3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Treatment received by children who visit traditional healers(2009-11-24T10:58:37Z) Ayibor, Prosper KwameOne hundred caregivers/parents were interviewed in the survey to find out treatments children who visited the traditional healers received and the outcome of such treatments, fees paid and motivation for soliciting the services of traditional healers. The mean age of respondents was 28.8 years and 22.4 months for children. Seventy five percent of respondents visited the traditional healer voluntarily while 25% were pressurised by family. The majority of respondents (70%) sent their children to the traditional healers for treatment for either inyoni (sunken anterior fontanel) or ibala (capillary naevus). Six-four percent of the children were given oral herbal preparations, 57% had scarification while others had talisman/amulet for protection. Seventy-five percent of the children recovered after visiting the traditional healers. Six-three percent of the caregivers/parents were satisfied with the treatment received and expressed their willingness to visit again. Recommendations have been offered to improve collaboration between western medical and traditional medical practices for the benefit of children.Item A pilot study of the effect of a sensory diet on the in-seat behaviour of grade one learners in the classroom(2009-11-10T07:54:21Z) Demopoulos, MariaSensory integration based paediatric occupational therapists working in schools commonly function with a dual role of providing the child with therapy to assist the child to function optimally as well as act as consultants in assisting teachers to develop strategies to help promote the classroom performance of students with sensory processing difficulties. A single-group pre test post test quasi-experimental research design was used in this pilot study on a convenient sample of 11 participants to explore the effects before and after exposure to the intervention of a sensory diet on the in-seat behaviours of the child and determine whether the desirable sensory input is effective in improving the performance of children with sensory processing difficulties during a handwriting lesson. The behaviours showing the highest trend of improvement in the hypothesized direction included less distractibility and trend of work ethos related behaviours (not giving up easily and completing the task; being less impulsive, not working too fast, better planning; better able to initiate and carry tasks out independently). Trends of various in-seat behaviours (restless, overactive and fidgety, disorganized on self and in his work, difficulty in getting down to his work, slow to complete a task) to regress in the hypothesized direction were also noted. Descriptive and statistical analysis was performed to examine trends in changes of pre- and post-intervention behavioural scores. The data were also analysed using Poisson’s regression to the normal distribution to calculate p values (using a chisquared distribution) to compare the number of observations in a period of time intervals. Implications of the results of the study for therapists working with students with sensory processing difficulties and their teachers are discussed.Item The effect of physiotherapy in a group on the motor function of children with developmental coordination disorder(2009-10-20T08:34:02Z) Brenner, JulieChildren with Developmental Coordination Disorder (DCD) are a heterogeneous group who have a marked impairment in the performance of functional motor skills. DCD affects 5-8 % of children in the mainstream educational system, with twice as many boys than girls being affected. DCD often co-occurs with other developmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit (ADD), severe learning disabilities and reading disabilities and is often associated with educational, social and emotional problems that often persist beyond adolescence. Current research has shown that children with DCD do not outgrow their motor problems and without intervention they do not improve (Zoia et al, 2006; Barnhart et al, 2003; Peters and Wright, 1999). The aim of this study was to investigate the effect of an eight week group gross motor intervention programme on 26 children with Developmental Coordination Disorder (DCD) at Forest Town School, which is a special-needs school for children with learning disabilities. The intervention programme consisted of gross motor activities commonly used by the physiotherapists at the school for their DCD groups. The children attended a thirty-minute physiotherapy session a week, in groups of up to 6, for eight weeks. The children’s motor performance was assessed using the Bruininks-Oseretsky Test for Motor Proficiency (BOTMP) pre- intervention, post- intervention and then eight weeks after the intervention had ceased. The children were used as their own controls. The results of the statistical analysis revealed that the mean group gross motor and fine motor scores significantly improved after the intervention. It was found that the gross motor scores improved by a larger percentage than the fine motor, which may be because the intervention consisted purely of gross motor activities. The fine motor scores also significantly improved, implying that there was a transfer or generalisation of skills to the fine motor tasks. The improvement in the motor performance was found to be maintained eight weeks after the intervention was stopped. It was concluded in the study that the eight week group physiotherapy programme at Forest Town School improved the motor skills of children with DCD and learning difficulties. Physiotherapy in a small group may therefore be a cost