Validity and reproducibility of resting metabolic rate measurements in rural Bangladeshi women: comparison of measurements obtained by Medgem™ and by Deltatrac™ device

OBJECTIVE

To assess reproducibility and validity of resting metabolic rate (RMR) of Bangladeshi women as measured with the MedGem device and using the Deltatrac metabolic monitor as a reference; and (2) to evaluate the FAO/WHO/UNU basal metabolic rate (BMR)-prediction equations.

DESIGN

In each of two sessions, resting oxygen consumption was measured in triplicate by MedGem and in triplicate by Deltatrac device.

SETTING

Matlab area, the rural field research area of the Centre for Health and Population Research, Bangladesh (ICDDR,B).

SUBJECTS

A total of 37 nonpregnant, nonlactating women, aged 27.6 +/- 4.5 y, BMI 20.8 +/- 3.1 kg/m(2) participated.

RESULTS

The difference in oxygen consumption by MedGem and Deltatrac device was significantly level dependent. Within-subject within-session variations (expressed as CV) were 9.0 and 3.0% (P < 0.01) and within-subject between-session variations were 8.2 and 4.5% (P < 0.01) for MedGem and Deltatrac, respectively. Mean RMR measured by Deltatrac (5.17 +/- 0.51 MJ/day) was not significantly different from the BMR predicted by the FAO/WHO/UNU equations (5.16 +/- 0.42 MJ/day) in the second session and only 0.19 MJ/day higher than predicted in the first session (P < 0.05).

CONCLUSION

Reproducibility and validity of the MedGem device was poor compared to the Deltatrac reference method. The FAO/WHO/UNU BMR-prediction equations give a good estimation of the BMR of rural, nonpregnant, nonlactating Bangladeshi women of 18-35 y.

SPONSORSHIP

Wageningen University (The Netherlands) and ICDDR,B (Bangladesh).

Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial

BACKGROUND

Pneumonia is a leading cause of morbidity and mortality in young children. Early reversal of severity signs--chest indrawing, hypoxia, and tachypnoea--improves outcome. We postulated that zinc, an acute phase reactant, would shorten duration of severe pneumonia and time in hospital.

METHODS

In a double-blind placebo-controlled clinical trial in Matlab Hospital, Bangladesh, 270 children aged 2-23 months were randomised to receive elemental zinc (20 mg per day) or placebo, plus the hospital's standard antimicrobial management, until discharge. The outcomes were time to cessation of severe pneumonia (no chest indrawing, respiratory rate 50 per min or less, oxygen saturation at least 95% on room air) and discharge from hospital. Discharge was allowed when respiratory rate was 40 per minute or less for 24 consecutive hours while patients were maintained only on oral antibiotics.

FINDINGS

The group receiving zinc had reduced duration of severe pneumonia (relative hazard [RH]=0.70, 95% CI 0.51-0.98), including duration of chest indrawing (0.80, 0.61-1.05), respiratory rate more than 50 per min (0.74, 0.57-0.98), and hypoxia (0.79, 0.61-1.04), and overall hospital duration (0.75, 0.57-0.99). The mean reduction is equivalent to 1 hospital day for both severe pneumonia and time in hospital. All effects were greater when children with wheezing were omitted from the analysis.

INTERPRETATION

Adjuvant treatment with 20 mg zinc per day accelerates recovery from severe pneumonia in children, and could help reduce antimicrobial resistance by decreasing multiple antibiotic exposures, and lessen complications and deaths where second line drugs are unavailable.

Efficacy of various amendments for amelioration of fly-ash toxicity: growth performance and metal composition of Cassia siamea Lamk

Plants of Cassia siamea Lamk were grown in garden soil (control), fly-ash (100%) and fly-ash amended by various ameliorants (cowdung manure, press-mud, garden soil; 1:1, w/w). The plants survived in fly-ash (100%) though their growth was less in comparison to the treatments. Fly-ash+press-mud (1:1, w/w) proved to be the best combination as growth (total biomass, leaf number, photosynthetic area, total chlorophyll and protein) was significantly high in this treatment followed by cowdung manure and garden soil. Leaves and roots accumulated significant amount of Cu, Zn, Ni and and Fe. However, the concentration of all the metals was more in roots than leaves except Ni. Although, fly-ash contains high amount of metals but the metal uptake was more in the plants grown in fly-ash+press-mud mixture. Inspite of high metal availability in fly-ash and press-mud mixture, plant growth was good. This might be attributed to the some metal detoxification mechanism active in this treatment. The present study concluded that C. siamea seems to be a suitable plant for developing a vegetation cover on fly-ash dumps.

