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A baseline assessment of developmental delays among children under 5 years in a high-HIV- prevalence setting in the Cape Metropole 在一个高艾滋病毒流行的设置在开普敦大都会5岁以下儿童发育迟缓的基线评估
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
& # x0D;& # x0D;& # x0D;& # x0D;背景。由于多种因素,全球有2亿多儿童面临无法充分发挥其发展潜力的风险。艾滋病毒暴露尤其令人担忧,因为有证据表明,艾滋病毒阳性母亲所生的孩子很可能出现发育迟缓。此外,艾滋病毒的社会心理和经济影响,如父母患病、精神健康状况不佳、贫穷和营养不良,也影响儿童的发展。目标。通过基于玩具的康复干预,评估和解决生活在艾滋病毒高流行环境中的2 - 5岁儿童面临的发展挑战,并使用年龄和阶段问卷(ASQ-3)分析这些儿童中观察到的发育迟缓的患病率和性质。方法。为此,制定并实施了“光明起点”方案,目标是生活在艾滋病毒高流行环境中的儿童。2019年,我们在南非开普敦实施了一个试点项目,共有90对看护儿童。使用年龄和阶段问卷(ASQ-3)对24、36、48和60个月的儿童进行基线调查,以评估所有儿童(N=141)的发育进展。结果。调查结果显示,64%的儿童至少在一个领域有延迟,37%的儿童有多个延迟。超过一半的儿童在精细运动技能方面有发育迟缓(51%),而大运动和解决问题的迟缓分别为30%和26%的儿童。在17%和14%的儿童中分别观察到沟通和个人-社会领域延迟。结论。该方案中儿童发育迟缓的发生率高得惊人。这些发现表明,发育迟缓是生活在艾滋病毒高流行环境中的儿童的一个严重问题。发育迟缓儿童的早期识别和及时转诊至关重要,并可能使儿童充分发挥其发展潜力。& # x0D;& # x0D;& # x0D;
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 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.
 
 
 
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引用次数: 0
In-hospital neonatal mortality in a level-2 hospital in Cape Town, South Africa 南非开普敦一家二级医院的住院新生儿死亡率
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
背景。新生儿死亡率(出生后28天内死亡)是南非5岁以下儿童死亡率的一个主要因素。在新生儿护理方面取得了许多进展,但这些干预措施的影响尚未在高等教育学术中心之外进行研究。描述南非开普敦新萨默塞特医院新生儿高级监护病房8年来的新生儿死亡率。收集新生儿死亡记录并输入数据库;根据围产期问题识别程序分类对死亡进行编码。分析了2011年至2018年(不包括2014年)的新生儿死亡情况。新生儿死亡296例;新生儿死亡的出生体重中位数(四分位数间距(IQR))为1140 (790 - 2420)g;中位妊娠(IQR)为29(25 - 38)周。不成熟(132/296,45%)是最常见的死亡原因,其次是缺氧(67/296,23%)和感染(61/296,21%)。有250例(84%)新生儿在出生后第一周死亡。新生儿死亡人数呈下降趋势(从2011年的48例降至2018年的34例),死亡率呈下降趋势(从45.2‰降至28.2‰)。这是由于不成熟造成的死亡减少;其他原因导致的死亡人数大致保持不变。我们观察到新生儿死亡人数和每1000名入院患者的死亡率下降,其中早产儿死亡率下降幅度最大。早产儿呼吸系统护理的进步可能有助于早产儿死亡率的降低。需要采取上游产科干预措施,以解决与缺氧有关的新生儿死亡原因。
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引用次数: 0
Adolescent self-consent to medical interventions in South Africa 南非青少年对医疗干预的自我同意
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
南非法律规定,18岁以下的儿童可以自行同意接受治疗和终止妊娠。van Heerden等人于2020年在《南非儿童健康杂志》上发表的一篇文章发现,12岁及以上的儿童能够对医疗程序给予知情同意,因为他们能够做出治疗选择,理解信息,权衡选择并提供决定的理由。然而,只有14岁以上的孩子才能真正理解更抽象的概念。本文考虑法律是否与儿童能力的实证数据一致。它通过审查有关儿童能力的法律的演变,询问目前关于能力的法律标准,并最终评估法律是否反映了目前的经验知识来做到这一点。我们的结论是,关于医疗的法律与van Heerden等人的发现并不冲突。然而,关于14岁以下儿童终止妊娠的法律和经验数据之间的协同作用较少。议会强调获得保健服务的机会,不希望年龄或父母同意成为青少年获得医疗援助的障碍;然而,数据显示,14岁以下的儿童在更复杂和抽象的医疗选择上挣扎。我们建议,《选择法案》中关于14岁以下儿童终止妊娠咨询的建议需要通过颁布法规或国家政策来更全面地实施。同意;医疗;能力;法律。
