Browsing by Department "Division of Child and Adolescent Psychiatry"
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- ItemOpen AccessAn assessment of kangaroo mother care among staff in a specialized neonatal intensive care unit, Asmara, Eritrea(2018) Araya, Elsa Semere; Shea, Jawaya; Bergman, NilsIntroduction: Preterm delivery remains the major cause of newborn infants’ morbidity and mortality globally and more so in low-income countries like Eritrea. Research has shown that the provision of Kangaroo mother care (KMC) can contribute to a reduction in morbidity and mortality among newborn infants. However, there is limited research on the practice of KMC in Eritrea. Methods: A mixed methods approach was adopted in a phenomenographic study to collect the data. Eleven participants with work experience of at least two years were recruited from the Specialised Neonatal Intensive Care Unit (SNICU) at Orotta Paediatric Hospital (OPH), Asmara, Eritrea. Data were collected via individual interviews and observations. Results: The results showed that participants had no prior KMC training and education. In addition, staff had limited knowledge and mixed attitudes about KMC practice. There were also no KMC guidelines and protocols. Furthermore, space was not adequate for full KMC practice except for implementation of the kangaroo position. The researcher’s observation confirmed similar evidence of a lack of availability of a KMC ward and lack of protocols and guidelines. Limited interaction and communication about KMC between participants and parents was also observed. Some of the most common hindrances to KMC practice were the perception that KMC increased staff work load and that it was time consuming. In addition, lack of regular KMC training for staff, lack of a convenient setup and too few staff members were among the hindrances. One staff members also perceived that KMC practice was not culturally accepted. 15 Conclusion: The results of this study showed that there were no proper KMC guidelines and protocols in the ward. In addition, only the kangaroo position was practiced, not the full KMC protocol. Furthermore, staff had limited knowledge and mixed attitudes. The observation component of the research highlighted the lack of space and KMC protocols and guidelines as key limitations for delivering KMC. Therefore, it is recommended that a programme to improve staff knowledge be implemented, that evidence-based KMC guidelines and polices be made available, that the KMC ward be expanded, and that health education about KMC practice be brought to the population through mass media
- ItemOpen AccessBedding covers for people with allergic rhinitis(2005) Swingler, GeorgeA patient comes to you asking whether using a mattress cover would help her allergic rhinitis. You know that she is allergic to house-dust mites and you know also that bedding covers have been widely recommended for allergic rhinitis, not least by several clinical guidelines. You have also heard however that some doubt has been cast on the evidence supporting these recommendations. With your interest raised, you determine to try to find out for yourself..
- ItemOpen AccessBereavement in children : a school based intervention programme(1998) Feigenbaum, Pat; Berg, Astrid; Keen, RosemaryThe consequences of childhood bereavement are two-fold, in the pain he/ she suffers at the time of the death, and in future psychiatric disorders which can follow unresolved mourning. The bereaved child needs a familiar and responsible adult outside the family to help him/her cope with his/her grief, because parents are sometimes emotionally absent from him/her due to their own grief or they seek to "protect" the child from the pain of the loss. This study presents a programme given to 164 primary school teachers from nine schools in Cape Town to educate them in how to help the bereaved child in the classroom situation, so that they can fill the role of an outside responsible adult in the life of the bereaved child. 78 bereavements occurred in the nine schools in the year of the study. It was found that the teachers responded positively to the training programme and that they perceived it to be helpful in dealing with a bereaved child.
- ItemOpen AccessBringing Parent–Child Interaction Therapy to South Africa: Barriers and Facilitators and Overall Feasibility—First Steps to Implementation(2022-04-07) Dawson-Squibb, John-Joe; Davids, Eugene Lee; Chase, Rhea; Puffer, Eve; Rasmussen, Justin D M; Franz, Lauren; de Vries, Petrus JThere is a large assessment and treatment gap in child and adolescent mental health services, prominently so in low- and middle-income countries, where 90% of the world’s children live. There is an urgent need to find evidence-based interventions that can be implemented successfully in these low-resource contexts. This pre-pilot study aimed to explore the barriers and facilitators to implementation as well as overall feasibility of Parent–Child Interaction Therapy (PCIT) in South Africa. A reflective and consensus building workshop was used to gather South African PCIT therapist (N = 4) perspectives on barriers, facilitators, and next steps to implementation in that country. Caregiver participants (N = 7) receiving the intervention in South Africa for the first time were also recruited to gather information on overall feasibility. Facilitators for implementation, including its strong evidence base, manualisation, and training model were described. Barriers relating to sustainability and scalability were highlighted. Largely positive views on acceptability from caregiver participants also indicated the promise of PCIT as an intervention in South Africa. Pilot data on the efficacy of the treatment for participating families are a next step. These initial results are positive, though research on how implementation factors contribute to the longer-term successful dissemination of PCIT in complex, heterogeneous low-resource settings is required.