Mammographic criteria for determining the diagnostic value of microcalcifications in the detection of early breast cancer

OBJECTIVE

To evaluate the importance of microcalcifications in the detection of breast carcinoma in conventional mammography.

METHODS

This prospective study was carried out at Aga Khan University Hospital (AKUH). Mammograms of 68 patients with microcalcifications were evaluated. Craniocaudal and oblique views of both breasts were acquired on routine basis with cone compression and magnified views when required.

RESULTS

Among 68 patients with microcalcifications, 61 (89%) had clustered microcalcifications while 7 patients (10.29%) had scattered microcalcifications. Microcalcifications can occur in benign and malignant diseases. While evaluating clustered microcalcifications, few criteria have been established to determine malignant clustered microcalcifications, these include specific and nonspecific criteria. Among specific and statistically significant criteria for malignant microcalcifications, which were identified in this study, were irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. In a cluster total number of >30 microcalcifications and at least 10 microcalcifications/cm2 of a cluster are also important in diagnosing a malignant cluster, but are included in nonspecific criteria because they can be present in benign diseases also. Scattered bilateral microcalcifications are usually present in benign breast diseases, but in this study, two patients with breast cancer had profuse bilateral scattered microcalcifications.

CONCLUSION

This study shows that specific and statistically significant criteria for malignant microcalcifications, are irregularity of size, irregularity of density, linear or branched shape and Le Gal's type V distribution. Scattered bilateral microcalcifications are usually present in benign breast diseases, but irregular shape and development of new calcifications among diffusely scattered bilateral calcifications, on follow up study, should also raise suspicion for being malignant.

Environmental monitoring of asbestos products manufacturing units--a case study

Air borne asbestos dust concentration and occupational health environment of workers in a asbestos products manufacturing unit was monitored, and compared with the standards. Study reveals that overall airborne asbestos concentration in the unit is well within the limit, but the workers, which were exposed to air borne asbestos dust, showed a marked increase in deterioration of lung function as compared to the control population, which was not exposed to this dust. Further more, the population which was exposed to airborne asbestos dust along with other predisposing factors like cigarette smoking, showed a marked deterioration of lung function as compared to the population exposed only to air borne asbestos dust.

Reduction of cholera in Bangladeshi villages by simple filtration

Based on results of ecological studies demonstrating that Vibrio cholerae, the etiological agent of epidemic cholera, is commensal to zooplankton, notably copepods, a simple filtration procedure was developed whereby zooplankton, most phytoplankton, and particulates >20 microm were removed from water before use. Effective deployment of this filtration procedure, from September 1999 through July 2002 in 65 villages of rural Bangladesh, of which the total population for the entire study comprised approximately 133,000 individuals, yielded a 48% reduction in cholera (P < 0.005) compared with the control.

Energy stress during pregnancy and lactation: consequences for maternal nutrition in rural Bangladesh

OBJECTIVE

To assess the relationship of energy stress during pregnancy and lactation to maternal body stores in marginally nourished rural Bangladeshi women.

SUBJECTS AND METHODS

Two-hundred and fifty-two women were followed from 5-7 months of pregnancy until 6 months postpartum. Energy intake was estimated during pregnancy and at 1, 3 and 6 month(s) postpartum using 24 h dietary recall. Body weight was measured on enrollment, another once or twice during pregnancy, and at 1, 3 and 6 month(s) postpartum. The weekly rates of pregnancy weight gain and postpartum weight changes were determined. Weight and length of the infants were measured at birth and at approximately 1, 3 and 6 month(s).

