Simultaneous screening for COVID-19 and tuberculosis, India

Objective

To evaluate the implementation of new operational workflows for simultaneous screening of coronavirus disease 2019 (COVID-19) and tuberculosis at four high-volume COVID-19 testing centres located in tertiary hospitals in Mumbai, India.

Methods

Each centre already offering antigen-detecting rapid diagnostic tests were equipped with a rapid molecular testing platform for COVID-19 and tuberculosis, sufficient laboratory staff, and reagents and consumables for screening. Using a verbal tuberculosis questionnaire, a patient follow-up agent screened individuals visiting the COVID-19 testing centres. Presumptive tuberculosis patients were asked to provide sputum samples for rapid molecular testing. Subsequently, we reversed our operational workflow to also screen patients visiting tuberculosis outpatient departments for COVID-19, using rapid diagnostic tests.

Results

From March to December 2021, we screened 14 588 presumptive COVID-19 patients for tuberculosis, of whom 475 (3.3%) were identified as having presumptive tuberculosis. Of these, 288 (60.6%) were tested and 32 individuals (11.1%) were identified as tuberculosis positive (219 cases per 100 000 individuals screened). Of the tuberculosis-positive individuals, three had rifampicin-resistant tuberculosis. Among the remaining 187 presumptive tuberculosis cases not tested, 174 reported no symptoms at follow-up and 13 individuals either refused testing or could not be traced. Of the 671 presumptive tuberculosis cases screened for COVID-19, 17 (2.5%) were positive by antigen rapid diagnostic tests, and five (0.7%) who tested negative, later tested positive on the molecular testing platform (2483 COVID-19 cases per 100 000 individuals screened).

Conclusion

Simultaneous screening for COVID-19 and tuberculosis in India is operationally feasible and can improve real-time on-site detection of COVID-19 and tuberculosis.

Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra

Introduction

Adherence to tuberculosis (TB) medication is one of the critical challenges to tuberculosis elimination in India. Digital adherence technologies (DAT) have the potential to facilitate medication adherence and monitor it remotely. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is one such DAT piloted in Nasik, Maharashtra, from April 2020 to December 2021. The study aims to assess the adherence and cost-effectiveness of TMEAD compared to the standard of care among patients with drug-sensitive tuberculosis (DSTB) residing in the urban areas of Nasik, Maharashtra, India.

Methods

A quasi-experimental study was conducted among new cases of TB as per the National TB Elimination Programme (NTEP) residing in the urban geography of Nasik. The intervention and control arms were purposively selected from non-contaminating TB units (TUs). A total of 400 DSTB patients (200 in the intervention group and 200 in the control group) were enrolled. After enrolment, patients in the intervention arm were provided with the TMEAD device and followed for 24 weeks to assess treatment outcomes. Adherence was measured as those patients who have completed 80% of prescribed doses, as reported during patient follow-up, and further validated by analyzing the trace of rifampicin in urine among 20% of patients from both arms. A budget impact analysis was done to assess the impact of the TMEAD program on the overall state health budget.

Results

Out of 400 enrolled DSTB patients, 261 patients completed treatment, 108 patients were on treatment, 15 patients died, and 16 patients were defaulters over the study period. The study reported overall treatment adherence of 94% among those who completed treatment. Patient reports indicated high levels of treatment adherence in the intervention group (99%) as compared to the control group (90%). Adherence assessed through analyzing trace of rifampicin in the urine sample for the intervention arm was 84% compared to the control arm (80%). Per beneficiary (discounted) cost for TMEAD was Indian rupees (INR) 6,573 (USD 83). The incremental cost-effectiveness ratio of the intervention is INR 11,599 (USD 146), which shows that the intervention is highly cost-effective.

Conclusion

This study revealed that patient-reported treatment adherence was high in TMEAD when compared to standard therapy of care for DSTB patients and the intervention is cost-effective. TMEAD could complement the national strategy to end TB by improving adherence to the treatment regimen in India.

