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fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;

NUTRITIONAL SUPPORT FOR MALNOURISHED


PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA

Venue
Atlanta Hall, Toronto, Canada
April 5th 2008

Project Implemented by:


International Medical Health Organization (IMHO) - A USA based 501(3)(c) non-profit organization
2 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
PLATINUM SPONSORS

Akila Senthil, AMP, Invis Inc. Tel: 905-283-3318.

Wijay Senatahirajah(Gobu), Able Legal Services Inc., Tel: 416-293-2111.

Atlanta Party Hall, Tel: 416-298-5784.

Jay Jayanathan & Family, Florida, USA.

Sarangan & Rupa Gnanasambandhan Family.

GOLD SPONSOR

The Law office of Gary Anandasangaree, Tel: 905-321-1100.

SILVER SPONSORS

Ratheeshan Sivapragasam, Coldwell Banker, Tel: 416-497-9794 Srikumar & Thanja Kanagaratnam Family

Melani David, Barristers and Solicitors, Tel: 416-430-0044 Surendra & Sakthi Santhirasekaram Family

Vincent Sinnadurai, Residential Mortgages, Tel: 416-438-1688x2000 Serendib Paints & Décor, Tel: 416-913-3396

Roopesh Parike, Pharmacist, Tel: 416-299-0399 or 647-290-4208 Dr. Gerald Emanuel & Family

Rajah Mahendran, Homelife GTA, Real Estate, Tel: 416-315-9397 Krishna Vigneswaran, VMS Travels, Tel: 416-670-0573

Jayanthi Sritharan, Homelife GTA, Real Estate, Tel: 416-918-5872 Kesavan Law office, Tel: 416-568-9843

Ramanan Ramachandran HomeLife Today Realty Inc., Tel: 416-670-6467 Vanni Tamil Community & Cultural Center

Dilan Pharmacies Inc O/S Legacy Pharmacy, Tel: 416-299-0399 Markandeyar Family

Analai Cultural Organization Of Canada Rubini Grocery Store

Old Students Association of Pungudutivu Ninativu Development Society

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 3
Njitfis <Lnra;tjw;Nf my;yw; gLfpd;w mtu;fs;

eyk; fhg;Nghk; ,e;j Nkyjpf nrytpid vg;gb Vw;ghu;fs;? ,jw;fhd


nryT vt;tsT? rpwpyq;fhf; fhR &gh 1400-00. fdba
gzkhapd; ntWk; $ 14.00 khj;jpuNk. Mdhy; ,e;jr; rpW
mjpgh; ngh. fdfrghgjp njhifapid khjhe;jk; nrytopf;fpd;w epiyapy; me;jf;
fug;gpzpfspd; FLk;g epiy ,lk; nfhLf;f khl;Nld;
vd;fpwNj.
ehisa r%fk; eykpf;f xU r%fkhf tpsq;f
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Ntz;Lk;. ,d;iwa murpy; G+fk;gq;fSf;fpilNa>
Kd;te;Js;sJ. mtu;fSf;Ff; fu;g;gk; jupj;j 4tJ khjk;
md;whlk; capiuNa mlF itj;j epiyapNy> ehshe;jk;
njhlf;fk; 10tJ khjk; tiu Ngh\hf;Fs;s rj;J ey;ff;
tapw;wpidf; fOTtjw;Nf NghJkhd $Noh fQ;rpNah
$ba Fiw epug;G czTfis toq;f Kd;te;Js;sJ.
Fbg;gjw;Fk; ehjpaw;w epiyapNy> njupe;Njh njupahkNyh
fu;g;gtjpfshfp tpl;l ek; jhafg; ngz;fshy; eykhd vdNt> xt;nthU fu;g;gpzp ngz;zpw;Fk; 6 khjq;fs;
r%fj;ij cUthf;Fjw;F Ntz;ba ey;y Foe;ijfisg; njhlu;e;J cjtp toq;Ftjw;Fj; Njitahd gzk; $ 84.
ngw;Wj; juKbAkh? nkhj;jkhf cs;s cjtp Njitahd 3000 fu;g;gpzpg; ngz;
fSf;F tUlk; xd;wpDf;Fj; Njitahd gzk; & 252>000.00
fUg;igapNy FbapUf;Fk; me;jf; Foe;ij 280 ehl;fspy;
MFk;. ,e;j epWtdk; ,jpy; xU gFjpapid toq;fpAs;sJ.
ntspNa te;J ,e;j cyfpidf; fhz;gjw;F Kd;du;
CHA vd miof;fg;gLk; Consortium of Humanitarian agencies
mjid Cl;b tsu;j;jJ ahu;? jd;idNa cUf;fpj; jd;
(kdpjhgpkhd Kftufq;fspd; FOkk;) Fiwepug;Gg; Ngh\
fUg;igapy; cs;Ns gjpj;j Kl;il rpwpJ rpwpjhf tsUk;
izfis (Nutritional supplements) tpiyf;F thq;fp ahog;
tiu njhg;G+o; nfhb %ykhf me;jj; jha; jhd; tQ;rfk;
ghzj;jpw;F mDg;GfpwJ. mjid mq;Nf cs;s cley
,y;yhky; toq;fp te;jhs;. ghidapy; ,Ue;jhy; jhNd
kUj;Jt mYftyfq;fs; jhjpkhu;fs; %ykhf tpepNah
mfg;igapy; tUnkd;gJ go nkhop. mz;ikapy; fpilj;j
fpf;fpwJ.
Gs;sp tpgug;gb tl kw;Wk; fpof;F rpwpyq;fhtpy; cs;s
10>000 fu;g;gpzpfspy; 3>000 Ngu; kpfTk; Fiwe;j Ngh\hf;F IMHO ehd;F tUlq;fSf;F Kd;du; USA apdJ kdpjhg
cilatu;fshfNt cs;sduhk;. mg;gb vd;why; fu;g;gk; kpf;f rpy kUj;Jtu;fshy; njhlq;fg;gl;lJ. itj;jpa fyh
jupj;Js;s ngz;fspNy %d;wpy; xU gFjpapdu; Fiw epjp uFuh[; jiyikapy; cs;s ,e;j mikg;G ghupa gy
Ngh\hf;F epiyapy; cs;stu;fs;. ,tu;fs; %yk; gpwf;fg; Kaw;rpfis ,e;jf; FWfpa fhyj;jpy; ntw;wpfukhf
NghFk; Foe;ijfs; jhd; vkJ ehisa rKjhaj;jpid epiwNtw;wpAs;sJ. ,J ehs; tiu &. 11 ,yl;rj;jpDf;fhd
elj;jg; Nghfpwtu;fs;. MfNt> ehisa r%fj;jpd; %d;wpy; ,jatpay;> rpWePupapay;> vd;G %l;bay;> Gw;WNeha; kUj;J
xU gpui[fs; eyk; Fd;wpatuha; tuTs;shu;fs;. ,jdhy; tk;> fz;> ehrp> njhz;il kUj;Jtk;> kw;Wk; cjuFlyp
vkJ r%fNk ghjpg;gilag; Nghtij czuyhk;. ay; rk;ge;jkhd gy JiwfspYk; ,uz;lhk; epiyg; ghJ
fhg;gpdpy; fhy; gjpj;J msg;gupa Nrit Mw;wpAs;sik
,J jtpu;f;f Kbahjjh? jtpu;f;ff; $baJ vd;gJ
vk;ik vy;yhk; tpaf;f itj;Js;sJ.
mg;gOf;fw;w cz;ik. vg;gbj; jtpu;g;gjhk;? ,jidNa
IMHO (International Medical Health Organisation) (midj;Jyf fdlh tho; jkpo; kf;fSk; ,e;j ed;Kaw;rpapy; jPtpu
kUj;Jt ey mikg;G) Kd; vLj;Jr; nra;fpwJ. khd MjuT fhl;l Kd; te;jjpy; ve;j tpjkhd Mr;rupaKk;
,y;iy. jhaf kf;fspd; ey;tho;T> mtu;fspd; Rgpl;rk;
aho;g;ghzj;jpy; cs;s cly; eyj;Jiw ,af;FdUld;
vd ve;ehSk; rpe;jpj;jgb ,Uf;fpd;w fdba jkpo;r; r%fk;
,izj;J mq;Nf cs;s Fiw Ngh\hf;F fu;g;gpzpfSf;F
,r;rPupa njhz;by; jk; gq;F vd;d vd cupikAld; Nfl;L
cjTlk; Kaw;rpapy; <Lgl;Ls;sJ. Fiw Ngh\hf;Ff;
Njitahdtw;wpid cw;rhfj;NjhL nra;a tpiofpd;wJ.
fu;g;gpzpg; ngz; xUtUf;F kpff; Fiwe;j msT khjhe;jj;
,jd; tpisNt Vg;upy; 5e; Njjp ,uT 7:00 kzpf;F mw;yhd;uh
Njit xU ghf;nfw; khg;gTlu;> 30 gy;ypd itw;wkpd;fs;
fy;ahz kz;lgj;jpy; eilngWfpd;w nray; jpl;l
kw;Wk; xU Nghj;jy; Gnww;wpndf;]; MfpaitNa. G+..,J
tpsf;ff; $l;lk;. $ 50>000 Nrfupf;fyhk; vd;w mgpyhir
jhdh? vd cq;fspy; mNefu; Mr;rupag;gLtPu;fs;. ,e;
Ald; xOq;F nra;ag; gl;l ,e;j> ,uT czTld; $ba
ehl;bNy tho;tjw;F VNjh tpjj;jpNy ehk; mjpU\;lk;
nray; jpl;l tpsf;ff; $l;lj;jpy; ek;ktu;fs; gq;F gw;wp
nra;jpUf;f NtZk;. ,e;ehl;by; thOk; mj;jid Fbkf;
mtu;fspd; fdtpid edthf;Fthu;fs; vd;w ek;gpf;if
fspd; eyj;jpidg; NgZk; muRk;> xt;nthU Fbkfdp
vkf;F epiwaNt cz;L.
dJ eyj;ijAk; fhj;jpLk; kUe;Jtj; JiwAk; mq;F tho;
ekJ cld; gpwg;GfSf;F fdtpYk; vl;l Kbahj eyk; fhg;Nghk;. ek;ktu;fisg; NgZNthk;. ew;gzpapy;
tug;gpurhjq;fs;. jd;ifNa jdf;F cjtp vd tho;tpay; <LgLNthk;.

