Showing papers in "Journal of Tropical Pediatrics in 1991"
TL;DR: It is concluded that even in rural areas of a developing country it is possible to collect from mothers the much needed and valid fertility and mortality data through epidemiological surveillance by using lay-reporters.
Abstract: A total of 492 deaths of children below 5 years of age were registered during a 2-year period of demographic surveillance in a rural population of Ethiopia, where an epidemiologic study base population of 28,780 individuals was established in 1987. Data were collected by lay-reporters using a verbal autopsy method. The under-five cumulative mortality rate was 209 per 1000 children. When sub-divided into infants and children 1-4 years, the respective yearly mortality rates were 101 and 32.3 per 1000. There were considerable variations within the district by Peasants' Associations. Rural Lowlands experienced the highest mortality rates, especially for children 1-4 years. Mortality trends over a 2-year period indicate a significant increase for the child population, but not for infants. Similar trends were observed for boys and girls although the rates for boys were generally higher especially during infancy. More deaths occurred in the months of April, June, and July, and October and November indicating two peak seasons in both years. More deaths occurred in Peasant's Associations that were furthest from the health centre. Major probable causes of death were acute respiratory infections, measles, and diarrhoea. It is concluded that even in rural areas of a developing country it is possible to collect from mothers the much needed and valid fertility and mortality data through epidemiological surveillance by using lay-reporters.
50 citations
TL;DR: Mild to moderate iron deficiency in the mother does contribute to lower iron reserves in the foetus, if not frank iron depletion, and severe iron deficiency anaemia to lower birth weight and gestation.
Abstract: Haemoglobin and ferritin estimations employing the micro-ELISA technique were done in 308 random selected mothers in labour and their newborns. The values of haemoglobin and serum ferritin as well as birth weight and gestation of babies born to iron depleted, and mildly and moderately anaemic mothers were no different from those of newborns of non-anaemic women. However, the values of serum ferritin per se in all these newborns were much lower than what are generally reported from the western countries. Babies born to severely anaemic women, on the other hand, showed elevated levels of haemoglobin and serum ferritin, and lower birth weights and gestation. Thus, mild to moderate iron deficiency in the mother does contribute to lower iron reserves in the foetus, if not frank iron depletion, and severe iron deficiency anaemia to lower birth weight and gestation.
40 citations
TL;DR: Analysis of the available data shows that there has been clear reduction in reported morbidity from dysentery since 1982, with a sharp decline in 1988, and that the incidence of cholera, typhoid, and paratyphoid are all on the increase since 1982.
Abstract: Diarrhoea diseases continue to be one of the most important causes of morbidity and mortality in the developing world, particularly among young children. Recognizing the importance of the diarrhoeal problem, the World Health Organization has established a global programme for the control of Diarrhoeal Diseases (CDD). The widespread use of ORT is an important part of this programme. In Nigeria, a nationwide execution of the CDD began in 1986. In view of the huge population of Nigeria, an evaluation of the efficacy of the CDD programme at reducing morbidity and mortality from diarrhoeal diseases has national and global importance. Analysis of the available data shows that there has been clear reduction in reported morbidity from dysentery since 1982, with a sharp decline in 1988, and that the incidence of cholera, typhoid, and paratyphoid are all on the increase since 1982. An analysis of community-based CDD survey data revealed minimal, but insignificant impact on diarrhoeal diseases incidence and diarrhoeal treatment practices in Nigeria from 1986 to 1989. Using the technique of decision analysis, the total annual number of acute diarrhoeal episodes for children under 5 years old in Nigeria was estimated to be 83.2 million and this may have been responsible for at least 314,200 deaths in this age group in 1989 alone, despite the implementation of the CDD programme. CDD interventions, by their very nature, are problematic to evaluate. In fact, evaluation may be one of the most challenging and frustrating aspects of the whole programme. Thus far, CDD in Nigeria is short of its goals.
38 citations
TL;DR: Data suggest that exclusive emphasis on ORT will have little impact on diarrhoea mortality among children in rural Bangladesh, and a broader strategy, both preventive and curative, including measles immunization, nutrition education, dietary management of diarrhea, and the treatment of dysentery in the community, carries a greater potential.
