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| Sunday, 26 January 2003 |
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Features |  |
| News Business Features Editorial
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Compiled by Carol Aloysius Fever? Rapid breathing? Your child could be developing... : PNEUMONIA Pneumonia is a common illness among young children. It could have fatal results if not treated early. Dr. Bandu Gunasena, Consultant Chest Physician, Galle Hospital, discusses its prevention, symptoms and treatment with staff writer Don Asoka Wijewardene in the following article. Pneumonia is a general term referring to an infection of the lungs that can be caused by a variety of micro-organisms, including viruses, bacteria and parasites. Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). When this happens, symptoms of pneumonia appear after two or three days of a cold or sore throat. Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Some common symptoms include: fever, chills, cough; unusually rapid breathing; breathing that makes a "grunting" or wheezing sound; laboured breathing that makes a child's rib muscles retract (muscles between ribs draw inward with each breath); vomiting, chest pain, abdominal pain, decreased activity, loss of appetite (in older children) or poor feeding (in infants); and bluish or grey colour of the lips and fingernails. Sometimes a child's only symptoms are fever and rapid breathing. And sometimes, when pneumonia is in the lower parts of the lungs near the abdomen, there may be no breathing problems at all - only fever and abdominal pain. When pneumonia is caused by bacteria, the infected child usually becomes sick relatively fast, with the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia.
Prevention There are vaccines to prevent infections by viruses or bacteria that cause some types of pneumonia. For example, children usually receive routine immunisations against haemophilus influenzae and pertussis (whooping cough) beginning at age two months - the pertussis immunisation is the "P" part of the routine DTP injection. Children with chronic illnesses, who are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. Doctors may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in children who have been exposed to someone with certain types of pneumonia, such as pertussis. Children with HIV infection may also receive prophylactic antibiotics to prevent pneumonia caused by pneumocystis carini. Antiviral medication is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe. In general, since pneumonia is usually caused by bacteria or viruses that are contagious, it is advisable to keep children away from anyone who already has pneumonia or an upper respiratory tract infection that can lead to pneumonia. If someone in your home has a respiratory infection or throat infection, keep his or her drinking glass and eating utensils separate from those of other family members, and wash your hands frequently especially if you are handling used tissues or dirty handkerchiefs. The incubation period for pneumonia varies,depending on the type of virus or bacteria causing the infection.Some common incubation periods are: respiratory syncytial virus, 4-6 days, influenza, 18-72 hours. With treatment, most types of bacterial pneumonia can be cured within 1-2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4-6 weeks to resolve completely. Home treatement If your doctor has prescribed antibiotics for your child's bacterial pneumonia, give the medicine on schedule for as long as your doctor directs. This will help your child recover faster and will decrease the chance that infection will spread to others in the household. Use a cool-mist humidifier to increase moisture in the air. Encourage your child to drink fluids, especially if there is a fever. Professional treatement In most cases, pneumonia can be treated with antibiotics given to your child by mouth at home. The type of antibiotic used depends on the type of pneumonia. Infants may be hospitalised for treatment if their pneumonia is caused by pertussis (whooping cough bacteria) or other bacterial pneumonia, or if they have lung infections that may have spread into the bloodstream. ############# Moderate malnutrition - are we paying attention? by Channa R. Jayasekera
Take a look at the two pictures. The first is an Angolan child being weighed at a clinic, and the second is a North Korean child eating. Which of these children is/are malnourished? If you answered "the first one," you will receive only partial credit. The correct answer is "both". Is it obvious? Definitely not. Malnutrition, albeit its common interpretation, does not lead only to the severe physical and mental wasting that we see, like in the Angolan child, among the most impoverished people of the world. It is indeed universal, and its reach, mainly in the form of 'moderate' malnutrition, is greatly underestimated. Moderate malnutrition is what we see (or don't see!) in the North Korean child, and it stems from low intake of certain nutrients, rather than acute starvation. It is obvious that moderate malnutrition is not easily detectable, unless by a trained person. This is where the danger lies. Impact of moderate malnutrition The significance of moderate malnutrition becomes clear when we look at statistics of its impact. Its chief forms, protein-energy malnutrition and iodine, iron and vitamin A deficiencies, affect billions of people. We can look at the effects of malnutrition as two ways - direct and
contributory. Direct effects are what we would expect in someone not
receiving the nutrition that is needed to maintain body function. These
