1
|
Sarmin M, Shaly NJ, Sultana T, Tariqujjaman M, Shikha SS, Mariam N, Jeorge DH, Tabassum M, Nahar B, Afroze F, Shahrin L, Hossain MI, Alam B, Faruque ASG, Islam MM, Osmany DEMMF, Ahmed CM, Manji K, Kissoon N, Chisti MJ, Ahmed T. Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial. BMJ Open 2023; 13:e068660. [PMID: 37045565 PMCID: PMC10106066 DOI: 10.1136/bmjopen-2022-068660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Diarrhoea is one of the leading causes of under-5 childhood mortality and accounts for 8% of 5.4 million global under-5 deaths. In severely malnourished children, diarrhoea progresses to shock, where the risk of mortality is even higher. At icddr,b Dhaka Hospital, the fatality rate is as high as 69% in children with severe malnutrition and fluid refractory septic shock. To date, no study has evaluated systematically the effects of inotrope or vasopressor or blood transfusion in children with dehydrating diarrhoea (eg, in cholera) and severe acute malnutrition (SAM) or severe underweight who are in shock and unresponsive to WHO-recommended fluid therapy. To reduce the mortality of severely malnourished children presenting with diarrhoea and fluid refractory shock, we aim to compare the efficacy of blood transfusion, dopamine and epinephrine in fluid refractory shock in children who do not respond to WHO-recommended fluid resuscitation. METHODS AND ANALYSIS In this randomised, three-arm, controlled, non-masked clinical trial in children 1-59 months old with SAM or severe underweight and fluid refractory shock, we will compare the efficacy of dopamine or epinephrine administration versus blood transfusion in children who failed to respond to WHO-recommended fluid resuscitation. The primary outcome variable is the case fatality rate. The effect of the intervention will be assessed by performing an intention-to-treat analysis. Recruitment and data collection began in July 2021 and are now ongoing. Results are expected by May 2023. ETHICS AND DISSEMINATION This study has been approved by the icddr,b Institutional Review Board. We adhere to the 'Declaration of Helsinki' (2000), guidelines for Good Clinical Practice. Before enrolment, we collect signed informed consent from the parents or caregivers of the children. We will publish the results in a peer-reviewed journal and will arrange a dissemination seminar. TRIAL REGISTRATION NUMBER NCT04750070.
Collapse
Affiliation(s)
- Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Jahan Shaly
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tania Sultana
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shamima Sharmin Shikha
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nafisa Mariam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Didarul Haque Jeorge
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mosharrat Tabassum
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Baharul Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Karim Manji
- Department of Pediatrics, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research,Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
2
|
Ara G, Sanin KI, Khanam M, Sarker MSA, Tofail F, Nahar B, Chowdhury IA, Boitchi AB, Gibson S, Afsana K, Askari S, Ahmed T. A comprehensive intervention package improves the linear growth of children under 2-years-old in rural Bangladesh: a community-based cluster randomized controlled trial. Sci Rep 2022; 12:21962. [PMID: 36536016 PMCID: PMC9763408 DOI: 10.1038/s41598-022-26269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Approximately one-third of children under the age of five are stunted in developing countries and many of them are micronutrient-deficient. We designed a comprehensive intervention package including egg/milk-based snacks to improve linear growth and dietary diversity among 6 to 12-month-old children in rural Bangladesh. In this 1-year community-based cluster randomized controlled longitudinal experiment, 412 mother-infant pairs were randomly assigned to receive either monthly food vouchers (for eggs, milk, semolina, sugar, and oil) to prepare egg and milk-based snacks for their children, along with multiple micronutrient powder (MNP), counseling on child feeding and handwashing, or regular government health communication alone (control; n = 206, treatment; n = 206). The trial was conducted in 12 clusters (small administrative units of sub-district). The primary inclusion criteria were ultra-poor households with limited resources and having children under 2-years-old. The primary and secondary outcomes were differences in children's length gain and dietary diversity. The effect of intervention on child growth was examined using a mixed effect linear regression model. Mean weight and length of the children did not significantly differ between groups at baseline. Around 90% of the children in both groups were breastfed. After receiving intervention for 12 months, LAZ score increased by 0.37 (CI 0.24, 0.51, p < 0.001) and risk of stunting reduced by 73% (OR: 0.27, CI 0.13, 0.58, p = 0.001). This comprehensive intervention package improved the growth and dietary diversity of children in extremely poor Bangladeshi households. A scaling-up of this intervention in contexts with limited resources should be taken into consideration.Trial registration: This trial registered retrospectively at ClinicalTrials.gov as NCT03641001, 21/8/2018.
Collapse
Affiliation(s)
- Gulshan Ara
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Kazi Istiaque Sanin
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Mansura Khanam
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Md. Shafiqul Alam Sarker
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Fahmida Tofail
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Baitun Nahar
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Anika Bushra Boitchi
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sarah Gibson
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Kaosar Afsana
- grid.52681.380000 0001 0746 8691BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Sufia Askari
- grid.490985.90000 0004 0450 2163The Children’s Investment Fund Foundation, 7 Clifford Street, London, W1S 2FT UK
| | - Tahmeed Ahmed
- grid.414142.60000 0004 0600 7174International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| |
Collapse
|
3
|
Mahfuz M, Hossain MS, Alam MA, Gazi MA, Fahim SM, Nahar B, Ahmed T. Chronic Aflatoxin Exposure and Cognitive and Language Development in Young Children of Bangladesh: A Longitudinal Study. Toxins (Basel) 2022; 14:toxins14120855. [PMID: 36548752 PMCID: PMC9784379 DOI: 10.3390/toxins14120855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Aflatoxin can cross the blood-brain 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 child's 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 children's cognitive score (β: -0.69; 95% CI: -1.36, -0.02), receptive language score (β: -0.90; 95% CI: -1.62, -0.17), and expressive language score (β: -1.01; 95% CI: -1.96, -0.05). 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.