effective solution for the treatment of children with DCD in government-funded schools and hospitals that have a limited number of physiotherapists available to treat these children.Item A quality of care audit of children referred with suspected epilepsy to two hospitals in Pietermaritzburg, KwaZulu-Natal(2009-10-20T07:22:08Z) Madekurozwa, Matilda NtombizonkeTwo public sector hospitals in Pietermaritzburg, KwaZulu-Natal, Edendale and Grey‟s have specialist clinics for children with epilepsy. Children with suspected epilepsy are referred to Edendale and Grey‟s hospital Paediatric Outpatient Department for their assessment from primary health care clinics, level 1 and level 2 hospitals. Health care workers managing children with suspected epilepsy do not adhere to childhood epilepsy guidelines and protocols and therefore find epilepsy a difficult condition to manage. The purpose of this clinical audit was to assess the quality of care of children referred to Edendale and Grey‟s hospital with suspected epilepsy. Information obtained from this audit will be used to improve the quality and consistency of patient care and therefore reduce childhood morbidity and mortality from the complications of epilepsy among children in Area 2, KwaZulu-Natal. Materials and Methods The Paediatric Outpatient Department registers at Edendale and Grey‟s hospital were used to identify children referred with suspected epilepsy, and their case notes were retrieved. Children who met the inclusion criteria for the study were: i) those referred to the Paediatric Outpatient Department, Neurodevelopment or Epilepsy clinics for their first assessment with a diagnosis of suspected epilepsy and ii) children aged 14 years at Grey‟s hospital and 10 years at Edendale hospital. Children excluded from the study were those i) with febrile convulsions; ii) who had repeat visits and iii) not referred with suspected epilepsy. MN Madekurozwa v Letters from referring hospitals and patient case notes were reviewed and this information was used to fill in the audit forms. A modified British Paediatric Neurology Association audit tool was used for the study. The study period covered was from January 1st 2004 to January 31st 2006. Results From the two-site audit, 232 folders were retrieved and of these 119 case notes met the inclusion criteria and were reviewed, 83 from Edendale and 36 from Grey‟s hospital. The median age of the patients at Edendale hospital was 4-years (age range 2-months to 10-years) at Grey‟s hospital the median age was 3-years (age range 8-months to 12-years). Sixty-six patients were male and fifty-three were female. At Edendale hospital, the majority of patients, 88% were seen within a week of referral, with only 2% seen more than a month later. Of these patients, 37% were assessed by interns and 16% by paediatricians. At Grey‟s hospital the majority of patients were seen more than a month after booking for their first assessment and were assessed by registrars (35%), paediatricians (28%) and senior medical officers (14%), none of the patients were assessed by interns. From reviewing the history, examination, diagnosis, treatment, communication and future care it was found that the overall care of children presenting with suspected epilepsy to both hospitals was poor. Conclusion This was a retrospective study that relied on the availability and review of patient case notes and adequate documentation by the assessing health care workers. The findings from this audit suggest that the quality of care of children presenting with suspected epilepsy to Edendale and Grey‟s hospital is inadequate, with a lack of adherence to guidelines as shown by the lack of adequate statements from history taking, diagnosis, inappropriate use of investigations and inadequate counselling on treatment and future patient care. To improve the management of children referred with suspected epilepsy there should be an improvement in health care worker training to ensure that epilepsy guidelines are adhered to. There should also be an improvement in caregiver and child counselling and education; and strengthening of systems - record keeping, research, and audit with a regular review of epilepsy guidelines.Item The relationship between child personal carbon monoxide (CO) exposure and amount of time spent in close proximity to indoor fires in rural North-West Province(2009-05-22T10:24:54Z) Mafojane, Elias TshepisoBackground: Indoor air pollution due to the burning of biomass fuels has been associated with acute respiratory infections amongst children less than five years old in developing countries. Very little is known about the relationship between child indoor pollution exposure and time spent near indoor fires. Aim: To describe the relationship between the amount of time that children spend close to indoor fires and carbon monoxide exposure. Methods: Cross-sectional study based in rural North-West of South Africa. Secondary analysis of caregivers’ estimates of their children’s time-activity budgets and children’s exposure to carbon monoxide (N=100). Results: The time spent by children near indoor fires is non-significantly related to their CO exposure (regression coefficient -0.030 to -0.036) after adjusting for explanatory variables. Conclusion: It is important to be cautious about encouraging caregivers to keep children away from indoor fires at the expense of other established intervention strategies.Item Prevalence, causative factors and management of nocturnal enuresis in South African children(2009-05-19T07:18:57Z) Fockema, Margaret WilleminaObjective A cross sectional study using a self-administered questionnaire to establish the prevalence and causative factors of nocturnal enuresis in 