Age and Gender-dependent Correlates as Risk Factors of Recurrent Headache among Bangladeshi Secondary School Children.

Magnitude of recurrent headache (RHA) is not well explored among school-children (schoolers) particularly in developing countries like Bangladesh, though recent literature reveals that RHA connotes serious public health implication(s) particularly in schoolers in resource constraint countries. To study age and gender-dependent correlates of RHA among secondary-level schoolers and to determine if these remains its risk-factors. Cross-sectional population based respondent-dependent study employing direct interviews using pre-tested open and closed-ended questionnaire following ICHD-II (2004) diagnostic criteria. Overall, 17% RHA was observed among 1499 schoolers surveyed initially, being more in pubertal/adolescents (13-15 years) than pre-pubertal (11-12 years) ones. Of screened-out 255 RHA positive cases, migraine (MHA) was observed in 55.3% while tension-type-headache (TTH) in 19.6% schoolers. RHA demonstrated a steady-inclining trend with schooler's age. Gender difference was obvious in MHA (p<0.001) but not in TTH (p<0.31). Pubertal schoolers (OR=8.75) and boys (OR=1.8) remained at greater risk for migraine but less risky for TTH. Mass-awareness program is imperative to prevent RHA among schoolers towards progressing it into chronicity, psycho-socially handicapped and economically burdened. Further in-depth studies warrant prudent data to examine its long-term risks/underlying factors involving more diverse population (school-children) from different geographical areas and cultural contexts.

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.

Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh.

BACKGROUND: Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh. STUDY DESIGN: A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used. OBJECTIVES: To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children. METHODOLOGY: Direct interviews were used to collect the data and clinical check up was performed in all children. RESULTS: In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P<0.001) and bed linen (P<0.001), overcrowded sleeping arrangements (P<0.001) and infrequent bathing (P<0.001) with soap (P<0.001). This was further related to household income (P<0.001 for both). CONCLUSION: The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.

Analysis of Disability Adjusted Life Years (DALYs) among arsenic victims: a cross-sectional study on health economics perspective.

Arsenic contamination of ground water is a major public health problem in Bangladesh. It is estimated that more than 20 million people are potentially exposed to arsenic poisoning. This cross-sectional study was carried out in Haziganj Upazila under Chandpur district between September to December, 2001 with the objectives to assess the socioeconomic consequences and disease burden in terms of Disability Adjusted Life Years (DALYs). A total of 168 subjects suffering from arsenicosis were studied. Both age and disability weights were considered to calculate DALYs. Agricultural labour and housewives suffered more from the disease. A strong relationship (p<0.005) was found between duration of suffering and occupation of the subjects. Also, there was a strong relationship between age of onset and education of the study subjects (p<0.006). No deaths directly from arsenicosis were reported. It may be noticed that 47% of the patients would be living with disability for more than 51 years. A strong relationship exists (p<0.002) between educational level and Years Lived with Disability (YLDs). A total of 7930 YLDs were lost due to arsenicosis, which accounts for 1908 DALYs.

The distribution of Ascaris lumbricoides in human hosts: a study of 1765 people in Bangladesh.

The Ascaris lumbricoides expelled by 1765 people in a poor urban community in Bangladesh were recovered and counted after the subjects had been treated with pyrantel pamoate. The subjects were divided into 22 classes by age and sex (mean n = 80) to examine how prevalence, mean worm burdens and measures of aggregation of worms varied with age and between the sexes, and to see how a measure of aggregation, k, calculated in 3 ways (by maximum likelihood, from moments, or from the percentage uninfected) compared with an empirical aggregation index (the percentage of subjects who expelled an arbitrary 80% of all worms) and with the proportion who were moderately to heavily infected (defined as > or = 15 worms). The prevalence of infection ranged from 64% to 95%, mean worm burdens ranged from 7 to 23 worms, and k ranged from 0.3 to 1.2. There were significant differences between adult males and females in the prevalence of infection, mean worm burdens and measures of aggregation, differences which are probably driven more by behaviour than immunity. The parameter k was better described in terms of the proportion who were moderately to heavily infected (linear; range 0.15-0.58) than by the empirical aggregation index (non-linear; range 0.30-0.49).

Antibody isotype responses to antigens of Ascaris lumbricoides in a case-control study of persistently heavily infected Bangladeshi children.

