This thesis is a report on the value and limitations of the practical application of the Forced Expiratory Volume and Forced Vital Capacity test in children aged from 7 to 16 years. The first part deals with review of the literature on lung function and evolution of the Forced Expiratory Volume and Forced Vital Capacity test. The method and apparatus used in the test, the establishment of "normal values", the correlation of these values and certain anthropometric data, the establishment of prediction formulae for normal values, a study of the effect of factors such as sex, "learning" and repeatability, posture, daily and day-to-day variations, and the inhalation of isoprenaline on these normal values are reported. The second part deals with the practical application of the test in various pathological conditions affecting the cardio-respiratory system. The effect of respiratory disorders on ventilatory function is reported and an attempt is made to assess the effect of management, medical treatment and prognosis of a respiratory disorder at any given stage of that disorder acknowledging always that the complete evaluation of a patient requires more than laboratory tests.

The problem of childhood obesity in South Africa has reached epidemic proportions. It is estimated that one in five South African children are either overweight or obese; with twenty percent of children under the age of six being overweight. This is mainly due to a poor diet and a lack of exercise. The aim of this study is to determine the overweight / obesity prevalence amongst grade-one learners at selected schools in the West Rand, Mogale City. The weight and height of each subject was to be physically measured by the researcher and compared to norms for that age category. This study further aims to determine their parents knowledge / perceptions regarding childhood nutrition and physical activity. To this end a questionnaire was constructed so that parental knowledge / beliefs could be assessed. This study has found both overweight and underweight within the same population. The results indicate overweight / obesity in seventeen subjects (3.7%). Eleven girls (4.8%) and six boys (3%) were overweight representing a boy to girl ratio of 1: 1.8 among the overweight group. Among the overweight subjects, girls represented 65% while boys represented 35%. This study has also found underweight / stunting of growth among the eight and nine year old subjects as their weight for height fell below the 25th percentile. Further classification of the study sample according to school-fee structure revealed that all subjects with overweight / obesity were found within low-fee schools, representing 4%. One boy and one girl each were found with obesity among the overweight group having a body mass index (BMI) of 23.8 and 24.8 respectively. Therefore obesity was found in 12% among the overweight group and within low-fee structure schools.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine (Child Health Community Paediatrics) Johannesburg 2014 / Study Aim: To identify the criteria used to diagnose childhood tuberculosis (TB) at two paediatric outpatient departments in Johannesburg between 01 November 1997 and 30 June 1998 and to compare the criteria used to those used by the World Health Organization in the diagnosis of childhood TB. Study Design: An observational descriptive, retrospective, hospital outpatient-based study. Setting: Paediatric outpatient departments of Coronation Hospital (CH) and Johannesburg General Hospital (JGH). Patients and Methods: Patients ranging from the ages of 3 months to 14 years who attended the two paediatric outpatient departments and were diagnosed and notified as having TB, comprised the study population. Criteria used to establish the diagnosis of TB for each patient were extracted from patient records. Clinical history and baseline clinical characteristics were analysed using standard statistical methods, and criteria used to make a diagnosis of tuberculosis were compared to those recommended by the World Health Organization. Results: One hundred and one patients were diagnosed with TB at the two outpatient departments during the eight month study period. The combination of symptoms suggestive of active TB, which included persistent cough >1 month associated with fever, weight loss and loss of appetite, was more common in the JGH cohort (32 of 51 patients; 63%) compared to the CH cohort (10 of 50 patients; 20%); Odds Ratio (OR) 6.74 (95% Confidence Interval [CI], 2.54-18.41), P<0.001. One third (32%) of the total group of children had a positive TB exposure history. Tuberculin skin test (TST) reactions were positive in 86% of the total cohort, with a similar result being seen at both hospitals. Submission of specimens for microbiological assessment was not a common practice in either outpatient department, with 95% (96 of 101 participants) not having any specimens collected. Overall, 93% (94 of 101 participants) were classified as having ‘Probable’ TB. Conclusion: Criteria being used to diagnose childhood TB in the two paediatric outpatient departments are comparable to the WHO criteria recommended for the diagnosis of childhood TB. The majority of children diagnosed were classified as ‘Probable’ TB. TST was the main diagnostic tool used in the two outpatient departments at the time of study conduct.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science Johannesburg, 2012 / Introduction: Diarrhoea is a major cause of mortality and morbidity amongst children under five years of age worldwide. Aim: To characterise the bacterial aetiologies and molecular characterises the pathogens associated with hospitalization for diarrhoeal disease among South African children aged less than 5 years Methods: Children aged < 5 years hospitalized with diarrhoea were enrolled. Standard microbiological methods (culture, biochemical tests, serotyping) and molecular methods (PCR) were used, targeting bacterial pathogens such as diarrhoeagenic Escherichia coli (DEC), Salmonella species, Shigella species, Vibrio cholerae and Campylobacter species. Results: A total of 1816 stool specimens were processed, of which 633 (35%) were positive for enteric bacterial pathogens. Isolates in order of frequency included 562 DEC, 49 Shigella spp., 20 Salmonella spp., 2 Campylobacter spp. There were 48 (8%) enteric bacterial infections identified with more than one pathogen. Co-infections of bacterial pathogens with other organisms include 52 bacterial agents concurrent with Cryptosporidium co-infection, 128 with rotavirus coinfection and 9 episodes which included Cryptosporidium and rotavirus co-infections. Conclusion: The overall recovered bacterial pathogens from stool specimens was 35% with DEC being the most commonly identified.

