Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 61
Filtrar
1.
PLoS One ; 15(12): e0243128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33264364

RESUMO

BACKGROUND: Diarrhea is one of the leading causes of mortality in children under five globally. When it is associated with bacteremia, mortality is even higher. However, bacteraemia in diarrheal children has gained little attention in spite of its deleterious impact in under-five mortality. So, we aimed to evaluate associated clinical and laboratory factors for death in under-five children hospitalized with both diarrhea and bacteremia. METHODS: In this retrospective cross-sectional study, we used patients' electronic database of Dhaka Hospital of 'icddr,b', and enrolled all under-five children with diarrhea and bacterial growth in their blood samples on admission between June-2014 and May-2017. Clinical and laboratory characteristics were compared between those who died and who survived with a special attention to bacterial pathogens related to deaths and their sensitivity pattern. RESULTS: In a total of 401 diarrheal children with bacteraemia, 45 (11%) died. Although Salmonella Typhi (34%) was the most predominant isolate followed by Staphylococcus species (16%) and Pseudomonas species (9%), children who died more often had E. coli (OR = 5.69, 95% CI = 2.42-13.39, p = <0.001) and Klebsiella bacteraemia (OR = 4.59, 95% CI = 1.84-11.46, p = 0.001) compared to those who survived. However, none of them was significantly associated with deaths in regression analysis when adjusted with other potential confounders. E. coli was 100% resistant to ampicillin, 41% to gentamicin, and 73% to ceftriaxone and Klebsiella species was 96% resistant to ampicillin, 42% to gentamicin, and 62% to ceftriaxone. Study children who died had significantly higher overall resistance pattern shown in World Health Organization (WHO) recommended one of the first line antibiotics in treating childhood sepsis such as ampicillin (80% vs. 50%, p = 0.001) and in second line antibiotic such as ceftriaxone (49% vs. 22%, p = 0.001) compared to the survivors. In logistic regression analysis, after adjusting for potential confounders, we found that clinical sepsis (aOR 3.79, 95% CI 1.60-8.96, p = 0.002), hypoxemia (aOR 4.20, 95% CI 1.74-10.12, p = 0.001), and hyperkalaemia (aOR 2.69, 95% CI 1.05-6.91, p = 0.039) were found to be independent predictors of deaths and receipt of sensitive antibiotic (aOR 0.42, 95% CI 0.18-0.99, p = 0.048) was revealed as the independent protective factor for deaths in this population. CONCLUSION AND SIGNIFICANCE: The results of our data suggest that diarrheal children with bacteremia who died more often had gram negative bacteremia compared to those who survived and these pathogens are highly resistant to WHO recommended first line and second line antibiotics. The results further emphasize the critical importance of early identification of important clinical problems such as clinical sepsis, hypoxemia and hyperkalaemia in diarrheal children and treat them with potential sensitive antibiotic(s) in order to reduce bacteremia related mortality in children with diarrhea, especially in resource limited settings.

2.
Trop Med Int Health ; 25(8): 1032-1042, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32428974

RESUMO

OBJECTIVE: To determine the pathogen-specific risk of seizure in under-five children hospitalised with moderate-to-severe diarrhoea (MSD) in rural settings. METHOD: This was a prospective case-control study with follow-up, conducted in a sentinel facility of Global Enteric Multicenter Study in Mirzapur, a rural community of Bangladesh between 2007 and 2010. Children aged 0-59 months who presented with MSD and seizure constituted the cases whereas those who did not have seizure comprised the controls. MSD was defined if the episodes were associated with dehydration or dysentery or required hospitalisation with diarrhoea or dysentery. All enrolled children were followed up at home within 50-90 days of enrolment. A total of 64 cases and 128 randomly selected controls formed the analysable dataset. RESULTS: The result of logistic regression analysis after adjusting for potential confounders revealed that shigellosis (Shigella species, OR = 5.34, 95% CI = 2.37-12.04) particularly S. flexneri (OR = 3.34, 95% CI = 1.48-7.57), S. flexneri 6 (OR = 23.24, 95% CI = 2.79-193.85), S. sonnei (OR = 6.90, 95% CI = 2.34-19.85); norovirus (OR = 6.77, 95% CI = 1.69-27.11), fever (OR = 16.75, 95% CI = 1.81-154.70) and loss of consciousness (OR = 35.25, 95% CI = 1.71-726.20) were the independent risk factors for seizure in MSD children. At enrolment, cases had lower WHZ (P = 0.006) compared to their peers, follow-up anthropometrics showed significant improvement in WHZ (P < 0.001) and WAZ (P < 0.05), whereas deterioration in HAZ (P < 0.001) in both cases and controls. CONCLUSION: Childhood MSD episodes particularly due to Shigella and norovirus are often associated with seizure. Prompt identification and appropriate management of children with shigellosis may reduce occurrence and adverse consequences of seizure linked with MSD.


