Although there is a wealth of knowledge on categorization early in life, there are still many unanswered questions about the nature of category representation in infancy. For example, it is unclear whether infants are sensitive to boundaries between complex categories, such as types of animals, or whether young infants exhibit such sensitivity without explicit experience in the lab. Using a morphing technique, we linearly altered the category composition of images and measured 6.5-month-olds’ attention to pairs of animal faces that either did or did not cross the categorical boundary, with the stimuli in each pair being equally dissimilar from one another across the two types of image pairs. Results indicated that infants dichotomize the continua between cats and dogs and between cows and otters, but only when the images are presented in their canonical, upright orientations. These findings demonstrate a propensity to dichotomize early in life that could have implications for social categorizations, such as race and gender.

Background: Improvement in neonatal care has changed the features of severe hyperbilirubinemia and reduced the number of babies who need exchange transfusion (ET) to avoid bilirubin-induced neurological dysfunction. We conducted this study to determine the demographic and clinical characteristics of the exchanged babies, in order to identify their risk factors, and to determine the adverse effects and outcomes associated with ET. Methodology: This was a retrospective descriptive study, reviewing folders of infants who required ET at CMJAH from June 2006 to December 2011. Results: There were 63 patients who underwent 66 exchange transfusions. Patients exchanged in the neonatal unit accounted for 60.3%, with the rest of the patients (39.7%) being exchanged in the general ward. Preterm babies accounted for 45.7%, and the majority were inborn (44%). The majority were male (58.7%), term (54.3%), and the mean birth weight was 2.29 Kg (±0.89). The median age at exchange was 5 days (mean 4.5 days ±2.1 SD). The cause of jaundice was undetermined in most patients (84.1%), while ABO incompatibility and Rhesus disease accounted for 7.9% and 6.3%, respectively. Seven babies (11.1%) had an abnormal neurological examination before exchange and five (7.9%) were labelled as kernicterus. The mean bilirubin before exchange was 325 mmol/l ±118. The complications of ET were seen in 22.2% of patients. These were Necrotising Enterocolitis (NEC) (1.58%); seizure (1.58%); apnoea (4.76%); bleeding (3.1%); renal failure (3.1%); hypoglycaemia (4.76%); thrombocytopenia (67.6%); and hypercalcemia (85%). We had three deaths, of which two were due to neonatal sepsis acquired prior to exchange, with one case of perforated NEC in an infant with other comorbidities. Hence, the mortality associated with ET in our study was 1.5 percent. At discharge, three infants remained with signs of kernicterus (4.7%). Conclusion: Kernicterus remains a cause of concern in our settings, and mechanisms ought to be put in place to detect severe jaundice in discharged term babies who may benefit from early phototherapy (PTT) and ET; as this is shown to be a relatively safe procedure in our settings, especially in infants without other severe comorbidities. ACKNOWLEDGEMENTS I would like to take this opportunity to thank Prof Daynia Ballot, my research supervisor, who has been an inspiration for research and accepted the task of guiding me through the challenging journey of conducting and writing this review.

There is a high incidence of head injury in children, yet few studies have systematically studied cognitive outcome. This study was designed as a survey to (a) establish the nature of intellectual and neuropsychological deficits that occur after head injuries of differing severity in children aged 6 to 14 years, (b) establish the nature of recovery curves in the first year after injury, and (c) determine which medical and psychosocial factors are associated with poor cognitive outcome and which functions show persisting impairment. From 1134 children admitted with head injury to Red Cross and Groote Schuur Hospitals during a 2-year period, a consecutive sample of all those who had post-traumatic amnesia (PTA) over 1 hour, a compound depressed or basal skull fracture, a seizure, or any evidence of neurological involvement, was collected (n=388). Further requirements that they should be between 6 and 14 years, English or Afrikaans speaking, and have no history of significant cerebral pathology or mental retardation, reduced the sample to 123 children. Severity groups were formed according to the length of PTA: 56 moderates (PTA less than 1 day), 40 severes (PTA 1 to 7 days), and 28 very severes (PTA more than 7 days). They were matched for age, sex, socioeconomic status and ethnic group with 46 controls who had traumatic injury not involving the head. Detailed accident, medical and psychosocial data were collected. The children were assessed on a battery of tests covering intelligence, language, motor speed, visuographic and memory functions, as soon as they were out of PTA (Tl), 3 months later (T2), and at 1-year post-injury (T3). The 4 groups are compared at each interval on Tukey' s studentized range test and the extent of recovery within and between the groups is compared by repeated measures analysis of variance.