RESULTS

Maternal energy intake at 5-7 months of gestation was 1464+/-416 kcal/day (mean+/-s.d.). Women gained a mean of 200 g/week or a total of 4 kg during the second half of pregnancy. An analysis of maternal weight showed no indication of accrual of fat stores during pregnancy. Dietary energy during lactation exceeded the intake during pregnancy by 248-354 kcal/day. Mothers lost an estimated average of 1 kg of weight during the first 6 months of lactation. The mean (+/-s.d.) birth weight was 2.55+/-0.38 kg, and the prevalence of low birth weight (<2500 g) was 48%. Infants exhibited some catch-up growth only during the first 3 months but overall growth during the first 6 months did not change from their relative status at birth when compared with NCHS reference.

CONCLUSIONS

These rural Bangladeshi women failed to gain sufficient weight during the last half of pregnancy to maintain body weight during lactation when the energy demand is high. Poor growth of their primarily breastfed infants raises concern about the adequacy of lactation in this community.

Children's fluid intake during diarrhoea: a comparison of questionnaire responses with data from observations

Many of the individual questions used by the World Health Organization for household surveys on diarrhoea management have not been systematically assessed. This study assessed the use of simple questions to caretakers of children to estimate the proportion of young children who received increased quantities of fluids during diarrhoeal episodes by comparing caretakers' responses with data obtained by direct observations. Children aged 4-35 mo (n = 215) with diarrhoea starting within the last 24 h were observed for 12 h. These children were observed for 12 h again 2 wk later, when healthy. On the following day the questionnaire was administered to the caretakers. The observation focused on the frequency of feeding episodes, including breastfeeding and the type and quantity of fluids consumed by the child. The same questionnaire was administered to the caretakers of another group of children (n = 421) with diarrhoea in the past 2 wk. The mean number of feedings (6.0 +/- 3.8 vs 5.0 +/- 3.5), breastfeeding episodes (11.2 +/- 3.6 vs 8.4 +/- 3.3), breastfeeding duration (85.8 +/- 36.3 min vs 49.1 +/- 22.8 min), other fluid intake (345.8 +/- 309.6 ml vs 120.9 +/- 136.4 ml) and total fluid consumption (653.9 +/- 240.4 ml vs 399.5 +/- 133.6 ml) were significantly higher (p < 0.0001) during diarrhoea compared with healthy periods. At the population level, the simple questionnaire administered to caretakers was found to have high agreement between the reported increase in fluid consumption and the actual increase in fluid intake (defined as > or = 100 ml). At the individual level, caretakers' questionnaire responses for detecting increased fluid intake were highly sensitive (84.3%), but specificity (36.4%) and agreement (0.22) were low.

CONCLUSION

This study documents that children had higher fluid intake, which included both breast milk and other fluid, during acute episodes of diarrhoea. Further research is warranted to improve the specificity and agreement of caretakers' responses to simple questions regarding change in fluid intake during diarrhoeal episodes.

Genomic profiles of clinical and environmental isolates of Vibrio cholerae O1 in cholera-endemic areas of Bangladesh

Diversity, relatedness, and ecological interactions of toxigenic Vibrio cholerae O1 populations in two distinctive habitats, the human intestine and the aquatic environment, were analyzed. Twenty environmental isolates and 42 clinical isolates were selected for study by matching serotype, geographic location of isolation in Bangladesh, and season of isolation. Genetic profiling was done by enterobacterial repetitive intergenic consensus sequence-PCR, optimized for profiling by using the fully sequenced V. cholerae El Tor N16961 genome. Five significant clonal clusters of haplotypes were found from 57 electrophoretic types. Isolates from different areas or habitats intermingled in two of the five significant clusters. Frequencies of haplotypes differed significantly only between the environmental populations (exact test; P < 0.05). Analysis of molecular variance yielded a population genetic structure reflecting the differentiating effects of geographic area, habitat, and sampling time. Although a parameter confounding the latter differences explained 9% of the total molecular variance in the entire population (P < 0.01), the net effect of habitat and time could not be separated because of the small number of environmental isolates included in the study. Five subpopulations from a single area were determined, and from these we were able to estimate a relative differentiating effect of habitat, which was small compared with the effect of temporal change. In conclusion, the resulting population structure supports the hypothesis that spatial and temporal fluctuations in the composition of toxigenic V. cholerae populations in the aquatic environment can cause shifts in the dynamics of the disease.

