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ABSTRACT: SUMMARY To date many studies have measured the effect of key child survival interventions on the main cause of mortality while anecdotally reporting effects on all-cause mortality. We conducted a systematic literature review and abstracted cause-specific and all-cause mortality data from included studies. We then estimated the effect of the intervention on the disease of primary interest and calculated the additional deaths prevented (i.e. the indirect effect). We calculated that insecticide-treated nets have been shown to result in a 12% reduction [95% confidence interval (CI) 0ยท0-23] among non-malaria deaths. We found pneumonia case management to reduce non-pneumonia mortality by 20% (95% CI 8-22). For measles vaccine, seven of the 10 studies reporting an effect on all-cause mortality demonstrated an additional benefit of vaccine on all-cause mortality. These interventions may have benefits on causes of death beyond the specific cause of death they are targeted to prevent and this should be considered when evaluating the effects of implementation of interventions.
Epidemiology and Infection 07/2012; · 2.84 Impact Factor
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ABSTRACT: To validate maternal recognition of neonatal illnesses at home compared to assessment by community health workers (CHWs) during routine household surveillance for neonatal illness in rural Bangladesh.
Surveillance in the intervention arm of two cluster-randomized, controlled trials of newborn interventions conducted in Sylhet and Mirzapur districts of Bangladesh. CHWs promoted birth and newborn care preparedness during two prenatal visits, including recognition of neonatal illnesses. CHWs assessed 8472 neonates on post-natal days 0, 3, and 6 between 2004 and 2005 in Sylhet, and 7587 neonates on post-natal days 0, 2, 5, and 8 between 2004 and 2006 in Mirzapur. In both sites, CHW identified neonates with very severe disease (VSD), using clinical algorithms that included ascertainment of illness history reported by mother and observation of clinical signs of illness. We calculated sensitivity, specificity, positive predictive value and negative predictive value of maternal report of any illness sign compared to CHWs' assessments and classification of VSD. Analysis was restricted to mothers whose neonates were assessed by CHWs at home during the routine visit schedule.
Maternal report of any signs had sensitivity of 24% and 20% and positive predictive value of 45% and 54% in Sylhet and Mirzapur, respectively.
Maternal recognition of neonatal illnesses at home was poor in two rural areas in Bangladesh. Interventions need to be designed to improve maternal recognition, and routine post-natal assessment by CHWs at home may be an essential component of community-based newborn care to improve care-seeking for newborn illness.
Tropical Medicine & International Health 06/2010; 15(6):743-53. · 2.80 Impact Factor
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ABSTRACT: Diarrhoea is a leading cause of morbidity and mortality yet diarrhoea specific incidence and mortality rates for older children, adolescents, and adults have not been systematically calculated for many countries. We conducted a systematic literature review to generate regional incidence rates by age and to summarize diarrhoea specific mortality rates for regions of the world with inadequate vital registration data. Diarrhoea morbidity rates range from 29.9 episodes/100 person-years for adults in the South East Asian region to 88.4 episodes/100 person-years in older children in the Eastern Mediterranean region and have remained unchanged in the last 30 years. Diarrhoea mortality rates decline as the child ages and remain relatively constant during adulthood. These data are critical for improving estimates worldwide and further highlight the need for improved diarrhoea specific morbidity and mortality data in these age groups.
Epidemiology and Infection 03/2010; 138(9):1215-26. · 2.84 Impact Factor
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S Chang,
S El Arifeen,
S Bari,
M A Wahed,
K M Rahman,
M T Rahman,
A B A Mahmud,
N Begum,
K Zaman,
A H Baqui, R E Black
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ABSTRACT: Many children have diets deficient in both iron and zinc, but there has been some evidence of negative interactions when they are supplemented together. The optimal delivery approach would maximize clinical benefits of both nutrients. We studied the effectiveness of different iron and zinc supplement delivery approaches to improve diarrhea and anemia in a rural Bangladesh population.
Randomized, double blind, placebo-controlled factorial community trial.
