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1
Sylvester, Dianne. "Genes underpinning predisposition to childhood cancer." Thesis, The University of Sydney, 2020. https://hdl.handle.net/2123/22458.
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The genetic changes underpinning cancer predisposition in children are not clearly defined and warrant further research, as identification of a genetic contribution to a patient’s disease can be beneficial for patients and their families. With technological advances, it is now possible to discover a broad spectrum of genetic changes implicated in cancer predisposition by sequencing the genome. An analytical review of six publications utilising germline genome sequencing in paediatric oncology found that these studies differed in the selected childhood cancer diagnoses and the genes considered for interpretation, resulting in differences in the proportions of childhood cancer patients that were reported to carry clinically relevant pathogenic germline variants. In this study, childhood cancer patients that presented with phenotypes indicative of a genetic susceptibility to cancer, such as multiple cancer diagnoses, a family history of cancer and/or a genetic diagnosis, underwent germline exome sequencing. Sequencing data were analysed for rare germline variants in over 1000 cancer predisposition, cancer associated and DNA repair genes, that were predicted to cause a loss of function or to be deleterious. Almost one quarter of childhood cancer patients with features suggestive of a genetic predisposition to cancer were found to carry pathogenic or likely pathogenic germline variant/s in 12 known cancer predisposition genes. A rare variant burden analysis of 31 autosomal dominant cancer predisposition genes found that deleterious germline variants were significantly enriched in a cohort of 63 childhood cancer patients compared to a cohort of 1107 genetically matched healthy aged controls. Novel germline variants not previously associated with cancer predisposition were also detected in 10 genes in 16 childhood cancer patients. This study has expanded our understanding of cancer predisposition in children, by discovering the diagnostic potential of sequencing patients with defined phenotypic features, and by linking pathogenic or likely pathogenic germline variants in known predisposition genes with new cancer diagnoses. Ultimately, by combining the analysis of family pedigrees with functional gene studies and data-sharing, the significance of novel germline variants associated with the onset of cancer in childhood will be established. As more childhood cancer predisposition genes are identified and characterised, screening processes may be more routinely incorporated into paediatric clinical care.
2
Star, Kristina. "Safety of Medication in Paediatrics." Doctoral thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-197323.
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Background: In paediatrics, the limited documentation to guide medication, the lack of suitable dosage forms, and the continuous development in childhood present a scenario where safety of medication is a particular challenge. Aim: To explore reported adverse drug reactions (ADRs) and the challenges in prescribing and administering medicines in paediatrics, in order to identify and suggest areas needing international surveillance within medication safety and improvement in the clinical setting. Methods: Four exploratory studies were conducted. Worldwide reporting of suspected ADRs (individual case safety reports, ICSR) with ages 0-17 years were examined overall. Twenty published case reports and ICSRs for adolescents, who developed a rare and incompletely documented ADR (rhabdomyolysis) during antipsychotic medicine use, were analysed in-depth. Prescribed doses of anti-inflammatory medicines were studied in a UK electronic health record database. Transcribed focus group interviews with 20 registered nurses from four paediatric wards in Sweden were analysed for factors that may promote or hinder safe medication practices. Descriptive statistics, multiple regression, and content analyses were used. Results: Although, skin reactions and anti-infective medicines were most frequently reported, and more reported in paediatric patients than in adults, medication errors and adverse reactions related to psychostimulant medicines were reported with increased frequency during 2005 to February 2010. The in-depth case analysis emphasised the need for increased vigilance following changes in patients’ medicine regimens, and indicated that ICSRs could contribute with clinically valuable information. Prescribed dose variations were associated with type of dosage form. Tablets and capsules were prescribed with a higher dose than liquid dosage forms. Six themes emerged from the interviews: preparation and administration was complex; medication errors caused considerable psychological burden; support from nurse colleagues was highly valued; unfamiliar medication was challenging; clear dose instructions were important; nurses handling medications needed to be accorded higher priority. Conclusions: Age-specific screening of ICSRs and the use of ICSRs to enhance knowledge of ADRs and medication errors need to be developed. Access to age-appropriate dosage forms is important when prescribing medicines to children. To improve medication safety practices in paediatric care, interdisciplinary collaborations across hospitals on national or even global levels are needed.
3
Boss, Patricia M., and res cand@acu edu au. "Indicators of Satisfaction & Success For a Paediatric Outreach Nursing Service in Metropolitan Sydney, NSW." Australian Catholic University. School of Nursing, 2005. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp118.25102006.
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The purpose of this study was to determine the indicators of customer satisfaction and service success of a newly established paediatric outreach nursing service. Referring agents and care recipients were both consumers of the paediatric outreach nursing service. Both groups of consumers were surveyed to determine their satisfaction with the service delivery. Two satisfaction survey tools were developed to measure customer satisfaction. The tools were piloted and refined prior to distributing them. Both tools had a series of closed-ended questions and 3 open-ended questions. Eight service indicators were developed. These were designed to test the effectiveness of the service provided. The service indicators were piloted over two periods of three months and then modified based on the findings of the pilot period. The Paediatric Outreach Service (POS) is a positive service model for health care delivery. The survey results indicated that stakeholders were generally satisfied with the service delivery. When measured against service indicators that were developed for POS, the service performance was above average, with some opportunity to improve practice. Underpinned by a family-centered framework, POS has the capacity to empower children and their families in the planning and implementation of a management plan for the child’s illness. Such empowerment may lead families to practice better healthcare, develop better health-seeking practices and ultimately lead to healthier children. The results from this study has implications for nursing practice. The data obtained from this study may be useful to service providers considering commencing a paediatric outreach nursing service. Data may also be useful for existing service providers to use in order to review the aspects that consumers value against the service they currently provide. Keywords ambulatory care; paediatrics; home-nursing; community; evaluation; satisfaction; success; indicators
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Moore, Ryan. "International Normalised Ratio Monitoring in Children: Comparing the accuracy of portable point-of-care monitors to standard of care laboratory monitoring at Red Cross War Memorial Children's Hospital." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/32880.
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Background. There is an increasing trend in the use of long-term oral anticoagulation therapy in children. Monitoring the international normalised ratio (INR) is an integral part in management of these patients, but standard laboratory testing of the INR presents challenges in this age group. Point-of-care INR monitors such as the Mission® PT/INR monitor provide advantages in efficiency and accessibility but have not been evaluated for accuracy in the South African paediatric setting. Objectives. This is a feasibility study with the aim to evaluate the accuracy of the Mission® PT/INR Monitor in comparison to standard laboratory INR measurement, in children presenting for INR testing. Methods. We compared the accuracy of the Mission® PT/INR monitor to the Sysmex Cs2100i laboratory analyser in 37 children aged between 1 year and 17 years, who presented for INR testing. The sample size was limited due to time constraints. 40 paired POC INR and laboratory INR values were obtained. Results. The majority of participants in the study were outpatients (62%) and required INR testing as part of screening in non-cardiac disease (81%) - the majority had chronic liver disease, and a minority were on warfarin therapy (13.5%). The mean INR value on the Mission® PT/INR was 1.49 (standard deviation (SD) 0.73) and was comparable to the Sysmex Cs-2100i (mean INR value 1.39 with SD 0.69). The Bland-Altman difference plot revealed good agreement. Bias between the two methods was 0.13 (SD 0.23). In total, 92.5% of POC INR values were within 0.5 units of laboratory INR value. Conclusion. The Mission® PT/INR point-of-care monitor has a clinically acceptable level of accuracy in children when compared with laboratory INR measurement, but larger studies are needed in the paediatric setting to evaluate patient safety and clinical outcomes. There is a need for implementing POC INR monitoring in outpatient settings but this practice will require robust assessment of infrastructure and quality control before application.
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Naidoo, Nayestha. "Neonatal Sepsis And Antibiotic Sensitivity Patterns At A South African Tertiary Nursery – Evolution Over A 15 Year Period." Master's thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31063.
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Background
Neonatal infection is an important cause of morbidity and mortality in babies. The causative pathogens and their antibiotic susceptibility patterns should be monitored so that treatment regimens can be adjusted to maintain efficacy and avoid selection of resistant organisms. Objectives To compare the incidence of culture positive neonatal sepsis; and to describe the pathogens and antibiotic resistance profiles for significant organsims over a 15-year period in a tertiary nursery in Cape Town.
Methods
Retrospective blood culture data for 12 months were collected at three time points over a 15-year period. Blood cultures from 2004, 2013 and 2017 were analysed. All neonates with growth on blood cultures were included.
Results
During 2004 a total of 817 (43.3% of total admissions) blood cultures were taken, 171 (9.1% of total admissions) were culture positive. The most common invasive organisms were Klebsiella pneumoniae (31.8% of invasive organisms), S.aureus (26.1%) and enterococcus species (7.3%). There were 102 contaminants (12.5% of total cultures) of which 7.8% were due to Coagulase-negative Staphylococcus (CONS). In 2013 a total of 1070 (46.8% of total admissions) blood cultures were taken, 124 (5.4% of total admissions) were culture positive. Common invasive organisms were Klebsiella pneumoniae (53.8% of invasive organisms), E. coli (12.8%) and S. aureus (10.3% ). Forty-six blood cultures were deemed contaminated (4.3% of all cultures) and of these 2.1% were due to CONS. In 2017, there were 581 blood cultures taken (26.5% of total admissions), 56 were culture positive (2.6% of total admissions). Commonly occuring invasive organisms were Klebsiella pneumoniae (32.4% of invasive organisms), Group B streptococcus (16.2%) and Acinetobacter (13.5%). Twenty-nine blood cultures were considered contaminated (5.6% of cultures) of which 1.7% were CONS. The gram-negative organisms showed an increasing resistance to penicillin, ampicillin and aminoglycosides but remained sensitive to carbapenems.
Conclusions
The initial reduction in positive blood cultures from 2004 to 2013 was primarily due to the reduction of contaminants, probably reflecting improved blood sampling techniques. The large reduction in Gram-negative organisms from 2013 to 2017 suggests improved infection control measures , but gram-negative organisms remained prominent in all three cohorts. Emergence of resistant organisms is concerning and in keeping with other nurseries worldwide. These data illustrate the need for antibiotic stewardship, infection control measures and ongoing surveillance.
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Lupton-Smith, Alison Rosalie. "An investigation into regional ventilation in infants and children; its distribution and determinants." Doctoral thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24911.
