Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1988"
TL;DR: Sixty-seven percent fewer episodes of LT-ETEC diarrhea were noted in the BS-WC group than in the WC group during short-term follow-up, but no reduction was evident during the ensuing nine months.
Abstract: The B subunit (BS) of cholera toxin and that of the heat-labile enterotoxin (LT) of enterotoxigenic Escherichia coli (ETEC) are antigenically similar. We therefore assessed whether a combined cholera toxin BS/whole-cell (BS-WC) oral vaccine against cholera conferred cross-protection against LT-producing ETEC (LT-ETEC) diarrhea in a randomized, double-blind field trial among rural Bangladeshi children and women. The 24 770 persons who ingested two or more doses of BS-WC vaccine were compared with 24 842 controls who took two or more doses of killed whole-cell (WC) oral cholera vaccine. Sixty-seven percent fewer episodes of LT-ETEC diarrhea were noted in the BS-WC group than in the WC group during short-term (three-month) follow-up (P < .01), but no reduction was evident during the ensuing nine months. Short-term protection was particularly notable against LT-ETEC diarrhea causing life-threatening dehydration (protective efficacy, 86^0; P < .05).
337 citations
Journal Article•
TL;DR: In this paper, the oral B subunit killed whole-cell (BS-WC) and killed wholecell (WC) cholera vaccines was assessed in 63 498 Bangladeshi children aged 2-15 years and women aged over 15 years.
Abstract: The protective efficacy of oral B subunit killed whole-cell (BS-WC) and killed whole-cell (WC) cholera vaccines was assessed in 63 498 Bangladeshi children aged 2-15 years and women aged over 15 years. Each received three doses of BS-WC, WC, or placebo in a randomised, double-blinded fashion. Surveillance for cases seeking medical care up to six months after the third dose revealed 26 cases of confirmed cholera in the placebo group, 4 cases in the BS-WC group (protective efficacy 85%; p less than 0.0001), and 11 cases in the WC group (protective efficacy 58%; p less than 0.01). For each vaccine protective efficacy was consistent in different age-groups (2-10 years versus greater than 10 years) and for different severities of cholera.
266 citations
TL;DR: It is concluded that BS-WC and WC vaccines confer significant protection against cholera, particularly in persons vaccinated when older than five years, and in younger persons protection was transient.
Abstract: We assessed the protective efficacy (PE) of three doses of B subunit-killed whole cell (BS-WC) and killed whole cell-only (WC) oral cholera vaccines in a randomized, double-blind trial among 62,285 children and women residing in rural Bangladesh. After one complete year of surveillance, 110 cases of cholera were detected in the placebo group, 52 in the WC group (PE, 53%; P less than .0001), and 41 in the BS-WC group (PE, 62%; P less than .0001). Protection was greater for BS-WC recipients than for WC recipients only during the initial eight months of observation. Both vaccines conferred equivalent protection against cholera associated with life-threatening dehydration and against less severe cholera. High-grade, sustained protection was observed in persons vaccinated when older than five years; in younger persons protection was transient. We conclude that BS-WC and WC vaccines confer significant protection against cholera, particularly in persons vaccinated when older than five years.
154 citations
TL;DR: The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area, and underscores the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal deaths in settings such as rural Bangladesh.
Abstract: This paper reports findings from a study of maternal mortality in Matlab, Bangladesh during the 1976-85 period. The study employed a multiple-step procedure to identify maternity-related deaths to all reproductive-aged women within the study area during this period. A total of 387 maternal deaths were identified, resulting in an overall maternal mortality ratio of 5.5 per 1,000 live births. The introduction of a family planning program in half of the Matlab study area led to a moderate but significant reduction in maternal mortality rates, relative to the comparison area. This appears to have been primarily due to a reduction in the overall number of pregnancies in the treatment area, since among women who became pregnant, mortality risks remained high. The results of this study underscore the need for a broad-based service strategy that includes but is not limited solely to family planning, in order to achieve significant reductions in maternal mortality levels in settings such as rural Bangladesh.