4 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
Project Proposal

Nutritional deficiency and anemia are common problems among pregnant mothers and
children in Jaffna peninsula. The main reasons for malnutrition are poverty and
unavailability of nutritious food. Fishing and farming communities have lost their
livelihoods as their work places are held as high security zones. Recent collapse of
ceasefire and closure of A9 highway (only land route to the Jaffna peninsula) has made
the living conditions even worse.

There are about 10,000 pregnant mothers in Jaffna District. Among them about 30%

(3,000 mothers) are severely malnourished with body mass index less than 18.5.

The Colombo prices of some supplementations in January 2008 are as follows (US$ 1 =

SLRs 110):

1. Calcivita – SLRs 250


2. Ovron - SLRs170
3. Nutritional food pack-healthy food for pregnant ladies 375gm – SLRs 540
4. Protinex -SLRs 490

Total = SLRs1,450 per month per mother


Please calculate as above leaving a 10% margin for increase in prices.

Typically, most pregnant mothers in Jaffna visit a health clinic during the end of their
first trimester or beginning of the second trimester. Most mothers will need support
during the last six months of their pregnancy. We believe the approximate cost for
improving nutrition for pregnant mothers in Jaffna may come up to US$ 100 per
pregnancy. For 3,000 pregnant mothers, the cost is US$ 300,000 per year. We hope
to implement this project over the course of 2008.

International Medical health Organization (IMHO) will take responsibility for purchasing
the milk products and vitamins in Colombo, Sri Lanka, transporting them to Jaffna and
distributing them to the identified pregnant mothers through our local partners in Sri
Lanka. In addition, we will provide quarterly reports.

International Medical health Organization (www.imhousa.org) was founded by a group


of physicians in USA in 2003 to rebuild the broken health care infrastructure in the war-
torn areas of the island.
Federal Tax ID Number: 59-3779465
P.O. Box 901, Bel Air, MD 21014 – 0901, USA.
www.imhousa.org
Email: imho@imhousa.org

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 5
IMHO’S 2007 Project Summary

Greetings, Family and Friends!

Since 2004, IMHO has undertaken many health and nutrition related projects in the island of Sri Lanka and in other parts
of the world. As always, THANK YOU for your generous support. This letter is intended to update you on our current and
future projects.

As we are a volunteer organization, our administrative cost continues to be less than 2% of our budget. Even the
funds spent on administrative side (for accounting and auditing) are raised by individual donors. Almost all your funds go
towards the identified humanitarian project.

Since we are a 501c3 registered organization, our accounts are transparent to the public and IRS. The IMHO Board
accounts for every dollar that is spent. The decisions are made democratically by a diverse group of 11 board members.
We take pride in our volunteer service to the organization and consider an honor to serve our people in need.

For IMHO operations, 2007 has been a difficult year due to the breakdown of 2002 ceasefire agreement at the ground
level and the closure of A9 highway. However, we continued with our projects. The credit goes to the dedicated staff and
individuals in Sri Lanka. As a small charity in USA, we are blessed with strong grass root NGOs as our partners in Sri
Lanka.

Following are the projects, IMHO successfully implemented in 2007:


1. With the closure of A9 highway, IMHO was able to purchase emergency and urgent medications in Colombo and
transport to Jaffna and Kilinochchi with the help of Sri Lankan Red Cross and Consortium of Humanitarian
Agencies (CHA). Partnered with Direct Relief International (DRI) in raising part of the funds.
Budget: US$ 49,000
2. Continue to run mobile clinics with the help of Centre for Health Care (CHC) in rural areas and IDP camps. Both
medical service and medications are provided free of charge. Similar projects were undertaken in the rural areas
of the Jaffna peninsula with the help of consultants at the Jaffna Teaching Hospital.
These visits cost us US$1 per patient!
Budget: US$ 22.800
3. With the Muttur and Vaharai displacements, we were able to work with CHA in funding a project providing clean
water, sanitation, nutrition and basic health care to over 1,000 families.
Budget: US$20,000
4. Funded a micro credit program for women-headed families through Eastern Self-reliant Community Organization
(ESCO) based out of Batticaloa. Over 100 mothers and 350 children benefited from this program.
Budget: US$30,000

5. IMHO strongly believes in capacity-building projects. Along this line, supported Jaffna medical students with
financial need, incentive allowances for doctors working in the islets and postgraduate training of doctors and
nurses and further development of Institute of Health Sciences (IHS).
Budget: US$29,100
6. Funded specific medical projects at the Psychiatric and Pediatric units at the Batticaloa Teaching Hospital.

