Vitamin D and tuberculosis: review and association in three rural provinces of Afghanistan.

OBJECTIVES: 1) To update the 2006 systematic review and meta-analysis by Nnoaham & Clarke exploring the association between serum vitamin D and risk of active tuberculosis (TB) following discrepant evidence; and 2) to identify whether TB and vitamin D are associated in rural Afghanistan. METHODS: Systematic review and meta-analysis of studies published between January 1980 and June 2014 using Nnoaham & Clarke's methodology. For this case-control study, 90 age- and sex-matched pairs were recruited from rural provinces, and blood 25-hydroxyvitamin D concentrations were measured using enzyme-linked immunosorbent assay. RESULTS: Sixteen studies were eligible for review. Eleven showed differences between vitamin D levels in TB patients and controls, two showed partial differences and three showed none. Studies on African and European populations show lower vitamin D levels in TB patients, but results from Asia vary. No significant differences were found in vitamin D levels in our rural Afghan population. Controls had a higher body mass index (BMI) (mean control BMI 21.50 kg/m(2), mean case BMI 18.86 kg/m(2), P < 0.001), and were more likely to have been employed (40% of controls, 15.6% of cases, P = 0.002). CONCLUSION: Genetic differences may account for the differences among study results in the systematic review. Vitamin D levels are not associated with TB among Afghans living in these rural provinces.

The effects of social variables on symptom recognition and medical care seeking behaviour for acute respiratory infections in infants in urban Mongolia.

OBJECTIVE: To investigate potentially modifiable factors associated with carers' recognition of symptoms and timely presentation of infants with acute respiratory infections (ARI) in urban Mongolia. METHODS: A prospective cohort study nested in a randomised controlled trial of infant swaddling. Data were collected on social, educational and childcare variables and all doctor contacts for ARI in primary and secondary care by regular questionnaires to carers of infants during the first 6 months of life. FINDINGS: Analyses were based on 9024 ARI related doctor contacts for 4554 illness episodes in 1218 infants. Delay in medical care seeking (>3 days from acute lower respiratory infection (ALRI) symptom onset) was associated with younger maternal age (OR (95% CI) 3.8 (1.2 to 11.6)), single child families (3.8 (1.2 to 11.61)), absent father (4.1 (1.2 to 14.4)) and residence more than 1 km from a clinic (3.5 (1.2 to 10.2)). CONCLUSION: There is a continuing need to educate carers of infants in the management of ARI, particularly those of younger age and those with limited family support.

Depression in Mongolian women over the first 2 months after childbirth: prevalence and risk factors.

BACKGROUND: Social, political and economic changes in Mongolia have followed post-Soviet style government policies and contributed to both increased liberalisation and reduced security in employment and family finances. This is the first study to attempt to assess the prevalence of depression in a population of Mongolian women in the post-partum period and assess risk factors, including financial position, associated with the condition. METHODS: A total of 1044 women who had delivered healthy babies in Ulaanbaatar between October and December 2002 were screened for depression using the WHO Self Reporting Questionnaire between 5 and 9 weeks post-partum. Further details on the mother, her family and social and economic circumstances were simultaneously collected. Analysis of risk factors for probable depression was undertaken using multiple logistic regression techniques. RESULTS: The prevalence of depression was 9.1% (95% CLs 7.5%-11.1%). Variables significantly and independently associated with risk of probable maternal depression included economic factors, mother being subject to physical abuse, dissatisfied with the pregnancy, concerned about her baby's behaviour, and her own health problems. LIMITATIONS: The sample was drawn from a population of mothers all of whom had healthy, full-term babies of normal birth weight. Clinical confirmation of diagnosis was not established. CONCLUSIONS: Mongolian women with young infants in Ulaanbaatar probably experience depression at rates comparable with other cultures. Factors associated with probable depression were dominated by health, relationships and financial position.

The effects of swaddling on oxygen saturation and respiratory rate of healthy infants in Mongolia.

BACKGROUND: Infant swaddling is common practice in some developing countries where infant respiratory morbidity is also prevalent. Little is known about the effect of swaddling on respiratory variables in healthy infants. Such information could have important implications for respiratory diseases. AIMS: To compare respiratory rates (RR) and arterial oxygen saturations (SaO2) of healthy swaddled infants and non-swaddled infants during different conditions of sleep and arousal. SETTING: Community based, nested case control study in Ulaanbaatar, Mongolia. SUBJECTS AND METHODS: Habitually swaddled and non-swaddled infants aged 9-10 weeks taking part in a randomised controlled trial of swaddling. Respiratory rate and SaO2 were measured during quiet wakefulness, feeding, quiet and active sleep. Habitually swaddled infants were studied in swaddled and non-swaddled conditions. Habitually non-swaddled infants were studied only in the non-swaddled state. RESULTS: SaO2 was higher during awake states compared with sleep states in all groups of infants. Habitually swaddled infants had lower mean SaO2 in the swaddled compared with non-swaddled condition (96.5% vs. 96.9%, p < 0.01) but these were not significantly different from the mean SaO2 of non-swaddled infants (96.9%, minimum p = 0.22). Habitually swaddled infants in the swaddled and non-swaddled states had similar respiratory rates, but these were, in both cases, significantly lower than in habitually non-swaddled infants. CONCLUSION: Swaddling has little or no clinical effect on SaO2 or respiratory rates in healthy 9-10-week-old infants in Mongolia.

Detection of depression in women of child-bearing age in non-Western cultures: a comparison of the Edinburgh Postnatal Depression Scale and the Self-Reporting Questionnaire-20 in Mongolia.

BACKGROUND: This study assesses, for the first time, the validity and internal reliability of the Edinburgh Post Natal Depression Scale (EPDS) and the WHO Self-Reporting Questionnaire 20-item version (SRQ-20) in detecting depression in Mongolian women of reproductive age. METHODS: 100 women age recruited from two psychiatric units specialising in depression (n = 55) and three community-based child immunisation clinics (n = 45) in Ulaanbataar, Mongolia, were formally psychiatrically assessed by a clinician and by administering the revised Clinical Interview Schedule (CIS-R). Each woman also completed the EPDS and SRQ-20. RESULTS: Ninety four women provided complete data and identical optimal cut-off points for both the EPDS (11.5) and SRQ-20 (8.5) were determined against both the psychiatrist's and CIS-R based diagnosis using standard validation parameters. On all parameters the SRQ-20 performed better than the EPDS. The sensitivity of the SRQ-20 in detecting depression was 93% and the specificity 97% against the psychiatrist's diagnosis. Internal reliability was satisfactory. LIMITATIONS: The use of a mixed clinical and community sample for validation, and a single psychiatrist may limit the generalisability of these results. CONCLUSIONS: The SRQ-20 performed well and better than the EPDS in detecting depression in this group of Mongolian women.