Collapse
Affiliation(s)
- Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
- Faculty of Medicine and Health Technology, University of Tampere, 3352 Tampere, Finland
| | - Md. Shabab Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Md. Ashraful Alam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
- Correspondence:
| | - Md. Amran Gazi
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka 1212, Bangladesh
| |
Collapse
|
4
|
Faruque ASG, Alam B, Nahar B, Parvin I, Barman AK, Khan SH, Hossain MN, Widiati Y, Hasan ASMM, Kim M, Worth M, Vandenent M, Ahmed T. Water, Sanitation, and Hygiene (WASH) Practices and Outreach Services in Settlements for Rohingya Population in Cox's Bazar, Bangladesh, 2018-2021. Int J Environ Res Public Health 2022; 19:ijerph19159635. [PMID: 35954994 PMCID: PMC9368108 DOI: 10.3390/ijerph19159635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 05/14/2023]
Abstract
(1) Background: This study aimed to investigate the existing water, sanitation, and hygiene (WASH) policy and practice of the study population and strengthen the evidence base by documenting changes in the WASH policy and practice over 3 years of the Rohingya refugee humanitarian crisis, Cox's Bazar, Bangladesh. (2) Methods: A cross-sectional surveillance design was followed; the sampling of the study population included the Rohingya refugee population and neighborhood host nationals who required hospitalization soon after seeking care and enrolled into the diarrheal disease surveillance in diarrhea-treatment centers. Throughout the study period of 3 years, a total of 4550 hospitalized individuals constituted the study participants. (3) Results: Among the hospitalized Rohingya refugee population; the use of public tap water increased significantly from 38.5% in year 1 to 91% in year 3. The use of deep tube well water significantly changed from 31.3% to 8.2%, and the use of shallow tube well water reduced significantly from 25.8% to 0.4%. Households using water seal latrine were 13.3% in year 1 and increased significantly to 31.7% in year 3. ORS consumption at home changed significantly from 61.5% in the first year to 82.1% in third year. Multivariable analysis demonstrated patients' age groups at 5 to 14 years, and 15 years and more, drinking non-tube well water, soap use after using toilet, use of non-sanitary toilet facility, father's and mother's lack of schooling, and some and severe dehydration were significantly associated with the Rohingya refugee population enrolled into the diarrheal disease surveillance. (4) Conclusion: The findings indicate significant advances in WASH service delivery as well as outreach activities by aid agencies for the Rohingya refugee population living in settlements.
Collapse
Affiliation(s)
- ASG Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Correspondence:
| | - Baharul Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Irin Parvin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Ashok Kumar Barman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Soroar Hossain Khan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - M Nasif Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Yulia Widiati
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - ASM Mainul Hasan
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - Minjoon Kim
- UNICEF Bangladesh Country Office, Dhaka 1207, Bangladesh
| | - Martin Worth
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - Maya Vandenent
- UNICEF Bangladesh Country Office, Dhaka 1207, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Office of Executive Director, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| |
Collapse
|
5
|
Faruque ASG, Khan AI, Nahar B, Islam SMR, Hossain MN, Abdullah SA, Khan SH, Hossain MS, Khan FH, Prajapati M, Widiati Y, Hasan ASMM, Kim M, Musto J, Vandenent M, Clemens JD, Ahmed T. Cholera outbreak in Forcibly Displaced Myanmar National (FDMN) from a small population segment in Cox's Bazar, Bangladesh, 2019. PLoS Negl Trop Dis 2021; 15:e0009618. [PMID: 34550972 PMCID: PMC8457470 DOI: 10.1371/journal.pntd.0009618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background Bangladesh experienced a sudden, large influx of forcibly displaced persons from Myanmar in August 2017. A cholera outbreak occurred in the displaced population during September-December 2019. This study aims to describe the epidemiologic characteristics of cholera patients who were hospitalized in diarrhea treatment centers (DTCs) and sought care from settlements of Forcibly Displaced Myanmar Nationals (FDMN) as well as host country nationals during the cholera outbreak. Methods Diarrhea Treatment Center (DTC) based surveillance was carried out among the FDMN and host population in Teknaf and Leda DTCs hospitalized for cholera during September-December 2019. Results During the study period, 147 individuals with cholera were hospitalized. The majority, 72% of patients reported to Leda DTC. Nearly 65% sought care from FDMN settlements. About 47% of the cholera individuals were children less than 5 years old and 42% were aged 15 years and more. Half of the cholera patients were females. FDMN often reported from Camp # 26 (45%), followed by Camp # 24 (36%), and Camp # 27 (12%). Eighty-two percent of the cholera patients reported watery diarrhea. Some or severe dehydration was observed in 65% of cholera individuals. Eighty-one percent of people with cholera received pre-packaged ORS at home. About 88% of FDMN cholera patients reported consumption of public tap water. Pit latrine without water seal was often used by FDMN cholera individuals (78%). Conclusion Vigilance for cholera patients by routine surveillance, preparedness, and response readiness for surges and oral cholera vaccination campaigns can alleviate the threats of cholera. Bangladesh observed a large-scale arrival of forcibly displaced individuals from Myanmar in August 2017. The Bangladesh Government, UN agencies, and international and national non-governmental organizations responded immediately with extensive humanitarian response. However, threats of cholera outbreaks were prevailing. The Government of Bangladesh as lead, with technical support from icddr,b collaborating with international agencies undertook a massive oral cholera vaccination (OCV) campaign immediately as a pre-emptive measure to alleviate threats of the cholera outbreak. Despite that mass OCV campaign, threats of cholera outbreak were existing due to new arrivals of the displaced population with compromised host susceptibility, frequent visits to settlements by Bangladesh nationals without exposure to OCV, and the declining vaccine immunity among OCV recipients as well as an increasing number of cohort children without any exposure to OCV. The population faced a cholera outbreak during September-December 2019. This study aims to describe the characteristics of cholera patients, their care-seeking pattern, camp-wise distribution, source of drinking water, sanitation facility, OCV status, and share the experiences from effective interventions to prevent a cholera outbreak. Vigilance for cholera patients by routine surveillance, preparedness for both preventive and control measures, and response readiness for surges and OCV campaigns can alleviate the threats of cholera.