145 citations
TL;DR: In communities with a high prevalence of malnutrition breast feeding may substantially enhance child survival up to 3 years of age, and was evident only in severely malnourished children.
Abstract: The effect of breast feeding on nutritional state, morbidity, and child survival was examined prospectively in a community in rural Bangladesh. Every month for six months health workers inquired about breast feeding and illness and measured arm circumference in an average of 4612 children aged 12-36 months. Data from children who died within one month of a visit were compared with those from children who survived. Roughly one third of the deaths in the age range 18-36 months were attributable to absence of breast feeding. Within this age range protection conferred by breast feeding was independent of age but was evident only in severely malnourished children. In communities with a high prevalence of malnutrition breast feeding may substantially enhance child survival up to 3 years of age.
122 citations
TL;DR: It is concluded that measles vaccination was associated with a pronounced and sustained reduction in the rate of death among children in rural Bangladeshi children in this study.
Abstract: To ascertain whether measles vaccination was associated with reduced mortality rates in rural Bangladeshi children, the authors conducted a case-control study in four contiguous areas, two of which had participated in an intensive measles vaccination program which began in the spring of 1982. Cases were 536 children who had died in the four-area region at the age of 10-60 months between April 1982 and December 1984. Two age- and sex-matched controls were selected from the four-area region for each case; each control had survived at least through the date of death of the matched case. Measles vaccination was associated with a 36% (95% confidence interval 21%-48%) proportionate reduction in the overall rate of death and a 57% (95% confidence interval 43%-67%) reduction in the rate of deaths directly attributed to measles or ascribed to diarrhea, respiratory illness, or malnutrition. The association of measles vaccination and reduced mortality remained unchanged after the authors restricted controls to children who had survived at least one year after the deaths of their matched cases. Moreover, children vaccinated in 1982 exhibited a sustained reduction in the rate of death in 1983 and 1984. The authors concluded that measles vaccination was associated with a pronounced and sustained reduction in the rate of death among children in this study.
109 citations
TL;DR: There was complete correlation of the Pcr+ phenotype with virulence in the smooth strains in this study, suggesting that Congo red binding can be utilized as a quick and reliable alternative to the Sereny test.
Abstract: Smooth strains of Shigella dysenteriae type 1, Shigella flexneri, Shigella boydii, and Shigella sonnei which form pigmented colonies (Pcr+) on Congo red agar were virulent in the Sereny test. Smooth variants unable to bind Congo red (Pcr-) were avirulent. Measurements of dye uptake from solution showed that S. dysenteriae type 1 bound the most dye, followed in order of uptake by S. flexneri, S. boydii, and S. sonnei. Using the salt aggregation test (SAT) to determine cell surface hydrophobicity, we found the same order of species. The SAT could not, however, detect differences in surface properties between Pcr+ and Pcr- pairs of isogenic smooth strains. Enteroinvasive Escherichia coli strains used in the study showed SAT and Congo red-binding properties which were similar to those of the S. flexneri strains. A direct correlation was found between pigment-binding ability and the presence of the large 140-megadalton plasmid in S. flexneri, enteroinvasive E. coli, and S. boydii but not in S. dysenteriae type 1 or S. sonnei strains. Congo red interacted with outer membranes and outer membrane proteins of S. dysenteriae type 1 but not with lipopolysaccharides. However, rough mutants of Shigella species deficient in lipopolysaccharides bound Congo red and formed pigmented colonies, showing that dye binding as a virulence assay may be misinterpreted in such cases. There was complete correlation of the Pcr+ phenotype with virulence in the smooth strains in this study, suggesting that Congo red binding can be utilized as a quick and reliable alternative to the Sereny test.
