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Biomedical subjects

A Tomkins

Publications and source records attributed to A Tomkins.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prediction of illness severity and outcome of children symptomatic following kerosene ingestion.

Kerosene pneumonitis is usually self-limiting and secondary infection is rare. Long-term studies in developed countries have produced conflicting results about complications. The position in developing countries, where children are exposed to adverse environmental and nutritional factors, is unknown. The aim of the present work was to determine whether there is an increase in respiratory or other illnesses following kerosene pneumonitis and whether these changes could be related to the severity of the initial lung damage. Fifty-seven children with clinical signs of pneumonitis were examined on admission and after overnight observation. Clinical signs were assessed for their usefulness for predicting severity. Cases and matched neighbourhood controls were seen every 2 weeks for 3 months. The time to predict most reliably the severity of short-term ill effects was 12-24 hours after the initial insult. There was no significant difference in respiratory symptoms during the 3-month follow-up in cases compared with controls. However, mild diarrhoea and fever were reported significantly more often in cases than in controls. Morbidity after clinical recovery was not shown to be a problem, irrespective of the severity of the acute event.

Case-Control Studies↗
PubMed1995

The prevalence of behavioural problems amongst homeless primary school children in an outer London borough: a feasibility study.

OBJECTIVES: To investigate the prevalence of behavioural problems amongst homeless primary school-age children in an outer London borough. DESIGN: Cross-sectional study of homeless primary school children and permanently housed control children. SETTING: Selected primary schools in an outer London borough. SUBJECTS: Children from non-refugee families officially accepted as homeless by the local authority, and housed controls from the same schools. OUTCOME MEASURE: Rutter behavioural rating scale. RESULTS: Fewer homeless children (38%, 18 of 48) than housed (88%, 50 of 57) were born in the UK, or spoke English at home. Only 19 (40%) of the fathers of homeless children compared with 43 (75%) of housed children's fathers lived with them. Some 49% of homeless children's scores suggested a behavioural problem, compared with 11% of controls. Altogether, 94% of homeless and 100% of housed children were registered with a general practitioner. CONCLUSIONS: High levels of behavioural problems were found in homeless children. With numbers of homeless children expected to rise in the 1990s this finding merits urgent attention.

Case-Control Studies↗
PubMed1995

Determinants of nutritional status in south-west Uganda.

In a cross-sectional survey carried out of 4320 children 0-59 months old in South-west Uganda various socio-economic and environmental factors were related to poor nutritional status. Diarrhoea was strongly associated with all the anthropometric parameters examined, suggesting a bidirectional influence of diarrhoea on malnutrition and of malnutrition on diarrhoea. The other most important variables independently associated with one or more anthropometric parameters were: distance from a health unit, living in a household not able to hire labour, and whose members worked on other people's land, religion, parental education, crowding conditions, sanitation, acreage, ownership of cow, father's occupation, birth order, ethnicity, and prolonged breastfeeding. This data indicates that a range of specific interventions are likely to be necessary for the improvement of nutrition in this community.

Anthropometry↗
PubMed1995

An evaluation of a project to improve child nutrition in Tanzania.

Dietary bulk has been cited as an important factor influencing the nutritional intake of young children in developing countries. In Tanzania, a potential solution to the problem of dietary bulk in weaning foods, has been the promotion of 'kimea' or 'power flour' which is a cereal grain that has been sprouted (germinated). Flour made from this germinated grain contains amylase and has a thinning effect when added in small quantities to thick porridge thus allowing small children to consume a greater quantity of porridge. Alternatively, the effect of adding kimea to porridge can be seen as improving energy density because more flour can be added to the mixture whilst the same consistency is maintained. The frequency of use of kimea and mothers' perceptions about its value for young child feeding were evaluated in eight villages of Kyela district, Mbeya region, Tanzania. In four villages kimea had been promoted (project villages) and in the other four villages there had been no special programme of promotion (nonproject). A total of 131 mothers attending MCH clinics and 37 dispensary staff were interviewed. Forty two per cent of project village mothers and 18% of nonproject village mothers had heard about the use of kimea for young child feeding but only 45% of these mothers used kimea when preparing porridge for their young children. Reasons for low adoption rates are discussed. Thirty seven per cent of mothers who had heard about kimea were unable to describe correctly how to use it to thin porridge.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Determinants of stunting and recovery from stunting in northwest Uganda.

BACKGROUND: Socioeconomic deprivation is associated with unhealthy living conditions and insufficient nutrient intake which affect linear growth. This study investigates the major risk factors which influence stunting in Northwest Uganda, the age range at which growth failure is more likely to occur, and the age at which chances of recovery are higher. METHODS: In February-March 1987, 1072 children < 5 years, were selected from 30 villages in Arua district (Northwest Uganda) and included in a longitudinal study. The children were measured for length and height; household socioeconomic and environmental variables were collected in order to assess risk factors for the future development of stunting. Two years after baseline, the height of the children was measured again. RESULTS: Children who were < 29 months old at baseline were at higher risk for linear growth faltering in the following 2 years; income, mother's education and presence of stunting at baseline were significant predictors of stunting. However, being stunted at age < 6 months or between 54 and 59 months old carried the same risk of remaining stunted after 2 years, and the probability of recovering from stunting was the same in every age group. CONCLUSIONS: These results suggest that, in this population, linear growth is influenced by environmental factors. It is a dynamic process continuing beyond the first 2-3 years of life, and the probability of catching up is very similar across all age groups < 5 years old. Recovery from stunting is more associated with mother's education than with income.

