Methodological challenges in a study on falls in an older population of Cape Town, South Africa.

Background: Falls are a major cause of disability, morbidity and mortality in older persons, but have been under researched in developing countries.

Objective: To describe challenges encountered in a community-based study on falls in a multi-ethnic population aged ≥65 years in a low-income setting.

Methods: The study was conducted in four stages: A pilot study (n=105) to establish a sample size for the survey.

Risk factors for falls in older adults in a South African Urban Community.

Background: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries.

Methods: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa.

Early clinical predictors of a severely abnormal amplitude-integrated electroencephalogram at 48 hours in cooled neonates.

Aim: There is a need to identify infants with hypoxic ischaemic encephalopathy who have a poor outcome despite therapeutic hypothermia. A severely abnormal amplitude-integrated electroencephalogram at 48 h predicts death or disability. Our aim was to determine whether clinical assessment at age 3-5 h predicts a severely abnormal amplitude-integrated electroencephalogram at 48 h or death in cooled infants.

Early clinical signs in neonates with hypoxic ischemic encephalopathy predict an abnormal amplitude-integrated electroencephalogram at age 6 hours.

Background: An early clinical score predicting an abnormal amplitude-integrated electroencephalogram (aEEG) or moderate-severe hypoxic ischemic encephalopathy (HIE) may allow rapid triage of infants for therapeutic hypothermia. We aimed to determine if early clinical examination could predict either an abnormal aEEG at age 6 hours or moderate-severe HIE presenting within 72 hours of birth.

Methods: Sixty infants ≥ 36 weeks gestational age were prospectively enrolled following suspected intrapartum hypoxia and signs of encephalopathy.

Defining hypoxic ischemic encephalopathy in newborn infants: benchmarking in a South African population.

Objectives: There are few population-based studies of hypoxic ischemic encephalopathy (HIE) in sub-Saharan Africa, and the published criteria that are used to define and grade HIE are too variable for meaningful comparisons between studies and populations. Our objectives were (1) to investigate how the incidence of HIE in our region varies with different criteria for intrapartum hypoxia and (2) to determine how encephalopathy severity varies with different grading systems.

Method: We reviewed the records of infants with a diagnosis of HIE born between September 2008 and March 2009 in public facilities in the Southern Cape Peninsula, South Africa.

Can a new paediatric sub-specialty improve child health in South Africa?

Compared with other middle-income countries, child health in South Africa is in a poor state, and should be addressed by focusing on the health care needs of all children across a system or region. Paediatricians have had little effect on this situation, partly because their training is not aligned with South African needs. The proposed re-engineering of primary health care will be limited by the skewed distribution of staff and the lack of suitable skills.

Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology.

Objectives: Lay health workers (LHWs) are used in many settings to increase immunisation uptake among children. However, little is known about the effectiveness of these interventions. The objective of this review was to assess the effects of LHW interventions on childhood immunisation uptake.

WITHDRAWN: Conjugate vaccines for preventing Haemophilus influenzae type B infections.

Background: Haemophilus influenzae (H. influenzae) is an important cause of meningitis and pneumonia in children. Vaccine cost is a significant barrier to use in low income countries.

WITHDRAWN: Chest radiograph in acute respiratory infections.

Background: Chest radiography is widely used during the management of acute lower respiratory infections, but the benefits are unknown.

Objectives: To assess the effects of chest radiography on clinical outcome in acute lower respiratory infections.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1), MEDLINE (1950 to January 2007) and EMBASE (January 1976 to February 2007).

WITHDRAWN: Symptomatic treatment of the cough in whooping cough.

Background: Whooping cough is an important cause of childhood morbidity and mortality. There are 20 to 40 million cases of whooping cough annually world-wide, 90% of which occur in developing countries, resulting in an estimated 200 to 300,000 fatalities each year. Much of the morbidity is due to the effects of the paroxysmal cough.

Educational outreach to general practitioners reduces children's asthma symptoms: a cluster randomised controlled trial.

