K Akram

International Centre for Diarrhoeal Disease Research, Bangladesh, Mujib City, Dhaka, Bangladesh

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Publications (11)45.35 Total impact

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    ABSTRACT: The incidence of low birthweight (LBW) in Bangladesh is one of the highest in the world. Inadequate rest of the mothers during pregnancy is a contributing factor to LBW. To assess the perception and practice of rest during pregnancy, 136 mothers and family members who make important decisions on family matter (FDM) were studied in rural Bangladesh. Eighty per cent of mothers perceived the importance of rest during pregnancy, whereas only 29 per cent practised rest (p < 0.003). Of the mothers who lacked perception, none practised. Eighty-five per cent of FDM perceived rest as important, yet only 27 per cent practised rest. Mothers' education and socioeconomic status were significantly associated with perception (p < 0.028,p < 0.001) and practice (p < 0.008,p < 0.006) of rest. The mother's education was also significantly (p < 0.000) associated with the socioeconomic status of the family. Our study suggests that the inability to take rest was due to workload at home, illiteracy, low socioeconomic status and failure of family members to share the workload.
    Journal of Tropical Pediatrics 10/2000; 46(5):311-3. DOI:10.1093/tropej/46.5.311 · 0.86 Impact Factor
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    ABSTRACT: The emergence of the new strain Vibrio cholerae O139 and its rapid spread in Bangladesh and India together with its detection in several other countries, have raised the question whether this constitutes the beginning of the eighth pandemic of cholera, and if so, how large a threat it poses. In an attempt to answer this question, epidemic spread patterns of Vibrio cholerae O139 strain in Bangladesh were studied. Initially the epidemic moved quickly and affected the entire coastal and estuarine tidal plains of southern Bangladesh. In the flood plains of the northern regions it affected mostly the north-eastern and north-central areas, at a slower pace than in the southern areas. In the beginning the new strain totally displaced both biotypes (classic and El Tor) of Vibrio cholerae O1. Nearly 2 years after its initial detection, striking differences in the distribution of V. cholerae O139 and O1 were observed. In most northern areas, the new strain was replaced by V. cholerae O1, whereas in the southern coastal regions, the O139 strain continues to dominate epidemics. The study suggests that the O139 strain may become endemic in the coastal ecosystem. The threat of a pandemic, therefore, may not be as large as it first seemed.
    Tropical Medicine & International Health 07/1996; 1(3):393-8. DOI:10.1046/j.1365-3156.1996.d01-54.x · 2.30 Impact Factor
  • Transactions of the Royal Society of Tropical Medicine and Hygiene 09/1995; 89(5):506. DOI:10.1016/0035-9203(95)90086-1 · 1.93 Impact Factor
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    ABSTRACT: In July, 1994, in one of the worst cholera outbreaks in recent times, an estimated 12,000 Rwandan refugees died in Goma in eastern Zaire. The Vibrio cholerae strains were resistant to tetracycline and doxycycline, the commonly used drugs for cholera treatment. Despite the efforts of international organisations, which provided medical relief by establishing treatment centres in Goma, mortality from the disease was much higher than expected. In the area of Muganga camp, which had the largest concentration of refugees and where most of the medical aid organisations were active, the highest reported case-fatality ratio for a single day was 48%. The slow rate of rehydration, inadequate use of oral rehydration therapy, use of inappropriate intravenous fluids, and inadequate experience of health workers in management of severe cholera are thought to be some of the factors associated with the failure to prevent so many deaths during the epidemic. In one of the temporary treatment centres with the worst case-fatality record, our team showed that improvement of these factors could increase the odds of survival of cholera patients even in a disaster setting.
    The Lancet 03/1995; 345(8946):359-61. DOI:10.1016/S0140-6736(95)90344-5 · 39.21 Impact Factor
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    ABSTRACT: For decades, epidemic cholera in Bangladesh has produced contrasting pictures of appearance and disappearance of Vibrio cholerae, which until recently, remained confined to the biotypes and to serotypes of V. cholerae O1. The classical biotype continued to survive and coexisted with El Tor biotype in southern Bangladesh despite its disappearance from the rest of the world during the present pandemic. For the first time in history, during the cholera epidemic in 1993, both biotypes (classical and El Tor) of V. cholerae O1 have disappeared and have been replaced by a new strain of V. cholerae non-O1 (designated as O139 Bengal). Environmental changes occurring in the Bay of Bengal may have resulted in the emergence of the new epidemic strain of V. cholerae in Bangladesh.
    Tropical and geographical medicine 02/1994; 46(3):147-50.
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    ABSTRACT: In 1991, a major epidemic of diarrhoea broke out in Bangladesh. To estimate the extent of cholera during diarrhoea epidemics and to focus on the public health issues related to cholera in Bangladesh, we have used the government figures of the 1991 epidemic and data from our own experience of epidemic interventions in nearly 400 rural upazilas (sub-district) between 1985 and 1989 and in 1991. Our data showed that V. cholerae 01 was the most frequently (40%) isolated enteropathogen during the epidemics. The disease is widely distributed in the country. Only 24% of the total 1,648 laboratory confirmed cholera patients were below 5 years of age, and children below 2 years of age accounted for only 10% of the total. Access difficulty to medical care and absence of a reliable surveillance were thought to be the constraints to early detection and appropriate intervention, thus, there were more deaths during the epidemics. We have shown that a high proportion (59%) of cholera patients during their illness in the rural areas were not visited by the government surveillance staff and that most (80%) were treated at home. Access to treatment by qualified physicians was limited to 23% of the patients, whereas a large proportion of the patients were treated by the unqualified rural practitioners (68%), and the others (9%) had no access to any health care providers. Our experience also indicated a higher case fatality ratio (14%) prior to intervention by qualified physicians during epidemics and an overall fatality ratio of 4%, despite the significant reduction (less than 1%) achieved by the intervention. Cholera is highly epidemic in Bangladesh.(ABSTRACT TRUNCATED AT 250 WORDS)
    Journal of diarrhoeal diseases research 07/1992; 10(2):79-86.
  • A B Islam, A K Siddique, K A Akram
    Tropical and geographical medicine 01/1991; 43(1-2):117-8.
  • Tropical Doctor 05/1990; 20(2):83-5. · 0.53 Impact Factor
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    ABSTRACT: In May 1985, a cyclone and tidal surge devastated Sandwip, an island off the Southern Corner of Bangladesh. Within one week after this disaster a cholera epidemic broke out. It resulted in 12,194 registered cases and 51 deaths. The factors contributing to the occurrence of the epidemic are analyzed.
    Tropical and geographical medicine 11/1989; 41(4):377-82.
  • A K Siddique, K Akram, Q Islam
    Tropical Doctor 02/1988; 18(1):40-2. · 0.53 Impact Factor
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    ABSTRACT: The outcome of an intervention of a shigellosis epidemic during April-July 1985 at Dimla, northern Bangladesh is reported. People of the epidemic-affected community operated a makeshift hospital to provide early indoor treatment for 1,708 patients of blood dysentery, based on empirically selected antibiotic(s), oral rehydration of the patients and giving them high-protein diets. They raised funds and received technical and logistic assistance from the physicians and officials of the local government health centre and of the International Centre for Diarrhoeal Disease Research, Bangladesh. In comparison with the number of deaths recorded before intervention, there was a 187-fold reduction of case-fatality ratio from 11.2 to 0.06% (p less than 0.0001). Probable causes for this precipitious decline of mortality are discussed. It is concluded that such a community action in the intervention of a rural shigellosis epidemic in a developing country may avert death almost totally.
    Journal of diarrhoeal diseases research 6(3-4):215-20.