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Over a 10 month period 184 children, aged 5 years or less, who died at home had their nutritional status and HIV serostatus established; necropsies were also carried out. The HIV antibody test was positive in 122/184 (66%). Of the HIV seropositive children Pneumocystis carinii pneumonia was present in 19 (16%), cytomegalovirus pneumonia in nine (7%), and lymphoid interstitial pneumonitis in 11 (9%). Opportunistic infection was therefore seen in 28/122 (23%) of the seropositive cases but in none of the seronegative cases. Tuberculosis was present in 8/184 (4%): 6/122 (5%) in HIV seropositive and 2/62 (3%) in seronegative children. Lung aspirate showed positive bacterial isolates in 106/ 122 (86%) of HIV seropositive and 46/62 (74%) of seronegative children with Gram negative organisms predominating in both groups. Malnutrition was common and affected 106/184 (58%); positive growth was obtained in 98 (92%) of the malnourished children irrespective of their HIV serostatus. Malnutrition was significantly associated with bacterial lung infection after adjustment for the confounding effect of HIV status. No association was found between HIV serostatus and bacterial lung infection that could not be attributed to malnutrition at the time of death. The importance of adequate nutrition in reducing the risk of bacterial infection in HIV infected children is apparent.

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In order to determine the incidence of sudden infant death syndrome (SIDS) in Zimbabwe, a prospective study was done in infants aged 1 month to 1 year who were certified as dead at home and brought to the accident and emergency department of Mpilo Central Hospital in Bulawayo from July 1992 to June 1993. There were four cases of SIDS among a total of 18,889 registered live births, giving an incidence rate for SIDS of approximately 0.2/1000 (95% CI 0.004-0.4/1000). SIDS appears to be uncommon in black Africans of low socio-economic status in Zimbabwe. Child rearing practices, parental lifestyle and a home environment different from that of Europeans might explain the low incidence of SIDS in the population.

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From July 1992 to May 1993 a study was performed of the relationship between bacteraemia, nutritional status and HIV status in 212 out of 334 consecutive infants and children aged 0-5 years, who had died at home in Bulawayo, Zimbabwe. The remaining 122 children were excluded because the time period between death and arrival at the hospital was over 3 h. A pathogen was isolated from 92 (43%) children and Klebsiella species were most commonly isolated. A positive HIV-1 serology was found in 122 (58%) children and 110 (52%) children were malnourished. Malnutrition was significantly associated with bacteraemia at death after adjustment for the confounding effect of age and HIV status (odds ratio 4.28; 95% CI 2.27-8.07; P < 0.001). No association was found between either HIV serostatus or proven HIV infection and bacteraemia, which could not be attributed to nutritional status. Conclusion. Bacteraemia, in particular with Gram-negative bacteria, is an important cause of death in malnourished children in Zimbabwe regardless of their HIV-1 antibody status.

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Beckwith-Wiedemann syndrome is an easily recognised syndrome in its complete form with macroglossia and exomphalos. The three cases reported here are an attempt to increase awareness of the existence of this syndrome which has serious consequences. All our patients had the combination of macroglossia and exomphalos, but none developed symptomatic hypoglycaemia. Growth patterns were distinctly different in all cases. One patient was the first of a pair of twins. The syndrome is inherited in an autosomal dominant fashion with incomplete penetrance and variable expressivity. Early diagnosis should alert the clinician to the risk of eventual neonatal hypoglycaemia and long term follow up is warranted because of a possible development of malignancies in childhood. The reason for the very low incidence of the syndrome in Bulawayo remains unexplained.

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A prospective study was done of children less than 13 years of age, who died at home or on their way to hospital and those who died in hospital, over a one year period. Fifty seven (86%) of the 66 children who were dead on arrival and 94 (77%) of the 122 children who died after admission were 2 years old or less. The main causes of death in both groups were identical and infections were the most frequent diagnosis. AIDS was the most common cause with 23 (35%) of the deaths in the children who were dead on arrival and 27 (22%) of the deaths in the children who died after admission. An overall positive HIV-I serology was found in 31 (47%) of the children in the dead on arrival group and in 50 (41%) of the children in the group that died after admission.

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A type of cardiomyopathy characterised by isolated severe dilatation of the right heart with right ventricular hypertrophy and absence of cardiac arrhythmias is described in seven patients. Only girls were affected and all except one lived in rural Zimbabwe. Six were under 5 years old. This probably represents a new type of cardiomyopathy.

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Forty children, aged 2 months to 11 years, with severe acute pneumonia were investigated by needle aspiration of the lung. Fourteen organisms were isolated in only 13 patients. Streptococcus pneumoniae was isolated in six patients, Staphylococcus aureus in three, and Haemophilus influenzae in two. Two patients had mixed organisms.

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The management of 25 children with empyema thoracis in Zimbabwe is discussed. The method adopted in 21 of these children using simple drainage and continuous irrigation with 0.1% solution of povidone iodine compared well with more aggressive methods. The method can be carried out easily in a rural environment. 2 of these 21 children died, one because of aspiration. The results among the survivors were good - excellent in 14 of the 21 children and fair in 2. There were no side effects attributable to the povidone iodine. The method failed in 3 patients who had to be dealt with surgically. Staphylococcus aureus was the commonest organism responsible for empyema.

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Eleven children under 16 years of age with purulent pericarditis were seen in one hospital in one year. The condition was always secondary to a septic focus elsewhere, usually staphylococcal pneumonia; its incidence after pneumonia was 0.64%, but this may be an underestimate. Clinical diagnosis can be difficult in patients with pneumonia as the heart is not always enlarged. Persistent or progressive liver enlargement was an important diagnostic feature. The presence of excess pericardial fluid was easily confirmed by echocardiography. Early diagnosis and drainage followed by continuous irrigation with 0.1% povidone iodine solution usually resulted in rapid recovery, but two patients died.

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