The SAJCH is an online, peer-reviewed medical journal devoted to all aspects of health and healthcare of neonates, infants and children, of particular relevance and interest to its southern African readership.
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Tribute to Professor Ella Hartman (29/6/1942 – 8/01/2026)
Copyright (c) 2026 - https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2026 S Kalistas https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2026 C Naidu https://creativecommons.org/licenses/by-nc/4.0
Diagnostic utility of lung ultrasound in preterm neonates with respiratory distress at a tertiary neonatal intensive care unit in South Africa
Background. Accumulating data suggest the potential for lung ultrasound (LUS) to diagnose pathology in preterm babies, but there are no published data from South Africa (SA). Objectives. To describe LUS diagnoses, respiratory pathology and outcomes in preterm babies receiving non-invasive respiratory support in a tertiary SA neonatal unit, and to compare LUS with clinical diagnoses and surfactant administration. Methods. We conducted a prospective, observational study of babies at 27 - 34 weeks’ gestation, with birthweight ≥800 g, receiving non-invasive respiratory support and who had LUS at age ≤3 hours. Surfactant was administered at a fraction of inspired oxygen (FiO2) of 0.35 - 0.45 and was not influenced by LUS findings. Results. Fifty-one neonates were included, of whom 16% received surfactant, all with respiratory distress syndrome (RDS) as their only clinical diagnosis, compared with multiple diagnoses in the non-surfactant group, including RDS (93%), transient tachypnoea of the newborn (TTN) (16%) and pneumonia (14%). Lung ultrasound indicated less RDS in the non-surfactant group than the surfactant group (42% v. 88%; p=0.02), and more TTN (61% v. 13%; p=0.01). The LUS score (LUSS) predicted surfactant administration (area under the curve 0.8 (95% confidence interval 0.67 - 0.94)). A LUSS of 7 had the best combined sensitivity (75%) and specificity (72%) but a low positive-predictive value (33%). A LUSS of 8 identified 8 (19%; n=8/43) additional babies for surfactant who did not need treatment. Conclusion. LUS suggested more diagnoses than clinical assessment, particularly TTN, but did not accurately predict surfactant administration at an FiO2 of 0.35 - 0.45.
Copyright (c) 2024 Dr Fefekazi Mpisane-Jama, Prof Alan R Horn, Wisdom Basera https://creativecommons.org/licenses/by-nc/4.0
Incidence of intraventricular haemorrhage in very low-birthweight infants in a group of private hospitals in Johannesburg, South Africa, 2018 - 2022
Background. Intraventricular haemorrhage (IVH) is a common complication among very low-birthweight infants (VLBWIs), affecting ~20 - 30% of VLBWIs. Most published reports on the incidence of IVH in South Africa (SA) come from public sector hospitals, with few studies having been conducted in private sector hospitals. Objectives. To determine the incidence of IVH and factors associated with moderate to severe IVH in VLBWIs admitted to private sector hospitals. Methods. This was a retrospective study of VLBWIs admitted to neonatal intensive care units in three private hospitals in Johannesburg, SA, from 2018 to 2022. The study was a secondary analysis of data provided by the Vermont Oxford Network. VLBWIs admitted in three hospitals that gave permission for their data to be used were analysed. Incidence was determined based on all VLBWIs who had cranial ultrasound scans performed during admission. Comparisons were performed between VLBWIs with normal findings or mild IVH and those with moderate to severe IVH. Results. A total of 186 VLBWIs were admitted to the three private hospitals during the study period, of whom 135 (72.6%) had cranial ultrasound scans performed. Of these VLBWIs, 34 had some degree of IVH and 18 had moderate to severe IVH, giving an incidence of 25.2% for any IVH and 13.3% for moderate to severe IVH. The odds of having moderate to severe IVH were lower if birth was via caesarean section (CS) v. vaginal (adjusted odds ratio (aOR) 0.09; 95% confidence interval (CI) 0.02 - 0.45; p=0.004) and gestational age was ≥28 weeks (aOR 0.08; 95% CI 0.01 - 0.86; p=0.037), while odds were higher for neonates born to mothers who received antenatal magnesium sulphate (aOR 8.60; 95% CI 1.64 - 44.87; p=0.011). Conclusion. The incidence of IVH in VLBWIs admitted to certain private hospitals was comparable to the incidence reported in high- income countries. The odds of VLBWIs having moderate to severe IVH were lower when infants were born by CS or were of higher gestational age, but higher if the mother received antenatal magnesium sulphate. Although routine CS cannot be recommended for delivery of VLBWIs based on the study findings, as we did not review the indications for CS, some VLBWIs may benefit from being delivered by CS. The unexpected finding of magnesium sulphate being associated with high odds of moderate to severe IVH needs to be studied further.
