Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1990"

Birth intervals and childhood mortality in rural Bangladesh.

Abstract: This study investigates the relationship between birth intervals and childhood mortality, using longitudinal data from rural Bangladesh known to be of exceptional accuracy and completeness. Results demonstrate significant but very distinctive effects of the previous and subsequent birth intervals on mortality, with the former concentrated in the neonatal period and the latter during early childhood. The impact of short birth intervals on mortality, however, is substantially less than that found in many previous studies of this issue, particularly for the previous birth interval. The findings are discussed in terms of the potential for family planning programs to contribute to improved child survival in settings such as Bangladesh.

Death in Shigellosis: Incidence and Risk Factors in Hospitalized Patients

Abstract: The total number of admissions and deaths of patients with shigellosis were ascertained at the Dhaka Treatment Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh, 1974-1988, and the characteristics of 67 patients who died were compared with those of 134 discharged alive. Of 9780 Shigella-infected inpatients, 889 (9.1%) died; 32.3% of deaths occurred in children less than 1 year of age. Fatality rates were highest (10.3%) in Shigella sonnei-infected patients and lowest (6.7%) in Shigella dysenteriae type 1-infected patients. Age less than 1 year, lack of breast feeding in patients 1-2 years of age, hypothermia, severe malnutrition, severe dehydration, altered consciousness, abdominal distension, thrombocytopenia, hypoproteinemia, hyponatremia, hypoglycemia, renal failure, and bacteremia were all significantly more common in case patients. In a multivariate analysis, younger age, decreased serum protein, altered consciousness, and thrombocytopenia were predictive of death. Thus in Bangladesh the fatality rate for hospitalized patients infected with any species of Shigella remains high despite relatively intensive inpatient care, and young, hypoproteinemic patients are at greatest risk of fatal illness.

Reduction in diarrhoeal diseases in children in rural Bangladesh by environmental and behavioural modifications

Abstract: The impact of a water, sanitation and hygiene education intervention project on diarrhoeal morbidity in children under 5 years old was evaluated in a rural area of Bangladesh. Data were collected throughout 1984-1987, covering both pre- and post-intervention periods, from an intervention and a control area. The 2 areas were similar with respect to most socio-economic characteristics and baseline levels of diarrhoeal morbidity. The project showed a striking impact on the incidence of all cases of diarrhoea, including dysentery and persistent diarrhoea. By the end of the study period, children in the intervention area were experiencing 25% fewer episodes of diarrhoea than those in the control area. This impact was evident throughout the year, but particularly in the monsoon season, and in all age groups except those less than 6 months old. Within the intervention area, children from households living closer to handpumps or where better sanitation habits were practised experienced lower rates of diarrhoea. These results suggest that an integrated approach to environmental interventions can have a significant impact on diarrhoeal morbidity.

Hypoglycemia during diarrhea in childhood. Prevalence, pathophysiology, and outcome.

Abstract: To determine the frequency and outcome of hypoglycemia during diarrhea in childhood, we screened 2003 consecutive patients less than 15 years of age who were admitted to a diarrhea treatment center in Dhaka, Bangladesh. Hypoglycemia, defined as a blood glucose concentration less than 2.2 mmol per liter, was found in 91 patients (4.5 percent), 39 (42.9 percent) of whom died. We also measured the plasma concentrations of glucoregulatory hormones and gluconeogenetic substrates in 46 of the patients with hypoglycemia who were 2 to 15 years old and in 25 normoglycemic patients matched with them for age and weight. The patients with hypoglycemia had had diarrhea for less time than the normoglycemic patients (median, 12 vs. 72 hours; P less than 0.05), and their last feeding had been 18 hours before admission, as compared with 9 hours for the normoglycemic patients (P less than 0.05). The groups were similar in terms of nutritional status, the proportion of patients who had fever, and the types of pathogens recovered from stool samples. The plasma C-peptide concentrations were low (less than 0.30 nmol per liter) in all the hypoglycemic patients. As compared with the normoglycemic patients, the patients with hypoglycemia had elevated median plasma concentrations of glucagon (44 vs. 11 pmol per liter; P = 0.001), epinephrine (3400 vs. 1500 pmol per liter; P = 0.012), norepinephrine (7500 vs. 2900 pmol per liter; P = 0.002), and lactate (3.5 vs. 2.1 mmol per liter; P = 0.020) and similar alanine and beta-hydroxybutyrate concentrations. Eighteen hypoglycemic patients with severe malnutrition had been ill longer than 26 better-nourished patients with hypoglycemia (median duration of illness, 18 vs. 10 hours; P = 0.023) and had lower median plasma concentrations of lactate (1.9 vs. 3.9 mmol per liter; P = 0.021) and alanine (173 vs. 293 micromol per liter; P = 0.040). We conclude that hypoglycemia is a major cause of death in association with diarrhea. Because the glucose counterregulatory hormones were appropriately elevated in the children with diarrhea and hypoglycemia, whereas the gluconeogenetic substrates were inappropriately low, we further conclude that the hypoglycemia observed in such patients is most often due to the failure of gluconeogenesis.

