Sudden Unexplained Afiica - NCBI

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lives, sudden unexplained infant deaths. (SUID) could easily go unnoticed.' As part of a community nutritional assess- ment survey inSouthern Rwanda, inter-.
Lete to the Editor

0.45 and specificities of 0.80, 0.94, and 0.71,1-3 supporting Dr. Hales' suggestion that our "one finger" criterion may have produced higher sensitivity (0.62) and lower specificity (0.66) than generally reported.4 These observations highlight the need for standard criteria for interpreting the Tinel sign and other findings. The hand pain diagram was a highly significant correlate of the electrophysiologic diagnosis (odds ratio 4.95, 95% CI 1.87, 13.08) in logistic analyses adjusted for the Tinel sign (odds ratio 3.11, 95% CI 1.26, 7.70).5 This result suggests that each test contributes independent diagnostic information and that the location of selfreported symptoms is of greater diagnostic value than nerve percussion provocation-rather than that two fingers are better than one. El Jeffley N. Ka, MD, MS

References 1. Golding DN, Rose DM, Selvarajah K. Clinical tests for carpal tunnel syndrome: an evaluation. BritJRheum 1986;25:388-390. 2. Geilman H, Gelberman RH, Tan AM, Botte MJ. Carpal tunnel syndrome. An evaluation of the provocative diagnostic tests. J Bone

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3. Stewart JD, Eisen A. Tinel's sign and the carpal tunnel syndrome. Br Med J.

1978;1125-1126. 4. Katz JN, Lason MG, Fossel AH, Liang MH. Validation of a surveillance case definition of carpal tunnel syndrome.AmJPub

Heakh. 1991;81:189-193. 5. Katz JN, Laon MG, Sabra A, et al. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Int Med 1990;112:321-327. Requests for reprints should be sent to Jeffrey N. Katz, MD, MS, Robert B. Brighman Mul-

March 1992, Vol. 82, No. 3

tipurpose Arthritis Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Sudden Unexplained Infant Deaths in Central Afiica In less developed countries, where infectious diseases and protein-energy malnutrition exert a terrible toll on infant lives, sudden unexplained infant deaths (SUID) could easily go unnoticed.' As part of a community nutritional assessment survey in Southern Rwanda, interviewers also asked mothers the following question: "Did one of your children ever die (between birth and 24 months of age) suddenly and unexpectedly during his/her sleep, while healthy just hours before when you put your child to sleep?" Out of a complete list of 2933 families living in four representative rural communes in Southern Rwanda, 460 were randomly selected. Of these, 412 (90%o) were successfully interviewed. Mothers reported a total of 20 SUID deaths in 19 affected families. With an average of 7 children per family, the incidence of reported SUID was approximately 6.9 per 1000 live births. Excluding 5 children who died between 12 and 24 months, the reported incidence was 5.2 per 1000 live births. This is similar to the incidence in known high-risk populations, such as inner-city African Americans in the United States.2-3 Although not a single study has addressed the incidence of SUID in Central African populations, it is apparent that many of the known risk fac-

tors for SUID are highly prevalent, in particular factors affecting intrauterine growth and development.4,5 The incidence estimates reported here may not be accurate, but they underscore the need for a more careful assessment. Ol Marc Buerys, MD, PhD Ann Chao, MS Bernadette Mukafauwa, MD Jess F. Kraw, MPH, PhD A d Saah, MD, MPH

References 1. Peterson DR. Evolution of the epidemiology of sudden infant death syndrome. Epidemiol Rev. 1980;2:97-112. 2. Black L, David RJ, Brouillette RT, Hunt CE. Effects of birthweight and ethnicity on incidence of sudden infant death syndrome.

JPediatr. 1986;108:209-214. 3. Kraus JF, Greenland S, Bulterys M. Risk factors for sudden infant death syndrome in the US Collaborative Perinatal Project. IntJ

EpidemioL 1989;18:113-120. 4. Bulterys M. Adverse effects on intrauterine growth and development and the risk ofsudden infant death syndrome. Los Angeles, Calif: University of California, Los Angeles; 1989. Thesis. 5. Bulterys M, Greenland S, Kraus JF. Chronic fetal hypoxia and sudden infant death syndrome: Interaction between maternal smoking and low hematocrit during pregnancy. Pediatbics. 1990;86:535-540. Marc Bulterys, Ann Chao, and Bernadette Mukafaranswa are with the National University of Rwanda; Marc Bulterys and Ann Chao also are with The Johns Hopkins University School of Hygiene and Public Health. Jess F. Kraus is with the UCLA School of Public Health. Alfred Saah is with The Johns Hopldns School of Hygiene and Public Health. Requests for reprints should be sent to Marc Bultetys, MD, PhD, Centre Universitaire de Sante Publique, National University of Rwanda, BP 399, Butare, Rwanda, Africa.

American Journal of Public Health 467