Glycemic Status among Pregnant Women during 24th to 28th Gestational Age

Gestational diabetes mellitus (GDM) is a heterogeneous group of metabolic disorder, which result in varying degrees of maternal hyperglycemia and pregnancy associated risk. Glucose intolerance usually returns to normal range within 6 weeks after delivery. This study was undertaken to determine the glycemic status who attended for antenatal care. This study enrolled pregnant women, with their gestational age between 24th - 28th weeks. This analytical cross sectional study was carried out in the department of Biochemistry, BIRDEM General Hospital, Dhaka, Bangladesh from July 2014 to June 2015. Total 135 subjects were selected to evaluate the glycemic status among Bangladeshi pregnant women attending BIRDEM General Hospital. Among them 41 were GDM subjects and 94 were non GDM subjects. The mean fasting plasma glucose values (mmol/L) and 2 hours after 75gm glucose values of GDM were 6.06±1.26 and 9.78±2.74 respectively compared to non GDM patients were 4.82±0.38 and 7.26±0.41 respectively and the mean of HbA₁C (%) of GDM and non GDM were 5.87±0.73 and 5.43±0.31 respectively.

Multicentric Hospital-Based Surveillance of Pertussis Amongst Infants Admitted in Tertiary Care Facilities in India

OBJECTIVE

To estimate the disease and economic burden of pertussis amongst hospitalised infants in India.

DESIGN

Multicentric hospital-based surveillance study.

PARTICIPANTS

Hospitalised infants with clinical suspicion of pertussis based on predefined criteria.

OUTCOME MEASURES

Proportion of infants with laboratory-confirmed pertussis, economic burden of pertussis amongst hospitalised infants.

RESULTS

693 clinically suspected infants were recruited of which 32 (4.62%) infants had laboratory-confirmed pertussis. Progressive cough with post-tussive emesis (50%) and pneumonia (34%) were the common clinical presentations; apnea in young infants was significantly associated with pertussis. Infants with pertussis were more likely to be younger (median age 102.5 days vs.157 days) and born preterm (42.9% vs 24.5%). Almost 30% infants with pertussis had not received vaccine for pertussis with 50% of these infants aged less than 2 months. Pertussis was associated with higher costs of hospitalisation, pharmacy and loss of working days by caregivers as compared to non-pertussis cases.

CONCLUSIONS

Younger infants, those born preterm and those inadequately immunised against pertussis are at higher risk of pertussis infection. Timely childhood immunisation and introduction of maternal immunisation for pertussis can help in reducing the disease burden.

Provision of palliative care in National Cancer Grid treatment centres in India: a cross-sectional gap analysis survey

OBJECTIVES

This study aimed to identify gaps in palliative care (PC) provision across the National Cancer Grid (NCG) centres in India.

METHODS

We performed a cross-sectional validated web-based survey on 102 NCG cancer centres (Nov '17 to April '18). The survey questionnaire had seven sections collecting data relating to the capacity to provide cancer care and PC, drug availability for pain and symptom control, education, advocacy, and quality assurance activities for PC.

RESULTS

Eighty-nine NCG centres responded for this study-72.5% of centres had doctors with generalist PC training, whereas 34.1% of centres had full-time PC physicians; 53.8% had nurses with 6 weeks of PC training; 68.1% of the centres have an outpatient PC and 66.3% have the facility to provide inpatient PC; 38.5% of centres offer home-based PC services; 44% of the centres make a hospice referral and 68.1% of the centres offer concurrent cancer therapy alongside PC. Among the centres, 84.3% have a licence to procure, store and dispense opioids, but only 77.5% have an uninterrupted supply of oral morphine for patients; 61.5% centres have no dedicated funds for PC, 23.1% centres have no support from hospital administration, staff shortage-69.2% have no social workers, 60.4% have no counsellors and 76.9% have no volunteers. Although end-of-life care is recognised, there is a lack of institutional policy. Very few centres take part in quality control measures.

CONCLUSIONS

The majority of the NCG centres have the facilities to provide PC but suffer from poor implementation of existing policies, funding and human resources.