Assuntos
Diarreia/epidemiologia , Diarreia/microbiologia , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Convulsões/epidemiologia , Convulsões/microbiologia , Bangladesh/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Comorbidade , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Medição de Risco , Fatores de Risco , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença , Shigella
3.
J Water Health ; 18(2): 207-223, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32300093

RESUMO

Cholera, an acute diarrheal disease spread by lack of hygiene and contaminated water, is a major public health risk in many countries. As cholera is triggered by environmental conditions influenced by climatic variables, establishing a correlation between cholera incidence and climatic variables would provide an opportunity to develop a cholera forecasting model. Considering the auto-regressive nature and the seasonal behavioral patterns of cholera, a seasonal-auto-regressive-integrated-moving-average (SARIMA) model was used for time-series analysis during 2000-2013. As both rainfall (r = 0.43) and maximum temperature (r = 0.56) have the strongest influence on the occurrence of cholera incidence, single-variable (SVMs) and multi-variable SARIMA models (MVMs) were developed, compared and tested for evaluating their relationship with cholera incidence. A low relationship was found with relative humidity (r = 0.28), ENSO (r = 0.21) and SOI (r = -0.23). Using SVM for a 1 °C increase in maximum temperature at one-month lead time showed a 7% increase of cholera incidence (p < 0.001). However, MVM (AIC = 15, BIC = 36) showed better performance than SVM (AIC = 21, BIC = 39). An MVM using rainfall and monthly mean daily maximum temperature with a one-month lead time showed a better fit (RMSE = 14.7, MAE = 11) than the MVM with no lead time (RMSE = 16.2, MAE = 13.2) in forecasting. This result will assist in predicting cholera risks and better preparedness for public health management in the future.


Assuntos
Cólera/epidemiologia , Clima , Modelos Teóricos , Bangladesh , Cidades , Previsões , Humanos , Incidência , Estações do Ano
4.
Clin Infect Dis ; 2020 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-32239137

RESUMO

BACKGROUND: Azithromycin is frequently used to treat shigellosis however clinical outcomes are uncertain. METHODS: We performed an observational cohort study in Bangladesh of patients with invasive diarrhea treated empirically with azithromycin. Susceptibility testing was performed by broth microdilution and disk diffusion post hoc on all Shigella isolates and clinical response was correlated with in vitro susceptibility. RESULTS: There were 149 Shigella culture positive patients in the primary analysis. Infection with Shigella with decreased susceptibility to azithromycin was significantly associated with persistence of diarrhea at day 5 (31% vs. 12%, relative risk 2.66 (1.34, 5.28)); culture positivity at day 5 or 6 (35% vs. 5%, RR 5.26 (1.84, 14.85)); and a higher rate of overnight hospitalization (58% vs. 39%, RR 1.49 (1.06, 2.09)). Shigella flexneri was more common than S. sonnei (58% vs. 36%), however S. sonnei constituted most of the isolates with decreased susceptibility to azithromycin (67%) and most of the MDR strains (54%), thus poor clinical outcomes were associated with S. sonnei. The current epidemiological cutoff for S. flexneri of ≥16 µg/ml to define decreased susceptibility to azithromycin was clinically predictive of poor outcome. Patients with S. sonnei and a low MIC (4 µg/ml) still had elevated rates of persistent diarrhea and culture positivity. CONCLUSIONS: This study documents worse clinical outcomes for Shigella flexneri with decreased susceptibility to azithromycin, as well as S. sonnei, and supports the utility of susceptibility testing and clinical breakpoints for azithromycin. S. sonnei is an emerging drug resistant threat.

5.
Health Promot Perspect ; 10(1): 66-73, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32104659

RESUMO

Background: Hypertension (HTN) is well established as a leading cause of common serious illnesses worldwide. We carried out this qualitative research to understand perception of and experiences related to HTN among rural Bangladeshi hypertensive women. Methods: A total of 74 female hypertensive participants who were diagnosed as HTN were purposively recruited in a rural community in Mirzapur, Bangladesh. A focus group discussion(FGD) was applied to share their perception and experiences. Transcripts were read in an iterative process, and a thematic analysis was performed. This paper is reported followed by COREQ checklist. Results: Three main themes were generated; (i) Perception of HTN based on experiences, (ii)Knowledge of management of HTN, and (iii) Barriers of management of HTN. Under the themes, seven subthemes were identified. The participants only knew about their high blood pressure(HBP) when they had symptoms, and they applied traditional remedies in the rural context to deal with those symptoms. Even though more than half of participants had relevant knowledge of how to manage HTN, but still there were social-cultural and economic barriers and lack of social infrastructure to access healthcare, existed to practice them. Conclusion: Based on our study reports, health education programs at the household and community level could be a potential starting point for any preventive and containment strategy in rural communities of Bangladesh.

