Functional difficulty among young children in Bangladesh: An analysis of nationally representative data

Functional difficulty in children is a crucial public health problem still undervalued in developing countries. This study explored the socio-demographic factors and anthropometry associated with children's functional difficulty in Bangladesh. Data for 2-4-year-old children, obtained from Multiple Indicator Cluster Survey 2019, were used in this study. The mixed-effects logistic regression model was used to analyse the data. Children whose mothers had functional difficulty were found to be 2.75 times more likely to have functional difficulty than children whose mothers had no functional difficulty (95% CI 1.63-4.63). Male children were more likely to experience functional difficulty than female children (OR = 1.48). Furthermore, stunting was found to be significantly associated with functional difficulty (OR = 1.50). The study also revealed that division and mother's education, specifically, children with mothers having higher secondary + education, had significant association with the outcome variable. The findings provided a vital overview of child disability in a developing country.

Unraveling birth weight determinants: Integrating machine learning, spatial analysis, and district-level mapping

Despite a decrease in the prevalence of low birth weight (LBW) over time, its ongoing significance as a public health concern in Bangladesh remains evident. Low birth weight is believed to be a contributing factor to infant mortality, prolonged health complications, and vulnerability to non-communicable diseases. This study utilizes nationally representative data from the Multiple Indicator Cluster Surveys (MICS) conducted in 2012-2013 and 2019 to explore factors associated with birth weight. Modeling birth weight data considers interactions among factors, clustering in data, and spatial correlation. District-level maps are generated to identify high-risk areas for LBW. The average birth weight has shown a modest increase, rising from 2.93 kg in 2012-2013 to 2.96 kg in 2019. The study employs a regression tree, a popular machine learning algorithm, to discern essential interactions among potential determinants of birth weight. Findings from various models, including fixed effect, mixed effect, and spatial dependence models, highlight the significance of factors such as maternal age, household head's education, antenatal care, and few data-driven interactions influencing birth weight. District-specific maps reveal lower average birth weights in the southwestern region and selected northern districts, persisting across the two survey periods. Accounting for hierarchical structure and spatial autocorrelation improves model performance, particularly when fitting the most recent round of survey data. The study aims to inform policy formulation and targeted interventions at the district level by utilizing a machine learning technique and regression models to identify vulnerable groups of children requiring heightened attention.

From the local disparities to national realities: Mapping and multilevel modeling of catastrophic health expenditure in Bangladesh using HIES 2016

In developing nations, catastrophic health expenditures have become an all-too-common occurrence, threatening to push households into impoverishment and poverty. By analyzing the Household Income and Expenditure Survey 2016, which features a sample of 46,080 households, this study provides a comprehensive district-by-district analysis of the variation in household catastrophic health expenditures and related factors. The study utilizes a multilevel logistic regression model, which considers both fixed and random effects to identify factors associated with catastrophic health expenditure. The findings of the study indicate that districts located in the eastern and southern regions are at a significantly higher risk of experiencing catastrophic health expenditures. A potential explanation for this trend may be attributed to the high prevalence of chronic diseases in these districts, as well as their economic conditions. The presence of chronic diseases (AOR 5.45 with 95% CI: 5.14, 5.77), presence of old age person (AOR 1.50 with 95% CI: 1.39, 1.61), place of residence (AOR 1.40 with 95% CI: 1.14, 1.73) are found to be highly associated factors. Additionally, the study reveals that the thresholds used to define catastrophic health expenditures exhibit substantial variation across different regions, and differ remarkably from the threshold established by the WHO. On average, the thresholds are 23.12% of nonfood expenditure and 12.14% of total expenditure. In light of these findings, this study offers important insights for policymakers and stakeholders working towards achieving universal health coverage and sustainable development goals in Bangladesh.

Sociodemographic risk factors of under-five stunting in Bangladesh: Assessing the role of interactions using a machine learning method

