Well-nourished Children Research Articles

Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia

Background: Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children.Objective: We assessed the effect of micronutrients, long-chain n−3 fatty acids, or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children.Design: Two 2-by-2 factorial randomized controlled double-blind trials were performed home-based in Adelaide, South Australia, and at 6 primary schools in Jakarta, Indonesia. A total of 396 children (aged 6-10 y) in Australia and 384 children in Indonesia were randomly allocated to receive a drink with a micronutrient mix (iron, zinc, folate, and vitamins A, B-6, B-12, and C), with docosahexanoic acid (DHA,88 mg/d) and eicosapentaenoic acid (EPA, 22 mg/d), or with both or placebo 6 d/wk for 12 mo. Biochemical indicators were determined at baseline and 12 mo. Cognitive performance was measured at baseline, 6 mo, and 12 mo.Results: The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children. DHA+EPA treatment increased plasma DHA and total plasma n−3 fatty acids in both countries. The micronutrient treatment resulted in significant increases in scores on tests representing verbal learning and memory in Australia (estimated effect size: 0.23; 95% CI: 0.01, 0.46). A similar effect was observed among Indonesian girls (estimated effect size: 0.32; 95% CI: −0.01, 0.64). No effects were found on tests measuring general intelligence or attention. No effects of DHA+EPA on the factors of cognitive tests were observed.Conclusion: In well-nourished school-aged children, fortification with multiple micronutrients can result in improvements in verbal learning and memory.

Effect of vitamin A supplementation on immune function of well-nourished children suffering from vitamin A deficiency in China

To clearly clarify the protective effect of vitamin A supplementation on immune function of well-nourished children suffering from vitamin A deficiency. Three hundred sixty-two children in two kindergartens in Wuhan China were enrolled. Detailed dietary assessment and anthropometry were undertaken to facilitate the exclusion of malnourished children. Seventy vitamin A-deficient children with informed consent were randomly divided into the vitamin A-deficient-supplemented group and vitamin A-deficient placebo group, 35 vitamin A-sufficient children (age- and sex-matched with the vitamin A-deficient-supplemented group children) were selected as vitamin A-sufficient placebo group. The baseline and follow-up level of selected immune parameters of the 105 children in three intervention groups were compared. The total proportion of severe and marginal vitamin A-deficient children was 10.9 and 21.96%, respectively. At baseline, the serum complement C3 and sIgA level of vitamin A-sufficient children was significantly higher than that of vitamin A-deficient children (P < 0.05). However, the serum lysozyme level of vitamin A-sufficient children was inversely lower. After intervention, vitamin A-deficient-supplemented children increased serum vitamin A, complement C3 and sIgA level, but their serum lysozyme level inversely decreased. Vitamin A deficiency was still a serious health problem in children in China cities. Vitamin A supplementation was efficacious in ameliorating serum vitamin A status and partially impaired immune function of well-nourished children suffering from vitamin A deficiency.

Nursing of malnourished children with emphasis on polyunsaturated fatty acids

Omega-3 (Ω-3) and omega-6 (Ω-6) fatty acids (FAs) are essential FAs needed for brain and retina development and maintenance of red blood cell (RBC) membranes. This study investigated the association between the profile of FAs in the membranes of RBCs and malnutrition in children. Demographic, anthropometric, and breast-feeding data and blood samples for analysis of FAs were obtained from malnourished and well-nourished children. The results indicate significant between-group differences in the profile of FAs. These findings support the need for adequate intake of Ω-3 FAs in promoting optimal growth and development processes and emphasize the role of nurses as providers of nutritional and anticipatory guidance for parents and caretakers.

Psychosocial care and nutritional status of children aged 6-36 months among patrilineal (Karo) and matrilineal (Minangkabau) households in Jakarta.