Abstract: Diarrhoeal mortality and hospital admissions for diarrhoea are described among children under the age of 5 years in a large rural Bangladeshi community during 1986-87. Acute watery (dehydrating) diarrhoea was associated with 11 per cent of all deaths among infants aged 1-11 months and 5 per cent among children aged 1-4 years. Acute non-watery diarrhoea, including bloody dysentery and diarrhoea with mucoid stools, was associated with 16 per cent of all deaths among children aged 1-4 years. In this age group, persistent diarrhoea, particularly when accompanied by recent and/or severe wasting, was associated with 63 per cent of all diarrhoeal deaths and 34 per cent of all deaths. These data suggest that exclusive emphasis on ORT will have little impact on diarrhoea mortality among children in rural Bangladesh. A broader strategy, both preventive and curative, including measles immunization, nutrition education, dietary management of diarrhoea, and the treatment of dysentery in the community, carries a greater potential.
34 citations
TL;DR: Clinical features associated with respiratory distress, birth asphyxia, admission to nursery after 6 hours of birth, and hypothermia on admission were found to be important factors related to death among nursery admissions.
Abstract: Determinants of death in newborns admitted to the Intensive Care Unit were studied taking into consideration antenatal history, intrapartum events, and clinical findings. Over 3 years (1984, 1985 and 1986) 1747 admissions were the subjects of this study. Of these, 424 deaths formed the study group and 1323 survivors form the control group. Odds ratio, attributable risk, univariate analysis, multiple stepwise regression, and analysis of variance were obtained. Clinical features associated with respiratory distress, birth asphyxia, admission to nursery after 6 hours of birth, and hypothermia on admission were found to be important factors related to death among nursery admissions.
31 citations
TL;DR: Within this uniformly deprived African community, there were individuals who had a much higher susceptibility to diarrhoea compared to others, and an understanding of this variability may point the way towards more effective interventions in the control of diarrhoeal disease.
Abstract: Prospective surveillance of patterns of diarrhoeal disease was conducted in a cohort of 204 young children living in a rural community in Zimbabwe. Trained field assistants recorded morbidity data obtained by weekly recall of mothers. Diarrhoea was defined by a commonly used local word, and a diarrhoea-free gap of three or more days was taken to signify a new attack. Diarrhoea was common in this study population with a peak incidence between 6 and 18 months of age. There was, however, wide individual variability in diarrhoea attack rates (range 0 to 20 attacks) during the 22 month study period. Whilst only 6 per cent of the recorded diarrhoea episodes were persistent (lasting longer than 14 days), a high proportion (26 per cent) of subjects had at least one attack of persistent diarrhoea (PD) during follow up. Children who had frequent attacks of acute diarrhoea also tended to have PD; PD was rare in those with few attacks. Thus, within this uniformly deprived African community, there were individuals who had a much higher susceptibility to diarrhoea compared to others. An understanding of this variability may point the way towards more effective interventions in the control of diarrhoeal disease.
29 citations
TL;DR: The observed changes in maternal weight throughout normal term pregnancy are described to see if any relationship exists between maternal weight and gestational age of women entering pregnancy with different weights; and to explain how the weight changes affected the birth weights of their babies.
Abstract: A prospective study on 600 gravid women, 492 of whom eventually delivered normal singleton babies following uncomplicated pregnancies is described. Maternal weight measurements per gestational age were recorded from the 10th week till delivery in these randomly selected women attending regular antenatal clinic. The purpose of this paper is: to describe the observed changes in maternal weight throughout normal term pregnancy; to see if any relationship exists between maternal weight and gestational age of women entering pregnancy with different weights; and to explain how the weight changes affected the birth weights of their babies. Mean maternal weight gained in pregnancy was found to be 13.3 +/- 4.56 kg for all deliveries. The mean weight gained for mothers who delivered term (37-41 weeks) low birth weight babies (LBW, weight 0-2500 g) was 9.53 +/- 3.69 kg and the mean for mothers who had large for gestational age babies (LGA, birth weight greater than or equal to 3800 g) was 15.97 +/- 2.67 kg and the mean for mothers who had standard or normal weight babies (NW, birth weight 2501-3799 g) was 13.05 +/- 4.86 kg. The change in maternal weight per unit time was found to be constant for all mothers from the 12th week for normal pregnancy till delivery (r = 0.97, P less than 0.01) except in the obese mothers, most of whom had no consistent gain in weight throughout pregnancy (r = -0.32). The mothers who delivered LBW infants gained less in every trimester when compared with the standard (NW). The mothers of LGA babies gained more in every trimester than did the standard.(ABSTRACT TRUNCATED AT 250 WORDS)
29 citations
TL;DR: In this article, the impact of vitamin A prophylaxis on child morbidity and mortality was investigated in two slum areas outside of Bombay and the experimental group included 2217 children under 5 years of age 433 of which were under the age of 1 year while the control group was comprised of 2060 children 416 of whom were under 1 year of age.