5-10 year old South African children. Subjects and methods A questionnaire was distributed to the parents of 4700 school going children between the ages of 5-10 years in selected areas of Gauteng, Kwa-Zulu Natal and the Western Cape in South Africa. Where permission was granted, schools listed in these areas, and schools from different socio-economic areas (suburbs differing in affluence), were contacted telephonically. Those willing to participate were included in the study. Parents anonymously filled out the questionnaire and returned it to school. Data were reported as frequency and percentages in tables and graphs. The Chi-square test was used to compare proportions between groups with Fisher’s Exact test used to correct for small numbers of observations (n<5). Age differences were determined using Student’s t-test. A p value of less than 0.05 was considered to be statistically significant. Results The questionnaire response rate was 72.1%. The overall prevalence of nocturnal enuresis was 16.0%, 14.4% for mono-symptomatic nocturnal enuresis and 1.6% for daytime incontinence. A positive family history was found in 50.5% children and constipation was a problem in 16.0% of children with enuresis. Various stress factors were linked to enuresis according to vi the parents’ perceptions. Only 28.3% had received a form of treatment and 13.5% had been treated by a doctor. A higher prevalence rate of enuresis could not be linked to a lower socio-economic grouping. Parents’ awareness of treatment modalities available to their children is outdated and most of the management of the problem was done by the parents themselves. Conclusion These results suggest that the prevalence of nocturnal enuresis and associated causative factors in South Africa is similar to the prevalence in other countries, although it is difficult to compare these prevalence rates as studies use different inclusion criteria.Item Determinants of vaccination coverage among children aged 12-23 months in rural KwaZulu-Natal(2009-05-18T12:24:00Z) Ndirangu, James Ng'Ang'aTo evaluate the impact of maternal HIV-infection on routine childhood immunization coverage, comparison was made on the immunization status of children born to HIV-infected and HIV-uninfected women in rural KwaZulu Natal. The study population was all children enrolled in the routine demographic surveillance system as at 31st December 2005 (n=18,171) in Africa Centre Demographic Surveillance Area. Sampling of subjects was done based on the dates of birth that were between the period 1st Jan 2004 and 31st December 2005 (n=2,020). This was further divided based on maternal HIV status namely; 236 HIV (+), 777 HIV (-) and 1,007 HIV (unknown). The main outcome measure was the percent of complete routine childhood immunizations recommended by the WHO as assessed from the Road-to- Health cards or maternal recall during household interviews. For all vaccines, children born to HIV-infected mothers had lower immunization coverage than children born to HIV-negative mothers (78.21% vs. 86.52%). The children of mothers who were HIV-infected were 31-55% (P-value <0.020) less likely to be immunized compared to children of mothers who were HIVuninfected. We conclude that maternal HIV-infection is associated with childhood under immunisation. VCT health workers should encourage HIV-infected mothers to complete childhood immunization. Improving access to immunization services could benefit vulnerable populations such as children born to HIV-infected mothers.Item Epidemiology of primary paediatric brain tumours at Johannesburg and Chris Hani Baragwanath hospitals from April 1995 to April 2005(2009-05-15T10:55:05Z) Nkusi, Agabe EmmyEpidemiology of primary paediatric brain tumours has been studied extensively in developed countries of the west. Such studies are lacking in developing countries especially sub-Saharan Africa. This study seeks to establish the epidemiology of primary brain tumours seen among children that were treated at Chris Hani Baragwanath and Johannesburg Hospitals from April 1995 to April 2005. The records of 252 patients who presented with this condition during the study period were reviewed, for the following details: ● Demographic details such as age, gender and race ● Diagnosis and the date when it was made ● The follow-up period at the hospital(s)/clinic(s) ● The anatomical location of the tumours; supratentorial or infratentorial ● The treatment that was given which included mainly surgery for tumour removal or biopsy, radiotherapy, chemotherapy and others which included ventriculoperitoneal shunt, external ventricular drain insertion. ● The outcome of treatment included: - alive - dead - presumed alive - lost to follow-up It was found: ● That 225 patients had full demographic details of race, gender and age. ● That there was a slight male predominance among children with primary brain tumour. ● That the majority of children with brain tumours were black, followed by whites which is in keeping with the country’s demographics. ● The three most common tumours were astrocytomas, medulloblastomas and brainstem gliomas in the descending order of frequency. ● Medulloblastomas were the commonest tumours in the infratentorial region while craniopharyngiomas were commonest tumours in the supratentorial region. ● More children had infratentorial tumours ● Younger children were more likely to have infratentorial tumours. ● Majority of patients had surgery either for diagnosis or for diagnosis and treatment. ● Few patients were presumptively diagnosed clinically and by imaging modalities ● Combination therapy of surgery, chemotherapy and radiotherapy had the best survival outcome while chemotherapy as the only form of treatment