A perinatal information system - abstract

A feasibility study was carried out on the use of a perinatal information system at the Mt. Hope Women's Hospital (MHWH). This system consists of the Simplified Perinatal Clinical Record (SPCR), a personal computer and a specially designed software package. The information system identifies high-risk pregnancies and provides statistical analysis on perinatal mortality and morbidity. Data from 1,000 consecutive deliveries at the MHWH from the 1st January to 28th February, 1986, were collected on the SPCR forms and analysed on a personal computer. The syste was easy to use. The results obtained indicated an apparent increase in the stillbirth rate in 1986 as compared to 1981 - 1984. It identified chronic anaemia (13.4 percent) and pre-eclampsia (8.0 percent as the two main causes of maternal pathology. It is recommended that this perinatal information system, with slight modification, should be introduced generally in Trinidad and Tobago and the rest of the Caribbean. (AU)

Population distribution of Trichuris trichiura in a community of Jamaican children

The trichuris trichiura worm burdens of 23 children in a Place-of-Safety in Kingston, Jamaica were assessed by stool collection for more than five days after treatment with mebendazole. This procedure was repeated after a seven-month period of natural reinfection. For both collections the maximum rate of worm expulsion was achieved on the fourth day after starting treatment. The worm populations were overdispersed and well described by the negative binomial probability model (k=0.29) in each case. For any one individual, the number of worms passed on the first expulsion was unrelated, absolutely or relatively, to the number passed on the second. These data suggest that: knowledge of the time dependency of helminth expulsion is essential for the accurate determination of worm burdens by this method; populations of Trichuris are more highly aggregated than those of Ascaris and thus may be more susceptible to control by selective rather than random chemotherapy; and the inherent predisposition of hosts to infection may be of minor importance in determining the distribution of worms in the population-heavily infected hosts appear no more or less likely to acquire large worm burdens on subsequent exposures. (AU)

Composition of oral solutions prepared by Jamaican mothers for treatment of diarrhoea

Oral rehydration with sucrose-electrolyte solutions is now established as a safe and effective way to treat dehydrated children in hospital. In Jamaica, oral rehydration with World Health Organization approved packets of glucose-electrolyte salts supplied by the United Nations International Children's Emergency Fund has been successfully introduced in the main children's hospitals in Kingston. However, because of the difficulty of supplying packets to scattered urban and rural community clinics, mothers are advised by health personnel as well as on radio and television programmes to prepare various homemade sugar-salt solutions to treat children with diarrhoea at home. The composition of solutions prepared by mothers varies dangerously. To reduce errors, a double ended spoon has been designed to help mothers to make up solutions more accurately. The value of the spoon has been established under the most favourable conditions. To obtain the maximum rate of absorption of water and electrolytes in dehydrated children, the oral solution should approximate closely to the WHO recommended solution which contains glucose 110 mmol/l (sucrose 210 mmol/l), sodium 90mmol/l, potassium 20 mmol/l, chloride ions 80 mmol/l, and bicarbonate 30 mmol/l. We compared the composition of salt-sugar solutions prepared by Jamaican mothers according to current health education and those prepared by means of the double-ended spoon. (AU)

The ankle jerk in severe protein energy malnutrition (PEM) - abstract

Although muscular atrophy is a cardinal feature of severe PEM, there are little data on neuromuscular function. We therefore measured the ankle jerk in 16 severely malnourished children (age range 6 - 60 months, median 11.5 months) on admission, daily for the first week and then weekly until discharge. The results were compared with those from 9 healthy Jamaican children (age range 5 - 28 months median 14 months). The angle jerk was elicited by electrically stimulating the sciatic nerve in the popliteal fossa. Movement of the foot was recorded on an oscilloscope via a transducer attached to the left great toe. Measurement of latency period, contraction, plateau and relaxation times were made from photographs of the oscilloscope tracings. At all times and with all variables, the malnourished children had a wide range of measurements. Compared with the controls, there was no difference in the latency period (26ñ5 msecs vs 25ñ3). The contraction time was significantly slower on admission (162ñ10 msecs vs 130ñ5) but at 30 days post admission was significantly faster (106ñ4 msecs vs 130ñ5 msecs). The relaxation times showed a tendency to be slower on admission and faster after recovery but the differences were significant. The plateau time was also of a similar pattern with the recovery value being significantly shorter (33ñ3 msecs vs 46ñ4 msecs). Thus in all variables, on admission, there was a wide range with the times being slower than normal attaining normality at about 2 weeks after admission and thereafter being faster. In 3 children tested 1 month after discharge the angle jerk remained faster than controls. Thyroid function tests were all normal. The fact that the latency period was unchanged suggests that these changes are distal to the sarcoplasmic reticulum. They may be related to the supply of energy to the muscles during rapid growth or to the order in which the different muscle fibre types are repleted during recovery from severe PEM (AU)

Oral rehydration using high and low sodium and potassium solutions in dehydrated Jamaican children with diarrhoea - abstract

The indications and pathophysiological principles underlying the use of glucose electrolyte solutions for treating diarrhoea with dehydration are well understood. The exact composition for the Caribbean is disputed, because the WHO recommended solution which contains 90mmols/L of sodium was developed for cholera and may produce hypernatremia. To establish the value of this solution in Jamaican children, we studied 84 cases of diarrhoea in children aged 5 to 18 months attending Bustamante Children's Hospital, Kingston. The children were assessed clinically and body weight, blood samples, urine and stool samples were studied at 0, 6 and 24 hours. Treatment was with oral rehydration solution given at a rate of 200 mls per hour. Cases were divided at random into two groups, one given a solution containing 90 mmols Na, the other, 60 mmols of Na. In both groups, clinical and biochemical indices improved rapidly, weight increased, serum specific gravity fell and bicarbonates rose. In the high sodium group, 5 cases developed hypernatremia at 6 hours and persistence of hyponatremia was seen in a few cases in the low sodium group. In a second study, 25 children were given standard GE solution, but the potassium was increased from 20 to 35 mmols/1 and the cases divided randomly into high and normal potassium groups. The GEsol was given as 2 volumes of solution to 1 of water. In this study the high potassium group showed no cases of hypokalemia whereas 19 - 33 percent of the low potassium group had this problem at 24 hours. It was concluded that the standard oral rehydration fluid containing 90 mmols/1 of sodium, given as 2 volumes of water to 1 of water is safe and effective in the cases seen in Jamaica and that a higher potassium concentration of 35mmols/1 would be more effective in correcting hypokalaemia than the present 20 mmol/1 solution. This regime is now standard practise in both Bustamante Children's Hospital and at the University Hospital of the West Indies and has led to dramatic reductions in hospitalization rates, use of drip sets and of intravenous therapy (AU)

Zinc and immunocompetence in protein-energy malnutrition

Malnourished children have thymic atrophy which is reversed by zinc supplementation. To see if their defect in cell-mediated immunity was also associated with zinc deficiency ten children were skin-tested with Candida antigen on both arms. One test site was covered with local zinc sulphate and the other with placebo ointment. There was a highly significant increase in the typical delayed-hypersensitivity reaction at the site covered with zinc. The magnitude of the difference between the supplemented and unsupplemented arms correlated negatively with the plasma-zinc concentration. These data show that zinc deficiency is a cause of the immunoincompetence seen in malnutrition. The normal reactions of the zinc-supplemented side indicate that, of the many nutritional deficits of malnourished children, zinc deficiency specifically impairs the cell-mediated immune system. Local skin-testing with and without zinc may provide a measure of zinc status. Local application of zinc may enhanc the reliability of tests to diagnose diseases such as tuberculosis in malnourished patients.(AU)