Value of different staging systems for predicting neurological outcome in childhood tuberculous meningitis.

BACKGROUND: The stage of tuberculous meningitis (TBM) at presentation is strongly associated with prognosis. OBJECTIVE: To compare different staging systems for TBM in predicting outcome. METHODS: The associations of different staging systems with neurological outcome were assessed using clinical, diagnostic and outcome data of 554 TBM children admitted to Tygerberg Children's Hospital from January 1985 to April 2005. RESULTS: The refined Medical Research Council (MRC) scale after 1 week (84%, 95%CI 81-88) had the highest discriminatory power in predicting neurological morbidity. The Glasgow Coma Score (GCS) on admission, GCS after 1 week, the 'refined' MRC scale on admission and Tygerberg Children's Hospital (TCH) staging method all had excellent discriminatory powers in predicting outcome. Improvement of staging after 1 week occurred in children who did not have signs of raised intracranial pressure (P = 0.004) or brainstem dysfunction on admission (P = 0.030). CONCLUSIONS: The 'refined' MRC scale 1 week after diagnosis showed the best association with neurological outcome after 6 months of treatment. The excellent discriminatory power of the TCH scale and its simplicity of use make it the ideal scale for use in resource-poor settings.

Adverse Social; Nutrition and Health Conditions in Rural Districts of Kwazulu-Natal and the Eastern Cape Provinces; South Africa

Objective: This study determined the socio-demographic; nutritional and health status of children and their caregivers in two rural districts in KwaZulu-Natal (KZN) and one rural district in the Eastern Cape (EC); South Africa. Design: A cross-sectional survey was conducted. Setting: The study population resided in Umkhanyakude (sub-district Jozini) and Zululand (sub-district Pongola) in KZN; and in OR Tambo (sub-district Nyandeni) in the EC province. Subjects: Children 0 to 59 months old (Umkhanyakude n = 398; Zululand n = 303; OR Tambo n = 364) and their caregivers were included.Methods: Structured interviewer-administered questionnaires were conducted and height and weight were measured.Results: Households in OR Tambo had less access to services (tap water 3; toilets 33); compared to Umkhanyakude (tap water 50;toilets 82) and Zululand (tap water 74; toilets 98). Wood was the main energy source used to cook food in all three districts ( 75).Grants were a main source of income (Umkhanyakude and Zululand 61; OR Tambo 55). Many households obtained vegetables from their own garden (Umkhanyakude and Zululand 30; OR Tambo 70). The households that reportedly had enough food available at all times (Umkhanyakude and Zululand 25; OR Tambo 17); were in the minority. The diarrhoea prevalence reported by the caregivers was high (Umkhanyakude 35; Zululand 24; OR Tambo 24). The prevalence of stunting was higher for children older than 12 months and varied between 22 and 26. The prevalence of overweight among children 0 to 23 months exceeded the prevalence of underweight. The prevalence of overweight and obesity among caregivers was high (Umkhanyakude 42; Zululand 60; OR Tambo 56).Conclusion: Concerted efforts are needed to address the adverse social; nutrition and health conditions in these districts

The targeting of nutritionally at-risk children attending a primary health care facility in the Western Cape Province of South Africa.