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Changing body position is commonly used in the management of individuals with respiratory diseases and those receiving mechanical ventilation, in order to optimise ventilation and oxygenation. In acute respiratory distress syndrome (ARDS), prone positioning is reported to improve oxygenation by recruiting collapsed dorsal lung regions, although this has not been confirmed in children. Ventilation distribution is well established in adults as being gravity dependent. Clinical practice in the paediatric population has been guided by the notion that all children, irrespective of the presence or absence of disease and age, consistently demonstrate the opposite ventilation distribution pattern to adults and this pattern is said to occur until the second decade of life. Studies in the paediatric population are limited to a few reported from the 1980's, on very heterogeneous populations. With advances in technology, new methods of examining regional ventilation, such as electrical impedance tomography (EIT), have become available. Recent neonatal studies using EIT have reported a dissimilar ventilation distribution to the conventional paediatric pattern. Despite a growing number of studies examining the effects of various interventions on ventilation distribution, very few exist in infants and children older than 6 months of age. Furthermore, differing methodologies and the manner in which ventilation distribution is described and analysed makes pooling the available data in the paediatric population extremely difficult. An understanding of how ventilation is distributed under normal conditions is imperative when examining the effects of different interventions and medical conditions on ventilation distribution. This thesis aimed to describe the effects of body position, head position, age, and respiratory muscle activity on ventilation distribution in children between six months and nine years of age under normal conditions, with respiratory disease, neuromuscular disease, and during mechanical ventilation. Furthermore, the effect on ventilation distribution of prone positioning in children with ARDS was evaluated. Regional ventilation distribution was measured using thoracic EIT and respiratory muscle activity was measured using surface electromyography (sEMG) using standardised methodology. Results of a series of sub-studies indicate that ventilation distribution is more complex and variable than previously thought, with no standard "paediatric pattern" of ventilation. Overall, greater ventilation occurred in the right and dorsal lungs, respectively, in different positons. Head position did not affect regional ventilation in the children studied. Age had a variable effect on ventilation distribution, with healthy children under 12 months of age more likely to follow the paediatric pattern, particularly in side lying positions; however the response was not uniform. The presence of mechanical ventilation, disease state and respiratory muscle activity did not affect ventilation distribution with these children also showing variable patterns of regional ventilation distribution. Data suggests that turning children with ARDS into the prone position does not result in recruitment of the dorsal lung regions, but rather more homogenous ventilation throughout the lungs. Furthermore, results suggest that children with greater ventilation inhomogeneity at baseline are more likely to respond positively (improvement in oxygenation index) to prone positioning. This research provides novel insights into ventilation distribution and respiratory muscle activity in infants and children older than six months of age under a number of different conditions. These results contribute to a better understanding of the factors influencing the distribution of regional ventilation and the mechanisms by which prone positioning in ARDS may improve oxygenation in this population. These findings have potentially important clinical implications, as well as providing baseline data for future clinical studies. Given the variability observed, these studies highlight the potential clinical utility of EIT to monitor different interventions and outcomes. An important strength of the studies presented in this thesis, is that they were performed in a standardised manner, using relatively homogenous individual populations and validated measures of describing ventilation distribution. This methodology could provide a template for future studies in the paediatric population, to allow for comparison between studies.
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Githinji, Leah Nyawira. "Lung function in perinatally HIV-infected adolescents on antiretroviral therapy in Cape Town, South Africa." Doctoral thesis, Faculty of Health Sciences, 2019. http://hdl.handle.net/11427/31387.
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Background: Lung disease is a common complication of human immunodeficiency virus (HIV) infection in children and adolescents. As antiretroviral programmes have strengthened and HIV diagnosed earlier, survival of perinatally HIV-infected children has improved. Therefore, an increasing number of perinatally HIV-infected children are surviving into adolescence, with development of chronic multisystem disease including chronic lung disease (CLD). However, there is limited information on the determinants, spectrum and progression of lung disease. Lung function testing, an objective, non-invasive, reproducible tool, is useful in characterising CLD and in monitoring disease progression. Aim: To investigate the spectrum, determinants and progression of lung function in perinatally HIV-infected adolescents on antiretroviral therapy (ART) in Cape Town, South Africa. Specific objectives included describing the spectrum and determinants of lung function; investigating cardiopulmonary dysfunction and investigating progression of lung function over two years. Methods: The study population was from a prospective cohort, the Cape Town Adolescent Anti-retroviral cohort (CTAAC), that enrolled 515 perinatally HIV-infected adolescents on ART and 110 age-matched HIV-uninfected adolescents followed six-monthly for two years in Cape Town, South Africa. Eligibility criteria were adolescents, aged 9-14 years, with perinatally acquired HIV, who had been on ART for at least six months. Comprehensive lung function testing was done, and clinical and lung function data collected at baseline, 12 and 24 months. Results: At baseline, HIV-infected adolescents had lower forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, diffusing capacity for carbon monoxide, respiratory system compliance and functional residual capacity; and higher airway resistance and lung clearance index compared to HIV-uninfected adolescents, p< 0.05 for all. At 24 months, FEV1 and FVC remained lower in the HIV-infected compared to the uninfected, p< 0.05 for both. Impaired cardiopulmonary function was detected in 13% of HIV-infected adolescents and 8% of HIV-uninfected adolescents, p=0.136. Past PTB was significantly associated with a low cardiopulmonary function, OR 2.3, 95%CI 1.2-4.4. Conclusion: Perinatally HIV-infected adolescents had lower lung function and higher resistance and ventilation inhomogeneity compared to age-matched HIV-uninfected adolescents at baseline. Lung function tracked, remaining lower at two years. Previous PTB or severe LRTI were predictors of lower lung function. Co-existent cardiopulmonary dysfunction occurred in a minority. These data highlight respiratory disease risk in this vulnerable group and may inform policy to strengthen strategies to prevent and manage HIV-associated lung or cardiopulmonary disease. Four of the chapters (2-5) of this thesis are presented as published manuscripts. Chapter 1 encompasses an overview of the burden of HIV disease and the spectrum of HIV associated chronic lung disease in adolescents and the utility of lung function in the diagnosis of chronic lung disease. Study methodology is also detailed in this chapter. Chapter 2 (published manuscript) comprises a comprehensive review of published data on lung function (over and above the literature included in the individual papers) in HIV infected children and adolescents and summarises studies that have been done in Africa, USA, Europe and Asia. Chapter 3 (published manuscript) describes the spectrum and determinants of comprehensive lung function parameters (flow, volume, compliance, resistance, ventilation inhomogeneity) in perinatally HIV-infected adolescents with a comparator group of age-matched HIV-uninfected adolescents. Chapter 4 (published manuscript) further explores the prevalence and determinants of coexistent cardiopulmonary dysfunction in perinatally HIV-infected adolescents on ART. Chapter 5 (published manuscript) describes the progressive changes in spirometry over two years in perinatally HIV-infected adolescents compared to HIV-uninfected age matched controls. It also addresses the associations of low lung function, factors amenable to public health interventions. Chapter 6 is a summary of the study findings and recommendations.
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Horn, Alan Richard. "Early prediction of hypoxic ischaemic encephalopathy in newborn infants in a resource-limited setting." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/11188.
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Includes bibliographical references.Hypoxic ischaemic encephalopathy (HIE) after birth is an important cause of neonatal morbidity and mortality, particularly in resource-limited regions. Therapeutic hypothermia initiated within the first 6 hours of life, in settings that can offer neonatal intensive care, is a therapy that can reduce death or severe disability in newborn infants with moderate or severe HIE. Therapeutic hypothermia has not been shown to be safe or effective in low-resource settings where neonatal intensive care is not available; however, there are situations such as in some centres in South Africa, where limited neonatal intensive care (NICU) is available against a background of moderate neonatal mortality rates, relatively low socio-economic conditions and limited capacity for long-term follow-up. In such settings, accurate case definition and early prediction of HIE and outcome may assist with the appropriate allocation of resources. The amplitude-integrated electro-encephalogram (aEEG) is an ideal tool to use for prediction of outcome and the need for cooling, but it’s availability is limited, particularly at primary and secondary hospitals.
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Thompson, Mary Clare. "Neurodevelopmental outcome of the high risk infant in Cape Town." Doctoral thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/25807.
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The outcome of high risk infants provides an important audit of neonatal care. This audit renders valuable information to clinicians, parents and health care planners. Available outcome data from the developing world are sparse and urgently needed. This work was compiled with three aims in mind: to provide data from Cape Town on outcome of high risk infants (including both infants of very low birthweight and infants who have survived hypoxic ischaemic encephalopathy); to evaluate selected early neurodevelopmental assessments of these infants; and to propose a protocol for their effective follow-up. Three separate cohorts were selected and studied in order to achieve these aims. A prospective six-year follow-up study of infants with birth weights less than 1250 g was undertaken at Groote Schuur Hospital's Neonatal Intensive Care Unit. The aim of the study was to document the morbidity, mortality and neurodevelopmental outcome of these infants. Of 235 liveborn infants, 143 (61 %) survived to discharge. Better survival was documented for infants who weighed more than 900 g and were over 30 weeks gestation and whose mothers attended antenatal care. One hundred and six infants (83% of survivors) underwent clinical assessment at one year of age and were evaluated with the Griffiths Scales of Mental Development. Ninety six (91 %) of these survivors were seen and tested at two years of age and 80 (76%) were seen at six years of age together with 70 matched controls who had normal birthweights. Of the 106 infants assessed at one year of age, six infants were diagnosed as cerebral palsied, six were globally developmentally delayed without signs of cerebral palsy and one infant showed significant motor delay with a normal developmental quotient. At two years of age one further infant had cerebral palsy and nine more infants were developmentally delayed. At six years of age five infants had cerebral palsy, one was intellectually disabled and three were intellectually borderline. The major disability rate at one year of age was 11%, at two years of age was 22% and at six years of age was eight percent. The incidence of low birthweight children with possible learning disability was three times that of their matched controls and overall, the low birthweight children scored significantly less in all developmental measures. Forty-five infants who developed hypoxic ischaemic encephalopathy after birth were studied prospectively. A numeric scoring system for the assessment of hypoxic ischaemic encephalopathy during the neonatal period which had previously been developed at Groote Schuur Hospital was tested. The value of the score in predicting neurodevelopmental outcome at one year of age was assessed. Thirty five infants were evaluated at 12 months of age by full neurological examination and the Griffiths Scales of Mental Development. Five infants were assessed at an earlier stage, 4 who died before 6 months of age and one infant who was hospitalised at the time of the 12-month assessment. Twenty three (58%) of the infants were normal, 17 (42%) were abnormal, 16 with cerebral palsy and one with developmental delay. 25 infants were re-evaluated at 3 years of age. 15 of these 25 had been normal at one year of age and were evaluated with ten controls who had had an uneventful perinatal course. The Hypoxic lschaemic Encephalopathy Score was highly predictive for outcome. The best correlation with outcome was a combination of the peak score and evaluation on day seven; giving a positive predictive value of 92% and a negative predictive value of 100% for abnormal outcome, with a sensitivity of 100% and specificity of 93%. At three years of age the HIE survivors without cerebral palsy scored as well as their matched controls on Griffiths developmental evaluation. In these normal survivors no correlation between severity of HIE and developmental quotient was demonstrated. Infants with neurodevelopmental abnormality need to start therapy early and because of this, should be detected as soon as possible. Currently, no widely accepted method of early evaluation exists. A Perinatal Risk Rating, the Dubowitz Neurological Assessment and the Infant Neuromotor Assessment were compared in terms of predicting neurodevelopmental outcome at one year of age. A cohort of 130 consecutive neonatal intensive care unit graduates were selected according to high risk criteria. Each infant was examined at term gestational age on the Dubowitz Neurological Assessment and a Perinatal Risk Rating was allocated. The study infants were seen again at 18 weeks corrected age, when an Infant Neuromotor Assessment was done, and at one year of age the Griffiths Scales of Mental Developmental and full neurological examination were carried out. Of the 130 infants assessed at term, all were seen at 18 weeks. Thereafter five were lost to follow-up and two died. The outcome of all the remaining 123 infants is known. Prediction of a normal outcome at 1 year of age on the Dubowitz Neurological Assessment was 96% and for the Perinatal Risk Rating, 98%, but for an abnormal outcome they predicted only 56% and 42% respectively. The Infant Neurological Assessment at 18 weeks of age predicted a normal outcome at one year in 99% and an abnormal outcome in 82%. Very low birthweight infants are at higher risk for cerebral palsy and intellectual disability. In Groote Schuur Hospital, at six years of age, the major disability rate for infants with birthweights less than 1250 g was eight percent. Forty percent of term infants who survived hypoxic ischaemic encephalopathy had cerebral palsy with associated intellectual disability. The use of the Perinatal Risk Rating is appropriate in newborn facilities where cranial ultrasound is available. Otherwise the Dubowitz Neurological Assessment is an appropriate screening tool in the newborn period. Use of the Hypoxic Ischaemic Encephalopathy Score is recommended for clinical evaluation, prognostication and risk rating. It is proposed that high risk infants should be evaluated at 18 weeks corrected age with the Infant Neuromotor Assessment at a tertiary centre. If this assessment is normal, the infant can then be discharged to community clinic follow-up. Infants with more than one deviant sign at this age need continued review and those with more than three signs should be referred for neurodevelopmental therapy to a comprehensive neurodevelopmental clinic. Even those high-risk infants whose assessments are normal should be enrolled in a pre-school centre at five years of age to facilitate detection of learning problems prior to school entry.
