Knowledge, attitudes and practices regarding milk powder usage among mothers of 1-5 year old children in Pitakotte MOH area.

Introduction: Early childhood nutrition plays an important role in growth and development of children. However, due to false beliefs of parents, undue prominence has been given to milk in the child’s diet. Objective: To assess the knowledge, attitudes, practices and factors related to milk powder usage among mothers of 1-5 year old children. Method: A cross sectional study was carried out among 187 mothers of 1-5 year old children in five randomly selected weighing centres in Pitakotte MOH area using an interviewer administered questionnaire. Scores were given to knowledge, attitudes and practice. Results: The mean age of the children was 32 (SD 16.3) months. Mothers’ knowledge on milk/milk powder and their usage was good in 20% and level of attitudes was good in 55%. Parents received information regarding milk powder from doctors (42.4%) and TV advertisements (36.5%). The commonest factor mothers considered when selecting a milk powder was the brand name (69.7%). Mean age of initiating cow’s milk was 13.5 (SD 9.2) months. Forty seven percent selected a single brand to start feeding their children. At the time of conducting the survey, 47% were using one particular brand of full cream. While 52.8% gave concentrated milk, 33.7% gave diluted milk. One hundred and one (62%) used a cup while 44 (27%) used a bottle to give milk. Sixty (36.8%) mothers were giving the correct volume of milk, while 95 (58.3%) gave more than recommended. There was a statistically significant association between social class and level of practice (χ2=5.19;p<0.05;df=1). Practice was not significantly associated with mother’s level of attitudes, knowledge, age, education, parity or the sex of the child. Conclusions: Knowledge and practice regarding milk and milk powder usage among mothers is poor. Mothers of lower social classes have a good level of practice.

Body surface area estimation: Cross validation of several prediction equations.

Background Body surface area (BSA) is used in clinical practice to prescribe medication, standardize measured parameters etc. Normogram has been the gold standard. However, there are several prediction equations in the published literature. A simple method giving an accurate estimation would help to assess BSA in day to day clinical practice efficiently. Objective To assess the accuracy of different equations for the estimation of BSA in a group of Sri Lankan children. Method Data collected in 3 different school surveys carried out between 2002 and 2005 were used. BSA estimated by 9 prediction equations described in the literature were compared with the BSA assessed by normogram. Results Two thousand three hundred and thirty eight girls and 639 boys, between the ages of 5-16 years, were assessed. The mean ages of the boys and girls were 10.3±1.47 years and 11.5±2.47 years respectively. The highest mean BSA estimation was given by Gehan & George equation (boys 1.14±0.20m2 and girls 1.2 ± 0.25m2) and lowest by Yu et al (boys 1.08±0.20m2 and girls 1.13±0.25m2). Estimates correlated highly with BSA assessed by normogram. When the estimates were compared with normogram, equation of Mattar gave the highest bias for both groups (females 0.0152m2 and males 0.0177m2). Mosteller equation gave relatively low bias (females 0.0077m2, and males 0.0072 m2). Conclusions All equations gave very good agreement between each other. Out of the equations, easiest to use in day to day clinical practice is the equation described by Mosteller. The maximum bias in estimation would lead to less than 5% error in determining drug doses which is negligible in day to day clinical practice. Mosteller equation is suitable for routine clinical use.

Assessment of body composition in Sri Lankan children: validation of a skin fold thickness equation.

BACKGROUND: Morbidity associated with obesity is related to the fat mass (FM) of the body. The direct estimation of FM is difficult. Skin fold thickness (SFT) is a simple and cheap alternative for accurate assessment of FM, and population specific equations are necessary for accurate assessment of FM using SFT. OBJECTIVE: To develop a SFT prediction equation to estimate FM of Sri Lankan children. DESIGN, SETTING AND METHOD: Across-sectional descriptive study was done at the University Paediatric Unit of Lady Ridgeway Hospital, Colombo. Data were collected from 5 to 15 year old healthy children. Triceps, biceps, supra-iliac and subscapular SFT were measured using Harpendens skin fold caliper. Total body water was assessed using an isotope dilution method (D2O), and fat free mass calculated. FM was assessed based on 2 compartment body composition model. Multiple regression analysis was used to develop prediction equation and validated using PRESS (prediction of sum of squares) statistical technique. Independent variables were age, triceps SFT, subscapular SFT and sex. RESULTS: Prediction equation for FM [(0.68 x age) + (0.246 x triceps SFT) + (0.383 x subscapular SFT) - (1.61 x sex code) -3.45] was able to predict 76.4% of variance with a root mean squared error (RMSE) of 3.4 kg. PRESS statistics was 3.4 kg with press residuals of 1.56 kg. Bland-Altman technique showed that the majority of the residuals were within mean bias +/-1.96 SD. CONCLUSION: Results of this study provide an SFT equation for the prediction of FM in Sri Lankan children.