Copyright (c) 2026 M F Kleinhans, T Ramdin, S Velaphi https://creativecommons.org/licenses/by-nc/4.0
Risk factors for developing intraventricular haemorrhage in very low-birthweight infants at Kalafong Provincial Tertiary Hospital, South Africa, 2019 - 2020
Background. Intraventricular haemorrhage (IVH) remains a major concern as a result of the high prevalence of preterm births globally. Objectives. To identify maternal and neonatal risk factors associated with IVH, and to assess its incidence and most frequently occurring grade in a population of very low-birthweight infants (VLBWIs) at Kalafong Provincial Tertiary Hospital, South Africa (SA). Methods. This retrospective cohort study included all infants of birthweight <1 500 g admitted between 1 January 2019 and 31 December 2020. Associations between IVH and maternal and neonatal risk factors were analysed using Pearson’s χ2 test and Fisher’s exact test. Risk factors significantly associated with IVH were included in a binary logistic regression model to identify independent predictors. Risk factors significantly associated with IVH (p<0.05) corresponded to a 95% confidence level. Results. IVH was diagnosed during the first week of life in 43 out of 127 VLBWIs who met the inclusion criteria. Hypoglycaemia remained the most significant independent risk factor after adjusting for potential confounders in the multivariable logistic regression: adjusted odds ratio 4.02 (95% confidence interval (CI) 1.52 - 10.64). The incidence of IVH was 33.9% (95% CI 25.7 - 42.1). Grade I IVH occurred in 83.7% of infants, grade II in 9.3% and grades III - IV in 7.0%. Conclusion. This study found an association between hypoglycaemia and IVH, but causality could not be established owing to the nature of the study. In this tertiary hospital in SA, a third of VLBWIs had IVH, mostly graded as mild.
Copyright (c) 2026 M A Mahlako, N Paulse https://creativecommons.org/licenses/by-nc/4.0
Strategies to reduce the caesarean section rate at a regional hospital in northern KwaZulu-Natal Province, South Africa
Background. The caesarean section (CS) rate at Queen Nandi Regional Hospital (QNRH) in northern KwaZulu-Natal Province, South frica (SA), has remained above the national average for a public hospital in SA. In view of the short- and long-term complications of CS, effective strategies are required to reduce unnecessary CS. Objectives. To identify the indications for CS and the factors that contributed to the high CS rate at QNRH, with the aim of implementing interventions to reduce unnecessary and avoidable CS without compromising mother and baby outcomes. Methods. We conducted a 3-month retrospective audit (Q1 2024) of 100 randomly selected CS files from the labour ward birth register and from the postnatal ward. The data collected included patient demographics, referring facilities, CS category, indication for CS, Robson Ten Group classification, timing of CS, and maternal and perinatal outcomes. The CS rate for Q1 2024 was compared with Q2 2024 and Q3 2024 with and without local clinic deliveries. Referrals from the local clinics for CS in Q1 2024 were compared with institutional audits from 2020 and 2023. Tables and figures were used for analysis. Institutional ethics permission was obtained for the clinical audit and publication of the data. Results. During the study period, there were 2 077 deliveries in total and 1 366 CSs, giving a CS rate of 66%. Among the 100 randomly selected files analysed, there were 1 set of twins, 5 stillbirths (3 due to abruptio placentae grade 3b), 96 live births, and no maternal deaths. Of the patients, 44% were aged >20 - 30 years, 41% were in their first pregnancy, 70% were referred from our local clinics, and 48% were low risk; 26% had a body mass index >40 kg/m2, 15% were hypertensive, and 25% were HIV positive. In 47% of cases the indication for CS was fetal distress/non-reassuring cardiotocograph, followed by failed induction of labour (13%), failure to progress (6%), and breech presentation and abruptio placentae (5% each). More than 80% were urgent CSs, with more of these done during the night than during the day (37% v. 28%). A further 22% of the urgent CS were done during changeover time. Of the infants, 72% were born at a gestational age of 34 - 40 weeks and 80% had a birthweight of >2 500 - 4 000 g. All liveborn infants had a normal Apgar score. There were no maternal adverse outcomes. As expected, and owing to the short time frame for repeat in-depth analysis, there was no significant impact of CS trends when comparing Q1 2024 with Q2 and Q3 2024 for both institutional-based and population-based CS rates. Referrals from the local clinics contributed 70% towards our CS rate in Q1 2024 and remained consistently ~80% on average, when compared with institutional audits from 2020 (80%) and 2023 (85%). Conclusion. While measures were already in place to reduce rates of unnecessary CS at QNRH, the findings from our audit show that current strategies to reduce the CS rate will be unlikely to reach the target of 28% for public sector facilities, owing to our referral pattern and the drainage areas covered by this hospital. Despite the small sample size in this audit, evidence points towards the need for a district hospital in this subdistrict to help reduce our facility CS rate.
