Paediatric lver transplantation for children treated at public health facilities in South Africa: Time for change

Paediatric liver transplantation (PLT) is the only therapeutic option for many children with end-stage chronic liver disease or irreversible fulminant hepatic failure and is routinely considered as a therapy by paediatric gastroenterologists and surgeons working in developed countries. In South Africa (SA), a PLT programme is available at Red Cross War Memorial Children’s Hospital in Cape Town since November 1991, and another has rapidly developed at the Wits Donald Gordon Medical Centre in Johannesburg over the past decade. However, for most children with progressive chronic liver disease who are reliant on the services provided at public health facilities in SA, PLT is not an option because of a lack of resources in a mismanaged public health system. This article briefly outlines the services offered at Chris Hani Baragwanath Academic Hospital - which is typical of public health facilities in SA - and proposes that resources be allocated to establish an innovative, nationally funded centre that would enable greater numbers of children access to a PLT programme

The discriminative value of C-reactive protein levels in distinguishing between bacterial and viral pneumonia in children

Background: CRP testing is routinely performed on children admitted to the Chris Hani-Baragwanath Hospital (Soweto, Johannesburg) with pneumonia. The CRP is used to distinguish between bacterial and viral pneumonia, assisting the clinician to judiciously prescribe antibiotics. Objectives: 1. To evaluate whether the initial CRP measurement discriminates between bacterial and viral pneumonia. 2. To evaluate the effect of HIV infection on CRP responses in children with pneumonia. 3. To perform a costs analysis of routine CRP measurements in childhood pneumonia. Design: Retrospective review of case records. Results: This study analysed 570 children with pneumonia who were catergorised into four aetiological groups- 55 children had bacterial pneumonia, 145 viral pneumonia, 11 mixed pneumonia and in 359 children the aetiology was unknown. 244 (42.8%) children were co-infected with HIV and 186 (32.6%) children were malnourished. The median CRP value was significantly higher in bacterial pneumonia than in viral pneumonia or pneumonia of unknown aetiology (P <0.0001, Median test). Threshold CRP values of >10mg/L could distinguish between bacterial and viral pneumonia (P=0.0009, Fishers exact test). However, in HIV uninfected children, receiver-operating characteristic (ROC) curve plots showed that only 80% of bacterial infections could be predicted using threshold CRP values. A LHP value >10mg/L predicted all cases of bacterial pneumonia in HIV infected childvsn, HIV infection did not affect CRP responses in children suffering from bacterial and/or viral pneumonia. Costs analysis suggests that routine CRP testing is expensive and outweighs the savings accrued by sparing the use of antibiotics in viral pneumonw. Conclusions: In HIV uninfected children, the initial CRP does not detect 20% of children with bacterial pneumonia. In HIV infected children, other studies are needed to confirm whether a CRP value >10mg/L predicts all cases of bacterial pneumonia, Routine CRP testing is not recommended in children with pneumonia