Sociodemographic and Clinico-laboratory Profile of Expanded Dengue Syndrome: Experience from a Tertiary Hospital of Dhaka, Bangladesh.

Dengue is endemic in more than a hundred countries throughout the tropics. The classic presentation of dengue fever has expanded its horizon by involving different organ systems, and these system-specific presentations pose a diagnostic dilemma. The objective of this prospective observational study was to evaluate the sociodemographic, and clinical profile of expanded dengue syndrome (EDS) patients admitted to a tertiary hospital in Dhaka, Bangladesh. Data were collected from all admitted patients from April 2019 to September 2019 and diagnosed with dengue. The patients with dengue having EDS were followed up till discharge. Of 4200 dengue cases admitted during this period, 108 patients (2.57%) were diagnosed with EDS. Among the EDS cases, 94% were from Dhaka city, and 6% were outside Dhaka city; 66% of the patients were male. Gastrointestinal (GI) manifestations were the most common (87%) type of EDS, and among the GI presentations, acute acalculous cholecystitis (38.3%), acute pancreatitis (30.85%), acute hepatitis (21.27%) were the most frequent. Among the EDS cases, 5.55% had a central nervous system (CNS), 4.6% cardiovascular (CVS), and 1.88% had renal complications; 0.93% presented with myositis. The majority (90.74%) of the patients recovered with conservative management, 10 (9.26%) died. This study shows that expanded dengue syndrome (EDS) is not uncommon in Bangladesh's dengue viral infection. A high degree of clinical suspicion is the key to early diagnosis and treatment.

Blood deprivation and heat stress increase mortality in bed bugs (Cimex lectularius) exposed to insect pathogenic fungi or desiccant dust.

Bed bugs (Cimex lectularius L.) have returned as a nuisance pest in the last 20 years. Different bed bug control measures in combination have not been thoroughly studied, although induction of multiple stressors may improve extermination. The effects of heat stress only, heat stress followed by exposure to insect pathogenic fungi, and heat stress followed by exposure to desiccant dust on starved and blood-fed bed bugs were investigated. Five days at 22 °C (control), 32 °C, 34 °C, or 36 °C (heat stress) did not cause mortality in adults. However, their starved first instar nymphs produced after heat stress suffered mortalities of 33%, 56% and 100%, respectively. Exposure to insect pathogenic fungi after heat stress increased the mortality of adults and their progeny compared to exposure to fungi without heat stress. The beneficial effects of heat stress were not observed in blood-fed bed bugs. Desiccant dust killed all nymphs within 2 days and all adults within 3 days regardless of previous heat stress, but survival time was prolonged by access to blood. This study highlights the advantage of combining different methods in pest management, and points to heat stress combined with blood deprivation as possible management elements to increase the control success.

In Vitro Antibacterial Activity of Ethanol Extracts of Cinnamomum zeylanicum against Pseudomonas aeruginosa.

Cinnamomum zeylanicum as medicinal plants are measured as new resources for preparing elements in the treatment of antibiotic-resistant microbes as alternatives to antibiotics. This study was aimed to evaluate the antibacterial activity of ethanol extracts of Cinnamomum zeylanicum against a Gram-negative bacteria Pseudomonas aeruginosa. This experimental study was carried out in the department of Pharmacology & Therapeutics and department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2017 to July 2018. Evaluation of the in vitro antibacterial activity of ethanol extracts of Cinnamomum zeylanicum against Pseudomonas aeruginosa was performed by disc diffusion method. And also in this study we used broth dilution method to determine the minimum inhibitory concentration (MIC). Ethanol cinnamon extract (ECE) was found active against P. aeruginosa. Zone of inhibition (ZOI) ranged between 6-25mm at different concentration of extracts. The MIC was 0.3g/ml. Cinnamomum zeylanicum showed strong antibacterial activity against a Gram-negative bacteria Pseudomonas aeruginosa. The results may contribute to the development of potential antimicrobial agents for inclusion in antipseudomonal regimens.

The Antibacterial Activity of Ethanolic Extract of Cinnamon (Cinnamomum zeylanicum) against two Food Borne Pathogens: Staphylococcus aureus And Escherichia coli.

