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Johannesburg, South Africa

de Leon-Mendoza S.,Bless Tetada Kangaroo Mother Care Foundation Philippines and KMC Program Consultant | Mokhachane M.,Chris Hani Baragwanath Hospital
Current Women's Health Reviews | Year: 2011

Caring for preterm and low birth weight (LBW) newborns in neonatal care units (NCU) can overwhelm healthcare systems in both developed and developing countries. Ensuring intact survival and adequate growth until term gestation and/or appropriate size is reached before discharging a LBW to the home environment leads to overcrowding of NCUs. This system undoubtedly contributes to increased morbidity and mortality due to the acquisition of secondary infections. Integral to the Kangaroo Mother Care (KMC) intervention is the policy of "early discharge" to the care of the mother/family, maintaining the kangaroo position in the home environment, coupled with frequent follow-ups in specialty clinics. This policy however, has been challenged due to the risks of loss to follow-up and inability to track neonatal outcomes especially in resource-limited places where provisions for ambulatory care are not in place or if available, cannot be accessed. This paper reviews the best available evidence on benefits, risks and safety of early discharge of LBW infants weighing <2000gm from settings with and without KMC. Whereas safety and risks post-discharge are similar in both settings, the benefits on exclusive breastfeeding rates at discharge up to 3 months thereafter, maternal-infant bonding and family involvement are clearly evident in KMC settings. Unpublished experience by the authors on this policy are also discussed. A practical guide for the implementation of the early discharge policy of the KMC intervention is outlined. The early discharge policy is contingent upon a systematic, operational outpatient follow-up program, the absence of which should motivate the KMC program coordinator to devise appropriate measures to ensure survival and safety of the LBW infant in KMC. A low-care /KMC ward or a "halfway house" have been utilized as alternatives to home discharge in areas where follow-up cannot be assured. © 2011 Bentham Science Publishers Ltd.

Weedon M.,Chris Hani Baragwanath Hospital | Weedon M.,University of Witwatersrand | Potterton J.,University of Witwatersrand
Burns | Year: 2011

Burns represent the second most common cause of non-intentional death in children under the age of five. Burns are amongst the most traumatic injuries and may impose significant psychological, educational, social and future occupational limitations to the young child. This cross-sectional study aimed to determine the socio-economic and clinical factors which predict quality of life in children with burn in a burns unit in South Africa. The Paediatric Quality of Life Inventory (PedsQL) and the Household Economic and Social Status Index (HESSI) questionnaires were administered to children and their caregivers one week and three months post discharge from the Johnson and Johnson Paediatric Burns Unit, Chris Hani Baragwanath Hospital, Soweto. The improvement in the PedsQL scores suggests that the quality of life for children three months after discharge is good despite being burnt. The severity of the burn was found to be a significant predictor of quality of life (p = 0.00). Poor socio-economic status was clearly evident in demographic data of the subjects. The findings from this study are particularly important in identifying areas for further research that would be beneficial to developing countries. Furthermore, the results are important in the move towards more holistic care for paediatric burn survivors. © 2010 Elsevier Ltd and ISBI.

Cilliers A.,Chris Hani Baragwanath Hospital
Cochrane database of systematic reviews (Online) | Year: 2012