Copyright (c) 2026 L Govender https://creativecommons.org/licenses/by-nc/4.0
Validation and modification of a cardiotocograph interpretation training programme for midwives in South Africa to address existing interpretation inconsistencies, using the virtual nominal group technique
Background. Conventional models of cardiotocograph (CTG) interpretation training have focused on adherence to interpretation guidelines. There is a need for training in interpreting CTGs that emphasises integrating the complete clinical picture to inform clinical decision-making and improve patient safety. Objectives. To develop and validate a CTG interpretation training programme for midwives in South Africa to address the existing inconsistencies in interpretation. Methods. This study was underpinned by the Analysis, Development, Design, Implementation and Evaluation (ADDIE) theoretical framework. The study followed an explanatory sequential mixed-methods design with the aim of exploring and describing midwives’ level of knowledge of CTG interpretation and their learning needs. The learning needs identified informed the development of a training programme. A panel of nine experts participated in a virtual nominal group technique to validate the training programme and prioritise the learning units through anonymous ranking. Results. CTG interpretation training made up of the following learning units was developed and validated with the assistance of maternal and child health experts: Introduction to CTG interpretation; Technical aspects of CTG monitoring; Factors that affect the fetal heart rate during labour; Diagnosis; Clinician-woman relationship; Effective and timely communication of accurate information; Formulation of a comprehensive management plan after CTG interpretation; Using appropriate guidelines to inform decision-making; and Medicolegal hazards. Conclusion. This CTG interpretation programme differs from other conventional training programmes in that it focuses on the multifaceted nature of CTG interpretation and does not confine the training to CTG interpretation guidelines.
Copyright (c) 2026 S Lukhele, F M Mulaudzi, R Gundo https://creativecommons.org/licenses/by-nc/4.0
A conceptual framework to promote respectful maternity care
Background. This study presents a conceptual framework for respectful, woman-centred maternity care, integrating insights from the literature, systems theory, and critical theory. The framework incorporates healthcare institution and provider factors, ensuring dignity, respect and high-quality care throughout the maternity experience. Objectives. To outline the development process of this framework, which serves as a foundation for promoting respectful maternity care (RMC) in South Africa’s public healthcare settings. Methods. A theory-generative methodology was applied, using both inductive and deductive strategies to derive key conclusions, ensuring a comprehensive approach to theory construction. Results. The framework identifies and describes essential concepts that foster synergy in promoting RMC. By integrating diverse knowledge sources, it establishes a strong theoretical foundation, linking its principles to RMC and broader quality healthcare standards. Conclusion. The conceptual framework provides a structured approach for enhancing maternity care through a woman-centred perspective. It underscores the value of combining multiple viewpoints to inform maternity care strategies, aiming to improve the overall maternal experience and healthcare outcomes.