7.
Trop Med Health ; 47: 29, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073272

RESUMO

Background: Diarrheal disease still remains a major public health threat and is often associated with fatal outcome especially in children with shigellosis mostly in developing countries. This study aimed to determine the presence of any associations between drinking shallow tube well (STW) water and childhood shigellosis. A total of 1394 children aged 0-59 months who presented with moderate-to-severe diarrhea (MSD) in Kumudini Women's Medical College and Hospital, Bangladesh, from December 2007 to March 2011 were enrolled into the study. Results: Among the study children, STW users often represented poor families (44% vs. 37%, p = 0.010); less often had household electricity (60% vs. 68%, p = 0.001) and cemented floor material (12% vs. 21%, p < 0.001); washed hand before eating (79% vs. 84%, p = 0.020); and had Shigella sonnei infections (7.8% vs. 13.1, p = 0.002) compared to deep tube well (DTW) water families (in bivariate analysis). After adjusting for covariates, a significant negative association was observed between childhood MSD episodes due to Shigella sonnei infections and the use of STW water (aOR 0.53, 95% CI 0.36, 0.79). Conclusions: An emergence of less severe Shigella sonnei has replaced relatively more severe Shigella flexneri among the MSD children from DTW-user families. However, more monitoring in terms of disease surveillance for changes in the distribution of Shigella serogroups and serotypes and its upsurges and antimicrobial susceptibility is essential.

8.
PLoS One ; 14(4): e0214568, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947271

RESUMO

OBJECTIVE: The objective of this study was to describe the age and sex-specific prevalence of renal insufficiency, and observe its trends over a decade at an urban Bangladesh setup. METHOD: This was a cross-sectional study, in which we observed the Estimated Glomerular Filtration Rate (eGFR) of 218,888 adults, aged ≥19 years, who had submitted their blood specimen to the Clinical Biochemistry Laboratory of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during the years 2006-2015. We applied CKD-EPI definition in estimating eGFR using their age-and sex-specific serum creatinine concentrations. Based on the eGFR, we classified the population into five stages of renal insufficiency (stage-1 to stage-5), at age intervals of five-years. Data were analysed using the Linear Regression and Multinomial Logistic Regression models. RESULTS: Females constituted 43% (n = 94,931) of the study population; and 34% (n = 42,576) of the males and 31% (n = 29,830) of the females had their serum creatinine concentrations above the upper limit of the laboratory reference cut-off. The overall prevalence of stage-2 to stage-5 renal insufficiency were 24% (n = 52,126), 17% (n = 38,539), 8% (n = 16,504) and 6% (n = 12,665) respectively; the prevalence were 23% (n = 1,890), 19% (n = 1,579), 9% (n = 769) and 9% (n = 770) respectively in 2006, and 24% (n = 10,062), 17% (n = 6,903), 6% (n = 2,537) and 5% (n = 1,924) respectively in 2015. The prevalence was higher among the females. At least 2% of the adults, younger than <44 years, had stage-4 and stage-5 in 2015. The age-adjusted eGFR was significantly lower among the post-menopausal females (aged ≥46 y) compared to the same age group males (64.08±10.83 vs. 66.83±10.41 mL/min/1.73 m2; p<0.001). Compared to 2006, the number of individuals with renal insufficiency (stage 2 and above) had increased at least two times, irrespective of age, in 2015. A single year of increase in the age was significantly associated with 1.32 unit reductions in the eGFR; and the reductions were higher for females who also had higher odds of renal insufficiency stages-2 and beyond. CONCLUSION: This study observed high prevalence of stage-2 to stage-5 renal insufficiency in Bangladeshi populations, irrespective of age, and especially among the females.


Assuntos
Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/epidemiologia , Adulto , Fatores Etários , Idoso , Bangladesh/epidemiologia , Cidades , Creatinina/sangue , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pós-Menopausa , Prevalência , Tamanho da Amostra , População Urbana , Adulto Jovem
9.
Matern Child Nutr ; 15(3): e12815, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30903804

