26 research outputs found
Risk factors associated with severe underweight among young children reporting to a diarrhea treatment facility in Bangladesh
Protein-energy malnutrition (PEM) is a serious health problem among
young children in Bangladesh. PEM increases childhood morbidity and
mortality. Information is needed on the major risk factors for PEM to
assist with the design and targeting of appropriate prevention
programmes. To compare the underlying characteristics of children, aged
6- 24 months, with or without severe underweight, reporting to the
Dhaka Hospital of ICDDR,B in Bangladesh, a case-control study was
conducted among 507 children with weight-for-age z-score (WAZ) <- 3
and 500 comparison children from the same communities with WAZ >- 2.
5. There were no significant differences between the groups in age
[overall mean\ub1standard deviation (SD) 12. 6\ub1 4. 1 months] or
sex ratio ( 44% girls), area of residence, or year of enrollment.
Results of logistic regression analy-sis revealed that
severely-underweight children were more likely to have: undernourished
mothers [body mass index (BMI) < 18. 5, adjusted odds ratio (AOR)=
3. 8, 95% confidence interval (CI) 2. 6- 5. 4] who were aged < 19
years (AOR= 3. 0, 95% CI 1. 9- 4. 8) and completed < 5 years of
education (AOR= 2. 7, 95% CI 1. 9- 3. 8), had a history of shorter
duration of predominant breastfeeding (< 4 months, AOR= 2. 3, 95% CI
1. 6- 3. 3), dis-continued breastfeeding (AOR= 2. 0, 95% CI 1. 1- 3.
5), and had higher birth-order ( 65 3 AOR= 1. 8, 95% CI 1. 2- 2.
7); and fathers who were rickshaw-pullers or unskilled day-labourers
(AOR= 4. 4; 95% CI 3. 1- 6. 1) and com-pleted < 5 years of education
(AOR= 1. 5; 95% CI 1. 1- 2. 2), came from poorer families (monthly
income of Tk < 5, 000, AOR= 2. 7, 95% CI 1. 9- 3. 8). Parental
education, economic and nutritional characteristics, child-feed-ing
practices, and birth-order were important risk factors for severe
underweight in this population, and these characteristics can be used
for designing and targeting preventive intervention programmes
Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh
Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean±SD age 23.5±15.3 months) were admitted during June 2005âMay 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula
Chronic Aflatoxin Exposure and Cognitive and Language Development in Young Children of Bangladesh : A Longitudinal Study
Aflatoxin can cross the bloodâbrain barrier, damage brain tissues, and have the potential to harm the development of the human brain. Although dietary aflatoxin exposure is common in children, there is a paucity of data on aflatoxin exposure and child developmental outcomes. The childâs cognitive, motor, and language functions were assessed using the Bayley Scales of Infant and Toddler Development-III or BSID-III at the same time points. Association between exposure to aflatoxin and subtests of BSID-III were examined using mixed-effect linear regression. Aflatoxin assays were performed on 194, 167, and 163 children at 15, 24, and 36 months of age, and chronic aflatoxin exposure was detected in 20.6%, 16.8%, and 60.7% of children, respectively. Multi-variable analyses showed that aflatoxin exposure was independently related to the childrenâs cognitive score (ÎČ: â0.69; 95% CI: â1.36, â0.02), receptive language score (ÎČ: â0.90; 95% CI: â1.62, â0.17), and expressive language score (ÎČ: â1.01; 95% CI: â1.96, â0.05). We did not observe any association between exposure to aflatoxin and the motor function of children. Chronic exposure to aflatoxin exposure was linked to reduced cognitive, expressive, and receptive language scores of the study children. Further research is needed in a different setting to confirm this novel finding.publishedVersionPeer reviewe
Experience in Managing Severe Malnutrition in a Government Tertiary Treatment Facility in Bangladesh
Children with severe acute malnutrition, defined as weight-for-height
<70% of the reference median or bilateral pedal oedema or mid-arm
circumference <110 mm having complications, were managed in the
Nutrition Unit of the Chittagong Medical College Hospital (CMCH)
following the guidelines of the World Health Organization, with support
from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children
aged less than five years (mean\ub1SD age 23.5\ub115.3 months) were
admitted during June 2005\u2013May 2006. Of them, 66% were aged less
than two years, and 84.2% belonged to households with a monthly income
of less than US 40. The main reason for bringing children by their
families to the hospital was associated major illnesses:
bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary
tuberculosis (9%), or other conditions, such as meningitis,
septicaemia, and infections of the skin, eye, or ear. The exit criteria
from the Nutrition Unit were: (a) for children admitted without oedema,
an absolute weight gain of 65500 and 65700 g for children
aged less than two years and 2-5 years respectively; and for children
admitted with oedema, complete loss of oedema and weight-for-height
>70% of the reference median, and (b) the mother or caretaker has
received specific training on appropriate feeding and was motivated to
follow the advice given. Of all the admitted children, 7.6% of parents
insisted for discharging their children early due to other urgent
commitments while 11.7% simply left with their children against medical
advice. Of the 138 remaining children, 88% successfully graduated from
the Nutrition Unit with a mean weight gain of 10.6 g/kg per day
(non-oedematous children) and loss of -1.9 g/kg per day (oedematous
children), 86% graduated in less than three weeks, and the
case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions
as a training centre, and 197 health functionaries (82 medical
students, 103 medical interns, and 12 nurses) received hands-on
training on management of severe malnutrition. The average cost of
overall treatment was US 14.6 per child or approximately US$ 1 per
child-day (excluding staff-cost). Food and medicines accounted for 42%
and 58% of the total cost respectively. This study demonstrated the
potential of addressing severe acute malnutrition (with complications)
effectively with minimum incremental expenditure in Bangladesh. This
public-private approach should be used for treating severe acute
malnutrition in all healthcare facilities and the treatment protocol
included in the medical and nursing curricula
