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1.
Dev Med Child Neurol ; 66(8): 990-1012, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38351549

RESUMO

AIM: To review the epidemiology and outcomes of African children with cerebral palsy (CP) over a 21-year period. METHOD: The PubMed, Scopus, and Web of Science online databases were searched for original research on African children with CP aged 18 years and younger published from 2000 to 2021. RESULTS: A total of 1811 articles underwent review against explicit criteria; 93 articles were selected for inclusion in the scoping review. The reported prevalence of CP ranged from 0.8 to 10 per 1000 children. Almost half had perinatal risk factors, but up to 26% had no identifiable risk factor. At least one-third of children with CP had one or more comorbidities, most commonly epilepsy, intellectual disability, and malnutrition. African children with CP demonstrated excess premature mortality approximately 25 times that of the general population, predominantly from infections. Hospital-based and younger populations had larger proportions of children with severe impairments. African children with CP had inadequate access to care and education, yet showed functional improvements compared to controls for all evaluated interventions. INTERPRETATION: The prevalence of CP in Africa remains uncertain. African children with CP have different risk profiles, greater premature mortality, and more severe functional impairments and comorbidities compared to the Global North. Several barriers prevent access to optimal care. Larger African studies on validated and effective interventions are needed.


Assuntos
Paralisia Cerebral , Humanos , Paralisia Cerebral/epidemiologia , Criança , África/epidemiologia , Prevalência , Adolescente , Pré-Escolar , Comorbidade , Fatores de Risco
2.
Autism ; : 13623613231200297, 2023 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-37822256

RESUMO

LAY ABSTRACT: Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings - in Europe and South Africa - to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.

3.
J Pediatr Rehabil Med ; 16(2): 275-286, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36847026

RESUMO

PURPOSE: The International Alliance of Academies of Childhood Disability created a COVID-19 Task Force with the goal of understanding the global impact of COVID-19 on children with disabilities and their families. The aim of this paper is to synthesize existing evidence describing the impact of COVID-19 on people with disabilities, derived from surveys conducted across the globe. METHODS: A descriptive environmental scan of surveys was conducted. From June to November 2020, a global call for surveys addressing the impact of COVID-19 on disability was launched. To identify gaps and overlaps, the content of the surveys was compared to the Convention on the Rights of the Child and the International Classification of Functioning, Disability and Health. RESULTS: Forty-nine surveys, involving information from more than 17,230 participants around the world were collected. Overall, surveys identified that COVID-19 has negatively impacted several areas of functioning - including mental health, and human rights of people with disabilities and their families worldwide. CONCLUSION: Globally, the surveys highlight that impact of COVID-19 on mental health of people with disabilities, caregivers, and professionals continues to be a major issue. Rapid dissemination of collected information is essential for ameliorating the impact of COVID-19 across the globe.


Assuntos
COVID-19 , Pessoas com Deficiência , Criança , Humanos , COVID-19/epidemiologia , Inquéritos e Questionários , Cuidadores , Avaliação da Deficiência
4.
Childs Nerv Syst ; 39(4): 1029-1039, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36525135

RESUMO

BACKGROUND: Neurodevelopmental delay is a significant long-term complication of childhood tuberculous meningitis (TBM). The objective of this study was to assess risk factors for neurodevelopmental delay in children with TBM. METHODS: We conducted a retrospective cohort study of children diagnosed with TBM at Tygerberg Hospital, Cape Town, South Africa, over a 30-year period between 1985 and 2015. We assessed the relationship between demographic, clinical, laboratory and neuro-imaging characteristics, and cognitive impairment at the conclusion of anti-tuberculous treatment. Poor outcome was defined as moderate-to severe cognitive impairment. RESULTS: A total of 327 TBM patients were included, 71 (21.7%) suffered a poor outcome. Multivariate analysis revealed that decreased level of consciousness (adjusted OR (aOR): 4.68; 95%CI: 2.43-13.88; p = 0.005), brainstem dysfunction (aOR: 3.20; 95%CI: 1.70-6.00; p < 0.001), and radiological infarction (aOR: 3.47; 95%CI: 1.87-6.45; p < 0.001) were associated with a poor developmental outcome. Left hemispherical (single and multiple) stroke and bilateral stroke were associated with poor developmental outcomes. CONCLUSION: Certain neurological signs as well as radiological infarct characteristics are important predictors of poor developmental outcome. Anticipation of the likely level of cognitive impairment at diagnosis allows more accurate prognostication and prompt institution of supportive and rehabilitative measures, after the acute illness.