Iron supplementation alone increased diarrhea, but adding zinc, separately or together, attenuated these harmful effects. Combined zinc and iron was as effective as iron alone for iron outcomes. All supplements were vomited <1% of the time, but combined iron and zinc were vomited significantly more than any of the other supplements. Children receiving zinc and iron (together or separately) had fewer hospitalizations. Separating delivery of iron and zinc may have some additional benefit in stunted children.
Separate and combined administration of iron and zinc are equally effective for reducing diarrhea, hospitalizations and improving iron outcomes. There may be some benefit in separate administration in stunted children.
European journal of clinical nutrition 11/2009; 64(2):153-60. · 3.07 Impact Factor
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ABSTRACT: Acute lower respiratory tract infection (ALRI) is the most important global cause of childhood death. Micronutrient deficiencies may increase the risk of ALRI. A case-control study was conducted to assess the association between vitamin D status and ALRI in rural Bangladesh.
Children aged 1-18 months hospitalized with ALRI (cases) were individually matched to controls on age, sex, and village (N = 25 pairs). The mean serum 25-hydroxyvitamin D concentration [25(OH)D] in cases and controls was compared using paired t-test. The unadjusted and adjusted odds of ALRI were assessed by multivariate conditional logistic regression.
Mean [25(OH)D] was significantly lower among ALRI cases than controls (29.1 nmol/L vs. 39.1 nmol/L; p = 0.015). The unadjusted odds of ALRI was halved for each 10 nmol/L increase in [25(OH)D] (OR 0.53, 95% CI 0.30-0.96). Adjustment for confounders increased the magnitude of the association.
Vitamin D status was associated with early childhood ALRI in a matched case-control study in rural Bangladesh. Randomized trials may establish whether interventions to improve vitamin D status can reduce the burden of ALRI in early childhood.
Acta Paediatrica 11/2009; 99(3):389-93. · 2.07 Impact Factor
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ABSTRACT: The reason for lack of data on burden of Haemophilus influenzae type b (Hib) in developing countries was mainly failure of detection of this fastidious organism in laboratories. Use of isovitalex (IVX) was suggested as an essential supplement for growing this organism. This study was carried out to investigate the impact of IVX supplementation to chocolate agar for detection of Hib.
Chocolate agar with and without supplementation of IVX was prepared. Clinical samples as well as reference strains of Hib were simultaneously cultured on both the media.
H. influenzae isolates (N=194) were simultaneously grown on chocolate agar (CA) with and without isovitalex (IVX). Average colony size of H. influenzae on CA with IVX (CA-IVX) was larger only by 0.10 cm (range 0.05 to 0.16 cm) compared to CA alone. Addition of IVX to CA increased the cost of media by 2.1-fold.
Isovitalex is not essential for the isolation and growth of H. influenzae almost halving the cost.
The Indian journal of medical research 02/2009; 129(1):99-101. · 1.84 Impact Factor
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Global Public Health 10/2008; 3(4):366-382. · 0.92 Impact Factor
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ABSTRACT: Zinc is an essential micronutrient and deficiency can lead to an increased risk for infectious diseases and growth retardation among children under 5 years of age. We aimed to estimate disease-specific and all-cause mortality attributable to zinc deficiency.
We estimated the prevalence of zinc deficiency in Latin America, Africa and Asia, where based on zinc availability in the diet and childhood stunting rates, zinc deficiency is widespread. The relative risks of death among zinc-deficient children for diarrhea, malaria and pneumonia were estimated from randomized controlled trials. We used the comparative risk assessment methods to calculate deaths and burden of disease (measured in disability-adjusted life years, DALYs) from each of these three diseases attributable to zinc deficiency in these regions.
Zinc deficiency was responsible for 453,207 deaths (4.4% of childhood deaths), and 1.2% of the burden of disease (3.8% among children between 6 months and 5 years) in these three regions in 2004. Of these deaths, 260,502 were in Africa, 182,546 in Asia and 10,159 in Latin America. Zinc deficiency accounted for 14.4% of diarrhea deaths, 10.4% of malaria deaths and 6.7% of pneumonia deaths among children between 6 months and 5 years of age.
Zinc deficiency contributes to substantial morbidity and mortality, especially from diarrhea. Zinc supplementation provided as an adjunct treatment for diarrhea may be the best way to target children most at risk of deficiency.
