By 19 June, 90 619 covid-19 cases have been identified,3 mostly concentrated in urban areas.4 As a result of the government’s actions—such as enforcing lockdown, shutting down educational ...institutions and offices, and putting restrictions on the movement of vehicles5—people in urban communities are staying at home, reducing mobility and physical activity.6 Furthermore, being confined at home, people have indulged in binge eating,7 which may be linked to the increase in depressive illnesses amid the pandemic.8 Regardless of the pandemic, 68% of urban college students in the country consume fast food regularly, and 29.9% of them are obese.9 Processed food industries and restaurants are loosely regulated in Bangladesh, and the nutritional value of food is often overlooked.10 All these factors are leading to increased overweight and obesity, which is associated with weakened immunity.11 Early reports indicate a substantial epidemiological shift in vulnerable age groups for covid-19 in Bangladesh compared with other countries. There is a dire need for large scale epidemiological studies to investigate this association as well as public health programmes to improve knowledge and practice in order to reduce obesity among urban populations through healthy eating and exercise. 10.1038/oby.2001.31 11331430 9 Banik R Naher S Pervez S. Fast food consumption and obesity among urban college going adolescents in Bangladesh: a cross-sectional study.
Summary Background In developing countries, mortality in children with very severe pneumonia is high, even with the provision of appropriate antibiotics, standard oxygen therapy, and other supportive ...care. We assessed whether oxygen therapy delivered by bubble continuous positive airway pressure (CPAP) improved outcomes compared with standard low-flow and high-flow oxygen therapies. Methods This open, randomised, controlled trial took place in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We randomly assigned children younger than 5 years with severe pneumonia and hypoxaemia to receive oxygen therapy by either bubble CPAP (5 L/min starting at a CPAP level of 5 cm H2 O), standard low-flow nasal cannula (2 L/min), or high-flow nasal cannula (2 L/kg per min up to the maximum of 12 L/min). Randomisation was done with use of the permuted block methods (block size of 15 patients) and Fisher and Yates tables of random permutations. The primary outcome was treatment failure (ie, clinical failure, intubation and mechanical ventilation, death, or termination of hospital stay against medical advice) after more than 1 h of treatment. Primary and safety analyses were by intention to treat. We did two interim analyses and stopped the trial after the second interim analysis on Aug 3, 2013, as directed by the data safety and monitoring board. This trial is registered at ClinicalTrials.gov , number NCT01396759. Findings Between Aug 4, 2011, and July 17, 2013, 225 eligible children were recruited. We randomly allocated 79 (35%) children to receive oxygen therapy by bubble CPAP, 67 (30%) to low-flow oxygen therapy, and 79 (35%) to high-flow oxygen therapy. Treatment failed for 31 (14%) children, of whom five (6%) had received bubble CPAP, 16 (24%) had received low-flow oxygen therapy, and ten (13%) had received high-flow oxygen therapy. Significantly fewer children in the bubble CPAP group had treatment failure than in the low-flow oxygen therapy group (relative risk RR 0·27, 99·7% CI 0·07–0·99; p=0·0026). No difference in treatment failure was noted between patients in the bubble CPAP and those in the high-flow oxygen therapy group (RR 0·50, 99·7% 0·11–2·29; p=0·175). 23 (10%) children died. Three (4%) children died in the bubble CPAP group, ten (15%) children died in the low-flow oxygen therapy group, and ten (13%) children died in the high-flow oxygen therapy group. Children who received oxygen by bubble CPAP had significantly lower rates of death than the children who received oxygen by low-flow oxygen therapy (RR 0·25, 95% CI 0·07–0·89; p=0·022). Interpretation Oxygen therapy delivered by bubble CPAP improved outcomes in Bangladeshi children with very severe pneumonia and hypoxaemia compared with standard low-flow oxygen therapy. Use of bubble CPAP oxygen therapy could have a large effect in hospitals in developing countries where the only respiratory support for severe childhood pneumonia and hypoxaemia is low-flow oxygen therapy. The trial was stopped early because of higher mortality in the low-flow oxygen group than in the bubble CPAP group, and we acknowledge that the early cessation of the trial reduces the certainty of the findings. Further research is needed to test the feasibility of scaling up bubble CPAP in district hospitals and to improve bubble CPAP delivery technology. Funding International Centre for Diarrhoeal Disease Research, Bangladesh, and Centre for International Child Health, University of Melbourne.
