J. B. Moody

Total dose iron infusion, malaria and pregnancy in Papua New Guinea

A study was made of 544 mothers and their 556 newborns in an area of endemic malaria, to analyse effects of total dose intravenous iron infusion (TDI) to mothers during pregnancy. 34% of these mothers received TDI before delivery. A range of haematological tests was carried out on newborns and mothers in addition to anthropometry. 84% of mothers had had ante-natal care and data were also collected retrospectively from ante-natal records. TDI was associated with more slide positive peri-natal malaria in primipara (odds ratio: 5.46) but not in multipara. When all relevant factors were considered TDI was not associated with an overall improvement in haemoglobin status from the first ante-natal level recorded to the post-natal check. Post-natal malaria was associated with lower ante-natal and post-natal haemoglobin levels. There was no evidence of any effect of TDI in pregnancy or of maternal malaria on foetal maturity or birth weight. Gestational age, maternal weight, parity and maternal post-natal haemoglobin were all significantly correlated with birth weight. TDI to the mother was associated with higher neo-natal serum ferritins and lower neo-natal haemoglobins. Maternal post-natal malaria was associated with significantly lower iron in serum in newborns. It is suggested that routine total dose iron infusion to anaemic pregnant mothers in malaria endemic areas may be contraindicated.

Effect of iron prophylaxis on morbidity due to infectious disease: report on clinical studies in Papua New Guinea

A controlled trial of iron prophylaxis (3 ml intramuscular iron dextran) to two-month-old infants was carried out on the north coast of Papua New Guinea where there is high transmission of malaria. The initial hypothesis was that iron deficiency increased susceptibility to infections and thus iron supplementation in a situation of actual or potential iron deficiency would diminish this susceptibility. Findings detailed elsewhere indicate that the placebo control group became relatively iron deficient and that the iron dextran group had adequate iron stores and a higher mean haemoglobin; however, prevalence of malaria recorded in the field was higher in the iron dextran group. Analysis of field and hospital infectious morbidity in the trial indicated a deleterious effect of iron dextran for all causes and for respiratory infections (the main single reason for admission). Total duration of stay in hospital was significantly increased in the iron dextran group. Analysis of other factors showed a deleterious effect of low weight for height at the start of the trial; a significant positive correlation between birth haemoglobin and hospital morbidity rates and a positive interaction between haemoglobin and iron dextran on hospital morbidity. A possible association between malarial experience and other infectious morbidity is discussed.

Aflatoxins and kwashiorkor: clinical studies in Sudanese children

Aflatoxin analysis of blood and urine by high performance liquid chromatography in 584 Sudanese children is reported. The results in 404 malnourished children comprising 141 kwashiorkor, 111 marasmic kwashiorkor and 152 with marasmus are compared with 180 age-matched controls and correlated with clinical findings. The aflatoxin detection rate and mean concentration were higher in serum of children with kwashiorkor than the other groups. The difference between the detection rate in kwashiorkor and controls was significant (p less than 0.05). The aflatoxin detection rate in urine was highest in the marasmic kwashiorkor group and the mean concentration was higher in the marasmic kwashiorkor and marasmic groups than in the kwashiorkor and control groups. There were important differences in the detection of certain aflatoxins between the groups. Aflatoxicol was detected in the sera of 16 (11.6%) kwashiorkor, in six (6.1%) marasmic kwashiorkor, but in none of the controls and only once in marasmus. These differences are highly significant (p less than 0.0001). The ratio of AFB1 to AFM1 was higher in the sera and urines of kwashiorkors than in controls, suggesting that the normal transformation of AFB1 to AFM1 may be impaired in kwashiorkor with consequent increase in transformation of AFB1 to aflatoxicol. The study therefore provides evidence of differences in the metabolism of aflatoxins in children with kwashiorkor compared with children with other forms of malnutrition and normally nourished children and confirms the association between aflatoxins and kwashiorkor contained in a preliminary report on this work.

Height and weight growth standards for Nigerian children

A mixed longitudinal growth study of two groups of Nigerian Yoruba children was begun in 1962 at the Institute of Child Health, University of Ibadan, in order to establish height and weight growth standards in Nigeria. One group was drawn from elite families, the other from poor families living in a traditional environment. Four hundred and twenty-one elites and 475 poor normal children of one month to 3 1/2 years of age, with known dates of birth were recruited from 1962 to 1971. They were measured every three or six months from four weeks to ten years. Results for males only are presented in this paper. Third, 50th and 97th centiles of height and weight over the age range one month to ten years were calculated and the curves, smoothed using the cubic spline technique, are illustrated. Charts for clinical use in Nigeria are also presented. Comparison of the elite Nigerian data with U.S.A. figures showed them to be very similar. The Nigerian poor heights and weights compared well with the elite up to three months, after which time they lagged behind progressively until ten years. Elite Nigerians are taller and heavier than many other indigenous African groups, being very similar to American Blacks. The poor Nigerians are among the shortest and lightest of the African groups. It is concluded that the U.S.A. data may be used as an international reference population for Africans, but the elite Nigerian data would be more appropriate for Nigerian target standards. These may have to be modified for clinical use in some areas and in the light of studies of other African groups.

