Intra- and extracellular water dynamics on rehydration in cholera and noncholera patients.

To estimate the intra- and extracellular body water compartments during rehydration of patients with cholera and noncholera diarrhea by bioimpedance analyzer, we studied 30 patients with acute watery diarrhea. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW) of severely dehydrated adult patients were measured with a dual frequency bioimpedance analyzer at different phases of rehydration. Fluid compartments between cholera and noncholera patients were compared. Cholera patients gained more TBW than noncholera patients during recovery. Unlike patients with noncholera diarrhea, the gain in cholera patients was mainly contributed by the ICW (1.5 +/- 1.6 vs 3.0 +/- 1.2 liters, respectively, P < 0.01). It was also observed that the recovery of the ICW compartment in cholera patients occurred rapidly within the first 2 hr after infusion. Differential dynamics of body water compartments in cholera compared to noncholera patients as observed in this study may contribute further to understanding the mechanism of dehydration in diarrheal disease, which might help in improving case management.

Birth kits for safe motherhood in Bangladesh.

Tetanus infection remains the leading cause of high neonatal mortality in Bangladesh. Birth kits which instruct and assist in a clean, safe birth are seen as a key measure in reducing the high incidence of neonatal deaths. A multisectoral programme has developed a simple kit and tested its potential for distribution to pregnant women. Initial results are positive and development is continuing.

PIP: In the late 1980s, the Christian Commission for Development in Bangladesh developed and field tested a simple, affordable birth kit to sell to pregnant women in rural areas. It hoped the kits would reduce neonatal tetanus mortality. Interviews with traditional birth attendants and focus group discussions with women of childbearing age and with men's groups made up the 1st phase. These activities allowed the Commission to decide upon the design, contents, and logo of the birth kits. The bright red and blue box with a logo of a breast-feeding mother contained a plastic bag to protect the contents which included soap, 2 pieces of gauze, a polythene sheet, and the autoclaved items of 3 cord ties and a new razor blade. Pictures on a pretested, folded panel were used to convey directions on how to use the kits. The Commission conducted field trials in 5 rural areas by giving the kits to women in their last month of pregnancy and interviewing them within 1 month of delivery. They tended not to understand that the polythene sheet was to be used as a clean surface. The researchers redesigned the kit accordingly. They conducted more field trials to validate the original results. They also test marketed 3000 prototype kits with a goal of covering 50% of expected births. Each kit retailed for 10 taka. The cost had been as issue, however. 58% of the kits were sold. Most people bought their kits from women's groups. The commission next planned to scale up kit production to meet existing demand. They redesigned the box to reduce costs. They intended to have local women assemble the box which would be 33% cheaper. They proposed to initially limit promotion efforts to posters, pamphlets, and maybe rickshaw broadcasts.

Evaluation of indigenous plants in the treatment of acute shigellosis.

The clinical efficacy of three indigenous plants was compared with that of ampicillin and placebo in a randomized double blind clinical trial. Eighty-two men with shigellosis were studied. Sixteen patients received dried unripe fruit powder of 'bel' (Aegle marmelos), 19 received dried powdered plant of 'thankuni' (Hydrocotyle asiatica), 15 received a similar preparation of 'gandhavadulia' (Paederia foetida), 15 received ampicillin and 17 received a placebo. Treatment with indigenous plants did not show any clinical improvement or bacteriological cure as compared to ampicillin. The natural history of shigellosis was obtained by documenting the response of the indigenous plants and placebo treated groups.

The impact of training traditional birth attendants in improving MCH care in rural Bangladesh.

This study evaluates the impact of training in changing the knowledge and practices of traditional birth attendants (TBAs) with regard to antenatal, intranatal and postnatal care of mothers and newborn babies. Training has improved the quality of their care. Most TBAs (71.2%) had traditional beliefs as to the cause of neonatal sickness, and training has led them to change their beliefs in favour of infection. Prior to training, a majority (58%) of the TBAs never used to make antenatal visits, while after training 72% of them began making such visits. They also have learned the importance of antiseptic measures during delivery. Training also has helped to eliminate harmful practices such as septic abortion.

Comparative efficacies of pivmecillinam and ampicillin in acute shigellosis.

The clinical efficacies of pivmecillinam and ampicillin were compared in a randomized double-blind trial in the treatment of acute shigellosis. Of 44 adult male patients, all culture positive for Shigella strains, 22 patients received 400 mg of pivmecillinam and 22 patients received 500 mg of ampicillin every 6 h. Both drugs were administered orally for 5 days. Four patients receiving ampicillin were infected with Shigella strains that were resistant to ampicillin but susceptible to pivmecillinam, and two patients receiving pivmecillinam were infected with Shigella strains resistant to both ampicillin and pivmecillinam. The mean duration of diarrhea in all patients receiving pivmecillinam was 3.3 days compared with 4.5 days in patients receiving ampicillin (P less than 0.05). When patients infected with the resistant strains were excluded, the mean duration of diarrhea in patients receiving pivmecillinam was 3.2 days compared with 4.1 days in patients receiving ampicillin. The patients infected with strains susceptible to both antibiotics had mean durations of fecal excretion of Shigella strains of 1.2 days for those treated with pivmecillinam and 1.4 days for those treated with ampicillin. The patients infected with organisms resistant to both drugs had longer durations of diarrhea and fecal excretion of Shigella strains. The results suggest that pivmecillinam is as effective as ampicillin and can be a useful drug for the treatment of shigellosis.