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Sunday, 11 January 2009

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Chikungunya bares its fangs again

More than 3,500 cases of chikungunya have been reported during the last two weeks in the most recent outbreak that had hit mainly Ratnapura, Kalmunai, Moneragala and Polonnaruwa districts.

Dr. Paba Palihawadana, Director, Epidemiological Unit, Ministry of Health cautions residents of those areas to be watchful of their immediate surroundings and take necessary steps to clean up of mosquito breeding sites.

Dr. (Ms) Paba Palihawadana, Director, Epidemiological Unit, Ministry of Health

Chikungunya fever is a viral disease transmitted to humans by the bite of infected mosquitoes. Chikungunya virus (CHIKV) is spread by Aedes aegypti and Aedes albopictus mosquitoes.

It is the same aedes aegypti mosquito that spreads dengue fever. The Virus which was first isolated from the blood of a febrile patient in Tanzania in 1953, was reported from Sri Lanka in 1969.

Since then, as Dr. Palihawadana reveals cases of Chikungunya were not reported from Sri Lanka until the outbreak in the latter part of 2006 that affected the major districts including Colombo and Kalutara.

The present outbreak has mainly affected remote areas such as Ratnapura, Polonnaruwa, Kalmunai and Moneragala. Now it has moved on to less urban areas from urban areas. The population who have not been previously exposed to the virus are vulnerable and get affected by the virus from time to time.

In the early stages it is very difficult to differentiate between chikungunya and dengue. Though it is very much less severe than dengue and is not life threatening, it causes lots of disabilities.

It takes several weeks (months) for a patient to get back to normal. But if very old people get infected, they can die as a result of related causes like high fever. The most common symptoms are high fever (normally above 100 F (40 C)), severe joint pains and rash.

Other symptoms may include headache, fatigue, nausea and vomiting.” If high fever lasts for more than three days and does not subside even if you take paracetamol and consume lots of liquids, we would advise the patient to see a doctor.”

High fever is often accompanied with shaking chills. After a few days, fever may subside but rise again resulting in a saddle back fever curve.

Joint pain is polyarticular - pain may occur proportionately in knees, elbows, ankles and small joint sites of previous injuries. Pain is more acute as one wakes up in the morning. Joints may swell without significant fluid accumulation.

Even after recovery, joint pain may remain for several months and are accompanied by muscle pain. The condition of those who are already suffering from joint pains would get worse if they are struck by Chikungunya.

Rash could appear on the first day itself or later. It usually arises as a flush on the face and neck.

Aedes aegypti mosquito, one of the two types of mosquitoes who spread the CHIKV virus is actually the primary vector of CHIKV to humans. It is a household container breeder and aggressive daytime biter.

Aedes albopictus (the Asian tiger mosquito) may also play a role in human transmission of the virus in Asia, and various forest-dwelling mosquito species in Africa have been found to be infected with the virus.

Mosquitoes become infected when they feed on a person infected with CHIKV. When infected mosquitoes bite other humans, the virus spreads. Time frame from infection to illness can be 2-12 days, but is usually 3-7 days.

Treatment

There is no vaccine or specific antiviral treatment for chikungunya. Treatment is symptomatic. It is advisable to rest and consume a lot of liquids, take paracetamol to relieve fever and joint pain. Aspirin should be avoided during the acute stages of illness. If joint pain continues, it is necessary to go for analgesic and a long-term anti-inflammatory therapy.

Prevention

Prevention tips are similar to those of dengue fever.

1.To avoid mosquito bites it is necessary to use mosquito repellents, mosquito coils or protective clothing. Use a mosquito net.

2.Try to eliminate mosquito breeding sites where water can collect after rains. Most of the time it is after intermittent rains that we see the virus spreading. Water can get collected in discarded plastic containers, tyres, leaf axil, coconut shells, blocked gutters, bird baths, and flower pots.

In addition, a person who is already suffering from chikungunya, should try his best to limit his exposure to mosquito bites to avoid further spreading of the infection. It is advisable for the patient to stay indoors or under a mosquito net.

************

Dr. Paba Palihawadana noted that one of the causes for the spread of the disease is the increasing number of unplanned cities. There are no proper means of waste disposal, and no proper drainage system.

