Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Subject: search.filters.subject.Child, Preschool

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    Prevalence of functional constipation in infants and toddlers in Sri Lanka.
    (Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.
    OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.
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    Bowel habits in Sri Lankan infants and toddlers, a population based study.
    (Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.
    OBJECTIVE: To obtain knowledge about bowel habits in healthy population of infants and toddlers in Sri Lanka. METHODS: We selected healthy children between 7 months and 5 years of age who visited vaccination and weighing clinics. To achieve data we used a self-administered questionnaire about the child's bowel habits during the previous two months. All subjects were selected in Gampaha district, Sri Lanka. Only those without defecation disorders were used for analysis. RESULTS: A total of 879 toddlers were eligible for analysis, (female n = 442 [50,3%], mean age 21,7 months, standard deviation [SD] 12,5 months). Of them, 595 (69,6%) defecated once a day, 20 (2,3%) had defecation >3/week and 6 (0,7%) <3/week. Stool consistency was hard or very hard in 30 (3,4%), 665 (78,9%) had smooth and soft stool and 107 (12,2%) had varying consistency. Straining and painful stool were reported in 560 (64,7%) respectively 194 (23%) of the sample, stool holding was present in 93 (10,8%) and 44 (4,9%) passed blood with the stool. No children reported fecal incontinence. CONCLUSIONS: This study provides data on normal bowel habits of Sri Lankan toddlers and infants. Bowel habits and disorders related to defecation in Sri Lankan toddlers and children differ from those living in the West probably due to dietary, genetic and environmental variations
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    Developing a tool to screen for disability among pre-school children: preliminary results
    (Sri Lanka Medical Association, 2014) Perera, K.M.N.; Wijerathne, L.; Jayasinghe, C.; Kasturiratne, A.; Hettiarachchi, S.; Fonseka, R.; Jayasena, B.N.; Siriwardhena, D.; Godamunne, P.; Dahanayake, W.; Pathmeswaran, A.; Wickremasinghe, A.R.
    INTRODUCTION AND OBJECTIVES: To develop and validate a tool that can be used by pre-school teachers to identify disabilities in the pre-school age group. METHODS: A multidisciplinary team was formed and the initial tool was developed^ Consensual validity was achieved by using nominal group technique and the tool was pre-tested in the Ragama MOH area. To assure criterion validity, the tool was used to screen all the children in the pre-school age group (2-5 years) in an MOH area randomly selected from the Anuradhapura District. The screened positives .were referred to an expert panel for confirmation of diagnosis and follow-up if required. RESULTS: Thousand nine hundred children were invited for screening and 1536 participated (478 2-3 years, 495 3-years, 560 > 4 years of age) and 267 (17.4%) were referred to the expert panel. Out of the referrals, majority (38.9%) had multiple disabilities. Hearing and speech difficulties were seen in (29.6%). Psycho social problems (11.6%), disabilities and other diseases (19.8%) accounted for the rest. The response rate for confirmation by experts was 64%. The predictive value of a positive test was 79.5%. The prevalence of disabilities among the screened pre-school age group was 88 per 1000 (95% Cl= 74 to 103). CONCLUSIONS: This tool can be used to screen children in the pre-school age for disabilities.
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    Nutrition in early life, immune-programming and allergies: the role of epigenetics
    (Allergy and Immunology Society of Thailand, 2013) Amarasekera, M.; Prescott, S.L.; Palmer, D.J.
    Early life nutritional exposures are significant determinants of the development and future health of all organ systems. The dramatic rise in infant immune diseases, most notably allergy, indicates the specific vulnerability of the immune system to early environmental changes. The associated parallel rise in metabolic diseases including obesity, childhood type 2-diabetes and non-alcoholic fatty liver disease highlights the interplay between modern dietary patterns and increasing abnormalities of both immune and metabolic health. The low-grade inflammation that characterize these non-communicable diseases (NCDs) suggests a central role of the immune system in the pathogenesis of these conditions. Understanding how environmental influences disrupt the finely balanced development of immune and metabolic programing is of critical importance. Diet-sensitive pathways are likely to be crucial in these processes. While epigenetic mechanism provides a strong explanation of how nutritional exposures can affect the fetal gene expression and subsequent disease risk, other diet-induced tissue compositional changes may also contribute directly to altered immune and metabolic function. Although modern dietary changes are complex and involve changing patterns of many nutrients, there is also interest in the developmental effects of specific nutrients such as folic acid levels, which have clear epigenetic effects on programming. Here we examine the current knowledge of the nutritional-programming of immune health and how research into nutritional-epigenetics in the context of allergic disease as one of the earliest onset NCDs can expand our knowledge to discover the biological processes sensitive to nutritional exposures in early life to prevent later disease risk.
