The Effects of Iron Deficiency and Anaemia on Primary School Learners' Scholastic Performance

Background. Iron deficiency anaemia (IDA) is a preventable cause of cognitive impairment and other negative effects on the academic potential of learners. Objectives. To determine the local prevalence of IDA among grade 2 learners in a resource-poor community and to evaluate the association between IDA and the learners' scholastic performance. Methods. This was a case-control observational design study. Data were collected using a stadiometer and an electronic scale; HemoCue Hb 201+ system and official grade 1 school reports. Results. The point prevalence of IDA was found to be 9.8% (n=19); with a higher prevalence among girls (58%). There was no statistically significant difference between the performances of the two groups (p=0.511) in mathematics. There was a statistically significant difference for life skills (p=0.00017); and the difference between the groups in literacy or languages approached statistical significance (p=0.071). Conclusions. The results of this study suggest that IDA is prevalent and may have negative effects on learners' scholastic performances. Such negative effects warrant early preventive measures so as to avoid the possibilities of school failure; drop-out and poor productivity in adulthood

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.

Impact of multi-micronutrient supplementation on growth and morbidity of HIV-infected South African children.

Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur frequently in HIV-infected children. We investigated whether multi-micronutrient supplementation would improve the growth performance and reduce the number of episodes of diarrhea and/or of respiratory symptoms in HIV-infected children. In a double-blind randomized trial, HIV-infected South African children aged 4-24 months (n = 201) were assigned to receive multi-micronutrient supplements or placebo daily for six months. The children were assessed for respiratory symptoms or diarrhea bi-weekly; weights and heights were measured monthly. In total, 121 children completed the six month follow up study period (60%). A total of 43 children died; 27 of them had received supplements. This difference in mortality was not statistically significant (p = 0.12). Weight-for-height Z-scores improved significantly (p < 0.05) among children given supplements compared with those given placebo (0.40 (0.09-0.71)) versus -0.04 (-0.39-0.31) (mean (95% CI)). Height-for-age Z-scores did not improve in both treatment groups. The number of monthly episodes of diarrhea in the placebo group (0.36 (0.26-0.46)) was higher (p = 0.09) than in the supplement group (0.25 (0.17-0.33)) and the number of monthly episodes of respiratory symptoms was significantly higher (p < 0.05) among children on placebos (1.01 (0.83-1.79)) than those on supplements (0.66 (0.52-0.80)). Multi-micronutrient supplements significantly improved wasting and reduced the number of episodes of diarrhea and respiratory symptoms.

Clinical neonatal rotavirus infection: association with necrotising enterocolitis.

BACKGROUND: Rotavirus is the most important aetiological agent causing severe gastroenteritis in children <2 years of age in South Africa and worldwide. Most endemic neonatal nursery strains are thought to be asymptomatic. However, serious conditions have been reported to be associated with rotavirus infection, such as necrotising enterocolitis (NEC), diffuse intravascular coagulopathy, pneumonia, apnoea and seizures. METHODS: We studied newborns needing screening for sepsis in our Neonatal Unit. Rotavirus screening was included in the septic screen. The clinical signs and symptoms were studied in the control group (no rotavirus identified) and the study group (rotavirus identified in the stools). RESULTS: Of the 169 babies screened for sepsis, 44 (26%) were rotavirus positive. Of the remainder, 63 comprised the control group. Rotavirus-positive stools were identified from day 4 of life. The virus was excreted in the stools for a mean of 4 days per infection episode. Asymptomatic infection was only observed in one baby; the others had clinical signs and symptoms ranging from mild to severe and even death. Gastrointestinal symptoms were prominent manifestations of rotavirus infection. There was a high incidence of NEC (66% in the study group v. 30% in the control group). Of the rotavirus-infected babies, 9 died; 3 had no other pathogens identified, so that rotavirus infection could have been the cause of death. CONCLUSIONS: Rotavirus infection in the neonate is rarely asymptomatic. It is a dangerous condition that may cause death. It is associated with, and probably a cause of, NEC.

Duration of hospitalization and appetite of HIV-infected South African children.

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumonia (9.0 ± 2.5 vs. 5.9 ± 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of HIV-uninfected children (18.6 ± 5.8 vs. 25.2 ± 7.4). The eating rates (g min(-1) ) of HIV-infected children were also slower (17.6 ± 6.2 vs. 10.1 ± 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.

The economic burden of diarrheal disease in a tertiary level hospital, Gauteng, South Africa.

