Out come of induction of remission in undernourished children with acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) is the most common childhood leukaemia. On the other hand under-nutrition is a common problem in our country. This prospective study was conducted to see the outcome of induction of remission in undernourished children with acute lymphoblastic leukaemia. This study was carried out in the department of Paediatric hematology and oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU) during the period from November 2002 to October 2004. A total of sixty (60) children who were diagnosed as acute lymphoblastic leukaemia in 1 to 15 years of age were included in this study. But the children with previous history of congenital disease and that of chemotherapy or steroid were excluded from this study. Patients were divided into two groups on the basis of Z score of weight for age. Thirty (30) children those with Z score- 2 or less were classified as undernourished and was labeled as Group A and another thirty (30) patient those Z score above-2 were classified as well nourished and was placed in Group B, After inclusion into the study, completion of induction of remission was monitored by physical examination and laboratory investigations. The result showed that mean age in Group A was 77.16 ± 7.07 months and that in Group B was 74.13 ± 5.09 months with male preponderance in both the groups. Mean body weight in Group A was 14.55 ± 0.76 Kg and that in Group B was 21.40 ± 1.05 kg (p<0.001). Children in Group A required 39.06 ± 0.72 days to complete induction but in Group B it required 31.63 ± 0.17 days (p<0.04). Hospital stay in Group A children was 52.10 ± 1.08 days and in Group B 42.37 ± 0.50 (p<0.002). The result suggested that under nutrition has an influence on the out come of induction of remission in undernourished children with acute lymphoblastic leukaemia. So appropriate measures are essential to improve nutritional status of children for successful management of ALL in children.

Attitude of the parents seeking service from the paediatricians

The overuse of antibiotics and other medicines have been standing a dangerous proposition and researchers are coming in fore front analyzing and assessing the aftermath of years of misperceptions and inappropriate usage of drugs prescribed by the pediatricians. Two hundred and two parents from the community as well as from the outpatient department of medical college hospitals were interviewed, to study their attitude while seeking for the health service for their children. Data were collected through a face-to-face interview using a structured questionnaire. One hundred and ninety nine (82.7%) of the parents interviewed were mothers and only 3 (1.5%) were fathers. One hundred and sixty-seven (82.7%) parents were from the urban population and the rest 35 (17.3%) were from rural areas. The mothers mean stay in the educational institution was 11.8 years and that of the father's was 13.1 years. About 34.7% parents had to seek for doctor's advice at least once or twice a month and around 43% had to visit doctor's clinic. Most (66.8%) of the parents were from the family earning tk.6000 to tk.20000 a month, 19.8% and 13.4 % were from the families earning below tk.6000 and above tk.20000 respectively. A vast majority of the parents expressed their preference for advice to medicines. Among the medicines they like antibiotics more than vitamins. Majority of the parents showed their interest to spend more time and to have less medicine. For anorexic children parents preferred advice to medicines. An overwhelming majority (98%) of the parents was interested to get advice and ORS for diarrhea. For ARI also a larger number (56.1%) of parents opted for advice only and no medicine at all but 37.1% kept their option for both. A large majority of the parents were preferring more frequent visit and having fewer medicines than the conditions of more medicines with less frequented visits.