Masters Degrees (Paediatrics and Child Health)
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Browsing Masters Degrees (Paediatrics and Child Health) by browse.metadata.advisor "Cotton, Mark F."
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- ItemClinical characteristics and outcome of children evaluated and treated at Tygerberg Children’s Hospital during a measles epidemic(Stellenbosch : Stellenbosch University, 2014-04) Ferreira-Van Der Watt, Talita Aletta; Finlayson, Heather; Rabie, Helena; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: Objective: To describe the clinical characteristics and outcome of children presenting to Tygerberg Children’s Hospital with measles infection Methods: This was a retrospective, descriptive study of children presenting to Tygerberg Children’s Hospital, from 1 February to 31 March 2010 with a diagnosis of measles, during the measles epidemic of 2009/2010. Folders of every second admission were reviewed. Data was analysed using Statistica version 10 of 2012. The study was approved by Stellenbosch University Ethics Committee. Results: Five hundred and eighty five children were seen and evaluated for complicated measles, 239 patients were included. Seventy nine percent (n=189/239) were admitted of which 54.3% were male. The median age at admission was 9 (Interquartile range 6 to 19) months. Children less than 9 months accounted for 50.2% (n=120) and 25.9% (n=62) were less than 6 months of age. The median WHO weight-for-age Z-score (WAZ) was 0.69 (IQR - 1.82 to 0.29), malnutrition was found in 39.9% (n=81) of children less than 5 years. Children residing in the Khayelitsha sub-district accounted for 43.1% (n=103) of the study population. Uptake of the first dose of measles vaccine was 31.1% and of the second dose of measles vaccine was 23.8%. The median length of stay (LOS) was 3 days (IQR 2 – 5 days). Gastroenteritis (67.4%; n=161) and pneumonia (54.4%; n=130) were the most common complications. The majority assessment. A single dose of children had more than one complication at the time of of vitamin A was received by 71.1% (n=170/239) of children during evaluation and 47.6% (n=114/239) received 2 doses. Seven (2.9%; n=7/239) patients required ICU care. Four (57.1%; n= 4/7) were less than 9 months of age. Pneumonia (85.7%; n=6) was the most common reason for admission. Four (1.7%; n=4/239) children died. The median age at death was 9 months (IQR 7 – 14 months). Pneumonia (75%; n=3/4) was the most common cause of death. HIV testing was done in 40.6% (n=97/239) of children. HIV exposure was found in 28.9% (n=69/239) on history. HIV infection was present in 8.4% (n=20/239) of children, of these, 60% (n=12/20) were on HAART. HIV-infected children were older than HIV-uninfected children (median 40 and 9 months respectively, p=0.003). Thirty percent (n=6/20) of HIV- infected children had received any measles vaccination prior to admission. Five percent (n=1/20) of HIV-infected children died vs 4.2% (n=3/72) of children who were confirmed HIV negative. Conclusion: Our study showed that measles causes a significant burden of morbidity and mortality in children. HIV infection however did not increase the morbidity and mortality due to measles co-infection. Interventions to improve vaccination rates and practices at community level are required in order to prevent further epidemics in the future. Further research is needed to determine whether the first measles vaccine dose should be given earlier rather than 9 months of age in order to prevent early infection.
