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Copyright of African Journal of Ecology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Burn injuries in Africa are common with between 300,000 and 17.5 million children under 5 years sustaining burn injuries annually, resulting in a high estimated fatality rate. These burns are largely environmentally conditioned and therefore preventable. The Western Cape Province in South Africa can be regarded as a prototype of paediatric burns seen on the continent, with large numbers, high morbidity and mortality rates and an area inclusive of all factors contributing to this extraordinary burden of injury. Most of the mechanisms to prevent burns are not easily modified due to the restraint of low socio-economic homes, overcrowding, unsafe appliances, multiple and complex daily demands on families and multiple psycho-social stressors. Children <4 years are at highest risk of burns with an average annual rate of 6.0/10,000 child-years. Burn care in South Africa is predominantly emergency driven and variable in terms of organization, clinical management, facilities and staffing. Various treatment strategies were introduced. The management of HIV positive children poses a problem, as well as the conflict of achieving equity of burn care for all children. Without alleviating poverty, developing minimum standards for housing, burn education, safe appliances and legislation, we will not be able to reduce the 'curse of poor people' and will continue to treat the consequences. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Intraperitoneal bowel perforation may occur in utero as a result of a variety of abnormalities and typically results in sterile meconium ascites, pseudocysts, and/or calcification in the fetus. On the other hand, extraperitoneal bowel perforation in intrauterine life is extremely rare. The object of this report is to present our experience of prenatal extraperitoneal rectal perforation, defining the clinical presentation, management, and progress. Methods and Materials: Nine babies who were identified from 2 centers in the Republic of South Africa with fetal extraperitoneal rectal perforation are presented. The details of these babies were obtained retrospectively from the case notes. Results: All patients presented at or shortly after birth with air and meconium tracking below the pelvic floor manifesting as either an expanding, meconium-stained aerocele or with perirectal spreading sepsis. Where abdominal signs were present, laparotomy confirmed the extension of the meconium perforation into the peritoneal cavity. Management was by diverting colostomy, drainage of the perineal collection, and supportive therapy. A posterior approach to the rectum and excision of a fibrotic section of the lower rectal wall was performed in one case. One case developed rectal stenosis that was treated by dilatation before colostomy closure. In all the other cases, digital examination performed before colostomy closure ruled out significant narrowing. There was no mortality, and the site of the rectal perforation healed in all cases to leave good anorectal function after treatment. Conclusions: Fetal extraperitoneal perforation is extremely rare, but the clinical features are easily recognizable, and when appropriate therapy is instituted, the outcome is likely to be good with normal anorectal function to be expected in the long-term. The exact cause of the condition is unknown. [Copyright &y& Elsevier]

Over the past two decades, chronic peritoneal dialysis (PD) has emerged as the first choice pediatric dialysis modality. A recent study visually identified the cause of malfunction of PD catheters at the Red Cross Children's Hospital in Cape Town. The reasons that could be found, lead to changed Tenckhoff insertion-techniques from open to laparoscopic. This included suturing of the tip, omentectomy and ovarian-pexy by laparoscopy. In the present paper we prospectively analyzed, if changed insertion technique lead to an improved outcome. Patients and Methods: 26 Patients required 36 laparoscopic Tenckhoff insertions during the period August of 2003 and July of 2006. Overall a total number of 222.5 catheter-months have been observed. Laparoscopic insertion technique required 3 port placements. The tip of the catheter was sutured to pelvic peritoneum, omentectomy performed through a port site and ovariopexy done when required. Results: The mean lifespan of all Tenckhoff's was 6.4 6.3 months. The tip of the catheter was sutured 20 times, omentectomy done in 9 cases and 6 patients underwent ovarian pexy. In the group where the tip was sutured to the pelvic peritoneum catheter life was 8.4 months compared to the non-sutured group which was only 4.1. Omentectomy lead to an overall catheter survival of 8.0 months compared to the no omentectomy group, which had a survival of 5.8 months. The complication-rate concerning early problems and malfunctions in the sutured and omentectomy groups was also lower. Patients who underwent both, suturing of the tip and omentectomy had no malfunctions at all. Conclusion: Omentectomy and suturing the tip can lower the complication-rate and prolong catheter survival. Using these procedures could decrease costs and morbidity and prevent patients from having further operations. [ABSTRACT FROM AUTHOR]