Abstract: Although a preventive program has been in place in India since 1971 vitamin A deficiency and blinding malnutrition remain major public health problems for children under 6 years of age. Moreover there are indications that subclinical vitamin A deficiency and xerophthalmia are associated with measles acute lower respiratory infections and diarrhea. The impact of vitamin A prophylaxis on child morbidity and mortality was investigated in 2 slum areas outside of Bombay. The experimental group included 2217 children under 5 years of age 433 of whom were under the age of 1 year while the control group was comprised of 2060 children 416 of whom were under 1 year of age. The final sample was comprised of 195 children under age 1 year in the experimental group and 192 under-1s in the control group. A baseline survey was undertaken in 1985; the study period was from January 1985-June 1988 with the intervention consisting of 200000 IU of vitamin A in arachis oil. Throughout the study period in both the experimental and control groups the most common illnesses observed among children were fever respiratory tract infection diarrhea worm infestations in the gastrointestinal tract skin infection otitis media post-measles complications and malnutrition. Beginning in 1986 a significant decline was recorded in the experimental area in the number of children suffering from 4 or more episodes of these illnesses per year. By June 1988 the incidence of each of the above-cited illnesses was lower in the experimental area. Further confirmation of the efficacy of vitamin A administration was the lowering in under-5 mortality from 16.80/1000 in 1985 to 3.64/1000 in 1988 in the experimental group compared to relative stability of this rate (65.50/1000 in 1985 to 47.90/100 in 1988) in the control area.
29 citations
TL;DR: It is recommended that home-based records document all health centre visits, including those for curative care, and that missed opportunities and vaccination timing be routinely evaluated during vaccine coverage surveys.
Abstract: Missed opportunities and inappropriately time immunization substantially reduced the coverage achieved in Mozambique and Guinea Conakry. During coverage surveys in Mozambique, we noted dates of attendance at a health facility for growth monitoring or vaccination, and in Conakry we also abstracted dates of curative care visits from home-based documents. In Mozambique, an average of 84 per cent of children aged 12-23 months had documents, and an average of 53 per cent of children were fully and correctly vaccinated. Among children with cards, 11 per cent had received all vaccines, but at least one dose was applied before the recommended age or with too short an interval between doses (inappropriately timed vaccinations). A further 8 per cent of children had sufficient documented contacts with preventive services to be fully vaccinated, but immunization opportunities had been missed. In Conakry, 54 per cent of 12-23 month-old children had immunization cards, and only 19 per cent were fully and correctly vaccinated. Among children with cards, 9 per cent had received all vaccines, but some were inappropriately timed, and 19 per cent had enough contacts with curative or preventative services to be fully vaccinated, but opportunities had been missed. We recommend that home-based records document all health centre visits, including those for curative care, and that missed opportunities and vaccination timing be routinely evaluated during vaccine coverage surveys.
28 citations
TL;DR: The urinary excretion of aflatoxins in normal children from a periurban area, as well as those hospitalized with kwashiorkor and marasmus was assessed and it was concluded that aflatoxin exposure is unusual in this population and that a flatoxins do not play a primary role in the pathogenesis of kwashimorkor.
Abstract: The urinary excretion of aflatoxins in normal children from a periurban area, as well as those hospitalized with kwashiorkor and marasmus was assessed. In no case was aflatoxin isolated from the urine. It is concluded that aflatoxin exposure is unusual in this population and that aflatoxins do not play a primary role in the pathogenesis of kwashiorkor.
27 citations
TL;DR: Improved prenatal and perinatal health care delivery should lead to a decline in the frequency of neonatal seizures, a study of 57 infants with Neonatal seizures showed.
