Overcoming access barriers for facility-based delivery in low-income settings: insights from Bangladesh and Uganda.

Women in both Bangladesh and Uganda face a number of barriers to delivery in professional health facilities, including costs, transportation problems, and sociocultural norms to deliver at home. Some women in both the countries manage to overcome these barriers. This paper reports on a comparative qualitative study investigating how some women and their families were able to use professional delivery services. The study provides insights into the decision-making processes and overcoming access barriers. Husbands were found to be particularly important in Uganda, while, in Bangladesh, a number of individuals could influence care-seeking, including unqualified local healers or traditional birth attendants. In both the settings, cost and transport barriers were often overcome through social networks. Social prohibitions on birth in the health facility did not feature strongly in women's accounts, with several Ugandan women explaining that friends or peers also used facilities, while, in Bangladesh, perceived complications apparently justified the use of professional medical care. Investigating the ways in which some women can overcome common barriers can help inform policy and planning to increase the use of health facilities for child delivery

Nephrogenic Diabetes Insipidus Secondary to Obstructive Uropathy – An Unusual Presentation- A Case Report

Diabetes insipidus is a clinical condition, characterized by polyuria and polydipsia, that results from either insufficient production or end organ resistance to antidiuretic hormone (ADH). Diabetes insipidus is of two types: central diabetes insipidus (CDI) and nephrogenic diabetes insipidus (NDI).Children with diabetes insipidus may present with polyuria, polydipsia, frequent dehydration, constipation, and failure to thrive. Acquired NDI may results from various drugs and conditions but NDI due to obstructive uropathy is very rare. There are very few case reports of NDI due to obstructive uropathy. We report a 2-year-old child who presented with diabetes insipidus as a consequence of obstructive uropathy.Keywords: Nephrogenic diabetes insipidus; Obstructive Uropathy; Child.

Comparative study of Bacillus clausii and multistrain probiotics in the management of acute diarrhoea in children

Background: Diarrhoea is the second most common cause of under-five mortality especially in developing world. Many studies have been conducted so far using different probiotic strains with variable outcome. So, the aim of the present study was to compare the clinical efficacy of Bacillus clausii and multi strain probiotic formulation as adjunct treatment of acute diarrhoea.Methods: This prospective single blind randomized controlled clinical trial included 300 infants and children between 6 months to 6 years of age admitted in a tertiary care hospital Sylhet, Bangladesh with acute watery diarrhoea having varied dehydration status ranging from no to severe dehydration excluding shocked state. Cases were randomly assigned to three groups which were group I (n=100) comprised of children who were treated with standard treatment (according to WHO guideline) only as control group, group II (n=100) who received standard treatment plus Bacillus clausii and group III (n=100) who received standard treatment plus multi strain probiotic formulation (Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium infantis, Streptococcus thermophilus). Primary outcome variables were duration, frequency of diarrhoea and consistency of stool. Secondary outcome variable was duration of hospital stay.Results: Mean duration of diarrhoea was significantly shorter (p=0.001) in group III (2.62 days) compared to group I (3.26 days) and group II (3.22 days). Frequency of diarrhoea was significantly lower on day 3 of probiotic administration in group III (p 0.05) in group II in comparison to group I and group III.Conclusions: Multistrain probiotic formulation is effective in reducing the duration, frequency of diarrhoea and duration of hospital stay

Efficacy of Cyclophosphamide versus Cyclosporine in Frequent Relapse Nephrotic Syndrome – A Hospital Based Study

Introduction: The clinical outcome of patients with Frequent Relapse Nephrotic Syndrome (FRNS) or Steroid Dependent Nephrotic Syndrome (SDNS) treated with cyclophosphamide or cyclosporine (CsA) is yet to be established. This study was carried out to compare the efficacy of CsA with cyclophosphamide in patients with FRNS or SDNS.Materials and Methods: A total of 54 FRNS or SDNS children were randomly enrolled in this prospective study from August 2013 to July 2014. All the study subjects were treated with prednisolone 60 mg/m2 /day until the patients were in remission for three consecutive days. The patients were then randomly divided into two groups (Group-A & Group-B). Group-A was treated with cyclophosphamide at a dose of 2.5 mg/kg/day for 60 days, along with tapering dose prednisolone for 8 weeks. The Group-B study population was treated with cyclosporine at a dose of 3 mg/kg/day for 6 months or longer along with tapering dose of alternate day prednisolone for the initial 8 weeks. Four patients in Group-B and one patient in Group-A did not continue the treatment. So, we followed-up 49 children during this period.Results: The efficacy of both drugs was good after 6 months of treatment. Remission was observed in 80% of the cases in Group-A and 79% of the cases in Group-B. Even after 6 months of treatment 6.7% and 10.5% of the patients with SDNS in Group-A and Group-B needed to continue corticosteroid therapy, respectively. The side effects of immunosuppressive therapy were more frequently observed in Group-B patients. On the other hand, the mean serum creatinine level after 6 months therapy was 0.55±0.21mg/dl in Group-A and 0.84±0.43 mg/dl in Group-B. The difference between the two groups was statistically significant (p<0.05).Conclusions: This study showed that both drugs were effective in FRNS and SDNS.Keywords: Child; Nephrotic syndrome; Cyclophosphamide; Cyclosporine

