Showing papers by "International Centre for Diarrhoeal Disease Research, Bangladesh published in 2001"

Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums.

Abstract: Objectives. To describe breastfeeding practices and investigate the influence of exclusive breastfeeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhea. Methods. A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and followed from birth to 12 months of age. After enrollment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported deaths. Proportional hazards regression models were used to estimate the effect of breastfeeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and diarrhea were measured. Results. The proportion of infants who were breastfed exclusively was only 6% at enrollment, increasing to 53% at 1 month and then gradually declining to 5% at 6 months of age. Predominant breastfeeding declined from 66% at enrollment to 4% at 12 months of age. Very few infants were not breastfed, whereas the proportion of partially breastfed infants increased with age. Breastfeeding practices did not differ between low and normal birth weight infants at any age. The overall infant mortality rate was 114 deaths per 1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold higher risk of infant deaths resulting from all causes and 2.40- and 3.94-fold higher risk of deaths attributable to ARI and diarrhea, respectively. Conclusion. The important role of appropriate breastfeeding practices in the survival of infants is clear from this analysis. The reduction of ARI deaths underscores the broad-based beneficial effect of exclusive breastfeeding in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhea deaths.

Molecular analysis of antibiotic resistance gene clusters in vibrio cholerae O139 and O1 SXT constins.

Abstract: Many recent Asian clinical Vibrio cholerae E1 Tor O1 and O139 isolates are resistant to the antibiotics sulfamethoxazole (Su), trimethoprim (Tm), chloramphenicol (Cm), and streptomycin (Sm). The corresponding resistance genes are located on large conjugative elements (SXT constins) that are integrated into prfC on the V. cholerae chromosome. We determined the DNA sequences of the antibiotic resistance genes in the SXT constin in MO10, an O139 isolate. In SXTMO10, these genes are clustered within a composite transposon-like structure found near the element's 5′ end. The genes conferring resistance to Cm (floR), Su (sulII), and Sm (strA and strB) correspond to previously described genes, whereas the gene conferring resistance to Tm, designated dfr18, is novel. In some other O139 isolates the antibiotic resistance gene cluster was found to be deleted from the SXT-related constin. The El Tor O1 SXT constin, SXTET, does not contain the same resistance genes as SXTMO10. In this constin, the Tm resistance determinant was located nearly 70 kbp away from the other resistance genes and found in a novel type of integron that constitutes a fourth class of resistance integrons. These studies indicate that there is considerable flux in the antibiotic resistance genes found in the SXT family of constins and point to a model for the evolution of these related mobile elements.

Amebiasis and Mucosal IgA Antibody against the Entamoeba histolytica Adherence Lectin in Bangladeshi Children

Abstract: Amebiasis is the third leading parasitic cause of death worldwide, and it is not known whether immunity is acquired from a previous infection. An investigation was done to determine whether protection from intestinal infection correlated with mucosal or systemic antibody responses to the Entamoeba histolytica GalNAc adherence lectin. E. histolytica colonization was present in 0% (0/64) of children with and 13.4% (33/246) of children without stool IgA anti-GalNAc lectin antibodies (P= .001). Children with stool IgA lectin-specific antibodies at the beginning of the study had 64% fewer new E. histolytica infections by 5 months (3/42 IgA(+) vs. 47/227 IgA(-); P= .03). A stool antilectin IgA response was detected near the time of resolution of infection in 67% (12/18) of closely monitored new infections. It was concluded that a mucosal IgA antilectin antibody response is associated with immune protection against E. histolytica colonization. The demonstration of naturally acquired immunity offers hope for a vaccine to prevent amebiasis.

Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial

Abstract: Objective: To evaluate the effect of simultaneous zinc and vitamin A supplementation on diarrhoea and acute lower respiratory infections in children. Study design: Randomised double blind placebo controlled trial. Setting: Urban slums of Dhaka, Bangladesh. Participants and methods: 800 children aged 12-35 months were randomly assigned to one of four intervention groups: 20 mg zinc once daily for 14 days; 200 000 IU vitamin A, single dose on day 14; both zinc and vitamin A; placebo. The children were followed up once a week for six months, and morbidity information was collected. Results: The incidence and prevalence of diarrhoea were lower in the zinc and vitamin A groups than in the placebo group. Zinc and vitamin A interaction had a rate ratio (95% confidence interval) of 0.79 (0.66 to 0.94) for the prevalence of persistent diarrhoea and 0.80 (0.67 to 0.95) for dysentery. Incidence (1.62; 1.16 to 2.25) and prevalence (2.07; 1.76 to 2.44) of acute lower respiratory infection were significantly higher in the zinc group than in the placebo group. The interaction term had rate ratios of 0.75 (0.46 to 1.20) for incidence and 0.58 (0.46 to 0.73) for prevalence of acute lower respiratory infection. Conclusions: Combined zinc and vitamin A synergistically reduced the prevalence of persistent diarrhoea and dysentery. Zinc was associated with a significant increase in acute lower respiratory infection, but this adverse effect was reduced by the interaction between zinc and vitamin A. What is already known on this topic Trials of vitamin A supplementation have failed to show a beneficial effect on morbidity in children Experimental studies have shown that, in the presence of zinc deficiency, vitamin A supplementation fails to reverse vitamin A deficiency Coexistence of deficiencies of zinc and vitamin A could be a reason for the failure of vitamin A supplementation, but data in humans are limited What this paper adds Combined zinc and vitamin A supplementation is more effective in reducing persistent diarrhoea and dysentery than either vitamin A or zinc alone Zinc alone increased respiratory illnesses, but interaction between zinc and vitamin A reduced this adverse effect

Randomized, placebo-controlled, clinical trial of hyperimmunized chicken egg yolk immunoglobulin in children with rotavirus diarrhea.

Abstract: BackgroundHyperimmunized bovine colostrum containing antibodies has been shown to be effective in the treatment of rotavirus diarrhea. Antibodies derived from eggs of immunized hens may be a less expensive and more practical alternative. In this study, children with proven rotavirus diarrhea

Neonatal Morbidity and Care‐seeking Behaviour in Rural Bangladesh

Abstract: The present study was undertaken to assess the pattern of reported neonatal morbidity and the care-seeking behaviour for neonates in rural Bangladesh. Data were collected from 1511 women who had live births during January 1996-August 1998 in four rural subdistricts, which are the field sites of the Operations Research Project of the International Centre for Diarrhoeal Disease Research, Bangladesh. A structured questionnaire was used to collect information from the mothers who were interviewed in their homes. Forty-nine per cent of the neonates were reported to have suffered from some kind of morbidity, Fever was the most common morbidity reported in the study population (21 per cent), followed by breathing difficulty (11 per cent). Birth order, complications during pregnancy, andlor delivery and death of a sibling were found to be significantly associated with reported neonatal morbidity. Eighty-seven per cent of the mothers sought care for their newborns. Some were taken to several different providers, the commonest being homeopaths (38 per cent) and village doctors (37 per cent). Seventeen per cent were taken to trained providers, and only 5 per cent to government health facilities. Seeking care from trained providers was found to be associated with the gender of the neonate, birth order, antenatal care of the mother from trained providers, father's education and monthly expenditure of the family. The results of this study suggest that efforts should be made to raise community awareness regarding neonatal morbidity, the importance of seeking care from trained personnel and the availability of services for these conditions.

Causes of childhood deaths in Bangladesh: an update.

