Food insecurity and its consequences in indigenous children and youth in Canada.

Food insecurity (FI) is at a crisis level in some Indigenous communities and impacts many of the half million First Nations Inuit and Métis (FNIM) children across Canada, particularly in isolated northern communities. This can lead to malnutrition and can have significant impacts on the physical, intellectual, emotional and social development of a child, often with lasting effects across the life course. This is a narrative review article with extensive search of the medical literature with input from the FNIM National organizations. The primary cause of FI is an imbalance between the high price of food relative to household income, where poverty is a driving factor. The cost and lack of availability to healthy foods has resulted in a transition to unhealthy market foods. Food security programs need to be prioritized, multi-faceted and multi-tiered within a framework of food sovereignty. Translational science, research, to practice is also important. The use of successful Indigenous based models of FI, towards food sovereignty using self-determination, Indigenous Knowledge, strength-based models, and ancestral sustainability are critical. Continued community-based evaluation of FI towards sustainable healthy food programs are important for communities to initiate track, evaluate, and grow robust community-based programs to counter-balance FI. Continued scientific research in the fields of FI, food sovereignty, and their relationship to co-occurring conditions related to healthy eating and beverage consumption are vastly important to the health of Indigenous Peoples. These are all part of many Indigenous connection to the earth, through food source, the maintenance of health through ancestral ways of living, set in the premise of looking forward multiple generations towards the continued resiliency through food, diet, relationship, and sovereignty. Food Security is a human right and needs to be urgently addressed for Indigenous children in Canada.

Potential Impact of COVID-19 on Recently Resettled Refugee Populations in the United States and Canada: Perspectives of Refugee Healthcare Providers.

Recently resettled refugee populations may be at greater risk for exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a virus that causes coronavirus 2019 (COVID-19), and face unique challenges in following recommendations to protect their health. Several factors place resettled refugees at elevated risk for exposure to persons with COVID-19 or increased severity of COVID-19: being more likely to experience poverty and live in crowded housing, being employed in less protected, service-sector jobs, experiencing language and health care access barriers, and having higher rates of co-morbidities. In preparing for and managing COVID-19, resettled refugees encounter similar barriers to those of other racial or ethnic minority populations, which may then be exacerbated by unique barriers experienced from being a refugee. Key recommendations for resettlement and healthcare providers include analyzing sociodemographic data about refugee patients, documenting and resolving barriers faced by refugees, developing refugee-specific outreach plans, using culturally and linguistically appropriate resources, ensuring medical interpretation availability, and leveraging virtual platforms along with nontraditional community partners to disseminate COVID-19 messaging.

Ten-year experience of fetal alcohol spectrum disorder; diagnostic and resource challenges in Indigenous children.

BACKGROUND: Although fetal alcohol spectrum disorder (FASD) can have a disproportionate impact in some Indigenous communities, there is a paucity of literature on its epidemiology. OBJECTIVE: To characterize the epidemiology of Indigenous individuals under the age of 18 years who were diagnosed with FASD at Anishnawbe Health Toronto over a 10-year period. METHODS: Children who were assessed at Anishnawbe Health Toronto from 2002 to 2012 and met the 2005 criteria for FASD were included. The multidisciplinary team assessed neurodevelopmental abnormalities, FASD facial features and growth parameters and enquired about maternal alcohol consumption, current custody and involvement with the criminal justice system. RESULTS: Forty-nine children were diagnosed with FASD. None of these had full fetal alcohol syndrome (FAS); 12 were diagnosed as partial FAS and 37 with alcohol-related neurodevelopmental disorder (ARND). Thirty-five were male and the median age at diagnosis was 9 years. Nineteen were wards of children's services, and 8 were living with adoptive parents. All children had abnormalities in psychometric testing. Other issues included: behavioural issues (80%); learning disabilities (63%); attention deficit hyperactivity disorder (43%); developmental delay (14%); involvement with the criminal justice system (12%) and alcohol abuse (10%). The morbidity and impairment for ARND was higher on almost every measurement compared with partial FAS. CONCLUSIONS: FASD is a preventable cause of lifelong significant morbidity to Indigenous children with a high proportion of children needing foster-care services and involvement with the criminal justice system at an early age. Although ARND is difficult to diagnose, it can result in significant morbidity. Additional resources for culturally sensitive primary prevention and early diagnosis of FASD for Indigenous families are required.

