children had scores below the global mean. By 8 years of age, cognitive development scores significantly fell again (mean = 73; 88% of children <85). The magnitude of the loss was substantial and warrants sustained interventions throughout childhood that support children’s cognitive development in LMICs. The first 1 00 days of life are important, but insufficient to inoculate children against the negative consequences of poverty and coping with multiple, chronic community challenges (e.g. HIV, alcohol abuse, interpersonal violence)
{"title":"Losses of children’s cognitive potential over time: A South African example","authors":"MJ Rotheram-Borus, J Christodoulou, E Rotheram-Fuller, M Tomlinson","doi":"10.7196/sajch.2023.v17i3.2002","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i3.2002","url":null,"abstract":"About 250 million children under the age of 5 years in low- and middle-income countries (LMICs) lose lifelong cognitive potential. However, the primary focus of interventions has been to increase survival and promote growth. All pregnant women in 24 non-contiguous, low-income areas in Cape Town, South Africa (N=1 238) were recruited between 2009 and 2010 and reassessed six times over 8 years post birth. Mothers in half of the 24 areas were randomised to receive home visits by community health workers, concentrated during the pregnancy and the first 6 months of life. At 18 months, the children’s cognitive development was at the global norm, i.e a mean standard deviation (SD) value of 100 (15). By 5 years of age, the mean cognitive development fell to one SD below the global norm (<85; mean = 83) and 60% of children had scores below the global mean. By 8 years of age, cognitive development scores significantly fell again (mean = 73; 88% of children <85). The magnitude of the loss was substantial and warrants sustained interventions throughout childhood that support children’s cognitive development in LMICs. The first 1 00 days of life are important, but insufficient to inoculate children against the negative consequences of poverty and coping with multiple, chronic community challenges (e.g. HIV, alcohol abuse, interpersonal violence)","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"161 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":"135780925","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 : 2023-07-20DOI: 10.7196/sajch.2023.v17i2.1944
S. Ndlovu, T. M. Esterhuizen, R. Uys, MB ChB, M. Kruger, FC Paed
Background. There is a paucity of data regarding childhood cancer incidence in low- and middle-income countries owing to a lack ofdisease-specific, hospital- and population-based registries.Objective. To describe the disease profile and outcome of children with cancer, treated at a single institution in South Africa between1994 and 2014.Methods. Data collected included demographic data (age at diagnosis, sex, stage or risk group, race) and 5-year overall survival (OS) of children aged ≤15 years diagnosed with cancer. Time to event and factors associated with 5-year outcomes were analysed, using Kaplan-Meier curves and Cox regression analysis.Results. The most common malignancies were leukaemia (27.7%), brain tumours (18.4%), lymphomas (14.1%), nephroblastoma (8.0%)and soft-tissue sarcomas (7.4%) for 935 patient records. Limited-disease solid tumours and standard-risk haematological malignancieshad good OS rates of 77.7% and 85.9%, respectively, although OS for the whole group was 60.2%. Nephroblastoma (89.3%), retinoblastoma (86.7%), Hodgkin’s lymphoma (89.7%) and Burkitt lymphoma (75.5%) had the best OS. Type of cancer (p<0.01), solid-tumour stage (p<0.001) and risk classification for haematological malignancies (p<0.001) were significantly associated with mortality.Conclusions. Underlying cancer diagnosis, stage and risk group remained significant factors influencing survival with good OS for limited disease in solid tumours and standard-risk haematological malignancies, which was comparable with survival rates in high-income countries.
