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Biomedical subjects

D Mahalanabis

Publications and source records attributed to D Mahalanabis.

At least 109 records · Page 6Linked to original sources
PubMed1994

Infectious agents causing acute watery diarrhoea in infants and young children in Bangladesh and their public health implications.

We studied the age specific distribution of enteropathogens in young children presenting at a large diarrhoeal diseases hospital in urban Bangladesh. A 5 per cent systematic sample was used to examine 1207 rectal swab specimens of children aged 1-35 months with acute watery diarrhoea. Variation in isolation rates of enteropathogens was observed in different age groups. Overall rotavirus (26 per cent) and Campylobacter (26 per cent) were the most common pathogens followed by enterotoxigenic Escherichia coli (15 per cent), Vibrio cholerae 01 (7 per cent), other Vibrios (9 per cent), Shigella (4 per cent), and Salmonella (< 1 per cent). In early infancy (1-5 months) more rectal swab specimens did not yield any enteropathogen compared to older children of 24-35 months old (44 v. 30 per cent). Rotavirus was most frequently detected (35 per cent) in children between 6 and 11 months old. Attendance of cholera cases at the hospital was alarmingly high in the third year of life (29 per cent). The study provided useful information that, in general, children under 2 years are predominantly infected with agents [rotavirus, Campylobacter, and enterotoxigenic Escherichia coli (ETEC)] for which antibiotic therapy is not usually indicated. These patients can be managed effectively with oral rehydration therapy and proper feeding. Knowledge of pathogens associated with more severe forms of diarrhoea may help in optimizing strategies for vaccination when suitable vaccines are available against enteric infections.

Acute Disease↗
PubMed1994

Absorption of macronutrients from a high-protein diet in children during convalescence from shigellosis.

Absorption of macronutrients and energy intake were determined in 29 children aged 24-59 months, during convalescence from acute shigellosis. A 72 h metabolic balance study was performed to determine the absorption of carbohydrate, fat, and protein. Eighteen children received a high-protein (5 g/kg/day) diet, and 11 children received a standard-protein (2.5 g/kg/day) diet. The mean +/- SD energy intake was 612 +/- 38 kJ/kg/day for children receiving the high-protein diet, compared with 633 +/- 50 kJ/kg/day for the standard-protein group. The coefficient of carbohydrate absorption was 89 and 92% for the high-protein and standard-protein diets, respectively (p = 0.059). The coefficient of protein absorption was 80 and 71% for the high-protein and standard-protein groups, respectively, and was significantly higher in the high-protein group (p < 0.01). Absorption of fat was similar in both groups. The results of the study show better absorption of protein from a high-protein diet during convalescence, which may have a positive impact on catch-up growth of children suffering from shigellosis.

Child, Preschool↗
PubMed1994

Comparison of pivmecillinam and nalidixic acid in the treatment of acute shigellosis in children.

The efficacy of oral pivmecillinam was compared with nalidixic acid in the treatment of acute shigellosis in children 1-8 years of age. In a double-blind trial we studied 80 comparable children with bloody diarrhoea of less than 3 days' duration. Shigella spp. was isolated in 71 children. Patients were randomly assigned to receive either pivmecillinam, 50 mg/kg.day, or nalidixic acid, 60 mg/kg.day, both given orally for 5 days. The stool frequency decreased progressively in both treatment groups. Nalidixic acid failed to eradicate Shigella species in 10 patients, compared with three in the pivmecillinam group (p = 0.04). Similarly, clinical failure was observed in 11 of 37 patients receiving nalidixic acid and in 2 of 26 patients infected with nalidixic acid-susceptible strains as against none in the group receiving pivmecillinam. The results suggest that pivmecillinam given orally was, in fact, more effective than nalidixic acid in the treatment of acute shigellosis in children, particularly when the resistant strains are taken into account.

Acute Disease↗
PubMed1994

Intake from an energy-dense porridge liquefied by amylase of germinated wheat: a controlled trial in severely malnourished children during convalescence from diarrhoea.

