RESUMO
Objectives: To determine the prevalence and determinants of xerophthalmia among children aged 0-60 months . Methods: This cross-sectional study included 3571 children under 5 years of age from six villages and four periurban areas. Children with xerophthalmia were identified and severity graded using the WHO classification. The main outcome measures were sociodemographic, nutritional and comorbidity related risk factors of xerophthalmia. A pretested questionnaire carrying information on the above factors was administered to the caregivers. Univariate and multivariate binary logistic regression analyses were performed to examine the association of each of these factors with xerophthalmia. Results: The overall prevalence of xerophthalmia was of serious public health importance at 9.1%. Prevalence of both mild (night blindness, and Bitot’s spots) and severe forms (corneal changes) of xerophthalmia increased with age. Bitot’s spots and night blindness were the commonest manifestations. Rural dwelling, lower social class, maternal illiteracy and occupation outside home were significant antecedent socio-demographic risk factors on univariate analysis. Multivariate analysis revealed low intake of proteins and vitamin A containing foods as well as predominant maize diet to be significant dietary factors. Nutritional wasting and a preceding history of measles were significant comorbid determinants (P<0.05). None of the socio-demographic variables emerged significant on multivariate analysis. Conclusions: Vitamin A deficiency remains a significant public health problem in Aligarh district.The proximal factors in a child’s mileu viz nutrition and comorbidities were more significantly associated with xerophthalmia than the distal socio-demographic factors, thereby making a case for their cost effective prevention.The high magnitude of the problem calls for intensification of existing prophylactic measures in these areas.
RESUMO
OBJECTIVE: Typhoid fever is a major public health problem. A test which is simple, reliable and can be carried out in small laboratories is the need of the hour. We prospectively evaluated typhidot M and Diazo tests vis-à-vis blood culture and Widal test in children. METHODS: Patients aged 6 months to 12 years, having fever of more than four days duration with clinical suspicion of typhoid fever were enrolled. Patients in whom other diagnosis was made served as control. The tests under scrutiny were validated against blood culture and then all the four tests were evaluated among patients who presented in the first week of illness. RESULTS: Blood culture was positive in only 27.3 percent of the cases. Among these culture positive cases, typhidot M test had the highest sensitivity, specificity, PPV and NPV of 90 percent (95 percent CI = 74.4-96.5), 100 percent (95 percent CI = 90.1-100), 100 percent (95 percent CI = 87.5-100), and 92.1 percent (95 percent CI = 79.2-97.3) respectively. Diazo test ranked next with sensitivity, specificity, PPV and NPV of 86.7 percent (95 percent CI = 70.3-94.7), 85.7 percent (95 percent CI = 70.6-93.7), 83.9 percent (95 percent CI = 67.4-92.9), 88.2 percent (95 percent CI = 73.4-95.3) respectively. Among clinically suspected typhoid cases, the overall sensitivity, of blood culture, Widal, typhidot M, Diazo was 27.3 percent (95 percent CI = 19.8- 36.3), 64.6 percent (95 percent CI = 55.3-72.9), 89.1 percent (95 percent CI = 81.9-93.7), 80.9 percent (95 percent CI = 72.6-87.2) respectively. In the first week of illness, typhidot M showed the best sensitivity [86.2 percent (95 percent CI = 69.4-94.5)] followed by Diazo [79 percent (95 percent CI = 61.6-90.2)], Widal [41.4 percent (95 percent CI = 25.5-59.3)] and blood culture [31 percent (95 percent CI = 17.3-49.2)]. CONCLUSION: Both Typhidot M and Diazo are good screening tests for the diagnosis of typhoid fever. Typhidot M is superior to Diazo but the latter is more suitable to resource poor settings being economic and easy to perform.