Thermal injuries amongst infants are common and a cause of significant mortality and morbidity in South Africa. This has been attributed to the lack of an enabling environment (poverty-related lack of safe living conditions) and the cognitive and physical developmental immaturity of infants, who depend on their surroundings and adults to keep them safe. This is a retrospective observational study of 548 infant admissions over 48 months. Infant was defined as children below 13 months of age. The 548 infants constituted 23% of all paediatric burn admissions of ages 0-12 years. Three hundred and fourteen were males (57%) and 234 (42.7%) females. The infants were divided in a pre-ambulatory group of 143 (26%) infants of 0-6 months and an ambulatory group of 7 months to 12 months consisting of 457 (83.3%). The total body surface area (TBSA) ranged from 2-65%. Seventy-six percent (417 infants) occurred in the home environment. Scalds accounted for 86% (471 infants) and 6% (33 infants) were as a result of flame burns. Non-accidental injuries accounted for 1.2%. The anatomical distributions varied between the pre-ambulatory and ambulatory groups. Conservative management was done in 397 (72.4%) and 101(18.4%) infants underwent surgery. Infection was suspected in 76 (13.5%) infants with positive blood cultures in 15(20%) of the 76. ICU care was received in 46 (8.3%) infants and 15 (32.6%) of these had inhalation injuries. Of the inhalation injuries 11(23.9%) infants underwent mechanical ventilation of an average of 4.4 days. Ventilator associated pneumonia was diagnosed in 8(17%) of the ventilated children. The mortality rate was 0.36%. The surgically treated patients acquired more complications than the conservatively treated group. Special treatment considerations should be considered in this paediatric sub-group. [ABSTRACT FROM AUTHOR]

Introduction: Pruritus or itch is a common symptom after burn injuries. The Itch Man Scale has been recommended to assess itch severity in children. The aim of this prospective observational study was to perform a cross-cultural validation of the Itch Man Scale by comparing it with the Numeric Rating Scale (NRS) and the Toronto Pediatric Itch Scale.Method: At Red Cross War Memorial Children's Hospital in Cape Town, South Africa, parents of pediatric burn patients assessed their child's itch with the Itch Man Scale, NRS and Toronto Pediatric Itch Scale. Children from the age of 6years also rated the Itch Man Scale and NRS themselves. The Spearman rank order correlation between the different scales was calculated to determine construct validity.Results: Over a two-month period, 255 pediatric burn survivors with a median age of 2.3years (IQR 1.4-4.0) were included; 35 of them were aged 6-13years. Parents' Itch Man Scale ratings correlated significantly with parents' NRS ratings (0.82, 95% CI 0.78-0.86) and with the Toronto Pediatric Itch Scale of the parent (0.80, 95% CI 0.75-0.84). The correlation between the older children's Itch Man Scale rating and those of their parents was 0.66 (95% CI 0.37-0.83).Conclusion: We concluded that the Itch Man Scale has promising validity and is a user-friendly tool to use in clinical practice to determine the itch intensity in children younger than 13years in a South African setting. [ABSTRACT FROM AUTHOR]

Aim The aim was to investigate hand surface as a percentage of body surface area from infancy to 13 years of age using physical measurement and digital planimetry and establish the influence of age, gender, BMI for age and ethnicity, specifically in the South African population. A secondary aim included the development of a template for burn size measurement. Methodology This was a cross-sectional observational study. Demographic information was obtained from each participant. Body mass index (BMI) and body surface area (BSA) were determined using several established formulas. The hand area was measured using a standard physical measurement method and a digital planimetry method. All data was presented in an Excel and SPSS spreadsheet and the calculations performed with SPSS 24.0. Results Three-hundred and sixty-eight burn patients and 150 children from a nearby primary school were enrolled. The age ranged from 1 month to 13 years. The hospital patient group was significantly younger, included more boys and had a lower BMI by age. Most patients (98.7%) were African or mixed race compared to the school children who were primarily Caucasian (p < 0.001). The seven formulas to determine the BSA were highly comparable with Intraclass correlation coefficient (ICC) of 0.997 (95% CI 0.996–0.998). Actual hand surface area measured ranged from 22.44 cm 2 to 164.9 cm 2 . The mean measured and digital percentage HSA of TBSA for all participants was 0.929% with a SD of 0.088. Male children, had a larger HSA as a proportion of TBSA by 0.036%. Generally, as the child gets older from toddler to late childhood, the hand becomes relatively smaller by a factor of approximately 0.08%. As the BMI increased, the hand got relatively smaller. Conclusion The potential value of the physical measurement method is that it lends itself to direct measurement during examination of the burnt child. The study showed that there are minor differences between racial groups, gender, BMI and age variations. The clinical relevance of these variations is negligible. [ABSTRACT FROM AUTHOR]