RESUMO

Stunting in children is a global public health concern. We investigated how global DNA methylation relates to food intakes, dietary diversity, and development of stunting among 324 children aged 24-36 months in a slum community in Dhaka, Bangladesh. Stunted children (height-for-age z score ˂-2; n = 162) and their age- and sex-matched nonstunted counterparts (height-for-age z score ˃-1; n = 162) were selected by active community surveillance. We studied global DNA methylation, measured as 5-mC% content in whole blood. Dietary intake, anthropometric measurement, and sociodemographic information were obtained. In the multiple linear regression model, increased global DNA methylation level in children was significantly associated with consumption of lower amount of energy, coef: .034 (95% CI [.014, .053]); P = .001, protein, coef: .038 (95% CI [.019, .057]); P = .000, carbohydrate, coef: .027 (95% CI [.008, .047]); P = .006, zinc, coef: .020 (95% CI [.001, .039]); P = .043, total dietary intakes, coef: .020 (95% CI [.001, .039]); P = .043, and intake from plant sources, coef: .028 (95% CI [.009, .047]); P = .005, after adjusting for other covariates. Moreover, higher fruits and vegetables consumption was significantly associated with lower 5-mC% level, coef: -.022 (95% CI [-.041, -.002]); P = .028. Our findings suggest a significant association between low dietary intakes and increased global DNA methylation. We also found increased global DNA methylation in stunted children. To establish the relationship among the macronutrient intakes, global DNA methylation, and stunting, future prospective studies are warranted in resource-poor settings.


Assuntos
Metilação de DNA , Carboidratos da Dieta/administração & dosagem , Proteínas na Dieta/administração & dosagem , Ingestão de Energia/etnologia , Transtornos do Crescimento/genética , Áreas de Pobreza , Bangladesh/epidemiologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos Transversais , Inquéritos sobre Dietas , Epigênese Genética , Humanos , Oligoelementos/administração & dosagem , População Urbana , Vitaminas/administração & dosagem
10.
Clin Infect Dis ; 69(12): 2059-2070, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-30753368

RESUMO

BACKGROUND: Following the conclusion of a human rotavirus vaccine (HRV) cluster-randomized, controlled trial (CRT) in Matlab, Bangladesh, HRV was included in Matlab's routine immunization program. We describe the population-level impact of programmatic rotavirus vaccination in Bangladesh in children <2 years of age. METHODS: Interrupted time series were used to estimate the impact of HRV introduction. We used diarrheal surveillance collected between 2000 and 2014 within the 2 service delivery areas (International Centre for Diarrhoeal Disease Research, Bangladesh [icddr,b] service area [ISA] and government service area [GSA]) of the Matlab Health and Demographic Surveillance System, administered by icddr,b. Age group-specific incidence rates were calculated for both rotavirus-positive (RV+) and rotavirus-negative (RV-) diarrhea diagnoses of any severity presenting to the hospital. We used 2 models to assess the impact within each service area: Model 1 used the pre-vaccine time period in all villages (HRV- and control-only) and Model 2 combined the pre-vaccine time period and the CRT time period, using outcomes from control-only villages. RESULTS: Both models demonstrated a downward trend in RV+ diarrheal incidences in the ISA villages during 3.5 years of routine HRV use, though only Model 2 was statistically significant. Significant impacts of HRV on RV+ diarrhea incidences in GSA villages were not observed in either model. Differences in population-level impacts between the 2 delivery areas may be due to the varied rotavirus vaccine coverage and presentation rates to the hospital. CONCLUSIONS: This study provides initial evidence of the population-level impact of rotavirus vaccines in children <2 years of age in Matlab, Bangladesh. Further studies are needed of the rotavirus vaccine impact after the nationwide introduction in Bangladesh.


Assuntos
Assistência à Saúde , Diarreia/prevenção & controle , Diarreia/virologia , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Rotavirus/imunologia , Saúde da População Rural , Bangladesh/epidemiologia , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Vigilância em Saúde Pública , Vacinas contra Rotavirus/administração & dosagem , Fatores de Tempo , Cobertura Vacinal
11.
Clin Infect Dis ; 69(3): 505-513, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-30351379

RESUMO

BACKGROUND: Noroviruses are the most common cause of epidemic and endemic acute gastroenteritis (AGE) worldwide. The burden of norovirus disease in low-income settings is poorly understood. METHODS: We tested stool samples from children less than 5 years of age with diarrhea who were admitted in a rural hospital in Bangladesh from 2010-2012 and from matched, healthy controls from the same catchment area. RESULTS: Norovirus was detected in 109 (18%) of 613 children with diarrhea and in 30 (15%) of 206 healthy controls. Most (n = 118; 85%) norovirus infections belonged to genogroup II (GII). Of these, GII.4 viruses were identified in 36 (33%) of the cases and in 6 (21%) of the controls. Other major genotypes included GII.3 (13%), GII.6 (11%), and GII.13 (11%) in the cases and GII.6 (17%) and GII.2 (14%) in the controls. The greatest risk of severe norovirus disease (Vesikari score ≥11) was associated with GII.4 infections. GII.4 viruses were the predominant genotype detected during the winter (55%) and rainy season (23%), while GII.3 (19%) and GII.13 (19%) viruses were the most prevalent genotypes during the summer. Vomiting was significantly associated with GII.4 infections, while longer durations of diarrhea were associated with GI.3 infections. CONCLUSIONS: Future studies are needed to understand the high rates of virus shedding in children without AGE symptoms.