A study on psychosocial care among Karo (patrilineal kinship) and Minangkabau (matrilineal kinship) households who lived in Jakarta, Indonesia was aimed at investigating psychosocial care practices of mothers and the relation of psychosocial care to the nutritional status of children aged 6-36 months as indicated by Weight-for-Age (WFA), Weight-for-Height (WFH), and Height-for-Age (HFA) Z-scores. The study was a cross sectional study. The tool used to assess the psychosocial care was the Home Observation for Measurement of the Environment (HOME) inventory scale for infants and toddlers. Psychosocial care of 52 respondents from Karo and 87 from Minangkabau were generally good. Out of the total 45 items of the six sub-scales HOME inventory, 1 item in sub-scale I (Emotional and verbal responsiveness), 4 items in sub-scale II (Acceptance of child's behavior), 1 item in sub-scale IV (Provision of play materials), 1 item in sub-scale V (Parental involvement with child), and 3 items in sub-scale VI (Opportunities for variety in daily stimulation) were statistically different between the two ethnic groups. More Minangkabau children were underweight and wasting compared to Karo children. Within the Karo group, well-nourished children in terms of WFA and WHA tended to have greater total HOME scores than their underweight and wasting counterparts. Among Minangkabau group, well-nourished children in terms of WFA, WHA, and HFA tended to have greater total HOME scores than their underweight, wasting, and stunting counterparts. The total HOME score of well-nourished Karo children in terms of WFA, WFH and HFA were greater than that of well-nourished Minangkabau children.

Subjective Global Nutritional Assessment for children

Background:Subjective Global Assessment (SGA), a method of nutritional assessment based on clinical judgment, has been widely used to assess the nutritional status of adults for both clinical and research purposes.Objective:Foreseeing benefits of its use in children, we chose to adapt SGA and test its validity and reproducibility in the pediatric population.Design:We prospectively evaluated the preoperative nutritional status of 175 children (aged 31 d to 17.9 y) having major thoracic or abdominal surgery with the use of Subjective Global Nutritional Assessment (SGNA) and commonly used objective measurements. Each child underwent nutritional assessment by 2 independent assessors, one performing measurements of anthropometrics and handgrip strength and one performing SGNA. To test interrater reproducibility, 78 children had SGNA performed by a third assessor. Occurrence of nutrition-associated complications was documented for 30 d postoperatively.Results:SGNA successfully divided children into 3 groups (well nourished, moderately malnourished, severely malnourished) with different mean values for various anthropometric and biochemical measures (P< 0.05). Malnourished children had higher rates of infectious complications than did well-nourished children (P= 0.042). Postoperative length of stay was longer for malnourished children (8.2 ± 10 d) than for well-nourished children (5.3 ± 5.4 d) (P= 0.002). No objective nutritional measures showed association with outcomes, with the exception of serum albumin, which was not clinically predictive because mean concentrations were in the normal range irrespective of the presence or absence of complications.Conclusion:SGNA is a valid tool for assessing nutritional status in children and identifying those at higher risk of nutrition-associated complications and prolonged hospitalizations.

Effector T lymphocytes in well-nourished and malnourished infected children

The mechanisms involved in impaired immunity in malnourished children are not well understood. CD4(+) CD62L(-) and CD8(+) CD28(-) do not express the naive cell markers CD62L and CD28, suggesting that they function as effector T cells. Using a flow cytometry-based analysis we examined the proportions of CD4(+) CD62L(-) and CD8(+) CD28(-) T cell subsets in well-nourished infected (WNI) and malnourished infected (MNI) children. Here we report that WNI children had a higher percentage of CD4(+) CD62L(-) (11.1 +/- 1.0) and CD8(+) D28(-) (40.2 +/- 5.0) T cell subsets than healthy (6.5 +/- 1.0 and 23.9 +/- 4.8) and MNI children (7.4 +/- 1.1 and 23.1 +/- 6.2, respectively) (P < 0.5). Data suggest that WNI children respond efficiently against pathogenic microbes. In contrast, relatively low numbers of circulating of CD4(+) CD62L(-) and CD8(+) CD28(-) T cells in MNI children may represent an ineffective response to infection. Levels of effector T cells in children with gastrointestinal infections versus those suffering from respiratory infections were also significantly different within the WNI group. While WNI children with gastrointestinal infections had higher absolute and relative values of CD8(+), and CD8(+) CD28(-) T subsets, by those with respiratory infections had higher values of CD4(+) lymphocytes. However, due to the small number of subjects examined, our results in WNI children should be interpreted with caution and confirmed using a larger sample size. Our data suggest that altered expression of CD62L and CD28 receptors may contribute to impaired T cell function observed in MNI children.