AIM: The aim of this study was to determine the practices of primary health care (PHC) nurses in targeting nutritionally at-risk infants and children for intervention at a PHC facility in a peri-urban area of the Western Cape Province of South Africa. METHODOLOGY: Nutritional risk status of infants and children <6 years of age was based on criteria specified in standardised nutrition case management guidelines developed for PHC facilities in the province. Children were identified as being nutritionally at-risk if their weight was below the 3rd centile, their birth weight was less than 2500 g, and their growth curve showed flattening or dropping off for at least two consecutive monthly visits. The study assessed the practices of nurses in identifying children who were nutritionally at-risk and the entry of these children into the food supplementation programme (formerly the Protein-Energy Malnutrition Scheme) of the health facility. Structured interviews were conducted with nurses to determine their knowledge of the case management guidelines; interviews were also conducted with caregivers to determine their sociodemographic status. RESULTS: One hundred and thirty-four children were enrolled in the study. The mean age of their caregivers was 29.5 (standard deviation 7.5) years and only 47 (38%) were married. Of the caregivers, 77% were unemployed, 46% had poor household food security and 40% were financially dependent on non-family members. Significantly more children were nutritionally at-risk if the caregiver was unemployed (54%) compared with employed (32%) (P=0.04) and when there was household food insecurity (63%) compared with household food security (37%) (P<0.004). Significantly more children were found not to be nutritionally at-risk if the caregiver was financially self-supporting or supported by their partners (61%) compared with those who were financially dependent on non-family members (35%) (P=0.003). The weight results of the nurses and the researcher differed significantly (P<0.001), which was largely due to the different scales used and weighing methods. The researcher's weight measurements were consistently higher than the nurses' (P<0.00). The researcher identified 67 (50%) infants and children as being nutritionally at-risk compared with 14 (10%) by the nurses. The nurses' poor detection and targeting of nutritionally at-risk children were largely a result of failure to plot weights on the weight-for-age chart (55%) and poor utilisation of the Road to Health Chart. CONCLUSIONS: Problems identified in the practices of PHC nurses must be addressed in targeting children at nutritional risk so that appropriate intervention and support can be provided. More attention must be given to socio-economic criteria in identifying children who are nutritionally at-risk to ensure their access to adequate social security networks.

Infestation with the sheep body louse (Bovicola ovis) in Merino lines divergently selected for maternal multiple rearing ability.

Data were obtained from a population consisting of 160 Merino ewes, as well as 64 male and 75 female progeny of these ewes at the 2-tooth age. The age and sex groups were maintained in separate flocks. The population has been divergently selected from the same base since 1986, either for (high or H line) or against (low or L line) maternal multiple rearing ability. All animals were inspected for sheep lice (Bovicola ovis) during September/October 2002 after a wool growth period of at least 4 months. When expressed relative to mean L-line performance, the advantage in lambs weaned per ewe during the lambing season amounted to approximately 110% in the H line (1.01 vs 0.48; P < 0.01). The proportion of animals on which 1 or more lice were observed were markedly lower in 2-tooth replacement ewes than in replacement rams and mature breeding ewes (0.053 vs 0.625 and 0.531, respectively; P < 0.01). One or more lice were observed on a lower proportion of H-line ewes than on those of the L line (0.413 vs 0.571, respectively; P < 0.10), while a similar tendency was observed in 2-tooth ewe hoggets (0.033 vs 0.143, respectively; P = 0.16). When the mean number of lice on individuals on which 1 or more lice were observed was compared between lines, the average number of lice observed on H-line young rams was lower than in the L line (4.36 +/- 0.85 vs 9.71 +/- 1.84 lice, respectively; P < 0.01). A similar tendency was observed in mature breeding ewes (2.15 +/- 0.38 vs 3.22 +/- 0.42 lice, respectively; P < 0.20). The more highly reproductive H-line ewes were not more susceptible to infestation with B. ovis than ewes of the L line. In fact, available evidence suggest that H-line animals could be more tolerant of B. ovis than those of the L line.

Iron status of South African women working in a fruit-packing factory.