Copyright (c) 2026 P Lunda, C S Minnie, W Lubbe https://creativecommons.org/licenses/by-nc/4.0
Rapid response, E-MOTIVE and suction tamponade for postpartum haemorrhage (ARREST PPH): A quality improvement project
Background. Research supports routine monitoring of blood loss, early bundled treatment of postpartum haemorrhage (PPH), and suction uterine tamponade for refractory PPH. Objectives. To implement recent research evidence and World Health Organization guidance on the prevention and management of PPH. Methods. We co-designed, with input from midwifery and medical staff, and conducted a quality-of-care improvement project at Princess Marina Hospital, Gaborone, Botswana. We conducted training and placed posters in the labour ward promoting evidence- based third-stage care with a novel checklist mnemonic, BOND (Baby skin-to-skin, Oxytocic, iNitiate blood loss monitoring, Delay cord clamping); use of the reusable MaternaWell Tray for blood loss monitoring after birth; early implementation of the MOTIVE bundle for PPH (uterine Massage, Oxytocin, Tranexamic acid, IntraVenous fluids, Examination, and, if needed, Escalation); and early use of suction tube uterine tamponade with the improvised Levin tube for refractory PPH. We provided in-service mentorship. Observations. Unstructured observations indicate good uptake of the treatment interventions. Routine blood loss monitoring has been difficult to institutionalise. Conclusion. The mnemonic-driven checklist approach is promising. Creative solutions are needed to further advance behaviour change. Training materials are available on the Obstetric Skills Library (YouTube).
Copyright (c) 2026 F Rubgega, N M Nkuba, S Hanson, R Luckett, B Moreri-Ntshabele, N Memo, G J Hofmeyr https://creativecommons.org/licenses/by-nc/4.0
Perinatal Priorities – a partnership for good
Copyright (c) 2026 E Buchmann https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2025 Claudia Naidu https://creativecommons.org/licenses/by-nc/4.0
Background: Haemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates has not been thoroughly explored in a resource-limited setting. The prevalence and clinical course of hsPDA in the Free State, South Africa, are unknown. Objective: To determine the prevalence, outcome and management approach of hsPDA in very low birth weight (VLBW) infants at Universitas Academic Hospital and Pelonomi Tertiary Hospital. Methods: This retrospective cross-sectional study was conducted at two tertiary hospitals from January 2020–December 2022 and included all VLBW (≤ 1.5kg) neonates diagnosed with hsPDA by echocardiogram. PDA treatment included conservative- medical- or surgical management. Short-term outcomes included death, discharge, length of stay, and associated complications. Results: Of the 1 523 VLBW neonates, 161 (10.6%) were diagnosed with hsPDA. A 29 week median gestational age was found (IQR 27, 30). More patients received conservative management (65.8%) than medical closure (32.9%). Conservatively managed neonates received fluid restriction (33.5%) and diuretics (16.8%). Of those receiving medical intervention, 29.2% received paracetamol and 3.7% ibuprofen. Two underwent surgical ligation. Definite NEC (Modified Bell staging 2 & 3) (14.4%) and moderate to severe BPD (13.0%) were the most observed complications. The median length of stay was 38 days (IQR 14, 60). Forty-nine (30.4%) neonates died. Two-thirds (67.0%) of patients had a follow-up echocardiogram. Length of stay was the shortest for the group that received no treatment (p-value <0.001). Conclusion: Our study revealed that the prevalence of hsPDA was 10.6%. Commonly associated complications were NEC and BPD. Conservative management was the most common modality used. Treatment modalities might not decrease the length of stay in VLBW infants with hsPDA.
haemodynamically significant patent ductus arteriosus
Copyright (c) 2026 Ifedolapo Leslie, Dr Moodley https://creativecommons.org/licenses/by-nc/4.0
Background: There is limited data on the hospital admissions for children with Cerebral Palsy (CP) in Africa Objectives: To examine the lifetime post- neonatal hospitalisation of all the children with CP, who attended the CP clinic at Red Cross War Memorial Children's Hospital (RCWMCH), in the Western Cape Province, South Africa. Methods: This descriptive study examined the lifetime post- neonatal hospitalisation of all the children with CP who attended, at least once, the dedicated CP clinic at this tertiary paediatric hospital during a 12-month period in 2021. The statistical strategy included descriptive statistics and logistic regression used to model the association between CP comorbidities and hospitalisation. Results: The study included 877 children and young adults with CP, aged 1-23 years. Out of these, 800 children had their CP Classified according to the Surveillance of Cerebral Palsy in Europe (SCPE) Classification, with the majority being non- ambulatory (61.5%, n=492) were non- ambulatory (Gross Motor Function Classification System [GMFCS] IV-V). Over two- thirds, (73.1, 585/800) of the entire cohort were admitted to the hospital at least once per year, primarily the non- ambulatory children (63.6%, 372/585). The top emergency diagnoses were seizures (22.8%,293/1283), respiratory related illnesses (14.7%,188/1283) and gastrointestinal disorders (7.6%,98/1283). Orthopedic procedures were the most frequently documented elective admission diagnosis (17.1%,219/1283). In our cohort of children with CP, the odds of their first hospital admission being elective were higher in ambulatory children with orthopedic complications (odds ratio (OR) 3.78,95% Confidence Interval (CI) 1.82 - 7.86; p<0.01). Conclusion: The study highlights the significant burden of hospital admissions particularly in non- ambulatory children with CP. It also underscores the importance of preventing and effectively managing complications to reduce emergency hospitalisations of children with CP.