- ItemCongenital rubella in the Western Cape Province of South Africa : a vaccine preventable condition(Stellenbosch : Stellenbosch University, 2015-12) Van der Westhuizen, Tarryn; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child HealthENGLISH ABSTRACT : Background: Congenital rubella syndrome (CRS) is characterized by multiple defects causing physical, intellectual and developmental retardation, auditory and visual problems, placing a huge burden on health care services in countries where rubella immunization is not routine. The incidence and extent of CRS in South Africa, where rubella vaccine is not included in the expanded program on immunization (EPI), is unknown. Objective: To determine the minimum prevalence and morbidity of CRS in the public sector of the Western Cape province of South Africa, as well as to describe the clinical presentation and features of all confirmed and probable CRS cases at Tygerberg Children’s Hospital. Methods: A retrospective descriptive study and case series using clinical records. Rubella serology data was retrieved from National Health Laboratory Systems at Tygerberg Academic Hospital between 01 January 2006 and 31 December 2011 and Groote Schuur Hospital between 01 January 2008 and 31 December 2011. For confirmed CRS, detection of rubella by PCR or specific IgM antibodies below 3 months of age was diagnostic. For probable CRS, a PCR or IgM positive at 3 months - 1 year of age with more than two of the following conditions: cataracts, congenital glaucoma, congenital heart disease, hearing impairment or pigmentary retinopathy. Alternatively, one of one of these conditions plus any of the following: purpura, splenomegaly, microcephaly, mental retardation, meningoencephalitis, radiolucent bone disease or neonatal jaundice within 24 hours of birth. Confirmed cases between 01 January 2008 and 31 December 2011 from the two laboratories were used to calculate a minimum prevalence for the Western Cape. Medical records of infants with confirmed and probable CRS under a year of age from Tygerberg between 01 January 2006 and 31 December 2011 were reviewed for inclusion in the case series. Results: Thirty confirmed cases were identified from 01 January 2008 and 31 December 2011 in the two laboratories for a minimum prevalence of 0.073 cases per 1000 population for the Western Cape (95% confidence interval [CI] 0 – 0.1). Twenty confirmed and probable cases were obtained from Tygerberg Children’s Hospital from 01 January 2006 to 31 December 2011. The median gestational age at birth was 37 weeks (interquartile range [IQR] 32 – 38). Fourteen (70%) had low birth weight (LBW), nine (45%) were premature and seven (35%) were small for gestational age (SGA). Six women (30%) gave a history of rubella in pregnancy, five in the first trimester and one in the second trimester. The most common presenting signs were: petechiae in eight (40%), and cataracts in seven (35%) infants. Other presenting signs in the infants included hepatosplenomegaly. Nine (45%) had ophthalmologic involvement, all with cataracts; of these three had pigmentary retinopathy and one had congenital glaucoma. Four of the twelve tested (33%) had hearing impairment and ten (50%) had microcephaly. Cardiac anomalies were noted in eleven of the infants. One infant presented with bilateral knee arthritis, not previously described in CRS. Eleven of fourteen LBW infants (79%) and three of six (50%) with birth weights above 2500g had at least one major congenital anomaly (p = 0.3). All three deaths occurred in SGA term infants. Eight of the twenty infants (40%) required more than one hospital admission, with seven (35%) also requiring intensive care. Hospital stay in LBW infants was also significantly longer than those with birth weights above 2500g (median 27 vs 6 days) (p = 0.01). Seven patients (35%) underwent a surgical procedure with three requiring more than one procedure. PDA ligation and cataract removal were most common. Conclusions: CRS has extensive morbidity and high mortality, requiring a multidisciplinary approach. Rubella immunization should be urgently incorporated into the extended program of immunization in South Africa to prevent this devastating infection.
