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A randomized, double-blind, placebo-controlled trial was conducted to evaluate the effect of simultaneous vitamin A supplementation and diphtheria, pertussis and tetanus (DPT) vaccination on the antibody levels. Infants aged 6-17 wk (n = 56) were randomly given 15 mg oral vitamin A or placebo at the time of their DPT immunization. Three such doses were given at monthly intervals. Immunoglobulin (Ig) G antibodies to diphtheria, pertussis and tetanus were assayed on enrollment and 1 mo after the third dose. Baseline antibody concentrations to diphtheria, pertussis and tetanus did not differ between the vitamin A-supplemented and placebo-treated groups. The postdose antibody to diphtheria level was significantly greater in the vitamin A than in the placebo-treated group. The geometric mean +/- SEM antibody levels (mg/L) were 22.9 +/- 1.2 and 11.0 +/- 1.3 in the vitamin A and placebo groups, respectively (P = 0.029). The postsupplementation concentrations of antibodies to pertussis and tetanus did not differ between the two groups. These results suggest that antibody response to diphtheria vaccination was potentiated by simultaneous vitamin A administration and DPT immunization.

At immunization contact, 165 infants 2.5 mo old were randomly assigned to receive either 15 mg vitamin A (retinyl palmitate) or placebo. Three doses were given at monthly intervals with each diptheria, pertussis, tetanus and oral polio (DPT/OPV) immunization dose. The diarrhea and acute respiratory infection (ARI) morbidity was similar in the vitamin A and placebo groups. However, the duration (days per child-year, mean [+ or -] SD) of ARI was less in the vitamin A group compared with placebo group (27.6 [+ or -] 17.1 vs. 40.8 [+ or -] 22.7; P = 0.005). Fasting retinol concentrations were measured at entry and in 61 infants, the relative dose response (RDR) test was done 1 mo after the third dose of vitamin A. Eighty-five percent of the infants had serum retinol concentration < 0.70 mol/L at entry. After 3 mo the serum retinol levels improved significantly in both groups, and in the vitamin A-supplemented group the serum retinol concentration was significantly better than that in the placebo group (P = 0.02). However, 61% of the infants remained deficient despite vitamin A supplementation. Among vitamin A-supplemented infants only, diarrhea and ARI morbidity during the 3-mo period were compared in children with normal versus children with abnormal RDR at the end of the supplementation period. The ARI episodes were more frequent in the supplemented infants who remained vitamin A deficient at the end of the 3 mo (P = 0.027). Also, the cumulative duration (days, mean [+ or -] $D) of fever and cough was 5.0 [+ or -] 2.8 in the normal versus 11.2 [+ or -] 6.0 in the deficient group (P = 0.04). The results of this study suggest that a large proportion of infants remain vitamin A deficient even after large dose vitamin A supplementation because of frequent respiratory infections, particularly those accompanied by fever. INDEXING KEY WORDS: * vitamin A * diarrhea * acute respiratory infection * fever * humans

Introduction Despite the high prevalence of breast-feeding, only a small proportion of infants below four months of age are exclusively breast-fed in developing countries (1). Diarrhoeal morbidity (2-4) and mortality [...], Lactation counsellors were trained to advise mothers of partially breast-fed infants who were admitted to hospital because of diarrhoea, so that they could start exclusive breast-feeding during their hospital stay. Infants (n = 250) up to 12 weeks of age were randomized to intervention and control groups. Mothers in the intervention group were individually advised by the counsellors while mothers in the control group received only routine group health education. During follow-up at home by the counsellors a week later, only the mothers in the intervention group were counselled. All the mothers were evaluated for infant feeding practices at home two weeks after discharge. Among the 125 mother-infant pairs in each group, 60% of mothers in the intervention group were breast-feeding exclusively at discharge compared with only 6% in the control group (P < 0.001); two weeks later, these rates rose to 75% and 8% in the intervention and control groups, respectively (P < 0.001). However, 49% of mothers in the control group reverted back to bottle-feeding compared with 12% in the intervention group (P < 0.001). Thus, individual counselling had a positive impact on mothers to start exclusive breast-feeding during hospitalization and to continue the practice at home. Maternal and child health facilities should include lactation counselling as an integral part of their programme to improve infant feeding practices.

