3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Neurodevelopmental delay among HIV-infected preschool children receiving antiretroviral therapy and healthy preschool children in Soweto, South Africa(2012-05) Lowick, SarahNeurodevelopmental delay has been documented in up to 97.5% ofHIV-infected childfen in Soweto who were not yet on ART. With growing numbers of children in South Africa being successfully treated with antiretroviral treatment (ART), the effects of ART on neurocognitive functioning in children require investigation. The objective of this study was to determine the extent of neurodevelopmental delay in stable HIV -infected preschool children (aged) 5-6 years) receiving ART and compare it to an apparently healthy . (unconfirmed HIV-status) group of preschool children. Thirty HIV-infected preschool children (virologically and immunologically stable on ART for> 1 year) were conveniently sampled from 350 eligible children on ART at the Harriet Shezi Children's Clinic in Soweto, Johannesburg. The comparison group comprised thirty well-nourished preschool children attending the Lilian Ngoyi Primary Health Care Clinic in Soweto for routine immunisations. Each child was assessed using the Griffiths Mental Development Scales-Extended Revised Version (GMDS-ER), at a single point in time. The overall developmental z-scores on GMDS-ER were <-2 (indicating severe delay) in 27 (90%) children in the HIV-infected group compared to 23 (76%) in the comparison group (p=0.166). Mental handicap (overall GQ<70) was evident in 46.7% of children in the HIV -infected group compared to 10% in the comparison group (p= 0.002). There was a 7.88-fold increased likelihood of severe delay in the HIV infected group. The HIV -infected group and comparison group had significantly different (p=0.001) mean overall GQ scores of70 (95% CI: 66.0-74.0) and 78 (95% CI: 75.6- 80.5), respectively, with lower mean scores in the HIV -infected group in all individual domains. Early initiation of ART in HIV-infected infants may improve cognitive functioning among this group, however, intervention strategies which optimize early cognitive development for all children in the area, need to be urgently considered.Item Noncompaction of the ventricular myocardium: factors associated with the compaction ratio in congenital and acquired paediatric cardiac disease(2009-11-17T11:49:08Z) Hunter, Vivienne IslaLeft ventricular (LV) noncompaction is characterized by the presence of an extensive trabecular myocardial layer within the luminal aspect of the compact myocardium of the ventricular wall. The trabeculae are both excessive in number and more prominent than normal. Noncompaction may occur in isolation usually with clinical features of dilated cardiomyopathy, or it may be associated with congenital or acquired heart diseases. Echocardiography is the reference standard for diagnosis, where a ratio of thickness of trabecular-to-compact myocardium (compaction ratio) of >2 is a major diagnostic criterion. Noncompaction is usually considered to result from persistence of the highly trabeculated myocardium found in early cardiogenesis of the human embryo. If persistence of excess trabeculae is the only determinant of the compaction ratio it would be expected that it would remain a consistent measurement in postnatal life. However, temporal changes in the degree of noncompaction in individual case reports have raised the question as to whether the compaction ratio might be sensitive to haemodynamic or other factors. In the present dissertation, I assessed echocardiographically whether the compaction ratio is associated with increases in indices of LV volume preload in 100 children or adolescents with ventricular septal defects (VSD), and 36 with chronic rheumatic heart disease (RHD). Compared to 79 normal controls (compaction ratio=1.4±0.07), patients with VSDs (compaction ratio=2.0±0.2, p<0.0001) and RHD (compaction ratio = 2.0±0.3, p< 0.0001) had a marked increase in the compaction ratio. A compaction ratio>2 was found in 42% of patients with VSDs and 47% with RHD. In VSDs, independent of age and gender, the compaction ratio was positively associated with LV mass index (LVMI) (partial r=0.44, p<0.0001), VSD size (partial r=0.4, p<0.0001), LV end diastolic diameter indexed (LVEDD) (partial r=0.24, p= 0.01), and the presence of additional shunts (partial r=0.21, p=0.02). In RHD, independent of age and gender, the compaction ratio was positively associated with LVEDD (partial r=0.62, p=0.0001), and LVMI (partial r=0.48, p=0.005), and negatively with LV ejection fraction (partial r=0.31, p=0.03). The strong association of indices of LV volume load and the compaction ratio would suggest that haemodynamic influences are contributing to the compaction ratio both in congenital and acquired cardiac disease in childhood. Thus an increased compaction ratio may be the consequence of an increased volume preload, and therefore may not necessarily occur only as a result of persistence of embryonic patterns.Item Uptake of the prevention of mother-to-child-transmission programme at a primary care level in Sedibeng District(2009-04-29T09:54:51Z) Berthet, EmilieIntroduction: Prevention of mother-to-child-transmission of HIV is a priority public health problem in Africa as pregnant women and their children are the most vulnerable. In South Africa, a prevention of mother to child transmission of HIV (PMTCT) programme has been implemented in antenatal clinics to reduce paediatric HIV/AIDS. It is necessary to assess the uptake of this programme by pregnant women. Objectives The purpose of this study was to determine the uptake of the PMTCT programme in the antenatal clinics of Sedibeng district. Using data coming from all the antenatal clinics (ANC) at a primary health care levelin Sedibeng for 2005 and 2006, we determined the proportion of ANC attendees who accepted to be counselled, the proportion of these who accepted to be tested for HIV, the proportion of these who came back for results and the proportion who were HIV positive. Nevirapine (NVP)uptake was determined as well among HIV positive women and babies born to HIV positive women. Methods Data collection was by a record review of PMTCT records from all antenatal clinics in the district. To determine maternal uptake of PMTCT, data were extracted from antenatal clinics monthly collation sheets for 2005 and 2006. Nevirapine uptake for the babies born to HIV positive mothers was determined in one facility: data were v - collected in the midwife obstetric unit of the community health centre from both the Nevirapine register and the mothers’ delivery records. Results A total of 8010 women attended in Sedibeng antenatal clinics in 2005 and 10217 in 2006. In 2005 95 % of attendee women accepted to be counselled among whom 91% accepted to be tested for HIV. In 2006 93% women accepted to be counselled among whom 91% accepted to be tested. Almost all tested women came back for results: 99% came back for results in 2005 and 98% in 2006. The proportion of HIV positive women in the attendees population was 23% in 2005 and 24% in 2006. Nevirapine was dispensed to only 600 per 1000 HIV positive women in 2005 and 539 per 1000 HIV positive women in 2006. From June 2005 to May 2006 only 59% of babies born to an HIV positive mother received NVP. Discussion and conclusion The study showed a good uptake of voluntary counselling and HIV testing in Sedibeng district antenatal clinics. But a low proportion of HIV positive women and HIV-exposed babies received NVP. There was probably a loss of follow up of women between ANC visits and delivery. Nevirapine uptake must be improved in Sedibeng antenatal clinics and further investigations need to be done to understand the factors influencing uptake.Item "Deep down and very superficial": an investigation of self-concept in children with learning difficulties(2008-09-22T13:25:29Z) Smith, MelanieAbstract will not load on to DSpaceItem The unconscious life of the child with obsessive-compulsive disorder(2008-05-19T13:14:39Z) Epstein, Tamarin GwendolynThis qualitative study explores the unconscious life of four children diagnosed with Obsessive-Compulsive Disorder (OCD) specifically related to selfconcept, personality, and psychopathology using a case study approach. A review of literature on childhood OCD is presented and the study is located within a psychodynamic theoretical framework. Findings indicate that the children are emotionally maladjusted, with high levels of anxiety and psychopathology. They have low self-esteem and poor body images, mostly tending towards immaturity. Two of the children have personality disturbances (neurotic, hysterical personalities). All the children have disturbed superegos (harsh or neurotic). Although their symptoms are currently mild, and some have ceased, analysis suggests they have been repressed and continue to affect them. They are sexually preoccupied and conflicted due to the unsuccessful resolution of the Oedipus complex. They have poor impulse control and considerable anger and aggression (mostly overt). They experience their environment as unstable and frightening and have anxieties about physical injury and being watched. The boys have regressed sex drives and homosexual tendencies, and have not identified with their fathers. The girls have identified with their mothers but experience masturbation guilt and blocked sexual drives, causing anxiety and moodiness. The children are all highly defended and escape from feelings of helplessness, inadequacy, and isolation, and discharge anxiety and aggressive instincts by using the defenses of undoing, reaction formation, acting-out, fantasy (sometimes violent), projection, displacement, and intellectualisation. Their strong dependency needs suggest fixation in the oral stage of psychosexual development. They tend towards self-directed aggression and depression. Most have family histories of mood disorders (particularly depression), and obsessions linked to fears of economic hardship due to parental illness or death. Most have histories of anxiety disorders or anxiety-related problems, and family histories of anxiety disorders and/paternal OCD. They all experienced a personally traumatic event precipitating the onset of OCD.Item Ethnicity and Sex Differentials in Infant and Child Mortality in Ghana(2006-11-01T07:17:36Z) Antobam, Samuel KojoSex differentials in infant and child mortality have been reported in many studies. These studies posit that generally the male child has better survival advantage over than the female child. However, none of these studies have examined the role of ethnicity in understanding these differentials. The question then is, to which extent does sex differences in child mortality exist in a society with patrilineal and matrilineal structures. Using Ghana Demographic and Health Survey of 2003 (GDHS, 2003), the study examines the intensity of these differentials by employing indirect method of estimation, and bivariate and multiple regression models, while giving detailed consideration to the differences in biological and behavioural/environmental perspectives as regards child health and nutritional care. It is found that among all the four major ethnic groups in the country, including the matrilineal societies, the male child has higher survival advantage than the female counterpart. The study therefore concludes that ethnicity, be it matrilineal or patrilineal, does not make any difference in sex differentials in child mortality.