To Tell or Not to Tell: Exploring the Preferences and Attitudes of Patients and Family Caregivers on Disclosure of a Cancer-Related Diagnosis and Prognosis

PURPOSE

To understand the preferences and attitudes of patients and family caregivers on disclosure of cancer diagnosis and prognosis in an Indian setting.

METHODS

Overall, 250 adult patients with cancer and 250 family caregivers attending the outpatients of a tertiary cancer hospital for the first time were recruited purposively. The mean ages of patients and caregivers were 49.9 years (range, 23-80 years) and 37.9 years (range, 19-67 years), respectively. Separately, they completed prevalidated, close-ended preference questions and were interviewed for open-ended attitude questions.

RESULTS

A total of 250 adult patients (response rate, 47.17% overall, 73.2% in men, and 26.8% in women) and 250 family caregivers (response rate, 40.65% overall, 84.0% in men, and 16.0% in women) participated. Significant differences were observed in the preference to full disclosure of the name of illness between patients (81.2%) and caregivers (34.0%) and with the expected length of survival between patients (72.8%) and caregivers (8.8%; P < .001). The patients felt that knowing a diagnosis and prognosis may help them be prepared, plan additional treatment, anticipate complications, and plan for future and family. The caregivers felt that patients knowing a diagnosis and prognosis may negatively affect the future course of illness and cause patients to experience stress, depression, loss of hope, and confidence.

CONCLUSION

Patients with cancer preferred full disclosure of their diagnoses and prognoses, whereas the family caregivers preferred nondisclosure of the same to their patients. This novel information obtained through a large study with varied participants from different parts of the country will help formulate communication strategies for cancer care.

A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment

Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.

Effects of participatory learning and action with women's groups, counselling through home visits and crèches on undernutrition among children under three years in eastern India: a quasi-experimental study

Background

India faces a high burden of child undernutrition. We evaluated the effects of two community strategies to reduce undernutrition among children under 3 years in rural Jharkhand and Odisha, eastern India: (1) monthly Participatory Learning and Action (PLA) meetings with women’s groups followed by home visits; (2) crèches for children aged 6 months to 3 years combined with monthly PLA meetings and home visits.

Methods

We tested these strategies in a non-randomised, controlled study with baseline and endline cross-sectional surveys. We purposively selected five blocks of Jharkhand and Odisha, and divided each block into three areas. Area 1 served as control. In Area 2, trained local female workers facilitated PLA meetings and offered counselling to mothers of children under three at home. In Area 3, workers facilitated PLA meetings, did home visits, and crèches with food and growth monitoring were opened for children aged 6 months to 3 years. We did a census across all study areas and randomly sampled 4668 children under three and their mothers for interview and anthropometry at baseline and endline. The evaluation’s primary outcome was wasting among children under three in areas 2 and 3 compared with area 1, adjusted for baseline differences between areas. Other outcomes included underweight, stunting, preventive and care-seeking practices for children.

Results

We interviewed 83% (3868/4668) of mothers of children under three sampled at baseline, and 76% (3563/4668) at endline. In area 2 (PLA and home visits), wasting among children under three was reduced by 34% (adjusted Odds Ratio [aOR]: 0.66, 95%: 0.51–0.88) and underweight by 25% (aOR: 0.75, 95% CI: 0.59–0.95), with no change in stunting (aOR: 1.23, 95% CI: 0.96–1.57). In area 3, (PLA, home visits, crèches), wasting was reduced by 27% (aOR: 0.73, 95% CI: 0.55–0.97), underweight by 40% (aOR: 0.60, 95% CI: 0.47–0.75), and stunting by 27% (aOR: 0.73, 95% CI: 0.57–0.93).

Conclusions

Crèches, PLA meetings and home visits reduced undernutrition among children under three in rural eastern India. These interventions could be scaled up through government plans to strengthen home visits and community mobilisation with Accredited Social Health Activists, and through efforts to promote crèches.

Trial registration

The evaluation was registered retrospectively with Current Controlled Trials as ISCRTN89911047 on 30/01/2019.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7274-3) contains supplementary material, which is available to authorized users.