Hospital admissions for lower respiratory tract infections among infants in the Canadian Arctic: a cohort study.

BACKGROUND: It is unknown whether this burden of disease of lower respiratory tract infections is comparable across the Canadian Arctic. The objectives of this surveillance study were to compare the rates of hospital admission for lower respiratory tract infection and the severity of infection across Arctic Canada, and to describe the responsible viruses. METHODS: We performed a prospective multicentre surveillance study of infants less than 1 year of age admitted in 2009 with lower respiratory tract infection to all hospitals (5 regional, 4 tertiary) in the Northwest Territories, Nunavut and Nunavik to assess for regional differences. Nasopharyngeal aspirates were processed by means of a polymerase chain reaction respiratory viral panel, testing for 20 respiratory viruses and influenza A (H1N1). The role of coinfection was assessed by means of regression analysis for length of stay (short: < 7 d; long: > 14 d). Outcomes compared included rates of lower respiratory tract infection, respiratory syncytial virus infection, transfer to tertiary hospital and severe lower respiratory tract infection (respiratory failure, intubation and mechanical ventilation, and/or cardiopulmonary resuscitation). RESULTS: There were 348 admissions for lower respiratory tract infection in the population of interest in 2009. Rates of admission per 1000 live births varied significantly, from 39 in the Northwest Territories to 456 in Nunavik (p < 0.001). The rates of tertiary admissions and severe lower respiratory tract infection per 1000 live births in the Northwest Territories were 5.6 and 1.4, respectively, compared to 55.9 and 17.1, respectively, in Nunavut and 52.0 and 20.0, respectively, in Nunavik (p ≤ 0.001). Respiratory syncytial virus was the most common virus identified (124 cases [41.6% of those tested]), and coinfection was detected in 51 cases (41.1%) of infection with this virus. Longer length of stay was associated with coinfection (odds ratio [OR] 2.64) and underlying risk factors (OR 4.39). Length of stay decreased by 32.2% for every 30-day increase in age (OR 0.68). INTERPRETATION: Nunavut and Nunavik have very elevated rates of lower respiratory tract infection, with severe outcomes. Respiratory syncytial virus was the most common virus identified, and coinfection was associated with longer length of stay. Targeted public health interventions are required to reduce the burden of disease for infants residing in these Arctic regions.

Cost-effectiveness of palivizumab compared to no prophylaxis in term infants residing in the Canadian Arctic.

BACKGROUND: Hospital admissions for respiratory syncytial virus infection result in large health expenditures for Inuit infants. Palivizumab has been shown to be highly effective in reducing such admissions in preterm Inuit infants. We performed a cost-effectiveness analysis estimating the incremental cost-effectiveness ratio (ICER) for palivizumab prophylaxis per admission related to respiratory syncytial virus avoided in healthy term infants across the Canadian Arctic. METHODS: We compared universal palivizumab prophylaxis in term infants less than 6 months of age to no prophylaxis in 8 Arctic regions: the Northwest Territories, Nunavut, Nunavut without Iqaluit, the 3 subregions of Nunavut (Kitikmeot, Kivalliq and Qikiqtaaluk), the Qikiqtaaluk Region without Iqaluit, and Nunavik (northern Quebec). Costs were acquired from the territorial governments, hospitals and contracted agencies. The perspective is that of the public payer, with a 6-month timeline. In scenario A, universal prophylaxis was provided until the end of the respiratory syncytial virus season, and in scenario B, infants received prophylaxis until 5 months of age. The ICERs of scenario A were compared with those of scenario B. RESULTS: Under scenario A, the cost per admission avoided was as high as $546 115 in the Northwest Territories, compared with a cost savings of $36 145 in the Kitikmeot Region. Under scenario B, the ICER showed cost savings of $48 549 in the Kitikmeot Region and $2731 in the Kivalliq Region, with low ICERs in Nunavik of $15 601. INTERPRETATION: Considerable cost savings were found for the Kitikmeot Region with universal palivizumab prophylaxis in term infants with both scenarios, whereas cost savings were found for the Kivalliq Region with scenario B. Stopping prophylaxis at 5 months of age was a more cost-effective strategy in all regions except the Kitikmeot Region. Nunavik had low ICERs, and prophylaxis should be considered for this region.

Scabies.