Therapy for Shigellosis. II. Randomized, Double-Blind Comparison of Ciprofloxacin and Ampicillin

Abstract: Ciprofloxacin, 500 mg every 12 h, was compared with ampicillin, 500 mg every 6 h, both given for 5 days, in the treatment of 121 adult males hospitalized with severe shigellosis. Treatment was randomized and double-blinded. At the completion of treatment, there was resolution or marked improvement in symptoms in 57 (95%) of 60 ciprofloxacin-treated patients, 23 (88%) of 26 ampicillin-treated patients infected with an ampicillin-susceptible strain of Shigella, and 15 (43%) of 35 ampicillin-treated patients infected with an ampicillin-resistant strain of Shigella (ampicillin-R group) (P less than .01, ciprofloxacin or ampicillin groups vs. ampicillin-R group). Bacteriologic failure was less common (P less than .025) in the ciprofloxacin group (0/60) than in the ampicillin (3/26, 12%) or ampicillin-R groups (5/35, 14%). Ciprofloxacin-treated patients had a mean of 29 stools during the study, compared with 46 for ampicillin-treated patients (P = .004). Thus ciprofloxacin seems to be an effective, and perhaps superior, alternative to ampicillin in treating patients with shigellosis.

Breast feeding and the risk of severe cholera in rural bangladeshi children

Abstract: The association between breast feeding and the risk of severe cholera was examined in a case-control study of rural Bangladeshi children under 36 months of age who were studied in 1985-1986 during a field trial of killed oral cholera vaccines. A total of 116 cases who were treated for severe cholera were compared with 464 age-matched community controls without severe cholera. Overall, the odds ratio relating breast feeding to severe cholera (0.30, p less than 0.0001) reflected a 70% reduction in the risk of severe cholera among breast-fed children. The estimated reduction of risk declined with age, but was clearly evident in children up to 30 months of age. Although the association between breast feeding and a reduced risk of severe cholera was not significantly greater in children of mothers who had received cholera vaccine than in children whose mothers had received placebo during the trial, maternal vaccination per se was suggestively associated with a reduced risk of severe cholera in their nonvaccinated children (odds ratio = 0.53, p = 0.05). These results indicate that breast feeding was associated with a substantial reduction of the risk of severe cholera and raise the possibility that vaccination of mothers may provide protection to their young children in endemic settings.

Bacterial contamination of weaning foods and drinking water in rural Bangladesh

Abstract: The aim of this study was to determine what weaning foods and food preparation practices expose children to a high risk of diarrhoeal disease through exposure to a contaminated diet. Bacterial contamination of 897 food and 896 drinking water samples was assessed in a water and sanitation intervention project. The geometric mean of faecal coliforms per g or ml was 7.5 x 10(3) in left-over rice. 1.4 x 10(2) in other types of boiled rice, 2.5 x 10(2) in milk, 4.8 in household drinking water, and 3.5 in bread. Multiplication of faecal coliforms occurred when there was a delay of more than 4 h between preparation and consumption of food. All samples were more contaminated in the rainy than in the dry season. Strategies to reduce contamination should therefore focus on 'wet' foods, early consumption after preparation, and re-heating of left-over foods. Understanding the reasons for the faulty practices is also essential to the formulation of effective measures.