Copyright (c) 2026 Dr Thembi J. Katangwe, Prof Mariana Kruger, Prof Ronald Van Toorn, Prof Regan Solomons, Prof. Kirsty Donald https://creativecommons.org/licenses/by-nc/4.0
Abstract Background: Red cell distribution width is easily available in routine haemogram reports but there is scarce literature from India regarding its role as a prognostic tool for critically ill children. Materials and method: This was a tertiary care Paediatric Intensive Care Unit (PICU) based observational study. Laboratory variables included for study were complete blood count, serum electrolytes, mechanical ventilation days, need for inotropes and blood transfusion, duration of PICU stay and final outcome (discharge or death). Paediatric risk of mortality scoring (PRISM) III was done in all hospital admissions. Results: There was significant association between requirement of oxygen support and mechanical ventilation in higher red cell distribution width (RDW) groups (p value 0.034 and <0.001). There was significant association between high RDW values and thrombocytopenia and leucocytosis (p value 0.034 and <0.001). High RDW values were significantly associated with increased mortality and length of stay and high PRISM scores (p values <0.001, <0.001, <0.001 respectively) in hospital. Conclusion: RDW can be used as potentially inexpensive and easily available laboratory biomarker for identifying the severe morbidity children admitted to paediatric ICUs in low resource settings.
Copyright (c) 2026 animesh indu, baljeet maini, NS Chithambram https://creativecommons.org/licenses/by-nc/4.0
Necrotising enterocolitis in infants with in‐utero SARS-CoV-2 exposure in Tshwane, South Africa
Background. Literature suggests an association between in-utero SARS-CoV-2 exposure and necrotising enterocolitis (NEC). Objective. To determine whether admitted infants exposed to SARS-CoV-2 in utero had a higher NEC incidence than unexposed infants; and to describe the overall incidence of NEC during the COVID-19 pandemic to explore potential associations. Methods. The evaluation period included 1-year pre-COVID-19 (April 2019 - March 2020) and a 2-year COVID-19 period (April 2020 - March 2022). An electronic database was used to identify infants and to collect routine data. Additional databases were used to identify mothers with COVID-19 and SARS-CoV-2-exposed neonates. Results. All infants exposed to SARS-CoV-2 in utero tested negative for COVID-19 before admission, indicating no vertical transmissions. Among 32 SARS-CoV-2-exposed infants, one developed NEC (incidence 3.1%), compared with 2.5% in unexposed infants (p=0.834). NEC incidence was similar across periods (1.8% v. 2.5%; p=0.147). The median day of life of NEC diagnosis was 12 days for both periods. The sex distribution of infants with NEC was similar during both periods. Conclusion. While this study did not demonstrate a statistically significant increase in NEC incidence during the COVID-19 pandemic, a potential association cannot be excluded, owing to the potential pathophysiological mechanisms that support this hypothesis.
