Traditional remedies in children around Eastern Cape, South Africa.

OBJECTIVE: To gauge the views of mothers and other caregivers on the use of traditional remedies in the community. DESIGN: Descriptive study. SETTING: Five health centres affiliated to the UNITRA, Faculty of Health Sciences. METHODS: Medical students administered a questionnaire to mothers and other caregivers. Areas covered included how commonly traditional remedies are used, experience with traditional remedies in children, reasons for use, how administered, and problems encountered. RESULTS: There were 103 respondents, 7.8% rated use of traditional remedies non-existent, 20.4% rated it as rare and the rest said it was common. 57.3% of the respondents had used these remedies in their children, and 83.1% of them said they would use them again. Only 20.7% of respondents reported problems with these remedies, including diarrhoea, vomiting, fever and death. The preparations used were known by only 40.7% of respondents. The remedies were administered by the mother and grandmother in 82.8% of cases; and were mainly given orally, by enema or by scarification. The amount administered varied from spoonful(s) up to 2.5 l. Children of all ages were given traditional remedies, usually for diarrhoea, fevers and constipation, or as prophylactics. These remedies were used because they are effective, available and safe, or due to customary beliefs and pressure from others. CONCLUSION: The use of traditional remedies in children is common in communities around Umtata. There is need to study the composition and activity profiles of commonly used preparations so as to develop appropriate management protocols in case of toxicity.

When is it herbal intoxication? A retrospective study of children admitted with herbal intoxication at Umtata General Hospital, South Africa.

OBJECTIVE: To establish the profile and fate of children admitted with a "herbal intoxication" label. DESIGN: Retrospective cross sectional study of records for all children admitted with "herbal intoxication" for the years 1998 to 2001 inclusive. SETTING: The Paediatrics Department at Umtata General Hospital, the main teaching hospital for the University of Transkei Faculty of Health Sciences. MAIN OUTCOME MEASURES: Demographic profile, herbal medication history and clinical progress and fate of children admitted with "herbal intoxication". RESULTS: There were 156 case records for the period under review. The age range was a few days to 12 years, being neonates 30 (19.2%); one to six months, 77 (49.4%); seven months to one year 34 (21.8%); one to five years, 11 (7.0%); five years and older, four (2.6%). The reasons for giving the herbal preparations were stated in only 52 cases (33.3%), of which five were for diarrhoea and vomiting, four for constipation and abdominal pain, three to change stool colour, and 41 for "playte" (generic term given to all types of ill health). The preparations were administered orally (n=95), by enema (n=12), and both orally and by enema (n= 12), while route of administration was not stated in 37 of the cases. Sixty eight (43.6%) of the children died, 84 (53.8%) improved, while the fate of four (2.6%) was not indicated. Most of the deaths (63.2%) were among the zero to six months age group, and most deaths occurred within two days of admission. The average duration of stay (days) in hospital was 2.94 +/- 0.65 (range 1 to 39) for the group that succumbed and 8.88 +/- 0.73 (range 1 to 40) for the survivors (p < 0.001). CONCLUSION: There is a high mortality rate among children admitted with suspicion of herbal intoxication, and there is need to manage such children with vigilance.

Prostaglandin E2 is raised in kwashiorkor.

OBJECTIVE: Infection is a common occurrence in children with kwashiorkor. It has been suggested that infection in kwashiorkor results from immune depression, and that the immune depression of kwashiorkor is caused by a diet-associated elevation of prostaglandin E2 (PGE2). The purpose of this study was to determine whether levels of PGE2 are abnormal in children with kwashiorkor. SETTING AND SUBJECTS: Plasma PGE2 and plasma proteins were measured in children admitted with oedematous kwashiorkor, and compared with PGE2 in children with cerebral palsy. RESULTS: Plasma PGE2 was higher in children with kwashiorkor than in control children (7.25 +/- 3.5 v. 3.51 +/- 1.59, P < 0.01). Within the kwashiorkor study group there was a significant negative correlation between log-transformed serum PGE2 and total plasma protein (r = -0.59, P < 0.001), plasma albumin (r = -0.63, P < 0.001), weight-for-age (r = -0.37, P < 0.05), and height-for-age (r = -0.37, P < 0.05). The difference in mean values of PGE2 in children with kwashiorkor who recovered from the illness and those who died was not significant (7.1 +/- 2.6 v. 9.1 +/- 4.8, P = 0.36). CONCLUSION: Significantly higher PGE2 levels in children with kwashiorkor provide adequate reason for the depression of immune function known to occur in these children. Elevated PGE2 levels may also be implicated in other components of the illness.

Serum free carnitine levels in children with kwashiorkor.

OBJECTIVE: To determine the serum free carnitine concentration in normally nourished children and in children with kwashiorkor and to relate the carnitine concentration to the ability to oxidise exogenous long chain fatty acids in the body. STUDY DESIGN: A cross-sectional comparative study of two age-matched groups. SUBJECTS: Forty seven children with kwashiorkor and 47 age-matched normally nourished children. MAIN OUTCOME MEASURES: Fasting blood samples were enzymatically analysed for free carnitine levels. 13C labelled hiolein was administered orally and the recovery of 13C from the breath air was monitored after administration of the feed. The cumulative per cent dose (CUMPD) recovery of 13C 16 hours after the ingestion of labelled hiolein was determined. RESULTS: Normal children had significantly higher free carnitine concentrations (mean = 60.7 mumol/l; 95% confidence interval of the mean = 42.7-77.8) than the kwashiorkor children (mean = 16.5 mumol/l; 95% confidence interval of the mean = 11.3-19.8)(p < 0.001). There was no correlation between serum free carnitine concentration and serum albumin in kwashiorkor subjects, but there was a significant correlation between serum free carnitine concentration and the degree of weight loss as indicated by the weight: weight for age and sex ratio. The greater the weight loss, the lower the serum carnitine concentration amongst the kwashiorkor children (r = 0.46; p < 0.01). There was a linear relationship between serum free carnitine and hiolein oxidation (r = 0.89; p < 0.001). CONCLUSION: There is carnitine deficiency in kwashiorkor, and that the impaired lipid oxidation in kwashiorkor is related to this deficiency.