Browsing by Author "Westwood, Tony"

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    Cystic fibrosis in black patients: Western Cape experiences
    (2006) Westwood, Tony; Brown, Ruth
    Cystic fibrosis (CF) in non-American black Africans has only been described in case reports. CF was first reported in a South African black child with meconium ileus in 1959.1 Ten years later Levin and colleagues2 described twins born to a Sotho mother and a Zulu father. One twin had meconium ileus, the other had pancreatic insufficiency. Not long after the identification of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in 1989, molecular genetics proved that CF in Africa was a CFTR mutation-based disease. A study of 3 CF cases in black South Africans included clinical data and the results of a systematic investigation of the CFTR gene in each case.3 Four genes had the 3120+1G A mutation that is significantly prevalent in African Americans. Another carried a different mutation (G1249E) and the last carried a previously unidentified 54 base pair deletion in exon 17a.
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    Deaths at Red CrossChildren's Hospital, Cape Town 1999-2003 - a study of death notification forms
    (2006) Grandin, Wilson; Westwood, Tony; Lagerdien, Kashifa; Shung King, Maylene
    Objectives. The availability of cause-specific mortality data for children in South Africa is limited. Hospital-based data have the potential to contribute to understanding of the causation of childhood death in South Africa. The objectives of the study were to gain insights into the causes of death in a South African children’s hospital. Design. Prospective, descriptive study of death notification forms. Setting. Red Cross War Memorial Children’s Hospital, Cape Town. Methods. Data from 1999 to 2003 were analysed by direct and underlying causes of death (using a modified Global Burden of Diseases (GBD) classification) and demographic variables. Death rates per 1 000 hospital admissions were calculated for certain common causes of death. Seasonal correlates of mortality were examined. Results. There were 1 978 deaths. The number of deaths per year increased by 11.4% over the period. The death rate rose from 15.9 to 18.4 per 1 000 admissions from 1999 to 2002, declining to 17.4/1 000 in 2003. The death rate was higher for females than for males (18.4/1 000 versus 17.6/1 000, p = 0.007). Sixty per cent of deaths occurred in children less than 1 year old. GBD group I diseases (infectious, nutritional, perinatal) accounted for the greatest proportion of deaths (58.6%), followed by non-communicable diseases (29.1%), and injuries (7.9%). HIV/AIDS accounted for 60% of infectious deaths (31.6% of all deaths). Diarrhoea-related mortality was 3 times higher in summer than in winter. Congenital conditions dominated GBD group II (57.5%). Conclusion. The analysis shows the value of routinely recording data on childhood hospital deaths. The results mirror those of the South African Medical Research Council’s Burden of Disease studies but also reflect the hospital’s tertiary functions. Female children were at higher risk of death. Childhood HIV related deaths are a major challenge to the health system.
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    Diagnosing cystic fibrosis in South Africa
    (2006) Westwood, Tony; Henderson, Bertram; Ramsay, Michele
    Cystic fibrosis (CF) occurs in all South Africa’s population groups. While well described in the white and coloured populations, its presence in black African populations is less well known. Recent evidence from the group of CF patients in the Western Cape suggests an incidence of 1 in 3 000 and 1 in 10 300 live births in the white and coloured populations respectively.1 In black South African populations, carrier frequency estimates have been used to project an incidence of 1 in 4 624 live births.2 Further evidence of the presence of CF in these populations is presented in this issue of the Journal. 3 While considering or being aware of the diagnosis is the first step in identifying CF, diagnosing the disease presents challenges at clinical and laboratory levels in South Africa. In simple terms, the diagnosis of CF requires a patient to have suggestive clinical features as well as 2 positive sweat tests and/or 2 identified disease-causing CF transmembrane conductance regulator (CFTR) gene mutations.