Children In Cape Town Research Articles

Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa.

We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.

The effect of active brain-breaks on fundamental movement skills and executive functioning of Grade one children in Cape Town, South Africa

ABSTRACT Developing children’s FMS and executive function is a critical aspect of early childhood. The aim was to evaluate the fundamental movement skills (FMS) and executive function. The objectives were to investigate the locomotor and object control skills as well as inhibitory control and working memory of the selected children. Grade 1 (6–8-years-old) learners (N = 157) in Cape Town, South Africa were assessed with the Test for Gross Motor Development (TGMD-2) and Head Toes Knees and Shoulder task, before and after a 6-week active brain-break intervention. Participants were divided into a control (n = 53) and an experimental (n = 104) group. The results indicated an overall statistically significant difference (p < 0.05) for pre- and post-testing in both groups for FMS executive functioning (p < 0.01).The results highlight the importance of exposing Grade 1 learners to FMS and physical activity bouts during academic lessons to create opportunities for movement, development of FMS and enhancement of executive functioning.

Molecular epidemiology and antibiotic resistance of staphylococci other than Staphylococcus aureus in children in Cape Town, South Africa.

Staphylococci other than Staphylococcus aureus (SOSA) have emerged as significant pathogens in healthcare settings, particularly among patients with indwelling devices and immunocompromised individuals. Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis are the most common commensal SOSA species and are implicated in infections such as endocarditis and bacteremia. SOSA infections in neonates and children have been reported globally. Recent increases in antibiotic resistance and virulence among SOSA strains in clinical settings have highlighted the need to describe the reservoirs of SOSA to enable monitoring of these emerging pathogens. Stool samples were collected from 150 healthy children from Cape Town communities between 2017 and 2020. Staphylococci were isolated, identified using mass-spectrometry, and antimicrobial susceptibility testing and Illumina whole genome sequencing were performed. Among the participants, 50 (33.3%) were colonized by SOSA, with S. haemolyticus (n = 38; 25.3%) being the most common, followed by S. hominis (n = 5; 3.3%) and Mammalicoccus sciuri (n = 5; 3.3%). Out of the 77 initially isolated S. haemolyticus strains, 23 were identified as Staphylococcus borealis through whole genome sequencing. All S. haemolyticus isolates (n = 49) were methicillin resistant, with 65.3% (n = 32) harbouring mecA. In S. haemolyticus, SCCmec type VIII(4A) was detected in 42.0% of ST9 isolates while non-mecA methicillin resistant S. haemolyticus isolates were mostly ST49 (41.1%). Additionally, 16 (50.0%) S. haemolyticus strains contained non-typeable SCCmec elements. High rates of methicillin resistance were identified among colonizing SOSA in Cape Town, increasing the risk of transmission to clinical settings. This study also identified a new species, S. borealis, for the first time in Africa.

Primary nephrotic syndrome in children in Cape Town, South Africa

Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have beenassociated with certain race groups in parts of South Africa. However, there are no recent studies of childhood PNS in Cape Town.Objectives. To describe the demographics, histological subtypes and steroid response of patients with PNS who underwent kidney biopsiesat Red Cross War Memorial Children’s Hospital (RCWMCH) over a 10-year period.Methods. Details of patients with PNS who underwent kidney biopsies in the Paediatric Nephrology Department at RCWMCH between2006 and 2015 were retrospectively recorded.Results. A total of 103 patients were included in the study. Most patients were either of mixed race (42%) or black (36%), with a mean age of6.8 years and a male-to-female ratio of 1.19:1. The most identified histopathological subtype was mesangioproliferative glomerulonephritis(MesPGN; 60% (n/N=62/103)). Of the patients with focal segmental glomerulosclerosis (FSGS), MesPGN and minimal change disease(MCD) 45% (n/N=43/95) were steroid-resistant, and 54% (n/N=51/95) were steroid-sensitive. There was no significant associationbetween any race group and steroid response. Patients with FSGS were more likely to be black, while MCD was more common in mixed-race patients (p=0.04). There was no difference in the likelihood of being mixed race or black between patients with FSGS and MesPGN(p=0.472).Conclusion. MesPGN was the most common histopathological subtype found in our study. There was no significant association betweenrace and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race wasnot otherwise significantly associated with any histopathological subtype

Serum Immune Responses to Group A Streptococcal Antigens following Pharyngeal Acquisitions among Children in Cape Town, South Africa.

