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- ItemOpen AccessA prospective study to assess the value of liquid chromatography-tandem mass spectrometry in the management of paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa(2020) Washaya, Norbertta Nzwisisayi; Buys, Heloise; Muloiwa RudzaniBackground: Paediatric poisoning is a common presentation to emergency departments worldwide. There is a paucity of data on the role of liquid chromatography-tandem mass spectrometry (LC-MS/MS), in the management of paediatric poisoning in low-and middle-income countries (LMICs). In high-income countries, most studies are retrospective, and few include children. Objective: The study describes the prevalence of liquid chromatography-tandem mass spectrometry confirmed paediatric poisoning at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods Children admitted with suspected poisoning between 1 January 2017 and 31 December 2017, were recruited. All patients had a urine and/or blood sample sent for LC-MS/MS toxicology. Data collected included demographic data, clinical features, investigations, management, outcome and social interventions. Results 152 children, with median age of 39 (IQR 25 -61) months were enrolled of which 128 (84%) were poisoning cases. Of the 128 poisoning cases, 88 (69%) presented with a history of ingesting a known substance, 16(12%) an unknown substance and 24(19%) were cases of occult poisoning. LC-MS/MS was able to identify a substance in 92% of the cases of occult poisoning. In those who had presented with a seemingly known substance, LC-MS/MS found a different substance in 15 cases. LC-MS/MS was also able to detect multiple drugs in 40 patients. Of the poisoning cases, six (5%) cases were attempted homicide cases and 5 (4%) cases were attempted suicide cases. No children died. Individualized social interventions were instituted in poisoning cases. Emergency placement safety reasons was required in 6 children. Conclusion: When the limitations are known, LC-MS/MS is useful in identifying cases of occult poisoning; identifying patients who have ingested multiple substances and/or an unknown substance and when targeted towards child protection. As LC-MS/MS is an expensive test, it should be used judiciously in LMICs.
- ItemOpen AccessActive Play: perceived and actual motor performance among Ghanaian children(2021) Doe-Asinyo, Rosemary Xorlanyo; Gretschel, PamelaBackground: There is limited data on active play both in terms of perceived competence and actual motor performance in children living in low- and middle-income countries. Promotion of active play in children is crucial for enhancing participation in physical activity and reducing the burden of obesity. Regular engagement in active play is important for promoting optimal development and increasing physical activity levels in children. Despite the increased interest in active play and physical fitness worldwide, many children in low-resource settings are thought to be physically inactive due to the lack of physical activity-promoting resources and programmes. The 2018 Ghana Report Card on physical activity reports that a high proportion of Ghanaian children do not achieve recommended physical activity levels and a high percentage of these children have poor motor skills. To date, no published study has examined active play among school-aged children in Ghana. Investigating the nature of active play by assessing perceived and actual motor performance among Ghanaian children can serve to increase our understanding of activity deficits, movement difficulties and associated factors in this population. Aim: The aim of this study was to investigate the nature of active play in children aged 6-12 years in Ghana. Specific Objectives: 1. To determine children and caregivers' perceptions of children's motor performance in active play using the Motor Coordination Questionnaire (MCQ). 2. To determine children and caregivers' perceptions of the importance of active play. 3. To identify additional forms of active play and games (which are not listed on the MCQ) that children and caregivers perceive to be important and meaningful. 4. To determine the relationship between MCQ ratings by caregivers and children. 5. To determine the relationship between children's MCQ and actual motor performance. 6. To determine the relationship between caregivers' MCQ and actual motor performance. Methodology: A cross-sectional descriptive and analytical design was used. Three primary schools were purposively selected for this study. The study recruited 406 children and their caregivers for this study. Ethical approval was sought from the Ethics Review Committee of the Ghana Health Service (GHS-ERC 052/05/19) and the University of Cape Town Faculty of Health Sciences Human Research Ethics Committee (HREC REF: 112/2020). Data was collected from both caregivers and children (aged 6-12 years) using questionnaires and the Performance and Fitness (PERF-FIT) test battery. The MCQ-caregivers and MCQ-children were used to assess perceived motor performance, and the PERF-FIT test was used to measure children's actual motor performance. In using the Statistical Package for Social Sciences (SPSS) version 24.0 (SPSS Inc, IBM Company, Armonk, NY), Pearson or Spearman's correlation coefficient was calculated to determine the relationship between children and caregivers' perceptions as well as the relationship between the perceptions and the actual motor performance of the children. Results: Both children (75.6%-94.2%) and their caregivers (69.3%-95.4%) perceived good motor performance of the children during active play. Children (82.8%-96%) and their caregivers (83.2%-94.4%) also regarded active play as very important. Twenty-four additional games were found to be of importance to Ghanaian children and their caregivers. Weak negative, weak positive and sometimes moderate positive correlation between MCQ items and the PERF-FIT items were found. Conclusions: This study shows that we can't rely solely on perceptions, but need actual motor performance, to accurately measure motor performance during active play. We found that parents and children do not accurately estimate the actual level of motor performance. Further studies should be done to understand confounding variables that may have caused poor relationship between perceived and actual motor performance. There is a need for a valid tool like the PERF-FIT to help in accurate measurement of motor performance.