Assuntos
Acidente Vascular Cerebral , Tuberculose Meníngea , Humanos , Criança , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico por imagem , Estudos Retrospectivos , África do Sul/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/complicações
5.
Dev Psychobiol ; 64(4): e22271, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35452546

RESUMO

Approximately 7% of preterm infants receive an autism spectrum disorder (ASD) diagnosis. Yet, there is a significant gap in the literature in identifying prospective markers of neurodevelopmental risk in preterm infants. The present study examined two electroencephalography (EEG) parameters during infancy, absolute EEG power and aperiodic activity of the power spectral density (PSD) slope, in association with subsequent autism risk and cognitive ability in a diverse cohort of children born preterm in South Africa. Participants were 71 preterm infants born between 25 and 36 weeks gestation (34.60 ± 2.34 weeks). EEG was collected during sleep between 39 and 41 weeks postmenstrual age adjusted (40.00 ± 0.42 weeks). The Bayley Scales of Infant Development and Brief Infant Toddler Social Emotional Assessment (BITSEA) were administered at approximately 3 years of age adjusted (34 ± 2.7 months). Aperiodic activity, but not the rhythmic oscillatory activity, at multiple electrode sites was associated with subsequent increased autism risk on the BITSEA at three years of age. No associations were found between the PSD slope or absolute EEG power and cognitive development. Our findings highlight the need to examine potential markers of subsequent autism risk in high-risk populations other than infants at familial risk.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Transtorno do Espectro Autista/diagnóstico , Pré-Escolar , Eletroencefalografia , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Estudos Prospectivos
6.
BMJ Open ; 12(4): e058135, 2022 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418432

RESUMO

OBJECTIVE: A robust literature has identified associations between prenatal maternal depression and adverse child social-emotional and cognitive outcomes. The majority of prior research is from high-income countries despite increased reporting of perinatal depression in low/middle-income countries (LMICs). Additionally, despite the comorbidity between depression and anxiety, few prior studies have examined their joint impact on child neurodevelopment. The objective of the current analysis was to examine associations between prenatal maternal depression and anxiety with child social-emotional and cognitive development in a cohort from the Western Cape Province of South Africa. DESIGN: Prenatal maternal depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory Scale at 20-24 weeks' gestation. Child neurobehaviour was assessed at age 3 using the Brief Infant-Toddler Social Emotional Assessment and the Bayley Scales of Infant Development III Screening Test (BSID-III ST). We used linear regression models to examine the independent and joint association between prenatal maternal depression, anxiety and child developmental outcomes. RESULTS: Participants consisted of 600 maternal-infant dyads (274 females; gestational age at birth: 38.89 weeks±2.03). Children born to mothers with both prenatal depression and trait anxiety had higher social-emotional problems (mean difference: 4.66; 95% CI 3.43 to 5.90) compared with children born to mothers with no prenatal depression or trait anxiety, each condition alone, or compared with mothers with depression and state anxiety. Additionally, children born to mothers with prenatal maternal depression and trait anxiety had the greatest reduction in mean cognitive scores on the BSID-III ST (mean difference: -1.04; 95% CI -1.99 to -0.08). CONCLUSIONS: The observed association between comorbid prenatal maternal depression and chronic anxiety with subsequent child social-emotional and cognitive development underscores the need for targeting mental health support among perinatal women in LMICs to improve long-term child neurobehavioural outcomes.