Assuntos
Infecções por Caliciviridae/epidemiologia , Diarreia/epidemiologia , Fezes/virologia , Norovirus/genética , Doença Aguda , Bangladesh/epidemiologia , Estudos de Casos e Controles , Pré-Escolar , Efeitos Psicossociais da Doença , Diarreia/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/virologia , Genótipo , Voluntários Saudáveis , Humanos , Lactente , Recém-Nascido , Masculino , Pobreza/estatística & dados numéricos , Prevalência , RNA Viral/genética , População Rural/estatística & dados numéricos , Estações do Ano , Eliminação de Partículas Virais
12.
Vaccine ; 36(43): 6393-6400, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30236635

RESUMO

Group A rotavirus causes a substantial proportion of diarrhoea related deaths worldwide among children under five years. We analyzed rotavirus prevalence and genotypes distribution among patients admitted with diarrhoea at icddr,b hospital in Dhaka during 2012-16. Stool specimens (n = 1110) were collected from diarrhoea patients and tested for RVA antigen using enzyme immunoassay. Rotavirus positive samples were G (VP7) and P (VP4) genotyped by RT-PCR and sanger sequencing. Data on clinical manifestations were collected from icddr,b hospital surveillance system. A total of 351 (32%) patients were positive for rotavirus antigen, about half of those were children under two years old. During the study period, G1P[8] (27%) was the most prevalent strain, followed by G12P[8] (15%) and G9[P4] (9%). Mixed G or P genotypes were identified in a substantial proportion (23%) with few strains of rare combinations such as G1P[4], G1P[6], G2P[6], G2P[8], G9P[6]. The genotypic fluctuation was noteworthy; G12P[8] was the major strain in 2012-14 but sharply decreased in 2015-16 when G1P[8] became the most common strain. G3P[8] re-emerged (17%) in 2016 after 11 years. Since the Government of Bangladesh has planned to include rotavirus vaccine in national immunization programme from 2018, our data will provide baseline information on rotavirus genotypes in the pre-vaccination era to observe the selection pressure on genotypes in the post vaccination epoch.


Assuntos
Genótipo , Infecções por Rotavirus/epidemiologia , Rotavirus/genética , Antígenos Virais/imunologia , Bangladesh/epidemiologia , Proteínas do Capsídeo/genética , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/virologia , Fezes/virologia , Feminino , Gastroenterite/epidemiologia , Gastroenterite/virologia , Humanos , Lactente , Filogenia , Prevalência , RNA Viral/genética , Infecções por Rotavirus/virologia , Vacinas contra Rotavirus/imunologia , Análise de Sequência de DNA
14.
Trop Med Health ; 46: 17, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29875615

RESUMO

Background: The present study aimed to examine the risk factors for death due to pneumonia in young children and healthcare behaviors of the guardians for children in rural Bangladesh. A prospective autopsy study was conducted among guardians of children aged 4 weeks to 59 months in Mirzapur, Bangladesh, from 2008 to 2012. Results: Pneumonia was the primary cause of death, accounting for 26.4% (n = 81) of all 307 deaths. Of the pneumonia deaths, 58% (n = 47) deaths occurred in younger infants (aged 4 weeks to < 6 months) and 24.7% (n = 20) in older infants (aged 6-11 months). The median duration of illness before pneumonia death was 8 days (interquartile range [IQR] 3-20 days). Prior to death, 91.4% (n = 74) children with pneumonia sought treatment, and of those who sought treatment, 52.7% (n = 39) sought treatment ≥ 2 days after the onset of disease. Younger infants of 4 weeks to < 6 months old were at 5.5-time (95% confidence interval [CI] 2.5, 12.0) and older infants aged 6-11 months were at 3-time (1.2, 7.5) greater risk of dying from pneumonia than older children aged 12-59 months. Children with a prolonged duration of illness (2-10 days) prior to death were at more risk for death by pneumonia than those who died from other causes (5.8 [2.1, 16.1]). Children who died from pneumonia sought treatment 3.4-time more than children who died from other causes. Delayed treatment seeking (≥ 2 days) behavior was 4.9-time more common in children who died from pneumonia than those who died from other causes. Children who died from pneumonia more often had access to care from multiple sources (5.7-time) than children who died from other causes. Conclusions: Delay in seeking appropriate care and access to multiple sources for treatment are the underlying risk factors for pneumonia death in young children in Bangladesh. These results indicate the perplexity in guardians' decisions to secure appropriate treatment for children with pneumonia. Therefore, it further underscores the importance of focusing on mass media coverage that can outline the benefits of seeking care early in the progression of pneumonia and the potential negative consequences of seeking care late.