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    The Costs and cost-cffectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds
    (Public Library of Science, 2009) Hall, A.; Horton, S.; de Silva, N.
    BACKGROUND: It is estimated that almost a half of all of people living in developing countries today are infected with roundworms, hookworms, or whip worms or combinations of these types of intestinal nematode worms. They can all be treated using safe, effective, and inexpensive single-dose generic drugs costing as little as USD 0.03 per person treated when bought in bulk. The disease caused by intestinal nematodes is strongly related to the number of worms in the gut, and it is typical to find that worms tend to be aggregated or clumped in their distribution so that <20% of people may harbour >80% of all worms. This clumping of worms is greatest when the prevalence is low. When the prevalence rises above 50%, the mean worm burden increases exponentially, worms are less clumped, and more people are likely to have moderate to heavy infections and may be diseased. Children are most at risk. For these reasons, the World Health Organization (WHO) currently recommends mass treatment of children > or =1 year old without prior diagnosis when the prevalence is > or =20% and treatment twice a year when the prevalence is > or =50%. METHODS AND FINDINGS: The risk of moderate to heavy infections with intestinal nematodes was estimated by applying the negative binomial probability distribution, then the drug cost of treating diseased individuals was calculated based on different threshold numbers of worms. Based on this cost analysis, a new three-tier treatment regime is proposed: if the combined prevalence is >40%, treat all children once a year; >60% treat twice a year; and >80% treat three times a year. Using average data on drug and delivery costs of USD 0.15 to treat a school-age child and USD 0.25 to treat a pre-school child (with provisos) the cost of treating children aged 2-14 years was calculated for 105 low- and low-middle-income countries and for constituent regions of India and China based on estimates of the combined prevalence of intestinal nematode worms therein. The annual cost of the three-tier threshold was estimated to be USD 224 million compared with USD 276 million when the current WHO recommendations for mass treatment were applied. CONCLUSION: The three-tier treatment thresholds were less expensive and more effective as they allocated a greater proportion of expenditures to treating infected individuals when compared with the WHO thresholds (73% compared with 61%) and treated a larger proportion of individuals with moderate to heavy worm burdens, arbitrarily defined as more than 10 worms per person (31% compared with 21%).
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    A Review and meta-analysis of the impact of intestinal worms on child growth and nutrition
    (Wiley-Blackwell, 2008) Hall, A.; Hewitt, G.; Tuffrey, V.; de Silva, N.
    More than a half of the world's population are infected with one or more species of intestinal worms of which the nematodes Ascaris lumbricoides, Trichuris trichiura and the hookworms are the most common and important in terms of child health. This paper: (1) introduces the main species of intestinal worms with particular attention to intestinal nematodes; (2) examines how such worms may affect child growth and nutrition; (3) reviews the biological and epidemiological factors that influence the effects that worms can have on the growth and nutrition of children; (4) considers the many factors that can affect the impact of treatment with anthelmintic drugs; (5) presents the results of a meta-analysis of studies of the effect of treating worm infections on child growth and nutrition; (6) discusses the results in terms of what is reasonable to expect that deworming alone can achieve; (7) describes some important characteristics of an ideal study of the effects of deworming; and (8) comments on the implications for programmes of recommendations concerning mass deworming.
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    A Novel molecular basis for beta thalassemia intermedia poses new questions about its pathophysiology
    (American Society of Hematology, 2005) Premawardhena, A.; Fisher, C.A.; Olivieri, N.F.; de Silva, S.; Sloane-Stanley, J.; Wood, W.G.; Weatherall, D.J.
    During a study of the molecular basis for severe forms of beta thalassemia in Sri Lanka, 2 patients were found to be heterozygous for beta thalassemia mutations. Further analysis revealed that one of them has a previously unreported molecular basis for severe thalassemia intermedia, homozygosity for quadruplicated alpha globin genes in combination with heterozygous beta thalassemia. The other is homozygous for a triplicated alpha globin gene arrangement and heterozygous for beta thalassemia. Their differences in clinical phenotype are explainable by the interaction of other genetic factors and, in particular, their early management. The clinical course of the 2 propositi underlines the importance of full genotyping and a long period of observation before treatment is instituted, particularly in patients with beta thalassemia intermedia associated with extended alpha globin gene arrangements. The hemoglobin (Hb) F levels in these patients with severe beta thalassemia intermedia, compared with other forms of this condition in the Sri Lankan population and elsewhere, are unusually low, a consistent finding in extended alpha globin gene interactions and in dominant beta thalassemia, raising the possibility that increased levels of HbF production in beta thalassemia may require mutations at both beta globin gene loci
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