- ItemOpen AccessAn adapted triage tool (ETAT) at Red Cross War Memorial Children’s Hospital Medical Emergency Unit, Cape Town: An evaluation(2013) Buys, H; Muloiwa, R; Westwood, C; Richardson, D; Cheema, B; Westwood, AObjective. To evaluate the efficacy of an adapted Emergency Triage Assessment and Treatment (ETAT) tool at a children’s hospital. Design. A two-armed descriptive study. Setting. Red Cross War Memorial Children’s Hospital, Cape Town, South Africa. Methods. Triage data on 1 309 children from October 2007 and July 2009 were analysed. The number of children in each triage category (red (emergency), orange (urgent or priority) and green (non-urgent)) and their disposal were evaluated. Results. 1. The October 2007 series: 902 children aged 5 days - 15 years were evaluated. Their median age was 20 (interquartile range (IQR) 7 - 50) months, and 58.8% (n=530) were triaged green, 37.5% (n=338) orange and 3.8% (n=34) red. Over 90% of children in the green category were discharged (478/530), while 32.5% of children triaged orange (110/338) and 52.9% of children triaged red (18/34) were admitted. There was a significant increase in admission rate for each triage colour change from green through orange to red after adjustment for age category (risk ratio (RR) 2.6; 95% confidence interval (CI) 2.2 - 3.1). 2. The July 2009 cohort: 407 children with a median age of 22 months (IQR 7 - 53 months) were enrolled. Twelve children (2.9%) were triaged red, 187 (45.9%) orange and 208 (51.1%) green. A quarter (101/407) of the children triaged were admitted: 91.7% (11/12) from the red category and 36.9% (69/187) from the orange category were admitted, while 89.9% of children in the green category (187/208) were discharged. After adjusting for age category, admissions increased by more than 300% for every change in triage acuity (RR 3.2; 95% CI 2.5 - 4.1). Conclusions. The adapted ETAT process may serve as a reliable triage tool for busy paediatric medical emergency units in resource-constrained countries and could be evaluated further in community emergency settings.
- ItemOpen AccessCare Through Family: a conceptual model of children’s nursing care(2021) North, Natasha; Leonard, Angela; Bonaconsa, Candice; Coetzee, MinetteThis project aimed to work with nurses to describe and document their practice. Nurse researchers from CNPDI worked with five teams of nurses in diverse paediatric settings in southern Africa to develop detailed descriptions of how nurses involve families in the care of their hospitalised child. We observed care and interviewed nurses and families to develop detailed descriptions of practice. We used visual research methods including graphic facilitation, sociograms and photographic elicitation to construct a detailed picture of routines, activities and environments. Holistic accounts of ‘real’ nursing practices were constructed through 1:1 and group interviews, exploring the underlying rationales and values. Comprehensive case study reports were produced for each setting and reviewed by key nurse participants. Together, researchers and nurses developed statements reflecting the model of care. After analysis of the data we constructed a description of nursing practice in the form of a model of nursing care which we call ‘Care Through Family’. The model is ordered around six themes. Each theme has a guiding principle, in the form of an illustrative statement reflecting the philosophies of care observed. Implementation of the model is supported by a self-assessment tool to guide nursing teams through a facilitated process of reflection and further practice development.
