Browsing by Author "Wege, Martha Helena"

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    Open Access
    A retrospective review of the prevalence and management of anaemia in children in at Red Cross War Memorial Children's Hospital
    (2015) Wege, Martha Helena; Hartley, Patricia; Muloiwa, Rudzani
    Introduction Childhood anaemia is a major public health problem, iron deficiency being most common. WHO estimates anaemia to occur in 24.1% of pre-school South African children. Our study describes prevalence and management of anaemia in children aged 6 - 36 months presenting to a children's hospital. Methods In a retrospective cross-sectional study, laboratory data were used to estimate prevalence of anaemia in children aged 6 - 36 month presenting to medical emergency or ambulatory services of Red Cross Children's Hospital in 2012. A random sample of 50% of anaemic children was sampled for detailed review. Results 2661 subjects were included. Anaemia (H b < 10.5) was found in 40.8 % (1088/2661. Children presenting to medical emergency had a higher prevalence of anaemia compared to those presenting to ambulatory services ( 42.7% vs. 34.9 % ; p=0.001 ). Anaemia prevalence increased with decreasing age with RR 1.25 (95% CI 1.10 - 1.43) and RR 1.15 (95% CI 1.02 - 1.31) in children aged 6 - 11 months and 12 - 23 months respectively compared to children aged 24 - 36 months. Microcytosis was found in 51.3% (558/1088) of anaemic children and in 19.3% (n=303/1573) of children without anaemia ; p<0.001 Folders were reviewed i n 502 children with anaemia , 36.1% had mild anaemia (Hb 10 - 10.5g/dl), while moderate ( Hb 8 - 10 g/dl ) and severe ( Hb < 8 g/dl ) anaemia was found in 52.5% and 11.4% respectively. Breastfeeding for longer than six months was associated with higher risk of microcytic anaemia [RR 1.26 (95%CI 1.08 - 1.47)]. Only 12.2 % (31 /254) of children with microcytic anaemia received adequate iron therapy, 50.0 % (127/254) received no iron therapy. Conclusions Prevalence of anaemia in children presenting to hospital is higher than predicted for well children in South Africa. The risk is higher in younger and acutely sick children. Prolonged breasting is associated with increased risk of microcytosis. Most children with suspected iron deficiency anaemia did not receive appropriate treatment.
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    Open Access
    Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?
    (2020) Wege, Martha Helena; Morrow, Brenda; Rossouw, Beyra; Argent, Andrew
    Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare.