A South African perspective on children's rights: pertinent issues in remedial and protection interventions

This article focuses on specific issues that pose a threat to the application of children's rights in South Africa. Under remedial interventions survival, development and the standard of living and health will be discussed; while issues pertaining to children's right to education and parental care are also addressed. As far as protection interventions are concerned attention will be paid to abuse and neglect, child labour and children in difficult situations such as violence, disabilities, juvenile justice and street children.     

BNP and ANP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction.

BACKGROUND: The prevalence of chronic heart failure (CHF) with systolic dysfunction is increasing. Plasma natriuretic peptides have been envisaged as diagnostic and predictive markers. AIMS: To investigate the relationship between the levels of B-type natriuretic peptide (BNP) and A-type natriuretic peptide (ANP) and the clinical and functional parameters of CHF in outpatients with CHF at baseline, compared with normal healthy controls; to find out the differences in a randomised controlled trial between patients treated with an angiotensin-converting enzyme (ACE) inhibitor, captopril, or an angiotensin receptor blocker (ARB), irbesartan. These differences were assessed throughout the six-month treatment period and at the sixth month. METHODS: Plasma BNP (pmol/L) and ANP (pmol/L) were determined in 68 hypertensive patients with dilated cardiomyopathy, NYHA class III-IV and ejection fraction (EF) < or = 40%, and in 26 normal controls. Statistical analysis for BNP and ANP was done by Students t-test. The patient group was randomly subdivided into two subgroups of 34 patients, each treated with either an ARB, irbesartan, or an ACE inhibitor (ACE-I), captopril. BNP and ANP were measured in both subsamples and correlated with clinical, functional and neurohormonal parameters throughout a follow-up period of six months and at the sixth month. RESULTS: The mean EF in the patient sample was 33.43+/-6.52% and in the controls was 61.96 +/-3.53% (p=0.000). The mean BNP (pmol/L) in patients was 44.78+/-54.36 and in the controls was 7.12+/-8.28 (p=0.000) and the mean ANP (pmol/L) was 30.32+/-25.97 in patients and 11.18+/-7.92 in controls (p=0.000). A statistically significant difference was found between patients and healthy controls. Significant correlations were found between natriuretic peptides and EF. Between the baseline phase and the sixth month, BNP and ANP decreased significantly in the ARB group. At the sixth month, both BNP and ANP were lower in the ARB group. Evidence of clinical benefit was found with both ARB or ACE-I treatment throughout the six months, with patients moving from classes III and IV to class II NYHA. Improvement of EF was also found, with transition of patients with lower EF (even <30%) to higher values. EF was higher in the ARB group at the sixth month. CONCLUSIONS: BNP and ANP can be useful diagnostic tools in hypertensive CHF patients with moderate-to-severe LV dysfunction. The decrease in BNP and ANP in the ARB group throughout six months, as well as the lower value at the sixth month, suggest a prognostic value of these parameters.     

Outpatient initiation of the ketogenic diet in children with pharmacoresistant epilepsy: An effectiveness,safety and economic perspective

BackgroundChildren with pharmacoresistant epilepsy usually receive ketogenic diet (KD) as an inpatient, which makes it an expensive treatment.ObjectiveTo compare the effectiveness, safety, and costs of outpatient versus inpatient initiated KD.DesignRetrospective observational non-inferiority study.Patients/settingPatients (1–18 years of age) who started KD either inpatient or outpatient.Main outcome measuresEffectiveness was defined as ≥50% seizure reduction. Safety was measured by the numbers of emergency visits and complications. Economic impact was analyzed by calculating total costs of treatment.Statistical analysesNon-inferiority of outpatient initiation was tested using 95% confidence intervals of the differences in effectiveness and safety endpoints between groups with non-inferiority margins of 10%. Nonparametric bootstrap techniques were used to derive a 95% confidence interval for the mean difference in total costs between the groups.ResultsHundred and five patients started KD in the period 2001 to 2017: 43 inpatient and 62 outpatient. At three months, the KD was effective in 61% of outpatients versus 63% of inpatients. The KD was considered safe in 36% of the outpatients, as compared to 29% in the inpatients. Outpatient initiation was shown to be non-inferior to inpatient initiation in terms of safety. Total health care costs of outpatient initiation were € 2901, as compared to € 8195 of inpatient initiation per patient (mean difference € 5294, 95% CI; -€ 7653 to -€ 2935).ConclusionsOur study suggests that outpatient KD initiation is no worse than inpatient initiation in terms of effectiveness and safety, while carrying lower health care costs.     

Staff attitudes and services provided by community-based organizations for alcohol and other drug users in Cape Town,South Africa: Implications for training and education

Aims: The aims of this study were: (i) to describe the nature of and the extent to which community-based organizations (CBOs) in Cape Town provide services to people who have alcohol and other drug (AOD) problems; (ii) to examine the relationship between CBOs’ attitudes towards individuals with AOD problems and the types of services provided; and (iii) to compare CBOs’ attitudes towards alcohol- and drug-using clients. Method: A cross-sectional survey of 51 health and social welfare CBOs in Cape Town, South Africa. Results: A high proportion of clients served at CBOs have alcohol- and drug-related problems. Findings suggest that CBOs may be more accessible to poor black South Africans and women than traditional AOD treatment centres. CBOs that hold more positive attitudes towards AOD-using clients tend to provide more AOD-related services and serve more clients with AOD-related problems. Findings also indicate that CBOs’ attitudes are more positive towards alcohol users than towards drug users. Conclusions: This study highlights the important role that CBOs play in the delivery of services for people with AOD-related problems in South Africa. It also reveals the need to increase capacity among the agencies via training and education.     

Measuring distress in South African children during burns dressing changes: A pilot study

Objectives: To establish and trial a practical, evidence-based, sensitive, language-fair, and culture-fair test battery to measure South African children’s distress during burns dressing change. Methods: We previously identified a broad test battery for pediatric procedural distress from the literature. This comprised child and parent heart rate; three instruments for observed distress behaviors—(1) Face, Legs, Activity, Cry, Consolability (FLACC); (2) Pain Behavior Check List (PBCL); and (3) Children’s Hospital Eastern Ontario Pain Scale (CHEOPS); and dressing change time, number of nurses required, and nurses’ perspectives of child’s distress. A consecutive cohort of South African inpatient children with burns was recruited. In the first study, three observers independently piloted the broad set of measures on four children. This set was subsequently modified to increase practicality of application and measurement sensitivity. In the second study, the modified battery was tested on 16 children for sensitivity to different children’s distress levels during burns dressing change phases. Results: The modified test battery was comprised of the CHEOPS, dressing change time, number of nurses required, and nurses’ qualitative perspectives of child’s distress. In combination, these tests were practical and sensitive to children’s distress. Discussion: South African children’s distress during burn dressing changes manifests in different ways. Adequate capture of it requires a comprehensive set of objective, observational, and qualitative measures, which are independent of language and culture.     

Gestational high-fat programming impairs insulin release and reduces Pdx-1 and glucokinase immunoreactivity in neonatal Wistar rats

Hyperglycemia and compromised β-cell development were demonstrated in neonatal rats programmed with a gestational high-fat diet. The aim of this study was to determine whether these changes were attributed to impaired insulin release and altered immunoreactivity of Pdx-1, glucokinase (GK), and glucose transporter (GLUT)–2 in high-fat–programmed neonates. Fetuses were maintained, via maternal nutrition, on either a standard laboratory diet (control) or a high-fat diet throughout gestation (HFG). Pancreata from 1-day–old neonates were excised for islet isolation and the subsequent measurement of insulin release at 2.8, 6.5, 13, and 22 mmol/L glucose. Other pancreata were either snap frozen for quantitative polymerase chain reaction or formalin fixed for immunohistochemistry followed by image analysis. The HFG neonates had reduced insulin release at 13- and 22-mmol/L glucose concentrations. No significant differences were found in Pdx-1, GK, or GLUT-2 messenger RNA expression. In HFG neonates, immunoreactivity of both Pdx-1 and GK was significantly reduced, with a nonsignificant reduction in GLUT-2. Gestational high-fat programming impairs insulin release and reduces Pdx-1 and GK immunoreactivity.