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引用次数: 0
Hypothermia in preterm very-low-birthweight infants in a neonatal care unit of a tertiary hospital in Limpopo Province, South Africa 南非林波波省一家三级医院新生儿护理病房早产儿极低出生体重婴儿的低温治疗
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
背景。尽管有许多预防新生儿热损失的干预措施,但在发展中国家,预防分娩后体温过低仍然是一个令人关注的问题。目的:确定南非林波波省一家三级医院新生儿监护室(NCU)收治的早产儿极低出生体重儿的体温过低患病率及其危险因素。我们进行了一项回顾性研究(2015年1月- 7月),分析了满旺医院新生儿护理科收治的婴儿病历数据。入院时体温过低是主要结局,腋窝体温为36.5℃。收集的产妇数据包括年龄、胎次、产前皮质激素的使用和分娩方式,而新生儿数据包括性别、出生体重、胎龄、Apgar评分、分娩时复苏、入院和出院日期、住院时间、发病率、干预措施和婴儿结局。该研究共纳入了252对新生儿和母亲,35%的婴儿在入院时出现过低温症。入院时低体温的相关因素包括出生在冬季、分娩时复苏、使用同步吸气式气道正压通气(SiPAP)、呼吸窘迫综合征和死亡率。在我们的研究中,入院时的低体温相对较高,与产房复苏、呼吸窘迫综合征、SiPAP的使用、冬季和新生儿死亡率有关。因此,在分娩后、运输期间和新生儿重症监护病房入院时,将婴儿体温保持在36.5°C至37.5°C的理想范围可能会改善新生儿结局。
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引用次数: 0
Cultural and linguistic applicability of the English PEDS tools in a low-income community: A caregiver perspective 英语PEDS工具在低收入社区的文化和语言适用性:一个照顾者的视角
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
背景。使用结构化发育筛查工具进行定期发育监测是有效识别发育迟缓和残疾的一种行之有效的方法。大多数筛查工具是在高收入国家开发和标准化的,然后针对低收入和中等收入国家进行调整和转化。然而,文化差异和观点使得对低收入社区的发展筛查工具进行翻译和调整具有挑战性。确定照顾者对父母发展状况评估(PEDS)和PEDS:发展里程碑(DM)的语言和文化适宜性的看法,作为南非低收入社区适应过程的第一步。参与者(N=102)采用便利抽样在免疫诊所选择。我们采用了调查研究设计。定量资料采用描述性统计分析,定性调查反馈调查采用数据驱动归纳法分析。在“个人发展计划”问卷上,38.2%的受访者认为问题1中的“发展”一词不合适;在第2 - 9题中,51%的人更喜欢“有时担心”这个短语,而不是“有任何担忧”。在PEDS:DM测试中,124道题中有58道被认为很难。由于文化或语言差异,大多数问题都有问题(49个问题),而9个问题对于孩子的年龄来说太难了。表达性语言发展领域面临的挑战最大。目前的研究依赖于强大的社区参与,使社区主导的PEDS工具适应。这些工具上的项目完全从社区的角度来看待,使社区在这一过程中成为“专家”,确保这些工具具有更大的背景相关性和适用性,并可推广到类似的低收入社区。
{"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":null,"pages":null},"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}
引用次数: 0
Profiles of patients with myelomeningocele admitted to the neonatal unit at Universitas Academic Hospital in Bloemfontein, South Africa 南非布隆方丹大学学术医院新生儿病房收治的脊髓脊膜膨出患者概况
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