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Gray, Claudia Liesel. "The prevalence and patterns of IgE-mediated food allergy and sensitisation in South African children with atopic dermatitis." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/12874.
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Includes bibliographical references.Background: The prevalence of food allergy in South Africa is unknown, but previously thought to be low, particularly in black South Africans. We hypothesised that food allergies would be low in Xhosa patients, even those at increased risk of food allergy such as children with atopic dermatitis (AD). This study aimed to determine the prevalence of, patterns and risk factors for, IgE-mediated food allergy in South African children with moderate to severe AD. It is the first food allergy prevalence study in South Africa to utilise controlled food challenges and component analysis, and is unique for its comparison of food allergy patterns between ethnic groups in the same geographical area. Methodology: This was a prospective, observational study in a paediatric university hospital in Cape Town. Children with moderate to severe AD, aged 6 months to 10 years, were randomly recruited from the dermatology clinic. They were assessed for sensitisation and allergy by questionnaire, skin prick tests (SPT), Immuno Solid Phase Allergen Chip (ISAC) test and incremental food challenges. Sensitised patients were also tested for specific IgE by ImmunoCAP test. Results: One hundred participants (59 black Africans and 41 of mixed race) were enrolled, median age 42 months. There were high overall rates of food sensitisation (66%) and food allergy (40%). Egg (25%) and peanut (24%) were the most common allergies. Black participants had comparable sensitisation (69% vs 61%) but lower allergy rates (34% vs 46%) than mixed race participants. This was especially evident for peanut allergy (15% vs 37%, p=0.01). Early onset AD (< 6 months), severe eczema, and young age < 2 years were significant risk factors for food allergy. The ISAC test was less sensitive than SPT and ImmunoCAP tests. Only 42% of cases of perceived food allergy were confirmed as true food allergy.
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Botes, Alida Maria. "A description of the characteristics at presentation of children diagnosed with Diabetes Mellitus from 2005-2009 at Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22985.
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Objective: To document the demographics, the pattern of clinical and laboratory characteristics at the time of diagnoses for all the newly diagnosed diabetics younger than 14 years reviewed at the Diabetic clinic at the Red Cross War Memorial Children's Hospital (RCWMH) during 2005-2009. Method: A retrospective folder review was done of all the newly diagnosed diabetics younger than 14 years old at the age of diagnosis. 225 patients were included for analysis. Patients were grouped according to age into a young group (1 month to < 5 years old), a middle group (5years - < 9 years) and an older group (9years - <14 years). Neonates were excluded as well as children who became diabetic secondary to another condition. Results: 58% of the patients were female and most of the patients were diagnosed with type 1 diabetes (96%). The median age at diagnosis was 8.5 years with a mean HbA1c of 11, 3%. 68% of the patients were in the normal weight category while 8, 4% of the patients were obese. 148 (65%) of the 225 patients presented in diabetic ketoacidosis (DKA). Only one of the patients classified with type 2 diabetes presented in DKA. 51 (22,67%) of the patients were less than 4 years old at the time of diagnosis. 53% of the Caucasian children were less than 4 years old at diagnosis while most of the children in the black and coloured group were diagnosed after 10 years of age. A seasonal variation was seen especially in the young age group with 66% presenting in autumn or winter months. Conclusions: Almost a quarter of diabetic children presented before the age of 4 years. A large proportion of patients presented in diabetic ketoacidosis which can be life threatening. Due to lack of information at diagnosis, this could be under reported significantly and calls for increase awareness amongst physicians and parents to recognise symptoms earlier. Prospective studies on childhood diabetes in South Africa are needed as well as a registry for childhood diabetes.
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Laurence, Craig. "Correlation between pro-inflammatory alleles and clinical and laboratory markers of allergy in Xhosa South Africans." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22821.
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Background: Asthma and allergic disease are the result of a complex interaction between genetic predisposition and environmental exposure. It is likely that multiple genes are involved in the progression from allergen exposure to the development of signs and symptoms of allergic disease. Although advances in genetic research have progressed exponentially in the past twenty years, and a growing body of evidence from the developed world has yielded several promising candidate polymorphisms, the precise nature of the genetic basis for allergic disease remains to be elucidated. In addition, there is a paucity of literature in this field from the developing world, and for people of African origin in particular. Several studies suggest that the prevalence of asthma and allergic disease in South Africa has increased significantly over the past forty years, at a rate that is too rapid to be explained by genetic modification. A likely explanation for this trend is that an increasing number of genetically susceptible individuals are being exposed to environmental stimuli that are critical to the formation of allergic disease. It is possible, although unproven, that evolutionary adaptation of inflammatory immune responses may increase the genetic predisposition to allergic disease amongst people of Black African origin. This thesis represents the first analysis of several single nucleotide polymorphisms (SNPs) with regards to their prevalence in the Xhosa population, as well as the correlation between these SNPs and clinical and laboratory markers of allergic disease in this population. Methods: A cross-sectional sample of about 300 unrelated Xhosa school children was obtained from a local high school. Phenotypic data was collected in the form of a symptom questionnaire, blood samples for total IgE as well as IgE to Ascaris lumbricoides, skin prick tests to common local food and aeroallergens, as well as a modified methacholine challenge to establish the prevalence of bronchial hyper-reactivity. In addition, genotyping was performed to investigate the prevalence of twenty-seven SNPs in this population. We aimed to establish a baseline of the prevalence of potential pro-inflammatory alleles (PIAs), as well as to investigate the relationship between these PIAs and clinical and laboratory markers of asthma and allergic disease. Results: We found several significant associations between several SNPs and allergic disease, specifically in genes relating to the development of immune tolerance (IL-10), genes relating to TH1 inflammation (IL-12 and IFNGR1) and genes relating to TH2 inflammation (IL-4, IL- 4R, IL-13). Unfortunately, the generalizability of our findings is limited by, amongst others, the selection of pupils from a single school and the use of self-reported end points as markers of clinical phenotypes rather than physician diagnosed allergic illnesses. Conclusion: This is the first trial of its kind in the Xhosa population. Despite the limitations described above, we feel that this study has provided valuable baseline prevalence data, and unearthed some interesting associations between PIAs and allergic disease. We would welcome further research in this population to confirm or refute our findings.
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Weakley, Kate. "Juvenile idiopathic arthritis in two tertiary centres in the Western Cape, South Africa." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10744.
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Juvenile idiopathic arthritis (JIA) is defined as arthritis of unknown aetiology that begins before the 16th birthday and persists for at least 6 weeks, other conditions being excluded. As JIA is a disease with serious functional implications, a descriptive study would not be complete without reviewing both the functional and clinical parameters of the disease. There has been very little African data on this subject. The objective of this study is to describe the functional disability and clinical disease characteristics in a sample of children diagnosed with JIA in Cape Town, South Africa.
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Nuttall, James Jolyon Care. "The performance of HIV rapid antibody detection assays in children." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20296.
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Background: HIV rapid antibody assays are important for screening children aged <18 months for HIV exposure and children ≥ 18 months for HIV infection. Limited available data indicate variable performance of different HIV rapid tests in comparison to laboratory HIV antibody assays. The aim of this study was to evaluate the diagnostic accuracy of 6 HIV rapid tests currently used in South Africa for screening children using whole blood. Methods: A prospective descriptive cross-sectional laboratory study was conducted at two paediatric healthcare facilities in South Africa. Sensitivity and specificity analyses and positive and negative likelihood ratios were performed. The reference standard was the laboratory HIV enzyme-linked immunosorbent assay (ELISA) test and HIV polymerase chain reaction (PCR) test. Results: Blood samples from 1159 children (896 <18 months of age) with valid HIV ELISA test results were included in the analysis. A total of 5768 HIV rapid tests (4446 in children <18 months of age) were performed. Sensitivity of HIV rapid tests for detecting HIV exposure among children <18 months of age ranged from 38.7% to 94.7%. Four HIV rapid tests attained specificity in excluding HIV exposure among children <18 months of age of >98%. Seroreversion rates were lowest with the Determine rapid test. Three HIV rapid tests (Abon, Advanced Quality, Determine) detected 100% of HIV-infected children <18 months of age, the Reveal, SD Bioline and Insti rapid tests missed 27 (41.5%), 1 (4.5%) and 1 (1.5%) of the HIV-infected children respectively. In children ≥ 18 months of age, sensitivity of rapid tests for detecting HIV infection ranged from 69.2% to 100% and specificity of all rapid tests was 100%. Conclusions: None of the 6 HIV rapid tests evaluated achieved both the World Health Organisation recommended sensitivity and specificity standards for any antibody assay used in screening for HIV exposure in children <18 months. The Determine test showed the best overall diagnostic accuracy and is therefore recommended as the preferred screening test for children. Recommendations: on the use of specific HIV rapid tests in infants and young children should be based on evaluation of their performance in the population to be tested.
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Omarjee, Zakiyya. "An audit of endocrine dysfunction in children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004." Master's thesis, University of Cape Town, 2006. http://hdl.handle.net/11427/26765.