Assuntos
Ansiedade , Depressão , Ansiedade/psicologia , Desenvolvimento Infantil , Pré-Escolar , Cognição , Estudos de Coortes , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Mães/psicologia , Gravidez , Estudos Prospectivos , África do Sul/epidemiologia
7.
PLOS Glob Public Health ; 2(10): e0001124, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36962592

RESUMO

Previous literature has identified associations between diabetes during pregnancy and postnatal maternal depression. Both maternal conditions are associated with adverse consequences on childhood development. Despite an especially high prevalence of diabetes during pregnancy and maternal postnatal depression in low- and middle-income countries, related research predominates in high-income countries. In a South African cohort with or without diabetes, we investigated associations between adverse maternal experiences with postnatal maternal depression and child social-emotional outcomes. South African mother-child dyads were recruited from the Bishop Lavis community in Cape Town. Participants consisted of 82 mother-child dyads (53 women had GDM or type 2 diabetes). At 14-20 months postpartum, maternal self-report questionnaires were administered to assess household socioeconomic status, food insecurity, maternal depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)), maternal trauma (Life Events Checklist), and child social-emotional development (Brief Infant Toddler Social Emotional Assessment, Ages and Stages Questionnaires: Social-Emotional, Second Edition). Lower educational attainment, lower household income, food insecurity, living without a partner, and having experienced physical assault were each associated with postnatal maternal depressive symptoms and clinical maternal depression (EPDS ≥ 13). Maternal postnatal depression, lower maternal educational attainment, lower household income, household food insecurity, and living in a single-parent household were each associated with child social-emotional problems. Stratified analyses revealed maternal experiences (education, income, food insecurity, trauma) were associated with postnatal maternal depressive symptoms and child social-emotional problems only among dyads with in utero exposure to diabetes. Women with pre-existing diabetes or gestational diabetes in LMIC settings should be screened for health related social needs to reduce the prevalence of depression and to promote child social-emotional development.

8.
Wellcome Open Res ; 4: 178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31984243

RESUMO

In those who survive tuberculous meningitis (TBM), the long-term outcome is uncertain; individuals may suffer neurocognitive, functional and psychiatric impairment, which may significantly affect their ability to lead their lives as they did prior to their diagnosis of TBM. In children who survive, severe illness has occurred at a crucial timepoint in their development, which can lead to behavioural and cognitive delay. The extent and nature of this impairment is poorly understood, particularly in adults. This is in part due to a lack of observational studies in this area but also inconsistent inclusion of outcome measures which can quantify these deficits in clinical studies. This leads to a paucity of appropriate rehabilitative therapies available for these individuals and their caregivers, as well as burden at a socioeconomic level. In this review, we discuss what is known about neurocognitive impairment in TBM, draw on lessons learnt from other neurological infections and discuss currently available and emerging tools to evaluate function and cognition and their value in TBM. We make recommendations on which measures should be used at what timepoints to assess for impairment, with a view to optimising and standardising assessment of neurocognitive and functional impairment in TBM research.

9.
Paediatr Int Child Health ; 39(2): 132-138, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30328387

RESUMO

Background: There is currently a great need in South Africa for culturally appropriate neurodevelopmental screening measures in order to facilitate early identification of neurodevelopmental problems in children. Neurodevelopmental screening has the potential to decrease the burden at health-care facilities as it is time, resource and cost effective. Aim: To assess the use of the Molteno Adapted Scale (MAS), a locally developed screening measure, to suggest an optimal cut-off score and investigate its accuracy in detecting developmental delays. Method: The MAS was assessed by evaluating three components: accuracy, efficacy and usefulness. For each of 136 participants, MAS scores were compared with dichotomised scores from the Griffiths Mental Development Scales (GMDS). Receiver operating characteristic (ROC) curves were generated to determine the accuracy of the MAS in identifying developmental delay defined by the GMDS. Sensitivity, specificity and predictive values were calculated for potential MAS cut-off scores. Results: The MAS had an excellent area under the ROC curve, indicating good test accuracy. A developmental quotient of 83 was identified as optimal for screening purposes, with acceptable sensitivity (71.4%) and specificity (90.7%) as well as predictive values (29.4% positive predictive value and 98.3% negative predictive value) for developmental delay on the GMDS. Conclusion: The present study provides preliminary evidence supporting the use of the MAS for screening.