- ItemOpen AccessCharacteristics and predictors of treatment effectiveness of children seen at the Therapeutic Learning Centre, Division of Child and Adolescent Psychiatry, Red Cross War Memorial Children's Hospital during the period 1992-2008(2012) Dhansay, Yumna; Flisher, Alan J; Joska, JohnIncludes abstract. Includes bibliographical references.
- ItemRestrictedChest radiograph in acute respiratory infections(2005) Swingler, George H; Zwarenstein, MerrickBackground: Chest radiography is widely used during the management of acute lower respiratory infections, but the benefits are unknown. Objectives: To assess the effects of chest radiography on clinical outcome in acute lower respiratory infections. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1950 to January 2007) and EMBASE (January 1976 to February 2007). Selection criteria: Randomised or quasi-randomised trials of chest radiography in acute respiratory infections. Data collection and analysis: Both review authors independently applied the inclusion criteria, extracted data and assessed trial quality. Main results: We identified two trials. One, of 522 outpatient children (and performed by the review authors), found that 46% of both radiography and control participants had recovered by seven days (relative risk (RR) 1.01, 95% confidence interval (CI) 0.79 to 1.31). Thirty-three per cent of radiography participants and 32% of control participants made a subsequent hospital visit within four weeks (RR 1.02, 95% CI 0.79 to 1.30) and 3% of both radiography and control participants were subsequently admitted to hospital within four weeks (RR 1.02, 95% CI 0.41 to 2.52). The other trial involving 1502 adults attending an emergency department found no significant difference in length of illness, the single outcome prespecified for this review (mean of 16.9 days in radiograph group versus 17.0 days in control group, P > 0.05). Authors’ conclusions: There is no evidence that chest radiography improves outcome in outpatients with acute lower respiratory infection. The findings do not exclude a potential effect of radiography, but the potential benefit needs to be balanced against the hazards and expense of chest radiography. The findings apply to outpatients only.
- ItemOpen AccessChild and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis(BioMed Central, 2018-06-26) Mokitimi, Stella; Schneider, Marguerite; de Vries, Petrus JBackground Mental health problems represent the greatest global burden of disease among children and adolescents. There is, however, lack of policy development and implementation for child and adolescent mental health (CAMH), particularly in low- and middle-income countries (LMICs) where children and adolescents represent up to 50% of populations. South Africa, an upper-middle income country is often regarded as advanced in health and social policy-making and implementation in comparison to other LMICs. It is, however, not clear whether this is the case for CAMH. The national child and adolescent mental health policy framework of 2003 was developed to guide the establishment of CAMH policies provincially, using a primary care and intersectoral approach. This policy provided a framework for the nine South African provinces to develop policies and implementation plans, but it is not known whether this has happened. The study sought to examine the history and current state of CAMH policy development and implementation, and to perform a systematic analysis of all available CAMH service-related policies. Methods A comprehensive search was performed to identify all provincial mental health and comprehensive general health policies across South African provinces. The Walt and Gilson policy triangle framework (1994) was used for analysis. Results No South African province had a CAMH policy or identifiable implementation plans to support the national CAMH policy. Provincial comprehensive general health policies addressed CAMH issues only partially and were developed mainly to address the challenges with HIV/AIDS, TB, maternal and child mortality and adherence to the millennium development goals. The process of policy development was typically a consultative process with internal and external stakeholders. There was no evidence that CAMH professionals and/or users were included in the policy development process. Conclusions In spite of South Africa’s upper-middle income status, the absence of any publically-available provincial CAMH policy documents was concerning, but in keeping with findings from other LMICs. Our results reinforce the neglect of CAMH even at policy level in spite of the burden of CAMH disorders. There is an urgent need to develop and implement CAMH policies in South Africa and other LMICs. Further research will be required to identify and explore the barriers to policy development and implementation, and to service development and scale-up in CAMH.
