Down-regulation of abaI, abaR, Bap and OmpA genes in Acinetobacter baumannii by ethanol extract of Glycyrrhiza glabra after toxicity assessment.

Acinetobacter baumannii is a pathogen that has caused rising concerns within healthcare facilities in recent years. As antibiotic overuse and resistance rise, natural remedies with the potential have received attention as antibiotics that might have fewer side effects and lower resistance. Glycyrrhiza glabra was used to investigate its effects on A. baumannii's quorum sensing and biofilm production abilities. In this study, the toxicity assessment of Glycyrrhiza glabra L. extract on rats, the phytochemical analysis and the quantitative measurement for the association of the biofilm reduction with the active components in the plant was determined. The results indicated ciprofloxacin and gentamicin were the most effective antibiotics and that various capabilities of biofilm-productions were demonstrated, only four percent of the samples established robust biofilm, while 40% to 56% demonstrated weak to moderate biofilm production, respectively. Phytochemical qualitative testing of ethanol leaf extracts from Glycyrrhiza glabra showed the existence of flavonoids, alkaloids, phenolic, tannic acid, and terpenoids, but no saponins. Assessment of toxicity revealed a low hazard, with an LD50 of 4.95 g/Kg. Our results showed that the extract's SICs elucidated a substantial quantitative decrease in biofilm production by the bacterial isolates, including the reference ATCC strain, which is known to be a potent biofilm producer. As a conclusion, biofilm creation in Acinetobacter baumannii has been shown to be greatly reduced by G. glabra extract.

Corrigendum to "Diets of Men and Women in Rural Bangladesh are Equitable but Suboptimal" [Current Developments in Nutrition (2023), Volume 7, Issue 7].

[This corrects the article DOI: 10.1016/j.cdnut.2023.100107.].

Comparing delivery channels to promote nutrition-sensitive agriculture: A cluster-randomized controlled trial in Bangladesh.

We use a randomized controlled trial in rural Bangladesh to compare two models of delivering nutrition content jointly to husbands and wives: deploying female nutrition workers versus mostly male agriculture extension workers. Both approaches increased nutrition knowledge of men and women, household and individual diet quality, and women's empowerment. Intervention effects on agriculture and nutrition knowledge, agricultural production diversity, dietary diversity, women's empowerment, and gender parity do not significantly differ between models where nutrition workers versus agriculture extension workers provide the training. The exception is in an attitudes score, where results indicate same-sex agents may affect scores differently than opposite-sex agents. Our results suggest opposite-sex agents may not necessarily be less effective in providing training. In South Asia, where agricultural extension systems and the pipeline to those systems are male-dominated, training men to deliver nutrition messages may offer a temporary solution to the shortage of female extension workers and offer opportunities to scale and promote nutrition-sensitive agriculture. However, in both models, we find evidence that the presence of mothers-in-law within households modifies the programs' effectiveness on some nutrition, empowerment, and attitude measures, suggesting that accounting for other influential household members is a potential area for future programming.

Diets of Men and Women in Rural Bangladesh Are Equitable but Suboptimal.

Background: Recent evidence suggests that diet inequities between men and women may have diminished within rural Bangladeshi households. However, this has not been directly tested with appropriate physiologic adjustments and it is unclear whether changes have occurred across socioeconomic strata. Understanding intrahousehold dietary patterns at different points on the income and food-security distribution in rural Bangladesh-particularly, within ultrapoor and farm households-is important for appropriate design of gender-sensitive and nutrition-sensitive interventions, which often target these groups. Objective: Using 2012 and 2016 data, we aimed to examine gender differences in diet quantity and quality among ultrapoor and farm households in rural Bangladesh. Methods: The study used baseline 24-h dietary data from 2 randomized control trials conducted in rural Bangladesh: the Transfer Modality Research Initiative (ultrapoor households) and the Agriculture, Nutrition, and Gender Linkages project (farm households). Ordinary least squares regressions with household-level fixed effects tested for gender differences among constructed diet measures, such as caloric intake, caloric adequacy ratio, dietary diversity score, global diet quality score, and probability of consuming moderate or high levels of healthy food groups. Results: In both samples, on average, women consumed fewer calories than men in the same households but consumed near equal or more in reference to their caloric needs. Women scored <1% lower than men on diet quality indicators and showed similar probabilities to men of consuming healthy foods. Most men and women in both samples were calorically inadequate (>60%) and recorded poor diet quality scores that indicated high risk of nutrient inadequacy and chronic disease (>95%). Conclusions: In both ultrapoor and farm households, although men record higher intake quantities and diet quality scores, the apparent male advantage disappear when energy requirements and the magnitudes of difference are considered. Diets of men and women in these rural Bangladeshi households are equitable but suboptimal.

