Mother’s dietary diversity and association with stunting among children <2 years old in a low socio‐economic environment: A case–control study in an urban care setting in Dhaka, Bangladesh

Mothers are often responsible for preparing nutritious foods in their households. However, the quality of mother’s diets is often neglected, which may affect both mother’s and child’s nutrition. Because no single food contains all necessary nutrients, diversity in dietary sources is needed to ensure a quality diet. We aimed to study the association between mother’s dietary diversity and stunting in children <2 years attending Dhaka Hospital of icddr,b, a diarrhoeal disease hospital in Dhaka, Bangladesh. A case–control study (n = 296) was conducted from November 2016 to February 2017. Data were collected from mothers of stunted children <2 years (length‐for‐age z score [LAZ] < −2) as “cases” and nonstunted (LAZ ≥ −1) children <2 years as “controls.” Mothers were asked to recall consumption of 10 defined food groups 24 hr prior to the interview as per Guidelines for Minimum Dietary Diversity for Women. Among the mothers of cases, 58% consumed <5 food groups during the last 24 hr, compared with 45% in control mothers (P = 0.03). Children whose mothers consumed <5 food groups were 1.7 times more likely to be stunted than children whose mothers consumed ≥5 food groups (P = 0.04). Intake of food groups such as pulses, dairy, eggs, and vitamin A rich fruit was higher in control mothers. Proportion of mother’s illiteracy, short stature, monthly family income <BDT 11,480, absence of bank account, and poor sanitation was also found to be higher in stunted group. Further study particularly intervention or longitudinal study to see the causality of mother’s dietary diversity with child stunting is recommended.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148421/1/mcn12665.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148421/2/mcn12665_am.pd

Site-Specific Analysis of the Incidence Rate of Enterotoxigenic \u3ci\u3eEscherichia coli\u3c/i\u3e Infection Elucidates an Association with Childhood Stunting, Wasting, and Being Underweight: A Secondary Analysis of the MAL-ED Birth Cohort

Asymptomatic infection by fecal enteropathogens is a major contributor to childhood malnutrition. Here, we investigated the incidence rate of asymptomatic infection by enterotoxigenic Escherichia coli (ETEC) and assessed its association with childhood stunting, wasting, and being underweight among children under 2 years of age. The Malnutrition and Enteric Disease birth cohort study included 1,715 children who were followed from birth to 24 months of age from eight distinct geographic locations including Bangladesh, Brazil, India, Peru, Tanzania, Pakistan, Nepal, and South Africa. The TaqMan array card assay was used to determine the presence of ETEC in the nondiarrheal stool samples collected from these children. Poisson regression was used to estimate the incidence rate, andmultiple generalized estimating equations with binomial family, logit link function, and exchangeable correlation were used to analyze the association between asymptomatic ETEC infection and anthropometric indicators such as stunting, wasting, and being underweight. The site-specific incidence rates of asymptomatic ETEC infections per 100 child-months were also higher at the study locations in Tanzania (54.81 [95% CI: 52.64, 57.07]) and Bangladesh (46.75 [95% CI: 44.75, 48.83]). In the Bangladesh, India, and Tanzania sites, the composite indicator of anthropometric failure was significantly associated with asymptomatic ETEC infection. Furthermore, a significant association between asymptomatic heat-stable toxin ETEC infections and childhood stunting, wasting, and being underweight was found in only the Bangladesh and Tanzania sites

Underweight, overweight and obesity among reproductive Bangladeshi women : a nationwide survey

The double burden of malnutrition is becoming more prevalent among Bangladeshi women. Underweight, overweight, and obesity were examined among women aged 15–49 years using the 2017–2018 Bangladesh Demographic and Health Survey (BDHS). A dataset of 20,127 women aged 15–49 years with complete Body Mass Index (BMI) measurements were extracted and categorized as underweight, normal weight, overweight, and obesity. A multiple logistic regression that adjusts for clustering and sampling weights was used to examine underweight, overweight, and obesity among reproductive age Bangladeshi women. Our analyses revealed that the odds of being overweight and obese were higher among women who completed primary and secondary or more levels of education, rich households, breastfeeding women, and women exposed to media (newspapers and television (TV). Women from the poorest households were significantly more likely to be underweight (AOR = 3.86, 95%CI: 2.94–5.07) than women from richer households. The likelihood of being underweight was higher among women with no schooling, adolescent women, and women not using contraceptives. Conclusions: Overweight and obesity was higher among educated and affluent women while underweight was higher among women from low socioeconomic status, indicating that tailored messages to combat overweight and obesity should target educated and affluent Bangladeshi women while improving nutrition among women from low socioeconomic status

Determinants of campylobacter infection and association with growth and enteric inflammation in children under 2 years of age in low-resource settings