The burden of sickle cell disease lies in Africa where resources are limited . Hydroxyurea may be an affordable treatmentoption for these patients. Purpose To asses whether hydroxyurea has any effect in reducing vaso-occlusive crises, hospitalization and transfusion requirements in children with homozygous sickle cell a n a e m i a . To e v a l u a t e t h e t o x i c i t y o f h y d r o x y u r e a . M e t h o d s T h i s i s a r e t r o s p e c t i v e , d e s c r i p t i v e s t u d y o f c l i n i c a l and h a e m a t o l o g i c a l o u t c o m e s i n c h i l d r e n w i t h s i c k l e c e l l a n a e m i a t r e a t e d w i t h h y d r o x y u r e a . R e s u 1t s Ten p a t i e n t s w e r e e v a l u a t e d . H y d r o x y u r e a d e c r e a s e d t h e r a t e o f v a s o - o c c 1 u s i o n and d e c r e a s e d t h e t r a n s f u s i o n r e q u i r e m e n t s . The c l i n i c a l and h a e m a t o l o g i c a l b e n e f i t s w e r e g r e a t e s t when f o e t a l h a e m o b l o b i n was m a x i m a l . T h e r e was no s h o r t - t e r m t o x i c i t y . C o n c l u s i o n H y d r o x y u r e a a m e l i o r a t e s symptoms in sickle cell disease. On going studies are n e e d e d t o a s s e s s l o n g - t e r m e f f e c t s .

Background: Group B streptococcus (GBS) is a leading cause of invasive bacterial disease in neonates. The possibility of maternal immunization with GBS-vaccines is being explored. Vaccine candidates include serotype-specific polysaccharide-protein conjugates and GBS surface proteins, including pilus island proteins. In this project, we aimed to undertake capsular serotype identification, pilus island identification and genotypic characterization of GBS isolates associated with colonization in mothernewborn dyads and invasive disease in infants. Methods: Colonizing GBS isolates were identified by vaginal swabbing of mothers (n=541) during active labor and from skin of their newborns post-delivery (n=395). Invasive GBS isolates from infants (n=284) were identified through laboratory-based surveillance. GBS serotyping was done by latex agglutination. Serologically nontypeable isolates were typed by a serotype-specific PCR method. The pilus islands from 541 colonizing isolates and 284 invasive isolates were characterized by real-time PCR targeting the ancillary protein 1 and 2. We undertook sequence typing based on the three most heterogeneous genes (adhP, atr and glnA) of multilocus sequence typing (MLST) on GBS isolates identified in young-infants with invasive disease (n=283) and those associated with maternal (n=525) and newborn colonization at birth (n=369). A total of 121 colonizing and 131 invasive disease GBS isolates that were representative of 55 and 35 clusters respectively were analyzed by the remaining four MLST genes. The gbs2018 locus was characterized by DNA sequencing.

