Frequency and Prevalence of Nappy Rash in Indian Infant s Population

Please download to get full document.

View again

of 8
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information Report
Category:

Travel

Published:

Views: 17 | Pages: 8

Extension: PDF | Download: 1

Share
Related documents
Description
Review Article Frequency and Prevalence of Nappy Rash in Indian Infant s Population Deepa Yaduwanshi*. Chandra Kumari Dept. of Home science (Human Development) Banasthali Vidyapith, Banasthali, Rajasthan,
Transcript
Review Article Frequency and Prevalence of Nappy Rash in Indian Infant s Population Deepa Yaduwanshi*. Chandra Kumari Dept. of Home science (Human Development) Banasthali Vidyapith, Banasthali, Rajasthan, (India) A study was carried out to conduct prevalence and frequency of nappy rash in Indian infant s population The study was centered on role of diaper in nappy rash The study was carried out in Udaipur city. Total 110 Infants and their parents were selected for the survey of frequency and prevalence of nappy rash. Study revealed that the frequency of moderate rash reached a maximum at age 9 to 12 months. Rash frequency and severity were significantly lower when the mean number of diaper reported changes per day was above average, regardless of the type of nappy used. Infants nappyed exclusively in disposable nappies had a significantly lower mean rash grade and a significantly lower frequency of moderate and severe rash. The frequency of combined moderate and severe rash increased with increasing number of bowel movements per day. Infants partially or wholly breast-fed or those with a history of breastfeeding tended to have a lower prevalence of moderate and severe rash compared to the infants who fed on proprietary milk preparation. Key word: Nappy Rash, Disposable Diapers, Candida Infection INTRODUCTION Diaper rash, or diaper dermatitis, an acute, inflammatory reaction of the skin in the diaper area, is one of the most common dermatitis in infants. Because the condition is rarely of significant health consequence and is limited to the diaperwearing years of infancy, few investigations have been conducted to determine factors that are related to its frequency and severity in the general *Address for correspondence population of infants. Investigations of the effects of diaper types (cloth or disposable) on diaper dermatitis yielded conflicting results (Grant et al., 1973; Wiener,1970;Stein, 1982). A similar study (Jordan et al.,1982) also gathered data on the effects associated with infant age, frequency of diaper changes, and such practices as bathing frequency, extent of cleansing, and application of ointment at diaper changes. The objectives of this observational study, including both retrospective and prospective elements, were to determine the frequency and 25 P a g e severity of diaper dermatitis among a randomly selected infant population and to look for relationships among the rash and a variety of factors including infant age, sex, diet, and diapering practices.(pratt et al.,1955;sezer,1967;barbero et al.,1952) METHODS AND MATERIALS Locale of Study The study was carried out in Udaipur district of Rajasthan state. A private hospital was selected for the survey of prevalence and frequency of Nappy rashes in infants.the locale was selected purposely because the investigator is a resident of Udaipur, so there was ease in accessibility and better interaction with the respondents. Selection of Sample The present study required three types of subjects i.e. Infants, infant s mothers and retail shopkeepers of diaper for market survey and for the survey of prevalence and frequency of Nappy rashes in infants. Selection of Infants A total of 110 infants, roughly equal numbers of males and females, aged 1 to 20 months (mean age 10 months )at the time of study, were selected by purposive sampling technique. Subjects were required to be healthy infants with no atopy, unusual skin condition, or chronic illness as determined from the medical history provided by the parents. Infants who were routinely taking medication (other than vitamins and minerals) prescribed by a physician were excluded from the study. Out of 110 infants, 50 infants comprised of experimental group who were routine user of disposable diapers, in general good health as evidenced by medical history and dermatological examination.the ages (mean±sd) of infants in these studies were 7.13±3.06 months. Only younger age of the infants were enrolled in this study in order to increase the probability for the occurrence of nappy rash episodes. Selection of parents A total of 110 parents were selected for the survey of prevalence and frequency of nappy rash. The age group of selected parents was 20-35years. A. Tools and Techniques Following tools were prepared for the collection of data for the study. Interview schedule For the investigations of frequency and severity of nappy rashes among general Indian infant population a 20 item interview schedule was drawn up to ask the parents of children wearing nappies who attended the outpatient clinics of a private Hospital, Udaipur. Nappy rash was simply defined to parents as a rash in the Nappy region thought to be caused by the infant wearing a nappy. 26 P a g e S. No. Gender None Moderate Severe Total Medical and Personal History A questionnaire was completed by the parent or guardian of each study participant. It dealt with characteristics of the infant's family, habits (diet, sleep, number of bowel movements per day), and medical history (allergies, visits to physician, skin sensitivity); and the mother's habits and practices (nappy change frequency, type of nappy used, type of soap used).(tanino et al.,1959;buuen, 1976) Visual analog scale for the assessment of Nappy rashes A Visual analog scale was developed for the assessment of Nappy rashes. This grading scale was developed to reflect the etiology of the diaper skin breakdown, beginning with healthy skin and no rash at grade-0. The low levels of diaper rash, represented by grades , are attributed to compromises in skin integrity as evidenced by dryness/scaling and aberrant desquamation, and skin erythema attributed to an irritant response. Specific rash features, i.e. eruptions, papules, and vesicles, are slight in severity at a grade of 1.5 and erythema increases. As the skin eruptions worsen, visual scaling disappears because the barrier has been broken and the irritant response (erythema) worsens. Ulceration, severe erythema and moderately severe eruptions are characteristic of more significant rash and are given grades (Borovik,1977; Koblenzer,1973) Evaluation of Skin Condition of the Nappy Area Recruited infants were examined by investigator. Each infant's skin in the nappy area was graded using the scale. Grades were based on the type and severity of lesions (erythema, skin integrity, eruptions, edema) and extent and location of the affected area The overall grade was determined from the severity of the lesions and then adjusted one-half grade unit upward or downward depending on the size of the area affected. RESULT AND DISCUSSION Frequency and Severity of Observed Nappy Rash Table 1 shows the distribution of nappy rashes. The distribution of rash severity was Table: 1 Distribution of Nappy Rashes among Male and Female Infants 1 Male Female Total not symmetric on this scale showing a prevalence of higher grades. The majority 27 P a g e cumulaative Percentage of the infants (79%) had no rash or very slight rash ( grade 1.0) % infants had moderate grade of rash (rash of grade 1.5 to 2.5 was described as moderate). It is characterized by redness and scaling of the skin. Severe rash was associated with skin ulcerations and severe erythema. 3.63% of infants was found with severe rash grade Frequency of Infants Nappy Rash Severity None Moderate Severe Fig. 1: Distribution for Nappy Rash Severity The overall severity spectrum of diaper rash can be broken into three subcategories. Rash of less than grade 1.0 was random, described as slight by the parents, and, based on the frequency of physician involvement, not regarded as a threat to the infant's health or comfort. Grade 2.0 to 2.5 rash was more stable with time and perceived as more of a threat to the infant's health and comfort. When grades were plotted against cumulative percentage of cases, a segmentation of the overall distribution was apparent with discontinuities occurring around grades 2 and 3. Fig.2 shows the frequency of rash based on the maturity of the infants. The rashes were divided into three severity categories: none to slight (grade 1.0), moderate (grade 1.0 to 2.0), and severe (grade 3.0). Table 2: Nappy rash with regards to age S. No. Nappy Rash Grade Age (months) Total 1 None Moderate Severe Grand Total The prevalence of each category is shown as a function of a maturity index, which is the actual age of the infant corrected for gender related deviations in weight from the norm. The frequency of moderate rash reached a maximum at age 9 to 12 months. The presence of severe rash was relatively constant at approximately a 5 per cent level across 6-15 months studied. Thus, it seems that, as the infant ages, the skin in the diaper region is subjected to fewer insults from contact with feces and urine, which would be expected to decrease the prevalence of nappy rash arising from such contact. 