PubMed · 15805238
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Andrew L Schwaderer, George J Schwartz. 2005. Treating hypernatremic dehydration.. https://doi.org/10.1542/pir.26-4-148
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Although diarrhoea and malaria are among the leading causes of child mortality and morbidity in Sub-Saharan Africa, few detailed studies have examined the patterns and determinants of these ailments in the most affected communities. In this paper, we investigate the spatial distribution of observed diarrhoea and fever prevalence in Malawi using individual data for 10,185 children from the 2000 Malawi Demographic and Health survey. We highlight inequalities in child health by mapping the residual district spatial effects using a geo-additive probit model that simultaneously controls for spatial dependence in the data and potential nonlinear effects of covariates. The residual spatial effects were modelled via a Bayesian approach. For both ailments, we were able to identify a distinct district pattern of childhood morbidity. In particular, the results suggest that children living in the capital city are less affected by fever, although this is not true for diarrhoea, where some urban agglomerations are associated with a higher childhood morbidity risk. The spatial patterns emphasize the role of remoteness as well as climatic, environmental, and geographic factors on morbidity. The fixed effects show that for diarrhoea, the risk of child morbidity appears to be lower among infants who are exclusively breastfed than among those who are mixed-fed. However, exclusive breastfeeding was not found to have a protective effect on fever. An important socio-economic factor for both diarrhoea and fever morbidity was parental education, especially maternal educational attainment. Diarrhoea and fever were both observed to show an interesting association with child's age. We were able to discern the continuous worsening of the child morbidity up to 8-12 months of age. This deterioration set in right after birth and continues, more or less linearly until 8-12 months, before beginning to decline thereafter. Independent of other factors, a separate spatial process produces district inequalities in child's health.
The present study was carried out in Ouagadougou (Burkina Faso) with the aim of determining if the duration of the habituation period (1, 5 or 10 days) to low and high energy density gruels affected the amounts consumed or the energy intakes from gruels consumed by 6-9-month-old infants. Thirty infants were chosen randomly among the eligible children in the study area and randomly assigned to two groups (S1 and S2). Each infant was given successively for 10 consecutive days two experimental gruels, each type of gruel being fed twice a day. The 15 infants in group S1 received low energy density gruel (G1) in the first period and high energy density gruel (G2) in the second, and the 15 infants in group S2 received G2 in the first period and G1 in the second. The two periods of 10 days were separated by 4 days during which the infant received his or her usual foods. The intakes of experimental gruels and other complementary foods were measured on days 1, 5 and 10 of each period. Whatever the type of gruel, the 10-day period of habituation did not result in an increase in the amounts consumed or in the energy intakes from these gruels. The amounts of G1 consumed on day 5 were significantly higher than those of G2 (9.0 vs 6.8 g/kg/meal; p = 0.044). Energy intakes from G2 were significantly higher than those from G1 on days 1 (28.8 vs 18.0 kJ/kg/meal; p = 0.0002), 5 (28.8 vs 19.2 kJ/kg/meal; p = 0.002) and 10 (25.9 vs 15.5 kJ/kg/meal; p = 0.0004). Daily frequencies of breastfeeding (approximately 5.6), water drinking (approximately 3.7) and meals with foods other than experimental gruels were relatively high and did not vary with the duration of the habituation period or the type of gruels. Whatever the type of gruel, the increase in the duration of the habituation period did not increase the amount consumed or energy intakes. The study confirmed that consumption of high energy density gruels led to a 60% increase in energy intakes in comparison with the consumption of low energy density gruels.
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