ABSTRACT
In Tunisia, several studies on domestic injuries have been carried out on children attending care facilities. Nevertheless, there is a lack of data on incidence and kinds of child domestic injuries amongst general population because of absence of a reliable data collect system. To estimate the incidence and kinds of domestic injuries through a prospective survey "here-there" within two cohorts of young children attending two mother and child protection centers [MCPC] in Tunis during the three first years of their life and to analyze the importance of health professional training in improving data collect. A prospective study "here-there" was carried out on two cohorts of children in two mother and child protection centers [MCPC] between January 2007 and December 2009. Only children aged less than 3 months at their first contact with the centers were included and followed up until age of 3 years. In the MCPC2 [cohort2], health personnel have been trained on data collection importance related to child domestic accident and asked to monitor accidents by calling parents while a phone line got available for this aim. In the MCPC1, health personnel was asked to work as they used to do and to collect data on child domestic injuries when children attend the center. 192/435 domestic accidents were recorded within cohort 2 vs only 1/686 within cohort 1. Annual incidence rate was 14.7% for the cohort 2. The kinds of accidents were: falls 78.2% [falls from high plans 84.6%], injuries15.1% [injury by cutting things 58.6%], burns 5.7% [burns by hot liquid 54.5%], intoxications 1%. In terms of damages, we recorded 4 cases of broken bones [thighbone, elbow, handwrist], stitches in 11 cases, broken teeth in 3 cases and nail pulled out in one case. No death was recorded. Training impact on accident prevention was not studied. Child domestic accidents are relatively frequent. Health personnel training allows to improve data. The kinds of recorded accidents indicate the need to educate parents on best practices towards strengthening prevention
ABSTRACT
The delivery of a large baby may indicate that the mother had abnormal glucose tolerance during pregnancy. Glycosylated hemoglobin [HbA1c] concentration might be expected to identify women who had high blood glucose concentration before delivery. The aim of this study was to identify retrospectively, gestational diabetes in mothers of large baby and determine the HbA1c cutoff value. HbA1 was measured in 216 patients within the first three days of postpartum: 100 had large babies: weighing over than 4000g and 113 had normal-sized babies [control group]. We exclude mothers who had preterm, hypotrophy baby, stillborn, and diabetic mothers. The mean concentration of HbA1c was significantly higher in group with large babies than in group control [6.17%+ 085 vs 5.17+0.571=9.78 p<0.001]. The value of HbA1c=5.85%, evaluated by ROC curve, was considered as risk factor of macrosomia and then gestational diabetes. 83.5%of mothers with large babies had HbA1c 7 5.85 vs 7.8%of those with normal sized babies [p<0.0001]. No other significant differences were found between the two groups in other parameters. HbA1 c level may be of value as a postpartum screen for unrecognized diabetes and may help discriminate between a constitutionally large but otherwise normal newborn and a large infant of a diabetic mother. HbA1c measurements should be obtained in women with large babies, and, if upper than cutoff value found by curve ROC: 5.85%, maternal and fetal surveillance is recommended