Maternal and foetal iron and folate activities at parturition - abstract

This study was undertaken to determine the extent to which anaemia in the mother is reflected in the neonate and to what extent iron and folate deficiency might contribute to maternal anaemia. Haemoglobin (Hb), serum iron, transferrin saturation, serum folate and red cell (RBC) folate were measured in blood samples taken from 85 mothers and from the umbilical cords at delivery. Forty-two per cent of the mothers were anaemic by WHO standards (Hb <110 g/l) and 27 per cent were anaemic using a cut-off point of 106 g/l. Twenty-eight per cent of the neonates were considered anaemic (cord Hb <136 g/l). Serum iron and folate and RBC folate were significantly higher (p<0.01) in cord than maternal blood. Only 3.5 per cent of the mothers had serum iron defiency(<8.1 æmol/l) while 35 per cent had serum folate deficiency (<6.8 æmol/l). At low (<106 g/l) compared to adequate (>110 g/l) maternal Hb, maternal mean serum iron and folate and RBC folate were all significantly lower (p<0.05). No significant differences were found in cord mean serum iron and folate and mean RBC folate between cord bloods with low Hb compared to those with adequate Hb. At deficient (<6.8 æmol/l) compared to adequate (>13.6 æmol/l) maternal serum folate, maternal mean Hb and mean RBC folate were significantly lower (p<0.001) and p<0.0001, respectively); similarly, both cord mean serum folate and mean RBC folate were significantly lower (p<0.0001 and p <0.001, respectively). These results suggest that mothers who are anaemic at parturition do not necessarily have anaemic babies except when the maternal anaemia is extremely severe. Folate deficiency appears to be a bigger contributor than iron deficiency to anaemia in pregnancy (AU)

Bothrops atrox snake bite in a six-year-old child

A rare case of snake bite poisoning presenting as disseminated intravascular coagulation is presented. It is important to consider this entity in the differential diagnosis of children presenting with acute bleeding disorders in the West Indian islands where Bothrops atrox is present, namely, in Trinidad, St. Lucia and Martinique. (AU)

A family with homozygous haemoglobin E in Trinidad and Tobago

We report the first case of homozygous E in the West Indies, and describe the family, whose ancestors came to Trinidad from India approximately 100 years ago (AU)

Paediatric acquired immunodeficiency syndrome (PAIDS) in Trinidad and Tobago

The first twenty-one cases of Paediatric Acquired Immunodeficiency Syndrome (PAIDS) in Trinidad and Tobago were studied. An overwhelming majority of patients were of African descent. Most of the children presented within the first year of life, the average time between presentation and death was one and a half months, and the majority presented with either diarrhoea or pneumonia or failure to thrive, common conditions in the West Indies. Fever lasting longer than two weeks as well as hepatomegaly were clues which led to a definite diagnosis (AU)

Variations of the prevalence of IgG and IgM antibodies to Toxocara in Trinidadian school children - abstract

Toxocara involvement in ocular lesions was suspected following the high frequency of IgG antibodies in serum samples of patients attending the Eye Clinic at the General Hospital, Port-of-Spain. Also, a high prevalence of IgG antibodies to Toxocara was found in 5-9 year-old children in certain Caribbean islands. Fifty children, aged 6-15 years with equal numbers of boys and girls, were randomly selected from 5 schools in rural South and Central Trinidad. A stool sample (examined for parasites) and a 5ml blood sample were obtained from each student. Serum from 17 patients with ocular symptoms and from 39 patients with other symptoms were also examined. Serum IgG and IgM antibodies (to Toxocara) were determined by ELISA method. Fifty children from one school were given a thorough eye examination. The prevalence of antibodies seemed to increase with age, from 54 per cent in 5-7 year olds to 87 per cent in 12-13 year olds for IgG, and from 56 per cent to 61-63 per cent for IgM antibodies. IgG antibodies to Toxocara were more prevalent in males than females, but there was no positive correlation with reported geophagia or association with domestic pets. There was a higher prevalence of IgGs (88 per cent) in sera from patients with ocular lesions than in those without such lesions (39 per cent, p<0.01). Results suggest the need for a comprehensive study of toxocariasis in childhood in Trinidad and Tobago (AU)

Blastocystis hominis in two children of one family

Two apparently healthy children from the same family were found to have moderate to heavy Blastocytis hominis in their stools samples whilst being investigated for intestinal symptoms: sporadic, painless, rectal bleeding in one and persistant diarrhoea in the other. After treatment with metronidazole, they had no further signs and stool samples became negative. Eighteen months later, both were asymptomic, and stool samples continued to be negative for the parasite (AU)

Paediatric excretory urography at the Port-of-Spain General Hospital, 1985-1987 - abstract

