Frequency and significance of electrolyte abnormalities in pneumonia.

To determine the frequency of electrolyte disturbance in pneumonia, we studied 264 hospitalized children with pneumonia for serum sodium and potassium concentration, and plasma osmolality (Posm) on the day of admission. Urine osmalality (Uosm) and urine spot sodium concentration were measured in those who had a serum sodium less than or equal to 130 mEq/L. Hyponatremia was found in 27%, hypernatremia in 3.7%. Hypokalemia (serum potassium less than or equal to 3.5 mEq/L) in 19 and 2% had hyperkalemia (serum potassium greater than or equal to 6.5 mEq/L). Of all the hyponatremia, 68% were secondary to syndrome of inappropriate ADH secretion (SIADH) as suggested by a concomitant lowering of Posm less than or equal to 280 mosm/kg and increased urinary osmolality and sodium excretion. Hyponatremia was associated with 60% longer hospital stay, two fold increase in complications and the 3.5 times higher mortality compared to that of normonatremia. The above variables were affected further, if hypokalemia coexisted with hyponatremia.     

Morbidity and mortality in diarrhea in rural Haryana

Five thousand children under 6 years of age from 69 villages in Haryana were followed up for 2 years to assess the extent and severity of acute diarrheal disease. Almost 70–75 per cent of children suffered from diarrhea every year. The annual attack rate was 1·92/child during the first year and 2·16/child in the second year. Thirty four per cent suffered from 3 or more episodes. Maximum attack rate of 2·69/child/year was seen in children 1–2 years of age. No severe dehydration was seen and one or more signs of dehydration were reported in 3013 (12·2%) cases. Diarrhea accounted for 23·1 per cent (27) of total deaths (117) during the study period. The case fatality rate in 7424 episodes of diarrhea was 3·63/1000 episodes. The findings of this prospective study have operational and logistic implications in national diarrheal disease control programme and may strengthen the monitoring of the desease.     

Prevalence of behaviour problems in Ajmer school children

In a questionnaire survey of 10,000 primary school children, parents and teachers reported behaviour problems in 38% of 6199 children on whom complete information was made available. Categorization of 3572 behaviour problems according to a modified APA-DSM II classification showed aggressive reactions to be the commonest (22.7%). This was followed by disorders of sleep (17.1%), unsocial aggressive reactions (15.5%), aggressive-regressive reactions (13.5%), regressive reactions (10.7%), school grade problems (8.7%) and others. Significant influence of sex, age and socio-economic class was noted on the overall prevalence, and prevalence of specific behaviour problems. A general lack of awareness among the parents about the childhood behavioural problems was noticeable from the pattern of utilization of the pediatric outpatient services in the study area. There is a need to educate parents on behaviour of children and the significance of behavioural deviations.     

Improving access to MCH care facilities within existing health infrastructure

To improve maternal-child services (MCH) services within existing health infrastructures, an operational project was initiated in district Ambala, Haryana, in northern India in February 1985. The main project strategies are training of primary health care (PHC) workers, logistic improvement, and monitoring. This paper reports on the 1st year of project operation and deals with the changes in availability of MCH care facilities. Before and after surveys were undertaken in a sample of 71 and 74 villages, respectively, across 3 blocks of the intervention area (population=370,000). 62 villages from 2 adjacent blocks (population=250,000) were also surveyed at the same time as the after survey; these served as concurrent controls. The information was collected from the village leaders and healthworkers by trained fieldworkers. The villages in intervention area registered a substantial improvement in availability of oral rehydration salts (from 0-67.5%), cotrimoxazole for treatment of acute respiratory infection (from 0-54%), contraceptives (from 34-65%), disposable safe birth kit (from 0-54%), scales for weight (from 24-53%), and health education material (from 0-46%) at the end of the 1st year of project operation. Although the developmental characteristics of the villages included in the after survey and in the concurrent control group did not differ significantly, there was a 2-4 fold increase in MCH facilities in the intervention area. A substantial improvement in MCH care facilities can be achieved in a short period of time even within the constraints of an existing health infrastructure through focused efforts in training and logistics improvement.