Perinatal Mortality in Matlab, Bangladesh: A Community-Based Study

Abstract: In 1986 as part of the ongoing Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research Bangladesh health workers regularly visited households in Matlab district to record vital events and other demographic data. They recorded 497 fetal deaths and early neonatal deaths. Low birth weight contributed to 25% of fetal deaths followed by prolonged labor (19%) maternal medical problems (13%) malpresentation at term (12%) and twins (2%). The cause of fetal death for 28% could not be determined. Similarly low birth weight causes 63% of very early neonatal deaths followed by prolonged labor (31%) and 37% and 15% respectively in 4-7 day old neonates. The 2nd leading cause of death for 4-7 day old neonates was neonatal tetanus (25%w0. Males were more likely to die from tetanus than females (relative risk=4.3; p=.015). The women at lowest risk included those 20-24 years old who were pregnant for the 2nd-3rd time those 25-29 years old who were pregnant for the 4th-5th time and those 30-34-years old who were pregnant for the 6th-7th time. Even though the perinatal mortality rates in the study and comparison areas in Matlab did not significantly differ (74 and 75 total births/1000) the rate fell significantly from 82 (1979) to 65 (1986) in the area where maternal and child health and family planning services (MCH-FP) existed (p<.001). Further the rate declined significantly more in the 2nd half of the study period (1983-1986) than in the 1st half (1979-1982) in the MCH-FP area (p<.002). Moreover the difference between the 2 areas was only significant in the 2nd half (p<.04). Perinatal mortality was highest from August to December. The researchers credit the tetanus toxoid as having more of an impact on reducing the perinatal mortality in the study area than family planning interventions.

Epidemiology of shigellosis in Teknaf, a coastal area of Bangladesh: a 10-year survey.

Abstract: The epidemiological data on shigellosis in Teknaf, a coastal area of Bangladesh, were reviewed for a 10-year period (1975-84). Certain similarities and differences were observed in the epidemiology of the disease in Teknaf when compared with urban Dhaka and rural Matlab. Similarities included: round-the-year infection with two peaks, one in the monsoon period and the other in the winter period; high male to female attendance ratio at the treatment centre; the predominance of infection in the under-15-year age group; high mortality rate in the under-5-year age group of both sexes and in females of all age groups; the multiple drug resistance of organisms. Differences included the higher isolation rate of organisms in Teknaf (42.1% as against 11-12% in Dhaka and Matlab) and the preponderance of Shigella dysenteriae 1 infection in females in Teknaf. The unusually high isolation rate of shigella makes Teknaf the area with the highest incidence of shigellosis in Bangladesh.

Randomised double blind trial of single dose doxycycline for treating cholera in adults.

Abstract: OBJECTIVE--To compare the efficacy of a single dose of doxycycline (200 or 300 mg) with the standard multiple doses of tetracycline in patients with cholera. DESIGN--Randomised double blind controlled trial. Patients were given a single 200 mg dose of doxycycline, a single 300 mg dose of doxycycline, or multiple doses of tetracycline (500 mg, six hourly intervals). SETTING--Hospital in Bangladesh treating diarrhoea. PATIENTS--261 Patients aged over 15 admitted to the hospital with severe dehydration due to acute watery diarrhoea associated with Vibrio cholerae. All vibrios isolated from the stools and rectal swabs of patients, including those patients with prolonged excretion of vibrios, were sensitive to tetracycline. The stools of all patients at admission were negative for shigella and salmonella. INTERVENTIONS--All patients received rapid intravenous acetate solution for the first four hours after admission to hospital. They were then entered in the study and randomised. Oral rehydration was started immediately after the intravenous treatment. If signs of severe dehydration reappeared during oral treatment patients were given rapid intravenous acetate solution until dehydration was fully corrected. MAIN OUTCOME MEASURES--Stool output in first 24 hours and till diarrhoea stopped, total intake of oral rehydration fluid, duration of diarrhoea, and excretion of vibrio after receiving antibiotic treatment. RESULTS--The median stool outputs during the first 24 hours (275 ml/kg body weight) and till diarrhoea stopped (296 ml/kg body weight) were significantly higher in patients receiving 200 mg doxycycline as a single dose than in patients receiving either standard tetracycline (242 ml/kg body weight and 254 ml/kg body weight) or 300 mg doxycycline (226 ml/kg body weight and 255 ml/kg body weight). Similarly, median consumption of oral rehydration solution (18.45 l) was significantly higher in patients receiving 200 mg doxycycline than in patients receiving either 300 mg doxycycline (16.10 l) or standard tetracycline (14.80 l). Almost equal numbers of patients in each group required unscheduled intravenous acetate solution to correct dehydration during antibiotic treatment. Patients treated with doxycycline (low or high dose), however, had more prolonged excretion of bacteria. CONCLUSIONS--A single 300 mg dose of doxycycline is as effective as the standard multiple dose tetracycline treatment for cholera in terms of stool output, duration of diarrhoea, vomiting, and requirement for oral rehydration solution.

Iron in tubewell water and linear growth in rural Bangladesh.