Study of the Prevalence of Dyspepsia in the Adult Population in a Rural Community of Bangladesh

Dyspepsia is a symptom complex that includes epigastric pain, post-prandial fullness, bloating, early satiety, belching, nausea, vomiting, heartburn, acid regurgitations and anorexia. The most widely applied definition of dyspepsia is the Rome working team formulation namely chronic or recurrent pain or discomfort centered in the upper abdomen. Till date the prevalence of dyspepsia in Bangladesh has not been studied much. The last study was done in 1987 in a rural community and the prevalence of dyspepsia was found to be 41.4%. However, associated risk factors were not assessed and definition of dyspepsia was much narrower as well as the dysmotility type dyspepsia was not included in that study. Hence it is now high time to carry out another study to see the prevalence of dyspepsia in Bangladesh and the risk factors associated with it. To determine the prevalence of dyspepsia and the demographic risk factors associated with dyspepsia in the adult population in the rural community of Bangladesh. This cross sectional population based study carried out in Ghior Union of Manikgonj district of Bangladesh from January 2007 to April 2008. All persons 18 years or above living in Ghior Union were considered as the study populations with using a pre-designed questionnaire. This study showed that the prevalence of dyspepsia to be 61.9%. Reflux- like dyspepsia was the commonest sub-type of dyspepsia without reflux symptoms comprising 43.9% of the total population and 70.9% of the dyspeptics. Dysmotility like dyspepsia comprised more than half of the dyspeptics. Nausea (40.7%) was the most predominant dysmotility like dyspeptic symptoms followed by early satiety (38.4%); 13.9% of the population had history of recurrent upper abdominal pain and 11.9% of the population had gastro-esophageal reflux disease (GERD). There was considerable overlapping (16.7%) of IBS with dyspepsia. Female sex, younger age (<40 years), low family income (<5000 Taka per month), lower educational level (up to primary level), smoking and use of NSAIDs were significantly associated with dyspepsia. The prevalence of dyspepsia in adult population of Bangladesh is 61.9% which is very high compared to other countries and also much higher than the prevalence found in our country thirty years back. A great change in the socio-economic status and lifestyle of the people along with environmental pollution and food adulteration may be responsible for this increase in prevalence. This study was conducted in only one union of this country, so it was not representative of the whole population of the country. Therefore further study with large population size including rural and urban peoples from different parts of Bangladesh is needed to estimate the accurate prevalence of dyspepsia in our country.

Genotypes of hepatitis C virus infection in Bangladeshi population

Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide also in Bangladesh. Prevalence of Hepatitis C virus infection in rural adult population of Bangladesh is reported to be 0.6% but the exact pattern of existing genotype has not been well studied. Genotyping of HCV is important for the planning of treatment duration and predicting the response to treatment in HCV infection. This study was done to identify the existing HCV genotypes in the diagnosed cases of chronic hepatitis C infection in Bangladesh. This study was a prospective as well as retrospective cross-sectional observational study done in the department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka Bangladesh. Cases were also taken from department of Hepatology of Bangabandhu Sheikh Mujib Medical University and Square General Hospital, Dhaka. The study was from January 2010 to March 2011. In total, 417 patients having chronic HCV confirmed by positive anti-HCV and HCV-RNA tests attending to above mentioned institutions were included in this study. Out of the 417 study subjects, 303 were males (72.66%) and 114 (27.34%) were females between 05 to 78 years of age. Most cases were in the age group 30-50 years (57.06%). The study showed that 209 (50.19%) were infected with Genotype 3. Next common identified genotype of HCV was a combination of type 3 & 4, which accounted for 120 (28.77%) and genotype -1 represented 59 (14.14%) of the cases. Other less common identified genotypes were 2, 4, 5 and mixed genotypes -1 & 3, 5 & 6 and 2 & 3; the figure being 12(2.87%), 8(1.91%), 1(0.23%), 5(1.19%), 2(0.47%) and 1(0.23%) respectively. Several subtypes were also found. Genotype 3 was the commonest HCV genotype among the Bangladeshi population. Different HCV genotypes will give a good idea regarding the plan of treatment and possible response rate as well as prognosis of HCV infection in Bangladesh. This study had some limitation like relatively smaller sample size and shorter period for the study. Further studies over a larger population are needed to draw any conclusive opinion.