Experience in developing countries

No Absrtact. Marcos Borato-Viana presented detailed data on height deficits during and many years after treatment of children with acute lymphoblastic leukemia (ALL). In a cohort of Brazilian children, and in a review of the literature from the past 20 years, it was clear that significant height deficit occurs in children who were given only chemotherapy, but it was greater in those who had additional cranial irradiation. Young age at the time of treatment was an additional risk factor. Providing human growth hormone to these children improves their growth without risking leukemic relapse, though there is a slightly increased risk of second malignancies, notably brain tumors. These data indicate the need for long-term monitoring, until achievement of final height, with therapeutic intervention when required. In the Summary of the First Workshop held in Puebla in November, 1997, it is clearly stated that malnutrition is an adverse prognostic factor in children with cancer. Socioeconomic disadvantage and poor compliance with treatment are inter-related with malnutrition in this regard. In this Second Workshop, preliminary information presented by José Carlos Jaime-Perez suggests that, by intervening in the nutritional status of children with ALL, it may be possible to improve their compliance with treatment. The hypothesis is that malnutrition and poor compliance contribute synergistically to the compromised delivery of scheduled chemotherapy to socioeconomically disadvantaged children in developing countries. The prospective study which is being conducted in the Hospital Universitario de Nuevo León, in addition to measuring in detail the nutritional status of children with ALL, including measures of body composition, involves close interactions of the patients and relatives with nutritionists who, in addition to making recommendations about diet and nutritional supplements, actively promote compliance with anti-leukemic therapy. Other studies to examine the impact of nutritional intervention on treatment compliance are encouraged. The studies reported by Federico Antillon, which are being conducted in Guatemala, may reflect conditions common to other developing countries and were designed after a meeting of the Central American consortium AHOPCA in Guatemala City. Preliminary data show a prevalence of some degree of nutritional depletion in up to 58% of newly diagnosed children with all types of cancer. For ALL the prevalence of malnutrition at diagnosis was 55%. Abandonment of therapy and treatment failure were more common in under-nourished than in well-nourished children when nutritional status was determined by arm anthropometry (mid upper arm circumference and triceps skin fold thickness). Given that these measures are less subject to variation between racial/ethnic groups than is the case with height and weight, it is recommended that arm anthropometry become part of the standard of care for children with cancer in developing countries.

Nutritional status of children during treatment for acute lymphoblastic leukemia in the Central American Pediatric Hematology Oncology Association (AHOPCA): preliminary data from Guatemala

Preliminary data reveal some degree of nutritional depletion in up to 54% of newly diagnosed children with acute lymphoblastic leukemia in Guatemala. Deaths due to abandonment of therapy and treatment failure were more common in under-nourished than in well-nourished children when nutritional status was determined by arm anthropometry (mid upper arm circumference and triceps skin fold thickness). Given that these measures are less subject to variation between racial/ethnic groups than is the case with height and weight, it is recommended that arm anthropometry become part of the standard of care for children with cancer in developing countries.

Iron absorption is more closely related to iron status than to daily iron intake in 12- to 48-mo-old children.

Few studies have evaluated iron absorption in small children after the first year of life. Our objectives were to examine the relations among iron intake, iron absorption, and iron status in a group of healthy children. We studied 28 children, ages 12 to 48 mo, after a 7-d home adaptation to a diet representative of their usual daily mineral intake. A multi-tracer stable isotope study was performed to assess iron absorption both from a meal ((58)Fe) and from a reference iron dose ((57)Fe) given with ascorbic acid without a meal. Iron intake was 6.9 +/- 2.4 mg, approximately the 35th percentile of typical U.S. intakes. Absorption of (58)Fe was related to serum ferritin (r(2) = 0.319, P = 0.0018) and more so to reference dose iron absorption (r(2) = 0.653, P < 0.0001). Iron absorption was negatively correlated with zinc intake (r(2) = 0.090, P = 0.0049) but was not correlated with iron intake (P = 0.20). However, zinc intake was not correlated with measures of iron status, including reference dose iron absorption and serum ferritin (r(2) < 0.1, P > 0.25). Total absorbed iron was similar to needs estimated by the Institute of Medicine. We conclude that iron absorption in young children is more closely related to iron status than to iron intake. Reference dose iron absorption may be superior to serum ferritin as a surrogate measure for iron status in this age group. Although zinc intake may affect iron absorption from a meal, it does not appear to have a detectable effect on overall iron status in otherwise well-nourished children.

