Infectious diseases at the paediatric isolation units of Clairwood and King Edward VIII Hospitals, Durban

Objective. Information on diseases of public health importance is scanty or  unavailable in South Africa as a result of a weak health surveillance system. Large institutional databases of common diseases can, therefore, provide useful ancillary information for planning and policy, despite unavoidable selection bias. We conducted a 12-year retrospective review (1985 - 1996) of all children admitted to the only isolation facility for the Durban metropolitan region. ·Our aim was to document changes in admissions and mortality for common childhood infectious diseases and to detect any impact of the HIV epidemic on these diseases.Results. During these years 19 037 children were admitted and annual admissions decreased by 79%. Measles accounted for the majority of admissions (58%), followed by varicella at 23%. No cases of poliomyelitis, diphtheria or cholera have been seen since 1990. Typhoid fever, mumps, tetanus and pertussis have  decreased, but remain at low endemic levels. Between 1994 and 1996, 1% of measles and 15.3% of varicella cases have been associated with illV-l infection; this has resulted in 56% of measles deaths and 75% of varicella deaths occurring in HIV co-infected children. Overall, 60% of deaths during the past 3 years have been in illV co-infected children. HIV testing based solely on clinical suspicion was performed in 11% and 29% of measles and varicella cases, respectively. Average all-disease mortality was 5.3%, a decrease of 87% over the study period, with measles accounting for most deaths (86%).Conclusions. The changing profile of childhood infectious diseases described at the paediatric isolation units is consistent with available national data. Probable reasons for these changes are the shift in emphasis to primary health care issues, and a gradual improvement in socio-economic conditions of the poor

Influence of elevation and rainfall on leaf growth, bean characteristics and yield components of arabica and robusta coffee under changing climatic conditions in Karnataka state, India

The study was undertaken to analyze the behaviour of coffee under changing climatic conditions in different coffee liaison zones of Karnataka State, India, during 2017-2020. Sample estates were identified based on elevation and rainfall patterns in different zones of the Chikkamagaluru and Hassan districts. The leaf growth parameters, bean characteristics and yield components were recorded in all the sample estates. Correlation studies indicated a significant positive relationship between the elevation, rainfall with specific leaf area (r = +0.912) and productivity (r = 0.475) during the pre-monsoon period. The monthly summer rainfall during March and April showed a significant correlation with yield in robusta (r = 0.511) and arabica (r = 0.451), indicating that blossom shower during this period significantly influenced the productivity of coffee. The studies between elevation, the quantum of rainfall and bean defect parameters indicated a significant (p<0.05) positive correlation. A positive relationship was also found between elevation and peaberry production in both robusta (r = 0.716) and arabica coffee (r= 0.456), respectively. However, there was also a significant relationship between rainfall (2020) and Jollu percentage (r = 0.386) in robusta coffee, indicating that higher elevation and rainfall-induced more peaberry content and Jollu percentage under changing climatic conditions. The overall result indicated that changes in climatic conditions such as excess rainfall and continuous soil moisture led to more vegetative growth than reproductive growth. This also produced more bean abnormalities which in turn affected the yield and quality of the coffee

South African guideline for the diagnosis, management and prevention of acute viral bronchiolitis in children

Endorsement. South African Thoracic Society, South African Society of Paediatric Infectious Diseases, United South African Neonatal Association. Objective. To develop and publish a guideline for doctors managing acute viral bronchiolitis, because this condition is extremely common in South Africa, it is responsible for significant morbidity in the population, and subsequently a great deal of patient and parental distress, and the disease is costly, since many children are unnecessarily subjected to investigations and treatment strategies that are of no proven benefit. The main aims of the guideline are to promote an improved standard of treatment based on understanding of the disease and its management, and to encourage cost-effective and appropriate management. Evidence. A detailed literature review was conducted and summarised into this document by a selected working group of paediatricians from around the country. Recommendations. These include the appropriate diagnostic and management strategies for acute viral bronchiolitis

