Nutritional status of children under five in three state foster care institutions in Sri Lanka

This study evaluated the prevalence of protein energy malnutrition (PEM) in children under five years (n = 52), in three randomly selected, State operated foster care institutions in Sri Lanka. The prevalence of PEM, was (51.9%), underweight (63.5%) and wasting (25.0%) was found to be considerably higher than the national prevalence (13.5%, 29.4%, 14.0%, respectively). Based on this preliminary evidence, it is recommended that a study representative of all institutionalised children in both State and private facilities be conducted to identify deficiencies and recommend improvements to institutional care in Sri Lanka.     

An attempt to measure burden of disease using disability adjusted life years for Sri Lanka

INTRODUCTION: Disability adjusted life years (DALY) is a measure of burden of disease (BOD) that assesses the years of healthy life lost due to disease or illness. OBJECTIVE: The main objective of the study was to develop a draft measure of the BOD in Sri Lanka, using DALY. METHODS: Computation was done for 100 disease categories identified to reflect the disease pattern in Sri Lanka. Factors that were considered for the calculation of DALY were incidence, degree of disability, duration of the illness and age of onset. RESULTS: Injuries, ischaemic heart disease, asthma, disease of the pulmonary circulation and burns contribute to 55% of BOD in Sri Lanka. CONCLUSION: The highest burden was due to non-communicable diseases, as their duration and degree of disability are high. Diseases such as malaria, which are short term illnesses with low disability, although affecting large numbers, did not give a high value for DALY.     

Zinc and vitamin A supplementation in Australian Indigenous children with acute diarrhoea: a randomised controlled trial

OBJECTIVE: To evaluate the role of zinc and vitamin A supplementation in the recovery of Indigenous children hospitalised for acute diarrhoea. DESIGN: A randomised controlled 2 by 2 factorial trial of supplementation with zinc and vitamin A. SETTING AND PARTICIPANTS: Aboriginal children (aged < 11 years) hospitalised for acute diarrhoea at Alice Springs Hospital, Northern Territory, April 2001-July 2002. MAIN OUTCOME MEASURES: Duration of diarrhoeal illness; re-admission for diarrhoeal illness within 120 days. RESULTS: Our study involved 392 Aboriginal children with 436 episodes of diarrhoea. Supplementation with zinc, vitamin A, or combined zinc and vitamin A had no significant effect on duration of diarrhoea or rate of re-admission compared with placebo. Median diarrhoea duration after starting supplementation was 3.0 days for the vitamin A and zinc supplemented and placebo groups (P values 0.25 and 0.69, respectively). The number of re-admissions did not differ significantly between those receiving vitamin A or zinc and the relevant placebo groups (relative risk [95% CI], 1.2 [0.7-2.1] and 1.3 [0.8-2.1], respectively). CONCLUSION: Vitamin A and zinc supplementation may not be indicated for in-hospital management of acute diarrhoeal disease in Aboriginal children living in remote areas. This finding may not apply to children with malnutrition, for whom other studies suggest a benefit. Larger trials incorporating more comprehensive data on the vitamin A and zinc status as well as nutritional status of study populations might help to explain the different results in different populations.     

Effect on clinical outcome of breast feeding during acute diarrhoea

The effects of oral rehydration fluid alone and of oral rehydration fluid plus breast feeding on the course and outcome of acute diarrhoea were assessed in two groups of 26 children aged under 2 years. Children who continued to be breast fed during treatment with oral rehydration solutions passed significantly fewer diarrhoeal stools. They also passed, on average, a smaller volume of diarrhoeal stools and recovered from diarrhoea sooner after the start of treatment. Their requirement for oral rehydration fluid was significantly reduced. Breast feeding exerts a beneficial effect on the course and outcome of acute diarrhoea by reducing the number and volume of diarrhoeal stools.     