OBJECTIVE: To evaluate the role of an energy-dense diet liquefied with amylase-rich flour from germinated wheat (ARF) in increasing the energy intake in severely malnourished infants and young children and its acceptability to mothers. DESIGN: A randomized controlled clinical trial with two sets of controls. SETTING: Nutrition rehabilitation unit of a large diarrhoea treatment centre where mothers stay with their very severely malnourished children. SUBJECTS: 78 severely malnourished children aged 5-18 months just recovered from diarrhoea. INTERVENTION: Children were randomly assigned to receive either an energy-dense porridge made liquid by adding ARF (test diet) or an unaltered thick porridge of similar energy density (control 1 diet), or the porridge made liquid with addition of water to have the same viscosity as the test diet but of lower energy (control 2 diet), in four major meals a day for 5 days and intake was measured; breast-milk was measured by test weighing. Children also received an additional three milk-cereal meals a day. RESULTS: The mean energy intake (95% CI, P value for difference between test and control) was 385 (339-431), 289 (251-327, P < 0.005), and 255 (222-289, P < 0.001) kJ/kg.d respectively. Feeding test diet was not associated with significant adverse effects e.g. on diarrhoea, vomiting, breast-milk intake, and was well accepted by mothers. CONCLUSION: The results suggest that use of an energy-dense ARF-treated liquefied porridge increases calorie intake by very severely malnourished children during convalescence from diarrhoea, and that it does not produce any adverse effect.

Amylases↗
PubMed1994

Clinical trials of improved oral rehydration salt formulations: a review.

Reviewed are all the published clinical trials of glycine-based oral rehydration salts (ORS), L-alanine-based ORS, L-glutamine-based ORS, maltodextrin-based ORS, and rice-based ORS, as well as the results of several recently completed, but unpublished, studies of these formulations that were supported by WHO. All experimental ORS formulations contained the same concentrations of salts as citrate-based WHO-ORS; all trials were randomized comparisons with WHO-ORS, and all except those with rice-based ORS were double-blind studies. The rate of stool loss and, less frequently, the duration of diarrhoea were used as indicators of clinical performance to compare ORS formulations. The following conclusions were reached concerning the efficacy and use of modified ORS formulations. Rice-based ORS (50 g/l) is superior to WHO-ORS for patients with cholera, and for such patients it can be recommended in any situation where its preparation and use are practical. Rice-based (50 g/l) and WHO-ORS solutions are equally effective for treating children with acute non-cholera diarrhoea, when feeding is resumed promptly following initial rehydration, as has been consistently recommended by WHO. Since rice-based ORS is not superior to WHO-ORS for such children, there is no apparent reason to advise a change from glucose to pre-cooked rice in the recommended formulation for WHO-ORS. Maltodextrin-based ORS formulations (50 g/l) and WHO-ORS appear to be equally effective for treating children with acute non-cholera diarrhoea; there is no reason to advise a change from glucose to maltodextrin in the recommended formulation for WHO-ORS. Amino-acid-containing ORS formulations are not recommended for either non-cholera or cholera diarrhoea, since they are more costly and have no clinical advantage over WHO-ORS for children with acute non-cholera diarrhoea or over rice-based ORS for persons with cholera.

Child, Preschool↗
PubMed1994

Severity of cholera during concurrent infections with other enteric pathogens.

In a clinic-based case-control study in Bangladesh we evaluated whether children with diarrhoea due to V. cholerae O1 in association with other enteric pathogen(s) are likely to manifest more severe disease as indicated by development of moderate or severe dehydration. Children with moderate or severe dehydration were defined as cases and those with no dehydration were controls; both cases and controls had acute diarrhoea. A systematic sample of 268 dehydrated cases and 699 nondehydrated controls aged 1-35 months with acute watery diarrhoea of 6 days or less was included. In a multivariate analysis it has been shown that infection with Vibrio cholerae O1 in association with another diarrhoea pathogen (odds ratio = 7.07) was strongly correlated with status of dehydration than those with the V. cholerae O1 infection as a single pathogen (odds ratio = 3.63). Either group was associated with significant risk of dehydration. The results of the study suggest that more than one enteropathogen may be simultaneously involved in causing severe diarrhoea, and appropriate public health measures to reduce environmental contamination should be beneficia

Bacterial Infections↗
PubMed1994

Maternal and socioeconomic factors and the risk of severe malnutrition in a child: a case-control study.