Rhus coriaria extracts inhibit quorum sensing-related virulence and biofilm production in drug-resistant Pseudomonas aeruginosa recovered from burn wounds.

Objectives: Numerous studies have confirmed sumac's ability to inhibit pathogens and even eradicate chronic drug-resistant infections. Current research was conducted to demonstrate the action of various sumac extracts at sub-inhibitory concentrations in modulating pathogen-related characteristics instead of killing them. Materials and Methods: The influence of sumac extracts on the quorum sensing dependent virulence of multidrug-resistant isolates of Pseudomonas aeruginosa recovered from burn wounds was considered by detecting the effect on biofilm development, various virulence factors, and expression of bacterial exotoxin A and quorum sensing related genes. Results: Experiments to characterize and measure sumac extract's impact on the P. aeruginosa growth, biofilm, exoproteases, pyocyanin, motility, and the quorum sensing networks revealed that all studied characteristics were reduced by concentrations below inhibition without affecting bacterial growth. Furthermore, the expression of exotoxin A, rhl, and las glucons was declined or even inhibited by lower levels of sumac fruit fractions. Conclusion: The findings revealed that sumac fights infections either by its inhibitory effect on the bacterial cells or by reducing bacterial signaling and virulence by disruption of the bacterial signal system.

Trends and Inequities in Food, Energy, Protein, Fat, and Carbohydrate Intakes in Rural Bangladesh.

BACKGROUND: Tracking dietary changes can inform strategies to improve nutrition, yet there is limited evidence on food consumption patterns and how disparities in food and nutrient intakes have changed in Bangladesh. OBJECTIVES: We assessed trends and adequacies in energy and macronutrient intakes and evaluated changes in inequities by age group, sex, and expenditure quintile. METHODS: We used panel data from the 2011 and 2018 Bangladesh Integrated Household Survey (n = 20,339 and 19,818 household members aged ≥2 y, respectively). Dietary intakes were collected using 24-h recall and food-weighing methods. Changes in energy and macronutrient intakes were assessed using generalized linear models and adjusted Wald tests. Inequities in outcomes were examined by age group, sex, and expenditure quintile using the Slope Index of Inequality and Concentration Index. RESULTS: Between 2011 and 2018, dietary diversity improved across sex and age groups (30-46% in children, 60-65% in adolescents, 37-87% in adults), but diets remain imbalanced with ∼70% of energy coming from carbohydrates. There were declines in intakes of energy (3-8%), protein (3-9%), and carbohydrate (9-16%) for all age groups (except children aged 2-5 y), but an increase in fat intake (57-68% in children and 22-40% in adults). Insufficient intake remained high for protein (>50% among adults) and fat (>80%), whereas excessive carbohydrate intake was >70%. Insufficient energy, protein, and fat intakes, and excessive carbohydrate intakes, were more prevalent among poor households across survey years. Inequity gaps decreased for insufficient energy intake in most age groups, remained stable for insufficient protein intake, and increased for insufficient fat and excessive carbohydrate intakes. CONCLUSIONS: Despite improvements in dietary diversity, diets remain imbalanced and inequities in insufficient energy, protein, and fat intakes persist. Our findings call for coherent sets of policies and investments toward a well-functioning food system and social protection to promote healthier, more equitable diets in rural Bangladesh.

Designing for empowerment impact in agricultural development projects: Experimental evidence from the Agriculture, Nutrition, and Gender Linkages (ANGeL) project in Bangladesh.