OBJECTIVE: The aim of this study was to determine the iron status, and the risk factors for iron deficiency (ID) and iron-deficiency anaemia (IDA), of non-pregnant adult women working in a fruit-packing factory. DESIGN: A cross-sectional analytical study was done on 338 women, 18 to 55 years of age. Information on demographic data, risk factors for ID, smoking, and the consumption of red meat, chicken and fish was collected by questionnaire. Height and weight were measured and the body mass index (BMI) calculated. A non-fasting venous blood sample was analysed for haemoglobin (Hb), serum ferritin (SF), serum iron, serum transferrin and C-reactive protein; transferrin saturation (TFS) was calculated. SETTING: Fruit-packing factory in the Western Cape, South Africa. RESULTS: The mean value for Hb was 13.06 (standard deviation (SD) 1.16) g dl-1 and for SF 48.0 (SD 47.8) microg l-1 (geometric mean 26.44 microg l-1). Women were categorised on the basis of iron status: 60% had a normal iron status (NIS); 12.6% had low TFS (<16%) but normal Hb (>or=12 g dl-1) and SF (>or=12 microg l-1) concentrations (LTS); and 27.4% had low iron status (LIS), defined as combinations of low SF (<12 microg l-1 or <20 microg l-1), low TFS (<16%) and low Hb (<12 g dl-1). More than 30% of the women were obese The risk ratio for LIS (LIS vs. NIS) was 3.8 (95% confidence interval (CI) 1.9-7.6) if women were still menstruating or 3.2 (95% CI 1.6-6.2) if they were pregnant during the past 12 months. Women with LIS consumed significantly smaller portions of red meat, chicken and fish than did women in the other two groups. CONCLUSIONS: IDA (low Hb, SF and TFS) and ID (low SF and TFS) did not seem to be a major problem. Women who were still menstruating or were pregnant during the past 12 months were at greater risk for ID. The consumption of smaller portions of red meat, chicken and fish was related to LIS. A high prevalence of obesity, which demonstrated the coexistence of both under- and overnutrition, was observed.

Endometrial function in vervet monkeys (Cercopithecus aethiops): morphology, beta3 integrin and insulin-like growth factor binding protein-1 expression during the menstrual cycle and pregnancy in the normal and disrupted endometrium.

The expression of endometrial beta3 integrin and insulin-like growth factor binding protein-1 (IGFBP-1) was studied in cycling and pregnant vervet monkeys. There were clear changes of beta3 integrin expression during the menstrual cycle, with the strongest immunostaining observed on day 26. Moderate to strong expression was observed during pregnancy. The expression of IGFBP-1 during the menstrual cycle was weak but upregulated during pregnancy with moderate to strong staining. The administration of a single dose of onapristone at 10 mg/kg on days 17, 21 and 22 of the menstrual cycle, followed by a biopsy on days 22, 22 and 26, respectively, and during pregnancy (34-44 days menstrual age) 24 h before the biopsy, disrupted and desynchronized the endometrium. However, no effect on beta3 integrin expression could be observed and staining reflected the untreated patterns. The same applied to IGFBP-1 except that during pregnancy the expression of this protein was reduced or abolished. The results suggest that beta3 integrin is associated with endometrial receptivity in vervet monkeys and that IGFBP-1 plays an important role during pregnancy in this species. The administration of onapristone appeared to only influence IGFBP-1 expression. To our knowledge, this is the first time that these endometrial proteins have been investigated in vervet monkeys. This study should therefore contribute to improving our understanding of the reproductive function of this species.

The effect of adjuvant steroid treatment on serial cerebrospinal fluid changes in tuberculous meningitis.

Three recent studies found that corticosteroids improve clinical outcome and mortality in tuberculous meningitis (TBM), although the exact mechanism of action of the drug remains speculative. A number of reports on the effect of corticosteroids on cerebrospinal fluid (CSF) findings in TBM have been published, often with conflicting results regarding serial cell counts and protein levels. As part of a controlled, randomized trial on the effect of oral prednisone on outcome in childhood TBM at our institution, CSF was collected and analysed weekly during the 1st month of treatment. We found no significant difference in serial CSF cell counts between the steroid and non-steroid groups in the study. However, the steroid group had significantly lower CSF protein and globulin levels after the 1st month of treatment, and a more steady rise in CSF glucose levels than the non-steroid group. Knowledge of the different CSF responses during the course of anti-tuberculosis therapy is important in clinical decision-making.

Poor nutritional status in older black South Africans.