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Background: Craniopharyngiomas account for 6-10% of childhood brain tumours and are the third most common intracranial tumours of childhood. Despite their benign histological appearance, they are often associated with a poor outcome and have significant associated morbidity. Aim: To analyse the data of children with craniopharyngiomas at Red Cross Children's Hospital and Groote Schuur Hospital from 1976 to 2004 with respect to age at presentation, presenting symptoms and preoperative and post-operative endocrine dysfunction. Patients and methods: The records of 45 children aged between 9 months and 13 years were reviewed. The majority of children in the study were aged between 5 and 10 years. There was a considerable delay in the diagnosis in most cases especially in areas outside of Cape Town. Pre-operative tests prior to 2000 were incomplete but have improved since then. Twenty nine percent of our patients had a near total excision of the craniopharyngioma and 29% had partial excisions necessitating adjuvant radiotherapy. The endocrinological, neuro imaging and presenting symptoms were analysed and post-operative tests were reviewed. Where possible neuropsychiatric assessments were accessed as well in order to assess long term neurocognitive deficits Results: The age of presentation of craniopharyngiomas in our group of patients was much younger than in other studies with the largest group of affected children being between 5 and 10 years of age. The most common presenting symptoms in this group were headaches (62%) and visual disturbances (57%). Sixty four percent of the children had preoperative endocrine testing for pituitary dysfunction of which 59% were ACTH and TSH deficient and only 38% were growth hormone deficient. After surgery multiple endocrinopathies were universal with 56% of children having pan hypopituitarism at follow up. There was no reversal of pre-existing hormone deficits after surgery. The management of craniopharyngiomas remains controversial. Twenty nine percent of our patients had a near total excision and 29 % had a partial excision combined with radiotherapy with a further 6 patients receiving intratumoral bleomycin for recurrences. Post operatively the majority of children were on replacement therapy but only 6 patients (14%) received human growth hormone or are receiving human growth hormone currently due to a lack of funds to provide human growth hormone for children with growth hormone deficiency. Seventy percent of the children had central diabetes insipidus post operatively reflecting posterior pituitary damage. Our overall survival rate from 1976 to 2004 was 91 % with a mortality rate of 13%. Most of the deaths were attributed to recurrences of the craniopharyngioma and the complications of bleomycin treatment. Conclusion: Craniopharyngiomas remain tumours associated with significant morbidity. Total excision of the tumour remains a favourable option but the proximity of the craniopharyngioma to the pituitary gland and optic tracts results in devastating sequelae. Although the medical and surgical management of craniopharyngiomas has improved, a significant number of patients had endocrine sequelae. The management of craniopharyngiomas in an African context compares favourably internationally but with limited resources especially with regard to growth hormone replacement, a large proportion of our children are not receiving optimal treatment.
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Spittal, Graeme William. "Characteristics of childhood-onset Systemic Lupus Erythematosus in Cape Town, South Africa." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/6016.
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Wiles, Jodi Isaacs. "Descriptive study evaluating the use of the Road to Health card by doctors in a tertiary paediatric hospital setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20295.
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Background: The South African Road to Health Card (RTHC) is a parent-held personal child health record used by health professionals and parents to monitor the health and development of a child. Low possession and retention of the RTHC by parents, as well as inadequate use of RTHC by health professionals, have lessened its efficacy and purpose. Objectives: This study aimed to describe the level of possession of the RTHC by a sample of caregivers of patients admitted to Red Cross War Memorial Children's Hospital (RCWMCH), and to determine the extent and accuracy of doctors' transfer of clinical information between the RTHC and hospital records. Methods: A cross-sectional and analytical study was conducted in four general paediatric wards at RCWMCH. Consecutive patients were enrolled at discharge during office hours over a six week period. Data were extracted from a photograph of the RTHC and the participant's hospital record. Both the 1995 Chart version and the 2009 Booklet version of the RTHC were included in the study. The presence or absence of selected items of information on the RTHC and the hospital record were recorded - the primary outcome was the transfer of the specified information between records. The outcomes are presented as proportions, with 95% confidence intervals (CI).
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Procter, Claire. "Lumbar punctures in the paediatric emergency medicine department at Red Cross War Memorial Children's Hospital: An evaluation." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20854.
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Background: Lumbar punctures (LPs) are frequently performed in the paediatric medical emergency unit (MEU) department to diagnose or exclude meningitis. Unsuccessful lumbar punctures (LPs) cause diagnostic uncertainty which may prolong hospital stay and result in unnecessary antibiotic treatment and increased costs to the hospital and patients. It is important to determine factors that may be effective in reducing unsuccessful LPs. There is a paucity of studies on this topic from sub-Saharan Africa. Previous studies have shown inconsistent results and the use of sedation has not previously been studied. Aims: To determine the prevalence of unsuccessful lumbar punctures(LPs) and the factors influencing this in the medical emergency unit (MEU) and short stay ward (SSW) at Red Cross War Memorial Children's Hospital, Cape Town.
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North, Natasha. "What is the capacity of the children's nursing workforce in seven selected Sub-Saharan African countries? Gathering insights from Botswana, Kenya, Namibia, Malawi, South Africa, Uganda and Zambia." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29838.
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Background
This study attempted to identify as far as possible the extent of the children’s nursing workforce in five selected countries in the sub-Saharan African region. Strengthening children’s nursing training has been recommended as a primary strategy to reduce the underfive mortality rate in African nations, including South Africa and Malawi. The current level of data monitoring capacity worldwide means that it is not possible to disaggregate the children’s nursing workforce in countries in the World Health Organisation African Region from the data provided by the WHO Global Atlas of the Health Workforce database. Yet developing an accurate depiction of the specialist children’s nursing workforce is a necessary step towards optimizing children’s health service delivery.
Methods
In attempting to respond to this need, this study adheres to a collaborative research philosophy, using a convergent parallel mixed methods design, incorporating a scoping documentary review, together with quantitative (surveys and case study compilation) and qualitative (interview) components collected independently and then integrated during analysis and interpretation, to generate data addressing three related questions: how many children’s nurses are believed to be in practice nationally; how many such nurses are recorded on the nursing register nationally; and how many children’s nurses are being produced through training.
Results
Findings suggest there are approximately 3 728 children’s nurses across the five countries in this study. A combined total of 260 children’s nurses are produced through training each year across the five countries on average. Survey responses, interview data and content analysis of items identified through the scoping review suggest that adequate information regarding the children’s nursing workforce is not currently available to inform decision-making.
Conclusion
In conclusion, it is hoped that the data generated might contribute towards identifying the size of the children’s nursing workforce, as a first step towards identifying what would represent a viable and sustainable regional children’s nursing workforce for the future.
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Switala, Juli. "Evaluation of children with haemophagocytic lymphohistiocytosis (HLH) at Red Cross War Memorial Children's Hospital 1991-2010." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/11104.
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Includes bibliographical references.Haemophagocytic Lymphohistiocytosis (HLH) is a rare haematological disorder in children. However, this is probably an underestimation due to the difficulty in diagnosing the disease. HLH is characterized clinically by persistent fevers, organomegaly, cytopaenias and typical biochemical derangements viz. hypertriglyceridaemia, hyperferritinaemia and hypofibrinogenaemia. Other associated findings include decreased natural killer cell (NKC) function and raised soluble CD 25. The exact pathophysiology of HLH is not completely understood but involves a trigger (often an infection) which sets off an uncontrolled inflammatory cascade, characterized by an increase in hyperactivated macrophages and T lymphocytes which leads to increased production of cytokines, alongside reduced cellular cytotoxicity as a result of reduced or absent NKC function.
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Browde, Kate. "Indication for and outcomes of continuous Positive Airways Pressure (CPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) in children admitted to Red Cross War Memorial's Hospital (RCWMCH) excluding those with primary respiratory aetiologies." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25195.
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Aim: Noninvasive Continuous Positive Airway Pressure (nCPAP) and High Flow Nasal Cannula oxygen therapy (HFNC) are non-invasive ventilation (NIV) modalities appropriate for children in developing countries. There is minimal literature describing nCPAP and HFNC use in children with respiratory compromise secondary to non-pulmonary disease. This study aimed to describe the characteristics and outcomes of all children without primary lung pathology, who received nCPAP and HFNC during their admission to Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods: This was a prospective observational study of routinely collected data, between August 2015 and January 2016. Primary and secondary outcome measures were NIV failure (progression to intubation and invasive ventilation) and Paediatric Intensive Care Unit (PICU) admission respectively. Comparative statistics were conducted using Mann-Whitney U tests. Data significantly associated with the primary and secondary outcomes on univariate analysis were entered into backward stepwise logistic regression models to determine independent predictive factors. Results: There were 31 cases of nCPAP and one case of HFNC use in 31 patients (median (IQR) age 3.5 (1.8 – 7.6) months. The majority (n=23; 71.9%) presented with primary diarrhoeal disease. There were two deaths (6.5%), 17 (53.1%) Paediatric Intensive Care (PICU) admissions, and five (15.6%) cases received invasive ventilation (NIV failure). Median (IQR) duration of hospital stay was 11.50 (6.0 – 17.5) days. Patients who failed NIV had lower admission SaO2 than those without treatment failure (95 (95-99)% vs 100 (100-100)%; p = 0.03). On multiple logistic regression, lower temperature (OR 0.19; 95% CI 0.05 – 0.78; p = 0.02) and receiving inotropes in the emergency setting, (OR 23.05; 95% CI 1.64 – 325.06; p = 0.02) were independently associated with PICU admission. Conclusions: nCPAP is used clinically for the management of children with respiratory compromise secondary to non-pulmonary illnesses, particularly diarrhoeal disease. Larger controlled clinical studies are needed to determine the effectiveness and utility of nCPAP in this population. HFNC was not commonly used, and this modality requires further investigation in this population.
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Wicht, Carl Bryce. "Development and validation of a questionaire as a screening tool for developmental disability in 9 month old infants : September 1996 - January 1997." Master's thesis, University of Cape Town, 1999. http://hdl.handle.net/11427/26767.
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In the past two decades major focus has been placed on child's rights, survival and development. This has occurred both on an international level and, since the inception of the Government of National Unity (GNU) in South Africa, nationally, provincially and locally through various development programmes. Development in a child concerns the sequential acquisition of cognitive, motor and social skills. Adverse biological and environmental factors will have a major negative impact on a child's development. It is therefore crucial that children affected by these adverse factors are identified as early as possible, to prevent disability or facilitate intervention to ensure that they reach their maximum developmental potential. The global prevalence for developmental disability (DD) is 7-10% of the population. The national prevalence for South African children is not known but a recent Disability Survey by the Department of Health in 1998 quotes 5. 7% - 6.1 % for the overall population. Developmental disability is therefore an important priority to be addressed, especially at the primary health care level. This has been highlighted in the White Paper on Integrated National Disability Strategy of the GNU in 1997. The efficacy of intervention for developmental disabilities is debated. Scientifically this efficacy has not been proven unequivocally but there is consensus from parents, professionals and advocacy groups that early intervention is beneficial. Taken that early identification is essential, screening is the ideal method in the South African context for detection of developmental disability. There are numerous screening tools used for this purpose which need to fulfil certain criteria to ensure effectiveness. Important issues around existing developmental screening tools have been: time taken to administer the test; reliability, validity and sensitivity; measurement methods; ease of administering; and applicable age range. Questions which record parents' or caregivers' observations of their child's developmental skills have been used as effective screening tools for developmental disability. A large study which assessed prevalence of disability using a "Ten Question" format has been used extensively in Bangladesh and found to be effective. A 10-question tool was developed to screen for developmental disabilities in 9-month-old infants, the age of attendance at clinics for measles immunisation. The questions focused on the four areas traditionally tested in developmental assessments, namely speech and hearing, gross and fine motor, vision and personal/social functions. Other factors such as weight, head circumference, dysmorphic features and chronic illness were documented concurrently. The 9-month screening tool in this study was tested at Site B Clinic (Khayelitsha) and Eastridge Clinic (Mitchells Plain) and extended to high risk clinics such as the Neonatal Elevated Risk, Cerebral Palsy and Developmental Clinics of Red Cross War Memorial Children's Hospital. This was a prospective observational study. 235 9-month-old infants were seen between the period September 1996 to January 1997. The interviews were conducted in Xhosa (53%), Afrikaans (28%) and English (19%). The questionnaire was administered to the parent or caregiver of each infant. This was followed by an examination and neurodevelopmental assessment of the infant. On assessment 192 infants (82%) had no disability, 39 (16%) had developmental disability and 4 (2%) were at risk for motor disability. A further analysis of the 39 infants with developmental disability revealed that 25 (64%) were language impaired only, 2 (5%) were motor disabled and 12 (31%) were globally disabled (i.e. in both language and motor areas). Males and females were equally affected. The results showed that the 9-month screening questionnaire is a valid tool for the screening for developmental disability. The overall sensitivity of the questionnaire was 97.7% (95% Confidence interval [CI] of 95.8 - 99.6) and specificity 88.5% (95% CI of 84.4 - 92.6). The positive predictive value was 65.6% and negative predictive value 99.4%. Only one infant who was at risk for motor disability was missed by the questionnaire. On evaluation of the questions in specific areas (i.e. speech, hearing, motor, vision, squint), the numbers assessed were too small for meaningful analysis. As personal and social development involves motor, language and hearing skills, this area was not used on its own in the overall assessment of the infant, but those questions were incorporated into other areas of the screen. Of concern was that a number of infants screened positive for DD on certain questions (e.g. language), but on assessment were found to have disability i n a different developmental area (e.g. motor). In these cases, the questionnaire identified the children with disability - but for the incorrect reason. Certain issues would need to be addressed prior to implementation of the screening tool to ensure an adequate, appropriate screening procedure and prevention of falsely raising the expectations of parents. This involves personnel training, monitoring of screening, referral mechanisms, intervention once DD is identified and involvement of the family as a partner in the process.
