Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 1993"

The bangladesh cyclone of 1991: why so many people died.

Abstract: Living with natural disasters has become a way of life in Bangladesh. On the night of 29 April 1991 a severe cyclonic storm, accompanied by tidal surges up to 30 feet high, battered the coastal areas of Bangladesh for 3–4 hours. Thousands of people were killed and property worth billions of dollars was destroyed. After the cyclone, several studies, using epidemiological and anthropological methods, looked at the impact of the cyclone. It was estimated that over 67,000 people lost their lives. Women, children and the elderly were much more at risk and so were those from the socio-economically disadvantaged section of the population. Cyclone shelters were few in relation to need but proved very helpful in saving lives. At least 20 per cent more deaths would have occurred in the absence of these shelters. The article documents impressive improvements in Bangladesh's-ability to cope and makes recommendations for the future.

Diagnosis of pathogenic Entamoeba histolytica infection using a stool ELISA based on monoclonal antibodies to the galactose-specific adhesin.

Abstract: Monoclonal antibodies (MAbs) directed against pathogen-specific epitopes of the galactose adhesin of Entamoeba histolytica were used in an ELISA to detect antigen from pathogenic E. histolytica. Single stool specimens from 74 patients in Bangladesh were used. The ELISA for pathogenic E. histolytica was positive in all 12 stool specimens with pathogenic amebae subsequently cultured, in no stool specimens with nonpathogenic E. histolytica and in 2 of 40 stools with other or no intestinal parasites detected. Specificity and sensitivity of the assay for pathogenic E. histolytica were 97% and 100%, respectively. These preliminary data offer promise for an ELISA using MAbs to the galactose adhesin as a rapid and sensitive means to detect the presence of pathogenic E. histolytica infection in stool specimens.

Breast-feeding and the risk of life-threatening rotavirus diarrhea: prevention or postponement?

Abstract: This study attempted to assess the relationship between breast feeding and the risk of life-threatening rotavirus diarrhea among Bangladeshi infants and children younger than 24 months of age. A rural Bangladesh community was the base for this case-control study which included 102 cases with clinically severe rotavirus diarrhea detected in a treatment center-based surveillance system during 1985 and 1986 and 2587 controls selected in three surveys of the same community during the same calendar interval. Cases and controls were compared for the frequency of antecedent breast feeding patterns. Compared with other feeding modes exclusive breast feeding of infants was associated with significant protection against severe rotavirus diarrhea (relative risk [RR] = 0.10; 95% confidence interval [CI] = 0.03 0.34). However during the second year of life the risk of this outcome was higher in breastfed than in non-breastfed children (RR = 2.85; 95% CI = 0.37 21.71) and no overall protection was associated with breast feeding during the first 2 years of life (RR = 2.61; 95% CI = 0.62 11.02). Although exclusive breast feeding appeared to protect infants against severe rotavirus diarrhea breast feeding per se conferred no overall protection during the first 2 years of life suggesting that breast feeding temporarily postponed rather than prevented this outcome. While not detracting from efforts to promote breast feeding to alleviate the burden of diarrhea due to nonrotaviral enteropathogens these findings case doubt on whether such efforts will impact on the problem of severe rotavirus diarrhea. (authors)

Albendazole as a treatment for infections with Giardia duodenalis in children in Bangladesh

Abstract: Albendazole, a broad spectrum anthelmintic recently shown to be active in vitro against Giardia duodenalis, was given at 4 different dosages and compared with metronidazole in the treatment of children in Bangladesh infected with Giardia. Three stools were collected over 10 d after treatment and examined microscopically. Albendazole was found to be effective: single doses of either 600 mg (n = 103) or 800 mg (n = 114) successfully treated 62% and 75% of infections, respectively; 400 mg given either once a day for 3 d (n = 116) or for 5 d (n = 115) successfully treated 81% and 95% of all infections, respectively. Albendazole given daily at 400 mg for 5 d was as effective as metronidazole, which cured 97% of infections (n = 230). Albendazole may thus be an alternative treatment for infections with Giardia, while the moderate efficacy of single doses may provide a benefit in addition to its effects on several species of intestinal helminths.