European journal of clinical nutrition 03/2008; 63(5):591-7. · 3.07 Impact Factor
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ABSTRACT: To review the evidence supporting the inclusion of zinc for diarrhoea management specifically in sub-Saharan Africa where diarrhoea remains a leading cause of morbidity and mortality.
We searched PubMed for studies assessing the efficacy and effectiveness of zinc for the treatment and prevention of common childhood morbidities.
We included only studies conducted in sub-Saharan Africa.
Details of studies conducted in sub-Saharan Africa are presented in the context of the global evidence supporting the use of zinc for diarrhoea management.
There is a significant body of evidence to support the use of zinc for diarrhoea management in sub-Saharan Africa. The accelerated introduction of zinc into routine community-based diarrhoea treatment is critical for the reduction of diarrhoea morbidity and mortality.
East African medical journal 10/2007; 84(9):441-9.
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ABSTRACT: To determine the effect of low-dose weekly supplementation with iron, zinc or both on growth of infants from 6 to 12 months of age. SUBJECTS/METHods: A total of 645 breastfed infants age 6 months who were not severely anemic (Hb> or = 90 g l(-1)) or severely malnourished (weight-for-age > or = 60% median) were randomized to receive 20 mg iron and 1 mg riboflavin; 20 mg zinc and 1 mg riboflavin; 20 mg iron, 20 mg zinc and 1 mg riboflavin; or riboflavin alone (control) weekly for 6 months.
Baseline characteristics were similar among the four supplementation groups. Weight, length and mid-upper arm circumference were assessed at baseline, 8, 10 and 12 months of age. There was no interaction of iron and zinc when given in a combined supplement on either weight or length (P>0.05). There were no effects of either iron or zinc on the rate of length or weight gain for all infants or when stratified by baseline Hb concentration.
Weekly supplementation of 20 mg Fe, 20 mg Zn, or both does not benefit growth among infants 6-12 months of age in rural Bangladesh, a region with high rates of anemia and zinc deficiency.
European journal of clinical nutrition 09/2007; 63(1):87-92. · 3.07 Impact Factor
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A H Baqui,
E K Williams,
G L Darmstadt,
V Kumar,
T U Kiran,
D Panwar,
R K Sharma,
S Ahmed,
V Sreevasta,
R Ahuja,
M Santosham, R E Black
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ABSTRACT: To describe selected newborn care practices related to cord care, thermal care and breastfeeding in rural Uttar Pradesh and to identify socio-demographic, antenatal and delivery care factors that are associated with these practices.
A cross-sectional survey in rural Uttar Pradesh included 13,167 women who had a livebirth at home during the two years preceding data collection. Logistic regression was used to identify socio-demographic, antenatal and delivery care factors that were associated with the three care practices.
Use of antenatal care and skilled attendance at delivery were significantly associated with clean cord care and early breastfeeding, but not with thermal care. Antenatal home visits by a community-based worker were associated only with clean cord care. Women who received counseling from health workers or other sources on each of the newborn care practices during pregnancy were more likely to report the respective care practices, although levels of counseling were low.
The association between newborn care practices and antenatal care, counseling and skilled delivery attendance suggest that evidence-based newborn care practices can be promoted through improved coverage with existing health services.
The Indian Journal of Pediatrics 03/2007; 74(3):241-7. · 0.52 Impact Factor
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Abdullah H. Baqui,
E. K. Williams,
G. L. Darmstadt,
V. Kumar,
T. U. Kiran,
D. Panwar,
R. K. Sharma,
S. Ahmed,
V. Sreevasta,
R. Ahuja,
M. Santosham, R. E. Black
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ABSTRACT: ObjectivesTo describe selected newborn care practices related to cord care, thermal care and breastfeeding in rural Uttar Pradesh and
to identify socio-demographic, antenatal and delivery care factors that are associated with these practices.
MethodsA cross-sectional survey in rural Uttar Pradesh included 13, 167 women who had a livebirth at home during the two years preceding
data collection. Logistic regression was used to identify socio-demographic, antenatal and delivery care factors that were
associated with the three care practices.