A cross-sectional analytical study was undertaken to describe the nutritional status and dietary intake of the elderly black population of Cape Town. A stratified proportional sample of 148 men and women aged 60 years and older (mean = 68.9+/-5.7) was selected from informal and formal peri-urban settlements. The study population was predominantly urbanized, although most subjects had migrated from non-urban areas. Trained fieldworkers conducted a 24-h recall dietary assessment and performed anthropometrical measurements. Mean energy intakes fell below the recommended dietary allowance (RDA) for both men and women; 27% and 36% of men and women, respectively, had energy intakes <67% RDA. Total fat intake was low and contributed 24-26% total energy. Mean dietary fibre intake was low at 11-16 g/day. Mean intakes fell below the RDA for vitamin D, calcium, zinc and vitamin B6. Less than two and a half servings per day were consumed from the vegetable and fruit group and less than one serving per day from the calcium-rich food group. Over half (51.3%) of the women and 18% of the male were obese (body mass index > or =30). We concluded that older black subjects in Cape Town have energy profiles in line with prudent dietary guidelines and more favorable than other elderly groups in the country, with regard to atherogenic risk. However, micronutrient and dietary fiber intake is inadequate, largely due to low reported energy intakes, particularly in women.

Serial lumbar CSF presure measurements and cranial computed tomographic findings in childhood tuberculous meningitits.

Intracranial pressure (ICP) was monitored in 218 consecutive children with hydrocephalus secondary to tuberculous meningitis (TBM). All children underwent cranial computerized tomographic (CT) scanning and continuous lumbar cerebrospinal (CSF) pressure monitoring on admission. Noncommunicating hydrocephalus (37 children), as determined by air encephalography, was treated by ventriculoperitoneal (VP) shunting and communicating hydrocephalus (181 children), by means of daily acetazolamide and frusemide. Response of ICP to treatment in the group with communicating hydrocephalus was assessed by means of repeated CSF pressure monitoring and CT scanning. One hundred and eighty-five of the 218 patients survived the 1st month of treatment. The aim of this study was the retrospective determination of (1) the relationship between ICP measurements and CT findings on admission and (2) the characteristics of the ICP recording which correlated best with the CT criteria of compensated hydrocephalus after the 1st month of treatment. No relationship was found between the level of baseline CSF pressure and the degree of hydrocephalus, as demonstrated by CT scanning, on admission. Seventy-five per cent of the patients with communicating hydrocephalus that survived the 1st month of treatment complied with the CT criteria for compensated hydrocephalus. All these patients had a baseline CSF pressure below 15 mmHg and absence of high-amplitude B waves on the pressure recording done at the end of the 1st month. In this study repeated lumbar CSF pressure monitoring proved to be an effective instrument to assess the response of communicating tuberculous hydrocephalus to medical treatment and also accurately predicted the timing of compensation of the hydrocephalus.

Distribution and potential biologic function of the thrombin receptor PAR-1 on human keratinocytes.

Thrombin has recently been shown not only to exert procoagulant activities, but also to induce mitogenic responses of different cell types involved in wound healing via binding to and cleavage of the thrombin receptor. In order to further explore these aspects of thrombin function, human keratinocytes (HaCaT cell line) were examined for their potential mitogenic responsiveness to thrombin and for the dependency of this process on the expression of the high-affinity thrombin receptor. Quiescent keratinocytes were stimulated in the mitogenic assay with alpha-thrombin and the thrombin receptor activating peptides TRAP42-55 (SFLLRNPNDKYEPY) and TRAP42-46 (SFLLR). A strong induction of cell proliferation was noted with alpha-thrombin, TRAP42-55 and TRAP42-46, but not with the "scrambled" peptide (FSLLR). These findings confirm that keratinocytes express the thrombin receptor and that the sequence of the first two amino acids of the generated neo-N-terminus are important for the activation of the receptor. Using cDNA fragments of the 5' coding sequence of the receptor, Northern blot analysis confirmed that HaCaT keratinocytes express the thrombin receptor. Expression of the receptor was also detected on normal human keratinocytes by immunohistochemistry and in situ hybridization. These data demonstrate the expression and biologic function of the human thrombin receptor on human keratinocytes, suggesting that thrombin, among other mediators, plays an important part in the orchestration of epidermal growth and repair processes.

A preliminary evaluation of a sheep blowfly trap in the Western Cape.