Collapse
Affiliation(s)
- Abu S. G. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - M. Nasif Hossain
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | | | - Yulia Widiati
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar, Bangladesh
| | | | - Minjoon Kim
- UNICEF Bangladesh Country Office, Cox’s Bazar, Bangladesh
| | - Jennie Musto
- World Health Organization, Cox’s Bazar, Bangladesh
| | - Maya Vandenent
- UNICEF Bangladesh Country Office, Cox’s Bazar, Bangladesh
| | - John David Clemens
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| |
Collapse
|
6
|
Faruque ASG, Khan AI, Islam SMR, Nahar B, Hossain MN, Widiati Y, Hasan ASMM, Prajapati M, Kim M, Vandenent M, Ahmed T. Diarrhea treatment center (DTC) based diarrheal disease surveillance in settlements in the wake of the mass influx of forcibly displaced Myanmar national (FDMN) in Cox's Bazar, Bangladesh, 2018. PLoS One 2021; 16:e0254473. [PMID: 34339419 PMCID: PMC8328326 DOI: 10.1371/journal.pone.0254473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In August 2017, after a large influx of forcibly displaced Myanmar nationals (FDMN) in Cox's Bazar, Bangladesh diarrhea treatment centers (DTCs) were deployed. This study aims to report the clinical, epidemiological, and laboratory characteristics of the hospitalized patients. METHODS The study followed cross-sectional design. In total 1792 individuals were studied. Other than data, a single, stool specimen was subjected to one step rapid visual diagnostic test for Vibrio cholerae. The provisionally diagnosed specimens of cholera cases were inoculated into Cary-Blair Transport Medium; then sent to the laboratory of icddr,b in Dhaka to isolate the colony as well as perform antibiotic susceptibility tests. Data were analyzed by STATA and analyses included descriptive as well as analytic methods. RESULTS Of the total 1792 admissions in 5 DTCs, 729 (41%) were from FDMN settlements; children <5 years contributed the most (n = 981; 55%). Forty percent (n = 716) were aged 15 years and above, and females were predominant (n = 453; 63%). Twenty-eight percent (n = 502) sought treatment within 24h of the onset of diarrhea. FDMN admissions within 24h were low compared to host hospitalization (n = 172, 24% vs. n = 330, 31%; p<0.001). Seventy-two percent (n = 1295) had watery diarrhea; more common among host population than FDMN (n = 802; 75% vs. n = 493; 68%; p<0.001). Forty-four percent admissions (n = 796) had some or severe dehydration, the later was common in FDMN (n = 46; 6% vs. n = 36; 3%, p = 0.005). FDMN often used public taps (n = 263; 36%), deep tube-well (n = 243; 33%), and shallow tube well (n = 188; 26%) as the source of drinking water. Nearly 96% (n = 698) of the admitted FDMN used pit latrines as opposed to 79% (n = 842) from the host community (p<0.001). FDMN children were often malnourished. None of the FDMN reported cholera. CONCLUSION No diarrhea outbreak was detected, but preparedness for surges and response readiness are warranted in this emergency and crisis setting.
Collapse
Affiliation(s)
| | | | | | | | | | - Yulia Widiati
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar, Bangladesh
| | | | | | - Minjoon Kim
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar, Bangladesh
| | - Maya Vandenent
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar, Bangladesh
| | | |
Collapse
|
7
|
McCormick BJJ, Caulfield LE, Richard SA, Pendergast L, Seidman JC, Maphula A, Koshy B, Blacy L, Roshan R, Nahar B, Shrestha R, Rasheed M, Svensen E, Rasmussen Z, Scharf RJ, Haque S, Oria R, Murray-Kolb LE. Early Life Experiences and Trajectories of Cognitive Development. Pediatrics 2020; 146:peds.2019-3660. [PMID: 32817437 PMCID: PMC7461241 DOI: 10.1542/peds.2019-3660] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multiple factors constrain the trajectories of child cognitive development, but the drivers that differentiate the trajectories are unknown. We examine how multiple early life experiences differentiate patterns of cognitive development over the first 5 years of life in low-and middle-income settings. METHODS Cognitive development of 835 children from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite observational cohort study was assessed at 6, 15, 24 (Bayley Scales of Infant and Toddler Development), and 60 months (Wechsler Preschool and Primary Scale of Intelligence). Markers of socioeconomic status, infection, illness, dietary intake and status, anthropometry, and maternal factors were also assessed. Trajectories of development were determined by latent class-mixed models, and factors associated with class membership were examined by discriminant analysis. RESULTS Five trajectory groups of cognitive development are described. The variables that best discriminated between trajectories included presence of stimulating and learning resources in the home, emotional or verbal responsivity of caregiver and the safety of the home environment (especially at 24 and 60 months), proportion of days (0-24 months) for which the child had diarrhea, acute lower respiratory infection, fever or vomiting, maternal reasoning ability, mean nutrient densities of zinc and phytate, and total energy from complementary foods (9-24 months). CONCLUSIONS A supporting and nurturing environment was the variable most strongly differentiating the most and least preferable trajectories of cognitive development. In addition, a higher quality diet promoted cognitive development while prolonged illness was indicative of less favorable patterns of development.
Collapse
Affiliation(s)
| | | | | | | | - Jessica C. Seidman
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | | | | | | | | - Zeba Rasmussen
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | | |
Collapse
|
8
|
Alam MA, Richard SA, Fahim SM, Mahfuz M, Nahar B, Das S, Shrestha B, Koshy B, Mduma E, Seidman JC, Murray-Kolb LE, Caulfield LE, Ahmed T. Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study. PLoS One 2020; 15:e0227839. [PMID: 31978156 PMCID: PMC6980491 DOI: 10.1371/journal.pone.0227839] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/30/2019] [Indexed: 01/01/2023] Open
Abstract
Background Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, and to identify the factors associated with early-onset stunting. Methods and findings Children from the MAL-ED cohort study were followed from birth to 5 years of age in six LMICs. The Wechsler Preschool Primary Scales of Intelligence (WPPSI) was used to assess cognitive abilities (fluid reasoning) at 5 years and was adapted for each culture. Stunting was categorized as early-onset persistent (first stunted at 1–6 months and persisting at 60 months), early-onset recovered (first stunted at 1–6 months and not stunted at 60 months), late-onset persistent (first stunted at 7–24 months and persisting at 60 months), late-onset recovered (first stunted at 7–24 months and not stunted at 60 months), and never (never stunted). Mixed effects linear models were used to estimate the relationship between stunting status and cognitive development. Children with early-onset persistent stunting had significantly lower cognitive scores (-2.10 (95% CI: -3.85, -0.35)) compared with those who were never stunted. Transferrin receptor (TfR) was also negatively associated with cognitive development (-0.31 (95% CI: -0.49, -0.13)), while the HOME inventory, an index of quality of the home environment (0.46 (95% CI: 0.21, 0.72)) and socio-economic status (1.50 (95% CI: 1.03, 1.98)) were positively associated with cognitive development. Conclusions Early-onset persistent stunting was associated with lower cognitive development in children at 5 years of age in this cohort of children.
