Impact of Corticosteroid Therapy on Lifestyles in Asthmatic Children from Sri Lanka.

This study was conducted to ascertain the impact of inhaled corticosteroids therapy (ICS) in alleviation of lifestyle restrictions in 200 asthmatic children. 90 children on ICS were reviewed at 3 months. Restrictions on bathing, food, play activities and school attendance were found in >70%. These were not related to asthma severity. Following ICS, reduction in symptoms, hospital admissions, outpatient visits and nebulizations were noted between 67%-73%. Restrictions on bathing, food, play activities and school attendance had been waived off in 23%- 55%. We conclude that ICS significantly alleviated symptoms and lifestyle restrictions. However, the reduction on lifestyle restrictions was less than symptom control.

Genetic and environmental risk for asthma in children aged 5-11 years.

Objective To assess genetic and environmental risk factors of asthma among children aged 5-11 years. Design A cross sectional analytical study. Method Data were collected from children aged 5-11 years in 3 schools in Gampaha District. 441 children with asthma and 1510 without asthma were evaluated for following risk factors viz. family history of atopy, gender, duration of breast feeding, commencement of formula in infancy, dusty home environment, passive indoor cigarette smoking, presence of firewood smoke in bedroom when cooking, burning of mosquito coil and incense stick/powder and presence of pets at home. Data were analyzed using Epi info version 6 and SPSS package. Chi Squared test was used in bivariate analysis and forward logistic regression was used to adjust confounding factors. Results Risk of asthma in child (on bivariate analysis) was increased when father has a history of asthma (odds ratio (OR) 6.4 (95% confidence interval (CI) 3.2 -13.2), mother has a history of asthma (OR 4.4, CI 2.6 -7.5), sibling has asthma (OR 4.3, CI 2.0 - 9.7), father has a history of allergic rhinitis (OR 2.0, CI 1.5-2.8), mother has a history of allergic rhinitis (OR 2.5, CI 1.9-3.4) and sibling has allergic rhinitis (OR 3.4, CI 2.1-5.4). Asthma risk was significantly increased with following environmental factors: non continuation of breast feeding beyond first 6 months in infancy (OR 1.5, CI 1.2-1.9), presence of firewood smoke in bedroom when cooking (OR 1.4, CI 1.1- 1.9), use of mosquito coil (OR 1.5, CI 1.2 -1.9) and dusty home environment (OR 1.8, CI 1.4-2.3). After adjusting for confounding factors, paternal history of asthma, maternal history of asthma, allergic rhinitis in mother and sibling, non continuation of breastfeeding beyond first 6 months of life and dusty environment remained significant with increased risk of asthma (p < 0.01). Conclusions This study reinforces that asthma has a multifactorial aetiology. Childhood asthma is influenced by paternal asthma more than maternal asthma. Significant modifiable environmental factors in this study were duration of breastfeeding in infancy and dusty home environment.

Prevalence of asthma and atopic symptoms in children aged 5-11years.

Objective To assess prevalence of asthma and atopic symptoms in a group of school children aged 5- 11years and to look at prevalence of usage of asthma medications. Setting Three schools in Gampaha District in August 1998. Method A questionnaire translated into Sinhala was distributed to parents/guardians of 2195 children aged 5-11 years in Grades 1-5 of the schools and the filled questionnaires were collected through class teachers. Asthma, allergic rhinitis and eczema were defined using the clinical criteria of the International Study of Asthma and Allergic Conditions (ISAAC). Data was analysed using Epi Info version 6. Chi squared test and Chi squared test for trend were used for significance testing. Results Return rate of questionnaire was 93%. Sixty six percent were completed by mother, 30% by father and rest by guardian. Prevalence of asthma was 23% and of exercise induced asthma 11%. Prevalence rate of allergic rhinitis was 10% and eczema 3%. Within the specific group of asthma, in response to leading question "Has your child had asthma" only 19% of parents gave a positive answer. Prevalence of asthma in males did not significantly differ from that in females (p=0.5). A decreasing trend of asthma was observed with increasing age in girls (p less than 0.05). Eighty four percent of asthmatic children were using salbutamol orally and 9% without asthma in study population were also using salbutamol. Conclusions One in 5 children aged 5-11 years in study population had asthma but parental perception about asthma was poor. More than 80% of asthmatics had some medications for the disease.

A preliminary study on neonatal septicaemia in a tertiary referral hospital paediatric unit.

OBJECTIVE: To estimate the incidence of neonatal septicaemia, and to identify risk factors, clinical presentations and causal organisms. DESIGN: A cross-sectional study. SETTING: Neonatal Care Unit, University Paediatric Unit, Colombo North Teaching Hospital. SUBJECTS: Neonates admitted from January to December 1996 with clinical evidence of septicaemia. METHOD: Gestational age, birth weight and mode of delivery were evaluated as risk factors for septicaemia. Although diagnosis of septicaemia was made on clinical grounds, blood cultures were performed in all babies. Data was analysed by using Epi Info version 6. RESULTS: 98 babies had septicaemia. Incidence of septicaemia was 24.4 per 1000 live births and case fatality rate was 11.2%. Incidence was significantly higher in preterm babies, babies with low birth weight (LBW) and those born following instrumental delivery. 21.4% developed septicaemia on the first day of life, 74.5% between 2 and 7 days and 4.1% after the first week. Common presenting features were fever 61.2%, jaundice 52%, lethargy 37.8% refusal of feeds 25.5%, coffee grounds vomiting 22.4%, and fits 12.2%. Common bacteria identified were Klebsiella 26.5%, Staphylococcus aureus 15.3%, coliform bacilli 9.2% and spore forming bacilli 9.2%. Common sensitive antibiotics were amikacin 88.9%, amoxycillin + clavulanic acid 83%, ceftriaxone 78.1% and netilmicin 63.9%. CONCLUSIONS: Septicaemia is an important cause of morbidity, particularly in preterm babies, in babies with LBW and those with instrumentation at birth. The high incidence of late onset septicaemia together with the findings of Klebsiella and Staphylococcus aureus as common and resistant pathogens for septicaemia indicate that the majority were nosocomial infections.