96 citations
TL;DR: In the area of Bangladesh where the study was done reduction of diarrhoea-related morbidity and mortality will depend on control and treatment of shigellosis, and community health workers have been instructed to provide antibiotics for patients with a history of bloody dysentery.
83 citations
TL;DR: Overall mortality rates were higher in the BS-WC group and 23% lower in the WC group during the first year, and reductions of mortality were observed only in women vaccinated at ages over 15 years, however, no differences in cumulative mortality were evident at the end of the second year of surveillance.
73 citations
TL;DR: These findings support and extend previous observations in this community of parental son preference in caring for children in Matlab, a rural area in Bangladesh.
Abstract: We examined drug purchases for children less than five years of age from privately owned pharmacies in Matlab, a rural area in Bangladesh. The male to female incidence rate ratio was 1.71 (95 per cent confidence intervals = 1.27, 2.28) for overall drug purchase, and 2.94 (95% CI = 1.14, 7.73) for purchase of drugs prescribed by physicians. Our findings support and extend previous observations in this community of parental son preference in caring for children.
65 citations
TL;DR: It is suggested that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.
Abstract: Sixty-three patients with Salmonella typhi infections were randomly assigned to receive either ceftriaxone iv in single daily doses of 75 mg/kg for children and 3-4 g for adults for seven days or to receive 60 mg of chloramphenicol/kg a day orally or iv in four divided doses until defervescence and then 40 mg/kg a day to complete 14 d. In the ceftriaxone group, one death occurred, and two of seven patients still febrile 11 d after starting treatment were given chloramphenicol. In the chloramphenicol group, one death and one gastrointestinal perforation occurred. The probability of remaining febrile was similar for both groups during the first seven days but was significantly greater for patients receiving ceftriaxone during the 14-d period. Patients in the chloramphenicol group were more likely to be bacteremic on day 3. These results suggest that a seven-day course of once-daily ceftriaxone shows promise as an alternative to 14 d of chloramphenicol for treating typhoid fever.
TL;DR: The results indicate that invasive amebiasis in this population differs from other diarrheal diseases, affecting mainly children greater than 2 years and adults and causing severe and fatal illness characterized by extensive colitis with diverse systemic consequences.
Abstract: To describe the epidemiologic and clinical features associated with invasive amebiasis in Bangladesh, 85 hospitalized diarrheal patients with hematophagous trophozoites of Entamoeba histolytica in their stools were compared to a control group of 84 hospitalized diarrheal patients without amebiasis. Postmortem examinations were carried out in 22 deaths due to amebiasis. For the patients with amebiasis, there was a bimodal age distribution with peaks at 2-3 years and greater than 40 years, whereas the control patients had a unimodal distribution with the peak at 0-1 year. The sex distribution was equal in childhood but young adults were predominantly female and older adults predominantly male. The clinical features significantly associated with amebiasis were prolonged dysentery, prior measles rash, malnutrition, hyponatremia, hypokalemia, and hypoproteinemia (all P less than 0.05). The case fatality rate in amebiasis was 29%, which was significantly higher than 11% for the controls (P less than 0.05). Postmortem findings included extensive colitis with deep ulcers and complications, including colonic perforation in 2 cases, peritonitis in 4 cases, pneumonia in 9 cases, and septicemia in 5 cases. These results indicate that invasive amebiasis in this population differs from other diarrheal diseases, affecting mainly children greater than 2 years and adults and causing severe and fatal illness characterized by extensive colitis with diverse systemic consequences.
TL;DR: Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea, and the introduction of family food to the diet was associated with higher rates.
Abstract: With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.
TL;DR: In the Bangladeshis studied in Dhaka, income, education, and most strongly, urban residence during childhood correlated positively with digoxin inactivation, consistent with the hypothesis that the metabolic functions of the anaerobic gut flora may be determined by environmental factors operative early in life and tend to remain stable in adulthood.
TL;DR: Defence mechanisms possibly exist which protect against E. histolytica but are ineffective against Giardia, which may account for the difference in infant infection rates with these parasites.