ResultsUse of antenatal care and skilled attendance at delivery were significantly associated with clean cord care and early breastfeeding,
but not with thermal care. Antenatal home visits by a community-based worker were associated only with clean cord care. Women
who received counseling from health workers or other sources on each of the newborn care practices during pregnancy were more
likely to report the respective care practices, although levels of counseling were low.
ConclusionThe association between newborn care practices and antenatal care, counseling and skilled delivery attendance suggest that
evidence-based newborn care practices can be promoted through improved coverage with existing health services.
The Indian Journal of Pediatrics 02/2007; 74(3):241-247. · 0.52 Impact Factor
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ABSTRACT: To assess the rates, timing and causes of neonatal deaths and the burden of stillbirths in rural Uttar Pradesh, India. We discuss the implications of our findings for neonatal interventions.
We used verbal autopsy interviews to investigate 1048 neonatal deaths and stillbirths.
There were 430 stillbirths reported, comprising 41% of all deaths in the sample. Of the 618 live births, 32% deaths were on the day of birth, 50% occurred during the first 3 days of life and 71% were during the first week. The primary causes of death on the first day of life (i.e. day 0) were birth asphyxia or injury (31%) and preterm birth (26%). During days 1-6, the most frequent causes of death were preterm birth (30%) and sepsis or pneumonia (25%). Half of all deaths caused by sepsis or pneumonia occurred during the first week of life. The proportion of deaths attributed to sepsis or pneumonia increased to 45% and 36% during days 7-13 and 14-27, respectively.
Stillbirths and deaths on the day of birth represent a large proportion of perinatal and neonatal deaths, highlighting an urgent need to improve coverage with skilled birth attendants and to ensure access to emergency obstetric care. Health interventions to improve essential neonatal care and care-seeking behavior are also needed, particularly for preterm neonates in the early postnatal period.
Bulletin of the World Health Organisation 10/2006; 84(9):706-13. · 4.64 Impact Factor
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K Zaman,
M Yunus,
S E Arifeen,
A H Baqui,
D A Sack,
S Hossain,
Z Rahim,
M Ali,
S Banu,
M A Islam,
N Begum,
V Begum,
R F Breiman, R E Black
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ABSTRACT: The objective of the study was to determine the prevalence of smear-positive tuberculosis (TB) in a rural area in Bangladesh at Matlab. A TB surveillance system was established among 106,000 people in rural Bangladesh at Matlab. Trained field workers interviewed all persons aged > or = 15 years to detect suspected cases of TB (cough > 21 days) and sputum specimens of suspected cases were examined for acid-fast bacilli (AFB). Of 59,395 persons interviewed, 4235 (7.1%) had a cough for > 21 days. Sputum specimens were examined for AFB from 3834 persons, 52 (1.4%) of them were positive for AFB. The prevalence of chronic cough and sputum positivity were significantly higher among males compared to females (P < 0.001). The population-based prevalence rate of smear-positive TB cases was 95/100,000 among persons aged > or = 15 years. Cases of TB clustered geographically (relative risk 5.53, 95% CI 3.19-9.59). The high burden of TB among rural population warrants appropriate measures to control TB in Bangladesh. The higher prevalence of persistent cough and AFB-positive sputum among males need further exploration. Factors responsible for higher prevalence of TB in clusters should be investigated.
Epidemiology and Infection 10/2006; 134(5):1052-9. · 2.84 Impact Factor
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S E Arifeen,
J Bryce,
E Gouws,
A H Baqui, R E Black,
D M E Hoque,
E K Chowdhury,
M Yunus,
N Begum,
T Akter,
A Siddique
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ABSTRACT: The multi-country evaluation of Integrated Management of Childhood Illness (IMCI) effectiveness, cost and impact (MCE) is a global evaluation to determine the impact of IMCI on health outcomes and its cost-effectiveness. MCE studies are under way in Bangladesh, Brazil, Peru, Uganda and the United Republic of Tanzania. The objective of this analysis from the Bangladesh MCE study was to describe the quality of care delivered to sick children under 5 years old in first-level government health facilities, to inform government planning of child health programmes.