Abstract: The growth of 694 children from rural Bangladesh was studied. Children drinking water containing greater than 1 mg iron/l (n = 628) were significantly taller than those drinking less than 1 mg iron/l (n = 66): their mean (SD) height for age Z score was -2.10 (1.34) compared with -2.45 (1.24), p less than 0.05. This suggests that iron deficiency may contribute to growth retardation in poor communities.

The effect of maternal and child health and family planning services on mortality: is prevention enough?

Abstract: OBJECTIVE--To examine the impact on mortality of a child survival strategy, mostly based on preventive interventions. DESIGN--Cross sectional comparison of cause specific mortality in two communities differing in the type, coverage, and quality of maternal and child health and family planning services. In the intervention area the services were mainly preventive, community based, and home delivered. SUBJECTS--Neonates, infants, children, and mothers in two contiguous areas of rural Bangladesh. INTERVENTIONS--In the intervention area community health workers provided advice on contraception and on feeding and weaning babies; distributed oral rehydration solution, vitamin A tablets for children under 5, and ferrous fumarate and folic acid during pregnancy; immunised children; trained birth attendants in safe delivery and when to refer; treated minor ailments; and referred seriously ill people and malnourished children to a central clinic. MAIN OUTCOME MEASURES--Overall and age and cause specific death rates, obtained by a multiple step "verbal autopsy" process. RESULTS--During the two years covered by the study overall mortality was 17% lower among neonates, 9% lower among infants aged 1-5 months, 30% lower among children aged 6-35 months, and 19% lower among women living in the study area than in those living in the control area. These differences were mainly due to fewer deaths from neonatal tetanus, measles, persistent diarrhoea with severe malnutrition among children, and fewer abortions among women. CONCLUSIONS--The programme was effective in preventing some deaths. In addition to preventive components such as tetanus and measles immunisation, health and nutrition education, and family planning, curative services are needed to reduce mortality further.

Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh.

Abstract: This study examined the role of food and water contamination in a health impact evaluation of a water and sanitation intervention project. Although lower diarrhoea rates were found in the improved area no consistent difference in food and water contamination was observed between areas. Furthermore, no relationship was found between contamination and diarrhoea in either area, even after controlling for the nutritional status of children. These results imply that other vehicles of transmission might be more important than food and water in diarrhoeal transmission. The focus of interventions should therefore be on changing behaviours to improve overall hygiene.

Transmission of diarrhoea in two crowded areas with different sanitary facilities in Dhaka, Bangladesh.

Abstract: To determine the importance of water-borne and water-washed transmission of diarrhoea we compared the degree of contamination of children's hands and drinking water with their diarrhoeal morbidity. Diarrhoeal incidence in 137 children aged 1-6 years was obtained through fortnightly home visits during the calendar year 1985. Bacterial contamination of hands and drinking water was assessed semi-quantitatively by direct contact using agar-coated slides incorporating a selective medium permitting growth of Enterobacteriaceae (Hygicult, Orion Diagnostica, Finland). Results were expressed as 2-day mean log of colony forming units per gram (cfu/g). Children were studied in two densely populated urban areas: 56 children in one area with latrines and tubewells and 81 children in the other without such facilities. Mean diarrhoea attack rates were lower in the better sanitary area (2.5 vs 3.2, P less than 0.05) as were mean log levels of water contamination (3.1 cfu/g vs 4.3 cfu/g, P less than 0.001). There was no significant correlation between water contamination and diarrhoeal incidence on an individual basis. However, in both areas diarrhoea incidence was significantly correlated with the degree of contamination of hands. After adjusting for age the risk of diarrhoea increased significantly for children with more contaminated hands in the unimproved area. This relationship strongly supports the promotion of handwashing as a method of controlling diarrhoeal diseases and, by implication, the greater importance of water quantity compared to quality.

Cryptosporidiosis: a cause of diarrhea in Bangladesh.

