School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls.

BACKGROUND: Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world. OBJECTIVE: We investigated whether long-term, weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls, including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia. DESIGN: Subjects were 266 girls with hemoglobin concentrations of 80-119.9 g/L (group A) and 358 girls with hemoglobin concentrations of 120-130 g/L (group B) who were otherwise healthy. Two hundred sixty-six girls in group A and 268 girls in group B were randomly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk. Ninety of the girls in group B were randomly assigned to receive only 5 mg folic acid weekly. Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation. RESULTS: By the end of the study, 2% of the girls had dropped out and > 96% had taken > or = 20 of the 22 tablets; side effects were minimal. Mean plasma ferritin increased significantly in all iron-supplemented groups, independently of initial hemoglobin values and iron doses. Ferritin concentrations decreased in the girls supplemented with folic acid only. As expected, hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin. Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low. Mean hemoglobin increased significantly and consistently in relation to the length of treatment. CONCLUSION: Long-term, weekly iron-folate supplementation was found to be a practical, safe, effective, and inexpensive method for improving iron nutrition in adolescent schoolgirls.

Obstetric outcomes in an aboriginal community: a comparison with the surrounding rural area.

Antenatal, intranatal and postnatal features of all Aboriginal women who lived at Cherbourg Aboriginal Community and delivered during 1990, 1991 and 1992 were compared with all non-Aboriginal women in the same rural area who delivered at Kingaroy Base Hospital during 1991. Almost all the Aboriginal women also delivered at Kingaroy. The data for 146 Aboriginal and 139 non-Aboriginal women were taken from the hospital records. The Aboriginal women were generally younger at delivery (Aboriginal 35% younger than 20 years vs non-Aboriginal 12%), made their first antenatal visit later (Aboriginal 49% after 20 weeks vs non-Aboriginal 10%) and made fewer antenatal visits (Aboriginal 43% < 4 visits vs non-Aboriginal 2% < 4 visits). They were more likely to be anaemic (Aboriginal 65% < 110 g/L vs non-Aboriginal 13% < 110 g/L), have a sexually transmitted disease (STD; Aboriginal 13% vs non-Aboriginal 2%) and drink alcohol (Aboriginal 54% vs non-Aboriginal 32%). After making an allowance for repeat Caesarean sections, there was no significant difference in the proportion of abnormal deliveries, but birthweights of Aboriginal infants were lower. Postnatally, the only significant difference between the two groups was a lower incidence of jaundice in Aboriginal infants. Multifactorial analysis showed that birthweights were significantly decreased by primagravidy, alcohol intake and STD. It is likely that the effects of STD and alcohol on birthweight were due to associated lifestyle factors. When these factors were allowed for, ethnic background had no significant effect on birthweight.

Patterns of disease among children: a simple and versatile measure of child health in communities.

OBJECTIVE: To derive an indicator of community child health that is simple, stable, cost-effective and suitable for small communities. METHODOLOGY: Discharge diagnoses of children have been tabulated for hospitals in Australia and other countries and from an Aboriginal community, for up to 40 years. The differences in ratios between main diagnostic groups relate to the child health status in the community. RESULTS: As we pass from 'developing' to 'developed' conditions, the proportion of different diagnoses changes with a relative decrease in gastroenteritis and a relative increase in respiratory and other diseases. These changes parallel changes in infant mortality rates and child growth that are independent indicators of community child health. CONCLUSIONS: The ratios of diagnoses of hospital discharges, the 'disease pyramid' is a reliable, valid and cost-effective way of measuring child health in a community while avoiding many of the uncertainties of conventional disease-specific and age-specific discharge rate statistics.

Influence of families on the growth of children in an aboriginal community.

