Association of autism spectrum disorder and gestational diabetes mellitus of mothers in Bangladesh

Background: Globally Approximately 1 in 110 children has Autism Spectrum Disorder (ASD) and the cumulative incidence of this disorder seems to be increasing. To date, the etiology of ASD is unknown. Gestational diabetes is a common pregnancy complication whose prevalence is increasing among women of reproductive age and results in both short-and long-term adverse outcomes for the offspring and may contribute to ASD risk. Aims & Objectives: The aim of the study was to determine the association of maternal gestational diabetes mellitus with autism spectrum disorder in children. Material & Methods: A case control study was conducted among the children 5-7 years old diagnosed with an autism spectrum disorder (n=99) in special need primary schools and a similar age control group of children (n= 198) without the disease at randomly selected primary schools. The groups of children were compared with the obstetric information regarding Gestational Diabetes Mellitus (GDM) of mothers during their index pregnancy. Results: Compared with the control subjects, cases had significantly older parents and were more likely to be high socioeconomic status. History of GDM during index pregnancy were higher in cases than controls [OR=2.30, CI= 1.36 – 3.91].Prenatal and perinatal risk factors were more prevalent among case mothers compared with controls. Collectively, these conditions were associated with a higher likelihood of ASD than controls. Among cases family history of DM were more common compared with controls [OR=23, CI= 10.84 – 48.94]. Case mothers had greater frequencies of threatened abortion [OR= 3.23, CI= 1.94- 5.37], bleeding during pregnancy [OR=1.25, CI=0.20–7.61] and more likely to have experienced cesarean section. Male children were more affected by ASD [OR= 2.87, CI= 1.67 – 4.90] compared with controls. Conclusions: Maternal DM in pregnancy is responsible for at least a good proportion of cases of ASD which in turn has been proven as independent risk factors for autism

Awareness on Breast Cancer among the Women of Reproductive Age

Objective: To assess the level of awareness on breast cancer among women of reproductive age. Materials and methods: A cross-sectional descriptive study was conducted in OPD of Dhaka Medical College Hospital among the 175 respondents by face to face interview using pretested semi structured questionnaire. Results: One forth (23%) aged 21-25 years, mostly Muslim (86.3%), housewives (72.57%), had children (81.05%) and live in urban (69%) area. One third of them were illiterate and married at 16-20 years. Slightly less than half of their family income was taka 4500 to 5500. Six of 10 respondents (64%) knew that it was common cancer in women and almost all (94.29%) mentioned that breast cancer did not occur in old age. In addition half of them said that it was not inherited, signs and symptoms of breast cancer was spontaneous clear or bloody discharge from nipple often associated with a lump (61.14%), and it could not be cured (54.3%). Majority of them (78.9%) did not know that early diagnosis improves treatment outcome and the risk factor of breast cancer (65.14%). Half of them (57.5%) had knowledge that clinical breast examination as screening method of breast cancer but vast majority did not practice clinical breast examination. Only 16.67% of the respondents did BSE regularly and among them 83.33% did not know the best time for breast self examination. Practice breast feeding was universal among them but for less than 6 months. Conclusion:The study found that women were not so much aware regarding breast cancer and also preventive measures, risk factors so on. So for better awareness, campaign and counseling program from both Government and NGOs is needed.