Gene–environment interaction in skeletal maturity and body dimensions of urban Oaxaca Mestizo schoolchildren

Objective: The study analyzed the relationship between skeletal age (SA) and the difference between skeletal and chronological ages (SA–CA) and body size among growth-stunted and well-nourished children.Methods and materials: Tanner–Whitehouse 2 (TW2) 20 bone, radius–ulna–short (RUS) bone, and carpal SAs were analyzed in three cross-sectional samples of school children aged 6–13 years: Mestizo children (n = 396) from the city of Oaxaca, southern Mexico, and American Black (n = 570) and White (n = 432) from Philadelphia. The Oaxaca children were mild-to-moderately undernourished while the Philadelphia children were well nourished. The total sample included 1398 radiographs assessed with the Tanner–Whitehouse protocol by a single, experienced rater. Maturity scores were converted to TW2 20 bone, RUS and carpal SAs.Results: Correlations of SA and SA–CA differences with body dimensions (height, sitting height, leg length, weight, triceps skinfold, arm and estimated midarm muscle circumferences) were consistent and approximately equal in magnitude for the well-nourished samples but were different among Oaxaca children. SAs of Philadelphia children were significantly more highly correlated with body dimensions than were SA–CA differences compared to Oaxaca Mestizo children. Patterns of RUS and carpal SA correlations with body size (height, sitting height, and leg length) in Oaxaca children were different from the Philadelphia samples. Oaxaca children tended to have advanced RUS SA and delayed carpal SA.Conclusion: Long bone complexes mature earlier than round bone complexes in Oaxaca children compared to Philadelphia Black and White children, resulting in short stature in Oaxaca children. Results suggest a gene–environment interaction effect on the program for skeletal growth and maturation in undernourished Oaxaca children compared to well-nourished Black and White children from Philadelphia.

¿Qué se hace para no morir de hambre? Dinámicas domésticas y alimentación en la niñez en un área rural de extrema pobreza de México

To describe and compare household dynamics in terms of structure, beliefs and nutrition-related behavior in the homes of malnourished and well-nourished children less than five years of age. The authors carried out a qualitative ethnographic study using participant observation, and in depth interviews. Interviews were conducted with the child's caretaker or key informants, prior oral informed consent. Child care and childhood feeding practices at home and in the community were the focus of observations. The study included two periods of field work conducted in 2001, in three rural municipalities from the Río Balsas region, in Guerrero state, Mexico. The study's ethical and methodological aspects were approved by the National Research Commission of the Mexican Institute of Social Security. Households were differentially characterized by number of members, composition, type of relationship, source of income, and interactions among household members and with the community. Monoparental structures, in an early stage of the household cycle, give rise to conditions that render the child prone to malnutrition. Extended family structure represented more favorable household dynamics.

Malnutrition in the second year of life and psychosocial care: a case-control study in an urban area of Southeast Brazil

The present study aimed to identify and measure the relationship between malnutrition and psychosocial care in the second year of life. A case-control study compared 101 malnourished 12-23-month-old children (weight-for-age < 5th percentile, WHO/NCHS) to 200 well-nourished children (weight-for-age > 25th percentile) for exposure to various maternal behaviors related to psychosocial care. A psychosocial care score was constructed, based on the number of desirable maternal behaviors that were absent (the higher the score, the worse the quality of childcare). The association was modified by per capita family income. After adjusting for possible confounders, children from higher-income households showed no association between psychosocial care and malnutrition. For children from lower-income households, worse psychosocial care doubled the risk of malnutrition (OR = 7.26; 95%CI: 2.42-21.82) compared to low income alone (OR = 3.08; 95%CI: 1.28-7.42).

Cow's Milk and Linear Growth in Industrialized and Developing Countries

The strongest evidence that cow's milk stimulates linear growth comes from observational and intervention studies in developing countries that show considerable effects. Additionally, many observational studies from well-nourished populations also show an association between milk intake and growth. These results suggest that milk has a growth-stimulating effect even in situations where the nutrient intake is adequate. This effect is supported by studies that show milk intake stimulates circulating insulin-like growth factor (IGF)-I, which suggests that at least part of the growth-stimulating effects of milk occur through the stimulation of IGFs. Given that the biological purpose of milk is to support the newborn during a period of high growth velocity, such an effect seems plausible. Adding cow's milk to the diet of stunted children is likely to improve linear growth and thereby reduce morbidity. In well-nourished children, the long-term consequences of an increased consumption of cow's milk, which may lead to higher levels of IGF-I in circulation or an increase in the velocity of linear growth, are likely to be both positive and negative. Based on emerging data that suggest both growth and diet during early life program the IGF axis, the association between milk intake and later health is likely to be complex.