Are the environmental niches of Vibrio cholerae O139 different from those of Vibrio cholerae O1 El Tor?

BACKGROUND

Vibrio cholerae are known to be normal inhabitants of surface water. However, the environmental niches of the different strains of cholera are not well known, and therefore, populations at risk for cholera outbreaks cannot be clearly identified.

METHODS

This study identifies environmental risk factors for cholera caused by V. cholerae O1 El Tor and O139 and environmental niches of the two strains present in Matlab, a cholera endemic area of Bangladesh. The study year was 1993, the year that the O139 strain first appeared in the study area. Patients who had either strain of cholera identified in a laboratory were included in the study. A geographic information system was used to map the household locations of the patients, to describe the human sanitary environment and population density, and to address potential anthropogenic and environmental risk factors of the disease. Spatial point pattern and exploratory spatial data analysis techniques were used to define the environmental niches of the two cholera strains.

RESULTS

The study suggests the niches of O1 El Tor and O139 strains of V. cholerae appear to be similar, based on common environmental risk factors.

CONCLUSIONS

The results of this study support a theory that O1 El Tor could possibly be replaced by the newer O139 strain in the future.

Health profile of lock factory workers in Aligarh

In order to assess the health problems and its relationship to the nature of work of lock factory workers, a field based cross sectional study was carried out in sixty randomly selected lock factories in urban industrial areas of Aligarh city. Nine hundred fifty seven lock factory workers were included in the study out of them 45.7 percent were found to be suffering from one or more than one diseases. Detailed study of the workers showed that 73.05 percent were suffering from respiratory tract diseases, a majority of them having upper respiratory tract infection. Diseases showed a definite trend either increasing (Chronic bronchitis, Emphysema etc) or decreasing (upper respiratory tract infection, Bronchial asthma, Injuries & accidents), according to the age and duration of work. Polishing & filing appeared to be the most hazardous type of the work as shown in the proportion of chest diseases, (56.6%) & (38.3%) in polishing & filling workers respectively.

Safety and immunogenicity of tetravalent rhesus-based rotavirus vaccine in Bangladesh

BACKGROUND

Rotavirus is the most common cause of severe gastroenteritis among children worldwide.

OBJECTIVES

To compare the safety, immunogenicity and shedding patterns of rhesus rotavirus (RRV)-tetravalent vaccine vs. placebo among infants in rural Bangladesh.

METHODS

A double blinded, placebo-controlled trial was conducted in which infants (n = 120) were randomly assigned to receive three doses of either vaccine or placebo administered at approximately 6, 10 and 14 weeks of age together with routine immunizations. Data on possible adverse effects of vaccinations were collected daily for 7 days after each dose. Stool samples were collected after each dose, and serum samples were obtained before the first and after the third vaccination.

RESULTS

Fever (> or = 38 degrees C), as measured by study assistants, was noted more frequently among vaccinees (15%) than among placebo recipients (2%) during the 7 days after vaccination but was not reported more frequently by parents of vaccinees vs. placebo recipients. Overall 87% of vaccinees had an antibody response (measured by IgA or anti-RRV-neutralizing antibodies) after vaccination compared with 32% of placebo recipients. Rates of seroconversion were higher among subjects with lower levels of prevaccination antibodies and those who shed rotavirus after vaccination. Vaccine strain viruses were detected in stools from placebo vaccine recipients who had evidence of IgA seroconversion.

CONCLUSIONS

In this population RRV-tetravalent vaccine was comparably immunogenic and safe as in trials conducted in developed countries, where this vaccine has been proved effective in preventing severe rotavirus diarrhea. These data support continued evaluation of rotavirus vaccines in developing countries.

