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Biomedical subjects

A Briend

Publications and source records attributed to A Briend.

At least 55 records · Page 3Linked to original sources
PubMed1993

Gender and age differentials in risk factors for childhood malnutrition in Bangladesh.

A case-control study of risk factors of clinical marasmus was undertaken to determine which factors differed according to gender and age groups. Case patients were children whose mid-upper arm circumference measured less than 110 mm and control subjects were children matched for age and sex with an arm circumference more than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1 to 4 years were studied. The effect of various demographic, socioeconomic, environmental, and health factors was investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children with siblings under 5 years old. This increased risk was observed irrespective of gender or age. Children who consumed formula foods also had an increased risk of marasmus. Again, this elevated risk was maintained for boys and girls. Overall, higher maternal education was associated with a reduced risk of marasmus; however, this was only statistically significant for boys and for children 18 months or older. Religion was also associated with marasmus but only in older children (> or = 18 months). These results indicate that better strategic planning is necessary to formulate effective interventions to reduce severe malnutrition, particularly in societies where strong age- and sex-preferential behavior exists.

Age Factors↗
PubMed1993

Risk factors for clinical marasmus: a case-control study of Bangladeshi children.

A case-control study of risk factors of clinical marasmus was undertaken to guide intervention efforts in rural Bangladesh. Cases were children whose mid-upper arm circumference measured < 110 mm and controls were children matched for age and sex with arm circumference > 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied. The effects of various demographic, socioeconomic, environmental, and health factors, reported by mothers, were investigated in a multivariate analysis using conditional logistic regression. Results showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio [OR] = 2.51; 95% confidence interval [CI]: 1.33-4.74), and children who consumed formula foods (OR = 16.41, 95% CI: 3.39-79.36). Higher maternal education was associated with reduced risk of marasmus, compared with no education, the OR for < 5 years of schooling = 0.57, 95% CI: 0.23-1.41; OR for > or = 5 years of schooling = 0.34, 95% CI: 0.15-0.76. The strong association of childhood marasmus with mother's education and child spacing supports the notion that non-nutritional factors should be essential components of efforts to reduce severe malnutrition in Bangladesh.

Bangladesh↗
PubMed1993

Comparative effects of nicotinic acid and nicotinamide on cholera toxin-induced secretion in rabbit ileum.

Nicotinic acid reduces the cholera-toxin induced fluid secretion in experimental animals but its toxicity at high doses prevent its therapeutic use in patients suffering from cholera. This study aimed to determine whether nicotinamide, the non toxic amide derivative of nicotinic acid, is as effective as nicotinic acid in inhibiting cholera toxin induced intestinal secretion in vivo. Four intestinal loops, with their blood supply intact, were isolated in 30 rabbits and injected with either (i) 30 mM mannitol, (ii) 30 mM mannitol + 10 micrograms cholera toxin, (iii) 30 mM glucose, or (iv) 30 mM glucose + 10 micrograms cholera toxin. These rabbits were then randomly assigned to three groups receiving intraluminally either 100 mg/kg of nicotinic acid, 100 mg/kg of nicotinamide, or 10 ml/kg of Ringer solution. Measurement of intestinal fluid accumulation showed that nicotinic acid, but not nicotinamide, significantly reduced cholera toxin induced intestinal secretion.

Animals↗
PubMed1992

The risk approach to intervention in severe malnutrition in rural Bangladesh.

To determine whether clinical marasmus occurs in small groups of children from easily recognizable high-risk households, the authors conducted a case-control study to identify risk indicators that may be used in targeted interventions. Cases were children whose mid-upper arm circumference measured less than 110 mm, and controls were children matched for age and sex with arm circumferences greater than 120 mm. Between June 1988 and June 1989, 164 such pairs of children aged 1-4 years were studied in Matlab, Bangladesh. Conditional logistic regression analysis showed an increased risk of marasmus among children from families with other children under 5 years of age (odds ratio = 2.80, 95% confidence interval 1.56-5.02) and children who consumed formula foods (odds ratio = 18.81, 95% confidence interval 4.15-85). Higher maternal education was associated with reduced risk of marasmus. Further examination of these risk indicators suggests that the resources saved through targeting fewer households will be negated by missing many children with marasmus. The authors conclude that the application of targeted interventions against marasmus, using the risk approach, is unlikely to be efficient.

Arm↗
PubMed1992

Limited impact of a targeted food supplementation programme in Bangladeshi urban slum children.

