116 research outputs found
Maternal Underweight and Its Association with Composite Index of Anthropometric Failure among Children under Two Years of Age with Diarrhea in Bangladesh
Malnutrition in women has been a long-standing public health concern, with serious effects on child survival and development. Maternal body mass index (BMI) is an important maternal nutritional indicator. There are few published studies although child anthropometric failures do not occur in isolation and identifying children with single versus several co-occurring failures can better capture cases of growth failure in combination: stunting, wasting, and underweight. In the context of multiple anthropometric failures, traditional markers used to assess children’s nutritional status tend to underestimate overall undernutrition. Using the composite index of anthropometric failure (CIAF), we aimed to assess the association between maternal undernutrition and child undernutrition among children with diarrhea under the age of two and to investigate the correlates. Using 1431 mother-child dyads from the Antibiotic for Children with Diarrhea (ABCD) trial, we extracted children’s data at enrollment and on day 90 and day 180 follow-ups. ABCD was a randomized, multi-country, multi-site, double-blind, placebo-controlled clinical trial. The Bangladesh site collected data from July 2017 to July 2019. The outcome variable, CIAF, allows combinations of height-for-age, height-for-weight, and weight-for-age to determine the overall prevalence of undernutrition. The generalized estimating equation was used to explore the correlates of CIAF. After adjusting all the potential covariates, maternal undernutrition status was found to be strongly associated with child undernutrition using the CIAF [aOR: 1.4 (95% CI: 1.0, 1.9), p-value = 0.043] among the children with diarrhea under 2 years old. Maternal higher education had a protective effect on CIAF [aOR: 0.7 (95% CI: 0.5, 0.9), p-value = 0.033]. Our study findings highlight the importance of an integrated approach focusing on maternal nutrition and maternal education could affect a reduction in child undernutrition based on CIAF.publishedVersionPeer reviewe
Hypophosphataemia among Severely-malnourished Children: Case Series
Phosphorus is an essential substance in our body, and hypophosphataemia
(HP) is well-described in rickets, refeeding syndrome, diabetic
ketoacidosis (DKA), and in chronic alcohol-abuse. However, to our
knowledge, HP among severely-malnourished children has not been studied
in detail, and information on prevalence, severity, and treatment is
scarce. Currently, there are only a few published case reports of HP.
This case series describes three cases of HP that presented to Dhaka
Hospital of the International Centre for Diarrhoeal Disease Research,
Bangladesh (icddr,b). Our first case required mechanical ventilation
for respiratory distress associated with severe hypokalaemia (K 1.1
mmol/L) and moderate hypophosphataemia (P 2.1 mg/dL). The second case
presented with severe sepsis which was associated with symptomatic
hypocalcaemia (Ca 1.68 mmol/L), hypokalaemia (K 1.82 mmol/L), and
severe hypophosphataemia (P 0.9 mg/dL). The third case presented with
pneumonia and sepsis which were complicated by hypokalaemia (K 2.05
mmol/L) and severe hypophosphataemia (P 1.1 mg/dL). Marked lethargy and
severe hypotonia were associated with HP in all of these cases.
Manifestations of HP are diverse and can occur in association with
other electrolyte imbalances, especially among malnourished children.
Malnutrition, combined with sepsis, is one of the major killers of
children younger than 5 years of age, and both malnutrition and sepsis
can cause HP. It is concluded that the underlying causes of morbidity,
including HP, should be actively sought and treated to reduce the
mortality of children aged below five years
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Vibrio cholerae in rural and urban Bangladesh, findings from hospital-based surveillance, 2000–2021
With more than 100,000 cases estimated each year, Bangladesh is one of the countries with the highest number of people at risk for cholera. Moreover, Bangladesh is formulating a countrywide cholera-control plan to satisfy the GTFCC (The Global Task Force on Cholera Control) Roadmap\u27s goals. With a particular focus on cholera trends, variance in baseline and clinical characteristics of cholera cases, and trends in antibiotic susceptibility among clinical isolates of Vibrio cholerae, we used data from facility-based surveillance systems from icddr,b’s Dhaka, and Matlab Hospitals from years 2000 to 2021. Female patients comprised 3,553 (43%) in urban and 1,099 (51.6%) in rural sites. Of the cases and most patients 5,236 (63.7%) in urban and 1,208 (56.7%) in the rural site were aged 15 years and more. More than 50% of the families belonged to the poor and lower-middle-class; in 2009 (24.4%) were in urban and in 1,791 (84.2%) were in rural sites. In the urban site, 2,446 (30%) of households used untreated drinking water, and 702 (9%) of families disposed of waste in their courtyard. In the multiple logistic regression analysis, the risk of cholera has significantly increased due to waste disposal in the courtyard and the boiling of water has a protective effect against cholera. Rotavirus (9.7%) was the most prevalent co-pathogen among the under-5 children in both sites. In urban sites, the percentage of V. cholerae along with co-existing ETEC and Campylobacter is changing in the last 20 years; Campylobacter (8.36%) and Enterotoxigenic Escherichia coli (ETEC) (7.15%) were the second and third most prevalent co-pathogens. Shigella (1.64%) was the second