& # x0D;& # x0D;& # x0D;& # x0D;背景。髓脊膜膨出(MMC)是一种常见的神经管缺损,有明显的后遗症。最近关于南非MMC死亡率和发病率的数据有限。目标。描述南非布隆方丹大学学术医院(UAH)新生儿病房收治的MMC患者的结局和特征。 方法。对2017年1月1日至2019年12月31日期间入住新生儿病房的53例MMC患者进行了一项回顾性描述性研究。审查了电子病历。数据包括结局、住院时间、并发症和母婴特征。 结果。住院病人死亡率为11.3% (n=6/53)。平均住院时间为18天。MMC并发症包括脑积水(88.7%);n=47/53), II型Chiari畸形(44.7%;N =21/47),下肢瘫痪(84.9%;N =45/53),下肢畸形(60.4%;N =32/53),脑膜炎(52.8%;N =28/53),神经性膀胱(37.7%;N =20/53)和肛门张力丧失(41.5%;n = 22/53)。62.2% (n=33/53)的患者进行了MMC修复,27.3% (n=9/33)出现了并发症。伤口败血症和破裂是最常见的并发症(18.2%,n=6/33),发生并发症的中位时间为8天。62% (n=31/50)的病例未进行产前声纳检查。产前检出MMC的病例占20%。 结论。本研究的住院病人死亡率低于其他低收入和中等收入国家报告的死亡率,尽管发现了显著的发病率。缺乏高质量的产前护理和获得产前声纳是早期发现MMC的障碍。其他医疗保健系统基础设施的失败可能是原因之一,这突出了需要持续的跨部门合作,以预防、早期发现和管理MMC,以改善患者的预后。& # x0D;& # x0D;& # x0D;
{"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":"&#x0D; &#x0D; &#x0D; &#x0D; 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).&#x0D; Objective. To describe the outcomes and characteristics of patients with MMC admitted to the neonatal unit at Universitas Academic Hospital (UAH) in Bloemfontein, SA.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; &#x0D; &#x0D; &#x0D;","PeriodicalId":44732,"journal":{"name":"South African Journal of Child Health","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820900","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}
引用次数: 0
RSV bronchiolitis in 2018: A descriptive study of children admitted to two Johannesburg tertiary hospitals 2018年呼吸道合胞病毒细支气管炎:一项对约翰内斯堡两家三级医院住院儿童的描述性研究
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
背景。呼吸道合胞病毒(RSV)是全世界儿童严重毛细支气管炎最常见的病因。目的:描述毛细支气管炎住院儿童的临床特点和预后,并将rsv毛细支气管炎与其他病毒性毛细支气管炎患儿进行比较。回顾性研究了2018年2月1日至8月31日期间在夏洛特麦克塞克约翰内斯堡学术医院(CMJAH)和纳尔逊曼德拉儿童医院(NMCH)接受病毒筛查的毛细支气管炎患儿,并对rsv阳性和阴性患儿进行了比较。这些儿童被国家卫生实验室鉴定为接受了呼吸道病毒多重分子分析,并对医院图表进行了回顾性回顾。本研究共比较了131例来自CMJAH和NMCH的毛细支气管炎患儿,其中58例来自CMJAH, 73例来自NMCH。在样本组中,65例(49.6%)患儿有RSV, 66例(50.4%)患儿无RSV。RSV患儿中,55例(42%)为单纯RSV患儿,10例(7.6%)为RSV合并其他呼吸道病毒患儿。鼻病毒是该队列儿童中检测到的第二常见病毒(n=17, 12.9%),其次是腺病毒(n=12, 9.2%)和冠状病毒(n=9, 6.9%)。RSV毛细支气管炎患儿需要住院治疗的一个具有统计学意义的危险因素是年龄小于6个月(p<0.001)。毛细支气管炎是儿童常见病。呼吸道合胞病毒是6个月以下住院婴儿严重毛细支气管炎的最常见原因。
{"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":null,"pages":null},"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}
引用次数: 0
Outcome of two cohorts with nephroblastoma treated with consecutive International Society of Paediatric Oncology protocols in a South African paediatric oncology unit 在南非儿科肿瘤科连续接受国际儿科肿瘤学会治疗的肾母细胞瘤的两个队列的结果
Q3 Medicine Pub Date : 2023-10-19 DOI: 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.