Budget: US$ 12,960


7. Supported health care and nutrition program at the Oncology unit at the Jaffna Teaching Hospital.
Budget: US$ 6,200
8. Helped BRAC, a grass root NGO to help with their relief efforts to those affected by Cyclone Sidr in Bangladesh.

Budget: US$ 5,000

6 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
Following projects are in progress:
1. Building and development of a Psychiatric unit in Vavuniya, first of its kind in the district. The project is being
coordinated through Sri Lankan Red Cross.
Budget: US$ 40,000
2. Construction and development of a Diabetic center at the Jaffna Teaching Hospital in conjunction with the Ministry
of Health, Sri Lanka.
Budget: US$ 70,000
3. Funding of a state-of-the-art medical laboratory at the Jaffna Teaching Hospital in conjunction with the Ministry of
Health, Sri Lanka.
Budget: US$ 52,600
4. Renovation of Psychiatric ward, Tellipalai hospital.
Budget: US$ 30,000
5. Funding of Victory home (Vettri manai), an institution that cares for the mentally challenged women with multiple
needs. This project is co-funded by Operation USA, a California based NGO.
Budget: US$ 10,000
6 .Funding of livelihood project for the resettled women headed families in Vaharai. Fifty families will benefit from this
project; each will receive a cow for income generation. This project will be implemented by the Sarvodaya/Batticaloa
and co-funded by Operation USA. Budget: US$ 12,000.

Our immediate future projects include:


1. Provide nutritional support for severely malnourished pregnant mothers in the Jaffna peninsula. This will cost
US$10 per mother per month. Most mothers get medical attention only during their second trimester.
That is US$ 60 per pregnancy!
2. Initiate health care related projects in other impoverished areas of the island.
3. Continue to respond to emergency and urgent medical needs.

As always, IMHO is indebted to you for your moral and financial support.

Happy holidays and a healthy New Year! &RQWDFWXVDW


With warmest winter wishes. ,0+2
32%R[   
Board of Directors %HO$LU0' (PDLOLPKR#LPKRXVDRUJ
IMHO 86$ ZZZLPKRXVDRUJ 

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 7
Pearls in What screening tools are available for early can-
cer detection or prevention?

Cancer 1. Lung cancer: None available as a screen-


ing test but smoking cessation will lead to
significant risk reduction. Ninety percent
Thavam Thambipillai M.D, Ohio
of lung cancers are associated with smok-
ing!
Cancer is one of the 2. Breast cancer: There 3 components to this
• Breast self examination: Should be
leading causes of done monthly and ask your doctor on
how to do it. Report any abnormalities
death among to your physician promptly.
• First mammogram by 40 years of age
people of all ages. or 10 years before the age at which
your first degree relative was diag-
Following are the top 3 causes of cancer deaths nosed of breast cancer
in men and women in the western world: • Annual examination by your physician
1. Lung cancer 3. Prostate cancer: Digital rectal examina-
2. Breast or prostate cancer tion by your physician and a blood test
3. Colon cancer called PSA (prostate specific antigen) by
age 50 years. Most but not all prostate
Best way to treat cancer is to prevent! How to cancers are located peripherally and can
prevent cancer? be palpated on rectal examination. PSA
1. Stop smoking! testing is controversial.
2. Healthy life style: Good diet and exercise 4. Colon and rectal cancer: Digital rectal
3. See your GP or family doctor regularly exam and occult blood testing by age 40
4. Follow-up with all cancer screening tests and colonoscopic evaluation by age 50.
8 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
Ragu Sinnarajah M.D, Maryland

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 9
matory response to bacteria. Recent advances in
Dental Decay & research have translated into new methods to treat
advanced gum disease. A lower dose of doxycycline
Gum Disease (Periostat 20mg) given twice a day helps in modu-
lating the patient’s response. I have been using this
Dr. Shanmugavadivel, Toronto medication on several of my patients with chronic
gum disease.

Periodontal disease causes separation of gum from


teeth resulting in deep pocket formation. Delivering
an antibacterial topical agent into the diseased site
helps to eliminate the infection.

“Atridox” has been approved for use in Canada for


this purpose by Health Canada. It is a controlled- re-
lease doxycycline gel that is applied under the gum.
This topical gel provides a valuable adjunct to peri-
odontal treatment in cases requiring additional care.

Over the past 20 years, evidence has accumulated


relating periodontal disease with diabetes, coronary
heart disease and stroke. Another condition that is
claimed to be associated with advanced gum disease
is preterm low birth weight infants. The existing evi-
dence indicates that this topic deserves further stud-
ies.

Other major cause of early tooth loss is dental de-


cay. It is a common condition seen in kids who do not
brush their teeth properly. Harmful social and bio-
Periodontal disease or advanced gum disease is
logical risk factors (lower social class and education-
one of the causes for tooth loss in adults. As one ages,
al level of parents, higher sugar consumption, poor
there is an increasing likelihood that periodontal dis-
brushing and eating habits) accumulated early in life
ease may become evident. This disease is a result of
contribute to the development of high level of caries
invasion of bacteria deep into the gum and support-
in childhood.
ing tissues of the teeth.
In trying to fight dental caries, in additional to pro-
By maintaining good oral hygiene, regular preven-
viding routine dental care, dentists need to identify
tive dental care, it is commonly successful in preserv-
patients who are more prone to the decay process.
ing periodontal health. However, if this disease be-
These kids can benefit from active anticaries battery
comes evident there are several treatment modalities
of treatment. The Cari Screen testing meter provides
available – scaling, root planning, periodontal surgery
a test that measures the ATP in biofilm. Cari Free
and in some cases antibiotics are utilized in therapy.
Treatment Rinse elevates the local pH to kill the caries
Much of the destruction of the periodontal (gum producing bacteria in the plaque biofilm and thereby
and adjoining) tissues results from patient’s inflam- decreasing the dental decay.

