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Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1982"


Journal Article•DOI•
TL;DR: While little progress has been made in understanding the mode of transmission of v. cholerae 01, and in identifying practices for prevention, fluid therapy in this area has decreased the case fatality rate significantly and provides guidance for similar programs elsewhere.
Abstract: Since 1963, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), formerly the Cholera Research Laboratory, has maintained a field station in Matlab to treat patients from a surveillance population of 240,000 who have cholera and other diarrheal diseases. Since 1966, the authors have analyzed hospital records of 7141 surveillance-area patients culture-positive for v. cholerae 01 to relate the seasonality, age and sex distribution, and geographic trends with hypotheses concerning transmission, immunity, and risk groups. From this review, they have found that: 1) children 2-9 years old and adult women are most commonly hospitalized for cholera; 2) V. cholerae 01 emerges simultaneously throughout the area of surveillance, with the early cases being of different phage types; 3) three patients were hospitalized twice for cholera compared with 29 expected on the basis of life-table analysis (p less than 0.01), suggesting that immunity to severe disease conferred by previous illness may be stable and long-lasting; 4) no constant relationship was found between the times of onset or peaks of the yearly cholera epidemic and the times of onset or peaks of the monsoon rains or river water levels; and 5) an outbreak of multiply antibiotic-resistant V. cholerae 01 infection documented in 1979 raises questions about the dissemination of resistance plasmids, antibiotic-use patterns, and the need for other drugs in addition to tetracycline. While little progress has been made in understanding the mode of transmission of v. cholerae 01, and in identifying practices for prevention, fluid therapy in this area has decreased the case fatality rate significantly and provides guidance for similar programs elsewhere.

339 citations


Journal Article•DOI•
TL;DR: Longitudinal studies were done in two villages rural Bangladesh to learn more about the interactions between infectious diseases and the nutritional status of children, and found E. coli diarrhea had a peak incidence during the hot months, and shigellosis was more frequent during the cool, dry months.
Abstract: Longitudinal studies were done in two villages rural Bangladesh to learn more about the interactions between infectious diseases and the nutritional status of children. Diarrheal diseases, identified by surveillance of 197 children aged 2-60 months, were studied for bacterial, viral and parasitic enteropathogens in 1978-1979. The annual incidence of diarrhea was highest in children aged 2-11 months, and declined progressively with age from seven to four episodes per child per year. An enteropathogen was identified from rectal cultures taken during diarrhea in 51% of episodes and from 6% of monthly cultures taken when diarrhea was not present. Enterotoxigenic Escherichia coli were the pathogens found most frequently, followed by shigellae and rotaviruses. Diarrheal episodes associated with shigellae had the longest duration, while episodes associated with Vibrio cholerae or with rotavirus were more frequently associated with dehydration. E. coli diarrhea had a peak incidence during the hot months, and shigellosis was more frequent during the cool, dry months.

299 citations


Journal Article•DOI•
TL;DR: It was revealed that illnesses of the upper respiratory tract, such as purulent rhinitis and pharyngitis, had the highest prevalence, and diarrheas were the second most common illnesses, with a peak prevalence rate in children 6-11 months of age.
Abstract: Longitudinal studies were done in two villages in rural Bangladesh to learn more about the interactions between infectious diseases and the nutritional status of children. An intensive system of surveillance was used to determine the occurrence and frequency of infectious diseases in a cohort of 197 children aged 2-60 months in 1978-1979. This surveillance revealed that illnesses of the upper respiratory tract, such as purulent rhinitis and pharyngitis, had the highest prevalence. Diarrheas were the second most common illnesses, with a peak prevalence rate in children 6-11 months of age. Diarrhea was also the most frequent reason for hospitalization of study children. The overall prevalence of infectious diseases was high: at least one and often several concurrent illnesses were noted on 75% of all days of observation. Compared with children in the surrounding area, children in this study had a low mortality rate, perhaps because of medical services provided during the study. Nevertheless, the extensive morbidity from infectious diseases may have had adverse effects on the growth and development of the children.

