Excess prevalence of non diabetic renal disease in native American children in Manitoba.

We undertook a 1-year prospective point prevalence study to test the hypothesis that there is an excess of non-diabetic renal disease in native American children; 29.6% (73/247) of the population attending the only regional pediatric nephrology clinic in 1993 were native compared with 8.2% of the Manitoba population in this age group (odds ratio = 4.4, P < 0.001). Patients were classified as low risk (normal renal function, no deterioration expected), high risk (normal renal function, deterioration probable), or established chronic renal failure (creatinine clearance chronically low or post renal transplant). Patients were further classified as suffering from congenital renal anomalies, genetic or metabolic disease, or acquired renal disease. Odds ratios were calculated based on data from the Aboriginal Peoples' Population Survey and Statistics Canada census data. The odds ratios for low-risk renal disease, high-risk renal disease, and chronic renal failure were 3.8, 5.6, and 6.3, respectively (P < 0.001 in all categories). The odds ratios for congenital, genetic, or acquired disease were 4.5 (P < 0.001), 0.9 (P = ns), and 6.1 (P < 0.001), respectively. Native American children in Manitoba demonstrate increased prevalence of serious congenital and acquired renal disease. These children are also more likely to live in medically underserviced communities, long distances from tertiary care centers. This study emphasizes the importance of considering factors other than diabetes mellitus when considering the problem of renal disease in native Americans.

Vitamin D deficiency in a Manitoba community.

OBJECTIVE: Using a cross-sectional survey, to investigate the vitamin D status of a random sample of 80 mother-child pairs (child age 3-24 months) in a Manitoba community with a high incidence of rickets. METHOD: A questionnaire on feeding habits, gestational history, maternal diet and vitamin supplements was administered to mothers in their homes with the assistance of a local interpreter. Venous blood was collected from both mother and child for serum 25-hydroxyvitamin D levels. RESULTS: Of 91% babies initially breastfed, 36% received no formula or milk after weaning and 40% received no vitamin supplements. 24% of mothers took no vitamin supplements during pregnancy and lactation. Knowledge about rickets was poor. In 43% of children and 76% of mothers, serum 25-hydroxyvitamin D levels were below normal range. CONCLUSIONS: Vitamin D levels are low in this population due to lack of fortified dairy products and vitamin D supplements. A public health program should include counseling on rickets and vitamin D supplementation for all infants and pregnant or lactating women.

PIP: In the isolated Island Lake area of northern Manitoba, which has a high incidence of rickets, interviews were conducted with 80 mothers, each with a child at least 2 years old, living in St. Theresa Point and Garden Hill in their homes during June-July 1987 to determine their knowledge and attitudes towards rickets. Nurses obtained blood samples from the women and their young children so the researchers could determine the vitamin D status of both. The mother-child pairs were native Canadians from the Ojibway linguistic group that speaks its own dialect of Ojibway-Cree. Mothers initially breast fed 91% of the children. After weaning, 1/3 of infants received neither infant formula nor milk. No vitamin supplements were given to 40%. Many of the children who did receive vitamin supplements did not receive them regularly. 70% of the mothers did not drink any milk. 24% were milk-intolerant. 24% took no vitamin supplements during pregnancy and lactation. Mothers who did take supplements did not do so regularly. 17% claimed that their skin was sensitive to sunlight. 84% of mothers in one community had never heard of rickets. Most did not know its cause. Neither mothers nor the children were exposed to the sunlight in the summer. When outside, almost all small infants were completely covered to protect them from the elements. The mean 25-hydroxy-vitamin D level was 26.2 nmol/l for the children and 19.8 nmol/l for the mothers. 43% of children and 76% of mothers had a 25-hydroxy-vitamin D level below the normal range. These high levels of vitamin D insufficiency were even more troublesome given that the blood was taken in late June and July when vitamin D levels would be likely to be at their highest. The dearth of vitamin D fortified dairy products and vitamin supplements greatly contributed to the low level of vitamin D status in this area. The findings show a need for public health officials to include education on rickets and vitamin D supplementation for all infants and pregnant or lactating women.

Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination.

A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. The overall annual incidence rate of H. influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000. For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000. A total of 85% and 100% of the cases of H. influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively. The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.

Injuries and deaths associated with off-road recreational vehicles among children in Manitoba.

Injuries and deaths associated with off-road recreational vehicles are of increasing concern in North America. We reviewed all hospital admissions and deaths attributed to these vehicles in Manitoba from April 1979 to April 1985 among children 16 years of age or younger. Of the 693 hospital admissions and deaths 480 were associated with motorbikes, snowmobiles or all-terrain vehicles (ATVs). The incidence of injuries resulting from snowmobile and dirtbike accidents remained stable over the study period; however, there was an almost exponential increase in the number of admissions because of ATV-related injuries. There were 21 deaths during the study period. Preventive measures through legislation are necessary to reduce the numbers of injuries and deaths; these include mandatory registration, licensing and enhanced safety regulations.

Hyperbilirubinemia in Inuit neonates.

A prospective study was undertaken to determine if Inuit and Caucasian neonates have different patterns of physiologic jaundice. Daily blood samples obtained by heel pricks of Inuit and Caucasian neonates born at the Churchill (Man.) Health Centre were assayed for the total serum bilirubin concentration. The mean peak bilirubin level in the Inuit group was significantly higher than that in the Caucasian group (8.76 v. 6.04 mg/dl [150 v. 103 mumol/l]) and occurred later (on day 3 rather than day 2). Of the Caucasian neonates, those who were breast-fed in hospital had a significantly higher (P less than 0.05) mean peak bilirubin level than those who were not, and among all the neonates who were not breast-fed in hospital the Inuit had a significantly higher mean peak bilirubin level than the Caucasians (7.98 v. 3.64 mg/dl [136 v. 62 mumol/l]). These findings indicate that factors other than breastfeeding, some of which may be genetic, are responsible for the higher and later peak in the serum bilirubin concentration in Inuit neonates.