Copyright (c) 2025 Prof M Coetzee, Dr H Naidoo, Dr RM Tshehla, Dr H Mulol, Prof U Feucht https://creativecommons.org/licenses/by-nc/4.0
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc/4.0
Introduction: Hypotension in preterm infants remains a major cause of morbidity and mortality. Hydrocortisone has been documented to improve blood pressure in inotrope resistant preterm infants though there is limited information about its efficacy and outcomes. Aim: The aim of the study was to describe characteristics and outcomes of preterm neonates admitted to the neonatal intensive care unit (NICU) with hypotension and received hydrocortisone. Method: This was a retrospective descriptive study of hypotensive preterm neonates admitted at the NICU in Chris Hani Baragwanath Academic Hospital(CHBAH) between January and December 2020. Results: Of 191 hypotensive preterm neonates, 176(92.1%) received inotropes with 122 (69.3%) administered hydrocortisone. Mean gestational age and birthweight were 32(+/-2.5) weeks and 1.47(+/-0.52) kgs respectively. More females presented with hypotension than males (54% versus 44%). Dobutamine (52%) was the most common inotrope used. The mean hydrocortisone dose was 4(2-12) hours. The commonest dosing frequency was 8 hourly in 107 (87.7%) neonates and hydrocortisone administration improved both systolic and diastolic blood pressures (p=0.001). Sepsis (p=0..3), nSOFA score >10 (p=0.001) and lenght of stay (p=0.001) were predictors of mortality. Sepsis (OR 3.66 95% CI:1.21-11.09) and a high nSOFA score (OR 1.37,95% CI: 1.01-1.84) were strongly associated with mortality. Conclusion: Hydrocortisone significantly improved blood pressure in hypotensive preterm neonates. More studies should be undertaken to strengthen current protocols and improve outcomes. Keywords: neonate, hypotension, hydrocortisone, preterm, survival.
Copyright (c) 2026 Dr Raymond Tsakila, Professor Firdose Nakwa, Professor Kebashni Thandrayen https://creativecommons.org/licenses/by-nc/4.0
Mortality rate of infants with gastroschisis and healthcare-associated infections admitted in the neonatal and paediatric intensive care units in a tertiary hospital in Tshwane district, South Africa
Background. Gastroschisis is associated with significant morbidity and mortality in neonates. Healthcare-associated infections (HAIs) worsen outcomes, with a high mortality, and timely management is crucial for survival. In South Africa, data regarding mortality and HAI management in neonates with gastroschisis are limited. Objectives. To evaluate the incidence of mortality and factors associated with mortality in neonates with gastroschisis admitted in the intensive care unit (ICU) and treated for HAI. Methods. A retrospective study was conducted from July 2017 to October 2023. Eligible infants were identified using intensive care admission registers and the neonatal database. Patient demographics, treatment modalities, and outcomes, including mortality, were analysed. The Score for Neonatal Acute Physiology II (SNAP-II) severity was calculated retrospectively. Results. A total of 66 neonates with gastroschisis and HAI that were admitted in the intensive care units were included in this study. Three neonates were managed for HAI twice, resulting in 69 HAI episodes. The incidence of culture-positive HAI was 77.9%, with a mortality of 84.8% per included neonate. Approximately half of the positive bacterial cultures with sensitivity testing were resistant to at least three classes of antimicrobial drugs. A SNAP-II score ≥30 was associated with higher mortality (p=0.038). Inotropic support was required in 76.8% of cases, correlating with higher mortality (p<0.001). Conclusion. HAI remains a major cause of mortality in neonates with gastroschisis. Higher SNAP-II scores and inotropic support were associated with poor outcome. The high incidence of multidrug-resistant pathogens highlights the need for tailored antimicrobial strategies. Further research is needed to improve survival rates in this high-risk populations.