An insecticide-free sheep blowfly trapping system, utilising a synthetic lure, was evaluated at 4 localities in the Western Cape. Control sites, where no suppression was practised, were identified for each locality. The blowfly population was monitored for 48 hours monthly at each of the localities. Five to 7 suppression traps at the respective localities were identified for this purpose. Three to 10 traps were set monthly for monitoring in the control areas. Trapping resulted in the suppression (P < 0.01) of the Lucilia population at Caledon, where a large area of approximately 50 km2 was trapped. The suppression area of all the localities was < or =850 ha. At Elsenburg, blowfly numbers were low. There was a strong suggestion of a general reduction in the Lucilia numbers at this locality. Trapping failed to reduce Lucilia numbers at Tygerhoek and Langgewens. Lack of control over the influx of Lucilia from adjacent sheep-producing areas probably contributed to this result. The observed response at Elsenburg was probably due to its situation in a predominantly wine-growing area. Most of the blowflies recovered from the control traps during the month with the highest yield at the respective localities belonged to the genus Lucilia. The results obtained at Caledon and published reports suggest that large-scale trapping of Lucilia spp. may play a role in an integrated pest management system for blowflies.

Purification of mast cell proteases from murine skin.

Different subpopulations of mast cells are characterized by their abundant contents of either tryptase or in addition chymase. These two neutral proteases are found in mast cells and may thus hold a key to the understanding of mast cell dependent reactions. Such studies are however hampered by the lack of readily available supplies of chymase. We have therefore studied the simultaneous purification of both proteases from hairless moro hr/hr mouse skin, using a sequence of salt extractions and chromatographic separations. After three steps of extraction, a 13-fold purification with an 82% yield was obtained for tryptase and a 15-fold purification with a 90% yield for chymase. Further one step purification on conventional sephadex, sephacryl and octyl sepharose columns was unsatisfactory because of further protein contamination of the fractions. Heparin affinity chromatography caused a high loss of tryptase and residual protein contamination. Gradient elution on a benzamidine sepharose 6B column resulted however in a single, low yield (17.9%) tryptase peak and a broader, high yield (>90%) chymase peak, and a 34% yield high purity fraction. The proteases thus purified exhibited their typical inhibitor profile. On Western blot analysis and on autoradiography in the presence of the serine protease inhibitor diisopropylfluorophosphate (DFP), only one 28 kD molecule with chymase activity was identified, whereas a broad 32-38 kD band of tryptase monomers was noted. Taken together, these data show that, after salt extraction and a single benzamidine affinity chromatography step, both mast cell chymase and tryptase can be separated and in case of chymase also highly purified, allowing thus for the study of biological activities of this molecule.

Effects of a prudent diet containing either lean beef and mutton or fish and skinless chicken on the plasma lipoproteins and fatty acid composition of triacylglycerol and cholesteryl ester of hypercholesterolemic subjects.

In this two-phase crossover study, 39 hypercholesterolemic subjects followed a prudent diet with either lean red meat or fish and skinless chicken (treatment groups), and 13 subjects (reference group) followed their habitual diet. Fasting blood samples were analyzed for plasma total cholesterol, triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein one- and two-cholesterol, apolipoprotein-B, very low density lipoprotein cholesterol, and very low density lipoprotein TAG, and fatty acid composition of plasma TAG and cholesteryl ester (CE). Body mass and blood pressure were determined. Seven-day dietary records were kept once at baseline and twice during the treatment periods. Significant differences were observed in dietary intake between the baseline and treatment diets and between the two treatment diets. HDL-C (P < 0.05) and diastolic blood pressure (P < 0.01) were higher in patients on the red meat diet than in those on the chicken-fish diet. No other significant differences in lipoproteins were observed between the effects of the two treatment diets. The linoleic acid (%), eicosapentaenoic acid (%), and the eicosapentaenoic acid/arachidonic acid ratios in TAG and CE were higher (P < 0.01) in subjects on the chicken-fish diet than in those on the red meat diet. In conclusion, this study showed that the effect of two lipid-lowering diets containing either lean red meat or skinless chicken and fish on the atherogenic lipoproteins did not differ significantly. A prudent diet with skinless chicken and fish, however, had a more favorable effect on the fatty acid composition of the plasma TAG and the CE than did the lean red meat diet.