Nutritional status of schoolchildren in an urban area of Sri Lanka

BACKGROUND: As in many other Asian countries, Sri Lanka is in the phase of a rapid demographic, nutritional and epidemiological transition. As a result dietary habits and lifestyle are changing. These have led to new health problems in the region. Childhood overweight and obesity are examples of such problems. OBJECTIVE: To provide information on the nutritional status of 8-12 years old schoolchildren in an urban area of Sri Lanka. SUBJECTS AND METHODS: Seven schools situated in the city of Colombo were randomly selected. They showed a fair representation of children of all social levels. Fifty students from each grade (years 4, 5, 6, 7) of each school were randomly selected. Their height was measured using a stadiometer to the closest 0.1cm and weight measured using an electronic weighing scale (Seca, France) to the closest 100 g. Calibration was checked with a standard weight at each 25 measurements. Information regarding behaviour, feeding practices and socioeconomic factors were obtained by a questionnaire filled by the parent or the guardian. To define obesity and overweight, sex and age specific body mass index (BMI) criteria recommended by the International Obesity Task Force (IOTF) were used. The age and sex specific BMI 5th percentile from revised NCHS (2000) growth charts were used to define thinness. Weight and height Z score of less than -2 from the median of height for age and weight for age derived using the ANTHRO software (CDC, USA) were used to define stunting and underweight respectively. Data were analysed using Epilnfo 2000 (CDC, USA) computer package. RESULTS: Anthropometric data of 1 224 children (48% boys), and feeding practices and behaviour pattern data of 1 102 children (44% boys) were analysed. Obesity prevalence among boys (4.3%) was higher than in girls (3.1%). The prevalence of thinness was 24.7% in boys and 23.1% in girls. 5.1% of boys and 5.2% of girls were stunted. 7.0% of boys and 6.8% of girls were underweight. 66% of obese children and 43.5% of overweight children belonged to high-income category (monthly family income more than Rs. 20,000). Apart from family income, behaviour patterns did not significantly influence the nutritional status. CONCLUSIONS: Although the data are not representative of the entire country, nutritional transition is evident in the city of Colombo. Obesity and overweight in older children are some emerging nutritional problems that may be the consequence of emerging patterns of the lifestyle and diet in response to social and cultural changes.     

Loa loa in a Sri Lankan expatriate from Nigeria

A worm was extracted from the subconjunctival space of the left eye in a 14-year old Sri Lankan girl, who returned to Sri Lanka in 1983 after spending six years in Nigeria. It was identified as a male Loa loa. A history of evanescent (Calabar) swellings was obtained. She also had significant eosinophilia. Microfilariae were not detected in the blood. This is the first case of Loa loa infection reported from Sri Lanka.     

Clinical features,risk factors and efficacy of cryotherapy in cutaneous leishmaniasis in Sri Lanka

INTRODUCTION: The first autochthonus case of cutaneous leishmaniasis in Sri Lanka was reported in 1992. Several case reports from different parts of the island have been documented. The case incidence has increased in the recent past. OBJECTIVES: To determine the clinical patterns, risk factors and efficacy of cryotherapy for cutaneous leishmaniasis in Sri Lanka. PATIENTS: Sixty-five patients with cutaneous leishmaniasis. DESIGN: Prospective study. SETTING: Department of Parasitology, Faculty of Medicine, Colombo. METHODS: Direct smears prepared from lesion aspirates or punch biopsies were stained and examined for Leishmania sp. All patients with positive smears were included in the study. A pre-designed questionnaire was completed based on clinical evaluation, and the patients were treated and followed up regularly. Investigations were repeated on day 14 and day 90 depending on the response to treatment. RESULTS: Lesions were non-tender, non-itchy papules (early lesions), scaling single nodules or dry crust forming single or multiple ulcers. Young adult males with outdoor behavioural characteristics were mostly affected. Other risk factors were close proximity to jungles, potential reservoir hosts in the environment, lack of awareness and inadequate knowledge and use of preventive measures. Compliance rate for cryotherapy was 40%. The need for frequent hospital visits, the long course of treatment, limited availability and undesirable side effects were identified as reasons for poor compliance. Smear positive rate on day 14 after treatment was 89%. CONCLUSIONS: Cutaneous leishmaniasis is now an established disease in Sri Lanka. Raising public awareness, early diagnosis, definite species identification, availability of proper treatment methods and vector studies are important for its effective control.     