10 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
gw; #j;ijAk; KuR tpahjpAk;
Dr. Shanmugavadivel, Toronto
gw; #j;ijfSk; KuR tpahjpfSNk gy; rk; Rj;jkhf itj;jpUg;gJ ,yFthdjy;y. mjdhy; gy;
ge;jkhd tpahjpfspy; ngUk;ghd;ikahff; fhzg;gL itj;jpaupd; MNyhrid ngw;W epue;jug; gw;fisr;
fpd;wd. gw; #j;ijfs; Foe;ijfisAk; ,sk; rPu; nra;Ak; Nehf;Fld; rpy ghw; gw;fis mfw;wpNah
guhaj;jpdiuAk; mjpfkhfg; ghjpf;fpd;wd. KuR my;yJ ‘fpspg;’ (clips) ‘g;Nwr];’ (braces) Nghd;w
tpahjpfs; nghJthf eL tajpdupYk; KjpNahupYk;
eilKiwfis Nkw;nfhz;Nlh rpfpr;irfisr;
,Ug;gijg; ghu;f;fpNwhk;.
nra;Jnfhs;s Ntz;Lk;.
,yq;ifapypUe;J fdltpw;F Gyk; ngaUk;
tpuy; #g;Gjy;> ehf;ifj; js;Sjy; thahy; Rthrpj;
Foe;ijfspd; gw;fspy; ngUkstpy; gw; #j;ijfspd;
ghjpg;G ,Ug;gij ehd; fz;L tUfpNwd;. jy; Nghd;w gof;fkpUf;Fk; gl;rj;jpy; gw;fspYk;
jhilfspYk; ehsiltpy; tpUk;gj;jfhj tpisTfs;
gw; #j;jfisj; jLg;gjw;F Kaw;rp vLf;f Ntz;baJ
Vw;gLfpd;wd. ,tw;iwf; fl;Lg;gLj;Jk; Kaw;rpfshf
xt;nthU ngw;NwhupdJk; flikahFk;. czT
‘fpspg;’ cgNahfpf;fg; gLfpd;wd.
cz;lTlNdNa gw;fisr; Rj;jk; nra;Ak; Kiwia
ehk; gof;fj;jpw; nfhz;Ltu Ntz;Lk;. tsu;e;jtu;fs; KuR tpahjpfs; cs;stu;fSf;F Kurpy; tPf;fk;>
gy; E}y; (floss) nfhz;L jpdKk; xU jlit Rj;jk; ,uj;lf; frpT vd;gd Muk;g epiyapYk; tpahjp Kw;wpa
nra;a Ntz;baJ mtrpakhFk;. ehk; cl;nfhs;Sk; fl;lj;jpy; NehTk; gw;fspy; <lhl;lKk; fhzg;gLk;.
czT tiffspYk; ftdk; nrYj;jNtz;Lk;.
rj;Js;s gw;fSf;Ff; nfLjy; tpistpf;fhj czT KuR tpahjpfs; XupU ehl;fspy; Vw;gLk; tpahjp
tiffs; tpUk;gj;jf;fd. fsy;y. gyfhyg; Gwf;fzpg;ghy; mit cUthfpd;wd.
nts;is epwj;jpdiug; Nghyd;W vk;ktu;fspy; KuR
NkYk; tUlj;jpw;F xU jlitahtJ gy; itj;jp
auplk; nrd;W gw;fisg; ghu;itapLtJld; mtw;iwr; tpahjpfs; mjpfkhff; fhzg;gLfpd;wd.
Rj;jk; nra;tjdhy; gw;fspy; Vw;gLk; rpijTfisj; KuR tpahjpfisj; jLg;gjw;Fk; ehd; Kd;G Fwpg;
jLf;f KbAk;. gw;fspy; rpW Jthuq;fs; Vw;gbd; gpl;lJ Nghd;W gw;fspd; Rj;jk;> cl;nfhs;Sk; czT>
mit clNd epug;gg;gLjy; Ntz;Lk;.
fpukkhd gy; itj;jpag; guhkupg;G> vkJ clypd;
”gw; rpfpr;irfSf;Ff; fhg;GWjp ,y;iy vd;gjdhy; MNuhf;fpak; vd;gd Kf;fpakhdit.
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ePz;lfhy KuR tpahjpfs; ,Uja tpahjpfisAk;
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NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 11
Chronic Kidney
• Three simple tests can detect CKD: blood pres-
Disease (CKD) sure, urine albumin and serum creatinine.

Kandasamy Rajaram M.D, New Jersey How do your kidneys help maintain health?
In addition to removing wastes and fluid from your
The Facts About Chronic Kidney Disease (CKD)
body, your kidneys perform these other important
• Early detection can help prevent the progres-
jobs:
sion of kidney disease to kidney failure.
• Regulate your body water and other chemi-
• Heart disease is the major cause of death for all
cals in your blood such as sodium, potassium,
people with CKD.
phosphorus and calcium
• Glomerular filtration rate (GFR) is the best esti-
• Remove drugs and toxins introduced into your
mate of kidney function.
body
• Hypertension causes CKD and CKD causes
• Release hormones into your blood to help your
hypertension.
body:
• Persistent proteinuria means CKD.
1. regulate blood pressure
• High risk groups include those with diabetes,
2. make red blood cells
hypertension and family history of kidney dis-
3. promote strong bones.
ease.

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What is chronic kidney disease (CKD)? kidneys and damage the surrounding tissue.
• Malformations that occur as a baby develops
Chronic kidney disease includes conditions that
in its mother’s womb. For example, a narrow-
damage your kidneys and decrease their ability to
ing may occur that prevents normal outflow of
keep you healthy by doing the jobs listed. If kidney
urine and causes urine to flow back up to the
disease gets worse, wastes can build to high levels in
kidney. This causes infections and may damage
your blood and make you feel sick. You may develop
the kidneys.
complications like high blood pressure, anemia (low
• Lupus and other diseases that affect the body’s
blood count), weak bones, poor nutritional health
immune system.
and nerve damage. Also, kidney disease increases
• Obstructions caused by problems like kidney
your risk of having heart and blood vessel disease.
stones, tumors or an enlarged prostate gland
These problems may happen slowly over a long pe-
in men.
riod of time. Chronic kidney disease may be caused
• Repeated urinary infections.
by diabetes, high blood pressure and other disorders.
Early detection and treatment can often keep chronic What are the symptoms of CKD?
kidney disease from getting worse. When kidney dis-
Most people may not have any severe symptoms
ease progresses, it may eventually lead to kidney fail-
until their kidney disease is advanced. However, you
ure, which requires dialysis or a kidney transplant to
may notice that you:
maintain life.
• feel more tired and have less energy
What causes CKD? • have trouble concentrating
• have a poor appetite
The two main causes of chronic kidney disease
• have trouble sleeping
are diabetes and high blood pressure, which are re-
• have muscle cramping at night
sponsible for up to two-thirds of the cases. Diabetes
• have swollen feet and ankles
happens when your blood sugar is too high, causing
• have puffiness around your eyes, especially in
damage to many organs in your body, including the
the morning
kidneys and heart, as well as blood vessels, nerves and
• have dry, itchy skin
eyes. High blood pressure, or hypertension, occurs
• need to urinate more often, especially at night.
when the pressure of your blood against the walls
of your blood vessels increases. If uncontrolled, or Anyone can get chronic kidney disease at any age.
poorly controlled, high blood pressure can be a lead- However, some people are more likely than others to
ing cause of heart attacks, strokes and chronic kidney develop kidney disease. You may have an increased
disease. Also, chronic kidney disease can cause high risk for kidney disease if you:
blood pressure. • have diabetes
• have high blood pressure
Other conditions that affect the kidneys are:
• have a family history of chronic kidney disease
• Glomerulonephritis, a group of diseases that
• are older
cause inflammation and damage to the kid-
• belong to a population group that has a high
ney’s filtering units. These disorders are the
rate of diabetes or high blood pressure
third most common type of kidney disease.
• Inherited diseases, such as polycystic kidney
disease, which causes large cysts to form in the

