Various studies conducted in Indonesia have shown that administration of Vitamin A to pre-school children had decreased the mortality and morbidity rates among them. In the first study conducted in the province of Acheh in North Sumatra, a twice yearly high dose of vitamin A led to a 34% decrease in mortality. In a second study in Bogor, conducted by fortifying the nutritional additive MSG with vitamin A and distributing the product in a designated area, the mortality rate among preschool children was 45% less than in a control area. In the third study also conducted in Bogor, where vitamin A was given to lactating women 2 weeks after giving birth and then directly to the infants themselves after 5 months of age, the mortality rate was 38% lower. The prevalences of respiratory and diarrhoeal infections were statistically lower than in the control gorups. Another study on preschool children showed a two-fold increase of anti TT IgG on primary immunisation against tetanus when compared to a control group and a four-fold increase with a secondary immunisation. Other studies conducted in Bogor and other parts of the world have showed that smaller doses given more often are more effective than bigger doses given less often.
The high incidence of photodermatitis among dermatological patients prompted the study of the condition. In the 18 months from October 1972 to March 1974, 199 patients presented with light sensitive dermatitis, forming 9% of all new cases seen in the Dermatology Clinic at Kuantan. A detailed history, including that of the use of drugs, proprietary and commercial products, was taken in each patient to determine the aetiology. Where there was suspicion of contact sensitisation, photo-patch tests were done with the suspected agents using natural sunlight as a source of ultra-violet light. The aetiology of photodermatitis in these patients is discussed. The systemic and topical use of medicaments accounts for the largest number of cases. It is inferred that the ready availability to the public of medicaments containing known photosensitisers and the unawareness of light sensitive dermatitis are factors responsible for the large number of patients developing this condition in this tropical climate where there is an abundance of ultra-violet light and where people wear light clothing.
Epidemiological features as reflected by 101 patients with unequivocal sea-snake bite received in north-west Malaya are reviewed. Enhydrina schistosa caused over half the bites, including seven of the eight fatal bites. It is the most dangerous sea-snake to man. Over 90 per cent of the victims were male and 80 of the 101 patients were fishermen bitten at their job. Most victims were bitten on the lower limb through treading on the snake, and this resulted in more cases of serious poisoning than upper limb bites (caused through handling nets, sorting fish and so on). Only 14 cathers were bitten (through treading on the sea-snake; no bathers were bitten while swimming). In patients coming to hospital more than six hours after the bite, there was a four-fold increase in serious poisoning compared with patients coming within six hours of the bite. Thus, as time elapses after the bite, the victim is less likely to seek medical help unless poisoning is severe. Despite the lethal toxicity of sea-snake venom, in patients seen during 1957-61 before sea-snake antivenom became available, the mortality was only 10 per cent. Trivial or no poisoning followed in 80 per cent of the bites. On the other hand, of 11 patients (20 per cent) with serious poisoning, over half (six patients) died despite supportive hospital treatment. These epidemiological features observed in Malaya probably apply to most fishing folk along Asian coastlines where sea-snakes abound. If this is so, sea-snake bite must be a common hazard feared by millions of fishing folk, and a common cause of illness and death. But it is unlikely that the extent of this problem will be revealed to orthodox medicine for many decades because most fishing villages are far from medical centres; and even if hospitals or medical centres are available, fishing folk are usually reluctant to attend them. Only one species of sea-snake, Pelamis platurus, extends to the east coasts of Africa and west coasts of the tropical Americas, but for various reasons this species does not appear to constitute much of a hazard to fishing folk in these areas. Although bathers are occasionally bitten along Asian coasts, when they inadvertently tread on a sea-snake, the risk of sea-snake bite in this area is extremely low. The prevention of sea-snake bite and poisoning is considered. Highly effective antivenom is now available for treating victims with serious poisoning; death should not occur provided adequate medical treatment is given within a few hours of the bite. The main problem is provision of adequate medical care at rural medical centres and overcoming the reluctance fishing folk often have in attending these centres.