Knowledge on Reproductive Health Issues Among the Unmarried Adolescent Girls

Objective: To assess the level of knowledge of the adolescent girls regarding reproductive health issues. Materials and methods: A cross sectional descriptive type of study was carried out among 150 unmarried adolescent girls of Vashantek slum in Dhaka city by face to face interview using a semistructured questionnaire from January to June 2008. Results: The mean age of the respondents were 16.4±2.9 years ranging from 10-19 years. Out of 150 respondents, 130 had history of menstruation and their median age of menarche was 13 years. The correct knowledge was high among the adolescent having secondary level of education than the SSC and above or primary level of education and the difference was statistically significant (p<0.05). About three-fourths of the respondents had sufficient knowledge about hygienic menstrual practice. Majority of the girls could mention the legal age of marriage. Regarding the demerits of early marriage, majority mentioned some of the demerits but not all. Three-fifths of the respondents had no knowledge on importance of family planning and regarding the methods of family planning, majority of them had no knowledge. Majority of the respondents heard the disease AIDS but regarding the knowledge on causative agent half of them had no knowledge. More than two-fifths had no knowledge on mode of transmission of AIDS. It was also found that majority of the  respondents had no knowledge on symptoms of AIDS and three-fifths had no knowledge on prevention of AIDS. Conclusion: So formal, informal and special educational program may be taken to educate the adolescent girls on reproductive health issues and government should be more concerned about this

Unmet Needs Of Family Planning And Practice Of Family Planning In A Selected Urban to Rural Migrated Population Of Dhaka City

Objective: To ascertain the unmet needs of family planning & identify the practice of family planning among the urban to rural migrated slum dwellers. Materials and methods: A cross-sectional descriptive study was done randomly among selected 600 slum dwellers residing in two selected slums of Dhaka city. Data collected by face to face interview using pretested semi structured questionnaire. Results: Among the respondents 87.7% of were females, illiterate was 60% and most (79.9%) of the houses were katcha and (37.3%) of the families had 5-7 persons in each family. Most families (70%) had monthly income of less than 5000 (app.US$70) taka per month. Majority (89.3%) of the families lived in the villages before coming to Dhaka. About 31.34% were living in present slum for 5-10 years and 80% came for search for better work. It was also found that 33.7% of the couples were not using any contraceptive method. About 29% of these couples did not mention any specific cause for not using family planning method.  Only 3.5% of the respondents said of any sort of difficulty in collecting contraceptives and the main difficulty was shyness. As regards knowledge of above consequence of not using contraceptive method 97.7% opined that it would cause unplanned pregnancy, which indicated their awareness towards family planning. Conclusion: The study found that the respondents were aware about the needs of family planning but a great number of them were not using any contraceptive method without any specific reason. Some behavior change communication activities can be run within these areas to bring them under the family planning methods which eventually enhance the population control activity of the country

Association of autism spectrum disorder and gestational diabetes mellitus of mothers in Bangladesh

Background: Globally Approximately 1 in 110 children has Autism Spectrum Disorder (ASD) and the cumulative incidence of this disorder seems to be increasing. To date, the etiology of ASD is unknown. Gestational diabetes is a common pregnancy complication whose prevalence is increasing among women of reproductive age and results in both short-and long-term adverse outcomes for the offspring and may contribute to ASD risk. Aims & Objectives: The aim of the study was to determine the association of maternal gestational diabetes mellitus with autism spectrum disorder in children. Material & Methods: A case control study was conducted among the children 5-7 years old diagnosed with an autism spectrum disorder (n=99) in special need primary schools and a similar age control group of children (n= 198) without the disease at randomly selected primary schools. The groups of children were compared with the obstetric information regarding Gestational Diabetes Mellitus (GDM) of mothers during their index pregnancy. Results: Compared with the control subjects, cases had significantly older parents and were more likely to be high socioeconomic status. History of GDM during index pregnancy were higher in cases than controls [OR=2.30, CI= 1.36 – 3.91].Prenatal and perinatal risk factors were more prevalent among case mothers compared with controls. Collectively, these conditions were associated with a higher likelihood of ASD than controls. Among cases family history of DM were more common compared with controls [OR=23, CI= 10.84 – 48.94]. Case mothers had greater frequencies of threatened abortion [OR= 3.23, CI= 1.94- 5.37], bleeding during pregnancy [OR=1.25, CI=0.20–7.61] and more likely to have experienced cesarean section. Male children were more affected by ASD [OR= 2.87, CI= 1.67 – 4.90] compared with controls. Conclusions: Maternal DM in pregnancy is responsible for at least a good proportion of cases of ASD which in turn has been proven as independent risk factors for autism

Non Obstetric Causes and Presentation of Acute Abdomen among the Pregnant Women.