Abstract: Knowledge of the causes of child death is important for health-sector planning since they relate to available interventions. Little is known about causes of child death in Bangladesh from the conventional sources since there is no vital registration system and very few deaths are attended by a qualified physician. To determine the cause structure of child deaths verbal autopsy interviews were conducted in the Bangladesh Demographic and Health Survey (BDHS) 1993/94 national sample. Verbal autopsy is a method of finding out the causes of death based on an interview with the next of kin or other caregivers. Between BDHS 1993/94 and BDHS 1996/97 1–4-y-old child mortality in Bangladesh declined by about 27.0%. This impressive decline prompted a verbal autopsy study using the BDHS 1996/97 national sample to determine whether the cause structure had changed. The same verbal autopsy instrument and methods to collect the data and the same computer algorithm to assign causes of death were used in both surveys. Comparison of BDHS 1993/94 and 1996/97 cause-specific mortality rates revealed that deaths due to almost all causes had declined although significantly so only for acute respiratory infections (ARI) persistent diarrhoea and drowning. Deaths due to neonatal tetanus acute watery diarrhoea and undernutrition had not decreased at all. (authors)

Chronic Arsenic Poisoning and Respiratory Effects in Bangladesh

Abstract: Chronic Arsenic Poisoning and Respiratory Effects in Bangladesh: Abul Hasnat MILTON, et al. Arsenic Cell, NGO Forum for Drinking Water Supply & Sanitation, Bangladesh—A large population in Bangladesh have been exposed to naturally occurring inorganic arsenic through their drinking water. A prevalence comparison study of respiratory disorders among subjects with and without arsenic exposure through drinking water was conducted in Bangladesh. Characteristic skin lesions, keratoses and pigmentation alteration, and the water arsenic level confirmed the arsenic exposure. Three villages were selected from health awareness campaign programs. Participants in these courtyard meetings who had suspected skin lesions. i.e., keratosis, hyperpigmentation and hypopigmentation, were examined by a well-trained medical officer to confirm the diagnosis. Unexposed subjects were randomly selected from another village, where tubewells were not contaminated with arsenic. We interviewed and examined 218 individuals irrespective of age and sex from these villages. The arsenic level in their drinking water was measured and the mean arsenic level was 614 pg/l (ranging from 136 6mu;g/lto 1, 000 μg/l). Information regarding respiratory system signs and symptoms was also collected. There were few smokers, and analyses were therefore confined to nonsmokers. The overall crude prevalence (or risk) among the exposed subjects for chronic cough, and chronic bronchitis, was three times the prevalence in the control population. Age was a slightly negative confounding factor. The crude prevalence ratios were noticeably increased for female participants compared to male participants. A possible explanation for this noticeably increased occurrence of respiratory signs and symptoms in women is related to the presence of weakness. These results add to the evidence that long-term ingestion of arsenic can cause respiratory problems especially among females. (J Occup Health 2001; 43: 136-140)

Microbiological Analysis of Tube-Well Water in a Rural Area of Bangladesh

Abstract: Five tube-wells in Matlab, Bangladesh, were selected for analysis of selected biophysicochemical parameters. The results showed that all tube-well water samples contained zooplankton and bacteria. Results for some of the parameters were outside the accepted limits recommended by the World Health Organization for drinking water. It is concluded that water from tube-wells should be treated if used as drinking water.

Sexually transmitted infections among married women in Dhaka, Bangladesh: unexpected high prevalence of herpes simplex type 2 infection

Abstract: Objectives: To document the prevalence of reproductive tract infections (RTI) and sexually transmitted infections (STI) among women attending a basic healthcare clinic in Dhaka, Bangladesh, to identify risk factors associated with the diseases and to estimate the incidence of syphilis, hepatitis C (HCV), hepatitis B (HBV), and herpes simplex type 2 (HSV-2) infection. Methods: A cross sectional sample of 2335 consecutive women was examined during 1996–8. Women were interviewed about risk factors for RTI/STI and tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, Treponema pallidum, HIV, HCV, HBV, HSV-1 and HSV-2 infection as well as vaginal candidosis and bacterial vaginosis. Women with antibodies to T pallidum were retested at regular intervals. One year after ending the study seroconversion for syphilis, HBV, HCV, and HSV-2 infection was detected among women initially negative for the respective diseases. Results: The overall prevalence rate of N gonorrhoeae, C trachomatis, T vaginalis, and T pallidum infection was 0.5%, 1.9%, 2.0%, and 2.9% respectively. Overall, 35% of the women had antibodies to hepatitis B core antigen, 0.9% had HCV, and 12% HSV-2 infection. Risk factors for gonorrhoea/C trachomatis infection were a husband not living at home or suspected of being unfaithful. HSV-2 infection was associated with the same risk factors and with a polygamous marriage. The prevalence of HSV-2 infection among women "at risk" was 23%. HIV infection was not diagnosed. Repeated serological examination indicated that only 32% of women with serological evidence of syphilis had active disease. The seroincidences of HBV, HCV, and HSV-2 were 0.03, 0.007, and 0.009 per person year. Seroconversion for syphilis was not observed. Key Words: sexually transmitted infections; genital herpes; Bangladesh

