Detection and prevention of childhood disability with the help of Anganwadi workers.

OBJECTIVES: To evaluate the role of Anganwadi Workers (AWW) for detection and prevention of disability in children below 6 years of age. DESIGN: Cross sectional and longitudinal follow up. SETTING: Ten Anganwadi Centers in ICDS Urban Project. METHODS: Trained AWWs identified disabilities and instituted preventive measures like immunization and supplementary nutrition. Simultaneous independent verification by pediatricians. Repeat survey after 6 mo of follow-up. Results: Amongst the 1545 children, AWW identified disability in 126 subjects which were verified in 118 cases by pediatricians. The disability rate was 7638 per 100,000 population. Visual, mental, orthopedic, speech and hearing disabilities rates were 4790, 2654, 583, 518 and 453 per 100,000 population, respectively. In the repeat survey, 35 of the 74 children with visual disability (mostly xerophthalmia), 4 of the 9 with orthopedic disability and 3 of the 7 with hearing disability could be managed satisfactorily. CONCLUSIONS: AWW can help in early detection and appropriate management of incipient and preventable childhood disabilities.

Surveillance of drug induced diseases in children.

A hospital based prospective study on drug induced diseases (DID) in children below 14 years of age was done for a duration of two years. A total number of 20,310 patients were examined in pediatric department during this period, out of which 204 (1.004%) patients were diagnosed as DID. Children with severe reactions were admitted in pediatric ward for in hospital intensive surveillance. The male:female ratio in DID was 1.2:1. DID were most common in neonates (24.51%). Erythmatous maculopapular rashes (67.12%) formed the most common pool of DID in neonates. Thrombophlebitis (41.56%) was most commonly seen in infants above 28 days of life, and in children up to 14 years of age. Out of 204 cases of DID, 9 (4.41%) died. Aplastic anemia was most morbid DID, as all the 7 patients of aplastic anemia died. Chloramphenicol was responsible for all the cases of aplastic anemia. Other two deaths were from erythma multiforme and C.C.F. The most commonly involved drugs, other substances and vaccines were baby powders, massage oils, ampicillin, co-trimoxazole, i.v. infusions (electrolytes and mannitol), DPT and measles vaccines.

Growth patterns in breastfed babies during first six months of life.

Growth of exclusively breastfed 126 normal newborns in urban slums and those delivered at Nehru Hospital, Medical College, Gorakhpur were studied upto six months of age. The average weight of both boys and girls was almost equivalent to the 25th percentile of NCHS standard upto 3 months but fell below these standards thereafter. The average length in both boys and girls was between 25th and 50th percentile of NCHS data. The average head circumference in girls was between 25th and 50th percentile of NCHS data at all ages but in boys it was between 10th and 25th percentile at 4, 5 and 6 months of age. The average weight, length, head and chest circumference in both boys and girls were comparable to ICMR standards. The observations indicate that exclusive breastfeeding should be promoted for adequate growth of infants during first six months of life.

Breastfeeding and childhood cancer.

Total duration of breastfeeding and of exclusive breastfeeding was studied and compared in 99 childhood cancer cases and 90 controls. The difference between the average duration of breastfeeding in cases and controls was significant (p < 0.05), but when average duration of exclusive breastfeeding was compared in cases and controls the difference was highly significant (p < 0.001). In lymphoma cases and controls the difference between the average duration of breastfeeding was moderately significant (p < 0.01). However, when average duration of exclusive breastfeeding was compared in lymphoma cases and controls the difference was highly significant (p < 0.001). When other cancer groups and controls were compared with respect to their total duration of breastfeeding and duration of exclusive breastfeeding the differences when insignificant (p > 0.05). Cases and controls were not different with respect to their age, sex, birth year, birth order, age and educational status of mothers, smoking of fathers and socioeconomic status. However, a positive family history of cancer was obtained in 4 (4%) of cases whereas in controls it was obtained in only 1 (1.1%).

