Malnutrition in children: analysis of epidemiology, risk determinants and advances in management

Malnutrition in children is one of the major health challenges faced worldwide but more frequently in South Asian countries including Pakistan. The objective of this review is to analyse the situation of malnutrition, its risk determinants, assessment and management strategies. This review is based on information collected from PubMed, Google scholar, Medline, World Bank, World Health Organization [WHO], United Nations Children's Fund [UNICEF] websites and books. It is concluded that malnutrition status is improving but at a slower pace. Pakistan has a high prevalence of wasting, stunting, and micronutrient deficiencies

Common birth marks; to identify the frequency in infants presenting to out patient of Tertiary Care Hospital

Objectives: To identify the frequency of common birthmarks presenting in outpatients department of dermatology until and to increase awareness among doctor about the common phenomena

Patients and Study Design: A cross sectional study

Setting: OPD of Dermatology department of Dow University Hospital

Period: January 2014 till October 2014

Methods: During a year, by using non-probability convenient sampling only 100 patients of both genders were enrolled in the study after ensuring inclusion, exclusion criteria. Complete history was recorded and a thorough general physical and cutaneous examination was performed. Information was collected on predesigned questionnaire after taking informed consent. Data Analysis was carried out on SPSS statistics software

Results: Out of 100 patients, 43% were males and 57% were females. In 69.6% patients, the birthmarks were noticed around time of delivery, 28.3% patients were noticed within 1[st] year of life and 2.2% later in 5 year. Pigmented birthmarks were identified in 65.2% patients while 34.8 % have vascular birthmarks.71.1% had no changes in color during life span. While 37.8% had 1-3 cms birthmark and 45.7% have reported an increase in birthmark

Conclusions: We found birthmarks benign; they may grow with age but they do not need treatment unless there is concern either cosmetically or they have pain and discharge

childhood asthma being treated appropriately

It was a descriptive study done in the department of Pediatrics, Jinnah Medical College hospital Karachi from October 2005 to September 2006. All children between 1 to12 years, diagnosed as asthma [on clinical grounds] were enrolled. Information regarding asthma severity and use of regular drugs in past 6 months was recorded in a pre-de-signed Proforma. Disease severity was classified according to GINA guidelines as intermittent and persistent. Persistent group was further subdivided into mild, moderate and severe categories. Treatment in accordance to GINA guidelines was considered as a standard therapy. A total of 150 patients were enrolled, out of which only 4.7% were of intermittent category while 95.3% were of persistent type [39.3% mild persistent, 44% moderate persistent and 12% severe persistent]. Patient in intermittent group were not on any regular long term medication. Seventy six percent of the patients with persistent asthma were on quick relief drugs, while controller drugs were being used in19.3% cases only. Limited use of inhalers with or with out spacer device and nebulizers was observed [14% cases]. Inappropriate drugs according to GINA guidelines, e.g.: antihistamines, cough and cold preparations, mast cell stabilizers and drugs from hakims and homeopaths, were not included in the study results. Majority of the patients was not found to be treated according to GINA guidelines. Controller medications were being under prescribed while in its place reliever medication was being inappropriately advised on regular basis

Auto immune hemolytic anemia in a child precipitated by chicken pox

Auto Immune Hemolytic Anemia [AIHA] is a rare entity in children. We report a case of an adolescent girl with AIHA, which was precipitated by chicken pox. Clinical course over 3 years, till remission is described

Determinants of bottle use amongst economically disadvantages mothers

There is documented evidence of increased risk of infant mortality in formula fed infants versus breast fed babies. The hazards of bottle use for infant feeding, especially in underprivileged communities, are also well known. As the issue of bottle use is directly related to childhood survival and mortality, there is legislation against propagation of bottle-feeding in Pakistan. To obtain information about determinants of bottle use for infant feeding in a low-income periurban community. Community based cross-sectional study. 150 mothers with infants up to one year of age were included in the study period from October 03 to March 04. Out of these 102 mothers were found using bottle for infant with or without breast-feeding. The tendency to use the bottle increased in relation to child's increasing age. Only 17% of the infants under the age of 3 months were offered bottle, it was 69% between 4 to 6 months and it increased to 76%.in infants from 7 months to 1 year. The attributes associated with increased bottle use were mother's older age, illiteracy and increased parity. Bottle use is a public health issue in poor and illiterate mothers of developing countries. While, in Pakistan, laws are enacted against its propagation, we need community-based strategies to bring about a socio-cultural shift in the growing prevalence of bottle use found in the study