Effect of external electric field on the charge density waves in one-dimensional Hubbard superlattices

We have studied the ground state of one-dimensional Hubbard superlattice structures with different unit-cell sizes in the presence of an electric field. A self-consistent Hartree-Fock approximation calculation is done in the weak- to intermediate-interaction regime. Studying the charge gap at the Fermi level and the charge density structure factor, we get an idea of how the charge modulation on the superlattice is governed by the competition between the electronic correlation and the external electric field.

Clinical profile and predisposing factors of cerebral palsy

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child Development & Neurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Surface enhanced Raman scattering of 2,2' biquinoline adsorbed on colloidal silver particles

Surface enhanced Raman scattering (SERS) in silver sol and normal Raman spectra in the bulk and in solution of 2,2' biquinoline (BQ) molecule have been investigated. The observed Raman bands along with their corresponding FTIR bands have been assigned based on the established assignments of the vibrational bands of the parent napthalene and quinoline molecules. Existence of both the cis and trans form of the BQ molecule in solution and in the bulk are inferred from the normal Raman and FTIR spectra, whereas SERS study reveal that in the surface adsorbed state the molecule exists in the cis form. Definite evidence of the charge transfer interaction to the overall contribution in the SER enhancement have been reported. The excitation profile also supports the CT interaction. Estimated enhancement factor of the principal SERS bands indicate that the molecule is adsorbed on the silver surface through both the nitrogen atoms with the molecular plane almost perpendicular to the surface. This preferred orientation of the molecule is in conformity with its existence in the cis form in the surface adsorbed state.

pH-Dependent Surface-Enhanced Raman Scattering of 8-Hydroxy Quinoline Adsorbed on Silver Hydrosol

Surface-enhanced Raman scattering (SERS) of 8-hydroxy quinoline (HQ) adsorbed on silver hydrosols are compared with the FTIR and normal Raman spectrum in the bulk and in solution. Definite evidence of the charge transfer interaction to the overall contribution in the SER enhancement has been reported. The excitation profile study also supports the evidence of a charge transfer interaction. The effect of pH variation on the SER band intensity is explained in terms of chemisorption of the molecule on bare and chlorinated silver surfaces. The apparent enhancement factor calculations of the principal Raman bands indicate that in the surface-adsorbed state, an HQ molecule is oriented neither flat nor vertical to the silver surface but is tilted. Copyright 2000 Academic Press.

The progressive impact of psychological climate: a prognosis of health care providers' subjective powerlessness in reform legislation

This study explores the impact of psychological climate variables on the perceived powerlessness of health care providers with regard to their contribution in reform initiatives. It is proposed that perceptions of powerlessness in intra-organizational settings can and do extend to subjective powerlessness in the socio-political arena. A conceptual framework for the theoretical arguments is provided. The hypotheses were tested on survey data from health care providers employed in a major US primary metropolitan statistical area. Several highly significant relationships were observed. Since the actions of health care administrators are primarily responsible for shaping their institutions' psychological climate, recommendations regarding how administrators can foster psychological climates that induce more provider involvement in reform are offered.

A hepatocyte-targeted conjugate capable of delivering biologically active colchicine in vitro

A derivative of colchicine was synthesized, in a manner that preserved its important structural features, and conjugated to an asialoglycoprotein. The conjugate was characterized by ultraviolet-visible spectrophotometry and protein analysis. An average coupling ratio of 2 mol of colchicine per mole of asialoglycoprotein was achieved. The conjugate was stable to incubation in serum but was split into its separate components under chemically reducing conditions. Incubation with cells in culture revealed that the conjugate had antiproliferative activity similar to that of colchicine, but only in asialoglycoprotein receptor-containing cells. There was no effect at all on asialoglycoprotein receptor (-) cells. Furthermore, the antiproliferative effect of the conjugate on receptor (+) cells was blocked by addition of a large molar excess of free asialoglycoprotein. Immunofluorescence microscopy revealed disruption of microtubules in cell cultures that were pretreated with the conjugate. These results indicate that a colchicine conjugate that is taken up specifically into cells by asialoglycoprotein receptors and released intracellularly in a biologically active form can be prepared.

