The occurrence of outbreaks of cholera in Africa in 1970 and in Latin America in 1991, mainly in coastal communities, and the appearance of the new serotype Vibrio cholerae O139 in India and ...subsequently in Bangladesh have stimulated efforts to understand environmental factors influencing the growth and geographic distribution of epidemic Vibrio cholerae serotypes. Because of the severity of recent epidemics, cholera is now being considered by some infectious disease investigators as a "reemerging" disease, prompting new work on the ecology of vibrios. Epidemiological and ecological surveillance for cholera has been under way in four rural, geographically separated locations in Bangladesh for the past 4 years, during which both clinical and environmental samples were collected at biweekly intervals. The clinical epidemiology portion of the research has been published (Sack et al., J. Infect. Dis. 187:96-101, 2003). The results of environmental sampling and analysis of the environmental and clinical data have revealed significant correlations of water temperature, water depth, rainfall, conductivity, and copepod counts with the occurrence of cholera toxin-producing bacteria (presumably V. cholerae). The lag periods between increases or decreases in units of factors, such as temperature and salinity, and occurrence of cholera correlate with biological parameters, e.g., plankton population blooms. The new information on the ecology of V. cholerae is proving useful in developing environmental models for the prediction of cholera epidemics.
How Vibrio cholerae spreads around the world and what determines its seasonal peaks in endemic areas are not known. These features of cholera have been hypothesized to be primarily the result of ...environmental factors associated with aquatic habitats that can now be identified. Since 1997, fortnightly surveillance in 4 widely separated geographic locations in Bangladesh has been performed to identify patients with cholera and to collect environmental data. A total of 5670 patients (53% <5 years of age) have been studied; 14.3% had cholera (10.4% due to V. cholerae O1 El Tor, 3.8% due to O139). Both serogroups were found in all locations; outbreaks were seasonal and often occurred simultaneously. Water-use patterns showed that bathing and washing clothes in tube-well water was significantly protective in two of the sites. These data will be correlated with environmental factors, to develop a model for prediction of cholera outbreaks
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Clinical and environmental Vibrio cholerae organisms collected from February 2004 through April 2005 were systematically isolated from 2 rural Bangladeshi locales. Their genetic relatedness was ...evaluated at 5 loci that contained a variable number of tandem repeats (VNTR). The observed minimal overlap in VNTR patterns between the 2 communities was consistent with sequential, small outbreaks from local sources.
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DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cholera remains a major public health threat in many developing countries around the world. The striking seasonality and annual recurrence of this infectious disease in endemic areas remain of ...considerable interest to scientists and public health workers. Despite major advances in the ecological and microbiological understanding of Vibrio cholerae, the causative agent of the disease, the role of underlying large‐scale hydroclimatic processes in propagating the disease for different seasons and spatial locations is not well understood. Here we show that the cholera outbreaks in the Bengal Delta region are propagated from the coastal to the inland areas and from spring to fall by two distinctly different transmission cycles, premonsoon and postmonsoon, influenced by coastal and terrestrial hydroclimatic processes, respectively. A coupled analysis of the regional hydroclimate and cholera incidence reveals a strong association of the space‐time variability of incidence peaks with seasonal processes and extreme climatic events. We explain how the asymmetric seasonal hydroclimatology affects regional cholera dynamics by providing a coastal growth environment for bacteria in spring, while propagating the disease to fall by monsoon flooding. Our findings may serve as the basis for “climate‐informed” early warnings and for prompting effective means for intervention and preempting epidemic cholera outbreaks in vulnerable regions.
Key Points
Seasonal and spatial cholera transmission cycles in the Bengal Delta
Spring‐to‐fall and coastal‐to‐inland transmission pattern
Seasonal and interannual cholera is modulated by hydroclimatic processes
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BFBNIB, CEKLJ, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To describe clinical characteristics and age- and season-specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease.
A total of 252 ...infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993-1996. Demographic and household determinants were linked to the probability of illness using logistic regression models.
The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6-11-mo and 12-17-mo age groups. Diarrheal rates peaked during the spring and summer. Among host-related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea.
Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea-related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The burden of enterotoxigenic Bacteroides fragilis (ETBF)–related diarrhea was determined in a birth cohort of 252 children in rural Bangladesh. Isolation rates of ETBF in stool and risk factors for ...acquisition of ETBF and disease were established. Of 382 B. fragilis–positive specimens, 14.4% of the strains found in them produced enterotoxin, as determined by a tissue-culture assay. The overall isolation rate of ETBF was 2.3% (40/1750) from diarrheal specimens and 0.3% (15/5679) from nondiarrheal specimens collected throughout the 2 years of the study (P<.001). ETBF was isolated from 20.3% (40/197) of the B. fragilis–positive diarrheal specimens and from 8.1% (15/185) of the B. fragilis–positive nondiarrheal specimens (P<.001) and was significantly associated with acute diarrheal disease in children ⩾1 year of age (P=.0001). The diarrheal illness was mild in nature. In conditional multivariate analyses that examined environmental and host risk factors, the presence of livestock in the household area was linked to the acquisition of ETBF (chickens, P<.05; cows, P=.06). ETBF was found to be a small but significant contributor to diarrheal disease in this rural community. Improved management of livestock may be useful for the prevention of ETBF infection
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Sack and Siddique believe that disinfecting a cholera corpse with bleach before returning it to the families in some West African countries may decrease the spread of cholera among funeral guests.
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DOBA, GEOZS, IJS, IMTLJ, IZUM, KILJ, KISLJ, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SIK, UILJ, UKNU, UL, UM, UPCLJ, UPUK, VSZLJ
Aim: To describe clinical characteristics and age‐ and season‐specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease. Methods: A ...total of 252 infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993–1996. Demographic and household determinants were linked to the probability of illness using logistic regression models. Results: The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6–11‐mo and 12–17‐mo age groups. Diarrheal rates peaked during the spring and summer. Among host‐related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea.
Conclusion: Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea‐related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Purpose
This paper aims to examine the exogenous effects of experiential attitude toward green (EAG), instrumental attitude toward green (IAG), injunctive norms on green (ING), descriptive norms ...about green (DNG), green perceived control (GPC) and green self-efficacy (GSE) on green purchase intention (GPI). Moreover, this paper also investigates the causal factors of green purchase behavior (GPB) considering green knowledge (GK), the salience of green behavior (SGB), environmental constraints (ECPG) and green habit (GH).
Design/methodology/approach
The research model was adopted to measure the green behavior of Bangladeshi consumers using an integrated behavior model (IBM). The data were randomly collected from 372 respondents and partial least squares structural equation modeling (PLS-SEM) approach was used to test the hypotheses.
Findings
PLS results imply that all independent variables (EAG; IAG; ING; DNG; GPC and GSE) impact GPI; and SGB, GH and GPI influence GPB. On the other hand, GK and ECPG have no significant effect on GPB.
Research limitations/implications
There may present a gap in the outcomes of the study to signify the generalizability because the survey was conducted in some cities of Bangladesh which may not represent the country as a whole.
Practical implications
This study anticipates the cause-effect relationship between GPI, GPB and their determinants. The results of the study can help marketers understand green consumer behavior and design appropriate strategies and tactics for new marketing challenges.
Originality/value
This research investigates green purchase behavior in a developing country. It empirically confirms the validity of IBM in assessing green behavior, especially for Bangladesh, a booming economy and suitable for investment. Although ample research explored green purchase behavior, green habit and saliency have not been considered in measuring green purchase behavior.
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