Malnutrition, Cell-mediated Immune Deficiency, and Diarrhea: a Community-based Longitudinal Study in Rural Bangladeshi Children

Abstract: A community-based longitudinal study was conducted in Matlab, a rural area of Bangladesh, from May 1988 to April 1989 to examine the associations among malnutrition, cell-mediated immune deficiency, and the incidence of diarrhea in children under age 5 years. A cohort of 705 children was followed for a year; illnesses were ascertained every fourth day by home visits, anthropometric status was evaluated monthly, and cell-mediated immune status was assessed by a multiple antigen skin test at baseline and every 3 months. The diarrhea incidence rate was 4.6 episodes per year. Approximately three quarters of the children were below -2 z score weight for age and height for age, and about a third were below -2 z score weight for height. There was a modest association between undernutrition and the incidence of diarrhea. About 10-20% of the study children were anergic, and these children experienced a 50% increased incidence of diarrhea compared with their immunocompetent counterparts. This association persisted after controlling for the effects of age, nutritional status, socioeconomic status, and history of diarrhea in the previous 3 months. Malnutrition and cell-mediated immune deficiency were important independent risk factors for the occurrence of diarrhea and must both be considered in the design of interventions for the control of this condition.

Gender Preference and Birth Spacing in Matlab, Bangladesh*

Abstract: Gender preference, particularly son preference, is believed to sustain high fertility in many Asian countries, but previous research shows unclear effects. We examine and compare gender-preference effects on fertility in two otherwise comparable populations in Bangladesh that differ markedly in their access to and use of contraception. We expect, and find, stronger effects of gender preference in the population that has more access to contraception and higher levels of contraceptive use. Thus gender preference may emerge as a significant barrier to further national family planning efforts in Bangladesh. We find that if a woman has at least one daughter, the risk of a subsequent birth is related negatively to the number of sons. Women with no daughters also experience a higher risk of having a subsequent birth; this finding suggests that there is also some preference for daughters. Son preference is strong in both the early and later stages of family formation, but women also want to have at least one daughter after having several sons.

Use of the polymerase chain reaction and fluorescent-antibody methods for detecting viable but nonculturable Shigella dysenteriae type 1 in laboratory microcosms

Abstract: Epidemiological studies of shigellosis in Bangladesh have demonstrated that surface-water sources can act as foci of infection. Studies of laboratory microcosms have shown that shigellae become nonculturable but remain viable when exposed to environmental samples of water. The present study was carried out to detect viable but nonculturable Shigella dysenteriae 1 from laboratory microcosms by the polymerase chain reaction and the fluorescent-antibody techniques. S. dysenteriae 1 was inoculated into laboratory microcosms consisting of water samples collected from ponds, lakes, rivers, and drains in Bangladesh. The survival of S. dysenteriae in microcosms was assessed by viable counting on MacConkey agar. After 2 to 3 weeks, S. dysenteriae 1 became nonculturable but remained viable. After 6 weeks, this nonculturable but viable S. dysenteriae 1 was detected by both the polymerase chain reaction and the fluorescent-antibody methods. The viable but nonculturable state of S. dysenteriae 1 demonstrated in this study may be important for understanding the epidemiology of shigellosis.

Enteric adenovirus infection among infants with diarrhea in rural Bangladesh.