261 citations


Journal Article•DOI•
TL;DR: It is suggested that hand-washing has a positive interrupting effect, even in unsanitary environments, in checking the spread of the disease.
Abstract: High attack rates, increasing resistance to antibiotics and high mortality make shigellosis a serious problem. As Shigella is associated with poor hygiene we examined the effectiveness of a simple intervention, washing hands with soap and water, in checking the spread of the disease. The study population was comprised of confirmed cases of shigellosis. These and matched controls were followed up for 10 days. Several pieces of soap and earthenware pitchers for storing water were provided to the study families and they were advised to wash their hands with soap and water after defaecation and before meals. Compliance was monitored daily by observing the size of the soap and residual water. Rectal swabs of contacts of both the groups were obtained for culture. The secondary infection rate was 10.1% in the study group and 32.4% in the control group. The secondary case (symptomatic) rate was 2.2% in the study group and 14.2% in the control group. These results suggest that hand-washing has a positive interrupting effect, even in unsanitary environments.

249 citations


Journal Article•DOI•
TL;DR: The proportion of a child's food samples that contained E. coli was significantly related to the child's annual incidence of diarrhoea associated with enterotoxigenic E. Escherichia coli, highlighting the importance of seeking locally available foods that are hygienic as well as nutritious to supplement the diets of breastfeeding children in developing countries.
Abstract: In longitudinal studies of infectious diseases and nutrition in Bangladesh, we determined the degree of bacterial contamination of traditional weaning foods and evaluated the role of these foods in the transmission of diarrhoeal diseases. 41% of samples of food items fed to weaning aged children contained Escherichia coli; these organisms were used as indicators of faecal contamination. Milk and foods prepared particularly for infants were more frequently and heavily contaminated with E. coli than was boiled rice, and E. coli levels were found to be related to the storage of cooked foods at high environmental temperatures. 50% of drinking water specimens also contained E. coli, but colony counts were approximately 10-fold lower than in food specimens. The proportion of a child's food samples that contained E. coli was significantly related to the child's annual incidence of diarrhoea associated with enterotoxigenic E. coli. This observation underscores the importance of seeking locally available foods that are hygienic as well as nutritious to supplement the diets of breastfeeding children in developing countries.

207 citations


Journal Article•DOI•
23 Oct 1982-BMJ
TL;DR: In October 1979 a surveillance system was set up at the International Centre for Diarrhoeal Disease Research, Bangladesh, Hospital at Dacca to study a 4% systematic sample of the 100 000 patients with diarrhoea who come to the hospital for care each year.
Abstract: In October 1979 a surveillance system was set up at the International Centre for Diarrhoeal Disease Research, Bangladesh, Hospital at Dacca to study a 4% systematic sample of the 100 000 patients with diarrhoea who come to the hospital for care each year. From December 1979 to November 1980 inclusive, 3550 patients were studied. A recognised pathogenic organism was identified for 66% of patients screened for all pathogens, one-third of whom had a mixed infection with two or more agents. Enterotoxigenic Escherichia coli was the most common enteropathogen detected in all age groups (detection rate 20%), followed by rotavirus (19%), Campylobacter jejuni (14%), and Shigella (12%). Infants and young children (up to 5 years) were most often infected with rotavirus, enterotoxigenic E coli, and C jejuni and older children (5-14 years) had more infections with enterotoxigenic E coli, Shigella, and E histolytica. Surveillance has helped to define the range of disease among patients attending the Dacca Hospital. Sixty-five per cent of patients complained of watery diarrhoea, a presentation that was significantly more common in patients with Vibrio cholerae 0:1 (91%), enterotoxigenic E coli (78%), rotavirus (77%), and C jejuni (71%) than in all patients studied. Dysentery, defined as a history of diarrhoea with blood, was the presenting complaint of 20% of all patients but 55% of those with Shigella. Only patients with V cholerae 0:1 and enterotoxigenic E coli were at increased risk for severe dehydration. In addition surveillance has been used to identify areas where patient care can be improved and to generate new ideas for research.

201 citations


Journal Article•DOI•
TL;DR: The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old.
Abstract: The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.

148 citations


Journal Article•DOI•
TL;DR: These practices have probably not led to improvements in health and may have promoted the emergence and persistence of drug-resistant micro-organisms and control measures at government, producer, prescriber and consumer levels need to be pursued.
Abstract: Antibiotic use by 175 000 people in the Matlab rural surveillance area (MSA) of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) was studied to identify practices which might affect microbial drug resistance. We surveyed a 3% sample of drug purchases from pharmacies in the MSA over a four-week period in August and September 1980. Fifty-seven drug purchases were made per thousand Matlab residents per week; 9% of these were of tetracycline and 26% were antibiotics. Forty-eight per cent of the antibiotic tablets or capsules for persons aged 15 years or more were purchased in quantities which represented less than a single day's dose and rarely was a full course of therapy purchased at one time. The rate of tetracycline purchase for young children--in whom it is usually contraindicated--equalled the rate for older children and young adults. These practices have probably not led to improvements in health and may have promoted the emergence and persistence of drug-resistant micro-organisms. To optimize antibiotic use, control measures at government, producer, prescriber and consumer levels need to be pursued.

