Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1987"

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban bangladesh ii. a randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea

Abstract: An educational intervention was designed to improve three water-sanitation behaviors empirically shown to be associated with high rates of childhood diarrhea in Dhaka, Bangladesh: lack of handwashing before preparing food, open defecation by children in the family compound, and inattention to proper disposal of garbage and feces, increasing the opportunity for young children to place waste products in their mouth. Fifty-one communities, each comprising 38 families, were randomized either to receive (n = 25) or not to receive (n = 26) the intervention. During the six months after the intervention, the rate of diarrhea (per 100 person-weeks) in children under six years of age was 4.3 in the intervention communities and 5.8 in the control communities (26% protective efficacy; p less than 0.0001). A corresponding improvement in handwashing practices before preparing food was noted, although no improvement was observed for defecation and waste disposal practices. These data suggest that educational interventions for water-sanitation practices can have an important beneficial effect upon childhood diarrhea in developing countries, particularly when the interventions are designed in a simple way to promote naturally occurring salutory behaviors that are empirically associated with lower rates of childhood diarrhea.

Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study.

Abstract: Although responses to 24-hour recall and knowledge-attitude-practice questionnaires are commonly used in water-sanitation studies as surrogates for direct observation of behaviour, the validity of this approach is questionable We therefore compared questionnaire data with those obtained by direct observation of practices related to water storage, handwashing, and defecation among 247 families in urban Dhaka, Bangladesh Analysis of the results indicates that accord between the replies to the questionnaires and the data collected by direct observation was poor and that the responses to the two questionnaires were often contradictory Significant disagreements between the results of questionnaires and observations arose usually because desirable practices were over-reported by the respondents The results of the study suggest that in urban Bangladesh 24-hour recall and knowledge-attitude-practice questionnaires should not be used as proxies for direct observation of hygiene practices

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban bangladesh i. application of the case-control method for development of an intervention

Abstract: A case-control study was performed to develop an empirically based intervention for improving water sanitation practices and rates of childhood diarrhea among families residing in urban Bangladesh. For 3 months fortnightly histories of diarrhea were taken for all children under age 6 among 1350 families to estimate age-specific rates of diarrhea in the population. A total of 247 randomly sampled families termed sentinel families were visited once during the study for prolonged observations of water sanitation practices. Behaviors potentially affecting incidence of diarrhea were compared in a case group (n=45) defined as sentinel families whose children had rates at least 1.7 times the rates expected for similarly aged children and in a control group (n=53) defined as sentinel families without any episodes of childhood diarrhea during the period of observation. 3 practices differentiated the 2 groups: more control (82%) than case (53%) mothers who were observed to prepare food washed their hands before beginning the preparation (p 0.01); fewer control families (33%) than case families (80%) had ambulatory children who when observed to defecate did so in the familys living area (p 0.01); and fewer control (30%) than case (47%) families had children who were observed to place garbage or waste products in their mouth (p 0.10). Focus on these 3 empiric associations enabled the design of a community-specific educational intervention which is simple in construction and based upon naturally occurring financially feasible salutary practices. (authors)

Hydrolysed wheat based oral rehydration solution for acute diarrhoea.

Abstract: A randomised three cell study was carried out in 78 children with acute diarrhoea to evaluate the relative efficacy of oral rehydration solution (ORS) made from partially hydrolysed wheat grain, cooked rice powder, or glucose. Twenty six patients with comparable age, body weight, duration of diarrhoea, and degree of dehydration were studied in each of the three groups. Initial rehydration was carried out by using intravenous Dhaka solution within one to two hours followed by administration of oral rehydration solution. The mean ORS intake during the first and second 24 hours of treatment in patients with cholera receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. The stool output during the same period in patients receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. Similar trends in both ORS intake and stool output were observed during the next 24 hours.

Rapid diagnosis of cholera by coagglutination test using 4-h fecal enrichment cultures.