There is limited information on the human immune response following infection with group A Streptococcus (Strep A). Animal studies have shown, in addition to the M protein, that shared Strep A antigens elicit protective immunity. This study aimed to investigate the kinetics of antibody responses against a panel of Strep A antigens in a cohort of school-aged children in Cape Town, South Africa. Participants provided serial throat cultures and serum samples at two-monthly follow-up visits. Strep A recovered were emm-typed, and serum samples were analyzed by enzyme-linked immunosorbent assay (ELISA) to assess immune responses to thirty-five Strep A antigens (10-shared and 25-M peptides). Serologic evaluations were performed on serial serum samples from 42 selected participants (from 256 enrolled) based on the number of follow-up visits, the frequency of visits, and throat culture results. Among these, there were 44 Strep A acquisitions, 36 of which were successfully emm-typed. Participants were grouped into three clinical event groups based on culture results and immune responses. A preceding infection was most convincingly represented by a Strep A-positive culture with an immune response to at least one shared antigen and M peptide (11 events) or a Strep A-negative culture with antibody responses to shared antigens and M peptides (9 events). More than a third of participants demonstrated no immune response despite a positive culture. This study provided important information regarding the complexity and variability of human immune responses following pharyngeal acquisition of Strep A, as well as demonstrating the immunogenicity of Strep A antigens currently under consideration as potential vaccine candidates. IMPORTANCE There is currently limited information regarding the human immune response to group A streptococcal throat infection. An understanding of the kinetics and specificity of antibody responses against a panel of Group A Streptococcus (GAS) antigens will serve to refine diagnostic approaches and contribute to vaccine efforts, which together will serve to reduce the burden of rheumatic heart disease, a major source of morbidity and mortality especially in the developing world. This study, utilizing an antibody-specific assay, uncovered three patterns of response profiles following GAS infection, among 256 children presenting with sore throat to local clinics. Overall, the response profiles were complex and variable. Of note, a preceding infection was most convincingly represented by a GAS-positive culture with an immune response to at least one shared antigen and M peptide. Also, more than a third of participants demonstrated no immune response despite a positive culture. All antigens tested were immunogenic, providing guidance for future vaccine development.

Prevalence of group A streptococcal carriage in school children from Cape Town: A cross- sectional study and systematic review

&#x0D; &#x0D; &#x0D; &#x0D; Background. Asymptomatic children can be a major reservoir of pharyngeal group A streptococcus (GAS). The role of GAS carriage causing subsequent infections resulting in the manifestation of clinical symptoms, or being associated with transmission to uninfected individuals, is not entirely clear. Furthermore, data on GAS carriage from countries in Africa remain scant with only a few studies reporting carriage.&#x0D; Objectives. We performed a cross-sectional study to determine the prevalence of asymptomatic pharyngeal carriage of group A streptococci in school children in Cape Town. We considered our results in the context of a meta-analysis of data of GAS carriage in Africa.&#x0D; Methods. We conducted a school-based cross-sectional study from 2009 to 2011 in two Cape Town peri-urban communities, enrolling 950 healthy learners. Pharyngeal swabs were obtained from learners and processed at the National Health Laboratory Service (NHLS) microbiology laboratory at Groote Schuur Hospital, Cape Town. Thereafter, we conducted a systematic review through a comprehensive literature search among several sources. Prevalence estimates with 95% confidence intervals (CIs) were determined using a random-effects meta-analysis model.&#x0D; Results. GAS was isolated from 31 participants corresponding to a carrier rate of 3% (95% CI 2% - 4%). Combining our results with 18 other studies revealed a pooled prevalence of 9% (95% CI 6% - 11%). Regional pooled rates were similar across southern, eastern and northern Africa, of between 9% (95% CI 6% - 11%) and 11% (95% CI 4% - 21%) while countries within Central Africa had a pooled estimate of 7% (95% CI 5% - 9%). Western Africa had the lowest pooled estimate of 2% (95% CI 1% - 2%).&#x0D; Conclusion. There was a relatively low rate of carriage of GAS in asymptomatic school children residing in South Africa. Pooled prevalence rates revealed regional differences across the African continent as regards the rate of GAS carriage, with the western and northern African regions having rates of GAS carriage that were lower and higher respectively than those of East, Central and southern African countries, which demonstrated similar rates of carriage.&#x0D; &#x0D; &#x0D; &#x0D;

