Factors contributing to the reduction in childhood stunting in Bangladesh: a pooled data analysis from the Bangladesh demographic and health surveys of 2004 and 2017-18

BACKGROUND

Over the last two decades, Bangladesh has made progress in reducing the percentage of stunted children under age 5 years from 51% in 2004 to 31% in 2017. Such reduction has created a source for new research to understand its contributing factors. The present study aims to identify such crucial factors which contributed in reducing the percentage of under-five stunting status of children from 2004 to 2017-18.

METHODS

The study used data from the Bangladesh Demographic and Health Surveys (BDHS), conducted in 2004 and in 2017-18, focused on children under-5-years of age (U5). The sample sizes were n = 6375 children included in the 2004 survey and n = 8312 children included in the 2017-18 survey. Descriptive analysis and bivariate analysis were conducted for a general characterization of the samples. Logistic regression was used to find out the significant factors contributing to the prevalence of stunting among U5 children. Furthermore, the Fairlie decomposition technique was used to identify the crucial factors that contributed to the reduction of stunting.

RESULTS

The prevalence of stunting among U5 children has declined significantly, from 49.8 to 30.7% between the two survey periods (2004 and 2017-18). Estimates of decomposition analysis show that overall, the selected variables explained 50.6% of the decrease in the prevalence of stunting. Mother's characteristics such as age at first birth, education level, working status and BMI (body mass index) status were the primary contributors of this change. Father's characteristics, such as education explained 9% of this change.

CONCLUSION

The results of the study highlight the importance of increasing maternal education and reducing inter-household wealth inequality to improve nutritional status of U5 children. In order to achieve further reduction in stunting, among U5 children in Bangladesh, this paper calls for policymakers to develop effective programs to improve maternal education, raise parental awareness of parents regarding children's height and weight, and aim to significantly reduce inter-household inequalities.

Differential in infant, childhood and under-five death clustering among the empowered and non-empowered action group regions in India

Background

With 8,82,000 deaths in the under-five period, India observed varied intra-state and inter-regional differences across infant and child mortality in 2018. However, scarce literature is present to capture this unusual concentration of mortality in certain families by examining the association of the mortality risks among the siblings of those families along with various unobserved characteristics of the mother. Looking towards the regional and age differential in mortality, this paper attempts to provide evidence for the differential in mortality clustering among infants (aged 0–11 months), children (12–59 months) and under-five (0–59 months) period among mothers from the Empowered Action Group (EAG) and non-EAG regions of India.

Methods

The study used data from the National Family Health Survey (2015–16) which includes all the birth histories of 475,457 women aged 15–49 years. Bivariate and multivariate analyses were used to fulfil the objectives of the study. A two-level random intercept Weibull regression model was used to account for the unexplained mother (family) level heterogeneity.

Results

About 3.3% and 5.9% of infant deaths and 0.8% and 1.6% of childhood deaths were observed in non-EAG and EAG regions respectively. Among them, a higher percentage of infant and child death was observed due to the death of a previous sibling. There were 1.67 times [95% CI: 1.55–1.80] and 1.46 times [CI: 1.37–1.56] higher odds of infant and under-five mortality of index child respectively when the previous sibling at the time of conception of the index child was dead in the non-EAG regions. In contrast, the odds of death scarring (death of previous sibling scars the survival of index child) were 1.38 times [CI: 1.32–1.44] and 1.24 times [CI: 1.20–1.29] higher for infant and under-five mortality respectively in the EAG regions.

Conclusion

The extent of infant and child mortality clustering and unobserved heterogeneity was higher among mothers in the non-EAG regions in comparison to their EAG region counterparts. With the growing situation of under-five mortality clustering in non-EAG states, region-wise interventions are recommended. Additionally, proper care is needed to ameliorate the inter-family variation in mortality risk among the children of both EAG and non-EAG regions throughout their childhood.