This paper aims to demonstrate the importance of studying interactions among various sociodemographic risk factors of childhood stunting in Bangladesh with the help of an interpretable machine learning method. Data used for the analyses are extracted from the Bangladesh Demographic and Health Survey (BDHS) 2014 and pertain to a sample of 6,170 under-5 children. Social and economic determinants such as wealth, mother's decision making on healthcare, parental education are considered in addition to geographic divisions and common demographic characteristics of children including age, sex and birth order. A classification tree was first constructed to identify important interaction-based rules that characterize children with different profiles of risk for stunting. Then binary logistic regression models were fitted to measure the importance of these interactions along with the individual risk factors. Results revealed that, as individual factors, living in Sylhet division (OR: 1.57; CI: 1.26-1.96), being an urban resident (OR: 1.28; CI: 1.03-1.96) and having working mothers (OR: 1.21; CI: 1.02-1.44) were associated with higher likelihoods of childhood stunting, whereas belonging to the richest households (OR: 0.56; CI: 0.35-0.90), higher BMI of mothers (OR: 0.68 CI: 0.56-0.84) and mothers' involvement in decision making about children's healthcare with father (OR: 0.83, CI: 0.71-0.97) were linked to lower likelihoods of stunting. Importantly however, risk classifications defined by the interplay of multiple sociodemographic factors showed more extreme odds ratios (OR) of stunting than single factor ORs. For example, children aged 14 months or above who belong to poor wealth class, have lowly educated fathers and reside in either Dhaka, Barisal, Chittagong or Sylhet division are the most vulnerable to stunting (OR: 2.52, CI: 1.85-3.44). The findings endorse the need for tailored-intervention programs for children based on their distinct risk profiles and sociodemographic characteristics.

Impact of child's cognitive and social-emotional difficulties on child abuse: Does mother's justification of intimate partner violence also play a role?

BACKGROUND

Violence against children has been a persistent problem in developing nations. The adverse effects of physical violence bear a considerable impact on children's physical and psychological development resulting in both short and long-term issues.

OBJECTIVE

The aim of this study was to explore whether children with cognitive and social-emotional difficulties (CSEDs) were at a higher risk of experiencing physical abuse and whether mothers' views on intimate partner violence (IPV) were also related to physical abuse against children.

PARTICIPANTS AND SETTING

The Bangladesh Multiple Indicator Cluster Survey-2019 was used with a sample of 27,086 children aged 5-14.

METHODS

Generalized linear modelling along with a machine learning method of classification trees was employed to investigate the important sociodemographic characteristics and identify the most vulnerable groups of children based on their likelihood of exposure to household-violence.

RESULTS

Nearly 62.5 % of the children were physically abused by their mothers. Children with CSEDs were 53 % (OR 1.53; 95 % CI: 1.41, 1.67) more likely to experience physical abuse and mothers' justification of IPV was associated with a 16 % higher risk (OR 1.16; 95 % CI: 1.08, 1.26). Moreover, younger children aged 11 or below belonged to the high-risk groups of experiencing abuse.

CONCLUSIONS

The findings suggest that violence against children is widespread in Bangladesh, especially in children having CSEDs. Mothers' acceptance of IPV was also associated with increased abusive practice against children. Sincere focus on these issues is imperative if Bangladesh intends to achieve the sustainable development goal 16.2 of eradicating all forms of violence against children and ensure their safe development.

Selection of organic materials potentially used to enhance bioremediation of acid mine drainage

Acid mine drainage (AMD), produced when sulfide minerals are subjected to oxygen and water, is one of the major issues in mining industries. Without proper management, AMD's release to the environment would cause seriously prolonged environmental and health issues, such as increases soil acidity and reduces water quality due to extremely low pH, high sulphate concentration, and heavy metal solubility. AMD treatments are divided into two categories, i.e., active treatment, conducted by applying a chemical to the AMD to neutralize pH and precipitate heavy metals; and passive treatment, which relies on biological and biochemical processes. The active treatment may provide an immediate effect, but costly and yet sustainable; meanwhile, passive treatment takes time to establish and to generate an effect, but it is more economical, sustainable, and environmentally friendly. The wetland system is an example of passive treatment. Therefore, this review focuses on passive treatments, especially the selection of organic materials used in constructed AMD wetland treatment. Organic materials play a central role in the wetland system, i.e., to chelate metal ions, remove sulphate from the solution, increase pH, and growth media for microbes, especially sulphate reducing bacteria (SRB) and plants are grown in the system. Overall, organic materials determine the effectiveness of the wetland system to neutralize AMD passively and sustainably.

Impact of COVID-19 on hospital admission of acute stroke patients in Bangladesh

BACKGROUND

With the proposed pathophysiologic mechanism of neurologic injury by SARS CoV-2, the frequency of stroke and henceforth the related hospital admissions were expected to rise. This paper investigated this presumption by comparing the frequency of admissions of stroke cases in Bangladesh before and during the pandemic.

