Risk factors for stunting and wasting at age six, twelve and twenty-four months for squatter children of Karachi, Pakistan

Objective: A high proportion of stunting and wasting in children under-five has been reported from developing countries. This paper presents the nutritional status of a two year cohort of urban squatter children in Karachi, Pakistan and assesses risk factors for wasting and stunting at the reference ages of six, twelve and twenty-four months.Methods: A birth cohort of 738 children were visited at specific intervals by trained nurses to collect information on anthropometric measurements, feeding practices and intercurrent illnesses. Socioeconomic and demographic information included water and sanitation facilities, availability of electricity, type of house construction material and average monthly income. Information about the mother\u27s reproductive history was also obtained.Results: At two years the proportion of stunting and wasting was 41.8% and 10.6% respectively. Intrauterine growth retarded children had a higher risk of stunting and wasting at all reference ages as compared to children who were appropriate for gestational age. In the logistic regression models, intrauterine growth retardation was the only significant risk factor that remained in all models at each reference age.CONCLUSION: The consistent association of IUGR for stunting and wasting adds to the growing body of evidence that by improving maternal health we will ultimately break the vicious cycle of malnourishment and improve the health and well-being of future generations. We suggest interventions to improve the nutritional status of Pakistani urban children living in squatter settlements focused on mothers and children

Causes of reproductive age mortality in low socioeconomic settlements of Karachi

The Maternal and Infant Mortality Survey (MIMS) was conducted in eight squatter settlements of Karachi. The female mortality rate was 151.0 per 100,000 women aged 10-49 years and the maternal mortality ratio was 281 per 100,000 livebirths. The leading causes of deaths among women were complications of pregnancy (28.1%), infectious diseases (24.8%), cardiovascular diseases (20.7%), neoplasia (10.7%) and trauma (10.7%). Hemorrhage (47.1% of all maternal deaths), tuberculosis (40.0% of all infectious disease deaths), oropharyngeal cancer (23.1% of all neoplastic deaths), and burns (61.5% of all trauma deaths) were among the major causes identified. Maternal deaths were associated with young age and nulliparity (p-value \u3c 0.01), and a higher proportion occurred in the hospital or on the way to the hospital as compared to non-maternal deaths

Risk factors for intrauterine growth retardation: results of a community-based study from Karachi

There is a serious lack of community-based information on low birthweight or intrauterine growth retardation from Pakistan. A community based prospective study was conducted in four squatter settlements of Karachi, to examine the prevalence and risk factors for adverse pregnancy outcome. This paper reports on the prevalence and risk factors for intrauterine growth retardation (age) among 755 singleton births. The incidence of intrauterine growth retardation was 25.4% (192 intrauterine growth retarded and 563 appropriate for gestational age). Major socioeconomic risk factors identified were low maternal education (RR = 1.4, 95% CI = 1.0,2.1) and poor housing material (RR = 1.7, 95% CI = 1.0,3.0). Among the significant biologic factors, primiparity (RR = 1.9, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.4,2.7), consanguinity (RR = 1.4, 95% CI = 1.1,1.8), short birth to CI = 1.1,2.1), short stature (RR = 2.2, 95% CI = 1.6,3.0), low maternal weight (RR = 2.0, 95% CI = 1.6,2.5) and non-vegetarian diet (RR = 2.3, 95% CI = 1.3,4.2) were especially important. Investigations to assess the adverse mortality and morbidity effects of intrauterine growth retardation are ongoing

The EOS CERES Global Cloud Mask

To detect long-term climate trends, it is essential to produce long-term and consistent data sets from a variety of different satellite platforms. With current global cloud climatology data sets, such as the International Satellite Cloud Climatology Experiment (ISCCP) or CLAVR (Clouds from Advanced Very High Resolution Radiometer), one of the first processing steps is to determine whether an imager pixel is obstructed between the satellite and the surface, i.e., determine a cloud 'mask.' A cloud mask is essential to studies monitoring changes over ocean, land, or snow-covered surfaces. As part of the Earth Observing System (EOS) program, a series of platforms will be flown beginning in 1997 with the Tropical Rainfall Measurement Mission (TRMM) and subsequently the EOS-AM and EOS-PM platforms in following years. The cloud imager on TRMM is the Visible/Infrared Sensor (VIRS), while the Moderate Resolution Imaging Spectroradiometer (MODIS) is the imager on the EOS platforms. To be useful for long term studies, a cloud masking algorithm should produce consistent results between existing (AVHRR) data, and future VIRS and MODIS data. The present work outlines both existing and proposed approaches to detecting cloud using multispectral narrowband radiance data. Clouds generally are characterized by higher albedos and lower temperatures than the underlying surface. However, there are numerous conditions when this characterization is inappropriate, most notably over snow and ice of the cloud types, cirrus, stratocumulus and cumulus are the most difficult to detect. Other problems arise when analyzing data from sun-glint areas over oceans or lakes over deserts or over regions containing numerous fires and smoke. The cloud mask effort builds upon operational experience of several groups that will now be discussed

