The role of developmental stimulation in nutritional rehabilitation.

OBJECTIVE: To evaluate the role of developmental stimulation and nutritional supplementation in rehabilitation of malnourished children in the hospital and community settings. DESIGN: Prospective follow up study. SETTINGS: (i) Nutrition clinic of a teaching hospital; and (ii) Community Nutrition Project in coastal Kerala. SUBJECTS: (i) Hospital study: 100 children aged 6-24 months with moderate and severe Protein Energy Malnutrition (PEM) constituted the study group. The control group consisted of well nourished children matched for age and sex, 50 from high (Control I) and 50 from low socioeconomic (SE) status (Control II). The study group was randomized into two subgroups to administer the interventions namely composite stimulation package (STIM) or nutritional management (NUT). (ii) COMMUNITY STUDY: A cohort of 332 children aged 6-24 months with varying grades of PEM were studied. As per the area of residence, they were divided into three subgroups; 2 study groups to administer the two interventions namely STIM or NUT and a control group. METHODS: In both the hospital and community studies, environmental parameters, growth and development were assessed initially. After two years, the study groups were reassessed in comparison with the control groups. A final IQ assessment was done in each subgroup by a tester blinded to the grouping. RESULTS: (i) Hospital study: Control children from high SE status (Control I) had the highest overall scores compared to those from low SE status (Control II) as well as the study groups with PEM even after administering either STIM or NUT. Both the interventions produced a significant positive impact on growth and development, but STIM was found superior to NUT. (ii) Community study: There was a high prevalence of PEM in the community, which reduced significantly after the interventions. STIM was found superior in its positive impact on growth and development. In both studies, direct correlation was observed between environmental parameters and anthropometric scores and between anthropometric scores and IQ. CONCLUSIONS: The benefit of developmental stimulation in nutritional rehabilitation and the need for providing better environment for deprived children are brought out in this study.

Furazolidone in typhoid fever--correlation of clinical efficacy with serum bactericidal activity.

Treatment of typhoid fever with furazolidone produces a high cure rate. This is a clinical curiosity, as furazolidone is described to be poorly absorbed. The present study examined whether furazolidone could produce unequivocal clinical response and, if so whether this was due to the drug producing bactericidal levels in the serum. Twenty one patients selected by defined criteria were treated with furazolidone and evaluated for definite clinical response in 5-7 days. Bactericidal activity of pre dose and post dose sera were estimated in seven patients showing definite clinical response. All the seven patients had a clinical cure without the drug producing significant bactericidal levels in the blood. Hence we concluded that the major site of action of furazolidone was in the intestine. It is our postulate that the organisms reaching the intestine in large numbers from bile are prevented from gaining re-entry into the circulation by the action of furazolidone in the intestine. After repeated cycles of entry of organisms into the intestine from bile and the simultaneous prevention of its re-entry into the circulation, the number of organisms remaining in circulation comes down considerably, thus helping the immune system to bring about a cure.

Breastfeeding and childhood cancer.

Total duration of breastfeeding and of exclusive breastfeeding was studied and compared in 99 childhood cancer cases and 90 controls. The difference between the average duration of breastfeeding in cases and controls was significant (p < 0.05), but when average duration of exclusive breastfeeding was compared in cases and controls the difference was highly significant (p < 0.001). In lymphoma cases and controls the difference between the average duration of breastfeeding was moderately significant (p < 0.01). However, when average duration of exclusive breastfeeding was compared in lymphoma cases and controls the difference was highly significant (p < 0.001). When other cancer groups and controls were compared with respect to their total duration of breastfeeding and duration of exclusive breastfeeding the differences when insignificant (p > 0.05). Cases and controls were not different with respect to their age, sex, birth year, birth order, age and educational status of mothers, smoking of fathers and socioeconomic status. However, a positive family history of cancer was obtained in 4 (4%) of cases whereas in controls it was obtained in only 1 (1.1%).

Trivandrum Developmental Screening Chart.

The Trivandrum Developmental Screening Chart (TDSC) was designed by selecting 17 test items from BSID (Baroda Norms). It was validated both at the hospital and community level against the standard DDST. TDSC had a sensitivity of 66.7% and specificity of 78.8%, which makes it an acceptable simple screening tool even for the community level worker.

Growth faltering and developmental delay in children with PEM.

Anthropometric measurements, Somatic Quotient (SQ), Development Quotient (DQ), Motor Quotient (MoQ) and Mental Quotient (MeQ) in 136 children in the age group 1-24 months with varying degrees of protein energy malnutrition (PEM) were compared with an equal number of comparable well nourished children. There was a progressive reduction in SQ, DQ, MoQ and MeQ as the degree of PEM advanced. There was a direct linear correlation between SQ and DQ and between height and DQ in 4 degrees PEM. However, there was no direct correlation between head circumference and either DQ or MeQ.