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Background: Illness, lack of vocabulary and unwillingness to discuss emotional distress may contribute to poor communication with children. Drawings may play a crucial role in enhancing communication with this patient group. Aim: This study aimed to describe the pictures drawn by primary school learners in the children's palliative care programme in Bloemfontein, South Africa, and to evaluate whether drawings can be used to assess emotional wellbeing. Methods: Drawings were assessed according to standardised human figure drawing guidelines and emotional indicator (EI) scales. Pictures were discussed with the child and compared with the clinical presence of depression or emotional discomfort. Results: A total of 29 pictures drawn by 20 children were assessed. Of the 20 participants, 18 were boys, with a mean age of 10.2 years, and 12 children were assessed as having clinical depression. Conclusions: The presence of two or more EIs, small pictures or pictures in dark colours may indicate clinical depression. Health professionals are advised not to try to interpret the picture, but to use the picture to enhance communication. Let the child explain the picture, rather than relying only on the assessment tool. [ABSTRACT FROM AUTHOR]

Background: Little is known about the long-term outcome of antiretroviral therapy (ART) for children with advanced-stage HIV. Aim: To assess the outcome in children with advanced HIV initiated on ART. The predictors for survival, general wellbeing and the role of palliative care were assessed. Methods: Patient files, retained patient records and personal follow-up were used for data collection. Data on baseline characteristics, ART treatment and progress were collected at baseline, 6, 12 and 48 months. Information regarding general wellbeing and school attendance and performance were collected. Results: 37 children were started on ART. At 48 months there were 18 known survivors and 7 known to have died. Another 12 were transferred to another programme or lost to follow-up. There was no significant difference in baseline characteristics between groups. All eligible children attended school and all received medical care. The hospice programme offered holistic care and support. Conclusions: No baseline characteristic could predict the outcome of children with advanced HIV initiated on ART. A hospice support programme can contribute to positive outcomes even when ART is initiated in children with advanced disease. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate outcomes of children with advanced HIV disease who are initiated on antiretroviral therapy under multiprofessional specialist paediatric hospice care. Design: A retrospective cohort file review methodology was undertaken in a specialist paediatric hospice in South Africa. Methods: Antiretroviral therapy was initiated for children with a CD4% of less than 15% (for children under 6 years of age) or a CD4 count under 200 for children over 6 years of age. According to the World Health Organization Europe (2007) staging criteria, all children were stage 3/4 HIV disease. Multiprofessional staff provided daily tailored assessment and care. Each child was followed for 6 months. Data on mortality, CD4 count, CD4 percentage, body weight, and viral load were measured at initiation and a follow-up after 6 months. Findings: Of the 37 children initiated on ART therapy, 31 survived at 6 months. From a baseline of mean body weight 13.3 kg, there was an average of 3.2 kg increase (P < 0.001). Mean CD4 counts more than doubled (P < 0.001), with a mean increase of 467 cells per mm3 blood. Mean CD4 percentages increased from 13.6--19.4% (P < 0.001). Viral load decreased significantly from a median 271 000 copies per mm3 blood to a median of 25 (imputed value for undetectable viral load) (P < 0.001). Twenty-three children had an undetectable viral load. Conclusion: For children with advanced HIV disease, who are least likely to access or respond to treatment, this study demonstrates a novel approach to managing care successfully. [ABSTRACT FROM AUTHOR]