An outbreak of poliomyelitis in Andhra Pradesh (South India).

An outbreak of poliomyelitis that occurred in the year 1992 in Telangana region of Andhra Pradesh, South India was investigated to understand the reasons for persistence of poliomyelitis in the general population and for the outbreak in Andhra Pradesh in particular. The study comprised of a detailed investigation of epidemiological and clinical features, serology and vaccination status and a case control study to calculate vaccine efficacy by matched pair analysis. The outbreak occurred after a relative quiescence of 3 years. The age group of the patients ranged from 2 months to 5 years, 26.5% being infants and 70.2% being children between 1 and 5 years. The outbreak was mainly caused by Type 1 poliovirus. Vaccine efficacy was found to be 70%. Antibody response was not high in cases. Seventy six per cent of the children with poliomyelitis were unvaccinated. Ignorance of the mothers and family interference were the main causes for not vaccinating the children. The study indicates the need to increase the vaccination coverage and inclusion of children upto 5 years in the programme. Absence of vaccination is the major risk factor for the outbreak. The persistence of poliomyelitis in older children, low antibody response and suboptimal vaccine efficacy point out the problem of achieving control with OPV in tropical countries and suggest the need for alternate strategies. Better health education strategies need to be developed.

Factors influencing survival in esophageal atresia.

There is little published literature from the third World countries that described the factors influencing survival of babies with esophageal atresia. We analysed 25 consecutive neonates treated for esophageal atresia. The overall survival rate was 36%. All 4 babies in Waterston Group A, 37.5% in Group B, and 15.4% in Group C survived. All 9 preterm babies died. Only 2 of the 16 babies who had pre-operative chest infection survived. The mean delay in diagnosis was 54 h in outborn babies and 20 h in hospital-born babies. We believe that a survival rate of 40% is easily achieved with minimum infrastructural inputs. Simple methods and practices that would vastly improve operative results have been suggested.

Clinical profile of klebsiella septicemia in neonates.

A detailed clinical study of 51 consecutive cases of neonatal klebsiella septicemia was carried out prospectively over a 20 months period. The incidence was 6.27 per 1000 live births. Majority (85.5%) were either preterms or small for date. Almost fifty percent babies had associated perinatal risk factors. Mean age of onset was 5.7 +/- 2.2 days. General symptoms were the earliest to occur at mean age of 5.7 days followed by respiratory, alimentary, hematological and neurological symptoms at 6.2, 6.3, 6.6 and 7.9 days respectively. About half of the neonates had associated complications; commoner being meningitis (20%), bleeding manifestations and sclerema (17.6% each) and pneumonia (15.7%). Cefatoxime was found to be the drug of choice (86% sensitivity). Nine babies (17.6%) died during the study period at a mean age of 9.1 +/- 3.2 days. Mean duration of hospital stay in rest of neonates was 27.9 +/- 12.1 days. Neurological symptoms were commoner in late onset disease. Bleeding manifestations, sclerema and granulocytopenia were seen exclusively in preterms. Presence of respiratory symptoms, bleeding, sclerema, shock and granulocytopenia were identified as poor prognostic factors in neonatal klebsiella septicemia.

Prognostic score for kerosene oil poisoning.

Ninety five consecutive children with kerosene oil poisoning were studied, the first 70 retrospectively (internal group) and the rest 25, prospectively (external group) over a period of 3 years and 8 months. Based on clinical features and severity of illness in initial 70 cases, a weighted scoring system to determine the outcome was evolved. This included: (i) fever--absent 0, present 1; (ii) severe malnutrition--absent 0, present 1; (iii) respiratory distress--absent 0, present 2, with cyanosis 4; and (iv) neurological symptoms--absent 0, present 2, with convulsions 4. The scores ranged from 0 to 10 in the internal group. Using discriminate function analysis, a score of 4 or more was found to be associated with prolonged hospital stay and complications. The risk of dying increased if the score was equal to or more than 8. The predictive value of the score was 85.7%. For validation, this scoring was applied to the external group as well and 84% of cases could be correctly predicted.

Kerosene oil poisoning--a childhood menace.

This study documents 3-year retrospective analysis of accidental kerosene oil poisoning in 70 children with regard to clinical profile, radiological changes and outcome. About 77% of cases were between 1 and 3 years old. Fifty children (71.4%) developed significant symptoms, with onset soon after to within 10 hours of ingestion. These included breathlessness (55.7%), fever (47.1%), cough (31.4%), restlessness (25.7%) and abdominal distension (15.7%). Chest X-rays were obtained in 65 children. Abnormal radiographs were seen in 45 (69.2%) children with right basal infiltrates being the commonest picture (21.4%). Ingestion of more than one ounce of kerosene oil adversely affected the clinical and radiological profile. Severely malnourished children had extensive radiological changes and poorer clinical outcome. One case developed myocarditis, a complication which has not been reported to the best of our knowledge. Mortality rate was 4.3%. All deaths occurred within 48 hours of admission.

Evaluation of social marketing of oral rehydration therapy.

Attempts, at social marketing of oral rehydration therapy (ORT) through television, in changing the knowledge and practice of mothers with regard to its use was assessed. One hundred and eighty seven consecutive mothers (38 excluded due to non use of ORT) were administered a preplanned questionnaire to assess their socio-economic profile, educational status, concept of diarrhea and correct use of ORT. Fifty nine mothers who watched these programmes on TV regularly formed the study group. These were compared with 90 mothers who had gained such knowledge from non-television sources. The correct application of knowledge of ORT was significantly better in study group compared with control group. The educational status of mothers had a positive impact on motivation to use ORT at home in the study group. Mass media campaigns through "TV spots" is an effective way of improving knowledge of mothers on ORT in a developing country.

Multi drug resistant Salmonella typhi infection: clinical profile and therapy.

Multiple drug resistant Salmonella typhi infection was observed in thirty five recent cases among forty eight children with bacteriologically proven enteric fever. Incidence of complications such as shock, myocarditis, encephalopathy and paralytic ileus was higher among these. A combination of cephalexin and gentamicin was successfully used in the management of these children.