- ItemOpen AccessChild and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers(2022-07-14) Mokitimi, Stella; Jonas, Kim; Schneider, Marguerite; de Vries, Petrus JBackground Current work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa. Methods Using focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters. Results Results highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives. Conclusions Findings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a ‘case study’, we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.
- ItemOpen AccessCorrection to: The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation(BioMed Central, 2018-01-31) Hoosen, Nikhat; Davids, Eugene L; de Vries, Petrus J; Shung-King, MayleneAbstract After publication of the article [1], it has been brought to our attention that the authors listed in Table 1 are in the wrong order. They should be listed as follows:
- ItemOpen AccessCorrelates of Attention Deficit/Hyperactivity Disorder (ADHD) among children in a clinical psychiatric center in Northern Nigeria(2011) Sale, Shehu; Joska, JohnThis study primarily aims at determining the correlates of Attention Deficit Hyperactivity Disorder (ADHD) among children and adolescents in Northern Nigeria. The secondary aims of the study include a comparison of the identified correlates with results from other developing countries and the developed nations. The results would also provide a rational basis for advocating preventive measures for targeted problems associated with ADHD in the study.
- ItemOpen AccessA deaf child in the family : a preliminary study of the social-emotional impact of deafness on parenting and family life in Cape Town(2003) Kleintjes, Sharon Rose; Molteno, ChrisThis study documents hearing parents' experiences of the impact of deafness on raising their deaf children during the preschool years. It focuses on their experience of health services for their child. The study population of 20 children was drawn from parents with children under 6 years of age diagnosed with moderate to profound loss of hearing at the Developmental Ciinic, Red Cross Chiidren’s Hospital, Rondebosch; Cape Town. Data was collected from 2 sources, namely a semi-structured interview, which was analysed for themes, and a questionnaire, which measures parental stress, communication difficuities, and experience of professional support.
- ItemOpen AccessDelirium in children and adolescents(2009) Hatherill, Sean; Flisher, Alan JIncludes abstract. Includes bibliographical references (leaves 334-373).
- ItemOpen AccessThe development and implementation of an intervention programme for young sexual offenders(2006) Meys, Ulrich; Flisher, Alan JOver the last decade, sexual abuse committed by young sexual offenders has increasingly been reported in South Africa. Such offenders are often inappropriately managed by both mental health and related professionals and the justice system. This dissertation describes the process involved in the development and implementation of a diversion programme for young sexual offenders in the local setting by the use of action research. This is preceded by an overview of the concepts of diversion and the characteristics, assessment and management of young sexual offenders. The development and implementation process is presented in stepwise action cycles, highlighting the various action steps that were taken. These are evaluated in the 'observation' and 'reflection' sections of each cycle. Twelve action cycles, spanning a period of 6 years, are described, beginning with the identification that young sexual offenders and their management posed a problem, the development of a diversion programme and the initial pilot studies, through to the formation of SAYSTOP, a multidisciplinary umbrella organisation. Further steps describe the wider implementation of the programme, facilitator training and follow-up studies conducted on young sexual offenders. The multi-disciplinary role played by SAYSTOP in the management of young sexual offenders is discussed and the SAYSTOP diversion programme is compared to guidelines suggested in the literature. The strengths, weaknesses and limitations of both the process and the SAYSTOP diversion programme are discussed in the conclusion, followed by recommendations for future guidelines and policy decisions regarding young sexual offenders. Results indicate that sexual offences committed by youths in South Africa are common and that no intervention programmes exist that aim to rehabilitate these offenders. Professionals from various fields were able to combine their experience and develop a group intervention programme targeting these youths. Following successful administration of this programme to young sexual offenders a manual documenting both the content and objectives of group sessions was developed. Structured workshops with the aim of training future facilitators (probation officers) ensured that the diversion programme was implemented on a regional level in the Western and Eastern Cape. Follow-up studies on young sexual offenders and feedback from facilitators indicated that the core concepts of the programme were understood by participants although several areas were identified that needed to be addressed in more detail. The follow-up studies showed that none of the youths re-offended, although disappointingly only ± 30% of youths could be interviewed. A system whereby young sexual offenders could be managed and followed-up over a longer period within a continuum of care model could not be implemented. Insufficient resources and high staff turnover are identified as key factors that hampered both the development and implementation of the SAYSTOP diversion programme. Although the SAYSTOP diversion programme proved to be successful as a first line of intervention, further refinement of the programme content, development of a continuum of care model and a central management structure involving all role players is necessary for this form of diversion programme to be successful in the future.
