Childhood Mortality Due to Drowning in Rural Matlab of Bangladesh: Magnitude of the Problem and Proposed Solutions

Drowning is an important cause of mortality among children in rural Bangladesh. Children aged 1–4 year(s) are at a high risk of death from drowning. Although deaths of children due to drowning in Bangladesh are acknowledged as an important cause of death, little effort has been made to address the issue of preventing deaths from this cause. This study has attempted to describe the problem and suggests possible prevention strategies, which may contribute to reducing childhood mortality from drowning. Data presented in this study were collected from Matlab where ICDDR, B has been maintaining a demographic surveillance since 1966. During the study period from 1985 to 2000, 989 deaths from drowning were reported, of which 796 (80.5%) were children in the age-group of 1–4 year(s), 48 (4.8%) were in the age-group of less than one year, and 145 (14.7%) in the age-group of 5–19 years. During 1985–2000, death rate per 1,000 children due to all causes among children of 1–4-year age-group decreased appreciably from 20.7% to 5.2%, while drowning-related deaths did not. Forty-five percent (n=359) of drowning-related deaths occurred in ponds, 16.8% (n=134) in ditches, 8.1% (n=64) in canals, and 4.4% (n=35) in rivers. The sites of more than 25% of drowning-associated deaths were not recorded. Analysis of seasonal variation revealed that most deaths due to drowning occurred during April-October, i.e. mostly during the monsoon months. It was also observed that the majority (67%) of mothers of victims had no formal education. Deaths due to drowning were mostly associated with children aged 1–4 year(s) and were 20% more common among boys than among girls (odds ratio=1.2, 95% confidence interval 1.04–1.38, p<0.012). The paper recommends some interventions to reduce the number of deaths due to drowning in rural Bangladesh, which include: (a) increasing awareness among mothers and close family members about the risk of drowning, (b) door-fencing, and (c) filling of unused ditches and water holes around households

Mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes in children with idiopathic steroid resistant nephrotic syndrome

Background: Many children with idiopathic steroid resistant nephrotic syndrome have been reported worldwide due to mutation of NPHS1, NPHS2, WT1 and LAMB2 genes. This study aimed to determine the frequency of mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes and their association with renal histopathological patterns of idiopathic steroid resistant nephrotic syndrome patients. Methods: This cross-sectional study was conducted on 25 patients with idiopathic steroid resistant nephrotic aged 1-17 years in the Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from July 2017 to June 2018. Next Generation Sequencing and mutation analysis were performed after DNA extraction from patients\u27 venous blood lymphocytes. Histopathological study of renal tissue was done among 17 patients. Results:  A little more than half (56%) of the patients were male. The mean age at the initial attack of nephrotic syndrome was 94.2 months. They mostly had minimal change disease (41%) and IgA nephropathy (12%). One subject had the NPHS2 gene mutation, histopathologically diffuse mesangial proliferative glomerulonephritis, and clinically stage-4 chronic kidney disease. Another subject had the COL4A5 gene mutation and focal segmental glomerulosclerosis.  Both were male and had no familial renal disease, consanguinity, or hematuria. Conclusion: Children with idiopathic steroid resistant nephrotic syndrome showed NPHS2 and COL4A5 gene mutations. Histopathologically, they showed diffuse mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis

Childhood Mortality Due to Drowning in Rural Matlab of Bangladesh: Magnitude of the Problem and Proposed Solutions