- ItemOpen AccessChildren's constructions of gender: A participatory project(2019) Mohana, Malini; Boonzaier, FlorettaStudies on the construction of gender have largely focussed on adolescents and young adults in South Africa. This leaves a significant gap in understanding the ways in which gender is constructed and negotiated by younger children. This study, therefore, investigated how younger children narrate and experience their gendered lives, and whether these stories resisted or maintained dominant narratives of gender. Twelve participants between the ages of eight and fourteen participated. The research used participatory action research (PAR) methods. Specifically, Photovoice, journaling, collages and drawing were used to represent the stories and narratives that the participants chose to share. The Photovoice component culminated in a community exhibition which showcased the participants’ photos. In addition, the participants took part in focus groups and individual interviews. The focus group transcripts, individual interview transcripts, collages, photographs, drawings and journal entries were analysed using thematic narrative analysis. The study showed that children construct gender based on contradictory messaging, and exercise defiance of normative gendered constructs within the limits of heteronormative gender identity. Four main narrative themes emerged: Negotiating gendered expression; Normalisation of gendered violence; Subjugating female bodies; Narratives of conformity and resistance. Based on the findings, the recommendation was made to use play as both a means of exploration and education in children’s understanding of gender.
- ItemOpen AccessChildren's Institute submission on the draft regulations to the Children's Act 38 of 2005(Children's Institute, 2008-08) Proudlock, Paula; Meintjes, Helen; Moses, SueWritten submission to the national Department of Social Development, 11 August 2008.
- ItemOpen AccessConstipation in children(South African Academy of Family Physicians, 2013) Brown, R A; Wood, R JConstipation in children is a universal problem, occurring in 0.7-28% of the population. The exact aetiology is unknown, but the majority of children have a functional, rather than organic, aetiology. Symptoms associated with constipation include abdominal pain, a poor appetite and faecal incontinence, all of which interfere with the quality of life of the child and his or her family. Early intervention with appropriate management is necessary to prevent ongoing sequelae. Once an organic cause has been excluded, a programme of intervention should be implemented, namely evacuation of any faecal mass present, followed by regular maintenance therapy to encourage evacuation of a daily soft stool for at least 2-3 months, prior to gradual withdrawal. Emotional support, exercise and dietary modification are linked to the therapy and will ensure a successful outcome. Failure to implement the protocol may result in ongoing problems in up to 50% of children as they enter adulthood.
- ItemRestrictedEmpathy in autism spectrum disorder: Predictions from child/adolescent temperament, parenting styles, and parenting stress(2019) Ross, Toni Carmen Faith; Malcolm-Smith, Susan; Hamilton, KatieIndividuals with autism spectrum disorder (ASD) exhibit definitional impairments in social relatedness; a phenomenon that can be explained, in part, by their deficits in empathy. Despite the extent of these deficits, relatively little is known about which factors promote or impede empathic functioning within this group. To date, studies of neurotypical children and adolescents suggest the explanatory power of temperament, parenting style, and parenting stress; associations which have yet to be adequately explored with ASD. Thus, the overarching aim of this investigation was to test whether the aforementioned intra- and interindividual features would predict empathy amongst children and adolescents with ASD. To account for some of the heterogeneity in ASD, two groups of parent-child dyads were recruited: one comprising male children and adolescents with intact receptive and expressive language (n = 40, M = 7.68 years); the other, males with little to no language use in either domain (n = 40, M = 9.09 years). A third group of parent-child pairs comprising male neurotypical children and adolescents with age-appropriate language functioning was included as a comparison sample (n = 40, M = 9.53 years). Parents completed wellestablished questionnaires pertaining to child/adolescent temperament and empathy, as well as parenting style and parenting stress, primarily via telephonic interviews. Results showed that temperamental regulation and negative affectivity were linked to empathy within the neurotypical group in positive and inverse directions, respectively. Only regulatory processes were positively associated with empathy within the non-verbal ASD group, whilst only negative affectivity was inversely associated to empathy within the verbal ASD group. Further, warm, responsive, autonomy-promoting parenting was positively associated with empathy within the neurotypical group, whilst punitive and lax parenting were inversely associated with empathy. Positive forms of parenting were also found to predict empathy within both ASD groups – though somewhat less so within the verbal ASD group. Perhaps a consequence of the severity of their empathic deficits, lax and permissive parenting techniques were not tied to empathy within the ASD groups. Finally, parenting stress was inversely linked to empathy within the non-verbal ASD and neurotypical groups only. Results highlight that findings obtained within neurotypical samples cannot always be extrapolated to ASD. Results further underscore the need for ASD interventions to adopt a family systems perspective, teaching parents how to perceive and respond to their children in adaptive ways.
