3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Knowledge, attitude and practice (KAPs) of dental trauma among staff in early childhood developmental centers (ECDCs) in Hillbrow, Johannesburg(2011-11-28) Nemutandani, Mbulaheni SimonItem The effect of caregiver training on time-use of children living in residential care facilities(2011-04-07) Koch, Lyndsay CarolInfants and toddlers living in residential care facilities are at risk of developmental delay. Environmental factors contributing to this risk are the temporal context (how children spend their time) and social context (how and when caregivers interact with children). This study compared time-use patterns of children living in residential care facilities where caregiver training had previously taken place versus those in facilities where caregiver training had not taken place using a non-experimental, cross-sectional static group comparison study design. Spot observations were used to estimate time-use patterns of infants and toddlers living in residential care in Johannesburg. Results show that caregiver training increased the quantity of time infants spent with their caregivers (temporal context) and the quality of time toddlers spent with their caregivers (social context). Thus caregiver training has the potential to improve the environment in residential care facilities and can be used as an intervention strategy by occupational therapists.Item Lymphoid proliferation of the parotid gland in paediatric patients with HIV infection(2011-04-07) Kungoane, TsholofeloIntroduction: HIV associated parotid lymphoepithelial lesions in children are not well documented. Most studies have concentrated on the adult population. Objectives: The present study aimed to document the disease, its risk factors and anti-retroviral treatment outcome in children. Materials and methods: The study was conducted at 2 HIV and AIDS facilities weekly over a 6 month period. “Parotid swellings” in children below 13 years were analysed. A retrospective medical chart review was conducted. Results: Seventy-one children were included; 47 with swelling (Group 1) and 24 without swelling (Group 2). Thirty-nine had parotid swelling of 1or both glands, 6 had submandibular and parotid swelling and 2 with only submandibular swelling. Twenty-six children in Group 1 were receiving HAART, 19 reported a reduction in size of lesion, 6 reported no effect and only 1 had the lesion after 11 months of HAART. Conclusion: Parotid lymphoid proliferation in children is more common than previously reported. The prevalence of this lesion could not be determined as not all children with parotid swelling presenting at the clinics were included in the study. Children with lower viral loads showed an increased risk of developing parotid lymphoid proliferation. The parotid lesions responded well to HAART but did not completely resolve.Item Pre-hospital emergency care student experience with paediatric emergency cases in Johannesburg, Gauteng(2011-03-18) Stein, Christopher Owen AlexanderAdequate exposure to paediatric pre-hospital emergency cases for students undertaking clinical learning is a key component of preparation for independent practise. Both clinical reasoning and psychomotor skills require practise in a realistic environment in order to best equip the qualifying practitioner for demands of the real world of pre-hospital emergency care. The aim of this study was to retrospectively describe the exposure of pre-hospital emergency care students in the University of Johannesburg‟s National Diploma in Emergency Medical Care programme to emergencies involving paediatric patients in the Greater Johannesburg Metropolitan area over a continuous eight year period, between 1 January 2001 and 31 December 2008. Patient care records contained in an electronic clinical learning management information system entered over the eight-year study period were analysed in order to characterise the exposure of students to paediatric emergency cases in general, and clinical skills performed during this exposure. Results showed that, with the exception of infants and children seen by first year students, median exposure to paediatric emergency cases for students in all academic years was below 50%. Exposure to emergencies involving younger patients was generally lower than that for older patients, however the acuity of patients increased with decreasing age. Exposure to most clinical skills also decreased with decreasing patient age. Opportunities for students to practise critical or invasive skills were relatively rare. Suggestions for the improvement of student exposure to paediatric emergency cases and clinical skills include a period of internship and greater utilisation of hospital-based clinical skills exposure and practice.Item A retrospective histopathologic review of paediatric oral and maxillofacial cases presented in Johannesburg, 1987-2007(2011-03-08) Munsamy, ClintonThe characterisation of oral and maxillofacial histopathology found in children has been reported from developed countries of the west and in some developing countries in Africa but as yet not from South Africa. A retrospective study was designed to evaluate the epidemiological features of paediatric oral and maxillofacial histopathology seen at the University of the Witwatersrand’s Division of Oral Pathology from January 1987 to December 2007. A total of 1,258 children ≤ 16 years of age with histologically confirmed disease in the oral and/or maxillofacial region were recorded, with a male to female ratio of 1:1,05. A progressive increase in the frequency of oral and maxillofacial lesions was seen with increase in the age of the patient. Most lesions were concentrated in the 13-16 year age group (41,5%). Pathology involving the jaw bones formed the largest category of all oral and maxillofacial pathologies (40% of the total number of cases) and was predominated by odontogenic cysts and tumours (61,8%). Odontogenic tumours showed a significantly higher frequency in children over 12-years of age (P=0,006). A higher frequency