Prevalence of IDDM in schoolchildren in Khartoum, Sudan.

The prevalence of insulin-dependent diabetes mellitus (IDDM) in 42,981 schoolchildren (aged 7-14 yr) in Khartoum, Sudan, was determined. With the 1985 World Health Organization revised criteria for diagnosis and classification of diabetes mellitus, the overall crude prevalence rate of IDDM was 0.95/1000 in the age groups studied. This figure is thought to reflect the minimum prevalence of IDDM in that population, because there is an inherent tendency in the method of screening used toward underestimating the true prevalence rate. The prevalence of IDDM was found to increase significantly with age and was slightly higher in girls than boys, but this was not statistically significant. Of 41 children with IDDM detected in the survey, 7 were not known to have IDDM before but were showing suggestive symptoms at the time of the study. This study showed that IDDM in childhood is not rare in Sudan and that probably a substantial number of undiagnosed cases exist.

Breast milk composition in Ethiopian and Swedish mothers. I. Vitamin A and beta-carotene.

The vitamin A and beta-carotene contents of breast milk were determined at different stages of lactation in three population groups: nonprivileged Ethiopian, privileged Ethiopian, and Swedish mothers. In addition, a fractionation of vitamin A giving the proportion of retinol was performed. The concentrations of retinol-binding protein (RBP) and (in part of the material) beta-carotene and prealbumin in plasma were also measured. The mean concentrations of vitamin A and beta-carotene in the milk from the Swedish mothers (period 0.5 to 6.5 months) were in the range of 40.0 to 53.1 and 16.3 to 20.8 mug/100 ml, respectively. For the privileged Ethiopian mothers (period 0.5 to 3.5 months) the corresponding ranges were 36.2 to 36.4 and 26.2 to 28.1 mug/100 ml and for the nonprivileged Ethiopian mothers (period 0.5 to 6.5 months) 28.1 to 33.1 and 23.9 to 25.6 mug/100 ml. Only the nonprivileged Ethiopian mothers were examined during a later stage of lactation (6.5 to 11.5 and 11.5 to 23.5 months). The concentrations of vitamin A and beta-carotene in their milk showed a downward trend. The proportion of retinyl ester (percentage of total vitamin A content) was significantly higher in the milk of Swedish mothers than in privileged and nonprivileged Ethiopian mothers. In the Swedish mothers retinol constituted 3.5% of the total vitamin A content of the milk; in Ethiopian mothers it was 15 to 30%. Determination of RBP in plasma showed normal values for Swedish mothers and lowered values for Ethiopian mothers--particularly the nonprivileged, in whom 14 of 81 values were below 20 mug/ml. RBP was demonstrated in colostrum, but only in a low concentration (in the order of 5 mug/ml).

How exclusive is exclusive breastfeeding? A comparison of data since birth with current status data.

BACKGROUND: There is no accepted and widely used indicator for exclusive breastfeeding since birth. Indeed, the difference between 'current status' data on exclusive breastfeeding and data on 'exclusive breastfeeding since birth' is rarely recognized. We used data from a longitudinal study to examine this issue. METHODS: A descriptive longitudinal, prospective study design was used in which 506 mother-infant pairs were included. The mothers completed daily recordings on infant feeding during the first nine months after birth. A research assistant conducted fortnightly home visits with structured interviews. The resulting data on breastfeeding patterns are presented in two different ways: analysis of 'current status' data based on a single 24-hour recording of infant feeding at 2, 4 and 6 months of age, and analysis of data 'since birth', i.e. data on infant feeding for every day, starting from birth until the ages of 2, 4 and 6 months. RESULTS: A wide discrepancy between the results obtained from the two analyses was found. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%). CONCLUSIONS: Current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes. We propose that in many studies an indicator called 'exclusive breastfeeding since birth' could be added.

Long-term follow-up of children breast-fed by mothers using oral contraceptives.

