Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been ...well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, and to identify the factors associated with early-onset stunting.
Children from the MAL-ED cohort study were followed from birth to 5 years of age in six LMICs. The Wechsler Preschool Primary Scales of Intelligence (WPPSI) was used to assess cognitive abilities (fluid reasoning) at 5 years and was adapted for each culture. Stunting was categorized as early-onset persistent (first stunted at 1-6 months and persisting at 60 months), early-onset recovered (first stunted at 1-6 months and not stunted at 60 months), late-onset persistent (first stunted at 7-24 months and persisting at 60 months), late-onset recovered (first stunted at 7-24 months and not stunted at 60 months), and never (never stunted). Mixed effects linear models were used to estimate the relationship between stunting status and cognitive development. Children with early-onset persistent stunting had significantly lower cognitive scores (-2.10 (95% CI: -3.85, -0.35)) compared with those who were never stunted. Transferrin receptor (TfR) was also negatively associated with cognitive development (-0.31 (95% CI: -0.49, -0.13)), while the HOME inventory, an index of quality of the home environment (0.46 (95% CI: 0.21, 0.72)) and socio-economic status (1.50 (95% CI: 1.03, 1.98)) were positively associated with cognitive development.
Early-onset persistent stunting was associated with lower cognitive development in children at 5 years of age in this cohort of children.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Severe acute malnutrition (SAM) and environmental enteric dysfunction (EED) are highly prevalent among children residing in resource-limited countries like Bangladesh. L-carnitine may play a role in ...improving the growth and ameliorating the EED among nutritionally vulnerable children. To investigate the role of L-carnitine supplementation on the rate of weight gain, duration of hospital stays, and EED biomarkers among children with severe acute malnutrition. This study is a double-blinded, placebo-controlled, randomized clinical trial aiming to enroll diarrheal children with SAM between 9-24 months of both sexes attending the nutritional rehabilitation unit (NRU) of Dhaka Hospital of icddr,b. It is an ongoing trial including two arms where one arm receives L-carnitine supplementation, and the other arms receive a placebo for 15 days in addition to the existing standard treatment of SAM. The primary outcome is the rate of weight gain, and the secondary outcomes include duration of hospital stay and EED biomarkers. Outcomes are assessed at baseline and 15 days of post-intervention. We hypothesize that the L- carnitine supplementation for 15 days in children with SAM will improve the rate of weight gain and biomarkers of EED.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To investigate the prevalence and sociodemographic determinants of household-level mother-child double burden (MCDB) of malnutrition in Bangladesh.
The analysis was done using Bangladesh Demographic ...and Health Survey 2014 data. Multivariable logistic regression identified the sociodemographic factors associated with double-burden households.
Nationally representative cross-sectional survey.ParticipantsA total of 5951 households were included in the analysis.
A coexistence of overweight or obese mother and underweight or stunted or wasted child (OWOBM/USWC) was found in 6·3 % households. The prevalence of overweight or obese mother and underweight child (OWOBM/UWC) was 3·8 %, of overweight or obese mother and stunted child (OWOBM/STC) was 4·7 %, and of overweight or obese mother and wasted child (OWOBM/WSC) was 1·7 %. Mother's age 21-25 years at first birth, middle wealth index group, having two or three children and having four or more children showed statistically significant (P<0·05) associations with OWOBM/UWC. Households with mother's age 21-25 years at first birth, middle wealth index group, no exposure to information media, having two or three children and having four or more children had higher odds of OWOBM/STC and OWOBM/USWC which were statistically significant (P<0·05). Delivery of child through caesarean section was significantly associated with OWOBM/USWC (P<0·05).
Although the prevalence of MCDB of malnutrition in Bangladesh is low, prevention programmes must consider the nutrition concerns of the entire household to prevent future risks. Such programmes also need to be tagged with family planning and increasing awareness through social and behaviour change counselling and exposure to information media.