Introduction: Burns amongst children in South Africa are common and usually occur in the immediate home environment. In surveys many parents have requested ongoing educational burn prevention programs. This exploratory thematic parent orientation study assessed the level of parental knowledge on burn prevention strategies in the home.Methods: Study populations included: Parent with a burned child admitted to hospital, parents of non-burnt hospital attenders and hospital naive parents unbiased by previous exposure to burns. Participants answered a burn prevention questionnaire consisting of five sections. In this, two pictures depicting the circumstances associated with paediatric burns sustained at home were used, one with 15 potential danger points and one sanitized. There was no educational intervention prior to parents viewing the pictures.Results: There were 268 participants; 72 burnt inpatient, 97 non-burnt outpatients and 99 hospital naive participants. The inpatient population displayed the highest incidence of informal housing. A positive relationship was identified between the overall study population and burns general knowledge and prevention. Educated participants were more knowledgeable about burns and better at identifying risk factors. Knowledge about burns was higher in the outpatient population and the highest in the Naïve group when compared to the Inpatients group (p<0.01). The naïve group scored higher in prior knowledge about burns and burn prevention. Of the potential 15 danger points only four of 72 inpatients and three of 97 outpatients identified more than 80% of the potential danger points as compared to 43 of 99 of the naïve group. The dangling kettle cord, the use of a mug to pour paraffin into a lantern and the child pulling a tablecloth were the most common dangerous aspects identified. We demonstrated a positive correlation between participants' ability to identify potential dangers, identify safe practice and implementing safe practice.Conclusion: Our findings show that people living in environments optimal for burn incidents know relatively little about burn prevention strategies. Future intervention needs to not only target the population's behavior but most importantly needs to promote better education models. [ABSTRACT FROM AUTHOR]

This study was a component of a broader review to evaluate burn care in South Africa. A prospective audit of 353 children with thermal injuries admitted to the Red Cross War Memorial Children's Hospital in Cape Town was performed during 2012/2013. The audit was based to assess the adherence of initial burn management to the provincial policy guidelines on the clinical management of the burn wound. The community management of each patient prior to admission to a burns centre was assessed for the following: basic demographics, emergency home management, wound cover, analgesia and transport to medical facilities. Their ages ranged from 1 month to 14 years. The average total body surface area [TBSA] was 15% [1-86%]. Most of the injuries were due to hot water accidents [78.5%] followed by flame burns (9%), direct contact and electricity burns. Two hundred and twenty five children [63%] received first aid measures at home, including cooling with water [166] ice [30] and a cooling agent. No cooling was instituted in 130 and 65% of the patient's wounds were cooled for 10 min or less. Eighty percent proceeded to the referral centre or burns unit without their wounds being covered; with only 19 patients having any medical type of dressing available at home. Two hundred and ninety five children [83.6%] received pain medication prior to admission at the burns unit. Of the 316 patients not directly attending the burns unit, 137 received i.v. fluids of which 95 had burns greater than 10% TBSA. None of the patients were in shock on admission and all i.v. lines were functioning. Forty-four children with burns greater than 10% did not receive i.v. fluids. The audit identified six factors that were inadequately addressed during the pre-admission period: first aid, cooling of the wound, early covering of the wound, resuscitation, pain management and transfer. If these could be readdressed, basic burn care would be substantially improved in the study area. [ABSTRACT FROM AUTHOR]

Introduction: The Red Cross Children''s Hospital is the only children''s hospital in South Africa. It has a dedicated trauma unit for all children under the age of 13 and serves a population of approximately 2 million inhabitants. As part of the Child Accident Prevention Foundation program we have kept a database of all children treated for trauma in our hospital since 1991. Presently, we have over 88,000 entries in our database. Aim: To study our experience with ingested foreign bodies in children. Materials and methods: A retrospective study was performed using the Child Accident Prevention Foundation of Southern Africa (CAPFSA) database of a total of 3677 patients presenting with foreign bodies. The hospital folders were searched using a standardised data extraction form. Only foreign bodies aspirated or ingested were included. Results: To date, 241 folders have been analysed. Demographics: Both sexes were equally affected (boys, 49%). Age ranged between 0 and 12 years, although there was only one child under the age of 1. At the age of 3 years, there was a peak in incidence (24% of all cases). Nature of ingested object: Although the objects were from a range of materials, most were metal (40%) or plastic (23%). The most commonly ingested object was a coin (28%), a ball (20%) or bone (8%). The size ranged from 0.1 to 3 cm (as measured by virtual ring), the most common size of an ingested foreign body was 0.5 cm. Anatomical site: The most common anatomical site of impaction was the nose (41%), followed by the esophagus (20%), the stomach (14%) and bowel (11%). Other anatomical sites included hypopharynx, nasopharynx, bronchus, larynx and oral cavity. Severity of symptoms: Only 0.4% of our cases were assessed as being severe, 14% as moderate, and 44% as mild. Forty-two percent had no symptoms. Removal: Fifty-seven percent of ingested foreign bodies were removed surgically, 19% were left in situ, 14% spontaneously dislodged and only 1% was removed by Foley catheter manipulation. Conclusion: A presentation with a foreign body is quite common in our patient population, representing approximately 4.2% of all our cases. The majority of ingested foreign bodies produced mild or no symptoms, needed surgical removal and had no complications. [Copyright &y& Elsevier]