Indiana University-Purdue University Indianapolis (IUPUI) / Obturator therapy has been proposed for many years as an aid in maxillary orthopedics for the complete unilateral cleft lip and palate infant. The obturator appliance had the added benefit of providing a false palate against which the infant can suckle. This has aided in the feeding of these infants to assure adequate nutrition with the least effort for parent and child. The current study assessed three aspects of obturator therapy at James Whitcomb Riley Hospital for Children, Indianapolis, Indiana. Parental evaluations of the obturator proved to be very positive. Almost all parents (96%) rated it as beneficial and would recommend its use to other parents with cleft lip and palate infants. Weight gain analysis over the first nine months of life demonstrated that these infants were only slightly below the average for birth weight. At three and nine months of age, a number (69% and 56% respectively) had maintained their original weight percentile rankings or had just dropped into the next lower category. Thus, many of the infants were able to achieve adequate nutrition, a problem noted by many authors when obturator therapy was not used. It should be emphasized that each infant underwent either one or two major surgical procedures during this time period. Arch symmetry assessments at one, four and ten months showed a gradual reduction in lateral posterior crossbite, canine crossbite, and anterior crossbite tendency. Although the arches still showed some collapse at the end of ten months of age, the pattern was much better than at initial presentation with values much closer to normal. Improvements in arch symmetry was expected as the maxilla grew. From the results of this study, obturator therapy appears to be beneficial in maxillary orthopedics by helping to maintain adequate weight gain and gain parental acceptance.

Thesis (M.Med.(General Surgery)--University of the Witwatersrand, Faculty of Health Sciences, 2014. / Background. Renal insufficiency is increasingly common in end-stage liver disease and allocation of livers to this category of patient has escalated. The frequency of combined liver-kidney transplantation (CLKT) has consequently increased. Indications for CLKT in children differ from those for adults and typically include rare congenital conditions; subsequently limited numbers of this procedure have been performed in paediatric patients worldwide. Scant literature exists on the subject. Methods. Subsequent to institutional approval, a retrospective chart analysis of all paediatric CLKTs performed at the Transplant Unit, Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa between January 2005 and July 2013 was conducted. Results. Defining children as younger than 18 years of age, 43 patients had received a liver transplant since 2005, of whom 8 received a CLKT. Indications included autosomal recessive polycystic kidney disease (n=3), primary hyperoxaluria type 1 (n=4) and heterozygous factor H deficiency with atypical haemolytic uraemic syndrome (n=1). Graft combinations included whole liver and one kidney (n=5), whole liver and two kidneys (n=1) and left lateral liver segment and one kidney (n=2), all from deceased donors. Patient age ranged from 4 to 17 years (median 9) and included 4 females and 4 males. Weight ranged from 13 to 42 kg (median 22.5). We describe one in-hospital mortality. The remaining 7 patients were long-term survivors with a survival range from 6 to 65 months. Conclusions. Although rarely indicated in children, CLKT is an effective treatment option, appropriately utilising a scarce resource and significantly improving quality of life in the recipient.

There is a general agreement that food habits change over time. This has been clearly shown in studies conducted in first world countries, but until recently this information has been lacking in South Africa, particularly among preschool children, although nutrition information is available on dietary intake at a particular point of time in some groups. Changing food habits may affect disease. With the rapidly changing socio-political situation in South Africa diet too must have changed and one cannot rely on previous nutritional information. New reliable information is needed to help plan future health needs of all South Africans. Dietary intake in association with dental health has been studied by numerous investigators. Regarding energy and specific nutrients, studies have thus far shown no relationship of energy to dental caries incidence; carbohydrate, particularly sugars, have shown both positive and negative relationships to caries incidence and indirectly dietary fats may be associated with low caries because fat and sugar intake are inversely proportional to each other. The role of trace elements has varied from caries promoting to cariostatic. It is clear though that because of the complex nature of the caries process, carbohydrate intake, together with other macro- and micronutrients, does not fully explain the development of this disease. This could be influenced by the fact that most of the studies conducted on diet and dental health have been cross-sectional. The Vipeholm study in Sweden, the Hopewood House study in Australia and more recently the Michigan study in the United States are the only longitudinal studies that have examined the association between diet and dental caries incidence and both the Vipeholm and Hopewood House studied only selected groups in institutions. Until now no true longitudinal study had been conducted among South African preschool children regarding the association between diet and the development of dental caries. The Birth-to-Ten study is the first such longitudinal study that selected a random sample representative of the population groups in the country and has provided unique information on the longitudinal dietary intake together with the dental health at 1- and 5- years. In addition no South African study has looked at the impact of past diet on the present dental health of the same South African children and the Birth-to-Ten study provided this opportunity.