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Webb, Nicholas Guy. "Assessment 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." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27083.
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Background: 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.
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Hendricks, Lesley Jill. "An analysis of the phenotypic features of chromosomes 22q11.1 deletion syndrome at Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29805.
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Chromosome 22q11.2 deletion syndrome (22qDS) is an inherited autosomal dominant disorder. It is the second most commonly occurring syndrome, Trisomy 21 being the most common. It is the most common microdeletion syndrome. The clinical range of features with which affected individuals present is very broad and includes congenital heart disease (particularly conotruncal malformations), palatal abnormalities, characteristic facial features, and learning difficulties. In total, there are more than 180 different phenotypic features associated with 22qDS. Due to the wide variability of phenotypic features that can arise in 22qDS it is often difficult to know when to test for the syndrome. Oskarsdottir’s criteria are widely used in clinical recognition for 22qDS. However, in a study done previously at Red Cross War Memorial Children’s Hospital, this same criteria was found to only have a positive predictive value of 14% for 22qDS. This is likely due to the fact that Oskarsdottir’s study was based on a largely Caucasian study population. Our population in Southern Africa is largely non-Caucasian. Previous studies have confirmed that non-Caucasian population groups with 22qDS have different presenting phenotypic features. For this reason, in this study we sought to describe the typical phenotypic features with which children with 22qDS present in our local population in South Africa. A retrospective folder review was done of the phenotypic features of all patients who had had a FISH test done on the suspicion on 22qDS. A total of 144 patient folders were reviewed (72 patients who were FISH positive for 22qDS and 72 patients who were FISH negative and functioned as the control arm of this study). A review on the phenotypic features of children with 22qDS revealed the most common presentation to be congenital heart disease (44%), failure to thrive (33%), dysmorphic features (32%) and cardiac failure (25%). A positive family history was only noted in 13 patients. Of those patients with a positive family history of 22qDS, only 5% were proven FISH positive for 22qDS themselves (less than the 10% described in the literature). Younger children presented more frequently with CHD, while older children presented with developmental delay and dysmorphic features. In general, developmental delay, palatal abnormalities and feeding difficulties were less common in our study population than described in the literature. Our particular patient population presented with the following CHD: isolated VSD (46%), tetralogy of Fallot (20.8%), truncus arteriosus (14.5%), PS/pulmonary artery stenosis (20.8%) and interrupted aortic arch (6%). Interrupted aortic arch was found to be the most sensitive marker for 22qDS in children with cardiac lesions. The cardiac lesions with the highest positive predictive value for 22qDS was non-isolated VSD (54%). Dysmorphic features with the highest sensitivity for 22qDS included bulbous nose (75%), abnormal digits (64%) and posteriorly rotated ears (68%). Primary immune deficiency, thymus abnormalities, cleft palate and behavioural issues were described less in this study than previously described in the literature. In conclusion, it is clear that non-Caucasian populations have some unique phenotypic expressions of 22qDS. It is imperative that clinicians maintain a high index of suspicion for patients with 22qDS.
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Daniels, Adriaan. "Examining the reliability of discharge ICD coding in the Red Cross War Memorial Children's Hospital administrative database." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29811.
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Background: Discharge diagnostic data from hospital administrative databases are often used to inform decisions relating to a variety of vital applications. These may include the allocation of resources, quality of care assessments, clinical research and for the formulation of healthcare policy to name a few. Having accurately coded and reliably captured discharge data for patients is of paramount importance for any hospital and health system to function efficiently. Objectives: 1. Retrospectively examine the reliability of the ICD discharge coding in the Red Cross War Memorial Children’s Hospital (RCWMCH) administrative database for primary and secondary discharge diagnoses. 2. Formulate recommendations for improvement to the current system. Methods: This study was a retrospective folder review of 450 patient admissions to the short stay and general paediatric wards at the RCWMCH between 1 August 2013 and 1 September 2014. International Classification of Diseases version 10 (ICD-10) discharge coding was completed for each admission by the principal investigator and compared with the corresponding admission data captured for each patient within the Clinicom® Health Information System. Agreement comparison was done to both four-character and three-character ICD-10 code specificity. Results: Of the initial 450 randomly selected folders, 396 (88%) were analysed during the folder review process. The median number of total diagnoses (primary diagnosis plus secondary diagnoses) coded by the principal investigator (PI) folder review was 3 with a distribution of 1 to 10 (IQR 2 - 4). The median number of total diagnoses coded in Clinicom® was 1 with a distribution of 1 to 3 (IQR 1 - 1). Agreement of primary diagnosis coding to four characters was 26.3% with slight improvement to 34.3% when assessed to three characters. Agreement for secondary diagnoses to four characters was 14.9% and 27.7% when assessed to three characters. Conclusion: Reliability of administrative discharge data from RCWMCH is poor. Inadequacies with regard to the employment of dedicated and/or adequately trained coding personnel may be significant contributors to the problem.
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Sher, Rebecca Yael Nthabiseng. "Patterns of Detectable Viral Load in a cohort of HIV-infected adolescents on antiretroviral therapy." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29716.
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Background
Despite improved treatment and access to care, adolescent AIDS deaths are decreasing more slowly than in any other age group. There is lack of longitudinal data around adolescent adherence and the dynamics of viraemia over time. We aimed to describe patterns of detectable viral load in a cohort of adolescents attending an antiretroviral clinic in Cape Town, South Africa.
Methods
We conducted a retrospective cohort study of all patients on ART aged 10-19 years. Participants were included if they underwent at least two HIV viral load (VL) measurements and attended the Groote Schuur Hospital HIV Clinic for at least 24 months between 2002 and 2016. The primary outcome was two consecutive VL >100 copies/ml, in line with the lower limit of detection of assays in use over the follow-up period.
Results
Of 482 screened subjects, 327 met inclusion criteria. Most subjects were vertically infected (n= 314; 96%), and 170 (52%) were male. Overall, 203 episodes of confirmed detectable VL involving 159 (49% [95% CI 43%–54%]) subjects were experienced during the follow-up period. A total of 111 (34%) subjects never experienced detectable VL, while 16 (5%) never suppressed throughout the follow-up period. Median age at first detectable VL was 14 (IQR 11-16) years. Of the 159 subjects who experienced detectable VL, 102 (64%) re-suppressed, of which 38 (37%) had a subsequent detectable VL. Six subjects had genotyped resistance to protease inhibitors. Four of these never suppressed, while two suppressed on salvage regimens. Total follow-up time was 1723 person years (PY), of which 880 (51%) were contributed by the 159 subjects who experienced detectable VL. Overall time with detectable VL was 370 PY. This comprised 22% of total follow-up time, but 42% of the follow-up time contributed by those who experienced detectable VL. The rate of detectable VL was 11.8 (95% CI 10.3–13.5) episodes per 100 PY. The risk increased by 24% for each year of increasing age (RR 1.24 [95% CI 1.17-1.31]; p< 0.0001). Neither prevalence, duration nor rate of detectable VL was influenced by gender.
Conclusion
Detectable VL was seen in nearly half of adolescents, with the rate increasing with age. Viraemia was not a static process, and adolescents moved in and out of this state as adolescence progressed. Further study is warranted to correlate these findings with risks and clinical outcomes.
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Le, Roux David Martin. "Incidence of bacteraemia in HIV-infected children in Africa, and the impact of highly active antiretroviral therapy." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/11483.
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Includes abstract.Includes bibliographical references.
From November 2002 to December 2006, a placebo-controlled, randomized trial investigated the incidence of tuberculosis and the overall mortality in a cohort of HIV-infected children in Cape Town, South Africa. They were randomized to receive either Isoniazid Preventive Therapy (IPT) or placebo. In addition, they were randomized to receive trimethoprim/sulfamethoxaxole prophylaxis on either a daily or a three-times-per-week schedule. The aim: To describe the incidence of bacteraemia, and the spectrum of organisms cultured. To determine if there was a difference in the incidence of bacteraemia between children using Isoniazid Preventive Therapy (IPT) versus placebo; and to determine if there was a difference in the incidence of bacteraemias between the groups using daily versus thrice-weekly trimethoprim/sulphamethoxazole prophylaxis.
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Machingaidze, Pamela Rudo. "The clinical use and indications for head computed tomography scans in paediatric ambulatory care (short stay ward and medical emergencies) at a children’s hospital over a one-year period, 1st January-31st December 2013." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29345.
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Background: Computed tomography (CT) imaging is an indispensable tool in the management of acute paediatric illness. It offers quick answers, allowing timely lifesaving decision-making. Clinical evidence is required to maximise its benefits against radiation-exposure risks to patients and cost to the healthcare system.
Aims: The study aimed to retrospectively investigate clinical presentation and indications of head CT at a tertiary paediatric hospital.
Methods: Records of children presenting with acute illness to the medical emergency unit, excluding trauma, of Red Cross War Memorial Children’s Hospital, Cape Town, over one year (2013) were retrospectively reviewed. Participants were included if they underwent head CT scan within 24 hours of presentation. Clinical data were extracted from records and CT findings reported by a paediatric radiologist.
Results: Inclusion criteria were met by 311 patients; 188 (60.5%) were boys. The median age was 39.2 (IQR 12.6-84.0) months. Commonest indications were seizures (n=169;54.3%), reduced level of consciousness (n=140;45.0%), headache (n=74;23.8%) and suspected ventriculoperitoneal shunt (VPS) malfunction (n=61;19.7%). In 217 (69.8%) patients CT showed no adverse findings. In the 94 (30.2%) patients in whom CT abnormalities were detected, the predominant findings were hydrocephalus (n=54;57.4%) and cerebral oedema (n=29;30.9%). Abnormal CT findings were commoner in patients with nausea or vomiting (n=21;9.3%, p=0.05) papilloedema (n=3;1.3%, p=0.015) and long tract signs (n=23;10.2%, p=0.02). Forty-seven patients (15.1%) required surgical intervention after CT of which 40 (85.1%) needed a ventricular drainage procedure. A larger proportion of patients with VPS (25/62;40.3%) required surgical intervention compared to patients without VPS (22/249;8.8%, p <0.001)
Conclusion: Most children presenting with acute illness (excluding trauma) and undergoing emergency head CT have normal findings. Patients with ventriculoperitoneal shunts constituted a large proportion of patients requiring intervention after CT. Considerations should be made to use clinical presentation to select patients most likely to benefit from CT.