Background Blastocystis spp. (Blastocystis) is a widely distributed gastrointestinal protist frequently reported in countries with tropical and sub-tropical climate. We sought to determine the ...factors associated with Blastocystis infection and investigate its role on biomarkers of intestinal health among slum-dwelling malnourished adults in Bangladesh. Methodology Total 524 malnourished adults with a body mass index less than or equal to18.5 kg/m.sup.2 were included in this analysis. Presence of Blastocystis in feces was evaluated by TaqMan Array Card assays. Principal findings Blastocystis was tested positive in 78.6% of the participants. Prevalence of infection with atypical strains of enteropathogenic Escherichia coli (aEPEC) (56% vs. 38%, p<0.001), and Trichuris trichiura (28% vs. 15%, p-value = 0.02) was significantly greater in adults with Blastocystis, while Giardia intestinalis was significantly lower (8% vs. 14%, p-value = 0.04) in Blastocystis positive adults. Malnourished adults who were living in households with high crowding index (aOR = 2.18; 95% CI = 1.11, 4.65; p-value = 0.03), and infected with aEPEC (aOR = 2.14; 95% CI = 1.35, 3.44; p-value = 0.001) and Trichuris trichiura (aOR = 1.97; 95% CI = 1.08, 3.77; p = 0.03) were more likely to be infected with Blastocystis. A significant negative relationship was observed between Blastocystis and fecal concentrations of alpha-1 antitrypsin (beta = -0.1; 95% CI = -1.7, -0.1; p-value<0.001) and Reg1B (beta = -3.6; 95% CI = -6.9, -3.0; p-value = 0.03). Conclusions The study findings suggest that the presence of Blastocystis in human intestine influences gut health and may have potential pathogenic role in presence of other pathogens.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
Environmental Enteric Dysfunction (EED) can be assessed by faecal biomarkers such as Myeloperoxidase (MPO), Neopterin (NEO) and Alpha‐1 anti‐trypsin (AAT). We aimed to test the association ...of intestinal pathogens with faecal markers of EED among slum‐dwelling children in first 2 years of life.
Methods
The MAL‐ED birth cohort data of Bangladesh site were used to conduct this analysis. Multivariable analyses using Generalized Estimating Equations (GEE) were performed to test the association between intestinal pathogens and faecal markers of EED.
Results
Giardiasis, ascariasis and trichuriasis were the most frequent parasitic infections and Campylobacter spp., Enteroaggregative Escherichia coli (EAEC) and Enterotoxigenic Escherichia coli (ETEC) were the common bacterial pathogens observed in stool samples of the children. Overall, 71%, 97% and 58% of stool samples were above values considered normal in non‐tropical settings for MPO, NEO and AAT respectively. Giardiasis was found to be significantly associated with MPO (Coefficient = 0.55; 95% CI = 0.15, 0.95; P‐value = 0.008) and AAT concentrations (Coefficient = 0.34; 95% CI = 0.04, 0.63; P‐value = 0.03). A significant association was found between trichuriasis and NEO (Coefficient = 0.90; 95% CI = 0.19, 1.61; P‐value = 0.01). Trichuriasis (Coefficient = 1.71; 95% CI = 0.32, 3.11; P‐value = 0.02) and giardiasis (Coefficient = 1.51; 95% CI = 0.79, 2.23; P‐value <0.001) were significantly associated with EED score. Children with EAEC had significantly higher MPO concentrations (Coefficient = 0.33; 95% CI = 0.06, 0.61; P‐value = 0.02).
Conclusion
The study results imply the importance of intestinal pathogens in contributing to intestinal inflammation and increased intestinal permeability in young children.
Objectif
La dysfonction environnementale entérique (DEE) peut être évaluée à l'aide de biomarqueurs fécaux tels que la myéloperoxydase (MPO), la néoptérine (NEO) et l'alpha‐1 anti‐trypsine (AAT). Nous avons cherché à tester l'association entre les pathogènes intestinaux et les marqueurs fécaux de la DEE chez les enfants vivant dans les bidonvilles au cours des deux premières années de la vie.