Abstract: Fecal samples from diarrheal patients and non-diarrheal controls were examined for Cryptosporidium oocysts in a year-long prospective study at a diarrhea treatment center in Dhaka, Bangladesh. Cryptosporidium oocysts were detected in 42 (3%) of 1,382 diarrheal patients but in none of 235 non-diarrheal controls. In 32 (76%) of 42 patients, no other enteropathogens were detected. Children less than 5 years of age were more commonly infected than older children (4.8% vs. 1.6%, P greater than 0.05) and adults (4.8% vs. 0.2%, P less than 0.01). A higher number of cases were detected during hot and humid months (April--July). Nineteen children less than 5 years of age (index cases) and their 71 family members were followed for 3 weeks after the release of the index cases from the hospital. Diarrhea continued for greater than 14 days (persistent diarrhea) in 8 (32%) index children. Cryptosporidium oocysts were detected in 1 (12.5%) of 8 family members who developed diarrhea during the follow-up period. Index cases excreted oocysts for 3-28 days (12.37 +/- 8.35 days). Almost all the patients recovered with oral rehydration. Cryptosporidium ssp. cause self-limited diarrhea episodes in children less than 5 years of age in Bangladesh, with a low frequency of intrafamilial transmission.

Does malnutrition predispose to diarrhoea during childhood? Evidence from a longitudinal study in Matlab, Bangladesh.

Abstract: It is posited that diarrhoeal illness during one period has influence on diarrhoeal illness in a subsequent period. This relationship may potentially mask the association between malnutrition and subsequent diarrhoea. To test this, we analysed data on cross-sectional anthropometry in combination with data on diarrhoeal morbidity collected longitudinally in a community-based study of 1262 children (aged 6-60 months) during March-December, 1976, in Matlab, Bangladesh. The results confirmed the posited relationship between diarrhoeal morbidities in two consecutive periods and showed that the risks of diarrhoeal attack and longer diarrhoeal illness increased more than threefold during the 2 months following diarrhoeal illness during the preceding 2 months (previous diarrhoea). Children with no previous diarrhoea indicated a positive association between malnutrition and subsequent diarrhoea, but the pattern found among children with previous diarrhoea was not understandable. Logistic regression analyses performed separately for younger and older children showed that controlling for effects of previous diarrhoea, maternal illiteracy and household poverty, severe malnutrition as assessed by weight-for-age was found to be strongly associated with the risk of longer diarrhoeal illness in a 2-month interval in the age group 24-60 months; in the same age group the association with the risk of diarrhoeal attack was significant at the 10 per cent level. No such association for malnutrition, however, was found in the age group 6-23 months.

Persistent diarrhoea: clinical efficacy and nutrient absorption with a rice based diet.

Abstract: Twenty six infant boys, aged 4 to 18 months, suffering from persistent diarrhoea and 25 age matched healthy controls without diarrhoea were given a diet based on rice powder, egg white, glucose, and soya oil. The clinical efficacy of the diet was studied and a 72 hour metabolic balance study was done. Twenty one patients recovered from diarrhoea within seven days. Median coefficients of absorption of nutrients in persistent diarrhoea patients were 68.0% (range 28.0 to 92.0) for total energy, 60.0% (range 21.0 to 97.0) for fat, 53.0% (range -122.0 to 82.0) for nitrogen, and 81.0% (range 23.0 to 97.0) for carbohydrates. The corresponding values among the control subjects were 90.0% (range 76.0 to 99.0), 95.0% (range 71.0 to 99.0), 70.0% (range 10.0 to 95.0), and 93.0% (range 85.0 to 98.0) respectively. Absorption of all macronutrients in the control subjects was on average significantly higher than in the patients. Nutrient absorption is substantially reduced in persistent diarrhoea and a rice based diet is clinically effective in most patients.

Twinning rates in a rural area of Bangladesh.

Abstract: In this study we investigate the incidence of twin births over a period of 16 years in a rural area of Bangladesh using data from the Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research. Over the study period twinning rates fluctuated between 7.8 and 11.2 per 1000 live births. The twinning rate was strongly correlated with maternal age; the rate for mothers over 35 years of age was about 3 times higher than for mothers younger than 20 years. The variation in twinning rate with maternal age is due to the variation in dizygotic twinning; the rate of monozygotic twinning is almost constant for all ages. Twinning rates were higher in the treatment area than in the comparison area after controlling for maternal age and parity. The rates were lower for monozygotic twinning and higher for dizygotic twinning in the treatment area than in the comparison area. Seasonality was observed for both twins and singletons, but the peak for twinning precedes that for singleton births by more than a month.

Role of plasmids in virulence-associated attributes and in O-antigen expression in Shigella dysenteriae type 1 strains.

