Impact of introduction of the Haemophilus influenzae type b conjugate vaccine into childhood immunization on meningitis in Bangladeshi infants.

OBJECTIVES: Some Asian countries have been reluctant to adopt Haemophilus influenzae type b (Hib) conjugate vaccination because of uncertainty over disease burden. We assessed the impact of introduction of Hib conjugate vaccine into the Expanded Program on Immunization in Bangladesh on purulent and laboratory-confirmed H influenzae meningitis. STUDY DESIGN: Within a well-defined catchment area around 2 surveillance hospitals in Dhaka, Bangladesh, we compared the incidence of Hib meningitis confirmed by culture, latex agglutination, and polymerase chain reaction assay among infants 1 year before and 1 year after introduction of Hib conjugate vaccine. We adjusted the incidence rate for the proportion of children who sought care at the surveillance hospitals. RESULTS: Among infants, the incidence of confirmed Hib meningitis decreased from 92-16 cases per 100,000 within 1 year of vaccine introduction (vaccine preventable incidence = 76; 95% CI 18, 135 per 100,000). The incidence of purulent meningitis decreased from 1659-1159 per 100,000 (vaccine preventable incidence = 500; 95% CI: 203, 799 per 100,000). During the same time period, there was no significant difference in the incidence of meningitis due to Streptococcus pneumoniae. CONCLUSIONS: Introduction of conjugate Hib conjugate vaccine into Bangladesh Expanded Program on Immunization markedly reduced the burden of Hib and purulent meningitis.

Effect of supplementation of mustard oil cake on intake, digestibility and microbial protein synthesis of cattle in a straw-based diet in Bangladesh.

The objective of this study was to analyse the effects of different levels of rumen-degradable protein (RDP) on intake, digestibility and microbial protein synthesis by supplementing mustard oil cake (MOC) on rice straw-based diet of cattle (Bos indicus) in Bangladesh. A 4 × 4 Latin square design was applied. Four diets having constant energy (7.0 MJ/kg of dry matter (DM)) with varying levels of RDP (M(0) = 4.1 g/MJ (control), M(1) = 6.3 g/MJ, M(2) = 8.3 g/MJ and M(3) = 12.4 g/MJ of metabolizable energy (ME)) were received by each animal for a period of 28 days. A metabolism trial was conducted for 7 days. Results indicate that with increasing levels of RDP, crude protein (CP) and RDP intake increased significantly (P < 0.01). The significant (P < 0.01) increase in digestibility values are obtained for DM, organic matter, CP and digestible organic matter in the rumen. The digestibility of neutral detergent fibre and acid detergent fibre was also increased significantly (P < 0.05). The total nitrogen (N), ammonia-N and total volatile fatty acids increase significantly (P < 0.01) while the rumen pH increased from M(0) to M(2) and decreased thereafter. The efficiency microbial N intake increased significantly (P < 0.01) but showed a curvilinear response with higher RDP level (12.40 g/RDP/MJ ME). This study concludes that supplementation of RDP from MOC enhances the intake, digestibility and microbial protein synthesis which ultimately increases utilization of low-quality feed resources that can be used for developing cost-effective feeding systems on a straw-based diet in tropical regions.

Task-sharing in menstrual regulation services: Implementation efforts and lessons learned in Bangladesh.

OBJECTIVE: To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician providers in Bangladesh. METHODS: We conducted a desk review of relevant policies and health service information from grey and published literature on task-sharing in menstrual regulation services, plus stakeholder interviews with 19 representatives of relevant health organizations to investigate facilitators for and barriers to the implementation of task-sharing of these services. RESULTS: Task-sharing in menstrual regulation began in 1979 as part of the national family planning program. The Ministry of Health and Family Welfare has guidelines for menstrual regulation services provided by a wide range of healthcare workers using manual vacuum aspiration and the medications misoprostol and mifepristone. Despite government approval, implementation of task-sharing is challenging owing to lack of skilled providers, lack of facility readiness, and unmet need for family planning. CONCLUSION: The government needs to implement effective planning for skills building of nonphysician providers and ensuring facility readiness for provision of menstrual regulation services to reduce unsafe abortion in Bangladesh.

Clinicopathological features of lupus anticoagulant; experience at AFIP during last seven years.

BACKGROUND: The lupus anticoagulant (LA) belongs to family of immunoglobulins, most commonly an IgG isotype. These antibodies have been identified most frequently in association with thromboembolic events, recurrent fetal loss and thrombocytopenia. The aim of the present study was to evaluate the presenting clinical and pathological features in patients LA positive presenting at AFIP Rawalpindi over the period of Jan 1993 to Nov 2000. MATERIAL/METHODS: Retrospective analysis of patients presenting with positive LA was carried out. RESULTS: 1583 suspected cases were screened for LA including 1370 females and 213 males. 1024 cases presented with history of recurrent abortions, 292 with thrombosis, 152 with thrombotic strokes before the age of 45 years, 52 with thrombocytopenia and 63 with miscellaneous disorders. Out of 1024 patients tested for recurrent abortions, 130 (13%) females were positive for lupus anticoagulant. Ten (6.5%) of 152 patients presenting with strokes were found positive. Out of 292 cases presenting with thrombosis 17 (5.9%) were found positive. CONCLUSIONS: The lupus anticoagulant prevalence in Pakistani patients with recurrent fetal loss, stroke and thrombosis is statistically significant. Clinicians should be made aware of association of LA with various diseases. The successful management of these patients depends upon close liaison with obstetricians, physicians and haematologists.