Abstract: A study of 57 infants with neonatal seizures admitted to the Special Care Baby Unit of the Jos University Teaching Hospital over a 3-year period showed perinatal asphyxia and hypoglycaemia as the principal aetiologic factors in 47 and 19 per cent of the cases, respectively Seizures were commoner in preterm infants, and among them outcome was also poorer As regards aetiological factors, outcome was poorest with perinatal asphyxia; with a mean (SD) mental age of 725 (91) weeks at a chronological age of 24 months Outcome in infants with seizures and coma was most favourably predicted by the absence of abnormal neurological signs, and the way the infant was feeding at 7-10 days All infants who were clinically and neurologically normal and taking more than half their estimated requirements by mouth at 7 days were not handicapped The overall incidence was 75/1000 live births The mortality (193 per cent) was closely related to the aetiology In view of the fact that the associated adverse perinatal events are largely preventable, improved prenatal and perinatal health care delivery should lead to a decline in the frequency of neonatal seizures
TL;DR: Findings indicate that any deviation below standard weight, height, and arm circumference is associated with greater prevalence of disease and international standards are appropriate for preschool aged children in Papua New Guinea and by inference in other developing countries.
Abstract: To test the validity of using international standards as references for the assessment of nutritional status, investigations have been carried out on pre-school aged children selected from three distinct ecological environments in Papua New Guinea. Field work included anthropometric measurements (weight, height, triceps skin-fold, mid-upper-arm circumference, mid-upper-arm muscle circumference), together with pathological and clinical assessments (intestinal helminths, diarrhoea, splenomegaly, PEM signs). The findings indicate that any deviation below standard weight, height, and arm circumference is associated with greater prevalence of disease. International standards are therefore appropriate for preschool aged children in Papua New Guinea and by inference in other developing countries.
TL;DR: The colostrum of mothers delivering pre-term, though less in amount, is rich in soluble anti-infective agents and cells, which compensates for the limited capacity of milk intake in the pre- term infant.
Abstract: The different anti-infective factors in the colostrum of 25 mothers delivering pre-term (33.04 +/- 2.18 weeks gestation) and 10 mothers full delivering term (39.1 +/- 0.87 weeks gestation) babies were measured. The mothers of both the groups were comparable with respect to age, parity, nutrition, and haemoglobulin levels. Although the mean volume of colostrum (12 hours) was significantly lower in pre-term (32.28 +/- 7.92 ml) than in full term (44 +/- 4.83 ml) colostrum (P less than 0.05), the concentrations of total protein, sIgA, lysozyme, and lactoferrin were significantly higher in preterm than in full-term colostrum. IgG and IgM levels were similar in both the groups of colostrum. In both the groups, s-IgA was the predominant immunoglobulin. Moreover, the absolute counts of total cells, macrophages, lymphocytes, and neutrophils were significantly higher in pre-term compared to full-term colostrum. Macrophage were the predominant cells. Degree of prematurity has been found to have profound influence on the volume, protein concentration, and cell and macrophage counts of colostrum. Thus, more pre-term the newborn was, the mother produced less amount of colostrum. Total protein concentration and absolute cell count were significantly higher in the colostrum samples of mothers delivering between 28 and 32 weeks as compared to those delivering between 33 and 36 weeks. It is concluded that the colostrum of mothers delivering pre-term, though less in amount, is rich in soluble anti-infective agents and cells. The higher concentration of protective factors compensates for the limited capacity of milk intake in the pre-term infant.
TL;DR: There is a need for better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and review of the indications and techniques of breech delivery to reduce the occurrence of brachial plexus injuries.
Abstract: A prospective study was carried out on 26,176 Malaysian neonates born in the Maternity Hospital, Kuala Lumpur over a 12-month period to determine the incidence and associated risk factors of brachial plexus injuries. This condition was found in 42/26,176 neonates (1.6 per 1000 livebirths). Multiple logistic regression analysis of affected and control neonates from a nested case-control study showed that increasing birth weights and breech deliveries were the significant risk factors. Our study suggests that to reduce the occurrence of this condition, there is a need for: (i) better assessment of fetal size and maternal pelvimetry to enable earlier diagnosis of cephalo-pelvic disproportion, and (ii) review of the indications and techniques of breech delivery.
