Assessment of the quality of childcare centres in the Colombo Municipal Council area.

Background: There are 2 dimensions of childcare quality: process and structure. The interactions, activities, materials, learning opportunities, health and safety routines refer to process quality. Structural quality includes the group size, adult-child ratio and professional training of staff. No large scale studies are available on the quality of Sri Lankan childcare centres. Objectives: To assess the quality of preschool and day care centres in the Colombo Municipal Council (CMC) area and to evaluate how structural inputs and cost influence the process quality. Design: Descriptive cross-sectional qualitative study Method: Process quality was assessed using the Early Childhood Environmental Rating Scale-Revised. The cost and structural quality was assessed using a self-administered questionnaire. Results: Overall process quality was mediocre, with 25% preschools being of poor quality and 6% being of good quality. Over half the centres did not have appropriate number of staff. Eighty percent of child groups were larger than appropriate. Only 8% of centres were led by a graduate. Of the teachers, 90% had preschool teacher training. Smaller student groups cared for by a higher number of staff had significantly higher process quality. Better quality preschools cost more. Conclusions: The quality of care provided by childcare centres in the 6 Medical Officer of Health areas of CMC area was mediocre.

Deficiencies associated with the use of inhaler devices for asthma.

Objective: To study the deficiencies associated with the use of inhaler devices among children with asthma. Design: Observational descriptive study Method: Study population comprised consecutive children seen at all medical clinics of Lady Ridgeway Hospital using inhaler devices for asthma. Study was carried out from February 2008 until 150 patients were enrolled. Data was collected using an interviewer administered questionnaire. Technique of using inhaler was checked. Knowledge about maintenance of the device was assessed. Results: Of the 150 patients 63% were in the 5-13 year age group. Fifty six percent were using the inhaler for 1-4 years. Seventy one percent in the below 2 year age group used the Holding chamber (Babyhaler). Forty percent in the 2-4 year age group used a volume spacer and a face mask. Eighty four percent in the 5-13 year age group used a dry powder inhaler or volume spacer without the face mask. Steroids alone were used by 84% of children while 16% used combination drugs. Compliance was good in 85%. Technique was satisfactory in 67% cases. Conclusion: There are major deficiencies in the usage of inhaler devices among patients with asthma.

Fatal septicaemia caused by Chromobacterium violaceum.

We report a case of Chromobacterium violaceum septicaemia in a 10-year old boy admitted to hospital in September 2001, two weeks after he suffered a crush injury of the left foot. In spite of surgical debridement and antibiotics his condition worsened and he developed multiple liver and lung abscesses. He died one week after admission and a blood culture grew Chromobacterium violaceum.