- ItemOpen AccessLaboratory findings that occur in Klebsiella pneumoniae blood stream infection in HIV-infected children compared to HIV uninfected children, at a South African children's hospital, Cape Town, 2006–2011: a nested-descriptive cross-sectional study(2022) Shapaka, Johanna Tekla; Buys, Heloise; Muloiwa, RudzaniBackground: Bloodstream infection (BSI) caused by Klebsiella pneumoniae (KP), is a leading cause of hospitalassociated childhood mortality. There are limited data on how poor outcomes of KPBSI can be predicted in poorly resourced areas. This study aimed to assess if the profile of differential counts from full blood counts (FBC) taken at two time points in children <13 years with KPBSI could be used to predict the risk of death. Methods We conducted a retrospective study of a cohort of children admitted to hospital between 2006-2011 with KPBSI. FBC collected within 48 hours (T1) of blood culture and 5-14 days later (T2), were reviewed. Differential counts were classified as abnormal if they were higher or lower than laboratory ranges for normal results. The risk of death was assessed for each category of differential counts. Risk ratios adjusted (aRR) for potential confounders were used to estimate the effect of cell counts on risk of death using multivariable analysis. Data were stratified by HIV status. Results: Of 296 children included, median age 5 (IQR:2-13) months, 82 were HIV -infected. Ninety-five (32%) of the children with KPBSI died. Mortality in HIV-infected and uninfected children was 39/82 (48%) and 56/214 (26%), respectively (p <0.001). Independent associations with mortality were observed with leucopenia, neutropenia and thrombocytopenia. Risk of mortality in children with thrombocytopenia at T1 and T2 was aRR 2.5 (95% CI: 1.34-4.64) and 3.18 (95% CI: 1.31-7.73) respectively in the HIV-uninfected group, whereas the risk for mortality in the HIV-infected group with thrombocytopaenia at T1 and T2 was aRR 1.99 (95% CI: 0.94-4.19) and 2.01 (95% CI: 0.65-5.99) respectively. Neutropenia in the HIV-uninfected group at T1 and T2, showed aRR 2.17 (95% CI: 1.22- 3.88) and 3.70 (95% CI 1.30-10.51) respectively, while in the HIV-infected group, they were aRR 1.18 (95% CI 0.69-2.03) and 2.05 (0.87-4.85) at similar time points. Risk of mortality related to leucopenia at T2 was associated with mortality in HIV-uninfected and HIV-infected patients was aRR 3.22 (95%CI 1.22-8.51) and 2.34 (1.09-5.04) respectively. Persistently high band cell percentage at T2 in HIVinfected children indicated a risk of mortality of aRR 2.91 (95% CI 1.20-7.06). Conclusion Abnormal neutrophil counts and thrombocytopenia are independently associated with significant mortality in children with KPBSI. In resource-limited countries haematological markers have the potential to predict KPBSI mortality.
- ItemOpen AccessNeuropsychiatric complications of efavirenz in children with HIV-1 infection(2018) Hammond Charles; Eley BrianBackground: Efavirenz is associated with transient neuropsychiatric manifestations but the impact on neurocognition is unknown. Genetically determined black South Africans who are slow metabolizers of efavirenz may be at risk of toxicity. This study describes neuropsychiatric and neurocognitive manifestations of South African children with suspected efavirenz neurotoxicity. Method: This retrospective study describes clinical features of 12 children with suspected efavirenz neurotoxicity (2008 – 2014). Results: Twelve children were referred (aged 3 years 4 months to 12 years, mean 7 years 8 months; 8 indigenous African (black) and 4 mixed ancestry). Six had acute neuropsychiatric manifestations after 2-8 weeks (mean 5 weeks) on efavirenz including drowsiness, seizures, sleep disturbances, behavioural changes, ataxia and slurred speech. Symptoms resolved over a few weeks in four. Two black children were phenotypically slow metabolizers with high plasma efavirenz concentrations above normal range resulting in discontinuation of efavirenz. Nine children had neurocognitive concerns potentially exacerbated by long-term efavirenz (6-72 months therapy; mean 31 months), and showed poor performance in all neurocognitive domains. Conclusion: Efavirenz causes transient neuropsychiatric adverse effects and may contribute to poor longterm neurocognitive outcomes in HIV-infected children. Genetically slow metabolizers are at risk of neurotoxicity. Prospective studies comparing efavirenz-treated and efavirenz-naïve children are needed.