{"title":"Trends in childhood cancers at Tygerberg Hospital from 1994 to 2014","authors":"S. Ndlovu, T. M. Esterhuizen, R. Uys, MB ChB, M. Kruger, FC Paed","doi":"10.7196/sajch.2023.v17i2.1944","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1944","url":null,"abstract":"Background. There is a paucity of data regarding childhood cancer incidence in low- and middle-income countries owing to a lack ofdisease-specific, hospital- and population-based registries.Objective. To describe the disease profile and outcome of children with cancer, treated at a single institution in South Africa between1994 and 2014.Methods. Data collected included demographic data (age at diagnosis, sex, stage or risk group, race) and 5-year overall survival (OS) of children aged ≤15 years diagnosed with cancer. Time to event and factors associated with 5-year outcomes were analysed, using Kaplan-Meier curves and Cox regression analysis.Results. The most common malignancies were leukaemia (27.7%), brain tumours (18.4%), lymphomas (14.1%), nephroblastoma (8.0%)and soft-tissue sarcomas (7.4%) for 935 patient records. Limited-disease solid tumours and standard-risk haematological malignancieshad good OS rates of 77.7% and 85.9%, respectively, although OS for the whole group was 60.2%. Nephroblastoma (89.3%), retinoblastoma (86.7%), Hodgkin’s lymphoma (89.7%) and Burkitt lymphoma (75.5%) had the best OS. Type of cancer (p<0.01), solid-tumour stage (p<0.001) and risk classification for haematological malignancies (p<0.001) were significantly associated with mortality.Conclusions. Underlying cancer diagnosis, stage and risk group remained significant factors influencing survival with good OS for limited disease in solid tumours and standard-risk haematological malignancies, which was comparable with survival rates in high-income countries.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"67 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139357178","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 : 2023-06-21DOI: 10.7196/sajch.2023.v17i1.1898
L Coopoosamy, J Schoeman, DT Reynders, FE Omar, A Büchner
Background. The outcome of patients with neuroblastoma in South Africa has always been very poor. We conducted a retrospective study in one state-funded paediatric oncology unit (POU), to describe the clinical course, evaluate prognostic factors and report outcomes of patients with neuroblastoma.Methods. We analysed routine data from one POU, gathered between 1993 and 2018. Kaplan-Meier curves were used to illustrate 2-year survival rates and to evaluate possible prognostic factors.Results. Data from 87 patients were included and analysed. The median age was 41 months. The majority of the patients presented with stage 4 disease (77%). The most common presenting symptoms were bone pain, loss of weight, and abdominal distention. Chemotherapy was administered to 74 patients, and only 5 patients (6%) received palliative chemotherapy as first-line treatment. Only 18 of the 87 patients had surgery (21%) and 13 of 87 had radiation (15%), while 10 patients received palliative radioactive iodine (131I-miBG) therapy. Patients with ferritin levels >120 ng/dL did not have a poorer outcome, and those with a raised lactate dehydrogenase (LDH) level displayed a shorter survival time but it was not statistically significant. The 2-year overall survival was 24% for the whole cohort and 16% for the stage 4 patients at diagnosis.Conclusion. Neuroblastoma is a disease with a dismal outcome in our POU, mostly as a result of late presentation. To improve prognosis the focus should be on recognising danger signs to ensure early diagnosis and referral. We recommend adding danger signs for childhood cancer to the Integrated Management of Childhood Illness (IMCI) strategy in an attempt to improve early recognition and diagnosis of childhood cancer.
