Can early postpartum home visits by trained community health workers improve breastfeeding of newborns?

OBJECTIVE

Whether postpartum visits by trained community health workers (CHWs), reduce newborn breastfeeding problems.

METHOD

Community health workers made antenatal and postpartum home visits promoting newborn care practices including breastfeeding. CHWs assessed neonates for adequacy of breastfeeding and provided hands-on support to mothers to establish breastfeeding. History and observation data of 3495 neonates were analyzed to assess effects of CHW visitation on feeding problems.

RESULT

Inappropriate breastfeeding position and attachment were the predominant problems (12 to 15%). Only 6% of newborns who received home visit by CHWs within 3 days had feeding difficulties, compared to 34% of those who did not (odds ratio: 7.66, 95% confidence interval (CI): 6.03 to 9.71, P=0.00). Latter group was 11.4 times (95% CI: 6.7 to 19.3, P=0.00) more likely to have feeding problems as late as days 6 to 7, than the former.

CONCLUSION

Counseling and hands-on support on breastfeeding techniques by trained workers within first 3 days of birth, should be part of community-based postpartum interventions.

High titre of anti-Ascaris immunoglobulin E associated with bronchial asthma symptoms in 5-year-old rural Bangladeshi children

BACKGROUND

Increasing interest has arisen whether helminthic infections protect against asthma and allergy. The prevalence of wheezing among Bangladeshi children is higher in rural areas where helminthic infectious burden is greater, which is contrary to the general assumption.

OBJECTIVE

We therefore examined the association between Ascaris infection, serum level of anti-Ascaris IgE, which should be investigated differently from the infection, and wheezing in 5-year-old children from rural Bangladesh.

METHODS

A total of 219 children who reported wheezing during the previous 12 months and 122 randomly selected age-matched individuals who had never experienced wheezing were tested for serum levels of total and specific Ascaris, Dermatophagoides pteronyssinus, alternaria and cockroach IgEs, and for intestinal helminth infection as well.

RESULTS

Anti-Ascaris IgE levels were significantly and independently associated with current wheezing during the previous 12 months [odds ratio (OR) per log(e) increment is 1.31 (95% confidence interval (CI) 1.08-1.60), P=0.007], a history of at least four episodes of wheezing [OR per log(e) increment is 1.52 (95% CI 1.18-1.96), P=0.001], wheezing with sleep disturbances [OR per log(e) increment is 1.35 (95% CI 1.10-1.64), P=0.011] and wheezing with speech disturbances [OR per log(e) increment is 1.57 (95% CI 1.19-2.08), P=0.001]. These were adjusted for gender, pneumonia history, parental asthma, Trichuris infection, use of dry leaves as fuel and other specific IgE levels. The prevalence of Ascaris infection by the presence of wheezing was not significantly different (76% vs. 72%, respectively).

CONCLUSION

We conclude that a high titre of anti-Ascaris IgE is associated with an increased risk of asthma symptoms among 5-year-old rural Bangladeshi children with a high helminthic infectious load.

Exclusive breastfeeding reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums

OBJECTIVES

To describe breastfeeding practices and investigate the influence of exclusive breastfeeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhea.

METHODS

A prospective observational study was conducted on a birth cohort of 1677 infants who were born in slum areas of Dhaka in Bangladesh and followed from birth to 12 months of age. After enrollment at birth, the infants were visited 5 more times by 12 months of age. Verbal autopsy, based on a structured questionnaire, was used to assign a cause to the 180 reported deaths. Proportional hazards regression models were used to estimate the effect of breastfeeding practices, introduced as a time-varying variable, after accounting for other variables, including birth weight. Overall neonatal, postneonatal and infant mortality, and mortality attributable to ARI and diarrhea were measured.

RESULTS

The proportion of infants who were breastfed exclusively was only 6% at enrollment, increasing to 53% at 1 month and then gradually declining to 5% at 6 months of age. Predominant breastfeeding declined from 66% at enrollment to 4% at 12 months of age. Very few infants were not breastfed, whereas the proportion of partially breastfed infants increased with age. Breastfeeding practices did not differ between low and normal birth weight infants at any age. The overall infant mortality rate was 114 deaths per 1000 live births. Compared with exclusive breastfeeding in the first few months of life, partial or no breastfeeding was associated with a 2.23-fold higher risk of infant deaths resulting from all causes and 2.40- and 3.94-fold higher risk of deaths attributable to ARI and diarrhea, respectively.

CONCLUSION

The important role of appropriate breastfeeding practices in the survival of infants is clear from this analysis. The reduction of ARI deaths underscores the broad-based beneficial effect of exclusive breastfeeding in prevention of infectious diseases beyond its role in reducing exposure to contaminated food, which may have contributed to the strong protection against diarrhea deaths.