Abstract: Entamoeba histolytica was studied in 33 lactating women and their infants in a periurban village in Bangladesh. Infant-mother pairs were followed for a period of 10-15 months: 67% of mothers excreted E. histolytica during the observation period, the majority for 3 months or more. Only one mother was symptomatic, with a mild, non-dysenteric diarrhoea. 58% of mothers were seropositive, several of them continuously and with a high titre, indicating past invasive infection. 67% had detectable antibodies in breast milk and 36% in saliva. Despite the high prevalence of E. histolytica in these mothers, infants were mostly uninfected: E. histolytica cysts in small numbers were found in only 2 of 1200 samples from infants aged 6 and 10 months. Several of the children were infected with Giardia lamblia. Although lower exposure to E. histolytica than to Giardia may account for the difference in infant infection rates with these parasites, defence mechanisms possibly exist which protect against E. histolytica but are ineffective against Giardia.
TL;DR: Bile peptone broth enrichment for 24 h was observed to be six times more effective than direct plating alone on salmonella-shigella agar for the recovery of P. shigelloides from stools.
Abstract: Bile peptone broth and alkaline peptone water (pH 8.5) were examined as enrichment media for the isolation of Plesiomonas shigelloides from stools, with salmonella-shigella agar as the isolation medium. After 423 parallel examinations in two different experiments, bile peptone broth enrichment for 24 h was observed to be six times more effective (P less than 0.01) than direct plating alone on salmonella-shigella agar. Bile peptone broth was found to be twice as effective as alkaline peptone water for the recovery of P. shigelloides from stools.
TL;DR: Findings suggest that if further reductions of adult female mortality are to be achieved the vigorous family planning program implemented in Matlab must be augmented with additional interventions addressing the other determinants of womens death.
Abstract: In recent years the issue of womens health in developing countries has received increased attention. Little is known however about the effectiveness of strategies to improve the health of women. An innovative family planning and health services program launched almost 10 years ago provides a unique opportunity to evaluate the impact of a service program upon adult female mortality rates. A total of 1039 women ages 15-44 died in the 10-year period from 1976-85 in 149 villages under the demographic surveillance system set up by the International Center for Diarrheal Diseases Research Bangladesh (ICDDRB). Of these 492 died in the treatment area where the service program started in 1978 and 547 died in the neighboring comparison area covered only by the government health services. After the start of the ICDDRB service program the overall mortality rate among women of reproductive age became significantly lower in the treatment area than in the adjacent comparison area (2.4 vs 3.0/1000 p=0.001). An analysis of cause-specific mortality rates revealed that 1/2 of the difference observed was due to a lower number of deaths due to obstetrical causes in the intervention area suggesting that this intensive family planning program was successful in limiting pregnancies and their related deaths. 22% of the difference observed was due to a lower number of deaths caused by infectious diseases. The rate of deaths due to injuries however remained similar in both areas. The breakdown by age revealed that the largest mortality differential after implementation of the service program was observed in the youngest age group. Access to modern medical care prior to death was substantially higher in the treatment area. These findings suggest that if further reductions of adult female mortality are to be achieved the vigorous family planning program implemented in Matlab must be augmented with additional interventions addressing the other determinants of womens death. These additional intervention which should include a strong maternity care program and actions to facilitate the access of rural women to community-based female health professionals have yet to be tested and evaluated in rural Bangladesh. (authors)
TL;DR: Cultures of shigellae in liquid minimal medium containing methionine, nicotinic acid, and tryptophan showed rapid growth and gave reasonably high cell yields, indicating that the auxotypes may be useful as epidemiological markers.