Abstract: A simple, rapid, and reliable method to detect Vibrio cholerae in fecal specimens would assist in the management of cases of severe diarrhea, especially since most such cases occur in areas with minimal laboratory facilities. A coagglutination test was used to detect V. cholerae antigen in bile-peptone broth incubated with feces. In the technique, Staphylococcus aureus Cowan 1 coated with anti-V. cholerae O1 antiserum was tested with cultures incubated for 4 h. When 165 specimens were tested, the sensitivity, specificity, and accuracy of the test, compared with standard culture methods, were 97, 99, and 98%, respectively. These promising results were better than those of dark-field microscopy using the same specimens, and the test was logistically easy to perform. The coagglutination test using enrichment broth culture of feces is a simple and rapid method which may be used to confirm a diagnosis of cholera.

Differential clinical features and stool findings in shigellosis and amoebic dysentery

Abstract: To obtain information that could assist the clinician to differentiate between shigellosis and amoebic dysentery, we compared clinical features and stool findings in 58 adult male patients in Bangladesh. Mean values indicated that patients with invasive amoebiasis were older and had a longer prehospital illness, a lower body weight, less frequent fever, a lower haematocrit and a higher white blood cell count than patients with shigellosis. The mean number of faecal leucocytes per mm 3 was significantly higher in shigellosis than in amoebiasis (28 700 vs 10 300) and correlated with the estimated number of faecal leucocytes per microscopic high power field in a wet mount preparation. Patients with shigellosis more often had over 50 white blood cells per high power field. Although the mean stool pH in amoebiasis was lower than in shigellosis (6.26 vs 6.60), the difference was not statistically significant. Concentrations of stool electrolytes did not differ between the two diseases. These findings indicate that age, duration of illness, the presence of fever and the number of faecal leucocytes may help to differentiate between shigellosis and amoebic dysentery.

Scabies in urban Bangladesh.

Abstract: As a part of a larger project on hygiene education and diarrhoeal diseases we followed 766 children less than 6 years of age from October 1984 to September 1985 in Dhaka, Bangladesh. The aims were to estimate the annual risk of infestation with scabies in children, to describe its involvement of other family members, and to determine some of the familial and individual risk factors for apparent infestation by scabies. During this period 589 (77%) children appeared to have been infected with scabies, and 125 (16%) children were infested for more than 6 months. Of the factors examined, direct and indirect indicators of decreased wealth and incorrect hygiene practices correlated with higher rates of apparent infestation, although scabies rates remained high at all socioeconomic levels.

The aetiology of diarrhoea in children at an urban hospital in Bangladesh

Abstract: Enteric pathogens were studied in 104 cases with acute diarrhoea and in 74 age and sex matched concurrent controls. One or more pathogens were isolated from 59·1% of cases compared with 20·4% of controls (P < 0·001). Single enteropatnogens were detected in 33·7% and multiple enteropathogens in 25·4% of the cases. Enteropathogenic Escherichia coli (EPEC), Campylobacter jejuni, rotavirus, Vibrio cholerae non-O1 and enterotoxigenic Escherichia coli were the major pathogens detected. The high rate of isolation of EPEC from diarrhoea cases (23·1%) indicated a definite role for this pathogen in causing endemic diarrhoea in Bangladesh.

Suckling patterns and post-partum amenorrhoea in Bangladesh

Abstract: The association between breastfeeding patterns and resumption of menses postpartum was examined in a longitudinal study initiated in March 1976 in Bangladesh. Information on suckling patterns and menstrual status was collected on 148 breastfeeding women who were still amenorrheic at 17-25 months postpartum at the beginning of the study. Suckling was measured during an 8-hour period once a month for up to 19 months of follow-up. A high frequency of suckling was found even at this late postpartum duration. Total suckling time and the number of suckling episodes declined with the age of the child but the mean duration of each episode did not change. The fact that regression analyses did not show a correlation between suckling patterns and return of menses postpartum may be related to the large individual variations in suckling patterns and in the duration of amenorrhea in this population and the need to study suckling patterns for longer than 8 hours/day. (authors)

