AM Tomkins

London International Development Centre

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Roy Sk

North South University

Dilip Mahalanabis

Society for Applied Studies

James Wp

World Obesity Federation

S. M. Akramuzzaman

International Centre for Diarrhoeal Disease Research

RR Kingamkono

Tanzania Food and Nutrition Center

Rukhsana Haider

Child Health Research Foundation

J A Walker‐Smith

University of London

Coovadia Hm

University of KwaZulu-Natal

A.E. Msengi

Muhimbili Orthopaedic Institute

Drasar Bs

International Centre for Diarrhoeal Disease Research

Cooperative Institutions

International Centre for Diarrhoeal Disease Research

University College London

London School of Hygiene & Tropical Medicine

London International Development Centre

University of London

University of KwaZulu-Natal

Institute of Child Health

Great Ormond Street Hospital

Johns Hopkins University

World Health Organization

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Impact of zinc supplementation on persistent diarrhoea in malnourished Bangladeshi children

Acta Paediatrica (1998)

Roy Sk AM Tomkins Dilip Mahalanabis S. M. Akramuzzaman Rukhsana Haider

To evaluate the impact of zinc supplementation on the clinical recovery and body weight of children with persistent diarrhoea, a randomized, double‐blind, controlled trial was conducted in 190 children with persistent diarrhoea aged between 3 and 24 months. Children were randomly allocated to receive either zinc (20 mg d −1 ) syrup with multivitamin (2 × RDA) or multivitamin alone in three divided daily doses for 2 weeks. The trial was conducted in a diarrhoeal disease hospital in Dhaka, Bangladesh. Duration until clinical recovery (d), impact on body weight and serum zinc level after 2 weeks of zinc supplementation were recorded. The duration of illness was significantly reduced (33%) with zinc supplementation among children who were underweight (≤70% wt/age, p = 0:03). Supplemented male children also had a significant reduction (27%) in duration for recovery compared with unsupplemented children ( p = 0:05). From baseline to convalescence, zinc‐supplemented children maintained their serum zinc concentration (13.4 vs 13.6/ μ mol l −1 ), whereas unsupplemented children had a decrease in serum zinc after the 2 weeks of diarrhoea (13.6 vs 11.8 μ mol l −1 , p < 0:03). The mean body weight of the children in the supplemented group was maintained (5.72 vs 5.70 kg, p = 0:62) during hospitalization, unlike that of the control group, in which there was a reduction in body weight (5.75 vs 5.67 kg, p = 0:05). Five children in the unsupplemented group and one child in the zinc‐supplemented group died during the 2 weeks of supplementation ( p = 0:06). Zinc supplementation in persistent diarrhoea significantly reduced the length of the recovery period in malnourished children and prevented a fall in body weight and serum zinc concentration, indicating that zinc is a beneficial therapeutic strategy in this high‐risk childhood illness.

Multivitamin

Convalescence

Underweight

10.1111/j.1651-2227.1998.tb00943.x

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Citations (74)

Production of safe therapeutic feeds from contaminated water supplies

The Lancet (2001)

Roy Sk Andrew Seal AM Tomkins T Shameen M. Sirajul Islam

Limiting

Contaminated water

Water contamination

10.1016/s0140-6736(00)04746-2

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Impact of maternal infection on foetal growth and nutrition.

PubMed (1994)

AM Tomkins Sandra Murray Patrícia Helen de Carvalho Rondó Suzanne Filteau

Satisfactory rates of fetal weight gain and development are important for health in infancy, childhood, and adult life. Maternal infection, however, may retard fetal growth. Accessible and effective treatment for infection is therefore vital not only for the general health and well-being of women, but also to prevent the adverse effects of infection on fetal growth and development. Prevention and treatment interventions should pay attention to environment, poverty, lifestyle, diet, and the provision of health services for women which are user friendly and efficient. New strategies for the community-based management of a range of infections in women are also needed, especially with regard to reproductive tract infections. Such strategies will require sensitive consideration of cultural beliefs and practices as well as the development and delivery of health services providing effective, affordable, and acceptable treatment. The paper discusses the disadvantages of being born small, the multiple causes of intrauterine growth retardation, maternal infection and fetal nutrition, infection and maternal nutrition, placental dysfunction, fetal infection, prevention, problems with access to treatment for infection, culturally appropriate medication, and pre-pregnancy infection.

Neonatal Infection

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Acute phase proteins as markers of systemic illness in acute diarrhoea

Acta Paediatrica (1999)

Jonathan C. Darling SM Filteau JA Kitundu RR Kingamkono A.E. Msengi

Fifty‐seven Tanzanian children, 6–25 months, hospitalized with acute diarrhoea were grouped according to whether there was clinical evidence of systemic infection (SI) ( n = 35) or not ( n = 22). Serum acute phase proteins were measured in samples taken within 48 h of admission. Means for C‐reactive protein (CRP) and serum amyloid A (SAA) were significantly higher in children with SI compared to those without (geometric means (95% CI); CRP, mg/l: 22.1 (13.6‐35.5) vs 7.4 (4.4‐12.4); SAA, mg/l: 12.2 (6.8‐22.1) vs 4.9 (2.5‐9.7)). Levels of o 1 ‐acid glycoprotein were similar in both groups (1.16 g/l (0.95‐1.43) vs 1.04 (0.83‐1.29), respectively). CRP ≥ 30 mg/l had a positive predictive value of 95%, and specificity of 96% for correctly identifying SI, but a low sensitivity (51%) and negative predictive value (55%). Clinical outcome of diarrhoea was worse in children with SI: more needed intravenous fluids (23% vs 5%), the duration of diarrhoea was longer (59.4 vs 34.2 h) and mortality was higher (6% vs 0%). APPs were not found to be useful markers of systemic illness in acute diarrhoea in this population.

10.1111/j.1651-2227.1999.tb01093.x

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Detection of Disabilities by Schoolchildren: A Pilot Study in Rural Pakistan

Tropical Doctor (1999)

Khalid Saeed Sheila Wirz Richard Gater Malik H. Mubbashar AM Tomkins

An important consideration in planning services for disabled children is to establish the need, including the size of the potential beneficiary group. However, surveys are expensive and time consuming (especially surveys of disability, which has a low prevalence within the population), and can raise expectations of service for patients who are often very unsure about how to cope with their disabled child. The World Health Organization (WHO) has produced a series of survey tools which have been used to identify disabled children in settings where a service is planned. Zaman et al, produced the '10 Question Screen', a simple screening tool for use by community health staff to identify disabilities among children in the community. Both the WHO survey tools and the 10 Question Screen rely on trained primary health care (PHC) or community-based rehabilitation (CBR) staff. The small study reported here shows that schoolchildren are effective identifiers of disabled children within their home communities and may be a useful resource when there are no trained CBR or PHC workers to conduct surveys. Furthermore, the children's ability to identify within the five major disability groups was relatively robust when compared with medical diagnosis.

Beneficiary

Community-based rehabilitation

Community Health

10.1177/004947559902900309

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Citations (8)

Diet, body size and micronutrient status in Parkinson's disease.

PubMed (1992)

Rebecca Abbott M. Cox Hugh S. Markus AM Tomkins

Pathogenesis

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