Copyright (c) 2025 M M T Mbutho, M Coetzee https://creativecommons.org/licenses/by-nc/4.0
Breastfeeding and antiretroviral access among HIV-exposed children during the peak COVID-19 pandemic lockdown in a rural district in South Africa
Background. There is limited information on whether the period of highest movement restrictions during the COVID-19 pandemic impacted on antiretroviral coverage for supporting safe breastfeeding among HIV-exposed children. Objectives. To (i) measure the prevalence of breastfeeding among HIV-exposed children during peak COVID-19 lockdown (March - June 2020); and (ii) explore its association with antiretroviral coverage and other factors. Methods. A cross-sectional telephonic survey was conducted (September to November 2020), among women living with HIV (WLHIV) from rural Ehlanzeni District, South Africa (SA). Participants who were previously enrolled in a face-to-face study during 2019 and who provided consent for future studies, were invited to take part in the present survey. Data, including child feeding practices, were collected from maternal recall of the COVID-19 pandemic peak lockdown period. Descriptive statistics were calculated and factors associated with breastfeeding were analysed using log binomial regression. Results. A total of 322 WLHIV aged between 19 and 46 years were successfully interviewed. Of these, only 6.4% reported disruption in antiretroviral treatment (ART), 18 (5.6%) had children living with HIV (CLHIV), all of whom were on ART. Out of the 300 HIV-exposed uninfected children (HEUs) who were eligible for extended postnatal prophylaxis (extended PNP) (those still breastfeeding, and the mother either had a viral load (VL) ≥1 000 copies/mL or had not undergone VL testing within the past 6 months), 47.7% received it. During the COVID-19 peak lockdown, 30.1% of children were breastfed, including 28.6% (n/N=87/304) of HEUs and 62.1% of breastfeeding HEUs were on extended PNP. Log binomial regression analysis showed HEUs on extended PNP and CLHIV had increased likelihood of breastfeeding (prevalence ratio (PR) 1.8 (95% confidence interval (CI) 1.2 - 2.6) and PR 2.6 (95% CI 1.6 - 4.4), compared with eligible HEUs who were not on extended PNP. Conclusion. Good antiretroviral coverage supported safe breastfeeding practices during the COVID-19 peak lockdown in this rural setting in SA, with promising ongoing adoption of extended PNP during breastfeeding.
Copyright (c) 2025 Thandiwe E. Mbira, Andrew J. Prendergast , Thorkild Tylleskär , Phillippe Van de Perre, Ameena Goga, Nobubelo Ngandu https://creativecommons.org/licenses/by-nc/4.0
Developing simulation-based training for paediatric registrars using best evidence: Sepsis and the Phoenix Sepsis Criteria
Background. Sepsis is a leading cause of morbidity and mortality in children, particularly in resource-restricted settings. Early recognition and management are crucial to improving patient outcomes. Despite fairly extensive clinical exposure, paediatric registrars often manage these cases without direct supervision or time for critical reflection. Simulation-based learning experiences (SBLEs) offer a platform for mastering emergency care without risking patient safety. Objective. To develop, implement and evaluate an SBLE for paediatric registrars to enhance their confidence and learning in managing paediatric sepsis, incorporating the recently published Phoenix Sepsis Criteria and current evidence-based guidelines. Methods. An SBLE was developed according to the ADDIE instructional model. The learning experience included a prebriefing phase, a scenario execution using a SimBaby® manikin and a structured debriefing. Paediatric registrars evaluated the SBLE using the modified Simulation Effectiveness Tool (SET-M), which assessed self-reported learning and confidence across the prebriefing, simulated scenario and debriefing phases. Results. Seven registrars participated in the SBLE. The SET-M demonstrated high scores across all domains, with high median scores obtained for prebriefing (6/6), learning (17/18), confidence (16/18) and debriefing (15/15). Conclusion. This SBLE enhanced both confidence and learning related to managing paediatric sepsis as reported by participants. The simulation also provided a structured platform to introduce the Phoenix Sepsis Criteria and discuss context-appropriate care in resource-limited settings. The value of simulation in paediatric emergency training is demonstrated.
Copyright (c) 2025 Michelle Myburgh, Stephen Brown, Mathys Labuschagne https://creativecommons.org/licenses/by-nc/4.0
In the face of alobar holoprosencephaly: A case report
Holoprosencephaly (HPE) is a rare congenital brain malformation caused by incomplete forebrain cleavage during embryogenesis. Alobar HPE, the most severe form, is characterised by a single cerebral hemisphere and absent midline structures, accompanied by severe facial anomalies. We present the case of a neonate with alobar HPE, diagnosed postnatally, displaying facial dysmorphism, seizures and global hypertonia. Genetic testing revealed no chromosomal or significant genetic anomalies. Neuroimaging confirmed characteristic findings, including a mono ventricle and fused thalami. This report highlights the diagnostic challenges, multifactorial aetiology and the need for multidisciplinary care in managing this complex condition, emphasising its poor prognosis and associated complications.
Copyright (c) 2025 Kelsey-Lynne Hills, Mahtaab Khan, Joy Fredericks https://creativecommons.org/licenses/by-nc/4.0