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Westwood, Anthony Thomas Read. "Cystic fibrosis in children and adolescents in the Western Cape : epidemiological and clinical aspects." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/10745.
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Includes bibliographical references (leaves 284-314).Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by mutations on chromosome 7 in the gene for the CFTR protein. This gene encodes for a chloride channel on the apical surface of certain epithelial cells. The clinical manifestations of CF largely arise out of the resultant defect in water and electrolyte secretions in exocrine glands and epithelia such as are found in the pancreas, respiratory, gastrointestinal and genital tracts and sweat glands. First delineated as a clinical entity in the mid-20th century, CF was shown to be identifiable through the demonstration of elevated electrolyte levels in sweat - the sweat test. After many false starts, the underlying genetic defect was identified in the 1980s, culminating in the identification of the defective gene in 1989. This opened up possibilities of more accurate diagnosis and targeted treatments. Treatment of CF with pancreatic enzyme replacement therapy and antibiotics in the 1950s proved successful in controlling some of the severe and often fatal aspects of the disease. Further refinements to nutritional and antimicrobial therapies in the 1970s and 1980s produced rapid increases in longevity in many patients with CF. In SA, CF' has been identified since the 1950s. Clinical and research activities developed in the 1980s, mainly focused on the epidemiological and genetic aspects. Two clinical studies described features in children in Cape Town and adults in Johannesburg. My own clinical involvement in the RCCH's CF Service in Cape Town since 1992 led to the research activities that make up the bulk of this thesis. The thesis describes a number of aspects of CF as it affects patients in SA. The study population (described in Chapter 2) for most of the projects consists of 181 CF patients born between October 1974 and September 2003 who were identified by a combination of clinical features, positive sweat or genetic tests and/or post-mortem findings. All were resident in the Western Cape Province and received at least part of their health care at the RCCH. One hundred and sixty (88%) were born in the province and 21 settled in the province from elsewhere. Cape Town is unique in SA for its population demographics and the CF patients reflect this. CF has mainly been identified in coloured and white patients. Four black cases have been diagnosed. Compared with the CF population as described in the early 1980s, the CF population in the 21st century is larger (100 versus 64), older and there is a greater proportion of coloured patients. Nearly 3 in every 4 patients live in Cape Town.
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Wege, Martha Helena. "A retrospective review of the prevalence and management of anaemia in children in at Red Cross War Memorial Children's Hospital." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19898.
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Includes bibliographical referencesIntroduction Childhood anaemia is a major public health problem, iron deficiency being most common. WHO estimates anaemia to occur in 24.1% of pre-school South African children. Our study describes prevalence and management of anaemia in children aged 6 - 36 months presenting to a children's hospital. Methods In a retrospective cross-sectional study, laboratory data were used to estimate prevalence of anaemia in children aged 6 - 36 month presenting to medical emergency or ambulatory services of Red Cross Children's Hospital in 2012. A random sample of 50% of anaemic children was sampled for detailed review. Results 2661 subjects were included. Anaemia (H b < 10.5) was found in 40.8 % (1088/2661. Children presenting to medical emergency had a higher prevalence of anaemia compared to those presenting to ambulatory services ( 42.7% vs. 34.9 % ; p=0.001 ). Anaemia prevalence increased with decreasing age with RR 1.25 (95% CI 1.10 - 1.43) and RR 1.15 (95% CI 1.02 - 1.31) in children aged 6 - 11 months and 12 - 23 months respectively compared to children aged 24 - 36 months. Microcytosis was found in 51.3% (558/1088) of anaemic children and in 19.3% (n=303/1573) of children without anaemia ; p<0.001 Folders were reviewed i n 502 children with anaemia , 36.1% had mild anaemia (Hb 10 - 10.5g/dl), while moderate ( Hb 8 - 10 g/dl ) and severe ( Hb < 8 g/dl ) anaemia was found in 52.5% and 11.4% respectively. Breastfeeding for longer than six months was associated with higher risk of microcytic anaemia [RR 1.26 (95%CI 1.08 - 1.47)]. Only 12.2 % (31 /254) of children with microcytic anaemia received adequate iron therapy, 50.0 % (127/254) received no iron therapy. Conclusions Prevalence of anaemia in children presenting to hospital is higher than predicted for well children in South Africa. The risk is higher in younger and acutely sick children. Prolonged breasting is associated with increased risk of microcytosis. Most children with suspected iron deficiency anaemia did not receive appropriate treatment.
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Reddy, Deveshnee. "Acinetobacter baumannii infections in the paediatric intensive care unit of a tertiary hospital in South Africa." Master's thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/13974.
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Acinetobacter baumannii (A. baumannii) is now increasingly recognised as an important cause of nosocomial infections in paediatric intensive care unit (PICU) patients, particularly in developing countries, where it contributes significantly to morbidity and mortality. Furthermore, it has been documented that emerging antimicrobial resistance patterns complicate antibiotic choice in these patients. At present, more paediatric data is needed regarding these infections. This is a retrospective case-control study that aims to document the demographic data and relevant clinical details of patients in whom A. baumannii was cultured, either from blood or respiratory specimens (thus including both infections and colonisation), in the PICU at Red Cross War Memorial Children's Hospital (RCWMCH) during 2010. Secondary objectives include comparing these patients with those in whom A. baumannii was not cultured and determining which isolates were causing infection and which were colonisers. In addition; of the isolates regarded as infections, documenting the antimicrobial sensitivities and resistance of the organisms cultured, determining whether infections were late or early onset and determining whether specific bed numbers were consistently involved.
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Lampel, Netanya. "Screening of the human tumor necrosis factor (TNF) gene and its receptor 1 (TNFR1) gene for DNA alterations and the subsequent investigation of these and an IL12p40 polymorphism for an association with paediatric tuberculosis." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/8628.
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Includes bibliographical references (leaves 85-96).Infection with Mycobacterium tuberculosis is characterised by diverse outcomes; the majority of infected individuals remain well and yet others develop disease ranging from limited pulmonary tuberculosis to severe disseminated disease. The reasons for this diverse outcome are poorly understood, but host factors are thought to play an important role. In particular, a genetic component to susceptibility to tuberculosis has been proposed. An important clue was the description of a group of Maltese children with an unusual susceptibility to progressive non-tuberculous mycobacterial infections. These patients showed defective tumor necrosis factor (TNF) production in response to endotoxin and a failure to upregulate TNF production in response to interferon gamma as well as diminished interferon gamma production during T-cell proliferation. They were found to lack expression of the interferon gamma receptor ligand-binding chain (IFN-yR1) on their cell surfaces due to a single point substitution resulting in a truncated protein. Since then other defects in the type 1 cytokine pathway leading to susceptibility to non-tuberculous mycobacteria, as well as to tuberculosis, have been described in rare isolated cases. From these findings, the hypothesis arose that less severe mutations in such pathways might individually, or in combination, lead to increased susceptibility to tuberculosis in the general population. The following study forms part of a larger multi-centre collaboration, which aims to better understand the genetic basis of susceptibility to mycobacterial infection by addressing this hypothesis. The approach taken has been the recruitment and immuno-phenotyping of a large group of children with tuberculosis as well as control subjects. Candidate genes, of the type 1 cytokine pathways being investigated, include interferon gamma, interleukin12 and their receptors and TNF. The focus of the study described in this thesis has been the screening of a sub-cohort of patients and control subjects for DNA sequence alterations in the TNF and TNFR1 genes. The individuals in this cohort were selected on the basis of their whole blood stimulation assays, where either high or low levels of TNF in response to non-specific stimulatory factors, were the determining criteria. It was assumed that these two phenotypic groupings would be enriched for gene variants contributing to the TNF responses recorded in the stimulation assays. Once identified, these polymorphisms would be screened for frequencies in the broader patient and control groupings and assessed for any association with susceptibility to tuberculosis. This study was considered important in attempting to explain which genes and their polymorphisms are involved in determining the high prevalence of tuberculosis in African populations.
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Robertson, Gillian. "Hypernatraemic gastroenteritis in critically ill children." Master's thesis, University of Cape Town, 2005. http://hdl.handle.net/11427/9261.
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Levin, Lindsey Nicola. "Biliary atresia at Red Cross War Memorial Children's Hospital: A retrospective descriptive study reviewing the age of presentation, clinical course and outcome of infants presenting to RCWMCH with biliary atresia." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22822.
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Background: Biliary atresia (BA) is a progressive obstructive cholangiopathy of unknown aetiology, occurring during the perinatal period. If left untreated it rapidly progresses to hepatic fibrosis and cirrhosis, with death occurring within 2 years. It is the leading cause of end-stage liver disease in the paediatric population and remains the most common indication for paediatric liver transplantation in South Africa. Objectives: Despite a wealth of information from developed countries, very little information is available in Africa and other developing nations. This study aimed to describe the age of presentation, clinical course and outcome of infants presenting to Red Cross War Memorial Children's Hospital (RCWMCH) with BA. Methods: A retrospective folder review was conducted on all patients with BA presenting to RCWMCH between January 2003 and December 2013. The main outcomes assessed were median time to presentation to tertiary services, clearance of jaundice post Kasai procedure (bilirubin <20μmol/L) and 2- and 5-year overall survival (OS) and survival with native liver (SNL). Results: The median age at presentation in the 80 cases reviewed was 70 days. Kasai procedure (KP) was performed in 62 (77.5%) patients at a median age of 68 days. 18 patients who presented late did not undergo KP. Clearance of jaundice was achieved in 39% of KPs. 13 patients underwent KP beyond 90 days with a success rate of 38%. 2- and 5-year SNL rates were 41% and 37.5% respectively with OS of 59% at 2-years and 56% at 5-years. Liver transplant was only performed in 12 of the 54 patients who showed progression to require transplantation. Conclusions: Jaundice clearance post KP and SNL compared favourably with international figures, however, lower overall survival rates reflected lack of access to transplantation. Age at KP was not a predictor of poor outcome.
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Hutton, Hayley. "Clinical features and outcome of patients with severe lower respiratory tract infection admitted to a Paediatric Intensive Care Unit in the Western Cape, South Africa." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/24501.
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Objective: Acute lower respiratory tract infection (ALRTI) remains an important cause of childhood morbidity and mortality in low and middle income countries (LMIC). This study aims to describe the clinical features of children admitted to a Pediatric Intensive Care Unit (PICU) with severe ALRTI and to investigate risk factors, clinical course and in-hospital outcome. Design: Retrospective cohort study Setting: Red Cross War Memorial Children's Hospital, Cape Town, South Africa Patients: 265 children (0-12years) admitted to the PICU during 2012 with a primary diagnosis of ALRTI. Intervention: None. Measurements and main results: 265 patients [median (interquartile range, IQR) age 4 months (2-12months)] were admitted with ALRTI, 157(59.3%) were male. Co-morbid disease was present in 102(38.5%) including cardiac disease in 42(15.9%) or tuberculosis in 7(6.4%) . While only 27(10.2%) were HIV infected, 87(32.8%) children were HIV exposed. The in-hospital mortality was 34(12.8%); 24(9.1%) died in PICU and a further 10 in the medical wards following discharge from PICU. The median duration of ICU and hospital stay was 4.0 days (2.0-8.0) and 12.5 days (7.9-28.0) respectively. Most [192 (72.5%)] children required invasive ventilatory support, while 42 (15.8%) patients required cardiac inotropic support. Risk factors for mortality included severe malnutrition (Odds ratio (OR) 8.25; 95% CI 1.47- 46.21); informal housing without access to piped water and/or electricity (OR11.87; CI 1.89- 20.81); or need for inotropic support (OR 44.35; CI 8.20-239.92). HIV exposure or infection was associated with a significantly longer duration of hospital stay (p=0.002). Conclusion: Severe ALRTI occurs predominantly in young infants and is associated with a high mortality. Several sociodemographic risk factors impact on the risk of severe disease and poorer outcome.