Physical fitness and weight status of Grade One children in Cape Town, South Africa

Physical fitness and weight in young children are important indicators of health status. Literature has shown that fatness and physical fitness are highly intertwined; considering the two together is important as they influence each other. The aim of this study was to investigate the physical fitness levels and weight status of Grade 1 children (N=184) from two schools in Cape Town, South Africa, as well as differences in physical fitness and weight between boys and girls. A quantitative study design was applied. Physical fitness skills were evaluated by measuring five components: cardiorespiratory fitness, muscular strength, agility, flexibility and coordination. Children’s height and mass were measured to determine their Body Mass Index (BMI) and the International Obesity Task Force (IOTF) cut-offs were used to establish under- and overweight classifications of the children. Boys performed better than girls in the standing broad jump, shuttle run and throwing, whereas girls performed better in the flexibility test. Of the children, 84% were classified as normal weight, 11% were overweight and 5% were obese. The children in this study were relatively fit compared with children in other provinces in South Africa; however, their fitness levels can still be significantly improved.

Missed Opportunities for Vaccination and Associated Factors among Children Attending Primary Health Care Facilities in Cape Town, South Africa: A Pre-Intervention Multilevel Analysis.

Despite the substantial efforts at ensuring universal access to routine immunisation services among children in South Africa, major gaps in immunisation coverage remain. This study assessed the magnitude of missed opportunities for vaccination (MOV) and associated factors among children aged 0–23 months attending primary health care (PHC) facilities in Cape Town. We used multilevel binomial logistic regression models to explore individual and contextual factors associated with MOV, with children aged 0–23 months at Level 1, nested within PHC facilities (Level 2). A total of 674 children and their caregivers were enrolled. MOV prevalence was 14.1%, ranging from 9.1% to 18.9% across sub-districts. Dose-specific MOV prevalence was highest for the second dose of measles vaccine (9.5%) and lowest for the first dose of rotavirus vaccine (0.6%). The likelihood of a child experiencing MOV was significantly associated with caregivers’ low level of education (Odds ratio (OR) = 3.53, 95% credible interval (CrI): 1.13–11.03), recent receipt of immunisation messages (OR = 0.46, 95%CrI: 0.25–0.87), shared immunisation decision making by both parents (OR = 0.21, 95%CrI: 0.07–0.62) and health facility staff number (OR = 0.18, 95%CrI: 0.06–0.61). The burden of MOV among children in Cape Town is influenced by individual and contextual factors, which provide important opportunities for quality improvement and broader strategies to improve routine immunisation service delivery.

Fundamental movement skills proficiency amongst neurotypical grade one children in Cape Town, South Africa

Fundamental movement skills proficiency amongst neurotypical grade one children in Cape Town, South Africa

Neurodevelopment of HIV-exposed uninfected children in Cape Town, South Africa.

BackgroundEvidence shows that antiretroviral (ART) exposure is associated with neurodevelopmental delays in human immunodeficiency virus (HIV)-exposed uninfected (HEU) children. However, there are few insights into modifiable maternal and child factors that may play a role in improving neurodevelopment in HEU children. We used a parent-centric neurodevelopment tool, Ages & Stages Questionnaire (ASQ) to examined neurodevelopment in HEU children at 12–24 months of age, and associations with maternal and child factors.Methods505 HIV-infected women (initiated ART pre- or during pregnancy) with live singleton births attending primary health care were enrolled; 355 of their HEU children were assessed for neurodevelopment (gross motor, fine motor, communication, problem solving and personal-social domains) at 12–24 months using age-specific ASQ administered by a trained fieldworker. Associations with maternal and child factors were examined using logistic regression models.ResultsAmong mothers (median age 30 years, IQR, 26–34), 52% initiated ART during pregnancy; the median CD4 count was 436 cells/μl (IQR, 305–604). Most delayed neurodevelopment in HEU children was in gross (9%) and fine motor (5%) functions. In adjusted models, maternal socio-economic status (aOR 0.42, 95% CI 0.24–0.76) was associated with reduced odds of delayed gross-fine motor neurodevelopment. Maternal age ≥35 years (aOR 0.22, 95% CI 0.05–0.89) and maternal body mass index (BMI) <18.5 (aOR 6.76, 95% CI 1.06–43.13) were associated with delayed communication-problem-solving-personal-social neurodevelopment. There were no differences in odds for either domain by maternal ART initiation timing.ConclusionsDelayed neurodevelopment was detected in both gross and fine motor functions in this cohort of HEU children, with strong maternal predictors that may be explored as potentially modifiable factors associated with neurodevelopment at one to two years of age.