Pregnancies in adolescents: fetal, neonatal and maternal outcome.

We studied the perinatal morbidity and mortality among adolescent pregnancies in the semi-urban population of Gorakhpur. The number of eligible couples (females 15-44 yrs) were 24,000. Out of 430 adolescent married girls, 242 (56.3%) became pregnant during the study period. Nineteen (7.8%) of adolescent pregnancies were in the maternal age group less than 15 years and 110 (45.5%) and 113 (46.7%) pregnancies were in the age group 15-17 yrs and 17-19 yrs, respectively. The incidence of low birth weight babies was 67.3% of all live births. Infections during neonatal period, congenital anomalies and birth injuries were seen in 21.6, 8.6 and 13.1% newborns, respectively. Neonatal mortality rate was 136.2/1000 live births. Three adolescent mothers died during pregnancy or puerperium due to causes related to pregnancy. The incidence of LBW, neonatal and maternal morbidity and mortality associated with adolescent pregnancies were significantly higher.

JE virus encephalitis: 1988 epidemic at Gorakhpur.

Gorakhpur region experienced the most serious outbreak of Japanese encephalitis (JE) in 1988 in which 875 children were admitted in the Department of Pediatrics, BRD Medical College, Gorakhpur. Children between 7-10 years age group constituted half (49.3%) of these cases, convulsions (83.8%), altered sensorium (78.2%), headache (68.8%) and hypertonia (77.0%) were the main presenting features. IgM against JE virus was demonstrated in 18/25 CSF and 27/53 sera collected from these children. Significant titres of HI antibodies against JE were present in 498/670 patients. Patients were managed symptomatically. Dexamethasone and dopamine were given to only 137 (15.7%) children admitted with shock and peripheral circulatory failure. Almost a third (31.8%) of the patients expired, 51.4% recovered completely and 10.7% recovered partially. Corticosteroids did not improve the outcome. Twenty four patients had recurrence of symptoms after excellent recovery from acute attack of whom two died and 5 developed neurological deficits.

Prevalence and abuse of psychoactive substances in children and adolescents.

The present study has been carried out in the slum areas of Gorakhpur city, covering a population of 10,187 in the four colleges of Gorakhpur. Five hundred and eighty children and adolescents in urban slums, and 750 college students between 10-18 years were studied by means of a questionnaire card for detection of prevalence rate and various others co-relates of abuse of psychoactive substances. Overall, prevalence of abuse of psychoactive substances was 25% in slum areas, and 18% in college students. Abuse of tobacco was most frequent (50.3% & 72.5%) followed by that of alcohol (11.7% & 16.2%) in both the groups respectively. Cannabis was also used by some children (0.6%). More abusers were from Hindu families with low educational status and low family income. Surprisingly no one was found to be abusing tablets and street drugs.

Prescription audit of under six children living in periurban areas.

One hundred and seventy two children were prescribed, in 212 episodes of illness, antimicrobial agents (28.4%), followed by antidiarrheals (10.9%), nutritional products (9.4%), analgesics (7.5%) and steroids (6.8%). Ampicillin (22.7%) and cotrimoxazole (12.7%) were the most commonly prescribed antimicrobials. Tetracyclines, which are not indicated in children below 8 years, were used in 7.1% of total exposures of chemotherapeutic agents. Penicillin, a comparatively safe and useful drug, was used only in 4.5% exposures. Analgin and hydroxyquinolines were used frequently. Corticosteroids were used for simple ailments like diarrhea, fever and jaundice. ORS was used in only 13.9% episodes of diarrhea. Adverse drug reactions were noted in 30 (17.4%) cases and death in 6 (3.5%) cases. The average cost per prescription for neonates was Rs 32.43 and for a child was Rs 30.65. Weight of the children was not taken prior to prescribing drugs. There is need for prescription audit as there is high consumption rate of drugs, with overuse of antimicrobial and nutritional products, and misuse of steroids.