International Centre for Diarrhoeal Disease Research, Bangladesh

About: International Centre for Diarrhoeal Disease Research, Bangladesh is a facility organization based out in Dhaka, Bangladesh. It is known for research contribution in the topics: Population & Vibrio cholerae. The organization has 3103 authors who have published 5238 publications receiving 226880 citations. The organization is also known as: SEATO Cholera Research Laboratory & Bangladesh International Centre for Diarrhoeal Disease Research.

Impact of zinc supplementation on subsequent growth and morbidity in Bangladeshi children with acute diarrhoea.

Abstract: Objective: To assess the impact of zinc supplementation during acute diarrhoea on subsequent growth and morbidity in malnourished young children. Design: Double blind randomized controlled clinical trial Setting: International Centre for Diarrhoeal Disease Research, Bangladesh. Subjects: Sixty-five children aged 3–24 months with acute diarrhoea for less than 3 d. Intervention: Either elemental zinc (20 mg/d) in a multivitamin syrup or multivitamin syrup alone divided in three divided daily doses for a period of two weeks. Children were followed up weekly at home to assess subsequent growth and morbidity for a period of eight weeks. Main outcome measures: Gain in length and body weight and reduction in diarrhoea and respiratory tract infection. Results: During the follow-up, zinc supplemented children showed significantly greater cumulative length gain (18.9 mm vs 14.5 mm, P<0.03) and comparable body weight gain than the children of the control group. Subsequent length gain was not correlated with initial height in the zinc-supplemented group (r=−0.13), P=0.5), but was significantly correlated in the control group (r=-0.6, P<0.0007). Zinc-supplemented and stunted children ( ≤ 90% length for age n=18) experienced significantly fewer episodes of diarrhoea (0.07 vs 0.6, P 0.05) and respiratory illness (1.0 vs 2.4, P<0.01) compared to the control group. The underweight children (≤ 71% weight/age n=38) receiving zinc-supplementation also had fewer episodes of diarrhoea (0.4 vs 1.0, P<0.04) and shorter duration of diarrhoeal episodes (1.0 vs 3.0 d, P<0.04) compared to their counterparts in the control group. Conclusion: These results suggest that a short course of zinc supplementation to malnourished children during acute diarrhoea reduces growth-faltering and diarrhoeal and respiratory morbidity during subsequent two months. Sponsorship: Wellcome Trust.

Multiplex Real-Time PCR Assay Using Scorpion Probes and DNA Capture for Genotype-Specific Detection of Giardia lamblia on Fecal Samples

Abstract: Two major genotypic assemblages of Giardia lamblia infect humans; the epidemiologic significance of this phenomenon is poorly understood. We developed a single-vessel multiplex real-time PCR (qPCR) assay that genotypes Giardia infections into assemblages A and/or B directly from fecal samples. The assay utilized Scorpion probes that combined genotype-specific primers and probes for the 18S rRNA gene into the same molecule. The protocol was capable of detecting as few as 20 trophozoites per PCR on fecal DNA isolated using a commercial method or 1.25 trophozoites per PCR on fecal DNA isolated using a G. lamblia-specific oligonucleotide capture technique. The assay was specific for fecal specimens, with no amplification of the discordant genotype with the opposite Scorpion probe. When 97 clinical specimens from Bangladesh were used, the multiplex PCR assay detected 95% (21 of 22) of Giardia microscopy-positive specimens and 18% (13 of 74) of microscopy-negative specimens. Microscopy-negative and qPCR-positive specimens had higher average cycle threshold values than microscopy-positive and qPCR-positive specimens, suggesting that they represented true low-burden infections. Most (32 of 35) infections were assemblage B infections. This single-reaction multiplex qPCR assay distinguishes assemblage A Giardia infections from assemblage B infections directly on fecal samples and may aid epidemiologic investigation.