Collapse
Affiliation(s)
- Md Ashraful Alam
- icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stephanie A. Richard
- Fogarty International Center/National Institutes of Health, Bethesda, MD, United States of America
| | | | - Mustafa Mahfuz
- icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
- * E-mail:
| | - Baitun Nahar
- icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Subhasish Das
- icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Binod Shrestha
- Water Reed/AFRIMS Research Unit Nepal (WARUN), Kathmandu, Nepal
| | | | | | - Jessica C. Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, MD, United States of America
| | - Laura E. Murray-Kolb
- The Pennsylvania State University, University Park, PA, United States of America
| | | | - Tahmeed Ahmed
- icddr,b, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| |
Collapse
|
9
|
Hossain M, Nahar B, Haque MA, Mondal D, Mahfuz M, Naila NN, Gazi MA, Hasan MM, Haque NMS, Haque R, Arndt MB, Walson JL, Ahmed T. Serum Adipokines, Growth Factors, and Cytokines Are Independently Associated with Stunting in Bangladeshi Children. Nutrients 2019; 11:nu11081827. [PMID: 31394828 PMCID: PMC6723106 DOI: 10.3390/nu11081827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Growth in young children is controlled through the release of several hormonal signals, which are affected by diet, infection, and other exposures. Stunting is clearly a growth disorder, yet limited evidence exists documenting the association of different growth biomarkers with child stunting. This study explored the association between different growth biomarkers and stunting in Bangladeshi children. A quasi-experimental study was conducted among 50 stunted (length-for-age Z-score (LAZ) < -2 SD) and 50 control (LAZ ≥ -2 SD) children, aged 12-18 months, residing in a Bangladeshi slum. The enrolled stunted children received an intervention package, which included food supplementation for three months, psychosocial stimulation for six months, and routine clinical care on community nutrition center at the study field site. The controls received routine clinical care only. All children were clinically screened over the study period. Length, weight, fasting blood and fecal biomarkers were measured. All biomarkers levels were similar in both groups except for oxyntomodulin at enrolment. Leptin (adjusted odds ratio, AOR: 4.0, p < 0.01), leptin-adiponectin ratio (AOR 5.07 × 108, p < 0.01), insulin-like growth factor-1 (IGF-1) (AOR 1.02, p < 0.05), and gamma interferon (IFN-γ) (AOR 0.92, p < 0.05) levels were independently associated with stunting at enrolment. Serum leptin, leptin-adiponectin ratio, interleukin-6 (IL-6), IL-10, tumor necrosis factor-alpha (TNF-α), and fecal alpha-1-antitrypsin (AAT) levels increased significantly (p < 0.001), while IFN-γ levels significantly decreased among stunted children after six months of intervention. Leptin, leptin-adiponectin ratio, IGF-1, and IFN-γ are independently associated with stunting in Bangladeshi children. This trial was registered at clinicaltrials.gov as NCT02839148.
Collapse
Affiliation(s)
- Muttaquina Hossain
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh.
| | - Baitun Nahar
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Ahshanul Haque
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Dinesh Mondal
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Amran Gazi
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | - Md Mehedi Hasan
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
| | | | - Rashidul Haque
- Enteric and Respiratory Infections, icddr,b, Dhaka 1212, Bangladesh
| | - Michael B Arndt
- PATH, Seattle, WA 98109, USA
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98109, USA
- Childhood Acute Illness and Nutrition Network, Nairobi 00200, Kenya
- Departments of Medicine, University of Washington, Seattle, WA 98109, USA
- Department of Epidemiology, University of Washington, Seattle, WA 98109, USA
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka 1212, Bangladesh
- Department of Global Health, University of Washington, Seattle, WA 98109, USA
- James P. Grant School of Public Health, BRAC University, Dhaka 1212, Bangladesh
| |
Collapse
|
10
|
Nahar B, Hossain M, Mahfuz M, Islam MM, Hossain MI, Murray-Kolb LE, Seidman JC, Ahmed T. Early childhood development and stunting: Findings from the MAL-ED birth cohort study in Bangladesh. Matern Child Nutr 2019; 16:e12864. [PMID: 31237738 PMCID: PMC7038907 DOI: 10.1111/mcn.12864] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 01/20/2023]
Abstract
Information on the association between stunting and child development is limited from low‐income settings including Bangladesh where 36% of children under‐ 5 are stunted. This study aimed to explore differences in early childhood development (ECD) between stunted (length‐for‐age z‐score [LAZ] < −2) and nonstunted (LAZ ≥ −2) children in Bangladesh. Children (n = 265) aged 6–24 months who participated in the MAL‐ED birth cohort study were evaluated by trained psychologists at 6, 15, and 24 months of age using the Bayley Scales of Infant and Toddler Development‐III; child length and weight were measured using standard procedures. ECD scores (z‐scores derived from cognitive, motor, language and socio‐emotional skills) were compared between stunted, underweight (weight‐for‐age z‐score < −2), and wasted (weight‐for‐length z‐score < −2) children, controlling for child age and sex and maternal age, education, body mass index (BMI), and depressive symptoms. Stunted children had significantly lower ECD scores than their nonstunted peers on cognitive (P = .049), motor (P < .001), language (P < .001) and social–emotional (P = .038) scales where boys had significantly lower fine motor skills compared with girls (P = .027). Mother's schooling and BMI were significant predictors of ECD. Similar to stunting, underweight children had developmental deficits in all domains (cognitive: P = .001; fine motor: P = .039, and P < .001 for both gross motor and total motor; expressive communication: P = .032; total language: P = .013; social–emotional development: P = .017). Wasted children had poor motor skills (P = .006 for the fine motor; P < .001 for both gross motor and total motor development) compared with the nonwasted peers. Early childhood stunting and underweight were associated with poor developmental outcomes in Bangladesh.
Collapse
Affiliation(s)
- Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Munirul Islam
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Laura E Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania
| | - Jessica C Seidman
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
11
|
McCormick BJJ, Richard SA, Caulfield LE, Pendergast LL, Seidman JC, Koshy B, Roshan R, Shrestha R, Svensen E, Blacy L, Rasmussen Z, Maphula A, Scharf R, Nahar B, Haque S, Rasheed M, Oria R, Rogawski ET, Murray-Kolb LE. 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. J Nutr 2019; 149:1460-1469. [PMID: 31162601 PMCID: PMC6686051 DOI: 10.1093/jn/nxz055] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023] Open
Abstract
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 (β: -1.81, 95% CI: -2.75, -0.86), number of years of maternal education (β: 0.27, 95% CI: 0.08, 0.45), maternal cognitive reasoning score (β: 0.09, 95% CI: 0.03, 0.15), household assets score (β: 0.64, 95% CI: 0.24, 1.04), and HOME child cleanliness factor (β: 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.