Evaluation of anxiolysis and pain associated with combined peri- and retrobulbar eye block for cataract surgery.

STUDY OBJECTIVES: To evaluate five different preoperative anxiolytic regimens in cataract surgery performed under regional anesthesia; to quantify the pain associated with combined peri- and retrobulbar injection (PRBI) of local anesthetic drugs; and to describe a technique of painless eye block. DESIGN: Randomized, double blind, placebo-controlled study. SETTING: Private clinic. PATIENTS: 376 ASA I and II patients presenting for cataract surgery. INTERVENTIONS: Patients were extensively briefed by the nursing staff on the various procedures. Of the 376 study patients, 136 preferred to have no anxiolytic drug. The remaining 240 patients were randomly allocated to one of six groups to receive either 3 mg of bromazepam, 6 mg of bromazepam, 0.5 mg of alprazolam, 1 mg of alprazolam, 5 mg of diazepam, or a placebo on a double-blind protocol. All patients received a standard combined peri- and retrobulbar eye block (PRBB) before surgery. MEASUREMENTS AND MAIN RESULTS: Anxiety at various stages of the procedure and PRBB were measured on visual analog scale (0-10). PRBB pain was compared with pain of intravenous (i.v.) cannula placement. On admission, anxiety of the 136 patients who preferred no anxiolytic premedication was significantly less than that of the 240 patients assigned to one of the six treatment groups (p < 0.05). There was no difference between the six treatment groups in reported anxiety before surgery (p > 0.05) except for Group 1 (3 mg bromazepam), where anxiety increased before and during PRBB administration (p < 0.05). In all six treatment groups, anxiety decreased significantly 30 minutes after medication was administered (p < 0.05). For the total group, 61.18% of patients reported more or equal pain associated with the placement of the 20-gauge i.v. cannula than by the PRBB. Of the patients who received medication, 94% stated that, should they require another eye operation, they would like the same anxiolytic treatment. No patient requested general anesthesia for their next operation or to be rendered unconscious for PRBB. CONCLUSIONS: 1. There was interpersonal variation in the level of preoperative anxiety. 2. In patients who were anxious, the anxiolytic drugs and placebo decreasedanxiety although the level of anxiety did not differ between the anxiolytic drugs or between placebo and the anxiolytic drugs. The only difference was in Group 1 patients (3 mg promazepam), who reported slightly increased anxiety before and during PRBB administration (p < 0.05). 3. Placement of the PRBB is less painful than the insertion of a 20 g i.v. cannula.

Effect of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis.

OBJECTIVE: To study the effect of highdose prednisone on intracranial pressure (ICP), cranial computed tomographic (CT) findings, and clinical outcome in young children with moderate to severe tuberculous meningitis (TBM). STUDY DESIGN: Prospective, controlled, randomized study. METHODS: Continuous lumbar, cerebrospinal fluid pressure monitoring and contrasted CT scanning were performed in 141 consecutive children with TBM at admission. All children were then randomly allocated to a nonsteroid group (71 children) or a steroid group (70 children) who received prednisone (first 16 children, 2 mg/kg per day; next 54 children, 4 mg/kg per day) for the first month of treatment. ICP monitoring and CT scanning were repeated regularly, and clinical outcome was assessed after 6 months of antituberculosis treatment. RESULTS: No statistically significant difference in ICP or the degree of hydrocephalus (as demonstrated by CT scan) was found between the steroid and nonsteroid groups after the first month of treatment. Basal ganglia infarcts developed in 16% of children in the steroid group and 24% in the nonsteroid group during the first month of treatment. Neither this incidence nor the eventual size of infarcts present at admission differed significantly between the two treatment groups. Single or multiple tuberculomas were seen on the first CT scans of 7 children (5%), whereas tuberculomas developed in 11 children (8%) at treatment. Both the response of the tuberculomas to treatment and the incidence of new tuberculomas were significantly improved by steroid therapy. Basal enhancement was also significantly less in the steroid group after 1 month of treatment. Steroids lowered mortality in stage III TBM significantly. Similarly, more surviving children in the steroid group had IQs of greater than 75 than did the those in the nonsteroid group. No significant difference was found in the incidence of motor deficit, blindness, or deafness. CONCLUSIONS: Corticosteroids significantly improved the survival rate and intellectual outcome of children with TBM. Enhanced resolution of the basal exudate and tuberculomas by steroids was shown by serial CT scanning. Corticosteroids did not affect ICP or the incidence of basal ganglia infarction significantly.