An energy-dense supplementary food, together with nutrition education, was given to a group of moderately malnourished children aged 6-12 months in a poor slum community of urban Bangladesh. An age- and sex-matched control group received only nutrition education. Both groups were followed monthly with respect to weight gain and morbidity. The purpose of the study was to assess the differential impact of a targeted supplementary feeding programme with nutrition education and a nutrition education programme alone on monthly weight gain during 6 months. During the 1st 3 months of the intervention, the monthly weight gain of the supplemented children was 205 g vs 159 g in the control children (p less than 0.05). In the following 3 months, differences in weight gain were no more significant. Several possible explanations for this transient impact are discussed. It is suggested that nutrition education in the control group may have been responsible for the limited difference between the two groups, but seasonal and epidemiological factors may also have played a part.

Bangladesh↗
PubMed1992

Persistent diarrhea as a cause of childhood mortality in rural Bangladesh.

To determine the importance of persistent diarrhea in childhood mortality a multiple-step verbal autopsy method was used to study 1934 deaths in Matlab, Bangladesh. We found that most of the deaths from acute watery diarrhea occurred in infancy, whereas the peak of non-watery diarrhea deaths was in children over 12 months of age. Children suffering from persistent diarrhea and malnutrition were at highest risk of dying during their third year of life. Children with infectious diseases have a two to four times higher risk of dying if they are malnourished, and for diarrhea the risk is 17 times as high. Forty-nine percent of the diarrheal deaths were in children with malnutrition associated with persistent diarrhea. These results imply that fluid and dietary management are key aspects in the treatment of diarrhea, particularly for those episodes which persist. We conclude that attempts to reduce diarrhoeal deaths with vertical ORT programmes will not have major impact unless other interventions are directed to the persistent diarrhoea-malnutrition complex.

Acute Disease↗
PubMed1991

Contraceptive use and breast-feeding duration in rural Bangladesh.

The association between contraceptive use and breast-feeding duration was investigated in 2380 women in rural Bangladesh where women usually stop breast-feeding once pregnant. Life table analysis showed that women receiving regular injections of depo medroxy progesterone acetate (DMPA) and those using non-hormonal contraception breast-fed significantly longer than women using no contraception. In contrast, women using oral contraceptives (combination of 0.5 mg norgestrel and 0.05 mg ethinyl oestradiol) did not breast-feed longer than women using no contraception. It is suspected that prolongation of breast-feeding obtained by delaying the next pregnancy with this oral contraceptive was offset by the depressing effect of oestradiol on lactation. Thus, in communities where prolonged breast-feeding is associated with improved child survival, non-hormonal contraceptive methods, or injectable DMPA, should be preferred for lactating women to oestrogen-containing oral contraceptives.

Bangladesh↗
PubMed1991

A comparison of local handwashing agents in Bangladesh.

The efficacy of handwashing using ash, soap, mud or plain water was tested in a group of 20 women living in a slum of Dhaka in Bangladesh. Each woman was asked to wash her hands using each of the washing agents and the efficacy of handwashing was assessed by comparing estimated faecal coliform counts from post-washing hand samples. Mud and ash were found to be as efficient as soap. Research on appropriate handwashing techniques in the light of the existing practices is suggested.

Bangladesh↗
PubMed1990

The effect of maternal and child health and family planning services on mortality: is prevention enough?

OBJECTIVE: To examine the impact on mortality of a child survival strategy, mostly based on preventive interventions. DESIGN: Cross sectional comparison of cause specific mortality in two communities differing in the type, coverage, and quality of maternal and child health and family planning services. In the intervention area the services were mainly preventive, community based, and home delivered. SUBJECTS: Neonates, infants, children, and mothers in two contiguous areas of rural Bangladesh. INTERVENTIONS: In the intervention area community health workers provided advice on contraception and on feeding and weaning babies; distributed oral rehydration solution, vitamin A tablets for children under 5, and ferrous fumarate and folic acid during pregnancy; immunised children; trained birth attendants in safe delivery and when to refer; treated minor ailments; and referred seriously ill people and malnourished children to a central clinic. MAIN OUTCOME MEASURES: Overall and age and cause specific death rates, obtained by a multiple step "verbal autopsy" process. RESULTS: During the two years covered by the study overall mortality was 17% lower among neonates, 9% lower among infants aged 1-5 months, 30% lower among children aged 6-35 months, and 19% lower among women living in the study area than in those living in the control area. These differences were mainly due to fewer deaths from neonatal tetanus, measles, persistent diarrhoea with severe malnutrition among children, and fewer abortions among women. CONCLUSIONS: The programme was effective in preventing some deaths. In addition to preventive components such as tetanus and measles immunisation, health and nutrition education, and family planning, curative services are needed to reduce mortality further.

Adolescent↗
PubMed1990

Iron in tubewell water and linear growth in rural Bangladesh.

The growth of 694 children from rural Bangladesh was studied. Children drinking water containing greater than 1 mg iron/l (n = 628) were significantly taller than those drinking less than 1 mg iron/l (n = 66): their mean (SD) height for age Z score was -2.10 (1.34) compared with -2.45 (1.24), p less than 0.05. This suggests that iron deficiency may contribute to growth retardation in poor communities.

