Infant oral mutilation - a child protection issue?

Infant oral mutilation (IOM) is a primitive traditional practice involving the 'gouging out' of an infant's healthy primary tooth germs. This can lead to transmission of blood-borne diseases such as HIV/ AIDS, septicaemia and death. Other complications include eradication and/ or malformation of the child's permanent dentition. IOM is usually performed by village healers in low income countries as an accepted remedy for common childhood illness. The gingival swelling of the unerupted teeth is mistakenly thought to indicate the presence of 'tooth worms'. Crude methods to remove these are employed using unsterile tools. IOM has been reported in many African countries. More recently, some immigrants living in high income countries, such as the UK, have shown signs of IOM. Our aim is to raise awareness among clinicians about the existence of IOM practice being carried out among respective African immigrant groups. We encourage clinicians, particularly those working with paediatric patients to inform parents and carers of children with a history of IOM about the risks and consequences. As part of child safeguarding policies, dental practitioners and health care professionals should intervene if they are aware of any perceived plan that IOM is to be carried out in the future.

Comparison of Campylobacter jejuni genotypes from dairy cattle and human sources from the Matamata-Piako District of New Zealand.

AIMS: To identify the prevalence and types of Campylobacter jejuni carried by dairy cattle and the extent of overlap of these types with those causing disease in humans. METHODS AND RESULTS: Faecal samples from 410 dairy cattle were collected from 36 farms in the Matamata-Piako district in New Zealand. Campylobacter jejuni was isolated on all 36 farms, with a prevalence of 51% (95% CI 45-57) in dairy cattle and 65% (95% CI 58-72) in calves. Eighty-nine of these isolates were typed using Penner serotyping and pulsed field gel electrophoresis and were compared with 58 human C. jejuni isolates from people resident within this study area. CONCLUSIONS: Campylobacter jejuni were found in the faeces of over half of the dairy cows and calves examined. Twenty-one per cent of the bovine isolates and 43% of the human isolates formed indistinguishable clusters of at least one bovine and one human isolate. SIGNIFICANCE AND IMPACT OF THE STUDY: While a direct link between bovine isolates and human cases was not demonstrated, the finding of indistinguishable genotypes among C. jejuni isolates from bovine and human sources confirms that dairy cows and calves are a potential source of human campylobacteriosis. Barriers to separate bovine faecal material from the general public are therefore important public health measures.

An evaluation of the oral care given to patients when staying in hospital.

The aim of this preliminary clinical audit was to use the resource of patients attending medical or dental practices to conduct a survey into the experiences of those who had been hospital in-patients as to their opinion of the oral care provided. A self-completing questionnaire was used. All 33 respondents were unable to carry out their own oral hygiene for 21 different reasons. The period of this disability was at least one week for 51% and over three weeks for 12%. A total of 40% were full-denture wearers, 30% had their own teeth and partial dentures and 30% had natural teeth only. Fifty-two per cent were not asked if they required any assistance with oral care. None of the patients with full or partial dentures had them cleaned after meals. Of those with full dentures 80% did not have their dentures cleaned at night; the corresponding figures for those with partial dentures (60%) and those with their own teeth and no dentures (69%) showed a similar lack of care. Over 72% rated the oral care given in hospital worse than that which they were able to provide for themselves at home. As a result of this preliminary audit, an interface audit across all the hospitals and residential nursing homes of north and east Devon has been set up to investigate the provision of oral care and to set up procedures to address any deficiencies found. The conclusions from this preliminary audit reinforce recent research into the training of nurses in oral care which found that this was inadequate and that awareness of oral need was minimal.

A cross-sectional study of the oral healthcare instruction given to nurses during their basic training.

OBJECTIVE: To ascertain the current nurse training establishments' (NTEs') commitment to the teaching of oral care, and its coverage in nursing literature. DESIGN: Cross-sectional. SETTING: All NTEs in the UK for 1996/97 SUBJECTS AND METHODS: Self-completion questionnaire sent to all 162 Directors of Education of NTEs in the UK. MAIN OUTCOME MEASURES: A subjective assessment of the adequacy of the coverage of oral care in syllabi offered as part of nursing training; a subjective assessment of the relevance of literature recommended for student reading. RESULTS: 72% (117) responded. 27% (32) were post-registration NTEs not teaching oral care. The remaining 85 completed questionnaires were analysed. 79% (67) of these had no dental input; 75% (64) would welcome some. 28% (24) taught the use of an oral care assessment form; 38% (32) discussed dental plaque. 38% (32) had no exclusive lectures on oral care. Of 31 textbooks, only 1 had comprehensive coverage of the subject. The majority scored less than 25% on the assessment system. CONCLUSIONS: Many NTEs have oral care syllabus deficiencies. Students are recommended books which have insufficient information to provide an insight into oral care or dental disease. There would appear to be an urgent requirement for the nursing and dental professions to liaise in order to remedy this situation.