Three case definitions of malaria and their effect on diagnosis, treatment and surveillance in Cox's Bazar district, Bangladesh

In countries where malaria is endemic, routine blood slide examinations remain the major source of data for the public health surveillance system. This approach has become inadequate, however, as the public health emphasis has changed from surveillance of laboratory-confirmed malaria infections to the early detection and treatment of the disease. As a result, it has been advocated that the information collected about malaria be changed radically and should include the monitoring of morbidity and mortality, clinical practice and quality of care. To improve the early diagnosis and prompt treatment (EDPT) of malaria patients, three malaria case definitions (MCDs) were developed, with treatment and reporting guidelines, and used in all static health facilities of Cox's Bazar district, Bangladesh (population 1.5 million). The three MCDs were: uncomplicated malaria (UM); treatment failure malaria (TFM); and severe malaria (SM). The number of malaria deaths was also reported. This paper reviews the rationale and need for MCDs in malaria control programmes and presents an analysis of the integrated surveillance information collected during the three-year period, 1995-97. The combined analysis of slide-based and clinical data and their related indicators shows that blood slide analysis is no longer used to document fever episodes but to support EDPT, with priority given to SM and TFM patients. Data indicate a decrease in the overall positive predictive value of the three MCDs as malaria prevalence decreases. Hence the data quantify the extent to which the mainly clinical diagnosis of UM leads to over-diagnosis and over-treatment in changing epidemiological conditions. Also the new surveillance data show: a halving in the case fatality rate among SM cases (from 6% to 3.1%) attributable to improved quality of care, and a stable proportion of TFM cases (around 7%) against a defined population denominator. Changes implemented in the EDPT of malaria patients and in the surveillance system were based on existing staff capacity and routine reporting structures.

Association of HIV viral load with oral diseases

OBJECTIVE

The measurement of HIV viral load as a predictor of disease progression has revolutionized the medical management of HIV patients. In this study, oral diseases as measured by DMFT (decayed, missing and filled teeth), periodontal assessment and oral Candidacolonization, were related to HIV viral load. Also correlated was HIV status assessments, including CD4+ count, a history of intravenous drug abuse (IVDA) and the use of protease inhibitor drugs.

MATERIALS AND METHODS

Oral and periodontal examination, dental radiographs, and tongue swab for fungal culture was accomplished over a 2-month period on 39 HIV positive patients attending the University of Maryland Dental School. Twenty-eight (71. 8%) of these patients had a history of IVDA. Viral load was measured by a quantitative RT-PCR.

RESULTS

Among the patients with high viral load (>10 000 copies ml-1), 92.3% were found to have a history of IVDA. Also, patients with high viral load demonstrated average CD4+ counts of 136 mm-3 while moderate viral load (400-10 000 copies ml-1) corresponded to average counts of 271 mm-3. Periodontal pocket depths (PPD) of >5 mm at a minimum of two oral sites were found in 76.9% of the patients with high viral load. Among the high viral load patients, 69.2% had DMFT >20, 69.2% were culture positive for Candida and 81.5% of patients on protease inhibitors demonstrated moderate or low viral loads.

CONCLUSION

These data demonstrated that elevated viral load levels correlate well with oral disease prevalence in this predominantly IVDA population of HIV-infected dental patients.

Histochemical enzyme pattern of microfilaria of Setaria cervi

The present study deals with the histochemical localization of glucose-6-phosphatase, malic dehydrogenase and aldolase in the microfilaria of Setaria cervi. Marked activity of glucose-6-phosphatase was observed in the cephalic cells, excretory and anal pores, G-cells and Innenkörper. Malic dehydrogenase activity was noted throughout the body (including cuticle) of the microfilaria except for Innenkörper. Intense aldolase activity was observed in the excretory pore and G-cells only. Muscle cells and anal pore were negative for this enzyme.

Serum protein changes and their correlation with antibody production in rabbits following induced Setaria cervi infection

The sera obtained from normal control and Setaria cervi infected rabbits were analysed weekly both qualitatively and quantitatively. Electrophoretic studies as well as biochemical estimation reveal an increase in total protein and globulin and a decrease in albumin level. The changes were more marked in the third week, followed by a declining phase reaching an almost normal level by the sixth week. The increased globulin level analysed electrophoretically also coincided with the appearance of 2 precipitin arcs in immunoelectrophoretic analysis indicating a correlation between antibody production and hyperglobulinaemia.

Effect of anthelmintics on the enzyme activities of Setaria cervi (Nematoda: Filarioidea)

The present study deals with the comparative efficacy of Hetrazan, levamisole and tetramisole on the enzyme activities of adult Setaria cervi worms. The drugs were administered orally to white rats, intraperitoneally infected with the bovine filariid, Setaria cervi. Biochemical assays revealed the decreased activities of glucose-6-phosphatase, fructose-1,6-diphosphatase, lactate dehydrogenase and adenosine triphosphatase in the drug-treated worms. Hetrazan was relatively more effective than tetramisole and levamisole. A possible role of these enzymes in the energy supply and survival of the worm has been briefly discussed.