had the worst outcome. ● The overall 5 year survival rate for all the study participants was much lower than that of their counterparts in the literature. ● Children who had craniopharyngiomas and astrocytomas had better survival. ● Mortality incidence was slightly higher for whites than blacks but that could have been skewed by a high number of blacks that was lost to follow-up. ● A higher infratentorial tumour prevalence than in the literature was noted. It was noted that racial prevalence of primary paediatric brain tumours follows population demographics. From the results of this study, there is a need for a better record keeping and improved patients follow-up. There is also a need for a larger epidemiological study in the two hospitals. There is need to establish a specialized paediatric unit which will help start a paediatric team comprising of a paediatric neurosurgeon, paediatric oncologist, paediatric intensivist and neuroradiologist with dedicated neuropaediatric ICU. Such a team given resources will improve survival outcome of children with brain tumours.Item The sensory profile of children with speech and language disorders in London and the south of England(2009-05-05T12:07:16Z) Van der Linde, JanineChildren presenting with communication difficulties are among the most commonly occurring developmental problems. They were observed to have problems with their everyday activities in all the occupational performance areas, as well as displaying behaviours that have a negative impact on their functioning. These behaviours appear similar to those described in children with sensory processing and sensory modulation difficulties. Literature indicated a possible connection between speech and language difficulties and poor sensory integration. This study used the Sensory Profile, a parent report measurement of the child’s sensory responsiveness in daily life, to investigate the sensory processing and modulation of children with Specific Language Impairment, as reflected in their behavioural and emotional responses. The study indicated that this population has specific areas of sensory processing that are unique to children with SLI and that differ significantly in their sensory responsiveness from typical children and children with other conditions like Autism and Attention Deficit Hyperactivity Disorder.Item Clustering of mortality among children under five years due to malaria at the Ifakara demographic surveillance site in Tanzania(2009-04-28T13:20:00Z) Kamara, Mohamed KobloABSTRACT Introduction Under-five mortality is still a major cause of concern in Sub Saharan Africa and among the highest in the world. This is also exacerbated by the high prevalence and episodes of malaria in this age group, which accounts for 90% of all under-five deaths estimated in the region annually. The effect of detecting clustering of all cause and cause specific mortality and underlying factors is crucial for timely public health interventions. This is especially important for health authorities in Tanzania where under-five malaria attributable deaths accounts for 45% of the annual estimated mortality of 100, 000. Study objectives To estimate under-five mortality and analyze clustering of all cause and malaria specific mortality among under five children in Ifakara Demographic Surveillance System from 2002-2005. Methods Data from the Ifakara Health Research and Development Centre (IHRDC) were obtained for all under-five children who lived in 25 villages in the DSS from 2002 – 2005. Analyses for all cause and malaria cause specific under-five mortality were done using data collected from the DSS and verbal autopsy systems. Annual all cause and malaria specific mortality rates were calculated by dividing number of deaths and person years observed. Clustering of deaths for all cause and cause specific (malaria) in the 25 villages were analyzed using SaTScanTM version 7.0 software. A Poisson model was used to detect clusters with high rates in space and in space-time. Household assets and characteristics were used to construct a wealth index using Principal component analysis (PCA) in StataTM version9. The index was used to group households into five equal groups from poorest to least poor. Results Overall infants’ mortality was sixty-three times higher (326 per 1,000 person years) compared to children (5.1 per 1,000 person years) and with mortality rates between girls and boys were very similar, (15.8 and 14.8 per 1,000 person years). Year of death and place of death (village) were found to be significantly associated with malaria deaths. However, socio-economic status of parents in households where deaths occurred was not associated to malaria deaths in the DSS. A number of statistically significant clusters of all cause and cause specific malaria deaths were identified in several locations in the DSS. The located clusters imply that villages within the clusters have an elevated risk of under-five deaths. A space-time cluster of four villages with radius of 15.91 km was discovered with the highest risk (RR 2.71; P-value 0.020) of malaria deaths in 2004. Conclusion These findings demonstrate that there is non-random clustering of both all cause and malaria cause specific mortality in the study area. The high infant mortality results also suggest a careful examination of the data collection procedures in the DSS and require further studies to understand this pattern of mortality among the under-five population. Appropriate health interventions aimed at reducing burden of malaria should be strengthened in this part of rural Tanzania. There is need to replicate this study to other areas in the country.
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