SETTING:Limited data are available on the characteristics of tuberculosis (TB) disease in young children, especially in high-burden countries. OBJECTIVE:To assess the incidence and severity of TB in children aged <5 years. METHODS:TB records and chest radiographs of children born in Cape Town in 1999 and diagnosed with TB between 1999 and 2004 were reviewed retrospectively. RESULTS:A total of 1607 cases were registered. The cumulative incidence of definite (bacteriologically confirmed) and probable (radiological evidence and > or =1 TB clinical feature) TB in children aged <5 years was 2.9% and was highest between the ages of 12 and 23 months. Of 1233 children with definite or probable TB, 506 (41%) had severe disease (dissemination, cavities or >1 lobe involved). The under 5 years incidence of disseminated TB was 0.33%. Of 239 (15%) cases that were bacteriologically confirmed, clinical features typical of TB disease were individually present in <60%. The most common combined symptoms were cough for >2 weeks and weight loss, occurring in 43/239 (18%). CONCLUSION:TB incidence was high, and peaked in children aged 12-23 months. Many children experienced severe disease. A fifth of children with microbiologically confirmed disease presented with only one feature typically associated with TB.

This study aimed to determine the blood lead distributions among young children in the lead mining town of Aggeneys in South Africa's Northern Cape Province, and in the comparison community of Pella, about 40 Km away. A further objective of the study was to explore factors associated with elevated blood lead levels. Children aged between 6 and 10 years (average age, 8 years) were studied, 86 from Aggeneys and 68 from Pella. The results showed that blood lead levels among the children of Aggeneys averaged around 16 microg/dL, while in Pella the mean blood lead level equaled 13 microg/dL. Overall, children with raised blood lead levels performed less well at school relative to other children. Within Aggeneys, fathers of "high" lead children tended to shower at work rather than at home, which may have been insufficient to prevent lead from being transported into the home. In conclusion, more stringent environmental control measures are needed, as well as stricter personal hygiene measures, to prevent childhood lead exposure in the mining community.

OBJECTIVE:To determine blood lead levels among children attending schools in selected Cape Peninsula suburbs, and to assess the impact of a reduction in the lead content of petrol.DESIGN:A cross-sectional analytical study of children's blood lead levels and associated risk factors.SETTING:Selected inner city, suburban, and peri-urban schools in the Cape Peninsula, expected to have differing levels of environmental exposure to lead.SUBJECTS:Grade 1 schoolchildren for whom prior written parental consent had been obtained, and who were present at school on the day of the study.OUTCOME MEASURES:Blood lead levels (microgram/dl), associated with a wide range of potential risk factors.RESULTS:Median blood lead levels in suburbs varied from 14 to 16 micrograms/dl, the lowest levels occurring in the peri-urban suburb and the highest in the inner city suburb. Within the inner city suburb of Woodstock, variations in mean blood lead concentrations among schools were substantial, varying from 13 to 19 micrograms/dl. Overall, no change occurred in blood lead levels in this suburb subsequent to the lowering of the lead content of petrol.CONCLUSION:Every effort should be made in South Africa to control sources of lead in the urban environment. The study will serve as a useful baseline against which to measure the impact on blood lead levels of further actions which have been taken to promote the use of lead-free petrol in South Africa.

This series of booklets is a course of self-based learning on the comprehensive management of the sick infant and young child. It is intended for use by first level health workers who in South Africa are generally nurses. The principles used are based on the World Health Organisation strategy “Integrated Management of Childhood Illness (IMCI)”. For those who have not yet benefitted from full IMCI training the booklets provide specific information on important elements of child health care that each nurse should know and use. As her knowledge and experience expands she will increasingly approach each child in the comprehensive manner promoted in this series. The booklets are not intended as a substitute for existing training programmes but rather as an adjunct to such learning. Short case studies are employed to illustrate problems to be discussed in each section. (excerpt)

Little is known about the epidemiology of Haemophilus influenzae infections in South Africa. This study was designed to determine the prevalence, serotype distribution, antimicrobial susceptibility pattern and effect of age and hospitalisation on the carriage of H. influenzae in 322 Cape Town children. The overall and type b specific carriage rates in normal children (N = 107) were 45.8% and 4.7% respectively. The yield following nasopharyngeal culture was twice that following throat culture (P < 0.001). Children hospitalised with tuberculosis (N = 62) had significantly greater carriage rates, 66.1% and 37.1% respectively (P = 0.02). Institutionalised mentally handicapped children (N = 77) and children with tuberculosis attending an outpatient clinic (N = 76) had lower carriage rates (P < 0.02). Antimicrobial resistance was a major problem only in children hospitalised with tuberculosis (rifampicin 100%, penicillin 43.9%, erythromycin 85.4%, co-trimoxazole 82.9%). This universal resistance to rifampicin has not been reported previously. There was no difference in the mean age of children with positive or negative cultures, with the exception of those hospitalised with tuberculosis. In this group children infected with type b were much younger (mean 19.7 months) than those with other and non-typeable infections (32.1 months) and the non-infected (50.1 months) (P = 0.04). Duration of hospitalisation or outpatient therapy in the patients with tuberculosis did not influence carriage rates.(ABSTRACT TRUNCATED AT 250 WORDS)

An enzyme-linked immunosorbent assay (ELISA) for detecting serum IgG antibodies to an autoclaved suspension of Mycobacterium tuberculosis H37 RV was evaluated as a diagnostic tool in 132 clinical cases of childhood tuberculosis. The mean (SD) optical density value in these patients was 0.115 (0.122) compared with 0.022 (0.017) in the control group of patients who had non-tuberculous acute respiratory tract infections. Using as a cut-off level the mean of the control plus 2 standard deviations, the test sensitivity was 62% and the specificity was 98% in all the patients with a clinical diagnosis of tuberculosis. In the culture-positive group (n = 35), the sensitivity was 69%. A positive correlation was shown between the optical density levels and increasing age and chronicity of infection but not with respect to tuberculin skin reactivity, nutritional status and the duration of prior therapy. In addition, BCG vaccination (presence of a scar) did not affect the ELISA result. We conclude that this ELISA test is a useful diagnostic test in children.