Abstract: A total of 4,409 stool specimens from infants less than 5 years of age seeking treatment for diarrhea in Matlab, Bangladesh, were tested for the presence of adenoviruses by using an enzyme immunoassay (EIA). EIA-positive stool samples were serotyped with monoclonal antibodies specific for adenovirus type 40 (Ad40) and Ad41 and group antigen, inoculated into Graham G293 cells, and retested by EIA. Of adenovirus-positive cultures, 125 (2.8%) specimens were confirmed as enteric adenoviruses (EAds), of which 51 (40.8%) were typed as Ad40 and 74 (59.2%) were typed as Ad41, and 12 of 4,409 (0.3%) were identified as nonenteric adenoviruses. A slight peak of incidence of EAd infection was observed in the cool, dry months, and an outbreak of Ad40 infections occurred in March 1988, when the detection rate of EAd reached 12.3%. Information on age, gender, and symptoms was available for 80 infants infected with adenovirus only. Age distribution was similar for types 40 and 41 and nonenteric adenovirus; the median ages were 11, 12, and 12 months, respectively. The ratio of males to females for the 80 infants varied according to serotype; Ad40 had the highest male/female ratio, 2.17. The symptoms experienced by the 80 children were similar for each adenovirus type. The most common clinical features of EAd infection were watery diarrhea (87.5%), more than eight loose bowel movements per day in the 24-h period prior to presentation (68.8%), with vomiting (80.0%), abdominal pain (76.3%), and low-grade fever (95.0%); these symptoms are significantly similar to symptoms of infants infected with group A rotavirus. EAd infection generally gave rise to mild to moderate dehydration, which is significantly similar to dehydration produced by infection with rotavirus.

Treatment of typhoid fever with ceftriaxone for 5 days or chloramphenicol for 14 days: a randomized clinical trial.

Abstract: To compare the therapeutic efficacy of ceftriaxone given once daily for 5 days and chloramphenicol given four times daily for 14 days, a controlled trial was carried out with 59 patients who were culture positive for Salmonella typhi. Ceftriaxone was given to 28 patients in once-daily intravenous doses of 75 mg/kg of body weight to children and 4 g to adults for 5 days; chloramphenicol was given to 31 patients at a dosage of 60 mg/kg/day until defervescence and then at 40 mg/kg/day to complete 14 days of treatment. All Salmonella isolates were susceptible to both antibiotics. Clinical cures (defervescence without complications, no relapse, and no need for further treatment) occurred in 79% of the patients treated with ceftriaxone and 90% of those treated with chloramphenicol (P = 0.37). On the third day of treatment, blood cultures were positive for S. typhi for 60% of the patients in the chloramphenicol group and 0% of the ceftriaxone group (P = 0.001). Defervescence occurred in half the patients in both groups during the first 7 days, but on days 9 to 13 after the start of treatment, nine patients in the ceftriaxone group, compared with six patients in the chloramphenicol group, remained febrile (P = 0.4). The median hematocrit and total leukocyte counts at day 14 were significantly lower for the chloramphenicol group than those for the ceftriaxone group (P = 0.01 and P = 0.02, respectively). These results indicate that the effects of therapy with ceftriaxone for typhoid fever differed from those of chloramphenicol therapy in that blood cultures became negative earlier, prolonged fever persisted in some patients, and bone marrow suppression was reduced. We conclude that a short, 5-day course of ceftriaxone is a useful alternative to conventional 14-day chloramphenicol therapy in the treatment of typhoid fever.

Maternal nutritional status as a determinant of child health.

Abstract: To determine the relationship between the nutritional status of the mother and that of the child, 339 children aged 3-36 months and their mothers in two urban hospitals and a community out-patient clinic, were studied. The weight and height of both children and their mothers were measured, and body mass indices (BMI) of the mothers were calculated. Socio-economic status, maternal educational level, and dietary information were recorded in a predesigned questionnaire. The child's nutritional status, as indicated by weight for age (as a percentage of NCHS median), was associated with the body mass index of the mother (P < 0.001), socio-economic status of the family (P < 0.001), and breastfeeding status of the child (P < 0.005) in a multivariate analysis after adjusting for several prognostic factors. The results indicate that maternal nutritional status is a proximate determinant of a child's nutritional status and should be considered in programmes aiming at improving child health.

