Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso?

OBJECTIVES

To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context.

DESIGN

A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women.

SETTING AND SUBJECTS

Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso.

RESULTS

The mean DDS-9 and DDS-22 were 4.9 +/- 1.0 and 6.5 +/- 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women's socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 +/- 4.9 kg m-2 and 37% of them were overweight or obese (BMI > or = 25 kg m-2). Neither the DDS-9 nor the DDS-22 was associated with the women's anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22.

CONCLUSION

In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.

A prospective randomized trial of idarubicin vs daunorubicin in combination chemotherapy for acute myelogenous leukemia of the age group 55 to 75

A prospective randomized study was conducted comparing the efficacy and toxicity of two anthracyclines for the treatment of patients with acute myeloid leukemia (AML) between 55 and 75 years. A total of 220 patients were randomized to receive as induction chemotherapy cytosine arabinoside (Ara-C: 100 mg/m2/day; continuous infusion for 7 days) combined with either daunorubicin (DNR: 50 mg/m2/day, i.v. bolus for 3 days) (n=108) or idarubicin (IDA: 8 mg/m2/day, i.v. bolus for 5 days) (n=112). The complete remission (CR) rate was similar (P=0.296) after IDA (76/112; 68%) and DNR (66/108; 61%) (P=0.3). For patients aged 55-65, the CR rate was significantly higher after IDA (39/47; 83%) than after DNR (29/50; 58%) (P=0.007). Persistent leukemia was more frequent after DNR (26/108) than after IDA (13/112; P=0.015). Hematological and extra-hematological toxicities were similar. The CR patients were given a consolidation course of chemotherapy with Ara-C: 50 mg/m2/12 h, subcutaneously for 5 days, combined with either DNR:30 mg m2/day, i.v. bolus for 3 days or IDA:8 mg/m2/day i.v. bolus for 3 days according to the initial randomization, and then received a continuous maintenance treatment for 2 years. The survival and disease-free survival (DFS) were similar in both groups; there was no difference in the risk of relapse. However, there was a trend for a longer event-free survival (EFS) in the IDA group than for the DNR patients (P=0.07). Our results seem to indicate that IDA is probably more efficient than DNR for AML patients between 55 and 75 years, and confirm the data published in other studies comparing prospectively IDA and DNR in adults.

Childhood leukemia incidence in the vicinity of La Hague nuclear-waste reprocessing facility (France)

The incidence of leukemia is examined in young people (aged under 25 years) living within a 35 km radius of the French nuclear-waste reprocessing plant operating in La Hague, Normandy. During the period 1978-90, a total of 23 cases was diagnosed, giving an incidence rate of 2.99 per 100,000 which is close to the expected rate. In the 'canton' in which the nuclear plant is located, three cases of leukemia were observed compared with 1.2 expected, giving a standardized incidence ratio of 2.5. This nonsignificant finding is compatible with no increased risk and also with a sevenfold excess risk. Therefore, it reinforces the necessity of conducting a case-control survey, which is now planned, to assess the part played by occupational radiation exposure in leukemia incidence for this French area.

[Prevention in pediatrics in the Nord-Cotentin. Prospective study of 255 cases]

Over a 4 month period, the medical records of 255 children with an age range of 6 months to 3 years and who had been admitted to the Cherbourg Hospital Department of Pediatrics were prospectively studied. Ninety-nine % had received BCG vaccination but only 71% had a positive skin test. Ninety-two % were vaccinated against diphtheria, tetanus, whooping cough and poliomyelitis and 61% against measles. Seventy-eight % of parents said that they had correctly administered vitamin D, at least up to 18 months of age. Seventy % of children were fed cow's milk during the second half of the first year and at least 35% had at least one hematological sign of iron deficiency. The promotion of routine immunizations as well as vaccination against rubella-mumps-measles seems to be desirable goals. There is a need for the widespread use of adapted milk formulas up to 1 year of age and for systematic iron supplementation of pregnant women and of infants presenting with evidence of iron deficiency or on cow's milk.

[Acquired deficiencies in antithrombin III and C protein during treatment with L-asparaginase]

Fourteen children treated by L-Asparaginase for acute lymphoblastic leukemia had sequential coagulation studies performed including cephalin-kaolin time, Quick time, fibrinogen, factors II, VII + X and V, as well as antithrombin III and protein C, the major coagulation inhibitors. A severe antithrombin III and protein C deficiency was observed during therapy, with a coexisting hypocoagulability. This equilibrium partially explains the lack of thrombo-embolic phenomena in these children, despite the risk factors present. Although no substitutive therapy was instituted in these cases, their use in high-risk cases is discussed.

[Thalassemia major manifested by megaloblastic anemia caused by folate deficiency]

In a 11 month-old child, a deep anemia with reticulocytopenia and megaloblastosis on bone marrow aspiration revealed a thalassemia major. The low folate intake and the increased needs probably account for initial findings. Folic acid deficiency has already been described in patients with dyserythropoiesis or chronic hemolysis. Daily folic acid treatment is necessary in these patients.