The poor children of the poor: Coping with diabetes control in a resource-poor setting

Background. Coping with diabetes control is difficult for newly diagnosed and experienced patients alike. Children with diabetes face severe challenges, as they may not yet have attained the necessary  cognitive, fine motor or psychosocial skills required for performance of the tasks required from the diabetic patient. Most therefore require some adult assistance.Objectives. To establish whether paediatric diabetic patients are adequately supported by their families in terms of giving insulin injections and doing home blood glucose monitoring (HBGM), and whether insulin and the necessary equipment are appropriately stored in their homes.Methods. Patients attending a paediatric diabetes clinic were interviewed. The data collected included demographic variables, type of insulin, measurement of insulin doses, administration of insulin, and blood glucose monitoring tests.Results. Twenty-five subjects were interviewed: 18 measured the insulin themselves, five mothers and one aunt did so, and in one case the mother and patient did so together. The four children aged .10 years had their insulin measured by their mothers, but one had to administer the injection himself. Eight of the nine children aged 11 - 15 years measured and administered the insulin themselves; in four cases the doses were checked by an adult. The mothers of four children did the fingerpricks, and eight children were helped with measuring the results. Only two children aged 11 - 15 years had their doses checked by an adult.Conclusion. Adult assistance with regard to both insulin injections and HBGM is rarely forthcoming. The children seem not to be sufficiently supported by their families

Students Opinions on Autopsy and Death

Background: Autopsies are commonly seen on television, but are less common in real life. Worldwide, the autopsy rate has declined drastically over the past half century, from approximately 50% to only five to 22% in the 1990s. These percentages are inflated by the number of forensic autopsies, which suggests that hospital autopsy rates for other purposes are very low. Some students graduate without witnessing a formal autopsy, and some students and medical practitioners consider the autopsy to be of little value. The purpose of this study was to assess the thoughts and feelings of students towards autopsies at the end of their medical training. Method: A survey of final-year medical students’ thoughts and feelings on the autopsy, death and grief was performed by means of a self-administered questionnaire. Informed consent was obtained and the study was approved by the Ethics Committee. Results: Of the 164 respondents, 64 were female and 100 male. Their ages varied from 22 to 40, with a mean of 27,7 years. Only 11% had discussed their wishes with regard to an autopsy on themselves with their family, while 33% had discussed funeral arrangements. Most students thought that aspects of the autopsy should be changed, e.g. the deceased should remain anonymous, the number of students observing an autopsy should be reduced, the atmosphere should be more respectful and the organs should be handled with more care. During training, students have insufficient opportunities to discuss their thoughts and feelings about the autopsy, and issues of grief and death are insufficiently dealt with. Conclusions: Students’ emotional reactions are an important, but unfortunately neglected, aspect of medical training. Student teaching needs to deal effectively with expected reactions through the understanding and management of these emotional responses towards cadaver dissection and other medical procedures. At both undergraduate and postgraduate levels, medical education must emphasise the importance of the autopsy. This means that academic institutions need to perform a sufficient number of autopsies for students to have the opportunity to observe and participate in them.SA Fam Pract 2005;47(1): 47-5

The incidence and clinical presentation of infantile rotavirus diarrhoea in Sierra Leone

Objectives. An effective vaccine is needed to protect against severe rotavirus disease, an important cause of gastroenteritis. Since there are no data on the incidence and antigenic diversity of rotavirus infection in Sierra Leone, we studied its epidemiology to enable an effective vaccine strategy to be designed.Methods. Children between the ages of 3 and 30 months presenting with gastroenteritis to the Ola During Children’s Hospital in Freetown, Sierra Leone, were enrolled. Stool specimens were tested in South Africa using polyacrylamide gel electrophoresis to confirm rotavirus infection.Results. Over a 5-month period 143 children presenting with gastroenteritis were recruited. Stool samples obtained from 128 study subjects were tested for the presence of rotavirus; 45% were aged between 3 and 9 months (mean age 10.85 months), and 48 stool samples (37.5%) tested positive for rotavirus. The incidence of rotavirus infection was 20% higher in boys than in girls, a gender difference confirmed elsewhere in West Africa. The prevalence of rotavirus-positive stools peaked in August, coinciding with the rainy season. About 90% of the rotavirus-positive patients had severe diarrhoea, as opposed to only about two-thirds of the patients whosediarrhoea  as not caused by rotavirus; this difference was statistically significant.Conclusions. There is a high incidence of rotavirus infection in Sierra Leone, with rotavirus causing 37.5% of the gastroenteritis in this study. Patients with rotavirus gastroenteritis almost all had severe diarrhoea. The high incidence of rotavirus infection and the severity of the diseasepresentation make the institution of a rotavirus vaccine programme in Sierra Leone imperative

Social interaction of teenage mothers during and after their pregnancy

Extensive attention has been given to adolescent sexuality and teenage pregnancy in the past 30 years, yet many teenagers still fall pregnant. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The objective of the study was to describe the social interaction of teenage mothers at Ga-Rankuwa Hospital during and after their pregnancy. Seventy teenage mothers were interviewed using an interview schedule. Thirty-four of them stayed with both parents, 19 with the mother only and the rest with relatives or their partner's mother. Only one was married (by customary law), and most (59%) had known their partner for 12-24 months. Fifty-two talked to someone when they discovered that they were pregnant, nine were too scared to do so and the other nine were unaware of the pregnancy until it was discovered by a family member. Most (58) wished to return to school within a year, seven wished to find work (after first looking after the baby), and two wished to get married. In conclusion, the majority of teenagers who fall pregnant do so while still at school. Teenagers are at risk of unwanted pregnancies. Few first tell their mothers about the pregnancy, although most talk to someone soon after discovering that they are pregnant. Most, however, retain the support of their families during and after the pregnancy. Keywords: adolescent, pregnancy, social interaction, post-partum For full text, click here: SA Fam Prac 2004;46(2):21-2

Early infant feeding practices of mothers attending a postnatal clinic in Ga-Rankuwa

Background: Despite the recommendation of the World Health Organization (WHO) of exclusive breastfeeding for the first 4-6 months of life, several South African studies on infant feeding practices have shown that the introduction of feeds other than breastmilk before 4 months is a common practice. The timing of initiation of complementary feeding within the first 4 months is, however, difficult to determine.Objective: To determine feeding practices of mothers of infants 8 weeks of age or younger, attending the postnatal clinic at Ga-Rankuwa Hospital.Methods: A cross-sectional study of mothers attending the postnatal clinic at Ga-Rankuwa Hospital using a standardised interview schedule.Results: A total of 150 mothers were interviewed. All infants in the sample were younger than 9 weeks of age. The mean age of the sample was 37.4 (5.2 weeks) ±12.1 days. Although 99% of infants were breastfed, exclusive breastfeeding was practised by only 4.6% of the sample. Water was given to 88%, infant formula to 43% and complementary feeds to 37%. Forty-six per cent of mothers said that the reason for giving water to their babies was to prevent constipation. Infant formula was added because mothers believed that their breastmilk was insufficient for their infants\' needs. Of the complemented infants, 91% had received complementary feeds before 7 weeks of age. Thin maize meal porridge providing less than 1 kJ/ml and negligible protein was the most commonly given first food.Conclusion: Breastfeeding was almost universal, exclusive breastfeeding was the exception. Mixed feeding was common, with the introduction of complementary feeds occurring within the first 2 months of life, well before the WHO recommendations.South African Journal of Clinical Nutrition Vol. 18(2) 2005: 70-7