Collapse
Affiliation(s)
| | | | | | | | - Jessica C Seidman
- Fogarty International Center/National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | - Zeba Rasmussen
- Fogarty International Center/National Institutes of Health, Bethesda, MD
| | | | | | | | | | | | | | | | - Laura E Murray-Kolb
- The Pennsylvania State University, University Park, PA,Address correspondence to LEM-K (e-mail: )
| | | |
Collapse
|
12
|
Ara G, Khanam M, Papri N, Nahar B, Kabir I, Sanin KI, Khan SS, Sarker MSA, Dibley MJ. Peer Counseling Promotes Appropriate Infant Feeding Practices and Improves Infant Growth and Development in an Urban Slum in Bangladesh: A Community-Based Cluster Randomized Controlled Trial. Curr Dev Nutr 2019; 3:nzz072. [PMID: 31334480 PMCID: PMC6635820 DOI: 10.1093/cdn/nzz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/14/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Undernutrition and poor cognitive development affect many children in developing countries. Good nutrition and health care are essential for optimal child development and growth. OBJECTIVES We assessed the impact of peer counseling combined with psychosocial stimulation on feeding practices and child growth and development in slums in Bangladesh. METHODS We performed a community-based cluster randomized controlled trial in selected slums; 350 mother-infant pairs were allocated to receive peer counseling on feeding practices plus psychosocial stimulation (PC + PCS; n = 175) or usual health messages (control; n = 175) using restricted randomization. Data were collected at enrollment and 1, 3, 5, 7, 9, and 12 mo after delivery. We collected data on infant and young child feeding practices and anthropometric measurements from birth until 12 mo to assess the main outcomes, including feeding practices and growth. We used the Bayley Scale III at 12 mo to assess child development. The effects of the PC + PCS intervention were assessed by using regression models. RESULTS More mothers in the PC + PCS group than in the control group reported early initiation of breastfeeding (in the first hour: 89% compared with 78%, respectively; P < 0.05) and exclusive breastfeeding at 5 mo (73% compared with 27%, respectively; P < 0.001). Peer counseling had positively impacted infant length gain at 12 mo (P < 0.005). Children in the PC + PCS group were found to be more socially and emotionally active compared with controls at 12 mo (standardized score: 0.165 compared with -0.219, respectively; P < 0.05). CONCLUSION Combining peer counseling with psychosocial stimulation had positive effects on infant feeding practices and growth at 12 mo and on the social-emotional development of young children. This trial was registered at clinicaltrial.gov as NCT03040375.
Collapse
Affiliation(s)
- Gulshan Ara
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mansura Khanam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nowshin Papri
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Iqbal Kabir
- Bangladesh Breastfeeding Foundation, Institute of Public Health, Dhaka, Bangladesh
| | - Kazi Istiaque Sanin
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sihan Sadat Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| |
Collapse
|
13
|
Ruan-Iu L, Pendergast LL, Rasheed M, Tofail F, Svensen E, Maphula A, Roshan R, Nahar B, Shrestha R, Williams B, Schaefer BA, Scharf R, Caulfield LE, Seidman J, Murray-Kolb LE. Assessing Early Childhood Fluid Reasoning in Low- and Middle-Income Nations: Validity of the Wechsler Preschool and Primary Scale of Intelligence Across Seven MAL-ED Sites. Journal of Psychoeducational Assessment 2019. [DOI: 10.1177/0734282919850040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An adapted version of the Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III) was administered to assess cognitive functioning among 1,253 5-year-old children from the Malnutrition and Enteric Disease (MAL-ED) study—an international, multisite study investigating multiple aspects of child development. In this study, the factor structure and invariance of the WPPSI-III were examined across seven international research sites located in Bangladesh, Brazil, India, Nepal, Pakistan, South Africa, and Tanzania. Using a multiple indicator multiple cause (MIMIC) modeling approach, the findings supported the validity of a fluid reasoning dimension (comprised of block design, matrix reasoning, and picture completion subscales) across each of the seven sites, although the scores were noninvariant. Accordingly, these scores are recommended for research purposes and understanding relationships between variables but not for mean comparisons or clinical purposes.
Collapse
Affiliation(s)
| | | | | | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Raghavan R, Aaron GJ, Nahar B, Knowles J, Neufeld LM, Rahman S, Mondal P, Ahmed T. Household coverage of vitamin A fortification of edible oil in Bangladesh. PLoS One 2019; 14:e0212257. [PMID: 30943194 PMCID: PMC6447147 DOI: 10.1371/journal.pone.0212257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 01/24/2019] [Indexed: 12/24/2022] Open
Abstract
Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.
Collapse
Affiliation(s)
- Ramkripa Raghavan
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- Center on the Early Life Origins of Disease, Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States of America
| | - Grant J. Aaron
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Jacky Knowles
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | - Prasenjit Mondal
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
15
|
Nahar B, Hossain M, Ickes SB, Naila NN, Mahfuz M, Hossain D, Denno DM, Walson J, Ahmed T. Development and validation of a tool to assess appetite of children in low income settings. Appetite 2019; 134:182-192. [PMID: 30583008 DOI: 10.1016/j.appet.2018.12.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
Reliable and validated tools for measuring appetite of children in South Asia are not available. This study aimed to develop and validate a tool for assessing appetite level of under-five children. Based on literature review and findings from focus group discussions (FGDs), an initial 27-item interview-based tool, the "Early Childhood Appetite and Satiety Tool (ECAST)" was developed in Bangladesh. Fourteen FGDs were carried out in rural and urban settings and constructs for inclusion were derived from the themes and coding of FGDs and appetite assessment tools used in Western contexts. For structural validation, the ECAST-27-was administered on 150 mothers/primary caregivers of children aged 6-59 months, living in urban and rural areas. To validate the association with other variables, the ECAST was administered on mothers of children aged 12-24 months in the community (N = 50), and two groups of wasted, hospitalized children (Weight-for-length, Z score <-2SD) [group1: twenty acutely ill children aged 6-59 months; group 2: twenty children in nutritional rehabilitation aged 18-24 months]. Reliability of ECAST was estimated using Cronbach's alpha and Pearson's correlation coefficient. Kaiser-Meyer-Olkin = 0.73 and the Bartlett's test of sphericity, χ2(253) = 755.791, p < 0.001 indicated that the raw data were suitable. Given the convergence of the Scree plot, Kaiser's criterion and dropping of cross loading items, a 16-item ECAST was produced with three sub scales: Appetite cue; Food responsiveness and Emotion and preference, which were internally valid and had good test-retest reliability (Cronbach's alpha 0.6 and test-retest reliability 0.797). Total ECAST scores of wasted children with good appetite were significantly higher from those with poor appetite (p = 0.004 and 0.001 for two wasted groups respectively). Results suggest that ECAST may provide a useful measure to assess the appetite level of under-five children.
