Some aspects of the long-term effects of malnutrition on the behaviour of children in the Third World.
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Biomedical subjects
Publications and source records attributed to J P Stanfield.
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Neonatal tetanus is an important cause of avoidable morbidity and mortality. In the past this disease was overlooked by the health services of many developing countries, but recently the extent and magnitude of neonatal tetanus has become clearer and shown that it is a very serious health problem in the developing countries. The results of community-based surveys show that neonatal tetanus mortality rates range from less than 5 to more than 60 per 1000 live births; these deaths represent between 23% and 72% of all neonatal deaths. The results so far suggest that this disease claims the lives of over half a million new-born children every year. All forms of tetanus, and especially neonatal tetanus, remain substantially under-reported in many countries, and routine reporting systems identify only about 2-5% of the estimated number of tetanus cases (based on the results of community surveys). More reliable and accurate estimates of the incidence and mortality from tetanus are therefore required.The elimination of neonatal tetanus is an essential and attainable goal. It may be achieved by combining two approaches: (1) increasing the immunization coverage of women of child-bearing age, and especially pregnant women, with tetanus toxoid, and (2) improving maternity care, with particular emphasis on increasing the proportions of deliveries that are attended by trained persons.Neonatal tetanus mortality should serve as an index of the quality and the extent of utilization of the maternal health services, of the impact of immunization programmes, and of the progress being made in achieving the WHO goal of "Health for All by the Year 2000".The elimination of neonatal tetanus calls for a full commitment by governments and by other bodies, public and private, with a responsibility for the care of women and children. The occurrence of even a single case of neonatal tetanus is witness to failures in the health system, for prevention is possible through the actions of trained health staff in contact with the mother.
In a cross sectional sample of 655 Glasgow babies the mean birthweight, after adjusting for other factors, of those with unemployed fathers was 150 g less (P less than 0.02) than for babies whose fathers were employed. A longitudinal study of 107 babies from 2 contrasting areas in Glasgow one of which was a socially deprived area was carried out concurrently. The deficit in length of 2.6% for infants from the deprived area at age 12 months was completely explained by adjusting for length at 1 month, father's height, and father's employment status (P less than 0.01). The effect of unemployment on the babies' birthweight was not affected by adjustment for social class. Unemployment may be related to poor infant growth in inner city areas and a national study is needed to see if the recent rise in unemployment has affected this association.
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The protein-energy malnutrition classification schemes of Waterlow and McLaren, although similar in other respects, assess the weight-for-height of children in quite different ways. The drawbacks of their two methods are described, and an alternative method is presented which overcomes them. The new index is called weight/height2-for-age, and consists of the ratio weight/height2 expressed as a percentage of the same ratio for a reference child of the same age. Although the index is not age independent, it is insensitive to all but the grossest errors in age for children over 12 months old. The index is equally appropriate for the assessment of obesity. A slide-rule based on the Tanner standard is available to do the calculation.
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Twenty-seven babies from one deprived housing area in Glasgow were followed-up regularly, for periods varying between 2 months and 11 months (mean 7 months), in a prospective study of the viruses to be found in their stools by electron microscopy. Weekly stool specimens were collected in the home together with a history of the baby's health. Additional stool specimens were obtained, up to a maximum of one per day, during admissions to hospital. Over 500 specimens were obtained at home and another 320 in hospital. A wide variety of viruses (over 200 recognizates) were detected and it has been possible to plot their temporal relation to disease episodes. It became apparent that virus excretion was frequently unaccompanied by evidence of illness and it has not been possible to describe a typical illness syndrome associated with any of the morphological types of virus observed. The results suggest that, in one area of Glasgow at least, patterns of virus excretion in young babies are complex and will need further elucidation before the need for a vaccine to prevent infantile diarrhoea could be defined.
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Three groups of Ugandan children (20 in each group) and one comparison group of 20 children were examined between 11 and 17 years of age. The first three groups had been admitted to hospital for treatment of protein energy malnutrition between the ages of eight to 15, 16 to 21 and 22 to 27 months, respectively. The comparison group had not been clinically malnourished throughout the whole period up to 27 months of age. All the children came from one tribe and were individually matched for sex, age, education and home environment. It was found that the three malnourished groups fell significantly below the comparison group in anthropometric measurements and in tests of intellectual and motor abilities. No evidence was found for a relationship between the deficit and age at admission. Further analysis among the 60 malnourished children revealed that anthropometry and intellectual and motor abilities are the more affected the greater the degree of 'chronic undernutrition' at admission, but no correlation was found with the severity of the 'acute malnutrition'. The results show a general impairment of intellectual abilities, with reasoning and spatial abilities most affected, memory and rote learning intermediately and language ability least, if at all, affected. These findings are discussed in the context of a comprehensive and critical appraisal of the existing literature.
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