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V Fauveau

Publications and source records attributed to V Fauveau.

At least 19 recordsLinked to original sources
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

Effect of child survival on contraceptive use in Bangladesh.

A study in Bangladesh showed that couples who lost a child often stopped practising contraception in order to have another child. Logistic regression analysis revealed that contraceptive continuation was related to maternal age, parity, husband's education and the sex of the last child.

Adolescent↗
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↗
PubMed1992

Impact on mortality of a community-based programme to control acute lower respiratory tract infections.

Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.

Allied Health Personnel↗
PubMed1991

Effect on mortality of community-based maternity-care programme in rural Bangladesh.

Various community-based interventions have been proposed to improve maternity care, but hardly any studies have reported the effect of these measures on maternal mortality. In this study, the efficacy of a maternity-care programme to reduce maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh. Trained midwives were posted in villages, and asked to attend as many home-deliveries as possible, detect and manage obstetric complications at onset, and accompany patients requiring referral for higher-level care to the project central maternity clinic. The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area without midwives. Random assignment of the intervention was not possible but potentially confounding characteristics, including coverage and use of other health and family planning services, were similar in both areas. Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme. By contrast, during the following 3 years, the ratio was significantly lower in the programme than in the control area (1.4 vs 3.8 per 1000 live births, p = 0.02). The findings suggest that maternal survival can be improved by the posting of midwives at village level, if they are given proper training, means, supervision, and back-up. The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated.

Adolescent↗
PubMed1991

Excess female deaths among rural Bangladeshi children: an examination of cause-specific mortality and morbidity.

Excess female over male mortality during childhood, well known in the northern Indian subcontinent, is particularly marked in rural Bangladesh. While the determinants of this phenomenon and the respective roles of cultural and economic factors are still debated, little data exist on cause-specific mortality, to identify the specific causes of death producing this differential. In 1986-1987 in Matlab, a study area under intensive demographic surveillance in rural Bangladesh, female children aged 1 to 4 years had a risk of dying 1.8 times higher than male children (95% confidence interval: 1.5-2.1). The causes of death which contributed the most to this excess female mortality were severe malnutrition and diarrhoeal diseases. The risks of dying were 2.5 and 2.1 higher for female than for male children for these two causes, respectively. Possible mechanisms are examined using data on incidence of selected diseases and admission rates to curative facilities. There was no gender difference in incidence of severe diarrhoeal diseases, but female children with diarrhoea were taken to the hospital significantly less often than male children. In contrast, there was a higher incidence of severe malnutrition in female than male children, and a lower rate of hospital admission. The data suggest that gender differentials in mortality may not be as much affected by preventive measures against diarrhoea as by efforts to provide equivalent curative services to female and male children.

Bangladesh↗
PubMed1991

Diarrhoea mortality in rural Bangladeshi children.

Diarrhoeal mortality and hospital admissions for diarrhoea are described among children under the age of 5 years in a large rural Bangladeshi community during 1986-87. Acute watery (dehydrating) diarrhoea was associated with 11 per cent of all deaths among infants aged 1-11 months and 5 per cent among children aged 1-4 years. Acute non-watery diarrhoea, including bloody dysentery and diarrhoea with mucoid stools, was associated with 16 per cent of all deaths among children aged 1-4 years. In this age group, persistent diarrhoea, particularly when accompanied by recent and/or severe wasting, was associated with 63 per cent of all diarrhoeal deaths and 34 per cent of all deaths. These data suggest that exclusive emphasis on ORT will have little impact on diarrhoea mortality among children in rural Bangladesh. A broader strategy, both preventive and curative, including measles immunization, nutrition education, dietary management of diarrhoea, and the treatment of dysentery in the community, carries a greater potential.

Bangladesh↗
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

Measles among under-9-month-olds in rural Bangladesh: its significance for age at immunization.

Any decision to modify measles immunization strategies away from the use of the conventional vaccine given to children at 9 months of age to the adoption of recently proposed vaccine strains that can be given to 4-6-month-olds will depend on the age distribution of severe cases of measles in the community. Reported are the results of an analysis of two community-based measles surveillance systems in rural Bangladesh, which found that 17% of all measles cases reported for under-5-year-olds in a nonvaccinated population involved infants aged less than 9 months. In a vaccinated population from the same area, 31% of all measles cases reported for under-5-year-olds occurred among under-9-month-olds. Using a rather restrictive definition for measles-related deaths (those occurring within 6 weeks of the onset of the rash), the proportion of measles-related deaths that occurred before 9 months of age was 13% of all such deaths that were reported.

Age Factors↗
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

Perinatal mortality in Matlab, Bangladesh: a community-based study.