Assuntos
Antropometria/métodos , Testes Diagnósticos de Rotina/métodos , Transtornos do Neurodesenvolvimento/diagnóstico , Feminino , Humanos , Lactente , Masculino , Curva ROC , Sensibilidade e Especificidade , África do Sul
10.
Trop Med Int Health ; 23(10): 1129-1140, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30075490

RESUMO

OBJECTIVES: To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM). METHODS: A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0-14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact. RESULTS: In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040). CONCLUSIONS: The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Antituberculosos/uso terapêutico , Proteção da Criança/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Tuberculose Meníngea/tratamento farmacológico , Adolescente , Criança , Proteção da Criança/psicologia , Pré-Escolar , Feminino , Infecções por HIV/psicologia , Humanos , Lactente , Recém-Nascido , Masculino , Adesão à Medicação/psicologia , Qualidade de Vida/psicologia , África do Sul , Tuberculose Meníngea/psicologia
11.
J Int AIDS Soc ; 21(5): e25106, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29722482

RESUMO

INTRODUCTION: Early antiretroviral therapy (ART) has improved neurodevelopmental outcomes of HIV-infected (HIV-positive) children; however, little is known about the longer term outcomes in infants commencing early ART or whether temporary ART interruption might have long-term consequences. In the children with HIV early antiretroviral treatment (CHER) trial, HIV-infected infants ≤12 weeks of age with CD4 ≥25% were randomized to deferred ART (ART-Def); immediate time-limited ART for 40 weeks (ART-40W) or 96 weeks (ART-96W). ART was restarted in the time-limited arms for immunologic/clinical progression. Our objective was to compare the neurodevelopmental profiles in all three arms of Cape Town CHER participants. METHODS: A prospective, longitudinal observational study was used. The Griffiths mental development scales (GMDS), which includes six subscales and a global score, were performed at 11, 20, 30, 42 and 60 months, and the Beery-Buktenica developmental tests for visual motor integration at 60 months. HIV-exposed uninfected (HEU) and HIV-unexposed (HU) children were enrolled for comparison. Mixed model repeated measures were used to compare groups over time, using quotients derived from standardized British norms. RESULTS: In this study, 28 ART-Def, 35 ART-40W, 33 ART-96W CHER children, and 34 HEU and 39 HU controls were enrolled. GMDS scores over five years were similar between the five groups in all subscales except locomotor and general Griffiths (interaction p < 0.001 and p = 0.02 respectively), driven by early lower scores in the ART-Def arm. At 60 months, scores for all groups were similar in each GMDS scale. However, Beery visual perception scores were significantly lower in HIV-infected children (mean standard scores: 75.8 ART-Def, 79.8 ART-40W, 75.9 ART-96W) versus 84.4 in HEU and 90.5 in HU (p < 0.01)). CONCLUSIONS: Early locomotor delay in the ART-Def arm resolved by five years. Neurodevelopmental outcomes at five years in HIV-infected children on early time-limited ART were similar to uninfected controls, apart from visual perception where HIV-infected children scored lower. Poorer visual perception performance warrants further investigation.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Desenvolvimento Infantil/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas , Complicações Infecciosas na Gravidez/tratamento farmacológico , Feminino , Infecções por HIV/transmissão , Humanos , Lactente , Recém-Nascido , Masculino , Atividade Motora/efeitos dos fármacos , Gravidez , Estudos Prospectivos
12.
Metab Brain Dis ; 33(2): 537-544, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29427049