- ItemOpen AccessDiagnostic testing in allergy(2009) Motala, Cassim; Hawarden, Diane AthenaAtopy is a personal and/or familial tendency, usually in childhood or adolescence, to become sensitised and produce IgE antibodies in response to ordinary exposure to allergens, usually proteins. As a consequence, such individuals can develop the typical symptoms of asthma, rhinoconjunctivitis or eczema.
- ItemOpen AccessDifferent use of medical terminology and culture-specific models of diseaseaffecting communication between Xhosa-speaking patients and English-speakingdoctors at a South African paediatric teaching hospital(2006) Levin, M EBackground. Language and cultural differences between patients and health care providers may have adverse health consequences. Red Cross War Memorial Children’s Hospital is a paediatric teaching hospital in Cape Town where staff communicate mainly in English or Afrikaans, while many patients speak Xhosa as their first language. Objectives. To examine whether differences in the definitions of common respiratory medical terminology by patients and doctors cause miscommunication and to explore culturespecific models if used by parents in their definitions. Design. In-depth, semi-structured interviews were conducted with three speech communities, viz. 8 English-speaking doctors and 33 Xhosa-speaking parents, educated to grade 12 level or less and recruited from two areas in the hospital, the short-stay ward (Xhosa s-s) and the allergy clinic (Xhosa allergy). The sum of both groups of Xhosa-speaking patients are referred to as ‘Xhosa all’. Definitions were elicited for common respiratory terminology in both Xhosa and English. Contrastive linguistic analysis was used to identify the semantic properties for each group in order to condense the groups’ definitions into representative ‘core definitions’. Differences in the definitions of terminology were identified and words were classified as concordant (used in the same way) or discordant (used in different ways) by the three speech communities. Results. Parents experience difficulty in understanding terms used by doctors and words in common use were understood differently by these two groups. Most Xhosa words were not in the doctors’ vocabulary, and some common English words were not in the parents’ vocabulary. Where words were in the vocabulary of both groups, significant differences existed in the number and range of definitions, with many clinically significant discordances of definition being apparent. Some common examples relevant to paediatric respiratory problems are presented. Three culture-specific explanatory models of respiratory illness, ingqele, xakaxa and idliso, are illustrated.
- ItemOpen AccessEndoscopic injection sclerotherapy for bleeding varices in children with intrahepatic and extrahepatic portal venous obstruction: benefit of injection tract embolisation(2012) Bandika, Victor Lewa; Goddard, Elizabeth A; De Lacey, Ronalda D; Brown, Robin AlexanderBACKGROUND: The outcome of sclerotherapy for bleeding oesophageal varices may be influenced by injection technique. In a previous study at our institution, sclerotherapy was associated with a high re-bleeding rate and oesophageal ulceration. Embolisation of the injection tract was introduced in an attempt to reduce injection-related complications. METHODS: To determine the outcome and effectiveness of injection tract embolisation in reducing injection-related complications, we retrospectively reviewed a series of 59 children who underwent injection sclerotherapy for oesophageal varices (29 for extrahepatic portal vein obstruction (EHPVO) and 30 for intrahepatic disease) in our centre. RESULTS: Sclerotherapy resulted in variceal eradication in only 11.8% of the children (mean follow-up duration: 38.4 months). Variceal eradication with sclerotherapy alone was achieved in 20.7% and 3.3% of EHPVO and intrahepatic disease patients, respectively. Injection tract embolisation was successful in reducing the number of complications and re-bleeding rates. Complications that arose included: transient pyrexia (16.7%); deep oesophageal ulcers (6.7%); stricture formation (3.3%); and re-bleeding before variceal sclerosis (23%). CONCLUSION: Injection sclerotherapy did not eradicate oesophageal varices in most children. Injection tract embolisation by sclerosant was associated with fewer complications and reduced re-bleeding rates.
