Risk Of Illness In Children Research Articles

Breast Milk Reduces the Risk of Illness in Children of Mothers With Cholera

A protective effect of breastfeeding against cholera has been demonstrated in areas endemic of cholera. To assess the protection offered by breast milk from mothers living in an area that had been free from cholera for 7 years, we investigated mothers with cholera and their children during an epidemic with Vibrio cholerae El Tor in the capital of Guinea-Bissau. Eighty mothers with clinical cholera and their children were identified, and interviewed. Blood samples for vibriocidal and antitoxin antibodies were collected from mother-and-child pairs. Breast milk samples were collected from lactating mothers. Cholera was defined as acute watery diarrhea during the epidemic and a vibriocidal reciprocal titer of 20 or above. Three (7%) of 42 breastfed children had cholera as defined above compared with 9 (24%) of 38 nonbreastfed children (RR for breastfed children, 0.19; 95% CI, 0.04-0.91, adjusted for age). The 3 breastfed children who developed cholera received milk containing lower concentrations of anticholera toxin IgA/total IgA (median, 2.0 units/mL) than 14 children who had serologic signs of colonization but did not develop the disease (median, 17.4 units/mL). The protective effect of breast milk against cholera is not confined to endemic areas. Lactating mothers with cholera should receive supportive care to continue breastfeeding.

Excess risk of severe acute illness in children with chronic health conditions

Excess risk of severe acute illness in children with chronic health conditions

Méningites à salmonelles de l'enfant à Libreville. Étude rétrospective de neuf observations

Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult. The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid. Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels. The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.

The Risk of Heat Illness in Children Administered Antihistamines During Heat Acclimatization

The Risk of Heat Illness in Children Administered Antihistamines During Heat Acclimatization