RESUMO

The first case of Glutaric aciduria Type 1(GA1) in an African child was reported in 2001. GA1 has a prevalence of 1:5000 in black South Africans. Although early diagnosis is essential for a favourable outcome, newborn screening is not routine in South Africa where an estimated 320,000 children have HIV infection. Neurodevelopmental delay and encephalopathy are complications of both HIV and GA1. In such a setting it is important to recognise that HIV and GA1 can occur simultaneously. We present an HIV-infected South African male child of Xhosa descent with macrocephaly who commenced combination antiretroviral therapy (ART) at 8 weeks of age in a clinical trial which included a neurodevelopmental sub-study. He developed short-lived focal seizures at 16 months after minor head trauma. Neurological examination was normal. Neuroimaging showed temporal lobe atrophy, subtle hyperintense signal change in the globus pallidus, and focal haemosiderosis in the right Sylvian fissure region. As findings were not in keeping with HIV encephalopathy, a urine metabolic screen was undertaken which suggested GA1. Genetic testing confirmed Arg293Trp mutation. He began L-carnitine and a low protein diet as a restricted diet was not practicable. At 21 months he developed pulmonary tuberculosis, requiring 6 months treatment. He did not develop any neurologic motor symptoms. Serial neurodevelopmental and neuropsychological test scores until 9 years were similar to healthy neighbourhood controls, except for mild language delay at 3½ years. Detection of GA1, probably facilitated through participation in a clinical trial, was pivotal for a favourable outcome. The concomitant use of ART and anti-tuberculous therapy in a child with GA1 appears safe.


Assuntos
Erros Inatos do Metabolismo dos Aminoácidos/sangue , Encefalopatias Metabólicas/sangue , Encefalopatias/tratamento farmacológico , Encéfalo/patologia , Carnitina/uso terapêutico , Glutaril-CoA Desidrogenase/deficiência , Infecções por HIV/tratamento farmacológico , Atrofia/patologia , Encéfalo/virologia , Traumatismos Craniocerebrais/tratamento farmacológico , Traumatismos Craniocerebrais/patologia , Glutaril-CoA Desidrogenase/sangue , Humanos , Lactente , Masculino , Resultado do Tratamento
13.
Trop Med Int Health ; 23(1): 69-78, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29131457

RESUMO

OBJECTIVES: To compare neurodevelopmental outcomes of HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) infants in a peri-urban South African population. HEU infants living in Africa face unique biological and environmental risks, but uncertainty remains regarding their neurodevelopmental outcome. This is partly due to lack of well-matched HUU comparison groups needed to adjust for confounding factors. METHODS: This was a prospective cohort study of infants enrolled at birth from a low-risk midwife obstetric facility. At 12 months of age, HEU and HUU infant growth and neurodevelopmental outcomes were compared. Growth was evaluated as WHO weight-for-age, length-for-age, weight-for-length and head-circumference-for-age Z-scores. Neurodevelopmental outcomes were evaluated using the Bayley scales of Infant Development III (BSID) and Alarm Distress Baby Scale (ADBB). RESULTS: Fifty-eight HEU and 38 HUU infants were evaluated at 11-14 months of age. Performance on the BSID did not differ in any of the domains between HEU and HUU infants. The cognitive, language and motor scores were within the average range (US standardised norms). Seven (12%) HEU and 1 (2.6%) HUU infant showed social withdrawal on the ADBB (P = 0.10), while 15 (26%) HEU and 4 (11%) HUU infants showed decreased vocalisation (P = 0.06). There were no growth differences. Three HEU and one HUU infant had minor neurological signs, while eight HEU and two HUU infants had macrocephaly. CONCLUSIONS: Although findings on the early neurodevelopmental outcome of HEU infants are reassuring, minor differences in vocalisation and on neurological examination indicate a need for reassessment at a later age.


