Pre-Hospital Management and Risk Factors in Children with Acute Diarrhoea Admitted to a Short-Stay Ward in an Urban South African hospital with a High HIV Burden

Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are not well described.Objectives. To document pre-hospital home and primary care management of diarrhoea; and certain risk factors and complications of diarrhoea.Methods. We used a prospective descriptive convenience sample of children admitted to the short-stay ward at Tygerberg Hospital; Parow; Cape Town; between 1 February 2007 and 31 May 2008. Caregivers were interviewed; and demographic; clinical and laboratory variables were collected.Results. We recruited 142 children; median age 8.9 months. A third had moderate malnutrition. Twenty-four (16.9) were HIV-exposed; with 9 (6.3 HIV-infected. HIV-exposed children were significantly younger than unexposed children (p=0.03). Weight-for-age Z-scores (WAZ) were significantly lower in HIV-infected than in HIV-exposed; uninfected children (p=0.02). Eighty per cent of caregivers gave ORT and 35.2stopped feeds. Only 1 of 43 children aged under 6 months was exclusively breastfed. Advice at primary care level rarely complied with IMCI guidelines. Conclusions. Most caregivers do give ORT; but advice given at primary care level is often suboptimal. Many hospitalised children with diarrhoea are malnourished. Children with HIV infection are at increased risk of diarrhoeal disease and malnutrition; and HIV exposure appears to increase the risk of early presentation with diarrhoea. Ongoing strategies are needed to ensure optimal prevention policies; pre-hospital management and nutritional rehabilitation

The changing profile of pediatric meningitis at a referral centre in Cape Town, South Africa.

BACKGROUND: Pediatric meningitis remains a common cause of childhood morbidity and mortality in developing countries. Knowledge of the causative organisms in a region is of importance in guiding empiric antibiotic regimes and immunization schedules assisting decisions on primary health-care interventions. METHODS: This retrospective review of 557 meningitis cases represents a third pediatric survey conducted over a 3-year period (January 2007 to December 2009) at the same institution and after an interval of 14 years. Cases were identified using cerebrospinal fluid results. Demographic and laboratory variables were collected and meningitis was classified as aseptic/viral, bacterial, septic, tuberculous meningitis (TBM) or fungal. RESULTS: The commonest form of bacterial meningitis was TBM diagnosed in 22% (n = 126) of children. Streptococcus pneumoniae 4% (n = 23) and Klebsiella pneumoniae 3% (n = 17) were the next commonest causes of bacterial meningitis diagnosed. Haemophilus influenzae meningitis occurred in <1% (n = 3) of cases with a median age of 3 months. Aseptic meningitis remains the commonest category. Human immunodeficiency virus (HIV) testing was requested in 43% (n = 241) of cases; 8% (n = 46) were positive. CONCLUSION: TBM remains the commonest cause of pediatric bacterial meningitis in the Western Cape. It is concerning that the percentage of TBM cases out of the total study population has more than doubled compared with that in previous surveys. The low prevalence and young age of H. influenzae meningitis cases confirm the benefits derived from H. influenzae type b (Hib) vaccination.