Background Indoor air pollution due to use of biomass fuels (BMF) for household cooking and heating is a known risk factor of morbidity and mortality in children under the age of five years. A recent study in India suggested an association between biomass fuel smoke exposure anaemia and stunting among children under the age of five. The aim of this study was to investigate the association between BMF use, stunting and anaemia in children aged 12-59 months who participated in the 2006-2007 Swaziland Demographic and Health Survey (SDHS), whilst adjusting for potential confounders. Methods The study was cross-sectional and based on secondary data analysis of data collected through the household and women’s questionnaires in the 2006-2007 SDHS, which employed a multistage random sampling. Anthropometric measurements taken in the SDHS and the World Health Organization (WHO) 2006 Multi-Centre Child growth reference standards were used to ascertain children’s health status and the stunting outcome variable. A child, whose height-for-age ratio was below three standard deviations (SD) from the median of the WHO reference population in terms of height-for-age, was severely stunted or short for his/her age. A child, whose height-for-age ratio was between three and two SD below the median of the WHO reference population in terms of height-for-age, was mildly stunted. The exposure to BMF smoke variable was ascertained indirectly by type of fuel used for cooking. The exposure was a three category variable of cleaner fuel, outdoor BMF and indoor BMF use. All statistical analysis was done in STATA version 10. The relationship between BMF use and stunting or anaemia was determined using multinomial logistic regression analyses, whilst adjusting for potential confounding factors, identified in previous research. Results Of the 1612 children included in the study, 37% were anaemic. Nineteen percent were mildly and 18% were moderate to severely anaemic. Indoor BMF use, child age, low birth weight, mother’s age at birth, iron supplementation during pregnancy and mother’s anaemia status was significantly associated with child anaemia in univariate analysis. Outdoor BMF exposure, low birth weight, child age, mother’s anaemia status and wealth index was associated with child anaemia after adjusting for potential confounding. Overall 31% of children were stunted. Twenty percent were mildly stunted and 11% were moderate to severely stunted. Child sex, age, birth order, preceding birth interval, low birth weight, diarrhoea in preceding two weeks, anaemia status, iron supplementation during pregnancy, mother’s age at birth ,mother’s body mass index, mother’s education, wealth index, indoor BMF exposure and household crowding were each independently associated with stunting in univariate analysis. Only child sex, low birth weight and child age were significantly associated with stunting after adjusting for potential confounding. There was no evidence of an association between indoor BMF smoke exposure and child stunting after adjusting for all potential confounding factors. Conclusion This study did not find sufficient evidence to suggest that indoor BMF use is a statistically significant risk factor for anaemia or stunting in children aged 12-59 months participating in the 2006-2007 SDHS. There was however an evidence that, use of BMF outdoors significantly confers a protective effect against moderate to severe anaemia. Prospective research into these potential relationships are necessary, particularly the collection of primary data and accurate measurement of exposure to smoke emitted during BMF use for cooking and heating.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment for the degree of Master of Science in Physiotherapy. Johannesburg 2014 / The incidence of cerebral palsy has remained relatively constant over time. As medical technology advances survival rates of children born prematurely increase. The trend internationally and in South Africa, is to encourage the integration of children with cerebral palsy into society and to embrace and celebrate diversity. This extends to education, where children with cerebral palsy are increasingly being included into mainstream schooling environments. This is not a simple process as cerebral palsy is extremely diverse in presentation and consists of a number of associated conditions other than the well recognised physical impairments. This has a significant effect on children’s ability to participate and be included in mainstream environments. The process therefore requires careful monitoring in order to provide the relevant support and to make changes to the environment The main aim of the study was to establish participation, activity performance and task supports of children aged between four and 12 years in mainstream schooling environments in Gauteng, South Africa. This was then related to the child’s level of impairment. The School Function Assessment was used to establish the participation, task supports and activity performance of the children with cerebral palsy. The scores of this group were then compared to the scores of the typical population as set out in the user’s manual of the School Function Assessment. The Gross Motor Function Classification System was used to classify the children with cerebral palsy according to their level of impairment. The results of the School Function Assessment were then analysed according to Gross Motor Function Classification level. The results of the study demonstrate that children with cerebral palsy score lower on a number of aspects of the School Function Assessment when compared to typical students their age. This was particularly true of physical tasks. Children with cerebral palsy in this study generally functioned on a level below that of their typically developed peers with regards to physical tasks in and around the school environment. Children with cerebral palsy performed at or above the level of their typically developed peers with regard to cognitive/behavioural school activities. As the severity of motor impairment increased, children’s ability to participate in the school environment decreased, the amount of task assistance and adaptations required increased and their ability to consistently perform activities decreased.

M.Med. (Radiology), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Lymphobronchial tuberculosis (LBTB) is tuberculous lymphadenopathy involving the airways, which is particularly common in children. AIM: To describe the CT findings of LBTB in children, the parenchymal complications and associated abnormalities. METHOD: CT scans of 98 children with LBTB were retrospectively reviewed. Lymphadenopathy, bronchial narrowing, parenchymal complications and associations were documented. RESULTS: Infants comprised 51% of patients. The commonest lymphadenopathy was subcarinal (97% of patients). Bronchial compressions (259 in total) were present in all patients, of which 23% were severe / complete stenoses and 28% affected bronchus intermedius. Parenchymal complications were present in 94% of patients, including consolidation (88%), breakdown (42%), air trapping (38%), expansile pneumonia (28%), collapse (17%) and bronchiectasis (9%), all predominantly right-sided (63%). Associations included oval focal bodies, miliary nodules, pleural disease and intracavitory bodies. CONCLUSIONS: The most important CT finding of children with LBTB is visible airway compression as a result of lymphadenopathy. CT of children with LBTB showed that airway compressions were more severe in infants and most commonly involved bronchus intermedius. Numerous parenchymal complications were documented, all showing rightsided predominance. Several associations were identified.