Bangladesh↗
PubMed1990

Is diarrhoea a major cause of malnutrition among the under-fives in developing countries? A review of available evidence.

To evaluate whether, at the community level, diarrhoea is a major cause of malnutrition or inversely whether the association between diarrhoea and growth retardation can be explained by a higher susceptibility of malnourished children to diarrhoea, all recent studies examining the relationship between diarrhoea and malnutrition in the community were reviewed. It was determined, for each of these two hypotheses, to what extent four standard causality criteria were met, viz., (i) lack of temporal ambiguity, (ii) consistency of findings, (iii) strength of association and (iv) biological plausibility. That malnutrition predisposes to diarrhoea seems likely: this is supported by a series of studies which adequately fulfil the examined causality criteria and seems biologically plausible. On the other hand, it is not clear whether diarrhoea is a major cause of malnutrition. Some studies examine the effect of diarrhoea on nutritional status over short time intervals and it cannot be determined whether diarrhoea-induced growth faltering is transient or sustained. Other studies examining this effect over longer periods do not show clearly that diarrhoea precedes malnutrition. Inconsistencies between studies and lack of evidence supporting a biologically plausible mechanism also question the importance of diarrhoea as a cause of malnutrition.

Child, Preschool↗
PubMed1989

Are diarrhoea control programmes likely to reduce childhood malnutrition? Observations from rural Bangladesh.

Growth of rural Bangladeshi children aged 6-35 months was examined in relation to the history of diarrhoea in 1772 3-month intervals. Weight gain and linear growth were lower in intervals with a history of diarrhoea than in intervals without diarrhoea. However, comparison of weight and height gains in intervals during which diarrhoea occurred at the beginning or at the end showed that after non-bloody diarrhoeas children catch up and that deficits in weight gain and linear growth were no longer apparent a few weeks later. These findings suggest that the effect of diarrhoea on growth is transient and that efforts to control diarrhoea are unlikely to improve children's nutritional status in the long term.

Anthropometry↗
PubMed1989

Critical assessment of the use of growth monitoring for identifying high risk children in primary health care programmes.

OBJECTIVE: To see whether change in weight was a more useful index than weight for age in assessing the risk of dying among malnourished children. DESIGN: Prospective cohort study. SETTING: Rural community in Bangladesh being served by international health organisation. PARTICIPANTS: 1011 Children aged under 5, of whom 66 died. END POINT: Efficient screening method for identifying malnourished children at risk of dying. MEASUREMENTS AND MAIN RESULTS: Weight was measured every month. Weight for age and monthly change in weight averaged over one and three months were calculated. Sensitivity and specificity curves were used to compare the values of these two variables in identifying children with a high risk of dying. Weight for age was more sensitive than change in weight at all levels of specificity. Changes in weight, however, were independently related to the risk of dying even when intercurrent diseases and low weight for age were taken into account. CONCLUSIONS: For identifying children with a high risk of dying weight for age is a more efficient screening tool than a recent change in weight. Growth monitoring as currently recommended for primary health care programmes in developing countries does not seem to be the most effective approach in identifying children in need of urgent help.

Age Factors↗
PubMed1989

Breastfeeding improves survival, but not nutritional status, of 12-35 months old children in rural Bangladesh.

The association between breastfeeding, nutritional status and survival was investigated in a cohort of 1087 children aged 12-35 months from rural Bangladesh followed monthly during 2 years. Mean weight-for-age (%NCHS) of breastfed children was 69.6 per cent (s.d.: 9.3 per cent) compared to 70.6 per cent (s.d.: 10.7 per cent) (P less than 0.001) for non-breast fed children. This confirms that after 1 year of age, breastfed children tend to be more malnourished than non-breastfed children. Despite this difference in nutritional status, risk of dying, after adjusting for age, was six times higher in non-breastfed malnourished children than in similarly malnourished breastfed children. This suggests that breastfeeding beyond 1 year should be encouraged in communities with a high prevalence of malnutrition, despite the frequently observed association between prolonged breastfeeding and malnutrition.

Bangladesh↗
PubMed1989

Nutritional status, age and survival: the muscle mass hypothesis.

The relevance of nutritional indices derived from comparison with growth standards to assess the risk of dying was evaluated in a 2-year prospective study in rural Senegal. An average of 3151 children aged 6-59 months were measured twice a year and followed up during the intervening 6-month periods. Children who survived and those who died during follow-up were found to differ more by anthropometric measures directly related to absolute muscle mass (viz. weight, height or arm circumference) than by nutritional indices obtained from comparison with growth standards (weight-for-age, weight-for-height and height-for-age). The findings could not be explained by a confounding effect of age. This brings into question the current approach used to identify high-risk children.

Age Factors↗