An attempt has been made to quantitate drug consumption in a conurbation. The prescribing habits of physicians, self medication rate and therapeutic classes of drugs purchased have been evaluated. The study indicates that some of the prevailing practices in the area are unhealthy. The high self medication rate, faulty prescribing habits of physicians and liberal dispensing methods of pharmacist need to be viewed with concern. The wide gap between the precepts and practices prevailing among practitioners, the use of potent medicines without proper medical advice and the uninhibited sale of scheduled drugs over the pharmacy counter require careful consideration. If such unhealthy trends persist iatrogenic problems may surface in the near future. The physician, pharmacist and the public need to cooperate to create the proper pattern of drug usage.

Information on pharmacoepidemiology is particularly important in developing countries where a rational drug policy has not been adopted. In the present study, a profile of 1769 doctors' prescriptions and 763 self-orders were monitored at pharmacy outlets in the twin cities of Hyderabad and Secunderabad and 4 rural areas of Andhra Pradesh with the aim of identifying urban and rural differences, if any, in the self-medication rate, prescription costs, types of drugs purchased and factors influencing self-medication. Self-medication, expressed as the percentage of the total population that self-medicates, was found to be high in urban areas (37%) compared with rural areas (17%), and the majority of the over-the-counter sales were for prescription-only drugs. The majority of physicians' prescriptions were incomplete with respect to diagnosis and dosage regimen. The mean cost of the drugs purchased on doctors' prescriptions was 2-fold higher than the cost of drugs sold over the counter. A higher proportion of patients from rural areas (80%) purchased all the prescribed drugs compared with those from urban areas (54%). Financial constraints in urban areas were a major determinant in the partial purchase of prescribed drugs. In addition, the urban elite (i.e. professional people with high incomes, who comprise 18% of the total population) considered that all of the prescribed drugs were not necessary for their present disease. Nutritional products, potent compounds with analgesic, antipyretic and anti-inflammatory effects, and broad spectrum antibiotics constituted a high proportion of prescriptions in both urban and rural areas. The consumption of food supplements was higher in rural areas than in urban areas. Based on WHO criteria, most of the drugs (60%) prescribed in rural areas were nonessential, compared with 47% in urban areas. The results of this study emphasise the need for comprehensive measures, including information, training, legislation and education at all levels of the drug delivery system, to rationalise drug therapy by improving prescribing patterns and influencing self-medication.

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The Adolescent Growth Spurt (AGS) was studied in rural Hyderabad boys of 5+ years of age with known childhood nutritional background. Longitudinal data on height measurements of pre-school children available for 13 to 16 points of follow-up, during an 18 year period of study (i.e., from 1965-66 to 1983-84) were utilized for this purpose. A Preece and Baines model 1 (PB 1) function was fitted for height measurements of 323 boys aged 19-24 years in 1984. The boys were classified into three groups according to degree of under-nutrition at the age of 5+ years, using Boston reference values for height. Boys with severe height deficit at age 5+ were considered to have had a background of severe undernutrition and were referred as Group III. Boys with normal range height measurements at age 5+ were considered to have a normal nutritional background and were referred to as Group I. Group II boys had height deficits in between the above two groups and were considered to have milk to moderate undernutrition backgrounds. Group I boys had similar timing, intensity, duration of Adolescent Growth Spurt Period (AGSP) and gained a similar amount of height during puberty as did British boys. Group III boys differed significantly from British boys for AGS. They entered late into puberty, with significantly depressed intensity, but gained a similar amount of height, as a result of prolonged AGSP, which continued till 19.2 years. Thus a childhood background of undernutrition did not lead to any additional deficit in height during puberty. However, pre-pubertal height deficits were carried into adult height. The growth curves of rural Hyderabad children were parallel to the British distance height curve after 12 years of age. The mean constant height velocity curve of group I boys was superimposable on the British curve during puberty.

I . A study amongst schoolboys in villages around Hyderabad, India, showed that almost all the boys had riboflavin deficiency, 61 % had pyridoxine deficiency, and 9'4% had thiamin deficiency as judged by enzymic tests.2. The prevalence of angular stomatitis was 41.3 yo and that of glossitis was 18.2 %. Biochemical deficiency of riboflavin and pyridoxine was marginally higher in children with angular stomatitis with or without associated glossitis, than in children without oral lesions.3. Treatment with B-complex vitamins (containing 4 mg riboflavin and 10 mg pyridoxine) daily for I month produced significant reduction in the prevalence of glossitis but had no effect on angular stomatitis. The latter responded to topical application of gentian violet. 4.Small but significant changes in erythrocyte enzymes occurred over the period of I month even without vitamin supplements.5 . Results suggest that while glossitis is a relatively early manifestation of riboflavin or pyridoxine deficiency or both, angular stomatitis has a more complex aetiology perhaps associated with infection.Lesions of the mouth such as angular stomatitis and glossitis have been shown in experimentally-induced riboflavin deficiency as well as pyridoxine deficiency. Recent reports from the National Institute of Nutrition, Hyderabad, show that in adults this condition responds to treatment with either riboflavin or pyridoxine (Krishnaswamy, 1971 ; Iyengar, 1973). While glossitis seems to be more common amongst the adults of our community, angular stomatitis is more common amongst the children.A recent survey of rural schoolchildren living near Hyderabad, revealed a higher incidence of angular stomatitis amongst boys than amongst girls. The condition failed to respond to treatment with either riboflavin alone or with B-complex vitamins over a period of 3 weeks and 4 weeks respectively (K. V. R. Sarma, M. Damodaran and A. Tiar, unpublished results).The present study was carried out to investigate this observation further, by applying biochemical tests for assessing vitamin status, and examining the response to topical application of gentian violet. EXPERIMENTALThe subjects, 407 boys aged 5-1 3 years old and attending four rural schools near Hyderabad, were examined for clinical signs of vitamin deficiency such as angular stomatitis, glossitis, cheilosis, Bitot's spots, phrynoderma and angular scars. Of these, 168 boys had active angular stomatitis with or without glossitis (group A) whereas 134 boys were completely free of all lesions of the mouth including healed scars (group B). Boys in group A were further divided randomly into three subgroups (groups AI, A2 and A3) and those in group B into two subgroups (groups BI and B2).These boys were treated daily with either two tablets of B-complex vitamins (containing (mg/tablet): thiamin 2, riboflavin 2, pyridoxine 5, calcium pantothenate 2, niacin 20) (groups Ar and BI) or with placebo tablet containing IOO mg lactose (groups A2 and B2) or by topical application of a solution of gentian violet (10 g/l...