TL;DR: In vivo amodiaquine resistance declined significantly with increasing age of the child, and was found to be more common in children with low weight for age: this possible association requires further investigation in the study area, which has one of the highest rates of malnutrition.
Abstract: The standard in vivo 7-day test of drug resistance was conducted on 83 children with symptomatic P. falciparum infection, using a full 3-day course of amodiaquine. All children were living in an endemic malarious area of the East Sepik Province of Papua New Guinea. Analysis of blood amodiaquine levels by an ELISA method showed increased blood amodiaquine concentration with progressive days of treatment. By day 7 of the study period parasites had cleared in 68 (82 per cent) of the children while 15 (18 per cent) had persistence or recrudescence of P. falciparum. Of these 15 resistant cases, four were Rl resistant (early recrudescence), seven were R2, and four were R3. This is a higher proportion of R2/R3 resistance than has usually been reported in Papua New Guinea. In vivo amodiaquine resistance declined significantly with increasing age of the child. Resistance was found to be more common in children with low weight for age: this possible association requires further investigation in the study area, which has one of the highest rates of malnutrition in Papua New Guinea.
TL;DR: It is concluded that in children up to 18 months of age, breastfeeding offers substantial protection against death in children hospitalized with diarrhoea.
Abstract: The association between breastfeeding and mortality in children hospitalized for diarrhoea was investigated in a prospective manner in 309 subjects below 18 months of age. In multivariate logistic regression analysis, 36 cases who died were compared with 273 controls who were discharged in a satisfactory condition. Breastfeeding had a strong protective effect against mortality even after allowance was made for confounding variables (including nutritional status, chronicity of illness, associated non-enteral infections) and a possible bias of interruption of breastfeeding as an early consequence of the terminal illness. The adjusted odd's ratio (OR) and 95 per cent confidence intervals (95 per cent CI) for the protective effect were 2.7 and 2.1-3.6, respectively. The adjusted OR's (95 per cent CI's) were 6.0 (3.6-10.2), 2.6 (2.0-3.4), and 1.8 (1.4-2.5) for the age intervals 0-6, 7-12, and 13-18 months, respectively (P less than 0.001, less than 0.01, and less than 0.05, respectively). Further stratified analyses suggested a greater benefit in children with severe wasting, severe stunting, protracted illness, and diarrhoea as the sole illness. It is concluded that in children up to 18 months of age, breastfeeding offers substantial protection against death in children hospitalized with diarrhoea.
TL;DR: The diagnosis of CHF should be considered in children with hepatomegaly despite normal liver function tests, and particularly in those with renal abnormalities and/or evidence of portal hypertension, in view of the prevalence of consanguinity in Saudi Arabia.
Abstract: Congenital hepatic fibrosis (CHF) is a recognized cause of portal hypertension with oesophageal varices, gastro-intestinal haemorrhage and cholangitis in children without significant impairment of hepatic or renal function. This report describes the varied clinical presentation of CHF as seen at King Faisal Specialist Hospital and Research Centre (KFSH & RC) and emphasizes the clinical patterns that should enable a pediatrician to consider the diagnosis. Fourteen children with CHF were diagnosed between 1981 and 1988. The age at presentation ranged from 1.8-14 years (mean: 7.5 years); clinical manifestations at diagnosis were splenomegaly (12), hepatomegaly (11), failure to thrive (10), marked abdominal distention (4), and fever (4). Liver function tests were normal except for high alkaline phosphatase. Eight patients had polycystic kidneys confirmed on ultrasound examination. Upper gastro-intestinal endoscopy showed oesophageal varices of variable severity in all eight patients examined. Splenoportography revealed splenic vein occlusion in one patient. One patient died within days of admission with convulsions, coma, and aspiration pneumonia. One patient was lost to follow-up. The remaining 12 patients are all alive and receive regular follow-up. Two patients required splenorenal shunt. In view of the prevalence of consanguinity in Saudi Arabia, the diagnosis of CHF should be considered in children with hepatomegaly despite normal liver function tests, and particularly in those with renal abnormalities and/or evidence of portal hypertension.
TL;DR: Despite low infant and child mortality levels, morbidity load in Kerala, for 0-3-year-old children is very high and this is directly related to the quality of the environment.
