ABSTRACT
The objective of this study was to determine the knowledge, attitudes and current practices of psychiatrists and paediatricians in South Africa regarding the management of children with Attention Deficit/Hyperactivity Disorder (ADHD), to determine if there are significant differences between them. Three hundred and forty psychiatrists and 517 paediatricians were identified from the address list of the Health Professionals Council of South Africa. Each specialist was sent a survey questionnaire with a letter explaining the objectives and aims of the research. The questionnaire explored four themes: demographic data; attitudes to caring for children with ADHD; management of these children and knowledge about the use of stimulants. One hundred and seventy three (57.6%) psychiatrists and 316 (61%) paediatricians responded. Of these 145 and 278 respectively were practising medicine, and 51.7% (75) of the psychiatrists and 61% (169) of the paediatricians indicated that they manage children with ADHD. The results of the survey indicate that paediatricians and psychiatrists have adequate knowledge of ADHD and its management. Possibly because of the organisation of their practices psychiatrists were not as concerned as paediatricians about the time spent on each patient, but they were less likely to refer to other professionals. On the other hand, paediatricians had more of an interdisciplinary approach to the management of children with ADHD, but found them time consuming, remuneration inadequate and had little time to prepare extensive reports or liase with other professionals or schools. Psychiatrists appear to function within a neuro-biological model and have more knowledge on neuro-pharmacology and physiology. Paediatricians have a greater educational and family awareness, possibly reflecting differences in training. Both groups use methylphenidate as the medication of choice and both have adequate knowledge of its benefits, side effects and contra-indications.
ABSTRACT
BACKGROUND: Allergic rhinitis is a common condition, which causes considerable morbidity. South African data are scarce. OBJECTIVE: We sought to describe allergic rhinitis in atopic children in inland South Africa. METHODS: An observational, descriptive study of rhinitis occurring in 771 new patients seen consecutively by a single observer at a referral pediatric allergy clinic (Universitas Hospital, Bloemfontein) over an 8 1/2-year period (August 1984 to March 1993) was carried out. A detailed questionnaire was used to record clinical data. Chest and sinus x-rays, skin prick testing, and radioallergosorbent test were performed, and serum immunoglobulin E levels were determined. Response to drug treatment regimens was recorded at subsequent followup visits. RESULTS: Significant rhinitis was reported in 78.1% of patients, and mild intermittent rhinitis was reported in 21.4%. Male to female ratio was 1.6:1. Median age at onset of rhinitis symptoms was 6 months (range 0 months to 12 years), with 30.1% experiencing symptoms from birth. Rhinitis was chronic in 61.3%, although 53.5% reported seasonal variation. More children with rhinitis were born in midsummer than during other seasons, although this did not reach statistical significance (P = 0.46). Breast-feeding had no protective effect, and parental smoking and household pets were not found to be risk factors. Family history was positive for allergic rhinitis in 88% of patients. Exposure to dust, weather changes, strong odors, pets, pollens, and tobacco smoke were the most common trigger factors. Sinus x-ray findings associated poorly with clinical findings. The most common allergens identified were grass pollen, tree pollen, and cat. Oral antihistamines provided good symptomatic relief in 62.9% of patients who used them. Intranasal corticosteroids provided good relief in 78.0% of those who used them, and ketotifen provided relief in 54.4% of those who used it. CONCLUSIONS: Rhinitis is a common manifestation of allergy in the population studied. Onset occurs early in childhood. A family history of allergy is a risk factor for the development of the condition, and grass pollen is the most common allergen involved. Special investigations are of limited value. Appropriate treatment is very effective.