People who reside in town areas of Moneragala, Polonnaruwa, Thamankaduwa, Embilipitiya get affected largely due to large number of breeding sites that are available. People dispose of garbage, empty containers haphazardly.”

Due to security reasons dust bins have been removed. In areas like Embilipitiya people have got into the habit of just throwing away garbage.”

The present outbreak could be seen in those districts where people are not immune.

Fogging (applying a pesticide by rapidly heating the liquid chemical so that it forms\ very fine droplets that resemble smoke ora fog) is normally done if there is an outbreak. Malathion is the pesticide that is being used in this particular context.

“We have already done fogging in all four districts. It normally kills adult mosquitoes. When there is a high population of adult mosquitoes this normally expedites the spread of the disease. Now we continue with elimination of breeding grounds”, Dr. Palihawadana explained.

She further noted that the Health Ministry cannot fight the battle ‘alone.’ It should be a joint effort. Despite the fact that there is a scarcity of resources, the Health Ministry has already taken necessary steps to eliminate the disease.

It should be the duty of everyone to keep their immediate surroundings clean and hygienic. “If everyone takes care of their home gardens and follow proper garbage disposal methods, it is easy to reduce the mosquito population. Prevention is better than cure. The problem is that it is only when there is an outbreak that people think of taking preventive measures.


Unhealthy schoolbags: Can we relieve the burden?

The glimpse of a child carrying a heavy schoolbag must have generated sympathetic thoughts among everybody. We all see and talk about the uneasiness and difficulties our children face in carrying school material. Is it our responsibility? Can we do something?

Competitive educational environment has posed a challenge to school children in carrying a heavy load of books and other materials to the school. This has become a major problem not only in urban sector, but also in rural sector.

In a recent study carried out among schoolchildren by the Family Health Bureau, Ministry of Health, nearly 80% children carried a backpack as the schoolbag model. Only about 10% backpacks were compartmentalized.

A waist-belt was present in 29% of bags and only 30% schoolchildren used the waist-belt. However, 97% carried the backpack on both shoulders. The average weight of schoolbag was 3.72 kg.

The mean schoolbag weight as a fraction of total body weight was 11.04%. This was above the international cut-off of 10%. This study further revealed that a bag weighing more than 10% of bodyweight was carried by 58% of schoolchildren.

Obviously, there should be negative health consequences due to carriage of heavy schoolbag in improper ways. Recent studies in ergonomics related to schoolchildren, both internationally and in Sri Lanka, have shown that children undergo several negative impacts.

These include; musculoskeletal pain, high levels of general tiredness, schoolbag related injuries and postural displacements (shoulder level shifts and lateral deviation of the spine). Around 71% Sri Lankan schoolchildren reported musculoskeletal pain. Of them 36% suffered from recurrent pain. Among the associated factors, improper backpack behaviour was related to high risk of recurrent musculoskeletal pain.

Yes, we as parents, teachers or health professionals, do have a role to play in relieving such a burden. We have of opportunities to make all the stakeholders of health of schoolchildren knowledgeable on healthy schoolbags and related behaviour. We all can contribute to healthy schoolbag awareness campaign launched by the Family Health Bureau.

Following are the key messages;

Correct Selection

Correct model

Choose the healthiest model of the schoolbag - backpack model. A backpack is a sack carried on one’s back and secured with two straps that go over the shoulders and below the armpits. With this model, a higher weight could be carried with minimum stress to the body.

Correct size

Backpacks are available in different sizes in the market. The height of the backpack should be compatible with the back of the chest of the child. The lower edge of the bag should not go beyond the curve of the lower back.

Healthy features

Look for the healthy features of a backpack. The recommended features of a backpack include; two contoured and padded shoulder straps, movable straps, a waist belt and multiple compartments.

The well-padded shoulder straps minimize the pressure on blood vessels and nerves which are many in the neck and shoulders. It reduces the occurrence of pain and tingling in the neck, arms and hands. Movable straps adjust the backpack snugly fits in to the body of the child. The weight is better and evenly distributed within a compartmentalized backpack. Apart from helping to fix the bag on to the body, a waist belt transfer part of the weight of the bag to the hip region.