The efficacy of bismuth subsalicylate in the treatment of acute diarrhoea and the prevention of persistent diarrhoea

A controlled, randomized, double-blind study in Bangladeshi children (ages 4-36 mo) with acute diarrhoea was undertaken to determine whether bismuth subsalicylate (BSS) would prevent the development of persistent diarrhoea (PD) in young children. The children were randomized to two groups: 226 were given liquid oral BSS, (as Pepto-Bismol), 100 mg/kg/d for 5 d; 225 were given placebo of identical appearance. On admission to the study, the two groups were comparable both clinically and microbiologically. Rotavirus was found in 56% of all the children, and enterotoxigenic E. coli in 31% of a subsample studied. Children treated with BSS had less severe and less prolonged illness than those treated with placebo (p = 0.057). There was, however, no difference in the development of PD between the two groups (8% and 11%). Unexpectedly, patients treated with BSS gained significantly more weight (2.3%) than those treated with placebo (0.5%; p < 0.001) during the course of the study. No toxicity of BSS was detected.

CONCLUSION

Treatment with BSS had a modest therapeutic effect on acute diarrhoea, as has been previously demonstrated, but with no suggestion of a therapeutic effect on the prevention of persistent diarrhoea in this group of patients.

Efficacy of a packaged rice oral rehydration solution among children with cholera and cholera-like illness

In past studies, patients with cholera and cholera-like diarrhoea treated with rice oral rehydration solution (ORS) had lower purging rates and a shorter illness duration. We evaluated a new packet form of rice ORS (CeraLyte-90) in 167 boys aged 5 to 15 y, with acute, dehydrating cholera and cholera-like diarrhoea in Bangladesh. The patients were randomized to receive either CeraLyte-90 (n = 85) or glucose ORS (n = 82) and were given early feeding and early antibiotics. The efficacy of the two solutions was compared for stool output during the first 8 h, the first 24 h, and total output, duration of diarrhoea, hematocrit, serum electrolytes and requirement for unscheduled intravenous fluids. The clinical and laboratory characteristics of the two groups were comparable on admission, and most of the patients had cholera (88% and 84% in the CeraLyte and glucose groups, respectively). The mean (+/- SE) stool output was 20% less in the rice ORS group during the first 8 h of treatment (86.2+/-6.6 ml/Kg vs 108.8+/-7.9 ml/Kg, p < 0.05), but the outputs during the other time periods were similar in the two groups, although children in the rice ORS group had slightly more vomiting on day one (p < 0.05). The mean serum electrolyte concentrations in both groups of children remained within normal range.

CONCLUSION

The study documents the safety and efficacy of the new, packaged rice ORS.

Association between clinical type of diarrhoea and growth of children under 5 years in rural Bangladesh

BACKGROUND

The role of diarrhoea in the aetiology of growth retardation in young children remains controversial. To evaluate this, a population-based, longitudinal study of young children aged 6-48 months was conducted in Matlab, a rural area of Bangladesh, between May 1988 and April 1989.

METHODS

Data obtained from 584 children were examined by one-year (n = 412) and 3-month (n = 1220) growth periods. Each growth period was analysed based on clinical types of diarrhoea, namely, non-diarrhoea, non-dysentery diarrhoea (diarrhoea without blood), and dysentery (diarrhoea with blood). Weight and height gains were compared among the study groups initially by one-way analysis of variance followed by multivariate analysis adjusting for potential confounding variables.

RESULTS

Compared to non-diarrhoea and non-dysentery diarrhoea, dysentery was associated with significantly lower annual weight gain (1866 g [P < 0.01] and 1550 g [P < 0.05] versus 1350 g, respectively) and height gain (6.51 cm and 5.87 cm versus 5.27 cm [P < 0.01], respectively). Both 3-month dysentery and non-dysentery intervals were significantly associated with less weight gain compared to non-diarrhoea intervals (490 g and 522 g versus 637 g [P: < 0.05], respectively). Dysentery intervals were also associated with significantly poorer height gain compared to other intervals (2.19 cm versus 2.42 cm [P < 0.05] and 2.46 cm [P < 0.01], respectively).

CONCLUSIONS

The growth of young children is strongly influenced by the clinical type of diarrhoea and the impact is dependent on the proportion of dysentery episodes in the total diarrhoeal burden.