Abstract: Most (about 81%) of the clinical isolates of shigellae that were tested failed to grow in a minimal medium. Of the auxotrophic isolates belonging to the four Shigella species, 98% grew in a minimal medium containing methionine, nicotinic acid, and tryptophan. The combination of methionine and tryptophan appears to be an obligatory requirement for Shigella dysenteriae serotype 1 strains, while the combination of nicotinic acid and tryptophan appears to be obligatory for serotype 2. Requirements which varied in other isolates were, however, genetically stable, indicating that the auxotypes may be useful as epidemiological markers. Cultures of shigellae in liquid minimal medium containing the above three supplements showed rapid growth and gave reasonably high cell yields.
TL;DR: The decline in fertility may be due to several factors: deferred marriage; increase in divorces and husband-wife separations; high fetal wastage; voluntary fertility control through contraception, abstention, or induced abortion; and infecundability.
Abstract: This study investigates the effects of the 1974–75 famine on differential fertility in a rural population of Bangladesh, using information on household socioeconomic status collected in the 1974 census, and registration data on births, deaths and migrations for the period 1974–77 from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh. Occupation of household head was taken as a measure of socioeconomic status. Total fertility rates were analysed for three periods: pre-famine, famine and post-famine. Overall fertility declined due to the famine by 34%, but this was compensated partially by a 17% increase in the post-famine period. Fertility of women of all ages and socioeconomic groups was affected by the famine, a more pronounced effect being observed among the poor. Fertility showed a higher post-famine recovery among women in the middle socioeconomic groups and in those aged 25–34 years.
TL;DR: A presumptive diagnosis of cholera could be made in patients past infancy and early childhood who showed very severe dehydration, however, age-specific prevalence was strikingly different and seasonal variations considerable.
Abstract: This paper analyses a few selected features from the history and clinical examination of 1258 patients with acute diarrhoea and a single laboratory diagnosis of either cholera, rotavirus, or enterotoxigenic (ETEC) Escherichia coli infection. Age distribution and seasonality in Bangladesh were also studied. The duration of illness before admission was not significantly different in the 3 groups. Cholera occurred especially in the spring and early winter. Most cholera patients were between 3 and 10 years of age. Over 37% of the patients developed severe dehydration. In about 90% of cholera cases, the stools were alkaline (pH > 7). ETEC infections were seen mostly in April–May and September–October. Infants were frequently affected but from age 25 onwards the age distribution closely followed that of cholera. Severe dehydration occurred in 8·3% of patients and was more frequent than in rotavirus cases. Stool pH was as frequently acidic as basic. Rotavirus cases were concentrated during the winter in patients under 2 years of age. They had marked vomiting, yet severe dehydration was almost absent. Cough was present in half of them. The stools were usually acidic. In spite of considerable overlap of signs and symptoms between the 3 aetiological groups, a presumptive diagnosis of cholera could be made in patients past infancy and early childhood who showed very severe dehydration. However, age-specific prevalence was strikingly different and sea-sonal variations considerable.
TL;DR: In this article, the authors analyzed the plasmid profiles and antimicrobial susceptibility patterns of 343 strains of Shigella dysenteriae type 1, obtained from 18 different geographical locations.
Abstract: Plasmid profiles and antimicrobial susceptibility patterns of 343 strains of Shigella dysenteriae type 1, obtained from 18 different geographical locations, were analyzed. Three plasmids, with molecular sizes of 140, 6, and 2 megadaltons (MDa), were present in 94, 98, and 96%, respectively, of the 343 strains isolated during either epidemic or nonepidemic periods from 1965 to 1987. In addition to these plasmids, 83% of the strains harbored a 4-MDa plasmid and 25% harbored a 20-MDa plasmid. Various plasmid profiles were observed in which the 140-, 6-, and 2-MDa plasmids occurred commonly, irrespective of the place of isolation and drug resistance pattern of the strains. Certain profiles showed significant association with drug resistance patterns. These findings suggest that three plasmids, of molecular sizes 140, 6, and 2 MDa, are unique to S. dysenteriae type 1 strains and may indicate the global spread of a pathogenic bacterial clone. Additionally, these core plasmids, plus plasmids of various other sizes, could be used to identify emerging subclones which are causing both epidemic and sporadic disease. Thus, plasmid profiles of S. dysenteriae type 1 strains can be used to monitor possible pandemic strains as well as individual epidemic strains.