Changes in maternal nutritional status in a chronically malnourished population in rural Bangladesh

Abstract: This paper presents a descriptive analysis of maternal anthropometry in Bangladesh. Rural Bangladeshi women (aged 15–49) were found to have a mean height of 147.8 cm, mean weight of 40.8 kg with SD of 4.9 and arm circumference of 21.8 cm. Their mean weight was much lower than the weight for height standard and was negatively related to their ages. The prevalence of low hematocrit levels in this population was high (mean 34%). Nearly one tenth of the women had hematocrit levels of less than 30% even when not pregnant. A seasonal pattern of maternal nutrition was also seen, with a lean period from August through October. Body weight and hematocrit levels decreased in that period; weight gain is recorded in that period because pregnancy is also affected. This seasonal pattern of maternal weight and arm circumference correlated with seasonal availability of food. Overall, maternal nutritional status in rural Bangladesh was low at all times and was worsened by seasonal food scarcity and frequent pregnancies.

Cryptosporidium as a pathogen for diarrhoea in Bangladesh.

Abstract: Cryptosporidiosis, a zoonosis caused by Cryptosporidium species is a newly recognized coccidial protozoan infection causing diarrhoea in humans. Using a modified acid fast technique, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) has been screening a 4% sample of diarrhoea patients attending the ICDDR,B diarrhoea treatment center for Cryptosporidium in their stools as a part of an ongoing surveillance program. Positive specimens were confirmed by the standard Giemsa method. Cryptosporidia were identified predominantly in young children and were associated with watery diarrhoea, vomiting, cough and mild to moderate dehydration. The protozoan had a seasonal pattern with an increase in the hot, humid weather. We conclude that Cryptosporidium infection is relatively common in children in Bangladesh and may be responsible for a significant proportion of diarrhoea in this area.

Socioeconomic variables and rates of diarrhoeal disease in urban Bangladesh

Abstract: Sociodemographic factors including low maternal education, low economic status, inferior quality of housing, diminished access to water and sanitation facilities, and crowding in the household are associated with increased diarrhoea in the rural setting of many developing countries. To assess the relationship of these variables with diarrhoea rates in children in an urban setting we monitored the episodes of diarrhoea of children 3 1 2 months. Comparing incidence density ratios, we found that, of the factors listed above, only low family income and living in a one-room house were statistically associated with increased diarrhoea and that none of these variables was associated with a meaningfully increased risk of diarrhoea. We conclude that the risk factors for increased episodes of diarrhoea in the urban setting appear to be different from those of the rural setting.

Single dose tetracycline in cholera.

Abstract: A randomised clinical trial was carried out to explore the efficacy of single dose tetracycline therapy in cholera. One hundred and eighteen adult patients were assigned to receive either tetracycline in a single 1 g, or a single 2 g dose, or tetracycline 500 mg every six hours four times, or no antibiotics as controls. The means of total liquid stool volumes after treatment were lower in the single 1 g dose group (168.0 +/- 20.9 ml/kg), in single 2 g dose group (229.5 +/- 45.6 ml/kg), and multiple dose group (214 +/- 28.5 ml/kg), than in the control group (499.1 +/- 56.5 ml/kg) (p less than 0.05). Similarly, the means of durations of diarrhoea and intravenous fluid requirements were significantly lower in the single dose and multiple dose tetracycline groups, than in the controls (p less than 0.05). The mean durations of excretion of Vibrio cholerae were significantly shortened from 3.9 +/- 0.2 days in the control group to 1.9 +/- 0.2 days in single 1 g dose, to 2.2 +/- 0.4 days in single 2 g dose and 1.3 +/- 0.1 days in multiple dose groups, respectively (p less than 0.05). Three patients in the single 1 g dose group and two patients in single 2 g dose group had clinical relapses with excretion of V cholerae during the relapses, but this was not significantly more frequent than that in the multiple dose group (p greater than 0.05). These findings suggest that although multiple dose tetracycline therapy remains the best choice, a single dose of either 1 g or 2 g tetracycline appears to be a reasonable alternative for the treatment of cholera as an adjunct to rehydration therapy.

