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TALC direct recording scales
1600
TALC direct
recording scales
SIR,-Most primary health-care programmes in developing countries include growth monitoring but this is not often successful. TALC (Teaching Aids at Low Cost) direct recording scales have the potential to overcome some of the problems and, unlike most weighing scales, they are designed to be used in the home or in the community. Most weighing scales for children show the weight on a dial. The clinic worker reads this figure and plots it. The mother, on the other hand, is unlikely to have used graph paper, and the whole concept of representing information on graphs and histograms will be unfamiliar to her and, frequently, to health workers too. The TALC direct recording scales have a spring that stretches 1 cm/kg and is visible to the mother. The upper end is attached to, say, a hook in the house or to the branch of a tree. As the spring stretches, the mother herself can plot her child’s growth by placing the point of a pen through a hole in the pointer at the top of the spring (figure). The mother’s active participation means that she is more likely to understand that the spring should stretch further each month and that each dot should be higher up the chart. Since weighing can be unhurried and is done in or near the home, the child is less likely to be upset. Decision-making members of the family, including the father and grandmother, are more likely to be involved too. The community health worker has to see that the chart is correctly placed so that the mother will put the dot in the right month column, to steady the pointer (figure), and to encourage and guide the family discussion. The scales are made of ultraviolet-resistant, unbreakable plastic. Their strength can be demonstrated by throwing them onto a concrete floor and jumping on them. One batch of ten springs was stretched 50 000 times mechanically, and the greatest variation was only 0-4 mm. The scale can only be used with A4 charts on which the kilogram lines are 1 cm apart. Thirty TALC charts are supplied with each scale. The scales cost less than half the cost of existing scales, and the price will probably fall even more with greater volume production. There is also the potential for manufacture in developing countries, although the springs will probably have to be imported. So far experience with these scales has been limited. Here
examples. One of us (P. N.), visiting Zaire, asked about an infant born 3 months previously. She looked small and did not seem to have much energy. "As I had a set of scales with me I helped the father hang these on a tree and weigh his child. He was concerned when he saw the weight was well below the lower line. Since there was no clinic in the vicinity I impressed on him the importance of more frequent breastfeeding and regular weighing. Several weeks later when I returned I found the baby had gained weight well and was now above the line." The father had not needed reminding, nor did he need help with the weighing or the interpretation. Some months later the village had regular weighing sessions, held by the parents themselves. The mothers had decided it was not worth trudging all the way to the clinic just for weighing, and they only went to the nurse when there were special problems. A medical student (R. B.) arranged an elective in a district hospital in Ghana and he attempted a small study comparing the are two
TALC scales (38 mothers) with standard dial scales (41 controls). Those using the TALC scales were divided into groups of eight or ten, with a leader who undertook a training course and kept the scales. Before the introduction of the TALC scales a questionnaire, including specimen charts illustrating satisfactory and unsatisfactory growth, was completed with the mothers, and this was done again after one month and after six months. After one month 90% and after six months 100% of the mothers using TALC scales seemed to understand what a growth curve meant. The number of control mothers attending remained constant but individual participation varied; the proportions understanding growth curves varied between 25% and 50%. "My Ghanaian colleagues found that the mothers enjoyed and were proud of being involved in weighing their children. Other members of the family had become involved and, during the weighing process at home, few of the children cried. As the scales were left in the community, birth weights were recorded. The mothers seemed to understand the meaning of the growth curve and it appeared likely that growth
TALC scale in
use.