- ItemOpen AccessEstimating the burden of disease attributable to childhood and maternal undernutrition in South Africa in 2000(2007) Nannan, Nadine; Norman, Rosana; Hendricks, Michael; Dhansay, Muhammad A; Bradshaw, Debbie; South African Comparative Risk Assessment Collaborating GroupObjectives. To estimate the disease burden attributable to being underweight as an indicator of undernutrition in children under 5 years of age and in pregnant women for the year 2000. Design. World Health Organization comparative risk assessment (CRA) methodology was followed. The 1999 National Food Consumption Survey prevalence of underweight classified in three low weight-for-age categories was compared with standard growth charts to estimate population-attributable fractions for mortality and morbidity outcomes, based on increased risk for each category and applied to revised burden of disease estimates for South Africa in 2000. Maternal underweight, leading to an increased risk of intra-uterine growth retardation and further risk of low birth weight (LBW), was also assessed using the approach adopted by the global assessment. Monte Carlo simulation-modelling techniques were used for the uncertainty analysis. Setting. South Africa. Subjects. Children under 5 years of age and pregnant women. Outcome measures. Mortality and disability-adjusted life years (DALYs) from protein- energy malnutrition and a fraction of those from diarrhoeal disease, pneumonia, malaria, other nonHIV/AIDS infectious and parasitic conditions in children aged 0 - 4 years, and LBW. Results. Among children under 5 years, 11.8% were underweight. In the same age group, 11 808 deaths (95% uncertainty interval 11 100 - 12 642) or 12.3% (95% uncertainty interval 11.5 - 13.1%) were attributable to being underweight. Protein-energy malnutrition contributed 44.7% and diarrhoeal disease 29.6% of the total attributable burden. Childhood and maternal underweight accounted for 2.7% (95% uncertainty interval 2.6 - 2.9%) of all DALYs in South Africa in 2000 and 10.8% (95% uncertainty interval 10.2 - 11.5%) of DALYs in children under 5. Conclusions. The study shows that reduction of the occurrence of underweight would have a substantial impact on child mortality, and also highlights the need to monitor this important indicator of child health.
- ItemOpen AccessEverolimus for treatment of tuberous sclerosis complex-associated neuropsychiatric disorders(2017) Krueger, Darcy A; Sahin, MustafaAbstract Objective: To evaluate if short‐term treatment with everolimus was safe and could improve neurocognition and behavior in children with TSC. Methods: This was a prospective, double‐blind randomized, placebo‐controlled two‐center phase II study. Participants diagnosed with TSC and age 6–21 years were treated with 4.5 mg/m2 per day of oral everolimus (n = 32) or matching placebo (n = 15) taken once daily for 6 months. For efficacy, a comprehensive neurocognitive and behavioral evaluation battery was performed at baseline, 3 months, and 6 months. For safety, adverse events recorded continuously via patient diary were categorized and graded per NCI Common Toxicity Criteria for Adverse Events, version 3.0 (CTCAE 3.0). Analyses were performed on the intention‐to‐treat population (n = 47). Results: Nearly all assessment measures failed to demonstrate significant differences between the two groups at the end of 6 months. Only one measure each of executive function (Cambridge Neuropsychological Test Automated Battery Stockings of Cambridge) favoring placebo (P = 0.025) and social cognition (Social Responsiveness Scale Social Cognition Subscale) favoring everolimus (P = 0.011) was observed. A total of 473 adverse events (AE) were reported. The average number of total AE per subject was similar for both placebo and everolimus. Most were mild or moderate in severity and serious AE were rare. Interpretation While safe, oral everolimus administered once daily for 6 months did not significantly improve neurocognitive functioning or behavior in children with TSC.