In a long-term follow-up study 48 breast-fed children, whose mothers had used oral contraceptives containing 50 micrograms of ethinylestradiol while lactating, were compared to a matched control group whose mothers had not used any hormonal contraceptives during lactation. In spite of a very large number of data collected from several different sources of information, no effect could be demonstrated of the ingested steroid, neither upon the panorama of diseases nor upon intellectual or psychological behaviour of the infants and children up to 8 years of age. The mothers who used oral contraceptives lactated a significantly shorter period of time than the controls, but no differences were found in weight gain and height increase in the children between cases and controls.

PIP: When lactating women use hormonal contraceptives, small amounts of the steroids are transferred to the breast milk; these steroids can also be detected in infants' plasma after breastfeeding. In a long-term follow-up study 48 breast-fed children, whose mothers had used oral contraceptives (OCs) containing .50 microgram of ethinylestradiol while lactating, were compared to a matched control group whose mothers had not used hormonal contraceptives during lactation. The only significant difference between cases and controls was a shorter lactating period for the women who had used OCs. However, the study demonstrated no effect of the steroid ingested during the suckling period, neither upon the panorama of diseases nor upon intellectual or psychological behavior of the infants and children up to 8 years of age. The study looked at the 1st, 2nd, and 3rd consecutive illnesses of the children who became diseased as well as the age at debut and degree of difficulty; no significant differences were found between cases and controls. Nor were there any differences between the 2 groups according to a special control of 4-year old children or at school start. Also, no differences were found in weight gain and height increase between cases and controls. Admittedly, the present study includes a limited number of cases and controls. However, for each child a very large number of data was collected from several different sources of information and sets of data are complete for all cases and controls. The time period of observation in this prospective study is now 8 years; the study will be continued beyond puberty.

Minor and trace elements in human milk from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire. Results from a WHO/IAEA joint project.

Concentrations of As, Ca, Cd, Cl, Co, Cr, Cu, F, Fe, Hg, I, K, Mg, Mn, Mo, Na, Ni, P, Pb, Sb, Se, Sn, V, and Zn were determined in human whole milk samples from Guatemala, Hungary, Nigeria, Philippines, Sweden, and Zaire; in most of these countries, three groups of subjects representing different socioeconomic conditions were studied. Analytical quality control was a primary consideration throughout. The analytical techniques used were atomic absorption spectrophotometry, atomic emission spectrometry with an inductively coupled plasma, colorimetry, electrochemistry, using an ion-selective electrode and neutron activation analysis. The differences between median concentrations of Ca, Cl, Mg, K, Na, and P (minor elements) were lower than 20% among the six countries. Among trace elements, concentrations observed in Filipino milk for As, Cd, Co, Cr, Cu, F, Fe, Mn, Mo, Ni, Pb, Sb, Se, and V were higher than for milk samples from other countries. The remaining five countries showed a mixed picture of high and low values. In the case of at least some elements, such as, F, I, Hg, Mn, Pb, and Se, the environment appears to play a major role in determining their concentrations in human milk. The nutritional status of the mother, as reflected by her socioeconomic status, does not appear to influence significantly the breast milk concentrations of minor and trace elements. Significant differences exist between the actual daily intakes observed in this study and current dietary recommendations made by, for example, WHO and the US National Academy of Sciences. These differences are particularly large (an order of magnitude or more!) for Cr, F, Fe, Mn, and Mo; for other elements, such as, Ca, Cu, Mg, P, and Zn, they amount to at least a factor 2. In the opinion of the present authors, these findings point to the need for a possible reassessment of the dietary requirements of young infants with respect to minor and trace elements, particularly for the elements Ca, Cr, Cu, F, Fe, Mg, Mn, Mo, P, and Zn.

A longitudinal study on anthropometric and clinical development of Indian children adopted in Sweden. I. Clinical and anthropometric condition at arrival.