Effect of weaning period on nutritional status of children

To determine the effect of age of introduction and the type of weaning foods used, on the nutritional status of children under three years of age. Cross-sectional, community-based study. The study was conducted in rural areas of District Malir in Karachi, Pakistan, comprising of 900 villages spread over 1200 square kilometer, from November 2000 to April 2001. Patients and Three hundred and fifty-nine children under 3 years were included in the study. Based on the age of commencement of weaning, the children were categorized as children weaned at appropriate and inappropriate age. For the type of weaning foods, the children were grouped into two categories based on the nature of food items. Children for whom weaning was started at the recommended age of 4-6 months were found to be significantly less malnourished on anthropometric measurements as compared to the other set in which weaning was started at an earlier or later age. Significant statistical difference was noted in the children weaned on nutritious home-made items compared to children having commercial foods. Malnutrition is of multi-faceted origin beyond only poverty and food shortage. Inappropriate feeding practices can result in growth faltering as noted in the present study. Programmes should be launched for education of mothers regarding weaning practices

Rotavirus as the etiological agent of diarrhea in hospitalized children

Diarrheal diseases are a significant cause of mortality in children under five years of age and rotavirus is considered to be one of the major causes of childhood gastroenteritis. As it is a sig-nificant contributor to childhood mortality in developing countries, WHO recommends epidemiological studies regarding rotavirus especially in developing countries. As it is a vaccine preventable disease these researches can have a significant impact on the future recommendation of vaccines. To identify rotavirus in the stool analysis of children less than five years of age, presenting with acute diarrhea. To describe the age distribution and clinical features of rotavirus gastroenteritis. Hospital based, cross-sectional study. Analysis of 40 fecal samples was done for rotavirus by immunochromatography; rotavirus was identified in 6 [15%] samples. The majority of thechildren with rotavirus gastroenteritis were younger than 2.5 years. The children who tested positive for rotavirus had a better nutritional status than the children who were negative for the virus. No significant difference was seen in the duration of diarrhea and of hospitalization in the two groups. Diarrhea is a major public health problem in developing countries. Rotavirus as the etiological agent was detected in 15% of cases in the present study, which is in close approximation to several other studies from Pakistan. Still large-scale studies are required to determine the prevalence of rotavirus gastroenteritis that can have important implications for rotavirus vaccination. Meanwhile our strategy s-hould focus on good sanitation and clean drinking water to save our children from this democratic disease

Management of Acute Asthma in children using metered dose inhaler and small volume nebulizer

To determine whether the administration of 32 - agonist by Metered Dose inhaler [MDI] with accessory device [AD] is a as effective as the administration of 32 - agonist by small volume nebulizers [SVN] for the treatment of acute asthma. A cross sectional study was conducted at Emergency Room [ER] of National Institute of Child Health [NICH], Karachi, between October 2000 to March 2001. This study included 150 children, 6 months and older with a history of wheeze and presenting with an acute asthma exacerbation. Children were categorized into mild, moderate and severe asthma according to medical scoring system. Children were assigned randomly into group A and B to receive standard dose of 32 - agonist [salbutamol] by MDI/AD [group A] or SVN [group B]. Baseline : characteristics and asthma severity were recorded. All variables [dyspnoea, use of accessory muscles, cyanosis, respiratory rate, heart rate, blood pressure, oxygen saturation, pulsus paradoxus, and wheeze] and Peak Expiratory Flow Rate [PEFR] in children 5 years and older, were determined at pre and post inhalation therapy. Both groups did not differ in demographic characteristics. There were no significant differences in outcome measures. In children treated with MDI/ADs and SVNs. PEFR increased significantly in both the groups after completion of treatment, but PEFR was not statistically significant when compared in between groups. The data suggested that MDI/AD is an effective alternative to nebulizer for the treatment of children with acute asthma exacerbation in the ER