Assuntos
Desenvolvimento Infantil/fisiologia , Infecções por HIV/complicações , Saúde do Lactente/estatística & dados numéricos , Efeitos Tardios da Exposição Pré-Natal , Estudos de Coortes , Feminino , Nível de Saúde , Humanos , Lactente , Gravidez , Estudos Prospectivos , África do Sul
14.
J Child Neurol ; 30(10): 1327-32, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25512360

RESUMO

We investigated familial and environmental risk factors in a cohort of South African children diagnosed with attention-deficit hyperactivity disorder (ADHD). A prospective, hospital-based case control study was conducted comprising 50 children diagnosed with ADHD and 50 matched non-ADHD controls. The adjusted effect of familial-environmental risk factors on ADHD was determined by systematic assessment. Birth complications, parental psychiatric disorder, maternal ADHD, early childhood trauma, and nonmaternal child care were significant risk factors for ADHD. Prolonged breastfeeding was found to be protective. In a multivariable logistic regression model, 5 criteria (birth complications, breastfeeding <3 months, at least 1 parent with tertiary education, presence of parental psychiatric disorder, and nonmaternal primary caregiver) differentiated ADHD from non-ADHD controls with a sensitivity and specificity of 74% and 86%, respectively. We found a correlation between certain familial and environmental risk factors and ADHD. A 5-criterion multivariable logistic regression model may offer clinical guidance in ADHD diagnosis.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Adulto , Estudos de Casos e Controles , Criança , Família , Feminino , Humanos , Masculino , Estudos Prospectivos , Curva ROC , Fatores de Risco , Sensibilidade e Especificidade , África do Sul/epidemiologia
15.
Dev Med Child Neurol ; 56(7): 686-94, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24182356

RESUMO

AIM: The aim of this study was to explore the physical status and gait patterns of children with spastic diplegia secondary to human immunodeficiency virus encephalopathy (HIVE). METHOD: A cross-sectional study was conducted on children diagnosed with HIVE and spastic diplegia. Sociodemographic and clinical background information was obtained, followed by three-dimensional gait analysis (3DGA) and a physical examination including assessments of muscle tone, strength, motor control, contractures, and bony deformities of the lower extremities. RESULTS: Fourteen children (eight males, six females; mean age 5 y 8 mo [SD 9 mo], range 4 y 4 mo-6 y 10 mo) were studied. The cohort was divided into two groups based on distinctive gait patterns. Nine participants in group I showed only limited abnormalities. Group II displayed a more pathological gait pattern including stiff knee and equinus ankle abnormalities. Results of 3DGA, as with the physical examination outcomes, showed increased impairments from proximal to distal (except for hip extension). INTERPRETATION: This study provides a first description of distinctive gait patterns and related physical characteristics of children with HIVE and spastic diplegia. Further research is necessary.


Assuntos
Complexo AIDS Demência/complicações , Paralisia Cerebral/etiologia , Marcha/fisiologia , Atividade Motora/fisiologia , Tornozelo/fisiopatologia , Paralisia Cerebral/virologia , Criança , Pré-Escolar , Estudos de Coortes , Estudos Transversais , Pé Equino/etiologia , Feminino , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Exame Físico , Amplitude de Movimento Articular , Caminhada/fisiologia
16.
Artigo em Inglês | AIM (África) | ID: biblio-1270410

RESUMO

Background. Little has been published on autism in Africa; and it is not known whether South African children present with the same characteristics and challenges as described internationally.Objectives. To describe the demographics; history; clinical features; co-morbidity and yield of aetiological investigations in children diagnosed with a pervasive developmental disorder (PDD).Methods. This was a retrospective review of medical records of children fulfilling Diagnostic and Statistical Manual of Mental Disorders; 4th edition; text revision (DSM-IV-TR) criteria for a PDD who attended a tertiary developmental clinic at Tygerberg Hospital; Western Cape; South Africa; over a 2-year period (2008 - 2010) Results. Fifty-eight children were included. The median age at diagnosis was 42 months (range 15 - 106 months); and 45 (77.6) were boys. Forty per cent had complex autism (dysmorphism with or without microcephaly); and 12.1were macrocephalic. Most children (72.4 were non-verbal (using fewer than 10 non-echoed words); and 89.0had behavioural problems as reported by caregivers. The diagnostic yield of investigations was low.Conclusion. The profile of children with PDD attending a tertiary hospital developmental clinic in the Western Cape revealed that a high proportion had severe language impairment; behavioural problems and complex autism


