Health status of primary schoolchildren in Sri Lanka.

OBJECTIVE: To assess health status of 9-10-year old school children in Sri Lanka. DESIGN: A cross-sectional, descriptive study. Schools were selected to obtain a sample representative at national and provincial levels and 20 children were randomly selected from Grade 5 classes in each school. MEASUREMENTS: Children were examined for Bitot's spots and goitre. Height, weight, and visual acuity were measured according to standard procedures. Haemoglobin level was measured using finger-prick blood and a HemoCue meter. Geohelminth infections were quantified by faecal examination using the modified Kato-Katz technique. Height for age Z-scores (HAZ) and body mass index (BMI) were calculated as indicators of nutritional status. RESULTS: Two thousand five hundred and twenty eight children (1351 boys) from 144 schools (140 state schools and four private schools) were examined. Nationally, 15.5% of children were stunted (HAZ lower than -2.0 SD); 52.6% were thin (BMI < 5th centile of age- and sex-matched reference population); 3.1% were overweight (BMI > 85th centile); 12.1% were anaemic; 0.3% had Bitot's spots; 3% had a visible or palpable goitre; 4.6% were shortsighted; and 6.9% had one or more soil-transmitted nematode infection. Among children on whom anthropometry, haemoglobin and faecal examinations were all done, 64.6% (1332/2063) were thin, stunted, anaemic or infected with worms. A much higher proportion of children in the Northern and Eastern provinces had health problems when compared to the other provinces. CONCLUSIONS: The majority of older primary schoolchildren in Sri Lanka are undernourished. Anaemia, vitamin A deficiency, iodine deficiency and soil-transmitted nematode infections affect a much smaller proportion of them.

Coconut fat and serum lipoproteins: effects of partial replacement with unsaturated fats.

The aim of the present study was to examine the effect of reducing saturated fat in the diet, or partly replacing it with unsaturated fat, on the serum lipoprotein profile of human subjects. The study had two intervention periods, 8 weeks (phase 1) and 52 weeks (phase 2). In phase 1, total fat was reduced from 31 to 25% energy (polyunsaturated fatty acids (PUFA):saturated fatty acids (SFA) ratio increased from 0.2 to 0.4) by reducing the quantity of coconut fat (CF) in the diet from 17.8 to 9.3% energy intake. In phase 2, subjects were randomised to groups A and B. In group A total fat was reduced from 25 to 20% energy (PUFA:SFA ratio increased from 0.4 to 0.7) by reducing the quantity of CF in the diet from 9.3 to 4.7% total energy intake. In group B, the saturated fat content in the diet was similar to group A. In addition a test fat (a mixture of soyabean oil and sesame oil, PUFA:monosaturated fatty acids ratio 2) contributed 3.3% total energy intake and total fat contributed 24% energy intake (PUFA:SFA ratio increased from 0.7 to 1.1). At the end of phase 1, there was a 7.7% reduction in cholesterol (95% CI -3.6, -12.2) and 10.8% reduction in LDL (95% CI -4.9, -16.5) and no significant change in HDL and triacylglycerol. At the end of phase 2, the reduction in cholesterol in both groups was only about 4% (95% CI -12, 3.2) partly due the concomitant rise in HDL. The reduction in LDL at 52 weeks was significantly higher in group B (group A mean reduction 11%, 95% CI -20.1, -2.0 and group B mean reduction 16.2% 95% CI -23.5, -8.9). In phase 2, triacylglycerol levels showed a mean reduction of 6.5% in group 2A and a mean increase of 8.2% in group 2B. The reduction of saturated fat in the diet is associated with a lipoprotein profile that would be expected to reduce cardiovascular risk. The reduction of dietary saturated fat with partial replacement of unsaturated fat brings about changes in total cholesterol, HDL- and LDL-cholesterol that are associated with a lower cardiovascular risk.

The effect of tobacco smoking and of betel chewing with tobacco on the buccal mucosa: a cytomorphometric analysis.

The effect of tobacco use on the buccal mucosa has been assessed by cytomorphometry. Cell and nuclear diameters (CD, ND) of exfoliated oral squames were measured in tobacco smokers (S), betel chewers with tobacco (C) and those with a combined habit (S+C). Non-users (NU) served as controls. The mean CD values in S, C, S+C and NU were: 50.8 (+/-0.47), 49.39 (+/-0.48), 49.12 (+/-0.47) and 51.87 (+/-0.76) microm, and the mean ND values were: 8.83 (+/-0.07), 8.61 (+/-0.08), 8.72 (+/-0.10) and 8.33 (-/+ 0.09) microm, respectively. The least significant difference procedure (LSD at P=0.05) showed a significant reduction for CD in C and S+C and an increase for ND in all three habit groups, compared to the controls. This study shows that the use of tobacco influences the cytomorphology of the normal buccal mucosa. Betel chewing with tobacco influences the ND and CD, while smoking influences only the ND.

Diagnosis of oral premalignant and malignant lesions using cytomorphometry.

In this study cytomorphometry has been applied to smears collected from the buccal mucosa. Normal cells and the cells collected from lesions with no dysplasia, dysplasia and squamous. cell carcinoma were differentiated using discriminant analysis based on nuclear and cell diameter values. Cytomorphometrically the dysplastic and malignant cells were well discriminated from the normal cells. A sensitivity of 89%, specificity of 89.7%, positive predictive value of 80% and negative predictive value of 94.4% were obtained when comparing non-dysplastic lesions with dysplastic lesions.

Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma.

Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa (n = 40); Group 2: lesions with no epithelial dysplasia (n = 58); Group 3: lesions with epithelial dysplasia (n = 27); and Group 4: SCC lesions (n = 51). The mean CD and ND values were: Group 1: 51.78 (+/- 0.11) and 8.36 (+/- 0.49); Group 2: 45.73 (+/- 0.16) and 8.31 (+/- 0.68); Group 3: 41.32 (+/- 0.13) and 9.04 (+/- 0.46); Group 4: 38.58 (+/- 0.11) and 10.10 (+/- 0.56) microns, respectively. Correlation between the ND and CD was positive for Group 1 (r = 0.78, P < 0.05) and Group 2 (r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences (P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different (P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.

First trimester feeding in a rural Sri Lankan population.

One hundred Sinhalese mothers with infants at three months age in a rural population in Central Sri Lanka were interviewed by questionnaire on the feeding of their infants from birth to 3 months of life. 96% of babies were being breast fed at 3 months age. However, 32% have already been started on formula. Of this 32, eight mothers were from poor families receiving state subsidies. 20 of the 32 were giving expensive formulas made by multinational companies, (including four of the eight mothers receiving state subsidies and feeding formula) in spite of the availability of cheap comparable state subsidized formulas. In rural Sri Lanka only about a quarter have access to drinking water but 96% were giving water or other weak nutritional solutions at 3 months of age. 72% were using bottles for feeding. 77% were being given sugar and, 13% salt through non-milk solutions while 11% were getting sugar through their formula. Maternal employment, increasing maternal age, less than sixteen hours of maternal contact time per day with child, delay in initiation of breast feeding after birth were all significantly associated with a higher risk of formula feeding. A lower birth order and early initiation of breast feeding after birth were associated with a higher risk of babies being fed on non-milk solutions. In the light of these findings it is suggested that the time is now opportune for the National Nutritional Programme to shift its present emphasis from the promotion of breast feeding in these (and similar) areas to the promotion of exclusive breast feeding in the early infant's diet, while discouraging formulas, non-milk solutions, weaning foods, salt, sugar and the use of the bottle as a feeding utensil.