{"title":"Neuroblastoma: Can lessons from the past help to improve the future?","authors":"L Coopoosamy, J Schoeman, DT Reynders, FE Omar, A Büchner","doi":"10.7196/sajch.2023.v17i1.1898","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1898","url":null,"abstract":"Background. The outcome of patients with neuroblastoma in South Africa has always been very poor. We conducted a retrospective study in one state-funded paediatric oncology unit (POU), to describe the clinical course, evaluate prognostic factors and report outcomes of patients with neuroblastoma.Methods. We analysed routine data from one POU, gathered between 1993 and 2018. Kaplan-Meier curves were used to illustrate 2-year survival rates and to evaluate possible prognostic factors.Results. Data from 87 patients were included and analysed. The median age was 41 months. The majority of the patients presented with stage 4 disease (77%). The most common presenting symptoms were bone pain, loss of weight, and abdominal distention. Chemotherapy was administered to 74 patients, and only 5 patients (6%) received palliative chemotherapy as first-line treatment. Only 18 of the 87 patients had surgery (21%) and 13 of 87 had radiation (15%), while 10 patients received palliative radioactive iodine (131I-miBG) therapy. Patients with ferritin levels >120 ng/dL did not have a poorer outcome, and those with a raised lactate dehydrogenase (LDH) level displayed a shorter survival time but it was not statistically significant. The 2-year overall survival was 24% for the whole cohort and 16% for the stage 4 patients at diagnosis.Conclusion. Neuroblastoma is a disease with a dismal outcome in our POU, mostly as a result of late presentation. To improve prognosis the focus should be on recognising danger signs to ensure early diagnosis and referral. We recommend adding danger signs for childhood cancer to the Integrated Management of Childhood Illness (IMCI) strategy in an attempt to improve early recognition and diagnosis of childhood cancer.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090599","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 : 2023-06-21DOI: 10.7196/sajch.2023.v17i2.1946
E Verster, None L-A, K Chetty, L Van Wyk
At the height of the COVID‑19 pandemic, South Africa became the epicentre of the continent. Considering the paucity of data onCOVID‑19, we aimed to describe the clinical picture in a neonate, alert healthcare workers to the presence of co-infection with COVID‑19 and propose alternative treatment modalities. The use of surfactant was based on the pathophysiological mechanisms of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). There is mounting evidence in support of using surfactant in the management of severe COVID‑19. While viral co-infection is a common occurrence among neonates, our case shows that COVID‑19, together with rhinovirus infection, may result in a more rapid clinical deterioration, as opposed to rhinovirus infection in isolation.
{"title":"Late-neonatal SARS-CoV-2 infection: A curious case of COVID‑19 with respiratory co-infection and treatment with surfactant","authors":"E Verster, None L-A, K Chetty, L Van Wyk","doi":"10.7196/sajch.2023.v17i2.1946","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1946","url":null,"abstract":"At the height of the COVID‑19 pandemic, South Africa became the epicentre of the continent. Considering the paucity of data onCOVID‑19, we aimed to describe the clinical picture in a neonate, alert healthcare workers to the presence of co-infection with COVID‑19 and propose alternative treatment modalities. The use of surfactant was based on the pathophysiological mechanisms of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). There is mounting evidence in support of using surfactant in the management of severe COVID‑19. While viral co-infection is a common occurrence among neonates, our case shows that COVID‑19, together with rhinovirus infection, may result in a more rapid clinical deterioration, as opposed to rhinovirus infection in isolation.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090598","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}
Background. Appropriate infant feeding is crucial for growth and development of children in the first 5 years of their life. Despite theimplementation of the Baby-Friendly Hospital Initiative (BFHI), now known as Mother-Baby Friendly Hospital Initiative, exclusivebreastfeeding and complementary feeding practices remain barriers to optimal breastfeeding practices in South Africa.Objectives. To explore the impact of the BFHI on breastfeeding and complementary feeding practices of mothers for second or subsequent pregnancies.Methods. The study design was a cross-sectional survey and included 169 mother-baby pairs conveniently selected from clinics inLimpopo Province. Data were collected using a validated questionnaire and analysed for 157 complete data sets using the StatisticalPackage for Social Sciences version 26.0. Both univariable and multivariable logistic regression analyses were used to examine the impact of baby-friendly hospitals on breastfeeding practices of mothers.Results. Few mothers in both groups practised exclusive breastfeeding for the recommended time (BFHI 22.2%; non- BFHI 30.6%). Themain reasons for introducing early complementary foods were that the child was hungry, crying or was not satisfied with breastmilk.Mothers in the BFHI group were three times (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.13 - 10.98) more likely to breastfeedtheir infants, and two times (OR 2.22; 95% CI 1.08 - 4.58) more likely to initiate their infants on water with added glucose or salt beforethe age of 6 months than mothers in the non-BFHI group.Conclusion. Mothers from the non-baby-friendly group had better breastfeeding practices. Evidence showed that for second or subsequent pregnancies, exposure to a baby-friendly facility during first pregnancy did not sustain appropriate breastfeeding and complementary feeding practices. Whether mothers were exposed or not, practices were similar. Strengthening and continual evaluation of breastfeeding interventions might improve impact on child survival outcomes in the study area.