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 13
normalities in electrolytes, calcium, potassium,
Diabetes And and hemoglobin.
• Blood pressure for hypertension (high blood
Kidney Disease pressure).
• Ultrasound of the kidneys to rule out other
Kanagasabai Devacaanthan M.D, Florida causes including obstruction of the urinary
tract.
• Kidney biopsy to confirm diagnosis if neces-
Incidence
sary.
Diabetes is the most common cause of kidney fail-
How do you treat?
ure, and the damage to the kidney (diabetic nephrop-
athy) usually starts after 10 years. Statistics indicate There is no cure for diabetic nephropathy, but one
that about 1 out of 170 people who have diabetes will can slow the deterioration of kidney function by:
develop kidney failure. • Controlling blood pressure and keeping the
reading below 130/80.
What happens to the kidneys in diabetes?
• Controlling blood sugar.
The human body has two kidneys, and each kid- • Using medications such as ACE inhibitors and
ney has about 1 million units. These units filter the ARBs to decrease proteinuria, slow the worsen-
blood, separate the waste, and send it down with ing of kidney function, and also control blood
salt and water in the form of urine. In diabetes these pressure.
units start leaking protein into the urine and eventu- • Proper diet including low protein to decrease
ally end in kidney failure which causes accumulation the workload on the kidneys. Later stages
of the waste, salt, and fluid. need a decrease in sodium and potassium in
the diet.
• Avoiding medicines which can hurt the kidney
What are the symptoms of kidney failure? function such as NSAIDs (arthritis medicines
• The symptoms vary but may include: like Aleve and ibuprofen), contrast dye injec-
• Fluid and salt retention causing swelling of the tion for x-rays, etc.; and adjusting medication
face and legs and also shortness of breath. doses for decreased kidney function.
• Tired feeling from anemia (decrease of produc- • Treating urinary tract infections.
tion of erythropoietin from the kidneys). • Treating anemia with erythropoietin injections.
• Loss of appetite, nausea, and vomiting. • Stopping smoking.
• Headache which may be associated with hy- • Getting proper exercise.
pertension. • Controlling cholesterol.
• There may be no symptoms in the early stages • If the kidneys do fail, one can consider the op-
of kidney failure. tions of dialysis and/or kidney transplant.

How do you diagnose diabetic nephropathy? The care of patients with diabetic nephropathy
should be a team effort to include the primary care
Check the following:
physician, kidney specialist (nephrologist), and dieti-
• Urine for protein.
tian.
• Blood for a rise in creatinine and urea to assess
the degree of damage to the kidneys and ab-

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Ragu Sinnarajah M.D, Maryland

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 15
One key to headache management is good com-

Headache munication between patient and doctor. Your doctor


will need to obtain a careful history and description
K.N. Sena, M.D. of your headache symptoms.

The following is a basic overview of some of the


“Pulsing,” “pounding,” “throbbing.” To anyone who
major headache types; it may help you to understand
has ever suffered from headache, these descriptions
your headache and describe its symptoms accurately
are all too familiar. Nearly everyone experiences
to your doctor. This should not be used for “self-diag-
some form of head pain at one time or another. In
nosis” -- that is your doctor’s job. This overview should
fact, it is estimated that each year, 70% of the popu-
serve, instead, as a guide to help you understand the
lation will have at least one headache and over 5%
major headache types as you work with your doctor
of the population will seek medical attention for their
headaches. to find a treatment tailored to your needs. It should
also be pointed out that many patients may suffer
Fortunately, most headaches are not associ- from more than one type of headache or from a sub-
ated with serious underlying conditions and can be type of one of the major headaches.
treated with nonprescription medications. However,
some severe headaches need a doctor’s attention Migraine Headache: Migraine is the best known
and may require prescription drugs. There are several and most researched type of headache, although its
types of headache and, depending on their severity exact mechanism is not fully understood. It affects
and frequency, they may require different treatments. almost three times as many women as men. Migraine
Sometimes, it can be difficult to distinguish one type usually occurs on one side of the temple, but can af-
of headache from another. So, it is important to “know fect both sides of the head at the front or back. A
your symptoms” in order to help your doctor identify typical migraine attack usually lasts anywhere from
the type (or types) of headache you have and recom- four hours to more than a day, if not appropriately
mend or prescribe the best available treatment. treated.

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Table 1: Summary of Major Headache Types and Symptoms

Headache type Symptoms/description

May be preceded by aura, usually one-sided,


Migraine pain tends to be moderate to severe, pulsating,
and aggravated by physical activity, associated
with nausea, vomiting and sensitivity to light
and sound; affects more women than men

Dull, squeezing, non-pulsating pain, usually on


Tension-type headache both sides of the head, tends to be less severe
than migraine, mild sensitivity to light and
sound, no nausea.

Headaches occur in clusters with pain-free


Cluster headache periods in between; pain is very severe,
localized and stabbing; attacks briefer than
migraines; facial symptoms occur on same side
as headache; affects more men than women.

Pain does not fit other headache categories;


Local head or neck pain usually steady, dull and localized in head,
temple, or cheekbones; usually caused by an
injury or overuse of joints or muscles.

It may be preceded by an “aura,” which consists of around the skull.” Other effects of this headache may
symptoms or sensations ranging from visual distur- include mild sensitivity to light or sound, lighthead-
bances (such as flashes of light or geometric patterns) edness, blurred vision, and a general feeling of inabil-
to muscle weakness or difficulty speaking. The aura is ity to function normally. There is some overlapping
followed by head pain, which builds quickly to a peak of symptoms between this type of headache and mi-
intensity and then slowly tapers off. The pain peak graine.
is usually more severe than with tension headache. Cluster Headache: As the name implies, these types
Symptoms associated with migraine include nausea, of headaches occur in bunches or “clusters” followed
vomiting, and extreme sensitivity to light and sound. by pain-free periods. They are less common than mi-
During an attack, migraine sufferers may be unable graine, affecting less than 1% of the population, and
to engage in activities that require any type of exer- typically occur five times more often in men than in
tion (i.e. stair climbing). There are several subtypes of women. Patients who suffer from cluster headaches
migraine, which the treating doctor will need to con- usually describe a very severe, localized pain behind
sider when evaluating a migraine patient. and around one eye; they often say, “it feels like a nail
Tension-Type Headache: This type of headache is being driven into the eye.” Symptoms associated with
the most common. It usually consists of a dull pain cluster headache occur on the same side of the head
as the pain. They include tearing from the eye or dis-
that spreads across the head, typically on both sides.
charge from the nostril.
Many patients suffering from this type of headache
describe it as the sensation of a “band tightening Each cluster consists of regularly occurring head-
NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 17
aches that may last for months. The headaches usu- ceptibility to triggers will vary from person to per-
ally occur relatively close together and possibly at son. Factors such as age and sex can also influence
the same time of the day or night. They are typically how a trigger will affect each individual. For instance,
briefer than migraine attacks; each headache may younger people may have a higher tolerance of cer-
last from a half-hour to several hours. When a cluster tain triggers and women may be affected more often
of headaches ends, it may be several years before an- by weather changes or certain odors than men. With
other occurs. women, susceptibility to triggers often increases dur-
ing the pre- or postmenopausal period and decreases
Local Head or Neck Pain: This is a general term used
after menopause.
to describe pain that does not fall into one of the ma-
jor headache categories, but is problematic enough Table 2 contains many, but not all, of the triggers
to bring the patient in for a medical evaluation. It is that may bring on migraines in some susceptible
commonly caused by muscle injury or surrounding people:
tissue irritation, but may also be caused by irritation
Doctors often ask headache patients to keep a
of a joint or the spine of the neck. The pain usually
diary in which they record the time their headaches
occurs in a localized area, such as the back or side of
began, how long they lasted, what may have trig-
the head, the temple, or the cheekbones. It can be
gered them, where the pain was located, and what
described as steady and dull rather than throbbing
the character of the pain was. Several triggers may
and sharp. As the pain is generally caused by an ac-
be involved in the onset of your headaches so it is
cident or overuse of the muscle/joint, the problem is
important to identify as many as possible. Keeping a
usually resolved with rest, physical therapy, biofeed-
headache diary can be helpful for both you and your
back and/or medications.
doctor. Not only does it provide valuable information
If you have migraine headaches, you may have that can help your doctor determine which treatment
recognized that some things you do -- or don’t do is appropriate, but it can help give you direction amid
-- may provoke an attack. These are called migraine the confusion of recurring pain.
“triggers”. When you seek medical help for your head-
What is the analgesic rebound headache?
ache, it is not enough to discuss your symptoms with
your doctor. It is also important to identify the spe- Many people who experience chronic head pain at-
cific triggers of your headaches. By doing so, you may tempt to medicate themselves by taking a daily regi-
improve your condition by simply learning to avoid men of analgesics, or pain medications. These are the
your specific headache triggers. “rescue” drugs we all keep in our medicine cabinets
-- such as aspirin, acetaminophen or combination
A trigger can be either an external factor or an in-
pain medications. These drugs may be effective for
ternal factor that may lead to headache onset. What-
many patients. However, we now know that overuse
ever it may be, the trigger is not the cause of the head-
of these drugs may actually cause daily headaches
ache. Examples of external triggers include changes
rather than relieve them. This phenomenon is known
in weather, bright lights, or certain foods. Triggers
as analgesic rebound headache.
that occur internally include exhaustion, hunger or
the relaxation period following stress. The principle behind analgesic rebound headache
is drug dependency. The body becomes accustomed
Avoiding your triggers is not always easy and sus-
to having a certain level of pain medication in the
18 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
Table 2: Common Migraine Triggers

