Journal of Tropical Pediatrics - current issue

In this Issue April 2008

2008-03-29

Rotaviruses and Rotavirus Vaccines

Ebrahim, G. J. — 2008-03-29

Evidence behind the WHO Guidelines: Hospital Care for Children--What are the Useful Clinical Features of Bacterial Meningitis Found in Infants and Children?

Best, J., Hughes, S. — 2008-03-29

Pulmonary Function Correlates with Body Composition in Nigerian Children and Young Adults with Sickle Cell Disease

2008-03-29

Sickle cell disease (SCD) is associated with impaired growth and skeletal maturation. Decreased fat-free mass (FFM) and body fat (BF) have been reported in Nigerian children with SCD relative to healthy age- and gender-matched controls. Pulmonary abnormalities, including reduced forced vital capacity (FVC), forced expiratory volume in one second (FEV₁) and total lung capacity (TLC), have also been described in children with SCD. Since undernutrition is common in sub-Saharan Africa, we were interested in knowing the relationship between pulmonary function and body composition in Nigerian children and young adults with SCD. Body composition was determined using bioelectrical impedance and pulmonary function was assessed by spirometry in Nigerian children and young adults aged 7–35 years (n = 102) as well as healthy age-and gender-matched controls (n = 104). Age-adjusted data revealed 19–26% lower FFM for male (P < 0.001) and female (P < 0.001) subjects with SCD relative to the controls. FVC, FEV₁ and PEF were also significantly reduced in male and female children and young adults with SCD compared to their control counterparts. For both male and female patients and controls, FVC, FEV₁ and PEF correlated positively with FFM (P < 0.001). PEF for the female subjects with SCD diverged progressively with increasing age relative to the controls and the rate of change was significantly lower (P < 0.001). We conclude that pulmonary function is reduced in Nigerian children and young adults with SCD compared to controls and that for both groups, pulmonary function is directly related to body composition. These findings underscore the need for early nutritional intervention for children with SCD.

Malaria Mortality in Venezuela: Focus on Deaths due to Plasmodium vivax in Children

Rodriguez-Morales, A. J., Benitez, J. A., Arria, M. — 2008-03-29

Morbidity and mortality burden of malaria in the childhood represents a public health threat not only in countries with high levels of transmission, but also in those, such as Venezuela and others in Latin America, with moderate to low transmission. Usually its mortality has been attributed just to Plasmodium falciparum malaria, but the changing patterns of increase in Plasmodium vivax malaria morbidity and mortality are now causing concern. We studied malaria mortality by analyzing different epidemiological variables during a 10-year period in Venezuela, finding mortality rates ranging 0.10–0.36 deaths/100 000 population, with almost a third of deaths in children (<10 years old), corresponding 270 deaths to P. falciparum cases and 30 to P. vivax; but along the period with a decrease trend for P. falciparum and an increase trend for P. vivax.

Norovirus and Sapovirus Infections among Children with Acute Gastroenteritis in Ho Chi Minh City during 2005-2006

2008-03-29

A molecular epidemiological study on common diarrheal viruses was conducted in a children's hospital in Ho Chi Minh City between December 2005 and November 2006. Fecal samples were collected from 502 pediatric patients with acute gastroenteritis, and were screened for the presence of norovirus (NoV) and sapovirus (SaV). NoVs GII and SaVs were detected in 6.4% and 1.2% specimens, respectively, while there was no NoV GI found among studied samples. NoVs could be identified through the year, except in April and July, with the peak of detection rate (62.5%) during the rainy season. Conversely, four out of six (66.7%) of the SaV strains were identified during the dry season. Patients aged between 6 and 23 months were found to be more infected by NoVs. The overall mean severity score of norovirus-positive patients was 9.8 ± 3.6, and no significant difference of severity scores among patients belonged to different age groups, gender and place of living. The results of phylogenetic analysis showed the diversity of caliciviruses circulating in the area, and various types of recombination were identified among NoVs and SaVs detected. These results provide important information on calicivirus infections among Vietnamese children.

Factors Associated with Secular Trends in Mortality Attributed to Measles in Gweru, Zimbabwe, in 1967-89

Marufu, T., Siziya, S., Mudambo, K. S. T. — 2008-03-29

A retrospective study conducted in Gweru, Zimbabwe, investigated the trend and its associated factors in measles mortality between 1967 and 1989. Measles and malnutrition surveillance data were analysed in SPSS version 8.0 using the Forward Stepwise Linear Regression method. Measles case fatality rates ranged from zero to 48.2% (median: 4.2, Q₁ = 1.2, Q₃ = 12.9) and they significantly linearly declined [slope = –1.686; 95% confidence interval (CI) –2.327, –1.044; R² = 59%]. Rates of mortality among complicated measles cases (slope = 0.546, 95% CI = 0.133–0.345) and rates of mortality from malnutrition among children aged <5 years (slope = 0.459, 95% CI = 0.031–0.099) independently predicted (R² = 87%) measles case fatality rates. It was concluded that decline in rates of mortality among complicated measles cases, probably due to good management of such cases, and decline in rates of malnutrition among children aged <5 years may have contributed to the decline in measles case fatality rates.

