Analysis of the childhood fatal drowning situation in Bangladesh: exploring prevention measures for low-income countries.

OBJECTIVE: To determine the epidemiology of child drowning in order to propose possible interventions for Bangladesh and other similar low-income countries. DESIGN: Population-based cross-sectional study. SETTING: Rural and urban communities in Bangladesh. SUBJECTS: About 352,000 children 0-17 years were selected from over 171,000 households, using multistage cluster sampling. MAIN OUTCOME MEASURES: Incidence of fatal drowning. RESULTS: Drowning was the leading cause of death (28.6 per 100,000 child-years) in children aged 1-17 years. The highest incidence (86.3 per 100,000 child-years) was in children aged 1-4 years. More than two-thirds of drownings occurred in ponds and ditches. Most drownings (85%) happened in daylight. In more than one-third of cases of drowning, the child was alone. In the two-thirds of cases in which the child was accompanied, almost half were with children who were 10 years or below. Only 7% of drowned children over 4 years of age knew how to swim. CONCLUSIONS: Drowning is a major cause of childhood mortality in Bangladesh. Creating drowning-safe homes, improving supervision of children, modifying the environment, and developing water safety skills for children and the community may be effective interventions for drowning prevention.

Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh.

In terms of mortality, morbidity and disability, burns are emerging as a major child health problem in Bangladesh. This trend is similar to many other developing countries. To develop effective burn prevention programmes, information on its magnitude and determinants is necessary. The purpose of this study was to document the magnitude and determinant of childhood burns in Bangladesh, based on a population-based survey which was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. To facilitate data collection, face-to-face interviews were conducted. The rate of non-fatal burn among children under 18 years of age was calculated as 288.1 per 100,000 children-year. The highest incidence (782.1/100,000 children-year) was found among the 1-4 years age group. About 46% of non-fatal burn injuries occurred between 9 a.m. and 3 p.m. The incidence of childhood burn was found to be more than four times higher in rural children than urban children. Ninety percent (90%) of the childhood burns occurred at homes and the kitchen was the most common place. The rate of disability due to burn was 5.7 per 100,000 children per year. The rate of fatal burn was 0.6 per 100,000 per year among all children. The study findings confirmed that childhood burn was a major childhood illness in Bangladesh. An urgent and appropriate prevention programme is required to prevent these unwanted morbidities, disabilities and deaths due to burn.

A case of human ehrlichiosis acquired in Mali: clinical and laboratory findings.

We report on the clinical, epidemiologic, and laboratory characteristics of the first case of human ehrlichiosis acquired outside the United States caused by an Ehrlichia sp. other than E. sennetsu. The patient, a 24-year-old woman, presumably acquired the infection in Mali in northern Africa; the diagnosis was made when she returned to North America. The patient reported a fever and diarrhea a week before she left Mali; the diarrhea resolved, but the fever and chills continued. She also reported intermittent tingling in both hands and feet and muscle discomfort. Her temperature was 37.8 degrees C and her pulse rate was 100 per minute. She had two erythematous maculopapules (0.5 x 0.7 mm) on her thigh and ankle that resembled infected insect bites. Her hemoglobin level was 148 g/l with normal indices, and her white blood cell count was 10, 500/mm3 with many atypical lymphocytes and platelets. This report is intended to increase physicians' awareness of ehrlichiosis in foreign travelers and other patients, and suggests the need for further research to determine the prevalence and distribution of this disease.

Case-control study of risk factors associated with nosocomial Salmonella krefeld infection in dogs.

In a case-control study of risk factors associated with an episode of nosocomial Salmonella krefeld infection in dogs at the veterinary medical teaching hospital, data on 20 case dogs and 75 control dogs were obtained by review of hospital records. Univariate and multivariate statistical analyses were carried out for possible risk factors for infection to obtain odds of Salmonella krefeld isolation, given exposure to each risk factor of interest. Compared with control dogs, case dogs were 11.9 times more likely to have been fed rice, 7 times more likely to have had radiography done, 10.2 times more likely to have been a resident in ward 2, 5.6 times more likely to have been given antimicrobial agents orally, 11.3 times more likely to have been given antimicrobial agents parenterally, and 37.9 times more likely to have been given antimicrobial agents orally and parenterally (P less than 0.05).