Evaluation of the in vitro antibacterial activity of the ethanolic extract isolated from Cinnamomum zeylanicum bark against two food borne pathogens, Gram-positive Staphylococcus aureus and Gram-negative Escherichia coli. This experimental study was carried out in the department of Pharmacology & Therapeutics in collaboration with the department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2017 to July 2018. The antibacterial activity was tested at different concentrations of extracts of spice by using disc diffusion method. The extracts were prepared by using a solvent ethanol. The test microorganisms were also tested for their activity against a standard antibiotic Amikacin (500mg) by disc diffusion method and the result was compared with that of ethanolic extracts. Cinnamon had inhibitory activity against both Staphylococcus aureus and Escherichia coli. The ethanolic extracts were more effective against Staphylococcus aureus than E. coli. Staphylococcus aureus showed activity from 60% conc. (zone of inhibition 17mm) where E. coli from 80% conc. (ZOI 18mm). Maximum zone of inhibition was 26mm for both the test organisms. This result was also compared to those obtained against a standard antibiotic Amikacin where extract produced wider zone of inhibition of 26mm as compared to Amikacin for both test organisms. The present study showed that ethanolic extract of cinnamon demonstrated stronger antimicrobial effect against food borne pathogens.

Antibacterial Activities of Clove (Syzygium aromaticum) Extracts Against Three Food Borne Pathogens: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.

Evaluation of the in vitro antibacterial activity of aqueous and ethanolic extracts isolated from Clove (Syzygium aromaticum) buds against three food borne pathogens, gram-positive Staphylococcus aureus and gram-negative Escherichia coli & Pseudomonas aeruginosa. This interventional study was carried out during the period of July 2018 to June 2019 in the Department of Pharmacology and Therapeutics with the collaboration of Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh. The antibacterial activity was tested at different concentrations of both extracts of spice by using disc diffusion & broth dilution method. The extracts were prepared by using solvents aqueous & ethanol. The test microorganisms were also tested for their activity against a standard antibiotic Gentamicin (80mg) by broth dilution method and the result was compared with that of Aqueous and Ethanolic extracts. Aqueous and ethanolic extracts of clove had inhibitory activity against the test bacteria. Among different concentrations of the ACE, 500µg/ml & above concentration showed inhibitory effect against Staphylococcus aureus & Escherichia coli and 700µg/ml & above concentration showed inhibitory effect against Pseudomonas aeruginosa. In case of ECE, 500µg/ml & above concentration showed inhibitory effect against aforesaid bacteria. In disc diffusion method, S. aureus was found to be most susceptible to ACE (30.5mm) & Pseudomonas aeruginosa was found to be most susceptible to ECE (38mm). Minimum inhibitory concentrations (MIC) of ECE were lower than ACE for the test bacteria except Staphylococcus aureus where MICs of ACE & ECE were the same. This result was also compared against a standard antibiotic Gentamicin where the MICs of Gentamicin were lower in comparison to MICs of ACE & ECE. The present study showed that aqueous and ethanolic extracts of Clove demonstrated antibacterial effects against food borne pathogens.

Antibacterial Effect of Aloe vera (Aloe barbadensis) leaf gel against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae.

This experimental study was carried out to determine the antibacterial effect of Ethanolic extract of Aloe vera leaf gel (EAE) against standard strains of Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae in the Department of Pharmacology & Therapeutics in collaboration with the Department of Microbiology, Mymensingh Medical College, Mymensingh, Bangladesh from July 2017 to June 2018. Ethanol extract was used in five different concentrations (100, 200, 300, 400 and 500µg/ml). Dose dependent inhibitory effect was seen against the test organisms using disc diffusion method. For S. aureus, Zones of inhibition (ZOI) were 7, 12, 13, 16 and 20 mm at 100, 200, 300, 400 and 500 µg/ml respectively; for P. aeruginosa, ZOI were 0, 7, 12, 14 and 17 mm at 100, 200, 300, 400 and 500 µg/ml respectively; for E. coli, ZOI were 0, 8, 12, 15 and 18 mm at 100, 200, 300, 400 and 500 µg/ml respectively; for K. pneumoniae, ZOI were 7, 10, 11, 13 and 17 mm at 100, 200, 300, 400 and 500 µg/ml respectively. The minimum inhibitory concentration (MIC) was assessed by broth dilution technique. The MICs of EAE for S. aureus, P. aeruginosa, E. coli and K. pneumoniae were 500, 650, 650 and 600 µg/ml respectively. From the study it is clearly observed that ethanolic extract of Aloe vera leaf gel possesses antibacterial effect against the test pathogens. Further studies are required to detect and isolate the biologically active ingredients present in the Aloe vera leaves which are responsible for this antibacterial effect. Hopefully, that would lead to the discovery of new and more potent antimicrobial agents originated from Aloe vera.