OBJECTIVE: To examine the relation of maternal and socioeconomic factors with the development of severe malnutrition in young children. DESIGN: A case-control study. SETTING: A large diarrhoea treatment centre in a metropolitan city. SUBJECTS: Cases were 125 severely malnourished children, aged < 36 months, having weight-for-age < 55% of the United States National Center for Health Statistics (NCHS) median values. Controls (n = 125) were recruited concurrently matching for gender, disease type (i.e. diarrhoea or dysentery) and age stratum, having weight-for-age > 60% of NCHS median values. INTERVENTION: Mothers of the children were interviewed to record personal history and various socioeconomic variables and examined for height and weight. RESULTS: Maternal factors such as illiteracy, mothers' employment outside, lack of breastfeeding and maternal malnutrition (as indicated by low body mass index, weight or height); and selected socioeconomic indicators such as poor family income, use of unprotected surface water or unhygienic latrine were found to be significantly associated with severe malnutrition in their children. In multivariate analysis, maternal illiteracy and lack of breastfeeding were associated with approximately fourfold increased risk of severe malnutrition in their children. A strong positive association of employment of mothers outside homes with fivefold increased risk was surprising and may reflect a complex social problem of poor urban mothers; malnourished mothers were 2.5 times more likely to have severely malnourished children. CONCLUSION: The findings confirm the well-known association of lack of maternal education and breastfeeding with severe malnutrition of their children. Maternal malnutrition may be a useful indicator to identify at-risk families with severely malnourished children. However, its causal association, though plausible, cannot be inferred from the study.

Breast Feeding↗
PubMed1994

Evaluation of a non-radioactive chemiluminescent method for using oligonucleotide and polynucleotide probes to identify enterotoxigenic Escherichia coli.

We compared the applicability of an enhanced chemiluminescent (ECL) method for using gene probes with that of radioactive probes to identify enterotoxigenic Escherichia coli (ETEC) in stools of Bangladeshi children with diarrhoea. Colony blots of E. coli isolates were hybridized using both [alpha-32P]-dCTP labelled and fluorescein-11-dUTP labelled polynucleotide and oligonucleotide gene probes for heat-labile enterotoxin (LT), and heat-stable enterotoxin (ST). Analysis of 1,620 isolates obtained from 540 patients gave similar results by both radioactive and chemiluminescent probes. The ECL method was faster than the radioactive method. Both polynucleotide and oligonucleotide probes could be used by the ECL method. Hybridization and detection by the ECL method appeared to be a convenient alternative to radioactive probes for screening E. coli isolates for ETEC.

Base Sequence↗
PubMed1994

Use of rice-based oral rehydration solution in a large diarrhoea treatment centre in Bangladesh: in-house production, use and relative cost.

Glucose-based oral rehydration salt (ORS) is an appropriate and cost-effective tool to treat diarrhoeal dehydration. In patients with a high purging rate, particularly due to cholera, rice-based ORS has been shown to substantially reduce stool output compared to glucose ORS. However, it is not used in the hospitals or diarrhoea treatment centres largely because of the non-availability of a ready-to-use inexpensive packaged product and because of the problem of cooking. In a large diarrhoea treatment centre in Bangladesh (with an annual ORS consumption of approximately 140,000 litres), we have maintained in-house production of rice ORS and used it routinely for more than 600,000 patients over the last nine years. Semi-literate health workers cook rice ORS and supervise mothers in its use. Rice ORS is less costly (US $0.15 per patient treated compared with US $0.37 for glucose ORS) and is well accepted. It is an attractive alternative to glucose ORS in many fixed facility treatment centres in countries where rice is a staple and cholera is endemic. The process of its in-house preparation and use is described in this report which may assist hospitals wishing to use rice ORS in treating diarrhoea patients. Availability of a low cost ready-to-use rice ORS packet (which needs no cooking) with adequate shelf-life will increase its use at fixed facilities.

Bangladesh↗
PubMed1993

Rapid catch-up growth of children fed a high-protein diet during convalescence from shigellosis.

Sixty-nine children age 2-5 y, convalescing from shigellosis in a randomized clinical trial were fed either a high-protein diet containing 628 kJ.kg-1.d-1 with 15% of total energy as protein, or a standard-protein diet that was isoenergetic but with 7.5% of total energy as protein for 21 d. Children fed the high-protein diet showed a significant increase in height (1.02 +/- 0.44 cm; mean +/- SD) compared with the children who were fed the standard-protein diet (0.69 +/- 0.34 cm; P < 0.001). Similarly, increases in body weight were 1.25 +/- 0.48 vs 0.86 +/- 0.48 kg for the high-protein and the standard-protein diet, respectively (P < 0.001). The mean increases of serum proteins were also significantly higher in the high-protein group (P < 0.01). These results indicate that increasing the protein content of the diet during convalescence from shigellosis in children leads to more rapid catch-up growth.