Méthodes
Les données de la cohorte de naissance MAL‐ED du site du Bangladesh ont été utilisées pour effectuer cette analyse. Des analyses multivariées utilisant des équations d'estimation généralisées ont été effectuées pour tester l'association entre les pathogènes intestinaux et les marqueurs fécaux de la DEE.
Résultats
La giardiase, l'ascaridiose et la trichocéphalose étaient les plus fréquentes infections parasitaires et Campylobacter spp., Escherichia coli entéroagrégative (EAEC) et Escherichia coli entérotoxigène (ETEC) étaient les agents pathogènes bactériens courants observés dans les échantillons de selles des enfants. Dans l'ensemble, 71%, 97% et 58% des échantillons de selles étaient au‐delà des valeurs considérées comme normales dans les milieux non tropicaux pour la MPO, la NEO et l'AAT, respectivement. La giardiase était significativement associée à la MPO (coefficient = 0,55; IC95%: 0,15 ‐ 0,95; valeur p = 0,008) et aux concentrations d'AAT (coefficient = 0,34; IC95%: 0,04 ‐ 0,63; valeur p = 0,03). Une association significative a été trouvée entre le trichocéphalose et la NEO (coefficient = 0,90; IC95%: 0,19 ‐ 1,61; valeur p= 0,01). La trichocéphalose (coefficient = 1,71; IC95%: 0,32 ‐ 3,11; valeur p = 0,02) et la giardiase (coefficient = 1,51; IC95%: 0,79 ‐ 2,23; valeur p <0,001) étaient significativement associées au score de DEE. Les enfants avec EAEC avaient des concentrations de MPO significativement plus élevées (coefficient = 0,33; IC95%: 0,06 ‐ 0,61; valeur p = 0,02).
Conclusion
Les résultats de l’étude impliquent l'importance des agents pathogènes intestinaux dans l'inflammation intestinale et l'augmentation de la perméabilité intestinale chez les jeunes enfants.
Duodenal and plasma biomarkers of environmental enteric dysfunction that were identified through analyses of duodenal biopsy samples and the plasma of growth-stunted children were found to induce ...enteropathy of the small intestine in gnotobiotic mice.
Objectives
There remain hesitations and miscommunication regarding appropriate public health behaviours and conceptions related to COVID-19. We tested the effectiveness of the community-based health ...cell approach in improving knowledge, attitude and practice (KAP) related to COVID-19.
Setting
Households of the Bauniabadh slum area in Mirpur, Dhaka, Bangladesh.
Participants
Household heads (HHs) and homemakers (HMs) of intervention (n=211) and comparison households (n=209).
Interventions
Behaviour change communication delivered at the community level in a quasi-experimental manner through small-scale community meetings and home visits.
Outcome variables and methods
The outcomes of interest were before–after mean and per cent changes in KAP scores. Data were collected from HHs and HMs before and after the intervention and difference-in-differences (DID) analysis technique was applied.
Results
We found statistically significant (p<0.05) before–after differences in the responses to the KAP questions made by the intervention groups. The DID models estimated the improvements in COVID-19-related KAP of HHs by 16.58 (95% CI: 14.05, 19.12), 20.92 (95% CI: 18.17, 23.67) and 28.45 (95% CI: 23.84, 33.07) per cent points, respectively. The DID estimates of KAP in HMs were 17.8 (95% CI: 15.09, 20.51), 22.33 (95% CI: 19.47, 25.19) and 28.06 (95% CI: 23.18, 32.93) per cent points, respectively. Overall, 20.91 (95% CI: 18.87, 22.94) and 21.81 (95% CI: 19.68, 23.94) per cent points of improvement were observed among HHs and HMs, respectively. The DID estimates of before–after mean changes in different KAP domains ranged from 2.24 to 2.68 units and the overall changes in KAP scores among HHs and HMs were 7.11 (95% CI: 6.42, 7.8) and 7.42 (95% CI: 6.69, 8.14) units.
