Parental satisfaction with communication provided by different health care personnel at Lady Ridgeway Hospital for Children, Colombo.

Objective: To evaluate parental satisfaction with communication provided by health care personnel at Lady Ridgeway Hospital and to determine if differences existed in selected groups. Study design: A prospective descriptive cross-sectional study. Study setting: All six medical wards of Lady Ridgeway Hospital for Children, Colombo Study population: Patients aged 6 months to 14 years with a single hospitalization for a period of five or more days or with two or more hospitalization episodes for the same illness were serially enrolled until the calculated sample size of 458 were recruited. Method: Parental satisfaction with communication provided by doctors, nurses & physiotherapists was evaluated using a pretested questionnaire. Demographic details and parental knowledge about child’s illness were recorded by an interviewer not involved in the care of the child. Richards Scale (a five point scoring system) assessed parental satisfaction regarding ‘establishing rapport’, ‘health advice received’, ‘caring attitude towards patient’ & ‘moral support provided’. Results: Of 458 parents interviewed 95% were mothers. All received care from doctors and nurses but only 49 had met physiotherapists. Forty-one (9%) had more than 5 admissions for chronic illnesses, 53% were first admissions and 38% recurrent admissions. Hospital stay ranged from 5 to 21 days. Mean age of patients was 4.5 years. Male: female ratio was 3:2. Type of illnesses ranged from acute infections to chronic illness and disabilities. Majority of respondents were educated up to GCE O/L and 8% were graduates. Doctors were rated highest for their ability to establish rapport at initial encounter, and lowest for their ability to inform parents of prognosis and follow-up management plans. Time taken by doctors for questions of parents and advice given about the illness were also considered inadequate. There was overall satisfaction regarding a caring attitude by all three categories of personnel but physiotherapists were rated best in this aspect, doctors next and nurses the lowest. There was no significant variation in the demographic variables of ethnicity or gender and communication received. Parental knowledge on illness on the day of discharge was better in recurrent admissions although there was no significance (Mean score in first admissions 24.32, recurrent admissions 25.21). Conclusion: There was overall satisfaction among parents at LRH but we found several aspects of communication that need improvement for delivery of better quality in-door care.

A survey of breakfast practices of 4-12 year old children.

Objectives To assess time of intake of breakfast and choice of food consumed by school children, identify underlying reasons for prevailing breakfast practices and describe the knowledge and attitude of mothers about the nutritional needs of their children in relation to breakfast . Study design A descriptive cross sectional study using an interviewer administered questionnaire. Study setting A medical ward at Lady Ridgeway Hospital for Children, Colombo Study population Children aged 4-12 years, admitted to the professorial ward with an acute illness of less than three days duration between 1st December 2006 and 28th February 2007. Exclusion criteria were severe or chronic illness, food allergy, dietary restrictions, special diet schedules, growth abnormality/ties or developmental delay. Method A modified food frequency questionnaire was used to gather data on demographic and dietary details. Consumption patterns of five commonly eaten food groups were investigated based on dietary recall. Portion sizes and nutritive values were not assessed. Results Of a total of 220 children, 96% were school-going. Majority (81%) were resident in the Western province and were represented by Sinhalese (79.5%), Tamils (10.5%) and Muslims (10%). All mothers were literate and 60% had studied up to or above GCE (O Levels). In 80% monthly family income was above Rs. 8000. Population studied comprised mostly of primary school children. Male to female ratio was 1:1.08 and no significant differences in breakfast practices or nutritional status were found between sexes.

How a social worker could alleviate psychosocial problems of families accessing a child development clinic in Colombo.

Objectives To describe psychosocial issues faced and the services available to children accessing the child development clinic and how a social worker could help extend services provided through the clinic. Design A cross sectional descriptive qualitative study. Method All children attending the weekly clinic were seen by a social work researcher and medical officer, over a period of seven months and in-depth interviews conducted on twenty five selected patients with significant psychosocial problems. The parent or accompanying care giver was enrolled through a volunteer process and subjected to an open ended consultation on problems faced, services available and accessed, and reasons for not accessing same. A study was made of disability services in the community. Results All patients had psychosocial problems of varying degree. Twenty five children in whom social problems caused a significant adverse impact on the capacity of care givers in providing care and therapy included a broad range of complex issues. Financial concerns, poor utilization of government and non governmental support schemes, inadequacy of suitable transport, dearth of facilities for appropriate schooling, social isolation, lack of respite for caregivers and siblings, family disharmony, alcoholism, and absence of counseling services were among these. Viable options for solving identified problems and the ways in which a social services officer could assist in each situation are described. Conclusion Families of children with disabilities face several difficulties in accessing services. Even when relevant services are available they are not competent to obtain these and are in need of extra help. A hospital based social services officer working within the team of the CDC could fulfill this role, effectively connecting government policy with the people it targets.