Rabies surveillance in the United States during 1990.

In 1990, the United States and its territories reported 4,881 cases of rabies in animals to the Centers for Disease Control, a 1.5% increase from 1989. Of these, 553 were domestic animals, 4,327 were wild animals, and one was a human being. Pennsylvania reported the highest number (611) of rabies cases in animals in 1990. For the first time since surveillance of rabies in wild animals was begun in the 1950s, the number of cases of rabies in raccoons exceeded that in skunks. Particularly large increases of cases of rabies in wild and domestic animals were reported in New Jersey (469 cases in 1990 compared with 50 cases in 1989, an increase of 838% from 1989) and New York (242 cases in 1990 compared with 54 cases in 1989, an increase of 348%). The 1,821 cases of rabies in raccoons represented a 17.9% increase over those reported in 1989 and 24.5% over those in 1988. This increase was largely attributable to the larger number of rabid raccoons in New Jersey and New York. Other states that reported an increased number of rabies cases in animals in 1990 included Utah (77.8%), Louisiana (64.7%), North Dakota (60.3%), Arizona (28.6%), Oklahoma (27.5%), Delaware (22.2%), and Maryland (20.6%). Thirty states reported a decrease in the number of cases of rabies in animals.

Benefits and costs of using an orally absorbed vaccine to control rabies in raccoons.

In November 1989, the epizootic of rabies affecting raccoons in the mid-Atlantic states reached New Jersey. An economic evaluation was conducted in 2 counties first affected by the epizootic to estimate the costs of the epizootic and to assess the costs and benefits of orally administering a newly developed recombinant rabies vaccine to prevent further spread of the disease. Data on expenditures associated with prevention of rabies in human beings and domestic animals and laboratory testing of suspect animals were collected and analyzed for 1988 (before the epizootic) and 1990 (first full year of the epizootic). Benefit-cost ratios were calculated and used to evaluate the economic advisability of the vaccine at various vaccination program alternatives. Two indices of capital investment analysis, payback period and net present value, were used to evaluate the economic benefits of the rabies vaccine. Expenditures were estimated to be $1,952,014 in 1990 (primarily for pet animal vaccinations), compared with $768,488 in 1988. Benefit-cost ratios ranged from 2.21 for the most expensive vaccination program alternative to 6.80 for the least expensive alternative. The payback period varied from 0.69 to 2.11 years, and the net present value ranged from $2,105,453 to $4,877,452. The high costs of this epizootic necessitated the reallocation of scarce public health resources to various rabies prevention activities, particularly the vaccination of dogs. This study also demonstrated the usefulness of benefit-cost analysis in developing public health strategies. Although the mass application of this recombinant vaccine was found to be economically beneficial, other qualitative considerations must be used to supplement these findings.

The use of the enzyme-linked immunosorbent assay (ELISA) in serological diagnosis of Mycoplasma bovis in dairy cattle.

Between December 1985 and March 1987 an enzyme-linked immunosorbent assay (ELISA) was used with 3774 sera to estimate the prevalence of antibodies to Mycoplasma bovis in sera from three age groups of cattle in four dairies in California and to test for possible associations between the presence of M. bovis antibodies and the age or breed of the cattle and the farm. Unadjusted and adjusted associations were evaluated using the chi-square test for associations and multiple logistic regression analysis, respectively. There was a tendency for the proportion of cattle seropositive for M. bovis to increase steadily and approximately linearly with age (p less than 0.05). There was also a statistically significant relationship between a M. bovis seropositive test and being from Farm IV (p less than 0.05). Farm IV was the largest of the four dairies and this association may be due to the effect of herd size. These findings confirm the ubiquitous distribution of antibodies to M. bovis in dairy cattle in California and also support previous reports of herd size as an important factor in mycoplasmal mastitis.

A cross-sectional study of bluetongue virus and Mycoplasma bovis infections in dairy cattle: I. The association between a positive antibody response and production efficiency.

In a cross-sectional study of bluetongue virus (BTV) and Mycoplasma bovis (M. bovis) infections, a sample of 572 California dairy cows was tested for the presence of antibodies to answer the question: Is it possible to identify and to assess quantitatively the associations between positive antibody test and production? Serum samples collected from these cows during December 1986 were tested for the presence of antibodies to BTV and M. bovis using the enzyme-linked immunosorbent assay (ELISA). Data on milk production were extracted from individual cow sheets of the California Dairy Herd Improvement Association (DHIA) record-keeping system and interfaced with percentage ELISA results for analysis. Univariate and multivariate statistical analyses, using the chi 2 test for categorical variables or Student's t-test for continuous variables and multiple logistic regression respectively, were carried out to evaluate for possible associations between positive antibody tests to each agent and each production variable of interest. Complete data on all variables studied were obtained for 289 (50.5%) cows for M. bovis and 423 (74%) cows for BTV. For cows with complete data on all variables, estimates of the point prevalence of antibodies to BTV and M. bovis were 70.5% and 66.1%, respectively. Results of this study indicated that Guernsey cows were more likely to have a positive BTV test than Holstein cows and that cows in higher lactations were more likely to test positive to BTV ELISA than those in lower lactations (p less than 0.05). Because all cows except those on one farm were Holstein, our confidence in the effect of breed is limited. The association between lactation number and BTV seropositive test may be an age factor identified earlier in the study. For M. bovis, the results of the analysis indicated that seropositive cows were more likely to produce less milk, on a mature equivalent basis (ORadj = 0.96, p = 0.034), and that they had less extended 305 day milk production potential (ORadj = 0.90, p less than 0.0001) than seronegative cows.

A cross-sectional study of bluetongue virus and Mycoplasma bovis infections in dairy cattle: II. The association between a positive antibody response and reproduction performance.

In a cross-sectional study to determine the possible relationship between a positive antibody test to bluetongue virus (BTV) or Mycoplasma bovis infections and reproductive performance of dairy cows, data were collected on 572 California dairy cows during December 1986 for analysis. Serum samples were tested using an enzyme-linked immunosorbent assay (ELISA). Data on reproduction variables were extracted from the individual cow sheets of the California Dairy Herd Improvement Association records and interfaced with the serological results for analysis. Similar data analyses for both BTV and M. bovis were performed to identify and quantitatively assess the association of the reproduction variables and each agent. These associations were evaluated unconditionally using the chi 2 for categorical variables and Student's t-test for continuous variables. Logistic regression analysis was used to determine if reproduction variables with significant unconditional associations remained significant when adjusted for the effects of possible confounding factors. Both the BTV and M. bovis ELISA antibody titres indicated exposure to the agents. The results of the multiple logistic regression analyses indicated that cows seropositive for BTV were significantly older at first calving (p less than 0.03). For M. bovis, seropositive cows were more likely to have longer intervals from calving to last service and longer intervals from calving to pregnancy diagnosis than seronegative cows (p less than 0.05). The other reproduction variables examined were not significantly associated with ELISA seropositivity.

A seroepidemiological study on bluetongue virus in dairy cattle in the central valley of California.

A seroepidemiological study on bluetongue virus (BTV) infection in California dairy cattle was conducted to estimate the prevalence and distribution by age and season of BTV group-reactive antibodies and to look for possible associations between the presence of antibodies and cattle age or breed and farm. Between December 1985 and March 1987, a sample of cattle was tested at approximately two-month intervals for BTV group-reactive antibodies using an enzyme-linked immunosorbent assay (ELISA). Data taken during the month of December 1986 were used to evaluate possible associations between a positive antibody test and certain intrinsic (age, breed) and extrinsic (farm) factors. Univariate and multivariate statistical analyses using the chi-square test for associations and multiple logistic regression, respectively, were carried out for possible associations between positive antibody tests to BTV and each factor of interest. The strengths of the associations were determined using estimates of the odds ratio. Of the 3774 serum samples tested, 238 (6.3%) were from calves, 1045 (27.6%) were from heifers and 2492 (66.0%) were from cows. Seroprevalence varied from nil in calves on two occasions to over 90% on several occasions in cows. Cows consistently had higher prevalence rates than heifers or calves across all test dates (p less than 0.05). The seroprevalence of BTV group-reactive antibodies also showed a seasonal fluctuation, with the highest rates occurring during the warmer months of the year. These highest prevalence rates coincided with heavy activity of the known vector of BTV, Culicoides spp. Breed and farm effects were not statistically significant (p greater than 0.05). With the exception of one farm, all cattle were of the Holstein breed, which reduced confidence in assessing any breed effect in this study. Relative estimates of the sensitivity and specificity of BTV ELISA were 87% and 100% respectively, compared to the standard agar gel immunodiffusion (AGID) test. The observations support previous findings of seasonal distribution of BTV antibodies and suggest an age relationship, whereby older cattle are more likely to be positive to BTV group-reactive antibodies than younger cattle.

Consequences of childhood burn: findings from the largest community-based injury survey in Bangladesh.

In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10-14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be $462. In this study it was found that more than 61% of the families earn less than $50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority.

Evaluation of specificity of indirect enzyme-linked immunosorbent assay for diagnosis of human Q fever.

Ninety-five acute- and convalescent-phase serum specimens from 48 patients suspected of having rickettsial or Legionella infections were assayed for antibodies to Coxiella burnetii, the causative agent of Q fever. To evaluate the specificity of the indirect enzyme-linked immunosorbent assay (ELISA) for human Q fever, we compared the ELISA results with those of the indirect immunofluorescence antibody (IFA) test. The ELISA data were analyzed by two different criteria for a positive test. The first criterion for positive results by ELISA was based upon diagnostic titers established in a study of 150 subjects who had no demonstrable cellular or humoral immune responses to C. burnetii phase I or phase II whole cells or phase I lipopolysaccharide. The second criterion was based upon diagnostic antibody titers in a study of 51 subjects who had been diagnosed as having clinical Q fever and had fourfold or greater rises in humoral immune responses to C. burnetii phase I and phase II whole-cell antigens. A comparison of the ELISA and IFA test results of the 95 serum specimens indicated excellent agreement between the tests (Kappa = 92.9%; P < 0.05). None of the 38 patients whose etiologies were confirmed serologically as Legionnaires' disease or rickettsial diseases other than Q fever were classified as positive for C. burnetii by the ELISA. Only one patient identified by the IFA test as having Q fever was not scored positive by the ELISA. These results suggest that the ELISA is useful for epidemiologic screening and as a diagnostic test for human Q fever.

Seroepidemiology of infections due to spotted fever group rickettsiae and Ehrlichia species in military personnel exposed in areas of the United States where such infections are endemic.

A prospective, seroepidemiologic study of spotted fever group rickettsiae (SFGR) and Ehrlichia infections was done among 1194 US military personnel exposed in a heavily tick-infested area of Arkansas in 1990. Seroconversion (4-fold) and seroprevalence rates were determined by indirect immunofluorescent antibody assays. Seroconversions to SFGR occurred in 30 persons (2.5%), whereas seroconversion to Ehrlichia species occurred in 15 (1.3%). The majority of seroconverters did not report symptoms (22/30 [73%] of SFGR seroconverters; 10/15 [67%] of Ehrlichia species seroconverters). History of tick attachment was associated with seroconversion to SFGR (relative risk [RR] = 4.3, P < .001) and Ehrlichia species (RR = 3.6, P < .05). Use of permethrin-impregnated uniforms significantly decreased risk of infection (P < .01); use of bed nets increased risk by 4-fold. Tickborne infections represent a significant threat to military personnel training in areas in which these infections are endemic.