Browsing by Subject "Developmental Paediatrics"

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    Open Access
    A retrospective description of primary immunodeficiency diseases at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, 1975-2017
    (2023) Moodley, Sashmi; Donald, Kirsten
    Background: Even in the absence of global threat, children with disabilities were underrepresented in monitoring efforts and were less likely to have been included in response strategies during the COVID - 19 pandemic. The harmful effects of the pandemic were expected to be most damaging for those in the poorest countries. Objectives: Our study aimed to report the impact of the COVID-19 pandemic on families of children with disabling conditions in South Africa. Methods: Parents from an online parent network, initiated by Shonaquip Social Enterprise during the pandemic, were invited to participate in an online survey in October 2021. A quantitative analysis was conducted using Stata Statistical Software. Results: Sixty-eight (17%) of 400 parents in the network, completed the survey, 89% were mothers. Children aged 5-12 years represented 43% of the group. Eleven parents (16%) reported child health worsening compared to before the pandemic. Parent concerns included practicalities of infection control measures for their children and concerns about caregivers falling ill. Six (9%) children contracted COVID-19 infection and two (3%) children demised. Few families received telephonic contact from health providers. Indirect effects of the pandemic included loss of income and food shortages in more than half of the families. Twentytwo( 32%) families had opted not to send their children back to school even by the third wave of infections. Some positive experiences of lockdown reported by parents included more family time and the opportunity to reach out to other families, however 33 (49%) parents reported being highly stressed, with five (7%) revealing a need for substances to cope. Most parents (n = 50, 74%) reported feeling that care for children with disabilities was not prioritized in South Africa. Conclusion: This is one of the few studies in South Africa that explored childhood disability during the pandemic. A proportion of caregivers reported deterioration in their children's health during a time of limited access to health services. They have reported loss of family income, reduced access to educational services and challenges to mental health of caregivers. Families did not feel supported. Including the voices of parents highlight a range of challenges that need greater awareness. Post-pandemic, much change in practice is needed for families and children with disabilities.
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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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    Clinical profile of children with Autism Spectrum Disorder in a developmental clinic in Western Cape
    (2023) Mudawarima, Louisa; Petersen, Reneva; Donald, Kirsten
    Clinical profile of children with Autism Spectrum Disorder in a developmental clinic in Western Cape Abstract Introduction Autism Spectrum Disorder (ASD) is increasingly being recognised as a significant neurodevelopmental condition in African countries. There is some evidence to suggest that the children who present with ASD in Africa may be diagnosed late and have a more severe clinical picture. The purpose of this study was to describe the clinical profile of children with ASD in the neurodevelopmental clinic at Red Cross War Memorial Children's Hospital in Western Cape Province South Africa. Methods We sampled patients with a previous or new diagnosis who attended our clinic during the period January to July 2017. Consenting participants were administered a questionnaire with sociodemographic and clinical questions, clinical details of medical and developmental diagnosis were extracted from medical records and children. were further assessed using the Autism Diagnostic Observation Schedule version 2 (ADOS-2). Results A total of 32 patients were recruited into the study with 26 out of 32 (81%) being boys. On assessment as part of the study, all participants met DSM 5 criteria for the diagnosis of ASD. Most participants (94%) had not experienced general developmental regression but a substantial proportion (39%) had reported early regression of language milestones. Almost half of participants (48%) had self-injurious behaviour reported, 25% had associated motor difficulty and 10% comorbid epilepsy. More than half of participants (53%) required substantial support in day-to-day activities. Most participants (81%) were administered module 1 of the ADOS-2 reflecting the high proportion of children in the sample who were either preverbal or using only single words. Conclusions Children seen in this clinical sample reflected the more severe end of the autism spectrum with a significant proportion having associated comorbidities such as epilepsy, and motor difficulties. The phenotypic profile on the ADOS 2 in this study correlated well with clinical assessments.
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    The validation of a new development screening tool for developmental delays among HIV-Infected South African children
    (2015) Boyede, Ojombo Gbemisola; Donald, Kirsten A; Eley, Brian
    Background: Over 50% of HIV-infected children in South Africa have developmental delays. Early identification of affected children will lead to early intervention and favourable long-term outcome. Screening for developmental delay is not yet routine by many primary healthcare providers due to lack of locally available, rapid and sensitive screening tool s in busy Paediatric HIV clinics. A new screening tool was developed at the Red Cross War Memorial Children's Hospital (RCWMCH) for detecting moderate to severe global developmental delay among very young HIV infected children. The diagnostic accuracy and usefulness of the new tool was evaluated in this study. Objective: to validate the new RCWMCH developmental screening too l among HIV - infected South African children. Method: Forty-seven HIV-infected children in the age category 9-36 months attending the Infectious Disease Clinic (IDC) of the RCWMCH were screened using the new tool. Full developmental assessments of same children were performed using the Bayley Scale of Infant Development (BSID - III). Developmental Delay (global) was defined as composite scores 2 standard deviations below the mean in two or more developmental domains. Results: The sensitivity of the RCWMCH tool was 78.5%, specificity 54.6%, positive predictive value was 42.6%, and negative predictive value was 85. 7 %. Discussion: The RCWMCH screening tool was found to have sensitivity within the acceptable levels recommended for developmental screening tools. Its high negative predictive value will reduce unnecessary referrals for full developmental assessments in asymptomatic infants and toddlers. It is therefore recommended for screening for developmental delay among HIV-infected children from the age of 9 months to 3 years.