Background: Childhood asthma is common in Cape Town, a province of South Africa, but is underdiagnosed by general practitioners. Medications are often prescribed inappropriately, and care is episodic. The objective of this study is to assess the impact of educational outreach to general practitioners on asthma symptoms of children in their practice.

Chickenpox.

Introduction: Chickenpox is extremely contagious. Over 90% of unvaccinated people become infected, but infection occurs at different ages in different parts of the world - over 80% of people have been infected by the age of 10 years in the USA, the UK, and Japan, and by the age of 20-30 years in India, South East Asia, and the West Indies.

Methods And Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent chickenpox in healthy adults and children? What are the effects of interventions to prevent chickenpox in children exposed prenatally? What are the effects of interventions to prevent chickenpox in immunocompromised adults and children? What are the effects of treatments for chickenpox in healthy adults and children? What are the effects of treatments for chickenpox in immunocompromised adults and children? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review).

The utility of computed tomography for recent-onset partial seizures in childhood.

Objectives: To determine the diagnostic yield of computed tomography (CT) of the head in children presenting for the first time with partial seizures in a region with a high prevalence of tuberculosis and neurocysticercosis.

Design: Prospective cohort study.

Setting: The secondary-level ambulatory service of Red Cross Children's Hospital, Cape Town.

Clinical indicators of Pneumocystis jiroveci pneumonia (PCP) in South African children infected with the human immunodeficiency virus.

Background: Pneumocystis pneumonia (PCP) caused by Pneumocystis jiroveci is common in HIV-infected children, producing substantial morbidity and mortality. Initiation of timely, effective therapy depends on clinical identification of children with PCP.

Objective: To develop a clinical decision rule to diagnose PCP in HIV-infected children for use where diagnostic resources are limited.

A systematic review of existing national priorities for child health research in sub-Saharan Africa.

Background: We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.

Methods: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group.

Children in reviews: methodological issues in child-relevant evidence syntheses.

Background: The delivery of optimal medical care to children is dependent on the availability of child relevant research. Our objectives were to: i) systematically review and describe how children are handled in reviews of drug interventions published in the Cochrane Database of Systematic Reviews (CDSR); and ii) determine when effect sizes for the same drug interventions differ between children and adults.

Methods: We systematically identified all of the reviews relevant to child health in the CDSR 2002, Issue 4.

International collaboration, funding and association with burden of disease in randomized controlled trials in Africa.

Objective: This study aimed to assess whether randomized controlled trials conducted in Africa with collaborators from outside Africa were more closely associated with health conditions that have a burden of disease that is of specific importance to Africa than with conditions of more general global importance or with conditions important to developed countries. We also assessed whether the source of funding influenced a study's relevance to Africa.

Methods: We compared randomized controlled trials performed in Africa that looked at diseases specifically relevant to Africa (as determined by burden of disease criteria) with trials classified as looking at diseases of global importance or diseases important to developed countries in order to assess differences in collaboration and funding.

Induced sputum versus gastric lavage for microbiological confirmation of pulmonary tuberculosis in infants and young children: a prospective study.

Background: For microbiological confirmation of diagnosis of pulmonary tuberculosis in young children, sequential gastric lavages are recommended; sputum induction has not been regarded as feasible or useful. We aimed to compare the yield of Mycobacterium tuberculosis from repeated induced sputum with that from gastric lavage in young children from an area with a high rate of HIV and tuberculosis.

Methods: We studied 250 children aged 1 month to 5 years who were admitted for suspected pulmonary tuberculosis in Cape Town, South Africa.

Interobserver variability in the detection of mediastinal and hilar lymph nodes on CT in children with suspected pulmonary tuberculosis.

Background: The presence of mediastinal or hilar adenopathy is critical for the diagnosis of pulmonary TB. Interobserver variability in the detection of lymphadenopathy on CT in children affects the usefulness of CT as a gold standard.

Objective: To determine the interobserver variability for the detection of hilar and mediastinal adenopathy on CT in children.