139 citations


Journal Article•DOI•
TL;DR: It is suggested that a rice-powder electrolyte solution is efficient and safe to use as a rehydrating oral fluid in acute diarrhoea.

137 citations


Journal Article•DOI•
TL;DR: Serum antibodies to Norwalk virus and to rotavirus were measured during longitudinal studies of infectious diseases and nutrition in rural Bangladesh to find children with the lowest levels of antibody to rotvirus had the greatest risk of rotav virus diarrhea.
Abstract: Serum antibodies to Norwalk virus and to rotavirus were measured during longitudinal studies of infectious diseases and nutrition in rural Bangladesh. Initially, the prevalence of antibody to Norwalk virus was 7% in children younger than six months and increased to 80% in children two to five years of age. The incidence of titer increases was highest in one- and two-year-olds and in children who had low or undetectable levels of antibody. Some Norwalk virus infections appeared to result in diarrhea. Nearly all children had serum antibodies to rotavirus at the beginning of the study; however, children with the lowest levels of antibody to rotavirus had the greatest risk of rotavirus diarrhea. Over half of the children had a fourfold increase in titer of antibody to rotavirus during the year, and 7% had increases in two of the three study periods during the year. Most increases in titer of antibody to rotavirus appeared to result from subclinical infections.

119 citations


Journal Article•DOI•
TL;DR: In this article, the authors conducted a longitudinal field study of the physical growth of 197 children between 6 and 60 months of age in two rural villages of Bangladesh and found that 90% of the village girls and boys weighed less than the National Center for Health Statistics 5th percentile by 8 and 15 months respectively.

Journal Article•DOI•
08 May 1982-BMJ
TL;DR: The effectiveness of chlorpromazine in reducing fluid loss in cholera is confirmed, and a sedative effect, however, especially in children, may limit its usefulness and requires further study.
Abstract: A randomised controlled trial was conducted to investigate the ability of chlorpromazine to reduce intestinal secretion in cholera. Chlorpromazine had reduced loss of intestinal fluid in animals with diarrhoea induced by cholera toxin, and in a preliminary study the drug had reduced purging in patients with cholera. Forty-six adults with cholera were included in the randomised trial. Of these, 34 were treated with chlorpromazine (1 mg/kg or 4 mg/kg either by mouth or intramuscularly) and 12 served as controls. After treatment with the drug there was a significantly greater reduction in the rate of fluid loss in the treated patients than in the controls during the first (p less than 0.005), second (p less than 0.05), and fourth (p less than 0.01) eight-hour periods, but not during the third eight-hour period; the dose of 4 mg/kg was only marginally more effective than 1 mg/kg. The effect of chlorpromazine was strikingly biphasic, with one peak during the first eight hours and another 24-32 hours after administration. Chlorpromazine also significantly reduced the duration of diarrhoea, frequency of vomiting, and amount of intravenous fluid required. The drug induced mild sedation and no hypotension in these well-hydrated patients. These findings confirm the effectiveness of chlorpromazine in reducing fluid loss in cholera. A sedative effect, however, especially in children, may limit its usefulness and requires further study.

Journal Article•DOI•
TL;DR: TheRotavirus patients absorbed a lesser amount of all the nutrients than the cholera patients during the recovery period, suggesting the presence of a longer period of malabsorption in rotavirus than in cholERA.

Journal Article•DOI•
TL;DR: The impact of the various types of age misstatement increases the difficulty of interpreting weight-for-age and obscures accurate understanding of malnutrition in Bangladeshi children.
Abstract: Age data for 3,393 children, six years of age and under, in rural Bangladesh are analyzed for the level and pattern of age misstatement. Random error, age heaping at whole years, and preferences for particular ages are found in the data. Variation in age reporting is discovered to increase monotonically with age. Systematic errors in age misstatement display modest overstatement for the first four years of life and more pronounced understatement for ages 4, 5, and 6.

Journal Article•DOI•
TL;DR: Chlorpromazine is not recommend in the routine management of patients with watery diarrhea; however, it may be useful in treatment of children with severe cholera when added to standard treatment of hydration and tetracycline.