Serum vitamin A concentrations in asthmatic children in Japan

Vitamin A is an essential micronutrient with important roles in immunity and maintenance of normal epithelial cell differentiation. Little information is available regarding the relationship between vitamin A concentrations and asthma despite the repair of epithelial and other structural changes being of utmost importance for the relief of symptoms and control of the disease. The authors evaluated vitamin A and vitamin E concentrations in well-nourished children with asthma. The serum vitamin A and vitamin E concentrations were measured by high performance liquid chromatography methods. Statistical analysis was performed using the Mann-Whitney U-test and Peason's correlation coefficient test. According to these methods, the mean serum vitamin A concentrations were significantly lower (19.41+/-7.45 microg/dL, mean+/-SD) in asthmatic children than controls (29.52+/-11.34 microg/dL, P=0.0001). To compare the correlation of C-reactive protein and serum vitamin A concentrations, there was also significant difference between the two groups. The data suggest that there is a correlation between vitamin A deficiency and the mechanism of asthmatic response. These data support that the mechanism of hypovitaminosis A in asthmatic children may involve not only the acute phase response but also the various degrees of chronic epitherial damage of airways.

Cortisol and its action on the glucocorticoid receptor in malnutrition and acute infection

Severe malnutrition alone is believed to cause hypercortisolemia. Cortisol's effects are mediated through the glucocorticoid receptor, which binds the hormone in the cytosol, translocates to the nucleus, and promotes gene transcription. This observational study in marasmic children with and without acute infection tested the hypothesis that marasmus is associated with hypercortisolemia, less glucocorticoid receptor, and less receptor translocation to the nucleus. Twenty-eight Malawian children participated; 14 with marasmus and infection, 6 with marasmus without infection, and 8 well nourished with infection. Free serum cortisol, interleukin 6 and tumor necrosis factor α, leucine derived from whole-body proteolysis, and the amount of whole-cell and nuclear leukocyte glucocorticoid receptor were measured upon admission. Free serum cortisol concentration was increased in marasmic and well-nourished children with infection compared with uninfected children with marasmus (14.2 [8.5, 16.3], 24.4 [15.0, 39.2], 5.1 [3.5, 7.0] μg/L, median [25th, 75th percentiles]; P < .05 by Kruskal-Wallis test). The amount of whole-cell leukocyte glucocorticoid receptor was similar in all children (0.48 ± 0.33 signal units), but the amount in the nucleus was greatest in marasmic children with infection, followed by the amount in uninfected marasmic children, and then in well-nourished infected children (0.54 ± 0.58, 0.19 ± 0.13, 0.02 ± 0.5 signal units [mean ± SD]; P < .05 for all comparisons by analysis of variance). These findings suggest that hypercortisolemia is not associated with malnutrition alone, but does occur appropriately with acute infection. The increased nuclear glucocorticoid receptor abundance in marasmus demonstrates that nutritional status modulates glucocorticoid receptor action by mechanisms in addition to circulating glucocorticoid concentrations.

Dénutrition en cancérologie pédiatrique : prévalence et dépistage

Algorithms for nutritional pediatric support have been proposed in a French national nutritional framework program. However, they are not specific for oncology. With the pediatric nutritional risk score (PNRS) all children with cancer have a high risk of malnutrition, but a systematic nutritional support is not possible for all of them. Aim. – Estimation of malnutrition prevalence and identification of predictive factors of major weight loss during treatment defined by a weight loss more than 5% within 1 month, 7.5% within 3 months, 10% within 6 months. Population and methods. – This historical study included children registered with a solid tumor in 2002 in an oncology pediatric unit. Data collected at diagnosis were weight, height, PNRS, the Lansky functional score, tumor type. Furthermore weight, height, and major weight loss were collected at each cure of chemotherapy and during evolution. Malnutrition at diagnosis was defined using the weight for height ratio. Relations between major weight loss and risks factors were estimated using logistic regression. Results. – Seventy children were included, 16 (22.9%) were malnourished at admission. During chemotherapy, 29 (41.4%) children experienced a major weight loss. Odds ratio of those who were malnourished at diagnosis was not significantly higher in comparison to well-nourished children. Children with a high risk of malnutrition are those affected by Ewing tumor, B lymphom, head and neck localisations, osteosarcomas, metastatic cancers, or cancers treated by high dose chemotherapy with stem cell rescue. For these 29 (41.4%) children the major weight loss odds ratio was 5.9 [IC95% 2.0–16.7]. Conclusion. – Taking into account others factors with items of PNRS allows to screen children with an higher risk of a major weight loss during treatment and to enhance nutritional care plan for them.

