Journal of Health, Population, and Nutrition

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https://imsear.searo.who.int/handle/123456789/8

ISSN: 1606-0997 (Print)

Frequency: Quarterly

Language: English

Published by ICDDR,B: Centre for Health and Population Research

Peer-reviewed open access journal indexed in Index Medicus

Web site: https://www.banglajol.info/index.php/JHPN/

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Rotavirus serotypes: classification and importance in epidemiology, immunity, and vaccine development.
(2000-06-03) Hoshino, Y; Kapikian, A Z
The development and implementation of safe and effective vaccines to prevent the enormous health burden of rotavirus-associated disease is a global public health goal. Human rotaviruses, the major aetiological agents of severe infantile diarrhoea worldwide, display surprisingly diverse and complex serotypic specificities. Ten VP7 serotypes and 7 VP4 serotypes have so far been detected. An increasing number of observations, obtained from analyses of (i) natural rotavirus infections in infants and young children, (ii) experimental rotavirus infections in laboratory animals, and (iii) extensive rotavirus vaccine field trials performed in different populations of various parts of the world, appears to support the concept that serotype-specific antibodies to rotaviruses play an important role in protection against rotavirus-associated illnesses. Thus, the first licensed rotavirus vaccine (RRV-based quadrivalent vaccine) was designed to cover the epidemiologically important VP7 serotype 1, 2, 3, and 4.
Gluten-free diet improves iron-deficiency anaemia in patients with coeliac disease.
(2000-06-03) Sari, R; Yildirim, B; Sevinc, A; Buyukberber, S
Two cases of newly-diagnosed asymptomatic coeliac disease with 3 years of unexplained severe iron-deficiency anaemia are presented. Oral iron supplementation had no effect on their serum iron levels and, therefore, had no influence on their anaemia. Upper gastrointestinal endoscopy confirmed normal macroscopic findings. Duodenal biopsies revealed subtotal villous atrophy of the mucosa of the small intestine. A strict gluten-free diet led to an increase in serum iron, resolution of anaemia, and restitution of normal mucosal morphology. Thus, severe iron-deficiency anaemia associated with asymptomatic coeliac disease is responsible to gluten-free diet.
Isolation and antibiotic susceptibility of Salmonella, Shigella, and Campylobacter from acute enteric infections in Egypt.
(2000-06-03) Wasfy, M O; Oyofo, B A; David, J C; Ismail, T F; el-Gendy, A M; Mohran, Z S; Sultan, Y; Peruski, L F
While Campylobacter, Salmonella, and Shigella remain major contributors to acute enteric infections, few studies on these pathogens have been conducted in Egypt. From January 1986 to December 1993, 869 Salmonella, Shigella and Campylobacter strains were isolated from stool specimens from 6,278 patients, presenting to the Abbassia Fever Hospital, Cairo, Egypt, with acute enteric infections. Salmonella predominated, totalling 465 isolates, followed by Shigella with 258 isolates, and Campylobacter with 146 isolates. Of the Shigella isolates, 124 were Shigella flexneri, 49 were S. sonnei, 47 were S. dysenteriae (mainly serotype 1, 2, and 3), and 38 were S. boydii. Campylobacter spp. comprised 92 Campylobacter jejuni and 54 C. coli isolates. Isolation of Salmonella was highest during the months of February-March, June-July, and October-November, while that of Shigella was maximal from July to October. Isolation of Campylobacter increased during May-June and again during August-October. Although Salmonella was sensitive to amikacin, aztreonam, ceftriaxone, and nalidixic acid, it was, however, resistant to erythromycin, streptomycin, ampicillin, chloramphenicol, and tetracycline. Shigella (> 80%) was sensitive to amikacin, ceftriaxone, cephalothin, sulphamethoxazole-trimethoprim (except S. sonnei), aztreonam, and nalidixic acid. Resistance (> 50%) was noted only for ampicillin, chloramphenicol, and tetracycline. C. jejuni and C. coli were resistant to cephalothin, aztreonam, and streptomycin. Some of the above antibiotics were employed to characterize the Egyptian isolates, but did not have any clinical utility in the treatment of diarrhoea. Significant differences (p < 0.05) were observed in the resistance profiles of Shigella and Salmonella between late 1980s and early 1990s. The results suggest the use of fluoroquinolones or a third-generation cephalosporin as an empirical treatment of enteric diseases. However, alternative control strategies, including the aggressive development of broadly protective vaccines, may be more effective approaches to curbing morbidity and mortality due to acute enteric infections.