- ItemOpen AccessPaediatric epilepsy surgery in a middle-income country: the red cross war memorial children's hospital experience(2023) Louw, Lizet; Enslin, Johannes; Wilmshurst Joanne; Fieggen, A GPurpose While epilepsy surgery has been shown to reduce seizure frequency and severity and even cures seizures in children with drug-resistant epilepsy, data from middle-income countries (MIC) are lacking. Method This study is a retrospective review of children with drug-resistant epilepsy who underwent surgical treatment at Red Cross War Memorial Children's Hospital (RCWMCH) between 1 January 2000 and 31 December 2021 (HREC: 140/2020). Results During the 21-year study period, 60 patients underwent epilepsy surgery for drugresistant epilepsy. The median age of the children was seven years (IQR 4.81-10.27years) at the time of surgery, with a male predominance of 33 patients. The most common surgical procedure performed was an anterior temporal lobectomy for temporal lobe epilepsy in 19 cases (31.7%), followed by peri-insular hemispherotomy in 9 cases (15.0%) and frontal lobectomy in 8 cases (13.3%). Of the 60 patients, complete records were available for 55 patients noting complications in 11 (20.0%), of which 4 cases (7.3%) had major complications. Notably, 2 patients (3.6%) had new-onset psychiatric symptoms. The long term outcomes after surgery showed 1-year seizure freedom in 32 patients (58.2%); among these, 21 patients (38.2%) could stop ASM one year after surgery, 17 patients (30.9%) had a recurrence of their seizures, and three had to restart ASM after 2-3 years. Eight patients (14.5%) required repeat surgery. The one-year-Modified Engel scoring for the study population was: 1-A in 52.7%, I-B in 3.6%, I-C in 1.8%, II-A in 15.8%, III-A in 10.9%, IV-A in 3.6% and IV-B in 10.9%. The most common histological finding in anterior temporal lobectomy (ATL) was focal cortical dysplasia (FCD), found in 11 patients (57.9%). The periinsular hemispherotomy (PIH) cases had equal numbers of FCD and Rasmussen's encephalitis in 4 patients (44.4%). The number of FCD in this series is much higher than in international data. Conclusion Epilepsy surgery is an effective and attainable intervention for drug-resistant epilepsy in the paediatric population despite limited resources and challenging aetiological profiles. Low complication rates were comparable to international data, with good seizure freedom outcomes.
- ItemOpen AccessPaediatric triage in South Africa(Health and Medical Publishing Group, 2013) Cheema, B; Stephen, C; Westwood, AReducing child mortality is a high priority in sub-Saharan Africa, and swift, appropriate triage can make an important contribution to this goal. There has been a lot of interest and work in the field of triage of sick children in South Africa over the past few years. Despite this, in many parts of South Africa no formal system for triage of children in acute and emergency settings is used. This article aims to explain some of the key paediatric triage tools being considered and developed in South Africa. The triage tools discussed are the World Health Organization Emergency Triage Assessment and Treatment (ETAT), the South African adaptation of this tool known as ETAT-SA, the South African Triage Scale (SATS), and the Revised Paediatric SATS (P-SATS). The article describes how they were developed and their relevance to the country.