Drowning is an important cause of mortality among children in rural Bangladesh. Children aged 1-4 year(s) are at a high risk of death from drowning. Although deaths of children due to drowning in Bangladesh are acknowledged as an important cause of death, little effort has been made to address the issue of preventing deaths from this cause. This study has attempted to describe the problem and suggests possible prevention strategies, which may contribute to reducing childhood mortality from drowning. Data presented in this study were collected from Matlab where ICDDR,B has been maintaining a demographic surveillance since 1966. During the study period from 1985 to 2000, 989 deaths from drowning were reported, of which 796 (80.5%) were children in the age-group of 1-4 year(s), 48 (4.8%) were in the age-group of less than one year, and 145 (14.7%) in the age-group of 5-19 years. During 1985-2000, death rate per 1,000 children due to all causes among children of 1-4-year age-group decreased appreciably from 20.7% to 5.2%, while drowning-related deaths did not. Forty-five percent (n=359) of drowning-related deaths occurred in ponds, 16.8% (n=134) in ditches, 8.1% (n=64) in canals, and 4.4% (n=35) in rivers. The sites of more than 25% of drowning-associated deaths were not recorded. Analysis of seasonal variation revealed that most deaths due to drowning occurred during April-October, i.e. mostly during the monsoon months. It was also observed that the majority (67%) of mothers of victims had no formal education. Deaths due to drowning were mostly associated with children aged 1-4 year(s) and were 20% more common among boys than among girls (odds ratio=1.2, 95% confidence interval 1.04-1.38, p&lt;0.012). The paper recommends some interventions to reduce the number of deaths due to drowning in rural Bangladesh, which include: (a) increasing awareness among mothers and close family members about the risk of drowning, (b) door-fencing, and (c) filling of unused ditches and water holes around households

Mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes in children with idiopathic steroid resistant nephrotic syndrome

Background: Many children with idiopathic steroid resistant nephrotic syndrome have been reported worldwide due to mutation of NPHS1, NPHS2, WT1 and LAMB2 genes. This study aimed to determine the frequency of mutation of NPHS1, NPHS2, WT1, LAMB2, COL4A5 and other genes and their association with renal histopathological patterns of idiopathic steroid resistant nephrotic syndrome patients. Methods: This cross-sectional study was conducted on 25 patients with idiopathic steroid resistant nephrotic aged 1-17 years in the Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from July 2017 to June 2018. Next Generation Sequencing and mutation analysis were performed after DNA extraction from patients' venous blood lymphocytes. Histopathological study of renal tissue was done among 17 patients. Results:  A little more than half (56%) of the patients were male. The mean age at the initial attack of nephrotic syndrome was 94.2 months. They mostly had minimal change disease (41%) and IgA nephropathy (12%). One subject had the NPHS2 gene mutation, histopathologically diffuse mesangial proliferative glomerulonephritis, and clinically stage-4 chronic kidney disease. Another subject had the COL4A5 gene mutation and focal segmental glomerulosclerosis.  Both were male and had no familial renal disease, consanguinity, or hematuria. Conclusion: Children with idiopathic steroid resistant nephrotic syndrome showed NPHS2 and COL4A5 gene mutations. Histopathologically, they showed diffuse mesangial proliferative glomerulonephritis and focal segmental glomerulosclerosis

An outbreak of acute jaundice syndrome (AJS) among the Rohingya refugees in Cox's Bazar, Bangladesh: Findings from enhanced epidemiological surveillance.

In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population

Natural selection shapes the evolution of SARS-CoV-2 Omicron in Bangladesh

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved to give rise to a highly transmissive and immune-escaping variant of concern, known as Omicron. Many aspects of the evolution of SARS-CoV-2 and the driving forces behind the ongoing Omicron outbreaks remain unclear. Substitution at the receptor-binding domain (RBD) in the spike protein is one of the primary strategies of SARS-CoV-2 Omicron to hinder recognition by the host angiotensin-converting enzyme 2 (ACE2) receptor and avoid antibody-dependent defense activation. Here, we scanned for adaptive evolution within the SARS-CoV-2 Omicron genomes reported from Bangladesh in the public database GISAID (www.gisaid.org; dated 2 April 2023). The ratio of the non-synonymous (Ka) to synonymous (Ks) nucleotide substitution rate, denoted as ω, is an indicator of the selection pressure acting on protein-coding genes. A higher proportion of non-synonymous to synonymous substitutions (Ka/Ks or ω &gt; 1) indicates positive selection, while Ka/Ks or ω near zero indicates purifying selection. An equal amount of non-synonymous and synonymous substitutions (Ka/Ks or ω = 1) refers to neutrally evolving sites. We found evidence of adaptive evolution within the spike (S) gene of SARS-CoV-2 Omicron isolated from Bangladesh. In total, 22 codon sites of the S gene displayed a signature of positive selection. The data also highlighted that the receptor-binding motif within the RBD of the spike glycoprotein is a hotspot of adaptive evolution, where many of the codons had ω &gt; 1. Some of these adaptive sites at the RBD of the spike protein are known to be associated with increased viral fitness. The M gene and ORF6 have also experienced positive selection. These results suggest that although purifying selection is the dominant evolutionary force, positive Darwinian selection also plays a vital role in shaping the evolution of SARS-CoV-2 Omicron in Bangladesh