{"title":"Breastfeeding and complementary feeding practices of mothers exposed to the Baby-Friendly Hospital Initiative in Limpopo Province","authors":"XG Mbhenyane, TC Mandiwana, HV Mbhatsani, NS Mabapa, LF Mushaphi, BA Tambe","doi":"10.7196/sajch.2023.v17i2.1917","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1917","url":null,"abstract":"Background. Appropriate infant feeding is crucial for growth and development of children in the first 5 years of their life. Despite theimplementation of the Baby-Friendly Hospital Initiative (BFHI), now known as Mother-Baby Friendly Hospital Initiative, exclusivebreastfeeding and complementary feeding practices remain barriers to optimal breastfeeding practices in South Africa.Objectives. To explore the impact of the BFHI on breastfeeding and complementary feeding practices of mothers for second or subsequent pregnancies.Methods. The study design was a cross-sectional survey and included 169 mother-baby pairs conveniently selected from clinics inLimpopo Province. Data were collected using a validated questionnaire and analysed for 157 complete data sets using the StatisticalPackage for Social Sciences version 26.0. Both univariable and multivariable logistic regression analyses were used to examine the impact of baby-friendly hospitals on breastfeeding practices of mothers.Results. Few mothers in both groups practised exclusive breastfeeding for the recommended time (BFHI 22.2%; non- BFHI 30.6%). Themain reasons for introducing early complementary foods were that the child was hungry, crying or was not satisfied with breastmilk.Mothers in the BFHI group were three times (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.13 - 10.98) more likely to breastfeedtheir infants, and two times (OR 2.22; 95% CI 1.08 - 4.58) more likely to initiate their infants on water with added glucose or salt beforethe age of 6 months than mothers in the non-BFHI group.Conclusion. Mothers from the non-baby-friendly group had better breastfeeding practices. Evidence showed that for second or subsequent pregnancies, exposure to a baby-friendly facility during first pregnancy did not sustain appropriate breastfeeding and complementary feeding practices. Whether mothers were exposed or not, practices were similar. Strengthening and continual evaluation of breastfeeding interventions might improve impact on child survival outcomes in the study area.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135090600","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 : 2023-06-04DOI: 10.7196/sajch.2023.v17i2.1937
P Raphulu (née Manenzhe), J Wadula, DP Moore, KL Petersen
Background. Staphylococcus aureus infection is associated with considerable morbidity and mortality. There are relatively few studiesdescribing invasive S. aureus infections in children, particularly in low- and middle-income countries.Objectives. To describe the clinical spectrum and outcomes associated with S. aureus infection in children <14 years of age hospitalised atChris Hani Baragwanath Academic Hospital (CHBAH), South Africa, and to identify risk factors of invasive disease.Methods. A retrospective, descriptive study was conducted at CHBAH to define the spectrum of clinical presentation, risk factors,duration of treatment and outcomes of paediatric S. aureus infections for the period January through December 2013. Data were soughtfor all children <14 years of age.Results. Four hundred and twenty-two episodes of S. aureus infection were identified. Three hundred and forty-two (81%) infectionswere caused by methicillin-susceptible S. aureus (MSSA) and 80 (19%) by methicillin-resistant S. aureus (MRSA). Clinical data wereobtained for 286 (67.8%) cases, on which all further analyses were based. Clinical presentations for MSSA bacteraemia included skin andsoft tissue infection (45%), pneumonia (10%), meningitis (6%), bone/joint infections (5%) and urinary tract infections (3%). Five (8.3%)cases of MRSA were community-acquired. Admission to intensive care unit (ICU) was the only risk factor associated with MRSA infection(adjusted odds ratio (aOR) 125.55; 95% confidence interval (CI) 11.67 - 1 350.68). Hospital-acquired S. aureus infection was the only factorassociated with mortality on multivariate analysis (aOR 8.70; 95% CI 1.55 - 48.77).Conclusion. S. aureus is frequently isolated in paediatric bacterial infections. Closer attention to infection control would impact on MRSAand S. aureus mortality rates in our setting.
