Management of pneumonia in India and Indonesia.

Although the death rates from neonatal tetanus have been lowered and the death rates from childhood diarrhoea are becoming lower in India and Indonesia, death rates from pneumonia have not yet begun to fall. Pneumonia has become the greatest killer of children and the most important cause of preventable death. The reason for this relative rise in significance may lie in the failure to realize that the majority of the most acute cases of respiratory illness are not viral but rather bacterial infections which rapidly respond to appropriate antibiotic therapy. This paper reviews recent research on the aetiology of pneumonia; it examines age distribution and regional variation in morbidity and mortality; and it concludes by suggesting appropriate pneumonia treatment and case management guidelines. The essential priority is to make procaine penicillin available to children presenting with cough and a respiratory rate over 50 breaths per minute. This alone would substantially reduce the number of child deaths in India and Indonesia.

Acute diarrhoeal disease in India and Indonesia.

Acute diarrhoea is still a leading cause of child mortality and morbidity, second only to pneumonia as a killer of children, in India and Indonesia. Untreated diarrhoea precipitates malnutrition and is often the underlying cause of marasmus and kwashiorkor. Shigella and salmonella dysenteries are responsible for about 60% of all cases in Indonesia and India. These bacillary agents respond well to trimethoprim. Amoebiasis responds well to metronidazole. Most cases can be managed in the home, even if the exact cause is unknown, by giving liquids or a simple rehydration drink. Diarrhoea can be prevented by improving communal sanitation and personal hygiene, and by giving breast as opposed to bottle feeding of infants. Earlier introduction of supplementary feeding could provide the child with higher energy reserves giving it a better chance of survival when diarrhoeal insults occur.

Food intake and work allocation of male and female farmers in an impoverished Indian village.

1. The energy balance and activity allocation of eight male and eight female Indian farmers were measured for 4 d during 10 months in both the dry and wet seasons of 1983. 2. All food prepared and eaten was weighed and nutrient values were calculated from food composition tables. 3. Average energy costs per unit mass for fifteen tasks were estimated from data obtained using a Kofranyi-Michaelis respirometer. Each subject was observed from 05.00 to 20.00 hours and activities were recorded for each minute. The remaining activity was determined by recall. 4. Activity allocation was categorized qualitatively into time spent on economically productive work, free time and body maintenance. 5. The mean weight for male subjects was 48.2 kg; the average female weight was only 36.9 kg. The mean height for male and female subjects was 1.61 m and 1.49 m respectively. 6. For male subjects, the daily mean energy intake of 9.81 MJ (2350 kcal) was close to the calculated energy output of 9.54 MJ (2285 kcal). 7. The women's calculated daily expenditure of 8.22 MJ (1968 kcal) was slightly higher than their mean energy intake of 7.73 MJ (1852 kcal). 8. Although intake and output varied in relation to sex, weight and wealth the mean intake per kg body mass was equal for both males and females at 210 kJ (50 kcal) per kg. This is close to the minimum requirement for active Third World farmers. 9. The women spent significantly more time on economically productive work activities than the men (11.1 v. 8.1 h/d). Although female energy intake was 27% less than males, their productive work time was 27% higher.