Red Cross War Memorial Children's Hospital in Cape Town, South Africa was opened in 1956 through public subscription as a memorial to soldiers lost in the Second World War. The suggestion that the memorial take the form of a children's hospital was proposed by Vyvyan U.T. Watson. Mr Watson, a prominent businessman, had lost his first born and only son, Peter Tennant Watson, at about four years old, to an outbreak of diphtheria in Cape Town. Mr Watson was a major force in steering the organization of the building of the hospital. The Peter Pan statue on the hospital grounds, sculpted by Ivan Mitford-Barberton, was donated by Mr Watson and his wife, Gwendolyn. Mr Watson was later President of the South African Red Cross Society. It is one of two dedicated children's public hospitals in sub-Saharan Africa, and one of only a few dedicated children's hospitals in the Southern hemisphere.The hospital has academic links to the University of Cape Town's School of Child and Adolescent Health, the University of the Western Cape Dental School and the University of Stellenbosch; it is regarded as South Africa's leading centre for post-graduate specialist paediatric medical and surgical training..
Introduction: Continuous glucose monitoring (CGM) offers an advancement over traditional self-monitoring of blood glucose (SMBG) for people living with type 1 diabetes (T1D). However, evidence on the acceptability and feasibility of different CGM use cases in African populations remains limited. Methods: This was a pragmatic three-arm, randomised controlled trial on CGM conducted among people living with T1D in three public healthcare clinics in South Africa. Participants were assigned to Arm 1 (continuous CGM), Arm 2 (periodic CGM), or Arm 3 (SMBG). Diabetes education was provided at all study visits. Feasibility was assessed by adherence to CGM use and through the Glucose Monitoring Satisfaction Survey (GMSS). Diabetes distress was measured by the Diabetes Distress Scale (DDS), health-related quality of life (HRQoL) by the EQ-5D scales, and acceptability using the Theoretical Framework of Acceptability (TFA). Surveys were collected on paper and transferred to OpenClinica. Analyses were performed in R. The trial was registered in the Clinical Trials Registry ([NCT05944718][1]) on July 13, 2023. Results: A total of 83 participants were included in Arm 1, 85 in Arm 2, and 80 in Arm 3. CGM mean active time was 55% in Arm 1 versus 69% in Arm 2. The proportion of participants meeting the ≥70% active time threshold was higher in Arm 2 (52%) than in Arm 1 (34%). Diabetes' distress declined across arms during the intervention period, with no significant difference between arms; distress increased slightly six months post-intervention but remained below baseline. At 6 months, glucose monitoring satisfaction was significantly higher in both CGM arms than in the SMBG arm, and satisfaction increased over time in CGM arms. Health-related quality of life remained stable across arms during the intervention period with no significant difference between arms. High acceptability was observed in both CGM arms, with higher ratings in the periodic arm. Conclusions: CGM was acceptable to people living with type 1 diabetes and feasible to use in public-sector clinics in South Africa, with high acceptability under continuous and periodic use. Health-related quality of life remained stable across arms, and diabetes-related distress declined, during the intervention period, across arms. Glucose monitoring satisfaction rose significantly in both CGM arms compared to SMBG. Periodic CGM might be a promising and potentially more scalable option than continuous use for public-sector care. ### Competing Interest Statement Abbot sponsored registration (Prof Karsas and Prof Rheeder) for the SEMDSA (Society for Endocrinoloy, Metabolism and Diabetes of South Africa) congress in Durban 2025. Prof JA Dave has received honoraria from Abbot for continuing medical education activities on continuous glucose monitoring. ### Clinical Trial https://clinicaltrials.gov/study/[NCT05944718][1] ### Clinical Protocols ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The protocol was approved by the Faculty of Health Sciences Research Ethics Committee at the University of Pretoria (330/2023) and the Human Research Ethics Committee at the University of Cape Town (HREC REF 558/2023). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes De-identified individual participant-level?data?is available at https://zenodo.org/records/21531500 .?Study protocol?was already published at:?https://link.springer.com/article/10.1186/s13063-024-08132-7.? [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT05944718&atom=%2Fmedrxiv%2Fearly%2F2026%2F08%2F31%2F2026.08.26.26361479.atom
BACKGROUND:Acute lower respiratory tract infections (ALRIs) are a leading cause of pediatric mortality in low- and middle-income countries. In recent years, substantial research has been done to enhance risk stratification of children presenting with ALRIs, in a bid to improve health outcomes in resource-limited settings. We sought to analyze the performance of several pediatric ALRI risk scores in the prediction of mortality among children hospitalized with ALRIs in Kenya. METHODS:We retrospectively analyzed the data of 2182 children aged 2-24 months who were admitted to Kilifi County Referral Hospital, Kenya with severe ALRIs between January 2015 and December 2024. We evaluated the performance of 6 ALRI risk scores (RISC [HIV-negative], mRISC, RISC-Malawi, PERCH, PREPARE, and ReSVinet) in this population. Additionally, we created and evaluated a modified version of the ReSVinet score by including nutrition status. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS:The mid-upper arm circumference (MUAC) version of the RISC-Malawi score showed the highest discrimination for the outcome of in-hospital mortality (AUROC, 0.83; 95% confidence interval, .79-.86), whilst all other scores showed acceptable discrimination (AUROC, 0.70-0.79). The modification of ReSVinet to include nutrition status significantly improved its AUROC from 0.72 to 0.79. CONCLUSIONS:All risk scores showed at least fair performance in the prediction of in-hospital mortality within our dataset. The RISC-Malawi (MUAC) score appears to be the most promising candidate for future implementation; however, further research is needed to evaluate the calibration, feasibility, and clinical utility of these scores.
BackgroundCritically ill children on peritoneal dialysis (PD) are at an increased risk of raised intra-abdominal pressure (IAP). The aim of this study was to describe IAP and complications with a standard PD fill volume, using conventional PD and continuous flow PD (CFPD) in critically ill children with acute kidney injury. A secondary objective was to compare two IAP measurement techniques, which were direct measurement from the PD catheter via a manometer and indirect measurement via the bladder catheter to a transducer.MethodThis study was a secondary analysis of a previously published randomized controlled crossover trial. Within- and between-group changes in IAP, blood pressure and ventilation parameters were analysed using paired t-tests. Bland-Altman and intraclass correlation tests were used to assess agreement between direct and intravesicular measurement of IAP.ResultsFifteen participants (median (range) age and weight 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg) were included, of which 9 (60%) had raised IAP (>10 mmHg) after filling. No children developed compartment syndrome or other complications. Mean ± standard deviation IAP on conventional versus CFPD was 9.35 ± 2.97 and 11.5 ± 2.96 versus 9.3 ± 3.35 and 11.2 ± 3.62 when measured directly and indirectly, respectively (p > 0.5). Intravesicular measurement of IAP was constantly significantly higher compared to the direct method (p = 0.002); however, there was good correlation (Pearson correlation coefficient 0.7; p < 0.001) and moderate reliability (ICC = 0.6) between the methods.ConclusionIncreased IAP (>10 mmHg) was common, although not associated with serious adverse events, and warrants monitoring in these patients. The pressures measured are different with the two techniques used, although they do correlate well. More studies are needed to define increased IAP depending on the measuring technique and inform IAP measurement practice in children with acute PD.
