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| Friday, 14 March 2003 |
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Proper prenatal care vital in child health by Prof. Leela de A. Karunaratne
The primary responsibility of caring for the prenatal woman lies with her family since she needs a happy and healthy physical and psychosocial environment. When she makes contact with the health care system she has the right to receive a comprehensive package of health care which includes the following: * Counselling Delivery of this package of prenatal care needs the involvement of the community health team, the family physician and the obstetric team. These health care providers need to share the responsibility, accept the fact that each has a different but valuable share to contribute, and carry out their tasks in a complementary manner. Sharing should not be just an expression in words, it should be done in practical terms that would be beneficial to people and cost effective as well. When a woman reaches the end of her term of pregnancy, responsibility for her care must necessarily shift towards the obstetric team, since birth in this country is most likely to be in a hospital. Perinatal management is another important concern in child health and members of the obstetric team need to work together to ensure a safe delivery and a post partum free of adverse events. Care of the newborn begins in the hospital and it would be the responsibility of all health personnel providing obstetric and paediatric care, to perform their tasks in accordance with the objectives of the baby friendly hospital. An early screening of the newborn by clinical examination, early initiation of breast feeding, and educating the new mother regarding day to day care and the initial management of health problems, should be the priority concerns during the perinatal phase, but observation for signs of neonatal sepsis must not be forgotten. Within a short time a newborn would live in the community as a member of a family. It is within this social environment that most of a child's growth and maturation takes place, through the stages infancy, childhood, adolescence and adult life up to reproduction. The health needs during these stages are many and varies with every stage. During infancy and childhood, the emphasis in health care should be on, - enabling normal growth and development in a safe The responsibility for these actions would be with all the partners in child health care. When there are health problems caused by infection, injury, malignancy or genetic disorders, first contact care should be provided by health professionals at the primary level, and it is their responsibility to make the best use of their clinical acumen in managing the problems presented in a rational and cost-effective manner particularly in prescribing and investigating, and to take appropriate and timely action in the relatively few instances when. - congenital abnormalities or aberrations of growth and development are detected, - the first line of clinical management has not had satisfactory out come, or - the condition is severe or an emergency making it necessary for referral to the higher levels of paediatric care. Referral, for opinion and/or services should be accomplished by adequate and clear communication, either verbal or written. During referral, the care provider at the primary level should remain as coordinator of the child's total health care, and it is therefore the responsibility of the paediatric care providers in the higher levels to ensure that there is a return of information which is very much needed for follow up care. Approaching adolescence there is a change in the needs of health care and a fresh set of problems related to biological and social development emerge. The Problems of - * mal adjustment to society, although they are not quite as common as problems caused by infection, trauma or malignancy put together, they certainly need much care and concern. In view of these problems all the partners in child health care have a responsibility for ensuring. - compulsory primary education - adequate nutrition - reproductive healthcare, and - acceptance and adherence to international instruments for protecting the rights of a child. Considering care given by the health professionals it is the family physician who could provide life long care and therefore needs to be actively involved in taking responsibility and sharing it with the others specially the obstetricians and paediatricians and also the specialized counsellors. Also the holistic management of these problems need social transformation and the protection of human rights, and therefore it is a matter of great responsibility for the government policy makers, non-governmental organizations and the legal system of the country. The media too has to play a very useful role by focusing on the issues in an attempt to bring about a change of attitude among all, particularly the children, families and the community. The final phase in the life cycle of the child is adult life and reproduction. When we focus on this phase the important issues that could be envisaged are - - counselling in matters such as marriage, consanguinity or genetic disorders, and - reproductive health care and education in addition to promotive, preventive and curative health care, since the health of parents is very relevant to the health of the child. The best chance a child would have to grow and develop normally is in a healthy family. Healthy families do not just happen, they need to be planned particularly regarding size and spacing to ensure that every child is truly wanted. ************** Book on family health : A dream project on family health realised Speaking at the launching of the book on Family Health - Your Child of Your Family, Dr. Dennis J. Aloysius (co-author) of the book said: "Your Child Your Family" began as a dream project in the fertile mind of Prof. Herbert Aponso when Herbert was on a Sabbatical in Boston in 1989. After drafting the format and proposed content of the book, Mr. Herbert invited over 100 specialists - medical and non-medical - to contribute to the numerous and varied sections of the book. After a long period of gestation and activity, Herbert invited Harendra and me to be consultants to the book. This was because we were the most active of the contributors. Later he chose me to