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Biomedical subjects

B F Stanton

Publications and source records attributed to B F Stanton.

36 records · Page 2Linked to original sources
PubMed1988

Measles vaccination and childhood mortality in rural Bangladesh.

To ascertain whether measles vaccination was associated with reduced mortality rates in rural Bangladeshi children, the authors conducted a case-control study in four contiguous areas, two of which had participated in an intensive measles vaccination program which began in the spring of 1982. Cases were 536 children who had died in the four-area region at the age of 10-60 months between April 1982 and December 1984. Two age- and sex-matched controls were selected from the four-area region for each case; each control had survived at least through the date of death of the matched case. Measles vaccination was associated with a 36% (95% confidence interval 21%-48%) proportionate reduction in the overall rate of death and a 57% (95% confidence interval 43%-67%) reduction in the rate of deaths directly attributed to measles or ascribed to diarrhea, respiratory illness, or malnutrition. The association of measles vaccination and reduced mortality remained unchanged after the authors restricted controls to children who had survived at least one year after the deaths of their matched cases. Moreover, children vaccinated in 1982 exhibited a sustained reduction in the rate of death in 1983 and 1984. The authors concluded that measles vaccination was associated with a pronounced and sustained reduction in the rate of death among children in this study.

Bangladesh↗
PubMed1987

Socioeconomic variables and rates of diarrhoeal disease in urban Bangladesh.

Sociodemographic factors including low maternal education, low economic status, inferior quality of housing, diminished access to water and sanitation facilities, and crowding in the household are associated with increased diarrhoea in the rural setting of many developing countries. To assess the relationship of these variables with diarrhoea rates in children in an urban setting we monitored the episodes of diarrhoea of children less than 6 years of age from 1921 families living in 51 clusters throughout Dhaka city, Bangladesh, for 3 1/2 months. Comparing incidence density ratios, we found that, of the factors listed above, only low family income and living in a one-room house were statistically associated with increased diarrhoea and that none of these variables was associated with a meaningfully increased risk of diarrhoea. We conclude that the risk factors for increased episodes of diarrhoea in the urban setting appear to be different from those of the rural setting.

Adolescent↗
PubMed1987

An educational intervention for altering water-sanitation behaviours to reduce childhood diarrhoea in urban Bangladesh: formulation, preparation and delivery of educational intervention.

The formulation, preparation and delivery of an educational intervention previously shown to alter hygienic practices and reduce rates of childhood diarrhea in 25 slum communities in Dhaka, Bangladesh is described in detail. Successful aspects of the program included involvement of community members in goal determination, involvement of community members and women as trainers, focusing conflict into positive actions and utilization of informal training techniques. The failures included inadequate transfer of technical aid to communities and insufficient involvement of volunteer-trainers in curriculum development. We suggest possible explanations for these successes and failures and suggest that these hypotheses should, if possible, be subjected to formal evaluation.

Audiovisual Aids↗
PubMed1987

B subunit-whole cell and whole cell-only oral vaccines against cholera: studies on reactogenicity and immunogenicity.

We conducted a randomized trial among persons in rural Bangladesh to evaluate the side effects and immunogenicity of orally administered B subunit-killed whole cell (BS-WC) and killed whole cell-only (WC) cholera vaccines and a killed Escherichia coli strain K12 placebo proposed for field testing. Three doses of BS-WC, WC, E. coli, or a control agent were given with antacid to 1,257 women (aged greater than 15 years) and children (aged to to 15 years). The four groups exhibited no statistically significant differences in occurrence of symptoms after each dose, and rises in titers of vibriocidal (VC) antibodies to Inaba and Ogawa were twofold higher for vaccinees than for controls (P less than .001). Half of the persons with fourfold or greater VC responses to WC responded after the first dose; many additional patients, particularly young children, responded after subsequent doses. In contrast, 89% of persons who responded to BS-WC with twofold or greater rises in titer of IgG antibodies to cholera toxin did so after the first dose. After the third dose, vaccinees exhibited a fivefold higher rise in titer than did controls (P less than .001); a dose-to-dose booster effect was most evident in young children.

Administration, Oral↗
PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. I. Application of the case-control method for development of an intervention.