Multi-channel Chan-Vese model for unsupervised segmentation of nuclei from breast histopathological images

T he pathologist determines the malignancy of a breast tumor by studying the histopathological images. In particular, the characteristics and distribution of nuclei contribute greatly to the decision process. Hence, the segmentation of nuclei constitutes a crucial task in the classification of breast histopathological images. Manual analysis of these images is subjective, tedious and susceptible to human error. Consequently, the development of computer-aided diagnostic systems for analysing these images have become a vital factor in the domain of medical imaging. However, the usage of medical image processing techniques to segment nuclei is challenging due to the diverse structure of the cells, poor staining process, the occurrence of artifacts, etc. Although supervised computer-aided systems for nuclei segmentation is popular, it is dependent on the availability of standard annotated datasets. In this regard, this work presents an unsupervised method based on Chan-Vese model to segment nuclei from breast histopathological images. The proposed model utilizes multi-channel color information to efficiently segment the nuclei. Also, this study proposes a pre-processing step to select appropriate color channel such that it discriminates nuclei from the background region. An extensive evaluation of the proposed model on two challenging datasets demonstrates its validity and effectiveness.

Determinants of acquired disability and recovery from disability in Indian older adults: longitudinal influence of socio-economic and health-related factors

BACKGROUND

There is a higher burden of functional disability for Indian older adults with substantial variations across different geographic regions and socioeconomic groups as compared to other ageing Asian countries. Thus, using a national sample of older adults aged 60+ years, we aim to explore how common is acquiring of disability and recovery from disability among the older population of a developing country like India, and how do the various socioeconomic and health-related conditions impact this transition in disability status.

METHOD

The current study uses two waves of the India Human Development Survey (IHDS) and is based on panel data of 10,527 older adults. Both bivariate and multiple variable regression analysis were performed using two binary outcome variables in this study - whether older adults acquired disability and recovered from disability between round-I and round-II, respectively.

RESULTS

Nearly 31.5% and 4.4 % of older adults have acquired and recovered disability across the two rounds respectively. About 38.5%  and 45.8 % of female older adults' disability status changes to disable and recovered in round-II respectively. A lesser proportion of older adults have recovered from a disability who have a chronic disease in round-I. Cataract chronic conditions among older adults in round-I had shown 1.45 times (CI: 1.07-1.97) a significantly higher likelihood of acquiring disability in round-I. Older adults who were unmarried and were not working in round-I have 1.12 times (CI: 1.01-1.25) and 1.21 times (CI: 1.06-1.39) higher likelihood of acquiring disability in round-II respectively. Recovering from disability was mostly seen among older adults who belong to the richest (OR: 2.38, CI: 1.31-4.33) and medium (OR: 2.16, CI: 1.27-3.69) wealth quintile households. Older adults residing in the central region of India have 2.72 times (CI: 2.31-3.19) significantly higher chance of acquiring disability than those who were residing in northern regions.

CONCLUSION

Appropriate measures are required to highlight the importance of chronic physical diseases and several socio-demographic factors that may negatively affect the trajectory of disability in older ages.

Association of family structure with gain and loss of household headship among older adults in India: Analysis of panel data

BACKGROUND

Despite huge changes in demographic behaviors, the family continues to be the major source of psychosocial support for older adults in India. The loss of household headship can be a cause of disregard for the aged and is associated in a very fundamental way with other status losses. Our study used the two rounds of the India Human Development Survey to understand the association of family structure on the gain or loss status of household headship among 10,527 older adults.

METHOD

Bivariate analysis was done using the chi-square test for association. Equivalently, the multivariate analysis involved estimating multivariable logistic regression models. Multicollinearity did not affect the estimates from the regression models. For examining headship transition, we performed two complete sets of analysis, by taking gain in headship and loss in headship as the outcome variable respectively.

RESULTS

Across two rounds, a major shift in family structure was noticed as 6.8% of households moved from extended to a single generation. Results indicate that family structure was significantly associated with gaining and losing headship among older adults. Headship loss was more common among nuclear [OR: 2.16; CI: 1.28, 3.65] and extended [OR: 2.76; CI: 1.64, 4.66] family structures. Moreover, gaining headship was found to be significantly associated with married, educated, and working older adults.