Generic MCE Health Facility Survey tools were adapted, translated and pre-tested. Medical doctors trained in IMCI and these tools conducted the survey in all 19 health facilities in the study areas. The data were collected using observations, exit interviews, inventories and interviews with facility providers.
Few of the sick children seeking care at these facilities were fully assessed or correctly treated, and almost none of their caregivers were advised on how to continue the care of the child at home. Over one-third of the sick children whose care was observed were managed by lower-level workers who were significantly more likely than higher-level workers to classify the sick child correctly and to provide correct information on home care to the caregiver.
These results demonstrate an urgent need for interventions to improve the quality of care provided for sick children in first-level facilities in Bangladesh, and suggest that including lower-level workers as targets for IMCI case-management training may be beneficial. The findings suggest that the IMCI strategy offers a promising set of interventions to address the child health service problems in Bangladesh.
Bulletin of the World Health Organisation 05/2005; 83(4):260-7. · 4.64 Impact Factor
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ABSTRACT: The aim of the present study, which was undertaken as a sub-study within a randomized controlled trial of zinc supplementation, was to evaluate the effect of prolonged zinc supplementation on copper status as assessed by hematological markers.
Plasma copper and zinc were estimated at baseline and after 120 d of supplementation in a randomly selected infant subset (115) of the children. Of these, 61 children were in a zinc group (Z) getting 10 mg of elemental zinc, and 54 were in a control group (C) getting supplement without zinc.
Baseline plasma zinc was comparable in the two groups; post-supplementation zinc was significantly higher (Z 93.0 +/- 3.6 vs C 60.6 +/- 8.0) in the zinc supplementation group. There was no significant difference in the mean/median copper levels between the zinc and control groups. The percentage of children with plasma copper <100 microg/dl was also not significantly different between groups (baseline Z 14.8%, C 11.1%; post-supplementation Z 18.0%, C 11.1%). There were no differences between the zinc and control groups after 120 d of supplementation in hemoglobin (Hgb), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), or number of lymphocytes or granulocytes.
Zinc supplementation of 10 mg/d for 4 mo in this study did not affect copper status, as assessed by plasma copper concentration and hematological parameters, diagnostics of copper deficiency.
Acta Paediatrica 05/2004; 93(5):599-602. · 2.07 Impact Factor
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ABSTRACT: The study objective was to estimate the prevalence of selected sexually transmitted infections (STIs) and associated factors among Dhaka slum dwellers. Blood and urine specimens were collected from 1534 men and women. Participants in this cross-sectional study responded to a questionnaire, providing socioeconomic data, symptomatology and treatment-seeking behaviour. Specimens were tested for syphilis, hepatitis B (HBsAg), Neisseria gonorrhoeae, Chlamydia trachomatis, and HIV. Serologic evidence of syphilis infection was found in 6.0% of respondents, HBsAg in 3.8%. Prevalence rates of gonorrhoea and chlamydia were 1.7% and <1%, respectively. No HIV infections were found. Men were more than twice as likely as women to be infected with syphilis or HBsAg carriers. Behaviours facilitating STI transmission were common among men. Syphilis infection is prevalent enough to warrant the initiation of screening programmes in this population. The prevalence rate of hepatitis B carriage suggests that this population would benefit from universal vaccination against hepatitis B.
International Journal of STD & AIDS 09/2003; 14(9):614-21. · 1.09 Impact Factor
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ABSTRACT: Low referral completion rates in developing countries undermine the Integrated Management of Childhood Illness (IMCI) strategy for lowering child mortality. This study sought to identify factors constraining adherence to referral advice in a health system using the IMCI approach.
Caregivers of 160 children urgently referred to hospital were prospectively interviewed. Caregivers who accessed and did not access hospital were compared for potential referral constraining factors, including demographics, family dynamics, the severity of their child's illness, their interaction with the health system, self-perceived problems, and physical and financial access.