Response to an iron fortification programme in relation to vitamin A status in 6-12-year-old school children.

Plasma retinol and indices of iron status were measured in 148 school children (6-12 years) receiving a soup fortified with iron and vitamin C for a period of 15 weeks. The most significant change in serum iron (P = 0.0005) and transferrin saturation (P = 0.0002) was seen in subjects with plasma retinol > or = 40 micrograms/dl, while subjects with plasma retinol < 20 micrograms/dl showed no response. Serum ferritin improved most in the retinol categories < 40 micrograms/dl, suggesting that the absorption of iron was not impaired by marginal vitamin A status, but that it was rather the mobilisation of iron from stores that was affected. Changes in vitamin A status correlated positively and significantly with changes in serum iron (r = 0.37; P = 0.0001) transferrin saturation (r = 0.27; P = 0.004) and haemoglobin (r = 0.21; P = 0.03), but negatively with serum ferritin (r = -0.28; P = 0.003). The presence of marginal vitamin A deficiency in a community may limit the effectiveness of an iron intervention programme and vitamin A status should therefore also be considered when such programmes are planned.

The SASPREN primary care survey -- who consults the family doctor?

OBJECTIVE: To describe selected characteristics of patients consulting general/family practitioners in the Western Cape. DESIGN: A cross-sectional survey design was employed in which doctors completed a structured questionnaire during or immediately after each consultation. SETTING: Data were collected by family practitioners in private practice who were affiliated to the South African Sentinel Practitioner Research Network (SASPREN). PARTICIPANTS: All patients who had a face-to-face encounter with the doctor at his/her surgery. A total of 2 473 such encounters was included. MAIN OUTCOME MEASURES: Age, sex, race, method of payment and smoking status. RESULTS: Females outnumbered males in all race groups except blacks, where they comprised 48% of patients. Most patients were under the age of 14 years (23.3%) or between 25 and 44 years (33.3%). However, after the demography of the catchment population was taken into account, the highest utilisation of general practitioner services was found to be at extremes of age. This utilisation pattern was demonstrated in both sexes and all races. In relation to their distribution in the population, whites and Indians are over-represented in private practice while blacks and coloureds are under-represented. The bulk of patients (67%) pay for general practitioner services via some form of insurance (medical aid or benefit fund), but significant differences exist across race groups. In the case of blacks and Indians, the majority (72% and 64% respectively) of consultations are funded 'out of pocket'. An alarmingly high smoking prevalence was found in black and coloured men. In all race/sex groups smoking rates peak between 25 and 44 years. In this age group, 68.6% of black men and 73.3% of coloured men were current smokers. CONCLUSIONS: This study provides essential information on patients seen in family practice. Access to family doctor services in the Western Cape should be improved for blacks and coloureds. There is an urgent need for smoking cessation interventions in the region.

Serial CT scanning in childhood tuberculous meningitis: prognostic features in 198 cases.