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the award of a degree of Master of Medicine in Family Medicine / BACKGROUND: Diarrhea is an important health problem and has remained a threat to the lives of children under 5 years old especially in developing regions of the world. Presently, it is estimated that about 1.5 million of these children die every year from diarrhea that would have been prevented by giving oral rehydration therapy (ORT). The value of ORT in treating diarrhea has remained unquestionable but emerging evidence still points to unsatisfactory uptake. This study assessed the knowledge, attitudes and practices of mothers/caregivers regarding oral rehydration therapy at Johan Heyns community health center, Vanderbijlpark. OBJECTIVE: To assess the knowledge, attitudes and practices of mothers/caregivers regarding oral rehydration therapy at Johan Heyns community health center. METHODS: This study was a descriptive cross sectional study involving mothers/caregivers’ attended to by the primary health care (PHC) nurses at the Integrated management of childhood illnesses (IMCI) clinic of a large community health center in Sedibeng district. Respondents were systematically recruited until a sample size of 377 was reached. A face to face questionnaire was used to collect data on demography, knowledge, attitudes, practices and response to diarrhea from the participants. The data collected was analyzed by the use of descriptive statistics, chi-square test and Fisher’s exact test. The main outcome measures were the level of ORT knowledge of mothers/caregivers, attitudes, practices and response to diarrhea. RESULTS: Most of the caregivers were mothers (88.3%) who had completed matric (72.5%) and were unemployed (60.6%). The mean age was 30 years. About 53.3% of the caregivers gave ORT as an initial response to diarrhea, 30.2% took their child to the clinic/hospital, while 4% gave orthodox or traditional medicine. The majority of the caregivers (89.4%) had heard of ORT. The main source of ORT information was clinic/hospital (89.6%). Most of the caregivers (81.7%) said ORT stops diarrhea while 18.3% said it stops dehydration. Many of the caregivers (66%) had used ORT. The caregivers’ORT knowledge was significantly associated with attitude and (P= 0.0000). A small proportion of the caregivers (29%) had problems preparing ORT at home. Most of the caregivers’ children (75.5%) did not like the taste of ORT. The ORT attitude of caregivers was significantly associated with knowledge and practice (P=0.0000; P=0.0127). Less than half (33.7%, n=127) of the entire study sample (n=377) and about half (50%, n=127) of the caregivers who claimed that they could prepare ORT (67.4%, n=254) was able to prepare a correct recipe. Over half (54.2%) of the caregivers stopped giving ORT or did not know what to do when vomiting starts. A large number of the caregivers (72.7%) continued feeding their child at the onset of diarrhea. Many of the caregivers (82.8%) used only ORT at the onset of diarrhea while few (17.2%) added some unconventional remedies. There was no association between ORT practice and ORT knowledge (P=0.4797). CONCLUSION: This study shows a significant association between ORT knowledge and attitude, and also between ORT attitude and practice. There was no correlation between ORT knowledge and practice, therefore ORT knowledge did not satisfactorily translate to the practice. Majority of the caregivers could not prepare ORT correctly and either stopped giving ORT or did not know what to do when vomiting starts. The reported use of unconventional remedies like raw egg and custard by some caregivers to treat diarrhea at home is disturbing. It is obvious that much work still needs to be done to improve home treatment of diarrhea using ORT; a good starting point is to initiate new strategies aimed at improving caregivers’ education on the different aspects of ORT.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg in partial fulfilment of the requirements for the degree of Master of Science Physiotherapy. Johannesburg, 2014 / HIV is a global epidemic with the majority of people infected living in Sub-Saharan Africa. The era of Highly-Active Antiretroviral Therapy has resulted in HIV infected children living longer lives and more commonly reaching school going age. These children are expected to participate at the same level as their peers despite the numerous effects that HIV and HAART have on the body. The aim of this cross sectional comparative study was to compare the exercise endurance of a group of HIV infected children to that of their uninfected peers. Sixty children aged between seven and ten years were enrolled in the study; 30 HIV infected children and 30 children not infected with HIV. Children were assessed using the six minute walk test (6MWT) according to American Thoracic Society guidelines. The two groups were well matched in terms of socio-economic status, gender and age. Statistically significant differences were found when comparing anthropometric measurements of height and weight with HIV infected participants being shorter and weighing less than their non-infected peers. The distance walked in the 6MWT was significantly reduced in the HIV infected participants with these children walking 57.86 metres less than the non-infected participants. It was also found that HIV infected children had significantly lower heart rates at all stages of testing. Correlations were found between the distance walked in the 6MWT and average and maximum heart rates. This study confirms that the exercise endurance of a group of HIV infected children is significantly reduced when compared to their age matched non-infected peers. It indicates the need for further investigation into the exercise endurance in HIV-infected children in a larger more representative sample of the population. Further investigation into the possible benefits of the prescription of exercise programmes in children needs to be done.