An epidemiological study of protein calorie malnutrition in Rangoon

An epidemiological study of 238 cases of kwashiorkor admitted to the Rangoon Children's Hospital during the years 1968 and 1969 were studied. The peak age incidence was found to be between 2-3 years. The seasonal incidence of kwashiorkor is closely related to that of gastro-enteritis. The disease was found to be associated with low socio-economic status and family size. Bad feeding habits contributed to the develop-ment of the disease in 60 per cent of the cases.

Endemic goitre in Burma

Field and clinical studies of endemic g-1itre was carried out in the Chin Hills, Khamti District and Kayah State in !968 and 1969. The highest incidence in the Chin Hill Special Division was found to be 91.1 per cent of population surveyed. Incidence in Khamti and Kayah State were 51.8 per cent and 60.1 per cent respectively.

Amaemia in two Burmese villages

A mass haemoglobin (Hb) survey was done on a total of 1, 961 subjects from two villages: Shan-te-gyi in Insein district and Tu-ywin-bo in Myingyan district. 90 per cent and 80 per cent respectively of the population was covered. Blood film : mean corpuscular Hb concentration : serum iron; serum protein; serum, whole blood and red cell folates; Hb electrophoresis and osmotic resistance tests were done on adults with Hb less than 11g per cent. Stool examination for helminthic infestation and a dietary survey were done in both villages. The mena Hb value if 520 adult males was 14.08 g per cent (S.D.1.81) and that of 648 adult females was 12.335 g per cent (S.D.1.79). 50 per cent of the males, 34 per cent of the females and 55 per cent of the 793 children below 15 years were anaemic according to WHO criteria. Pregnancy and lactation are significant factors in lowering the mean Hb; the mean Hb of the pregnant group and lactating group being 10.86 g per cent (S.D.1.60) and 12.13g per cent (S.D.1.92) respectively, both of which are significantly lower than the mean Hb of the 12.58g per cent (S.D.1.67) of the non-pregnant, non-lactating group. However, the percent anaemic according to WHO criteria is 28 per cent and 42 per cent respectively in the pregnant and lactating group versus 33 per cent in the non-pregnant, non-lactating group. 47.1 per cent of the anaemic females and 28.60 per cent of the anaemic males had serum iron values below 50g per cent. There were only 4 cases of Thalassemia-E disease among the 117 anaemic adults tested. The stool survey on adults showed that only 4 out of 74 anaemics (5 per cent) and 5 out of 54 non-anaemic controls (9 per cent) had hookworm ova in Shan-te-gyi. Of 54 anaemics and 28 non-anaemic controls tested in Tu-ywin-bo, none had hookworm ova. In the village the iron intake was adequate according to the Interdepartmental Committee on Nutrition for National Defense (ICNND) standards.

Intestinal absorption in the Burmese

The xylose absorption test using 5g of xylose, the vitamin A absorption test, and the modified folic acid absorption test of Butterworth (1962) was performed on 55 apparently health Burmese adults, 41 subjects with recent diarrhea, and 7 subjects during diarrhoea. Among healthy Burmese (20 out of 55) 36 percent had subnormal xylose absorption (10-29 percent excretion) ; (3 out of 36) 8 percent had defective vitamin A absorption with 5 hour plasma vitamin A levels less than 150 g percent (9 out of 26) 35 percent had defective folate absorption with 5 hour urinary excretion less than 0.87 mg. Considerable variation in xylose absorption was found on repeating the test at one week intervals. Among subjects with recent diarrhoea (8 out of 41) 20 percent had abnormal xylose absorption (less than 10 percent excretion ) and (21 out of 41) 15 percent had subnormal xylose absorption (17 out of 30) 57 percent had defective vitamin A absorption ; and (20 out of 27) 74 percent had defective vitamin A absorption ; and (20 out of 27) 74 percent had defective folate absorption. The incidence of defective xylose, vitamin A and folate absorption was significantly higher in those with recent diarrheoa when compared with the healthy subjects. The incidence of impaired absorption of vitamin A and folate is higher in individuals with defective xylose absorption than in those with normal xylose absorption. Apparently, impaired small intestinal function exists in a considerable proportion of apparently healthy Burmese as revealed by defective xylose and to a lesser extent vitamin A and folate absorption. Also, that defective small intestinal function occurs during and up to one week after an acute episode of diarrheoa . The presence of predomin- antly leaf-shaped jejunal villi in Burmese subjects not suffering from diarrhoea is noted.

The thalassemias in Burma

A random sample of 232 adult Burmese males from among 1,886 workers was investigated for the presence of thalassemia. The methods used were peripheral blood film examination for erythrocyte morphology, red cell absolute indices using routine methods as well as the Coulter Counter, paper and starch gel electrophoresis for quantitation of Hb.A2 and Serum iron determinations. From the sample of 232 subjects 10 (4.3 per cent) were found to have the thalassemia trait of whom 2 have the beta-thalassemia trait and 8 have the alpha-thalassemia trait. The diagnostic criteria are discussed. the incidence is compared with that in other countries and the implications are discussed. Data on 25 subjects with Thalassemia Hb. E disease and 8 subjects with Hb. H disease on whom hematological and genetic studies have been completed are presented. The results of hematological, biochemical and genetic studies of an informative family having both Hb. H and Hb. E are presented. The implications as to the interaction between the thal. gene and the Hb. E gene are discussed.