81 research outputs found
Helicobacter pylori Infection in the Young in Bangladesh: Prevalence, Socioeconomic and Nutritional Aspects
Background The gastric acid barrier, an important host defence against small bowel infection, may be compromised by infection with Helicobacter pylori. In developing countries, H.pylori infection occurs early in life and prevelance of hypochlorhydria is high particularly in the malnourished, which may predispose a child to repeated gastrointestinal Infection and diarrhoea. Diarrhpea being a leading cause a childhood mortality and morbidity in developing countries, we investigated the prevelance of H. pylori infection in children in poor Bangladeshi community and explored its association with socioeconomic and nutritional status. Methods The study was conducted in a poor periurban community among 469 children aged -99months. Parents were interviewed ising a questionnaire. To detect active infection with H. pyloria13 C-urea broath test was performed and weight was recorded on a beam balance with a sensitivity of 20g. Results In all, 61% of 36 infants aged 1-3 months were positive for H. pylori, this rate dropped steadily with increasing age and was 33% in 10-15 month old children and then rose to 84% in 6-9 year olds. Overall H. pylori infection had no association with nutritional state of the child or family income but the infection rate was 2.5 times higher in children of mothers with no schooling. Conclusions The H. pylori infection rate is very high in early infancy in a poor periurban community of Bangladesh. The reason for a drop in the infection rate infancy is unclear but could be due to initial clearance of the infection by the body's defence mechanisms but with possible alteration of the gastric mucosa which sustains infection. Maternal education may be protective and may operate through some underlined proximate behavioural determinants. The rate of H. pylori infection and young children may predispose them to reapeated gastrointestinal infection and diahorrea
Prevalence, Clinical Predictors, and Outcome of Hypocalcaemia in Severely-malnourished Underfive Children Admitted to an Urban Hospital in Bangladesh: A Case-Control Study
Hypocalcaemia is common in severely-malnourished children and is often
associated with fatal outcome. There is very limited information on the
clinical predicting factors of hypocalcaemia in hospitalized severely-
malnourished under-five children. Our objective was to evaluate the
prevalence, clinical predicting factors, and outcome of hypocalcaemia
in such children. In this case-control study, all severely-malnourished
under-five children (n=333) admitted to the Longer Stay Ward (LSW),
High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka
Hospital of icddr,b between April 2011 and April 2012, who also had
their total serum calcium estimated, were enrolled. Those who presented
with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the
cases (n=87), and those admitted without hypocalcaemia (n=246)
constituted the control group in our analysis. The prevalence of
hypocalcaemia among severelymalnourished under-five children was 26%
(87/333). The fatality rate among cases was significantly higher than
that in the controls (17% vs 5%; p<0.001). Using logistic regression
analysis, after adjusting for potential confounders, such as vomiting,
abdominal distension, and diastolic hypotension, we identified acute
watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p=0.030), convulsion
on admission (OR 21.86, 95% CI 2.57-185.86, p=0.005), and lethargy (OR
2.70, 95% CI 1.633-5.46, p=0.006) as independent predictors of
hypocalcaemia in severely-malnourished children. It is concluded,
severely-malnourished children presenting with hypocalcaemia have an
increased risk of death than those without hypocalcaemia. AWD,
convulsion, and lethargy assessed on admission to hospital are the
clinical predictors of hypocalcaemia in such children. Presence of
these features in hospitalized children with severe acute malnutrition
(SAM) should alert clinicians about the possibility of hypocalcaemia
and may help undertake potential preventive measures, such as calcium
supplementation, in addition to other aspects of management of such
children, especially in the resource-poor settings
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
Clinical Predictors and Outcome of Metabolic Acidosis in Under-Five Children Admitted to an Urban Hospital in Bangladesh with Diarrhea and Pneumonia
BACKGROUND: Clinical features of metabolic acidosis and pneumonia frequently overlap in young diarrheal children, resulting in differentiation from each other very difficult. However, there is no published data on the predictors of metabolic acidosis in diarrheal children also having pneumonia. Our objective was to evaluate clinical predictors of metabolic acidosis in under-five diarrheal children with radiological pneumonia, and their outcome. METHODS: We prospectively enrolled all under-five children (n = 164) admitted to the Special Care Ward (SCW) of the Dhaka Hospital of icddr, b between September and December 2007 with diarrhea and radiological pneumonia who also had their total serum carbon-dioxide estimated. We compared the clinical features and outcome of children with radiological pneumonia and diarrhea with (n = 98) and without metabolic acidosis (n = 66). RESULTS: Children with metabolic acidosis more often had higher case-fatality (16% vs. 5%, p = 0.039) compared to those without metabolic acidosis on admission. In logistic regression analysis, after adjusting for potential confounders such as age of the patient, fever on admission, and severe wasting, the independent predictors of metabolic acidosis in under-five diarrheal children having pneumonia were clinical dehydration (OR 3.57, 95% CI 1.62-7.89, p = 0.002), and low systolic blood pressure even after full rehydration (OR 1.02, 95% CI 1.01-1.04, p = 0.005). Proportions of children with cough, respiratory rate/minute, lower chest wall indrawing, nasal flaring, head nodding, grunting respiration, and cyanosis were comparable (p>0.05) among the groups. CONCLUSION AND SIGNIFICANCE: Under-five diarrheal children with radiological pneumonia having metabolic acidosis had frequent fatal outcome than those without acidosis. Clinical dehydration and persistent systolic hypotension even after adequate rehydration were independent clinical predictors of metabolic acidosis among the children. However, metabolic acidosis in young diarrheal children had no impact on the diagnostic clinical features of radiological pneumonia which underscores the importance of early initiation of appropriate antibiotics to combat morbidity and deaths in such population
Impact of Lack of Breast Feeding during Neonatal Age on the Development of Clinical Signs of Pneumonia and Hypoxemia in Young Infants with Diarrhea
Hypoxemia is a grave sequel of pneumonia, and an important predictor of a fatal outcome. Pneumonia in the neonatal period is often associated with lack of breast feeding. However, there is no published report on the impact of the cessation of breast feeding in the neonatal period on the development of pneumonia and hypoxemia. The purpose of our study was to assess the impact of non-breast feeding or stopping breast feeding during the neonatal period (henceforth to be referred to as non-breast fed) on clinical features of pneumonia and hypoxemia in 0-6-month-old infants with diarrhea admitted to an urban hospital in Bangladesh.We prospectively enrolled all infants (n = 107) aged 0 to 6 months who were admitted to the Special Care Ward (SCW) of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B) with diarrhea and pneumonia from September 2007 through December 2007.We compared the clinical features of pneumonia and hypoxemia of breast fed infants (n = 34) with those who were non-breast fed (n = 73).The median (inter-quartile range) duration of hypoxemia (hours) in non-breast-feds was longer than breast-fed infants [0.0 (0.0, 12.0) vs. 12.0 (0.0, 21.75); p = 0.021]. After adjusting for potential confounders such as inability to drink, fever, head nodding, cyanosis, grunting respiration, and lower chest wall in drawing, the non-breast-fed infants with pneumonia along with diarrhea had a higher probability of cough (OR 9.09; CI 1.34-61.71; p = 0.024), hypoxemia (OR 3.32; CI 1.23-8.93; p = 0.017), and severe undernutrition (OR 3.42; CI 1.29-9.12; p = 0.014).Non-breast feeding or cessation of breast feeding during the neonatal period may substantially increase the incidence of severe malnutrition, incidence of cough, and both the incidence and duration of hypoxemia in young infants presenting with pneumonia and diarrhea. The findings emphasize the paramount importance of the continuation of breast feeding in the neonatal period and early infancy
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