Rotavirus infection in children hospitalised with diarrhoea in Sri Lanka.

Seasonal and clinical aspects of rotavirus-associated diarrhoea in 98 of the 326 children hospitalised for diarrhoea are described. Rotavirus infection was detected (30% overall) throughout the year from May 1980 to April 1981, but the prevalence was higher during the rainy season (40-50%). The age group in which rotavirus was detected most frequently was from 4 months to 2 years (34.6%). Watery diarrhoea and vomiting were significantly commoner in children with rotavirus diarrhoea (75% and 71% respectively) than those with non-rotavirus diarrhoea (54.2% and 60.8% respectively; p less than 0.05). Although about 15% of the children with rotavirus-associated diarrhoea showed blood or mucus in stools, the invasive nature of rotavirus infection cannot be drawn since the study did not include tests to detect other diarrhoeal pathogens.

The use of the Nabarro Thinness Chart in identifying children for nutrition supplementation in Sri Lanka.

This study compares the use of the Nabarro Thinness Chart with other nutritional screening tools among school children in Sri Lanka. It concludes that this method is a simpler, more precise approach to assess students requiring food supplementation in community programmes than others which are commonly utilized.

PIP: Since the aim of nutrition supplementation programs is to reduce morbidity and mortality and acutely malnourished children are at greatest risk, it is important to identify those children who are acutely malnourished. The Gomez chart does not distinguish, however, between those with chronic or acute malnutrition whereas the Nabarro chart only detects those with acute malnutrition. Therefore a pediatrician in Sri Lanka compared the weight for age chart of Gomez with the thinness chart of Nabarro in a hospital clinic and 2 community centers. The Gomez chart identified 82 children at the hospital clinic as needing food supplementation, but the Nabarro chart indicated that 54% were actually well nourished. Moreover 30% needed frequent supervision according to the Nabarro chart, but did not need food supplementation. At the 1st community center, none of the 14 children identified by the Gomez chart as needing food supplementation required food supplementation according to the Nabarro chart. The Gomez chart indicated that 13 children required additional nutrition at the 2nd community center, yet the Nabarro chart showed that only 3 needed nutritional supplementation. The percentage of false positives for the Gomez chart stood at 55%. Other researchers have shown that a portable Nabarro chart identified all 644 children in Africa who had a weight/height ratio of 80% of the reference and 5 additional children who had weight/height ratios between 80.2-83.3%. Others have deduced that the direction tendencies of error with using this chart still includes some children who may indeed not need supplementation. Since it permits public health workers in food supplementation intervention programs to use limited resources more effectively and efficiently, the Nabarro chart is preferable.

Management of febrile seizures in a developing country.

In the analysis of 128 patients with febrile convulsions, we identified hazards not encountered in the western world, which could alter the ultimate management of the child. These include administration of home remedies during the seizures, detrimental cultural beliefs and poor socio-economic conditions. All complex seizures in our series were initial seizures. Recurrent benign febrile seizures did not predispose to a complex seizure. Behaviour disorders were the most prominent side effect following long term phenobarbitone administration.

Martin-Bell syndrome fra(X) (q28) in a Sri Lankan family.

The Martin-Bell syndrome was observed in a family with six mentally retarded males, born to three sisters, who were of more than average intelligence. The males showed large ears, macrotestes, they were delayed in their development and had speech retardation. Five were pleasant and co-operative, while one had severe temper tantrums. The fra(X)(q28) was observed in the three males cytogenetically examined and in two of the three female potential carriers, who could be studied. It was expressed in 17-36% of the cells in the males cultured in 199 and in 5% and 39% in the two female carriers, studied under addition of methotrexate.

The advantages of breast-feeding: a developing country point of view.

PIP: One of the traditional practices related to child care which is undergoing the most rapid change in the 3rd world is breastfeeding. Concerned about the repercussions of this trend, the author reviews some important results of research carried out in developing countries on the advantages of breastfeeding for infants and their mothers, and notes some of the factors influencing 3rd World women in their choice of mode of infant feeding and the cost of bottle feeding to both national and family budgets. The importance of taking stock of the present situation and preventing its deterioration is underscored. Increased home and community support for women to breastfeed even when working outside the home, is especially needed.^ieng

Priorities for research in maternal nutrition in the developing world.

Two aspects of maternal nutrition are highlighted - an adequate weight at birth and successful lactation-as the outcome of satisfactory maternal nutrition. The following priorities for research are considered: 1. Prepregnancy weights and heights related to birth weight, height, skull circumference and placental weight. 2. Practical implementation of national supplementary feeding of pregnant mothers. 3. Support networks in pregnancy and lactation through the health care system. 4. Study of hypogalactia. 5. Assessment of lactation performance. 6. Lactational amenorrhoea. 7. Training of primary health care workers to improve maternal nutrition.

PIP: Minimum requirements for child survival in developing countries are adequate birth weight and successful lactation. Studies at the University Unit in Colombo found that of 1988 live births, 418 (21%) were 2500 gm; head circumference and crown heel length showed clear correlations with birth weight, at parities 3 there was a great proportion of low birth weight babies. Further research should study prepregnancy weights and height and weight gains in pregnancy, relating these to birth weight, height, and skull circumference and placental weight. Prenatal supplementation has been shown to improve birth weight although the best content and timing of the supplement are not clear. Lactation is on the decline in developing countries. In Sri Lanka it was found that the greatest number of breastfeeding failures occurred in the maternity wards since no encouragement or support was offered. Prediction of successful lactation and hypogalactia needs to be studied along with use of nutritionally at risk pregnancies. Since most maternal nutrition problems are specific to developing countries, studies that are simply designed are required in these areas.