proof-read the book with him. He came all the way from Kandy and spent several strenuous days with me - from dawn to dusk. I recall this period of exhausting activity with unmixed pleasure. The first edition was published in 1991. Herbert's fears and worries that the book would have poor readership and appeal were quickly proved as unjustified, 6000 copies were quickly sold, the demand was increasing and the stocks of books had almost reached zero level. "It has been a great privilege to associate with Herbert Aponso in the production of this book. Herbert had the vision and produced the first edition, giving it the apt title "Your Child Your Family". We pay tribute to the architect, who took several years to plan, write, edit and produce it. We were delighted to be co-authors with Herbert in this project. This book is a Guide to Health and Nutrition, not only in Sri Lanka; there has been a demand for it in other countries as well. It is our hope that this book will continue to serve the health needs of the people - the children and families, for many more years to come. We Prof. Herbert Aponso, Prof. Harendra de Silva and myself together with several contributors, both medical and non-medical, all specialists in their fields, have brought out the third edition of "Your Child Your Family". The English and Sinhala editions of 1991 and 1999 have now reached at least about 10,000 households, both in Sri Lanka and other countries such as India, Pakistan, UK, USA, Germany, Netherlands, UAE, Australia, New Zealand and even China and perhaps over 100,000 have benefited from it. This updated revision was undertaken in response to many requests from many persons who have testified that this book is a 'must' on the bedside table, for quick reference at times of illness, or, leisurely, for guidance on the promotion of health and good nutrition. Part I - The Road to Good Health - starts with a brief explanation of the structure and functions of the body together with presentations on understanding the mind and behaviour. It next proceeds to explain the basic principles of heredity. This is followed by guidance on the important events in the Journey of life, from the womb to the tomb. This section provides valuable information on parenting - bringing up of children. The next sections are devoted to environment and health. It then proceeds to give a clear picture of how the bodyguards itself against infections, including an update on immunisations (Vaccines). hazards to health, in the form of accidents both in the home and outside, and how to prevent and manage them, come next. The hazards of substance abuse - narcotic drugs, alcohol, smoking are included. The use and abuse of medicines and the cost of medicines are given an important consideration. This part ends with the important sections on safe motherhood and family planning. This section has been of great help to mothers as well as to their husbands. Part II is a comprehensive guide to food and nutrition: It starts with an explanation of the basic principles of nutrition, and is followed with practical information and advice on infant feeding, dietetics, unhealthy foods, the cholesterol problem, atherosclerosis (the cause of heart attacks and strokes), obesity and some of the other major nutritional disorders. The section on home gardening is well worth reading. The important chapter on growth and development in children should be read and understood by all those who are concerned with the care of children. ************** Alcohol and your health : Common misperceptions by Dr. D. P. Atukorale Continued from last week Is drinking small amounts of wine during pregnancy and breast feeding considered harmless? According to a book entitled "To Your Health - Two Physicians Explain The Health Benefits Of Wine" published in 1994 light drinking is safe during pregnancy because it will not cause foetal alcohol syndrome and the attendant problems namely malformations of the face, central nervous system deficiencies and long-term mental retardation. But research suggests that drinking even less than one drink a day can still result in decreased weight, height and head size as well as reduced I.Q. scores. Both the Surgeon General and the American College of Obstetrician advise that no amount of alcohol is safe during pregnancy. With regard to drinking while breast feeding, an old wives' tale says that a glass of wine or beer before breast feeding relaxes the mother and thereby allows her to produce more milk. But a study at the Monell Chemical Senses Center in Philadelphia found that breast fed infants end up with about 20 per cent less milk after their mothers have a drink than when they abstain. Studies on alcohol by American Cancer Society The largest study in the world on alcohol as far as I am aware was conducted in USA by the American Cancer Society. It showed that one can of beer, one 4 ounce glass of wine or one shot of whisky taken straight or in cocktail lowered the heart attack rate as well as 2,3,4,5, or 6 drinks. At one drink, the cancer rate and total death rate are lower. At two drinks the cancer rate is same as non-drinkers and both total death and heart disease death are lower. At three drinks cancer death rate is increased. At four drinks total death rate and cancer death rate is increased. Should we all take one drink a day just for medical purpose? We know from studies in orphans in Sweden and Iowa, that the orphans of alcoholic's become alcoholics themselves at four times the rate of non-alcoholics. This evidence suggests that there are potent genetic forces that either predispose you to alcohol abuse or protect from it. There are people who cannot drink even one alcoholic beverage without becoming addicted to alcohol. There are also marked racial and religious differences. People from Asia who metabolize alcohol differently are generally unable to tolerate alcohol because it causes them to flush in an uncomfortable way. With 19 million alcoholics in USA alone, the gene for alcoholism is not rare. Most of the groups in USA who strictly abstains from alcohol all run much lower heart attack rate than the rest of the country. Deficiencies caused by prolonged alcohol consumption There may be impaired secretion of gastric juice and loss of appetite. Malabsorption is also common in alcoholics. These people have deficiencies of amino-acids, calcium, folic acid and vitamin B 