Cerebral thrombosis in beta-thalassaemia major.

Two patients with homozygous beta thalassaemia complicated by cerebral thrombosis are reported. An alteration in coagulability due to a sudden increase in haematocrit and platelets was the probable cause in one patient. Although the other patient had many complications of thalassaemia, the cause for cerebral thrombosis was not identifiable.

Children of imprisoned mothers.

OBJECTIVES: To describe the problems faced by children during separation from their imprisoned mothers, and evaluate the health of children who accompanied their mothers into prison. DESIGN: A prospective observational study. SETTING: Welikada Prison, Colombo, Sri Lanka. METHODS: 200 randomly selected mothers who had left their children at home were interviewed using a questionnaire. During a period of 8 months 30 children living with their mothers in prison underwent physical and developmental examination and tuberculin testing. The living conditions within the prison were evaluated. RESULTS: During 18 months from January 1999, 4089 women were imprisoned. 88% were remanded, 20% awaited trial for more than one year in prison. 2416 were mothers. 1411 had at least one child under 12 years of age. The 200 mothers interviewed had 262 children under 12 years at home. Their care arrangements were: a relative (69%), father (16%), older sibling (4%), religious organisation (2.7%), neighbour (1.3%). None had received social services support. 70 children accompanied mothers into prison. In the 30 children followed up regularly 23% had scabies, 10% pediculosis, and 7% impetigo. No severe malnutrition was found and screening for tuberculosis was negative. 70% were breastfed. The child-friendly dormitory was inadequate to accommodate all children. CONCLUSION: Care arrangements and schooling were affected and no counselling services were provided during the imprisoned mothers' absence. The children within the prison enjoyed close bonds with the mothers and their physical needs were met. The child's best interest had not always been considered by court when deciding on custody during the mothers' imprisonment.

Thyroid function in thalassaemia major.

INTRODUCTION: Short stature is common in thalassaemia major. Hypothyroidism resulting from haemosiderosis has been implicated, but this complication has not been investigated in Sri Lanka. OBJECTIVES: To estimate the thyroid hormone level of patients with thalassaemia major and correlate height with age, iron status and thyroid hormone level. SETTING: University Unit, Lady Ridgeway Hospital, Colombo. DESIGN: A cross-sectional comparative study. METHODS: 33 patients with thalassemia major (19 males) aged 2 years 6 months to 23 years were studied. 21 healthy age and sex matched subjects from the same neighbourhood as the patients served as controls. Anthropometric measurements, skeletal maturity, serum ferritin and thyroid hormone levels were estimated. RESULTS: The height centiles and height standard deviation scores (SDS) were significantly lower in the patient group. Skeletal maturation was delayed by more than 1 year in 69% of patients. Undernutrition was not seen. The height SDS showed significant reduction with age (r = -0.5, 95% confidence limit -0.72 to -0.18) and with elevated serum ferritin levels (r = -0.8, 95% confidence limit = -0.9 to 0.62). Serum ferritin levels were elevated in the entire patient group with 70% being heavily iron overloaded (serum ferritin > 7000 ng/ml). The thyroxine (T4) levels were within the normal range in all 33 patients. The TSH levels were normal in 32 patients. The patient too had a normal T4 level. The control group had TSH levels comparable with the patients. CONCLUSION: Hypothyroidism was not present in our iron overloaded thalassaemic patients. The thyroid hormone levels were similar in patients with mild and heavy iron overload. We conclude that routine surveillance for hypothyroidism is unnecessary in thalassaemia major. Other causes for delayed skeletal maturation and short stature need investigation.

Do babies need water in Sri Lanka?