Clonal relationships among classical Vibrio cholerae O1 strains isolated between 1961 and 1992 in Bangladesh.

Abstract: In Bangladesh, the replacement of classical Vibrio cholerae by the E1 Tor biotype in 1968 and the reappearance of the classical biotype and its coexistence with the E1 Tor biotype after 1982 were never adequately explained. We have analyzed 23 classical V. cholerae isolates collected between 1961 and 1968, 14 classical isolates collected between 1982 and 1992 from the capital city, Dhaka, and 6 classical V. cholerae isolates collected from two southern districts of Bangladesh and studied restriction endonuclease cleavage patterns of rRNA genes (ribotypes) to investigate the clonal relationships among the isolates. Southern blots of total DNA digested with restriction enzyme BamHI, BglI, EcoRI, HindIII, or PstI were probed, using a cloned Escherichia coli rRNA operon. While restriction enzymes BamHI, EcoRI, and PstI failed to differentiate the isolates on the basis of ribotyping, BglI and HindIII produced digestion patterns that allowed differentiation. Ribotyping the isolates with BglI and HindIII revealed five different clones (ribotypes IA, IB, IIA, IC, and IIC) of classical vibrios in Bangladesh. Strains belonging to ribotypes IA and IB were isolated in Dhaka before 1968, and one ribotype (IA) was again isolated between 1982 and 1992. Ribotype IIA was isolated in 1988 and 1989, when both clones (IA and IIA) of classical vibrios coexisted with the EI Tor vibrios. Isolates belonging to ribotypes IC and IIC were collected in the southern districts of Bangladesh and were clearly different from those collected in Dhaka between 1968 and 1992 by ribotyping analysis with BglI. These results support the previous assumption that classical vibrios were never completely replaced in Bangladesh and also demonstrate the existence of more than one genetically different clone of classical V. cholerae. Images

Growth and survival of Shigella flexneri in common Bangladeshi foods under various conditions of time and temperature.

Abstract: Survival and growth of Shigella flexneri were assessed in various foods, including boiled rice, lentil soup, milk, cooked beef, cooked fish, mashed potato, mashed brinjal, and raw cucumber. Growth at 25 and 37 degrees C and survival at 5 degrees C were observed by viable counts on MacConkey agar. The organism grew well in all tested foods and growth increased from 10(5) to 10(8) to 10(10) cells per ml or g within 6 to 18 h after inoculation at 25 and 37 degrees C.

Bacterial clump formation at the surface of liquid culture as a rapid test for identification of enteroaggregative Escherichia coli

Abstract: Forty-one strains of enteroaggregative Escherichia coli formed clumps visible as a scum at the surface of a Mueller-Hinton broth shaker culture. Sixty-one control strains of E. coli did not. Scum formation is a simple, rapid, and inexpensive test for the identification of enteroaggregative E. coli.

Characterization of Vibrio cholerae O139 Synonym Bengal Isolated from Patients with Cholera-Like Disease in Bangladesh

Abstract: Vibrio cholerae O139 (synonym Bengal), a novel serovar of V. cholerae, is the causative agent of large outbreaks of cholera-like illness currently sweeping India and Bangladesh. Eight randomly selected V. cholerae O139 isolates were studied for their biological properties, which were compared with those of V. cholerae O1 and other V. cholerae non-O1. The V. cholerae O139 isolates were characterized by the production of large amount of cholera toxin, hemagglutination, weak hemolytic properties, resistance to polymyxin B, lysogeny with, and production of, kappa type phage (4/8 isolates only), and resistance to both classical and El Tor-specific phages. Thus, V. cholerae O139 isolates had an overall similarity with V. cholerae O1 El Tor.

Effects of biosocial variables on changes in nutritional status of rural Bangladeshi children pre- and post-monsoon flooding.