Improved indicators of infant mortality for integrated primary healthcare programmes

Mortality and fertility rates are decreasing rapidly in many developing countries. It is argued that the indices commonly used as measures of these changes, i.e. infant mortality rate and fertility rate, ignore the interaction between mortality and fertility, and do not reflect their combined impact in lowering overall infant mortality. The paper proposes new indicators of infant mortality, termed fertility-adjusted infant mortality ratio (FIMR), age-specific, fertility-adjusted IMR (AFIMR), and total infant mortality ratio (TIMR) that are more sensitive to rapid demographic changes. These indicators include the combined effects of changes in both fertility and infant mortality rates on overall infant mortality in a region and appear to measure the effects of integrated health programmes better. Further, these conceptualize the mother-infant pair as an appropriate unit with which to monitor mortality, and may be used for guiding allocation of resources intended to lower infant mortality. The application and usefulness of these indicators have been illustrated, using one hypothetical example and empirical data from the maternal-child health and family-planning programme in Matlab, Bangladesh, as well as data from white and black population groups in the U.S.A. The results of these examples demonstrate that the new indicators are more sensitive than traditional measures when describing infant mortality, and may better reflect the perception in infant mortality status in the community.

Maternal measles antibody decay in rural Bangladeshi infants--implications for vaccination schedules

Considerable numbers of measles cases occur below the target age for vaccination in the Indian sub-continent. The immunogenicity of measles vaccine in infancy is dependent on the rate of decay in maternal antibody since this antibody interferes with vaccine induced seroconversion. This study investigated maternal antibody decay in a rural population in Bangladesh and evaluated possible risk factors for early decay. Measles antibodies were assessed using both ELISA and Plaque Reduction Neutralization (PRN) test in 330 infant-mother pairs in a cross-sectional survey. PRN was more sensitive method than ELISA for determining antibody levels. Antibody levels decreased rapidly in infants with increasing age. By the age of 5 months, 67% (28/42) infants had practically no protective antibody left (30 mIU ml-1 or below). Only 12% infants at 5 months of age, and 5% at 8 months, had levels greater than 120 mIU ml-1--stated to 'protect' children. Multiple regression showed that maternal age was the only variable associated with the level of antibody (maternal weight, height and MUAC were not associated), decreasing by 1.06 mIU ml-1 for each year of age (P = 0.002). Infant's antibody concentration decreased with age by an average 2 mIU mL-1 for every month of life (P < 0.0001), and was determined by the maternal antibody concentration (P < 0.0001) (child's length, weight, MUAC, mother's gestational age and parity were not associated). The relatively rapid antibody decay suggests that the target age for measles vaccination might be reduced. Further, as the cohort of vaccinated mothers enters reproductive age in Bangladesh, a more rapid decay of antibody may be expected in future generations of Bangladeshi children. The information presented here suggests that a formal trial of standard measles vaccine at younger ages is justified in this population as it could confer considerable benefit in reducing infant measles.

A baseline study of tobacco use among the staff of Aligarh Muslim University, Aligarh, India

A cross-sectional study of 2,439 university employees and research scholars was carried out using the questionnaire method. The objective was to assess the prevalence and type of tobacco usage and to collect background data for planning health education programmes. The overall prevalence of tobacco usage was 51.5% among males and 30.3% among females. There were no female smokers, the preferred habit of tobacco usage among women being chewing. The prevalence of smoking among non-teaching staff members was significantly higher. Among females, the prevalence of tobacco chewers was higher in non-teaching staff members. Tobacco usage (both smoking and usage of other forms) rose with age. However, even at 20-30 years of age 25.4% of males were addicted to smoking. A majority of 60.6% had smoked for more than 10 years. Among the staff members (both teaching and non-teaching) the reason for smoking was either to relax or because of addiction, whereas the research scholars smoked to improve their image or for enjoyment/pleasure. The reasons given by users of other forms of tobacco were boredom, to pass the time or for no reason at all. Among non-users, the majority were aware of the harmful effects of smoking. Family pressure and traditions were also important reasons for not smoking. The study provides a clear picture of tobacco usage within the University.