Genomics, social media and mobile phone data enable mapping of SARS-CoV-2 lineages to inform health policy in Bangladesh.

Genomics, combined with population mobility data, used to map importation and spatial spread of SARS-CoV-2 in high-income countries has enabled the implementation of local control measures. Here, to track the spread of SARS-CoV-2 lineages in Bangladesh at the national level, we analysed outbreak trajectory and variant emergence using genomics, Facebook 'Data for Good' and data from three mobile phone operators. We sequenced the complete genomes of 67 SARS-CoV-2 samples (collected by the IEDCR in Bangladesh between March and July 2020) and combined these data with 324 publicly available Global Initiative on Sharing All Influenza Data (GISAID) SARS-CoV-2 genomes from Bangladesh at that time. We found that most (85%) of the sequenced isolates were Pango lineage B.1.1.25 (58%), B.1.1 (19%) or B.1.36 (8%) in early-mid 2020. Bayesian time-scaled phylogenetic analysis predicted that SARS-CoV-2 first emerged during mid-February in Bangladesh, from abroad, with the first case of coronavirus disease 2019 (COVID-19) reported on 8 March 2020. At the end of March 2020, three discrete lineages expanded and spread clonally across Bangladesh. The shifting pattern of viral diversity in Bangladesh, combined with the mobility data, revealed that the mass migration of people from cities to rural areas at the end of March, followed by frequent travel between Dhaka (the capital of Bangladesh) and the rest of the country, disseminated three dominant viral lineages. Further analysis of an additional 85 genomes (November 2020 to April 2021) found that importation of variant of concern Beta (B.1.351) had occurred and that Beta had become dominant in Dhaka. Our interpretation that population mobility out of Dhaka, and travel from urban hotspots to rural areas, disseminated lineages in Bangladesh in the first wave continues to inform government policies to control national case numbers by limiting within-country travel

Epidemiological, clinical, and public health response characteristics of a large outbreak of diphtheria among the Rohingya population in Cox's Bazar, Bangladesh, 2017 to 2019: A retrospective study.

BACKGROUND: Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. METHODS AND FINDINGS: Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. CONCLUSIONS: To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises

HBeAg/anti-HBe, alanine aminotransferase and HBV DNA levels in HBsAg positive chronic carriers

Abstract Serum samples from a total of 72 chronic hepatitis B virus carriers were analysed by serological, biochemical and molecular assays. The aim was to evaluate the relationship of the serological and biochemical parameters with molecular markers in order to assess the infectivity of virus. Out of 72 chronic HBsAg positive carriers, 28 patients were HBeAg positive and anti-HBe negative, 38 patients were HBeAg negative and anti-HBe positive, only 3 patients were positive for both HBeAg and antiHBe and the rest 3 patients were negative for both markers. Detectable HBV DNA level was found in 92.86% HBsAg-positive/anti-HBe negative patients along with raised alanine aminotransferase (ALT) level (67.86%) compared with HBeAg-negative/anti-HBe positive carriers (36.84%) (p value = 0.02) and out a total of 38 HBeAg-negative/anti-HBe positive carriers, 12 (31.58%) patients had detectable level of HBV DNA. Among the 14 HBeAg-negative/anti-HBe positive patients with elevated ALT level, 8 (57.14%) had detectable HBV DNA whereas out of 24 HBeAg-negative/anti-HBe positive patients with normal ALT level only 4 (16.66%) had detectable HBV DNA level. Significantly high rate of detection of HBV DNA was seen among anti-HBe positive patients with raised ALT level compared with the patients with normal ALT level (p value = 0.01)