Don't land them in hot trouble

By Tharuka Dissanaike

It is the simplest thing to avoid, said Dr. Y. Kulasekera of the Lady Ridgeway Hospital. But at least two young children are admitted to the LRH daily due to severe burns. This is just a small portion of the number of young burn victims islandwide. Their suffering, as Dr. Kulasekera said, is unnecessary and mostly due to sheer carelessness on the part of the parents.

The commonest cause of child burn injury is hot liquid. Coming a close second is bottle lamp burns. Then there are the myriad of other reasons like fireworks, electrical burns (irons, exposed wires), acid burns, eye injury by playing with lime and caustic soda and also by home made bombs in the poorer sections of society.

"Hot water burns are the most common," said Dr. Kulasekera, Consultant Surgeon. He said these could simply be avoided by taking care to keep hot liquids out of the child's reach.

Children are most often in the kitchen with the mother or maid when food is being prepared. When a mother is making milk, she will leave a jug of hot water and turn away for a minute. That instant is enough for a small child-perhaps in hunger- to reach for the jug. "Often such burns scorch the child's face, shoulder, chest and stomach area."

Curtain accidents are also common. Curtains shielding the kitchen often cause accidents where an adult carrying hot curry or tea coming through the doorway collides with a youngster playing on the other side.

"Hot curry is more dangerous than water, since it is thicker and can burn deeper," Dr Kulasekera points out. He adds that although steam inhalation is a highly recommended nasal decongestant, with small children it could turn out to be dangerous. Holding a protesting youngster over a steaming hot bowl covered with a net or towel can be a recipe for disaster. Often the child can struggle and get entangled in the covering and end up in the hot water. Another mistake is leaving the kettle filled with hot water nearby, which the child can overturn in his struggle.

The bath is the next danger. "Mothers generally prefer to put hot water in first and then fill in the cold water. Children seeing the basin filled will put their hands in or fall into the water and burn themselves."

Dr. Kulasekera said most child burn injuries due to hot water occur in the pre-school age group of 2-5. "These children can walk and are inquisitive. In the case of kerosene lamp burns it is generally children of school going age- most suffer accidental burns while they are studying at home." Dr. Kulasekera said a large portion of city dwelling people also use kerosene for lighting. Usually the lamp overturns by accident and the oil seeps out, often onto the person sitting close. Fire catches on fast.

"Kerosene lamp burns are more dangerous. They burn deeper and victims-if they survive- are left terribly maimed and scarred. Sometimes it is better that they die than survive," Dr. Kulasekera said.

The easiest way to prevent kerosene burns is to buy a properly designed lamp that has a screw-on lid which will prevent kerosene spill. A campaign to educate people on safe kerosene lamps has not given the desired result, Dr. Kulasekera said. "We should not be seeing any lamp burn victims because it is so easy to prevent."

Hasheli, an eight year old girl from Sandalankawa has been in hospital for nearly a month.

She was studying in the light of a kerosene lamp when an accident with the lamp caused severe burns to her face, abdomen and legs. Her wounds are still raw, the grafted skin waiting to heal. A mosquito net above the cot keeps away flies and disease carrying insects.

Still she breathes through a tube. Sobbing, Hasheli's mother told us "We have heard of such accidents before, but never thought it will happen to us." Hasheli's wounds may heal one day and she will step out of hospital but her scars will remain. This misfortune could have been avoided by simply using a safe lamp.

Dr. Kulasekera said that in case of a burn, of any sort, the best first aid measure is to pour as much cold water on it as possible. "Water will prevent the conduction of heat through to the lower layers of skin. It will ease the pain and wash away any fragments of clothing or food stuck to the skin."

In hospital, the treatment consists of controlling pain and warding off infections. After a week or so, the doctors would be able to judge the extent of damage to the body. Then skin grafting can begin. If a patient has 20 per cent burns around 5-6 operations are necessary to graft healthy skin tissue in the damaged areas. "This is at a tremendous cost to the hospital and country," Dr. Kulasekera said.

If the extent of burns is over 30 percent, the injury is often fatal.

Dr. Kulasekera states, "What is important is, burn injuries of small children can very well be avoided. Parents have a huge task in making the home environment safe for young children. These accidents happen of small mistakes, but for the child, it could well mean the end of his life."

Safety hints

• Keep children away from kitchen or design kitchen counters so that small children cannot reach utensils.

• Be watchful when there is hot water within the child's reach.

• Avoid steam inhalation for small children- there are effective medicines available.

• When filling the bath, first put in the cold water.

• Avoid curtains across kitchen doorways.

Beri-ness even in the land of plenty

A little over a century ago, Sri Lanka con tributed a new word, Beriberi, to the English language to describe a disease then widely seen in British colonies.