15.
Am J Trop Med Hyg ; 98(6): 1571-1576, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29714159

RESUMO

Antimicrobial overuse contributes to antimicrobial resistance. Empiric use of antimicrobials for diarrheal illness is warranted only in a minority of cases, because of its self-limiting nature and multifactorial etiology. This study aims to describe the factors contributing to antimicrobial overuse for diarrheal disease among children less than 5 years of age in rural Bangladesh. A total of 3,570 children less than 5 years of age presenting with diarrhea in a tertiary level hospital were enrolled in the study. The rate of antimicrobial use at home was 1,395 (39%), compared with 2,084 (89%) during a hospital visit. In a multivariate analysis, factors associated with antimicrobial use at home included residence located more than 5 miles from a hospital; use of zinc and oral rehydration salts at home; vomiting; greater than 10 stools per 24 hours; diarrheal duration greater than 3 days; and rotavirus diarrhea (P < 0.05 for all). Characteristics of children more likely to be given antimicrobials in a health-care setting included greater than 10 stools per 24 hours; duration of diarrhea greater than 3 days; use of antimicrobials before hospital presentation; fever (≥ 37.8°C); rectal straining; and Shigella infection (P < 0.05 for all). The most commonly used drugs in rotavirus diarrhea were azithromycin and erythromycin, both before hospital presentation and during hospital admission. Our study underscores the importance of diligent vigilance on the rationale use of antimicrobials both at home and in health-care facilities with a special concern for children less than 5 years of age living in rural Bangladesh.


Assuntos
Anti-Infecciosos/uso terapêutico , Diarreia/tratamento farmacológico , Uso Excessivo de Medicamentos Prescritos/efeitos adversos , Anti-Infecciosos/efeitos adversos , Azitromicina/uso terapêutico , Bangladesh/epidemiologia , Pré-Escolar , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Diarreia/virologia , Disenteria Bacilar/tratamento farmacológico , Disenteria Bacilar/epidemiologia , Eritromicina/uso terapêutico , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Fatores de Risco , Infecções por Rotavirus/tratamento farmacológico , Infecções por Rotavirus/epidemiologia , População Rural , Sorotipagem , Shigella/classificação , Shigella/isolamento & purificação , Centros de Atenção Terciária , Fatores de Tempo
16.
J Med Genet ; 55(7): 459-468, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514873

RESUMO

BACKGROUND: Breast milk is the sole nutrition source during exclusive breastfeeding, and polyunsaturated fatty acids (FAs) are critical micronutrients in infant physical and cognitive development. There has been no prior genomewide association study of breast milk, hence our objective was to test for genetic association with breast milk FA composition. METHODS: We measured the fractional composition of 26 individual FAs in breast milk samples from three cohorts totalling 1142 Bangladeshi mothers whose infants were genotyped on the Illumina MEGA chip and replicated on a custom Affymetrix 30K SNP array (n=616). Maternal genotypes were imputed using IMPUTE. RESULTS: After running 33 separate FA fraction phenotypes, we found that SNPs known to be associated with serum FAs in the FADS1/2/3 region were also associated with breast milk FA composition (experiment-wise significance threshold 4.2×10-9). Hypothesis-neutral comparison of the 33 fractions showed that the most significant genetic association at the FADS1/2/3 locus was with fraction of arachidonic acid (AA) at SNP rs174556, with a very large per major allele effect size of 17% higher breast milk AA level. There was no evidence of independent association at FADS1/2/3 with any other FA or SNP after conditioning on AA and rs174556. We also found novel significant experiment-wise SNP associations with: polyunsaturated fatty acid (PUFA) 6/PUFA3 ratio (sorting nexin 29), eicosenoic (intergenic) and capric (component of oligomeric Golgi complex 3) acids; and six additional loci at genomewide significance (<5×10-8). CONCLUSIONS: AA is the primary FA in breast milk influenced by genetic variation at the FADS1/2/3 locus, extending the potential phenotypes under genetic selection to include breast milk composition, thereby possibly affecting infant growth or cognition. Breast milk FA composition is influenced by maternal genetics in addition to diet and body composition.


