Growth parameters of Sri Lankan children during infancy: a comparison with World Health Organization multicentre growth reference study

OBJECTIVES: growth monitoring (GM) is an important intervention ensuring wellbeing of children. If GM to be meaningful it is essential to have reference standards appropriate for that population. In Sri Lanka growth charts based on WHO multi centre growth reference study (MGRS) are used for GM. This study was carried out to ascertain the appropriateness of MGRS charts for GM in Sri Lankan children. METHODS: out of a birth cohort of 2215 children, 250 from each sex were invited for a followed up. Children were examined at 2, 4, 6, 9 and 12 months, to measure weight and length. Statistical characteristics of weight and length for each sex were calculated and compared with MGRS data. RESULTS: out of babies invited to participate in the study 244 boys and 241 girls responded initially. Out of this 85% of boys and 86% of girls completed the follow up. Weight and length of both sexes deviated significantly at all ages from MGRS data. CONCLUSION: MGRS data seems to be inappropriate for monitoring growth of Sri Lankan children...

Growth parameters at birth of babies born in Gampaha district, Sri Lanka and factors influencing them.

Background: Growth parameters at birth are important for clinical decision-making. In Sri Lanka, the data from the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) are used to interpret these measurements. Materials and Methods: A descriptive cross-sectional study was conducted between September and October 2010 in hospitals of Gampaha district, Sri Lanka. The weight, length and head circumference of all normal-term babies born in the Gampaha district during this period were measured within 8 h of birth using standard techniques. Measurements were taken by medical graduates trained and supervised by a consultant paediatrician. Socio-demographic data were obtained using an interviewer-administered questionnaire. Results: Of the 2215 babies recruited, 1127 were males. The mean birth weight, mean length and mean head circumference at birth were 2.92 kg, 49.1 and 33.6 cm, respectively. Boys weighed and measured more than girls in all parameters, but the differences were not statistically significant. Growth parameters of babies included in this study deviated from that in the MGRS data. Mean values of MGRS data were between 75th and 90th centiles of this study population. Birth order, family income and maternal education were significantly (P < 0.01) associated with growth parameters. Contrary to common belief, growth parameters continued to increase progressively up to 41 weeks. Maternal age less than 20 years or more than 35 years was negatively associated with birth weight (P < 0.01). Conclusions: Growth parameters of new-born babies deviated significantly from the values of the MGRS data. Growth characteristics of one population may not be applicable to another population due to variations in maternal, genetic and socio-economic factors. Using growth charts not applicable to a population will result in wrong interpretations.

Iodine concentration in common potable water sources in the estates of Ratnapura district and thyroid status of children.

Introduction: Iodine deficiency is the single most important cause of hypothyroidism. Drinking water is an important source of iodine for humans. Objective: To identify the common potable water sources available to the estate population in the Ratnapura District, to determine the iodine concentrations in different water sources and to ascertain the relationship between water iodine concentrations and thyroid status of children 5 to 9 years of age. Method: A descriptive cross sectional study was carried out in three phases in 20 randomly selected estates in the Ratnapura district of Sri Lanka from September to November 2009. In phase 1, 1,683 households in the selected estates were surveyed to identify the drinking water sources. In phase 2, blood samples from 519 randomly selected children aged 5-9 years from the same estates were taken to assay TSH levels after obtaining informed written consent from parents. In phase 3, water samples from 23 identified sources (wells, rivers and springs) were analysed for iodine levels by the catalytic reduction method. Water sources were grouped on elevation above mean sea level. The mean TSH levels and water iodine concentrations were correlated. Results: The main source of drinking water was spring water (83.7%). Spring water at low altitudes had significantly higher iodine concentrations than that located at higher altitudes (p<0.01). The mean iodine concentration in spring water was significantly lower than that in other sources (p<0.001). There was no association between the mean TSH levels of children and the altitudes at which they lived (p>0.05). There was no significant association between TSH levels of children and iodine concentration in drinking water (p>0.05). Conclusions: The main potable water source available to the population in the Ratnapura District was spring water (84%). The mean iodine concentration of spring water was significantly lower as compared to other water sources. There was no significant association between serum TSH levels in children 5 to 9 years of age and iodine concentration in drinking water.

Constipation and functional faecal retention in a group of school children in a district in Sri Lanka.

Objective To assess the prevalence of constipation and functional faecal retention among a group of school children in Gampaha district of Sri Lanka. Method This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10- 16 years, in a semi-urban school in Gampaha District of Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. Results A total of 441 questionnaires were distributed and 429 (97.3%) responded (53.1% males, mean age 12.4 years, SD 1.5 years). According to Rome III criteria and PACCT, 46 (10.7%) had constipation. Prevalence of constipation was higher in males (14.5%) compared to females (6.5%) [OR 2.45, 95% CI 1.19-5.1, p=0.012]. Twenty three (5.4%) had functional faecal retention. Conclusions Chronic constipation is a significant problem, affecting approximately 10% of children in a semi-urban school in Gampaha district. It is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studies.