Epidemiology of persistent diarrhea among Guatemalan rural children.

A prospective, longitudinal two-year study to determine the epidemiology of persistent (> or = 14 days' duration) diarrhea in rural children of Guatemala was undertaken. Three-hundred and twenty-one children aged 0-35 months were kept under surveillance by twice-a-week home visits. The overall incidence of diarrhea was 0.147 per child-week; the incidence of persistent diarrhea was 0.014 per child-week. The peak of persistent diarrhea was observed in infants below six months of age, with a continuous decline thereafter. This trend in incidence of persistent diarrhea was associated with a higher proportion (16%) of illnesses persisting for more than 13 days in children younger than six months of age as compared to children 30-35 months old (4%). Males had more diarrhea (0.156 per child-week) than females (0.139 per child week). Among children above 18 months of age, the proportion of episodes that lasted for more than 13 days was lower in females than in males.

[Case study: operation of a mother-child nutrition program in El Salvador]. / Estudio de caso: funcionamiento de un programa de alimentación maternoinfantil en El Salvador.

One of the oldest international efforts in their combat of malnutrition have been the mother-child food programs (MCFP). The purpose of the study herein discussed was to detect the problems that affect the operation of the MCFP of the Ministry of Health of El Salvador, and to identify feasible measures to apply in a short term. This work analyzed the following: a) the operation of the program from the selection of the beneficiary to the delivery of the ration; b) the evolution of the beneficiaries, and c) the perception of the MCFP on mothers' part. The study covered 40 Health Services selected from all over the country; the revision of 556 children's files, and interviews to 136 mothers. It was found that the nurse is the person who plays the main role in the MCFP; that the most used criterion to enter or leave the program is the nutritional condition of the beneficiaries; that priority is given to children over pregnant women; that for most of the children there is a control kept on growth and vaccinations; and that what is mostly supervised is food handling and beneficiaries. Study of the children's files revealed that the average age of the children who enter the program is 18 months and at departure, 24 months, with a permanence of five months; and that the weight-for-age retardation when entering and leaving was similar for all the children studied, although it was different when the analysis was made by permanence and by age groups. Mothers' opinion on the MCFP permitted inference of what occurs at household levels with the donated foods; nevertheless, it is a subject that merits further study. Results of the study confirm some findings of others, although since they are specific for this Program, they allowed the appropriate decision-making for corrective measures of the MCPF.

[Nutritional status of Guatemalan preschool children hospitalized for acute respiratory infections]. / Estado nutricional de niños preescolares Guatemaltecos hospitalizados por infecciones respiratorias agudas.

Nutritional status (weight-for-age, length-for-age, and weight-for-length) was determined in 678 children aged 0-59 months, admitted to the San Juan de Dios General Hospital in Guatemala City with signs and symptoms of acute respiratory infections. Five hundred and fifty seven (82.2%) cases were bronchopneumoniae; 62 (9.1%) were pneumoniae, and 43 (6.3%) were bronchiolitis. Five hundred and seventy (82.6%) children lived in the urban zones of the capital city and 118 (17.4%) in the municipalities of the Department of Guatemala. Deficit in weight-for-age was found in 188 (27.8%) cases, while 176 (25.9%) showed a deficiency in length-for-age. In terms of weight-for-length, 84 (12.4%) were below -2.00 standard deviations of the reference curve. The children from out of the city showed the highest proportions of malnutrition. Monitoring of nutritional status of hospitalized children with infectious diseases can provide valuable information, not only for their management, but also for parental health education.

[Identification of pregnant patients at risk of delivering low birthweight infants in urban areas of Guatemala]. / Identificacion de embarazos con riesgo de producir ninos de bajo peso al nacer en areas urbanas de Guatemala.