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Thomas, Karla Mari. "Bacterial meningitis in neonates and children South Africa." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/10743.
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Includes bibliographical references.Acute bacterial meningitis is defined as the inflammation of the meninges. It is caused by various bacteria and the specific aetiology is age dependant. In the neonatal period the causative organisms are: Group B streptococci, Gram - negative bacilli (e.g.: E. coli, Klebsiella spp, Enterobacter spp, Salmonella spp) and Listeria monocytogenes. In infants and children up to the age of 5 the most common causative organisms include: Streptococcus pneumoniae, Haemophilus influenzae type B (Hib)and Neiseria meningitidis. The two chief causes of bacterial meningitis in children older than 5 are S. pneumoniae and N. meningitidis. Various studies have been performed to look at the profile of meningitis among the paediatric population. Objective: To investigate the aetiology of acute bacterial meningitis in South African newborns and children from 2005 - 2010.
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Chippendale, Sa-Eeda. "Severe allergic reactions at a tertiary paediatric service 2014 - 2016." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29566.
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Introduction: Anaphylaxis is a severe, life-threatening generalized hypersensitivity reaction. The European Anaphylaxis Registry was established to review and improve medical management of these patients, facilitate accurate comparisons between centres, highlight public health implications, and examine trends in treatment over time. This is replicated here in a South African setting. Methods: Participants comprised patients treated at Red Cross War Memorial Children’s Hospital (RCWMCH) for severe allergic reactions between January 2014 and August 2016. Recruitment was by applying relevant ICD- 10 coding to the hospital’s clinical summary system of admissions and discharges, the pharmacy’s records of adrenaline autoinjector dispensing, and referrals from the allergy department’s clinical staff. Participants who were screened but did not meet inclusion criteria after preliminary questioning and/or folder review were excluded. 156 episodes were analyzed. A local web-based registry was established, and used to capture data collected via a questionnaire in interviews at the RCWMCH Allergy Clinic. Results: Males, younger children, and participants of coloured ethnicity were more frequently affected. Skin and mucosa was most commonly involved, followed by respiratory and gastrointestinal upset, with cardiovascular and other systemic involvement occurring infrequently. More than 40% of episodes were graded as severe. Specific IgE was the most frequently requested testing. Nearly two-thirds of patients were seen with a recurrent episode. Food-related triggers predominated and decreased with age: particularly peanut, hen’s egg, fish, cashew nuts and cows’ milk. There was a strong correlation with atopic conditions, in excess of international trends. 3 Adrenaline was rarely used, by both lay persons when previously prescribed, and by professional attenders. Hospital admissions were infrequent, and no deaths were recorded. Prophylactic measures were almost universally instituted, but the success thereof could be improved. Conclusion: This is the first local comprehensive description of anaphylactic trends. Further areas of research are suggested: to investigate the propensity for allergic reactions in the coloured population, our much higher rate of association with other atopic disorders compared to international patterns, comparison of our baseline comorbid conditions for contextual analysis, and a review of barriers to care. Ongoing education and training to patients, parents, teachers, and health care workers is identified as a major area requiring intensification.
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Vandenbroucke, Natalie Joëlle. "Lung function determinants and mortality of children and adolescents with cystic fibrosis in South Africa 2007-2016." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31782.
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Objectives: Cystic fibrosis (CF) is one of the commonest inherited disorders in South Africa, affecting all population groups. Progressive pulmonary disease with declining forced expiratory volume in one second (FEV1) is the main predictor of morbidity and mortality in individuals with CF. This study aimed to describe the change in lung function, nutritional status and mortality of children and adolescents with CF, attending the Red Cross War Memorial Children’s Hospital (RCWMCH) CF Clinic and to identify factors associated with poor pulmonary function outcomes and mortality. Methods: A retrospective study was conducted of the clinical records and annual pulmonary function tests, with matched body mass index (BMI), of children between 5 and 18 completed years of age attending the RCWMCH CF clinic in Cape Town, South Africa, between January 2007 and December 2016. Results: A total of 143 study participants (51.4% male; median age at diagnosis 5.5 months) were included. Population mean FEV1 and body mass index (BMI) Z scores improved from -2.5 1.70 to -1.9 1.70 (p = 0.1) and from -0.7 1.2 to -0.4 1.2 (p = 0.3) respectively from 2007 to 2016. FEV1 Z score declined by an average of 0.17 per year of age and this was mirrored by an average decline in BMI Z scores of 0.07 for each year of advancing age. FEV1 decline was greater in patients who died compared to those who survived (p = 0.03). Of the factors postulated to influence lung function decline, there was no significant correlation between FEV1 at any age and age of diagnosis, sex, ethnicity, genotype, geographical location, pancreatic status, or Methicillinresistant S. aureus or Aspergillus spp. infection. Participants who were ever infected or colonised with P. Aeruginosa had consistently lower FEV1, however this difference only became significant at certain ages. On multiple stepwise regression analysis, only FEV1 at age 6 was found to be a significant independent predictor of mortality (adjusted odds ratio (95% CI) 0.5 (0.3 – 0.8); p = 0.005). Conclusion: Pulmonary function of children with cystic fibrosis improved non-significantly over the 10-year study period. FEV1 at age 6 was identified as an independent predictor for CF-related mortality. Early diagnosis and measurement of pulmonary function in young children with CF is essential to identify children at risk of poor outcomes.
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Hatherill, Mark. "Transport of critically ill children in a resource-limited setting." Master's thesis, University of Cape Town, 2001. http://hdl.handle.net/11427/10987.
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Includes bibliographical references.Transportation of critically ill children by inexperienced personnel may be associated with increased risk of transfer-related adverse events and mortality. To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting. Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective one-year audit of all children transferred directly to PICU from other hospitals. Data were collected for patient demographics and diagnostic category, referring hospital, transferring personnel, mode of transport, and the incidence of technical, clinical, and critical adverse events. Data are median (interquartile range, IQR). The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed.
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Copelyn, Julie. "Short-term outcomes of downreferral in provision of paediatric antiretroviral therapy at Red Cross War Memorial Childrens Hospital, Cape Town." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22761.
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Background: The large scale-up of paediatric HIV care necessitated down-referral of many children receiving antiretroviral therapy (ART) from Red Cross War Memorial Children's Hospital (RCWMCH). No published data exists on the outcomes of these children. Objectives: To assess clinical, immunological and virological outcomes of children receiving ART in the first 12 months after down-referral to primary health care (PHC) clinics, and identify determinants of successful down-referral. Methods: We conducted a retrospective cohort study of children <15 years of age who commenced ART at RCWMCH and were subsequently down-referred to one of two PHC clinics between January 2006 and December 2012. Baseline characteristics of patients and caregivers as well as CD4 counts, viral loads and weights were collected at 6 and 12 months post-down-referral. Outcomes included retention in care and viral suppression. Results: One hundred and sixteen children down-referred to Heideveld and Gugulethu were included. After down-referral 13.8% of the cohort never arrived at the designated clinic and 10% took longer than 8 weeks, therefore probably experiencing treatment interruption. At 12 months post down-referral only 68.2% remained in care at the designated clinics. No factors were associated with retention in care. For those children who remained in care at the PHC clinics, the clinical and immunological gains achieved prior to down-referral were sustained through 12 months of follow up, and 54.7% of the retained cohort had documented viral suppression at 12 months. Conclusion: Down-referral of children on ART is a vulnerable process with risk of loss to follow-up and treatment interruption.
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Mukuddem-Sablay, Zakira. "Adenovirus-associated pneumonia in South African children : presentation, clinical course and outcome." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/16697.
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Includes bibliographical referencesBackground: Pneumonia is an important cause of morbidity and mortality in children. Viruses have emerged as important aetiological agents in childhood pneumonia. The aim of this study was to document the clinical presentation, severity and outcome of adenoviral-associated pneumonia (AVP) in children and identify risk factors associated with poor outcome. Methods: A retrospective study of laboratory-confirmed AVP cases was conducted between 1 January and 31 December 2011. The medical records of adenovirus PCR positive respiratory tract samples identified through the National Health Laboratory Service (NHLS) database were retrieved. Demographic, clinical and outcomes data of children with AVP were extracted and analysed. Outcome measures were death and development of chronic lung disease (CLD). Results: 1910 respiratory samples were submitted to the NHLS from which 206/1910 (11%) AVP cases were identified. The median age was 12 months (IQR 6-24), 70 (34%) children were malnourished and 14 (7%) HIV-infected. Fever was the commonest presenting symptom occurring in 159 (77%) of cases. Seventy six (37%) required intensive care unit (ICU) admission. There was a high prevalence of co-morbid conditions with 98 (47%) having at least one; cardiac disease was the most common (48 (23%). Twenty nine (14%) developed CLD which was associated with hypoxia at presentation (26/29, 90%, p = 0.01) and admission to ICU (18/29, 62%, p < 0.01). Eighteen (9%) children died. Admission to ICU (OR 8.3, 95% CI 2.3-29.0) and blood stream infection (OR 11.2; 95% CI 2.3-54.1) were independent risk factors for mortality. Conclusion: Adenoviral-associated pneumonia is an important cause of pneumonia and CLD in young children in South Africa. Admission to ICU and blood stream infection were associated with poor outcome
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Frigati, Lisa Jane. "The impact of isoniazid preventative therapy and antiretroviral therapy on tuberculosis (TB) in HIV-infected children in a high TB incidence setting." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10467.
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The aim of this study is to investigate the combined effect of IPT [INH preventative therapy] and ART [antiretroviral therapy] on TB incidence in HIV-infected children. A cohort analysis will be performed using data from a prospective, double-blinded placebo controlled trial of INH versus placebo in HIV-infected children in Cape Town, South Africa.
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Moore, David Paul. "Aspect of tuberculosis case management at Red Cross Children's Hospital." Master's thesis, University of Cape Town, 2010. http://hdl.handle.net/11427/10863.
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Includes abstract.Includes bibliographical references (leaves 151-165).
Aim: To describe the spectrum of tuberculosis in children <15 years of age attending Red Cross War Memorial Children's Hospital between January 2006 and December 2008. Methods: A retrospective review of a paper-based Notifications Register and a database of culture-confirmed tuberculosis were undertaken. Laboratory and clinical data were analysed. Results: 1,314 episodes of tuberculosis were identified amongst 1,300 children. 433 (33%) of all cases were culture-confirmed; however, 120 (27.7%) of all culture-confirmed cases were not recorded in the paper-based Notifications Register. Conclusions: To improve the clinical service, detection of HIV co-infection in children undergoing evaluation for tuberculosis should be enhanced and strategies adopted to ensure that all children with culture- confirmed disease are notified and access antituberculosis therapy.