A case-control study was performed to develop an empirically based intervention for improving water-sanitation practices and rates of childhood diarrhea among families residing in urban Bangladesh. For three months fortnightly, histories of diarrhea were taken for all children under six years of age among 1,350 families to estimate age-specific rates of diarrhea in the population. A total of 247 randomly sampled families, termed sentinel families, were visited once during the study for prolonged observations of water-sanitation practices. Behaviors potentially affecting incidence of diarrhea were compared in a case group (n = 45), defined as sentinel families whose children had rates at least 1.7 times the rates expected for similarly aged children, and in a control group (n = 53), defined as sentinel families without any episodes of childhood diarrhea during the period of observation. Three practices differentiated the two groups: more control (82%) than case (53%) mothers who were observed to prepare food washed their hands before beginning the preparation (p less than 0.01); fewer control families (33%) than case families (80%) had ambulatory children who, when observed to defecate, did so in the family's living area (p less than 0.01); and fewer control (30%) than case (47%) families had children who were observed to place garbage or waste products in their mouth (p less than 0.10). Focus on these three empiric associations enabled the design of a community-specific educational intervention which is simple in construction and based upon naturally occurring, financially feasible, salutory practices.

Bangladesh↗
PubMed1987

An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. II. A randomized trial to assess the impact of the intervention on hygienic behaviors and rates of diarrhea.

An educational intervention was designed to improve three water-sanitation behaviors empirically shown to be associated with high rates of childhood diarrhea in Dhaka, Bangladesh: lack of handwashing before preparing food, open defecation by children in the family compound, and inattention to proper disposal of garbage and feces, increasing the opportunity for young children to place waste products in their mouth. Fifty-one communities, each comprising 38 families, were randomized either to receive (n = 25) or not to receive (n = 26) the intervention. During the six months after the intervention, the rate of diarrhea (per 100 person-weeks) in children under six years of age was 4.3 in the intervention communities and 5.8 in the control communities (26% protective efficacy; p less than 0.0001). A corresponding improvement in handwashing practices before preparing food was noted, although no improvement was observed for defecation and waste disposal practices. These data suggest that educational interventions for water-sanitation practices can have an important beneficial effect upon childhood diarrhea in developing countries, particularly when the interventions are designed in a simple way to promote naturally occurring salutory behaviors that are empirically associated with lower rates of childhood diarrhea.

Bangladesh↗
PubMed1987

An urban nutrition education and rehabilitation centre: a description of the programme and change in nutritional status of children who were enrolled.

We report on a community-based day care nutrition rehabilitation and education centre which was established by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in a slum in Dhaka, Bangladesh. Between March-December, 1985 approximately 10 children aged 1 to 5 years with a percent weight for height (% wt/ht) of 60 to 85 were enrolled in each of 9 sessions which were 3 to 5 weeks long. The children were fed 3 meals and 2 snacks daily made from locally available inexpensive foods. A nutrition education programme, developed with input from several feeding centres in Dhaka, included daily lessons, participatory cooking and personal hygiene sessions. Of the 85 children entering the programme, 82 (95%) completed 3 or more weeks. Relative to baseline, a median increase of 8.7% wt/ht was observed at 5 weeks (p less than 0.001), with the greatest improvement occurring in those children presenting with the lowest weights. Median increases of 7.2 and 7.4% wt/ht were noted 6 and 10 months after admission, respectively. Gender and minor illness did not have a significant impact on change in nutritional status. Poor performance of mothers in assigned chores was associated with inferior improvement in nutritional status 5 weeks but not 6 months post-admission. These results suggest that the intervention implemented by the centre may have been effective in improving nutritional status and that more rigorous evaluation of participants in relation to suitably matched concurrent controls should be performed.

Bangladesh↗
PubMed1987

Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study.

Although responses to 24-hour recall and knowledge-attitude-practice questionnaires are commonly used in water-sanitation studies as surrogates for direct observation of behaviour, the validity of this approach is questionable. We therefore compared questionnaire data with those obtained by direct observation of practices related to water storage, handwashing, and defecation among 247 families in urban Dhaka, Bangladesh. Analysis of the results indicates that accord between the replies to the questionnaires and the data collected by direct observation was poor and that the responses to the two questionnaires were often contradictory. Significant disagreements between the results of questionnaires and observations arose usually because desirable practices were over-reported by the respondents. The results of the study suggest that in urban Bangladesh 24-hour recall and knowledge-attitude-practice questionnaires should not be used as proxies for direct observation of hygiene practices.