TL;DR: La recherche d'un traitement est influencee par le niveau socio-economique and par l'eloignement des villages du complexe sanitaire.
Abstract: 84,6% des cas mortels de cholera au cours d'une epidemie avaient ete traites par des praticiens non qualifies des villages. Les malades traites par des medecins qualifies avaient des chances beaucoup plus grandes de survivre. La recherche d'un traitement est influencee par le niveau socio-economique et par l'eloignement des villages du complexe sanitaire. Actuellement les deces par cholera sont presque tous previsibles par une rehydratation simple et efficace
Journal Article•
TL;DR: Factors associated with childhood deaths in urban Bangladesh included being under one year of age, and several direct and indirect indicators of poor economic status: ie head of household earning a daily wage rather than a salary and family dependence on daily wages rather than on a salary.
Abstract: To assess sociodemographic characteristics predicting childhood mortality in urban Bangladesh the authors conducted a case-control study of subjects selected from 51 low and middle class areas of urban Dhaka between October 14 1984-October 13 1985. Cases were the 38 children under the age of 6 who died during this study interval; 6 surviving controls under age 6 who were selected for each case. Factors associated with childhood deaths included being under 1 year of age (odds ratio [OR]=11.80; p0.0001) and several direct and indirect indicators of poor economic status; i.e. head of household earning a daily wage rather than a salary (OR=2.63; p0.01); residence in a single-room dwelling (OR=2.63; p0.05); or residence in a structure of inferior construction (OR=2.58; p0.05). There were important gender-specific differences in the risk factors. Having 1 or more male siblings was associated with an increased risk of death for male children (OR=2.78; p0.05). while having at least 1 female sibling was suggestively associated with the risk of death for female children (OR=2.47; p0.10). Family dependence on daily wages rather than on a salary was associated with male deaths (OR=6.24; p0.001) but not with female deaths (OR=1.38). Other indices of poverty (poor construction of house and single-room dwellings) were also associated with an increased risk of male but not female deaths. The authors conclude that lower sociodemographic status appears to more substantially influence the risk of death in boys than in girls in low and middle class areas in urban Bangladesh perhaps reflecting gender-determined differences in the care of children. The success of efforts to improve child survival in this setting will require a better understanding of this important phenomenon. (authors)
TL;DR: It is concluded that discontinuation of breast-feeding during diarrhoea is an infrequent phenomenon in the rural Bangladeshi population, however, the association of cessation of Breast-feeding with severe clinical outcomes may be of considerable importance, particularly in countries where discontinuated breast- feeding is more common.
Abstract: Discontinuation of breast-feeding during an episode of childhood diarrhoea is widely regarded as a common, high-risk practice in the developing world. We studied cessation of breast-feeding in a rural Bangladeshi population under comprehensive surveillance for medically treated diarrhoeal episodes. Among 2129 episodes in children aged under 36 months and breast-fed before the onset of diarrhoea, there were only 33 (2%) in whom breast-feeding had stopped before presentation for care. Children in whom breast-feeding had stopped (cases) differed little from those in whom it had not (controls) in respect to exclusive vs partial breast-feeding, age, gender, or several maternal characteristics (maternal age, education, and recent maternal diarrhoeal illness). In contrast, cases were more likely to have presented with clinically severe illness or to have died within 30 d of presentation (odds ratio = 2.20, P less than 0.05). We conclude that discontinuation of breast-feeding during diarrhoea is an infrequent phenomenon in this population. However, the association of cessation of breast-feeding with severe clinical outcomes may be of considerable importance, particularly in countries where discontinuation of breast-feeding is more common.