Obesity and Related Behaviors among Adolescent School Boys in Abha City, Southwestern Saudi Arabia

2008-03-29

Using stratified sampling technique 2696 adolescent school boys (aged 11–19 years) in Abha City, Southwestern Saudi Arabia were interviewed and examined for weight and height using standardized techniques. The overall prevalence of obesity and overweight in the present study amounted to 16%. Using logistic regression analysis, lack of exercise practice in the previous week in general [aOR = 1.352, 95% confidence interval (CI) = 1.066–1.941] or in the class (aOR = 1.446, 95% CI = 1.083–1.931) were significantly associated with obesity. The present study showed that obesity among adolescent school boys in Abha City is a public health problem. There is a need for a national program in the country to prevent and control obesity among adolescents. The program should incorporate: dietary management of obesity, promotion of physical activity, health education campaigns and consideration of the possibility of providing facilities for practicing physical activity and exercise in the community.

Acute Bacterial Meningitis at the 'Complexe Pediatrique' of Bangui, Central African Republic

2008-03-29

To precis the aetiologies of children meningitis and the susceptibility to antibiotics of bacteria responsible for meningitis in Bangui, we conducted a prospective study between October 2004 and September 2005, at the ‘Complexe Pédiatrique de Bangui’, Central African Republic (CAR). Children from 1 day to 16 years with suspected meningitis and who underwent a lumbar puncture were enrolled. Gram staining, culture on chocolate blood medium, cell count, biochemistry (protein level, glucose ratio), capsular antigen detection were performed for each cerebrospinal fluid. MICs were determined by the E-test method. Four hundred and seventeen patients were enrolled during the study period; 130 were proven acute bacterial meningitis and 37 probable bacterial meningitis. Among proven bacterial meningitis, Streptococcus pneumoniae was the most common organism responsible for meningitis (62 cases, 48%) followed by Haemophilus influenzae (46 cases, 35%) and by Neisseria meningitidis and Salmonella sp. (8 cases, 6% each). Ninety-four percent and 96% of S. pneumoniae strains tested remain susceptible to benzylpenicilline and chloramphenicol, respectively. A beta-lactamase was detected in 92% of H. influenzae strains tested. However, MICs 50% and 90% for amoxicillin were found to be 1 and 4 mg/l, respectively and 33% of these strains were resistant to chloramphenicol. The global mortality rate was 35% (59/167). This mortality rate was 47% for S. pneumoniae, 33% for H. influenzae, 62% for Salmonella sp. and 13% for N. meningitidis. The probabilistic treatment with ampicillin and chloramphenicol usually administered for children meningitis in Bangui must be reconsidered particularly in cases of H. influenzae meningitis. It is of importance to reduce the presentation delays of children with suspected meningitis in Bangui. The H. influenzae b immunization would allow a dramatic reduction of meningitis cases and deaths in Central African children.

Helicobacter Pylori Infection and Gastroesophageal Reflux in Asthmatic Children

2008-03-29

The aim of this article is to investigate the prevalence of Helicobacter pylori (HP) infection, frequency of gastroesophageal reflux (GER), existence of atopy and levels of serum immunoglobulin E (IgE) in children with bronchial asthma. One hundred and thirty seven children who were diagnosed as bronchial asthma and/or wheezy child aged between 1 and 17 years were enrolled into the study. Peripheral venous blood samples were obtained to determine the total IgE and HP IgG antibody levels. GER was evaluated by the scintigraphic method and the presence of atopy was investigated by skin prick test. The study was conducted in 86 (62.8%) boys and 51 (37.2%) girls. HP IgG antibody levels were found negative in 125 (91.2%) and positive in 12 (8.8%) cases. GER was detected in 73 (53.7%) of the children. Forty-one (37.3%) children were accepted as atopic according to skin prick test results. The average total IgE levels of the participants was 168.89 ± 270.76 IU/ml. A significant difference could not be determined related to GER, atopy frequency and serum IgE levels between the cases who had HP antibody positivity or not. The present findings suggest that the rate of HP antibody positivity is low in patients with bronchial asthma and a significant difference could not be determined in GER, and atopy between patients with positive and negative HP antibodies. High atopy frequency found in our patient group raises the question of whether allergic diseases can be protective against fecal–oral infectious diseases.