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Argent, Andrew Charles. "The mechanics of breathing in acute severe croup." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10054.
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Includes abstract.Includes bibliographical references.
Croup is a common respiratory illness that has been recognized for many years. Despite recent advances in the utilization of steroids to treat the condition, it remains a significant cause of morbidity in children. In the developing world it may also remain a significant cause of mortality. Despite comprehensive descriptions of the disease process, its aetiological agents and clinical course, there are very few descriptions of the mechanics of breathing in croup. In addition there are very few methods described of measuring the severity of airway obstruction in patients with croup.
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Van, Dyk Jessi Grace. "Maternal methamphetamine use during pregnancy and subsequent neurodevelopmental and psychological sequelae in the child - a Cape Town experience." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/14814.
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Includes bibliographical references.Methamphetamine, part of the amphetamine group of drugs, was first discovered in Japan in 1919. It has been clandestinely manufactured in the United States since the 1960s, and is still legally produced there as a nasal inhalant, as treatment for Attention Deficit Disorder and exogenous obesity, as well as off-label treatment for narcolepsy. (1) It is a cheap (about R15- 30 per 'straw'), easily obtainable, odourless, white powder, which has a bitter, taste, but dissolves easily in water or alcohol. Known as, amongst others, ' speed', 'ice', 'crystal', 'chalk', 'glass', 'crank', and locally, 'tik', it can be smoked, snorted, orally ingested, injected intravenously or even administered anally. In South Africa the preferred method consists of placing the powder or crystal in a light bulb (from which the metal threading has been removed) and inhaling the fumes produced while heating the bulb from below with a lighter.(2). The use of methamphetamine has risen sharply globally over the last decade, used by 26 million people worldwide by 2007, more than heroin and cocaine combined, according to the United Nations Office on Drugs and Crime. This has been ascribed to many interlocking reasons: it is cheap, easily obtainable, easy to use without the need for needles or other special 'equipment', and it produces in the user a characteristic 'rush'. This feeling of confidence, power and heightened sexual levels, of feeling 'on top of the world' has made it especially popular amongst teenagers and young adults. (3)
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Meyer, Mandy-Lyn. "A review of children admitted to a regional hospital in Cape Town with community acquired pneumonia." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/20297.
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Background: Pneumonia is a leading cause of death in children under - five. Epidemiology in our province at regional level has not been described since 2004, when HAART was rolled out and pneumococcal conjugate vaccination (PCV) was introduced. Objectives: Describe the demographic profile, disease severity, risks for transfer and mortality and the management of children >2 months, admitted with CAP over a one year period. Methods: Retrospective descriptive study of every second patient (>2 months to 13 years) admitted to Somerset Hospital in 2012 with the diagnosis of CAP. Demographic, clinical and outcome data were extracted from hospital records and analysed using STATA®. Results: Of 380 cases reviewed, 90% had severe disease; the median age was 9.4 months (IQR 4.8 - 23). Of these 89 (23%) were LBW (<2500g) and 75 (20%) were born premature. Median age at presentation for these groups was 5.7 months compared with 10.6 months in t erm children ( p=0.0003 ). Forty - one (12%) were severely malnourished; 34 (9%) were HIV - positive. Children below 1 0 /12 were more likely to have incomplete immunisations (57/190, p=0.011). Only 15% of TB - exposed children < 5 years were on Isoniazid Prevention Therapy (IPT). Prevalence of comorbid conditions was high. Median duration of stay was 3 days (IQR 2 - 6); this increased to 6.5 (IQR 4.5 - 9.5) with neurological disease and 6 (IQR4 - 10) with proven RSV. Seventeen patients (4.5%) required transfer to tertiary level. Mortality rate was 0.5%. Conclusion: Preventative measures must focus on populations at risk - LBW and preterm children in first year of life, malnourished children and those with comorbidities like HIV. Immunisation and IPT rates can be improved.
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Mvalo, Tisungane Knox Titus. "Blood stream infections in oncology patients at Red Cross War Memorial Children's Hospital, Cape Town." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27377.
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Background: Infections cause significant morbidity and mortality in children with cancer, which may be related to the cancer or treatment received. There is paucity of data on the epidemiology of bloodstream infection (BSI) in sub-Saharan Africa. To address this knowledge gap, the present study was conducted at Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa. Methods: Structured literature review: From 1 April 2016 to 31 May 2016 a PubMed search was undertaken on BSI in Paediatric Oncology. The search string used was (bacteraemia OR blood stream infection) AND (paediatric OR pediatric) AND (oncology). Studies that did not describe infection patterns, risk factors for infection, morbidity/mortality, articles not in English and those exclusively describing neonatal or ICU patients were excluded from full review. Retrospective cohort study: A retrospective cohort study was conducted at the haematology-oncology unit of RCWMCH. All positive blood cultures from RCWMCH oncology patients taken between 1 January 2012 and 31 December 2014 were retrieved to identify patients who had BSI. Results: Structured literature review: 508 abstracts / articles were initially retrieved and screened. 478 studies were excluded as per the literature review exclusion criteria. Thus, 30 articles were included in full analysis, 17 retrospective studies, 4 prospective multicentre studies, 6 prospective single centre studies, 2 systematic reviews and 1 case report. All were observational studies. This literature review showed that BSI is a frequent and important cause of morbidity and mortality in paediatric oncology. Gram-positive bacteria was noted to be the leading type of pathogen causing BSI. Increased risk of BSI may be from the cancer itself, chemotherapy, hospitalisation, central venous catheter insertion, and oncology patients were at risk of multi-drug resistant infection. Research gaps noted included paucity of studies from Sub-Saharan Africa, limited analysis of the antimicrobial susceptibility of causative microorganisms and limited description of fungal BSI in oncology patients. Retrospective cohort study: From 436 positive blood culture results, 150 BSI episodes were identified amongst 89 patients; 49.1% of the culture isolates were Gram-positive bacteria, 41.6 were Gram-negative bacteria and 9.3% were fungal. Coagulase Negative Staphylococcus and Viridans Group Streptococcus were the most common Gram-positive isolates, and Escherichia coli and Klebsiella species the commonest Gram-negative isolates. The majority of BSI episodes occurred in patients with haematological malignancies (74%), in the presence of severe neutropaenia (76.4%) and whilst on or following chemotherapy (88%). Complications occurred in 14% of the BSI episodes. Fungal infections had the highest prevalence of complications (21.4%). Three children died during BSI as a result of multidrug resistant isolates, giving a case-fatality rate of 2%. Conclusion: The findings of our cohort study show that BSI are mainly caused by Gram-positive bacteria and associated with a low case-fatality rate. The results of this study are consistent with worldwide experience of BSI in paediatric oncology patients. This study provides an understanding of the spectrum of organisms causing BSI and the outcome of BSI in a sub-Saharan African context.
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Ayuk, Adaeze Chikaodinaka. "Environmental risk factors for asthma in 13-14 year old African children." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29369.
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BACKGROUND: Asthma prevalence in African children is high and increasing, with more severe disease than that in high income countries. Specific factors driving the rising prevalence or disease severity are poorly understood. The aim of this study was to investigate environmental factors associated with asthma and severity in African children using data obtained from International Study of Asthma and Allergies in Childhood, (ISAAC) III.
METHODS: A population based cross-sectional study of children aged 13-14 years from 10 African centres who participated in ISAAC III from randomly selected schools. The prevalence of asthma or severe asthma was calculated for each centre. Self-reported environmental exposures included engaging in physical exercise, television watching, biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for centre variations. Odds ratio and respective 95% confidence intervals (CI) were calculated.
RESULTS: Amongst 28490 adolescents from 232 schools in 10 African centres (4 middle income and 6 low income), the prevalence of asthma was 12.8% (CI 12.4-13.2), while prevalence of severe disease was 8.7% (CI 8.4-8.0). Factors most strongly associated with asthma were maternal smoking (OR= 1.41; 95% CI: 1.23 - 1.64), exposure to open fire heating (OR=1.28; 95% CI: 1.08 - 1.51) and electric heating (OR=1.13; 95% CI: 1.01 - 1.28), engaging in strenuous exercise (OR= 1.29; 95% CI: 1.11 - 1.50 and monthly use of paracetamol (OR 1.23; 95% CI 1.13 - 1.33, while having an elder sibling was protective for asthma (OR=0.87; 95% CI 0.77 – 0.98). Factors strongly associated with severe asthma were maternal smoking (OR=1.61; 95% CI: 1.38 - 1.89), having a cat pet at home (OR=1.14; 95% CI: 1.04 - 1.25), engaging in≥3 weekly physical exercise (OR=1.42; 95% CI: 1.23 - 1.64) and monthly consumption of paracetamol (OR=1.20; 95% CI: 1.07 - 1.34).
CONCLUSION: There was a high prevalence of severe asthma in African children. Several environmental exposures were associated with asthma or with severe disease. Strategies to reduce harmful environmental exposures must be strengthened to reduce the burden of childhood asthma in Africa.
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Nupen, Tracey Lee. "Characteristics and outcome of long-stay patients in a paediatric intensive care unit in Cape Town, South Africa." Master's thesis, University of Cape Town, 2015. http://hdl.handle.net/11427/19902.
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Objectives: To describe a rational basis for the definition of a long-stay patient (LSP) in a South African paediatric intensive care unit (PICU); to review the characteristics and outcomes of the patients who comply with the LSP definition; to assess the proportion of resources allocated to the LSP cohort; and to determine if the results of this study could be used as a predictive tool for future admissions. Methods: A retrospective descriptive study of routine data collected over one calendar year (2009) from a 20-bedded multidisciplinary PICU was conducted. The definition of a LSP in this setting was established using various models. The characteristics and outcomes of the long- and short- stay groups were compared using nonparametric Mann-Whitney U and Chi2 tests, with significant results entered into a stepwise multiple regression model. The proportion of ICU days consumed by LSP was calculated. Human Research Ethics Committee approval was obtained (Ref/Rec 105/2011).
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Akhalwaya, Shehnaaz. "Management of paediatric immune thrombocytopaenia in a South African centre from 1991-2011." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22793.
Full textAbstract:
Three hundred and seventeen patients meeting the diagnostic criteria for immune thrombocytopenia presented to Red Cross War Memorial Children's Hospital between 1991 and 2011. We retrospectively reviewed these patients in order to describe patient demography, the natural history of the disease, and different approaches to diagnosis and management. There were 162 males and 155 female patients. The median age of onset was 3.48 years old (IQR 1.66-6.36). In the 4 weeks preceding presentation, 98 (31%) patients had a viral illness. The median presenting platelet count was 7 x 109/L (IQR 3-14.5). Petechiae were the most common clinical sign at presentation (58%; 184/317). None of the patients presented with intracranial haemorrhages. The majority of patients in the study were admitted (234/317; 74%) with a median stay of 4 days (IQR 0-6). Bone marrow aspirates (BMA) were performed in 188 patients (59%). There was a reduction in BMA from 1991-2000 to 2001-2011 (p<0.001). There was an increase in the percentage of patients treated from 1991-2000 (77/170; 44%) to 2001-2011 (99/147, 67% p< 0.001). Resolution occurred in 75% of patients with a median time to resolution of 31 days (IQR 11-73 days). When we analysed the "survival estimate" from the 2 decades, despite differing rates of BMA, treatment rates and regimens, there was no statistical difference in resolution.