Serotypes and subgroups of rotavirus isolated from children in central Brazil.
(2000-06-03) Cardoso das, D; Soares, C M; Azevedo, M S; Leite, J P; Munford, V; Rácz, M L
Group A rotavirus, obtained from children of Goiânia, Brazil, during 1987-1994, were analyzed for subgroup and G serotype by enzyme-linked immunosorbent assay with monoclonal antibodies. The index of serotyping obtained was 61.4% with the following proportions: G1--19.7%, G2--28.0%, G3--9.8%, G4--1.5%, and G5--2.3%. It was observed that G1 occurred from 1987 to 1989 and from 1993 to 1994, and G2 from 1990 to 1993. About 94% of the samples (85/90) could be subgrouped with the following results: 55.5% for SG II, 7.8% SG I, and 31.1% for SG non-I-non-II. Unusual relationship patterns were also detected among serotypes, subgroups, and profiles of electropherotypes in 57.0% of the samples: 20 of them were G2/SG II/"long" profile. The results suggest that variation in temporal and regional characteristics should be considered in the development of rotavirus vaccine.
Identification of enteric pathogens in HIV-positive patients with diarrhoea in northern India.
(2000-06-03) Prasad, K N; Nag, V L; Dhole, T N; Ayyagari, A
Enteric pathogens associated with chronic diarrhoea in HIV-positive patients were studied. The study was conducted during January 1995-December 1998. Stool specimens from all diarrhoea patients (n = 26) were examined microscopically for ova and parasites using wet preparations and stained smears. Stool samples from diarrhoea patients were also cultured on appropriate media to isolate enteric bacterial pathogens. Of the 59 patients, 26 (44%) had prolonged diarrhoea for more than 4 weeks. Enteric pathogens were detected in 19 (73%) of the 26 patients: 17 patients harboured a single pathogen, and 2 patients had mixed pathogens. The detection rate of emerging parasites, including Isospora, Cryptosporidium, Blastocystis hominis, and Strongyloides stercoralis as a single agent, was significantly higher than conventional pathogens (50% vs 19.2%; p < 0.05). Only one patient harboured both conventional and emerging pathogens (Entamoeba histolytica and Cryptosporidium). Isospora belli was detected in 8 (31%) of the 26 diarrhoea patients: in 7 (27%) patients as a single agent and in one patient with S. stercoralis. Cryptosporidium was identified in 3 (11%) diarrhoea patients: in 2 (8%) patients as a single agent and in one patient with E. histolytica, followed by B. hominis in 2 (8%) patients. E. histolytica was most commonly isolated (3/26; 11.5%), followed by Giardia lamblia, enteropathogenic Escherichia coli, and Campylobacter jejuni (one patient each). Parasitic pathogens were frequently associated with HIV-positive patients with diarrhoea in northern India. I. belli was the most frequent parasite isolated, followed by Cryptosporidium. Stools of all HIV-positive patients with diarrhoea should thoroughly be investigated to identify aetiologic agents for proper management.
Vibrio cholerae O139 Bengal: a descriptive study.
(2000-06-03) Hossain, M S; Salam, M A; Rabbani, G H; Biswas, R; Mahalanabis, D
A prospective study was conducted to determine the clinical and laboratory characteristics and the clinical course of cholera due to Vibrio cholerae O139 Bengal. The study subjects included 22 adult males with stool culture-proven V. cholerae O139. On enrollment, mean +/- SD concentrations (mmol/L) of serum sodium, potassium, chloride, and bicarbonate were 134 +/- 3, 4 +/- 1, 102 +/- 4, and 13 +/- 4 respectively, and stool sodium, potassium, chloride, and bicarbonate concentrations were 120 +/- 24, 18 +/- 6, 93 +/- 16, and 37 +/- 9 respectively. Seventeen patients (7.8%) had faecal leukocytes ranging from 11 to 50 per high-power field. All V. cholerae O139 isolates (100%) were susceptible to tetracycline, erythromycin, and ciprofloxacin, 92% to furazolidine, and only 5% to trimethoprim-sulphamethaxazole. The median (interquartile) volume of liquid stool during the first 24 hours was 9 (5-12) litre. The median (interquartile) volume of liquid stool and the amounts of intravenous and oral rehydration fluids required during the entire study period were 16 (9-24) litre, 9 (6-18) litre, and 14 (9-20) litre respectively. The median (interquartile) duration of diarrhoea was 80 (48-104) hours. The median (interquartile) duration of excretion of V. cholerae O139 in stool was 5 (3-6) days. Clinical and laboratory features, and case management of cholera due to V. cholerae O139 are very similar to conventional cholera due to V. cholerae O1.