PIP: A prospective epidemiologic study of pregnant women obtaining prenatal care at a social security hospital in Guatemala City was the basis for an attempt to develop a method of identifying early in pregnancy women at risk of having low birth weight infants. Existing classifications of risk are not completely satisfactory for low income women in urban areas of developing countries. The sample included 17,135 women seen between April 1984 and January 1986. Women who had no prenatal care or who obtained it elsewhere were excluded. Social workers interviewed each woman at the 1st prenatal visit to obtain sociodemographic data. The nurses or physicians attending the women completed forms based on perinatal records developed by the Latin American Center for Perinatology and Human Development and adapted to local needs. A final visit was made just after delivery to complete the information in each file. Great care was taken to assure that the 24 examiners used the same standards for all measurement variables. The standardized data collection techniques were evaluated in a study of agreement between observers. The study was conducted in 4 sections covering sociodemographic variables, obstetric history, prenatal variables, and labor and delivery. Taking into account the size of the sample and the number of observers, it was concluded that the data were of acceptable quality. It is strongly recommended that periodic evaluation of the quality of data collected be included in all perinatal epidemiologic studies. It was also concluded that longitudinal studies of perinatal risk factors might not be needed in all regions or health areas; the association between the best known risk factors and the evolution of pregnancy has been established, and with few exceptions it appears to be relatively constant in all populations. It is recommended that perinatal services reduce the amount of data routinely collected to a minimum and apply the quality control and standardization procedures to a sample of patients and to all personnel completing records. This would assure an acceptable quality of data as a basis for medical or public health decision making. Relevant additional variables could be added as needed^ieng

[Basic procedures in data registers and processing]. / Procedimientos básicos en el registro y proceso de datos.

This paper describes the general principles that must be used as a frame of reference to identify the appropriate procedures for the management of data collected in large scale studies. It has two parts: 1) Data recording and, 2) data processing. In the first part (data recording), the various steps required for the preparation of forms and/or questionnaires and for the recollection of data are discussed. In the second part (data processing), the steps to achieve real quality control, proper coding and data entry for analysis are described. For the latter case, an outline of continuous general steps is proposed, and some statistical procedures commonly used for testing different hypotheses are identified. The overall process is illustrated through flow charts, emphasizing the fact that the processing and analysis of data, must be a continuous action which requires careful definition in the standard protocol of operations.

Reduction of blood pressure with calcium supplementation in young adults.

Epidemiologic and animal studies have suggested an inverse relationship between calcium intake and BP. Furthermore, calcium intake seems to be inversely correlated with the incidence of eclampsia in pregnancy. In a randomized clinical trial, young adults were allocated to a calcium-supplemented group receiving 1 g/day of elemental calcium (15 men and 15 women) or a placebo group (14 women and 13 men) for a period of 22 weeks. The calcium-supplemented group showed a significant decrease in diastolic BP; this effect was stabilized after nine weeks in women and six weeks in men. The reduction in diastolic BP was 5.6% and 9% from the initial values for women and men, respectively. This study supports epidemiologic and animal evidence of the effect of calcium intake on BP and suggests the need for more research exploring the mechanisms involved in the observed effect.

Procedimientos basicos en el registro y proceso de datos. / Basic procedures in the data register and processing

Se describen los principios generales que deben aplicarse como marco de referencia para identificar procedimientos apropiados en el manejo de datos recolectados en estudios de gran escala. La descripcion se hace en funcion de dos aspectos fundamentales: 1) el registro de datos y 2) el proceso de datos. En la primera parte (registro de datos), se definen las diferentes etapas a desarrollar en la preparacion de formularios y/o cuestionarios, y en la recoleccion de datos. En la segunda parte (proceso de datos) se delinean las etapas a ser implementadas para lograr el control de calidad, realizar la codificacion, y efectuar el ingreso de datos para su analisis. Con relacion a este ultimo aspecto, se propone un esquema de trabajo continuo por etapas, y se identifican algunos de los metodos estadisticos de uso comun al someter a prueba diversas hipotesis. El proceso se ilustra usando diagramas de flujo para algunas fases del proceso, en los que se senala en particular que el proceso y analisis de datos deben constituir una accion continua de principio a fin. Este debe definirse cuidadosamente en un protocolo de operaciones que norme todas las acciones del proceso

Population and nutrition; implications of sociodemographic trends and differentials for food and nutrition policy in Central America and Panama.

PIP: This paper looks into some of the sociodemographic trends and differentials that may be influencing the lack of improvement in the food and nutrition situation in rural Central America. Evidence is presented that indicates that it is more difficult to reduce malnutrition and fertility than it was to reduce infant and child mortality initially. When sociostructural changes are not forthcoming after the initiation of the mortality decline, then resultant population growth, distribution and composition dynamics can hinder improvement in nutrition. In particular, changes in the social composition differentials as a result of selectivity in mortality, fertility and migration have apparently contributed to the increasing nutrition gap between the well-fed and the poorly-fed classes.^ieng