of unicystic ameloblastoma than in the literature was noted. The remaining pathology, in decreasing order of frequency, involved the oral and perioral soft tissues (31,6%), the salivary glands (18%), oral mucosa (8,9%) and dental hard tissues (1,7%). Most lesions of soft tissue and salivary gland were reactive / inflammatory in nature and were outweighed by fibro-epithelial polyps and extravasation mucoceles respectively. Nearly two-thirds of the oral mucosal lesions were benign Human Papilloma Virus-induced lesions. Malignant neoplasms comprised 4,1% of the total number of cases with Burkitt’s lymphoma emerging as the most common malignancy. Although the smallest number of biopsy specimens was obtained from children younger than 5-years of age, the likelihood of a malignant diagnosis in the latter age group was substantially higher than in older children.Item An evaluation of computed brain scans in children at Chris Hani Baragwanath Hospital(2011-01-26) Vallabh, PreeteebenBackground: Computed tomography (CT) was introduced 40 years ago and it remains an essential part of medical practice. The indications for CT brain scans vary in different centres depending on the availability of scanners and financial resources. There is no data on the indications and results of CT brain scans in children at Chris Hani Baragwanath (CHB) Hospital. Aims: The indications for CT brain scans were quantitated and the overall results of the scans were assessed. The rate of radiological abnormalities by referral diagnosis was evaluated. Methodology: 361 Children undergoing CT brain scans were identified in a four month period from 22/01/2004 to 21/05/2004, and their records were prospectively reviewed. Results: The ages ranged from 2 days to 14 years. There were 213 males and 148 females with a male: female ratio of 1.4:1. Seizures was the commonest indication for scans (25.8%) in this study. The six common indications (partial and generalized seizures, trauma, central nervous system [CNS] infections, macrocephaly and psychomotor retardation) accounted for 67.6% of the scans. There were 233 (63.5%) abnormal scans. Cerebral atrophy was the commonest finding, present in 58 (16.1%) scans. Discussion: A high rate of positive scans was detected in this study, with intracranial infections featuring prominently (9.7%). This high yield of positive scans in the study population suggests the need for more scanner facilities at CHB hospital. DPDoFcuments Complete Click Here & Upgrade Expanded Features Unlimited PagesItem The impact of HIV on severe childhood malnutrition(2010-10-26) De Maayer, TimAim: Case fatality rates for child severe malnutrition have remained high globally and in South Africa. It has been postulated that much of this excess mortality is due to HIV infection. This study sought to examine case fatality rates in children with and without HIV infection, and with different forms of malnutrition. Methods: A prospective, observational study was undertaken at three academic hospitals in Johannesburg, South Africa. Severely malnourished children were identified and their anthropometric details, clinical features, laboratory findings and admission outcomes analysed. Nutritional status was categorised using the Wellcome and WHO classifications. All children had their HIV status established. Results: The case fatality rate in 113 severely malnourished children was 11.5%. Fifty one percent of children were HIV infected. Most (44%) of children had kwashiorkor, with 26% having marasmus and 20% classified as marasmic kwashiorkor. HIV positive children were significantly more likely to die than negative children (19% vs 3.6%, OR 6.2, 95% CI 1.2–59, p=0.02). Marasmic children were more likely to have HIV than those with kwashiorkor or marasmic kwashiorkor (83% vs 33%, OR 9.7, 95% CI 3.5–29.1, p< 0.001). Half (51%) of all HIV negative children whose mother’s status was known had an HIV positive mother. TB was suspected and treated in 24% of children, although confirmed in only 19% of these. Factors associated with an increased mortality included hypothermia (OR 9.7), hypoglycaemia (OR 9.7), shock (OR 7.2), thrombocytopaenia (OR 5.7), raised INR (OR 9.8) and the intravenous administration of fresh frozen plasma or packed red blood cells (OR 9.7 and 7.8 respectively). Conclusion: The HIV pandemic has altered the face of malnutrition in the study setting. Case fatality rates remain unacceptably high in HIV positive malnourished children. Specific guidelines for the management of severe malnutrition in HIV positive children and improved tuberculosis, growth monitoring and growth promotion programmes could reduce this impact.Item Parental consent or refusal to consent to HIV testing in children(2010-10-22) Bolton, Keith DuncanParental Consent or Refusal to Consent to HIV Testing in Children The acquired immune deficiency syndrome (AIDS) continues to represent the greatest infectious threat to humans of all time. It is estimated that some 33 million people are currently infected with the causative organism, the human immunodeficiency virus (HIV). More than 2 million of these are children. The AIDS epidemic now has its epicenter in sub-Saharan Africa where 75% of deaths occur. The treatment of AIDS with antiretroviral drugs (ARVs) has changed the outcome from inevitably fatal over months to years, to a chronic but manageable condition. Adherence to treatment is essential for maintaining good health and avoiding the development of resistance. Young children with HIV infection usually obtain the virus from their infected mother at, or about the time of birth or via breast milk. Prevention of mother to child infection (PMTCT) is possible through the use of ARVs and this has resulted in a dramatic decrease in infected children in the developed world. Poor provision and uptake of PMTCT in the developing world means that many children are still being infected. In these environments, over 60% of the children who die are infected. Treating these children with ARVs will usually prevent death and return the child to a good quality