ABSTRACT
The HIV/AIDS epidemic has placed increasing demands on limited paediatric intensive care services in developing countries. The decision to admit HIV infected children with Pneumocystis carinii pneumonia (PCP) into the paediatric intensive care unit (PICU) has to be made on the best available evidence of outcome and the ethical principles guiding appropriate use of scarce resources. The difficulty in confirming the diagnosis of HIV infection and PCP in infancy, issues around HIV counselling, and the variance in the outcome of HIV infected children with PCP admitted to the PICU in African studies compound this process. Pragmatic decision making will require evaluation of at least three ethical questions: are there clinical and moral reasons for admitting HIV positive children with PCP to the PICU, should more resources be committed to caring for HIV children who require the PICU, and how can we morally choose candidates for the PICU? Those working in the PICU in HIV endemic regions need to make difficult personal decisions on effective triage of admissions of HIV infected children with PCP based on individual case presentation, availability of resources, and applicable ethical principles.
Subject(s)
Developing Countries , Ethics, Clinical , HIV Infections/therapy , Intensive Care Units, Pediatric/ethics , Patient Selection/ethics , Child , Child, Preschool , Costs and Cost Analysis , Drug Costs , HIV Infections/economics , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric/economics , Intensive Care Units, Pediatric/supply & distribution , Pneumocystis , Pneumonia, Pneumocystis/economics , Pneumonia, Pneumocystis/therapy , South AfricaABSTRACT
Urinary tract infection (UTI) in infancy and childhood has received scant attention at primary health care (PHC) level, rarely featuring as one of the common diseases. In a prospective study conducted at a PHC clinic, 16 of 94 children (17%) from whom urine was collected by strict aseptic catheterization had bacteriuria (BU). Twelve of these had associated leucocyturia (> 5 WBC/HPF). The median age of those with BU was 9 months (range 1-30 months). BU rarely occurred in isolation (6%), but was most often detected in association with acute respiratory infection (43%) and acute diarrhoea (19%). No association of BU with mild malnutrition was detected in the 50% of children who were underweight for age. Gram-negative pathogens accounted for 14 cases (87.5%). These pathogens were resistant to commonly recommended antibiotics for UTI. Only five cases of BU returned for follow-up at 3 months; no abnormalities were detected on repeat catheter urine samples, urinary tract ultrasonography, voiding cystourethrogram and DMSA studies in them. From these and other findings we conclude that BU is probably often present in young children with common diseases attending PHC centres in developing countries. Further studies are required to establish exactly the role these pathogens play in the pathogenesis of UTI.
