Context: High quality acute flaccid paralysis surveillance system is a aquite important strategy for polio eradication. Surveillance data are the cornerstone to document a national polio free status. The aim of the present study is to evaluate the acute flaccid paralysis surveillance system in Kerkuk Governorate. Methods: Program evaluation of the Directorate of health, primary health care districts (sectors), hospitals, and primary health care centers in Kerkuk Governorate. All the responsible personnel for the acute flaccid paralysis surveillance system were interviewed and included in addition to the relevant records. Ordinary percentages were used in the description of acute flaccid paralysis cases. While rates were used in the evaluation of the performance indicators. Results: The study revealed a sensitive acute flaccid paralysis surveillance system (Non polio acute flaccid paralysis rate 3.98 and 3.1 in 2005 and 2006 respectively) with clear field guidelines. All the performance indicators were high indicating a high quality surveillance system in Kerkuk Governorate. Conclusions: Solid surveillance structure, regular contract and excellent case management were observed, in addition to regular passive and active surveillance. 7 , 200 &2 1 No 3 Vol.

Background: Down's syndrome (DS) or trisomy 21 is a chromosomal disorder frequently associated with a varied combination of morphological and structural birth defects. Individuals with Down syndrome are more prone to congenital heart defects such as atrioventricular septal defects (ASD), ventricular septal defects (VSD), isolated secundum atrial septal defects. Congenital and acquired gastrointestinal anomalies and hypothyroidism are common in patient with DS. Aims: To measure the frequency of congenital heart disease (CHD) among study population, to categorize CHD according to their anatomical location and to demonstrate socio-demographic characteristics of Down syndrome patients. Methods: Case series study design was conducted in Mosul over one year period starting from the 1 st ofDec. 2011 to the 30 th of Nov. 2012. Parents have been intervened by one of the investigators, and a specially designed questionnaire form were completed to each patient. Echocardiography have been conducted to all patients included in the study by a qualified pediatric cardiologist in Echo Unit-Khansaa Teaching Hospital, the echo result was recorded in the questionnaire form. Analysis of the data was conducted by using SPSS, and excels computer systems; simple rates and ratios were calculated in order to describe the study findings. Results: The present study includes a total of 69 patients diagnosed with Down's syndrome. Two thirds of study population was below six months of age. Male gender constitutes 69.6% of study population with male to female ratio 1:0.44. 39.2% of mothers are in age group ≥40 years. Fifty patients (72.5%) with DS diagnosed to have CHD by echocardiography. ASD was the most common defect and was diagnosed among 30% of patients, followed by complete AV canal and VSD which constitutes 20% each. 14.5% of patients with DS have extra cardiac anomalies and GIT anomalies were the most frequent one. Conclusion: The incidence of congenital heart disease in patients with Down's syndrome was high in this study (72.5%). ASD was the most frequent form observed.

Context: leukemia is the most common malignancy in childhood; many studies were conducted to explore the probable protective effect of breast feeding on childhood leukemia. The aim of the present study is to evaluate the effect of breast on the development of childhood leukemia. Methods: A case control design was conducted at the hematology unit;Ibn Alatheer pediatrics hospital in Mosul city. A total of 71 children diagnosed to have acute lymphoblastic leukemia and 70 children diagnosed to have diseases other than malignancy were included in the study as cases and controls respectively. SPSS and excel computer programs, chi squared test and Z test of two proportions, were used in statistical analysis. Results: The present study observed a protective association between breast feeding and the risk of childhood leukemia (OR=0.2, P<0.05). Moreover, the study showed increased risk of leukemia among children exposed to explosions near their residency (OR= 3.9, P<0.001). Conclusions: Breast feeding might have a vital protective effect against childhood leukemia. On the other hand, exposure to explosive materials might carry a high risk for developing leukemia.

Context: Acute otitis media (AOM) is the most frequent diagnosis in the children visiting offices. The prolonged and recurrent episodes of AOM may lead to hearing impairment and delayed speech development, which will influence the child's performance at school. Aim: The aim of this study is to identify the risk factors of acute otitis media in preschool children attending ENT clinics at Al-jamhory Teaching Hospital in Mosul. Methods: To achieve this aim, a case control study design was adopted. The sample of the present study included 150 children (cases) who have been diagnosed by the responsible ENT specialist according to the otoscopic examination with another 150 children (controls) who were diagnosed not to have AOM. Period of data collection was from 1 st of October 2011 to the 1 st of April 2012. Results: The present study showed that the highest frequency of acute otitis media occurred in the age group 1-2 years 39 patients (26%), and more frequent AOM attacks occurred in males. Clinical presentation among the cases were fever, otalgia, otorrhea, irritability, loss of appetite, vomiting, diminished hearing, and few patients presented with tinnitus and vertigo. The significant risk factors for AOM were day care attendance, bottle feeding for the 1 st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy. No association was found between craniofacial anomaly and occurrence of AOM in the present study. Conclusion: Day care attendance, bottle feeding during the 1 st 6 months of life, supine bottle feeding, pacifier use in the second 6 months of life, parental tobacco smoking, preterm baby, and allergy were found to be a significant risk factors for AOM among study population. Recommendation: Additional studies on potential measures to prevent AOM through the reduction of risk factors are needed.