Correct behaviour

Not only the right schoolbag that matters. Healthy schoolbag behaviour is crucial.

Correct loading

Only take books and material that are necessary for the day according to the timetable. Packing of the schoolbag should be done in a way so that heaviest items to be closer to the back of the child. Do not allow items within the bag slide around. The ideal weight of the schoolbag should be less than 10% of the child’s body weight. It should never be more than 15%.

Right wearing

Both shoulder straps should be worn. By adjusting the shoulder straps and wearing the waist belt, the backpack should be positioned snugly to the body. The bag should not be worn only in one shoulder or hung loosely from the back. The bottom of the bag should never go beyond four inches below the waistline. Loose backpacks on the back can pull the child backwards and strain musculoskeletal system.

Health professionals, when ever they get an opportunity could enlighten schoolchildren, parents and teachers with these simple and clear instructions to help choosing a healthy schoolbag and inculcate ergonomic bag behaviour among future productive generations. It is also essential to translate this knowledge to bag manufacturers. If healthy bags are not available in the market, the consumers - schoolchildren - have no option to choose from.

The Family Health Bureau has taken many steps to promote healthy schoolbag throughout the country. The Ministry of Education works in collaboration with this initiative. A media seminar was conducted in association with Health Education Bureau to disseminate information. This project was funded by the Health Sector Development Project of the World Bank.

(The writer is the Senior Registrar in Community Medicine, Child Health Unit, Family Health Bureau, Ministry of Healthcare and Nutrition)


Cashew nuts:

Nutritional and health aspects

Cashew tree is a native to costal areas of Brazil. In the 16th century, Portuguese explorers took cashew trees from this South American country and introduced them to other tropical regions such as India, Sri Lanka and some African countries and Asian countries where they are now also cultivated.

The cashew tree has always been a prized resource owing to its precious wood, cashew balm and cashew apple; but the cashew nut itself did not gain popularity until the beginning of 20th century. Today the leading commercial producers of cashew are India, Brazil, Mozambique, Tanzania and Nigeria.

Cashews known scientifically as Anacardium occidentale belong to the same family as the mango and pistachio nut.

How to select and store

Cashew are generally available in prepackaged containers. When you purchase cashew in a packaged container, make sure that here is no evidence of moisture or insect damage and that they are not shrivelled. If it is possible to smell the cashews, do so in order to ensure that they are not rancid.

Due to high content of oleic acid (which is a mono-unsaturated fatty acid), cashew are more stable than most other nuts, but should still be stored, in a tightly sealed container in a refrigerator where they will keep for about six months or in a freezer where they will keep for about one year.

Cashew nuts are actually the kidney-shaped seeds that adhere to the bottom of the cashew apple, the fruit of the cashew tree. While cashew apples are not appreciated by most urban Sri Lankans, they are recorded as delicacies in Brazil and Caribbean.

In Sri Lanka cashew are almost always sold after removing the shells. You have probably noticed that cashews in shells are not available in our boutiques, Sunday fairs and supermarket. To roast cashews at home do so gently in a 160-170 degree F over for 15-20 minutes to preserve the healthy oils.

Cashews in food

Cashew kernels have found applications in food since ages. Currently, the usage has expanded considerably and cashew has found its presence invaluable in many combinations of food. It is already popular with the manufacturing industry in biscuits, chocolates and ice-cream.

A wide application in Indian, Sri Lankan Eastern or Western cuisine makes cashew in food highly pleasurable. People enjoy the most when they eat the plain cashew.

“Bataleeya” cashew which was very popular about 15 years ago when it was served fresh after roasting fresh cashew kernels by the pretty damsels of “Bataleeya” are not so popular now as it is served in prepacked packets as these packets are not very fresh. people consume these tasty nuts both before, during and after aperitifs and as side - dishes appetizers or snacks before and after meals mainly during work lunches, breaks, cold meals and parties with relatives or friends. The advantage of cashew is that it has rich, delightful taste and is meaty and acceptable as it is.

Cashew curry is a very popular item among Sri Lankans and is a common dish served during Buddhist alms-giving (Dana) and most of the monks love it. Cashew dishes are served in most of the Indian and Chinese restaurants in Sri Lanka.