Production of heat-labile enterotoxin by strains of Aeromonas veronii bv veronii.
(2000-06-03) Singh, D V
Three isolates of Aeromonas veronii bv veronii (2 environmental, one blood infection) were examined to see if they produce any enterotoxin and, if so, to determine its characteristics. Two isolates caused fluid accumulation in the initial rabbit ileal loop tests. The other strain did so after a single passage through the rabbit ileal loop. All the isolates showed gradual enhancement of fluid secretion after each subsequent passage. Inocula of 1 x 10(4) viable cells and 0.25 mL of culture filtrate caused fluid accumulation comparable to those of toxigenic Vibrio cholerae 569B. The enterotoxic activity was inactivated at higher temperature, and showed biological activity over a wide range of pH. The only histopathological change observed was depletion of mucous from goblet cells. The findings of the study indicate that strains of A. veronii bv veronii produce a heat-labile, pH-stable diarrhoeagenic factor without causing any damage to the intestinal mucosa.
Antibiotic resistance conferred by conjugative plasmid in Escherichia coli isolated from community ponds of Kathmandu Valley.
(2000-06-03) Adhikari, R P; Kalpana, K C; Shears, P; Sharma, A P
Carbachol potentiates cholera toxin-induced secretion in a colonic epithelial cell line (HT29-19A) and rat ileal mucosa in vitro.
(2000-06-03) Mahmood, B; Warhurst, G; Higgs, N; Turnberg, L A
Recent studies show that enteric nerves are involved in the action of cholera toxin, both in vivo and in vitro. The aim of this study was to investigate in vitro the influence of carbachol, a cholinergic agonist, on the action of cholera toxin. Cultured HT29-19A cell lines and rat ileal mucosa were used in an Ussing chamber for the measurement of short-circuit current induced by cholera toxin. Cyclic AMP was measured from HT29-19A cell lines by standard radio-immunoassay. Pre-treatment of the HT29-19A cell lines with carbachol potentiated cholera toxin-induced secretory response, and enhanced accumulation of cAMP. Carbachol also potentiated the cholera toxin-secretory response in the rat ileal mucosa, but only following pretreatment with the prostaglandin synthesis inhibitor, indomethacin. There was synergistic interaction between cholera toxin and cholinergic neurotransmitter carbachol on the intestinal epithelium. Cholinergic agonists may play a role in regulating the secretory response to the toxin. Such interaction is masked in the intact tissues in vitro due to the release of prostaglandins during isolation.
Prevention of diarrhoea in a poor District of Santo Domingo, Dominican Republic: practices, knowledge, and barriers.
(2000-06-03) McLennan, J D
The study, conducted in a poor periurban community of Santo Domingo, Dominican Republic, assessed the practices, knowledge, and barriers relating to prevention of diarrhoea. A total of 582 caregivers of children, aged less than 5 years, were systematically sampled from four barrios. Results of the study showed that 55% of the caregivers did not boil drinking water for children; 38% did not always wash hands of the children prior to meals; 87% of the children did not always wear shoes outside their house; and 54% were breastfed for less than one year. Biomedical knowledge about these practices was high among the caregivers, and was not related to the reported behaviours. However, several barriers were significantly related to practices, including lapse in caregiving, limited resources, erroneous beliefs, and non-compliance by children. Health education, based on a biomedical knowledge-deficit model, may have little impact on improving the diarrhoea-prevention practices in these communities. Greater attention should, therefore, be directed toward the barriers experienced by caregivers of children.
Transition from Journal of Diarrhoeal Diseases Research to Journal of Health, Population and Nutrition.
(2000-06-03) Sack, D A
Determinants of use rate of oral rehydration therapy for management of childhood diarrhoea in rural Bangladesh.
(2000-09-01) Ali, M; Atkinson, D; Underwood, P