Foods and beverages Environmental Factors

Alcoholic beverages Bright or flickering lights


(especially red wine) Weather changes
Aged cheese Perfume
Smoked or pickled fish Strong odors
Sour cream or yogurt Second-hand cigarette smoke
Chocolate Polluted air
Nuts or beans Chemical fumes
Caffeine
Nitrites, MSG, artificial sweeteners

Medications Lifestyle changes

Diuretics Change in sleep pattern


Blood pressure medications Irregular eating habits
Asthma medications Relaxation period following stress
Nitroglycerin

Hormonal factors Physical factors

Menstruation Blow to the head


Pregnancy and delivery Physical exertion
(pregnancy relieves migraine in many Sexual activity
women) Neck injury
Oral contraceptives
Estrogen therapy
bloodstream; when blood levels fall, the headache Many patients with analgesic rebound headaches re-
recurs, or “rebounds.” Over time, the recurring head- quire hospitalization to wean them from their drug
aches may become transformed into a “chronic daily dependence.
headache” which can be very difficult to treat. The message here is a very important one: over-
Overuse of prescription and nonprescription pain use of pain medications can actually be a cause of
medications can undermine a doctors efforts to con- constant or recurring headaches. That is why doctors
trol headache. A patient who takes an excessive ask headache patients to report exactly what medi-
amount of pain medications is not likely to benefit cations they take, how often they take them, and in
from a preventative medication until the pain medi- what amounts. Only when these medications are
cations are withdrawn. The pain medications com- withdrawn can headaches be successfully treated.
pete with the preventative medication for binding Your physician needs this information to determine
sites in the brain known as receptors. By occupying the correct course of treatment.
the same binding sites as the preventative medica- The Migraine Foundation
tion, the analgesics may “crowd out” the preventative 365 Bloor Street East, Suite 1912
medication, affecting its ability to function properly. Toronto, Ontario, Canada M4W 315
NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 19
Ragu Sinnarajah M.D, Maryland