Rheumatic heart disease remains an important cause of acquired heart disease in developing countries. Although the prevention of rheumatic fever and the management of recurrences is well established, the optimal management of active rheumatic carditis is still unclear. This is an update of a review published in 2003 and previously updated in 2009. To assess the effects of anti-inflammatory agents such as aspirin, corticosteroids, immunoglobulin and pentoxifylline for preventing or reducing further heart valve damage in patients with acute rheumatic fever. We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (Issue 3, 2011), MEDLINE (1966 to Aug 2011), EMBASE (1998 to Sept 2011), LILACS (1982 to Sept 2011), Index Medicus (1950 to April 2001) and references lists of identified studies. No language restrictions were applied. Randomised controlled trials comparing anti-inflammatory agents (e.g. aspirin, steroids, immunoglobulins, pentoxifylline) with placebo or controls, or comparing any of the anti-inflammatory agents with one another, in adults and children with acute rheumatic fever diagnosed according to the Jones, or modified Jones criteria. The presence of cardiac disease one year after treatment was the major outcome criteria selected. Two reviewers independently extracted data. Risk of bias was assessed using methodology outlined in the Cochrane handbook. No new studies were included in this update. Eight randomised controlled trials involving 996 people were included. Several steroidal agents corticotrophin, cortisone, hydrocortisone, dexamethasone and prednisone, and intravenous immunoglobulin were compared to aspirin, placebo or no treatment in the various studies. Six of the trials were conducted between 1950 and 1965, one study was done in 1990, and the final study was published in 2001. Overall there was no significant difference in the risk of cardiac disease at one year between the corticosteroid-treated and aspirin-treated groups (six studies, 907 participants, relative risk 0.87, 95% confidence interval 0.66 to 1.15). Similarly, use of prednisone (two studies, 212 participants, relative risk 1.13, 95% confidence interval 0.52 to 2.45) compared to aspirin did not reduce the risk of developing heart disease after one year. Adverse events were not reported in five studies. The three studies reporting on adverse events all reported substantial adverse events. However, all results should be interpreted with caution due to the age of the studies and to substantial risk of bias. There is little evidence of benefit from using corticosteroids or intravenous immunoglobulins to reduce the risk of heart valve lesions in patients with acute rheumatic fever. The antiquity of most of the trials restricted adequate statistical analysis of the data and acceptable assessment of clinical outcomes by current standards. Additionally there was substantial risk of bias, so results should be viewed with caution. New randomised controlled trials in patients with acute rheumatic fever to assess the effects of corticosteroids such as oral prednisone and intravenous methylprednisolone, and other new anti-inflammatory agents are warranted. Advances in echocardiography will allow for more objective and precise assessments of cardiac outcomes.

Samuels A.,University of Pretoria | Samuels A.,University of Witwatersrand | Slemming W.,University of Pretoria | Balton S.,Chris Hani Baragwanath Hospital | Balton S.,University of Pretoria
Infants and Young Children | Year: 2012

As highlighted in recent series in The Lancet (2007, 2011), children from low and middle income countries are more likely to be adversely affected by early biological and psychosocial experiences that have their origins in environments characterized by poverty, violence, nutritional deficiencies, HIV infections, substance abuse, and inadequate learning opportunities. Due in part to discriminatory legacies of the past, these risks are all still highly prevalent in South Africa even after almost 20 years of democracy, creating a situation where a significant number of young children grow up at risk for developmental delay in comparison with those born with established risk. Thus, in a country where resources are scarce and where early intervention starts too late and ends too early for most children, it is vital that protective factors at various levels of the ecology be mobilized at the earliest opportunity to prevent the accumulation of risk factors as well as balance inequalities where risks are already established. Using Guralnick's developmental systems model as a framework, this article first reviews the current situation of young children in South Africa by focusing on policies, programs, and service provisioning that provide the impetus for early childhood intervention. On the basis of the model, its overarching framework, as well as typical case studies encountered in this context, the authors propose improvements toward a more cohesive and coordinated early intervention system in this country by highlighting efforts at advancing early screening and referral, interdisciplinary assessment, and family-focused community models of intervention. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Bonanno F.G.,Chris Hani Baragwanath Hospital
Journal of Emergencies, Trauma and Shock | Year: 2011

Shock syndromes are of three types: cardiogenic, hemorrhagic and inflammatory. Hemorrhagic shock has its initial deranged macro-hemodynamic variables in the blood volume and venous return. In cardiogenic shock there is a primary pump failure that has cardiac output/mean arterial pressure as initial deranged variables. In Inflammatory Shock it is the microcirculation that is mainly affected, while the initial deranged macrocirculation variable is the total peripheral resistance hit by systemic inflammatory response.

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