Pseudomonas aeruginosa bloodstream infection at a tertiary referral hospital for children

BackgroundThis study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa.MethodsA retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database.ResultsThe incidence risk of PABSI was 5.4 (95% CI: 4.34–6.54) PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37.4%). Overall, 69/91 (75.8%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (54.9%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24.2% and in multivariable analysis, empiric antibiotic therapy to which PA isolates were not susceptible, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality.ConclusionsPABSI caused appreciable mortality, however, appropriate empiric antibiotic therapy was associated with reduced 14-day mortality.

South African English Speech Development: Preliminary Data from Typically Developing Preschool Children in Cape Town

ABSTRACT English is one of eleven official languages in South Africa, but there is limited information on children’s acquisition of English and other languages in this context. This paper describes speech development in 308 children aged 3;0–5;11 acquiring South African English in Cape Town. The study focused on English speech acquisition, although children were grouped by language background into monolingual, isiXhosa bilingual, Afrikaans bilingual and trilingual groups. The primary objective was to describe phonetic and phonological acquisition (percentage consonants and vowels correct (PCC and PVC); phonetic inventory and phonological processes) by children’s age and language background. As a secondary objective we described the prevalence of speech disorders in the sample using Dodd’s (2005) framework. The Diagnostic Evaluation of Articulation and Phonology was used to assess participants with modified scoring criteria appropriate for the context. Phonological processes and inventories were broadly comparable to normative data for English speech acquisition documented in the literature, and a progression was observed with increasing age. PCC and PVC were similar for children within age bands despite different language backgrounds. Bilingual children showed aspects of English phonological development linked to their L1, and some differences in phonological processes were observed. Approximately 9% of children (n = 28) had speech difficulties, with 75% of this group having a speech delay. The study highlights the importance of adapting speech assessments for use with populations that differ from the originally intended audience. This work contributes to knowledge of typical speech development in South Africa and in multilingual contexts more generally.

The Relationship Between Hope and Life Satisfaction Among Children in Low and Middle Socio-Economic Status Communities in Cape Town, South Africa

The overarching aim of the study was to investigate the relationship between hope and life satisfaction among a sample of children in Cape Town, South Africa. More specifically, the study aimed to ascertain the moderating effect of socio-economic status on this relationship. The study uses secondary data from the first wave of the Children’s Worlds study. A cross-sectional survey design was employed with the use of stratified random sampling to select a sample of 1004 twelve-year old children attending primary schools within the Cape Town Metropole. The questionnaire administered, incorporated Huebner’s (School Psychology International, 12, 231–240, 1991) Students’ Life Satisfaction Scale and Snyder et al.’s (Journal of Pediatric Psychology, 22, 399–421, 1997) Children’s Hope Scale. Data were analysed by means of correlational analysis, and using the Process Tool for moderation. The results indicate that there is a significant relationship between hope and life satisfaction for both low and middle socio-economic status communities. It was also revealed that socio-economic status does not moderate the relationship between hope and life satisfaction. It is recommended that further exploration be conducted on the influence of SES on the relationship between hope and life satisfaction. Given that the current study found that SES does not moderate the relationship between hope and life satisfaction, it is recommended that future studies explore the role of SES as a possible mediator.