monitoring could soon become a "demand led" programme in this "
area." Our experience suggests that when the mother is involved in plotting her child’s weight she is able to understand what growth curves mean. Outstanding questions include how many scales will be required and will there be women’s groups that can organise their use? This is particularly important for the less educated mothers, whose children are those most in need of growth monitoring. If most weighing is undertaken in the community, will clinic workers have more time for other primary health-care activities? And will their skill with this weighing device give the women status and prestige so that they and their families play a part in community
development? All inquiries concerning these scales should be addressed Box 49, St Albans ALl 4AX, UK. International Centre for Growth Promotion, Department of Growth and Development, Institute of Child Health, London WC1 N 1EH, UK
to:
TALC, PO
DAVID MORLEY PATRICIA NICKSON RICHARD BROWN
Bedside culture to confirm tuberculous
pericarditis SIR,—Tuberculous pericarditis and penetrating cardiac injuries in South Africa.1-3 Carcinoma of the lung is the malignant disease seen at Cecilia Makiwane Hospital, Eastern Cape, often at a stage when surgery is not feasible. In African practice in the Eastern Cape, a pericardial effusion should are common
commonest
be considered tuberculous, unless an alternative cause is obvious.’ For example, in patients admitted with pericardial effusion over 18 months, tuberculosis was considered as the cause in 29 of 37 admitted to Cecilia Makiwane Hospital and in 28 of 62 admitted to Groote Schuur Hospital, Cape Town. Since tuberculosis, malignant disease, and the late effects of penetrating trauma cause bloody pericardial effusion, confirmation of tuberculosis as the cause, in a population at risk, is important. As HIV infection becomes more common, identification of the type of mycobacterial infection and its drug sensitivities will be important. In a recent study, tuberculosis was confirmed as the cause in 59% of 189 patients presenting with pericardial effusion,l a figure far greater than reported previously. This was the first time that bedside inoculation of double-strength liquid Kirchner culture medium (D SK) had been used to confirm a tuberculous aetiology in
pericarditis.4 We have compared DSK with conventional media (single strength Kirchner, Lowenstein-Jensen with and without pyruvate) and with a radiometric mycobacterial culture system (’Bactec 12B’).’ Pericardial fluid from patients presenting with pericardial
effusion was inoculated into DSK at the bedside and into sterile containers for the other studies. Cytological analysis of the effusion and other investigations were undertaken to make a diagnosis. For
TALC direct
recording scales
SIR,-Most primary health-care programmes in developing countries include growth monitoring but this is not often successful. TALC (Teaching Aids at Low Cost) direct recording scales have the potential to overcome some of the problems and, unlike most weighing scales, they are designed to be used in the home or in the community. Most weighing scales for children show the weight on a dial. The clinic worker reads this figure and plots it. The mother, on the other hand, is unlikely to have used graph paper, and the whole concept of representing information on graphs and histograms will be unfamiliar to her and, frequently, to health workers too. The TALC direct recording scales have a spring that stretches 1 cm/kg and is visible to the mother. The upper end is attached to, say, a hook in the house or to the branch of a tree. As the spring stretches, the mother herself can plot her child’s growth by placing the point of a pen through a hole in the pointer at the top of the spring (figure). The mother’s active participation means that she is more likely to understand that the spring should stretch further each month and that each dot should be higher up the chart. Since weighing can be unhurried and is done in or near the home, the child is less likely to be upset. Decision-making members of the family, including the father and grandmother, are more likely to be involved too. The community health worker has to see that the chart is correctly placed so that the mother will put the dot in the right month column, to steady the pointer (figure), and to encourage and guide the family discussion. The scales are made of ultraviolet-resistant, unbreakable plastic. Their strength can be demonstrated by throwing them onto a concrete floor and jumping on them. One batch of ten springs was stretched 50 000 times mechanically, and the greatest variation was only 0-4 mm. The scale can only be used with A4 charts on which the kilogram lines are 1 cm apart. Thirty TALC charts are supplied with each scale. The scales cost less than half the cost of existing scales, and the price will probably fall even more with greater volume production. There is also the potential for manufacture in developing countries, although the springs will probably have to be imported. So far experience with these scales has been limited. Here
examples. One of us (P. N.), visiting Zaire, asked about an infant born 3 months previously. She looked small and did not seem to have much energy. "As I had a set of scales with me I helped the father hang these on a tree and weigh his child. He was concerned when he saw the weight was well below the lower line. Since there was no clinic in the vicinity I impressed on him the importance of more frequent breastfeeding and regular weighing. Several weeks later when I returned I found the baby had gained weight well and was now above the line." The father had not needed reminding, nor did he need help with the weighing or the interpretation. Some months later the village had regular weighing sessions, held by the parents themselves. The mothers had decided it was not worth trudging all the way to the clinic just for weighing, and they only went to the nurse when there were special problems. A medical student (R. B.) arranged an elective in a district hospital in Ghana and he attempted a small study comparing the are two
TALC scales (38 mothers) with standard dial scales (41 controls). Those using the TALC scales were divided into groups of eight or ten, with a leader who undertook a training course and kept the scales. Before the introduction of the TALC scales a questionnaire, including specimen charts illustrating satisfactory and unsatisfactory growth, was completed with the mothers, and this was done again after one month and after six months. After one month 90% and after six months 100% of the mothers using TALC scales seemed to understand what a growth curve meant. The number of control mothers attending remained constant but individual participation varied; the proportions understanding growth curves varied between 25% and 50%. "My Ghanaian colleagues found that the mothers enjoyed and were proud of being involved in weighing their children. Other members of the family had become involved and, during the weighing process at home, few of the children cried. As the scales were left in the community, birth weights were recorded. The mothers seemed to understand the meaning of the growth curve and it appeared likely that growth
TALC scale in
use.
monitoring could soon become a "demand led" programme in this "
area." Our experience suggests that when the mother is involved in plotting her child’s weight she is able to understand what growth curves mean. Outstanding questions include how many scales will be required and will there be women’s groups that can organise their use? This is particularly important for the less educated mothers, whose children are those most in need of growth monitoring. If most weighing is undertaken in the community, will clinic workers have more time for other primary health-care activities? And will their skill with this weighing device give the women status and prestige so that they and their families play a part in community
development? All inquiries concerning these scales should be addressed Box 49, St Albans ALl 4AX, UK. International Centre for Growth Promotion, Department of Growth and Development, Institute of Child Health, London WC1 N 1EH, UK
to:
TALC, PO
DAVID MORLEY PATRICIA NICKSON RICHARD BROWN
Bedside culture to confirm tuberculous
pericarditis SIR,—Tuberculous pericarditis and penetrating cardiac injuries in South Africa.1-3 Carcinoma of the lung is the malignant disease seen at Cecilia Makiwane Hospital, Eastern Cape, often at a stage when surgery is not feasible. In African practice in the Eastern Cape, a pericardial effusion should are common
commonest
be considered tuberculous, unless an alternative cause is obvious.’ For example, in patients admitted with pericardial effusion over 18 months, tuberculosis was considered as the cause in 29 of 37 admitted to Cecilia Makiwane Hospital and in 28 of 62 admitted to Groote Schuur Hospital, Cape Town. Since tuberculosis, malignant disease, and the late effects of penetrating trauma cause bloody pericardial effusion, confirmation of tuberculosis as the cause, in a population at risk, is important. As HIV infection becomes more common, identification of the type of mycobacterial infection and its drug sensitivities will be important. In a recent study, tuberculosis was confirmed as the cause in 59% of 189 patients presenting with pericardial effusion,l a figure far greater than reported previously. This was the first time that bedside inoculation of double-strength liquid Kirchner culture medium (D SK) had been used to confirm a tuberculous aetiology in
pericarditis.4 We have compared DSK with conventional media (single strength Kirchner, Lowenstein-Jensen with and without pyruvate) and with a radiometric mycobacterial culture system (’Bactec 12B’).’ Pericardial fluid from patients presenting with pericardial
effusion was inoculated into DSK at the bedside and into sterile containers for the other studies. Cytological analysis of the effusion and other investigations were undertaken to make a diagnosis. For