In developing countries where ultrasonography and nuclear medicine scanning are not widely available, the intravenous pyelogram (IVP) is the principal method of visualizing the urinary tract. As a result, there exists a real potential for over requesting this relatively expensive study which is unpleasant and not without risk, especially in children. To assess the appropriate use of paediatric IVPs at the Port-of-Spain General Hospital, a retrospective study was done of all IVPs (n=373) performed on children at this institution during the 3-year period, 1985-1987. Radiological abnormalities were reported in 29 percent of cases. The most common abnormal findings were consistent with infection (29 percent) and hydronephrosis (26 percent). The most common indications for radiological study were urinary tract infection (23 percent) and haematuria (17 percent). Problems in making the diagnosis of a urinary tract infection in children were identified as the improper collection and handling of the urine specimen. Based on this survey, almost one-third of children who have IVPs at this institution do not have any indication for doing this potentially dangerous and certainly expensive procedure (AU)

Childhood asthma education project - abstract

An educational programme, consisting of a booklet explained by a nurse in four sessions and the showing of a videotaped dramatization of the same informaton, was administered to 16 parents of asthmatic children. Fifteen comparable parents were followed and used as a control group. This preliminary report shows that the parents of both groups had similar levels of knowledge of asthma at the initial test. On retesting at the six-month follow-up, the parents in both groups did significantly better than on the initial test. However, the experimental group's improvement was statistically better than that of the controls (p=0.003). More important are the changes in attitude and behaviour implied by the higher rate of casualty visits, and the higher rate of attacks identified in cases as compared with controls. The fall in admissions among cases, while controls had a steady rate of admissions in both the year of the study and in the preceeding year, has positive economic implications that are especially exciting in a developing country such as ours (AU)

Socio-economic, dietary, and cultural factors associated with diarrhoeal disease in Trinidad and Tobago

A survey was conducted in County Victoria South Trinidad, among mothers of children hospitalized with diarrhoea and matched controls (n=30 for each group). Socio-economic, dietary, and knowledge attitude-practice factors relating to diarrhoea were investigated and anthropometric measurements were taken. Ten per cent of children of both groups were found to be below normal limits for weight for length (or height). Consistent trends were seen of lower birth weight, earlier introduction of the bottle, and fewer house-pipes among cases. The most significant finding to emerge that over half the mothers withheld some or all food from the child during an episode of diarrhoea, and one-third also reduced fluid intake. Both practices need to be strongly discouraged. Until socio-economic conditions in Trinidad and Tobago improve to the point where infectious illnesses decline spontaneously, as happened in Europe and North America, immediate measures are essential to protect the young child at risk of diarrhoeal disease. It is suggested that priority be given to the following health education practices to both the public and medical profession. 1. Protection: by strongly encouraging breast feeding and discouraging bottle feeding. 2. Early treatment: provision of oral fluid-salt replacement therapy in the Community to prevent serious dehydration and quickly restore the child's appetite. (AU)

The Caribbean and New York: the heart connection - abstract

An association between North Shore University Hospital, New York and the Caribbean region started in 1982, whereby Caribbean children needing cardiac surgery were operated on at North Shore at no, or nominal, cost to the patient. During the last 6 years, 239 patients were referred for cardiac surgery 107 from Trinidad, 69 from Barbados, 19 from Jamaica, 18 from Saint Vincent, 17 from Saint Lucia, 4 from Dominica, 2 from Antigua and one each from Anguilla, Grenada and Nevis. Fifty of the patients were catheterised in Barbados between 1982 and 1985, and 55 were catheterised at Brookdale Hospital, New York, in 1986 - 1987. The other patients were catheterise at North Shore. Two hundred and sixteen (216) patients have had surgery - 180 open and 36 closed heart. Four had pacemaker implantations, 3 balloon valvuloplasties and 2 balloon atrial septostomies. There were 7 operative deaths (3.2 percent mortality) and 4 late deaths. An analysis of the programme points overwhelmingly to its high degree of success. Over the last 2 years, the programme has expanded to include 4 other major hospitals in New York. The programme is critically dependent on a system of co-operation and co-ordination between the referring and accepting physicians. Well-developed links have also been developed wihtin the wider New York based West Indian community. These links provide crucial logistic support to both patients and their families, thus increasing the economic viability of the programme while decreasing the trauma associated with the physical dislocation of extra-regional surgery. While the success of the programme is noted, it should in no way detract from the need to accelerate plans aimed at the development of an active open-heart surgical programme in the region (AU)

A radio and television campaign to educate Trinidadians and Tobagonians about diarrhoea, dehydration and oral rehydration - abstract

A radio and television campaign to educate people of Trinidad and Tobago about diarrhoea, dehydration and oral rehydration was conducted in 1985. Two radio and two television advertisements were developed which addressed the prevention and treatment of gastroenteritis. Sanitation, nutrition and oral rehydration therapy (ORT) were emphasised. Breast feeding was an essential component of both advertisements. The advertisements and a questionnaire were pre-tested at the Port-of-Spain General Hospital in January, 1985. From March 11 to 22, five hundred mothers, who had just given birth, were questioned by two trained interviewers at the three major hospitals in Trinidad. From April 1 to 22, 1985, the television advertisements were shown once a day during the major news programme; from July 1 to September 8, both radio and television advertising were given daily. The radio advertisements had no fixed time of delivery. Three hundred and sixty of the mothers were located and re-questioned by the same interviewers from November 15 to December 1, 1985. There was no change in the mothers' knowledge of the causes of gastroenteritis, which remained high. The campaign doubled the percentage of mothers who knew the signs of dehydration. The percentage of mothers who would use ORT increased from 55 to 84, but only 25 percent understood why. There was no recriprocal fall in the alternative fluids the mothers thought could be usefully given or in the use of foods or when to restart feeding. There was a small reduction in the number who thought that drugs were useful (AU)

The prevalence of nasal carriage of streptococcus pneumoniae and haemophilus influenzae in children from birth to three years of age attending immunization clinics - abstract

The population comprised ninety-six "well" children less than three years of age attending routine immunization clinics in four health centres in the Port-of-Spain area. The aim was to determine nasal carriage levels of pneumococcus and haemophilus influenzae amongst these children. The children were "well" and had not received antibiotics within two weeks of sampling. Swab were taken, using nasal and per-nasal seabs and innoculated immediately on growth media. They were then cultured and the organisms identified and sub typed. The population had an average age of 9.6 months: 52 percent were male. Fifty-three per cent of the children had a history of having had an upper respiratory tract infection within the 2 weeks preceding the specimen collection. Positive isolation of pneumococcus was obtained in 23 percent of the children. This result is surprisingly low and contrasts with levels ranging from 48 percent in North Carolina (Lada et al, 1974), and 53 percent in Dakar, Senegal to 100 percent in Papua, New Guinea (Gratten et al, 1984). Twenty-two per cent of the children yielded positive isolates of haemophilus influenzae. This again is a surprisingly low yield level. The accuracy of these results needs confirmation or refutation by further studies. Furthermore, the presence of other organisms, which could perhaps be the dominant organisms and which were not specifically cultured for in this study, needs to be considered (AU)

Neonatal jaundice at Port-of-Spain General Hospital - abstract

Neonatal jaundice is a major cause of morbidity in developing countries. The preventions of kernicterus is one of the goals of paediatricians in these countries. In an attempt to elucidate the aetiology of neonatal jaundice in our population, a prospective study was done at the Port-of Spain General Hospital from 15th June, 1986 to 30th September, 1986. Ninety-five patients were enrolled; 63 percent of the sample were of African descent, 19 percent of East Indian descent and 11 percent of mixed race. Forty-four per cent had ABO incompatibility, and 44 percent had no blood incompatibility, of which 26 percent were glucose-6-phosphate dehydrogenase (G6PD) deficient. G6PD deficiency was found in 21 percent of the total sample. In 33 percent of the sample, the aetiology is unknown. Moderate/severe jaundice (bilirubin > 16 mg/100 ml) was seen in 58 percent of the ABO incompatible group, 55 percent of the "unknown" group, 43 percent of the Rh incompatible group and 75 percent of the G6PD-deficient group. Most of the ABO incompatibility and Rh incompatibility cases (92 percent and 85 percent) developed jaundice within 48 hours of birth. In contrast, only 55 percent of the G6PD-deficient group and 50 percent of the "unknown' group developed jaundice early. Camphor was used by 60 percent of the G6PD-deficient group, 35 percent of the ABO incompatible group and 39 percent of the "unknown" group. Since 1984, there has been an active policy at the Port-of-Spain General Hospital which ensures that all children with ABO incompatibility are observed for forty-eight hours for the development of jaundice. It is recommended that a screening policy for G6PD deficiency should be adopted, since it is an important cause of jaundice in the children, presents later and can cause moderate/severe jaundice. Camphor use should be discouraged since it is a known precipitant of haemolysis in G6PD-deficient individuals (AU)

Response of mildly to moderately malnourished children to measles vaccination

Nutritional aspects of measles vaccination were examined in 51 Trinidadian children from one to three years of age with no prior history of measles. The subjects were divided into two weight-for-length groups derived from the Havard Standards and included 22 children with a weight-for-length of 90 percent or greater and 29 children with a weight-for-length of less than 90 percent. There were no significant differences in the two groups in general immune function, as assessed by white blood cell counts, immunoglobulin and C3 levels, nor in immune response, as assessed by measles antibody titres and direct migration inhibition of leukocytes to measles antigen following vaccination. All of the subjects seroconverted following vaccination, with titres of 1:40 or above. There were no significant changes in nutritional status in either group following vaccination, other than a small but significant rise in total serum protein levels in the normal group. (AU)

Visceral larva migrans: a family study - abstract

Visceral Larva Migrans (VLM) is difficult to diagnose on clinical grounds. There has not been adequate laboratory backup in making the diagnosis. Hence little is known of the prevalence of VLM in Trinidad. We have used a recently described ELISA test to identify a family at high risk for VLM based on the following criteria: history of pica, recurrent wheezing in the absence of a family history of bronchial asthma and extreme eosinophilia (over 30 percent peripheral eosinophils). In this paper, we describe the index case in detail and investigate the other members of the family, all of whom proved positive for VLM by serological testing. This is a probably an important public health problem (AU)