SUMMARYIn a prospective study of 652 sick pre-school children only 33% were found to be adequately nourished. Among the malnourished, 54.3% had first degree malnutrition while 32.3% and 13.4% had second and third degree malnutrition respectively. The majority of malnourished children (72.4%) had undernutrition: kwashiorkor (14.2%), marasmus 7.3%) and marasmic kwashiorkor (6.1%) was relatively less common. Furthermore, 58% of the underweight children were stunted, indicating malnutrition of some considerable duration. Malnutrition was essentially of postnatal origin and closely related to a high incidence of malnutrition-associated illnesses: diarrhoea (74%), measles (51%) and intestinal parasites (54%). Though breast feeding was universal and of adequate duration, milk production was mostly inadequate because of too early supplementation with low-energy cereal gruels with little or no protein-enrichment. The majority of children came from low socio-economic homes (61%) with mostly illiterate or semi-literate mothers. It is essential that newer methods of teaching be employed in the health education of these unfortunate mothers. Health institutions other than well-baby clinics need to have integrated units for nutritional and immunization surveillance and also for serving as avenues for the supply of free supplementary food items to children with poor weight gain, especially those from poor homes. Clinical Nutrition Units are needed to ensure that inpatients receive nutrients sufficient for continuing and catch-up growth.
Through a structured questionnaire, 523 parents and guardians who received prescription to collect medicine for their wards at the pharmacy of the Department of Child Health, Korle Bu Teaching Hospital were interviewed during the months of March and April, 1993. The objectives were to determine to what extent they remembered prescription instructions for their wards and to find out any other factors that contributed to drug non-compliance. A large percentage (about 80%) were able to recount instructions given correctly. It was however worrying, that quite a sizeable number could not recount instructions given. This obviously contributed to non-compliance. Other factors that were found and which could have contributed to non-compliance were: poor economic standing, non-availability of drugs at the hospital pharmacy, availability of similar drugs at home and patients getting well before the scheduled period of treatment is over. Of particular concern was the response by some parents/guardians that they would double the dosage to their wards to make up for a missed one should they forget any of the scheduled doses. Workers at pharmacy shops need to use simple practical means of giving prescription instructions, especially to illiterate patients.
Severe anaemia has remained a major cause of morbidity and mortality in children of Southern Ghana since the early 1960s. 71.1% of 15450 children attending the Korle Bu Teaching Hospital, Accra referred to the laboratory for haematological studies had haemoglobin (HB) levels below 11.0 Gm/dl while 27.7% of anaemic patients had Hb levels below 7.0 gm/dl. Indeed, 71.1% of children with severe anaemia had Hb levels below 5.0 gm/dl, thus requiring urgent blood transfusion. Though the Department of Child Health alone utilised 32.2% of total blood processed by the National Blood Transfusion Service at Korle Bu, as many as 259 (58.1%) of the 554 deaths in the emergency rooms per annum in children beyond the neonatal period were related to severe anaemia. Iron deficiency was the commonest cause of anaemia and contributed further to the anaemias of sickle cell disease and protein--energy malnutrition. In the light of the significant decline in the prevalence of childhood anaemia in the developed world following improved counseling in nutrition, fortification of foods with iron, and iron supplementation to infants and school children, and the documented attendant improvement in growth velocity and intellectual performance we support the planned national anaemia survey and recommend for early consideration iron supplementation to older infants and pre-school children at risk.Severe anemia has remained a major cause of morbidity and mortality in children of Southern Ghana since the early 1960s. Cases of anemia and anemia-associated mortality in the Korle Bu Teaching Hospital (KBTH), Accra, that occurred from January to December 1991 were reviewed. Data on hemoglobin levels, hypochromia, and malaria parasitemia of children referred from January to December 1991 were collected and analyzed to determine the prevalence of moderate/severe malaria parasitemia, anemia, and severe anemia. 10,989 (71.1%) of 15,450 children attending KBTH referred to the laboratory for hematological studies had hemoglobin (Hb) levels below 11.0 g/dl; while 3049 children (27.7%) of anemic patients had Hb levels below 7.0 g/dl. Of these 3049 children with severe anemia, 2185 (71.7%) had Hb levels below 5.0 g/dl, thus requiring urgent blood transfusion. Though the Department of Child Health alone utilized 32.2% of total blood processed by the National Blood Transfusion Service at KBTH, as many as 259 (58.1%) of the 554 deaths (306 male and 248 female) in the emergency room in children beyond the neonatal period were related to severe anemia. The main causes were nutritional anemia (n = 135), anemia associated with severe malaria (n = 56), anemia associated with sickle cell disease (n = 28), anemia associated with protein-energy malnutrition (n = 22), and 18 cases of anemia complicating gastroenteritis, pneumonia, meningitis, and convulsions. 108 (19.5%) deaths occurred because of neonatal sepsis, severe neonatal hyperbilirubinemia, meningitis and bronchopneumonia, severe anemia secondary to hemorrhage of the newborn, and faulty cord ligation. A significant decline occurred in the prevalence of childhood anemia in the developed world following improved counseling in nutrition, fortification of foods with iron, and iron supplementation to infants and schoolchildren with the attendant improvement in growth velocity and intellectual performance. A planned national anemia survey and early consideration of iron supplementation to older infants and preschool children at risk are recommended.