Epidemiological aspects and risk factors of toxocariasis in a pediatric population in Sri Lanka.

This cross-sectional study, carried out over a period of 11 months, investigated the relationship between Toxocara seropositivity, socio-demographic and environmental variables in a pediatric population. Risk factors for Toxocara infection were assessed by direct interview of parent or guardian using a structured pre-tested questionnaire. Eosinophilia and presence of helminth eggs or protozoan cysts in a fecal smear were recorded. Diagnosis of Toxocara seropositivity in children was based on IgG Toxocara Microwell Serum Elisa Kits. The ELISA test was regarded as positive if the optical density was 0.3 units or above. Unadjusted and adjusted odds ratios were calculated to determine risk factors for disease. The proportion of children who were positive for Toxocara antibodies in the study population was 20%. Children being exposed to a puppy of less than 3 months at home, visiting a playground frequently, living in a poorly constructed house and dogs having access to playgrounds were significant risk factors on univariate analysis. Of these four variables, only the first three variables (OR 19, OR 4 and OR 3, respectively) remained significant risk factors on the multivariate model. Presence of eosinophilia in seropositive children was significantly higher than the seronegative group (77% vs 40%; p < 0.001). This study indicates that dogs contribute significantly to children being seropositive for toxocariasis in Sri Lanka. Implementation of public health programs specifically focused on anti-parasitic treatment of dogs is recommended.

Metabolic consequences of childhood obesity--a preliminary report.

INTRODUCTION: Childhood obesity is increasing in Sri Lanka. Obesity related morbidity is mainly associated with the metabolic syndrome (MetS) and non-alcoholic steatohepatitis (NASH). Recent studies have shown these serious health consequences in obese children. OBJECTIVES: The objectives of our study were to document the presence of MetS and NASH in obese Sri Lankan children, to correlate the fat mass (FM) with the waist circumference (WC) and the body mass index (BMI), and to compare the association of the WC, BMI and the WHR (waist-hip ratio) with the metabolic derangements. METHOD: Children attending the Obesity Clinic at Lady Ridgeway Hospital, Colombo, from November 2004 to September 2005 were studied. The relevant sociodemographic data, anthropometric measurements and examination findings were documented. After a 12-hour overnight fast, blood was taken for estimation of lipid profile, serum insulin, liver enzymes and blood glucose. The oral glucose tolerance test (OGTT) was done in children over 5 years of age. Fatty infiltration of the liver was assessed by identifying specific features on ultrasonography and the degree of infiltration was given a score. We modified the International Diabetes Federation (IDF) 2004 guidelines to define MetS. NASH was defined as fatty infiltration of the liver associated with a raised serum ALT. RESULTS: Seventy children (40 boys) were studied. The mean (SD) age was 9.7 (2.5) and 9.3 (3.0) years for boys and girls respectively. Mean BMI was 25.9 in both groups. All patients had a WC > 98th percentile. MetS was found in 13 of the 63 (21%) children on whom all criteria were assessed. Sixty children had ultrasonography and NASH was seen in 11 (18%). The correlation of the percentage FM was greater with the BMI (r = 0.80; p < 0.001) than with the WC (r = 0.56; p < 0.001), but the WC was more significantly associated with the metabolic derangements than either BMI or WHR. CONCLUSIONS: Serious metabolic abnormalities are found in obese Sri Lankan children and the WC is a reliable indicator of these derangements.

Dietary and physical activity patterns of school children in an urban area of Sri Lanka.

Objective To provide information on nutritional status and dietary and physical activity pattern of 8-12 year old school children in an urban area of Sri Lanka. Method Seven schools in Colombo were randomly selected. These schools showed a fair representation of children of all social levels. Students of years 4, 5, 6 and 7 were included. 50 students from each grade of each school were randomly selected and recruited into study. The purpose of study was explained to the students and any withdrawals allowed. Medical officers performed the anthropometric measurements. Height was measured using a stadiometer and weight using an electronic weighing scale. Medical assessment was done in all children who participated in study. To define obesity and overweight, sex and age specific body mass index (BMI) cutoffs recommended by International Obesity Task Force were used. Age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Information regarding physical activity, behaviour, feeding practices and socioeconomic factors were obtained using a pretested questionnaire filled by parent/guardian. Data was analyzed using Epi Info 2000 (CDC, USA) software. Results One thousand two hundred and sixty six children were recruited to the study. Data of 1224 subjects were used in the anthropometric analysis, while 1102 data sets were used in analysis of dietary and physical activity. Of the latter group 44% were boys. The children belonged to 3 types of schools based on type of administration. About 12% each were from ages 8 and 12; the rest were almost equally distributed among the other 3 age categories. More than 80% of mothers had a level of education above GCE (O/L). 60.8% watched television for 1-2 hours each day during weekdays and 39.5% watched television for 3-4 hours during weekends. More than 50% engaged in daily physical activity for more than one hour during weekdays as well as weekends. 80.1% attended tuition classes. A similar distribution was seen in all age groups. Although consumption of vegetables was high, fruit consumption was not satisfactory. Majority had eggs or fish as their main source of protein. Prevalence of obesity and overweight increased with increase in family income and thinness was high among low socio-economic groups. Dental caries was the commonest health problem. Highest prevalence was among children from public non-national schools (48.7%), whilst public national and private schools had a prevalence of 10.5% and 11.8% respectively. Of the skin lesions commonest was scabies. Conclusion The main factor that influenced the nutritional status and related behaviour was the socioeconomic standard. Health programmes should be designed targeting these groups.