Antibody responses to Ascaris lumbricoides worm antigens were examined by ELISA in a case-control study of 2 groups of Bangladeshi children, one of which had been shown over a period of 12 months to be consistently lightly infected (controls) and the other consistently heavily infected (cases). The children showed a wide range in intensity of infection; children identified as cases were on average 4 times more heavily infected than the controls. There were no significant differences in weight, height, mid-upper arm circumference and skinfold thickness between the case or control subjects at the time blood samples for analyses by ELISA were collected. Children with repeatedly heavy infections with A. lumbricoides had higher concentrations of antibody isotypes to the antigens of A. lumbricoides than children who are repeatedly lightly infected. IgG1, IgG4 and IgE to worm antigens occurred in significantly higher concentrations in heavily infected subjects. This suggests that these antibody responses simply reflect the intensity of infection and may not play a significant role in protecting against heavy infections.

Household aggregation of Strongyloides stercoralis infection in Bangladesh.

Strongyloides stercoralis infections were shown to be aggregated in households in an urban slum community in Dhaka, Bangladesh. Parasitological data on 880 residents living in 280 households were analysed statistically using 3 different tests, each of which yielded significant evidence of household aggregation of S. stercoralis infection. One test was applied to the data after stratification for 4 variables were previously shown to be independently associated with infection. Evidence of household aggregation of infection remained after stratification, suggesting that aggregation is due not only to shared risk factors, but also to either familial genetic predisposition to infection or close contact person to person transmission of infection within households.

Strongyloides stercoralis in an urban slum community in Bangladesh: factors independently associated with infection.

Stool samples from 880 residents in an urban slum in Dhaka, Bangladesh, were collected on 3 occasions over one year, and examined for intestinal parasites. Information on many potential risk factors for infection was obtained by questionnaire from a respondent in each household studied. In a crude univariate analysis of the data, several of the factors were found to be significantly associated with Strongyloides stercoralis infection. Most of these factors were co-variate with one another, and with poverty generally. Using Mantel-Haenszel chi 2 tests to control for confounding effects of each variable individually, the following 4 factors remained independently associated with S. stercoralis infection: respondent's use of a community latrine rather than a private latrine, living in a house with an earth floor rather than a cement floor, being of Bihari ethnicity, and being 7-10 years of age. Implications of these results for the epidemiology and control of strongyloidiasis are briefly discussed.

Intensity of reinfection with Ascaris lumbricoides and its implications for parasite control.

Intestinal helminths are among the most common and widespread of human infections. Because it is typical to find that most worms are aggregated in a few potential hosts it has been suggested that some individuals are predisposed to heavy infections and that morbidity could be controlled by the treatment of heavily infected individuals only. We have studied the prevalence and intensity of reinfection with the intestinal nematode Ascaris lumbricoides among people living in Dhaka, Bangladesh. 880 people were treated with pyrantel pamoate three times at six month intervals, and on each occasion they collected all their stools for 48 h after treatment. Worms expelled by each subject were counted and weighed. The prevalence of infection at round 1 of treatment was 89% and the mean burden was 18.5 worms. Reinfection was rapid and at rounds 2 and 3 the prevalence was 82% and 80%, respectively, with mean burdens of 14.0 and 11.5 worms. The intensity of reinfection was not random: more subjects than expected became heavily reinfected (greater than or equal to 15 worms) and more subjects than expected remained lightly infected (less than or equal to 14 worms) (p less than 0.001). Worms were highly aggregated at each round of treatment but although just over 10% of all subjects were heavily infected at each and every round of treatment, over 60% of all subjects were heavily infected at least once. The findings show that some individuals seem to be susceptible to heavy infection whereas others are not, that deworming has a greater effect on the intensity of infection than on the prevalence, and that mass chemotherapy is likely to be a more effective means to control morbidity than is selective treatment of heavily infected individuals only.

Albendazole and infections with Trichuris trichiura and Giardia intestinalis.

One hundred and twenty-eight children aged 4 to 11 years old in Dhaka, Bangladesh were treated for infections with Trichuris trichiura and other intestinal parasites using a single dose of 400 mg of albendazole. Only one Trichuris infection was apparently cured although egg counts fell by about 50%. A larger single dosage is recommended to treat Trichuris. Eleven out of 46 infections with Giardia intestinalis were not detected after treatment (p less than 0.001).