Childhood pneumonia in Sub-Saharan Africa: Still a challenge

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Childhood pneumonia - progress and challenges

No Abstract. South African Medical Journal Vol. 96(9) (Part 2) 2006: 890-89

New advances in cystic fibrosis - implications for developing countries

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Diagnosis of pulmonary tuberculosis in children - what's new?

The global burden of paediatric tuberculosis (TB) has been underappreciated. Control programmes, focused on adult infectious cases, have largely based case detection and reporting on sputum smear results. However, evidence suggests that in developing countries, where most disease occurs, childhood TB constitutes a large proportion of the TB caseload, contributing approximately 15 - 20% of all cases

Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants

Abstract Background Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. Methods Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. Results Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. Conclusions Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health

Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Study

Background Childhood pneumonia causes substantial mortality and morbidity. Accurate measurements of pneumonia incidence are scarce in low-income and middle-income countries, particularly after implementation of pneumococcal conjugate vaccine. We aimed to assess the incidence, severity, and risk factors for pneumonia in the fi rst year of life in children enrolled in a South African birth cohort. Methods This birth cohort study is being done at two sites in Paarl, a periurban area of South Africa. We enrolled pregnant women (>18 years) and followed up mother–infant pairs to 1 year of age. We obtained data for risk factors and respiratory symptoms. Children received 13-valent pneumococcal conjugate vaccine according to national immunisation schedules. We established pneumonia surveillance systems and documented episodes of ambulatory pneumonia and pneumonia warranting hospital admission. We calculated incidence rate ratios for pneumonia with mixed-eff ects Poisson regression. Findings Between May 29, 2012 and May 31, 2014, we enrolled 697 infants who accrued 513 child-years of follow-up. We recorded 141 pneumonia episodes, with an incidence of 0·27 episodes per child-year (95% CI 0·23–0·32). 32 (23%) pneumonia cases were severe pneumonia, with an incidence of 0·06 episodes per child-year (95% CI 0·04–0·08). Two (1%) of 141 pneumonia episodes led to death from pneumonia. Maternal HIV, maternal smoking, male sex, and malnutrition were associated with an increased incidence of pneumonia. Interpretation Pneumonia incidence was high in the fi rst year of life, despite a strong immunisation programme including 13-valent pneumococcal conjugate vaccine. Incidence was associated with pneumonia risk factors that are amenable to interventions. Prevention of childhood pneumonia through public health interventions to address these risk factors should be strengthened. Funding Bill & Melinda Gates Foundation, South African Thoracic Society, Federation of Infectious Diseases Societies of South Africa, and University of Cape Town

New imaging approaches for improving diagnosis of childhood tuberculosis

In South Africa (SA), childhood tuberculosis (TB) still accounts for considerable morbidity and mortality. The incidence of TB disease and risk of progression to severe or disseminated forms are especially high in young children or those with HIV infection. Childhood TB presents most commonly as primary TB, often with non specific signs and symptoms; TB may also present as acute pneumonia. The clinical diagnosis can therefore be challenging. Furthermore, due to difficulty in obtaining good-quality specimens and the paucibacillary nature of childhood TB, microbiological confirmation is only achieved in a minority of children, especially in settings where there is limited capacity for microbiological confirmation

Asthma in South African children : reflection on new recommendations for care

The South African Childhood Asthma Working Group (SACAWG), a subcommittee of the Allergy Society of South Africa (ALLSA), published the first national asthma guidelines for children in 1992. Since then, the understanding of asthma and management strategies have evolved considerably. Asthma is now considered to be a spectrum of illness, reflecting different underlying inflammatory and airway processes. Over the past two decades, the importance of airway inflammation underlying asthma pathogenesis (rather than bronchoconstriction) has been recognised, with guidelines increasingly focused on effectively controlling chronic asthma symptoms, as well as preventing acute exacerbations through inhaled therapy.http://www.samj.org.zadm2022Paediatrics and Child Healt