Dankwart Friedrich Wittenberg

Atopy in HIV-infected children in Pretoria

INTRODUCTION The development or aggravation of a pre-existing atopic state in patients with human immunodeficiency virus (HIV) has not been thoroughly investigated in South Africa. HIV-infected adults have been shown to have a higher prevalence of atopy in some international studies, but this has not been documented in children. METHODS A prospective convenience sample of 50 children aged between 3 months and 12 years attending the Tshwane District Hospital Paediatric HIV Clinic in Pretoria was recruited. Their personal and family histories of atopy, World Health Organization (WHO) HIV clinical staging and Centers for Disease Control (CDC) immunological staging with CD4 counts were documented. An age- and sex-matched control group of 50 HIV-negative children was included. Skin prick tests (SPTs) to identify common aeroallergens were conducted on all patients. RESULTS One hundred children were enrolled, with 50 in each group. Ten per cent of the HIV-infected patients compared with 16% of controls had positive SPTs to aeroallergens. A higher percentage of the HIV-infected patients had chronic rhinitis and eczema (60% and 68%, respectively). There was no relationship between CD4 count and positive SPTs (p = 0.61), mean log CD4 count and presence of reported asthma (p = 0.71), and CD4 count and presence of reported dermatitis (p = 0.84). The CD4 count was not statistically different between children with and without a family history of atopy (p = 0.68). CONCLUSION It appears that the stage of HIV disease does not influence the development or expression of allergy. There is a high prevalence of dermatitis and chronic rhinitis in HIV-infected children, probably not atopic in origin.

Psychosocial and economic determinants of infant feeding intent by pregnant HIV infected women in Tshwane/Pretoria

Objectives . To determine the extent to which stigma, disclosure, coping and socio-economic factors would affect infant feeding choices made antenatally by pregnant HIV-positive women after the routine prevention of mother-to-child transmission counselling process. Patients and methods. The antenatal feeding choices and determinants of these choices of HIV-infected women were studied at four antenatal clinics in two Tshwane townships, between June 2003 and December 2005. Results . Seventy-four per cent of the 293 study participants intended to formula feed their babies, while 26% planned to breastfeed or mixed feed. The women who intended to breastfeed had lower active coping ability (adjusted odds ratio (AOR) 0.88, 95% confidence interval (CI) 0.82 - 0.94), were less likely to have disclosed their status to partners or husbands (AOR 0.54, 95% CI 0.30 - 0.99), were twice as likely to be married (AOR 2.06, 95% CI 1.03 - 4.12) and were twice as knowledgeable about HIV transmission through breastfeeding (AOR 2.11, 95% CI 1.14 - 3.90). Conclusion . Counselling on infant feeding choices among HIV-infected women should be sensitive to the numerous internal and external factors that influence the decision. The support that HIV-infected women need in making their infant feeding decisions will entail psychosocial, community-wide interventions, and frequent counselling sessions to assist them in coping with and disclosing their status.

Factors affecting HIV-infected mothers’ ability to adhere to antenatally intended infant feeding choice in Tshwane

Objectives . To determine the factors influencing the ability of HIV-infected mothers to adhere to antenatal feeding choices after routine prevention of mother-to-child transmission counselling. Patients and methods . The postnatal feeding practices of 222 HIV-infected mothers were compared with their prenatal intentions and with those of 53 uninfected mothers. Results . Ninety-four per cent of HIV-negative mothers were breastfeeding their babies at age 6 weeks, while 69% of HIVpositive mothers were formula feeding. Of the HIV-positive mothers who intended to formula feed prenatally, 25% changed their minds and breastfed, while 50% of 52 women planning to breastfeed switched to formula feeds. Mothers who did not adhere to their original intention to formula feed were significantly younger than those who remained with their original choice, and were more likely to have received negative or domineering support and to share their home with someone other than their partner. Conclusion . Women are influenced by circumstances in their homes and at the hospital to depart from their original feeding intent.