Assuntos
Ácidos Graxos Dessaturases/genética , Ácidos Graxos/genética , Estudo de Associação Genômica Ampla , Micronutrientes/genética , Alelos , Ácido Araquidônico/genética , Ácido Araquidônico/metabolismo , Dieta , Ácidos Graxos/metabolismo , Feminino , Genótipo , Humanos , Lactente , Micronutrientes/metabolismo , Leite Humano/química , Leite Humano/metabolismo , Mães , Fenótipo , Polimorfismo de Nucleotídeo Único/genética
17.
J Med Virol ; 90(4): 677-684, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29244212

RESUMO

Human adenoviruses (HAdVs) are common cause of nonbacterial acute gastroenteritis worldwide. Limited data exist on HAdVs molecular epidemiology associated with acute gastroenteritis in Bangladesh. We describe the genetic diversity and epidemiology of HAdVs among hospitalized diarrhea patients, including HAdV genotypes, clinical symptoms, and co-infecting enteric pathogens. Stool samples were collected from ongoing diarrhea surveillance during 2012-2015. HAdV was detected using PCR and genotyped by sequencing and phylogenetic analysis. Detailed socio-demographic and clinical information regarding each individual was recorded such as duration of diarrhea, dehydration status, vomiting, abdominal pain, fever, and severity. Of 871 fecal specimens, HAdV DNA was detected in 93 (10.7%). Among them 56% were co-infected with other known enteric viral and bacterial pathogens and 31.6% had severe gastroenteritis. The majority (55%) of HAdV positives were children <5 years of age. Two main clinical symptoms in HAdV infected patients were diarrhea and vomiting. HAdVs were detected throughout the year with low prevalence in winter (November-January). Five HAdV species (A, B, C, D, and F) including 17 different genotypes were identified during the study period, with enteric HAdV species F (HAdV-40/41) being the most dominant. However, non-enteric HAdV were also detected in substantial proportion of specimens (15% species C, 15% species D, 10.8% species A, and 4.3% species B). Our study demonstrates high genetic diversity of HAdVs including enteric and non-enteric HAdVs among diarrhea patients and provides a foundation for further clarification of the role of non-enteric HAdVs in diarrheal diseases.


Assuntos
Infecções por Adenovirus Humanos/epidemiologia , Infecções por Adenovirus Humanos/virologia , Adenovírus Humanos/classificação , Adenovírus Humanos/isolamento & purificação , Gastroenterite/epidemiologia , Gastroenterite/virologia , Genótipo , Infecções por Adenovirus Humanos/patologia , Adenovírus Humanos/genética , Adolescente , Adulto , Idoso , Bangladesh/epidemiologia , Criança , Pré-Escolar , Coinfecção/epidemiologia , Coinfecção/patologia , Coinfecção/virologia , Fezes/virologia , Feminino , Gastroenterite/patologia , Variação Genética , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Filogenia , Reação em Cadeia da Polimerase , Prevalência , Análise de Sequência de DNA , Adulto Jovem
18.
PLoS One ; 12(9): e0179418, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28877163

RESUMO

BACKGROUND: There is strong association between childhood rotavirus, diarrhoea, climate factors and malnutrition. Conversely, a significant nutritional transition (reduced under-nutrition) with a concurrent increasing trend of rotavirus infection in last decade was also observed among under 5 children, especially in developing countries including Bangladesh. Considering the pathophysiology of rotavirus, there might be an interaction of this nutrition transition which plays a pivotal role in increasing rotavirus infection in addition to climate and other man-made factors in urban areas such as Dhaka, Bangladesh. METHODS: Relevant monthly data from 1993-2012 were extracted from the archive of the Diarrhoeal Disease Surveillance System of icddr, b and linked with data collected from the Dhaka station of the Bangladesh Meteorological Department (mean temperature, rainfall, sea level pressure and humidity). Seasonal autoregressive integrated moving average time series models were deployed to determine the association between the monthly proportion of rotavirus infection and underweight, stunting and wasting adjusting for climate, socio-demographic and sanitation factors. FINDING: The proportion of rotavirus cases among all causes diarrhoea increased from 20% in 1993 to 43% in 2012 (Chi squared for trend p = 0.010). In contrast, underweight, stunting and wasting decreased from 59%-29% (p<0.001); 53%-21% (p<0.001) and 32%-22% (p<0.001) respectively over the same period. Mean ambient temperature increased from 25.76°C-26.62°C (p = 0.07); mean rainfall, sea level pressure and mean humidity decreased from 234.92-111.75 mm (p = 0.5), 1008.30-1006.61 mm of hg (p = 0.02) and 76.63%-70.26% (p<0.001), respectively. In the adjusted model, a decrease in monthly proportion of underweight [coef.: -0.189 (95% CI:-0.376, -0.003)] and wasting [-0.265 (-0.455, -0.075)] were significantly and inversely associated with rotavirus infection. However, an inverse but insignificant association was observed for stunting [-0.070 (-0.249, 0.109)]. INTERPRETATION: The reduction of acute childhood malnutrition is significantly associated with increasing rotavirus diarrhoea among under-5 children. Thus mass vaccination in addition to interventions directed at man-made modifiable predictors for prevention and control is warranted.