The word was derived from the Sinhalese Beri . It is thought that using it in duplicated form Beri Beri was an indication of how severe the "Beri -ness was!

The disease Beriberi was characterized by muscle weakness, related to a deficiency of the Vitamin B I (also called Thiamine). The condition was widely prevalent in those days in Britain's Asian colonies where the indigenous populations traditionally consumed polished rice.

Imagine my surprise when I happened to read a few years ago that doctors working in the 'Cleveland Clinic in America's state of Ohio had recognised the typical features of early Beriberi in what were otherwise normal American children. These youngsters had been complaining of vague symptoms such as muscle pains, poor appetite, tingling of the hands and legs and inability to sleep.

In contrast to their counterparts in the old British colonial medical services, doctors in modern America have access to a variety of sophisticated laboratory tests - so the Cleveland doctors took blood samples from their patients and had them analysed.

The blood tests revealed the startling fact that all the affected children had low levels of Vitamin B I - and following treatment with appropriate supplements of the deficient vitamin, they all recovered.

How, you might ask yourself, could such a form of dietary deficiency occur in a land of plenty like twentieth century America?

The problem in these children was simply due to the fact that they were eating vast quantities of Junk Foods!

Junk food consumption is primarily a phenomenon of the affluent West - but as life- styles in the cities of the developing world become more and more like those in the West, the problem of malnutrition due to affluence is likely to be seen in countries such as ours.

The proliferation of fast food outlets in Third World cities is an example of this growing trend. Families where both parents work are becoming commoner. With increasing urbanization and the breakdown of the extended family system, the cooked family meal becomes a rarity while chocolates, chips, take away foods and aerated waters take over as regular features of the working day's diet.

It is sad but true that one of the main aims of newly affluent Third Worlders is to appear as westernized as possible. It matters not that fizzy drinks and ice cream are known as junk food in the West - in Sri Lanka today these represent Western foods.

Vitamin B 1 is usually found in the germinating parts of cereals and other plants - for example in unpolished rice, wholemeal flour, peas, lentils and beans. Other good sources are milk, eggs, liver and kidney. Yeast has a high content too - which accounts for some of the beneficial effects of yoghurt and curd.

Polished rice, which undergoes a particular form of milling that removes the germinal vitamin - containing layers of the rice seed, has virtually no Thiamine. White flour too loses its Thiamine during the milling ("refining") process - although this loss can be mitigated by the addition of synthetic Vitamin Bl supplements to the milled flour.

Vitamin Bl has an important role in the body because it helps in the metabolism of carbohydrates. The more carbohydrates one consumes, the more Vitamin Bl is needed to make use of it.

Since junk foods are high in carbohydrates, but have little or no Thiamine those who live on junk foods are prone to develop Thiamine deficiency.

Lack of Thiamine manifests in two ways - the Dry form (characterized by weakness, degeneration of the muscles, nerve pains and the inability to perform co-ordinated movements) and the Wet form (a more advanced stage when fluid accumulates and causes the body to become severely swollen and heart failure to supervene).

In today's world, in the midst of plenty, the attraction of instant foods and the market driven taste for confectionery and savoury snacks has been responsible for reintroducing the same deficiency diseases that abounded in the underdeveloped colonies a hundred years ago.

It's a huge problem

Obesity or overweight, together with smok ing, stressful environment, excessive alcohol consumption and lack of physical activity form a group of lifestyle risk factors associated with increased morbidity and mortality from noncommunicable diseases, or NCDs.

NCDs include the following major diseases: cardiovascular diseases, cancer, diabetes, chronic rheumatic and respiratory diseases, oral diseases, genetic disorders and genetic predisposition to diseases. Most NCDs are associated with economic development, lifestyles - particularly inappropriate diets - and ageing. In many cases they are preventable.

What obesity is and how it is measured

More often than not, obesity is the result of unhealthy eating habits coupled with a sedentary way of life. When intake of energy with food exceeds energy expenditure, the excess is stored, in the form of body fat , in adipose tissue. Energy storage is part of the body's natural protection against famine and is fundamental for survival when food is scarce. However, when energy storage becomes the rule rather than the exception, it leads to obesity, which can be described as the point beyond which increasing body fat storage is associated with distinctively elevated health risks.

It is difficult to measure fat mass in the body. Therefore, the practical definition of obesity is based on the so-called Body Mass Index (BMI). BMI relates weight to height and different levels of high BMI, associated with health risks, are expressed in terms of degrees of overweight rather than degrees of obesity.

