Ann Trop Paediatr
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A survey of deaths in children under the age of 7 years was made over a 1-year period in a rural area of The Gambia with few facilities for curative medicine but with a good record of infant immunizations. One hundred and eighty-four deaths were investigated. Only 12% of deaths occurred in a hospital or health centre but an attempt was made to establish a cause of death by interviewing the family of each dead child and by examining any health records that were available. ⋯ Acute respiratory infections, malaria and chronic diarrhoea with marasmus were the most frequent causes of death after the 1st month of life. Few children died of diseases that could have been prevented by routine immunizations. An effective immunization programme has probably had some effect on deaths in infancy and early childhood but it will be necessary to find ways of preventing deaths from malaria, acute respiratory infections and chronic diarrhoea/marasmus at the primary health care level if infant and childhood mortality are to be reduced further in rural areas of The Gambia.
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Comparative Study Clinical Trial Controlled Clinical Trial
Tetanus neonatorum--experience with intrathecal serotherapy at Muhimbili Medical Centre, Dar es Salaam, Tanzania.
In an attempt to lower the mortality rate of neonatal tetanus a study was undertaken to determine whether intrathecal serotherapy influences mortality from this disease. Sixty-six babies with tetanus neonatorum were studied. ⋯ Infants who received intrathecal ATS also had fewer complications than controls (P less than 0.001) and the duration of hospital stay for the survivors was 19.3 days compared with 28.7 days for the control group (P less than 0.05). It is concluded that intrathecal ATS is superior to intramuscular ATS in the treatment of neonatal tetanus.
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Normal values for haemoglobin concentration, packed cell volume, red blood cell counts and mean cell volume were serially electronically determined in a cohort of 99 healthy, normal fullterm Nigerian babies and infants from age 1 day-6 months. Mean values of haemoglobin concentration, packed cell volume and red blood cell counts were lower at all ages than those established for caucasian infants at the corresponding ages although the pattern was similar in both races. Infant sex, method of delivery and the presence of haemoglobin S in the heterozygous form had no influence on the values of the red cell indices. Based on this study, it is recommended that separate levels of these haematological indices for the black neonates and infants should be adopted.
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The role of rotavirus infections in acute diarrhoea in young children was studied over a period of one year. Rotavirus was detected by electron microscopy and enzyme immunoassay methods in 40.2% of faecal specimens from 343 children with acute diarrhoea and in 4.7% of 86 controls. The infections were most common in children aged 2-12 months (42.3%). ⋯ Rotavirus-associated diarrhoea differed in several clinical parameters from bacterial associated and nonspecific diarrhoea. Rotavirus was detected throughout the year but was most frequent during months with little rainfall and low humidity (March-May). Our results suggest that in Kuwait, rotavirus infection is a major cause of childhood diarrhoea.
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Gram-stained buffy-coat smears from venous and capillary blood samples in 105 children suspected of septicaemia were examined for the presence of bacteria and the results compared with blood culture isolates. Gram-positive and Gram-negative bacteria were identified in 18 venous (44%) and 19 capillary (46%) buffy-coat preparations in 41 instances where bacterial organisms were isolated from the blood cultures. It is concluded that the examination of buffy-coat smears for bacteria in children suspected of septicaemia is a useful adjunct to blood cultures and, in areas where no facilities exist for culture of blood, may be a simple and rapid method of establishing the diagnosis of bacteraemia in suspected patients.