- ItemOpen AccessPatterns of mortality in children presenting to a tertiary paediatric emergency unit in Sub-Saharan Africa: a cross sectional study(2020) Josephs, Tracey; Buys, Heloise; Masu, Adelaide; Muloiwa, RudzaniBackground Pneumonia, diarrhoea and perinatal factors are the foremost killers of South African children as in other low- and middle-income countries. Poverty, poor access to care and pre-hospital care are reported major pre-hospital factors and lack of triage, poor skills, delays, poor adherence to treatment protocols and inadequate emergency care determining mortality have been reported to increase in-hospital mortality. Objectives To describe the clinical presentation and management of children admitted via the medical emergency unit (MEU) of the Red Cross War Memorial Children's Hospital (RCWMCH) who subsequently died. Methods We did a retrospective study undertaking a cross-sectional review of children who died following admission via RCWMCH MEU in 2008. Demographic information, clinical data, time factors and mortality data were reviewed and summarised by descriptive and inferential statistics. The unit utilised the WHO Emergency Triage Assessment and Treatment (ETAT) triage tool, categorising children into Red (emergency), orange (priority) and Green (non-urgent). Patient management was assessed by means of ETAT and the Integrated Management of Childhood Illness (IMCI) tools, which is used to identify severity of illness and strategize treatment plans accordingly. Results A total of 135 children met the inclusion criteria. The crude mortality rate was of 6.25 per 1000 admissions. Of the 135 children who died, 119 (88%) were under five years of age, 33(24%) were HIV-infected, of whom (88%) were under 5 years old. In 67 (50%), a chronic medical condition could be identified while 67 (50 %) were moderately or severely malnourished. There were 29 (22%) deaths within 24 hours of arrival at the MEU. Fifty-five (41%) presented after hours. Community health centres referred 65 (48%) patients, general practitioners referred 20 (15%) and 38 (28%) were self-referred. Ambulance services provided pre-hospital transport to 69 (51%). The two top presenting illnesses in 88 (65%) of the children were acute respiratory illness and acute gastroenteritis. Prior to referral, oxygen was not provided in 57 (59%) children, 35 (71%) with suspected sepsis did not receive antibiotics and glucose was not checked in 39 (80%) with depressed level of consciousness. The median time to ward transfer was 3.23 (IQR: 2.12-4.92) hours. Twelve deaths (9%) occurred in the MEU, 57 (42%) in PICU, 56 (42%) in medical wards and 10 (7%) in specialist wards. The five most common causes of death were acute respiratory infections in 45 (33%), acute gastroenteritis in 27 (20%), septicaemia 22 (16%), meningitis in 13 (10%) and cardiac conditions in 12 (9%) children. Conclusion The top causes of mortality in this hospital cohort in 2008 were pneumonia, acute gastroenteritis, and septicaemia. Using the IMCI and ETAT standard of care, suboptimal management was identified in pre-hospital management, as well as MEU management. Appropriate training and protocol implementation to improve morbidity and mortality should be undertaken.
- ItemOpen AccessPReS-FINAL-2253: A case series of HIV arthropathy in Cape Town(BioMed Central Ltd, 2013) Webb, K; Scott, C; Brice, NHIV arthropathy is well described in adults. Few studies have looked in depth at HIV arthropathy in children, and the characteristics of this entity have not been fully described.
- ItemOpen AccessPrevalence and Determinants of Vitamin D Deficiency in 1825 Cape Town Primary Schoolchildren: A Cross-Sectional Study(Multidisciplinary Digital Publishing Institute, 2022-03-16) Middelkoop, Keren; Walker, Neil; Stewart, Justine; Delport, Carmen; Jolliffe, David A.; Nuttall, James; Coussens, Anna K.; Naude, Celeste E.; Tang, Jonathan C. Y.; Fraser, William D.; Wilkinson, Robert J.; Bekker, Linda-Gail; Martineau, Adrian R.Vitamin D deficiency (25-hydroxyvitamin D[25(OH)D] <50 nmol/L) is common among adults in Cape Town, South Africa, but studies investigating vitamin D status of children in this setting are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 1825 Cape Town schoolchildren aged 6–11 years. Prevalence of vitamin D deficiency was 7.6% (95% Confidence Interval [CI] 6.5% to 8.9%). Determinants of vitamin D deficiency included month of sampling (adjusted odds ratio [aOR] for July–September vs. January–March 10.69, 95% CI 5.02 to 22.77; aOR for October–December vs. January–March 6.73, 95% CI 2.82 to 16.08), older age (aOR 1.25 per increasing year, 95% CI: 1.01–1.53) and higher body mass index (BMI; aOR 1.24 per unit increase in BMI-for-age Z-score, 95% CI: 1.03–1.49). In a subset of 370 participants in whom parathyroid hormone (PTH) concentrations were measured; these were inversely related to serum 25(OH)D concentrations (p < 0.001). However, no association between participants with hyperparathyroidism (PTH >6.9 pmol/L) and vitamin D deficiency was seen (p = 0.42). In conclusion, we report that season is the major determinant of vitamin D status among Cape Town primary schoolchildren, with prevalence of vitamin D deficiency ranging from 1.4% in January–March to 22.8% in July–September.