Abstract
Background
Bangladesh has experienced remarkable transformation in demographic, health, and nutritional status of the population. The changes have exposed the population to a number of ...challenges, the detrimental effect of which on health and nutrition is likely to be increased by the coronavirus disease 2019 (COVID-19) pandemic. We provide an overview of health and nutritional challenges in Bangladesh in relation to demographic transition and the COVID-19 pandemic.
Methods
We identified and reviewed recent reports, published articles, and pertinent gray literature on nutrition and food security in Bangladesh to provide historical and contextual information.
Results
The review identifies the progress as well as existing burden regarding nutrition and food security in Bangladesh and highlights the challenges in the coming days in regard to population growth and the COVID-19 pandemic. The country is on track to reduce all forms of childhood undernutrition, while the proportion of nutrition-related noncommunicable diseases is rising owing to changes in dietary intake, low physical activity, and sedentary lifestyle.
Conclusions
Despite remarkable progress, health and nutritional status of the population in Bangladesh faces challenges, particularly in relation to demographic transition and compounded by the COVID-19 pandemic, which require concerted attention from policymakers as well as stakeholders.
The effectiveness of micronutrient powder (MNP) on the health outcome of children is yet to be proved. Although studies identified the barriers to the use of MNP the underlying factors related to the ...barriers to the use of MNP are still unexplored. We examined the underlying factors associated with the barriers reported by the caregivers of the children aged 6-59 months in Bangladesh.
We analyzed pooled data of 3, 634 caregiver-child dyads extracted from eight cross-sectional surveys. The surveys were conducted as part of an evaluation of the Maternal, Infant and Young Children Nutrition programme (phase 2) in Bangladesh. We performed univariate analysis to find the barriers reported by the caregivers of the children. We identified the underlying factors related to the reported barriers by performing multiple logistic regression analysis.
The mostly reported barrier was perceived lack of need for MNP among the caregivers of the children (39.9%), followed by lack of awareness of the product (21.7%) and cost of the product (18.1%). Caregivers of older children (adjusted odds ratio (aOR): 1.69; 95% CI: 1.43, 2.00) and caregivers who maintained good infant and young child feeding practices (aOR: 1.32; 95% CI: 1.12, 1.57) perceived more lack of need for MNP. Caregivers of the female children (aOR: 0.79; 95% CI: 0.63, 0.98) were less likely to report that their children disliked MNP compared to the caregivers of the male children.
Programmes intended to effectively promote MNP among the caregivers of children aged 6-59 months should carefully consider the factors that could underlie the barriers to the use of MNP.
Abstract
Both
Campylobacter-
and
Shigella
-induced invasive enteritis are common in under-5 Bangladeshi children. Our study aimed to determine the factors associated with
Campylobacter
and
Shigella
...enteritis among under-5 children, the post-infection worsening growth, and the household cost of invasive enteritis. Data of children having
Shigella
(591/803) and
Campylobacter
(246/1148) isolated from the fecal specimen in Bangladesh were extracted from the Global Enteric Multicenter Study (GEMS) for the period December 2007 to March 2011. In multiple logistic regression analysis, fever was observed more frequently among shigellosis cases adjusted OR 2.21; (95% CI 1.58, 3.09). Breastfeeding aOR 0.55; (95% CI 0.37, 0.81) was found to be protective against
Shigella.
The generalized estimating equations multivariable model identified a negative association between
Shigella
and weight-for-height z score aOR − 0.11; (95% CI − 0.21, − 0.001); a positive association between symptomatic
Campylobacter
and weight-for-age
z
score aOR 0.22; (95% CI 0.06, 0.37) and weight-for-height z score aOR 0.22; (95% CI 0.08, 0.37). Total costs incurred by households were more in shigellosis children than
Campylobacter
-induced enteritis ($4.27 vs. $3.49). Households with low-level maternal education tended to incur less cost in case of their shigellosis children. Our findings underscore the need for preventive strategies targeting
Shigella
infection, which could potentially reduce the disease burden, associated household costs, and child growth faltering.
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.
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.
According to the Bangladesh National Tuberculosis Control Program (NTP), the proportion of childhood tuberculosis (TB) among all reported cases is only 3%. This is considerably lower compared to ...other high-burden countries. One of our previous studies identified substantial gaps at the primary care level related to capacity of service providers, supply of required logistics and community awareness about childhood TB. Therefore, we conducted an implementation study with the objectives to address those gaps.
