Browsing by Department "Division of Paediatric Medicine"
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- ItemOpen AccessAssessment 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, AnthonyBackground: 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.
- ItemOpen AccessBetter recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline(BioMed Central, 2017-08-23) Venter, Carina; Brown, Trevor; Meyer, Rosan; Walsh, Joanne; Shah, Neil; Nowak-Węgrzyn, Anna; Chen, Tong-Xin; Fleischer, David M; Heine, Ralf G; Levin, Michael; Vieira, Mario C; Fox, Adam TCow’s milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as well as diverse manifestations of non-IgE-mediated food allergy. For example, gastrointestinal CMA may present as food protein induced enteropathy, enterocolitis or proctocolitis. Concerns regarding the early and timely diagnosis of CMA have been highlighted over the years. In response to these, guideline papers from the United Kingdom (UK), Australia, Europe, the Americas and the World Allergy Organisation have been published. The UK guideline, ‘Diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy—a UK primary care practical guide’ was published in this journal in 2013. This Milk Allergy in Primary Care (MAP) guideline outlines in simple algorithmic form, both the varying presentations of cow’s milk allergy and also focuses on the practical management of the most common presentation, namely mild-to-moderate non-IgE-mediated allergy. Based on the international uptake of the MAP guideline, it became clear that there was a need for practical guidance beyond the UK. Consequently, this paper presents an international interpretation of the MAP guideline to help practitioners in primary care settings around the world. It incorporates further published UK guidance, feedback from UK healthcare professionals and affected families and, importantly, also international guidance and expertise.
- ItemRestrictedChildhood pneumonia - progress and challenges(Health and Medical Publishing Group, 2006) Zar, Heather J; Madhi, Shabir ARemarkable progress has been made in the development of antimicrobial therapy, effective vaccines and pneumonia management guidelines in the past 50 years. However, pneumonia is currently the leading cause of death in children younger than 5 years in developing countries, accounting for approximately 20% of childhood deaths. This article reviews changes in the epidemiology, management and prevention of childhood pneumonia in developing countries, specifically in Africa and South Africa, and addresses future challenges. MAIN FINDINGS: The HIV epidemic has sharply increased the incidence, severity of, and mortality due to, childhood pneumonia. Bacterial infection remains a major cause of pneumonia mortality. Additional pathogens such as Pneumocystis jirovecii and Gram-negative bacteria are found in HIV-infected children, associated with a high mortality. Mycobacterium tuberculosis is an important cause of acute pneumonia in both HIV-infected and uninfected children. Use of case management guidelines can substantially reduce neonatal, infant and under-5 mortality and pneumonia-specific mortality. General preventive interventions including micronutrient supplementation with zinc and vitamin A, and immunisations can substantially reduce the burden of childhood pneumonia. Despite a lower efficacy in HIV-infected children, vaccination protects against disease in a significant proportion of children. In South Africa, new advances over the past 50 years have included greater access to primary health care for children, the use of Integrated Management of Childhood Illness guidelines in primary care, development of guidelines for diagnosis and management of childhood pneumonia and adoption of an expanded immunisation programme that includes coverage for Haemophilus influenzae type b. The pneumococcal conjugate vaccine recently licensed in South Africa also has the potential to significantly reduce the burden of childhood pneumonia. Recent roll-out of the national antiretroviral programme can reduce the incidence and severity of HIV-associated pneumonia through the prevention of HIV infection, use of cotrimoxazole prophylaxis and treatment with antiretrovirals. CONCLUSION: Available, effective interventions for prevention and treatment of childhood pneumonia exist; the challenge is to achieve widespread implementation and high coverage rates in developing countries. Greater access to newer vaccines and to antiretroviral therapy and co-trimoxazole prophylaxis in HIV-infected children is necessary to further reduce the burden of childhood pneumonia and the discrepancies in global child lung health.
- ItemOpen AccessDiagnosing cystic fibrosis in South Africa(2006) Westwood, Tony; Henderson, Bertram; Ramsay, MicheleCystic 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.
