Children in Juba, southern Sudan: the second and third years of life.

A prospective study of child health has been continued until the children were 36 months old. The mortality rate in the second year was 8.1%. The most common cause of death was chronic undernutrition. The 79 children suffered seventy-six episodes of faltering weight gain; 47 lost 0.5 kg, and most did not reach their former weight for 5 months. Marasmus complicated eighteen faltering episodes; three were fatal. Of 45 children remaining in Juba to their 36th month none had marasmus, and their health was improved. 15 of 53 children, mean age 2.25 years, showed developmental delay. After 10 months 7 showed continued delay. Hepatitis B seemed to be transmitted to the children from both mothers and other sources. Day-care centres can help chronically undernourished children, and health education should be directed towards the parents' capabilities.

Infants in Juba, southern Sudan: the first twelve months of life.

A prospective survey of child health in Juba has been continued till the infants were 12 months old. They were visited monthly or more often if unwell. During the second 6 months of life 6 died; these deaths added to the 9 which occurred in the first 6 months produced an infant mortality rate of 11.8%. Diarrhoea was the whole or a partial cause of 11 of the 15 deaths in the first year. Growth in length by 12 months was satisfactory but the mean weight of the study infants was then at the third centile for healthy girls. Head circumference at 12 months was below normal and poor development was associated with the smaller head circumferences. Supplementary feeding had been started for all babies by the 12th month but only 4 of 127 had been weaned. 30 documented attacks of diarrhoea took place before supplementary feeding was started, suggesting that water given to infants is often contaminated.

PIP: A prospective survey of child health in Juba has been continued until the infants were 12 months old. They were visited monthly or more often if unwell. During the second 6 month of life, 6 infants died; these deaths added to the 9 which occurred in the first 6 month produced an infant mortality rate of 11.8%. Diarrhea was the whole or a partial cause of 11 of 15 deaths in the 1st year. Growth in length by 12 months was satisfactory but the mean weight of the study infants was then at the 3rd centile for healthy girls. Head circumference at 12 months was below normal and poor development was associated with the smaller head circumferences. Supplementary feeding had been started for all babies by the 12th month but only 4 of 127 had been weaned. 30 documented attacks of diarrhea took place before supplementary feeding was begun, suggesting that water given to infants is often contaminated.

Neonatal tetanus: mode of infection, prevalence, and prevention in southern Sudan.

Neonatal tetanus affects 1 in every 82 and kills 1 in every 110 infants born in the town of Juba, southern Sudan. It is also an important cause of death in adult life both in southern Sudan and in many other regions of the developing world. One vehicle of infection could be the fine string-like roots used to tie the cord. To prevent neonatal tetanus governments and aid-giving agencies should distribute to women and midwives kits containing a sterile blade, a sterile ligature, two or three sterile adhesive dressings for the umbilical stump, and two or three sterile swabs.

Infants in Juba, Southern Sudan: the first six months of life.

A longitudinal survey of child health in Juba was done to secure data on which preventive schemes could be based. 223 pregnant women were identified in a systematic search of a district. 5 infants were stillborn and 10 were born prematurely. The mothers of 5 of the 10 premature infants had had acute malaria at or immediately preceding delivery. 2 of these premature babies later died from causes attributable to prematurity and therefore indirectly to the preventable maternal malaria. The causes of neonatal mortality included tetanus caused by cutting the cord with a blade of grass. Between the 1st and 6th month, 5 infants died of infective enteritis, 1 of bronchopneumonia, and 1 of pyrexia of undetermined origin associated with convulsions. Growth was much impaired by diarrhoea, which caused 85 attacks among 63 babies, and by lower respiratory infections, of which there were 119 among 74 of the babies. Skin and eye infections were also common. Removal of the unerupted canine teeth, believed to cure or prevent illness, caused much distress and some aspiration bronchopneumonia. Health education and improved hygiene and water supplies would greatly reduce the extent of morbidity and mortality.

PIP: A longitudinal survey of child health in Juba was done to secure data on which preventive schemes could be based. 223 pregnant women were identified in a systematic search of a district. 5 infants were stillborn and 10 were born prematurely. The mothers of 5 of 10 premature infants had had acute malaria at or immediately preceding delivery. 2 of these premature babies later died from causes attributable to prematurity and therefore indirectly to the preventable maternal malaria. The causes of neonatal mortality included tetanus caused by cutting the cord with a blade of grass. Between months 1-6, 5 infants died of infective enteritis, 1 of bronchopneumonia, and 1 of pyrexia of undetermined origin associated with convulsions. Growth was much impaired by diarrhea, which caused 85 attacks among 63 babies, and by lower respiratory infections, of which there were 119 among 74 of the babies. Skin and eye infections were also common. Removal of the unerupted canine teeth, believed to cure or prevent illness, caused much distress and some aspiration bronchopneumonia. Health education and improved hygiene and water supplies would greatly reduce the extent of morbidity and mortality.

Cause of anaemia in malaria.

51Cr studies showed that after complete eradication of malarial parasites erythrocyte life-span is reduced for 4-5 weeks and that the reduction is associated with the presence of complement-containing immune complexes on the red-cell surface. The rate of erythrophagocytosis in the spleen is increased during this period. 59Fe studies of erythropoiesis indicated a mild degree of marrow depression. A very important factor causing anaemia in malaria appears to be a complement-mediated immune process.

Toxocariasis: serological diagnosis by enzyme immunoassay.

An enzyme-immunoassay was developed to measure the concentration of serum antibody specific for the secretory antigens released by migrating toxocaral larvae. This technique was evaluated by testing sera from healthy UK adults, and from patients with and without toxocariasis. In 922 healthy adults, 2.6% were found to have elevated specific antibody levels. Elevated values were observed twice as frequently in males as in females but showed no significant regression with age between 20 and 65 years. Of 62 patients with non-toxocaral helminthic infections, all had antitoxocaral antibody levels within the range of values observed in healthy controls and had a mean level which was not significantly elevated. All of 13 patients with clinical toxocariasis had enzyme-linked immunosorbent assay (ELISA) antibody levels above the 100th percentiles of both the healthy population and the helminth-infected group and had a significantly high mean value (p less than 0.001) more than 12 times that of the healthy or infected controls. The high degree of sensitivity and specificity of the toxocariasis enzyme-immunoassay indicates that this new test should be useful in reference immunodiagnostic applications and in large-scale seroepidemiological surveys.