Journal Article•DOI•
TL;DR: Reports on a study undertaken in Chittagong district of Bangladesh to examine the causes and some of the factors contributing to neonatal and postneonatal mortality and to identify the population at highest risk show that the age range 25-29 years conferred the greatest protection on neonates andPostneonates.
Abstract: Reports on a study undertaken in Chittagong district of Bangladesh to examine the causes and some of the factors contributing to neonatal and postneonatal mortality and to identify the population at highest risk. A cohort of 1351 infants born between July 1976 and June 1977 was longitudinally followed up for 1 year in the Teknaf Dysentery Project demographic surveillance system. Results of the survey show an overall infant mortality rate of 160/1000 live births. Neonatal and postneonatal components were 89 and 71/1000 births respectively. Major causes of neonatal and postneonatal death were: tetanus (21%); pneumonia (19%); prematurity (12%); malnutrition (8%); diarrheal diseases (7%); and fever (6%). Tetanus premaurity and congenital abnormalities were the commonest causes of neonatal death whereas pneumonia malnutrition diarrheal disease and fever were the most important causes during the postneonatal period. Complications in delivery were significantly correlated with increased risk of neonatal mortality. The age of the mother was also a determinant of neonatal and mortality. The age of the mother was also a determinant of neonatal and postneonatal viability with mothers under the age of 20 having the greatest risk of death of her newborn. The age range 25-29 years conferred the greatest protection on neonates and postneonates. When the age of the mother is controlled parity is positively related to neonatal postneonatal and infant mortality rate. Large family size also correlates positively with the mortality rate.

Journal Article•DOI•
TL;DR: This paper explores the mechanism through which socioeconomic status affects infant deaths in rural Bangladesh and finds that both neonatal deaths and postneonatal deaths were found to be higher in number among those whose mothers have no schooling.

Journal Article•DOI•
TL;DR: Patients with diarrheal illness associated with isolation of Salmonella frequency had vomiting, watery diarrhea, abdominal pain, and fever, but the clinical features of the illnesses and the socioeconomic backgrounds of the patients could not be distinguished from those of matched controls who were attending the same clinic.
Abstract: The authors studied the frequency of diarrheal illness associated with non-typhi Salmonella at two clinics in Bangladesh for the years 1977-1979. Non-typhi salmonellae were isolated from 0.29% of fecal specimens or rectal swabs in an urban area and 0.26% of similar specimens in a rural area; the frequency of isolations peaked in the summer months. Isolations of Shigella and Vibrio cholerae were much more common than Salmonella. Only two of 50 Salmonella isolates were resistant to more than one antibiotic. None of 13 isolates tested produced an enterotoxin. S. java and S. virchow accounted for 64% of all the isolates. Patients with diarrheal illness associated with isolation of Salmonella frequency had vomiting (88%), watery diarrhea (78%), abdominal pain (61%), and fever (39%), but the clinical features of the illnesses and the socioeconomic backgrounds of the patients could not be distinguished from those of matched controls who were attending the same clinic. The infrequency of Salmonella infection in an area where several other bacterial and viral enteric diseases are hyperendemic requires further investigation.

Journal Article•DOI•
TL;DR: Cholera was not totally eliminated, even in the one camp with sanitation facilities, suggesting that health education, as well as proper sanitation, is necessary to eradicate cholera.
Abstract: The purpose of this study was to determine the prevalence of cholera in two groups: (i) people using covered latrine and piped water; (ii) people using uncovered surface latrine and pond and tubewell water. The study population consisted of cholera cases admitted to the ICDDR, B hospital from three refugee camps. In the one camp with sanitation facilities, the cholera rate was 1.6 per 1,000, whereas in the two camps without facilities the rates were 4.0 and 4.3 per 1,000. Following demolition of the camps, the cholera rates decreased significantly in the camps geographical zones. Cholera was not totally eliminated, even in the one camp with sanitation facilities, suggesting that health education, as well as proper sanitation, is necessary to eradicate cholera.

Journal Article•DOI•
TL;DR: Results suggest that all the cereal based solutions were as effective as glucose based standard oral rehydration solution in the treatment of diarrhoea.


Journal Article•DOI•
TL;DR: It is shown that the measurement error due to graduation of scaling for anthropometric variables usually follows a uniform distribution and to what extent graduation in anthropometric scales affects th short-term intrasubject variance.
Abstract: It is shown that the measurement error due to graduation of scaling for anthropometric variables usually follows a uniform distribution. The result is used to investigate to what extent graduation in anthropometric scales affects the short-term intrasubject variance. It is seen that for commonly used graduations the effect is not to be considered substantial.