Nutritional status of schoolchildren in an urban area of Sri Lanka.

BACKGROUND: As in many other Asian countries, Sri Lanka is in the phase of a rapid demographic, nutritional and epidemiological transition. As a result dietary habits and lifestyle are changing. These have led to new health problems in the region. Childhood overweight and obesity are examples of such problems. OBJECTIVE: To provide information on the nutritional status of 8-12 years old schoolchildren in an urban area of Sri Lanka. SUBJECTS AND METHODS: Seven schools situated in the city of Colombo were randomly selected. They showed a fair representation of children of all social levels. Fifty students from each grade (years 4, 5, 6, 7) of each school were randomly selected. Their height was measured using a stadiometer to the closest 0.1cm and weight measured using an electronic weighing scale (Seca, France) to the closest 100 g. Calibration was checked with a standard weight at each 25 measurements. Information regarding behaviour, feeding practices and socioeconomic factors were obtained by a questionnaire filled by the parent or the guardian. To define obesity and overweight, sex and age specific body mass index (BMI) criteria recommended by the International Obesity Task Force (IOTF) were used. The age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Weight and height Z score of less than -2 from the median of height for age and weight for age derived using the ANTHRO software (CDC, USA) were used to define stunting and underweight respectively. Data were analysed using Epilnfo 2000 (CDC, USA) computer package. RESULTS: Anthropometric data of 1 224 children (48% boys), and feeding practices and behaviour pattern data of 1 102 children (44% boys) were analysed. Obesity prevalence among boys (4.3%) was higher than in girls (3.1%). The prevalence of thinness was 24.7% in boys and 23.1% in girls. 5.1% of boys and 5.2% of girls were stunted. 7.0% of boys and 6.8% of girls were underweight. 66% of obese children and 43.5% of overweight children belonged to high-income category (monthly family income more than Rs. 20,000). Apart from family income, behaviour patterns did not significantly influence the nutritional status. CONCLUSIONS: Although the data are not representative of the entire country, nutritional transition is evident in the city of Colombo. Obesity and overweight in older children are some emerging nutritional problems that may be the consequence of emerging patterns of the lifestyle and diet in response to social and cultural changes.

Ecchymoses: an unusual manifestation of toxocariasis in children.

OBJECTIVE: To investigate the aetiology of multiple ecchymoses associated with eosinophilia. SETTING: Professorial Paediatric Unit (PPU) at Lady Ridgeway Hospital (LRH) for children, Colombo. DESIGN: Prospective study from July 1998 to April 2000. MATERIALS AND METHODS: Patients admitted to the PPU with multiple ecchymoses associated with an absolute eosinophilia (> 1 x 10(9)/1) were investigated further to determine the possible aetiology; bleeding time, clotting time, platelet count, platelet function tests, stools examination and toxocara antibody tests were performed. Patients who were positive for toxocara were treated either with thiabendazole or albendazole. Patients who had geohelminth infestations were treated with mebendazole. RESULTS: 14 children (11 boys) were studied. 7 were between 1 and 5 years, and 7 were above 5 years of age. The mean eosinophil count was 4.3 x 10(9)/1. All patients had a prolonged bleeding time, but clotting time and platelet counts (mean value 220 x 10(9)/1) were normal. Platelet function tests were done in 5 patients. Twelve patients were positive for toxocariasis and the other 2 were positive for ascariasis. All children who were positive for toxocariasis had contact with pet cats or dogs. Six patients were treated with thiabendazole and 6 with albendazole. The two patients who had ascariasis were treated with mebendazole. Post-treatment mean eosinophil count was 0.63 x 10(9)/1, and the bleeding time was 4 minutes. CONCLUSION: Toxocariasis could present with ecchymoses due to an acquired bleeding disorder. Awareness of this would help to investigate, diagnose and treat early, and lessen parental anxiety.