Duration of protective immunity conferred by maternal tetanus toxoid immunization: further evidence from Matlab, Bangladesh.

OBJECTIVES: Although maternal tetanus immunization has been shown to be highly effective in the prevention of neonatal tetanus, unresolved questions remain concerning the required minimum number of doses and the resulting duration of effective immunity. This study examined the duration of effective immunity against neonatal tetanus provided by maternal tetanus immunization. METHODS: A randomized, double-blind cholera vaccine trial of 41,571 children and nonpregnant adult women carried out in 1974 in the Matlab comparison area of rural Bangladesh provided a unique opportunity to address dose and immunity issues. RESULTS: Children of women who received either 1 or 2 injections of tetanus toxoid experienced 4- to 14-day mortality levels consistently lower than those of children of unimmunized mothers. Analysis of neonatal-tetanus-related mortality showed that 2 injections of tetanus toxoid provided significant protection for subsequent durations of up to 12 or 13 years. CONCLUSIONS: The data demonstrate that a limited-dose regimen of maternal tetanus toxoid provides significant and extended protection against the risk of neonatal tetanus death.     

Iodine deficiency disorders in Bangladesh

An extensive iodine deficiency disorders survery was conducted in Bangladesh in 1993 to assess the latest iodine nutriture status of the country. The clinical variables of the survey were goitre and cretinism, and the biochemical variable was urinary iodine. The “EPI-30 cluster” sampling methodology was followed for selecting the survey sites. In each survey site, the study population consisted of boys and girls, aged 5–11 years, and men and women, aged 15–44 years, in about equal populations. the total number of survey sites was 78 and the total number of respondents was 30 072. The total number of urine samples was 4512 (15% sub-sample). The current total goitre rate (grade 1+grade 2) in Bangladesh is 47.1% (hilly, 44.4%; flood-prone, 50.7%; and plains, 45.6%). The prevalence of cretinism in the country is 0.5% (hilly, 0.8%; flood-prone, 0.5%; and plains, 0.3%). Nearly 69% of Bangladeshi population have biochemical iodine deficiency (urinary iodine excretion [UIE]<10 mg/dl) (hilly, 84.4; flood-prone, 67.1%; and plains 60.4%). Women and children are more affected than men, in terms of both goitre prevalence and UIE. The widespread severe iodine deficiency in all ecological zones indicates that the country as a whole is an iodine-deficient region. Important recommendations of global interest are made from the experience of the survey. An erratum to this article is available at .     

Role of breast feeding in preventing acquisition of roundworm and hookworm in Dhaka slum children

Breast feeding was found to give protection against many gastrointestinal infections in infants. A study has been conducted to examine whether breastfeeding protects children from contracting ascaris lumbricoides and hookworm infections. History of breast feeding and supplementation in urban children from low economic strata were obtained and stools were examined for ova of ascaris and hookworm. There was no significant difference in the presence of hookworm ova between the only breastfed group and the breastfed with supplemented group by two years of age. By the age of six and 24 months the presence of ascaris ova was significantly higher in the breastfed with supplemented group than the breastfed only group. It appears that exclusive breast feeding may have some role in preventing acquisition of ascaris infection in urban slums with poor sanitation facilities.     

Newborn survival in Bangladesh: a decade of change and future implications

Remarkable progress over the last decade has put Bangladesh on track for Millennium Development Goal (MDG) 4 for child survival and achieved a 40% decline in maternal mortality. However, since neonatal deaths make up 57% of under-five mortality in the country, increased scale up and equity in programmes for neonatal survival are critical to sustain progress. We examined change for newborn survival from 2000 to 2010 considering mortality, coverage and funding indicators, as well as contextual factors. The national neonatal mortality rate has undergone an annual decline of 4.0% since 2000, reflecting greater progress than both the regional and global averages, but the mortality reduction for children 1-59 months was double this rate, at 8.6%. Examining policy and programme change, and national and donor funding for health, we identified various factors which contributed to an environment favourable to newborn survival. Locally-generated evidence combined with re-packaged global evidence, notably The Lancet Neonatal Series, has played a role, although pathways between research and policies and programme change are often complex. Several high-profile champions have had major influence. Attention for community initiatives and considerable donor funding also appear to have contributed. There have been some increases in coverage of key interventions, such as skilled attendance at birth and postnatal care, however these are low and reach less than one-third of families. Major reductions in total fertility, some change in gross national income and other contextual factors are likely to also have had an influence in mortality reduction. However, other factors such as socio-economic and geographic inequalities, frequent changes in government and pluralistic implementation structures have provided challenges. As coverage of health services increases, a notable gap remains in quality of facility-based care. Future gains for newborn survival in Bangladesh rest upon increased implementation at scale and greater consistency in content and quality of programmes and services.     