OBJECTIVE: Some Aboriginal children have poor growth while others grow according to international standards. This study was designed to find whether these differences were related to families. METHODOLOGY: Data were obtained on 13 families at Cherbourg Aboriginal Community in Queensland. There were data on the growth and hospital admissions of children in these families for at least two generations. Data were taken from records of the Infant Health Clinic and Hospital on the Community. A total of 606 children were considered. RESULTS: The growth of a child during infancy is correlated with the growth of his/her mother in infancy, but not with the growth of the father. We have therefore defined families in the matrilineal line. There were marked and highly significant differences between the growth of children in the 13 families. The families with good growth in one generation were likely to have good growth of children in the next generation. CONCLUSIONS: In spite of the overall improvements in the growth of infants and children at Cherbourg, families tended to maintain their rankings from one generation to the next. It would be cost-efficient to target health advice to those families who have, in the past, had poor growth among their children.

Patterns of weight growth in aboriginal children on Queensland communities.

We have used data from existing health records to study the birthweights and percentage weights for age (%W/A) of children in five Aboriginal communities in Queensland. The data are from cohorts of children born in the 1950s-80s at Cherbourg, the 1960s-80s at Yarrabah and the 1970s-80s in Woorabinda, Palm Island and Doomadgee. Birthweights have not changed significantly in any of the communities and generally remain below the international level. The weights for 1 and 5 year old children have improved significantly at Cherbourg and Palm Island, but have dropped significantly at Doomadgee. The overall pattern is for children on remote communities to have a lower %W/A and less improvement in %W/A than those closer to population centres. Other workers have found the same pattern elsewhere. These patterns of growth are probably not directly related to the level of general health services, but rather to other facilities available and attitudes of mothers to child care. The results also show that Aboriginal children can reach international levels of %W/A, so the poor growth in many communities is potentially preventable.

Fascial planes within subcutaneous fat in humans.

We have used B-mode (brightness-mode) ultrasound to investigate the fascial planes within subcutaneous fat at the triceps and abdominal sites in a group of 17 women attending a weight control group over a 12 month period. In most subjects there was a single intralipid fascial plane at each site. As the thickness of adipose tissue increased, most of the change at the abdominal site was in the deep rather than the superficial layer of fat. At the triceps site both deep and superficial layers increased. Our findings confirm the presence of two different layers in human subcutaneous fat at the triceps and abdominal sites. These layers have been shown to be functionally different in animals and our study supports this in humans at the abdominal site.

The infant mortality rate at Cherbourg aboriginal community: an update.

The infant mortality rate (IMR) at Cherbourg Aboriginal Community in south-eastern Queensland remained high from 1906 to about 1955-60, but since then has dropped from over 200/1000 live births in 1956-60 to 16/1000 live births in 1986-90, compared with the 1987 rate for Queensland (9.2/1000) and Australia (8.6/1000). The rapid improvement in the IMR was associated with the installation of a piped and chlorinated water supply, sewerage and an intensive campaign to eradicate intestinal worms. There has also been a change in community attitudes towards routine health practices and it is likely that this has been a major factor in the changes.

The changing growth of aboriginal children.

We have used data from children at an Aboriginal settlement in Queensland to demonstrate the changing patterns of growth over the last 30 years. In cohorts of children born during the early 1950s and 1960s the mean weight-for-age value was satisfactory for the first three months of life, but then fell until aged 12 months and remained at about 92% of the NCHS median value until 5 years old. In the cohort born in 1972-73 there was some improvement and in the 1982-83 cohort the mean weight-for-age value was close to international levels from 1 to 5 years. The decline in weight-for-age between 3 and 12 months was still present. Length-for-age values were not available in the 1950s and 1960s but the mean value increased from the 1972-73 cohort to the 1982-83 cohort, which was close to international levels. The mean weight-for-length was close to international levels in the 1972-73 cohort, but in the 1982-83 cohort was high from 3 to 12 months and then fell close to the international level. These data indicate that the children at this Aboriginal settlement are now growing satisfactorily. The impaired growth between 3 and 12 months needs further investigation, but most of the earlier concerns about poor growth appear to have been resolved.

The effect of lactation and other factors on post-partum changes in body-weight and triceps skinfold thickness.

