A survey on febrile seizures at the Lady Ridgeway Hospital for Children.

Objectives To evaluate demographic, clinical and management aspects of febrile convulsions. Method A prospective study was carried out on all children admitted to Lady Ridgeway Hospital with a diagnosis of febrile convulsions during June and July 2002. Children with a history of afebrile seizures and those with evidence of a neurodevelopmental deficit or central nervous system infection were excluded. Data was obtained from medical records and direct interview of parents/guardians of children with febrile convulsions using a pre-tested validated questionnaire. Results 330 children were admitted with febrile convulsions. Male to female ratio was 3:2. The mean age was 22 months. Approximately 25% had a history of febrile convulsions in first degree relatives. 25% had complex febrile seizures. 80% of seizures occurred within 24 hours of the onset of fever. 24 (7%) children received long term prophylaxis for recurring febrile convulsions. Upper respiratory tract infection was the commonest trigger factor. 48% of the parents/guardians did not have a satisfactory knowledge of first aid.

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.

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.