Management of acute fever in children : guideline for community healthcare providers and pharmacists

Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. This guideline aims to assist pharmacists, primary healthcare workers and general practitioners in risk-stratifying children who present with fever, deciding on when to refer, the appropriate use of antipyretic medication and how to advise parents and caregivers.Reckitt Benckiserhttp://www.samj.org.zaam2014ay201

Clinical Profile and Predictors of Severe Illness in young South African Infants (

Background Most childhood deaths occur in the first two months of life. Simple symptoms and signs that reliably indicate the presence of severe illness, warranting urgent hospital management are of major public health importance. Objectives: To describe the disease profile of sick young infants aged 0-59 days presenting to King Edward VIII Hospital, Durban, South Africa and to assess the association between clinical features assessed by primary health workers and the presence of severe illness. Methods: Specific clinical signs were evaluated in young infants by a health worker (nurse), using a standardized list. These signs were compared to an assessment by an experienced pediatrician for the need for urgent hospital-based or clinic-based care. Results: 925 young infants were enrolled; 6

Acute viral bronchiolitis in South Africa: Diagnostic flow

Bronchiolitis may be diagnosed on the basis of clinical signs and symptoms. In a young child, the diagnosis can be made on the clinicalpattern of wheezing and hyperinflation.Clinical symptoms and signs typically start with an upper respiratory prodrome, including rhinorrhoea, low-grade fever, cough and poorfeeding, followed 1 - 2 days later by tachypnoea, hyperinflation and wheeze as a consequence of airway inflammation and air trapping.The illness is generally self limiting, but may become more severe and include signs such as grunting, nasal flaring, subcostal chest wallretractions and hypoxaemia. The most reliable clinical feature of bronchiolitis is hyperinflation of the chest, evident by loss of cardiacdullness on percussion, an upper border of the liver pushed down to below the 6th intercostal space, and the presence of a Hoover sign(subcostal recession, which occurs when a flattened diaphragm pulls laterally against the lower chest wall).Measurement of peripheral arterial oxygen saturation is useful to indicate the need for supplemental oxygen. A saturation of <92% atsea level and 90% inland indicates that the child has to be admitted to hospital for supplemental oxygen. Chest radiographs are generallyunhelpful and not required in children with a clear clinical diagnosis of bronchiolitis.Blood tests are not needed routinely. Complete blood count tests have not been shown to be useful in diagnosing bronchiolitis or guidingits therapy. Routine measurement of C-reactive protein does not aid in management and nasopharyngeal aspirates are not usually done.Viral testing adds little to routine management.Risk factors in patients with severe bronchiolitis that require hospitalisation and may even cause death, include prematurity, congenitalheart disease and congenital lung malformations

Acute viral bronchiolitis in South Africa: Strategies for management and prevention

Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxicchildren. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropiumbromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids,inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterialco-infection is suspected.Prevention of respiratory syncytial virus (RSV) disease remains a challenge. A specific RSV monoclonal antibody, palivizumab,administered as an intramuscular injection, is available for children at risk of severe bronchiolitis, including premature infants, youngchildren with chronic lung disease, immunodeficiency, or haemodynamically significant congenital heart disease. Prophylaxis should becommenced at the start of the RSV season and given monthly during the season. The development of an RSV vaccine may offer a moreeffective alternative to prevent disease, for which the results of clinical trials are awaited.Education of parents or caregivers and healthcare workers about diagnostic and management strategies should include the following:bronchiolitisis caused by a virus; it is seasonal; it may start as an upper respiratory tract infection with low-grade fever; symptoms arecough and wheeze, often with fast breathing; antibiotics are generally not needed; and the condition is usually self limiting, althoughsymptoms may occur for up to four weeks in some children

The bronchiolitis season is upon us – recommendations for the management and prevention of acute viral bronchiolitis

Despite being so common, bronchiolitis remains poorly diagnosed and managed. This article is intended as an update on issues pertaining to this condition.http://www.samj.org.zaam201