The importance of women's roles for nutrition-sensitive agricultural projects is increasingly recognized, yet little is known about whether such projects improve women's empowerment and gender equality. We study the Agriculture, Nutrition, and Gender Linkages (ANGeL) pilot project, which was implemented as a cluster-randomized controlled trial by the Government of Bangladesh. The project's treatment arms included agricultural training, nutrition behavior change communication (BCC), and gender sensitization trainings delivered to husbands and wives together - with these components combined additively, such that the impact of gender sensitization could be distinguished from that of agriculture and nutrition trainings. Empowerment was measured using the internationally-validated project-level Women's Empowerment in Agriculture Index (pro-WEAI), and attitudes regarding gender roles were elicited from both men and women, to explore potentially gender-transformative impacts. Our study finds that ANGeL increased both women's and men's empowerment, raised the prevalence of households achieving gender parity, and led to small improvements in the gender attitudes of both women and men. We find significant increases in women's empowerment scores and empowerment status from all treatment arms but with no significant differences across these. We find no evidence of unintended impacts on workloads and inconclusive evidence around impacts on intimate partner violence. Our results also suggest some potential benefits of bundling nutrition and gender components with an agricultural development intervention; however, many of these benefits seem to be driven by bundling nutrition with agriculture. While we cannot assess the extent to which including men and women within the same treatment arms contributed to our results, it is plausible that the positive impacts of all treatment arms on women's empowerment outcomes may have arisen from implementation modalities that provided information to both husbands and wives when they were together. The role of engaging men and women jointly in interventions is a promising area for future research.

Adolescent birth and child undernutrition: an analysis of demographic and health surveys in Bangladesh, 1996-2017.

Adolescent birth is a major global concern owing to its adverse effects on maternal and child health. We assessed trends in adolescent birth and examined its associations with child undernutrition in Bangladesh using data from seven rounds of Demographic and Health Surveys (1996-2017, n = 12,006 primiparous women with living children <5 years old). Adolescent birth (10-19 years old) declined slowly, from 84% in 1996 to 71% in 2017. Compared with adult mothers (≥20 years old), young adolescent mothers (10-15 years old) were more likely to be underweight (+11 pp), have lower education (-24 pp), have less decision-making power (-10 pp), live in poorer households (-0.9 SD) with poorer sanitation (-15 pp), and have poorer feeding practices (10 pp), and were less likely to access health and nutrition services (-3 to -24 pp). In multivariable regressions controlled for known determinants of child undernutrition, children born to adolescents had lower height-for-age Z-scores (-0.29 SD for young and -0.10 SD for old adolescents (16-19 years old)), weight-for-age Z-score (-0.18 and -0.06 SD, respectively) as well as higher stunting (5.9 pp) and underweight (6.0 pp) than those born to adults. In conclusion, birth during adolescence, a common occurrence in Bangladesh, is associated with child undernutrition. Policies and programs to address poverty and improve women's education can help delay marriage, reduce early childbearing, and improve child growth.

Randomized controlled trials of multi-sectoral programs: Lessons from development research.

Development is a multi-faceted process; achieving development goals thus requires a multi-sectoral approach. For over two decades, our research group of economists and nutritionists has designed and implemented randomized trials to assess the effectiveness of multisectoral programs in improving nutrition, food security, and other measures of well-being, largely at the request of developing country governments, development partners, and non-governmental organizations. Our approach addresses three perceived pitfalls of RCTs: the "black box" nature of RCTs, limited external validity, and challenges in translation of results to impacts at scale. We address these concerns by identifying and assessing programmatic pathways to impact with quantitative and qualitative methods; studying similar programs implemented by different organizations across various settings; and working closely with implementing partners in the design, research, and dissemination processes to inform adaptation and scale-up of programs and policies.

Quercus infectoria gall extracts reduce quorum sensing-controlled virulence factors production and biofilm formation in Pseudomonas aeruginosa recovered from burn wounds.

