Browsing by Author "Westwood, Anthony"

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    An analysis of the prevalence of children with disabilities and disabling chronic illnesses in the Western health sub-district of Cape Town, and the services available for them
    (2014) Redfern, Andrew William; Donald, Kirsten A; Westwood, Anthony
    Children with disabling chronic illnesses are known to have complex and frequently unmet health care needs. Limited information exists in South Africa regarding the prevalence of children with disability, as well their needs and utilization of services. The purpose of the current study is twofold: (1) identify the number of children known with disability, or disabling chronic illnesses in the western health sub-district of Cape Town; (2) analyse the health services that currently exist for these children. A period prevalence survey was conducted between January 2010 and December 2011. Numerous sources of information were sought to identify as many children with disabling chronic illness as possible. These included the referral hospitals for the Western sub-district, namely Red Cross War Memorial Children's Hospital and New Somerset Hospital, as well as the institutions where children with disability are cared for or educated, and relevant non-profit organisations in the disability sector. Information was gathered between January 2011 and Sept 2012.
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    Assessment of the efficacy and efficiency of rapid rehydration in children with dehydration due to gastroenteritis in the rehydration unit of Red Cross War Memorial Children's Hospital
    (2017) Webb, Nicholas Guy; Westwood, Anthony
    Background: Dehydration due to acute gastroenteritis (AGE) remains a leading cause of child death worldwide. The primary treatment is enteral rehydration. Children who fail a trial of oral fluids require rehydration in hospital, preferably via nasogastric tube. Traditionally, children have been rehydrated over 24 hours; 'Standard Rehydration' (SR). Most treatment guidelines now recommend 'Rapid Rehydration' (RR) over 4-6 hours. There are limited data comparing RR to SR, especially from low-resource settings. Objectives: To assess the efficacy and efficiency of RR in children with AGE in the Rehydration Unit of Red Cross War Memorial Children's Hospital, Cape Town. Methods: A retrospective cohort study was performed. The intervention cohort contained 67 children who received RR in March 2007. The control cohort contained 76 children who received SR in March 2006. The outcome measures were weight and hydration status at 4 hours and time to maximum weight to measure efficacy; and length of hospital stay (LOS) to measure efficiency. Results: Children in the intervention cohort experienced greater weight gain (p<0.01) and lower dehydration scores (p=0.01) at 4 hours. There was no difference in time to maximum weight. The LOS for the two groups were not statistically different. Conclusion: RR is an effective method of rehydrating children with AGE. In contrast to two studies in well-developed settings, reduction in LOS following RR could not be demonstrated. There is no reason not to adopt RR as the predominant rehydration method in settings such as ours. More research is required to evaluate the efficiency of RR.
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    Basic health care services for children
    (Children's Institute, 2010) Westwood, Anthony; Shung King, Maylene; Lake, Lori
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    Sickle cell disease in Cape Town: a perspective from two regional hospitals
    (2020) Vahed, Anisa; van Eyssen, Ann; Westwood, Anthony
    Background: Inherited hemoglobinopathies are a global health burden. Sickle cell disease (SCD) is the most common genetic disorder of haemoglobin in Africa but is uncommon in the South African population. Objectives This study aimed to describe the presentation and experience managing paediatric patients with SCD at two regional hospitals in Cape Town. Methods This retrospective study used routine data of children aged 0-13 years with SCD managed at New Somerset and Victoria Hospitals in Cape Town from January 2010 to December 2018. Data analysed included demographics, diagnosis, out- and in-patient episodes, and the need for transfers to tertiary level. Results We identified 63 patients of which three did not fit the study criteria and four had missing clinical records. Of the 56 children included, most were diagnosed at the regional hospital (n=32 [58%]) and only a third (n=18 [32%]) were down-referrals from tertiary level facilities. The annual number of new patients per year varied with the most in 2009 and 2015. The median age at first presentation was 20.1 months (interquartile range [IQR] 7.1-43.9 months). There was a male predominance. The majority (n=39 [67%]) were born in South Africa, eleven were born in the Democratic Republic of Congo (DRC) and six in other African countries. None of the parents were born in South Africa. The majority of parents were from DRC (73/110) and Nigeria (11/110). Approximately one third (39%) of patients had a family history of SCD and a quarter (25%) had an affected sibling. Most children were diagnosed incidentally via full blood count findings (66%); others presented with symptomatic anaemia (28%) or were screened because of an affected sibling (11%). The mean number of hospital days was 3.0 (range 0-13). Infections, bone crises and symptomatic anaemia accounted for the majority of hospital admissions. Referral for tertiary level care occurred in 23/56 (41%) patients with most requiring specialist opinion from haematology and/or other specialist disciplines. Nine (16%) children were lost to follow-up, one was transferred to another province and one died at another institution. Conclusion An increasing number of children diagnosed with SCD are being seen in health facilities in Cape Town and probably other parts of South Africa due to migration and children being born to families with SCD ancestries. Recognising the presentation and complications of SCD and developing competency at all levels of care in providing appropriate, protocolised management are important to reduce morbidity and mortality among children with SCD in our setting