- ItemOpen AccessPW03-022 - Neutrophilic skin disease and inflammation(BioMed Central Ltd, 2013) Webb, K; Hlela, C; Scott, CRobert Sweet first described a syndrome with a painful, erythematous nodular plaques, neutrophilic dermal infiltrates, fevers and peripheral neutrophilia. This cluster of syndromes became known as Sweet's syndrome. There have been many published cases in children of neutrophilic dermatoses and fever which are labeled as Sweet's syndrome. Recently, however, neutrophilic dermatoses have been associated with some autoimmune and autoinflammatory diseases .
- ItemRestrictedReconstitution of antimycobacterial immune responses in HIV-infected children receiving HAART(2006) Kampmann, B; Tena, G; Nicol, MP; Levin, M; Eley, BSObjective: Recent epidemiological studies in adults suggest that HAART can prevent the development of tuberculosis in HIV-infected individuals, but the mechanisms are incompletely understood and no data exist in children. We investigated whether changes in mycobacterial-specific immune responses can be demonstrated in children after commencing antiretroviral therapy. Design: We measured mycobacterial growth in vitro using a novel whole-blood assay employing reporter-gene tagged bacillus Calmette–Guérin (BCG) in a prospective cohort study in the tuberculosis-endemic environment of South Africa. Key cytokines were measured in supernatants collected from the whole-blood assay using cytometric bead array. Patients: A cohort of 15 BCG-vaccinated HIV-infected children was evaluated prospectively for in-vitro antimycobacterial immune responses before and during the first year of HAART. All children had advanced HIV disease. Nine children completed all study timepoints. Results: Before HAART, blood from children showed limited ability to restrict the growth of mycobacteria in the functional whole-blood assay. The introduction of HAART was followed by rapid and sustained reconstitution of specific antimycobacterial immune responses, measured as the decreased growth of mycobacteria. IFN-γ levels in culture supernatants did not reflect this response; however, a decline in TNF-α was observed. Conclusion: This is the first study using a functional in-vitro assay to assess the effect of HAART on immune responses to mycobacteria in HIV-infected children. Our in-vitro data mirror the in-vivo observation of decreased susceptibility to tuberculosis in HIV-infected adults receiving antiretroviral agents. This model may be useful for further characterizing immune reconstitution after HAART.
- ItemOpen AccessThe effect of inspiratory muscle training on clinical outcomes and health-related quality of life in children with neuromuscular disease and respiratory muscle weakness.(2021) Human, Anri; Morrow, BrendaBackground: Progressive respiratory muscle weakness and ineffective cough contributes to pulmonary morbidity and mortality in children with neuromuscular disease. Inspiratory muscle training aims to preserve or improve respiratory muscle strength, reduce respiratory complications and improve health-related quality of life. Objectives: To describe South African physiotherapists' knowledge and respiratory management strategies and determine the safety, viability, acceptability and efficacy of inspiratory muscle training for children 5-18 years with neuromuscular disease. Methods: Four studies were conducted: i) a quantitative descriptive survey; ii) a systematic review using Cochrane methodology; iii) a prospective, pre-experimental observational study and iv) a prospective, cross-over randomised controlled trial using a standardised 12-week inspiratory muscle training intervention. Results: i) South African physiotherapists (n=64) reported being aware of international clinical practice recommendations, however they favoured manual airway clearance techniques. The use of inspiratory muscle training in chronic management was well supported by South African physiotherapists. ii) Results of the systematic review (seven included studies; n=168) suggested that inspiratory muscle training may be effective in improving inspiratory muscle strength. There was insufficient evidence for an effect on patient morbidity or health-related quality of life. iii) The pre-experimental, pilot study (n=8) suggested that a six-week inspiratory muscle training programme was safe, viable, acceptable and associated with a significant increase in inspiratory muscle strength. iv) The cross-over randomised controlled trial (n=23) did not show evidence of a difference in the primary outcome measures (number of hospitalisations and respiratory tract infections) between intervention and control periods. There were no adverse events related to inspiratory muscle training. Inspiratory muscle strength (Pimax) and peak expiratory cough flow increased by 14.57 (±15.67)cmH2O and 32.27 (±36.60)L/min respectively during the intervention period compared to a change of 3.04 (±11.93)cmH2O (p=0.01) and -16.59 (±48.29)L/min (p=0.0005) during the control period. There was no evidence of change in spirometry, functional ability or total health-related quality of life scores following the intervention. Overall participant satisfaction with inspiratory muscle training was high and adherence was good. Conclusions: Inspiratory muscle training in children with neuromuscular disease is well tolerated, appears to be safe and is associated with significant improvements in inspiratory muscle strength and cough efficacy.