12. Advantage of alcohol consumption Advantages of alcohol consumption on the heart were discussed earlier. Other advantages of mild and moderate consumption of alcohol are increase in appetite, increase in flow of gastric and pancreatic juice and acceleration of digestion. One pint of beer provides about two per cent of requirement of thiamine of a moderately active man, about 60 per cent of niacin requirement, 13 per cent of riboflavin, 8 per cent of calcium, 12 per cent of phosphorus and 7 per cent of energy required. There are also obvious social advantages. However, physiological and social advantages cannot be praised on nutritional grounds. In the words of Houseman. "Ale, mane ale's the stuff to drink For fellows it hurts to think: Alcohol has long been known to be a vasodilator, a soporific and a diuretic as is shown in the following quotation of Shakespeare: Porter : "drink sir, is a provoker of three things. Macduff : "What three things does drink especially provoke" "Marry, sir, nose-painting sleep and urine. Lechery, sir, it provokes and unprovoked; it provokes the desire, but it takes away the performance" Macbeth 11, iii References 1. Food and Nutrition by Prof. T. W. Wikramanayake ************** Health Letter Box Activated charcoal The letter sent by R. Yatawara of Haycarb Ltd. re Activated Charcoal (D/N of 12/2) with ref. to my article in Health Watch (D/N of 31/1) made interesting reading. World's first drug? Charcoal could well have been the world's first 'drug'. Charcoal is not only effective in any type of poisoning, but it is absolutely safe and free of any side-effects. There is also no fear of over-dosage even in small children. Some care should however be taken in those taking other drugs too routinely as charcoal could absorb these drugs also (e.g. in epileptics). It is described in the British National Formulary as having the property of "binding many poisons in the stomach, thereby reducing their absorption. The sooner it is given, the more effective it is" - preferably within an hour. Against poisoning Charcoals tablets were available fifty years ago as 'Ultracarbon' tablets (E. Merck) and I had been using it regularly for many years till it went out of the market - for unknown reasons. I have found it highly effective. I particularly recall the 'Vadakaha Sudiya' episode during the total solar eclipse in 1954 when I treated over 150 patients that day successfully with charcoal tablets. There were also two other separate occasions when busloads of patients returning from trips had food-poisoning (chicken that had gone bad) were treated with similar success. The Adult dose I gave was 6 tablets stat (250 mg tabs) followed by 4 tabs. in 6 hrs. and 2 tabs. every 6 hrs. if necessary. It usually answers with 2 or 3 doses. For more serious poisoning the dose recommended in the BNF is much more: 50 Gms. of powdered charcoal - repeated 4-6 hourly. In 1984 I wrote to Haycarb Ltd. suggesting that they start manufacturing charcoal Tablets as a pharmaceutical product.They replied (same as in the D/N letter ) stating the problems involved : i) Coconut shell and Wood charcoal - difference in porosity and ii) the small market it probably would have. However I am glad to read that Haycarb Ltd. has now realised the efficiency and usefulness of charcoal not only as an antidote for simple food-poisoning, but also as a potential life-saver for poisons. Of course, charcoal should be used primarily as a first-line of treatment. For more serious cases other conventional treatment should follow in hospitals. As a 'universal antidote' it should find a place in the medicine cupboard of every home. It will not easily deteriorate and could be kept for a long time in an airtight container. Other uses Interestingly, there are other uses too for charcoal: 1) I believe that 2 tablets of Charcoal taken three times a day for a month or two will lower blood cholesterol. Perhaps someone in the Medical Faculty could conduct a trial on this. 2) Finely powdered charcoal has been used from time immemorial as a dentifrice in our land. I regularly use it (finely powdered and sieved, mixed with table salt and powdered clove) two or three times a week as a tooth powder. It may not be a mere coincidence that I have all my 32 teeth intact still! I would suggest that some enterprising local firm start making tooth-paste with charcoal as its main base. It will also help in combating bad breath. 3) A few pieces of charcoal in a net-bag placed inside a refrigerator. will keep away unpleasant smells from the refrigerator. State Pharmaceutical Corporation I do hope the S.P.C. will take steps to import Charcoal tablets or powder from India as soon as possible. If not, will it please let us know why import of this drug, which was formerly available here, has now been stopped? Coconut shell charcoal vs wood charcoal Will some institution (CISIR perhaps) please let us know whether there is an appreciable difference in absorption or porosity between coconut shell charcoal and wood charcoal? Dr. RILEY FERNANDO, Mount Lavinia. ************** Price healthy drugs We had two letters from our readers on the main story carried in this page last week on - 'Price healthy drugs' based on an interview given by the Commerce and Consumer Affairs Minister Ravi Karunanayaka and the Chairman of the newly formed Commerce Ministry Company for drug imports (STCM) Prof. Lal Chandrasena. Mrs. Maya Godamanne from Kitulampitiya, Galle, a retired teacher affected with heart disease in her letter states "I have to spend approximately Rs. 1,500 a month on the drugs alone which I have to take. I hope this new company will get down the brands of heart drugs I am prescribed to use under this parrel import policy so that I could also benefit from this most worthy endeavour of the ministry. The other letter is from a diabetic patient in Kegalle, K. Cumarasinghe 51 years who state that there is no CWE outlet closer to his area and that he would like if the ministry could appoint some agent to market the STCM drugs so that he and others in his area could also benefit. He says he has written separately to the ministry on this. |
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The quality of life in-utero has much effect on the subsequent growth
and development of a child, therefore prenatal care is a very important
beginning to child health care and is the right of every child.