Knowledge of AIDS and condom as a preventive measure against AIDS among married males and factors influencing it in Bangladesh

Background: The acquired immunodeficiency syndrome (AIDS) is now a global scourge of mankind. Nevertheless, Bangladesh is categorized as a low HIV prevalence country, from an epidemiological point of view, the HIV epidemic in Bangladesh is evolving rapidly. The majority of the studies on HIV/AIDS and condom use were carried out among the risk segment of people in the country. This study aimed to investigate the knowledge of AIDS and use of condoms among general population for prevention of HIV/AIDS in Bangladesh. Methods: Both quantitative and qualitative study designs were adopted in this study. Cross-sectional data were collected from rural and urban areas. Married males aged 20 years and above constituted the study population. Data on 524 male respondents were analyzed using SPSS software version 11.5. For qualitative data, selective in-depth interview was done using unstructured guidelines. Results: Analysis indicated that 26 of the respondents had no knowledge about AIDS. More than one-fifth 23 had poor, 26 had well and 25 had excellent knowledge on AIDS. Only 29 reportedly mentioned that condom might be a preventive measure against AIDS. Multivariate logistic regression analysis revealed that urban residents with access to electronic and printed media, better socioeconomic condition and service holders appeared to be significantly associated with knowledge of condom as a preventive measure for AIDS p<0.05. However, in the social context, the respondents had different views about use of condom as a preventive measure against AIDS. Conclusion: Useful and fruitful media campaigns to educate the people regarding the health consequences of STDs including HIV/AIDS and integrated approach is strongly suggested for disseminating knowledge and awareness to control the spread of HIV/AIDS among people in Bangladesh. Key words: Knowledge, awareness, STDs, HIV/AIDS, Condom, Bangladesh.     

NO donors inhibit Na,K-ATPase activity by a protein kinase G-dependent mechanism in the nonpigmented ciliary epithelium of the porcine eye

1. We developed a novel method to isolate nonpigmented epithelial (NPE) cells from porcine eyes in order to examine Na,K-ATPase responses to nitric oxide (NO) donors specifically in the epithelium. 2. Cells were treated with NO donors and other test compounds for 20 min prior to Na,K-ATPase activity measurement. 3. NO donors, sodium nitroprusside (SNP, 1 microM-1 mM), sodium azide (100 nM-1 microM) and S-nitroso-N-acetylpenicillamine (1 microM-1 mM) caused significant concentration-dependent inhibition of Na,K-ATPase activity. Detection of nitrite in the medium of L-arginine and SNP-treated NPE confirmed NO generation. 4. Concentration-dependent inhibition of Na,K-ATPase was also obtained by L-arginine (1-3 mM), a physiological precursor of NO and 8p-CPT-cGMP (1-100 microM), a cell permeable analog of cGMP. The L-arginine effect was abolished when the NO synthesizing enzyme, NO-synthase, was inhibited by L-NAME (100 microM). 5. The inhibitory effect of SNP or sodium azide on Na,K-ATPase activity was suppressed by soluble guanylate cyclase (sGC) inhibitors, ODQ (10 microM) or methylene blue (10 microM). 6. The inhibitory effect of 8p-CPT-cGMP on Na,K-ATPase was abolished by protein kinase G (PKG) inhibitors, H-8 (1 microM) and H-9 (20 microM), but not by the protein kinase A (PKA) inhibitor H-89 (100 nM). H-8 and H-9 partially suppressed the inhibitory effect of SNP on Na,K-ATPase. 7. Taken together the results indicate that Na,K-ATPase inhibition response to NO donors involves activation of sGC, generation of cGMP and activation of PKG. These findings suggest that Na,K-ATPase inhibition in NPE may contribute to the ability of NO donors to reduce aqueous humor secretion.     

Possible relationships between changes in body weight set-point and stress metabolism after treating rats chronically with D-fenfluramine. Effects of feeding rats acutely with fructose on the metabolism of corticosterone, glucose, fatty acids, glycerol and triacylglycerol

Rats were maintained on a corn oil diet and treated with D-fenfluramine at doses of 2.5 mg/kg twice a day for 11 days or with 10 mg or 25 mg/kg once a day for 12 days. The lower dose of D-fenfluramine produced no marked changes in body weight and after 11 days of treatment the weights of the rats on average were only 2% lower than the controls. The food intake of these rats was only decreased on the first day. The two higher doses of D-fenfluramine decreased the food consumption for about 3 days but thereafter it was similar to that of the control rats. The body weight of these rats fell on the first day, but after about four days the gain in body weight paralleled rather than approached that of the control rats. Increasing the dose of D-fenfluramine progressively decreased the relative size of the epididymal fat pad. At the end of the treatment period the rats were fed acutely with fructose to increase the circulating concentrations of corticosterone and to stimulate triacylglycerol synthesis. All three doses of D-fenfluramine decreased the concentration of circulating triacylglycerol after fructose feeding. The 10 mg/kg dose also decreased the basal concentration of triacylglycerol. The two higher doses of fenfluramine decreased the rises in the circulating concentrations of corticosterone, glycerol and fatty acids that are produced by fructose feeding. The basal concentrations of these compounds in the absence of fructose feeding were not significantly affected by the 10 mg/kg dose of D-fenfluramine. The possible relationship between the effect of chronic treatment with D-fenfluramine in decreasing a metabolic stress response and lipolysis is discussed relative to its hypotriglyceridaemic action and its effect on body weight-set point. The results demonstrate that D-fenfluramine produced persistent changes in metabolism at a time when the treated rats were growing at the same rate as the control rats and when they were eating similar quantities of food.     

Human rabies among the paediatric population in Bangladesh

This cross sectional study in the Infectious Disease Hospital (IDH), Mohakhali, Dhaka on rabies affected paediatric population was carried out to see the patterns of presentation, age group at risk, state of vaccination following animal exposure and the interval between animal exposure and the development of the disease. This one year study included the patients aged less than 15 years with clinically diagnosed rabies referred to the IDH between July 2008 and June 2009. Data was collected from the case sheets of rabies patients given by the relatives and attendants of the victims. A total of 70 cases were included in the study. In the present study most common age group were 5 to 10 years of age with 31(44.3%) patients followed by less than 5 years 23(32.9%) and the rest 16(22.9%) were more than 10 years of age. The male female ratio was 3:1. Among the 70 patients 59(84.3%) were from rural areas and only 11(15.7%) were from urban areas. Sixty six (94.3%) patients presented with bleeding from the site of injury and 4(5.7%) were without bleeding. Among the patients 53(75.7%) presented with bite on the limbs followed by bite on the face 8(11.4%), body 5(7.1%) and head 4(5.7%) cases. Thirty nine of the cases (55.7%) presented with multiple bites and 31(44.3%) had single bite. More than half that is 37(52.9%) patients presented with severe bite, 31(44.3%) had moderate bite and only 2(2.9 %) patients presented with mild bite. Fifty nine (84.3%) patients were unvaccinated whereas 11(15.7%) had history of vaccination after bite. Fifty two (74.3%) gave the history of bite by stray animal, 10(14.3%) by known rabid animal whereas 8(11.4%) had the history of bite by pet animal. Sixty eight patients (97.1%) had the history of bite by dog whereas 2(2.9%) reported cat bite. The mean±SD incubation period 45.38±26.91 days and range was 11-150 days. In the present study it is concluded that the 5-10 years group children were affected most, bites were mostly by stray animal, most of the children did not get post exposure prophylaxis and incubation period was between 11 to 150 days.