Conclusion
Scientifically valid information disseminated at the community level using the health cell approach could bring positive changes in KAP related to COVID-19.
BackgroundSevere acute malnutrition (SAM) and environmental enteric dysfunction (EED) are highly prevalent among children residing in resource-limited countries like Bangladesh. L-carnitine may play ...a role in improving the growth and ameliorating the EED among nutritionally vulnerable children.ObjectiveTo investigate the role of L-carnitine supplementation on the rate of weight gain, duration of hospital stays, and EED biomarkers among children with severe acute malnutrition.MethodsThis study is a double-blinded, placebo-controlled, randomized clinical trial aiming to enroll diarrheal children with SAM between 9-24 months of both sexes attending the nutritional rehabilitation unit (NRU) of Dhaka Hospital of icddr,b. It is an ongoing trial including two arms where one arm receives L-carnitine supplementation, and the other arms receive a placebo for 15 days in addition to the existing standard treatment of SAM. The primary outcome is the rate of weight gain, and the secondary outcomes include duration of hospital stay and EED biomarkers. Outcomes are assessed at baseline and 15 days of post-intervention. We hypothesize that the L- carnitine supplementation for 15 days in children with SAM will improve the rate of weight gain and biomarkers of EED.Trial registrationClinicalTrials.gov # NCT05083637. Date of registration: October 19, 2021.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess facility readiness and identify barriers to the facility-based management of childhood severe acute malnutrition (SAM) in public healthcare settings.
Qualitative methods were applied to ...assess readiness and identify different perspectives on barriers to the facility-based management of children with SAM. Data collection was done using in-depth interviews, key informant interviews, exit interviews and pre-tested observation tools.
Two tertiary care and four district hospitals in Rangpur and Sylhet Divisions of Bangladesh.
Healthcare professionals and caregivers of children with SAM.
Anthropometric tools, glucometer, medicines, F-75, F-100 and national guidelines for facility-based management of childhood SAM were found unavailable in some of the hospitals. Sitting and sleeping arrangements for the caregivers were absent in all of the chosen facilities. We identified a combination of health system and contextual barriers that inhibited the facility-based management of SAM. The health system barriers include inadequate manpower, rapid turnover of staff, increased workload, lack of training and lack of adherence to management protocol. The major facility barriers were insufficient space and unavailability of required equipment, medicines and foods for hospitalised children with SAM. The reluctance of caregivers to complete the treatment regimen, their insufficient knowledge regarding proper feeding, increased number of attendants and poverty of parents were the principal contextual barriers.
The study findings provide insights on barriers that are curbing the facility-based management of SAM and emphasise policy efforts to develop feasible interventions to reduce the barriers and ensure the preparedness of the facilities for effective service delivery.
Children living in resource-limited settings often suffer from multiple micronutrient deficiencies (MMD). However, there lacks evidence on the correlates of MMD in young children. We investigated the ...role of diets, water, sanitation and hygiene practice, enteric infections, and impaired gut health on MMD in children at 24 months of age using data from the multi-country MAL-ED birth cohort study. Co-existence of more than one micronutrient deficiency (e.g., anemia, iron, zinc, or retinol deficiency) was considered as MMD. We characterized intestinal inflammation by fecal concentrations of myeloperoxidase (MPO) and neopterin (NEO) measured in the non-diarrheal stool samples. Bayesian network analysis was applied to investigate the factors associated with MMD. A total of 1093 children were included in this analysis. Overall, 47.6% of the children had MMD, with the highest prevalence in Pakistan (90.1%) and lowest in Brazil (6.3%). MMD was inversely associated with the female sex OR: 0.72, 95% CI: 0.54, 0.92. A greater risk of MMD was associated with lower vitamin C intake OR: 0.70, 95% CI: 0.48, 0.94 and increased fecal concentrations of MPO OR: 1.31, 95% CI: 1.08, 1.51. The study results imply the importance of effective strategies to ameliorate gut health and improve nutrient intake during the early years of life.
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