Factors affecting desired family size in Bangladesh

Factors affecting desired family size in rural Bangladesh are examined using data from contraceptive prevalence surveys conducted between 1983 and 1991. The analysis suggests that mothers having two sons and one daughter are more inclined to perceive their family as complete than those having three sons and no daughter. Logistic regression analysis indicates that important determinants of desire for more children are age of woman, current contraceptive use status, work status, and family planning worker's visit. The policy implications of these findings are discussed.

Recent evidence on trends and differentials in Bangladesh fertility: an update

A comparison of contraceptive and fertility data for 1985-91 with data for 1983 shows that fertility has continued to decline in Bangladesh, in all segments of society. The magnitude of decline varied according to educational level, region and urban-rural locality. The percentage decline in total marital fertility rate was somewhat higher among urban than rural residents; educated women showed greater declines than uneducated, increasing the overall educational differences in total fertility by 1991. Factors contributing to the recent decline in fertility are discussed.

Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

Recent evidence on trends and differentials in Bangladesh fertility

Recent data from Bangladesh reveal evidence of some fertility decline. Although fertility increased among younger age groups between 1975 and 1983, it was offset by a decrease in fertility in the older age groups, resulting in a slight overall decrease in total fertility in 1983. Fertility was lower among urban residents, educated mothers and contraceptive users than among rural residents, uneducated mothers and contraceptive non-users, respectively, particularly in 1983.

Community health services and health care utilization in rural Bangladesh

The study, which is based on data from two household level health surveys conducted in 1976 and 1987 in the Companiganj area of rural Bangladesh, examines the premise that the utilization of public health care services can be increased by increasing the availability and accessibility of effective medicines to the public and by improving the disease recognition and management by the health practitioners. The results of the study suggest that the availability and accessability of modern effective medicines through the provision of decentralized community-based rural health services, by a well-trained and well-managed field personnel structure, had an incremental impact on the utilization of modern health care from a rural health center and its subcenters. The study further reveals that, in 1976 as well as in 1987, the overwhelming majority of the rural Bangladesh population were using modern Western medical practitioners, although most of these practitioners were informally trained or self-trained without any formal medical degrees or training. It is concluded that the persons responsible for health program planning and health program implementation need to ensure that the access to basic public health care services be made broad enough to cover the majority of the rural population through a system of decentralized curative and preventive services, as well as through a system of adequate training and deployment of health professionals, including training programs to improve the quality of medical services offered by the informal and self-trained practitioners of modern medicines.

Single dose piperazine therapy for Ascaris lumbricoides: an unsuccessful method of promoting growth

One-hundred eighty-five Bangladeshi children age 1 1/2 to 8 yr with no Ascaris lumbricoides infection or with light, moderate, or heavy infection were randomly assigned to treatment of placebo groups, with treatment given in a double-blind fashion. The groups were comparable for nutritional and socioeconomic parameters. Treatment consisted of a single dose of piperazine citrate administered twice within a 2-wk period. The cure rates for the low, moderate, and heavy A. lumbricoides infected subgroups were 53, 31, and 36%, respectively. With more severe infections, worm eradication was more difficult and the rate of reinfection after treatment was more rapid. The rate of reinfection was significantly different for the low A. lumbricoides infected treatment and placebo subgroups for 5 months after treatment, for the moderate treatment and placebo subgroups for 3 months after treatment, and for the heavy A. lumbricoides infected treatment and placebo subgroups there was a difference, although not significant, for 1 month after treatment. Anthropometric measurements were obtained for a period of 11 months. Analysis of covariance revealed no significant difference for change of weight, change of height, weight-for age, weight-for-height, height-for-age, triceps skinfold, midarm circumference, and the abdominal girth to chest circumference ratio between the treatment and placebo groups after drug administration. The results of this study do not support single dose worm therapy as a means to enhance growth.