Objective:To identify the non-obstetric causes and presentation of acute abdomen among pregnant women. Materials and methods:This was a cross sectional hospital-based study among 128 pregnant women by face to face interview using a semi-structured questionnaire. This study was conducted at the Gynecology & Obstetric Ward of 250 Bed General Hospital, Noakhali, Bangladesh, from January to August 2013. Data were analyzed by a software package used for statistical analysis (SPSS) version 11.5 (SPSS, Inc., Chicago, IL, USA).Mean age of participants was 25±4 years. Our findings showed that 81% were Muslim, 67% were lower middle income group, as well as 47% completed primary level of education. The results revealed that 28% had biliary ascariasis, 24% had peptic ulcer disease and 10% had lower urinary tract infection. We also found that 6% had acute pyelonephritis, 6% had acute gastroenteritis, 6% had acute cholecystitis, 6% had acute appendicitis, 2% had acute pancreatitis, 3% had choledocolithiasis, 2% had ovarian solid mass, 2% had twisted ovarian cyst, 4% had renal colic, and 1% had renal calculus. In non-obstetrical presentation of acute abdomen, the study found that 84% of respondents complained their pain lasting more than 24 hours. Besides, half of respondents felt pain in epigastrium and right hypochondrium. Cramping, prickling and aching type of pain were more, while 66% suffered from continuous pain. Our results also showed that 73% did not explain any aggravating factor and relieving factor, and the rest said food, fasting state and position change aggravated pain as well as relieved pain. Conclusion:The study concludes that precise diagnosis of the acute abdomen in pregnant women by continual updating of abdominal assessment knowledge, and clinical skills is necessary in the management of abdominal pain in obstetric settings

Prevalence of Type 2 Diabetes Mellitus Among Urban Bihari Communities in Dhaka, Bangladesh: A Cross-sectional Study in a Minor Ethnic Group

Introduction The prevalence, disease progression, and treatment outcomes for patients with type 2 diabetes vary significantly between ethnic groups. The Bihari community constitutes one of the most vulnerable populations in Bangladesh on the basis of access to health services and other fundamental rights. Our study aimed at finding out the prevalence and risk factors of type 2 diabetes among the Bihari adults in Dhaka city. Methods This cross-sectional community-based study was carried out among stranded Pakistanis (known as Bihari) living in camps in the Mirpur area from July 2014 to June 2015. Laboratory-based oral glucose tolerance test (OGTT) was the basis for the diagnosis of type 2 diabetes mellitus (DM). Anthropometric measurements, blood pressure, biochemical tests, family history, and socioeconomic information were obtained to determine the risk factors. Results The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were estimated at 10.11%, 8.74%, and 4.55%, respectively. Increased diastolic blood pressure, serum triglyceride, and cholesterol level were observed to be significantly (p < 0.05) associated with diabetes. Also, the presence of diabetes, high blood pressure, and obesity among relatives significantly increased the probability of diabetes. Conclusions To the best of our knowledge, this is the first study on diabetes prevalence among the Bihari community in Bangladesh. The prevalence of type 2 diabetes mellitus was found to be higher among the Bihari community compared to the general population in Bangladesh. Health planners and policymakers should realize the alarming situation and identified risk factors and consider the minor ethnic groups during decision-making regarding prevention and control of diabetes and other noncommunicable diseases

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease

<div><p>Background</p><p>Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh.</p><p>Methods</p><p>We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life.</p><p>Results</p><p>A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy.</p><p>Conclusions</p><p>This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.</p></div

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease - Fig 2

<p>The economic impact of chikungunya infection on days misses from work (A) and rating versus income ranges as 100% staked column (B). Respondents were asked to rate the chikungunya healthcare expenditure on their economic conditions on a numeric rating scale of 1 to 10. Rating 8–10, 5–7, 2–4 and 1 is considered as extreme, moderate, mild and no impact on economic conditions of respondents, respectively. One column in B illustrates the relative percentage of cases from different income ranges. The exchange rate of 1 USD is about 82 BDT.</p