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G Parent

Publications and source records attributed to G Parent.

41 records · Page 3Linked to original sources
PubMedDate not supplied

[Immuno-nutritional recovery of children with severe malnutrition].

In developing countries, more than 12 million children die each year from the combined effects of malnutrition and infection. Malnourished children have impaired cellular immunity and are particularly sensitive to opportunistic infections. However, immune recovery has rarely been investigated during nutritional rehabilitation. Indeed, mortality remains high during renutrition, and relapses are frequent. We established a center in Cochabamba, Bolivia, specifically to save these children by treating both clinical and nutritional problems and restoring immune function. The CRIN (center for immuno-nutritional recovery) admits children with severe malnutrition from the Cochabamba suburban area. They are from low income families, in crowded living conditions with poor sanitation and are weaned early. Nutritional diagnosis was based on weight-for-height, arm to head circumference ratio and clinical examination for edema, loss of subcutaneous tissue and diminished muscle mass. The children were examined daily, and first treated for respiratory and intestinal infections. Sociological and psychological aspects were also included in our holistic approach to treating severe malnutrition. Children received a four-stage diet lasting 2 months. During the initial phase (1 week) they were given an oil-sugar-milk based diet, with half lactose concentration, seven times a day. This supplied 1.5 to 2.5 g of protein and 120 to 150 kcal/kg of body weight, according to the PEM pattern. Protein and energy intake was then slowly increased during the transition phase (1 week). During the next, 'calorific-protein bombing' phase (6 weeks) 5 g of protein and 200 kcal/kg of body weight were given daily, such that there was sufficient energy for protein accumulation. During the last, discharge phase (1 week), the protein and energy contents were slowly decreased. Weight, height, arm and head circumferences, and triceps skin-fold thickness were measured weekly by standardized methods. Thymus size was assessed weekly by mediastinal ultrasound scanning with a portable scanner (ALOKA SSD-210 DXII, Tokyo) using a 5 MHz linear pediatric probe. Lymphocyte subpopulations in peripheral blood were investigated monthly using monoclonal antibodies. Compared to controls, the malnourished group had severe involution of the thymus, a significantly higher proportion of circulating immature T lymphocytes and a lower proportion of mature T lymphocytes. The two month longitudinal study showed that normal anthropometric values (90% NCHS weight for height) were recovered after one month of rehabilitation. However, immune recovery (thymic area of 350 nm2) required two months. This may explain the frequent relapses among malnourished children discharged after one month on the basis of 'apparent nutritional health'. Such children may remain immunodepressed, and should therefore be considered as high risk children. To test an immunostimulatory treatment, we designed a historical cohort study of malnourished children who received 2 mg of zinc per day. The children were matched for age, sex, anthropometric criteria and nutritional status with malnourished control children (treated previously with zinc). Anthropometric recovery was obtained in both groups in one month. Children receiving zinc attained immunological recovery within one month, whereas children not receiving zinc took two months. Thus zinc hastened immunological recovery concomitant with nutritional recovery such that the duration of hospitalization could be halved: after one month of this immuno-nutritional treatment, malnourished children appear to be sufficiently healthy to face their pathogenic home environment.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Large dams, health and nutrition in Africa: beyond the controversy].

The population in sub-Saharan Africa is growing faster than increases in food production, resulting in a net decrease in food production per capita. The Food and Agriculture Organization has stated that there is a "risk of widespread hunger" which could be prevented by "effective planning of water resources". However, the potential effects of such schemes on the human population are often inadequately assessed and the effect of large dams on human health is not clear. The potential risk to human health of water resources was emphasized a few years ago but no effective preventive programs were implemented, probably because of inadequate availability of information and lack of awareness. The effects on health of "large" water resource projects are not uniform within a population. Decision-makers have tended to focus on the positive effects, to obtain support for their plans. These include: 1) improvement in the well-being of the population (safe water more readily available, new infrastructure, better access to health care) and 2) increases in the food supply (more vegetables and fish available due to irrigation). Thus, there has been a logical expectation that more, better quality food will become available as a result of these schemes, whereas in fact, health and nutrition has often worsened, particularly in young children. Most of the diseases associated with water resource management are communicable, including diseases directly related to the presence of large quantities of water, such as: malaria, which increases in incidence immediately after the building of the dam, after which a new balance develops between the human population and the parasites, schistosomiasis, the disease which increases most in response to the building of dams, particularly in its most severe gastrointestinal form, diarrhea, as water is a major means of dissemination for many organisms, including those causing digestive tract infections and gastroenteritis (amebiasis, salmonellosis, cholera), due to poor sanitation, other parasitic infections, such as onchocerciasis and trypanosomiasis, which should be monitored as they may also threaten the population. Other communicable diseases may appear or increase in incidence with the influx of migrants to the irrigated area. Sexually-transmitted diseases and HIV infection are a particular problem. The large numbers of insects (mosquitoes, blackflies) may also have harmful effects on populations adapting to the new environment. These effects are related to each other and to the environmental changes. New types of food affect people's feeding habits and generate new sources of income. However, they may also lead to new and higher expenditure. There are also likely to be major socio-demographic changes associated with changes in reproductive behavior and women's activities. The location and nature of new homes and infrastructure (e.g. schools, health centers, roads) also contribute to the success or failure of the dam project. There are many constraints to be considered and a more comprehensive approach to the problem is required. Health and nutritional status may be used as simple indicators of the ability of the population to adapt to a new environment. This makes it possible to construct a causal model to identify the most effective and relevant areas of intervention. Health and nutrition issues are of vital importance and scientific findings should be used in decision-making processes for planning future large dam schemes.

Africa South of the Sahara↗