ABSTRACT
Background. West syndrome (WS) is a rare epileptic encephalopathy of infancy. There is currently no research on the incidence or prevalence of WS in Africa.Methods. We aimed to describe the outcome of children with WS at a quaternary-level hospital in KwaZulu-Natal, South Africa (SA). This was a retrospective chart review conducted on patients diagnosed with WS over a 10-year period. Eight children (males, n=7; African, n=6; Asian, n=2) identified with WS out of 2 206 admitted with epilepsy. The median age (range) at diagnosis was 7.5 (1 - 9) months. The average time between onset of epileptic spasms and diagnosis was 3.1 months.Results. Six patients had abnormal neuroimaging (atrophy (n=2); corpus callosum agenesis (n=2); tuberous sclerosis (n=1); focal dysplasia (n=1)). Drug management included sodium valproate (n=8), topiramate (n=7) and levetiracetam (n=3). Subsequent definitive treatment was intramuscular adrenocorticotrophic hormone (n=3), vigabatrin (n=2) and oral prednisone (n=4). Four (50%) patients had complete seizure remission (neuromigratory disorder (n=2); tuberous sclerosis (n=1); and idiopathic (n=1)) and 4 had partial remission (neonatal complications (n=3); idiopathic (n=1).Discussion. Most of our patients had symptomatic WS, with 50% remission on treatment. Outcomes were poorer in our study when compared with those in published data.Conclusion. Further collaborative studies are still needed to evaluate the true impact and prevalence of WS in SA
Subject(s)
South Africa , Spasms, Infantile/diagnosis , Spasms, Infantile/epidemiologyABSTRACT
The transmission of HIV through breastmilk; with the potential to infect the newborn; has had a major impact on child health worldwide. Although South African studies confirmed that exclusive breastfeeding reduced rates of mother-to-child transmission of HIV; the recommendation of formula feeding for HIV-exposed newborn infants; provided their mothers had the facilities for safe preparation of formula milk and complied with the AFASS criteria (formula feeding to be Acceptable; Feasible; Affordable; Sustainable; Safe); was introduced. Observations made by the nursing staff; fully aware of the risks of formula feeding; in the neonatal unit at King Edward VIII Hospital in 2009 showed that an increasing number of small; sick newborns were being formula fed.By conducting focus group discussions with nurses; mothers and counsellors and teasing out the confusions and misconceptions; relevant information was imparted to the groups to allow them to re-consider their misconceptions. Within a period of 2 months nurses were confident about re-counselling mothers with respect to appropriate feeding choices. HIV-positive mothers were trained to flash-heat their milk. Subsequently; policies for the unit were derived from the focus group discussions. In addition; regional hospitals in the Durban area (eThekweni) considered the introduction of flash-heating to their units. The South African Department of Health opted for infants to receive prophylaxis with daily nevirapine as long as they are breastfed; and the Nutrition Directorate decided to withdraw the issue of free replacement feeds in HIV-exposed babies. KZN was the first province to institute this policy. The Department of Health has recommended that neonatal units no longer encourage HIV-infected mothers to flash-heat their breastmilk unless the infant is not receiving ARV prophylaxis or the mother is not on treatment
Subject(s)
Breast Feeding , HIV Seropositivity , Infant, Newborn , Infectious Disease Transmission, Vertical , South Africa , Therapeutic MisconceptionABSTRACT
Most reports of survival of very-low-birth-weight (VLBW) babies focus on infants in tertiary care centres in large metropolitan areas.1-5 Extrapolating data from major centres to peripheral hospitals is problematic because of various factors; including poor socio-economic conditions; absence of intensive/special-care facilities and equipment; and limited number of staff with knowledge and skills in neonatal care in smaller hospitals.3 We were able to raise the survival rate (SR) from 21 to 40 following the use of low-cost measures between 2002 and 2005