Abstract: This study examined the effects of biosocial variables on changes in nutritional status of rural Bangladeshi children, aged less than 2 years, pre- and post-1987 monsoon flooding. Nutritional status was measured by weight for age: variables included were age, sex, sickness during 2 weeks preceding the survey, intake of vitamin A capsules, socioeconomic status of household, and mother's education. A multivariate logistic regression analysis revealed an adverse effect of flood on nutrition and the effect was dependent on sex of child and intake of vitamin A. After the flood the proportion of severely malnourished children was significantly greater among those who had not taken vitamin A. For boys the proportion with severe malnutrition increased after the flood and the increase was greater than for girls; however, boys always had a lower risk of severe malnutrition than girls.

A one-year survey of rotavirus strains from three locations in Bangladesh.

Abstract: Group A rotavirus strains from 3 locations in Bangladesh collected over one year were examined Serotypes 1–4 were found throughout in 2 locations, whereas an epidemic of RV diarrhoea due to a single rotavirus strain occurred in one location

Rapid detection of Shigella dysenteriae and Shigella flexneri in faeces by an immunomagnetic assay with monoclonal antibodies

Abstract: A rapid and sensitive method for the detection ofShigella dysenteriae type 1 andShigella flexneri serotypes in faeces based on capture of the bacteria with immunomagnetic particles is described. The particles were coated with either of two different monoclonal antibodies specific for the O-antigens ofShigella dysenteriae type 1 andShigella flexneri serotypes. Captured bacteria were detected by an enzyme immunoassay with O-antigen specific rabbit antiserum. The whole assay required 2 to 3 hours to perform and the sensitivity limit was 103 cfu/ml as determined by viable cell counting. One hundred and fifty enterobacteria strains, including 100Shigella strains from a strain collection, and 302 fresh faecal samples were used for the study. AllShigella dysenteriae type 1 andShigella flexneri culture-positive faecal samples were positive in the immunomagnetic assay. In addition 18 of 252 culture-negative faecal samples were positive. The immunomagnetic assay was compared with latex agglutination and indirect immunofluorescence using culture as the reference method. The immunomagnetic assay had a sensitivity of 100%, latex agglutination a sensitivity of 72% with 28% false-negative results, and indirect immunofluorescence a sensitivity of 95%. The immunomagnetic assay was superior in sensitivity since it also detectedShigella in faecal samples up to two days after antibiotic therapy had been started, which both latex agglutination and indirect immunofluorescence failed to do. The high sensitivity in detecting live and dead bacteria, and the ease of performance of the immunomagnetic assay render it an attractive method for detection ofShigella.

Can infants and young children eat enough green leafy vegetables from a single traditional meal to meet their daily vitamin A requirements

Abstract: To evaluate the feasibility of providing adequate vitamin A precursors to meet the daily need from a meal oftraditionally cooked green leafy vegetables and boiled rice and to understand mothers' perceptions and acceptance of leafy vegetables for infants and young children, 118 children aged 6 months to 3 years and their mothers were studied. The mothers were interviewed regarding their acceptance and perceptions about giving leafy vegetables to their young children. Their children were served a measured amount of rice and cooked leafy vegetables and mothers were asked to feed the child within about half an hour. Median intakes of leafy vegetables in children aged 6-11 months, 12-17 months and 18-35 months were 41 g, 71 g and 129 g respectively (in terms of raw green leaf). Approximately 40 g green leaf provides the recommended daily allowance for vitamin A precursors. 77% of the under-1-year-old children were breast-fed. The breast-fed children had a lower intake of vegetables than the completely weaned children. 87% of the children were found to like vegetables, 89% of the mothers liked to give vegetables to their children and 74% of the mothers answered that vegetables were good for health. Only two mothers (1.5%) refused to feed their children the leafy vegetables. The results show that leafy vegetables are acceptable to most of the mothers, and that children can eat enough leafy vegetables to meet a day's need of vitamin A precursors. Feasibility of feeding children enough green leafy vegetables at home on a regular basis needs further study.

Production of mucinase and neuraminidase and binding of Shigella to intestinal mucin.