A Dissertation Submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg for the degree of Master of Medicine. / Disturbed mineral and bone metabolism is frequently found in very low-birth-weight infants fed breast-milk during the first three months of life. The study was designed to assess the prevalence of this disturbed mineral homeostasis in a very low-birth-weight populatiun at Baragwanath Hospital and to determine whether the addition of a preterm infant formula to the feeds reduced the prevalence and increased the rate of weight gain. Fifty three neonates weighing less than 1200g born at Baragwanath Hospital were monitored for weight gain, growth and for biochemical and radiological evidence of metabolic bone disease. The infants were randomized to receive either breast-milk only feeds or a combination of breast-milk and a premature formula in order to assess the effect of the different feeds on the development of bone disease. Weight gain and growth were similar in both groups. Calcium and phosphorus intakes were higher in the mixed feeding group. However, serum calcium and phosphorus values were similar in the two groups throughout the study. The breast-milk group had significantly higher alkaline phosphatase levels. Radiological rickets was uncommun in both groups, although periosteal reactions and osteopenia occurred frequently and with similar prevalence in both groups. Overt rickets is not a major problem in very-low birth- weight infants born at Baragwanath Hospital, although raised serum alkaline phosphatase values occur frequently. Feeding with breast-milk and a premature infant formula in equal proportions (as opposed to breast-milk only) does not appear to have any effect on weight gain and growth in very low-birth-weight infants, but does partially prevent the pathological rise in alkaline phosphatase levels. / Andrew Chakane 2019

A research report submitted in partial fulfillment of the requirements for the degree of Master of Science (Dentistry) In the Department of Paediatric and Restorative Dentistry School of Oral Health Sciences Faculty of Health Sciences University of the Witwatersrand, Johannesburg / A Clinical Audit: Dental Treatment Needs and Treatment Received by 12 and 15 year old children who attended the WITS Dental Hospital during the period January 2006 to December 2010. Background The majority of children and adults are affected by dental caries and its sequelae in South Africa. Children, from lower socioeconomic backgrounds in particular, continue to experience a high burden of dental caries. Objectives - To determine the number and profile of 12 – year – old and of 15 – year – old patients who attended the Wits Dental Hospital during the period of January 2006 to December 2010. - To determine the dental treatment needs of the two index age groups, including caries prevalence and the teeth affected by caries. - To determine the treatment received during this period. - To determine the time taken to complete the treatment needed and the number of patient visits required. - To determine the obstacles to receiving or completing the prescribed treatment. xii | P a g e Subjects and Methods The study was based on a retrospective review of the dental treatment records of 12 – year – old and 15 – year – old children attending the WITS Dental Hospital during the period January 2006 to December 2010. The study was based on children treated in the dental chair and did not include children treated under general anaesthetic. A total of 143 dental treatment records were retrieved , but only 62% (89) of the records met the specified study requirements – (39 for 12 yr olds and 50 for 15 yr olds). Extracted data was recorded by the researcher onto specifically – formulated data capture sheets. Processing and analysis of data was carried out with SPSS for Windows, Version 13 . Chi – square tables were constructed for comparison of proportional distributions. Exact and Monte Carlo test statistics were calculated to identify significant relationships. Results The mean DMFT for the 12 – year – old age group was 3.0 . The DT accounted for 76.6% of the DMFT , the MT for 23.33% and the FT was nil. The mean DMFT for the 15 – year – old age group was 3.8. The DT accounted for 92.1% of the DMFT , the MT for less than 10% and the FT was nil. There is an increase in dental caries from 12 – year – old to 15 – year – old patients. Carious teeth are left untreated. Restorative dental treatment levels are low. Low levels of completed treatment plans noted. Conclusion The rise in dental caries from the 12 – year – old group to the 15 – year – old group, together with high levels of untreated caries and low levels of restorative dental xiii | P a g e treatment indicate the need to improve the oral health of school children. Evidence – based oral health prevention and promotion strategies must guide oral health policy planning, so that supportive environments are created and sustained to facilitate healthy choices and maintain optimal oral health.