Healthworkers fail to test sick children for HIV
A very high proportion of children died of AIDS-related illnesses in KwaZulu-Natal hospitals in 2005, yet over half had never been tested for HIV and only a handful were on antiretroviral treatment at the time of their death.
This suggests that healthworkers are simply missing the opportunity to treat children for HIV ‘ despite the fact that this province is at the epicentre of the world’s HIV/AIDS epidemic.
This is one of the findings of the report, ‘Saving Children 2005’, compiled by the Child Problem Identification Programme and the Medical Research Council. The child mortality at 15 hospitals countrywide were examined over five months in 2005 in order to assess the quality of child healthcare.
Five KwaZulu-Natal hospitals took part in the report: Edendale and Grey’s in Pietermaritzburg, GJ Crookes in Scottburgh, Mahatma Gandhi in Durban and Christ the King in Ixopo.
Almost one in ten children admitted to Grey’s Hospital in the five-month period in 2005 died — 107 deaths out of 1 074 children admitted. This was the highest mortality rate out of the 15 hospitals that took part in the report.
Most of the children died within 24 hours of being admitted to Grey’s, which is a referral hospital. This led the report to conclude that children were not being properly stabilised at other health facilities before being transferred to Grey’s.
At Grey’s, 46% of the dead children were HIV-infected or exposed, yet the HIV status of almost a third of the children wasn’t known.
The child death rate in all five KZN hospitals was higher than the national average of 6.8% of child admitted to hospital dying.
At Edendale Hospital, 58% of children who died were HIV-infected or exposed (by having an HIV-positive parent) ‘ yet over two-thirds had never been tested for HIV.
At GJ Crookes, 56% of the dead children were HIV-infected or exposed yet less than 40% had been tested.
At Christ the King Hospital, 38% of children who died were HIV-infected or exposed ‘ but two-thirds had not been tested for HIV.
At Mahatma Gandhi, the HIV status of almost nine out of 10 dead children (85.7%) was unknown.
Dr Kimesh Naidoo writes in the report that the prevention of mother-to-child HIV transmission programmes ‘have not decreased the number of infected newborn infants’ and that ‘rapid expansion of the ARV rollout to children is needed’.
The report also identified a list of problems hampering the proper treatment of children.
At GJ Crookes, there was a huge problem with medical equipment.
‘In 60% of cases, the equipment was either not available or it was broken and being repaired,’ according to the report.
The blood gas analysis machine, pulse oxymeter, and blood pressure apparatus were out of order, and a ventilator had been away for repairs for four months.
‘The quantity of available equipment was far less than the requirement per bed,’ and there was a ‘poor and interrupted supply of daily use items. Something was always out of stock and it took months for vital things to become available.’
At Edendale, the hospital filing system was ‘chaotic’ while the ‘the ward admission/ discharge book was in a poor condition with pages missing and records incomplete’ and case notes were ‘of a very variable quality and often very difficult to interpret’.
Mahatma Gandhi suffered huge staff shortages, very poor data collection a lack of resuscitation areas, high care and paediatric intensive care unit
There was a significant increase in child deaths at the hospital from 2004 (from 5.9% to 8.3%) although admissions had decreased and staff increased.
Despite being given ample time to respond to questions arising from the report, the KwaZulu-Natal Department of Health failed to do so. ‘ Health-e News Service.
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