One hundred and fourteen children (60% girls) adopted from India through five major adoption organizations, were recruited consecutively. This paper describes the environment of the children in India and in Sweden, discusses the certainty of the ages and reports their condition at arrival in Sweden. The median age at arrival was 9.3 months, 62% being below one year of age (range 3-72 months). Infectious diseases similar in kind and frequency to those noted in child populations in developing countries, were found. Height/age and weight/age mean values were approximately -2 standard deviation scores (SDS) of the NCHS/WHO standard, which is similar to the anthropometric status of Indian average children. There were no significant sex differences. Thirty-seven birth weights were known, the majority below 2,500 g. Psychomotor retardation was found in 29% of the children. In the children with stunting and in those with weight/age less than -3 SDS at arrival there were high percentages of psychomotor retardation, anaemia and combined wasting and stunting. Therefore these children should be regarded as a risk group and be followed up with special care.

A longitudinal study on anthropometric and clinical development of Indian children adopted in Sweden. II. Growth, morbidity and development during two years after arrival in Sweden.

One hundred and fourteen consecutively recruited children adopted from India (60% girls) to Sweden were studied during 2 years after arrival, with examinations monthly the first 6 months and thereafter every 3 months. Sixty-two percent were below 1 year of age at arrival. There was a mean increase from -2.2 standard deviation scores (SDS) height/age to -0.7 SDS during the two years, and a similar development for weight/age, with no significant difference between boys and girls. The weight/height remained at around -0.8 throughout the study period. Those who had lowest height/age at arrival had the most marked catch-up, but remained smaller throughout the 2 years. The psychomotor development was initially delayed in nearly 30% of the children, mainly among those stunted and/or with very low weight at arrival. After 2 years the rate was at a level similar to Swedish children. In a sub-sample, birth weight was found to be correlated to subsequent height and weight development. Hepatitis B, salmonella, giardia lamblia, trichuris trichiura, ascaris and hymenolepis nana were still found in a small percentage after 2 years. Other morbidity was at the same level as in Swedish children. Adopted children who are stunted and/or have a very low weight at arrival should be followed up with special care, and infectious diseases found at arrival should be kept in mind for differential diagnosis at subsequent disease episodes.

Infant feeding practices during the first six months of life in a rural area in Tanzania.

OBJECTIVE: To assess breastfeeding practices in infants aged 0-6 months, focussing particularly on beliefs, knowledge and practices affecting exclusive breastfeeding. DESIGN: A house-to-house survey with individual interviews using a structured questionnaire, key informants interviews and focus group discussions. PARTICIPANTS: One hundred and seven mothers were interviewed, nearly all of those living in Nkinga community with infants less than seven months old. The focus group discussions and key informant interviews were also held. SETTING: Nkinga community, Igunga District, Tabora region, Tanzania. RESULTS: Sixty four per cent of the sample was put to the breast within two to eleven hours. Prelacteal feeds were given to about 25% of the infants. The type of prelacteal fluid given was mainly glucose water in hospital and plain water with home deliveries. Forty six per cent of the mothers discarded colostrum. The median duration of exclusive breastfeeding was about two months and of full breastfeeding was about four months. CONCLUSION: The average duration of exclusive breastfeeding, though far below recommended levels, is higher than is found in most studies in Africa and Tanzania. This may be due to the efforts of hospital staff who had received special training on breastfeeding in recent years.

Menarcheal age and growth pattern of Indian girls adopted in Sweden. II. Catch-up growth and final height.

Adopted girls (n = 107) previously studied regarding menarcheal age in relation to age at arrival, were analysed as to growth pattern and final height related to nutritional status at arrival and menarcheal age. It was found that most girls had catch-up growth regarding height and half of them regarding weight. Faster catch-up and later arrival age in Sweden were associated with earlier menarche. The catch-up growth was, however, incomplete, and lower the initial height for age, lower was the height for age at the succeeding measurements, and the final height. The mean final height was 154 cm, but 8% of the girls were 145 cm or shorter. The data suggest that linear growth and final height is influenced by the preadoptive nutritional condition, as well as by the degree and timing of subsequent catch-up growth, and the timing of puberty. Pubertal onset is related to the degree and timing of catch-up growth.