Scabies is a contagious skin infestation caused by a mite. It causes significant global morbidity, with an estimated 300 million cases annually. Although it can affect individuals at any socioeconomic level, individuals who live in poverty or in overcrowded conditions are at much higher risk for scabies. Lack of local expertise can result in failure to recognize scabies, leading to delayed diagnosis and inadequate treatment of cases and contacts. Scabies disproportionately affects many Indigenous (First Nations, Inuit, Métis) communities where risk factors are present. Scabies risk is also higher in young children, the elderly and immunocompromised individuals. Institutional outbreaks of scabies have also been reported. Apart from a very itchy rash, scabies can lead to secondary bacterial infections and related complications, as well as to stigmatization, depression, insomnia and significant financial costs. Topical antiscabies lotions are still the mainstay of treatment, but oral ivermectin has also proven effective under certain circumstances. Asymptomatic and symptomatic household members should all be treated at the same time. In Canada and globally, the presence of scabies is usually a symptom of poor living conditions and a sign that basic necessities need improvement. Clinicians who work with Indigenous communities can improve their ability to diagnose and treat scabies, and should advocate for better living conditions where scabies is prevalent.

La gale est une infestation cutanée contagieuse causée par un acarien. Elle est responsable d'une morbidité importante dans le monde, puisqu'environ 300 millions de nouveaux cas se déclarent chaque année. Même si elle touche des individus de tous les milieux socioéconomiques, les personnes qui vivent dans la pauvreté ou qui habitent dans des logements surpeuplés y sont beaucoup plus vulnérables. À cause de l'absence de compétences locales, la gale risque de passer inaperçue, ce qui peut entraîner un retard de diagnostic et un traitement inadéquat des cas et des contacts. La gale est présente dans un nombre disproportionné de communautés autochtones (Premières nations, Inuits, Métis) où interviennent des facteurs de risque. Le risque de gale est également plus élevé chez les jeunes enfants, les personnes âgées et les personnes immunodéprimées. Des éclosions de gale se produisent également dans des établissements fermés. À part un prurit intense, la gale peut susciter des infections bactériennes secondaires et des complications connexes, de même que des préjugés, une dépression, de l'insomnie et des coûts financiers importants. Les lotions topiques contre la gale demeurent le pilier du traitement, mais l'ivermectine par voie orale s'est révélée efficace dans certaines situations. Les membres asymptomatiques et symptomatiques du ménage doivent tous être traités en même temps. Au Canada et dans le monde, la gale est généralement révélatrice de pauvreté et de manque d'accès aux besoins de première nécessité. Les cliniciens qui travaillent auprès des communautés autochtones peuvent améliorer leur capacité de diagnostiquer et de traiter la gale et doivent préconiser de meilleures conditions de vie dans les milieux où la gale est répandue.

Imported pediatric malaria at the Hospital for Sick Children, Toronto, Canada: a 16 year review.

BACKGROUND: Children under 5 represent 86% of annual malaria deaths in the world. Following increasing trends in international travel, cases of imported malaria are rising in North America. We describe the epidemiology of malaria diagnosed at a tertiary care pediatric center in the multicultural city of Toronto. METHOD: Retrospective chart review of all laboratory confirmed malaria from birth to <18 years between July 1, 1997 and June 30, 2013. Epidemiological data, travel history, chemoprophylaxis history, as well as clinical presentation, diagnosis and treatment were extracted. RESULTS: In total 107 children were diagnosed with malaria in the 16 year time period. Plasmodium falciparum malaria was identified in 76 (71%), Plasmodium vivax in 28 (26%). Median age of infected children was 6.7 years where 35% of children were born in Canada, 63% were recent or previous immigrants. Of those who resided in Canada, reason for travel included visiting friends or relatives (VFR) 95% and tourism or education (5%). Most common countries of infection were Ghana (22%), Nigeria (20%) and India (14%). Median parasitemia at presentation to our institution was 0.4% (IQR 0.1-2.3) with a maximum parasitemia of 31%. Nineteen (18%) met the WHO criteria for severe malaria due to hyperparasitemia, with 3 of these cases also meeting clinical criteria for severe malaria. One third of patients had a delay in treatment of 2 or more days. Ten percent of children had seen two or more primary health care professionals prior to admission. Prophylaxis was documented in 22 (21%), and out of those, 6 (27%) were appropriate for the region of travel and only 1 case was documented as adherent to their prescription. There were no cases of fatality. CONCLUSION: Malaria continues to be a significant disease in returning travelers and immigrant or refugee populations. An increase in physician awareness is required. Appropriate pre-travel advice, insect protection measures, effective chemoprophylaxis is needed to reduce the incidence and improve the management of imported pediatric malaria.

