Vitamin D [Serum 25(OH) cholecalciferol] Insufficiency is Associated With Childhood Asthma: Recent Case-Control Findings From Bangladesh.

Objectives. To evaluate the interaction between childhood asthma and S. 25(OH) cholecalciferol among Bangladeshi children. Methods. This case control study was conducted in child asthma clinic, Bangladesh Shishu Hospital Institute during March-August 2021. Comparison was made between clinically-diagnosed (following GINA guideline) asthmatic children (2-12 years-old) (cases = 87) and age and sex-matched children having no respiratory illness (controls = 90) using SPSS' (Statistical Package for Social Science, V.23.0 Windows) software. Results. Serum 25(OH) cholecalciferol was found to be significantly lower among the cases than the controls (P < .01). The cases had 3.4 times higher likelihood of having low vitamin D (combined deficient + insufficient) than the controls (P < .01). Conclusions. The results of the study demonstrate an association of Serum 25 (OH) cholecalciferol with asthma which underscores the importance of potential future trial to evaluate the efficacy of Vitamin-D supplementation for understanding the outcomes of asthmatic Bangladeshi children.

Management of bronchiolitis without antibiotics: a multicentre randomized control trial in Bangladesh.

OBJECTIVE: To ascertain that antibiotics have no role in the management of bronchiolitis. DESIGN: Multicentre randomized control trial (RCT). SETTING: Five purposively selected teaching hospitals in Bangladesh. PATIENT: Children under 24 months old with bronchiolitis. INTERVENTIONS: Children were randomized into three groups of therapeutic interventions: parenteral ampicillin (P-Ab), oral erythromycin (O-Ab) and no antibiotic (N-Ab) in adjunct to supportive measures. MAIN OUTCOME MEASURES: Clinical improvement was assessed using 18 symptoms/signs which were graded on a two-point recovery scale of 'rapid' and 'gradual', indicating improvement within 'four days' and 'beyond four days', respectively. RESULTS: Each intervention group consisted of 98 +/- 1 children having comparable clinico-epidemiological characteristics at the baseline. The trial revealed that most chesty features (features appearing to arise from chest, i.e. cough, breathing difficulty, wheeze, chest indrawing, tachypnoea, tachycardia, rhonchi and crepitation) demonstrated a gradual recovery, beyond 4th admission day and, not differing among the three intervention groups (p > 0.23, p < 0.62, p = 0.54, p < 0.27, p = 0.75, p = 0.76, p = 0.81, p > 0.98, respectively). Most non-chesty features (features appearing to arise away from chest, i.e. feeding/sleeping difficulties, social smile, restlessness, inconsolable crying, nasal flaring, fever and hypoxaemia) demonstrated a rapid recovery, within 4 days, remaining comparable among the three intervention groups (p < 0.07, p = 0.65, p = 0.24, p < 0.61, p = 0.22, p = 0.84, p = 0.29 and p = 0.96, respectively). However, nasal symptoms (runny nose and nasal blockage) also showed no difference among groups (p = 0.36 and p = 0.66, respectively). Thus, the dynamics of clinical outcome obviates that children not receiving antibiotics had similar clinical outcome than those who did. CONCLUSION: In hospital settings, managing bronchiolitis with only supportive measures but without antibiotics remains preferable.

Hospital management of severely malnourished children: comparison of locally adapted protocol with WHO protocol.

OBJECTIVES: To compare the effectiveness of locally adapted Institute of Child and Mother Health (ICMH) protocol with the WHO protocol for the management of severely malnourished children in Bangladesh. DESIGN: Quasi-experimental non-randomized clinical trial. SETTING: Hospital based. PARTICIPANTS: Severely malnourished children (2-59 mo) with weight for height<70% (n=60). INTERVENTION: Children treated with either WHO protocol (Group I, n=30) or ICMH protocol (Group II, n=30). OUTCOME VARIABLES: Clinical improvement, weight gain, time taken to achieve target weight gain, and mortality among the study subjects. RESULTS: Mean (SD) weight related to gain in Group I and Group II was 11.2 (4.1) and 11.1 (3.9) g/kg/day, respectively. The weight gain was not related to the age group or type of malnutrition. The time taken for edema to subside (7.3 d vs 8 d) and for improvement of appetite (6.5 d to 7.3 d vs 6.7 d to 8.4 d) was similar between the groups. The target weight gain was achieved in 28.3 (11.5) days in Group I against 27.9 (6.2) days in Group II (P=0.88). The mortality rate was 6.7% in each group. CONCLUSION: Treatment of severe malnutrition with locally adapted ICMH protocol using locally available foods is as efficacious as the WHO protocol.

Self-reported asthma symptoms in children and adults of Bangladesh: findings of the National Asthma Prevalence Study.

BACKGROUND: No population-based studies to determine the magnitude of the asthma problem have been carried out in Bangladesh. This study aimed to define the prevalence of asthma as well as to identify the risk factors of asthma in the general population of Bangladesh. METHODS: A cross-sectional study was conducted from January 1999 to August 1999 on 5642 Bangladeshi people. Data were collected from randomly selected primary sampling units of 8 municipality blocks of 4 large metropolitan cities, 12 municipality blocks of 6 district towns and 12 villages of 6 districts chosen randomly from all 64 districts of the country. Face-to-face interviews were performed with the housewives or other guardians at the household level using a structured questionnaire. RESULTS: The prevalence of asthma (wheeze in the last 12 months) was 6.9% (95% CI : 6.2-7.6). The prevalence of other asthma definitions were: ever wheeze (lifetime wheeze) 8.0% (95% CI : 7.3-8.7); perceived asthma (perception of having asthma) 7.6% (95% CI : 6.9-8.3); doctor diagnosed asthma (diagnosis of asthma by any category of doctor either qualified or unqualified) 4.4% (95% CI : 3.9-4.9). The prevalence of asthma in children (5-14 years) was higher than in adults (15-44 years) (7.3% versus 5.3%; odds ratio [OR] = 1.41, 95% CI : 1.09-1.82). Asthma in children was found to be significantly higher in households with

Nutritional rickets without vitamin D deficiency in Bangladesh.

To understand nutritional rickets in Bangladesh better, 14 rachitic and 13 'unaffected' children were evaluated. Seventy per cent of children with active rickets had no evidence of either vitamin D deficiency or familial rickets. Rickets in Bangladesh is probably related to calcium deficiency. Abnormalities in 'unaffected' children suggest that subclinical calcium insufficiency is common.