Abstract: Production of mucinase and neuraminidase by Shigella spp. and their ability to bind to mucin was investigated. All four species of Shigella produced these enzymes. Virulent and avirulent pairs of Shigella did not differ in their ability to produce the enzymes after 18 h of growth. However, a significant difference in neuraminidase production was noted in Shigella dysenteriae type 1 and S. boydii (12-15) at 10 h growth. Avirulent strains of S. dysenteriae type 1, S. flexneri 2a, and S. boydii bound significantly more amounts of mucin than their virulent counterparts.

Effects of family sex composition on fertility preference and behaviour in rural Bangladesh.

Abstract: The hypothesis of this study is that the effect of sex preference on fertility is dependent on the level of contraceptive use and the relative importance given to sex composition and family preference in determining contraceptive use. The effect of sex composition under different contraceptive prevalence conditions is examined by comparing in the Matlab intervention area 2 different periods: 1977-82 and low contraceptive use and 1984-88 and higher use. The study area comprised 149 villages and a total population of 187523. This research used data on 2111 women in the 1977 survey and 3140 women in the 1984 survey. Survey data were linked with the Matlab demographic surveillance system. The results showed that between 1977 and 1984 there was an increase in the percentage of women desiring no more children a decline in family size preference and an increase in contraceptive use. Contraceptive use was 20% for modern methods in 1977 and 38% in 1984. The general finding was that the higher the number of sons at any family size level the higher the percentage of women desiring no more children. The effect of sex preference on the percentage of women desiring no more children did not change between 1977 and 1984 (9.5% during 1978-82 and 19.5% during 1984-88); what did change was the percentage of women desiring no more children from 39.0% to 54.7%. Change would have occurred is there had been no sex preference; expected changes would have decreased the desire for no more children from 14.6% in 1977 to 16.4% in 1984. Without sex preference contraceptive use would also have declined from an increased prevalence in 1977 of 20.4% and 9.9% in 1984. the sex preference effect measure (SPEM) of Arnold (1985) was used and modified to quantify the effect of sex preference on fertility preferences and behavior. Fertility was consistently and negatively related to the number of living children. Without sex preference fertility would have decreased 9.5% during 1978-82 and 10.5% during 1984-88. Family size preference had increased in its importance in determining contraceptive use. The effect of sex composition on subsequent fertility remained constant between the 2 periods.

Electron microscopic study of the attachment and penetration of rabbit intestinal epithelium by Providencia alcalifaciens

Abstract: Ilea of adult rabbits with removable ileal ties (RITARD model) that developed diarrhoea and ileal loops of adult rabbits after inoculation with Providencia alcalifaciens, isolated from two patients with diarrhoea, were studied by transmission electron microscopy for enterocyte-bacterial interactions. Two modes of entry of bacteria into epithelial cells were seen: one directly by endocytosis associated with polymerization of cytoskeletal components and the other by disruption of tight junctions with entry into and proliferation in intercellular spaces.

Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control study.

Abstract: The role of common diarrheal pathogens in dehydration was examined in children with acute watery diarrhea who attended the treatment center of the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. Two hundred sixty-nine children with moderate or severe dehydration were matched with 700 children with no dehydration. Vibrio cholerae O1 infections were 5.5 times more likely to be associated with dehydration than in cases without this agent. No significant association could be found between the presence of enterotoxigenic Escherichia coli. Campylobacter jejuni, or rotavirus infection and dehydration. These results were obtained after simultaneously controlling for age, lack of oral rehydration therapy (ORT) at home, protein energy malnutrition, withdrawal of breast-feeding during diarrhea at home, poor housing, longer duration of diarrhea at home, and delay in reaching the treatment center. The cholera isolation rate was only 4.5% and thus explains only a small proportion of the cases of dehydration. In cholera-endemic areas, a strategy to prevent dehydration in small children is needed to ensure correct use of ORT at home, prompt referral, and the use of a suitable antibiotic when cholera is clinically suspected.