The real-life effectiveness of palivizumab for reducing hospital admissions for respiratory syncytial virus in infants residing in Nunavut.

UNLABELLED: BACKGROUND/ OBJECTIVE: Nunavut has the highest hospitalization rates for respiratory syncytial virus (RSV) worldwide, with rates of 166 per 1000 live births per year <1 year of age. Palivizumab was implemented in Nunavut primarily for premature infants, or those with hemodynamically significant cardiac or chronic lung disease; however, the effectiveness of the program is unknown. The objective of the present multisite, hospital-based surveillance study was to estimate the effectiveness of palivizumab in infants <6 months of age in Nunavut for the 2009 and 2010 RSV seasons. METHODS: Infants identified as palivizumab candidates who were <6 months of age were compared with all admissions for lower respiratory tract infection through multisite, hospital-based surveillance documenting the adequacy of palivizumab prophylaxis, admission for lower respiratory tract infection and the results of RSV testing. The OR for RSV admission in unprophylaxed infants was compared with those who were prophylaxed, and the effectiveness of palivizumab was estimated. RESULTS: Within the study cohort (n=101) during the two RSV seasons, five of the 10 eligible infants who did not receive adequate prophylaxis were admitted with RSV while two of the 91 infants <6 months of age eligible for palivizumab who were adequately prophylaxed were hospitalized with RSV (OR 22.3 [95% CI 3.8 to 130]; P=0.0005). The estimated effectiveness of palivizumab for the cohort was as high as 96%. Eight eligible infants were missed by the program and did not receive prophylaxis. CONCLUSION: Palivizumab was highly effective in reducing hospitalizations due to RSV infection in Nunavut. Further efforts need to be made to ensure that all eligible infants are identified.

The cost of lower respiratory tract infections hospital admissions in the Canadian Arctic.

BACKGROUND: Inuit infants who reside in the Nunavut (NU) regions of Arctic Canada have extremely high rates of lower respiratory tract infections (LRTIs) associated with significant health expenditures, but the costs in other regions of Arctic Canada have not been documented. OBJECTIVE: This prospective surveillance compares, across most of Arctic Canada, the rates and costs associated with LRTI admissions in infants less than 1 year of age, and the days of hospitalization and costs adjusted per live birth. DESIGN: This was a hospital-based surveillance of LRTI admissions of infants less than 1 year of age, residing in Northwest Territories (NT), the 3 regions of Nunavut (NU); [Kitikmeot (KT), Kivalliq (KQ) and Qikiqtani (QI)] and Nunavik (NK) from 1 January 2009 to 30 June 2010. Costs were obtained from the territorial or regional governments and hospitals, and included transportation, hospital stay, physician fees and accommodation costs. The rates of LRTI hospitalizations, days of hospitalization and associated costs were calculated per live birth in each of the 5 regions. RESULTS: There were 513 LRTI admissions during the study period. For NT, KT, KQ, QI and NK, the rates of LRTI hospitalization per 1000 live births were 38, 389, 230, 202 and 445, respectively. The total days of LRTI admission per live birth were 0.25, 3.3, 2.6, 1.7 and 3 for the above regions. The average cost per live birth for LRTI admission for these regions was $1,412, $22,375, $14,608, $8,254 and $10,333. The total cost for LRTI was $1,498,232 in NT, $15,662,968 in NU and $3,874,881 in NK. Medical transportation contributed to a significant proportion of the costs. CONCLUSION: LRTI admission rates in NU and Nunavik are much higher than that in NT and remain among the highest rates globally. The costs of these admissions are exceptionally high due to the combination of very high rates of admission, very expensive medical evacuations and prolonged hospitalizations. Decreasing the rates of LRTI in this population could result in substantial health savings.

Preventing unintentional injuries in Indigenous children and youth in Canada.

