The use of child soldiers in war with special reference to Sri Lanka.

Throughout history, the involvement of children in military operations has been extensively documented. The issue of child conscription is multi-faceted, with very few medical but more sociological aspects, including terrorism, politics, economics, history, culture and religion amongst other factors. Many United Nations Instruments as well as the International Criminal Court have documented that child conscription is detrimental to a child's development, violates Child Rights, and is a war crime. Efforts by international bodies to address conscription as child abuse have failed since the process is undertaken by groups rather than individuals, and because the law has no access to the perpetrators. The background to a conflict in Sri Lanka and various ethno-religious and political factors are discussed. The role of the diaspora community, the internet and various fund-raising mechanisms for war are discussed. The history of child conscription and studies examining reasons and the tasks assigned to them as conscripts as well as abusive aspects, especially in relation to emotional abuse, neglect and physical harm, are discussed. Documentation of conscription as child abuse needing a definition including a new definition of 'suicide by proxy' is stressed. The importance of culture and history, and the manipulation of the idealistic mind are discussed in the context of 'setting the stage' for child conscription. The toy weapon industry and the real arms industry, especially small arms, are important in maintaining conflicts, especially in the developing world. The conflicts of interests of members of the UN Security Council and the 'peace-keepers' of the world is discussed.

Neonatal and post-neonatal mortality in the Galle district.

OBJECTIVE: To determine some factors associated with infant mortality. DESIGN: Descriptive study. SETTING: Galle district in Sri Lanka. SUBJECTS: 350 infant deaths of singleton births. MEASUREMENTS: Association between variables. RESULTS: Neonatal:post-neonatal death ratio was 3.2:1, and 62.3% (218) were early neonatal deaths. First day deaths comprised 28.6% (100); 67.8% (237) died at the Teaching Hospital. A high incidence (65.7%) of low birthweight (LBW) was noted. Mean birthweights of neonates and post-neonates were 1925 +/- 729 and 2520 +/- 620 gram respectively, and the difference between means was statistically significant (p < 0.001). LBW and related disorders were the major cause of death in 44% (154) of the total sample, and in 55.8% (149) of neonates. Infections were the commonest cause (55.8%) of death in post-neonates. Pediatric clinical assessment to differentiate small-for-dates (SFD) was not recorded in 90.3%. Statistically significant associations were found between the period of death (neonatal and post-neonatal) and the following variables: period of gestation (p < 0.001); birthweight (p < 0.001) and cause of death (p < 0.001). CONCLUSIONS: There was a high incidence of neonatal deaths and a high proportion of early neonatal deaths. About one-third of deaths occurred on the first day of life. Incidence of LBW was high. The major cause of death was LBW and related disorders in the total sample and in neonates. Assessment of SFD was not carried out in the vast majority of infants.

PIP: Information was collected from hospitals, government medical centers, private hospitals, and death registrations in Galle district, Sri Lanka, in order to ascertain the factors associated with infant mortality. Deaths were grouped as low birth weight (LBW), birth trauma, infections, congenital anomalies, convulsions, and miscellaneous. The sample included 350 deaths (185 male and 165 female). 38.6% (135 deaths) were preterm at under 37 weeks. 93.3% of term (126 infants) and 65.5% of preterm (141 infants) died in the neonatal period. In the analysis of 336 infants, 65.7% (221 infants) were LBW, and 26.8% were very LBW at under 1500 grams. 85.9% of LBW babies and 57.4% of normal weight babies died during the neonatal period. 89 (40.3%) of the LBW babies were delivered at term, and 48.9% were LBW. 43.7% of the 335 infants were born in hospitals. 73.4% of infant deaths occurred at the hospital during the neonatal period. 14.3% of deaths took place at home. 44% of mortality was attributed to LBW, and LBW and related disorders accounted for 55.8% of neonatal mortality. 57.8% of postneonatal deaths were due to infections. 28.6% of neonatal deaths occurred within the first 24 hours, and 62.3% (218) occurred during the first week. There is a statistically significant association between time of death and period of gestation, birth weight, and cause of death. The importance of birth weight for child survival has been observed in other districts and other studies in Sri Lanka. The mean birth weight of infants dying in the neonatal period was 1925 +or- 729 g. In the postneonatal period, it was 2529 +or- 620 g.

Long term survival in subacute sclerosing panencephalitis.

A case of subacute sclerosing panencephalitis (SSPE) with a long survival of 8 years is reported. Long term survival in SSPE has not been previously reported from Sri Lanka.

Wilms tumour associated with unilateral dysplasia of the iris.

We report a case of Wilms tumour associated with unilateral partial aniridia. Although Wilms tumour is known to be associated with bilateral aniridia, there is only one previously reported case associated with dysplasia of the iris.

Acute liver failure in a patient with hepatitis A infection on sodium valproate therapy.

An epileptic patient on sodium valproate therapy, who developed acute liver failure following acute hepatitis A infection is reported. The hepatotoxic effects of this drug, and the possibility of intercurrent infection precipitating the toxic effects are discussed.

An unusual case of fatal accidental paraquat poisoning.

Paraquat, a useful contact herbicide is now used in over 130 countries of the world, including Sri Lanka. The number of cases of accidental poisoning reported with paraquat is small, relative to instances of suicide. When a clear history is not available, accidental paraquat poisoning is sometimes difficult to diagnose. A 9-year-old boy was admitted to a peripheral hospital with a history of diarrhoea and vomiting. He later developed abdominal pain, subcutaneous emphysema and difficulty in breathing. Following transfer to a district hospital and then to a teaching hospital, poisoning with paraquat was suspected only on day 11 of the illness. On persistent questioning, on day 13 of the illness the child remembered that the day prior to the onset of illness, on his way from a shop, he felt thirsty and having found an empty bottle of Gramoxone (paraquat) on the wayside he used it to drink water from a water tank. The child died on day 17 and the histology of the lung showed typical changes of paraquat poisoning. This tragic episode emphasises the need for proper disposal of empty containers of all poisonous substances.

Norrie's disease in an Asian family.

Norrie's disease, a congenital progressive oculo-acoustico-cerebral degenerative condition, is a sex linked recessive disorder. Previously described as atrophia oculi congeneti, it is associated with bilateral pseudotumour of the retina, lens, and corneal opacities, and phthisis bulbi. Some patients develop progressive deterioration of mental function and hearing. We report a Sri Lankan family with typical features of Norrie's disease.

Bacterial contamination of the small intestine of infants with enteropathogenic Escherichia coli and other enteric infections: a factor in the aetiology of persistent diarrhoea?

The duodenal microflora was studied during the first week of diarrhoea in 40 infants with acute infectious diarrhoea of different aetiologies and compared with that in a convalescent group and a group in whom diarrhoea of known aetiology had persisted for more than 14 days after an acute onset. In the acute phase 16 of the 40 infants had more than 10(4) colony forming bacteria/ml, predominantly upper respiratory commensals. In over half of the infants infected with enteropathogenic Escherichia coli a faecal type flora was found in the duodenum. This flora included the enteropathogenic E coli serotype isolated from the stool in three quarters of cases. Infants with persisting diarrhoea had significantly more faecal type bacteria in the duodenum than either those with acute diarrhoea or the convalescent group. In addition, there was a significant further increase in Enterobacteriaceae in infants whose persistent diarrhoea occurred after infection with enteropathogenic E coli. Infections with enteropathogenic E coli may have a predilection for disturbing the duodenal microflora, which may contribute to the development of persistent diarrhoea.