{"title":"The clinical spectrum of Staphylococcus aureus infections in children admitted to Chris Hani Baragwanath Academic Hospital, South Africa: A retrospective, descriptive study","authors":"P Raphulu (née Manenzhe), J Wadula, DP Moore, KL Petersen","doi":"10.7196/sajch.2023.v17i2.1937","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1937","url":null,"abstract":"Background. Staphylococcus aureus infection is associated with considerable morbidity and mortality. There are relatively few studiesdescribing invasive S. aureus infections in children, particularly in low- and middle-income countries.Objectives. To describe the clinical spectrum and outcomes associated with S. aureus infection in children <14 years of age hospitalised atChris Hani Baragwanath Academic Hospital (CHBAH), South Africa, and to identify risk factors of invasive disease.Methods. A retrospective, descriptive study was conducted at CHBAH to define the spectrum of clinical presentation, risk factors,duration of treatment and outcomes of paediatric S. aureus infections for the period January through December 2013. Data were soughtfor all children <14 years of age.Results. Four hundred and twenty-two episodes of S. aureus infection were identified. Three hundred and forty-two (81%) infectionswere caused by methicillin-susceptible S. aureus (MSSA) and 80 (19%) by methicillin-resistant S. aureus (MRSA). Clinical data wereobtained for 286 (67.8%) cases, on which all further analyses were based. Clinical presentations for MSSA bacteraemia included skin andsoft tissue infection (45%), pneumonia (10%), meningitis (6%), bone/joint infections (5%) and urinary tract infections (3%). Five (8.3%)cases of MRSA were community-acquired. Admission to intensive care unit (ICU) was the only risk factor associated with MRSA infection(adjusted odds ratio (aOR) 125.55; 95% confidence interval (CI) 11.67 - 1 350.68). Hospital-acquired S. aureus infection was the only factorassociated with mortality on multivariate analysis (aOR 8.70; 95% CI 1.55 - 48.77).Conclusion. S. aureus is frequently isolated in paediatric bacterial infections. Closer attention to infection control would impact on MRSAand S. aureus mortality rates in our setting.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134973436","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 : 2023-05-24DOI: 10.7196/sajch.2023.v17i1.1924
V. Khumalo, A. Witthers, B. Jugmohan, C. Westgarth-Taylor, A. Grieve, D. Harrison, J. Loveland
Background. A previous study on intussusception from our institution demonstrated a pneumatic reduction (PR) rate of 33%, witha mortality rate of 9.1%. Numerous protocol changes were implemented, and as part of a national prospective observational study, asubsequent cohort of patients was compared with the initial series.Objectives. To compare our current series of children presenting with intussusception with our previous series. Specifically, we aimed tocompare PR rates, resection rates, morbidity and mortality.Methods. This was a retrospective review of patients aged <3 years who presented with intussusception to Chris Hani BaragwanathAcademic Hospital in Johannesburg, South Africa, from 2011 to 2015 (era 2). Clinical outcomes of patients and management modalitieswere reviewed. These were compared with results reported in the previous article (2007 - 2010, era 1).Results. A total of 111 patients were included. PR was attempted in 52 patients (46.8%). It was successful in 25 patients (48.1%) andunsuccessful in 27 (51.9%), with an overall success rate of 22.5%. Eighty-six patients (77.5%) underwent surgical intervention. Bowelresection was performed in 54/86 of the surgically managed patients. No deaths were reported during the era 2 study period.Conclusion. Despite improved protocols, we could not demonstrate an improvement in the proportion of attempted PR cases comparedwith our previous series, and we did not achieve better PR rates. This failure is thought to be due to the delayed presentation of our patients,as well as an aggressive approach to management. However, this aggressive management strategy has decreased our mortality rate to zero.