背景。肾母细胞瘤是南非常见的儿童实体瘤。目的是确定1990年至2018年间诊断为肾母细胞瘤的患者的结局,并比较连续接受国际儿科肿瘤学会(SIOP)肾母细胞瘤治疗方案的两个队列的结局。这是一个回顾性的描述性研究,在泰格伯格医院的两个队列。队列1(1990 - 2007)采用SIOP 9和SIOP 93-01方案治疗,队列2(2008 - 2018)采用SIOP 2001方案治疗。数据包括人口学数据(诊断时的年龄、性别)、艾滋病毒状况、术前和术后分期、手术并发症、组织学类型、淋巴结取样、总生存期(OS)和无事件生存期(EFS),终点为诊断后两年。队列1中有60名儿童(M:F比1:1.14),平均年龄为42个月(四分位间距(IQR)16.25 ~ 56.5个月),队列2中有45名儿童(M:F比1:0.8),平均年龄为37个月(IQR 22 ~ 45.5个月)。队列2的局限性疾病患者(76%)多于队列1(55%)(趋势p=0.076)。两个队列均有良好的OS(分别为88%和93%)和EFS(分别为82%和80%)。队列1的一半(50%;n=30/60)没有淋巴结采样,随后四次复发,与OS (p<0.001)和EFS (p=0.006)显著相关。在队列1中,OS与EFS和基础组织学之间存在显著相关性(分别为p=0.006和p=0.015),而在队列2中,OS与EFS和组织学之间存在显著相关性(p=0.02)。在南非的一个机构中,肾母细胞瘤患儿接受连续SIOP治疗的OS良好。
{"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":null,"pages":null},"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}
引用次数: 0
Losses of children’s cognitive potential over time: A South African example 儿童认知潜力随着时间的推移而丧失:一个南非的例子
Q3 Medicine Pub Date : 2023-10-19 DOI: 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)
在低收入和中等收入国家,约有2.5亿5岁以下儿童丧失终身认知潜力。然而,干预措施的主要重点是提高存活率和促进生长。本研究于2009年至2010年间招募了南非开普敦24个不连续低收入地区的所有孕妇(N= 1238),并在分娩后8年内重新评估了6次。在24个地区中,有一半地区的母亲被随机安排接受社区卫生工作者的家访,主要集中在怀孕期间和出生后的头6个月。在18个月时,儿童的认知发展处于全球标准,即平均标准偏差(SD)值为100(15)。到5岁时,平均认知发展下降到比全球标准低一个标准差(<85;平均= 83),60%的儿童得分低于全球平均水平。到8岁时,认知发展得分再次显著下降(平均= 73;88%的儿童[lt;85]。这种损失的程度是巨大的,需要在整个儿童时期进行持续的干预,以支持中低收入国家儿童的认知发展。生命的头100天很重要,但不足以使儿童预防贫穷的消极后果,并应对多种长期社区挑战(如艾滋病毒、酗酒、人际暴力)。
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引用次数: 0
Trends in childhood cancers at Tygerberg Hospital from 1994 to 2014 1994 年至 2014 年泰格博格医院儿童癌症发病趋势
IF 0.4 Q3 Medicine Pub Date : 2023-07-20 DOI: 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.
背景。由于缺乏针对特定疾病的医院和人口登记,中低收入国家的儿童癌症发病率数据十分匮乏。描述1994年至2014年间在南非一家机构接受治疗的儿童癌症患者的疾病概况和治疗结果。收集的数据包括人口统计学数据(确诊年龄、性别、分期或风险组别、种族)以及确诊为癌症的15岁以下儿童的5年总生存率(OS)。采用卡普兰-梅耶曲线和考克斯回归分析法分析了事件发生的时间以及与5年生存率相关的因素。在935份病历中,最常见的恶性肿瘤是白血病(27.7%)、脑瘤(18.4%)、淋巴瘤(14.1%)、肾母细胞瘤(8.0%)和软组织肉瘤(7.4%)。局限性实体瘤和标准风险血液恶性肿瘤的OS率较高,分别为77.7%和85.9%,但整个组别的OS率为60.2%。肾母细胞瘤(89.3%)、视网膜母细胞瘤(86.7%)、霍奇金淋巴瘤(89.7%)和伯基特淋巴瘤(75.5%)的OS最佳。癌症类型(p<0.01)、实体瘤分期(p<0.001)和血液恶性肿瘤风险分类(p<0.001)与死亡率有显著相关性。基础癌症诊断、分期和风险组别仍然是影响生存率的重要因素,实体瘤和标准风险血液恶性肿瘤的局限性疾病具有良好的OS,与高收入国家的生存率相当。
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引用次数: 0
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South African Journal of Child Health
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