Feeding patterns, diarrhoeal illness and linear growth in 0-24-month-old children.

The aim was to study the impact of simple healthcare interventions in 0-24-month-old children living in rural communities outside Lahore, Pakistan. Newborns belonging to four birth cohorts were followed monthly from 0-24 months of age living in rural communities. Three cohorts were from the same village: Cohort A (1984-1987), n = 485; Cohort B (1990-1992), n = 544; and Cohort C (1995-1997), n = 518. A fourth, Cohort D, was from neighbouring villages (1995-1997), n = 444. Findings from Cohort A formed the basis of a healthcare programme, including promotion of optimal breastfeeding practices, advice on oral rehydration therapy, and continued feeding during diarrhoea. The outcome measures studied were time of initiation of breastfeeding, feeding of prelacteals, exclusive breastfeeding, diarrhoeal illnesses, and postnatal linear growth. The median time of initiation of breastfeeding decreased from 47 to 3 h and exclusive breastfeeding increased from 5 per cent in Cohort A to more than 80 per cent in the subsequent cohorts, at 1 month of age. No prelacteals were given to 34 per cent of newborns in later cohorts compared with 100 per cent in Cohort A. Diarrhoeal illnesses during the first 6 months had reduced significantly. Postnatal linear growth improved by about 3 cm in the later cohorts. Appropriate changes in breastfeeding practices through integrated and focused healthcare, especially antenatally, can reduce diarrhoeal illnesses, and sustain and improve linear growth in young children.

Determinants of stunting at 6, 12, 24 and 60 months and postnatal linear growth in Pakistani children.

UNLABELLED: A "nested" case-control design was used to identify cases from a longitudinally followed cohort of 1236 newborns registered during 1984-1987, living in three socioeconomically different areas. The children had a length <-2SDS (standard deviation scores) at 6, 12, 24 and 60 mo of age using the NCHS reference. The controls were matched for gender, area and month of birth. A logistic regression analysis was used for determining the risk factors for stunting at each age. Postnatal linear growth was also examined in these two groups of children and body size was compared with the NCHS reference and that of upper-middle-class children (n = 240). At 6 mo of age, prematurity and duration of breastfeeding showed a significant association with stunting. At 12 mo, maternal height, birthweight and stunting at 6 mo, while at 24 mo, stunting at 6, 12 and 18 mo were identified as important factors. At 60 mo, no other factors besides previous stunting could be identified. The mean height reached at 60 mo showed a deficit of 6 and 13 cm for the controls and the cases, respectively, compared to the NCHS reference. Twenty-eight percent of the children from the two poor areas who were stunted at 6 mo had improved by 60 mo of age. CONCLUSION: The risk factors for stunting varied at different ages, relating more to feeding at early ages and to previous stunting, predominantly at higher ages. The linear growth showed that faltering increased with age when cases and controls were treated separately. Recovery from stunting could also be demonstrated.

Clostridium difficile toxic megacolon following splenectomy.

A case of toxic megacolon following splenectomy for lymphoma is presented. The aetiology of Clostridial difficile infection is reviewed and the hazards of perioperative prohylactic antibiotics are discussed.

Dental development, dental age and tooth counts. A prospective longitudinal study of Pakistani children.

A sample of 443 Pakistani infants from four different socioeconomic areas was followed longitudinally study the emergence of the primary teeth. The mean ages of emergence of the primary teeth, without regard what kind of tooth and dental ages of the primary teeth were calculated. The subjects showed no sexual dimorphism in the emergence times of the primary teeth. The children from poor areas. were ahead by statistically significant differences from upper middle class, for emergence of the primary teeth 17-20. On comparison with Swedish standards (Hägg & Taranger, 1985) Pakistani children are delayed, by a statistically significant difference, in the emergence of primary teeth 1-16, however, they were at par in the emergence of 17-20 primary teeth.

Timing of emergence of individual primary teeth. A prospective longitudinal study of Pakistani children.

Primary tooth emergence in Pakistani children was investigated as a part of a prospective interdisciplinary study of growth and development. The average order of emergence of the primary teeth was in agreement with previous studies from other countries. There was no sex difference in emergence of individual primary teeth. The emergence of the primary incisors and mandibular first molars in both sexes, and the canines in boys were significantly delayed compared to Swedish standards (Hägg & Taranger 1986).

The validity of estimated age in rural Pakistani children based on interviews with mothers and tooth counts of primary teeth.

Assessment of chronological age in children aged 6-30 months was made by obtaining information from uneducated rural Pakistani mothers and by means of counting the number of emerged primary teeth. There was found no statistically significant difference in the validity in age assessment between two methods. The average difference between true chronological age and perceived age was -0.8 months (SD 2.5 months) in boys, and 0.9 months (SD 3.9 months) in girls. The average difference between true chronological age and dental age was -0.4 months (SD 3.5 months) in boys, and 0.8 months (SD 4.8 months) in girls.