- ItemA cross sectional analysis of perinatally HIV-infected (PHIV) adolescents in a paediatric infectious diseases clinic in the Western Cape, South Africa(Stellenbosch : Stellenbosch University, 2018-09) Van Heerden, Linda; Frigati, Lisa; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: Background Approximately 1.8 million adolescents were living globally with HIV in 2015. HIV is the leading cause of death in adolescents in Africa and the second leading cause of death in adolescence worldwide. Perinatally HIV-infected (PHIV) adolescents often have chronic complications due to late access to antiretroviral therapy (ART) and ART side effects. There is relatively little information on their psychosocial outcomes although poor adherence has been described. The aim of this study was to describe a cohort of perinatally HIV infected adolescents (PHIVA) attending Tygerberg Hospital, a tertiary hospital in the Western Cape in 2015. Material and Methods A retrospective descriptive study (folder review) describing all HIV- infected adolescents between the ages of 10 and 19 years attending the Infectious Diseases Clinic (IDC) during a 12 month period in 2015 was performed. Results Ninety-eight of approximately 400 (25%) patients attending the Tygerberg Paediatric IDC were adolescents. Of these, 55 (56%) were female. Median age at first clinic visit was 4.9 years (IQR 1.5- 9.4). Median age at most recent clinic visit was 14 years (IQR: 10-19). The majority were WHO clinical stage 3 and 4 at diagnosis (74%). Twenty-eight (28%) adolescents were on their original ART regimen with no change in drug for side effects, failure or intolerance. Sixty-seven (68%) remained on their first regimen with a single drug switch due to side effects. Fifty of sixty -one adolescents (82%) starting on Efavirenz remained on it. Of 94 adolescents with a viral load available at last clinic visit, 71 (81%) were virologically suppressed. Viral genotyping was done in 7 of the 17 adolescents (41%) with viral loads above 1000 copies/ml. Only 3 (3%) were on third line drugs. Few adolescents had chronic medical complications: 23/98 adolescents (23%) were documented to have chronic lung disease (CLD) with 58 (59%) previously having Pulmonary Tuberculosis (PTB), 2 (2%) having had multidrug resistant (MDR) Tuberculosis and 1 (1%) having had Extremely Drug Resistant (XDR) Tuberculosis. Four (4%) had cardiac disease, 1 (1%) had HIV related renal disease, 80 (80%) had documented dermatological complications. Forty-one (42%) had central nervous system complications such as seizures and neurodevelopmental delay. The median number of documented hospitalizations since diagnosis was 3 (IQR: 1-4) with no deaths in 2015. Sixty-eight percent (68%) of adolescents knew their HIV status. There was no documentation in 20 (20%), while 11 (11 %) were not disclosed to. For the latter, 7 had severe neurological disease. Fortyfive (55%) attended mainstream school and 34 (34%) a special school/care centre. Forty-six (47%) had failed a grade and 33 (33%) failed more than one grade. Five (5%) were on antidepressants. Fifty-six (57%) had been referred to a social worker for complex psychosocial issues. When comparing those diagnosed at an age less than 10 years to those diagnosed older than 10 years the only statistic significant difference was a lower baseline absolute CD4 count in those diagnosed after ten years of age (265 vs 554, p = 0,003). There was no difference in WHO staging at diagnosis, chronic complications or social issues. Conclusions Despite relatively late access to ART, adolescents had good virological outcomes that compare with international cohorts. There are fewer chronic medical complications than noted in other African cohorts. However, there are significant psychosocial and educational issues and more focused interventions are needed to address these.
- ItemThe outcome of accidental BCG overdosing during routine immunization of neonates(Stellenbosch : Stellenbosch University, 2019-12) Greybe, Leonore; Morrison, Julie; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.ENGLISH ABSTRACT: In January 2015, 19 neonates were accidently given intradermal BCG culture SSI, a dose 62.5 times above the standard BCG dose for neonates at a Western Cape private hospital. After recognizing the error, all neonates who were given BCG culture instead of the BCG vaccine were identified and their parents informed. A panel of paediatric infectious disease specialists were consulted and the decision was made to start treatment with high dose isoniazid and rifampicin. Fourteen of the nineteen neonates were enrolled and followed-up in order to observe what proportion of neonates would develop adverse reactions. Complications that were observed for included severe local and regional adverse reactions and systemic BCG disease. In this case series, no regional or systemic BCG disease occurred in any of the healthy term neonates who received an accidental overdose of BCG culture, instead of BCG vaccine. The conclusions of this case series are however limited by inconsistent follow-up and failure by the treating paediatricians to systematically record the required data. Expected mild adverse reactions occurred in all the neonates (n=14, 100%) in our study, which was much higher than expected when compared to the usual occurrence of BCG adverse reactions to the Bacillus Calmette-Guerin (BCG) vaccine in neonates as demonstrated by the randomised control trial by Nissen et al. The more common occurrence of mild adverse reactions could be explained by the much higher dose of BCG administered. The majority of local adverse reactions were however of short duration with approximately one third resolving within 2 weeks and not a single one being present at 6 months.