- ItemOpen AccessThe effect of a training and clinical facilitation programme for registered midwives in primary maternity settings with respect to managing labour: a pragmatic cluster randomised trial(2015) Clow, Sheila Elizabeth; Swingler, George H; Pattinson, R CBackground: Intrapartum complications contribute to nearly half of all avoidable maternal and perinatal deaths nationally. Inadequate understanding of the labour process by midwives, poor documentation of labour monitoring and inadequate systemlevel support may lead to wrong diagnosis, incorrect management, and the potential for missed opportunities to prevent mortality. Aim: To evaluate the effect of an intervention package of training and clinical facilitation on the quality of clinical management in labour by registered midwives in primary level public sector health facilities in rural South Africa. Methods: Research design : Pragmatic cluster randomised trial with 12 month follow-up. Setting and participants : Seventeen clusters stratified by geo-political region and size of service; 1020 labour records (60 per cluster / site; systematic random sample); and 154 registered midwives employed in the study sites during the study period. Participants were not blinded. Intervention : A package of clinical faclitation training for selected experienced midwife clinicians / managers, and an intrapartum educational update for midwives. Intervention and control sites continued receiving routine communication, all clinical guidelines and scheduled outreach activities. Main outcome measures : Primary outcome - clinical practice measuring partograph utilisation, using a modified partograph checklist, the testing of which is described in this study. Secondary outcome - midwives’ knowledge and skills, measured by written and clinical tests. Outcomes were analysed at the individual level using regression methods that allowed for clustering. The evaluator was blinded to the study allocation. Findings: The mean scores for the total partograph were not statistically significantly different between arms; the mean difference was 1.55 points out of a possible score 47 (95% CI: -1.18 to 4.28) p= 0.27. At a score of 27 the estimated absolute difference was 13.6% (95% CI : 0.16 to 0.25) p = 0.026. The total score for midwives’ knowledge and skills was 7 points (out of a possible 119) higher in the intervention arm (95% CI : 2.1 to 12.3), p=0.006. Conclusions: Although there was no difference in the quality of the overall completion of the partograph, there was a statistically significant difference in those of better quality completions in the intervention arm. Midwives’ knowledge and skills were higher in the intervention arm and those in the control arm deteriorated over time. This difference was statistically significant. Recommendations and implications for practice: This indicates a critical need to provide continuing professional education to midwives and to arrange midwifery staffing that optimises clinical practice in settings where intrapartum care is offered. In addition to regular, sustainable programmes to enhance partograph utilisation and midwife knowledge and skills, barriers to the utilisation of the partograph need to be investigated and addressed.
- ItemOpen AccessLanguage differences as an access barrier for Xhosa speaking patients at a children's hospital in Cape Town(2004) Levin, Michael; Motala, CasThe research documented in this thesis was conducted between November 2002 and March 2003. Rationale for the study. A problem faces many health professionals - that of communication between ourselves and patients who may differ from us in terms of the language spoken, educational level, medical knowledge, models of illnesses, socio-economic status, race and power.
- ItemOpen AccessProfile of children with head injuries treated at the trauma unit of Red Cross War Memorial Children's Hospital(2004) Lalloo, R; Van As, A BObjective. To describe the profile of childhood head injury patients treated in a trauma unit. Design. A retrospective record-based study. Setting. The trauma unit of the Red Cross War Memorial Children’s Hospital. Subjects. Children (under 13 years of age) presenting with head injuries between January 1991 and December 2001. Results. Of the almost 94 000 records, more than one-third were children presenting with head injuries. Fifty-nine per cent were boys, with more than half the sample under 5 years of age. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights, and traffic-related injuries. Almost twothirds of traffic-related injuries involved children as pedestrians being struck by a motor vehicle. More than 60% of injuries occurred in or around the child’s own home. Conclusions. Head injuries in children are a significant cause of morbidity. Prevention, especially in the home and on the streets, needs urgent attention.
- ItemOpen AccessThe role of the children’s nurse in optimising autonomic regulation: the Regul8 framework(2020) Coetzee, MinetteThe Regul8 framework represents an approach to providing fundamental children’s nursing care developed by Associate Professor Minette Coetzee at the Child Nursing Practice Development Initiative (CNPDI) in the Department of Paediatrics and Child Health at the University of Cape Town between 2008 and 2019. Originally known as the Seven Steps, and then the Seven (Plus One) Steps, the impetus for the work was to align emerging understandings and research outcomes with current children’s nursing practice. Concepts were developed through continuous exploration of emerging scientific fields and refined through a decade of teaching and learning alongside children’s nursing students, practitioners and educators from across Africa. The framework is designed to comprehensively address the major influences on regulatory function through an intentionally Afrocentric guide to children’s nursing care planning.
- ItemOpen AccessSodium and potassium disturbances in childhood diarrhoea(2006) Pillay, VictoriaIncludes bibliographical references.
- ItemOpen AccessThe skin microbiome: impact of modern environments on skin ecology, barrier integrity, and systemic immune programming(2017) Prescott, Susan L; Larcombe, Danica-Lea; Logan, Alan C; West, Christina; Burks, Wesley; Caraballo, Luis; Schoeman, Johan; Etten, Eddie Van; Horwitz, Pierre; Kozyrskyj, Anita; Campbell, Dianne ESkin barrier structure and function is essential to human health. Hitherto unrecognized functions of epidermal keratinocytes show that the skin plays an important role in adapting whole-body physiology to changing environments, including the capacity to produce a wide variety of hormones, neurotransmitters and cytokine that can potentially influence whole-body states, and quite possibly, even emotions. Skin microbiota play an integral role in the maturation and homeostatic regulation of keratinocytes and host immune networks with systemic implications. As our primary interface with the external environment, the biodiversity of skin habitats is heavily influenced by the biodiversity of the ecosystems in which we reside. Thus, factors which alter the establishment and health of the skin microbiome have the potential to predispose to not only cutaneous disease, but also other inflammatory non-communicable diseases (NCDs). Indeed, disturbances of the stratum corneum have been noted in allergic diseases (eczema and food allergy), psoriasis, rosacea, acne vulgaris and with the skin aging process. The built environment, global biodiversity losses and declining nature relatedness are contributing to erosion of diversity at a micro-ecological level, including our own microbial habitats. This emphasises the importance of ecological perspectives in overcoming the factors that drive dysbiosis and the risk of inflammatory diseases across the life course.