Assuntos
Cidades/epidemiologia , Clima , Diarreia/epidemiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Infecções por Rotavirus/complicações , Infecções por Rotavirus/epidemiologia , Rotavirus/fisiologia , Bangladesh/epidemiologia , Criança , Demografia , Diarreia/complicações , Diarreia/virologia , Transtornos do Crescimento/epidemiologia , Humanos , Umidade , Pressão , Chuva , Temperatura , Magreza/epidemiologia , Fatores de Tempo
19.
PLoS Negl Trop Dis ; 11(4): e0005512, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28448489

RESUMO

BACKGROUND: To take advantage of emerging opportunities to reduce morbidity and mortality from diarrheal disease, we need to better understand the determinants of life-threatening severe dehydration (SD) in resource-poor settings. METHODOLOGY/FINDINGS: We analyzed records of patients admitted with acute diarrheal disease over twenty-two years at the International Centre for Diarrhoeal Disease Research, Bangladesh (1993-2014). Patients presenting with and without SD were compared by multivariable logistic regression models, which included socio-demographic factors and pathogens isolated. Generalized additive models evaluated non-linearities between age or household income and SD. Among 55,956 admitted patients, 13,457 (24%) presented with SD. Vibrio cholerae was the most common pathogen isolated (12,405 patients; 22%), and had the strongest association with SD (AOR 4.77; 95% CI: 4.41-5.51); detection of multiple pathogens did not exacerbate SD risk. The highest proportion of severely dehydrated patients presented in a narrow window only 4-12 hours after symptom onset. Risk of presenting with SD increased sharply from zero to ten years of age and remained high throughout adolescence and adulthood. Adult women had a 38% increased odds (AOR 1.38; 95% CI: 1.30-1.46) of SD compared to adult men. The probability of SD increased sharply at low incomes. These findings were consistent across pathogens. CONCLUSIONS/SIGNIFICANCE: There remain underappreciated populations vulnerable to life-threatening diarrheal disease that include adult women and the very poor. In addition to efforts that address diarrheal disease in young children, there is a need to develop interventions for these other high-risk populations that are accessible within 4 hours of symptom onset.


Assuntos
Desidratação/epidemiologia , Desidratação/etiologia , Diarreia/complicações , Diarreia/etiologia , Hospitalização , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bangladesh/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
J Nutr ; 147(5): 948-954, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28298543

RESUMO

Background: Childhood undernutrition is a major public health problem in Bangladesh. Evaluating child nutrition programs is a priority.Objective: The objective of this study was to evaluate a community-based nutrition education program (implemented from 2011 to 2013) aimed at improving infant and young child feeding (IYCF) practices and growth in rural Bangladesh.Methods: A cohort-based evaluation was conducted that included 2400 women (1200 from Karimganj, the intervention subdistrict, and 1200 from Katiadi, the control subdistrict) enrolled at 28-31 wk gestation in 3 waves between January and October 2011. Follow-up occurred at 3, 9, 16, and 24 mo of offspring age. The main outcomes were exclusive breastfeeding (EBF), measured at 3 mo, timing of complementary feeding (CF) initiation and minimum acceptable diet (MAD), measured at 9 mo, and child growth [assessed via length-for-age z score (LAZ) and weight-for-length z score], measured at all follow-ups. The main exposures were subdistrict of residence and wave of enrollment. For IYCF practices as outcome, logistic regressions were used. Generalized estimating equations were used for child growth as outcome.Results: EBF rates at 3 mo remained unchanged between waves 1 and 3 in Karimganj (55.6% compared with 57.3%), but the proportion of infants receiving timely CF initiation and MAD at 9 mo increased significantly (CF: 27.1-54.7%; MAD: 8.4-35.3%). Mean LAZ at 24 mo remained unchanged between waves 1 and 3 in Karimganj (-2.18 compared with -1.98).Conclusions: The program was successful in improving the quality of infant diet at 9 mo and timely CF initiation, but not EBF at 3 mo or LAZ. These findings support the case for implementing simple messages in all programs aimed at improving infant diet, especially in settings in which supplementing overall household diet may not be feasible.


Assuntos
Aleitamento Materno , Dieta , Educação em Saúde , Promoção da Saúde , Fenômenos Fisiológicos da Nutrição do Lactente , Estado Nutricional , População Rural , Adulto , Bangladesh , Estatura , Transtornos da Nutrição Infantil/prevenção & controle , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Comportamento Alimentar , Humanos , Lactente , Desnutrição/prevenção & controle , Mães , Avaliação de Programas e Projetos de Saúde , Ganho de Peso , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA