voluntary agencies had been received in the previous 2 weeks by 33.1% of the families surveyed in Hiraan, 13.3% of the families surveyed in Bay, and none of those surveyed in Bakool and Gedo. Recommendations emphasized 1) distributing general basic rations in the most severely affected districts to provide a minimum of 1,800 kcal per person per day as well as a digestible source of protein; 2) preventing and treating existing vitamin A and C deficiencies; 3) continuing surveillance in the drought-affected regions to monitor changes in nutritional status and effectiveness of food assistance programs; 4) developing the capacities within the country to implement and maintain a nutrition monitoring system, especially during this emergency, through cooperation and coordination between the government and private organizations. Reported by: AA Suleiman, MD, Ministry of Health; Ministry of Interior, Somali Democratic Republic. S Lundgren, MD, World Health Organization, Mogadishu; US Agency for International Development, Mogadishu, Somali Democratic Republic. Office of Foreign Disaster Assistance, US Agency for International Development, Washington, DC. International Health Program Office; Div of Nutrition, Center for Health Promotion and Education, CDC. Editorial Note: Estimates of the prevalence of malnutrition from this survey in Somalia are higher than those reported during nondrought periods in Somalia (CDC, unpublished data) and comparable to other sub-Saharan countries under drought conditions (3-5). In addition, the 20% to 26% of the children who were between 80% and 84% of median weight-for-height are at risk of malnutrition due to further weight loss since several months lapsed between the survey and any potential harvest season. This assessment of health and nutritional status may not accurately estimate the prevalence and severity of undernutrition among all children in the drought-affected areas because the surveyors were unable to sample the populations in the areas inaccessible because of floodwaters or impassable roads. Officials in the government and from voluntary organizations had reported many of the more remote, inaccessible sites to be more severely affected by the drought. TABLE 2. Indicators of nutritional status among children less than 110 cm tall, by settlement type Somalia, May 1987 T Recommendations resulting from the survey emphasized early provision of food, including adequate calories and protein to prevent further nutritional deterioration. Vitamin deficiencies are also of concern. Vitamin A deficiency is the major cause of permanent blindness in preschool-aged children in the developing world and is easily prevented by vitamin A supplementation. In one region, signs and symptoms of vitamin A deficiency were reported at levels that, according to World Health Organization guidelines, warrant widespread prophylaxis and treatment of the population with 200,000 IU vitamin A capsules (6). The detection of scurvy in a largely agricultural region indicates the possibility of substantial shortages of foods rich in vitamin C. The risk of micronutrient deficiencies will increase if local food sources dwindle and the population becomes increasingly dependent upon food aid consisting largely of grains low in vitamins A and C. References 1. National Center for Health Statistics. NCHS growth curves for children, birth-18 years, United States. Rockville, Maryland: National Center for Health Statistics, 1977. DHEW publication no. (PHS)78-1650. (Vital and health statistics: data from the National Health Survey; series 11; no. 165). 2. World Health Organization. A growth chart for international use in maternal and child health care: guidelines for primary health care personnel. Geneva: World Health Organization, 1978. 3. Dillon JC, Lajoie N. Report of surveys of the nutritional status of the rural population in the Sahel from 1960 to 1979. Ottawa: International Development Research Center, 1981. 4. Centers for Disease Control. Rapid nutrition evaluation during drought conditions - Burkina Faso, 1985. MMWR 1986;35:5-6,11-2. 5. Rutherford GW, Mahanjane AE. Morbidity and mortality in the Mozambican famine of 1983: prevalence of malnutrition and causes and rates of death and illness among dislocated persons in Gaza and Inhambane Provinces. J Trop Pediatr 1985;31:143-9. 6. Ville de Goyet C, Seaman J, Geijer U. The management of nutritional emergencies in large populations. Geneva: World Health Organization, 1978. Epidemiologic Notes and Reports Case of Paralytic Illness Associated With Enterovirus 71 Infection On October 1, 1987, an 18-month-old child was admitted to a medical center in central Mississippi 2 days after the onset of severe weakness in his left leg. On September 22, 1987, the child had received measles/mumps/rubella (MMR) vaccine in his right thigh and diphtheria/pertussis/tetanus (DPT) vaccine in his left thigh. Five days after his vaccinations, his mother noted a temperature of 39.3 °C (102.8 °F) and a decrease in his appetite. On September 29, he began dragging his left leg and was unable to use it 1 day later. The child received DPT/oral polio vaccine (OPV) at 2, 4, and 6 months of age. He was never breast-fed, had not traveled outside Mississippi, and had no known contact with anyone who had. He began attending a day-care center at the beginning of September 1987. Thirteen of the other 97 attendees had OPV between August 1 and September 22, 1987. "When such prophylaxis is given, priority should be given to children under 5 years of age and to other risk groups, as indicated by local findings. Paralytic Illness - Continued The child was awake and alert and had right-sided otitis and possible tonsillitis when he was admitted to the medical center. The neurological examination was normal, except that the muscles in the left hip and thigh were not functioning, and the muscles below the left knee were weakened. The left knee-jerk reflex was absent; the left ankle-jerk reflex was present but slightly weaker than the right. The plantar reflex was downgoing and equal bilaterally. Lumbosacral X-ray films, magnetic resonance imaging of the lumbosacral spine, quantitative immunoglobulins, and skin tests for cellular immunity were normal. A lumbar puncture revealed normal glucose and protein and nine white blood cells (98% lymphocytes) in the cerebrospinal fluid. Nerve conduction studies and electromyograms of the lower left leg were normal except for absent or decreased activation of tested muscles. TABLE II. Notifiable diseases of low frequency, United States |