CONCLUSION

Since living in single generation household may preferably be encouraged among older adults than their living in a complex household without headship and value they deserve, the public intervention may support the independent living within the older population through housing policies that create additional choices presented to older adults making residential decisions.

Does lack of parental involvement affect school dropout among Indian adolescents? evidence from a panel study

Despite the gross enrolment ratio of Indian children, being almost 91% in grades 6-8, the equivalently soaring rates of school dropout after 8th grade remains a huge concern for the policymakers. Researches from the developed countries and some developing countries have shown the benefits of parental involvement in their children's education in terms of reduced dropout rates. However, there is a stark absence of similar evidence in the Indian context. Our study examines whether the lack of parental involvement during primary schooling of Indian children eventually results in school dropout when the children become adolescents. We used IHDS panel data of children (8-11 years) in round-I who become adolescents (15-18 years) in round-II. Bivariate, multivariable and stratified analyses were performed using logistic regression models. The findings from the multivariable models show that children, whose parents did not -participate in PTA meetings, -discuss academic progress with schoolteacher and -supervise their children's homework in round-I respectively had 1.15 (95% CI: 1.01-1.30), 1.14 (95% CI: 1.01-1.29) and 1.17 (95% CI: 1.01-1.34) times higher risk of school dropout in round-II. Further, a similar relationship was observed when hypothesized relationship by gender, type of school attended and type of community of the children were examined. Among male children, parents' non-participation in PTA meetings was associated with 1.21 (95% CI: 1.02-1.44) times greater odds of school dropout. Children from private schools also had a 2.17 (95% CI: 1.42-3.32) times greater risk of dropout if their parents did not supervise their children in homework These findings highlight the crucial role of parental involvement in their children's primary education, in terms of reduced school dropout. The findings call for programmatic interventions that create awareness and encourage parental participation in their children's schooling.

PREVALENCE AND RISK FACTORS OF UNDER NUTRITION AMONG UNDER FIVE CHILDREN IN A RURAL COMMUNITY

Children of today are citizens of tomorrow; the young child under 5 years is most vulnerable to the vicious cycles of malnutrition, infection and disability all of which influence the present condition of a child and the future human resource development of the nation as a whole. Hence the assessment of the ground reality as reflected by the statistics on nutritional status of children becomes very significant in this context.

The study was done to determine the prevalence of under-5 under nutrition and to identify the major child factors contributing to the development of under nutrition among the under 5 children.

This was a cross sectional study conducted in the rural community of Nitte, a field practice area of Department of Community medicine, K S Hegde Medical Academy among all the children of the anganwadis under ICDS scheme. A total of 133 under 5 children were assessed for their nutritional status and the factors that affect nutritional status.

The overall prevalence of under-5 under nutrition was found to be high at 63.16%. More girls were undernourished compared to boys, lower grades of undernourishment were more common and the prevalence of under nutrition increased with increasing age. There was a higher prevalence of underweight in children born with low birth weight, born premature, those children not exclusively breast fed and on improper complementary feeds. Immunization and Vitamin A supplementation of the under-5 children status was highly satisfactory.

Giant Occipital Intradiploic Epidermoid Cyst

Intraparenchymal or intradiploic epidermoid cysts are very rare. Most of these cysts, when present, tend to involve the frontal and temporal lobes, and occasionally, the pineal gland or the brain stem. Here, we report a 45-year-old female, who presented with localized occipital headache and a tender occipital swelling, gradually increasing in size. She was hemodynamically and neurologically stable and did not have any focal neurological deficits. Whole skull and brain imaging revealed a well-demarcated expansile lytic lesion in the right occipital bone, which was hypointense on T1-weighted and hyperintense on both T2-weighted imaging and diffusion-weighted imaging without any contrast enhancement. The patient underwent a right occipital craniotomy and total excision of the intradiploic space occupying lesion. Histopathological examination confirmed the lytic bone lesion over occipital bone as intradiploic epidermoid cyst.