of life in the family. It is necessary to test the child for infection before embarking on life-long complex treatment and this is done by testing blood or saliva for the virus or antibodies to the virus. A positive test in the child is usually a proxy for a positive test in the mother and this obviously has profound implications for her life. In all infants suspected of infection, a test is advised. In the Rahima Moosa Mother & Child Hospital about 10-15% of mothers refuse testing for their infants. These children are therefore denied the opportunity for life-saving treatment. This essay discusses the reasons why mothers may refuse HIV testing for their infants and explores the possible ethical choices and responses of healthcare workers to this refusal.Item Risperidone for disruptive behaviour in children and adolescents with learning disability(2010-10-21) Bezuidenhout, HeidreBackground Disruptive behaviour is the most commonly reported mental health problem in individuals with learning disability. Pharmacotherapy is part of a multidisciplinary approach to the treatment of disruptive behaviour. Risperidone, an atypical antipsychotic drug, is the most commonly used treatment for symptom improvement. It is therefore important to establish the efficacy and safety of risperidone therapy in this dependent, vulnerable and young population, given the well documented adverse effects and the potential for long term treatment. Objectives To assess the effects of risperidone for disruptive behaviour in children and adolescents with learning disability. Search strategy The following electronic databases were searched: CENTRAL (Cochrane Central Register of Controlled Trials); MEDLINE; PsycINFO; CINAHL; Clinicaltrials.gov; National Research Register (NRR). In addition, reference lists of relevant publications and narrative reviews were checked; handsearches were done; authors of published trials and pharmaceutical manufacturer of risperidone (Risperdal) were contacted. Selection criteria All randomised or quasi-randomised controlled trials of risperidone versus placebo (or no treatment) for children and adolescents (age less than 18 years) with a diagnosis of learning disability and disruptive behaviour were considered. Data collection and analysis Trial eligibility and data quality were evaluated and analysed by the author and independently verified by an additional reviewer. Unpublished data were considered for inclusion and relevant authors were contacted in the case of incomplete data. Results Four randomised controlled trials involving 279 children and adolescents were identified. The majority of the children were living at home and not institutionalised. Meta-analyses of the primary outcome scales (Nisonger Child Behaviour Rating Form, Aberrant Behaviour Checklist, Behaviour Problem Inventory) measuring several core symptoms of disruptive behaviour, namely conduct problems, self-injury, irritability, aggressive / destructive behaviours and stereotypy suggest statistically significant improvement in disruptive type behaviours in children treated with risperidone compared to placebo. Adverse event data showed that the prevalence of adverse effects viz. weight gain, sedation / somnolence and raised prolactin levels were significantly higher in the children receiving risperidone. Conclusions In the studies included in this review, risperidone treatment for disruptive behaviour in learning disabled children and adolescents appears to have a beneficial effect on certain symptoms of disruptive behaviour. However, the applicability of these findings to wider clinical practice remains unclear, due to poor methodological quality, inadequate study sample size and short duration of treatment of the included studies. Long term safety has not been established and serious adverse effects, affecting growth, are of concern. Further research is required to establish the efficacy and safety of risperidone for disruptive behaviour in learning disabled children and adolescents in clinical practice.Item Descriptive study of biopsy proven IgA and Henoch-Schonlein purpura nephropathy in two government hospitals in Johannesburg (South Africa)(2010-09-23) Mitchell, Jennifer GwenIgA (Immunoglobulin A) nephropathy is reported as the most common form of primary glomerulonephropathy worldwide. Despite this there is limited research on IgA nephropathy in African children. This study reviewed IgA and Henoch-Schonlein Purpura (HSP) nephropathies, as it is believed that they are variants of the same pathological process. This study hypothesized that IgA and HSP nephropathies occur in South African black children and that disease progression is worse in this population group and compares them to their international counterparts. Methods: The study was a retrospective review of the records of children that presented to the paediatric renal clinics at two academic hospitals in Johannesburg. It reviewed the epidemiology and progression in South African children. These results were then compared to appropriate international reviews. There were a total of 1835 paediatric renal biopsies between 1985 and 2008. Of these 51 were confirmed to be IgA nephropathy (3%) of which one was excluded. Children were reviewed as a whole and then divided into a HSP and an IgA nephropathy group. Results: The average age at presentation was 9.5 years old. There was a male predominance with a male to female ratio of 2.2:1. Racial differences were noted, and when reviewed in the light of the demographics of the area, there was a higher “prevalence” in Caucasian and Indian patients. The most common presenting symptom in the study population was haematuria. Nephrotic range proteinuria occurred in more than half of all patients. Presentation in acute renal iii dysfunction was uncommon. Predictors of a poor prognosis were found to be nephrotic range proteinuria, and a lower GFR at presentation. The study hypothesis that black African children with IgA or HSP nephropathy have a poorer prognosis than other children with similar presentations, was disproved.