Characterization of Vibrio cholerae 01 recently isolated in Bangladesh

Abstract: 91 strains of Vibrio cholerae O1, isolated in Bangladesh in January 1986, were examined for their biological behaviour and sensitivity to 6 antimicrobial agents. Biotyping indicated that 60 of the isolates belonged to the classical biotype and 31 to the El Tor biotype. 21 El Tor strains revealed β-haemolysis on blood agar plates, but only 8 showed complete haemolysis in broth. Serotyping indicated 79 Ogawa, 10 Inaba, and 2 Hikojima. Phage typing showed that all classical vibrios belonged to Mukerjee's phage type 1. El Tor vibrios were classified into 4 groups: one strain each in type 1 and type 5, 19 in type 4, and 10 in an untypable group. Prophage typing of El Tor vibrios identified 14 strains of Ubol type, 16 of cured Celebes type, and one of original Celebes type. No strain was resistant to tetracycline, minocycline, chloramphenicol, streptomycin, amoxicillin or nalidixic acid. The classical vibrios differed from those isolated before 1973 in toxin production pattern.

Comparability of Results Obtained by Two-Week Home Maintained Diarrhoeal Calendar with Two-Week Diarrhoeal Recall

Abstract: Many community based studies of diarrhoea in the developing world employ face-to-face interviews to obtain diarrhoeal histories. An alternative recording device that preserved the accuracy but avoided the expense and time commitment of the interview would be extremely valuable. To evaluate the comparability of episodes of diarrhoea obtained from a home-maintained two-week calendar with those histories given in response to a two-week health recall interview in a largely uneducated population, we studied approximately 1500 families for six months in Dhaka, Bangladesh. The diarrhoea records obtained for children by the two methods were highly comparable (Kappa value 0.83). The comparability was not impaired either by lack of maternal education nor by increased numbers of children in the household. We conclude that the two-week home maintained diarrhoea calendar offers comparable results with the two-week recall and in certain situations could be a useful substitute.

Differentials of fertility between polygynous and monogamous marriages in rural Bangladesh.

Abstract: This paper discusses polygynous marriages in rural Bangladesh using marital status and birth registration data from the Demographic Surveillance System (DSS) of the International Center for Diarrheal Disease Research for the period 1975-79. Of all the marriages recorded during this period about 5% were polygynous. To identify the women polygynously married 1974 census data of the DSS area were used. The difference in age at marriage between the polygynous groom and his subsequent wife was 15 years on average. The socioeconomic indicators studied were education occupation and area of dwelling space. In general these indicators between women in monogamous marriages were significantly higher than between the women in polygynous unions. During the period 1976-79 863 polygynous marriages were recorded (4.9% of all marriages in the study area). Polygynous marriages were found to be less frequent among men with 2ndary and higher levels of education. The highest proportion of polygynous marriages occurred among husbands with no schooling or Koranic education. The general fertility rate of women in monogamous marriages was significantly higher than for women in polygynous marriages overall and in all age groups except 20-24. During the period 1975-79 the mean number of liveborn children for monogamous women was higher than that of polygynous women.

Segmental necrotising enterocolitis: pathological and clinical features of 22 cases in Bangladesh.