Unintentional injuries are the leading cause of death in Canadian Indigenous children and youth, occurring at rates three to four times the national average. Death and disabling injuries not only devastate families and communities but take a heavy toll on health care resources. The lack of statistics, ongoing surveillance or injury prevention programs for Indigenous children and adolescents further compound human and health care costs. Indigenous communities are heterogeneous culturally, in terms of access to resources, and even as to risks and patterns of injury. Yet in general, they are far more likely to be poor, to have substandard housing and to have difficulty accessing health care, factors which increase the risk and impact of injury. There are urgent needs for injury surveillance, research, capacity-building, knowledge dissemination, as well as for injury prevention programs that focus on Indigenous populations. Effective injury prevention would involve multidisciplinary, collaborative and sustainable approaches based on best practices while being culturally and linguistically specific and sensitive.

A decade of respiratory syncytial virus epidemiology and prophylaxis: translating evidence into everyday clinical practice.

Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies. The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.

The cost effectiveness of palivizumab in term Inuit infants in the Eastern Canadian Arctic.

INTRODUCTION: Canadian, Inuit, full term infants have the highest rate of respiratory syncytial virus (RSV) infection globally, which results in substantial costs associated hospitalisation. METHODS: Decision-analytical techniques were used to estimate the incremental cost-effectiveness ratio (ICER) for palivizumab compared to no prophylaxis for Inuit infants of all gestational age. The time horizon was that of life-time follow-up, and costs and effectiveness were discounted at 5% per year. Costs (2007 CAD$) for palivizumab, hospitalisation (including medical evacuation, intensive care unit [ICU]), physician visits, and transportation were calculated based on the Canadian payer's perspective. Benefits on decreasing RSV hospitalisation were expressed as quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analysis (PSA) were conducted, varying: mortality rates, utilities, length of stay in hospital and ICU. RESULTS: For all of Baffin Island infants (<1 year), the ICER was $39,435/QALY. However, when infants were grouped by age and area of residence, those residing in Iqaluit (<1 year) had an ICER of $152,145/QALY, while those residing in rural areas (outside of Iqaluit) had an ICER of $24,750/QALY. Prophylaxis was a dominant strategy (cost saving) for rural infants under 6 months of age, with the PSA demonstrating that it was dominant 98% of the time. CONCLUSIONS: The ICERs suggested that palivizumab is a cost-effective option for the prevention of RSV for Inuit infants on Baffin Island compared to no prophylaxis. Palivizumab is highly cost effective in Arctic infants <1 year of age specifically residing outside of Iqaluit and is a dominant strategy for those under 6 months of age in rural areas. However, palivizumab is not cost effective compared to no treatment for infants of all ages residing in Iqaluit.

Risk factors and viruses associated with hospitalization due to lower respiratory tract infections in Canadian Inuit children : a case-control study.

OBJECTIVES: To examine risk factors for lower respiratory tract infections (LRTI) hospital admission in the Canadian Arctic. METHODS: This was a case-control study during a 14-month period among children less than 2 years of age. Cases were admitted to the Baffin Regional Hospital in Iqaluit, Nunavut with LRTI. Controls were age matched and came from Iqaluit and 2 communities. Odds ratios (ORs) of hospital admission for LRTI were estimated through multivariate conditional logistic regression modeling for following risk factors: smoking in pregnancy, Inuit race, prematurity, adoption status, breast-feeding, overcrowding, and residing outside of Iqaluit. Viruses in nasophayngeal aspirates were sought at the time of each hospital admission. RESULTS: There were 101 age-matched cases and controls. The following risk factors were significantly associated with an increased risk of admission for LRTI (adjusted OR): smoking in pregnancy (OR = 4.0; 95% CI: 1.1-14.6), residence outside of Iqaluit (OR = 2.7; 95% CI: 1.0 -7.2), full Inuit race (OR = 3.8; 95% CI: 1.1-12.8), and overcrowding (OR = 2.5, 95% CI: 1.1- 6.1). Non-breast-fed children had a 3.6-fold risk of being admitted for LRTI (95% CI: 1.2-11.5) and non-breast-fed adopted children had a 4.4-fold increased risk (95% CI: 1.1-17.6) when compared with breast-fed, nonadopted children. Prematurity was not associated with an increased risk of admission. Viruses were identified in 88 (72.7%) of admissions, with respiratory syncytial virus being identified in the majority of admissions, 62 (51.2%). Multiple viruses were isolated in 19 (15.7%) admissions. CONCLUSIONS: Smoking during pregnancy, place of residence, Inuit race, lack of breast-feeding, and overcrowding were all independently associated with increased risk of hospital admission for LRTI among Inuit children less than 2 years of age. Future research on the role of adoption and genetics on the health of Inuit children are required.