effects may not be apparent at first glance, but various The more unknown detriment of malnutrition however is very much more potent. This is that malnutrition is one of the most powerful and significant contributors to the likelihood and severity of illness, particularly in children. When a moderately malnourished child gets an infectious disease, the body's natural ability to overcome it has already been drastically crippled. Whether it is respiratory illnesses (pneumonia etc.), measles, malaria, diarrhoea, or any other, this potentiating effect of moderate malnutrition leads to much more severe episodes and a much higher likelihood of death. How does this happen? We are constantly bombarded with the millions of bacteria, viruses and the like, that cause disease. To protect us, the body has an amazing defense system - the immune system - that keeps the unwanted out (by using barriers like the skin) and, if they enter, destroys them with special cells and molecules like antibodies. It also provides the immunity we need to protect ourselves from re-occurrence of certain diseases for life - chicken pox, for example. Thus moderate malnutrition is a very serious issue that impairs health in a myriad ways. Turning the tide Surely, there must be a bright side to all this. The answer is yes and no. Theoretically, combating moderate malnutrition should be simpler than combating diseases like AIDS. This is because it requires often cheap, simple changes to lifestyle or treatments, coupled with viable public health services and people's compliance. In most cases, it is completely reversible if detected and acted upon early. For example, UNICEF has prevented almost a million child deaths since 1998 by mass distribution of vitamin A capsules that cost just three US cents (Rs. 3) annually per child, and need only be taken twice a year. Sri Lanka's predicament Sri Lanka has a significant public health problem with moderate malnutrition. According to Health Ministry statistics, 22 per cent of children under three years are stunted (significantly shorter than normal for their age) and 15 per cent are wasted (significantly lighter than normal for their age). Almost 18 per cent of the entire population is deficient in iodine. Over 30 per cent of pregnant women and half of all pre-school children are anaemic due to low iron stores. One third of all children under six years are deficient in vitamin A. Of course, areas directly affected by the war - the border villages and so-called 'un-cleared areas' are considerably worse off. There is urgent need and ample room for public displays of unity and concern... Sri Lanka too has a significant public health problem with moderate malnutrition. How can we eliminate this problem? Educating, empowering and providing new opportunities for young girls and women is critical to eliminate moderate malnutrition. The early introduction of free health care, free education and universal franchise have contributed enormously to raise the educational and health standards of women in Sri Lanka. These are unique assets that can be utilized in Sri Lanka to fight not only malnutrition, but also the spread of infectious and chronic disease. World Bank studies have shown that educating girls is the single most profitable investment of all. Being the typical caregivers to children, women play a vital role in their nutrition and hygiene. This then reduces the risks of child illness and death, and lessens health-related financial burdens. Educating girls has also shown to increase birth spacing - the time between consecutive births, which is highly beneficial to child nutrition and family well-being. From a purely nutritional and more direct standpoint, we need to encourage three main components of good nutrition - meeting the nutritional needs of pregnant women, increasing the prevalence of breastfeeding, and increasing the variety and nutritional quality of food that we normally eat. Nutritional needs during pregnancy shoot up and need to be compensated through diet and supplements. Besides the obvious need for more protein and carbohydrates, vitamins and other micro-nutrients like iron and folate have to be in increased supply. Estimates show that due to lack of iron, 50-75 per cent of pregnant women in developing countries are anaemic. This then reflects on the infant's health as well. Similarly, women with low vitamin A intake are known to give birth to infants who are vitamin A deficient, leading to various problems like night blindness (a reversible form of poor vision) and lower immunity. Hence taking care of pregnant women by making sure they meet their nutrient needs and seek health care during pregnancy ensures healthy infants and healthy mothers. Breastfeeding is undoubtedly the greatest gift of good health that can be given to an infant. Formula milk, however well prepared, is no substitute. Breast milk is not only rich in nutrients, but also in antibodies - the molecules that protect us from infectious diseases. It therefore drastically reduces the likelihood and severity of childhood infections while optimizing growth. The current recommendations for infant feeding are exclusively breastfeeding for the first six months, and then, complementing breast milk with other foods into the second year of life. According to UNICEF, only 24 per cent of Sri Lankan mothers exclusively breastfeed for at least 3 months. 60 per cent breastfeed in conjunction with other foods from three to six months and 66 per cent breastfeed in conjunction with other foods for a year. These numbers are too low, and need improvement. For older children and adults, there is no substitute for well-balanced meals. Tablets, supplements and the like are necessary only when our diet is bad. Imbalanced meals, for example once excessively heavy on starch (polished rice, unfortified bread/wheat products) and light on vegetables, pulses, meat/fish and dairy products, are good sources of energy but low on proteins, fat, vitamins or minerals. Such increasingly starchy meals that we commonly see are bad for two main reasons. First, they are very filling, which causes us not to eat for a long while. Secondly, they are almost exclusively carbohydrate. Overtime, our body is gradually malnourished of protein, vitamins and minerals due to such diets, which then brings on the myriad health and economic problems that have been discussed earlier. Detailed information about ideal foods, diets and practices are well known in the scientific community. Yet how much of this information is infused into the public? For example, who would think that drinking tea with our meals greatly reduces the amount