Concomitant Infection of Enterotoxigenic Escherichia coli in an Outbreak of Cholera Caused by Vibrio cholerae O1 and O139 in Ahmedabad, India

Abstract: In Ahmedabad, a major city in the state of Gujarat, India, an outbreak of acute secretory diarrhea caused by Vibrio cholerae O1 Ogawa El Tor, V. cholerae O139, and multiple serotypes of enterotoxigenic Escherichia coli (ETEC) occurred in January 2000. All of the representative V. cholerae O1 and O139 isolates examined harbored the ctxA gene (encoding the A subunit of cholera toxin) and the El Tor variant of the tcpA gene (encoding toxin-coregulated pilus). ETEC isolates of different serotypes were positive for the elt gene, encoding heat-labile enterotoxin. To further understand the molecular characteristics of the pathogens, representative isolates were examined by ribotyping and pulsed-field gel electrophoresis (PFGE). Ribotyping showed that the isolates of V. cholerae O1 Ogawa exhibited a pattern identical to that of the prevailing clone of O1 in areas where cholera is endemic in India, and all of the O139 isolates were identical to the BII clone of V. cholerae O139. PFGE of the representative O1 Ogawa isolates exhibited an identical pattern, comparable to the H pattern of the new clone of O1 reported in Calcutta, India. PFGE analysis of the V. cholerae O139 isolates showed identical patterns, but these differed from the PFGE patterns of O139 isolates reported during 1992 to 1997 in Calcutta. ETEC isolates showed genetic heterogeneity among isolates belonging to the same serotype, although the identical PFGE pattern was also observed among ETEC isolates of different serotypes. Antibiograms of the isolates were unusual, because all of the O139 isolates were resistant to nalidixic acid. Likewise, all of the E. coli isolates showed resistance to ciprofloxacin, norfloxacin, and nalidixic acid. This is a unique outbreak, and we believe that it is the first in which V. cholerae and ETEC were concomitantly involved.

Altering trends in the dominance of Shigella flexneri serotypes and emergence of serologically atypical S. flexneri strains in Dhaka, Bangladesh.

Abstract: Of 469 recently isolated Shigella flexneri strains, 452 agglutinated with Shigella flexneri-specific monoclonal antibodies. Of these, 396 could be assigned to 10 of the currently recognized 15 serotypes, with S. flexneri 2b dominating (23.2%). Of the 56 untypeable strains which showed invasive properties, 17 were serologically atypical and the remaining 39 belonged to a new serotype.

Determinants of infant growth in the slums of Dhaka: size and maturity at birth, breastfeeding and morbidity.