Perinatal deaths, comprising stillbirths and deaths during the first week of life, were monitored over the eight-year period 1979 to 1986 in a rural Bangladeshi population of 196,000. The perinatal mortality rate was 75 per 1000 total births. The rate was 13% higher in males than females. Stillbirth and early neonatal mortality rates were 37 and 38 per 1000 total births, respectively. The major causes of perinatal deaths are presented, as well as some of the maternal determinants. During the period under study, perinatal mortality declined regularly and significantly over time in an area covered by an intensive Family Planning and Health Services programme, but not in the adjacent control area. This raises the issue of the impact of such a programme upon perinatal mortality, and the need to include a strong maternity care component into primary healthcare strategies if further reductions of perinatal mortality are to be achieved.

Bangladesh↗
PubMed1990

Impact of measles vaccination on childhood mortality in rural Bangladesh.

This study examines the impact of measles vaccination on childhood mortality, based on longitudinal data from the Matlab maternal and child health/family planning programme in rural Bangladesh. It analyses the mortality experience of 8135 vaccinated and 8135 randomly matched nonvaccinated children aged 9-60 months, who were observed from March 1982 to October 1985. The results indicate that measles vaccination had a pronounced impact on both short- and long-term survival--the mortality rates for vaccinated children were as much as 46% less than those for nonvaccinated children. Immunization of children aged up to 3 years with measles vaccine appears to improve significantly their subsequent chances of survival. The findings underscore the need to give greater priority to measles vaccination within primary health care programmes in settings such as rural Bangladesh.

Bangladesh↗
PubMed1989

Deaths from injuries and induced abortion among rural Bangladeshi women.

Information about injuries and violence as causes of death of women is scarce and often incomplete, and particularly so regarding women in the rural areas of South Asia. This report provides detailed specific information collected in Matlab, a sub-district of rural Bangladesh. Of 1139 women (aged 15-44 yr) who died there during the 11-yr period from 1976 to 1986, 207 (18%) were victims of unintentional injuries or violence. In this study, unintentional injuries include domestic and traffic accidents, drowning and snake-bites, while violent deaths are defined as due to intentional injury and include homicide, suicide and lethal complications of induced abortion. Injuries and violence accounted for 31% of all deaths among women aged 15-19 yr. This proportion dropped significantly with age to 10% among women aged 35-44 yr. Unmarried women suffered a higher proportion of such deaths (36%) than married women (15%). Violent deaths during pregnancy and complications of induced abortion among young unmarried women deserve special attention. In the male-dominated society under study, suicide and homicide are observed to be two frequent consequences of illegitimate pregnancy. Although this study suffers from the absence of data on non-fatal injuries and attempted violence, it may serve as a basis for recommending preventive measures.

Abortion, Induced↗
PubMed1989

Epidemiology and cause of deaths among women in rural Bangladesh.

A total of 542 women aged 15 to 44 years died during the 10-year period 1976 to 1985 in the control area of Matlab, an area with a population of 90,000, representative of many other rural areas of southern Bangladesh. The corresponding age-specific mortality rate was 290 per 100,000 women 15-44 years. These deaths have been analysed retrospectively, using information collected through the Demographic Surveillance System set up by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and verbal autopsies conducted in the homes. Of these deaths, 175 (32%) were due to infectious diseases, 163 (30%) to direct obstetric complications, 67 (12%) to injuries, and the remaining 26% to other causes. Cause-specific and proportionate mortality rates showed a positive association with age for deaths due to infectious diseases, non-infectious diseases and unspecified causes, and an inverse association with age for deaths due to injuries. These rates showed a peak in the intermediate age group 25 to 34 years for deaths due to direct obstetric causes. No consistent trends were visible when annual rates were studied over time. Prior to death, 42% of the women were attended by traditional practitioners, and 33% were not attended at all. Demographic impact is discussed, emphasizing the contribution of obstetric causes to overall mortality. Priorities for health policy implications are proposed, focusing upon a strong maternity care programme, and improved availability of female health personnel, in the context of the socio-cultural constraints imposed on women in poor rural areas.

Adolescent↗
PubMed1988

Causes of maternal mortality in rural Bangladesh, 1976-85.

Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral.

Abortion, Spontaneous↗
PubMedDate not supplied

Is acute watery diarrhoea an important cause of morbidity and mortality among rural Bangladeshi children?

To assess the relative importance of acute watery diarrhoea (AWD) and other types of acute diarrhoea as causes of morbidity and mortality among infants and 1-4 years old children, we examined 3 different data sources from the Matlab field project of the International Centre for Diarrhoeal Disease Research, Bangladesh. In infants, prevalence rates for AWD and non-watery diarrhoeas were similar. In children, prevalence of AWD was 1.8 times lower than prevalence of other acute diarrhoeas. In infants, admission rate to a diarrhoea hospital was 4.1 times higher for AWD than for other acute diarrhoeas (P less than 0.001). In children, admission rate was only 1.7 times higher for AWD than for acute diarrhoeas (P less than 0.001). Infant mortality was 1.7 times higher for AWD than for other acute diarrhoeas, but child mortality was 3 times lower for AWD. These data suggest that, while diarrhoeal disease control programmes should give more importance to oral rehydration therapy in infants, field management of the other types of acute diarrhoea should receive more emphasis in children.

Bangladesh↗