28 P a g e Total Cloth Diaper Dispos able Diaper S.No Types of Diaper None Moderate severe Total χ2- value Relationship between Observed Rash and Nappy Type and Changing Frequency Among the 110 infants studied, nappy usage was reported as: cloth (50%), disposable (50%). Rash was then analyzed. Table. 3: 1 Nappy rashes with regards to types of Nappy P 0.001 Fig. 2: Frequency and severity of observed Nappy rash based on maturity based on nappy type for infant groups who reported a higher or lower daily nappy change rate than the average of 8. Two observations were made concerning nappy type and change frequency. First rash frequency and severity were significantly lower (P 0.001) when the mean number of diaper reported changes per day was above average (i.e., over 8), regardless of the type of nappy used. There was, as expected, a strong relation between change rate and infants' age; older infants were changed less often. Second, infants nappyed exclusively in disposable nappies had a significantly lower (P 0.001) mean rash grade and a significantly lower frequency of moderate and severe rash. Relationships among other factors and rash No significant differences were detected in the frequency or severity of rash experienced by males or females. Infants with claimed allergies did not show any more rash than the others although the number of these infants was small. There was the indication that the frequency of combined moderate and severe (greater than 3.0) rash increased with increasing Fig.3: Relationship between Observed Rash and Nappy Type 29 P a g e None Moder ate Severe S. No. No of bowel movement/day None Moderate Severe χ2-value number of bowel movements per day, suggesting that irritation from feces is a contributing factor. Infant diet may be an important factor in the etiology of nappy rash. It is commonly believed that breastfed infants experience less rash than formula- fed infants. Table 4: Nappy rashes with regards to frequency of Nappy changes S. No. Frequency of nappy changes Severity of Nappy rashes Total P 0.001 χ2- value The reported beneficial effects of breastfeeding over formula feeding can be attributed to lower stool ph, differences in the intestinal microflora and components of the feces and perhaps urine. Data on the frequency of breast-feeding among the population surveyed in our study supported the concept of dietary influence. Table 5: Nappy Rashes with Regards to Number of Bowel Movement/Day Total Infants partially or wholly breast-fed (44.5 per cent) or those with a history of breastfeeding tended to have a lower prevalence of moderate and severe rash compare to the infants (55.4 per cent) who fed on proprietary milk preparation. Fig. 4: Nappy Rashes with Regards to Frequency of Nappy Changes Fig. 5: Nappy rashes with regards to No. of Bowel movement/ Day 30 P a g e S.No Type of Feeding None Moderate Severe Total χ2-value The high rashes incidents can Fig 5:be attributed to the high amount of urease present in feces of infants who fed on proprietary milk Table Nappy rashes with regards types of Feeding Nappy rash Grade REFERENCE 1. Grant W, Street L, Feamow R. Diaper rashes in infancy. Clin Pediatr1973;12: Wiener F. The relationship of diaper rashes in the one-month-old infant. J Pediatr 1979,95: Breast Proprietary Milk Total Stein H. Incidence of diaper rash when using cloth and disposable diapers. J Pediatr 1982;101: Jordan WE, Blaney TL. Factors influencing infant diaper dermatitis. In: Maibach HI, Boisits EK, eds. Neonatal skin: structure and function. New York: Marcel Dekker, 1982 Fig. 6: Nappy rashes with regards type of feeding The results of this study suggested that the following factors are associated with development of Nappy rash: a) Maturity of the infant (within the limits described) b) Diet c) Frequency and duration of contact between the infant's skin and excreta (based on the effects of change frequency on development of rash). 5. Pratt AG, Reed WT. Influence of type of feeding on ph of stool, ph of skin, and incidence of perianal dermatitis in the newborn infant. J Pediatr 1955,46: Sezer V. The role of feeding in the etiology of neonatal diaper dermatitis. Turk J Pediatr 1967,7;9: Barbero GJ, Runge G, Fischer D, Crawford MN, Torres FE, Gyorgy P. Investigations on the bacterial flora, ph, and sugar content in the intestinal tract of infants. J Pediatr 1952,40: P a g e 8. Tanino J, Steiner M, Benjamin B. The relationship of perianal dermatitis to fecal ph. J Pediatr 1959;54: BuUen CL, Tearle PV, Willis AT. Bifidobacteria in the intestinal tract of infants. J Med Microbiol 1976;9: Borovik GA. Activity of digestive enzymes in the feces of healthy children in the first year of life. Pediatr Akush Ginekol 1977;2: Koblenzer PJ. Diaper dermatitis an overview. Clin Pediatr 1973,12: P a g e
Recommended
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks