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Weight Gain in Malnourished Children after 5 Months Food Supplementation in a Slum Setting in Bangladesh

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Food and Nutrition Sciences 2014年第14期5卷 1370-1378页

作者： Mustafa Mahfuz tahmeed ahmed A. M. Shamsir ahmed M. Munirul Islam M. I. Hossain Centre for Nutrition and Food Security International Centre for Diarrhoeal Disease Research Bangladesh (icddr b) Dhaka Bangladesh

We examined the rate of weight gain and absolute weight gain of underweight children (weight- for-age Z score < -2) aged between 6 - 24 months living in a slum of Dhaka city, in response to two different regimens of supplementary feeding. Comparison was also made with the weight gain of a healthy group of children from the same locality. In total 161 children, including 68 healthy children representing the control group, were enrolled for the 5 months supplementation. The two regimens of feeding were either ready-to-use therapeutic food (RUTF, Plumpy’Nut) or locally made cereal-based supplementary food Pushti packet which was recommended in the National Nutritional Program. No food supplementation was provided to control children. All children received vitamin A as part of the six-monthly national program, albendazole for deworming, immunization, and health and nutrition education. Multiple micronutrient powder (MNP) was provided only to Pushti packet and control children. The rate of weight gain on RUTF was 1.69 g/kg/day during the first month and gradually declined to 0.9 g/kg/day at the final month of the trial, whereas, the rate of weight gain on Pushti packet was 0.77 g/kg/day during the first month declining to 0.70 g/kg/day at the end of the trial. Rate of weight gain in the control group was steady between 0.47 - 0.50 g/kg/day. Absolute weight gains of 1085 g, 790 g and 730 g were observed in the RUTF, Pushti packet and the control groups, respectively which were significantly higher in the RUTF group. There was no statistically significant difference between the RUTF and Pushti packet groups in terms of rate of weight gain. Overall, weight gain was unsatisfactory for both supplementation groups. Better absolute weight gain was observed with RUTF supplementation compared to Pushti packet which prevented further deterioration in weight among the malnourished children.

关键词： Malnutrition RUTF Supplementation Underweight Bangladesh

Effect of Nutritional Support on Treatment of Multi-Drug Resistant Tuberculosis in Rajshahi Division, Bangladesh

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Journal of Tuberculosis Research 2020年第4期8卷 223-236页

作者： Md. Abu Sayem Md. Golam Hossain tahmeed ahmed Khaled Hossain Zahangir Alam Saud Institute of Biological Sciences University of Rajshahi Rajshahi Bangladesh Department of Statistics University of Rajshahi Rajshahi Bangladesh Department of Public Health James P. Grant School of Public Health Dhaka Bangladesh Department of Biochemistry and Molecular Biology University of Rajshahi Rajshahi Bangladesh

Introduction: Multi-drug resistant tuberculosis (MDR-TB) is a public health crisis throughout the world including Bangladesh particularly due to its complexities in diagnosis, longer treatment regimen, and adverse drug reaction. Nutritional supplementation has significant impact on patient’s weigh gain and optimum weight gain is a biomarker of treatment response. The objective of this study was to measure body mass index (BMI) progress among MDR-TB patients in different phases of treatment. Methodology: A prospective observational study was conducted from March 2010 to July 2015 in Chest Disease Hospital (CDH), Rajshahi and different communities of Rajshahi Division, Bangladesh. A total of 233 confirmed MDR-TB patients were selected from CDH who received treatment and nutritional support from ongoing national TB control program (NTP). They received free diagnosis, follow up tests, treatment and nutritional support as regular diet as well as cash amount Bangladeshi taka (BDT.) 1000 per month in CDH. Along with treatment, they also received only cash amount BDT. 1500 per month as nutritional support at community level. Weight measurement was taken at regular interval from enrollment to completion of treatment. Chi-square, paired t-test and linear regression analysis were used in this study.

关键词： Bangladesh BMI Progress MDR-TB Nutritional Support

Predictive Factors of Hyponatremia in Under-Five Severely Malnourished Children with Pneumonia Admitted to a Large Urban Hospital in Dhaka, Bangladesh: A Nested Case-Control Design

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Food and Nutrition Sciences 2013年第4期4卷 398-404页

作者： Cheryl Kay Zogg tahmeed ahmed Abu Syeed Golam Faruque Sumon Kumar Das Gazi Imran Mohammod Jobayer Chisti Centre for Nutrition & Food Security (CNFS) International Centre for Diarrhoeal Disease Research Bangladesh (icddrb) Dhaka Bangladesh Dhaka Shishu Hospital Dhaka Bangladesh Johns Hopkins Bloomberg School of Public Health Baltimore USA

Background: Hyponatremia is the most common electrolyte imbalance encountered in the management of diarrheal children. Common ramifications include cerebral edema and fatal outcomes. However, pediatric data remain lacking, particularly in developmental contexts where resources are limited and associated conditions like malnutrition and pneumonia are common. Aim: This study aimed to evaluate predicting factors associated with hyponatremia in children under five years of age with severe acute malnutrition (SAM) in Bangladesh. Methods: Using a nested case-control design, we compared clinical and laboratory characteristics of children with (n = 61) and without hyponatremia (n = 183) taken from a parent population of all children under five with SAM and clinical or radiological pneumonia admitted to Dhaka Hospital of icddr,b between April 2011 and June 2012 (n = 407). Results: Logistic regression analysis adjusting for potential confounders such as lack of breast feeding, duration of vomiting (days), and severe wasting revealed that older age (OR 1.05, 95%CI 1.02 - 1.07, p = 0.001) (5% increase in the relative odds of hyponatremia for each additional month of age), presence of diarrhea (OR 2.43, 95%CI 1.0 - 6.0, p = 0.05), and difficulty breathing (OR 1.52, 95%CI 1.0 - 2.05, p = 0.05) were significantly associated with hyponatremia. Conclusion: Our data suggest that older age, presence of diarrhea, and difficulty breathing in under-five children with SAM is independent predictors of hyponatremia. These findings underscore the importance of detecting simple clinical predictors early in order to facilitate appropriate management and to prevent potential ramifications of hyponatremia in SAM children, especially in resource-poor settings.

关键词： Children Diarrhea Hyponatremia Malnutrition Pneumonia

Etiology of Diarrhea among Severely Malnourished Infants and Young Children: Observation of Urban-Rural Differences over One Decade in Bangladesh

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Food and Nutrition Sciences 2013年第3期4卷 233-239页

作者： Sumon Kumar Das Mohammod Jobayer Chisti Sayeeda Huq Mohammad Abdul Malek Mohammed Abdus Salam tahmeed ahmed Abu Syed Golam Faruque International Centre for Diarrheal Disease Research Dhaka Bangladesh.

There is inadequate information on the etiology of diarrhea in severely malnourished (SM) young children. Thus, the study aimed to determine the etiology of diarrhea among severely malnourished (z score ?3.00 SD) children in rural and urban Bangladesh. From the database (2000-2011) of Diarrheal Disease Surveillance Systems (DDSS) at rural Matlab and urban Dhaka hospitals of icddr,b, 2234 and 3109 under-5 children were found severely malnourished (underweight, stunted or wasted) respectively. Two comparison groups [moderately malnourished (MM) and well-nourished (WN)] were randomly selected in a ratio of 1:1:1. Children with all categories of SM were more likely to be infected with Vibrio cholerae (rural—11%;urban—15%), Shigella (16%;9%), Salmonella (1%;2%) and Campylobacter (3%;4%);and less likely to have rotavirus (25%;20%) compared to only one SM category. Isolation rate of Vibrio cholerae was significantly higher among SM both in rural and urban children (7%;13%) than those of MM (5%;10%) and WN (2%;8%) and lower for rotavirus (30%;31%), (34%;43%), (35%;47%) respectively (p 0.01). However, for Shigella it was only higher among rural SM children (11%) [MM (9%), and WN (8%) (p 0.01)]. The isolation rate of Salmonella in SM (2%) was similar to that in MM (2%;p = 0.72) but significantly higher than that in WN (1%;p 0.01) among urban children. Isolation rates of bacterial enteric pathogens were higher but rotavirus was lower in SM children in both rural and urban area with geographical heterogeneity.

关键词： Diarrhea Under-5 Children Rural Severe Malnutrition Urban

Changing Trend of Overweight and Obesity and Their Associated Factors in an Urban Population of Bangladesh

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Food and Nutrition Sciences 2013年第6期4卷 678-689页

作者： Sumon Kumar Das Mohammod Jobayer Chisti Sayeeda Huq Mohammad Abdul Malek Lana Vanderlee Mohammed Abdus Salam tahmeed ahmed Abu Syed Golam Faruque Abdullah Al Mamun International Centre for Diarrheal Disease Research Dhaka Bangladesh School of Population Health University of Queensland Brisbane Australia. School of Public Health and Health Systems University of Waterloo Waterloo Canada

There is a scarcity of information examining the prevalence of overweight and obesity in the general population of Bangladesh. Thus, the present study aimed to estimate the changing trends and socio-demographic characteristics of overweight and obese individuals among an urban population inDhaka,Bangladesh. The present study included data from 49,532 patients enrolled in the Diarrheal Disease Surveillance System (DDSS) at theDhakaHospitalfrom 1993-2011. Overweight and obese was categorized among under-5 children (n = 508), 5 19 years (n = 96), and >19 years (n = 1330). Data was compared with normal weight and malnourished individuals of respective age strata. The proportion of overweight and obese increased from 0.64% 5.15% among children 0.001), 0.80% 6.70% among 5 19 years (p 0.001), and 3.66% 16.94% (p 0.001) among >19 years. Among those under-5, males [OR = 1.31 (95%CI 1.08, 1.57)] those with higher socio-economic status [1.99 (1.02, 3.82)], higher monthly mean family income [3.76 (2.41, 5.86)], non-slum residence [2.01 (0.74, 5.51)], high maternal literacy rate [3.66 (2.31, 5.79)], and using sanitary toilet [1.47 (1.07, 2.01)] were at higher risk of being overweight and obese compared to well-nourished and malnourished children. Among individuals 5 19 years, those with higher socioeconomic status and use of sanitary toilet were at higher risk of being overweight and obese. Among those >19 years, additionally males were less likely to be overweight and obese [0.59 (0.49, 0.68)]. Over the last two decades the prevalence of overweight and obesity in Dhaka city has increased at least five folds and it was much higher among those with better socioeconomic status.

关键词： Bangladesh Obesity Overweight Urban

Socio-demographic, host and clinical characteristics of people with typhoidal and non-typhiodal<i>Salmonella</i>gastroenteritis in urban Bangladesh

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Journal of Biomedical Science and Engineering 2013年第8期6卷 834-842页

作者： Sumon Kumar Das Mohammod Jobayer Chisti Mohammad Abdul Malek Shahnawaz ahmed Fahmida Dil Farzana Farzana Ferdous K. M. Shahunja Mohammed Abdus Salam tahmeed ahmed Abu Syed Golam Faruque Centre for Nutrition and Food Security (CNFS) International Centre for Diarrheal Disease Research Bangladesh (icddrb) Dhaka Bangladesh

Typhoidal (Salmonella enterica serover Typhi and Para-typhi A and B) (TS) and non-typhiodal Salmonella (NTS) gastroenteritis are less reported in Bangladesh. There is also a lack of report on socio-demographic and clinical characteristics of Bangladeshi people with typhoid fever and those with non-typhoidal Salmonella (NTS) gastroenteritis. Thus, the present study aimed to compare the socio-demographic, host and clinical characteristics, and seasonal variations between TS and NTS infections among patients attending at a large diarrheal disease hospital in urban Bangladesh. Information were extracted from the database of icddr,b in two different age stratums (0-14 years, and 15 years and above) as 54 with TS and 199 with NTS;and 65 with TS and 239 with NTS respectively after excluding all other pathogens. Randomly selected individuals with diarrhea but without any pathogen in stool constituted the control group (n = 253 and n = 304 respectively). Among 0-14 years, fever [aOR-4.35 (95% CI-1.45-13.06)] and drink unboiled water [aOR-0.22 (95% CI-0.06-0.83)] significantly differed between TS and NTS. Significant associations were observed with lower socio-economic context [aOR-10.02 (95% CI-3.79-26.45)], unbolied drinking water [aOR-2.16 (95% CI-1.05-4.43)], fever [aOR-4.54 (95% CI-1.71-12.03)], pneumonia [aOR-21.57 (95% CI-1.90-245.01)], wasting [aOR-2.60 (95% CI-1.21-5.57)], presence of RBC [aOR-0.09 (95% CI-0.02-0.33], leucocytes [aOR-3.97 (95% CI-1.76-8.99)] and macrophage [aOR-10.71 (95% CI-2.80-41.06)] in stool and alkaline pH [aOR-2.07 (95% CI-1.08-3.97)] when compared with control group. Among ≥15 years, TS was more frequently isolated from individuals with poor socio-economic background [aOR-2.09 (95% CI-1.0-4.33)] and use non-tap drinking water [aOR-0.29 (95% CI-0.13-0.66] compared to their NTS counterparts. Reported lack of formal schooling [aOR-0.65 (95% CI-0.44-0.96)], fever [aOR-2.10 (95% CI-1.03-4.31)], hospital stay (>24 hours) [aOR-1.66 (95% CI-1.05-2.62

关键词： Bangladesh Diarrhea Non-Typhiodal Salmonella Typhoidal Salmonella Urban

Predictors of Meningitis in Under-Fifteen Children Attending an Intensive Care Unit of an Urban Large Diarrheal Disease Hospital in Bangladesh

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Food and Nutrition Sciences 2014年第2期5卷 169-176页

作者： Farzana Afroze tahmeed ahmed Shafiqul Alam Sarker Abu S. G. Faruque Hasan Ashraf Pradip Kumar Bardhan Sumon Kumar Das Mohammod Jobayer Chisti Centre for Nutrition and Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh Centre for Nutrition and Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh School of Population Health The University of Queensland Brisbane Australia.

Background: Data are lack on predicting features of meningitis in diarrheal children although the great clinical importance. Objective: To evaluate clinical and laboratory features in predicting meningitis in under-fifteen children having diarrheal illnesses. Methods: Children aged 1 month to 15 years, admitted in the ICU of the Dhaka Hospital of icddr, b between March 2011 and February 2012 with fever and seizure or altered consciousness and having LP done were enrolled into this analysis. Those children who had abnormal CSF findings [pleocytosis (normal range of leukocyte, 0 - 10/mm3) and/or elevated protein (normal range, 0.10 - 0.45 mg/dl) and low glucose (normal value, 60% of corresponding blood glucose)] were defined as meningitis. Comparison was made between children with (cases = 17) and without meningitis (controls = 66) from our study children. Data were retrospectively collected from SHEBA, an online database system of the Dhaka Hospital of icddr, b. Results: Death was significantly higher among the cases compared to the controls (29% vs. 3%, p = 0.003). In logistic regression analysis, after adjusting for potential confounders, cases frequently had hypoxemia (95% CI 1.55 - 21.93), absent peripheral pulse (95% CI 1.95 - 27.13) and neutrophilia (95% CI 1.13 - 17.00). Conclusion: Our data suggest that children with meningitis had higher case fatality rate. Simple independent predictors of meningitis such as hypoxemia, absent peripheral pulse, and neutrophilia may help clinicians to initiate early and prompt management in order to curve lifelong sequel due to meningitis and death in such patient population especially those in resource poor settings.

关键词： Children Diarrhea Hypoxemia Meningitis Neutrophilia Peripheral Pulse

History of Vitamin A Supplementation Reduces Severity of Diarrhea in Young Children Admitted to Hospital with Diarrhea and Pneumonia

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Food and Nutrition Sciences 2013年第2期4卷 150-155页

作者： Mohammod J. Chisti Mohammed A. Salam Abu S. G. Faruque Hasan Ashraf Pradip K. Bardhan Sumon K. Das Sayeeda Huq Fahmida Chowdhury Shoeb B. Islam tahmeed ahmed Centre for Communicable Diseases (CCD) Dhaka Bangladesh. Centre for Nutrition & Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh Centre for Nutrition & Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh&Clinical Services (CS) Dhaka Bangladesh Centre for Nutrition & Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh&Clinical Services (CS) Dhaka Bangladesh Centre for Nutrition & Food Security (CNFS) International Centre for Diarrhoeal Disease Research Dhaka Bangladesh Clinical Services (CS) Dhaka Bangladesh Clinical Services (CS) Dhaka Bangladesh Research Administration Services (RAS) Dhaka Bangladesh

Background: Although the role of vitamin A in childhood pneumonia in association with diarrhea is not fully proven, we did not find any published data demonstrating the impact of lack of vitamin A supplementation in under-five children who present with the co-morbidities of pneumonia and diarrhea. This study examined whether previous vitamin A supplementation was associated with reduced severity and duration of diarrhea and pneumonia for children presenting with both illnesses. Methods: All admitted children (n = 189) aged 0 - 59 months to the Special Care Ward of the Dhaka Hospital of icddr,b with diarrhea and radiological pneumonia from September-December 2007 were enrolled. We compared clinical features of the children who received (n = 96) and did not receive (n = 93) high potency capsule vitamin A supplementation during previous immunization according to EPI schedule. Results: In logistic regression analysis, after adjusting for potential confounders such as respiratory rate, lower chest wall in-drawing, severe wasting and systolic blood pressure, vitamin A non-supplemented children with pneumonia and diarrhea more often presented in their early infancy (95% CI 1.01 - 1.09), had duration of diarrhea for >4 days (95% CI 1.79 - 11.88), had clinical dehydration (95% CI 1.2 - 5.63), and more often required hospitalization for >7 days (95% CI 1.03 - 8.87). But, there was no significant difference in the clinical features of pneumonia, such as history of cough, respiratory rate, lower chest wall in-drawing, nasal flaring, head nodding, grunting respiration, cyanosis, and inability to drink between the groups. Conclusion: Lack of vitamin A supplementation in under-five children with radiological pneumonia and diarrhea is independently associated with young infancy, duration of diarrhea for >4 days, dehydration and hospitalization for >7 days which underscores the importance of routine supplementation of vitamin A in young infancy. However, lack of vitamin A supplement

关键词： Bangladesh Diarrhea Children Lower Chest Wall In-Drawing Pneumonia Vitamin A Supplementation