Abstract: Objective: To investigate the influences of size at birth, breastfeeding and morbidity on growth during infancy in poor areas of urban Bangladesh. Design: This was a prospective observational study of a cohort of newborn infants followed until 12 months of age. Setting: Slum areas of Dhaka City in Bangladesh. Subjects: A total of 1654 newborn infants were enrolled at birth, and follow-up was completed for 1207 infants. Repeated anthropometric measurements and interviews of caretakers on infant feeding and morbidity were conducted. A mixed effects regression method was used for modeling infant growth. Results: After adjusting for other variables, mean differences in body weight by birth weight and length, small-for-gestational age and prematurity categories remained relatively constant throughout infancy. A positive impact of exclusive breastfeeding in the first 3–5 months on infant growth was detectable at 12 months of age. Although the bigger babies in the sample tended to grow relatively even bigger; exclusive breastfeeding appeared to counteract this pattern. Reported diarrhoea was associated with lower body weights and lengths even after adjusting for feeding patterns. Conclusions: Size at birth has an important role in determining growth during infancy. Effective strategies for improving birth weight, poorly addressed till now in Bangladesh, are needed. The sustained effect on growth and the even more beneficial effect in lighter infants are compelling reasons for promotion of exclusive breastfeeding in early infancy. European Journal of Clinical Nutrition (2001) 55, 167–178

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Abstract: This paper explores the potential direct role of health interventions in contributing to greater health equity. Longitudinal data from a study in rural Bangladesh is used to examine the impact of a measles vaccination program on gender and socioeconomic differentials in childhood mortality. Data analysis revealed that provision of measles vaccination alone has the potential to reduce child mortality risks markedly ranging from over three times higher to just over 1.5 times higher. The impact of measles vaccination is most pronounced among the poorest group and average economic status groups of children. The importance of gender itself is also evident with female children experiencing substantially higher mortality risks relative to male children and greater absolute reductions in mortality risks with vaccination. This mortality differential persists among children born to mothers with limited education (1-5 years). These findings reinforce and extend previously reported results on the effect of measles vaccination on childhood mortality in the study area. These results also underscore the need for developing special strategies and targeted approaches for reaching the most disadvantaged children.

A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh.

Abstract: In a double-blind randomized controlled clinical trial moderately malnourished Bangladeshi children (61–75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental) (ii) vitamin A (iii) both zinc and vitamin A or (iv) neither in 2 doses daily for 7 d. Clinical data on recovery and on stool output consistency and frequency were recorded for 7 d and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups but not in the vitamin A group in comparison with the control group. In children receiving zinc the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p = 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p < 0.001) but the 14% lower output than in the vitamin A group was not statistically different. The change in body weight over the 7 d study period was significantly different between the group receiving zinc and the control group (+111 g vs -90 g p = 0.045). The rate of clinical recovery of children within 7 d was significantly greater in the zinc group (88%) compared with the control group (46% p = 0.002) or vitamin A group (50% p = 0.005) but not statistically different from the zinc plus vitamin A group (67% p = 0.086). (excerpt)

Treatment Failure with the Use of Ciprofloxacin for Gonorrhea Correlates with the Prevalence of Fluoroquinolone-Resistant Neisseria gonorrhoeae Strains in Bangladesh

Abstract: Although ciprofloxacin is one of the recommended drugs of choice for the treatment of gonorrhea, in vitro resistance to this drug has been observed in surveillance studies and case reports from many parts of the world, including Bangladesh. However, to our knowledge, there have been no prospective studies of the correlation between in vitro response to the drug and treatment outcome. Therefore, a prospective study of 217 female sex workers in Dhaka, Bangladesh, was conducted to examine the correlation between the in vitro response of Neisseria gonorrhoeae and the outcome of ciprofloxacin treatment. Overall, 37.8% of the gonococcal isolates recovered from female sex workers were resistant to ciprofloxacin, and there was a good correlation between in vitro resistance and treatment failure. These findings suggest that in vitro resistance to ciprofloxacin is predictive of clinical treatment failure in patients with gonorrhea.

Anaemia among non-pregnant women in rural Bangladesh.