Abstract: This study was undertaken to estimate the morbidity pattern in children under 3 years in urban Kerala. Two cohorts of 111 and 74 children were selected from contrasting areas in Trivandrum city, capital of Kerala, by systematic sampling. Morbidity information on each child was gathered for one year through weekly visits and recording of symptoms by trained investigators. The results showed: 1. very high incidence rates of all illness groups studied, with peak incidence being observed in the first 6 months and the lowest in the third year; 2. up to six times greater risk for many disease groups in the more environmentally deprived area; 3. no significant differences in risk between sexes; 4. no seasonal variation. We conclude that despite low infant and child mortality levels, morbidity load in Kerala, for 0-3-year-old children is very high and this is directly related to the quality of the environment.
TL;DR: This paper uses data from 22 national surveys in developing countries to estimate the use of bottles for feeding of infants under 6 months of age, collected in the context of the Demographic and Health Surveys programme between 1986 and 1989.
Abstract: Researchers used data from 22 Demographic and Health Surveys conducted from 1986-1989 to determine the prevalence of bottle feeding among infants <6 months. Bottle feeding was very high (range 60.4-86.6%) in Latin America and the Caribbean except in Bolivia (32.1%). This was true even in rural areas and among lower socioeconomic groups. Moreover except for infants in Bolivia (4.6%) and Peru (9.7%) many infants were not breast fed at all (20.9-30.9%). Thailand and Sri Lanka also had high levels of bottle feeding (63.3% and 53.4% respectively). Bottle feeding was less common in Northern Africa and Sub-Saharan Africa (2.2-47.8%). In fact the countries with the lowest prevalence of bottle feeding were in Sub-Saharan Africa: Togo (13.3%) Senegal (8%) Zimbabwe (8%) Mali (4.4%) Burundi (2.8%) and Uganda (2.2%). Most bottle feeding in these 6 countries occurred among infants living in urban areas. Around 33% of the children in Botswana Ghana and Tunisia only received water from the bottle. This practice was also common in Kenya Liberia Sri Lanka and Thailand. These countries exhibited considerably higher bottle use in urban areas and among women of higher socioeconomic status. Using the bottle for water brings about contamination of either the bottle or water which in turn can cause diarrhea. Women who delivered in a medical facility were more likely to bottle feed especially those in Ghana Liberia and Morocco. This may have been a result of socioeconomic factors but marketing of infant formula which concentrates on medical facilities and health workers also contributed. Bottle use occurred in almost 50% of the countries because the mother worked. Policy makers should continue to promote breast feeding and enforce codes against bottle feeding promotion yet stress correct use of bottle feeding.
TL;DR: In a study of septic arthritis infants formed the bulk of patients though, notably, neonates were not encountered and it is strongly recommended that every effort should be made to obtain two bacteriological specimens for culture to improve bacteriological diagnosis of the disease.
Abstract: In a study of septic arthritis infants formed the bulk of patients though, notably, neonates were not encountered. Gram-negative bacterial of the Salmonella species, especially Salmonella typhimurium and Klebsiella species were the most important cause of septic arthritis in infants. Staphylococcus aureus was also isolated. The combination of blood cultures and joint aspirate cultures resulted in very high rate (72 per cent) of bacteria isolation. It is strongly recommended that every effort should be made to obtain two bacteriological specimens for culture to improve bacteriological diagnosis of the disease.
TL;DR: It is concluded that LBW is a strong risk factor for infant mortality, but not for diarrhoeal and respiratory morbidity in a community with ready access to obstetric and pediatric care.
Abstract: Low birthweight (LBW) infants are at risk of increased mortality, impaired growth, and increased morbidity. We studied the progress of all LBW infants (less than 2.5 kg) born in a West African village where there is a resident pediatrician and midwife. There were 426 live births during the 8 years studied of which 42 (10 per cent) were of LBW. There were 17 infant deaths (IMR = 40/1000). Mean birthweight and gestation of infants dying in the first year were significantly lower than those of all live birth (2.33 kg v. 2.99 kg, P less than 0.001; 36.9 w v. 38.9 w, P less than 0.05). The mean weights of the 32 surviving LBW infants (15 preterm, 17 full term, small for gestational age) were compared with those of 32 full term, appropriate for gestational age matched controls over the first year. Growth velocities of paired groups were identical. The significant differences in weight at 1 year (P less than 0.005) reflected those at birth (P less than 0.001). There were no significant differences in clinic attendance rate or incidence of diarrhoea and respiratory disease between the four groups. We conclude that LBW is a strong risk factor for infant mortality, but not for diarrhoeal and respiratory morbidity in a community with ready access to obstetric and pediatric care.