Assuntos
Transtorno Autístico , Deficiências do Desenvolvimento
17.
AIDS ; 26(13): 1685-90, 2012 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-22614886

RESUMO

OBJECTIVES: To evaluate the effect of early versus deferred antiretroviral therapy (ART) on the neurodevelopment of infants from Cape Town participating in the Children with HIV Early Antiretroviral Therapy (CHER) trial. DESIGN: HIV-infected infants were randomized to early (<3 months) or deferred ART. HIV-uninfected infants (HIV-exposed and HIV-unexposed) provide background data. METHODS: Neurological examination and Griffiths Mental Development Scales (GMDS) were administered between 10-16 months of age by testers blind to HIV status and randomized allocation. Mean quotients were compared using paired Student's t-tests. RESULTS: Sixty-four infants on early ART and 26 on deferred ART (of potential 77 and 38 respectively on CHER trial) were assessed at median age 11 months (range 10-16). On the GMDS, all scores were lower in the deferred arm and the General Griffiths and Locomotor Scores were significantly lower: mean (SD) =100.1 (13.8) vs. 106.3 (10.6) P=0.02; and 88.9 (16.3) vs. 97.7 (12.5), P<0.01, respectively. Children with HIV who received early ART performed as well as children without HIV except on the Locomotor subscale. Both infected and uninfected mean GMDS scores were within the average range. CONCLUSION: Infants initiated on early ART have significantly better Locomotor and general scores on the GMDS at median age 11 months compared to infants on deferred ART, despite careful monitoring and ready access to ART in the latter.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Deficiências do Desenvolvimento/prevenção & controle , Soropositividade para HIV/tratamento farmacológico , Desempenho Psicomotor/efeitos dos fármacos , Fármacos Anti-HIV/farmacologia , Contagem de Linfócito CD4 , Estudos Transversais , Deficiências do Desenvolvimento/epidemiologia , Esquema de Medicação , Feminino , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/fisiopatologia , HIV-1/efeitos dos fármacos , Humanos , Lactente , Masculino , Testes Neuropsicológicos , África do Sul/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Carga Viral
18.
J Trop Pediatr ; 58(4): 275-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22141110

RESUMO

INTRODUCTION: In-hospital treatment of children with tuberculous meningitis (TBM) is not a feasible option in many resource-poor countries. Home-based treatment has shown to be a viable alternative. Adherence is an important factor determining success of treatment. OBJECTIVE: Identify possible barriers to adherence of home-based treatment and caretaker perception of the disease. METHOD: A qualitative study consisting of 11 in-depth semi-structured interviews was performed based on principles of the health belief model. RESULTS: Barriers of adherence identified include poor understanding of the disease and transmission route, difficulty with medication administration and side effects, lack of access to the health-care facility, long waiting times and hidden costs of transportation. Caretakers showed good appreciation of the adverse effects of noncompliance and benefits obtained from taking treatment in the home environment. CONCLUSION: Improved doctor-patient communication, information brochures, structural changes to hospital settings, provision of financial and peer support all contribute to optimal TBM home-based treatment.