OBJECTIVES: To study the prevalence of exclusive breast feeding and the reasons for water supplementation, and investigate whether water is necessary in the humid climate of Colombo. SETTING: Well baby clinic in De Soysa Maternity Hospital for Women, Colombo. SUBJECTS: 200 breast fed infants born in a baby friendly hospital between the ages of 1 and 4 months. METHODS: The study sample was randomly selected. Sick infants and those of working mothers were excluded. The mothers' knowledge of feeding practices was recorded in an interviewer administered questionnaire. The infants' weights, lengths and rectal temperatures were measured and the osmolality of urine estimated. The room temperature and relative humidity were recorded on each day of study. The data were analysed using the Chi-Square statistical test. RESULTS: 69% of mothers introduced supplementary fluids within the first 4 months, because of advice from grandmothers or relatives, thirst, hiccups or constipation. 45% had introduced water with "rathakalkaya", a fluid traditionally given to infants in Sri Lanka. 90% of mothers had attended antenatal clinics in the De Soysa Hospital for Women. 70% of mothers who gave supplementary fluids were aware of the importance of exclusive breast feeding. The range of urine osomolalities of exclusively breast fed infants was 60 to 204 mosmol/kg. There were no significant differences in core temperatures and number of times urine was voided daily, or urine osmolalities, between exclusively breast fed and fluids-supplemented group of infants. CONCLUSIONS: Despite delivery in a baby friendly hospital a majority of mothers supplemented breast milk with water or other fluids during the first 4 months. The advice of grandmothers had a significant influence on early feeding practices. Exclusively breast fed infants were found to maintain water homeostasis under the hot, humid climatic conditions of this study.

Street children--a preliminary study.

OBJECTIVE: To study the background, life styles, health and prevalence of abuse of street children in Colombo. STUDY SAMPLE: 50 street children receiving temporary day care or night shelter from community service centres were serially recruited. DESIGN: A retrospective descriptive survey. Demographic, experiential and clinical data were collected by an interviewer, based on a semistructured questionnaire, followed by physical examination and laboratory investigation. RESULTS: The children were aged between 4 and 17 years. (Mean 10.5 years.) 64% were males and 18% belonged to ethnic minorities. The majority (84%) had family ties. Family disintegration was mentioned as the cause for life on the streets by 36%. Child labour was reported in 38%. 16% admitted to being sexually abused. 20% were tobacco smokers. Respiratory and skin infections, and injuries incurred in road traffic accidents were the main causes of morbidity. CONCLUSION: Street children in Colombo are an abused and exploited group. Road traffic accidents, and physical and sexual abuse are the main hazards of the street they are exposed to.

Vaccine storage conditions in clinics in Colombo.

OBJECTIVES: To study the practices of health personnel regarding vaccine storage and the integrity of the cold chain, during storage, in immunisation clinics. DESIGN: A cross-sectional descriptive survey based on a postal questionnaire and an observational study of the cold chain during storage of a randomly selected sample. SETTING: Colombo District. PARTICIPANTS: 10 health centres, 13 Colombo Municipal Council Clinics, 26 general practices receiving vaccines from health centres, 13 private hospitals and 10 state-run hospitals. METHOD: A pretested postal questionnaire collected information on storage conditions and compliance with EPI requirements. The sub-sample in which the temperatures were monitored consisted of 33% of the total. The study was carried out in 1995-1996, when there was an uninterrupted power supply. OUTCOME MEASURES: Responses to the postal questionnaires and the colour changes recorded in thermosensitive WHO cold chain monitors. RESULTS: The response rate to the postal questionnaire was 87.5%. All 63 respondents stored vaccines in refrigerators worked by electricity. Information regarding refrigerators showed 46% to be less than 5 years old and 17% were more than 15 years old. 97% of refrigerators had good door seals. Regular defrosting was claimed by 79% of clinics and 81% had a named person responsible for vaccine storage. Only 57% had thermometers available and temperatures were monitored daily in only 40% of clinics. 76% of refrigerators were used for purposes other than storage of vaccines. Colour changes were noted in 2 out of 22 cold chain monitors.

Power cuts and EPI vaccine storage.

OBJECTIVE: To study the integrity of EPI vaccine storage during interruptions to the power supply. SETTING: Health centres in Colombo District. METHOD: An interviewer-administered questionnaire was used to collect information on staff compliance with regulations of the expanded program of immunisation (EPI) and alternative facilities available for refrigeration during power failure. The refrigerator and storage conditions were inspected. The stored vaccines were tagged with thermosensitive cold chain monitors, which were read on revisiting the clinic 14 days later. During the study period, power cuts of 2 hours' duration were in force daily. A control study was carried out when there was no interruption to power supply. RESULTS: Diphtheria-pertussis-tetanus (DPT) and measles vaccines had been exposed to temperatures outside the prescribed range during power cuts. Oral polio vaccine had adequate storage with power cuts of 2 hours' duration. CONCLUSION: Alternative facilities for vaccine storage during power cuts were not available and the potency of DPT and measles vaccines were compromised with interruptions to power of 2 hours' duration or more.