METHODS

This is a retrospective analysis of stroke admissions in a 100-bed stroke unit at the National Institute of Neurosciences and Hospital (NINS&H) which is considerably a large stroke unit. All the admitted cases from 1 January to 30 June 2020 were considered. Poisson regression models were used to determine whether statistically significant changes in admission rates can be found before and after 25 March since when there is a surge in COVID-19 infections.

RESULTS

A total of 1394 stroke patients took admission in the stroke unit during the study period. Half of the patients were older than 60 years, whereas only 2.6% were 30 years old or younger. The male to female ratio is 1.06:1. From January to March 2020, the mean rate of admission was 302.3 cases per month, which dropped to 162.3 cases per month from April to June, with an overall reduction of 46.3% in acute stroke admission per month. In those two periods, reductions in average admission per month for ischemic stroke (IST), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and venous stroke (VS) were 45.5%, 37.2%, 71.4% and 39.0%, respectively. Based on weekly data, results of Poisson regressions confirm that the average number of admissions per week dropped significantly during the last three months of the sample period. Further, in the first three months, a total of 22 cases of hyperacute stroke management were done, whereas, in the last three months, there was an 86.4% reduction in the number of hyperacute stroke patients getting reperfusion treatment. Only 38 patients (2.7%) were later found to be RT-PCR SARS Cov-2 positive based on nasal swab testing.

CONCLUSION

This study revealed a more than fifty percent reduction in acute stroke admission during the COVID-19 pandemic. Whether the reduction is related to the fear of getting infected by COVID-19 from hospitalization or the overall restriction on public movement or stay-home measures remains unknown.

Hospital productivity: The role of efficiency drivers

A major feature of health-care systems is substantial variation in hospital productivity. Hospital productivity varies widely across countries. The presence of such variation suggests potential areas for improvement, which can substantially lower health-care costs. This research aims to investigate factors that may explain variations in hospital productivity by constructing a longitudinal data (panel) on English NHS hospital trusts. It also seeks to explore possible interactions among the factors in a data-driven manner. We employ unbiased panel regression tree techniques from the machine-learning literature to explore the complex interactive structure of the data. We next use econometric panel regression to deal with individual hospital effects to identify some of the determinants of hospital productivity. The findings point to the significance of efficiency-enhancing mechanisms for hospital productivity, including measures to reduce the length of stay, increase day case (outpatient) surgery rate, and to minimize errors. Further, such measures are shaped by more fundamental factors such as the availability of human capital and management practices. Our results underscore the importance of within-hospital efficiency-enhancing mechanisms to cost-adjusted hospital productivity. Improving hospital operational processes will enhance productivity. At a deeper level, human capital and management practices are likely to be most critical.

Hospital heterogeneity: what drives the quality of health care

A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

Are children living on dead-end streets more active? Near-home street patterns and school-going children's time spent outdoors in Dhaka, Bangladesh

This study aimed to investigate relationships between near-home street patterns and children's time spent outdoors (TSO). Participants were 60 (n=60) school-age Dhaka children, 7-11years old (16 girls and 44 boys) selected by a two-phase cluster sampling method. Data were collected from September 2010 to June 2011 by visiting each of 60 children's homes. Children's mean TSOs (in minutes) were reported by parents' face-to-face interviews, and near-home street pattern data were collected by systematic direct observations. The researchers also collected data on seven socio-demographic variables and three neighborhood built-environment variables. A backward selection based multiple linear regression was used to examine association between children's TSO and near-home street patterns. Results (adjusted R²=0.66 for weekdays and 0.68 for weekend) suggested that children's TSO were significantly associated with near-home street type: dead-end instead of through streets (28min on weekdays, p<0.01 and 66min on weekend, p<0.01). The width of the street, level of its branching and availability of an open space or playground near the house are also positively associated with TSO. Near-home street features significantly contribute to TSO in school-going children of Dhaka.