- ItemOpen AccessThe yield of nasopharyngeal bacteria from culture compared to polymerase chain reaction in South African children with lower respiratory tract infection(2022) Pillay, Vashini; Zar, HeatherBackground Lower respiratory tract infection (LRTI) is a major cause of morbidity and mortality in children under 5 years of age. Bacterial pathogens contribute significantly to this process. Culture of respiratory tract specimens is labour-intensive and slow. Polymerase chain reaction (PCR) is comparatively, a rapid, sensitive method of detecting low levels of nucleic acid for clinically relevant bacteria. This study compares the yield of bacteria obtained from culture and the FTDResp33 multiplex PCR of nasopharyngeal swabs (NPs) during LRTI episodes in children, in the Drakenstein Child Health Study. Methods At each episode of LRTI, 2 NPs were obtained, one for culture and one for PCR testing. Bacterial yields and concordance for the 5 commonest bacteria were compared using frequencies and proportions. Results From 13th August 2012 to 23rd November 2020, there were 859 episodes of LRTI in 434 children [median age 9.2 (IQR 3.8; 18.9) months; 0.2% HIV-infected]. S. pneumoniae, S. aureus, M. catarrhalis, H. influenzae and K. pneumoniae were the predominant bacteria detected by either method. Concordance between culture and PCR for S. pneumoniae, S. aureus, and K. pneumoniae was 84.9%, 89.7% and 86.3% respectively. Culture and PCR for H. influenzae had a concordance of 76.9%. The greatest discordance between culture and PCR was for the detection of M. catarrhalis (34.4%). Median bacterial loads on PCR for all 5 organisms were significantly associated with semi-quantitative culture results (p<0.001 for each). Adjusting for age and hospitalization, children on antibiotics at the time of sampling, had a reduced chance of having a positive culture (OR 0.1; 95% CI 0.1-0.4), and a reduction in PCR yield (OR 0.8; 95% CI 0.4-1.6). Conclusion: Significant concordance existed between PCR and culture for 4 of the 5 common bacteria, affirming PCR as a comparable method of testing to culture.
- ItemOpen AccessUnexplained HIV-1 infection in children — documenting cases and assessing for possible risk factors(HEALTH & MEDICAL PUBLISHING GROUP, 2004) Hiemstra, R; Rabie, H; Schaaf, H S; Eley, B S; Cameron, N; Mehtar, S; Janse van Rensburg, A; Cotton, M FBackground. In the year 2000 we reported possible horizontal transmission of HIV-1 infection between two siblings. An investigation of three families, each with an HIV-infected child but seronegative parents, permitted this finding. Sexual abuse and surrogate breast-feeding were thought unlikely. The children had overlapping hospitalisation in a regional hospital. Since then several cases of unexplained HIV infection in children have been reported. A registry was established at Tygerberg Children’s Hospital for collection of data on the extent of horizontal or unexplained transmission of HIV in children. Study design. Retrospective chart review. Results. Fourteen children were identified, 12 from the Western Cape and 1 each from the Eastern Cape and KwaZulu-Natal. Thirteen (92%) had been hospitalised previously. In the Western Cape, children had been hospitalised in 8 hospitals. Ten of 13 (77%) were admitted as neonates and 9 of 13 (69%) had 2 or more admissions. Intravascular cannulation and intravenous drug administration occurred in all but 2 children before HIV diagnosis. Conclusion. We have confirmed HIV infection in a number of cases where the source of infection has been inadequately explained. Circumstantial evidence supports but does not prove nosocomial transmission. Further studies and identification of medical procedures conducive to the spread of HIV are urgently needed.