Bangladesh↗
PubMed1986

Field trial of oral cholera vaccines in Bangladesh.

The protective efficacy of oral B subunit killed whole-cell (BS-WC) and killed whole-cell (WC) cholera vaccines was assessed in 63 498 Bangladeshi children aged 2-15 years and women aged over 15 years. Each received three doses of BS-WC, WC, or placebo in a randomised, double-blinded fashion. Surveillance for cases seeking medical care up to six months after the third dose revealed 26 cases of confirmed cholera in the placebo group, 4 cases in the BS-WC group (protective efficacy 85%; p less than 0.0001), and 11 cases in the WC group (protective efficacy 58%; p less than 0.01). For each vaccine protective efficacy was consistent in different age-groups (2-10 years versus greater than 10 years) and for different severities of cholera.

Administration, Oral↗
PubMed1986

Risk factors for developing mild nutritional blindness in urban Bangladesh.

Mild vitamin A deficiency may be associated with increased morbidity and mortality among children in developing countries. A community-based case-control study was performed to determine risk factors for mild ophthalmologic manifestations of vitamin A deficiency in urban Bangladeshi children. Cases were identified in children less than 14 years of age with night blindness with or without other signs of mild xerophthalmia detected in a house-to-house survey. Controls were randomly selected neighbors who lacked subjective and objective ophthalmologic evidence of vitamin A deficiency. Demographic characteristics that were independently associated with vitamin A deficiency in a logistic model included male gender, greater age (mean, 6.1 years in children with cases and 2.8 years in controls), and a greater number of children living with the family. After controlling for these demographic characteristics, poor intake of locally available vitamin A-rich foods, cessation of breast-feeding, and a recent history of protracted diarrhea remained associated with vitamin A deficiency. Maternal ignorance of prevention and control of vitamin A deficiency was also associated with increased risk. The results support programs that educate mothers to breast-feed and to provide appropriate food supplements and suggest that clinicians caring for children with chronic diarrhea should initiate vitamin A supplementation.

Adolescent↗
PubMed1986

Soiled saris: a vector of disease transmission?

We examined the relationship between uses of the sari that are potential health hazards and episodes of diarrhoea in children younger than 6 years in 247 families living in 51 slums in Dhaka, Bangladesh. These misuses appeared to be common (median of three per observation period) and were largely unrecognized by the women as possible sources of disease transmission. There appeared to be a positive correlation between the number of misuses of the sari and episodes of childhood diarrhoea.

Animals↗
PubMed1984

Changing spectrum of infective endocarditis in children. Analysis of 26 cases, 1970-1979.

The decade of the 1970s was marked by an increased survival of children with complex heart lesions, use of prosthetic material in open heart surgery, and placement of indwelling central catheters in critically ill patients. We analyzed all 26 cases of children with infective endocarditis (IE) seen at Yale University, New Haven, Conn, from 1970 through 1979 to determine whether these and other factors resulted in a change in pediatric IE. A larger proportion of cases arose postoperatively as compared with previous series. Among the postsurgical and catheterization-related cases, the most common infecting agents were streptococci, not the expected staphylococci. Although the number of cases was small, IE associated with prosthetic material had a favorable prognosis; all survivors of IE with prosthetic material were cured by medical regimens alone. The IE cases in children with previously normal hearts were associated with indwelling central catheters.

Anti-Bacterial Agents↗
PubMed1984

BCG prophylaxis against cancer: methodological evaluation of a continuing controversy.

A possible protective effect of tuberculosis against cancer, together with the known immune-stimulating properties of BCG, have motivated 14 investigations of BCG prophylaxis against cancer. The results have been conflicting: 3 studies found high levels of protection, 8 found no effect, and 3 suggested that BCG may actually raise the risk of cancer. To assess whether the inconsistent results could have a methodological basis, we analyzed each study according to several basic criteria necessary for scientific validity in cause-effect research. The analyses showed two major problems: (1) None of the studies used safeguards against detection bias by ensuring that the diagnosis of cancer in vaccinees and non-vaccinees was made with equal follow-up and surveillance procedures, and in an accurate and unbiased fashion; (2) Studies alleging that BCG is carcinogenic were weakened by the inappropriate use of cancer mortality data, by the analysis of multiple BCG-cancer associations without appropriate statistical adjustment, and by post hoc creation of new cancer risk categories after inspection of the data. Since these methodologic inadequacies preclude any firm conclusions about the role of BCG in preventing cancer, a resolution of the controversy will require new research, designed and conducted with greater attention to methodologic principles necessary to ensure scientific validity.

