Substantial and sustained reduction in under-5 mortality, diarrhea, and pneumonia in Oshikhandass, Pakistan: evidence from two longitudinal cohort studies 15 years apart.

BACKGROUND: Oshikhandass is a rural village in northern Pakistan where a 1989-1991 verbal autopsy study showed that diarrhea and pneumonia were the top causes of under-5 mortality. Intensive surveillance, active community health education and child health interventions were delivered in 1989-1996; here we assess improvements in under-5 mortality, diarrhea, and pneumonia over this period and 15 years later. METHODS: Two prospective open-cohort studies in Oshikhandass from 1989 to 1996 (Study 1) and 2011-2014 (Study 2) enrolled all children under age 60 months. Study staff trained using WHO guidelines, conducted weekly household surveillance and promoted knowledge on causes and management of diarrhea and pneumonia. Information about household characteristics and socioeconomic status was collected. Hurdle models were constructed to examine putative risk factors for diarrhea and pneumonia. RESULTS: Against a backdrop of considerable change in the socioeconomic status of the community, under-5 mortality, which declined over the course of Study 1 (from 114.3 to 79.5 deaths/1000 live births (LB) between 1989 and 1996), exceeded Sustainable Development Goal 3 by Study 2 (19.8 deaths/ 1000 LB). Reductions in diarrhea prevalence (20.3 to 2.2 days/ Child Year [CY]), incidence (2.1 to 0.5 episodes/ CY), and number of bloody diarrhea episodes (18.6 to 5.2%) seen during Study 1, were sustained in Study 2. Pneumonia incidence was 0.5 episodes /CY in Study 1 and 0.2/CY in Study 2; only 5% of episodes were categorized as severe or very severe in both studies. While no individual factors predicted a statistically significant difference in diarrhea or pneumonia episodes, the combined effect of water, toilet and housing materials was associated with a significant decrease in diarrhea; higher household income was the most protective factor for pneumonia in Study 1. CONCLUSIONS: We report a 4-fold decrease in overall childhood mortality, and a 2-fold decrease in childhood morbidity from diarrhea and pneumonia in a remote rural village in Pakistan between 1989 and 2014. We conclude that significant, sustainable improvements in child health may be achieved through improved socioeconomic status and promoting interactions between locally engaged health workers and the community, but that continued efforts are needed to improve health worker training, supervision, and the rational use of medications. TRIAL REGISTRATION: Not Applicable.

Tannin contents and protein digestibility of black grams (Vigna mungo) after soaking and cooking.

The objective of this research was to ascertain the effects of soaking black grams (Cultivar AARI-5732) in different salt solutions at different temperatures and different time periods, and different methods of cooking on the tannin content and protein digestibility. Tannin content of black grams was reduced to various extents by soaking at 30 degrees and 100 degrees C for different time periods. However, soaking at 100 degrees C increased the rate of extraction and reduced the extraction time of tannins. Soaking black grams in water at 100 degrees C reduced tannins by 22.14% in 45 minutes whereas about 2.5 times more tannin was reduced after soaking in sodium bicarbonate solution with or without sodium chloride. Maximum improvement in protein digestibility was also observed after soaking black grams in sodium bicarbonate solution. Tannin contents were further reduced along with improvement in protein digestibility as a result of cooking.

Biochemical changes in wheat during storage at three temperatures.

Biochemical changes in wheat grains stored at 10, 25 and 45 degrees C for six months were studied. A significant decrease in pH and an increase in titratable acidity was observed during storage of wheat grains at 25 degrees C and 45 degrees C. Moisture contents of wheat grains decreased by 15% at 25 degrees C and 26% at 45 degrees C during six months of storage. A significant decrease in water soluble amylose (20-28%) along with an increase in insoluble amylose contents (7.6-17%) were observed during storage at 25 and 45 degrees C. Amylase activity of the samples showed a decrease as the storage progressed. Total soluble sugars increased by 9% at 10 degrees C and 12% at 25 degrees C; a 37% decrease was observed after six months storage at 45 degrees C. Total available lysine decreased by 18.0% and 22.6% at 25 and 45 degrees C, respectively, after six months storage. In vitro protein digestibility of wheat grains decreased by 5.00% at 25 degrees C and 10.28% at 45 degrees C during six months of storage. However, no significant biochemical changes occurred during storage at 10 degrees C.