The role of care in nutrition -- a neglected essential ingredient.

PIP: The causes of poor child nutrition are undergoing a substantial re-assessment. Care consists of the actions necessary to promote survival, growth and development, involving household food security and health promoting behavior. Resources for improving care exist at the household level: income, food, time, attitudes, relationships, and knowledge. Care in terms of affection, emotional support, and effective allocation of resources with stability has a direct influence on child survival, growth, and development. The need for care of the young child is often greatest with cases of severe protein-energy malnutrition. Promoting breast feeding involves facilitation of breast feeding in the workplace and agreement by the food industry to ensure responsible advertising of infant and child feeding commodities. Care of school age children who are not coping in schools because of malnutrition requires an appropriate response, particularly for children who do not receive breakfast or are micronutrient deficient. In both developed and developing countries about 7% of children have some form of disability. However, on average only 2-3% of children are considered disabled by the community. Nutrition can do much to prevent disabilities and ensure that the disabled child is not at a disadvantage. Urban children from the age of 6 upwards will be vulnerable to shocks from lack of supervision and discipline/nurture, prostitution, drugs and poisoning. Care has to be provided in some form through other community institutions. Refugees and people in emergencies also require care because over the last 10 years the number of internally displaced people and refugees has grown in Africa and in the former Yugoslavia and Soviet Union. In Africa refugees and the displaced now number 20 million.^ieng

Agricultural strategies, food and nutrition: issues and opportunities.

Agricultural development in developing countries has not lead to significant improvements in the consumption and nutrition of poor people. One reason is that, in the design of policy and projects, consumption objectives have not been incorporated explicitly. Far greater understanding is required of the way rural people plan their strategies for obtaining household food; external assistance should build on these activities rather than undermine them. This has often occurred in the past. Five aspects of agricultural policy are considered which, if incorporated into planning and implemented, should lead to improvements in food consumption and nutrition. These are: first, a review of the way in which export crops should be introduced and promoted so that food security is not adversely affected; second, a discussion of the need to give greater attention to what are known as "minor" crops; third, a discussion of the importance of incorporating seasonality into planning; fourth, a review of the importance of women; and fifth, an examination of the ways in which crop breeding research should involve nutritional concerns. The paper concludes with some observations from Kenya whereby agricultural sector planning could incorporate nutritional objectives.

Cropping systems and household food security: evidence from three West African countries.

The following four articles describe several aspects of the complex yet basic processes of food production and consumption in African settings. Three elements in the picture stand out as subjects of current research and development action: traditional food crops, seasonality and women's activities. It is important that specialists enhance their understanding of those processes and the dynamic interrelations among particular elements, in the interests of improved nutrition and rural development.

Seasonal dimensions to rural porverty: analysis and practical implications.

This paper reports on a conference on seasonal dimensions to rural poverty. Presentations included specialised papers on climate, energy balance, vital events, individual tropical diseases, nutrition, rural economy, and women, and also multi-disciplinary case studies of tropical rural areas from the Gambia, Nigeria, Mali, Kenya, Tanzania, India and Bangladesh. While care is needed in generalising, the evidence suggested that for agriculturalists in the tropics, the worst times of year are the wet seasons, typically marked by a concurrence of food shortages, high demands for agricultural work, high exposure to infection especially diarrhoeas, malaria, and skin diseases, loss of body weight, low birth weights, high neonatal mortality, poor child care, malnutrition, sickness and indebtedness. In this season, poor and weak people, especially women, are vulnerable to deprivation and to becoming poorer and weaker. Seasonal analysis is easily left out in rural planning. When applied, it suggests priorities in research, and indicates practical policy measures for health, for the family, for agriculture, and for government planning and administration.