- ItemOpen AccessExploring condom use decision-making among adolescents: the synergistic role of affective and rational processes(2021-10-19) Davids, Eugene L; Zembe, Yanga; de Vries, Petrus J; Mathews, Catherine; Swartz, AlisonBackground Condom use remains the most effective behavioural method for the prevention of HIV and unplanned pregnancies. However, condom use remains inconsistent among young people. Exploring the condom use decision-making processes that adolescents engage in might provide information that would assist in the prevention of many challenges related to poor sexual and reproductive health outcomes. This study therefore aimed to explore the factors that influenced decision-making about sexual debut and condom use of adolescents from two schools in the Western Cape, South Africa. Methods A sample of 16 adolescents were selected using purposive sampling. Data were collected using semi-structured, individual interviews. Thematic analysis was used to analyse the data generated. Results The link between sexual debut and affective processes was frequently discussed in condom use decision-making. Decisions about sexual debut were influenced by the belief that sex was a perceived symbol of ‘true love’ on the one hand, and respect for perceived parental expectations of age-appropriate sex, on the other. Condom use decision-making was shaped by adolescents’ concerns about their future and lack of stability in their lives. Adolescents’ fears of pregnancy, parenthood and disease shaped their condom use decision-making. It became evident that rational and affective decision-making in condom use choice were not mutually exclusive, but that these processes happened simultaneously. Conclusions The study highlighted the role of affective states as part of the process of examining alternatives when deciding to use a condom or not. Interventions to strengthen condom use decision-making should therefore incorporate not only rational but also affective processes to improve adolescent sexual and reproductive outcomes.
- ItemOpen AccessFeasibility of a smartphone application to identify young children at risk for Autism Spectrum Disorder in a low-income community setting in South Africa(2018) Kümm, Aubrey Jonathan; de Vries, Petrus JIntroduction and aims More than 90% of children with Autism Spectrum Disorder (ASD) live in low- and middle-income countries (LMIC) where there is a great need for culturally appropriate, scalable and effective early identification and intervention tools. Smartphone technology and application (‘apps’) may potentially play an important role in this regard. The Autism&Beyond iPhone App was designed as a potential screening tool for ASD risk in children aged 12-72 months. Here we investigated the technical feasibility and cultural acceptability of a smartphone app to determine risk for ASD in children aged 12-72 months in a naturalistic, low-income South African community setting. Methodology 37 typically-developing African children and their parents/carers were recruited from community centres in Khayelitsha Township, Cape Town, South Africa. We implemented a mixed-methods design, collecting both quantitative and qualitative data from participants in 2 stages. In stage 1, we collected quantitative data. With appropriate ethics and consent, parents completed a short technology questionnaire about their familiarity with and access to smartphones, internet and apps, followed by electronic iPhone-based demographic and ASD-related questionnaires. Next, children were shown 3 short videos of 30s each and a mirror stimulus on a study smartphone. The smartphone front facing (“selfie”) camera recorded video of the child’s facial expressions and head movement. Automated computer algorithms quantified positive emotions and time attending to stimuli. We validated the automatic coding by a) comparing the computer-generated analysis to human coding of facial expressions in a random sample (N=9), and b) comparing automated analysis of the South African data (N=33) with a matched American sample (N=33). In stage 2, a subset of families were invited to participate in focus group discussions to provide qualitative data on accessibility, acceptability, and cultural appropriateness of the app in their local community. Results Most parents (64%) owned a smartphone of which all (100%) were Android based, and many used Apps (45%). Human-automated coding showed excellent correlation for positive emotion (ICC= 0.95, 95% CI 0.81-0.99) and no statistically significant differences were observed between the South African and American sample in % time attending to the video stimuli. South African children, however, smiled less at the Toys&Rhymes (SA mean (SD) = 14% (24); USA mean (SD) = 31% (34); p=0.05) and Bunny video (SA mean (SD) = 12% (17); USA mean (SD) = 30% (0.27); p=0.006). Analysis of focus group data indicated that parents/carers found the App relatively easy to use, and would recommend it to others in their community provided the App and data transfer were free. Conclusion The results from this pilot study suggested the App to be technically accurate, accessible and culturally acceptable to families from a low-resource environment in South Africa. Given the differences in positive emotional response between the groups, careful consideration should be given to identify suitable stimuli if % time smiling is to be used as a global marker for autism risk across cultures and environments.