Determination of Gender using Discriminant Analysis of Hand Dimensions among Adult Participants

Background: The estimation of gender using hand dimensions is a crucial role in forensic investigation and legal sciences. Objectives: In this study, the mean score of hand measurements have been derived and linear discriminant analysis has been applied to predict gender from hand dimensions. An Independent t-test has been employed to know discrimination between male and female. The accuracy of gender estimation has been derived and checked by ROC curve. Material and Methods: A sample of 150 participants has been collected for the completion of this study, where 78 males and 72 females were found aged between 18 and 24 years. The breadths and lengths of left and right hands of the participants have been measured. Results: Respondents’ mean score of length and breadth of left hand were found 17.69 ± 1.30 and 7.56 ± 1.17, respectively. It was found to be significantly different in the respondents’ mean scores of males and females. Conclusions: The hand dimensions of males were higher than females. The prediction of a number of females and males were 76 and 74, respectively, and its accuracy was observed 0.87. This research can be applied for larger sample and would be helpful in predicting gender discrimination among adults through hand dimensions

Healthcare-seeking Behaviour among the Tribal People of Bangladesh: Can the Current Health System Really Meet Their Needs?

Despite the wealth of studies on health and healthcare-seeking behaviour among the Bengali population in Bangladesh, relatively few studies have focused specifically on the tribal groups in the country. This study aimed at exploring the context, reasons, and choices in patterns of healthcare-seeking behaviour of the hill tribal population of Bangladesh to present the obstacles and challenges faced in accessing healthcare provision in the tribal areas. Participatory tools and techniques, including focus-group discussions, in-depth interviews, and participant-observations, were used involving 218 men, women, adolescent boys, and girls belonging to nine different tribal communities in six districts. Data were transcribed and analyzed using the narrative analysis approach. The following four main findings emerged from the study, suggesting that the tribal communities may differ from the predominant Bengali population in their health needs and priorities: (a) Traditional healers are still very popular among the tribal population in Bangladesh; (b) Perceptions of the quality and manner of treatment and communication can override costs when it comes to provider-preference; (c) Gender and age play a role in making decisions in households in relation to health matters and treatment-seeking; and (d) Distinct differences exist among the tribal people concerning their knowledge on health, awareness, and treatment-seeking behaviour. The findings challenge the present service-delivery system that has largely been based on the needs and priorities of the plainland population. The present system needs to be reviewed carefully to include a broader approach that takes the sociocultural factors into account, if meaningful improvements are to be made in the health of the tribal people of Bangladesh

Mycophenolate Mofetil versus Cyclosporine in Children with Frequent Relapse Nephrotic Syndrome

Introduction: Children with frequently relapsing nephrotic syndrome (FRNS) frequently develop adverse effects of prednisolone and attempts to induce long term remission in such patients have varying degree of success. Materials & Methods: We conducted a randomized clinical trial in a tertiary care level hospital to compare the efficacy and safety of a 1 year treatment with mycophenolate mofetil (MMF) and Cyclosporine (CsA) in 60 pediatric patients with FR-SSNS during one year period. We assessed the frequency of relapse as the primary end point and evaluated clinical and laboratory profile after 3 and 6 months of treatment. Results: Mean number of relapse was 1.50 ± 1.44 in MMF group and 0.72 ± 1.30 in CsA group at 6 months (p=0.045). Diarrhoea was statistically significant in MMF group. Hypertrichosis & hypertension were statistically significant in CsA group. There was no significant difference between groups with Hb levels, lipid profile, eGFR. Conclusion: The result of the study showed MMF is inferior to CsA in preventing relapse in patient with FRNS but less nephrotoxic