most common co-pathogen in the rural site. Azithromycin susceptibility increased slowly from 265 (8%) in 2006–2010 to 1485 (47.8%) in 2016–2021, and erythromycin susceptibility dropped substantially over 20 years period from 2,155 (98.4%) to 21 (0.9%). Tetracycline susceptibility decreased in the urban site from 2051 (45.9%) to 186 (4.2%) and ciprofloxacin susceptibility decreased from 2,581 (31.6%) to 1,360 (16.6%) until 2015, then increased 1,009 (22.6%) and 1,490 (18.2%) in 2016–2021, respectively. Since 2016, doxycycline showed 902 (100%) susceptibility. Clinicians need access to up-to-date information on antimicrobial susceptibility for treating hospitalized patients. To achieve the WHO-backed objective of eliminating cholera by 2030, the health systems need to be put under a proper surveillance system that may help to improve water and sanitation practices and deploy oral cholera vaccines strategically
Pulmonary Tuberculosis in Severely-malnourished or HIV-infected Children with Pneumonia: A Review
Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in
severely-malnourished and HIVpositive children has received very little
attention, although this is very important in the management of
pneumonia in children living in communities where TB is highly endemic.
Our aim was to identify confirmed TB in children with acute pneumonia
and HIV infection and/or severe acute malnutrition (SAM)
(weight-for-length/height or weight-for-age z score <-3 of the WHO
median, or presence of nutritional oedema). We conducted a literature
search, using PubMed and Web of Science in April 2013 for the period
from January 1974 through April 2013. We included only those studies
that reported confirmed TB identified by acid fast bacilli (AFB)
through smear microscopy, or by culture-positive specimens from
children with acute pneumonia and SAM and/or HIV infection. The
specimens were collected either from induced sputum (IS), or gastric
lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung
aspirates (LA). Pneumonia was defined as the radiological evidence of
lobar or patchy consolidation and/or clinical evidence of severe/ very
severe pneumonia according to the WHO criteria of acute respiratory
infection. A total of 17 studies met our search criteria but 6 were
relevant for our review. Eleven studies were excluded as those did not
assess the HIV status of the children or specify the nutritional status
of the children with acute pneumonia and TB. We identified only 747
under-five children from the six relevant studies that determined a
tubercular aetiology of acute pneumonia in children with SAM and/or
positive HIV status. Three studies were reported from South Africa and
one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and
12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%)
children were identified with active TB respectively, with a total of
93 (12%) children with active TB. Among 610 HIV-infected children in
three studies from South Africa and 137 SAM children from other
studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were
identified respectively. Children from South Africa were infected with
HIV without specification of their nutritional status whereas children
from other countries had SAM but without indication of their HIV
status. Our review of the existing data suggests that pulmonary
tuberculosis may be more common than it is generally suspected in
children with acute pneumonia and SAM, or HIV infection. Because of the
scarcity of data, there is an urgent need to investigate PTB as one of
the potential aetiologies of acute pneumonia in these children in a
carefully-conducted larger study, especially outside Africa
Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial
BACKGROUND: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. OBJECTIVE: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. METHODS: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients' increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. RESULTS: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients' mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. CONCLUSIONS: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30191
Introducing pulse oximetry for outpatient management of childhood pneumonia::An implementation research adopting a district implementation model in selected rural facilities in Bangladesh
BACKGROUND: Pulse oximetry has potential for identifying hypoxaemic pneumonia and substantially reducing under-five deaths in low- and middle-income countries (LMICs) setting. However, there are few examples of introducing pulse oximetry in resource-constrained paediatric outpatient settings, such as Integrated Management of Childhood Illness (IMCI) services. METHODS: The National IMCI-programme of Bangladesh designed and developed a district implementation model for introducing pulse oximetry in routine IMCI services through stakeholder engagement and demonstrated the model in Kushtia district adopting a health system strengthening approach. Between December 2020 and June 2021, two rounds of assessment were conducted based on WHO's implementation research framework and outcome variables, involving 22 IMCI service-providers and 1680 children presenting with cough/difficulty-in-breathing in 12 health facilities. The data collection procedures included structured-observations, re-assessments, interviews, and data-extraction by trained study personnel. FINDINGS: We observed that IMCI service-providers conducted pulse oximetry assessments on all eligible children in routine outpatient settings, of which 99% of assessments were successful; 85% (95% CI 83,87) in one attempt, and 69% (95% CI 67,71) within one