Repair of Borderline Operable Atrial Septal Defect with Severe Pulmonary Hypertension–after Medical Management

Large left to right shunt across an atrial septal defect results in volume overload and dilatation of the right atrium and ventricle. As a result of increased flow into the lungs, the pulmonary arteries, capillaries & the veins are dilated & there can be flow related pulmonary artery hypertension. Overtime this can lead to medial hypertrophy of pulmonary arteries & muscularization of arterioles resulting in pulmonary vascular obstructive disease. Once PAH develops, it is challenging to determine operability and predict outcomes after repair in borderline situations. We report a woman with large atrial septal defect and severe pulmonary hypertension 9.84 wood units /m2 of indexed total pulmonary vascular resistance. She underwent successful corrective repair of atrial septal defect after 4 months of medical management. This case supports that careful evaluation of reversibility of borderline pulmonary arterial hypertension associated with atrial septal defect and pre operative medical management with advanced pulmonary vasodilator therapy can modify a life to normal following closure of ASD. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20349 Pulse Vol.6 January-December 2013 p.44-47

Comparison of P2Y12 receptor inhibition by clopidogrel and prasugrel in patients undergoing percutaneous coronary intervention

Dual antiplatelet treatment (DAPT) with aspirin and clopidogrel is vital after percutaneous coronary intervention (PCI). Clopidogrel and prasugrel act on P2Y12 platelet surface receptors. Both these P2Y12 inhibitors are pro-drugs and depend on cytochrome system of the liver for their conversion to active metabolite. There is growing concern regarding suboptimal response in platelet inhibition by clopidogrel. Verify Now system got approval by Federal Drug Administration, USA, for assessing platelet function as its result is almost comparable to gold standard Light Transmission Aggregometry (LTA). There are no data on the prevalence of clopidogrel resistance in Bangladeshi population. Prasugrel, as an antiplatelet drug, is a newer introduction in this country. This study will show light on the efficacy of these drugs on our population especially in patients who undergo PCI where DAPT is mandatory. A total 120 (60 diabetics) patients with Acute Coronary Syndrome (ACS), were alternatively given 600 mg clopidogrel loading dose (LD) followed by 75 mg maintenance dose (MD) daily or 60 mg LD of prasugrel followed by 10 mg MD daily. Five samples of blood were taken at different time intervals over a period of 2 weeks. Measurement of percent inhibition of P2Y12 was done by VerifyNow. Patients who showed less than 20% inhibition (clopidogrel resistant) at any stage were switched to prasugrel. The outcomes of clopidogrel, prasugrel and clopidogrel switched to prasugrel groups were then compared. Nearly half (46.7%) of the patients in the clopidogrel group was found resistant to the drug as opposed to none in the prasugrel group. No difference was found between diabetic and non-diabetic subjects with respect to drug resistance. Intracoronary blood samples showed high degree of platelet inhibition with prasugrel. There was a gradual decline of platelet inhibition over two weeks with prasugrel. Almost fifty percent of the population is clopidogrel resistant in our study. Prasugrel is a much more potent antiplatelet drug and should be preferred in patients undergoing PCI. Prasugrel may also show resistance over time.

[Basidiomycetes: A new source of secondary metabolites.]

The area of natural products research is the most rapidly growing field of organic chemistry, due to the great technical developments in the isolation and identification techniques. Today, near to one million natural products -isolated from the most diverse living things- are known. Microorganisms are among the least-studied of these. Nevertheless, they offer large possibilities for the discovery of new structures and biological activities. Among the microorganisms, the Basidiomycetes present a production capacity and a range of biologically active metabolites, which have scarcely been investigated. The wide spectrum of natural products with biological activity produced by Basidiomycetes includes antimicrobial agents, antifungal, antiviral and cytotoxic activities, enzymes, plant growth regulators and flavors. These metabolites are generally grouped by their chemical origin, and the relationship between chemical structure and the different biological activities reported. The main objective of this review is to bring an updated revision of the numerous and interesting biosynthetic pathways from basidiomycetes.

Differential Gene Expression in the Laccase Gene Family from Basidiomycete I-62 (CECT 20197)

A family of genes encoding laccases has recently been described for the basidiomycete I-62 (CECT 20197). Transcript levels of genes lcc1, lcc2, and lcc3 were analyzed under four different culture conditions to study their expression patterns. Two of the laccase genes were clearly inducible by veratryl alcohol: the lcc1 gene is inducible in early stages of growth, and the lcc2 gene is also inducible but only when the organism reaches the stationary phase. Transcript levels for the third gene, lcc3, were uninduced by veratryl alcohol and repressed by glucose.