{"title":"Clinical outcomes of intussusception: The experience in Johannesburg, South Africa","authors":"V. Khumalo, A. Witthers, B. Jugmohan, C. Westgarth-Taylor, A. Grieve, D. Harrison, J. Loveland","doi":"10.7196/sajch.2023.v17i1.1924","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i1.1924","url":null,"abstract":"Background. A previous study on intussusception from our institution demonstrated a pneumatic reduction (PR) rate of 33%, witha mortality rate of 9.1%. Numerous protocol changes were implemented, and as part of a national prospective observational study, asubsequent cohort of patients was compared with the initial series.Objectives. To compare our current series of children presenting with intussusception with our previous series. Specifically, we aimed tocompare PR rates, resection rates, morbidity and mortality.Methods. This was a retrospective review of patients aged <3 years who presented with intussusception to Chris Hani BaragwanathAcademic Hospital in Johannesburg, South Africa, from 2011 to 2015 (era 2). Clinical outcomes of patients and management modalitieswere reviewed. These were compared with results reported in the previous article (2007 - 2010, era 1).Results. A total of 111 patients were included. PR was attempted in 52 patients (46.8%). It was successful in 25 patients (48.1%) andunsuccessful in 27 (51.9%), with an overall success rate of 22.5%. Eighty-six patients (77.5%) underwent surgical intervention. Bowelresection was performed in 54/86 of the surgically managed patients. No deaths were reported during the era 2 study period.Conclusion. Despite improved protocols, we could not demonstrate an improvement in the proportion of attempted PR cases comparedwith our previous series, and we did not achieve better PR rates. This failure is thought to be due to the delayed presentation of our patients,as well as an aggressive approach to management. However, this aggressive management strategy has decreased our mortality rate to zero.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47279308","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 : 2023-05-24DOI: 10.7196/sajch.2023.v17i2.1932
WV Nongaya, P Jeena
Background. Factors predisposing ventilated neonates to the risk for reventilation during infancy are largely unknown.Objective. To identify factors that predispose previously mechanically ventilated neonates to reventilation.Methods. Mechanically ventilated infants at the Inkosi Albert Luthuli Central Hospital paedicatric intensive care unit (PICU), SouthAfrica, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls whowere not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation andoutcomes of the ICU admission were collected and analysed using descriptive and comparative statistics.Results. Thirty-one reventilated index cases were identified at the PICU over a 15-month period and were matched with 31non-reventilated controls. Ex-preterm babies (n=26; 84%), males (n=19; 61.3%), chronic lung disease (CLD) of infancy (n=5; 16.7%)and prolonged neonatal length of stay (LOS) were common neonatal factors in reventilated neonates. Pneumonia (n=22; 71%), sepsis(n=11; 35.5%) and upper airway obstruction (UAO) (n=8; 25.8%) were common reasons for reventilation in neonates. There were noHIV-positive cases. Of the 31 reventilated cases, 5 (16.1%) demised and 15 (57.6%) survivors had morbidities, commonly seizures (n=8;30.8%) and short bowel syndrome (n=3; 11.5%).Conclusion. Pre-term birth, male, CLD of infancy and prolonged LOS were associated with an increased risk for mechanical reventilationin infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.