The author participated in an international survey organised by the British Medical Research Council (MRC) epidemiological unit in Cardiff, Wales which set out to compare the prevalence of asthma in several countries. The motivation for participating in this study was that very little previous prevalence data for asthma is available for coloured or white children in South Africa. A protocol designed by the British MRC Epidaemiology Unit was followed. One thousand one hundred and seventy four white children aged 12 years attending a random selection of primary schools in the Southern Suburbs of Cape Town were studied. A standard MRC questionnaire on asthma was completed by parents. The subjects then underwent an exercise challenge test (ECT) which involved running on the level for six minutes. During the ECT, we measured the forced expiratory volume in 1 second (FEVl) before and after the exercise. A fall in post exercise FEVl of 15% or greater was regarded as evidence of bronchoconstriction and considered diagnostic of asthma. This method is thought to identify 70-90% of asthmatics (Anderson 1985, Lee et al 1989, Pierson 1988). Using this criterion, 52 (4.4%) of the children had asthma. The prevalence of 4.4% in this study is higher than 3.1% reported in a previous study of black children in Guguletu (Van Niekerk et al, Clinical Allergy 1979). However, the age spectrum of children was different in that study. Terblanche et al (1990) report the prevalence of exercise induced bronchoconstriction (EIB) in white and coloured children to be 5.87% and 4.05% respectively. The level of FEVl reduction for a diagnosis of EIB approved for this study was lower than usually accepted. Using conventional criteria for a diagnosis of EIB, Burr et al (1989) reported a prevalence of 7.7% in Cardiff, Wales. This study confirms that exercise induced asthma is a common problem in 12-year old white children in Cape Town.