Abstract: To describe the pathology and clinical features of segmental necrotising enterocolitis (SNE) in children and adults, 22 diarrhoeal patients (median age two years, range two months to 50 years) in Bangladesh with this lesion detected at autopsy were examined and compared with two groups of diarrhoeal control patients. Gross pathology consisted of purplish or black mucosal or transmural discoloration with erosions or ulcerations in segments of the jejunum or ileum of 18 cases and of the colon alone in four cases. Two patients had intestinal perforations. Microscopically all specimens showed coagulation necrosis or haemorrhagic necrosis indicative of mucosal ischaemia. In 20 cases there was submucosal oedema and nine showed pneumatosis of the bowel. From 11, one or more of the invasive diarrhoeal pathogens Shigella, Campylobacter and Entamoeba histolytica were detected. From the comparison with controls significant associations were found for a long duration of diarrhoea, blood and mucus in stool, abdominal distension or tenderness, shock not attributable to hypovolaemia, septicaemia, and low concentration of serum protein (p less than 0.05). These findings indicated that segmental necrotising enterocolitis develops sometimes as a fatal complication of prolonged diarrhoeal illnesses associated with shock and hypoproteinaemia and is caused by ischaemic injury to the intestinal mucosa.

An urban nutrition education and rehabilitation centre: a description of the programme and change in nutritional status of children who were enrolled.

Abstract: We report on a community-based day care nutrition rehabilitation and education centre which was established by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in a slum in Dhaka, Bangladesh Between March-December, 1985 approximately 10 children aged 1 to 5 years with a percent weight for height (% wt/ht) of 60 to 85 were enrolled in each of 9 sessions which were 3 to 5 weeks long The children were fed 3 meals and 2 snacks daily made from locally available inexpensive foods A nutrition education programme, developed with input from several feeding centres in Dhaka, included daily lessons, participatory cooking and personal hygiene sessions Of the 85 children entering the programme, 82 (95%) completed 3 or more weeks Relative to baseline, a median increase of 87% wt/ht was observed at 5 weeks (p less than 0001), with the greatest improvement occurring in those children presenting with the lowest weights Median increases of 72 and 74% wt/ht were noted 6 and 10 months after admission, respectively Gender and minor illness did not have a significant impact on change in nutritional status Poor performance of mothers in assigned chores was associated with inferior improvement in nutritional status 5 weeks but not 6 months post-admission These results suggest that the intervention implemented by the centre may have been effective in improving nutritional status and that more rigorous evaluation of participants in relation to suitably matched concurrent controls should be performed

Giardia infection during pregnancy and lactation.

Abstract: Etude faite au Bangladesh dans les premiers mois du post-partum, les femmes qui allaitent excretent des G. lamblia plus frequemment que les femmes enceintes et les femmes qui n'allaitent pas

Vibriocidal titre in cholera cases and contacts: its value in assessing endemicity of or susceptibility to cholera.

Abstract: Vibriocidal antibody titre in excess of 1:40 occurred within two weeks of cholera infection, both in severe hospitalized cases, contact cases and in asymptomatic infected contacts. These levels, considered to be indicative of protection, persisted for six months or longer in more than half of the subjects irrespective of presence and severity of symptoms. Approximately 40% of infected family contacts had similar titres implying recent infection and subsequent protection. The use of antibiotics to treat acute cases, and whether infection was due to antibiotic resistant or sensitive Vibrio cholerae had no effect on the response of vibriocidal titre. Endemicity of cholera was higher than previously observed in Dhaka. Screening populations to obtain positive titre rates permits retrospective assessment of cholera infection and provides an indicator of future susceptibility.

Isolation of Clostridium difficile from diarrhoea patients in Bangladesh.

Abstract: An attempt was made to detect Clostridium difficile and its toxin from the stools of 20 patients with antibiotic-associated diarrhoea (AAD), 35 with colitis, six with chronic diarrhoea and 300 with watery diarrhoea. Two toxigenic and three non-toxigenic strains were isolated from patients associated with antimicrobial therapy. All 300 stools from watery diarrhoea patients, not associated with antibiotics, were negative for Cl. difficile and its toxin. We conclude that Cl. difficile might be a cause of AAD in Bangladesh.