Loperamide in acute diarrhoea in childhood: results of a double blind, placebo controlled clinical trial.

Fifty-three young children with acute diarrhoea were included in a hospital-based, double-blind trial of loperamide at two dose levels (0.4 and 0.8 mg/kg/day), given with standard oral rehydration therapy versus placebo plus oral rehydration therapy. The differences in the overall recovery rate were significant (P less than 0.05), the fastest being in the group given 0.8 mg/kg and slowest in the placebo group. Comparison between weights on admission and weights by day 3 showed that more children in the loperamide groups gained weight than in the placebo group (P less than 0.05). No serious side effects of loperamide were observed. The drug was withdrawn in one child because of excessive lethargy and sleep. The results indicate that loperamide in the doses employed is safe and may be a useful adjunct to oral rehydration in certain children.

Protein-energy malnutrition in northern Sudan: prevalence, socio-economic factors and family background

The socio-economic and family background and the nutrition of 145 children with kwashiorkor admitted to hospital in Khartoum over a 2-year period were compared with 113 marasmic kwashiorkor, 158 marasmic, and 186 nutritionally normal controls of similar age. Peak admissions for kwashiorkor were in the wet and post-wet season and the mean (SD) age was 1.6 (0.6) months. Mothers of malnourished children were more likely to be pregnant, and had poorer housing, sanitation and water supply, a lower income and food expenditure and less education than controls. Mothers of controls breastfed their children longer, introduced mixed feeding earlier, offered a wider variety of foods, and were more likely to have had their infants immunized. Neither family instability nor cultural practices which result in separation of children from their mothers appear to have an important role in protein-energy malnutrition in the Sudan. Families of kwashiorkor children had a higher food expenditure and better maternal education than marasmic children. There was no significant difference between the two groups in duration of breastfeeding or in the age of introduction of mixed diet. However, kwashiorkor children appeared to be offered more meat. Differences in food availability could account for the relative retardation of growth and lack of subcutaneous fat in marasmus compared to kwashiorkor.

Malumfashi Endemic Diseases Research Project XX. Demographic findings: mortality.

Population studies were undertaken as part of the Endemic Diseases Research Project at Malumfashi, northern Nigeria, 1974–1978. This paper is concerned with estimates of mortality. Analyses of prospective registration data indicate under-reporting of deaths and so reliance is placed on estimates derived from the application of indirect techniques to retrospective enumeration data. Twenty-seven per cent of all reported deaths were amongst infants and 64% of deaths occurred during the wet season. Estimates of infant and child mortality are spliced together with estimates of adult mortality to produce a current model life table for Malumfashi. The table suggests an infant mortality rate of 170%‰ and a total mortality in the first five years of life of about 320 per thousand live births. There is some indication that infant mortality has fallen from well over 200%‰ in recent years. This may have resulted in part from the establishment of mother and child health clinics in the area. All data point to a higher ...

Malumfashi Endemic Diseases Research Project, XIX. Demographic findings: population structure and fertility.

Population studies were undertaken as part of the Endemic Disease Research Project at Malumfashi northern Nigeria 1974-78. This paper is concerned with population composition and estimates of fertility. Results are based on retrospective enumeration data on 42493 people and on prospective registration data on a subset of 26100 people. The age-sex structure fits the model for developing countries: 45% under age 15 and just 3% aged 65 years and over. The scene for high fertility is set by an early mean age of 1st marriage for women age 15. The crude birth rate was 55% and the general fertility rate 221% (enumeration data). Detailed fertility analyses based on enumeration data suggest consistency particularly when the relationship between the pattern and the level of fertility is examined. The number of live births a woman could expect if she survived to the end of her reproductive period is on the average 6.8. More births were found to occur in the wet season than the dry season. The twinning rate was 1 in 69. (authors)

Malumfashi Endemic Diseases Research Project XXI. Some aspects of the collection of demographic data.

This paper considers some of the procedures used and problems encountered in the collection of demographic data for a large-scale medical project: the Endemic Diseases Research Project at Malumfashi in northern Nigeria, 1974-1979. 43,216 people were enumerated and a subset of 26,100 were visited monthly for one year for the purpose of registration of vital events. The majority of problems encountered are relevant to similar studies in developing countries. Some difficulties cannot be avoided, but it is considered helpful to identify them. Other situations, however, deserve particular attention, such as the development of adequate on-site data-checking mechanisms, as these are areas in which future programmes could benefit from the experience of the demographic studies in Malumfashi. More effort still needs to be put into the improvement of data collection methods themselves.