Correlation of Audio-Visual Reaction Time with Body Mass Index & Skin Fold Thickness Between Runners and Healthy Controls

Audio-visual reaction time is essential for activities like driving and very important in sports persons. Reaction time of 31 National level runners was compared with 31 controls. Runners were subdivided into two groups, group A (>2 yrs & < 3 yrs of training) and group B (>3 yrs & < 10 yrs of training). Correlation between Body Mass Index & Skin Fold Thickness with reaction time was also analyzed. Reaction time was significantly less in runners (p<0.05) when compared to controls and also in group B. Correlation analysis has shown negative correlation of BMI with reaction time with statistically significant value for green color in runners. Skin Fold Thickness also showed a negative correlation with reaction time but was not statistically significant. Improvement in reaction time by regular practice will ultimately improve sports person’s performance.

Development of sandwich dot-ELISA for specific detection of Ochratoxin A and its application on to contaminated cereal grains originating from India

In the present study, generation and characterization of a highly specific monoclonal antibody (mAb) against Ochratoxin A (OTA) was undertaken. The generated mAb was further used to develop a simple, fast, and sensitive sandwich dot-ELISA (s-dot ELISA) method for detection of OTA from contaminated food grain samples. The limit of detection (LOD) of the developed enzyme-linked immunosorbent assay (ELISA) method was determined as 5.0 ng/mL of OTA. Developed method was more specific toward OTA and no cross reactivity was observed with the other tested mycotoxins such as deoxynivalenol, fumonisin B1, or aflatoxin B1. To assess the utility and reliability of the developed method, several field samples of maize, wheat and rice (n = 195) collected from different geographical regions of southern Karnataka region of India were evaluated for the OTA occurrence. Seventy two out of 195 samples (19 maize, 38 wheat, and 15 rice) were found to be contaminated by OTA by s-dot ELISA. The assay results were further co-evaluated with conventional analytical high-performance liquid chromatography (HPLC) method. Results of the s-dot ELISA are in concordance with HPLC except for three samples that were negative for OTA presence by s-dot ELISA but found positive by HPLC. Although positive by HPLC, the amount of OTA in the three samples was found to be lesser than the accepted levels (>5 μg/kg) of OTA presence in cereals. Therefore, in conclusion, the developed s-dot ELISA is a better alternative for routine cereal based food and feed analysis in diagnostic labs to check the presence of OTA over existing conventional culture based, tedious analytical methods.

Evaluation of a multiplex PCR assay for concurrent detection of four major mycotoxigenic fungi from foods

AIM

To develop and evaluate a multiplex polymerase chain reaction assay (mPCR) for the concurrent detection of four major mycotoxin metabolic pathway genes, viz. nor1 (aflatoxin), Tri6 (trichothecene), FUM13 (fumonisin) and otanps (ochratoxin A).

METHODS AND RESULTS

A mPCR assay with competitive internal amplification control, employing specific primers for each of the aforementioned four genes, was optimized and validated using 10 reference strains and 60 pure culture isolates. The standardized mPCR assay detected all four mycotoxin metabolic genes in artificially contaminated maize samples with a sensitivity of 2 × 10(3) CFU g(-1) for nor1-positive Aspergillus strains, Tri6 and FUM13-positive Fusarium strains and 2 × 10(4) CFU g(-1) for otanps-positive Penicillium strains. When the developed mPCR assay was applied to 40 natural foods, 35% (14 of 40) of the samples were contaminated with either one or more mycotoxins. The mPCR results were further evaluated with high-performance liquid chromatography (HPLC), and in general, both the methods provided unequivocal results.

CONCLUSION

The current mPCR assay is a rapid and reliable tool for simultaneous specific and sensitive detection of aflatoxigenic Aspergillus strains, trichothecene- and fumonisin-producing Fusarium strains, and ochratoxigenic Penicillium species from naturally contaminated foods.