Collapse
Affiliation(s)
- Baitun Nahar
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Scott B Ickes
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daluwar Hossain
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Donna M Denno
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA; Childhood Acute Illness and Nutrition Network, Seattle, WA, USA
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, WA, USA; James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Department of Global Health, University of Washington, Seattle, WA, USA; James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| |
Collapse
|
16
|
Ickes SB, Hossain M, Ritter G, Lazarus M, Reynolds K, Nahar B, Ahmed T, Walson J, Denno DM. Systematic Review of Tools and Methods to Measure Appetite in Undernourished Children in the Context of Low- and Middle-Income Countries. Adv Nutr 2018; 9:789-812. [PMID: 30462177 PMCID: PMC6247147 DOI: 10.1093/advances/nmy042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain-often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.
Collapse
Affiliation(s)
- Scott B Ickes
- Departments of Health Services,Global Health,Program in Nutritional Sciences, University of Washington, Seattle, WA,Wheaton College Department of Applied Health Sciences, Wheaton, IL
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Gaelen Ritter
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | - Monica Lazarus
- Program in Nutritional Sciences, University of Washington, Seattle, WA
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Tahmeed Ahmed
- Global Health,Nutrition and Clinical Services Division, International Centre for Diarrheal Diseases Research, Bangladesh (icddr,b)
| | - Judd Walson
- Pediatrics,Global Health,Medicine,Epidemiology,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Donna M Denno
- Departments of Health Services,Pediatrics,Global Health,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya,Address correspondence to DMD (e-mail: )
| |
Collapse
|
17
|
Ara G, Khanam M, Papri N, Nahar B, Haque MA, Kabir I, Dibley MJ. Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh. Matern Child Nutr 2018; 14:e12605. [PMID: 29660858 PMCID: PMC6055706 DOI: 10.1111/mcn.12605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 11/29/2022]
Abstract
This study aimed to evaluate the impact of peer counselling on early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) rates for mother-infant pairs living in urban slums, Dhaka, Bangladesh. This randomized controlled trial enrolled 350 mother-infant pairs from selected slums between September 2014 and July 2016. The women assigned to intervention group received peer counselling from locally recruited, trained community female volunteers starting in third trimester of pregnancy until 6 months after delivery; control group received no intervention. EIBF, any liquids given after birth, and EBF were compared between groups. Follow-up was scheduled at enrolment, following childbirth, and every 2 months up to 6 months after delivery. Multiple logistic regressions were used to assess the effect peer counselling and other associated factors on EIBF and EBF practices. EIBF rate was higher in the intervention group than in the control group (89.1% vs. 77.4%, p = .005). More mothers in intervention group were exclusively breastfeeding at 5 months than mothers in the control group (73% vs. 27%, p < .005). Control mothers were twice as likely to not practice EIBF compared with intervention mothers (adjusted odds risk [aOR]: 2.53, CI [1.29, 4.97], p = .007). Overall, caesarean section was associated with an 8.9-fold higher risk of not achieving EIBF (aOR: 8.90, CI [4.05, 19.55], p < .001). Intervention mothers were 5.10-fold more likely to practice EBF compared with control mothers (aOR: 5.10, CI [2.89, 9.01], p < .001) at 5 months. This study demonstrates peer counselling can positively influence both EIBF and EBF among mothers living in urban area.
Collapse
Affiliation(s)
| | | | | | | | | | - Iqbal Kabir
- Bangladesh Breastfeeding Foundation (BBF), Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Khatun H, Islam SB, Naila NN, Islam SA, Nahar B, Alam NH, Ahmed T. Clinical profile, antibiotic susceptibility pattern of bacterial isolates and factors associated with complications in culture-proven typhoid patients admitted to an urban hospital in Bangladesh. Trop Med Int Health 2018; 23:359-366. [PMID: 29432657 DOI: 10.1111/tmi.13037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Typhoid fever is one of the major causes of morbidity and mortality in typhoid endemic countries like Bangladesh. However, data on the clinical and microbiological profile as well as factors associated with complications of typhoid in Bangladesh are scarce. We intended to characterise the clinical and microbiological profile of culture-proven typhoid fever and to identify factors associated with complications. METHODOLOGY Retrospective analysis of clinical data from 431 patients with culture-confirmed typhoid fever admitted to Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh, between January 2010 and December 2014. Clinical and microbiological profiles of the patients including age, sex, and duration of illness prior to hospital admission, haematological parameters and the antimicrobial resistance profile of the infecting isolate, duration of hospital stay and defervescence time were examined by logistic regression to identify the factors associated with complications. RESULT About one of three patients were children under 5 years, and 21.5% of them were severely malnourished. During hospitalisation, 17.4% patients developed complications; mainly encephalopathy (6.7%), ileus (6.5%) and pneumonia (3.5%). Among culture-positive cases, 28.3% isolates showed multidrug resistant (MDR) and more than 90% of isolates were resistant to nalidixic acid and had intermediate sensitivity to ciprofloxacin. Five isolates were resistant to azithromycin; all isolates were sensitive to cefixime and ceftriaxone. Complication was independently associated with duration of fever before admission (adjusted odds ratio: 0.85; 95% CI: 0.074-0.97; P < 0.05), thrombocytopenia on admission (AOR: 2.84; 95% CI: 01.06-7.57; P < 0.05), duration of hospital stay (AOR: 1.34; 95% CI: 1.15-1.57; P < 0.01) and defervescence time (AOR: 0.83; 95% CI: 0.70-0.99; P < 0.05). CONCLUSION The high prevalence of typhoid fever among under-five children and complications among hospitalised patients are matters of concern. Sensitivity of Salmonella Typhi to ceftriaxone and cefixime was better than to other conventional antibiotics. Shorter duration of fever and thrombocytopenia on admission can be considered as early signs of complications.
Collapse
Affiliation(s)
- Halima Khatun
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shoeb Bin Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nurun Nahar Naila
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Syed Aminul Islam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nur Haque Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.,James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| |
Collapse
|
19
|
Arora H, Ramasamy R, Nahar B, Hare J, Zuttion M. 168 Subcutaneous Leydig Stem Cell Autograft in Mice: An Approach to Increase Serum Testosterone. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2017.11.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
20
|
Naila N, Nahar B, Lazarus M, Ritter G, Hossain M, Mahfuz M, Ahmed T, Denno D, Walson J, Ickes S. "Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh. Matern Child Nutr 2017; 14. [PMID: 28730705 DOI: 10.1111/mcn.12473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/31/2017] [Accepted: 05/05/2017] [Indexed: 01/22/2023]
Abstract
Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.