Abstract: Objective: To estimate the prevalence and severity of anaemia among non-pregnant women in rural Bangladesh and describe its social distribution. Design: A cross-sectional study conducted in February‐March 1996. Haemoglobin concentration was measured on a capillary blood sample by cyanmethaemoglobin method. The World Health Organization (WHO) classification was used to define anaemia. Setting: Twelve randomly selected villages in Fulbaria thana of Mymensingh district, about 110 km northwest of Dhaka city in Bangladesh. Subjects: A systematically selected sample of 179 non-pregnant apparently healthy women aged 15‐45 years. Results: Anaemia was highly prevalent (73%; 95%CI 67‐79%). Most of the women had mild (52%) or moderate (20%) anaemia, but a few of them suffered from severe anaemia (1%). Ascaris was common (39%) while hookworm was not (1%). The anaemia prevalence had no statistically significant association with age, parity or Ascaris infestationOP . 0:05U: Women with less than 1 year of schooling, who were landless or who reported having an economic deficit in the household had significantly higher prevalence of anaemia OP , 0:05U: There was a significantly increasing trend in anaemia prevalence with decreasing socioeconomic situation (SES). However anaemia was common in all social strata. Conclusions: Although the overall anaemia prevalence among non-pregnant rural women is high, only a few women suffer from severe anaemia. Women of all SES groups irrespective of their age and parity are affected by anaemia.

Survival of Shigella dysenteriae type 1 on fomites.

Abstract: Studies have shown that various objects, such as utensils, toys, and clothes, can serve as vehicles for transmission of Shigella spp. Shigellae can become viable but non-culturable (VBNC) when exposed to various environmental conditions as shown in earlier studies. The present study was carried out to detect VBNC Shigella dysenteriae type 1 on various fomites by direct viable counting, polymerase chain reaction (PCR), and fluorescent antibody methods. S. dysenteriae type 1 was inoculated onto cloth, wood, plastic, aluminum, and glass objects. Results showed that 1.5-4.0 hours after inoculation, S. dysenteriae type 1 became non-culturable, and after five days, non-culturable but viable S. dysenteriae type 1 could be detected by both PCR and fluorescent antibody techniques. Fomites can be considered an important potential route of transmission of VBNC S. dysenteriae type 1 and a significant factor in the epidemiology of shigellosis.

Epidemiology of postshigellosis persistent diarrhea in young children.

Abstract: Background. Dysentery accounts for 20% of the 4.6 million diarrhea-associated deaths among children in developing countries, with the risk from death in dysenteric persistent diarrhea 10-fold higher than that in acute dysentery. Although Shigella accounts for the majority of dysenteric episodes, very little is known about the epidemiology of postshigellosis persistent diarrhea. Methods. Rural Bangladeshi children younger than 5 years of age (n = 1756) were followed for 1 month after exposure to sentinel cases of Shigella dysentery. The likelihood of an acute diarrheal episode becoming persistent was assessed. Results. Diarrhea caused by Shigella was significantly associated with an increased risk of persistent diarrhea (age-adjusted relative risk, 1.83; 95% confidence interval, 1.19 to 2.81). Despite the use of nalidixic acid in dysenteric episodes, persistent diarrhea occurred in 23% of children with shigellosis. Infection by multiply antibiotic-resistant Shigella isolates (age-adjusted relative risk, 3.76; 95% confidence interval, 1.51 to 9.36) and occurrence of shigellosis during infancy were observed to be risk factors for initiation of Shigella diarrhea persistence. However, 88% of the persistent shigellosis episodes occurred in older children, 50% were associated with nondysenteric shigellosis and 79% were caused by Shigella species other than Shigella dysenteriae 1. Conclusions. These data demonstrate the importance of Shigella as a cause of persistent diarrhea and indicate that strategies to prevent postshigellosis persistent diarrhea must be broad-based, with a focus on older children as well as infants, management of nondysenteric as well as dysenteric disease and prevention of diarrhea caused by multiple Shigella species.