[Global prevention of HIV infection. Steady sexual relations mean safe protection. Use of condoms is like Russian roulette]. / Global prevention av HIV-smitta. Stabila parförhållanden säkert skydd. Användning av kondom som rysk roulett.

PIP: As the human immunodeficiency virus (HIV) spreads, information campaigns have generally emphasized the importance of stable partner relationships and the use of condoms as defenses against infection. Until recently the condom was seen by the public mainly as a contraceptive, rather than as a protection. Although knowledge about condoms is practically universal among European men, only a minority (27% in Sweden, 12% in France) use them regularly, while in Japan, over 2/3 of the men report use. In the Third World, the discrepancy is even greater; despite intensive educational campaigns in Uganda, only 22% of urban men and 11% of rural men have ever used a condom. An intact condom is an effective barrier against HIV but in surveys in several countries, around 30% of homosexual men report having experienced failures in condoms during anal sex. Data on the failure rate in vaginal sex is less consistent but seems to lie in the 1-5% range. This failure rate is low enough to have a significant effect on the incidence of transmission of HIV and other sexually transmitted diseases. In Germany, for instance, a study found no HIV-positives among 448 prostitutes who used condoms in nearly 100% of intercourse. Public health educational strategy should put strong emphasis on condoms as a practical measure. Modification of high-risk behavior and stable relationships, however, are the only sure defense against HIV.^ieng

[Circumcision of boys--a child's right versus parents' right]. / Omskärelse av pojkar--barnets rättigheter står mot föräldrarnas.

Male circumcision was practiced long before Abraham established a covenant with God to the effect that he should circumcize himself and all male members of his house. Thereafter it has become a potent religion-ethnic commandment also in the Islamic world, although it is not mentioned in the Koran. Several million boys are circumcised yearly in for instance traditional Africa and the USA (in the USA originally as prophylaxis against masturbation). In Sweden the yearly figure is some 3000 boys. A comprehensive review of the literature reveals that there are no or only marginal medical benefits of the operation, particularly in view of the fact that up to 10% suffer complications, and also that newborns both experience pain and will respond more strongly to new pain stimuli for years to come. There are two opposing interests--those related to the religious tradition and those related to the welfare of the child as expressed in the United Nations Convention on the Rights of the Child.

[Children are losers in the African AIDS epidemic. Protective network of the extended family is diminishing]. / Barnen förlorarna i Afrikas AIDSepidemi. Storfamiljens skyddsnät börjar glesna.

PIP: Africa continues to be the continent that has the most HIV-infected people, with about 7.5 million HIV-positive cases at the end of 1992. In many regions 20-40% of pregnant women were found infected at maternal health centers. It is estimated that 5% of the population of Africa is comprised of children who have lost their mother or both parents. The World Health Organization has estimated that by the year 2000 up to 9 million children will be orphans. The African extended family has always been active in the care of children, particularly the grandparents, who have experience and take in grandchildren during the weaning period. The African extended family assures that the survivors are helped in a crisis situation. The social transformation, urbanization, and migration for employment in the last decades have diminished the social significance of the extended family, especially in cities, where traditions rapidly disappear. The AIDS epidemic has decimated the productive population, spreading fear coupled with ignorance about its routes of infection, and led to a situation where almost all such children are left without care in the worst affected areas. These children, abandoned at a young age, are very vulnerable psychologically, physically, and socially. Many such children have been abused sexually, and other turn to crime in groups. Organizations like Save the Children, the Red Cross, and various churches have organized help programs for orphans. In the Kagera region of Tanzania, which is one of the most afflicted areas, the Lutheran Church has initiated an aid program for children to make sure that every children has a place to live and is provided with clothes and meals, medical care, and schooling. If not all of these orphans find the opportunity to grow up in such a safe milieu, there is a high risk that their fate will be the same as that of their parents.^ieng