TL;DR: It appears that the present concentration of potassium in World Health Organization recommended ORS is not sufficient to correct deficits in some patients, and the need to raise the potassium concentration in ORS to above 20mEq per liter is suggested.
Abstract: 60 children in Bangladesh all under 4 years of age with acute watery diarrhea and moderate dehydration were treated with sucrose based oral rehydration solution (ORS) with 20mEq potassium chloride per liter and monitored to determine the efficacy of this fluid in raising serum potassium level. ORS only was given for the 1st 4 hours and then the child was given diluted mild formula and bread as well. No fruits or potassium rich fluid (e.g. green coconut water) were allowed during the study period. Rehydration as well as maintenance of fluid loss was done with ORS only. The serum potassium dropped significantly at 24 hours from the admission level and remained reduced at that level even after 48 hours of therapy with ORS. Of these 60 patients 22 were hypokalaemic on admission and 10 patients out of 19 remained so after 48 hours of therapy. Thus it appears that the present concentration of potassium in World Health Organization recommended ORS is not sufficient to correct deficits in some patients. The significance of these findings can be appreciated by considering the fate of infants in areas where diarrhea is hyperendemic who may have 3 attacks per year per child on average and who are in addition malnourished. Total potassium depletion may occur in these children during repeated diarrheal episodes resulting in higher morbidity and mortality. These findings suggest the need to raise the potassium concentration in ORS to above 20mEq per liter.
Journal Article•
TL;DR: Observations suggest that the toxin of V. fluvialis differs from the known cholera toxin in receptor site, mode of action and antigenicity.
Abstract: A total of 26 strains of Vibrio fluvialis was included in this study, which were isolated from patients with diarrhoea and other sources. The GM1 enzyme linked immunosorbent assays performed with the culture filtrates of V. fluvialis yielded negative results, indicating that their receptor site is different from that of the known labile toxin. The cholera antitoxin failed to neutralize the skin permeability factor activities of all the V. fluvialis culture filtrates and none of the concentrated culture filtrates gave any precipitin band, when tested against the cholera antitoxin in Ouchterlony's gel diffusion test. These observations suggest that the toxin of V. fluvialis differs from the known cholera toxin in receptor site, mode of action and antigenicity.
TL;DR: Because Bangladesh has suffered poverty frequent natural disasters and rapid population growth there has been a gradual decline in nutrient intake per individual and traditional dietary practices have undergone significant changes since 1937 which has contributed to the decline.
Abstract: Because Bangladesh has suffered poverty frequent natural disasters and rapid population growth there has been a gradual decline in nutrient intake per individual. Traditional dietary practices have undergone significant changes since 1937 which has contributed to the decline. In 1937 rice was the chief component of the diet at the village level with protein supplied by lentils peas Bengal green black and cow gram and kheshari. But the daily nutrient intake of poor people was better than that of today. Massive starvation during the famine in 1943 caused a change in dietary practices. People began to eat green leaves roots tubers and many unfamiliar foods because of the scarcity of cereal foods and the sharp increase in the price of rice. In 1970 a cyclone and a flood destroyed crops and people lived on food aid eating grain fish protein and milk powder. The war of independence in 1971 caused widespread destitution and 2 million people died. In the refugee camps in India children ate unfamiliar foods and gradually accustomed themselves to using wheat as their staple diet. In 1974 and 1977 crop failure and another flood caused more changes in dietary pattern. Although nutrition education programs have begun they have not been of benefit to the rural population. The pattern of nutrient intake has revealed weight faltering in females and levels are below the FAO recommendations for daily energy allowances. Nutrition survey reports from 1975 and 1982 show a gradual deterioration in nutritional status based on weight and height changes for poor children in rural areas. The decline is most evident in the 5-14 year age group with an accompanying increase in nutrition-related morbidity. Food production availability and economic constraints are the most important factors associated with the reduction in nutrient intake. Population density has also played a role in the reduction.