Unsuitable blood glucose measuring devices in neonatal or paediatric acute care

A newborn baby with persistent neonatal jaundice developed severe septicaemia. Blood glucose monitoring using Accuchek(R) revealed persistently high values, but laboratory blood glucose testing showed no instance of true hyperglycaemia. She was found to have galactosaemia. The Accu-chek® glucose meter does not discriminate between blood galactose and glucose.

Gastroenteritis in young children

Abstract Acute diarrhoea is due to intestinal infection. The patient ingests the pathogen which has contaminated water, food, drink, toys or anything that can be placed in the mouth. An inadequate and unsafe water supply, and poor application and practice of hygiene leads to faecal contamination. The most important complication is dehydration, with a poor correlation between the clinical features and actual dehydration. The management of the dehydrated patient depends on a careful assessment of the state of the circulation and the need for resuscitation. In most instances, oral rehydration is appropriate and fully effective if the solution is offered in small quantities at a time. Normally nourished infants do not require modification of their feeds beyond adapting the quantity offered as tolerated, but if diarrhoea persists, there is a risk of intestinal mucosal damage with malabsorption and nutritional consequences.

SAJCH online: Heading for a brighter future

The SAJCH continues as an online journal with a heightened emphasis on original research.

Discussion and Debate

Can South Africa (SA)s re-engineered primary healthcare service deliver the Youth-friendly Health Services (YFHS) package? The thrust of the Department of Healths new shift towards preventive health services relies heavily on community health workers (CHWs) as members of ward-based outreach teams that form the basis for health promotion activities, problem recognition, referral and home-based care.

Healthcare professionals and breastfeeding: To practise or to preach?

By common consensus, human breastmilk is not only the right food for optimal nutrition and growth for a newborn baby, but also a biological messenger system that inuences future health. Breastmilk aects gut maturation, immunity and nutritional programming, and the maternal act of breastfeeding contributes to infant emotional bonding and sense of security. Rightly, therefore, the World Health Organization has repeatedly stressed the importance of breastfeeding as an essential requirement for child health, and it is an almost automatic expectation that all healthcare practitioners (doctors, nurses, dieticians, etc.) support and promote healthy breastfeeding. Unfortunately, marketplace choices, misguided public inform- ation, workplace pressures and observed behaviour patterns of women in dominant or aspirational positions have resulted in alarmingly low breastfeeding rates, particularly in the developing world. In a large study in sub-Saharan Africa, Tylleskar et al. (1)

Quo vadis child health in South Africa? : editorial

The World Health Organizations definition of health as a state of physical, mental and social well-being implies for children the opportunity to grow and develop to a state of optimal functioning in adulthood. It is clear that this is not possible under circumstances of poverty, deprivation of access to resources of food, housing and education, existential insecurity, natural disasters and human conflict.

Should the routine approach to diarrhoea management be modified in an area of high prevalence of paediatric HIV infection

or urinary infection. Patients with diarrhoea were more likely to be tested for HIV if they were severely malnourished or clinically wasted, if they had hyponatraemia or hypokalaemia, and if they had hepatomegaly or lymphadenopathy. The presence of shock or severe dehydration on admission, or of comorbid pneumonia, did not differentiate between those who were tested for HIV and those who were not. There were statistically significant differences between those tested for HIV and those not tested in respect of outcome. Among the children tested for HIV, 24.2% of survivors had a prolonged hospital stay (more than 10 days), compared with 1.4% among those not tested (p<0.005). While more children in the group tested for HIV died in hospital (6.1% v. 2.6%), this did not reach statistical significance (p=0.466). Conclusion. In this study, HIV testing was found to be predominantly based on clinical grounds at the time of admission. Because of considerable clinical overlap between diarrhoea patients with and without HIV infection, HIV co-infection cannot be reliably predicted on clinical features alone and must be actively excluded. Effective ART is now available. All patients with diarrhoea must therefore be offered HIV testing to provide earlier access to appropriate management.