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, 6â36 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 ”mol/L. The mean plasma kynurenine, tryptophan concentrations, and the KT ratio (Ă 1000) were 6.93 ± 3.08 ”mol/L, 33.44 ± 16.39 ”mol/L, and 12.12 ± 18.10, respectively. With increasing child age, KYN concentration decreased (coefficient: â 0.26; 95%CI: â 0.49, â 0.04; p = 0.021); with increasing lymphocyte count, CIT concentration decreased (coef.: â 0.01; 95% CI: â 0.02,0.001, p = 0.004); the wasted child had decreased KT ratio (coef.: â 0.6; 95% CI: â 1.18, â 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.: â 0.02; 95% CI: â 0.03, â 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.: â 0.62; 95% CI: â 1.23, â 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
Early Life Child Micronutrient Status, Maternal Reasoning, and a Nurturing Household Environment have Persistent Influences on Child Cognitive Development at Age 5 years : Results from MAL-ED
Funding Information: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project (MAL-ED) is carried out as a collaborative project supported by the Bill & Melinda Gates Foundation, the Foundation for the NIH, and the National Institutes of Health/Fogarty International Center. This work was also supported by the Fogarty International Center, National Institutes of Health (D43-TW009359 to ETR). Author disclosures: BJJM, SAR, LEC, LLP, JCS, BK, RR, RS, ES, LB, ZR, AM, RS, BN, SH, MR, RO, ETR, and LEM-K, no conflicts of interest. Supplemental Tables 1â5 and Supplemental Figures 1â3 are available from the âSupplementary dataâ link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/jn/. Address correspondence to LEM-K (e-mail: [email protected]). Abbreviations used: HOME, Home Observation for Measurement of the Environment inventory; MAL-ED, The Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project; TfR, transferrin receptor; WPPSI, Wechsler Preschool Primary Scales of Intelligence.Peer reviewe
Early life child micronutrient status, maternal reasoning, and a nurturing household environment have persistent influences on child cognitive development at age 5 years: Results from MAL-ED
Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive development at 5 y. Methods: Observational follow-up visits were made of children at 5 y, previously enrolled in the community-based MAL-ED longitudinal cohort. The burden of enteropathogens, prevalence of illness, complementary diet intake, micronutrient status, and household and maternal factors from birth to 2 y were extensively measured and their relation with the Wechsler Preschool Primary Scales of Intelligence at 5 y was examined through use of linear regression. Results: Cognitive T-scores from 813 of 1198 (68%) children were examined and 5 variables had significant associations in multivariable models: mean child plasma transferrin receptor concentration (ÎČ: â1.81, 95% CI: â2.75, â0.86), number of years of maternal education (ÎČ: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (ÎČ: 0.09, 95% CI: 0.03, 0.15), household assets score (ÎČ: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (ÎČ: 0.60, 95% CI: 0.05, 1.15). In multivariable models, the mean rate of enteropathogen detections, burden of illness, and complementary food intakes between birth and 2 y were not significantly related to 5-y cognition. Conclusions: A nurturing home context in terms of a healthy/clean environment and household wealth, provision of adequate micronutrients, maternal education, and cognitive reasoning have a strong and persistent influence on child cognitive development. Efforts addressing aspects of poverty around micronutrient status, nurturing caregiving, and enabling home environments are likely to have lasting positive impacts on child cognitive development.publishedVersio
Effects of Food Supplementation and Psychosocial Stimulation on Growth and Development of Severely Malnourished Children : Intervention Studies in Bangladesh
Early childhood malnutrition is a global public health problem with serious short- and long-term consequences. The aim of this thesis is to evaluate the effects of psychosocial stimulation (PS) with or without food supplementation (FS) on growth and development of severely malnourished children, quality of home environment, motherâs child-rearing practices and depressive symptoms. The study setting was Dhaka, Bangladesh, and the participants were severely malnourished children, aged 6-24 months, admitted at Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). A hospital-based study was conducted in Nutrition Rehabilitation Unit of ICDDR,B hospital, where a control group (n=43) was studied initially, followed by an intervention group (n=54). All received standard nutrition rehabilitation care. The intervention group received daily group meetings and play sessions in the hospital, and was thereafter visited at home for 6 months. A community-based randomised trial was conducted including children (n=507) admitted at hospital for initial treatment of an acute infection, and thereafter assigned to PS, FS, PS+FS, clinic control or hospital control groups. PS was delivered at follow-up visits, fortnightly for 6 months at community clinics. FS included distribution of cereal-based food packets (150â300 kcal/day depending on age) for 3 months. All groups received standard medical care and micronutrient supplementation. In the hospital-based study, the intervention group had significantly higher scores in mental (p<0.001, effect size 0.52 SD) and motor development (p=0.047, effect size 0.37 SD), and weight (p=0.03, effect size 0.39 SD), after 6- months intervention. In the community-based trial, there was a significant effect of stimulation after six months of intervention on childrenâs mental development (group*session interaction p=0.037, effect size=0.37 SD) and weight (group*session interaction p=0.02, effect size=0.26 SD) but no effect on motor development or linear growth. The PS+FS and PS groups differed in total HOME score, two HOME subscales (maternal involvement and play materials), and in motherâs child- rearing practices scores but not in depressive symptoms. PS with or without FS had small improvement on childrenâs growth and development, quality of home environment and motherâs rearing-practices of severely malnourished children. More intensive interventions with longer duration are therefore recommended