Identification of a laccase gene family in the new lignin-degrading basidiomycete CECT 20197

A new lignin-degrading basidiomycete, strain I-62 (CECT 20197), isolated from decayed wood exhibited both a high dephenolization activity and decolorization capacity when tested on effluents from the sugar cane by-product fermentation industry. It has been classified as a member of the Polyporaceae family. The major ligninolytic activity detected in culture supernatants of basidiomycete I-62 was a phenoloxidase (laccase), in conjunction with small amounts of manganese peroxidase. No lignin peroxidase was detected. Laccase activity was produced in either defined or complete media. Addition of veratryl alcohol as the inducer, in defined medium, enhanced laccase production 10-fold. The use of fructose instead of glucose as a carbon source resulted in a 100-fold increase in laccase specific activity. Native isoelectrofocusing gels stained with guaiacol revealed the presence of at least seven laccase isozymes, with the most intense band being detected at pI 3. Southern hybridization analysis indicated the presence of a laccase gene family in strain I-62. Three different genes coding for phenoloxidases, lcc1, lcc2, and lcc3, were cloned and characterized. The high degree of homology between laccases from strain I-62 and laccases from Trametes species suggests a phylogenetic proximity between this new isolated fungus and the genus Trametes.

Regulation of cellular rabbit growth hormone (GH) receptor and GH-binding protein generation in vitro

In rabbits and probably in man, GH-binding protein (GHBP) is generated from proteolysis of GH receptor (GHR). The present study describes the modulation of spontaneous release of GHBP into the culture medium in relation to cellular GH receptor (GHR) in Chinese hamster ovary cells transfected with rabbit GHR complementary DNA. Secretion of GHBP (approximately 50K protein) from these cells was dependent on time, percentage of FCS, temperature, and protein synthesis. GHBP was detected in the medium at 30 min, and a linear increase was observed over the next 4 h. GHBP release was reduced by low incubation temperature, suggesting that GHBP cleavage is an energy-requiring mechanism. N-Ethylmaleimide (500 microM for 30 min at 30 C) markedly increased GHBP secretion, matched by a corresponding decrease in GHR. However, the lack of effect of N-ethyl-maleimide observed at 4 C further confirms the temperature dependence of GHBP release. We have attempted to characterize the GHBP release protease with a number of recognized protease inhibitors. Benzamidine (10 mM) was the only protease inhibitor that reduced GHBP release; however, it also reduced the cellular GHR level. Cycloheximide (20 micrograms/ml) caused a parallel disappearance of cellular GHR and secreted GHBP with a half-life of about 50 min, but increased GHR messenger RNA expression (superinduction). Indeed, 4 h after removal of cycloheximide, GHR and GHBP were increased by 181% and 369%, respectively, compared to the control value. In summary, Chinese hamster ovary cells expressing rabbit GHR provide a useful cellular model system for studies on the mechanism of GHBP generation from GHR and its physiological importance.

Acute pancreatitis in north-eastern peninsular Malaysia: an unusual demographic and aetiological pattern

A survey of 142 cases of acute pancreatitis was undertaken in two major hospitals serving the state of Kelantan in Malaysia. Females outnumbered males by a ratio of more than 3:1. The incidence among females peaked in the third decade of life. Twenty-one percent (23/109) of the females were pregnant. Ultrasonography revealed gallstones in only 9.4% (13/138). However, abnormalities of serum transaminases were found in 35% (35/100), suggesting that occult gallstones or microlithiasis may be the cause in a significant proportion of patients. Alcohol was virtually absent as an aetiological factor. There was a higher frequency of Ascaris infection in this group than a control hospital population (11/35 vs 33/242; p < 0.02) suggesting that ascariasis may be an important cause of acute pancreatitis in Kelantan. Only 8.4% fell into the category of severe pancreatitis. The overall mortality rate was 2.1%.

Helicobacter pylori infection in north-eastern peninsular Malaysia. Evidence for an unusually low prevalence

The prevalence of Helicobacter pylori infection was determined in peptic ulcer patients, in non-ulcer dyspepsia (NUD) patients, and in the general adult population. The H. pylori infection rate ascertained by microbiologic examination of multiple gastric antral biopsy specimens was 50% (17 of 34) in duodenal ulcer (DU), 5% (1 of 22) in gastric ulcer, and 9% (15 of 159) in NUD patients. A seroepidemiologic survey showed a prevalence of only 4.2% among 496 blood donors and 4.8% among 921 subjects who attended health screening clinics. H. pylori infection is relatively uncommon and does not appear to be the predominant factor in the pathogenesis of peptic ulcer disease in the area. The incidence of peptic ulcer perforations in the area in 1991-92 was 1.5 per 100,000 person-years, reflecting a relatively low frequency of peptic ulcers, which might be due to the low prevalence of H. pylori infection in the population.