SIGNIFICANCE AND IMPACT OF THE STUDY

This mPCR assay could be a supplementary strategy to current conventional mycotoxin analytical techniques such as thin-layer chromatography (TLC), high performance thin layer chromatography, HPLC, etc., and a reliable tool for high-throughput monitoring of major mycotoxin-producing fungi during the processing steps of food and feed commodities.

Enhanced ferritin/iron ratio in psoriasis

BACKGROUND & OBJECTIVES

Psoriasis is a chronic, recurrent skin disorder, with a poorly understood pathogenesis. Studies at molecular/genetic levels continue to explore various biomolecules as potential markers of the disease. In the present study, we sought to evaluate the possible roles of ferritin and iron in psoriasis.

METHODS

Patients with psoriasis (n=81) and healthy controls (n=45) were included. Patients were graded as mild, moderate and severe based on the Psoriasis Area Severity Index (PASI). Serum ferritin and iron levels were measured by electro chemiluminescence and inductively coupled plasma - atomic emission spectrometry (ICP-AES), respectively.

RESULTS

The ferritin levels in psoriasis patients were not significantly different from that of controls. There was no significant difference in ferritin concentrations between psoriasis groups of severity. Fe was found to be significantly reduced (P<0.05) in the psoriasis patients when compared to controls. The ferritin to Fe ratio was significantly higher (P<0.05) in the psoriasis groups when compared to the control group.

INTERPRETATION & CONCLUSIONS

Our results indicate a possible role of ferritin and iron in psoriasis. Further studies with large samples need to be done to confirm findings.

Quality of life in HIV/AIDS

Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV.

Quality of life in HIV/AIDS

Given the longevity achievable with current prophylactic and therapeutic strategies for persons with HIV infection, quality of life (QOL) has emerged as a significant medical outcome measure, and its enhancement has an important goal. This review highlights the relevance and complexity of physical, psychological, and social factors as determinants of health-related quality of life in HIV-infected persons. Existing data suggest that physical manifestations, antiretroviral therapy, psychological well-being, social support systems, coping strategies, spiritual well-being, and psychiatric comorbidities are important predictors of QOL in this population. Consequently, the impact of HIV infection on the dimensions of QOL, including physical and emotional well-being, social support systems, and life roles, has emerged as a key issue for persons infected with HIV.

Diet in dermatology: present perspectives

Many nutrients are essential for life, and an adequate amount of nutrients in the diet is necessary for providing energy, building and maintaining body organs, and for various metabolic processes. The role of food in the induction of various skin disorders and skin diseases leading to nutritional deficiencies is well known. The photo-protective potential of antioxidants, the effects of micronutrient supplementation on the skin immune system, and the modulating effects of fatty acids on skin disorders are well documented. Skin diseases due to nutritional deficiencies, the dietary role in skin immunity and various skin diseases, and the role of antioxidants and other supplements in skin health have been reviewed.

Relevance of psychiatry in dermatology: Present concepts

Skin is an organ that has a primary function in tactile receptivity and reacts directly upon emotional stimuli. Dermatological practice involves a psychosomatic dimension. A relationship between psychological factors and skin diseases has long been hypothesized. Psychodermatology addresses the interaction between mind and skin. It is divided into three categories according to the relationship between skin diseases and mental disorders. This article reviews different dermatological conditions under each of the three categories namely psychosomatic disorders, dermatological conditions due to primary and secondary psychiatric disorders. Dermatological conditions resulting from psychiatric conditions like stress/depression and those caused by psychiatric disorders are discussed. This review intends to present the relationship between the 'skin' and the 'mind' specifically from the dermatology point of view. The effects on the quality of life as a result of psychodermatological conditions are highlighted. A multidisciplinary approach for treatment from both dermatologic and psychiatric viewpoints are suggested.