Indiana University-Purdue University Indianapolis (IUPUI) / A survey of 441 children between the ages of 6 and 36 months, born and reared with a fluoridated water supply, revealed dental caries in 2.5 percent of those 6 to 17 months of age, 9.1 percent of those 18 to 23 months of age, and in 38.7 percent of the children 24 to 26 months of age. No significant differences were found in defs and deft relative to sex, race, or socioeconomic status. Caries prevalence is affected by method of feeding; children who had prolonged bottle-feeding (more than 15 months) had significantly increased caries. In 299 Caucasian children, gingivitis was present in 13.2 percent of those 6 to 17 months of age, 33.9 percent of those 18 to 23 months of age, and in 38.5 percent 24 to 36 months of age. There was little difference in the severity of the gingivitis, although significant difference in the frequency of gingivitis was demonstrated. The prevalence of gingivitis increased with age. Young children with dental caries also showed an increased prevalence of gingivitis. The presence of gingivitis, the presence of dental caries, and the absence of professional dental care in these young children all illustrate the necessity for prevention and treatment of oral disease in children under 36 months of age.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine Johannesburg, August 2013 / Asthma control is a central focus of the updated version of the GINA Guidelines, in which clinicians are encouraged to concentrate on assessment of control, defined by symptoms, lung function and the presence or history of exacerbations. Control is of critical importance in asthma and is now more important than the actual level of severity. Measures of asthma control do not necessarily perform well and all of them need to be looked at as a whole as studies have shown. Many factors have been found to be associated with poor asthma control ranging from concomitant rhinitis and co morbidities to poor compliance with medications or inappropriate inhaler technique in addition to home or environmental factors. Several factors around the home of asthmatic patients contribute to poor asthma control which includes parental smoking or smoking by other relatives within the home, biomass fuel exposure, exposure to aeroallergens and animal danders which all leads to failure in achieving control despite adequate drug therapy. This cross sectional study was conducted in 115 asthmatics children with the aim of determining the level of asthma control and home circumstances that contributes to poor asthma control. Most patients were males and blacks with 55.65% of patients having controlled asthma. Use of biomass fuel was uncommon in this study and none of the home circumstances was found to be associated with poor asthma control in this study. Day time and nocturnal asthma symptoms were significantly associated with poor asthma control. Good adherence to medications was found to be associated with asthma control similar association was not seen with good inhaler technique. The higher the FEV1 percent predicted the better the asthma control. Day time and nocturnal asthma symptoms were associated with FEV1. Results from this study need confirmation in a representative population study. Further longitudinal study is required to see if home circumstances may affect asthma control in patients that had controlled asthma.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the Masters of Medicine in Paediatrics (MMED) / Paediatric HIV Clinic, Harriet Shezi Children's Clinic in an academic hospital, Chris Hani Baragwanath Hospital, Soweto, South Africa. OBJECTIVE: To describe and compare clinical, immunological and virological characteristics of HIV-infected children co-treated for TB, comparing those investigated microbiologically and those not, with a detailed description of microbiological TB investigation results

A dissertation submitted to the Faculty of Medicine, University df the Witwatersrand in fulfilment of the requirements for the degree of Master of Science in Medicine Johannesburg 1992. / The objective of the research reported in this thesis was to describe the vaccination coverage of children aged 12 to 23 months in the Mosvold Health Ward of northern Kwa-Zulu. The Expanded Programme on Immunisation cluster sample technique was used. Simultaneous measurements of the children's weights and arm circumferences were done, and their birthplaces noted. Vaccination coverage rates were generally low; 74 to 83 per cent of the children had had BCG, 47 to 56 per cent had had three doses of DPT, 48 to 57 per cent had had three doses of polio and 47 to 56 per cent had had one dose of measles vaccine. Forty-eight per cent of the children had been born at home. Fifteen per cent had weights which Were more than two standard deviations below the median weight-for-age according to NCHS curves, 11 per cent had arm circumferences of 13,5 centimetres or less. The results are compared with other findings from else Where in southern Africa. Relevant literature on vaccination coverage improvement and the measurement thereof, is reviewed. Recommendations are made for increasing coverage rates in the Mosvold Health Ward) • / MT2017

This prospective study of acute myocarditis (AM) and endocardial fibroelastosis (EFE) was prompted by their common occurrence in infants and children in Cape Town, and by the persisting controversy regarding the possible relationship of these two conditions to each other, and to idiopathic, chronic, congestive cardiomyopathy (COCM). Patients with AM and EFE were analysed concurrently and over the long-term. The following hypotheses were investigated: A) that AM and EFE represent different phases of a common disease process, and B) that either AM or EFE evolves into COCM. From 1st June 1970 to 31st December 1976 (a study period of 6 years 7 months), 140 consecutive patients with AM or EFE were evaluated, and continually observed until 31st March 1979 (a total observation period of 8 years 10 months). Because there is no definitive, non-invasive, in-vivo diagnostic test for AM or EFE, an inclusive diagnosis of acute endomyocardial disease (EMD) was made in 123 patients who fulfilled all 4 rigid clinical criteria, i.e. a short history ( < 1 month), clinical evidence of myocardial involvement (heart failure, gallop rhythm or shock), radiological cardiomegaly (CTR > 0.55), and ST/T wave changes on electrocardiogram (ECG). Acute EMD was confirmed in all 20 patients who came to autopsy. A further 17 patients with insufficient clinical data had EMD at post-mortem.