PAEDIATRICS AND CHILD HEALTH IN A TROPICAL REGION

On a visit to the children's ward of a hospital in a Third World country, we once saw a UNICEF poster on one of the walls bearing the following question: "What would you like to be when you grow up?"

"ALIVE!" was the prompt answer given by a young boy whose photograph, with a beaming infectious smile, also appeared on the poster. This boy could easily have come from West, Central or East Africa, Yemen or

Peru or Brazil.

Oman, India, Cambodia, Vietnam, Malaysia, Indonesia, Papua New Guinea, Central America, Columbia,

The sad truth is that less developed countries of the world - the so called Third World - also happen to be concentrated in the tropics and subtropics. For the majority of children from these regions, normal health, growth and development are almost a luxury and unattainable goals, and simple survival is a tremendous achievement. It is therefore not surprising that when we think of tropical paediatrics, we almost always subconsciously think of paediatrics in the developing countries of the world. The diseases whic affect children in these regions are also diseases of the non- tropics, but there is a difference. In the tropi for various reasons, these diseases are not only likely to be more severe, but are also more frequer accompanied by complications that could result in unsatisfactory outcome. Additionally, certain importa, problems are peculiar to the tropics. It is therefore no wonder that mortality and morbidity rates are exceptionally and unacceptably high.

Most tropical countries have very limited medical resources. In the past decade, the emphasis on primary health care has made tremendous impact on the health of children in the developing countries. The success of some of these innovations has led some people, who would prefer to see the limited resources channelled into preventive paediatrics, to decry further expenditures on curative paediatrics. Few paediatricians, who have to deal on daily basis with the gaping yet unmet needs of these desperately ill children, would want to accept such demands. These colleagues, whilst accepting the philosophy and objectives of primary health care, still believe that there is a definite need to link preventive health practices with sound clinical care, even within constraints of available resources. This book is attempting to do just that, for doctors practising in tropical and developing countries.

The stimulus for this book was the sudden realization in Nigeria in the early 1990's that our few revered teachers of paediatrics and our up-and-coming ones too, were slowly but inexorably leaving the country for "greener pastures" in other regions of the world. It did not really matter what the reasons for the exodus were, but the drift was on. At the same time, the few available medical textbooks were becoming so expensive that medical students in our various medical schools could hardly afford to buy them. The logical reaction to this situation was to mobilize those teachers of paediatrics, still left in the country, to accept the challenges to dust-up their lecture notes and produce some text for the use of our medical undergraduates.

This book is the result of that combined effort. Our aim in this book is to focus on the basic needs of the undergraduate medical student, the general physician who has to care for children and the junior resident physician in paediatrics. We recognise that when one addresses audiences in countries where political instability, collapse of the economy and the heavy burden of international debt aggravate the difficulties of medical practice, perspectives are invariably coloured by these limitations. We accept responsibility for these short comings. No attempt is being made in this volume to compete with the up-to-date and state-of-the-art details available in the standard and reference paediatric textbooks. These wonderful texts are still recommended by us if they are available, and affordable!

As to be expected in a first attempt at a multi-authored book, repetitions are bound to occur. The editors have made efforts to reduce such repetitions. The gestation period of the book was rather prolonged, mostly due to the constraints of academic work in a demotivating socio-political and economic environment.

Consequently, some of the references may not be up to the minute. While thanking God that we are able to go to press, we recognise the limits of our efforts and hope and promise to improve on the endeavour in subsequent editions.