The demand for child curative care in two rural thanas of Bangladesh: effect of income and women's employment

Abstract: This study investigated the determinants of child health care seeking behavior in rural Bangladesh. It also examined the effects of income womens access to income and the price of child health care. Data on the use of child curative care were collected from two rural areas in Bangladesh--Abhoynagar thana in Jessore district and Mirsarai thana in Chittagong district on March 1997. These data were supplemented with socioeconomic and community data from the baseline surveys obtained from Abhoynagar and Mirsarai thanas in 1993 and 1994 respectively. Findings indicate that a womans involvement either in a credit union or in income generating activities affected the likelihood that curative care was used. However since these are two very different activities the effect on the set of child curative care varied. A mothers membership in a credit union increased the use of child curative care while her involvement in income-generating activities decreased the use of child curative care. The major difference between these activities is that the credit union has organized activities such as meetings where numerous subjects are discussed including the promotion of health care seeking behavior as well as ways to improve the quality of their lives. These activities help motivate women to seek preventive and curative health care. Furthermore the choice to seek care for a child was also affected by socioeconomic factors. Care for a sick child was more likely to have been sought (77%) if the household belonged to the middle-income rather than the low-income group.

Implementation of a Medical Geographic Information System: Concepts and Uses

Abstract: This paper introduces a medical geographic information system which has been implemented to enhance public-health research by facilitating the modelling of spatial processes of disease, environment, and healthcare systems in a rural area of Bangladesh. In 1966, a surveillance system was implemented to record all vital demographic events in the study area. Selected information on reproductive and child health, socioeconomic conditions, and health and family-planning interventions is being collected for the surveillance database. This paper discusses the conceptual design of integrating the surveillance database with the medical geographic information system and its use in conducting multidisciplinary health research. The paper is intended to help those who wish to implement a health-based geographic information system to understand the links between people and their environments and to better meet the health needs of target communities. Key words : Geographic information system; Geography, Medical; Bangladesh

Management of severe malnutrition and diarrhea.

Abstract: Children with severe malnutrition and diarrhea have high mortality rates that have been attributed to faulty case-management. Health workers are often unaware of the unique treatment requirements of severely malnourished children resulting in improper case-management. Moreover, the lack of prescriptive guidelines promotes the exercise of discretion in case-management that is often detrimental. Appropriate feeding from the start of treatment, routine micronutrient supplementation, broad-spectrum antibiotic therapy, less use of intravenous fluids for rehydration, and careful management of complications are factors that can reduce death, morbidity and cost of treating children with severe malnutrition and acute illnesses including diarrhea. In this paper is discussed a standardized protocol based upon the above mentioned factors for the management of severely malnourished children with acute illnesses including diarrhea. Implementation of the protocoi resulted in a 47% reduction in mortality in these children.

Characteristics of Children Hospitalized with Severe Dehydration and Persistent Diarrhoea in Bangladesh

Abstract: The study analyzed data from a systematic sample of children, aged less than five years, who presented with persistent diarrhoea (diarrhoea of more than 14 days duration). It aims to differentiate (a) non-severe persistent diarrhoea (with no or mild dehydration) and (b) severe persistent diarrhoea (with moderate or severe dehydration), and to identify individual characteristics associated with severe persistent diarrhoea. In total, 7,505 patients, who represented a 4% systematic sample of the patient population, were seen during January 1993-December 1995. Of them, 297 (4%) presented with persistent diarrhoea. The male:female ratio was 2:1. Eighty-three percent of them had mild or no dehydration, and 17% had moderate or severe dehydration. Severe malnutrition of the study patients defined as weight-for-age z-score 10 times during the last 24 hours prior to admission (OR, 10.0; CI, 1.2-87, p=0.03), lower respiratory tract infection (OR, 111; CI, 4.2-2955, p=0.004), and lack of mothers’ education (OR, 7.8; CI, 1.4-41.9, p=0.016) after controlling for confounders. Awareness and health education of mothers or caregivers and better case management during acutediarrhoeal episode might prevent the development of severe persistent diarrhoea in young children. In addition, children with severe persistent diarrhoea might need special attention to have adequate rehydration and control of extraintestinal infections, including respiratory tract infection. Key words: Diarrhoea, Infantile; Diarrhoea, Persistent; Diarrhoea, Acute; Child nutrition disorders; Dehydration; Bangladesh