Nutritional and medicinal value

Cashew is natures vitamin pill. Cashew kernel of 100 gms contribute about 600 calories. It is having a balanced nutritive profile. The nutritive values present in cashew kernels are protein, fats, carbohydrates, vitamins and minerals. It is a source of minerals like calcium, magnesium, phosphorus, sodium, iron and other minerals which help to prevent anaemia and nervous ailments.

Cholesterol

Cashews are rich in fat. The fat it constitutes about 47% of the total weight of the nut. This could be good news for people who feel weak or debilitated, but what does it mean to people who are conscious of their weight and fat intake?

Cashew has 0% cholesterol. Cashews have what is called the “good” fat. I do admit that cashews will add to your weight if you consume cashew ad lib, but moderate consumption is beneficial.

Cashew has the right combination of fat which could put your fears to rest. The ratio of saturated: mono unsaturated: polyunsaturated is 1:2:1. This is the ideal for human consumption. The relative abundance of mono-unsaturated fatty acids in cashew nut is an advantage for heart patients with low good (HDL) cholesterol. The fatty acid profile of fatty acids in cashew is conducive to the promotion of good health and hit relative abundance of fat in cashew nut is no way poses a nutritive risk.

Nutritive values for 100 gms of cashew nuts

Water 2.4%
Protein 20.5%
Fat 50%
Carbohydrate 18.7%
Energy 611 kcal

Fatty acid for 100g of cashew nuts

Saturated fatty acids 10%
Mono unsaturated fatty acids 29.4%
Polyunsaturated fatty acids 9.1%

Inorganic composition for 100 g of cashew nuts

Sodium 290 mg
Potassium 730 mg
Magnesium 250 mg
Phosphorous 510 mg
Iron 6.2 mg
Copper 2.04 mg
Zinc 2.04 mg
Chloride 490 mg
Manganese 1.8 mg
Selenium 34 micro grams

Vitamin contents

Retinol 6.0 (i.u.)
Carotene 6.0
Vitamin E 1.30
Thiamine 0.41
Riboflavin 0.16
Niacin 1.30
Foliate 68.0
Pantothenate 1.08
Biotin 13.0

Essential amino acids

Argine 650
Histiodine 130
Lysine 290
Tryptophan 110
Phenylalanine 270
Methionine 90
Threonine 200
Leucine 510

Health benefits

Heart protective mono unsaturated fats

Not only do cashew have a lower fat content than most other nuts, approximately 75% of this is unsaturated fatty acids plus about 75% of this unsaturated fatty acid content is oleic acid, the same heart healthy mono unsaturated fat found is olive oil. Studies show that oleic acid promotes good cardiovascular health even in individuals with diabetes.

Studies of diabetic patients show that mono-unsaturated fat when added to low fat diet can help to reduce high triglyceride levels.

Triglycerides are a form in which fats are carried in the blood and high triglyceride levels are associated with an increased risk for heart disease, so ensuring you have some mono unsaturated fats in your diet by enjoying cashew is a good idea especially for persons with diabetes.

Just a quarter cup of these delicious nuts supplies 37.4% of daily value for mono unsaturated fat. In addition these healthful mono unsaturated fat, cashew are a good source of copper magnesium, zinc and biotin.

Copper for antioxidant defence energy production, bones and blood vessels

An essential component of many enzymes, copper plays a role in a wide range of physiological processes including iron utilisation, elimination of free radicals, development of bone and connective tissue and development of the skin and hair pigment called melanin.

Copper is an essential component of enzyme super oxide dismutase which is important in energy production and antioxidant defence. Low dietary intake of copper may also be associated with increased free radical production and faecal water alkaline phosphates actively, risk factor for colon cancer.

Numerous health problems such as iron deficiency anaemia, ruptured blood vessels, osteoporosis, joint problem such as rheumatoid arthritis, brain disturbances, elevated LDL (bad) cholesterol level, irregular heart beat and increased susceptibility to infections can develop when copper intake is inadequate. Topping your morning cereal with a quarter cup of cashew will supply you with 38.0% of the daily recommended value of copper.

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