Campylobacter species infections have been associated with malnutrition and intestinal inflammation among children in low-resource settings. However, it remains unclear whether that association is specific to Campylobacter jejuni/coli. The aim of this study was to assess the association between both all Campylobacter species infections and Campylobacter jejuni/coli infections on growth and enteric inflammation in children aged 1-24 months. We analyzed data from 1715 children followed from birth until 24 months of age in the MAL-ED birth cohort study, including detection of Campylobacter species by enzyme immunoassay and Campylobacter jejuni/coli by quantitative PCR in stool samples. Myeloperoxidase (MPO) concentration in stool, used as a quantitative index of enteric inflammation, was measured. The incidence rate per 100 child-months of infections with Campylobacter jejuni/coli and Campylobacter species during 1-24 month follow up were 17.7 and 29.6 respectively. Female sex of child, shorter duration of exclusive breastfeeding, lower maternal age, mother having less than 3 living children, maternal educational level of \u3c6 \u3eyears, lack of routine treatment of drinking water, and unimproved sanitation were associated with Campylobacter jejuni/coli infection. The cumulative burden of both Campylobacter jejuni/coli infections and Campylobacter species were associated with poor growth and increased intestinal inflammation

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

Citrulline and kynurenine to tryptophan ratio : potential EED (environmental enteric dysfunction) biomarkers in acute watery diarrhea among children in Bangladesh

Two emerging biomarkers of environmental enteric dysfunction (EED) include plasma citrulline (CIT), and the kynurenine (KYN): tryptophan (TRP)/ (KT) ratio. We sought to investigate the plasma concentration of CIT and KT ratio among the children having dehydrating diarrhea and examine associations between concentrations of CIT and KT ratio with concurrent factors. For this analysis, we used cross-sectional data from a total of 102, 6–36 months old male children who suffered from non-cholera acute watery diarrhea and had some dehydration admitted to an urban diarrheal hospital, in Bangladesh. CIT, TRP, and KYN concentrations were determined at enrollment from plasma samples using ELIZA. At enrollment, the mean plasma CIT concentration was 864.48 ± 388.55 µmol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (× 1000) were 6.93 ± 3.08 µmol/L, 33.44 ± 16.39 µmol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: − 0.26; 95%CI: − 0.49, − 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: − 0.01; 95% CI: − 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: − 0.6; 95% CI: − 1.18, − 0.02; p = 0.042) after adjusting for potential covariates. The CIT concentration was associated with blood neutrophils (coef.: 0.02; 95% CI: 0.01, 0.03; p < 0.001), lymphocytes (coef.: − 0.02; 95% CI: − 0.03, − 0.02; p < 0.001) and monocyte (coef.: 0.06; 95% CI: 0.01, 0.11; p = 0.021); KYN concentration was negatively associated with basophil (coef.: − 0.62; 95% CI: − 1.23, − 0.01; p = 0.048) after adjusting for age. In addition, total stool output (gm) increased (coef.: 793.84; 95% CI: 187.16, 1400.52; p = 0.011) and also increased duration of hospital stay (hour) (coef.: 22.89; 95% CI: 10.24, 35.54; p = 0.001) with increasing CIT concentration. The morphological changes associated with EED may increase the risk of enteric infection and diarrheal disease among children. Further research is critically needed to better understand the complex mechanisms by which EED biomarkers may impact susceptibility to dehydrating diarrhea in children.publishedVersionPeer reviewe

Enteric viral pathogens and child growth among under-five children: findings from South Asia and sub-Saharan Africa.

Enteric viral pathogens are associated with a significant burden of childhood morbidity and mortality. We investigated the relationship between viral pathogens and child growth among under-5 children. We analyzed data from 5572/22,567 children enrolled in the Global Enteric Multicenter Study across seven study sites (2007-2011). Multiple linear regression was used to examine the association between the viral pathogens and changes of length/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length/height (WHZ) z-scores, stratified by diarrheal symptoms and adjusted for potential covariates. Rotavirus (18.51%) and norovirus (7.33%) were the most prevalent enteric viral pathogens among symptomatic and asymptomatic under-5 children, respectively. Infection with individual enteric viral pathogens hurts child growth in asymptomatic children. However, the relationship with HAZ was less clear and statistically non-significant. On the other hand, the combined viral pathogens demonstrated a strong negative influence on child growth [WAZ: β coef.: - 0.10 (95%, CI - 0.15, - 0.05); P < 0.001 and WHZ: β: - 0.12 (95% CI - 0.17, - 0.07); P < 0.001] among asymptomatic children. Infection with any viral pathogen was associated with growth shortfalls [HAZ: β: - 0.05 (95% CI - 0.09, 0.00); P = 0.03 and WAZ: β: - 0.11 (95% CI - 0.16, - 0.07); P < 0.001 and WHZ: β: - 0.13 (95% CI - 0.18, - 0.09); P < 0.001], though the relationship with HAZ was less evident and became statistically non-significant in older children. Notably, among symptomatic children with moderate-to-severe diarrhea, individual enteric viral pathogens, as well as the combined effects of these pathogens [WHZ: β: 0.07; (95% CI 0.01, 0.14); P = 0.03] and the presence of any virus [HAZ: β: 0.09 (95% CI 0.05, 0.13) & WAZ: β: 0.08 (95% CI 0.03, 0.12); P < 0.001], exhibited positive effects on child growth. While previous studies hypothesized that several viral pathogens had a conflicting controversial role in child growth, we find clear indications that enteric viral pathogens are associated with growth shortfalls, specifically among asymptomatic children. These findings highlight the need for preventive strategies targeting children with enteric viral pathogens, which could address the consequences of growth faltering