TL;DR: The results show that chest circumference is the better predictor of birth weight, partly perhaps because its measurement is more replicable.
Abstract: This paper is concerned with the prediction of birth weight using simple anthropometric indices, namely mid-arm and chest circumferences. Such indices are important tools in the identification of low birth weight infants in areas where scales are not widely available or where they are likely to be not robust enough to withstand rough treatment. This paper reports data from a study in Assiut, Egypt. The aim was to identify which of the two indices was the better predictor or whether measurements on both arm and chest circumference were required. The results show that chest circumference is the better predictor of birth weight, partly perhaps because its measurement is more replicable. Cut-off points for the identification of low birth weight infants are then identified.
TL;DR: Two-hundred-and-thirty-seven consecutive cases of neonatal tetanus treated in a rural health facility in Nigeria were reviewed and a relatively simple, low-cost protocol yielded results compatible with those obtained in tertiary care settings in Africa.
Abstract: Two-hundred-and-thirty-seven consecutive cases of neonatal tetanus treated in a rural health facility in Nigeria were reviewed. In spite of a high proportion of short incubation cases, a relatively simple, low-cost protocol yielded results compatible with those obtained in tertiary care settings in Africa. An incubation period of 6 days or less was the strongest predictor of mortality. Other prognostic factors were related to cord care and affected boys more than girls. Incidence was 40 per cent greater during the rainy season than during the dry season.
TL;DR: It is suggested that coupled with true demand breast feeding, the traditional weaning porridge could adequately support growth if introduced on time, even when breast milk intakes are less than optimal.
Abstract: Researchers followed 30 infants from 2 rural villages in Ghana for 6 months to determine the effect of supplementing their diet with traditional fermented maize porridge between 1-6 months of age on growth. All infants were still breast fed at the end of the study. Mean daily breast milk intake stood at 737 g at month 1 and 720 g at month 3. 33% started on 40-300 g/day of porridge during the 1st month. Supplementation at the 1st month produced the most satisfactory growth rates. By the 3rd month 67% had started. No infant had diarrhea during the 1st 3 months. No diarrhea after 3 months was attributable to timing of supplementation. The growth curves of both exclusively breast fed and supplemented infants were similar and above WHOs (NCHS) median. By the 4th month however the growth of the supplemented group stood considerably above both the NCHS median and the exclusively breast fed group. Indeed on average supplemented infants gained .85 g compared to about .6 g for exclusively breast fed infants. Even though the growth of the high breast milk intake group during the 1st 6 months was higher than the NCHS median the growth of the high supplemental intake group was higher yet. In addition the growth of exclusively breast fed infants began to falter at 4 months but that of the low supplemental intake group stayed above the NCHS median and was analogous to that of that of the high supplemental intake group. Similarly the mean weight of the supplemental groups had higher mean weights than exclusively breast fed infants beginning at 4 months. Moreover breast fed infants who received low breast milk intakes began to lag behind the growth of all other groups at 2 months. In general exclusively breast fed infants grew sufficiently for the 1st 3 months. In conclusion for infants who do not receive enough breast milk early supplementation could save their live.
TL;DR: A retrospective study was carried out on 40 children from Saudi Arabia with Henoch-Schönlein syndrome to delineate its clinical pattern and the main clinical features are comparable to those reported elsewhere.
Abstract: A retrospective study was carried out on 40 children from Saudi Arabia with Henoch-Schonlein syndrome to delineate its clinical pattern. More than 50 per cent of the cases occurred in winter. There was no apparent causal relationship with B-haemolytic streptococcal infection. All patients had skin rash. Fifty-eight per cent had gastrointestinal manifestations, 58 per cent had joint manifestations and 38 per cent had renal manifestations. The main clinical features of Henoch-Schonlein syndrome in Saudi children are comparable to those reported elsewhere.