Serial cranial computed tomographic (CT) scanning and intracranial pressure monitoring were performed on 198 children with stage II and III tuberculous meningitis. The aims of the study were to document the course of tuberculous hydrocephalus during medical and surgical treatment, as well as the prognostic significance of parenchymal changes in the brain as demonstrated by CT. Lumbar cerebrospinal fluid pressure was monitored continuously for a 1-hour period in all patients on admission and at weekly intervals in patients with communicating hydrocephalus for the 1st month of treatment. Cranial CT scanning was done on admission and repeated in survivors after 1 month and again after 6 months of antituberculous therapy. The raised intracranial pressure of 112 children with communicating hydrocephalus, as demonstrated by air-encephalography, was treated medically (with daily acetazolamide and furosemide) for 1 month. Thirty-one children with noncommunicating hydrocephalus were referred for immediate ventriculoperitoneal shunting. No significant difference was found in the eventual ventricular size or clinical outcome between the two treatment groups. Lumbar cerebrospinal fluid pressure changes in the children with communicating hydrocephalus closely followed changes in the degree of hydrocephalus during the course of treatment. The main cause of permanent neurologic disability was basal ganglia infarction, which occurred unilaterally in 21% and bilaterally in 10% of patients on admission and developed in a further 22% of children during treatment. A prominent subarachnoid space, which was seen on the CT scan of 36% of patients after the 1st month of treatment and which reverted to normal, probably relates to the poor nutritional state of these patients on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional status of 3-6 year-old African children in the Cape Peninsula.

A survey was conducted in the Cape Town metropolitan area in 1990 to determine the dietary intake and anthropometric status of 3-6 year-old African children (N = 163). Dietary data obtained from 24-hour recalls revealed that mean energy intake (5200 kJ) was low and that mean intakes of most nutrients fell considerably below the recommended dietary allowances (RDAs). The average diet included an adequate number of portions from the meat and cereal groups, but was inadequate with respect to the milk and fruit/vegetable groups when compared with the recommendations of the Department of Health Services and Welfare. The macronutrient energy distribution was within prudent dietary guidelines, with 28.1% of energy (E) being obtained from total fat, 63.7% from carbohydrate and 13.2% from protein. Anthropometric profiles expressed in terms of the National Centre for Health Statistics' (NCHS) standards, revealed evidence of growth retardation and wasting in this population, coexisting with emergent obesity. The development of a nutrition and health policy to address the problems of both deficit and excess represents a pressing challenge.

PIP: During the first quarter of 1990, Xhosa-speaking nurses interviewed mothers and took anthropometric measurements of 163 children 3-6 years old living in squatter and formal housing areas of Cape Town, South Africa, to determine the nutritional status of the children. 39% of the children received less than 67% of the recommended daily allowance (RDA) of calories (i.e., deficiency) and 3% received more than 120% of the RDA. Most children were deficient in calcium (80%), iron (77%), vitamin A (64%), riboflavin (52%), niacin (53%), vitamin B6 (58%), and vitamin C (76%). Most children received more than 120% of the RDA for folic acid (68%) and for vitamin B12 (63%). Milk consumption was low (median intake, 0.5 portion vs. 2-3 portions as recommended by the department of national health and population development guidelines). The diet was also deficient in vegetables and fruit intake (1.32 vs. =or 4 portions) and fat intake (2.5 vs. =or 4 portions). Children did receive adequate portions of meat and foods from the cereal group, however. Macronutrient energy distribution fell within prudent dietary guidelines: 28.1% of energy from total fat, 63.7% from carbohydrates, and 13.2% from protein. 44.8% of children had only 2 meals with more than 600 kJ. 15 children (9.2%) had only 1 meal. 27.6% were stunted. 7.7% were underweight. 7.9% were wasted. 20.1% were obese. The undernourished children and the obese children consumed a diet low in micronutrients. These anthropometric findings indicate a population in transition--acutely and chronically undernourished children coexisting with obesity. The overall findings suggest a need to develop a nutrition and health policy to address nutrient deficit and excess.

The food and meal pattern in the urban African population of the Cape Peninsula, South Africa: the BRISK Study.

A cross sectional dietary study, utilising the 24 hour recall method, was conducted among 983 African adults aged 15 to 64 years resident in the Cape Peninsula during 1990. An evaluation of the dietary intake pattern revealed a diet confined to a relatively narrow range of foods, but little evidence of nutrient-empty food intake. In terms of recommendations, insufficient dairy products and vegetables and fruits were consumed, while requirements for intakes of cereals and components of the meat and fat groups were met. Supper emerged as the main meal of the day, contributing most of the energy and was consumed by 89 pc of respondents. Between meal eating made a valuable contribution to total nutrient intake. The low intakes of dairy products and vegetables and fruits and the apparent move away from the traditional diet present particularly great challenges.