Dept. of Psychiatry & Mental Health

Liver transplantation at Red Cross War Memorial Children's Hospital

2017-07-07T09:50:39Z

Liver transplantation at Red Cross War Memorial Children's Hospital Spearman, C W N; McCulloch, M; Millar, A J W; Burger, H; Numanoglu, A; Goddard, E; Gajjar, P; Davies, C; Muller, E; McCurdie, FJ; Kemm, D; Cywes, S; Rode, H; Kahn, D The liver transplant programme for infants and children at Red Cross War Memorial Children’s Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. Patients and methods. Since 1987, 81 children (range 6 months - 14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. Results. Sixty patients (74%) survived 3 months - 14 years post transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) postliver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). Conclusion. Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.

Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia

2017-07-03T18:11:28Z

Antenatal depressive symptoms and utilisation of delivery and postnatal care: a prospective study in rural Ethiopia Bitew, Tesera; Hanlon, Charlotte; Kebede, Eskinder; Honikman, Simone; Onah, Michael N; Fekadu, Abebaw Background: Uptake of delivery and postnatal care remains low in Low and Middle-Income Countries (LMICs), where 99% of global maternal deaths take place. However, the potential impact of antenatal depression on use of institutional delivery and postnatal care has seldom been examined. This study aimed to examine whether antenatal depressive symptoms are associated with use of maternal health care services. Methods: A population-based prospective study was conducted in Sodo District, Southern Ethiopia. Depressive symptoms were assessed during pregnancy with a locally validated, Amharic version of the Patient Health Questionnaire (PHQ-9). A cut off score of five or more indicated possible depression. A total of 1251 women were interviewed at a median of 8 weeks (4–12 weeks) after delivery. Postnatal outcome variables were: institutional delivery care utilization, type of delivery, i.e. spontaneous or assisted, and postnatal care utilization. Multivariate logistic regression was used to examine the association between antenatal depressive symptoms and the outcome variables. Results: High levels of antenatal depressive symptoms (PHQ score 5 or higher) were found in 28.7% of participating women. Nearly two-thirds, 783 women (62.6%), delivered in healthcare institutions. After adjusting for potential confounders, women with antenatal depressive symptoms had increased odds of reporting institutional birth [adjusted Odds Ratio (aOR) =1.42, 95% Confidence Interval (CI): 1.06, 1.92] and increased odds of reporting having had an assisted delivery (aOR = 1.72, 95% CI: 1.10, 2.69) as compared to women without these symptoms. However, the increased odds of institutional delivery among women with antenatal depressive symptoms was associated with unplanned delivery care use mainly due to emergency reasons (aOR = 1.62, 95% CI: 1.09, 2.42) rather than planning to deliver in healthcare institutions. Conclusion: Improved detection and treatment of antenatal depression has the potential to increase planned institutional delivery and reduce perinatal complications, thus contributing to a reduction in maternal morbidity and mortality.

Overview of a paediatric renal transplant programme

2017-06-30T07:12:07Z

Overview of a paediatric renal transplant programme McCulloch, M; Gajjar, P; Spearman, W; Burger, H; Sinclair, P; Savage, L; Morrison, C; Davies, C; Ruysch van Dugteren, GPA; Maytham, D; Wiggelinkhuizen, J; Pascoe, M D; McCurdie, F J; Pontin, A; Muller, E; Numanoglu, A; Millar, A J W; Rode, H; Khan, D INTRODUCTION: Renal transplantation is the therapy of choice for children with end-stage renal failure. There are many challenges associated with a paediatric programme in a developing country where organs are limited. METHODS: A retrospective review was undertaken of 149 paediatric renal transplants performed between 1968 and 2006 with specific emphasis on transplants performed in the last 10 years. Survival of patients and grafts was analysed and specific problems related to drugs and infections were reviewed. RESULTS: On review of the total programme, 60% of the transplants have been performed in the last 10 years, with satisfactory overall patient and graft survival for the first 8 years post transplant. At this point, transfer to adult units with non-compliance becomes a significant problem. Rejection is less of a problem than previously but infection is now a bigger issue--specifically tuberculosis (TB), cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections with related complications. A wide variety of drugs are available for tailoring immunosuppression to minimise side-effects. CONCLUSION: It is possible to have a successful paediatric transplant programme in a developing country. However, to improve long-term outcomes certain issues need to be addressed, including reduction of nephrotoxic drugs and cardiovascular risk factors and providing successful adolescent to adult unit transition.

A case for integrating human rights in public health policy

2017-06-28T09:12:03Z

A case for integrating human rights in public health policy London, Leslie In a global environment where human rights and well-being are coming under increasing threat, both from the spectre of terrorism and from the counter-reaction to it,1 and where international governance systems continue to pay lip service to poverty reduction while encouraging unbridled private accumulation of wealth resulting in huge inequalities between and within countries,2,3 the need to make human rights considerations an integral part of how public health policies are formulated cannot be overemphasised. Contestation over entitlements to socio-economic rights has troubled health care systems worldwide, from resource-poor settings in Africa, where questions have been raised as to whether human rights approaches are best suited to addressing the problem of AIDS in Africa,4,5 through to the over-consumptive USA where universal access to health care remains a policy objective doomed to unfulfilment under market-fixated economic systems.6,7