Age Factors↗
PubMed1994

A computer simulation of household sampling schemes for health surveys in developing countries.

BACKGROUND: Cluster sample surveys of health and nutrition in rural areas of developing countries frequently utilize the EPI (Expanded Programme on Immunization) method of selecting households where complete enumeration and systematic or simple random sampling (SRS) is considered impractical. The first household is selected by choosing a random direction from the centre of the community, counting the houses along that route, and picking one at random. Subsequent households are chosen by visiting that house which is nearest to the preceding one. METHODS: Using a computer, and data from a survey of all children in 30 villages in Uganda, we simulated the selection of samples of size 7, 15 and 30 children from each village using SRS, the EPI method, and four different modifications of the EPI method. RESULTS: The choice of sampling scheme for households had very little effect on the precision or bias of estimates of prevalence of malnutrition, or of recent morbidity, with EPI performing as well as SRS. However, the EPI scheme was inefficient and showed bias for variables relating to child care and for socioeconomic variables. Two of the modified EPI schemes (taking every fifth house and taking separate EPI samples in each quarter of the community) performed in general much better than EPI and almost as well as SRS. CONCLUSIONS: These results suggest that the unmodified EPI household sampling scheme may be adequate for rapid appraisal of morbidity prevalence or nutritional status of communities, but that it may not be appropriate for surveys which cover a wider range of topics such as health care, or seek to examine the association of health or nutrition with explanatory factors such as education and socioeconomic status. Other factors such as cost and the ability to monitor interviewers' performance should also be taken into account.

Bias↗
PubMed1994

Anthropometry as a predictor for mortality among Ugandan children, allowing for socio-economic variables.

Length, height, weight and mid-upper arm circumference (MUAC) were measured in 4320 children aged between 0 and 59 months, and their socio-economic status was assessed, in 31 villages in Southwest Uganda during March-April 1988. A follow-up survey assessed the mortality of the children during the 12 months following anthropometry. Mortality rates were higher in those with low anthropometric indices at the first survey. MUAC was the most sensitive predictor of mortality followed by weight-for-age, height-for-age and weight-for-height. MUAC increased the predictive power of other parameters whereas the other parameters did not increase the predictive power of MUAC. MUAC below 12.5, 11.5 and 10.5 cm predicted 10.9%, 18.7% and 36.5% of the deaths respectively. Nutritional status was worse in the low socio-economic group but the predictive power of anthropometry for mortality was not influenced by socio-economic status. This suggests that nutrition per se has an influence on mortality which is independent of socio-economic status.

Age Factors↗
PubMed1993

Anthropometry and childhood mortality in northwest and southwest Uganda.

Two longitudinal studies were carried out in northwest and southwest Uganda to examine the relationship between anthropometry and childhood mortality. Although the prevalence of malnutrition was significantly different between the two geographic areas, the relative risk for mortality associated with low levels of anthropometry was similar. When the anthropometric parameters were compared among each other, mid-upper arm circumference was found to be the most powerful predictor of mortality. The findings of this study confirm that mid-upper arm circumference is the indicator of choice to identify children at higher risk of death.

Anthropometry↗
PubMed1992

Determinants of child mortality in south-west Uganda.

Anthropometric and sociodemographic variables were taken from 4320 children in a baseline survey carried out in March-April 1988 in the district of Mbarara, south-west Uganda. After 12 months a follow-up survey assessed the mortality of the children during the preceding year. Lack of ownership of cattle, recent arrival in the village, using candles for lighting, being of birth order higher than 5 and having a father with less than 8 years of schooling were significantly associated with child mortality. The addition of mid-upper arm circumference significantly improved the logistic model of socioeconomic variables and mortality and did not diminish the predictive power of socioeconomic variables in relation to increased mortality. This suggests that nutritional status and specific socioeconomic factors are both, independently, important predictors of child mortality.

Anthropometry↗
PubMed1992

Determinants of child nutrition and mortality in north-west Uganda.

An anthropometric survey of children aged 0-59 months in north-west Uganda in February-March 1987 indicated a high prevalence of stunting but little wasting. Use of unprotected water supplies in the dry season, prolonged breast-feeding, and age negatively affected nutrition; in contrast, parental education level improved nutrition. Mortality during the 12 months following the survey was higher among those who had low weight-for-age and weight-for-height, but children who had low height-for-age did not have higher mortality. Weight-for-age was the most sensitive predictor of mortality at specificities > 88%, while at lower specificity levels weight-for-height was the most sensitive. Children whose fathers' work was associated with the distillation of alcohol had a higher risk of mortality than other children. The lowest mortality was among children whose fathers were businessmen or who grew tobacco.

Age Factors↗