Bacterial enteropathogens isolated in childhood diarrhoea in Kuala Lumpur--the changing trend

A retrospective review of all stool samples obtained from children aged < 16 years with diarrhoea from University of Malaya Medical Centre (UMMC), Kuala Lumpur, from 1978 to 1997 was undertaken to ascertain the pattern of bacterial pathogens causing diarrhoea in children in an urban area in Malaysia. Of 26444 stool samples processed, 2989 (11%) were positive. The five most common bacterial pathogens isolated were non-typhoidal Salmonella (57%), enteropathogenic E. coli (EPEC) (14%), Shigella spp. (11%), Campylobacter spp. (5%) and Aeromonas spp. (4%). There was a significant reduction in the average percentage of positive isolation during the last 5 years of the study period as compared to the first 5 years (15.0% vs. 7.2%; r = -0.92, p = 0.0001). EPEC and Shigella spp. were less commonly isolated in the last five years compared with the first five years of the study (6% vs 21% p < 0.001 for E. coli; 7% vs 22%, p < 0.001 for Shigella spp.). This information is important for public health education in reducing the incidence of childhood diarrhoea further, and in the selection of appropriate antimicrobials in the management of extra-intestinal complications of childhood diarrhoea.     

致病性大肠杆菌肠炎36例分析

977例急性腹泻患儿中致病性大肠杆菌检出率为3.68%,其血清分型以 O_(126)B_(16)和 O_(111)B_4为主,发病季节多见于夏秋季,2步以下发病率最高占80.6%,临床症状以轻度至中度腹泻为主,无明显全身症状,症状的表现与血清型无明显关系。     

Role of planned parenthood for enrichment of the quality of life in Sri Lanka

The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was 5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.     

An observational study of staghorn calculi in south Sri Lanka

OBJECTIVES: To ascertain patient characteristics, management strategies and outcome of patients with staghorn calculi in southern Sri Lanka. METHODS: All patients with staghorn calculi seen at the urology unit in a teaching hospital during a period of eighteen months were included in this prospective study. Data in relation to patient demography, investigations, treatment and postoperative complications were collected. RESULTS: There were 60 patients with a mean age of 54 years. Eight (13%) of them were female. Urine pH was less than 7.0 in 52 (87%) patients. Urine culture was positive for bacteria in four (7%) patients. 58 patients underwent open surgery, and two patients were managed non-operatively. Seven (12%) patients developed postoperative complications. CONCLUSIONS: Staghorn calculi elsewhere are usually commoner in females and associated with alkaline urine. But in our study there was a clear male preponderance (M:F = 6.5:1), and urine pH was alkaline in 8 (13%) patients only. Hence the aetiological factors for staghorn calculi in Sri Lanka appear to be different. Although open surgical procedures which form the mainstay of treatment of staghom calculi in Sri Lanka can be performed safely and effectively, there is a necessity to provide minimal access surgical facilities.     

Growth hormone deficiency in Sri Lanka: a preliminary study

Growth hormone deficiency is a recognised cause of severe short stature. A community of 16,001 Sri Lankan children aged between 5 and 6 years was screened for short stature using a simple growth chart, and a sample of 172 identified as short was investigated for the aetiology. Growth hormone deficiency was confirmed in 12 out of the 172 children using the insulin-induced hypoglycaemia test. Another group of 27 out of the 172 children who could potentially benefit from growth hormone therapy were identified using an exercise screening test. Growth hormone deficiency has not been previously documented in Sri Lanka.     

Heart attacks: exploring new preventive strategies.