1. Mothers were followed from 1 month post-partum up to 12 months post-partum to measure changes in their body-weight and triceps skinfold thickness. 2. Overall there was a significant weight loss in the first few months but this levelled off by 7 months. 3. The triceps skinfold increased significantly up to 5 months post-partum and then decreased. 4. These changes in body-weight and skinfold were not affected by the duration of lactation, smoking or the educational achievement of the mothers, but were influenced by the initial body mass index and the desire to lose weight.

PIP: Health providers interviewed 174 mothers from Brisbane and Ipswich in Southeast Queensland, Australia about the health, growth, and feeding of their infants 1-12 months old. In addition, they researched the health, body weight, and social conditions of the mothers. The mothers ages ranged from 17-39 years (mean, 27.1). The mean body mass index (BMI) varied from 17.3-41.3 (mean, 23.9). Overall the mothers lost weight from the 1st month (100%) until the 6th month (96%) at which time body weight basically stayed the same. On the other hand, triceps skinfold thickness peaked at about 5 months (113%) after which it declined consistently to 96%. Opposite of the findings of other studies, this study showed no major differences between women who breast fed their infants for different lengths of time. Breast feeding duration, mother's age when finished with formal education, and present age did not significantly affect changes of body weight or triceps skinfold thickness. Smoking did significantly affect body weight at 11 months postpartum, however (p.05). Nevertheless, the researchers believed that there probably is no biological significance to this 1 finding. Mothers with a high 1 month BMI were significantly more apt to lose less weight or gain weight at 6 months postpartum (p.05) than those with a low BMI. Overweight mothers who already had an ample layer of adipose tissue in the triceps had a tendency to increase its size over the postpartum period (p.05). Even though all mothers wanted to lose more weight than they actually did, some significant changes did occur between the desire to lose weight and the actual changes in body weight and triceps skinfold (p.01-.05). Those women who wanted to lose more weight did do so. These results suggest that the changes in weight and skinfold occurred independent of lactation.

Sleep patterns of infants in the first year of life.

A prospective study of 132 infants aged from 1 month to 1 year found that infants who were breast fed or breast plus bottle fed were significantly more likely to wake at night throughout the first year. Social class of the family, parity of the mother, and the weight gain of the infant had no consistent effects. This increased waking was not due to mothers of wakeful infants prolonging breast feeding to soothe their infants.

Effects of feeding and social factors on diarrhoea and vomiting in infants.

In a prospective study of infants and their feeding in south east Queensland, Australia, the incidences of reported diarrhoea and/or vomiting in breast, bottle, and mixed (breast and bottle) fed infants were compared from birth to 1 year. Up to 6 months infants who were given breast feeds, with or without other milks, had less diarrhoea and/or vomiting than those given bottle feeds only. Breast feeding seemed to protect the infant against possible introduced infections even when other milks were given along with the breast milk. After 6 months breast feeding did not reduce the incidence of gastrointestinal infection. In both upper and lower social class families infants given solids before 3 months had less diarrhoea and/or vomiting than those given solids later. Bottle fed infants aged 3-6 months in upper social class families had fewer gastrointestinal problems than those of lower social class families. This study suggests that up to the age of 6 months, in this population, breast feeding protects the infant against diarrhoea and/or vomiting, but other milks and solids can safely be given to supplement the breast milk. Breast feeding conferred no significant protection after 6 months.

Recall by mothers of the birth weights and feeding of their children.

We have tested mothers' abilities to remember at a later date, the birth weight, duration of breastfeeding and time of introduction of other milks to their previous children, by comparing their recall with the information recorded by the nursing sisters at maternal and child health clinics at the time. Data were available for 81 children with present ages from 1 to 10 years. Birth weight and the duration of breast feeding were generally remembered accurately, but there were large discrepancies on the time of starting other milk feeds. This could pose diagnostic difficulties in some paediatric conditions, particularly milk allergies and intolerance.