Technical design and commissioning of the KATRIN large-volume air coil system

The KATRIN experiment is a next-generation direct neutrino mass experiment with a sensitivity of 0.2 eV (90% C.L.) to the effective mass of the electron neutrino. It measures the tritium $\beta$-decay spectrum close to its endpoint with a spectrometer based on the MAC-E filter technique. The $\beta$-decay electrons are guided by a magnetic field that operates in the mT range in the central spectrometer volume; it is fine-tuned by a large-volume air coil system surrounding the spectrometer vessel. The purpose of the system is to provide optimal transmission properties for signal electrons and to achieve efficient magnetic shielding against background. In this paper we describe the technical design of the air coil system, including its mechanical and electrical properties. We outline the importance of its versatile operation modes in background investigation and suppression techniques. We compare magnetic field measurements in the inner spectrometer volume during system commissioning with corresponding simulations, which allows to verify the system's functionality in fine-tuning the magnetic field configuration. This is of major importance for a successful neutrino mass measurement at KATRIN.Comment: 32 pages, 16 figure

Satellite Estimates of the Direct Radiative Forcing of Biomass Burning Aerosols Over South America and Africa

Atmospheric aerosol particles, both natural and anthropogenic are important to the earth's radiative balance. Therefore it is important to provide adequate validation information on the spatial, temporal and radiative properties of aerosols. This will enable us to predict realistic global estimates of aerosol radiative effects more confidently. The current study utilizes 66 AVHRR LAC (Local Area Coverage) and coincident Earth Radiation Budget Experiment (ERBE) images to characterize the fires, smoke and radiative forcings of biomass burning aerosols over four major ecosystems of South America

The Quality of Medical Care in Low-Income Countries: From Providers to Markets

Jishnu Das provides a perspective on a research article by Paul Garner and colleagues that reports a systematic review of 80 studies comparing the quality of private versus public ambulatory health care in low and middle income countries

Nitrate reducing bacterial activity in concrete cells of nuclear waste disposal

Leaching experiments of solid matrices (bitumen and cement pastes) have been first implemented to define the physicochemical conditions that microorganisms are likely to meet at the bitumen-concrete interface (see the paper of Bertron et al.). Of course, as might be suspected, the cement matrix imposes highly alkaline pH conditions (10 < pH < 11). The screening of a range of anaerobic denitrifying bacterial strains led us to select Halomonas desiderata as a model bacterium capable of catalyzing the reaction of nitrate reduction in these extreme conditions of pH. The denitrifying activity of Halomonas desiderata was quantified in batch bioreactor in the presence of solid matrices and / or leachate from bitumen and cement matrices. Denitrification was relatively fast in the presence of cement matrix (< 100 hours) and 2 to 3 times slower in the presence of bituminous matrix. Overall, the presence of solid cement promoted the kinetics of denitrification. The observation of solid surfaces at the end of the experiment revealed the presence of a biofilm of Halomonas desiderata on the cement paste surface. These attached bacteria showed a denitrifying activity comparable to planktonic bacterial culture. On the other side, no colonization of bitumen could be highlighted as either by SEM or epifluorescence microscopy. Now, we are currently developing a continuous experimental bioreactor which should allow us a more rational understanding of the bitumen-cement-microbe interactions

Prevalence of potential underlying aetiology of macrocytic anaemia in Dutch general practice

Background: Macrocytic anaemia (MCV \xe2\x89\xa5 100 fL) is a relatively common finding in general practice. However, literature on the prevalence of the different causes in this population is limited. The prevalence of macrocytic anaemia and its underlying aetiology were analysed in a general practice population. The potential effect of the different aetiology on survival was also evaluated. Methods: Between the 1st of February 2007 and the 1st of February 2015, patients aged 50 years or older and presenting to their general practitioner with a newly diagnosed anaemia, were included in the study. Anaemia was defined as haemoglobin level below 13.7 g/dL in men and below 12.1 g/dL in women. A broad range of laboratory tests was performed for each patient. The causes of anaemia were consequently determined by two independent observers based on the laboratory results. Results: Of the 3324 included patients, 249 (7.5 %) displayed a macrocytic anaemia and were subsequently analysed. An underlying explanation could be established in 204 patients (81.9 %) with 27 patients (13.2 %) displaying multiple causes. Classic aetiology (i.e. alcohol abuse, vitamin B12/folic acid deficiency, haemolysis and possible bone marrow disease) was found in 115 patients. Alternative causes (i.e. anaemia of chronic disease, iron deficiency, renal anaemia and other causes) were encountered in 101 patients. In addition, a notable finding was the median gamma GT of 277 U/L in patients diagnosed with alcohol abuse (N = 24, IQR 118.0-925.5) and 23 U/L in the remaining cohort (N = 138, IQR 14.0-61.0). The distribution of gamma GT values was statistically different (P < 0.001). Five year survival rates were determined for six categories of causes, ranging from 39.9 % (95 % CI 12.9-66.9) for renal anaemia to 76.2 % (95 % CI 49.4-103.0) for the category multiple causes. Conclusion: In addition to classic explanations for macrocytosis, alternative causes are frequently encountered in patients with macrocytic anaemia in general practice

Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies

Paul Garner and colleagues conducted a systematic review of 80 studies to compare the quality of private versus public ambulatory health care in low- and middle-income countries