Pattern of Growth Faltering and Recovery in Under-5 Children in India Using WHO Growth Standards - A Study on First and Third National Family Health Survey.

Objective: To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). Design: Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. Setting: General community. Subjects: Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). Main outcome measures: Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. Results: Mean WAZ score at ‘0’ month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. Conclusions: A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.

Ultrasound in the diagnosis of typhoid fever.

OBJECTIVES: To establish the efficacy of ultrasound (US) of the abdomen as a diagnostic test in Typhoid. To determine the ultrasound diagnostic criteria in cases of Typhoid. METHODS: The Widal test is the most commonly used method of detecting Typhoid fever, but does not provide results until a week after onset of fever due to the need for enough antibodies to develop to render a positive result. Abdominal Ultrasound was performed within three days of the onset of fever in 80 cases suspected to be having Typhoid fever. Subsequent follow-up scans were performed at five days, ten days and fifteen days. Subsequently, all 80 cases were found to be Widal positive and Salmonella culture was positive in 32 cases. We present our findings in 26 patients in the age group between 4 to 20 years in whom both Widal test and Salmonella culture was subsequently positive. RESULTS: The US findings were as follows: splenomegaly (n-26, 100%); Bowel wall thickening (n-22, 85%); mesenteric lymphadenopathy(n-20,77%); hepatomegaly with normal parenchymal echotexture (n-8, 31%); thickened gall bladder (n-16, 62%); biliary sludge (n-6, 23%); positive US Murphy's sign (n-7, 27%); pericholecystic edema with increased vascularity (n-6, 23%); mucosal ulceration in the wall of the gall bladder (n-1, 3.8%). CONCLUSION: In endemic areas like India, ultrasound findings of hepatomegaly, splenomegaly, ileal and cecal thickening, mesenteric lymphadenopathy and thick-walled gallbladder are diagnostic features of typhoid. Ultrasound can be a non-invasive, economical and a reasonably sensitive tool for diagnosing typhoid when serology is equivocal and cultures are negative.