Selected determinants and sequelae of exclusive breastfeeding up to six months among infants attending chosen well baby clinics in the Colombo District.

OBJECTIVES: To ascertain determinants and impact of the duration of exclusive breastfeeding (EBF) for four to six months on growth and incidence of respiratory tract and diarrhoeal infections DESIGN AND SETTING: A descriptive cross-sectional study of infants aged 4-6 months, visiting selected well baby clinics in Colombo. MEASUREMENTS: An interviewer administered questionnaire to determine duration and determinants of EBF and incidence of infections was used. Growth faltering was ascertained by perusing the growth chart. RESULTS: The EBF rate for 4 months and beyond was 52.1% with only 3.6% being exclusively breastfed for 5 months and none for 6 months. 61% attending hospital clinics had EBF for 4 or more months as compared to 42% at community clinics. Higher level of maternal education, EBF of earlier child for longer duration, greater number of antenatal clinic visits, hearing the optimal duration of EBF via media, being well instructed on expressed breast milk and Caesarean section delivery were positively associated with EBF of 4 months and beyond. Being underweight for age (< 3rd centile) was significantly associated with longer periods of EBF, although growth faltering was not. There was no significant association between the duration of EBF and incidence of respiratory or diarrhoeal infections. CONCLUSIONS: The EBF rate for 4 months and beyond was poor, with field clinics faring worse than hospital clinics.

Admission to medical schools in Sri Lanka: predictive validity of selection criteria.

OBJECTIVE: To assess the extent to which current selection criteria predict success in Sri Lanka's medical schools. METHODS: The study sample consisted of all students selected to all six medical schools in two consecutive entry cohorts. The aggregate marks of these students at the General Certificate of Education (GCE) Advanced Level examination, the district of entry, admission category, candidate type (school/private) and gender, were identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first summative examination and the final examination at the first attempt, and obtaining honours in either examination. Multivariate analysis using logistic regression was used to assess the extent to which these entry point factors predict variability in outcome measures. RESULTS: Aggregate scores among the 1740 students in the study sample ranged from 212 to 356, with a median of 285. The male:female ratio was 1.4:1. Private candidates (taking the examination for the third time) accounted for 22% of students. Being a school candidate, female and having a higher aggregate score, were the only independent predictors of success for all four outcome measures. The aggregate score alone accounted for only 1-7% of the variation in performance in medical school. CONCLUSIONS: Marks obtained at the A Level examination (the only academic criterion currently used for selection of medical students in Sri Lanka) is a poor predictor of success in medical school.

Middle East migration and health.

"Labour migration to the Middle East from Sri Lanka has been increasing in recent times. Such a situation has not only demographic, but economic and social implications.... [The author investigates the] impact on the health situation of the migrant workers as well as on the families that they have left behind...by reviewing [the literature] and by making use of the author's own personal experiences as a physician in the Middle East."

Eight years experience of a regional burns unit in Saudi Arabia: clinical and epidemiological aspects.

A retrospective analysis of 435 consecutive admissions to a regional burns unit over an 8-year period is presented. The majority were domestic accidents, while a few were suicidal and two were due to child abuse. Scalds were commoner than flame burns, 70.6 per cent were children under 12 years, 12.4 per cent had > 40 per cent TBSA affected, 66.9 per cent were deep partial or full thickness burns, 24.4 per cent had signs of shock on admission, 13.6 per cent had smoke inhalation injury. In spite of these known adverse factors the overall outcome was satisfactory, with a case fatality rate of 7.4 per cent and a residual disability rate of 10.8 per cent. Good initial resuscitation, a low infection rate (18.4 per cent) and the ready availability of appropriate surgical intervention (35.6 per cent), with good intensive care support, could account for the satisfactory outcome.

Pattern of formula feeding in the latter part of infancy: a preliminary survey.

The pattern of formula feeding in 111 infants between 5 and 12 months of age was studied by the use of a simple questionnaire filled in by the clinician during a consultation. Their growth pattern was noted by perusal of the weight-for-age chart, which forms part of the child health record sheet. Of the infants studied, 39 (35%) were on a starter formula, 39 (35%) were on an unmodified formula, 33 (30%) were on a special follow-on formula. The change over from starter formula to an unmodified or special follow-on formula was done at 6.9 months, which is later than recommended. Only 2 infants were on Lakspray, the cheapest unmodified formula. Growth faltering was seen in 70% of the infants studied and was apparently commoner in those on unmodified formula. Reconstitution of milk powder with water was done erroneously by 50% of the mothers, errors being most common in those using unmodified formula. Not providing a scoop inside the pack, and complex mixing instructions were the causes of error in reconstitution.

Atopy in parents of children dying with sudden infant death syndrome.

36 parents of infants who had died suddenly did not differ in frequency of atopic symptoms, immediate skin tests, IgE, IgE antibody, immunoglobulin G, A, and M, or yeast opsonisation, from 36 matched controls, although atopy was common (about half had atopy in both groups.