This implementation research was designed with pre and post-test evaluation at selected primary care facilities in urban and rural areas. Three interventions were implemented: (1) Training on childhood TB management for all categories of service providers (2) mass awareness campaign among primary and secondary school students and their teachers, mothers of <5y children, religious and community leaders and (3) facilitation of logistics supply at the study facilities. Training was conducted following the national guideline. We developed posters, leaflets, flipcharts and organized folksongs and street dramas as awareness campaign strategy. Quarterly follow up meetings were held with the facility managers of the study clinics. Cross-sectional surveys were conducted at the baseline and end line alongside review of service statistics to compare the change in community awareness and case detection of childhood TB.
Awareness regarding childhood TB among all target audience increased significantly showing better understanding of child TB symptoms, transmission, duration and treatment option. Overall proportion of TB case detection among children increased in all three sites compared to baseline as well as NTP estimate with relatively higher proportion in urban site. Majority of the children were suffering from extra-pulmonary TB and there were more female TB cases than male. However, supply and maintenance of necessary diagnostics and child friendly TB drugs remained suboptimal.
Through implementation research, detection of childhood TB cases increased in all study facilities exceeding the NTP's estimate. Community awareness on childhood TB improved significantly across all study sites as well. The NTP should implement strategies to raise community awareness alongside increasing the capacity of service providers and ensuring availability of diagnostics and pediatric TB drugs at the primary care level.
Documentation of micronutrient intake inadequacies among developing country populations is important for planning interventions to control micronutrient deficiencies. The objective of this study was ...to quantify micronutrient intakes by young children and their primary female caregivers in rural Bangladesh. We measured 24-h dietary intakes on 2 nonconsecutive days in a representative sample of 480 children (ages 24–48 mo) and women in 2 subdistricts of northern Bangladesh by using 12-h weighed food records and subsequent 12-h recall in homes. We calculated the probability of adequacy (PA) of usual intakes of 11 micronutrients and an overall mean PA, and evaluated dietary diversity by counting the total number of 9 food groups consumed. The overall adequacy of micronutrient intakes was compared to dietary diversity scores using correlation and multivariate regression analyses. The overall mean prevalence of adequacy of micronutrient intakes for children was 43% and for women was 26%. For children, the prevalence of adequate intakes for each of the 11 micronutrients ranged from a mean of 0 for calcium to 95% for vitamin B-6 and was <50% for iron, calcium, riboflavin, folate, and vitamin B-12. For women, mean or median adequacy was <50% for all nutrients except vitamin B-6 and niacin and was <1% for calcium, vitamin A, riboflavin, folate, and vitamin B-12. The mean PA (MPA) was correlated with energy intake and dietary diversity, and multivariate models including these variables explained 71–76% of the variance in MPA. The degree of micronutrient inadequacy among young children and women in rural Bangladesh is alarming and is primarily explained by diets low in energy and little diversity of foods.
Women’s experience of domestic violence has adverse consequences on women’s health globally and is itself affected by several factors. This study aims to determine the factors that are associated ...with experience of any form of domestic violence in rural Bangladesh. Data were derived from the baseline survey database of Suchana, a large-scale nutrition program in Bangladesh. Data of 5,440 women from poor households in rural areas were analyzed. Descriptive statistics were used to summarize the data. Multilevel logistic regression analysis was conducted to determine the factors that were significantly associated with experiencing any form of domestic violence. The prevalence of women experiencing domestic violence was found to be 35% and household food insecurity was 86%. Of the women’s characteristic domain, age at marriage, lack of any support from household members, visit from non-governmental organizations (NGO) health professionals, number of children, and decision-making power of women at the household level were significantly associated with reporting of domestic violence. Of the household characteristic domain, the associated factors were having a male household head, increased household size, low socio-economic status, having a loan, experience of at least one crisis event, and household food insecurity. The strength of association between household food insecurity and domestic violence was higher among poor families. Experience of domestic violence is inevitably associated with women’s decision-making power and household food insecurity. Behavioral change communication interventions may help to positively affect decision-making power but a holistic approach needs to be undertaken to reduce food insecurity, for which the underlying mechanism of food insecurity in Bangladesh needs to be explored further.
PDF