Collapse
Affiliation(s)
- Nurun Naila
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Monica Lazarus
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Gaelen Ritter
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| | - Muttaquina Hossain
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Center for Diarrheal Diseases Research, Dhaka, Bangladesh.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Donna Denno
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Judd Walson
- Department of Pediatrics, University of Washington, Seattle, WA, USA.,Childhood Acute Illness and Nutrition Network, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, WA, USA.,Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA
| | - Scott Ickes
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
21
|
Benfer KA, Weir KA, Bell KL, Nahar B, Ware RS, Davies PSW, Boyd RN. Oropharyngeal dysphagia in children with cerebral palsy: comparisons between a high- and low-resource country. Disabil Rehabil 2016; 39:2404-2412. [PMID: 27669884 DOI: 10.1080/09638288.2016.1229363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE There is paucity of research investigating oropharyngeal dysphagia (OPD) in young children with cerebral palsy (CP), and most studies explore OPD in high-resource countries. This study aimed at determining the proportion and severity of OPD in preschool children with CP in Bangladesh, compared to Australia. METHOD Cross-sectional, comparison of two cohorts. Two hundred and eleven children with CP aged 18-36 months, 81 in Bangladesh (mean = 27.6 months, 61.7% males), and 130 in Australia (mean = 27.4 months, 62.3% males). The Dysphagia Disorders Survey (DDS) - Part 2 was the primary OPD outcome for proportion and severity of OPD. Gross motor skills were classified using the Gross Motor Function Classification System (GMFCS), motor type/distribution. RESULTS (i) Bangladesh sample: proportion OPD = 68.1%; severity = 10.4 SD = 7.9. Australia sample: proportion OPD = 55.7%; severity = 7.0 SD = 7.5. (ii) There were no differences in the proportion or severity of OPD between samples when stratified for GMFCS (OR = 2.4, p = 0.051 and β = 1.2, p = 0.08, respectively). CONCLUSIONS Despite overall differences in patterns of OPD between Bangladesh and Australia, proportion and severity of OPD (when adjusted for the functional gross motor severity of the samples) were equivalent. This provides support for the robust association between functional motor severity and OPD proportion/severity in children with CP, regardless of the resource context. Implications for Rehabilitation The proportion and severity of OPD according to gross motor function level were equivalent between high- and low-resource countries (LCs). Literature from high-resource countries may be usefully interpreted by rehabilitation professionals for low-resource contexts using the GMFCS as a framework. The GMFCS is a useful classification in LCs to improve earlier detection of children at risk of OPD and streamline management pathways for optimal nutritional outcomes. Rehabilitation professionals working in LCs are likely to have a caseload weighted towards GMFCS III-V, with less compensatory OPD management options available (such as non-oral nutrition through tubes).
Collapse
Affiliation(s)
- Katherine A Benfer
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,b Paediatric Unit, Centre for the Rehabilitation of the Paralysed , Chapain , Savar , Dhaka , Bangladesh
| | - Kelly A Weir
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,c Menzies Health Institute of Queensland, Griffith University , Gold Coast Campus , Queensland , Australia
| | - Kristie L Bell
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia.,d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia
| | - Baitun Nahar
- e Nutrition and Clinical Services, International Centre for Diarrhoeal Disease Research , Mohakhali Dhaka , Bangladesh
| | - Robert S Ware
- f Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia.,g School of Population Health, The University of Queensland , Herston , Australia
| | - Peter S W Davies
- d Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Centre for Children's Health Research , South Brisbane , Australia
| | - Roslyn N Boyd
- a Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre , The University of Queensland, Level 6 Centre for Children's Health Research , South Brisbane , Australia
| |
Collapse
|
22
|
Nahar B, Hossain I, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev 2015; 41:483-93. [PMID: 25040164 DOI: 10.1111/cch.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh. METHODS Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention. RESULTS Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms. CONCLUSION The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.
Collapse
Affiliation(s)
- B Nahar
- Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | | |
Collapse
|
23
|
Hamadani JD, Nahar B, Huda SN, Tofail F. Integrating early child development programs into health and nutrition services in Bangladesh: benefits and challenges. Ann N Y Acad Sci 2014; 1308:192-203. [PMID: 24571219 DOI: 10.1111/nyas.12366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Bangladesh is one of the poorest countries of the world with the highest population density. The Bangladesh government recognizes the educational and financial benefits of early childhood development (ECD) and has incorporated ECD into the national plan of action. However, ECD activities are not fully established in the country and there have been few evaluations. In this paper, we present ECD programs that are integrated into health and nutrition services in Bangladesh. We present four evaluation reports of such programs and we also include seven published research projects showing evidence that such integrations are feasible. We provide short reviews on coverage, methodology, and effects of the published reports and share our experience of challenges faced and steps taken to solve them. Overall, very few programs are based on scientific evidence and fewer are even evaluated. The research projects so far conducted are promising and there is sufficient evidence on feasibility of integrating ECD activities into nutrition and health programs. Suggestions are made on measures to overcome the implementation problems and on suitable methods to establish high-quality ECD programs in Bangladesh and in other low- and middle-income countries.
Collapse
Affiliation(s)
| | - Baitun Nahar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.,International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Syed Nazmul Huda
- Institute of Nutrition and Food Science, Dhaka University, Dhaka, Bangladesh
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| |
Collapse
|
24
|
Nahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh. BMC Public Health 2012; 12:622. [PMID: 22871096 PMCID: PMC3490820 DOI: 10.1186/1471-2458-12-622] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/23/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parenting programmes are effective in enhancing parenting practices and child development. This study evaluated the effects of a intervention with psychosocial stimulation (PS) on the quality of the home environment and mothers' child-rearing practices in a community-based trial with severely malnourished Bangladeshi children. METHOD Severely underweight children (n = 507), 6-24 months of age, were randomly assigned to five groups: PS; food supplementation (FS); PS + FS; clinic-control (CC); and, hospital-control (CH). PS included fortnightly follow-up visits for six months at community clinics where a play leader demonstrated play activities and gave education on child development and child rearing practices. FS comprised cereal-based supplements (150-300 kcal/day) for three months. All groups received medical care, micronutrient supplements and growth monitoring. Mothers were given the Home Observation for Measurement of the Environment (HOME) inventory and a questionnaire on parenting at baseline and after six months to assess the outcome. RESULTS 322 children completed the study. After six months of intervention the PS + FS and PS groups benefitted in the total HOME score (depending on the comparison group, effect sizes varied from 0.66 to 0.33 SD) The PS + FS and PS groups also benefitted in two HOME subscales: maternal involvement (effect sizes: 0.8 to 0.55 SD) and play materials, (effect sizes: 0.46 to 0.6 SD), and child-rearing practices scores (effect size: 1.5 to 1.1 SD). The PS + FS group benefitted 4.0 points in total HOME score compared with CH, 4.8 points compared with CC and 4.5 points compared with FS (p < 0.001 for all). The PS group benefitted 2.4 points compared with CH (p = 0.035), 3.3 points compared with CC (p = 0.004), and 2.9 points compared with FS (p = 0.006). Child-rearing practice scores of the PS + FS group improved 7.7, 6.4 and 6.6 points and the PS group improved 8.5, 7.2 and 7.4 points more than CH, CC and FS, respectively (p < 0.001 for all). CONCLUSIONS Child-rearing practices of mothers of severely malnourished children and the quality of their home environment can be improved through community-based psychosocial stimulation with or without food supplementation. This may be of importance to promote child development.