A comprehensive review of biomarkers in psoriasis

Psoriasis is a common, chronic skin disorder, the pathogenesis of which is incompletely understood. Results from various clinical and experimental studies indicate that psoriasis is a complex, multifactorial disease with a genetic predisposition. Factors such as climate, physical trauma, drug, stress and infections (Streptococcus, human immunodeficiency virus) are known to trigger psoriasis. The success of treatment of psoriasis with T-cell depletion and antitumour necrosis factor (TNF)-alpha treatment is explained by the involvement of T cells and TNF- alpha in the pathogenesis of psoriasis. The biochemical basis for the pathogenesis of psoriasis can be attributed to both overexpression and underexpression of certain proteins in psoriatic lesions. The anomalies in protein expression can be classified as abnormal keratinocyte differentiation, keratinocyte hyperproliferation and inflammation. Oxidative stress (OS) and increased free-radical generation have been linked to skin inflammation in psoriasis. The review presents evidence for various markers of psoriasis that can be targeted for effective treatment, including biomarkers of inflammation, keratinocyte hyperproliferation and abnormal differentiation, and stress.

BH3-only protein BIK induces caspase-independent cell death with autophagic features in Bcl-2 null cells

The BH3-only protein BIK normally induces apoptotic cell death. Here, we have investigated the role of BCL-2 in BIK-induced cell death using Bcl-2+/+ and Bcl-2-/- mouse embryo fibroblasts. Ectopic expression of BIK in Bcl-2-/- cells resulted in enhanced cell death compared to Bcl-2+/+ cells. In these cells, while caspase-8 was activated, there was no significant activation of caspase-9 and 3. There was no detectable mitochondrial to cytosolic release of cytochrome-c. However, there was significant redistribution of AIF from mitochondria to the nucleus. The extent of BIK-induced cell death was augmented by treatment with the pancaspase inhibitor, zVAD-fmk. The Bcl-2 null cells expressing BIK exhibited autophagic features such as cytosolic vacuoles, punctate distribution of LC3 and enhanced expression of Beclin-1. The survival of BIK-expressing Bcl-2-/- cells was enhanced in the presence of PI3 kinase inhibitors 3-methyladenine and Wortmannin and also by depletion of Atg5 and Beclin-1. Death of BIK-expressing Bcl-2-/- cells treated with zVAD-fmk was increased under caspase-8 depletion. Our results suggest enhanced expression of BIK in the Bcl-2 deficient cells leads to cell death with autophagic features and the extent of such cell death could be increased by inhibition of caspases.

Induction of apoptosis by curcumin and its implications for cancer therapy

Curcumin (diferuloyl methane), the yellow pigment in turmeric (Curcuma longa), is a potent chemopreventive agent that inhibits proliferation of cancer cells by arresting them at various phases of the cell cycle depending upon the cell type. Curcumin-induced apoptosis mainly involves the mitochondria-mediated pathway in various cancer cells of different tissues of origin. In some cell types like thymocytes, curcumin induces apoptosis-like changes whereas in many other normal and primary cells curcumin is either inactive or inhibits proliferation, but does not appear to induce apoptosis. These together with reports that curcumin protects cells against apoptosis induced by other agents, underscore the need for further understanding of the multiple mechanisms of cell death unleashed by curcumin. Tumor cells often evade apoptosis by expressing several antiapoptotic proteins, down-regulation and mutation of proapoptotic genes and alterations in signaling pathways that give them survival advantage and thereby allow them to resist therapy-induced apoptosis. Many researchers including ourselves, have demonstrated the involvement of several pro and antiapoptotic molecules in curcumin-induced apoptosis, and ways to sensitize chemoresistant cancer cells to curcumin treatment. This review describes the mechanisms of curcumin-induced apoptosis currently known, and suggests several potential strategies that include down-regulation of antiapoptotic proteins by antisense oligonucleotides, use of proapoptotic peptides and combination therapy, and other novel approaches against chemoresistant tumors. Several factors including pharmacological safety, scope for improvement of structure and function of curcumin and its ability to attack multiple targets are in favor of curcumin being developed as a drug for prevention and therapy of various cancers.