20 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
The causes of reversible dementias include medi-
Dementia cation interactions, depression, vitamin deficiencies
and thyroid abnormalities.
Ragu Sinnarajah M.D, Maryland The causes of irreversible dementias are com-
monly called degenerative dementias and the dis-
eases include Alzheimer’s disease, ischemic vascular
Introduction dementias, dementia with Lewy Body disease, fron-
What does it mean when someone is said to have totemporal dementia, Parkinson’s dementia, normal
dementia? For some people, the word conjures up pressure hydrocephalus and mixed dementias.
scary images of “crazy” behavior and loss of con- Importance of Obtaining a Diagnosis
trol. In fact, the word dementia describes a group
The diagnosis of dementia requires a complete
of symptoms that includes short-term memory loss,
medical evaluation and may also require neuropsy-
confusion, the inability to problem-solve, the inability
chological testing.
to complete multi-step activities such as preparing
a meal, balancing a checkbook or even looking up a A medical evaluation for dementia usually includes
phone number and dialing the number, and some- the following:
times personality changes or unusual behavior. • Review of the history as to what the problem
is, how the problem started, in what order the
Saying that someone has dementia does not offer
problem evolved, how it is affecting the per-
information about why that person has these symp-
son’s ability to function in daily life.
toms. Compare it to someone who has a fever: the
• A medical history and medications are impor-
person is ill from the fever, but the high temperature tant, including the presence of hypertension,
does not explain the cause or why the person is ill, diabetes, history of head injuries, seizures and
such as having pneumonia or a bladder infection. also the medications that the individual is tak-
Does any loss of memory signify dementia? Is not ing.
memory loss a normal part of aging? When some- • Neurological examination helps to identify
one is old, memory problems can be just natural and symptoms and signs that may be present in
are to be expected. But those memory problems are particular kinds of dementia and other condi-
mild, and given time the individual is able to recollect tions such as stroke, Parkinson’s disease or
the memory and there is no functional impairment. hydrocephalus.
Serious memory loss is when an individual’s function- • Laboratory tests to rule out vitamin deficien-
al capacity to be gainfully employed, maintain self- cies or metabolic conditions such as thyroid
imbalance or Vitamin B12 deficiency.
care or live in a society is impaired and should not be
• A scan of the brain, such as a CT scan or MRI
ignored.
scan would be helpful in looking for evidence
Not all memory loss is due to Alzheimer’s disease, of hydrocephalus, brain tumor, subdural hema-
though it is the most common or well known enti- toma and strokes, which can produce demen-
ty. There are other conditions which can also cause tias.
memory and cognitive problems severe enough to in- • Lastly, neuropsychological testing, either done
terfere with daily activities. The conditions can affect at the bedside or formal testing might be ap-
younger as well as older people and some of them are propriate when there is doubt as to whether
reversible. Thus, a clear diagnosis is important. the noted memory difficulty is due to a brain
NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 21
problem or due to severe depression, which ing and manifest as memory difficulties, dif-
can mimic dementias. ficulty with gait and difficulty in controlling the
bladder. This is a totally reversible condition if
Reversible Dementias
diagnosed early, shunting of the ventricle and
• Emotional distress, depression or major life
releasing the fluid inside the brain to another
changes such as retirement, divorce or loss of a
body cavity can completely cure the memory
loved one can affect one’s physical and men-
difficulty.
tal health. Sometimes under severe distress,
• Chronic Subdural Hematoma. Sometimes
memory function can be affected and clinically
blood clots can form, especially in the elderly,
present as disturbances of memory function.
particularly if they are taking blood thinners
This is quite reversible.
such as aspirin or Coumadin for other medi-
• Adverse reaction to medications, especially
cal reasons. Blood clots can form slowly over
when multiple medications are taken together,
weeks and months between the brain and
can lead to memory difficulties. All medica-
skull bone, and can present as dementia with
tions, including over-the-counter medications
or without headache. A scan of the head can
have to be carefully looked into. It is also
diagnose this condition easily and if diagnosed
possible to obtain blood levels for some of the
and treated early, memory dysfunction can be
medications to see whether there is too much
corrected.
of the medication in one’s system, producing
memory difficulties. Irreversible Dementias
• Endocrine abnormalities such as abnormal-
These are degenerative conditions of the brain.
ity in thyroid function or adrenal function can
The cause of this is not clearly understood. There may
produce reversible dementia.
be a genetic component, but mostly it is due to the
• Metabolic disturbances such as electrolyte
reason that we are living longer and longer. With the
imbalance, low blood sugar, high or low cal-
passage of time, a person living up to 80 years of age
cium, and diseases of the liver or pancreas can
has as high as a 20% chance of developing degenera-
produce problems with memory function and
tive dementia.
many are correctable.
• Infections, (especially in senior citizens, when The common degenerative dementias include:
there is some memory difficulty, but not • Alzheimer’s Disease. This is the most common
enough to interfere with their lifestyle) such cause of dementia in people over 65, although
as a bladder infection or infection underneath the disease can occur in younger people.
the skin, even in a remote part of the body, Symptoms differ from person to person, but
can affect the memory function and present as there is a decline in memory, thinking and abil-
dementia. Certainly, syphilis and tuberculosis ity to function which gradually progresses over
of the covering of the brain have to be consid- a period of years with the patient developing
ered as they are treatable to a great extent. behavior changes and personality changes,
• Nutritional deficiencies, especially the B group eventually with demise occurring in about 10
of vitamins, such as Vitamin B12, folic acid or to 15 years time after the disease has been di-
thiamine, can produce impairment of memory agnosed. There is no specific treatment avail-
function. able at this time, though there are medications
• Hydrocephalus. Hydrocephalus is a condition that can slow down the deterioration of this
where cavities inside the brain start enlarg- condition, called cholinesterase inhibitors and
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Namenda. Lastly, medications to control the symptoms such
• Ischemic Vascular Dementia, or hardening of as controlling mood, if there is a mood disorder, with
the arteries of the brain, or cerebral atheroscle-
antidepressants, and controlling behavior, such as ir-
rosis. This is the second most common demen-
tia, characterized by an abrupt loss of function ritability or agitation, with medications is possible.
or general slowing of cognitive abilities. Some-
Prevention of Alzheimer’s Disease
times this is associated with weakness, numb-
ness or incoordination on one or the other Up-to-date research does not have any clear guide-
side of the body and these patients have the
lines as to how one could prevent Alzheimer’s disease
risk factors for cerebrovascular disease such as
high blood pressure, diabetes, smoking and from developing. One may be able to postpone the
coronary artery disease. development of Alzheimer’s disease by “good living”.
• Dementia with Lewy Bodies. This is a progres- This involves regular exercise to the body and brain.
sive degenerative disease and have symptoms
The former includes ideal weight, walking briskly two
common to Alzheimer’s disease and Parkin-
son’s disease. Behavior changes occur early in miles a day and the latter includes learning new activ-
the course of the illness. ities, reading magazines or papers and writing a short
• Frontotemporal Dementia. This is a degenera- version of it, playing cards, checkers and doing cross-
tive condition of the anterior part of the brain.
word puzzles. One should certainly avoid items that
Patients who have this condition have diffi-
culty with reasoning, personality, social graces, could hurt the brain which includes smoking, alcohol,
and behavior changes. This can be easily head injury, and treat hypertension, diabetes mellitus
misdiagnosed as psychological or an emotion- and elevated cholesterol. Daily vitamin supplements
ally based problem and tend to happens at an
are appropriate as well.
earlier age than 65 years.
• Parkinson’s Disease. People with Parkinson’s Recommended Reading:
disease, which is the second most common
• The Forgetting, Alzheimer’s: Portrait of an
neurodegenerative disorder, in addition to the
motor difficulties such as difficulty moving, Epidemic, David Shenk, 2001, Random House,
shaking and falling, also eventually develop New York, NY.
dementias. • Alzheimer’s Disease: Unraveling the Mystery,
Medical Treatment Anne Brown Rodgers, 2003, ADEAR (Alzheim-
There is no cure for the irreversible or degenera- er’s Disease Education Referral Center, a ser-
tive dementias. Treatment focuses on maximizing vice of the National Institute on Aging), Silver
the individual’s cognitive and functional abnormali-
Spring, MD.
ties. Cholinesterase inhibitors and Namenda may be
used in Alzheimer’s Disease and Lewy Body Disease • Caregiving at Home, William Leahy, M.D., 2005,
and to a lesser extent in frontotemporal dementias. Hartman Publishing Inc., and William Leahy,
In vascular dementia, controlling the risk factors for M.D., 8529 Indian School Road, NE, Albuquer-
cerebrovascular disease such as high blood pressure,
diabetes, high cholesterol, and stopping smoking as que, NM 87112, (505) 291-1274.
well as regular exercises may be helpful.
NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 23
Ragu Sinnarajah M.D, Maryland

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• ve;j xU nraypYk; mf;fiwapd;ik> vijAk;
re;Njhrkhf mDgtpf;f ,ayhik.
• grpapd;ik my;yJ mjpf grp (mjpfkhf
cz;zy;).
• epj;jpiuapd;ik my;yJ vg;NghJk; epj;jpiu
nfhs;sy;.
• ,ayhik my;yJ nraw;ghl;Lf; FiwT.
• fisg;G> rf;jpapd;ik.
• Fw;w czu;T my;yJ jhq;fs; xd;wpw;Fk;
mUfijaw;wtu;fs; vd;w czu;T.
• rpe;jpf;Fk;> KbntLf;Fk; jpwd; Fiwe;J
fhzg;gly;
• jw;nfhiy vz;zq;fs;> Kaw;rpfs;.

NkNy cs;stw;wpy; Ie;J Fzq;FwpfshtJ


,uz;L thuj;Jf;F Nky; Nky; ePbf;Fk; NghJ
xUtu; kdr;Nrhu;T Nehapdhy; ghjpf;fg;gl;ltuhf

kdr;Nrhu;T fUjg;gLthu;.

mt; Ie;jpy; xd;W ftiyahd kNdhghtk; my;yJ


mf;fiwapd;ik / vijAk; re;Njhrkhf mDgtpf;f
Rajam Theiventhiran M.D, New York ,ayhikahf ,Uf;fNtz;Lk;.

gy rkaq;fspy; kf;fspd; ,d> fyhr;ru> fy;tpawpT


“kdr;Nrhu;T” vd;w gjk; jd;Ds; gy fUj;Jf;fis mbg;gilapy; Fzq;Fwpfs; khwyhk;. cjhuzkhf
mlf;fp cs;sJ. md;whl tho;f;ifapy; Vw;gLk; jkpo; kf;fsplk; cly;> nka;g;ghl;L (Somatic complaints)
neUf;fPLfs;> Njhy;tpfs;> ghupa ,og;Gfs;> neUq;fpa Fzq;Fwpfs; nghJthf fhzg;gLk;. cjhuzkhf
xUtupd; kuzk; Nghd;wtw;wpd; gpd;du; Vw;gLk; jiy tpiwj;jy;> neQ;R Neh> ngU%r;R> kyr;rpf;fy;>
kdr;Nrhu;T ,ay;ghdJk;> toikahf ,og;Gfspd; epj;jpiuapd;ik> Fog;gk;> ,ayhik Nghd;wit.
jhf;fk; FiwAk; NghJk;> fhyj;jpd; Nghf;fpYk;
Fiwe;J tpLk;. kdr;Nrhu;tpd; jhf;fk; njhlu;e;J fLikahd kdr;Nrhu;T Nehapdhy; ghjpf;fg;gl;l
fhzg;gLk; NghJk; mJ xUtupd; nraw;ghl;il tUf;F fPNoAs;s Fzq;Fwpfs; fhzg;glyhk;.
(Functioning level) ghjpf;Fk; NghJk;> mJ xU Nehapay; • Nghypahd> jtwhd Mdhy; khw;wKbahj>
epiyahff; (Disease state) fzpf;fg; gLfpwJ. cWjpahd ek;gpf;if (Delusion). cjhuzk;:
jhq;fs; tho;f;ifapy; Kw;whfj;
kdr;Nrhu;T Nehapd; Fzq;fs;: Njhw;Wtpl;lhu;fs;> jq;fSf;F xU
• ftiyahd kNdhghtk; (Persistent sad khw;wKbahj nfhba Neha; Vw;gl;Ls;sJ
mood) - xt;nthU ehSk; mj;Jld; KO
Nghd;wit.
ehSk; ,e;epiy fhzg;gLk;. rpWtu;fspYk; • khag;GyDzu;T (Hallucination) - cz;ikahd
,isNahu;fspYk; ,yFtpy; Nfhgk;> vupr;ry; J}z;ly; ,y;yhky; Nfl;ly;> kzj;jy;
(Angry and irritable mood) milaf; $ba kNdh my;yJ czu;jy;.
epiy fhzg;gLk;. • jPtpu jw;nfhiy vz;zq;fs; my;yJ

NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 25
Kaw;rpfs;. jhf Fiwj;J epWj;j Ntz;Lk;.

kdr;Nrhu;tpw;F vjpuhd kNdhghtk; gpj;J Neha; 2) cstsr;rpfpr;ir (Psychotherapy / Counseling):


(Mania) vdg;gLk;.
,JTk; xU Kf;fpa rpfpr;ir KiwahFk;. vq;f spd;
,jdhw; ghjpf;fg;gl;ltu;fs; kpifahd re;Njhr
vz;zq;fisAk;> vjpu;ghu;g;Gf;fisAk;> nray;fis
khf ,Ug;ghu;fs;> mjpfkhf fijg;ghu;fs;> ,yF
Ak; khw;Wtjhy; kd czu;TfisAk; khw;wyhk;.
tpy; Mj;jpuk; milthu;fs;> Kd; Nahrid ,d;wp
cstsr;rpfpr;ir vq;fs; gpur;rpidfis xU MNuhf;
fhupakhw;Wthu;fs;> xNu Neuj;jpy; gy Ntiy fspy;
<LgLthu;fs; Mdhy; xd;iwAk; Kbf;f ,ayh fpakhd fz;Nzhl;lj;Jld; ghu;f;f cjTtJld;
ky; jpzWthu;fs;> mjpfkhd gzj;ij tPzhf jplkhd> cWjpahd> fbdq;fisr; rkhspf;ff;$ba
nrytopg;ghu;fs;. kNdhghtj;ijAk; cUthf;f cjTk;.

rpyUf;F kdr;Nrhu;Tk; gpj;J NehAk; khwp 3) kpd;typg;Gr; rpfpr;ir (Electroconvulsive therapy):


khwp tuf;$Lk;. ,tu;fs; Manic depressive disorder
,r;rpfpr;ir Kiw cldbahd tpisTfisf;
my;yJ Bipolar disorder My; ghjpf;fg;gl;ltu;fshff;
fUjg;gLthu;fs;. nfhLf;Fk;. ,J fLk; kdr;Nrhu;T nfhz;ltu;fSf;Fk;
cldbahd gyd; Njitg;gLgtu;fSf;Fk; mj;Jld;
rpfpr;ir Kiwfs;:
NtW rpy tpNrl re;ju;g;gq;fspYk; toq;fg;gLk;.
Nehapd; Fzq;Fwpfspd; jPtpuj;jpw;Fk; jhf;fj;jpw; cjhuzkhf kUe;J xj;Jtuhj my;yJ kUe;J
Fk; xg;g itj;jpa Kiw jPu;khdpf;fg;gLk;.
Ntiy nra;ahj xUtUf;F my;yJ rpfpr;ir
1) kUe;Jr; rpfpr;ir: Njitg;gLk; 4-6 khj fu;g;gpzpg; ngz;fSf;F ,J xU
kdr;Nrhu;itf; Fzkhf;Ftjw;F kUe;Jfs; xU jFe;j rpfpr;ir KiwahFk;.
Kjd;ikahd KiwahFk;. Nehahspfspd; Fzq;
cyf Rfhjhu epWtdj;jpdhy; kdr;Nrhu;T Nehah
FwpfSf;Fk; Njitf;Fk; Vw;g itj;jpau; kUe;ijj;
dJ kf;fspd; nraw;gLk; jpwikiaf; Fiwf;Fk;
Nju;e;njLg;ghu;. gytifahd> kpfg;ghJfhg;ghd>
Kjd;ikahd Nehahf milahsk; fhzg;gl;Ls;sJ.
jpwd;kpf;f kUe;Jfs; jw;NghJ cs;sd. cjhuzk;:
(sertraline)> Mz;fspy; 10 tpfpjkhNdhiuAk; ngz;fspy; 25 tpfpj
Prozac (Fluoxeting)> Paxil (Paroxitine)> Zoloft
Lexapro (esitalopram)> Wellbutrin (Bupropoine)> Effexor khNdhiuAk; ghjpf;Fk; ,e;Neha; Vio> gzf;fhud;>
(venelofaxine) Cymbalta. gbj;jtd;> gbfhjtd; vd;w NtWggby;yhky; vtUf;
Fk; tuyhk;. vdpDk; kpfTk; ghJfhg;ghd> jpwikahd>
xU kUe;J Ntiy nra;ahtpl;lhy; my;yJ mjd;
ghjfkhd gf;ftpisTfs; (negative side effects) $Lj njupTnra;ag;gl;l itj;jpa Kiwfs; jw;NghJ fz;L
yhf ,Ug;gpd; ,d;ndhU kUe;ijj; Nju;e;njLf;fyhk;. gpbf;fg;gl;Ls;sd.
rpy rkak; kUe;jpd; Muk;g tpisitf; fhz 1-6
Neha;f;fhd mwpFwpfs; Muk;gpj;j clNdNa
fpoikfs; nry;yyhk;. vdNt ek;gpf;ifiaj; jsu
rpfpr;iria Muk;gpj;jYk; G+uz FzkilAk; tiu
tplhky; itj;jpaupd; mwpTiuapd; gb kUe;ijj;
rpfpr;iria ePbj;jYk; NehapypUe;J kPo;tjw;fhd
njhlu;e;J vLf;f Ntz;Lk;. Nehapd; Fzk; njup
aj; njhlq;fpa ehspy; ,Ue;J 6 khjj;jpw;fhtJ rhj;jpaf;$Wfis mjpfupg;gJ kl;Lky;yhky; xU
rpfpr;iria njhlu Ntz;Lk;. kUe;ij epWj;Jk; MNuhf;fpkhdJk; nraw;jpwd; kpf;fJkhd tho;f;
NghJk; itj;jpaUld; fye;jhNyhrpj;J> rpwpJ rpwp ifia tho;tjw;F cjTk;.
26 ,yq;ifapy; tlf;F> fpof;F tho; rj;JzT Fd;wpa fh;g;gpzpg; ngz;fSf;fhd rj;JzT toq;Fk; jpl;lk;
NUTRITIONAL SUPPORT FOR MALNOURISHED PREGNANT MOTHERS IN NORTH & EAST OF SRI LANKA 27
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