EXPLORING INTERPERSONAL RELATIONSHIPS AMONG YOUNG ADULTS WHO WERE RAISED AS ONLY CHILDREN IN CAPE TOWN

It is thought that individuals raised as only children (i.e., children with no siblings) have difficulty forming interpersonal relationships. This study explored how young adults who were raised as only children experienced interpersonal relationships, specifically their relationships with peers, parents and romantic partners. Qualitative interviews were conducted with seven young adults who are only children. Participants were recruited using snowball sampling. Interviews were analysed using thematic content analysis. Participants described their relationships with their parents as good, often referring to them as friends or older siblings. All participants shared that they had limited experience with romantic relationships. Since many of the participants’ parents were divorced, parental divorce may have influenced the parent-child dynamic and deterred participants from entering into romantic relationships. However, even participants whose parents were married reported few romantic relationships and some believed that this may have been due to not having siblings who could have acted as role models in romantic relationships. The young adults also reported that being an only child did not affect their ability to make friends and viewed personality as more influential in forming friendships than being an only child. Whilst participants reported growing up as only children to be a largely positive experience, all expressed a desire to share a sibling bond.Â

Caregivers' Experiences of Pathways to Care for Seriously Ill Children in Cape Town, South Africa: A Qualitative Investigation.

PurposeUnderstanding caregivers’ experiences of care can identify barriers to timely and good quality care, and support the improvement of services. We aimed to explore caregivers’ experiences and perceptions of pathways to care, from first access through various levels of health service, for seriously ill and injured children in Cape Town, South Africa, in order to identify areas for improvement.MethodsSemi-structured, qualitative interviews were conducted with primary caregivers of children who were admitted to paediatric intensive care or died in the health system prior to intensive care admission. Interviews explored caregivers’ experiences from when their child first became ill, through each level of health care to paediatric intensive care or death. A maximum variation sample of transcripts was purposively sampled from a larger cohort study based on demographic characteristics, child diagnosis, and outcome at 30 days; and analysed using the method of constant comparison.ResultsOf the 282 caregivers who were interviewed in the larger cohort study, 45 interviews were included in this qualitative analysis. Some caregivers employed ‘tactics’ to gain quicker access to care, including bypassing lower levels of care, and negotiating or demanding to see a healthcare professional ahead of other patients. It was sometimes unclear how to access emergency care within facilities; and non-medical personnel informally judged illness severity and helped or hindered quicker access. Caregivers commonly misconceived ambulances to be slow to arrive, and were concerned when ambulance transfers were seemingly not prioritised by illness severity. Communication was often good, but some caregivers experienced language difficulties and/or criticism.ConclusionsInterventions to improve child health care could be based on: reorganising the reception of seriously ill children and making the emergency route within healthcare facilities clear; promoting caregivers’ use of ambulances and prioritising transfers according to illness severity; addressing language barriers, and emphasising the importance of effective communication to healthcare providers.

Group A Streptococcal emm Type Prevalence Among Symptomatic Children in Cape Town and Potential Vaccine Coverage

The molecular epidemiology of group A streptococcal pharyngeal infections in children in the Vanguard Community of Cape Town revealed 26 emm types among 157 isolates from 742 subjects. Coverage of a 30-valent vaccine is predicted to be 95% of pharyngitis cases in this population at high risk of rheumatic fever.

Routine programmatic delivery of isoniazid preventive therapy to children in Cape Town, South Africa.

Fourteen primary health care facilities in Cape Town, South Africa. To determine the proportion and characteristics of infectious adult tuberculosis (TB) cases that identify children aged <5 years who qualify for isoniazid preventive therapy (IPT), and to determine the proportion of children who initiate and complete IPT. A retrospective clinical record review conducted as a stratified cluster survey. Of 1179 records of infectious adult cases, 33.3% had no documentation of contacts. Of the remaining 786 records, 525 contacts aged <5 years were identified, representing 0.7 child contacts per infectious adult case. Older age, male, human immunodeficiency virus (HIV) positive, smear-negative and retreatment TB cases were all associated with no documentation of contacts. Of the 525 child contacts identified, less than half were screened for TB, 141 initiated IPT and 19 completed it. Less than 67% of infectious TB case records had documentation of contacts. Younger, female, HIV-negative and new smear-positive TB cases were more likely to have had contacts identified. Less than 14% of children already initiated on IPT completed 6 months of treatment.

Firearm injuries to children in Cape Town, South Africa: Impact of the 2004 Firearms Control Act

Before the introduction of the Firearms Control Act in 2004, the epidemiology of childhood firearm injuries from 1991 to 2001 in Cape Town, South Africa, was reported. This study analyses current data as a comparator to assess the impact of the Act. Firearm injuries seen at Red Cross War Memorial Children's Hospital, Cape Town, from 2001 to 2010 were respectively reviewed. Data recorded included the patients' folder numbers, gender, date of birth, age, date of presentation, date discharged and inpatient stay, firearm type, number of shots, circumstances, injury sites, injury type, treatment, resulting morbidities and survival. These data were compared with the 1991 - 2001 data. One hundred and sixty-three children presented with firearm injuries during this period. The results showed a decrease in incidence from 2001 to 2010. Older children and males had a higher incidence than younger children and females. Most injuries were to an extremity and were unintentional. Mortality had reduced significantly from the previous study (6% to 2.6%), as did the total number of inpatient days (1 063 to 617). Compared with the earlier study, this study showed a significant reduction in the number of children presenting with a firearm-related injury. Mortality and inpatient stay were also significantly reduced. The study shows the impact that the Firearms Control Act has had in terms of paediatric firearm-related injury and provides evidence that the medical profession can play an important role in reducing violence.

The evolving epidemic of drug-resistant tuberculosis among children in Cape Town, South Africa

Tygerberg Children's Hospital, Cape Town, South Africa. To determine the prevalence and trend of drug resistance and human immunodeficiency virus (HIV) co-infection among children with culture-confirmed tuberculosis (TB). Prospective surveillance from March 2007 to February 2009, compared to three previous surveys (1994-1998, 2003-2005, 2005-2007). Drug susceptibility testing (DST) against isoniazid (INH) and rifampicin (RMP) was performed using genotypic and phenotypic testing. If multidrug-resistant TB (MDR-TB) was detected, further DST against ethambutol (EMB) and second-line drugs was performed. A total of 294 children with a median age of 26 months (range 3 days-13 years) were diagnosed with culture-confirmed TB. DST results were available for 292 (99.3%); 41 (14%) were INH-resistant, including 26 (8.9%) with MDR-TB. Four children (1.4%) had RMP monoresistance. EMB resistance was present in 12/24 (50%) MDR-TB cases tested. Two isolates were resistant to ofloxacin; none had extensively drug-resistant TB. Of those tested, 29% (63/217) were HIV-infected. Any resistance to RMP increased between 1994 and 2009 (P < 0.001), as did RMP monoresistance (P = 0.009) and MDR-TB (P < 0.001). Sensitivity was 87.5% and specificity 100% for genotypic compared to phenotypic testing for INH resistance. RMP, and consequently multidrug, resistance is increasing among children with TB in this setting. EMB resistance is common among children with resistance to RMP and INH.

Rifampicin-monoresistant Mycobacterium tuberculosis disease among children in Cape Town, South Africa

Tygerberg Children's Hospital (TCH) and Brooklyn Chest Hospital (BCH), South Africa. To describe paediatric cases of rifampicin (RMP) monoresistant tuberculosis (RMR-TB) disease. Records of children with culture-confirmed RMR-TB between 1 March 2003 and 28 February 2009 were identified from a prospectively recorded database of drug-resistant TB at TCH and BCH. Mutation analysis was performed on available specimens. Eighteen children with a median age of 6.9 years (range 2 months-12.8 years) were identified. Nine (50%) were human immunodeficiency virus (HIV) infected and four (22%) were HIV-exposed but non-infected. Eleven (61%) had had previous TB treatment or prophylaxis. Nine children (50%) had cavitary disease and five children (22%) had extra-pulmonary disease. Twelve (67%) had adult TB source cases, including five (42%) adults with known RMR-TB. Primary transmission occurred among 11 children (61%) and acquisition of RMR-TB was possible in seven (39%) with prior RMP exposure. Median delay to specific RMR-TB treatment was 70 days (range 23-188). One child died from RMR-TB meningitis. Gene mutations consistent with RMR-TB were confirmed in five available samples. RMR-TB disease is increasingly encountered, particularly among HIV-infected and HIV-exposed non-infected children. Delay in commencing appropriate treatment for RMR-TB and high rates of cavitary disease could be a source of RMR-TB transmission.