Aging↗
PubMed1993

Common diarrhea pathogens and the risk of dehydration in young children with acute watery diarrhea: a case-control study.

The role of common diarrheal pathogens in dehydration was examined in children with acute watery diarrhea who attended the treatment center of the International Centre for Diarrhoeal Disease Research, Bangladesh, in Dhaka. Two hundred sixty-nine children with moderate or severe dehydration were matched with 700 children with no dehydration. Vibrio cholerae O1 infections were 5.5 times more likely to be associated with dehydration than in cases without this agent. No significant association could be found between the presence of enterotoxigenic Escherichia coli. Campylobacter jejuni, or rotavirus infection and dehydration. These results were obtained after simultaneously controlling for age, lack of oral rehydration therapy (ORT) at home, protein energy malnutrition, withdrawal of breast-feeding during diarrhea at home, poor housing, longer duration of diarrhea at home, and delay in reaching the treatment center. The cholera isolation rate was only 4.5% and thus explains only a small proportion of the cases of dehydration. In cholera-endemic areas, a strategy to prevent dehydration in small children is needed to ensure correct use of ORT at home, prompt referral, and the use of a suitable antibiotic when cholera is clinically suspected.

Acute Disease↗
PubMed1993

The ethnophysiology of digestion and diarrhoea in a Bangladeshi hospital population.

The results presented in this paper are drawn from a study of the acceptability of the weaning food, ARGC. The study aimed to investigate attitudes and practices surrounding weaning and the dietary management of diarrhoea. One hundred and twenty mothers of children aged between six months and 24 months suffering from mild diarrhoea and admitted to the ICDDR,B treatment centre were randomly selected. Diarrhoea was attributed by mothers to a number of causes; most common were contaminated food and breastmilk. Breastmilk was understood to have been spoiled either by the mother's diet or mystical forces termed batash. Batash was also suspected to directly making children sick in some instances. Thirty-six per cent of mothers attempted to manage diarrhoea at home by withholding normal foods from their children's diets and others modified their own diets. Less than a quarter of the children were normally fed vegetables, dal (lentils) or small fish. It appeared that fish was rarely given to young children and was regarded with some ambivalence and considered potentially attractive as a vehicle for malign forces that might attack young children and their mothers and cause illness. People were unwilling to feed their children fish and other items of the normal family diet because of notions about the digestive system and the concept of "digestive power" and the idea that young children did not have the digestive power to digest certain foods. It was suggested that early weaning might lead to poor and abnormal growth and development.

Adult↗
PubMed1993

Can infants and young children eat enough green leafy vegetables from a single traditional meal to meet their daily vitamin A requirements?

To evaluate the feasibility of providing adequate vitamin A precursors to meet the daily need from a meal oftraditionally cooked green leafy vegetables and boiled rice and to understand mothers' perceptions and acceptance of leafy vegetables for infants and young children, 118 children aged 6 months to 3 years and their mothers were studied. The mothers were interviewed regarding their acceptance and perceptions about giving leafy vegetables to their young children. Their children were served a measured amount of rice and cooked leafy vegetables and mothers were asked to feed the child within about half an hour. Median intakes of leafy vegetables in children aged 6-11 months, 12-17 months and 18-35 months were 41 g, 71 g and 129 g respectively (in terms of raw green leaf). Approximately 40 g green leaf provides the recommended daily allowance for vitamin A precursors. 77% of the under-1-year-old children were breast-fed. The breast-fed children had a lower intake of vegetables than the completely weaned children. 87% of the children were found to like vegetables, 89% of the mothers liked to give vegetables to their children and 74% of the mothers answered that vegetables were good for health. Only two mothers (1.5%) refused to feed their children the leafy vegetables. The results show that leafy vegetables are acceptable to most of the mothers, and that children can eat enough leafy vegetables to meet a day's need of vitamin A precursors. Feasibility of feeding children enough green leafy vegetables at home on a regular basis needs further study.

Bangladesh↗
PubMed1992

Compliance with diphtheria, tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups.