To study the importance of bone marrow inhibition in the pathogenesis of malarial anaemia, haematological and parasitological parameters were followed in patients with acute malaria. Three patient categories were studied, severe malarial anaemia (SA), cerebral malaria (CM) and uncomplicated malaria (UM). Red cell distribution width (RDW) was used as a surrogate marker of release of young erythrocytes and reticulocytes. Initially RDW was low in all patients in spite of markedly increased concentrations of erythropoietin (EPO). 3 d after institution of treatment and coinciding with parasite clearance RDW increased dramatically, reaching the highest levels 1–2 weeks later. Although severe anaemia was corrected by blood transfusion during the first 3 d of treatment, the peak RDW correlated significantly with the initial EPO levels. This suggests that Plasmodium falciparum infection causes a rapidly reversible suppression of the bone marrow response to EPO. Furthermore, the inhibition of bone marrow response was a general finding irrespective of initial haemoglobin levels suggesting that the severity of anaemia depends upon the degree of peripheral erythrocyte destruction in patients with suppressed bone marrow response to EPO.
Plasmodium falciparum species with reduced susceptibility to chloroquine have emerged in West Africa since the mid 1980s. Local strains, however, remain sensitive to amodiaquine with peripheral parasite clearance achieved within seven days in the majority. Blood cultures from 33 children (aged two to 12 years), who remained pyrexial after clearance of their parasitaemia, isolated causative organisms in 19 (57.6 pc) samples, with Salmonella species the commonest (68.4 pc) of all isolates. Complicating septicaemia needs consideration and early institution of treatment with antibiotics in children with severe malaria. Persistent pyrexia in malaria is not always due to resistance to antimalarials in areas with recent emergence of chloroquine resistant strains. A combination of amodiaquine and cotrimoxazole is suggested as a useful initial treatment.During May 1988 to August 1989, pediatricians enrolled 33 children aged 6 months to 12 years into a study to examine the role of septicemia in cases of severe malaria. The children had persistent fever (5 or more days) despite treatment with chloroquine and were admitted to the Department of Child Health of the University of Ghana Medical School in Accra with severe malaria (Plasmodium falciparum). At admission, all the children had malaria parasites in their blood films, 87.9% of whom had heavy peripheral parasitemia. Chloroquine cleared parasitemia within 3 days of treatment in only 33.3%. Treatment with oral amodiaquine followed when chloroquine failed to resolve the fever in 20 (60.6%) children. Children who still experienced fever then received intravenous (IV) penicillin and IV chloramphenicol over 7-14 days. Two (6.1%) children who died on days 5 and 13 still had a fever at death. 27.3% of all children had neurological complications. Pathogenic bacteria were isolated in 57.6% of all blood samples. Salmonella species were the most frequent species (68.4% of all isolates). These findings have motivated one of the clinical researchers to use a combination of oral amodiaquine (25 mg/kg) and co-trimoxazole to treat children with severe malaria and persistent fever.