BACKGROUND: Quercus gall extracts' ability to kill pathogens in vitro and even removal of chronic drug-resistant infections has been reported by several studies. The current investigation is focused on the action of extracts of Quercus infectoria gall in their sub-inhibitory concentrations on the corresponding bacterial behaviours instead of killing them. METHODS: The effect of gall extracts on the quorum sensing (QS) associated virulence of multiple drug resistant Pseudomonas aeruginosa recovered from burns wounds was studied. The influence of different extracts on the production of bacterial virulence and biofilm, and expression of the genes encoding quorum sensing and exotoxin A were investigated. Quorum sensing is a crucial regulator of virulence and biofilm development in Pseudomonas aeruginosa and other medical related microbes. RESULTS: Experiments to characterise and quantify Q. infectoria gall extracts impact on the quorum sensing networks of P.aeruginosa revealed that the expression of las, rhl, and exotoxin A (ETA) genes levels including the associated virulence were reduced by the extracts at their subinhibitory concentrations. CONCLUSIONS: The obtained results indicated that extracts of Q. infectoria galls fight infections either by their inhibitory constituents, which vigorously eradicate cells or by disruption of the pathogens quorum sensing system through weakening the virulence and bacterial coordination.

Low concentrations of local honey modulate Exotoxin A expression, and quorum sensing related virulence in drug-resistant Pseudomonas aeruginosa recovered from infected burn wounds.

OBJECTIVES: Honey's ability to kill microorganisms and even eradication of chronic infections with drug-resistant pathogens has been documented by numerous studies. The present study is focused on the action of honey in its sub-inhibitory levels to impact on the pathogens coordinated behaviors rather than killing them. MATERIALS AND METHODS: The impact of local honey on the quorum sensing related virulence of multidrug resistant Pseudomonas aeruginosa burn isolates was investigated by detection its effect on the virulence, biofilm formation and expression of quorum sensing related and exotoxin A genes. RESULTS: Experiments to characterise and quantify the impact of honey on the P. aeruginosa quorum sensing networks showed that the expression of exotoxin A ( ETA), las and rhl glucons reduced by low concentrations of honey including the associated virulence factors. CONCLUSION: Our results indicated that honey fights infections either by its bactericidal components which vigorously kill cells or by weakening bacterial coordination and virulence through interruption of quorum sensing system.

Randomized control trials demonstrate that nutrition-sensitive social protection interventions increase the use of multiple-micronutrient powders and iron supplements in rural pre-school Bangladeshi children.

OBJECTIVE: To examine the impact of a nutrition-sensitive social protection intervention on mothers' knowledge of Fe deficiency, awareness of multiple-micronutrient powders (MMP) and the consumption of MMP and other Fe supplements by their children aged 6-59 months. DESIGN: Two randomized controlled trials with treatment arms including cash transfers, food transfers, cash and food transfers, cash and nutrition behaviour change communication (BCC), and food and nutrition BCC were implemented over two years. Both included a control group that received no transfer or BCC. Transfer recipients were mothers living in poor households with at least one child aged less than 2 years at baseline. Probit models were used to analyse endline data. SETTING: Rural areas in north-west and south Bangladesh. SUBJECTS: Mothers (n 4840) and children 6-59 months (n 4840). RESULTS: A transfer accompanied by nutrition BCC increased the share of mothers with knowledge of Fe deficiency (11·9 and 9·2 percentage points for North and South, respectively, P≤0·01), maternal awareness of MMP (29·0 and 22·2 percentage points, P≤0·01), the likelihood that their children 6-59 months had ever consumed MMP (32 and 11·9 percentage points, P≤0·01), consumed MMP in the preceding week (16·9 and 3·9 percentage points, P≤0·01) and consumed either MMP or an Fe supplement in the preceding week (22·3 and 7·1 percentage points, P≤0·01). Improvements were statistically significant relative to groups that received a transfer only. CONCLUSIONS: Nutrition-sensitive social protection (transfers with BCC added) may be a promising way to advance progress on micronutrient deficiencies.

Understanding the determinants of adolescent nutrition in Bangladesh.