of iron we can extract from our food? Yet it is true, since molecules in tea called polyphenols are potent inhibitors of iron absorption. Would this information not be of relevance to those with high iron needs - pregnant women and girls? Another example is the ever-increasing scientific knowledge that people acquire 'developed world' chronic diseases (heart disease, cancer, diabetes etc.), simply by taking on 'developed world' dietary and life habits. The trendy 'fast food culture' which means eating high-fat and high-sugar foods, and low physical activity levels play into these diseases. We do not need these, especially when infectious diseases like malaria, diarrhoea etc., are still rampant in our country. As such, making information widely known is key to our nation's health. (The author is a student of international nutrition and nutritional biochemistry at Cornell University, New York, USA). ############# You &Your Doctor High blood pressure Q: I have been suffering from high blood pressure since I was 40 years. Now I am 50 years. My blood pressure is under control now with drugs i.e. Enalapil 5 mg at night and Atenolol 50 mg in the morning. But my doctor forces me to take drugs continuously. At every visit to my doctor my BP has remained at normal levels for the past one year. If my BP is normal why should I continue drugs? How long should one continue the drugs? What will happen if I stop taking medicine? Please give me your opinion. A: Usually one should continue medicine without interruption if BP is to be controlled within the normal range for his/her age. Sometimes you may have to take medicine for the rest of your life, because with your ageing process blood pressure also can go up gradually beyond safe levels. Only your doctor can reduce the quantity of drugs you are taking at present and that too under his close supervision. Otherwise if you try to stop or reduce your drugs on your own you may end up with complications of blood pressure leading to a risk of your life. This is relevant only to the High Blood Pressure state - called Essential Hypertensive Disease i.e. when there is no obvious treatable cause in your body, but you develop high pressure. On the other hand, one can develop temporary pressure states. In such situation lifelong treatment is not required. Emotional stress, tension, worries in your life are some of the causes. Some mothers develop high pressure during their pregnancy period, but comeback to normal after the child birth. by Dr. Sampath R. Nanayakkara ############# From our readers... Why Sri Lanka needs more speech therapists The role of a speech and language therapist is to treat adults and children who have speech and/or language difficulties. They consist of speech delay, language delay, speech and language delay, hearing problems, stammering, problematic conditions of speech and language after a stroke, difficulties regarding learning, voice problems and many other conditions which result speech abnormalities. Speech and language therapy is a comparatively new field in Sri Lanka although there has been a need for experienced persons in the field for a long time. Today there is a limited number of speech therapists who practice in the Government hospitals as well as in the private sector. For example, the Base hospitals centred in Colombo, Kandy, Ragama, Galle and Ratnapura have the facilities to obtain the services of speech therapists for those who suffer from speech and language deficiencies. A speech therapist plays an essential role both within a hospital environment and outside. He can work in a community based rehabilitation project, in a school or in any other social institution which needs the service of a speech therapist. It is important to note that speech therapy requires, team work. Hence a speech therapist should be a member of a multidisciplinary team comprising professionals of ENT, Peadiatric, Neurology, cleft lip and palate and rehabilitation. It is unfortunate that in most of instances of speech and language difficulties, the speech therapist's role begins late in the treatment and rehabilitation process. This is due to many reasons such as lack of awareness among health care professionals and the scarcity of speech therapists in the country specially in rural areas. In some cases, when patients finally seek their help, it is too late to intervene. This letter is to create an awareness of this therapeutic treatment facility now available for hundreds of people with speech and language deficiencies in Sri Lanka in the already mentioned hospitals which are equipped with necessary facilities and professionals. The field of speech and language therapy is still an emerging field. A great deal still remains to be done to meet the needs of the people with speech and language difficulties especially in a developing country like Sri Lanka. Chamika P. Vidanagamage, Speech language therapist |
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| Editorial | Security Produced by Lake House |
Some types of pneumonia cause symptoms that give important clues about
which germ is causing the illness. For example, in older children and
adolescents, pneumonia due to mycoplasma (walking pneumonia) is notorious
for causing sore throat and headache in addition to the usual symptoms of
pneumonia. In infants, pneumonia due to chlamydia may cause conjunctivitis
(redness of the eyes) with only mild illness and no fever. In pneumonia
due to pertussis (the whooping cough bacteria) the child may have long
coughing spells, turn blue from lack of air,or make a classic
"whoop" sound when trying to take a breath.
The world produces enough food to adequately feed each and every human
being, and to eliminate nutritional deficiencies. Yet, millions are
starving, hundreds of millions are in the throes of malnutrition and many
more are at risk of being malnourished.
measurements used
by medical personnel attest to their existence. Some of the most common
are low growth potential, low mental and cognitive ability, impaired
senses, higher incidence of birth difficulties for pregnant women, higher
risk of growth retardation of the fetus, and a multitude others.
