Mark C. Steinhoff

Clinical signs of acute lower respiratory tract infections in malnourished infants and children

OBJECTIVESnTo determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory infection (ALRI) in undernourished children.nnnMETHODSnThree hundred twelve children with ALRI and 446 with upper respiratory infection were classified according to weight and height as normal, stunted, wasted or stunted and wasted and also as normal, underweight or marasmus. The sensitivity and specificity of tachypnea, subcostal retractions and the presence of either sign in identifying children with a clinical diagnosis of ALRI or radiologic pneumonia in each of the nutritional categories were determined and compared.nnnRESULTSnAmong children with ALRI the mean respiratory rate in those with normal nutrition (61.5 +/- 16.1, n = 160) was not significantly different from those who were stunted (57.5 +/- 16.5, n = 59), wasted (61.3 +/- 14, n = 66) or stunted and wasted (55.4 +/- 12.8, n = 27) (P > 0.05) or from those classified as underweight (60 +/- 15.9, n = 150) or marasmus (62.5 +/- 14.5, n = 27) (P > 0.4). The sensitivity and specificity of tachypnea, subcostal retraction or the presence of either sign in detecting ALRI was also not statistically significantly different among the children in the different nutritional categories (P > 0.05). The sensitivity of tachypnea or subcostal retraction in identifying children with radiologic pneumonia was also not significantly different among children in the different nutritional categories; the sensitivity of either sign was higher in under-weight children than in children with normal nutrition (P = 0.028).nnnCONCLUSIONSnThe data suggest that the current WHO algorithm is suitable for diagnosis of ALRI in undernourished children.

Latex agglutination: an appropriate technology for the diagnosis of bacterial meningitis in developing countries

We evaluated prospectively the utility of a latex agglutination technique for the diagnosis of Haemophilus influenzae type b meningitis in a paediatric ward in India. Eight of 44 children had H. influenzae grown from cerebrospinal fluid. These proven cases plus four additional cases of H. influenzae meningitis were detected by the latex agglutination test. There were no cross reactions with other organisms. The high degree of sensitivity and specificity, combined with the speed and simplicity of this technique make it an appropriate method for developing countries.

Appropriate strategy for immunisation of children in India 3. Community-based annual pulse (cluster) immunisation

A strategy of annual pulse vaccination is proposed as the most appropriate technique for achieving high immunisation rates in our country. Because vaccine is taken to children in their communities on announced dates, acceptance will be much higher than with conventional clinic vaccination. A simplified immunisation schedule and a family-retained record are used to reduce complexity. Vaccines and other materials are managed at a district level; the local arrangements for vaccination are made by the PHC staff and village level workers. The advantages of this technique include higher coverage, shortened and strengthened cold chain, reduced red tape for recipients of vaccine, the involvement of private health institutions in a national campaign, and a strengthening of the PHC system.

Prevention and treatment of rabies

Rabies is a fatal disease which causes great anxiety in patients; it presents clinicans with a number of difficult decisions. We review recent developments in its prevention and treatment, and summarize current recommendations for prophylaxis.

Appropriate strategy for immunisation of children in India IV: Measles and its control, priority number one

Although a hidden health problem, measles is the commonest vaccinepreventable disease and the most common preventable cause of death among our underfives. These facts, plus the availability of a safe and effective vaccine make measles vaccination the highest priority in the control of communicable disease in India. The use of the pulse vaccination strategy will result in better coverage rates than the conventional strategy of immunisation in fixed health centres. India’s annual requirement of measles vaccine is 20 million doses. For economy and uninterrupted supply, measles vaccine must be manufactured in India without any further delay.

Poliovirus infection and Bell's palsy in children

During a 16-months study period at Vellore, South India, three out of five children presenting as Bells palsy were suffering from poliomyelitis. In polio-endemic countries, poliomyelitis should be considered when children present as Bells palsy.

Strategy for childhood immunization in India: 1. Prioritization of vaccines

A simple scoring system is presented to evaluate the necessity, efficacy and safety of vaccines so that priority may be assigned to them for routine use in children. Eleven common vaccines are listed according to priority and the high priority items are those against measles, poliomyelitis, diphtheria, tetanus and pertussis. Therefore measles, polio and DPT vaccines are recomended as the core group of vaccines for routine use in children in India. The continued use of smallpox vaccine seems unwarranted. The low priority vaccines namely BCG, typhoid and cholera may be used in special groups, endemic areas or epidemics. Rubella and mumps vaccines are also of low priority and need not be introduced at present.

Non bacterial gastroenteritis

Recent advances in virology have resulted in a reassessment of the role of viruses in acute gastroenteritis (AGE). Clinicians have long suspected that viruses caused AGE but scientific evidence for this association has been obtained only in recent years, t Many investigations in temperate and tropical areas have shown that specific bacterial agents cause only approximately 30 per cent of acute diarrheal disease. Virologic studies usually demonstrate equal frequency of viral isolates from both patients and healthy controls. In other words, adenoviruses, echoviruses and coxsackie viruses are not found to be associated with acute diarrhea.l, 2 However, the application of the electron microscope (EM) for the direct examination of stool has resulted in the discovery ot many viruses that were not previously detected by tissue culture methods of virus isolation. Two groups of viruses have been clearly associated with AGE, namely Norwalk virus and human rotavirus, and a number of other newly recognised viruses are under investigation.

Rational therapy for intestinal helminths.

The purpose of this article is to provide the clinician with recommendations, based on current data, for therapy of intestinl helminths. Cost effective decisions are facilitated by the presentation of the comparative cost of treatment regimens.