背景。导致通气新生儿在婴儿期发生通气风险的因素在很大程度上是未知的。目的:探讨早期机械通气新生儿易发生通气的因素。在南非Inkosi Albert Luthuli中心医院儿科重症监护病房(PICU)进行机械通气的婴儿，在新生儿期也进行了通气，并与年龄、性别、时间和地点匹配的婴儿期未进行通气的对照组进行了比较。收集两组患者的新生儿和产后记录，以及他们的临床表现和ICU入院结果的数据，并使用描述性和比较统计学进行分析。15个月期间在PICU发现31例呼吸恢复指数病例，并与31例未呼吸恢复的对照组相匹配。早产儿(n=26;84%)，男性(n=19;61.3%)，婴儿期慢性肺病(CLD) (n=5;16.7%)和延长新生儿住院时间(LOS)是呼吸恢复新生儿常见的新生儿因素。肺炎(n = 22;71%),脓毒症(n = 11;35.5%)和上气道阻塞(UAO) (n=8;25.8%)是新生儿呼吸的常见原因。无hiv阳性病例。在31例恢复通气的病例中，5例(16.1%)死亡，15例(57.6%)幸存者有发病，常见的是癫痫发作(n=8;30.8%)和短肠综合征(n=3;11.5%) .Conclusion。早产、男性、婴儿CLD和长时间LOS与婴儿机械通气风险增加有关。肺炎、败血症、婴儿期CLD和UAO是新生儿ICU出院后通气的常见指征。
{"title":"Characteristics of infants requiring mechanical reventilation in those previously ventilated during the neonatal period","authors":"WV Nongaya, P Jeena","doi":"10.7196/sajch.2023.v17i2.1932","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1932","url":null,"abstract":"Background. Factors predisposing ventilated neonates to the risk for reventilation during infancy are largely unknown.Objective. To identify factors that predispose previously mechanically ventilated neonates to reventilation.Methods. Mechanically ventilated infants at the Inkosi Albert Luthuli Central Hospital paedicatric intensive care unit (PICU), SouthAfrica, who were also ventilated during the neonatal period were compared with age-, gender-, timing-, and site-matched controls whowere not reventilated during infancy. Neonatal and postnatal records of the two cohorts and data on their clinical presentation andoutcomes of the ICU admission were collected and analysed using descriptive and comparative statistics.Results. Thirty-one reventilated index cases were identified at the PICU over a 15-month period and were matched with 31non-reventilated controls. Ex-preterm babies (n=26; 84%), males (n=19; 61.3%), chronic lung disease (CLD) of infancy (n=5; 16.7%)and prolonged neonatal length of stay (LOS) were common neonatal factors in reventilated neonates. Pneumonia (n=22; 71%), sepsis(n=11; 35.5%) and upper airway obstruction (UAO) (n=8; 25.8%) were common reasons for reventilation in neonates. There were noHIV-positive cases. Of the 31 reventilated cases, 5 (16.1%) demised and 15 (57.6%) survivors had morbidities, commonly seizures (n=8;30.8%) and short bowel syndrome (n=3; 11.5%).Conclusion. Pre-term birth, male, CLD of infancy and prolonged LOS were associated with an increased risk for mechanical reventilationin infancy. Pneumonia, sepsis, CLD of infancy and UAO were common indications for reventilation post neonatal ICU discharge.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139069","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 : 2023-05-24DOI: 10.7196/sajch.2023.v17i2.1954
R Vosloo, U Naidoo
Background. Poisoning has been reported as the fifth most common cause of injury-related deaths in children younger than five years worldwide. Little is known about accidental poison exposure among children at regional hospital level. Regional hospitals generally provide more specialised support to primary care facilities over a larger area. During the COVID-19 pandemic, lockdown measures may have increased home-based unintentional poisoning. Objectives. To determine the frequency, outcome and type of accidental poison exposure in children admitted to a regional hospital and compare cases before and during the COVID-19 pandemic. Methods. A review of admissions to Queen Nandi Regional Hospital in Empangeni was performed to document cases of accidental poison exposure over two years. Equal periods during 2019 and 2020 (April to December) were then compared. Children <13 years of age were included. Age, sex, date of admission, death or survival and type of poisoning were collected. Results. Cases of accidental poison exposure made up a small proportion of the total admissions over two years (n=252/5 071, 4.97%) with a low case fatality rate (0.40%). Boys made up the majority (n=132/252, 52.38%). Most were