Abstract: Summary The association of plasmids with virulence characters and O-antigen expression was studied in two virulent and seven avirulent mutant strains of Shigella dysenteriae type 1. Deletion of a 12-Mda segment from a 140-Mda plasmid in two smooth avirulent mutants made the derivatives avirulent in the Sereny test and noninvasive in HeLa cells. The mutants were unable to bind Congo red, and did not express the virulence marker antigen. Mutants completely lacking the 140-Mda plasmid also showed similar avirulent characters. However, rough mutants retained the ability to bind Congo red. Our results indicate that the essential gene(s) for virulence may be located on the 140-Mda plasmid, a small deletion from which may lead to avirulence. This deletion did not affect the protein antigen expression nor change their antigenicity. Analysis of lipopolysaccharide (LPS) patterns showed that strains containing the 6-Mda plasmid produced the complete LPS and were smooth, whereas strains containing either the 140- or a 4- or 2-Mda plasmid, in the absence of the 6-Mda plasmid, produced smaller amounts of O antigen and were rough. Western-blot analysis and crossed immuno-electrophoresis gave similar results. The 140-, 4-, or 2-Mda plasmid, in the absence of the 6-Mda plasmid, may code for non-specific galactosyl transferase-like activity which can add, non-specifically and at a reduced level, the galactose residue (the first sugar in the O antigen repeat unit) to the LPS core. This permits the completion of the O-antigen side chain in the absence of the rfp gene (present in the 6-Mda plasmid) which encodes the specific galactosyl transferase involved in O-antigen biosynthesis. Thus, our findings indicate that the 6-Mda plasmid of S. dysenteriae type 1 has an important role in the synthesis of the O-antigen side chains of LPS. However, the 140-, 4- and 2-Mda plasmids may also be indirectly responsible for these properties, but this may be less pronounced in the absence of the 6-Mda plasmid.

Fatal dysentery in rural Bangladesh.

Abstract: The purpose of this study was to find out the actual circumstances which lead to dysentery-related deaths in the rural Bangladesh. The Community Health Workers of the International Centre for Diarrhoeal Disease Research, Bangladesh have been collecting records of all deaths at the rural area of Matlab through a surveillance system since 1963. A review of existing data on dysentery-related deaths from this area during 1976-1981 suggests that deaths in children followed a recurring seasonal pattern with an increase during the post-monsoon season of August-November of each year. This seasonal pattern of death was not evident among adults. The overall dysenteric death rate during 1978-1981 was 13.3 per 10,000 population per year. The highest rates were in patients of the two extreme age groups. Deaths reported recently by the health workers were re-investigated. Although the causal agents producing fatal dysentery in most patients in the community remained unidentified, it was likely to be species of Shigella in childhood deaths. To identify clinical determinants of a fatal outcome, a case-control analysis was done with patients hospitalised with dysentery in 1980. The risk factors shown to be significantly associated with deaths were: longer median duration of illness (p = less than 0.001), female sex (p = 0.039), signs of respiratory infection (p = less than 0.001) and severe malnutrition (p = 0.002).

Makeshift treatment centre during a cholera epidemic in Bangladesh.

Abstract: Access difficulty to the health facilities often is a major problem for cholera patients requiring medical care, particularly in rural areas. In this context, during a number of cholera outbreaks, makeshift field treatment centres were introduced. We present here data collected at one such makeshift treatment centre, and discuss its effectiveness as a means of delivering live-saving care in rural Bangladesh

Child survival: should the strategy be redesigned? Experience from Bangladesh

Abstract: The paper examines recent studies which focus on the effectiveness of primary healthcare activities and concludes that in Bangladesh the potential for substantially improving child survival and growth is severely curtailed by unbalanced strategies. More specifically the paper argues; 1) that focusing interventions on at-risk children at 6 months of age is more effective and less costly in preventing malnutrition than monthly monitoring of growth; 2) that attempts to reduce deaths from diarrhea with vertical oral rehydration therapy programs will not have a major impact unless other interventions are directed to the persistent diarrhea-malnutrition complex; 3) that the impact of diarrhea on growth is transient and community efforts to control diarrhea are unlikely to show a sustained improvement in childrens nutritional status; 4) that the benefits of breastfeeding are still underestimated in view of its vital role in preventing deaths in poor malnourished children; and 5) that given the numerous constraints on full Expanded Program on Immunization (EPI) implementation tetanus toxoid and measles vaccination form the most cost-effective immunization strategy for child survival. (authors)

Zymodemes of entamoeba histolytica in dhaka, bangladesh

Abstract: Stool samples containing Entamoeba histolytica were obtained from two sources: an urban hospital and an urban slum. Using the enzyme patterns of three enzymes (E.C.2.7.1.1 hexokinase, E.C.5.3.1.9 g...