Comparison of the cost of hospitalization for respiratory syncytial virus disease versus palivizumab prophylaxis in Canadian Inuit infants.

BACKGROUND: The objectives were to compare actual respiratory syncytial virus (RSV) hospitalization rates and costs in a cohort of Inuit infants to hypothetical palivizumab prophylaxis strategies for infants of all gestational ages in the Eastern Canadian Arctic. METHODS: Incidence and costs of RSV hospitalization were collected for infants admitted to the Baffin Regional Hospital in 2002, before the initiation of palivizumab. There was a comparison of the actual costs to the costs associated with 8 palivizumab strategies stratified by age (<6 months, <1 year) and location (overall, town [Iqaluit], rural communities). It was assumed that each category would receive universal palivizumab prophylaxis resulting in a 78% decrease in RSV admissions. The net costs incurred, number needed to treat (NNT), and incremental costs per hospitalization avoided were calculated for each comparison. RESULTS: There was a great variation in the rates and costs associated with RSV admissions between Iqaluit and the communities. For infants <1 year of age residing in Iqaluit, the mean admission cost was $3915, and palivizumab prophylaxis had an NNT of 20.4 and cost of $162,551 per admission avoided. For rural infants <6 months, the mean cost of admission was $23,030, and palivizumab prophylaxis resulted in an NNT of 3.9 to 2.5 and cost savings of up to $8118 per admission avoided. CONCLUSIONS: Due to the high rates and costs associated with RSV admissions, administration of palivizumab in rural communities in the Canadian Arctic to infants less than 6 months of age could result in net cost savings.

Epidemiology of malaria presenting at British Columbia's Children's Hospital, 1984-2001: lessons for prevention.

BACKGROUND: Few studies have examined the epidemiology of imported malaria in Canadian children. Identifying populations at increased risk in Canada would enable targeted malaria prevention strategies within those groups. The study objective was to describe the epidemiology of malaria diagnosed at British Columbia's Children's Hospital (BCCH) between 1984 and 2001. METHODS: This was a retrospective chart review of malaria cases identified at BCCH and confirmed through the British Columbia Centre for Disease Control. Demographic and clinical data were recorded on a standardized form. RESULTS: Malaria was diagnosed 42 times in 40 children (age 24 days to 14.8 years). Thirty cases (71.4%) occurred in 28 Canadian residents, and 12 (28.6%) occurred in immigrant or refugee children. Twenty-six children (65%) were male. Thirty-one children (77.5%) were of East Indian descent. Thirty-three exposures (78.6%) to malaria occurred in the Indian subcontinent. Plasmodium vivax was identified in 37 cases (88.1%), P. falciparum in 3 (7.1%), and the species was unknown in 2 (4.8%). Fourteen cases in the resident children (46.7%) reported pre-travel counselling. Ten resident cases (33.3%) were prescribed chemoprophylaxis, primarily chloroquine, and at least six of them (60%) were non-compliant. The duration of symptoms prior to diagnosis was < 7 days in 27 cases (64.3%), 8 to 30 days in 10 (23.8%), > 30 days in 4 (9.5%) and the duration was unknown in 1 (2.5%). Twenty-four of 36 cases (66.7%) had seen 2 to more than 4 doctors before the diagnosis of malaria was made. CONCLUSION: The majority of children in our review were of East Indian origin and were exposed to malaria in India. Most had not sought or had received inadequate pre-travel counselling and had been non-compliant with chemoprophylaxis. As malaria is a potentially lethal but preventable disease, strategies to ensure adequate pre-travel counselling for high-risk groups are required.

High rate of Simkania negevensis among Canadian inuit infants hospitalized with lower respiratory tract infections.

To determine the prevalence of Simkania negevensis in causing pulmonary infections in children, nasopharyngeal washes were obtained from 22 infants hospitalized with acute bronchiolitis in the Baffin Island, Canada. 14 (63.6%) were positive for S. negevensis. Mixed infections with other respiratory viruses were common. All patients recovered without specific antibiotic treatment. Even though a high prevalence of S. negevensis was found, this organism may potentially well be an opportunistic agent rather than a true pathogen.