Collapse
Affiliation(s)
- Baitun Nahar
- International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
| | | | | | | | | | | |
Collapse
|
25
|
Nahar B, Ahmed T, Brown KH, Hossain MI. Risk factors associated with severe underweight among young children reporting to a diarrhoea treatment facility in Bangladesh. J Health Popul Nutr 2010; 28:476-483. [PMID: 20941899 PMCID: PMC2963770 DOI: 10.3329/jhpn.v28i5.6156] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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+standard deviation (SD) 12.6 +/- 4.1 months] or sex ratio (44% girls), area of residence, or year of enrollment. Results of logistic regression analysis 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), discontinued breastfeeding (AOR = 2.0, 95% CI 1.1-3.5), and had higher birth-order (> 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 completed < 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-feeding 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.
Collapse
Affiliation(s)
- Baitun Nahar
- ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh
- Institute of Mother and Child Health, Uppsala University, Sweden
| | | | - Kenneth H. Brown
- Department of Nutrition and Program in International and Community Nutrition, University of California Davis, USA
- Helen Keller International, Dakar, Senegal
| | - Md. Iqbal Hossain
- ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh
- Department of Nutrition and Program in International and Community Nutrition, University of California Davis, USA
| |
Collapse
|
26
|
Hossain MI, Dodd NS, Ahmed T, Miah GM, Jamil KM, Nahar B, Alam B, Mahmood CB. Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh. J Health Popul Nutr 2009; 27:72-9. [PMID: 19248650 PMCID: PMC2761803 DOI: 10.3329/jhpn.v27i1.3319] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
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 2005-May 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 > or = 500 and > or = 700 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.
Collapse
Affiliation(s)
- M Iqbal Hossain
- Mother and Child Health Services, ICDDR,B, Mohakhali, Dhaka 1212, Bangladesh.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Chauhan H, Chourasia S, Nahar B, Singh R. Synthesis and Characterisation of Mixed Dithiolatoarsenic(Iii) Alkyldithiocarbonates and Dialkyldithiocarbamates. PHOSPHORUS SULFUR 2008. [DOI: 10.1080/10426509808545474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- H.P.S. Chauhan
- a Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- b Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- c Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- d Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
| | - S. Chourasia
- a Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- b Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- c Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- d Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
| | - B. Nahar
- a Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- b Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- c Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- d Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
| | - R.K. Singh
- a Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- b Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- c Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
- d Institute of Chemical Sciences, Devi Ahilya University , Takshashila Campus, Khandwa Road, Indore-452001, India
| |
Collapse
|
28
|
Affiliation(s)
- H. P. S. Chauhan
- a Institute of Chemical Sciences, Devi Ahilya Vishwavidyalay , Takshashila Campus, Khandwa Road, Indore , 452001 , India
| | - B. Nahar
- a Institute of Chemical Sciences, Devi Ahilya Vishwavidyalay , Takshashila Campus, Khandwa Road, Indore , 452001 , India
| |
Collapse
|
29
|
Quazi S, Mohiduzzaman M, Khan MR, Nahar B, Rahman MM, Islam MN, Baquer M, Pandav CS, Yusuf HKM. Urinary iodine levels in three ecological zones of Bangladesh. Indian J Clin Biochem 1997; 12:128-33. [DOI: 10.1007/bf02873676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
|
31
|
Yusuf HK, Quazi S, Kahn MR, Mohiduzzaman M, Nahar B, Rahman MM, Islam MN, Khan MA, Shahidullah M, Hoque T, Baquer M, Pandav CS. Iodine deficiency disorders in Bangladesh. Indian J Pediatr 1996; 63:105-10. [PMID: 10829973 DOI: 10.1007/bf02823878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
An extensive iodine deficiency disorders survey was conducted in Bangladesh in 1993 to assess the latest iodine nutriture status of the country. The clinical variables of the survey were goitre and cretinism, and the biochemical variable was urinary iodine. The "EPI-30 cluster" sampling methodology was followed for selecting the survey sites. In each survey site, the study population consisted of boys and girls, aged 5-11 years, and men and women, aged 15-44 years, in about equal populations. The total number of survey sites was 78 and the total number of respondents was 30,072. The total number of urine samples was 4512 (15% sub-sample). The current total goitre rate (grade 1 + grade 2) in Bangladesh is 47.1% (hilly, 44.4%; flood-prone, 50.7%; and plains, 45.6%). The prevalence of cretinism in the country is 0.5% (hilly, 0.8%; flood-prone, 0.5%; and plains, 0.3%). Nearly 69% of Bangladeshi population have biochemical iodine deficiency (urinary iodine excretion [UIE] < 10 mg/dl) (hilly, 84.4; flood-prone, 67.1%; and plains 60.4%). Women and children are more affected that men, in terms of both goitre prevalence and UIE. The widespread severe iodine deficiency in all ecological zones indicates that the country as a whole is an iodine-deficient region. Important recommendations of global interest are made from the experience of the survey.
Collapse
Affiliation(s)
- H K Yusuf
- Department of Biochemistry, University of Dhaka, Bangladesh
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Yusuf HK, Quazi S, Islam MN, Hoque T, Rahman KM, Mohiduzzaman M, Nahar B, Rahman MM, Khan MA, Shahidullah M. Current status of iodine-deficiency disorders in Bangladesh. Lancet 1994; 343:1367-8. [PMID: 7910359 DOI: 10.1016/s0140-6736(94)92506-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|