OBJECTIVE: To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation. DESIGN: Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated. SETTING: Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS: 136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died. INTERVENTIONS: All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose. MAIN OUTCOME MEASURE: Rate of non-compliance with advice to return child for second vaccination. RESULTS: 46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose. CONCLUSIONS: Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother's education. Further research should be aimed at ways to make health education more effective among uneducated parents.

Bangladesh↗
PubMed1992

Impact of zinc supplementation on intestinal permeability in Bangladeshi children with acute diarrhoea and persistent diarrhoea syndrome.

Zinc has been shown to enhance intestinal mucosal repair in patients suffering from acrodermatitis enteropathica; but the impact on mucosal integrity during acute (AD) or persistent (PD) diarrhoea is unknown. One hundred eleven children with AD and 190 with PD aged between 3 and 24 months received, randomly and blind to the investigators, either an elemental zinc supplement of 5 mg/kg body wt/day or placebo in multivitamin syrup for 2 weeks while intestinal permeability and, biochemical and anthropometric markers were serially monitored. The permeability test was administered as an oral dose of 5 g lactulose/l g mannitol in a 20-ml solution followed by a 5-h urine collection. The ratio of the urinary probe sugars was correlated to clinical, biochemical, and microbiological parameters. At presentation, lactulose excretion was increased and mannitol excretion decreased in both AD and PD as compared with age-matched asymptomatic children. The lactulose/mannitol ratio (L/M) was higher in subjects with mucosal invasive pathogens (rotavirus and enteropathogenic Escherichia coli) compared with children excreting Vibrio cholera and enterotoxigenic E. coli. Two-week zinc supplementation significantly reduced lactulose excretion in both AD and PD, whereas the change in mannitol excretion and L/M was similar between study groups in both studies. Changes in lactulose excretion were significantly influenced by zinc supplementation in children with E. coli, Shigella sp., and Campylobacter jejuni stool isolates. The greatest reduction in total lactulose excretion was seen in supplemented children who on presentation were lighter (wt/age less than 80%), thinner (wt/ht less than 85%), and undernourished [middle upper arm circumference (MUAC) less than 12.5 cm] or with hypozincaemia (less than 14 mumol/L).(ABSTRACT TRUNCATED AT 250 WORDS)

Acrodermatitis↗
PubMed1992

Breast feeding and oral rehydration at home during diarrhoea to prevent dehydration.

In a case-control study we evaluated the role of maternal behaviour, as reflected in maintenance of breast feeding and the use of oral rehydration therapy (ORT) at home during acute diarrhoea, in preventing dehydration in infants and young children. A systematic 5% sample was taken of all children aged 1-35 months attending the treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute watery diarrhoea of six days or less between August 1988 and September 1989. There were 285 children with moderate or severe dehydration as cases and 728 with no dehydration as controls in the study. In a multivariate analysis using a logistic regression model we showed that withdrawal of breast feeding during diarrhoea was associated with a five times higher risk of dehydration compared with continuation of breast feeding during diarrhoea at home. Lack of ORT with either complete formula or a salt and sugar solution at home was associated with 57% higher risk of dehydration compared with receipt of a reasonable amount of ORT after controlling for several confounders. The confounding variables--that is, lack of maternal education, history of vomiting, high stool frequency, young age and infection with Vibrio cholerae 01--were also shown to be risk factors of dehydration. Health education programmes should promote continued breast feeding and adequate oral rehydration therapy for infants with acute diarrhoea at home.

Bangladesh↗
PubMed1992

Evaluation of preventive health services for hospitalised children under a child health programme.

In the hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the Child Health Programme (CHP) has been offering preventive health care services to about 60,000 patients per year. The patient populations are mostly children who stay with their mothers or other relatives. In this programme, health education, immunisation and nutrition rehabilitation services are offered. Health education is offered as group discussion and face-to-face interaction between the educator and the mother. Immunisation is offered daily from 0700h to 1900h to all children and women attending the hospital. Nutrition rehabilitation services, both inpatient and outpatient, are offered to severely undernourished children. These preventive services are implemented by health workers and health assistants. All attendants and adult patients participate in health education sessions. More than 80% of unimmunized children and 50% of unimmunized women receive immunisation. The experience of the CHP shows that it is possible to offer different preventive health care services to all attendants and patients attending a busy hospital.

Bangladesh↗