{"title":"Accidental poison exposure among children in a regional hospital in northern KwaZulu-Natal before and during the COVID-19 pandemic","authors":"R Vosloo, U Naidoo","doi":"10.7196/sajch.2023.v17i2.1954","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1954","url":null,"abstract":"Background. Poisoning has been reported as the fifth most common cause of injury-related deaths in children younger than five years worldwide. Little is known about accidental poison exposure among children at regional hospital level. Regional hospitals generally provide more specialised support to primary care facilities over a larger area. During the COVID-19 pandemic, lockdown measures may have increased home-based unintentional poisoning. Objectives. To determine the frequency, outcome and type of accidental poison exposure in children admitted to a regional hospital and compare cases before and during the COVID-19 pandemic. Methods. A review of admissions to Queen Nandi Regional Hospital in Empangeni was performed to document cases of accidental poison exposure over two years. Equal periods during 2019 and 2020 (April to December) were then compared. Children <13 years of age were included. Age, sex, date of admission, death or survival and type of poisoning were collected. Results. Cases of accidental poison exposure made up a small proportion of the total admissions over two years (n=252/5 071, 4.97%) with a low case fatality rate (0.40%). Boys made up the majority (n=132/252, 52.38%). Most were <five years old (n=220/252, 87.30%). Medicines (n=114/252, 45.24%), hydrocarbons (n=59/252, 23.41%) and pesticides (n=26/252, 10.32%) were the main types of poison. Domestic cleaner-, sanitiser- and disinfectant-related admissions were significantly increased during the pandemic (p=0.020). Conclusion. Accidental poison exposure occurs commonly in younger children. Medicines, hydrocarbons and pesticides made up the majority of cases. Domestic cleaner, hand sanitiser and disinfectant ingestion increased in the pandemic. Future research should involve primary care facilities, and risk factors as well as clinical severity should be investigated.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"117 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135140245","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 : 2023-05-24DOI: 10.7196/sajch.2023.v17i2.1926
GA Engwa, C Anye, BN Nkeh-Chungag
Background. There is a dearth of information on the relationship between indoor air pollution and lung function, especially amongsub-Saharan African children.Objective. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern CapeProvince of South Africa (SA).Methods. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PMfrom 23 classrooms was measured with a handheld particle counter and lung function was assessed with a handheld spirometer.Results. Mean (standard deviation) PM5 levels were higher (109.96 (75.39) μg/m3) than PM10 (84.84 (63.28) μg/m3) and PM2.5 (39.45(26.38) μg/m3). PM2.5, PM5 and PM10 correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV1), forced vital capacity(FVC), FEV25-75, as well as peak expiratory flow (PEF) but correlated positively (p<0.001) with the FEV1/FVC ratio.Conclusion. PM in classrooms showed a negative relationship with lung function in the study population.
{"title":"Relationship of indoor particulate matter and lung function in children from the Eastern Cape Province of South Africa","authors":"GA Engwa, C Anye, BN Nkeh-Chungag","doi":"10.7196/sajch.2023.v17i2.1926","DOIUrl":"https://doi.org/10.7196/sajch.2023.v17i2.1926","url":null,"abstract":"Background. There is a dearth of information on the relationship between indoor air pollution and lung function, especially amongsub-Saharan African children.Objective. To assess the relationship between indoor particulate matter (PM) and lung function in children living in the Eastern CapeProvince of South Africa (SA).Methods. This cross-sectional study included 540 children aged 10 - 14 years and was conducted between May and September 2016. PMfrom 23 classrooms was measured with a handheld particle counter and lung function was assessed with a handheld spirometer.Results. Mean (standard deviation) PM5 levels were higher (109.96 (75.39) μg/m3) than PM10 (84.84 (63.28) μg/m3) and PM2.5 (39.45(26.38) μg/m3). PM2.5, PM5 and PM10 correlated negatively (p<0.05) with forced expiratory volume in 1 second (FEV1), forced vital capacity(FVC), FEV25-75, as well as peak expiratory flow (PEF) but correlated positively (p<0.001) with the FEV1/FVC ratio.Conclusion. PM in classrooms showed a negative relationship with lung function in the study population.","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135139070","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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