Epidemiological Survey of Kawasaki Disease in Sichuan Province of China

Li, X.-h., Li, X.-j., Li, H., Xu, M., Zhou, M. — 2008-03-29

Objectives: To investigate the incidence and epidemiological characteristics of Kawasaki Disease (KD) in Sichuan province of China.

Methods: The questionnaire and diagnostic guideline for KD provided by Japan Kawasaki Disease Research Center (JKDRC) were used for the questionnaire investigation in pediatric departments of all hospitals in Sichuan province for data of KD diagnosed in their hospitals from 1 January 1997 to 31 December 2001.

Results: Of the 212 hospitals investigated, 91.5% responded to the questionnaire investigation, with a total of 1811 cases of KD identified. The incidence per 100 000 children <5 years of age was 4.26 in 1997, 5.21 in 1998, 8.57 in 1999, 7.70 in 2000 and 9.81 in 2001, respectively. The average incidence throughout the 5 years was 7.06 per 100 000. The ratio of male to female was 1.62 : 1. The age distribution showed a peak near 1–2 years of age. Cardiac sequelae were seen in 17.0% of the patients. Only 66.2% patients with KD had been treated with intravenous immunoglobulin.

Conclusion: The incidence of KD in Sichuan province was lower than that reported in Japan and Beijing, higher than that in Guangdong, Jiangsu and Shanxi province of China.

Clinical, Laboratory and Radiological Parameters in Children with Dengue Fever and Predictive Factors for Dengue Shock Syndrome

Chacko, B., Subramanian, G. — 2008-03-29

This article is a prospective study of the clinical, laboratory and radiological picture of children satisfying the case definition criteria of dengue by WHO admitted at Sri Ramachandra Medical College and Research Institute, a suburban tertiary referral centre, to determine the predictive factors for dengue shock syndrome (DSS). Data were analyzed by Chi-squared test and Student's t-test for significance after dividing the patients into two groups, those with and those without DSS for the same. Bleeding manifestations, presence of effusion on USG/X-ray, haematocrit >35%, WBC <4000/cumm, Na ≤130 meq/l, bicarbonate level of <18 mmol/l, deranged coagulation profile and serum glutamic pyruvic transaminase (SGPT) ≥40 IU were predictive of DSS.

Coverage of the National Vitamin A Supplementation Program in Ethiopia

Semba, R. D., de Pee, S., Sun, K., Bloem, M. W., Raju, V. K. — 2008-03-29

Periodic vitamin A supplementation is a major intervention to reduce morbidity, mortality, and blindness among children in developing countries. The goal was to characterize the coverage of the Ethiopia national vitamin A program among preschool children and to identify risk factors for not receiving vitamin A. In the Ethiopia Demographic and Health Survey of 2005, among 4762 preschool children, aged 12–59 months, 46.8% received a vitamin A capsule within the last 6 months. There were no significant differences in stunting, underweight, or wasting between children who did or did not receive a vitamin A capsule. In multivariate logistic regression analyses, maternal education of ≥10 years [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.23–2.92], 7–9 years (OR 2.47, 95% CI 1.67–3.65), 4–6 years (OR 1.56, 95% CI 1.18–2.07), and 1–3 years (OR 1.11, 95% CI 0.90–1.37), and paternal education of ≥10 years (OR 1.61, 95% CI 1.14–2.29), 7–9 years (OR 1.24, 95% CI 0.94–1.64), 4–6 years (OR 1.26, 95% CI 1.03–1.56), and 1–3 years (OR 1.29, 95% CI 1.05–1.50) were associated with the child receiving a vitamin A capsule compared with no years of formal parental education. Expanded coverage of the national vitamin A capsule program may help protect children from nutritional blindness and to help reach Millennium goals for reducing under-five child mortality in Ethiopia.

Seroprevalence of HIV and Other Vertically Transmitted Viral Infections Among Pregnant Women of Amritsar (Punjab, North India)

Jindal, N., Singla, N., Sheevani, , Kaur, R., Aggarwal, A. — 2008-03-29

Investigation of Relationship of Atherosclerotic Risk Factors and Early Atherosclerotic Findings in Obese Children by Doppler Ultrasonography

Dogu, A., Erguven, M., Yilmaz, O., Hayirlioglu, A., Erbahceci, A. — 2008-03-29

Gender Bias in Critically Sick Newborns and Young Infants: An Ethical Dilemma?

Garg, P., Waikar, M. — 2008-03-29