minute. The adherence to standard operating procedure related to pulse oximetry was 92% (95% CI 91,93), and agreement regarding identifying hypoxaemia was 97% (95% CI 96,98). The median performance-time was 36 seconds (IQR 20,75), which was longer among younger children (2-11 months: 44s, IQR 22,78; 12-59 months: 30s, IQR 18,53, p < 0.01) and among those classified as pneumonia/severe-pneumonia than as no-pneumonia (41s, IQR 22,70; 32s, IQR 20,62, p < 0.01). We observed improvements in almost all indicators in round-2. IMCI service-providers and caregivers showed positive attitudes towards using this novel technology for assessing their children. INTERPRETATION: This implementation research study suggested the adoption, feasibility, fidelity, appropriateness, acceptability, and sustainability of pulse oximetry introduction in routine IMCI services in resource-poor settings. The learning may inform the evidence-based scale-up of pulse oximetry linked with an oxygen delivery system in Bangladesh and other LMICs. FUNDING: This research was funded by the UK National Institute for Health Research (NIHR) (Global Health Research Unit on Respiratory Health (RESPIRE); 16/136/109) using UK aid from the UK Government to support global health research
Feasibility and acceptability of bubble continuous positive airway pressure oxygen therapy for the treatment of childhood severe pneumonia and hypoxemia in Bangladeshi children
Anthropometric Indices of Giardia-Infected Under-Five Children Presenting with Moderate-to-Severe Diarrhea and Their Healthy Community Controls: Data from the Global Enteric Multicenter Study
Among all intestinal parasitosis, giardiasis has been reported to be associated with delayed growth in malnourished children under 5 living in low- and middle-income countries. Relevant data on the nutritional status of children aged 0-59 months presenting with moderate-to-severe diarrhea (MSD) and giardia infection were collected from sentinel health facilities of the Global Enteric Multicenter Study's (GEMS) seven field settings, placed in diverse countries of Sub-Saharan Africa and South Asia between, December 2007 and February 2011. Then, this study analyzed a robust dataset of study participants (n = 22,569). Children having giardiasis with MSD constituted as cases (n = 1786), and those without MSD constituted as controls (n = 3470). Among the seven field sites, symptomatic giardiasis was 15% and 22% in Asian and African sites, respectively, whereas asymptomatic giardia infection (healthy without MSD) in Asian and African sites was 21.7% and 30.7%, respectively. Wasting and underweight were more frequently associated and stunting less often associated with symptomatic giardiasis (for all, p < 0.001). Symptomatic giardiasis had a significant association with worsening of nutritional status in under-five children. Improved socio-economic profile along with proper sanitation and hygienic practices are imperative to enhance child nutritional status, particularly in resource limited settings
Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya
Background: Even when undernourished children in low- and middle-income countries are treated using World Health Organisation recommended guidelines, they remain at elevated risk of death following hospital discharge. The role of community health workers (CHWs) in supporting post-discharge recovery to improve outcomes has not been adequately explored.
Methods: Qualitative research was conducted as part of the Childhood Acute Illnesses and Nutrition (CHAIN) Network in rural and urban Bangladesh and Kenya. Interviews were conducted with family members of a total of 64 acutely ill children admitted in four hospitals (two rural and two urban- across both contexts). Children included those with undernutrition, and interviews were repeated in family members’ homes over several months. Data collected from families were supplemented by observations in facilities and homes, key informant interviews with CHWs and policy makers in Bangladesh, and a review of relevant guidelines.
Findings: Guidelines suggest that CHWs could play a role not only in initially referring undernourished children to hospital, but also in supporting recovery post-discharge. However, the specific mechanisms to link CHWs into hospital discharge and post-discharge support processes are not specified. Data suggest a range of access and communication challenges that community health workers (CHWs) could potentially contribute towards overcoming. However, few families we interviewed reported any therapeutic interactions with CHWs post-discharge, especially in Kenya. Although CHWs are generally available in communities, they face significant challenges in conducting their roles, including unmanageable workloads, few incentives, lack of equipment and supplies and inadequate support from supervisors and some community members.
Conclusion/recommendations: There is need for context sensitive policy and guidance documents that include specific recommendations on post-discharge linkage or down-referral to support for vulnerable children. Consideration should be given to introducing and supporting a dedicated staff member (whether defined as a CHW or patient advocate) whose tasks and responsibilities include playing a linking role between family members and community-based post-discharge support services. These additional tasks should take into consideration the broader responsibilities of CHWs, and consider recognised challenges such as appropriate recognition, training and remuneration. Potential interventions need to be evaluated in carefully designed and conducted studies
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