Operative treatment of acute complications of diverticular disease: primary or secondary anastomosis after sigmoid resection.

OBJECTIVE: To assess the comparative effects of two surgical regimens on the outcome of acute complicated diverticular disease. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 60 patients who presented with acute complicated diverticular disease. INTERVENTIONS: 28 patient were treated by sigmoid resection and a Hartmann operation, and 32 by resection with primary anastomosis and defunctioning stoma. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The severity of peritonitis and the amount of faecal contamination were similar in the 2 groups. 12 patients died (7 in the Hartmann group and 5 in the primary anastomosis group). There were 3 radiological leaks with no clinical implications in the primary anastomosis group. 6 patients in the Hartmann group and 5 in the primary anastomosis group required reoperations for intra-abdominal abscess or infection. 7 and 3 patients, respectively, developed dysfunction of their stomas, and 9/21 and 3/27, respectively, required a permanent stoma (p = 0.02, 95% confidence interval of difference 0.07 to 0.56). 3 patients in the Hartmann group developed anastomotic leaks after closure of their stomas, 1 of whom required reoperation but died. No patient developed an anastomotic leak after closure of the stoma in the primary anastomosis group. CONCLUSION: Both regimens are accepted treatments for patients with acute complicated diverticular disease, but because of the higher morbidity after the Hartmann procedure we prefer primary anastomosis with covering stoma.

Nutrition in agricultural development: land settlement in Coast Province, Kenya.

PIP: Coast Province is the third area of population concentration in Kenya with more than 1.8 million people at the time of the census in 1989. The region is economically underdeveloped relative to central and western Kenya. In response to a great demand for land, the government of Kenya has since 1963 parcelled out tracts of land in Coast Province among smallholder tenants. This paper reviews the settlement of land in the province during 1960-70 and the effects upon later household income, food production, and nutrition. Findings are based upon information gathered from 300 tenant households surveyed between August 1985 and September 1986 in the Ukunda, Mtwapa, and Roka-East schemes respectively established in 1962, 1968, and 1969, and 150 households in rural comparison locations visited during the same period. In all aspects studied, including living conditions, household resources and income, food self-sufficiency and consumption, and nutritional status of children, the settlement tenants were better off than the rural population. Further analysis determined that the relatively better nutritional status of tenant households is only partly due to increases in food production and agricultural income. Income from employment was also higher than that of the rural comparison population. Households with large farms generally realized larger incomes, but they also had much larger families and food consumption, and the nutritional status of young children was lower among those households.^ieng

Child malnutrition in poor smallholder households in rural Kenya: an in-depth situation analysis.

OBJECTIVE: To investigate the effect of seasonal changes on household food availability on the nutritional status of preschool children from rural households. DESIGN: Households with preschool children were randomly selected from a sampling frame developed from a census list. Data were collected each month or at intervals for 14 months using pre-coded questionnaires. SETTING: The study was carried out in Njoro division, Nakuru district, Kenya. SUBJECTS: Subjects comprised 41 preschool children (22 girls and 19 boys) aged between 18 and 36 months. Households with preschool children were listed from a census conducted earlier. A random sample of 45 subjects was selected, out of which 41 completed the study. INTERVENTION: Food consumption data were collected monthly using the 24-h recall method, and by the 3-day weighed record method during the peak of each season. Subjects were measured once each month, while length was measured at three intervals over the study period. RESULTS: Significant differences in intake of calcium, vitamin A, thiamin and riboflavin were observed between the lean and the post-harvest months, but not with energy, protein, fat, iron, niacin and vitamin C. There were no significant seasonal differences in mean weight changes, which were at the rate of 182 g/month. Mean length increased at a faster rate during the lean season compared to the postharvest months. 51% of the children were stunted during the lean season compared to 28% in the post-harvest months. CONCLUSION: The results indicate a seasonal influence on energy and nutrient intake among preschoolers from low income rural households in Kenya.

PIP: Between April 1992 and June 1993, in Njoro division within Nakurua district of the Rift Valley Province in Kenya, nutritionists conducted a study of 41 children aged 18-36 months from low income smallholder households with limited off-farm incomes in the four cooperative farms of Mutukanio, Kamwago, Sosio, and Kamwaura to examine the effect of seasonal changes on household food availability and on nutritional status of preschool children. During the entire study, energy and nutrient intake, on average, was fairly good. Seasonal changes appeared to have a significant effect only on calcium, vitamin A, thiamin, and riboflavin intakes. Specifically, the intakes for all the aforementioned nutrients were higher in the post-harvest season than in the lean season. In the lean season, green vegetables and beans were in short supply. Energy intakes were on average 82-89% of the recommended daily intakes during the entire study period. Significant seasonal differences in mean weight changes (rate of 182 g/month) did not occur. The children grew in length at a faster rate during the lean season than the post-harvest season (0.9 vs. 0.8 cm/month). Stunting was more common during the lean season than the post-harvest season (51% vs. 28%). These findings revealed that seasonal changes in the household food supply influences the growth of preschool children in low income households on cooperative farms in Kenya.