Prenatal screening in rural Bangladesh: from prediction to care

Abstract: The role of antenatal care is being increasingly questioned particularly in resource-poor environments. The low predictability of antenatal markers for adverse maternal outcomes has led some to reject antenatal care as an efficient strategy in the fight against maternal and perinatal mortality. Few studies however have assessed the predictability of adverse outcomes other than dystocia or perinatal death and most studies have been hospital based. This population-based cohort study was undertaken to assess whether prenatal screening can identify women at risk of severe labor or delivery complications in a rural area in Bangladesh. Antenatal risk markers signs and symptoms were assessed for their association with severe maternal complications including dystocia malpresentation hemorrhage hypertensive diseases twin delivery and death. The results of the study suggest that antenatal screening by trained midwives fails to adequately distinguish women who will need special care during labor and delivery from those who will not need such care. The large majority of the women with dystocia or hemorrhage had no warning signs during pregnancy. A single blood pressure measurement and the assessment of fundal height on the other hand may detect a substantial number of women with hypertensive diseases and twin pregnancies. In addition women who had an antenatal visit were four times more likely to deliver with a midwife than women who had no antenatal visit. Antenatal care may not be an efficient strategy to identify those most in need for obstetric service delivery but if promoted in concurrence with effective emergency obstetric care and delivered in skilled hands it may become an effective instrument to facilitate better use of emergency obstetric care services. (authors)

Effects of Source- versus Household Contamination of Tubewell Water on Child Diarrhea in Rural Bangladesh: A Randomized Controlled Trial

Abstract: BACKGROUND: Shallow tubewells are the primary drinking water source for most rural Bangladeshis. Fecal contamination has been detected in tubewells at low concentrations at the source and at higher levels at the point of use. We conducted a randomized controlled trial to assess whether improving the microbiological quality of tubewell drinking water by household water treatment and safe storage would reduce diarrhea in children <2 years in rural Bangladesh. METHODS: We randomly assigned 1800 households with a child aged 6-18 months (index child) into one of three arms: chlorine plus safe storage safe storage and control. We followed households with monthly visits for one year to promote the interventions track their uptake test participants source and stored water for fecal contamination and record caregiver-reported child diarrhea prevalence (primary outcome). To assess reporting bias we also collected data on health outcomes that are not expected to be impacted by our interventions. FINDINGS: Both interventions had high uptake. Safe storage alone or combined with chlorination reduced heavy contamination of stored water. Compared to controls diarrhea in index children was reduced by 36% in the chlorine plus safe storage arm (prevalence ratio PR = 0.64 0.55-0.73) and 31% in the safe storage arm (PR = 0.69 0.60-0.80) with no difference between the two intervention arms. One limitation of the study was the non-blinded design with self-reported outcomes. However the prevalence of health outcomes not expected to be impacted by water interventions did not differ between study arms suggesting minimal reporting bias. CONCLUSIONS: Safe storage significantly improved drinking water quality at the point of use and reduced child diarrhea in rural Bangladesh. There was no added benefit from combining safe storage with chlorination. Efforts should be undertaken to implement and evaluate long-term efforts for safe water storage in Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT01350063.

What Point-of-Use Water Treatment Products Do Consumers Use? Evidence from a Randomized Controlled Trial among the Urban Poor in Bangladesh

Abstract: Background: There is evidence that household point-of-use (POU) water treatment products can reduce the enormous burden of water-borne illness. Nevertheless, adoption among the global poor is very low, and little evidence exists on why. Methods: We gave 600 households in poor communities in Dhaka, Bangladesh randomly-ordered two-month free trials of four water treatment products: dilute liquid chlorine (sodium hypochlorite solution, marketed locally as Water Guard), sodium dichloroisocyanurate tablets (branded as Aquatabs), a combined flocculant-disinfectant powdered mixture (the PUR Purifier of Water), and a silver-coated ceramic siphon filter. Consumers also received education on the dangers of untreated drinking water. We measured which products consumers used with self-reports, observation (for the filter), and chlorine tests (for the other products). We also measured drinking water’s contamination with E. coli (compared to 200 control households). Findings: Households reported highest usage of the filter, although no product had even 30% usage. E. coli concentrations in stored drinking water were generally lowest when households had Water Guard. Households that self-reported product usage had large reductions in E. coli concentrations with any product as compared to controls. Conclusion: Traditional arguments for the low adoption of POU products focus on affordability, consumers’ lack of information about germs and the dangers of unsafe water, and specific products not meshing with a household’s preferences. In this study we provided free trials, repeated informational messages explaining the dangers of untreated water, and a variety of product designs. The low usage of all products despite such efforts makes clear that important barriers exist beyond cost, information, and variation among these four product designs. Without a better understanding of the choices and aspirations of the target end-users, household-based water treatment is unlikely to reduce morbidity and mortality substantially in urban Bangladesh and similar populations.