The effects of hospitalization on the nutritional status of children

To evaluate the nutritional status of children at hospital admission and again at hospital discharge and to investigate factors associated with the onset and/or exacerbation of malnutrition. An observational study of 203 children under 5 years old admitted to a hospital in the city of Fortaleza between August and December 2003. Nutritional status, expressed in z-scores for weight/age, stature/age and weight/stature, was compared at the time of admission and on hospital discharge and broken down by sex, age, condition responsible for hospitalization and length of hospital stay. On admission prevalence rates for moderate and/or severe malnutrition (z-score < -2) were 18.7, 18.2 and 6.9%, for weight/age, stature/age and weight/stature, respectively. During their stay in hospital 51.6% of the 186 children who completed the study lost weight, with most weight being lost by those with prolonged hospital stays and pneumonia as the disease responsible for their hospitalization. Children who had malnutrition on admission were still malnourished at hospital discharge and 10 (9.17%) well-nourished children developed mild malnutrition while hospitalized. The prevalence of malnutrition at the time of admission was elevated and remained unchanged by discharge. Prolonged hospitalization and pneumonia were linked with weight loss in hospital.

Erythrocyte Riboflavin for the Detection of Riboflavin Deficiency in Pregnant Nepali Women

Riboflavin deficiency is common among chronic alcoholics, the elderly, and vegetarians (1)(2)(3)(4), but intake in the United States is generally adequate(5)(6), unlike the widespread deficiency in regions of the world with limited animal food sources(7)(8). Riboflavin status has been assessed from measurements in urine, plasma, and erythrocytes(9)(10)(11). The erythrocyte glutathione reductase activity coefficient (EGRAC) is the commonly used test and reflects the adequacy of riboflavin to support enzyme function(10). In this assay, the stimulation of erythrocyte glutathione reductase by FAD is measured in vitro, and a higher activity coefficient reflects a larger amount of unsaturated glutathione reductase apo-enzyme resulting from lack of FAD. The EGRAC cutoffs(12) are based on observational studies in well-nourished American school children (n = 431) and adult men (n = 6) and a depletion–repletion study in Indian adults (n = 8)(13)(14)(15). These cutoffs are usually ≥1.4 for deficiency status, 1.2 to <1.4 for marginal status, and <1.2 for acceptable status. Although erythrocyte riboflavin concentration is seldom used to assess riboflavin status, Hustad et al. (16) showed that the sum of erythrocyte flavin mononucleotide and FAD is correlated with the EGRAC and might be a useful indicator of riboflavin status in population studies. The elderly Irish persons (n = 122) in their study had marginal riboflavin status (mean EGRAC, 1.26), but no erythrocyte riboflavin cutoffs were evaluated. In healthy Californian adults (n = 22), we previously determined the 5th percentile of erythrocyte riboflavin concentration to be 170 nmol/L (range, 169–289 nmol/L) but did not measure the EGRAC in the same samples (L.H. Allen, unpublished data). The purpose of our study was to compare erythrocyte riboflavin concentrations against the EGRAC in a group of …

Antibiotic Treatment of Community Acquired Pneumonia in Well-Nourished Young Nigerian Children

Worldwide Streptococcus pneumoniae and Haemophilus influenzae are reported to be responsible for about 57 per cent of community-acquired pneumonia in children whereas Staphylococcus aureus contributes only 14 per cent. Based on this the WHO has recommended the use of crystalline penicillin and amoxycillin given sequentially for the treatment of severe community-acquired pneumonia. However this appears not to have been fully accepted in Nigeria presumably because most aetiological studies of pneumonia in the country have indicated that S. aureus and Klebsiella spp. predominate. However those in whom S. aureus and Klebsiella spp were isolated were not all cases of community-acquired pneumonia; while a substantial number were malnourished. Therefore we carried out a retrospective study of the use of the sequentially administered intravenous (i.v.) crystalline penicillin and oral amoxycillin or i.v. flucloxacillin given simultaneously with intramuscular (i.m.) gentamicin in the treatment of severe community-acquired pneumonia in well-nourished under-five-year olds in a hospital setting. (excerpt)

Zinc and infection: a review

Dietary zinc deficiency is widespread in developing countries and is often aggravated by intercurrent acute and chronic infections. Recent studies have demonstrated that zinc supplementation can significantly reduce the morbidity and mortality of apparently well-nourished children and shorten the time to recovery from acute infectious diseases. This review summarises current knowledge of the role of zinc in childhood diarrhoea, acute respiratory infections and malaria, and its potential role in diseases associated with impaired cellular immunity, namely tuberculosis, lepromatous leprosy and leishmaniasis, and explores avenues for future research.