BCG Vaccine↗
PubMed1983

Rotavirus diarrhoea: an expanding clinical spectrum.

To explore the clinical spectrum of rotavirus diarrhoea in Bangladeshi children, we reviewed surveillance data from randomly selected diarrhoeal cases who were intensively studied at the International Centre for Diarrhoeal Diseases Research--Bangladesh. Twenty-seven (29%) of children aged less than or equal to 4 years excreted rotavirus; rotavirus was the only pathogen isolated from 13 cases. Seven of these 13 cases displayed the typical features of rotavirus diarrhoea: occurrence in infancy, prominent vomiting, watery diarrhoea, and acid stools rarely exhibiting blood or leucocytes. In contrast, six of the 13 cases presented with non-watery diarrhoea. These cases were distinguished by older ages, infrequent vomiting, less acidic stools, faecal blood and leucocytes, and frequent left shifts on peripheral blood examination. We conclude that the clinical spectrum of rotavirus infections may include an invasive diarrhoeal syndrome that differs in several respects from the more widely appreciated watery diarrhoeal syndrome.

Adolescent↗
PubMed1982

A controlled evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolapse.

The absence of controlled evidence and the high prevalence of mitral-valve prolapse have created substantial uncertainty about whether this condition is an important risk factor for bacterial endocarditis. We evaluated this risk in a case-control study of hospital inpatients who had undergone echocardiography and who lacked any known cardiovascular risk factors for endocarditis, apart from mitral-valve prolapse and isolated mitral-regurgitant murmurs. Thirteen (25 per cent) of 51 patients with endocarditis had mitral-valve prolapse, as compared with 10 (seven per cent) of the 153 matched controls without endocarditis. For the 51 matched case-control sets, the odds ratio (8.2; 95 per cent confidence interval, 2.4 to 28.4) indicated a substantially higher risk of endocarditis for people with mitral-valve prolapse than for those without it. This association remained statistically significant when parenteral drug abuse and routine antibiotic prophylaxis preceding dental work and other forms of instrumentation were taken into account. Furthermore, the risk may be higher than is indicated by this study, since 46 per cent of the controls underwent echocardiography for clinically suspected mitral-valve prolapse, suggesting an overrepresentation of mitral prolapse in the control group. The results support the contention that mitral-valve prolapse is a significant risk factor for bacterial endocarditis.

Adult↗
PubMed1981

Effects of route and time of administration of antiserum on protection of mice from lethal infection due to group B Streptococcus type III.

The present study examines a mouse model of infection due to group B Streptococcus serotype III (GBS-III) as to the route and timing of antiserum administration for protection and quantitation of bacteremia with and without antiserum. Data for these parameters are contrasted with those after challenge with serotype Ia of group B Streptococcus (GBS-Ia). An intraperitoneal injection of GBS organisms and protective antiserum from a single syringe can be used to create an animal model of disease. Intraperitoneal injection of GBS-III resulted in bacteremia at 0.5 h both in animals who did not receive antiserum (17.4 X 10(2) +/- 7.6 X 10(2) colony-forming units per ml of blood samples) and in animals who received antiserum (19.3 X 10(1) +/- 6.8 X 10(1) colony-forming units per ml). Although intraperitoneal injection of GBS-Ia also resulted in bacteremia evident by 0.5 h in unprotected animals (30.1 X 10(2) +/- 3.8 X 10(2) colony-forming units per ml), no bacteremia occurred in protected recipients of this organism. Bacteremia due to GBS-Ia and GBS-III logarithmically increased until at least 7 h. Bacteremia due to GBS-III in protected animals was cleared by 24 h. Protection against GBS disease did not require simultaneous or proximate administration of the organism and the antiserum. Mice could be protected from death after intraperitoneal challenge with GBS-III or GBS-Ia by antiserum administered intravenously or intraperitoneally from 6 h before to 2.5 h after challenge.

Animals↗