Assuntos
Antituberculosos/uso terapêutico , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Adesão à Medicação , Tuberculose Meníngea/tratamento farmacológico , Adulto , Criança , Pré-Escolar , Comunicação , Feminino , Acessibilidade aos Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Humanos , Lactente , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Percepção , Relações Profissional-Família , Pesquisa Qualitativa , Fatores Socioeconômicos , África do Sul , Inquéritos e Questionários , Resultado do Tratamento
19.
J Child Neurol ; 26(8): 956-62, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21628697

RESUMO

Arterial stroke is the main cause of poor outcome in childhood tuberculous meningitis. Aspirin has an antithrombotic action at low dose and anti-ischemic and anti-inflammatory properties, which are dose-related. The aim of the study was to explore the possible benefits of aspirin in children with tuberculous meningitis. A total of 146 consecutive children with a diagnosis of probable tuberculous meningitis were studied. Patients were randomized into 3 groups: (1) placebo group, (2) low-dose aspirin group, and (3) high-dose aspirin group. Twenty-nine additional patients who received aspirin before admission were excluded from the randomized study, but continued on low-dose aspirin. Aspirin, irrespective of dose, did not show any significant benefit regarding morbidity (hemiparesis and developmental outcome) and mortality. Aspirin was well tolerated, but 1 death was probably related to aspirin. The fact that the outcome of the high-dose aspirin group compared favorably with the other treatment groups despite younger age and more severe neurological involvement at baseline needs further investigation.


Assuntos
Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Paresia/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Tuberculose Meníngea/tratamento farmacológico , Anti-Inflamatórios/administração & dosagem , Aspirina/administração & dosagem , Pré-Escolar , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Lactente , Masculino , Paresia/epidemiologia , Paresia/etiologia , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Meníngea/complicações , Tuberculose Meníngea/diagnóstico por imagem
20.
Pediatrics ; 123(1): e1-8, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19367678

RESUMO

OBJECTIVE: Tuberculous meningitis is the most severe extrapulmonary complication of tuberculosis, with high morbidity and mortality rates. The objective of this study was to assess the relationship between presenting clinical characteristics and outcome of pediatric tuberculous meningitis. PATIENTS AND METHODS: We present a retrospective cohort study of all of the children diagnosed with tuberculous meningitis in a large university hospital in South Africa between January 1985 and April 2005. We compared demographic, clinical, and diagnostic characteristics with clinical outcome after 6 months of treatment. RESULTS: We included 554 patients. Common characteristics on admission were young age (82%; <5 years), stage II or III tuberculous meningitis (97%), nonspecific symptoms existing for >1 week (58%), poor weight gain or weight loss (91%), loss of consciousness (96%), motor deficit (63%), meningeal irritation (98%), raised intracranial pressure (23%), brainstem dysfunction (39%), and cranial nerve palsies(27%). Common features of tuberculous meningitis on computed tomography scan of the brain were hydrocephalus (82%), periventricular lucency (57%), infarctions(32%), and basal meningeal enhancement (75%). Clinical outcome after 6 months was as follows: normal (16%), mild sequelae (52%), severe sequelae (19%), and death (13%). All of the patients diagnosed with stage I tuberculous meningitis had normal outcome. Factors associated with poor outcome in univariate analyses were as follows: African ethnicity, young age, HIV coinfection, stage III tuberculous meningitis, absence of headache and vomiting, convulsions, decreased level of consciousness,motor deficits, cranial nerve palsies, raised intracranial pressure, brain stem dysfunction and radiographic evidence of hydrocephalus, periventricular lucency, and infarction. Ethnicity, stage of disease, headache, convulsions, motor function, brainstem dysfunction, and cerebral infarctions were independently associated with poor outcome in multivariate logistic regression analysis. CONCLUSIONS: Tuberculous meningitis starts with nonspecific symptoms and is often only diagnosed when brain damage has already occurred. Earlier diagnosis will improve outcome significantly. We were able to identify presenting variables independently associated with poor clinical outcome.


Assuntos
Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/fisiopatologia , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Hospitais Universitários , Humanos , Hidrocefalia/etiologia , Hidrocefalia/terapia , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , África do Sul , Resultado do Tratamento , Tuberculose Meníngea/complicações , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/etnologia
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