Evidence on the nutritional status and diets of adolescents in low- and middle-income countries is scant. We characterized the nutritional status (body mass index Z-scores (BMIZs)) and nutrient intakes of adolescent boys and girls in rural areas in Bangladesh using the 2011-2012 BIHS data, used regression models to identify the socioeconomic determinants of these outcomes, and household fixed effects models to assess whether the gap between boys and girls changed with women's education and empowerment and household wealth. The adolescents' BMIZ and adequacy of their nutrient intakes were suboptimal. Gender differences varied by outcome and were not systematically in favor of boys. Household wealth was associated with higher BMIZ and probability of adequate energy and micronutrient intakes. Women's education and empowerment were mostly not associated with the study outcomes and did not modify gender differences. There is an urgent need to invest in improving the diets of adolescent boys and girls in Bangladesh. The limited role of women's education and empowerment in improving adolescent nutrition suggests that resources may be too constrained. It may also reflect deeply rooted beliefs about adolescent nutrition and differences between boys and girls that would need to be addressed to improve their nutrition.

Nutrition behaviour change communication causes sustained effects on IYCN knowledge in two cluster-randomised trials in Bangladesh.

Behaviour change communication (BCC) can improve infant and young child nutrition (IYCN) knowledge, practices, and health outcomes. However, few studies have examined whether the improved knowledge persists after BCC activities end. This paper assesses the effect of nutrition sensitive social protection interventions on IYCN knowledge in rural Bangladesh, both during and after intervention activities. We use data from two, 2-year, cluster randomised control trials that included nutrition BCC in some treatment arms. These data were collected at intervention baseline, midline, and endline, and 6-10 months after the intervention ended. We analyse data on IYCN knowledge from the same 2,341 women over these 4 survey rounds. We construct a number correct score on 18 IYCN knowledge questions and assess whether the impact of the BCC changes over time for the different treatment groups. Effects are estimated using ordinary least squares accounting for the clustered design of the study. There are 3 main findings: First, the BCC improves IYCN knowledge substantially in the 1st year of the intervention; participants correctly answer 3.0-3.2 more questions (36% more) compared to the non-BCC groups. Second, the increase in knowledge between the 1st and 2nd year was smaller, an additional 0.7-0.9 correct answers. Third, knowledge persists; there are no significant decreases in IYCN knowledge 6-10 months after nutrition BCC activities ended.

Behavior change communication activities improve infant and young child nutrition knowledge and practice of neighboring non-participants in a cluster-randomized trial in rural Bangladesh.

OBJECTIVE: To examine the impact on infant and young child nutrition knowledge and practice of mothers who were neighbors of mothers participating in a nutrition Behavior Change Communication (BCC) intervention in rural Bangladesh. METHODS: We analyzed data from 300 mothers whose neighbor participated in a nutrition BCC intervention and 600 mothers whose neighbor participated in an intervention that did not include BCC. We constructed measures capturing mothers' knowledge of infant and young child nutrition (IYCN) and measures of food consumption by children 6-24m. The effect on these outcomes of exposure to a neighbor receiving a nutrition BCC intervention was estimated using ordinary least squares and probit regressions. The study was registered with ClinicalTrials.gov (Study ID: NCT02237144). RESULTS: Having a neighboring mother participate in a nutrition BCC intervention increased non-participant mothers' IYCN knowledge by 0.17 SD (translating to 0.3 more correct answers). They were 14.1 percentage points more likely to feed their 6-24m children legumes and nuts; 11.6 percentage points more likely to feed these children vitamin A rich fruits and vegetables; and 10.0 percentage points more likely to feed these children eggs. Children of non-participant mothers who had a neighboring mother participate in a nutrition BCC intervention were 13.8 percentage points more likely to meet World Health Organization (WHO) guidelines for minimum diet diversity, 11.9 percentage points more likely to meet WHO guidelines for minimum acceptable diet, and 10.3 percentage points more likely to meet WHO guidelines for minimum meal frequency for children who continue to be breastfed after age 6m. Children aged 0-6m of non-participant mothers who are neighbors of mothers receiving BCC were 7.1 percentage points less likely to have ever consumed water-based liquids. CONCLUSIONS: Studies of nutrition BCC that do not account for information spillovers to non-participants may underestimate its benefits in terms of IYCN knowledge and practice.