Taken in isolation, these cut-off points do not imply targets for intervention. They should be interpreted always in combination with other determinants such as disease, smoking and blood pressure. Also, using BMI to classify individuals according to fatness may result in miscalculation because of the varying contributions of bone, muscle and fluid to body weight. The percentage of body fat increases with age and is higher in women than men.

Important Determinants

In dealing with obesity as a public health issue, it is important to understand that social, cultural, behavioral, biological and genetic factors have always been important determinants of both energy intake and expenditure in every society.

Genetics have a say in excess weight gain. It is clear today that overweight, when food is plenty, may result from a genetic predisposition. The mechanism through which genetic factors exert their influence remains unclear. It is quite possible that many genes are involved, affecting both energy expenditure and intake. Populations exposed to inadequate or fluctuating food supplies are believed to be genetically selected for a high level of efficiency in caloric utilization or fat storage. When more food becomes available, this efficiency may lead to an increase in the prevalence of overweight. In an affluent population of individuals with similar socioecomic values and resources, genetic factors become relatively more important in determining which individuals will become obese.

Biological factors play an important role. In many affluent societies the prevalence of grades 1 and 2 overweight in men increases with age up to about 55 years, then levels off before finally decreasing somewhat in old age. In women, prevalence continues to rise until old age and then levels off. Studies in affluent societies also demonstrate that BMI in women increases with the number of pregnancies. On average, mean body weight at different times after delivery is 0.5-2.4 kg higher than pre-pregnant weight.

Socioeconomic status is a major determinant of overweight. In most affluent societies, there is an inverse relationship between socioeconomic status (measured as educational level and/or profession) and prevalence of overweight. In societies where food is scarce, non-thinness is culturally desirable, and overweight may be seen as a visible indicator of wealth and status. The transitional period from poor to affluent society is usually accompanied by an overall increase in height, weight, and abdominal fatness. In affluent societies, thinness is hailed while overweight is regarded as an indicator of low socioeconomic status.

Marital status, or major changes in lifestyles connected with marriage, may promote weight gain in affluent societies. This was shown by studies in the USA and Europe. In some traditional societies, pressure is exerted on women to gain weight and remain overweight during their reproductive lives. The custom of "fattening huts" for elite pubescent girls in certain communities in West Africa is an example of such pressure and a clear indication of the extent to which overweight is related to cultural perceptions and values.

Behavioral determinants include lack of physical activity, alcohol consumption and smoking habits. Inactive individuals are more likely to gain weight. Besides, there is now substantial evidence linking increased physical activity to a more favourable fat distribution.

Overweight is a major risk factor for quite a number of NCDs:

*Coronary heart disease: Over weight is associated with an increased prevalence of cardiovascular risk factors such as hypertension, unfavourable blood lipid concentrations, and diabetes mellitus. A 10% reduction in body weight would correspond to a 20% reduction in the risk of developing coronary heart disease (CHD), about 40% of the incidence of CHD is attributed to a BMI above 21 and is therefore potentially preventable.

*Stroke: Overweight is among the major risk factors for stroke. Abdominal fatness may be associated with increased risks for stroke independently of BMI.

*Hypertension: Increased body weight is associated with elevated blood pressure. On average, a weight loss of 1 kg is associated with a decrease of 1.2-1.6 mm Hg in systolic and 1.0-1.3 mm Hg in diastolic pressure. Therefore, weight loss is recommended for all obese hypertensive individuals.

*Coronary heart disease: stroke and hypertension claim some 12 million lives each year, accounting for between a quarter and a third of all deaths globally.

*Diabetes mellitus: Overweight is a well established risk factor for non-insulin-dependent diabetes mellitus (NIDDM). Adult weight gain of more than 5 kg in 8 years is associated with significant increased risk of NIDDM. There is scientific evidence that weight loss in persons with NIDDM improves glucose tolerance and reduces the need for hypoglycemic drugs.

*Gall-bladder disease: Overweight is a major risk factor for the development of a gallstones. Independently of the degree of overweight, weight gain is associated with increased risk, which is more pronounced in women than in men. Long-term weight loss does not protect against the incidence of gallstones.

*Osteoarthritis: The risk factors for this condition are not well understood, but there is increasing evidence that overweight is associated with osteoarthritis in several joints, specifically hands and knees. However, the results of cross-sectional studies should be interpreted with caution, because the limitations imposed by osteoarthritis on physical activity may, in turn, contribute to the development of overweight.

*Cancer : The association between overweight and the formation of malignant growth in different parts of the body varies: overweight increases the risk of endometrial cancer: overweight probably increases the risk of post-menopausal breast cancer: the relationship between overweight and cancer of the colon, rectum, ovaries, and prostate is uncertain.

(World Health Organization Press Office)

More Plus * Starting school: how young? * Much more than A,B, C

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