TL;DR: Routine chest radiography of the mothers of 163 children investigated for possible tuberculosis accompanied by sputum culture from those mothers with suspicious chest radiographs identified active pulmonary tuberculosis in 12 (10 per cent) of mothers of the 117 children with probable (49 cases) and confirmed (68 cases) tuberculosis as discussed by the authors.
Abstract: Routine chest radiography of the mothers of 163 children investigated for possible tuberculosis accompanied by sputum culture from those mothers with suspicious chest radiographs identified active pulmonary tuberculosis in 12 (10 per cent) of the mothers of the 117 children with probable (49 cases) and confirmed (68 cases) tuberculosis. All but one of the cases of active maternal tuberculosis were identified in the mothers of children less than 1 1/2 years of age. Chest radiography of the mothers of children less than 1 1/2 years of age will aid the diagnosis of tuberculosis in the child and expedite the reduction of the infectious pool of active pulmonary tuberculosis cases in adults in the community.
TL;DR: It is suggested that the depressed circulating IGF-I and free T4 levels in addition to deficient GH reserve may be responsible for stunted stature in patients with schistosomal hepatic fibrosis.
Abstract: Serum insulin, growth hormone (GH), cortisol, free thyroxine (T4) and plasma insulin-like growth factor I(IGF-I) concentrations were measured in 20 children suffering from schistosomiasis as well as 10 healthy age-matched controls. Circulating GH and insulin levels were determined after an intravenous infusion of arginine HCl (10 per cent solution, 0.5 g/kg). Children with schistosomal hepatic fibrosis (n = 10) had heights more than 2 SD below the mean for their age and sex. Their circulating IGF-I, free T4, and cortisol levels were significantly reduced. They had markedly elevated serum insulin concentrations with normal response to arginine infusion. Their basal GH levels were normal with significantly reduced GH response to arginine provocation. Compared to controls, they had significantly lower serum albumin concentrations, prolonged prothrombin time and elevated alanine transferase (ALT) levels. Free T4 and IGF-I concentrations, and GH increments after provocation correlated significantly with the percentile heights of these patients (r = 0.90, 0.70, and 0.83, P less than or equal to 0.001, less than or equal to 0.05 and less than or equal to 0.01 respectively). Their IGF-I levels correlated closely with the prothrombin time and ALT concentrations (r = 0.87 and 0.77, P less than or equal to 0.002 and less than or equal to 0.01, respectively). It is suggested that the depressed circulating IGF-I and free T4 levels in addition to deficient GH reserve may be responsible for stunted stature in patients with schistosomal hepatic fibrosis.
TL;DR: It is suggested that the whole-cell pertussis vaccine produced in South Africa has been highly effective in controlling whooping cough, however, it was not able to prevent a moderate scale outbreak, even in the presence of high vaccination levels.
Abstract: In 1950 a whole-cell pertussis vaccine was introduced in Cape Town and was followed by a marked decline in reported whooping cough mortality and morbidity. This resulted in reduced awareness of whooping cough as a clinical problem and, in recent years, no routine diagnostic tests for Bordetella pertussis have been performed. An outbreak of whooping cough occurred in Cape Town between 1 June 1988, and 31 May 1989, with 292 children admitted to hospital for whooping cough during this period (hospital admission rate in children under 5 years of age = 187 per 100,000). In an investigation of 239 children attending four pre-primary schools in the city, the whooping cough attack rate was 33 per cent, while pertussis vaccine coverage was 95 per cent. In the latter part of the outbreak nasopharyngeal swabs and serology were performed in patients presenting to a children's hospital with suspected whooping cough. Bordetella pertussis was isolated from 3 out of 34 (9 per cent) children tested and the first isolate was serotyped as type 1,2,4. Available clinical and laboratory evidence indicated that the organism responsible for the outbreak was Bordetella pertussis. Coverage studies for pertussis vaccine in Cape Town indicated that between 81 and 93 per cent of children were fully immunized by 13 months of age. These findings suggest that, since its introduction, the whole-cell pertussis vaccine produced in South Africa has been highly effective in controlling whooping cough. However, it was not able to prevent a moderate scale outbreak, even in the presence of high vaccination levels.