BACKGROUND: Diarrheal disease remains one of the major causes of morbidity and mortality in young children in South Africa. Although a rotavirus vaccine will reduce rotavirus diarrheal morbidity and mortality, its introduction and sustainability will incur considerable costs. The aim of this study was to estimate the costs associated with diarrheal disease of all etiologies in children <5 years of age at Dr George Mukhari Hospital, a tertiary level hospital in Gauteng, South Africa. METHODS: Cost data were obtained by a review of systematically selected records of patients admitted for diarrhea during 2004 and the prospective recording of the treatment of consecutive inpatients admitted for diarrhea from February through June 2005. Data on hospital stay, medications, nondrug orders, and diagnostic tests were abstracted using standardized recording forms. Costs were calculated using 2004 and 2005 prices. Carers were interviewed using a standard interview schedule to determine out-of-pocket expenses. Stool samples were tested for rotavirus by the Medical Research Council Diarrheal Pathogens Unit. RESULTS: The review sample comprised 86 (20 rotavirus positive) patient records. The prospective sample comprised 77 inpatients (25 rotavirus positive). The mean duration (+/- standard deviation [SD]) of hospital stay was 4.6 +/- 3.4 days and 5.7 +/- 4.7 days for the review and prospective samples, respectively. The mean total inpatient cost (+/-SD) was R5963 +/- R4070 (review sample) and R7256 +/- R5599 (prospective sample; P > .05). Although mean total costs did not differ significantly between rotavirus-negative and -positive samples, mean facility and antibiotic costs were significantly higher for the rotavirus-negative sample (P < .05) in the prospective sample. Mean out-of-pocket expenses (+/-SD) were R100.00 +/- R112 for inpatients. CONCLUSION: Although total inpatient costs did not differ significantly between the rotavirus-negative and -positive patients, costs for the rotavirus-negative patients tended to be higher. Although a rotavirus vaccine will reduce the burden of diarrheal disease, it is imperative that measures for reducing the incidence and severity of diarrheal disease due to other pathogens are strengthened.

Short-term micronutrient supplementation reduces the duration of pneumonia and diarrheal episodes in HIV-infected children.

The duration of pneumonia and of diarrhea is reported to be longer in HIV-infected than in uninfected children. We assessed the effect of a multi-micronutrient supplement on the duration of hospitalization in HIV-infected children. In a double-blind, randomized trial, HIV-infected children (4-24 mo) who were hospitalized with diarrhea or pneumonia were enrolled (n = 118) and given a daily dose of a multi-micronutrient supplement (containing vitamins A, B complex, C, D, E, and folic acid, as well as copper, iron, and zinc at levels based on recommended daily allowances) or a placebo until discharge from the hospital. Children's weights and heights were measured after enrollment and micronutrient concentrations were measured before discharge. On recovery from diarrhea or pneumonia, the children were discharged and the duration of hospitalization was noted. Anthropometric indices and micronutrient concentrations did not differ between children who received supplements and those who received placebos. Overall, the duration of hospitalization was shorter (P < 0.05) among children who were receiving supplements (7.3 +/- 3.9 d) (mean +/- SD) than in children who were receiving placebos (9.0 +/- 4.9); this was independent of admission diagnosis. In children admitted with diarrhea, the duration of hospitalization was 1.6 d (19%) shorter among children receiving supplements than in those receiving placebos, and hospitalization for pneumonia was 1.9 d (20%) shorter among children receiving supplements. Short-term multi-micronutrient supplementation significantly reduced the duration of pneumonia or diarrhea in HIV-infected children who were not yet receiving antiretroviral therapy and who remained alive during hospitalization.

Improved appetite after multi-micronutrient supplementation for six months in HIV-infected South African children.

The aim of the study was to assess the effect of multi-micronutrient supplementation on the appetite of HIV-infected children. HIV-infected children (6-24 months) who had previously been hospitalized were enrolled into a double-blind randomized trial, and given daily multi-micronutrient supplements or placebos for six months. Appetite tests were performed at enrollment and after three and six months. Appetite was measured as ad libitum intake of a commercial cereal test food served after an overnight fast according to standardized procedures. Body weights and total amount of test food eaten were measured. In total, 99 children completed the study (50 on supplements and 49 on placebos). Amounts eaten per kilogram body weight in the supplement group at enrollment and after six months were 36.7+/-17.7 g/kg (mean+/-SD) and 41.3+/-15.0 g/kg respectively, while the amounts in the placebo group were 47.1+/-14.9 g/kg and 45.7+/-13.1g/kg respectively. The change in amount eaten per kilogram body weight over six months was significantly higher in the supplement group (4.7+/-14.7 g/kg) than in the placebo group (-1.4+/-15.1g/kg). Multi-micronutrient supplementation for six months seems to significantly improve the appetite of HIV-infected children.

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 whose diarrhoea was 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 disease presentation make the institution of a rotavirus vaccine programme in Sierra Leone imperative.

Multi-organ failure in adult onset Still's disease: a septic disguise.

The diagnosis of adult onset Still's disease is difficult in the absence of definite clinical and laboratory criteria. A delayed diagnosis of adult onset Still's disease was made in a 23-year-old female who developed multi-organ failure and disseminated intravascular coagulation with fingertip auto-amputation during a febrile illness considered septic due to the persistence of elevated serum procalcitonin concentration.