Effectiveness and safety of electronic cigarettes among sole and dual user vapers in Kuantan and Pekan, Malaysia: a six-month observational study

Background; Current studies on electronic cigarettes (ECs) have assessed the smoking cessation effectiveness and safety of EC among sole EC users. However, in Malaysia and elsewhere, most EC users also smoke conventional cigarettes (CCs). We aimed to investigate nicotine cessation for both ECs and CCs. Additionally, safety issues among sole EC and dual (EC and CC) users over a six-month period were reported. Methods; We observed 218 sole Malaysian EC and dual users over 6 months from June 2015 to November 2015. Both groups underwent exhaled breath carbon monoxide and saliva cotinine analyses to verify their nicotine cessation from both EC and CC use. Adverse events and withdrawal symptoms were assessed based on self-reports

Mislabelling of nicotine content in electronic cigarette liquids in Malaysia: implications on public health

Electronic cigarette (e-cig) is a battery-operated device which vaporises nicotine solution into a form of inhalable aerosol. The level of nicotine in the liquid for e-cig (e-liquid) may vary and the typical nicotine concentration reported is between 6 to 24 mg of per ml. Based on the National Electronic Cigarette Survey (NECS) 2016, 83.9% of e-cig adult users in Malaysia preferred eliquid with 6 mg/ml nicotine. In Malaysia, nicotine in products other than tobacco is regulated under the Poisons Act 1952, restricting its sale by licensed health professionals only. However, the sale of e-liquid containing nicotine is widespread and vapers are not assured of the accuracy of content versus that on the label of the e-liquid bottle. OBJECTIVE: To determine the actual nicotine concentration in selected e-liquid brands marketed in Malaysia. Methods: Samples (81 brands) obtained from respondents of the NECS 2016 were analysed using gas chromatography mass spectrometry (GC-MS) in selective ion mode (SIM) at a certified laboratory. Results: 15 samples labelled as no or zero nicotine were found to contain nicotine. Nine samples contained level of nicotine higher than what their labels indicated. Interestingly, 57 samples had nicotine concentrations that were lower than that indicated on the labels. The nicotine concentration percentage difference between labelled and result from analysis was found to be as low as from -99.16% to -1.28% in 64 samples, while in 4 samples the difference was higher; 0.083% to 163.0%, and the remaining 13 samples had no mention of nicotine concentration on their labels. Conclusion: Significant discrepancy was detected in nicotine concentration between the labelled and analysed values among the collected e-liquid samples. Strict regulation and enforcement is needed for e-cig liquids to ensure safety of users and compliance to current regulations on nicotine

Predictors of Relapse in Idiopathic Nephrotic Syndrome in Children Presenting to a Tertiary Center

Background and Aim: Idiopathic nephrotic syndrome (INS) is a disease of relapse and remission in children in which about 20-30% of the patients may experience a single episode in their lives while the rest suffer from relapse. Some factors contribute to relapse. The objective of this study was to explore the predictors of relapse in INS.Methods: A prospective longitudinal study was conducted in the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from September 2015 to August 2016. One hundred and ten patients with the first episode of INS were uninterruptedly enrolled in this study. After screening and subsequent confirmatory diagnosis, the patients were treated with a single morning dose of oral prednisolone 60 mg/m2/day for 6 weeks followed by oral prednisolone 40 mg/m2 every alternate day for the subsequent 6 weeks. The total number of relapses within six months after the initial episode was collected in a data collection sheet. Every relapse was correlated with age of onset, sex, initial serum albumin level, fasting serum cholesterol level, and time to response in the initial attack. The association between relapse and its potential risk factors was investigated using logistic regression analysis. Results: The study found that INS was significantly associated with sex and age (p< 0.05). Male children were 3.04 times (95% CI= 1.09- 8.45, P=0.03) more likely to experience relapse. Furthermore, children with respiratory tract infection  had a higher chance of relapse (OR= 4.43, 95% CI= 1.26-15.53, P=0.02). Lower cholesterol levels (≤500 mg/dl) were found to be a protective factor (OR= 0.13, 95% CI= 0.04-0.54, P=0.005) in this study. The chance of relapse was higher in children who responded after 2-4 weeks of starting treatment compared to those who responded in less than one week (p<0.005).Conclusion: The study found that the first episode INS had a higher risk of relapse in boys with respiratory tract infection and in patients who needed more than two weeks of prednisolone treatment to achieve remission.Keywords: Children; Frequently Relapsing; Predictors; Idiopathic Nephrotic Syndrome