Vitamin A supplementation has been resorted to by doctors in many developing countries to counter the adverse effects of vitamin A deficiency on infants. These countries have launched aggressive vitamin A supplementation programs for children 6 months to 6 years of age. However, the coverage of these programs is not as successful as that of the Expanded Program on Immunization (EPI), which has so far been doing well in Bangladesh. To remedy this problem, it was suggested that supplementation programs coincide with the EPI.

Introduction The oral rehydration salts (ORS) solution recommended by WHO is safe and effective for treating patients of all ages suffering from dehydration due to diarrhoea of any etiology, provided [...], Reviewed are all the published clinical trials of glycine-based oral rehydration salts (ORS), L-alanine-based ORS, L-glutamine-based ORS, maltodextrin-based ORS, and rice-based ORS, as well as the results of several recently completed, but unpublished, studies of these formulations that were supported by WHO. All experimental ORS formulations contained the same concentrations of salts as citrate-based WHO-ORS; all trials were randomized comparisons with WHO-ORS, and all except those with rice-based ORS were double-blind studies. The rate of stool loss and, less frequently, the duration of diarrhoea were used as indicators of clinical performance to compare ORS formulations. The following conclusions were reached concerning the efficacy and use of modified ORS formulations. Rice-based ORS (50 g/l) is superior to WHO-ORS for patients with cholera, and for such patients it can be recommended in any situation where its preparation and use are practical. Rice-based (50 g/l) and WHO-ORS solutions are equally effective for treating children with acute non-cholera diarrhoea, when feeding is resumed promptly following initial rehydration, as has been consistently recommended by WHO. Since rice-based ORS is not superior to WHO-ORS for such children, there is no apparent reason to advise a change from glucose to pre-cooked rice in the recommended formulation for WHO-ORS. Maltodextrin-based ORS formulations (50 g/l) and WHO-ORS appear to be equally effective for treating children with acute non-cholera diarrhoea; there is no reason to advise a change from glucose to maltodextrin in the recommended formulation for WHO-ORS. Amino-acid-containing ORS formulations are not recommended for either non-cholera or cholera diarrhoea, since they are more costly and have no clinical advantage over WHO-ORS for children with acute non-cholera diarrhoea or over rice-based ORS for persons with cholera.

Maternal and socio-economic factors such as mother's education, breastfeeding status and employment status are linked to the development of extreme malnutrition in children. Children who are not fed on breast milk reveal higher risks of severe malnutrition. Inadequate nutrition of mothers is linked to acute malnutrition in their children. There is a positive link between mother's employment and malnutrition of the children.

Results of a clinical trial on severely malnourished children, who were subjected to an energy-rich diet diluted with amylase-rich flour, revealed their acceptance of the nourishment. Subjects accepted porridge with sprouted cereal flour. Energy intake increased significantly in children as a result of the energy-rich diet and prevented the recurrence of diarrhea. Breast-feeding habits of infants were unaltered.

The feasibility of having children fed with green leafy vegetables to mee the dailyvitamin A requirements was studied in a group of heterogenous children from ages 6 to 35 months recovering from diarrhoea. Interviews were conducted to assess maternal perceptions and attitudes towards feeding their children with vegetables. Results showed that feeding children with green leafy vegetables were acceptable to most mothers and can meet the daily vitamin A needs.

The role of Shigella dysenteriae 1 infection in food intake of children afflicted with acute dysentery have been examined. Results show that S. dysenteriae 1 significantly reduced food consumption and energy intake by 82kJ/kg.d compared with other Shigella strains. Past research reveal that the severe anorexia can be attributed to the presence of toxins and the release of interleukin-1 and tumor necrosis factor in S. dysenteriae 1 infection. However, intensive feeding and persuasion was found to be effective in overcoming S. dysenteriae-produced anorexia in children.

INTRODUCTION A crucial field trial of oral electrolyte solutions in the treatment of cholera was carried out in India during the summer of 1971 when the disease appeared in a [...]