Stunting Status of Ever-Married Adolescent Mothers and Its Association with Childhood Stunting with a Comparison by Geographical Region in Bangladesh

The adolescence period is considered a life stage worthy of strategic health investments since it is a critical period of physical and neuro-maturational development. Adolescent girls face different health difficulties in that phase of life. Children born to adolescent mothers are at a higher risk of undernutrition. This paper aims to estimate the prevalence of stunting among adolescent mothers and their children in Bangladesh by time period and determine the associated factors of adolescent maternal stunting status. We also sought to establish the relationship between maternal and childhood stunting by comparing the geographical regions in Bangladesh. We derived data from the nationally representative Bangladesh Demographic and Health Survey, which was conducted between 2007 and 2017/18. The outcome variables of this study were ever-married adolescent girls&rsquo; stunting status and their children&rsquo;s stunting status. Interaction analysis between administrative division and maternal stunting status was conducted with childhood stunting as the outcome variable to investigate the impact of maternal stunting status on their children&rsquo;s stunting compared to geographical location. Our results indicated that in comparison to other divisions, the frequency of stunting among children and adolescent mothers was higher in the Sylhet region. It also revealed that children whose mothers were stunted had a 2.36 times increased chance of being stunted. Our study suggests that education for women could help them attain self-sufficiency and, as a result, reduce the prevalence of poor childhood nutrition, especially stunting

Transforming Chronic Disease Management with Chatbots: Key Use Cases for Personalized and Cost-effective Care

Chronic diseases, such as diabetes, hypertension, and heart disease, are a growing public health concern globally. The burden of these diseases on healthcare systems and patients is enormous. To address these challenges, innovative technologies, such as chatbots, have emerged as promising solutions to improve chronic disease management. Chatbots are artificial intelligence (AI) programs that can simulate conversations with humans and provide personalized and cost-effective care. This research paper aims to explore the key use cases for chatbots in chronic disease management, such as personalized education, symptom monitoring, medication management, and lifestyle coaching. Furthermore, it discusses the potential benefits and challenges of chatbots in chronic disease management, including patient engagement, data privacy, and the need for human oversight. Finally, the paper concludes that chatbots have the potential to transform chronic disease management by providing personalized and cost-effective care, but their integration into healthcare systems requires careful consideration of ethical, legal, and regulatory frameworks.</p

Association between Non-Typhoidal Salmonella Infection and Growth in Children under 5 Years of Age: Analyzing Data from the Global Enteric Multicenter Study

Non-typhoidal Salmonella (NTS) is one of the less focused on infections and is often associated with faulty child nutrition in the developing world. This study aimed to evaluate the association of NTS infection with growth faltering among children under the age of five. We analyzed data from 378 fecal NTS positive children with both moderate-to-severe diarrhea (MSD) and asymptomatic infection from the seven countries of South Asia and sub-Saharan Africa during enrolment and on day 60 follow up in the Global Enteric Multicenter Study (GEMS) for the period of December 2007 to March 2011. Children not associated with fecal NTS (n = 1134) were randomly selected from the same dataset (1:3 ratio) as a comparison group. The association between an explanatory variable and the outcome variable was longitudinally tested using generalized estimating equations (GEE), where the dependent variables were height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-score, and the independent variable was the presence of fecal NTS. The GEE multivariable model identified a negative association between fecal NTS and WAZ (coefficient: −0.19; 95% CI (confidence interval): −0.33, −0.04, and p value = 0.010), WHZ (coef: −0.19; 95% CI: −0.34, −0.05, and p value = 0.007), and HAZ (coef: −0.13; 95% CI: −0.27, −0.01, and p value = 0.073) after adjusting for age, gender, diarrhea, breastfeeding status, mothers’ education, number of children under the age of five, household size by the number of people regularly sleep at the home, handwashing practice, source of drinking water, wealth index, presence of co-pathogens, comorbidity, and study sites. In the GEMS, where children were followed during 50–90 days of enrolment, the presence of fecal NTS harmed the child’s anthropometric outcomes. Minimizing potential exposure to NTS is needed to curb worsening child undernutrition