67/160 (42%) referred children did not access hospital. Six factors were associated with non-access, including two health worker actions: not being given a referral slip [adjusted odds ratio (OR)= 15.3, 95% confidence interval (95% CI) 4.4-64.6] and not being told to go to the hospital immediately (adjusted OR = 5.3, 95% CI 1.9-16.3). Receiving both of these interventions reduced the risk of not accessing hospital to 19%, from 96% for those who received neither intervention. Several indicators of illness severity, including caregivers' ranking of their children's illness severity, the presence of severe illness signs and mortality, were investigated and found not to be important explanatory factors.
Providing a referral slip and counseling the caregivers of severely ill children to go to the hospital immediately appear to be powerful tools for increasing successful referral outcomes.
Acta Paediatrica 02/2003; 92(1):103-10. · 2.07 Impact Factor
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ABSTRACT: Topical therapy to enhance skin barrier function may be a simple, low-cost, effective strategy to improve outcome of preterm infants with a developmentally compromised epidermal barrier, as lipid constituents of topical products may act as a mechanical barrier and augment synthesis of barrier lipids. Natural oils are applied topically as part of a traditional oil massage to neonates in many developing countries. We sought to identify inexpensive, safe, vegetable oils available in developing countries that improved epidermal barrier function. The impact of oils on mouse epidermal barrier function (rate of transepidermal water loss over time following acute barrier disruption by tape-stripping) and ultrastructure was determined. A single application of sunflower seed oil significantly accelerated skin barrier recovery within 1 h; the effect was sustained 5 h after application. In contrast, the other vegetable oils tested (mustard, olive and soybean oils) all significantly delayed recovery of barrier function compared with control- or Aquaphor-treated skin. Twice-daily applications of mustard oil for 7 d resulted in sustained delay of barrier recovery. Moreover, adverse ultrastructural changes were seen under transmission electron microscopy in keratin intermediate filament, mitochondrial, nuclear, and nuclear envelope structure following a single application of mustard oil. Conclusion: Our data suggest that topical application of linoleate-enriched oil such as sunflower seed oil might enhance skin barrier function and improve outcome in neonates with compromised barrier function. Mustard oil, used routinely in newborn care throughout South Asia, has toxic effects on the epidermal barrier that warrant further investigation.
Acta Paediatrica 02/2002; 91(5):546-54. · 2.07 Impact Factor
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ABSTRACT: Many of the individual questions used by the World Health Organization for household surveys on diarrhoea management have not been systematically assessed. This study assessed the use of simple questions to caretakers of children to estimate the proportion of young children who received increased quantities of fluids during diarrhoeal episodes by comparing caretakers' responses with data obtained by direct observations. Children aged 4-35 mo (n = 215) with diarrhoea starting within the last 24 h were observed for 12 h. These children were observed for 12 h again 2 wk later, when healthy. On the following day the questionnaire was administered to the caretakers. The observation focused on the frequency of feeding episodes, including breastfeeding and the type and quantity of fluids consumed by the child. The same questionnaire was administered to the caretakers of another group of children (n = 421) with diarrhoea in the past 2 wk. The mean number of feedings (6.0 +/- 3.8 vs 5.0 +/- 3.5), breastfeeding episodes (11.2 +/- 3.6 vs 8.4 +/- 3.3), breastfeeding duration (85.8 +/- 36.3 min vs 49.1 +/- 22.8 min), other fluid intake (345.8 +/- 309.6 ml vs 120.9 +/- 136.4 ml) and total fluid consumption (653.9 +/- 240.4 ml vs 399.5 +/- 133.6 ml) were significantly higher (p < 0.0001) during diarrhoea compared with healthy periods. At the population level, the simple questionnaire administered to caretakers was found to have high agreement between the reported increase in fluid consumption and the actual increase in fluid intake (defined as > or = 100 ml). At the individual level, caretakers' questionnaire responses for detecting increased fluid intake were highly sensitive (84.3%), but specificity (36.4%) and agreement (0.22) were low. Conclusion: This study documents that children had higher fluid intake, which included both breast milk and other fluid, during acute episodes of diarrhoea. Further research is warranted to improve the specificity and agreement of caretakers' responses to simple questions regarding change in fluid intake during diarrhoeal episodes.
Acta Paediatrica 01/2002; 91(4):376-82. · 2.07 Impact Factor