Physiological roles of relaxin in prefertilizing activities of spermatozoa.

Relaxin was first introduced in 1926 by Frederick Hisaw. Previously, it was considered only having a role in pregnancy of mammals due to its important roles in pregnancy and parturition. In the last decade, the physiological role of relaxin in male reproduction has received attention, and it has become clear that relaxin can no longer be considered strictly as only a hormone of female reproduction. The accessory glands (especially the prostate gland) of the male reproductive system are the source of seminal relaxin, which is secreted into the seminal plasma and saturates the spermatozoa at the time of ejaculation. Several studies have reported that relaxin has important roles in improving motility in human spermatozoa. Investigations into the role of relaxin in other physiological sperm phenomena such as capacitation, acrosome reaction, and their mediating factors associated with successful fertilization have intensified. This review aims to provide up-to-date information about the physiological roles of relaxin in sperm motility, capacitation, acrosome reaction, and their mediating factors. Some studies demonstrated that relaxin increased the total motility and progressive motility. Several studies showed that relaxin not only increased sperm motility but also increased the rate of sperm capacitation and acrosome reaction. Though few studies revealed that relaxin improved the sperm prefertilizing activities through increasing the utilization of glucose and mediating the cholesterol efflux, Ca(2+)-influx, intracellular cAMP and protein tyrosine phosphorylation. Thus, the review concludes that the supplementation of relaxin into capacitating medium may have a beneficial role in prefertilizing activities of fresh and cryopreserved spermatozoa.

Effect of dietary Rhodobacter capsulatus on lipid fractions and egg-yolk fatty acid composition in laying hens.

The present study was conducted to investigate the effect of dietary Rhodobacter capsulatus on lipid fractions and egg-yolk fatty acid composition in laying hens. Thirty-six laying hens (30 weeks old) were randomly assigned into two dietary groups fed diets with (0.04%) or without (control) R. capsulatus for a 60-day feeding trial. Dietary R. capsulatus decreased (p < 0.05) serum and hepatic cholesterol and increased (p < 0.05) the excreta cholesterol, and resultant lower (p < 0.05) cholesterol contents in egg yolk. The concentration of polyunsaturated fatty acids (PUFA) and ratio to saturated fatty acids in egg yolk was improved (p < 0.05) by dietary R. capsulatus. The concentration of hepatic bile acid was increased (p < 0.05) and excreta bile acid was decreased (p < 0.01) in the laying hens fed R. capsulatus diet. The incorporation of 1-(14) C-palmitic acid into hepatic lipids and lipid fractions was increased (p < 0.05) in laying hens fed R. capsulatus diet. Moreover, dietary R. capsulatus did not appear to cause any adverse effects on laying hen performances. Therefore, dietary supplementation of R. capsulatus in layer diets may be a feasible means of producing eggs with lower cholesterol and higher PUFA contents for health conscious consumers.

Immune modulation in response to stress and relaxation.

Traditional medical science has kept the mind separate from the body. Recently people realize the effect of mind on health and psychoneuroimmunology is the new evolved science that describes the interactions between psyche and soma. In this review through a typical psycho-neuro-endocrino-immune network the effects of psychological stress (acute, brief naturalistic and chronic) and relaxation on immune modulation has been shown. From this network Corticotrophin Releasing Factor (CRF), Adrenocorticotrophic Hormone (ACTH), Glucocorticoids (GC), alpha-endorphin and Met-enkephalin are found as important endocrine components and T cells, B cells, monocytes/macrophages, Natural Killer (NK) cells and their cytokines that is Tumor Necrosis Factor-alpha (TNF-alpha), Interferon Gamma (IFN-alpha) and interleukins such as IL-1, IL-2, IL-4, IL-6, IL-10, IL-12 etc. are found as important immune components. Finally, it has been shown that, acute, brief naturalistic and chronic stress have different immune modulatory activities which are harmful to one's homeostasis and relaxation can help to maintain that homeostasis.

Management of type 2 diabetes mellitus by lifestyle, diet and medicinal plants.

Globally, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate and diabetes is one of them. If diabetes is not controlled then a lot of complication like coronary artery disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy and neuropathy arise in diabetic patients and causes morbidity and/or mortality. Diabetes is increasing at an epidemic form and in near future the largest increases will take place in the regions dominated by developing economies. So, it will be a great social and economical burden to developing countries as well as the developed. But if we be aware about our diet and lifestyle and take proper medication we may prevent and reduce the prevalence of diabetes. Oral medicine plays an important role in management of diabetes. But most of the oral drugs are costly and have a lot of side effects. For this it is also necessary to take medicines with fewer or no side effects. And antidiabetic medicinal plants may play an important role in this case. In this article we have tried to describe how diet and lifestyle with using medicinal plants may help to prevent or maintain diabetes and help to reduce the mortality and morbidity due to diabetes or complication related to it.

Intracellular signaling cascades induced by relaxin in the stimulation of capacitation and acrosome reaction in fresh and frozen-thawed bovine spermatozoa.

Relaxin is one of the 6-kDa peptide hormones, which acts as a pleiotropic endocrine and paracrine factor. Our previous studies revealed that sperm capacitating medium containing relaxin induced capacitation and acrosome reaction (AR) in fresh and frozen-thawed porcine or bovine spermatozoa. However, the intracellular signaling cascades involved with capacitation or AR induced by relaxin was unknown. Therefore, the present study was designed to investigate the intracellular signaling cascades involved with capacitation and AR induced by relaxin in fresh and frozen-thawed bovine spermatozoa. Spermatozoa were incubated in sperm Tyrode's albumin lactate pyruvate (Sp-TALP) medium supplemented with (40 ng ml(-1)) or without relaxin, and subjected to evaluation of chlortetracycline staining pattern, cholesterol efflux, Ca(2+)-influx, intracellular cyclic adenosine monophosphate (cAMP) and protein tyrosine phosphorylation. Capacitation and AR were increased (P<0.05) in both fresh and frozen-thawed spermatozoa incubated with relaxin. Cholesterol effluxes were greater in the fresh (P<0.01) and frozen-thawed (P<0.05) spermatozoa incubated with relaxin than the spermatozoa incubated without relaxin. Ca(2+)-influxes were also significantly stimulated by relaxin in the fresh (P<0.01) and frozen-thawed (P<0.05) spermatozoa. The Sp-TALP medium containing relaxin influenced the generation of intracellular cAMP in the fresh (P<0.01) and frozen-thawed (P<0.05) spermatozoa, and exhibited higher exposure of protein tyrosine phosphorylation in both sperm types than the medium devoid of relaxin. Therefore, the results postulate that relaxin exerts the intracellular signaling cascades involved with capacitation and AR through accelerating the cholesterol efflux, Ca(2+)-influx, intracellular cAMP and protein tyrosine phosphorylation in fresh and frozen-thawed bovine spermatozoa.

Application of EU tissue and cell directive screening protocols to anonymous oocyte donors in western Ukraine: data from an Irish IVF programme.

Anonymous oocyte donation in the EU proceeds only after rigorous screening designed to ensure gamete safety. If anonymous donor gametes originating from outside EU territory are used by EU patients, donor testing must conform to the same standards as if gamete procurement had occurred in the EU. In Ireland, IVF recipients can be matched to anonymous donors in the Ukraine (a non-EU country). This investigation describes the evolution of anonymous oocyte donor screening methods during this period and associated results. Data were reviewed for all participants in an anonymous donor oocyte IVF programme from 2006 to 2009, when testing consistent with contemporary EU screening requirements was performed on all Ukrainian oocyte donors. HIV and hepatitis tests were aggregated from 314 anonymous oocyte donors and 265 recipients. The results included 5,524 Ukrainian women who were interviewed and 314 of these entered the programme (5.7% accession rate). Mean age of anonymous oocyte donors was 27.9 years; all had achieved at least one delivery. No case of hepatitis or HIV was detected at initial screening or at oocyte procurement. This is the first study of HIV and hepatitis incidence specifically among Ukrainian oocyte donors. We find anonymous oocyte donors to be a low-risk group, despite a high background HIV rate. Following full disclosure of the donation process, most Ukrainian women wishing to volunteer as anonymous oocyte donors do not participate. Current EU screening requirements appear adequate to maintain patient safety in the context of anonymous donor oocyte IVF.

Lifestyle related causes of cancer and chemoprevention through phytonutrients.

Cancer is a leading cause of death worldwide. There are a lot of cancer causing agents which are divided as physical carcinogens, chemical carcinogens and biological carcinogens. But most of the carcinogens or causes of cancer are related to our lifestyle like diet, habit, occupation, radiation and some infection, etc. Chemoprevention is highly necessary to prevent cancer related preterm death. For this besides avoiding the causes of cancer we should concentrate ourselves on our diet. Because, numerous phytochemicals derived from edible plants have been reported to interfere with a specific stage of the carcinogenic process. Many mechanisms have been shown to account for the anticarcinogenic actions of dietary constituents and recently attention has been focused on intracellular-signalling cascades as common molecular targets for various chemopreventive phytochemicals. In this study, we tried to describe lifestyle related causes of cancer and the molecular basis of cancer prevention through the phytochemicals.

Blastocyst transfer for multiple prior IVF failure: a five year descriptive study.

Patients with recurrent IVF failure are generally regarded as having a poor prognosis, and when female age exceeds 35 yrs such patients face a particularly bleak outlook. This study reported on blastocyst transfer (BT) performed over a five-year interval in patients seeking "second opinion" after multiple failed IVF cycles. Clinical features and reproductive outcomes were compared between two sets of poor-prognosis IVF patients undergoing BT for the first time, the initial group underwent treatment in 2002 (n=66) and a second group presented five years later (n=392). The two clinical sets had no patients in common. The 2002 group had an average of 3.5 (+/- 1.1) prior failed IVF cycles at baseline, and mean (+/- SD) patient age was 36.4 (+/- 3.9) yrs. Average number of oocytes retrieved in this group was 10.4 (+/- 5.3) with a fertilisation rate of 58.8%. Although embryo arrest resulted in no transfer for 19 patients (28.8%), clinical pregnancy was achieved for 59.6% of transfers. Five years later, 392 patients underwent BT, but this group had an average of 4.5 (+/- 2.3) prior failed IVF cycles. Mean (+/- SD) female age was 36.0 (+/- 3.9) yrs, and the average number of oocytes retrieved in this group was 9.1 (+/- 5.4); the fertilisation rate was 59.5%. No blastocysts were available for transfer in 99 cases (25.3%); clinical pregnancy was achieved for 50.0% of transfers. The number of blastocysts transferred was similar in the two groups (1.6 vs. 1.3; p=0.06); the twinning rate rose slightly from 8.2% to 15.1% (p=0.12) despite an increased utilisation of single embryo transfer in 2007 (19.7% vs. 22.2%; p=0.40). Comparisons from 2002 and 2007 found no important differences between the two patient groups, except for a significantly higher rate of prior failed cycles in the 2007 group (p<0.001). This refractoriness was accompanied by a somewhat reduced blastocyst cryopreservation rate in 2007, compared to 2002 (27.6% vs. 29.5%; p=0.44). Clinical pregnancy rates are not adversely affected by application of BT in patients with multiple prior unsuccessful IVF cycles. For these patients, our data suggest that extended embryo culture and BT should be considered. Further controlled studies are needed to document more precisely the role of BT in this sub-set of refractory IVF patients.

First Irish pregnancies after IVF with gestational carrier.

In this report, our early experience with screening, monitoring and coordinating IVF utilising gestational carrier treatment is described. Although congenital and iatrogenic etiologies for uterine factor infertility manifest distinctly different reasons for considering a gestational carrier approach, we outline a unified management strategy for both conditions. One patient had congenital absence of the uterus and proximal vagina (Mayer-Rokitansky-Kuster-Hauser syndrome variant), while another patient presented post-hysterectomy and adjuvant brachytherapy for invasive squamous cervical carcinoma. Conception was established for both patients, the first pregnancies to be achieved using an IVF/gestational carrier technique in Ireland. As demonstrated here, selected patients with at least one intact ovary who suffer from uterine factor infertility can be excellent candidates for IVF with embryo transfer to a carefully screened gestational carrier. The role of individual and group counselling is reviewed; professional legal advice is prudent in complex cases.

Germatranyl substituted organotin (IV) carboxylates: synthesis spectroscopic characterization and biological activities.

Eight new organotin (IV) derivatives of general formula [N(CH2CH2O)3GeCH(R1)CH2COO](4-n)SnR(2)n, where n= 2, R(2) = C2H5 (1-5); R(1) = CH3 (1); C6H5 (2); p-CH3C6H4 (3); p-FC6H4(4); p-CH3OC6H4 (5) and n = 3, R(2) = CH2C6H5 (6-8), R(1) = CH3 (6); C6H5 (7); p-CH3C6H4 (8) have been synthesized by the reaction of di- or tri-organotin chloride with the corresponding germatranyl (substituted) propionic acid in the appropriate mole ratios using triethylamine as a base. The synthesized compounds were characterized by various spectroscopic techniques such as IR, multi-nuclear (1H, 13C, 119Sn) NMR, 119mSn Mössbauer, along with elemental analyses. They were also screened for in vitro anti-leishmanial activity against promastigotes of leishmania donovani and found some encouraging results.

In vitro anti-leishmanial activities of germatranyl and Silicon incorporated diorganotin derivatives: synthesis and spectroscopic properties.

A series of germanium and silicon incorporated diorganotin derivatives of general formula [N(OCH2CH2)3GeCH(R(1)CH2CO2]2 SnR2(2) where R1 = H3C, C6H5, p-CH3C6H4, p-FC6H4; R2 = H2CSi(CH3)2C6H5, H2CC6H5, p-CH3C7H7 were synthesized by the reaction of appropriate diorganotin dichlorides and germatranyl (substituted) propionic acid in 1:2 mole ratio, respectively. The evidence regarding their structure is mainly based on spectroscopic data obtained by multinuclear (1H, 13C, 29Si, 119Sn) NMR and 119mSn Mössbauer, IR and mass spectral studies in combination with melting points and elemental analyses. The compounds have been screened for in vitro anti-leishmanial activity against promastigotes of Leishmania major and the results offer potent activities which are better than the standard drug, pentamidine, for one compound.

Mass propagation of Rauwolfia serpentina L. Benth.

A protocol for mass propagation through axillary bud proliferation was established for Rauwolfia serpentina L. Benth. (Apocynaceae). MS medium supplemented with 1.5 mg L(-1) BA and 0.2 mg L(-1) NAA elicited the maximum number of shoots (4 multiple shoots) from nodal explants. These adventitious shoots were best rooted on half strength MS medium supplemented with 1.0 mg L(-1) each of IBA and IAA. The in vitro raised plants were acclimatized in glass house and successfully transplanted to field condition with almost 95% survival.

The influence of different hormone concentration and combination on callus induction and regeneration of Rauwolfia serpentina L. Benth.

The influence of media composition on callus induction and subsequent regeneration of Rauwolfia serpentina L. Benth has been studied. High frequency (96.43%) callus induction was obtained when nodal segments from in vitro raised shoots were cultured on MS medium supplemented with 0.5 mg L(-1) BA and 2.0 mg L(-1) NAA. The callus differentiated into adventitious shoots when it was subcultured on MS medium supplemented with 2.0 mg L(-1) BA with 0.2 mg L(-1) NAA. Regenerated shoots were best rooted on half-strength MS medium with 1.0 mg L(-1) each of IBA and IAA.

Inequity in maternal health-care services: evidence from home-based skilled-birth-attendant programmes in Bangladesh.

OBJECTIVE: To explore use-inequity in maternal health-care services in home-based skilled-birth-attendant (SBA) programme areas in Bangladesh. METHODS: Data from a community survey, conducted from February to May 2006, were analysed to examine inequities in use of SBAs, caesarean sections for deliveries and postnatal care services according to key socioeconomic factors. FINDINGS: Of 2164 deliveries, 35% had an SBA, 22.8% were in health facilities and 10.8% were by caesarean section. Rates of uptake of antenatal and postnatal care were 93% and 28%, respectively. There were substantial use-inequities in maternal health by asset quintiles, distance, and area of residence, and education of both the woman and her husband. However, not all inequities were the same. After adjusting for other determinants, the differences in the use of maternal health-care services for poor and rich people remained substantial [adjusted odds ratio (OR) 2.51 (95% confidence interval, CI: 1.68-3.76) for skilled attendance; OR 2.58 (95% CI: 1.28-5.19) for use of caesarean sections and OR 1.53 (95% CI: 1.05-2.25) for use of postnatal care services]. Complications during pregnancy influenced use of SBAs, caesarean-section delivery and postnatal care services. The number of antenatal care visits was a significant predictor for use of SBAs and postnatal care, but not for caesarean sections. CONCLUSION: Use of maternity care services was higher in the study areas than national averages, but a tremendous use-inequity persists. Interventions to overcome financial barriers are recommended to address inequity in maternal health. A greater focus is needed on the implementation and evaluation of maternal-health interventions for poor people.