Ischaemic heart disease is an emerging public health problem in Sri Lanka. Implementation of programs for lifetime control and prevention of established coronary risk factors such as smoking, hyperlipidaemia, hypertension, diabetes and hereditary risk are costly and unaffordable in countries such as Sri Lanka with limited resources for health care. Other potential risk factors which are less expensive with regard to prevention require investigation. This paper summarises several studies done over the past decade at Peradeniya, to investigate three such potential coronary risk factors of IHD, namely homocysteine, vitamin C and dietary fat.     

New virus associated with diarrhoea in neonates.

Since December, 1974, there has been an increase in the incidence of acute diarrhoea in the neonatal nurseries of five Melbourne metropolitan hospitals. Four of these have had epidemics, and the incidence of endemic diarrhoeal disease has increased. Extracts of faeces from 148 patients from the five hospitals were examined by electron microscopy. "Duovirus" particles were detected in 82 of these extracts, including at least one from each hospital. No bacterial pathogens were isolated. It seems likely that "duovirus" is an important cause of sporadic and epidemic acute diarrhoeal disease in neonates. It is important to note that the absence of a recognized bacterial pathogen does not exclude an infective cause, especially when sugar intolerance is present. Appropriate measures to minimize the spread of infection must be employed.     

Control of diarrhoeal disease in Tonga 1978-83

Tonga, like many developing countries, suffers from a shortage of medical staff and a high morbidity and mortality from paediatric diarrhoeal disease. In 1980 a programme was started to train medical assistants and village administrators in the correct use of oral rehydration salt solution for rehydration. The effect on morbidity, mortality, and admission to hospital over the six years 1978-83 was assessed. After the introduction of the scheme the number of deaths due to diarrhoea fell considerably and the state of hydration in children admitted to hospital with diarrhoea greatly improved. It is recommended that similar programmes be adopted where clinical problems of diarrhoea with dehydration persist. Instruction in the use of oral rehydration fluid was most effectively given by non-medical staff to groups of mothers, rather than by paediatricians in their inevitably brief, although important, explanation given in hospital.     

Acute diarrhoeal diseases--an approach to management

Acute diarrhoeal diseases rank second amongst all infectious diseases as a killer in children below 5 years of age worldwide. Globally, 1.3 billion episodes occur annually, with an average of 2-3 episodes per child per year. The important aetiologic agents of diarrhoea and the guidelines for management are discussed. Management of acute diarrhoea is entirely based on clinical presentation of the cases. It includes assessment of the degree of dehydration clinically, rehydration therapy, feeding during diarrhoea, use of antibiotic(s) in selected cases, micronutrient supplementation and use of probiotics. Assessment of the degree of dehydration should be done following the WHO guidelines. Dehydration can be managed with oral rehydration salt (ORS) solution or intravenous fluids. Recently WHO has recommended a hypo-osmolar ORS solution for the treatment of all cases of acute diarrhoea including cholera. Feeding during and after diarrhoea (for at least 2-3 weeks) prevents malnutrition and growth retardation. Antibiotic therapy is not recommended for the treatmentof diarrhoea routinely. Only cases of severe cholera and bloody diarrhoea (presumably shigellosis) should be treated with a suitable antibiotic. Pilot studies in several countries have shown that zinc supplementation during diarrhoea reduces the severity and duration of the disease as well as antidiarrhoeal and antimicrobial use rate. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.     

应用多水平模型分析成都市农村改厕的影响因素

目的了解成都市农村改厕的影响因素。方法于2011年7～8月，采用整群随机抽样的方法在成都市9个开展农村改厕项目县内抽取1134户已改厕农户展开调查，拟合二分类反应变量的两水平logistic回归模型，比较不同特征农户的无害化卫生厕所建设情况，探讨影响农村改厕进程的因素。结果低年龄、教育程度高、家庭儿童数增加、家庭无外出务工人员、卫生行为习惯好、卫生知识得分高等农户有更好的改厕倾向（P〈0.05）。结论改厕劳动力的缺乏、受教育程度较低以及不良的卫生习惯等都对改厕工作的进程带来不利影响。     

Anti-tuberculosis drug inducd hepatitis - a Sri Lankan experience

OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal). RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.