In rural Bangladesh, mothers were interviewed to identify factors that determine the use of oral rehydration therapy (ORT) for management of diarrhoea in children aged less than 5 years. The point prevalence of diarrhoea among 1,600 children was 11.6%, with 46% having acute watery diarrhoea. The overall ORT-use rate was 29%; only 17% of the cases used it adequately. Common reasons for not using ORS included misperception about diarrhoea and age of patients. Other reasons included incorrect assessments, severity, and difficulties with the administration of oral rehydration solutions. Promotion of ORT can be effected by improving the level of understanding of mothers with regard to assessment of severity, early initiation of treatment regardless of age, sex, type of diarrhoea, breast-feeding, and nutrition status.
Relationship of breast-feeding and hand-washing with dehydration in infants with diarrhoea due to Escherichia coli.
(2000-09-01) Oo, K N; Aung, W W; Thida, M; Toe, M M; Lwin, H H; Khin, E E
This prospective cohort study was carried out in the neonatal unit of the Yangon Children Hospital, Myanmar, to gather more information on the types of feedings and hand-washing practices of mothers as the determinant of severe dehydration in infants with acute diarrhoea due to Escherichia coli. The study subjects included 100 infants with diarrhoea, aged less than 4 months, admitted to the hospital from June 1997 to May 1998. Data on isolation of E. coli from rectal swab samples, types of feedings, hand-washing practices, and dehydration status were collected. Of the 100 cases, E. coli was isolated from rectal swab samples of 48 infants. Of these 48 cases, 28 had some dehydration and 20 had severe dehydration. Exclusive breast-feeding was observed only in the age group < 1 and > 1-2 month(s). The association of the severity of dehydration with other types of feedings compared to exclusive breast-feeding was not statistically significant. In this study, most mothers washed their hands with water only after cleansing their children's defaecation, and before and after feeding their children. The severity of dehydration was statistically significant in hand-washing practices when compared to washing with water only and washing with soap and water. This study has shown the association between types of feedings and hand-washing practices with dehydration in infants with acute diarrhoea due to E. coli. The results of the study suggest that there is a need for appropriate intervention programmes to promote exclusive breast-feeding and hand-washing practices with soap and water after cleansing children's defaecation, and before and after feeding children.
Improved indicators of infant mortality for integrated primary healthcare programmes.
(2000-09-01) Sack, D A; Ahmed, S; Razzaque, A; Chakraborty, J; Yunus, M
Mortality and fertility rates are decreasing rapidly in many developing countries. It is argued that the indices commonly used as measures of these changes, i.e. infant mortality rate and fertility rate, ignore the interaction between mortality and fertility, and do not reflect their combined impact in lowering overall infant mortality. The paper proposes new indicators of infant mortality, termed fertility-adjusted infant mortality ratio (FIMR), age-specific, fertility-adjusted IMR (AFIMR), and total infant mortality ratio (TIMR) that are more sensitive to rapid demographic changes. These indicators include the combined effects of changes in both fertility and infant mortality rates on overall infant mortality in a region and appear to measure the effects of integrated health programmes better. Further, these conceptualize the mother-infant pair as an appropriate unit with which to monitor mortality, and may be used for guiding allocation of resources intended to lower infant mortality. The application and usefulness of these indicators have been illustrated, using one hypothetical example and empirical data from the maternal-child health and family-planning programme in Matlab, Bangladesh, as well as data from white and black population groups in the U.S.A. The results of these examples demonstrate that the new indicators are more sensitive than traditional measures when describing infant mortality, and may better reflect the perception in infant mortality status in the community.
Vitamin A deficiency in children with acute diarrhoea: a community-based study in Bangladesh.
(2000-09-01) Ahmed, F U; Rahman, M E; Mahmood, C B
The prevalences of nightblindness and xerophthalmia were assessed in 400 children, aged 6-59 months, with acute diarrhoea in a rural community in Bangladesh. The prevalences of nightblindness, conjunctival xerosis, and Bitot's spot were 7.8%, 9.5%, and 2.7% respectively. Fifty-two percent of the children who complained of nightblindness had ocular signs of vitamin A deficiency compared to 9% of those without nightblindness (p < 0.000). The nightblindness was significantly higher among the male children, aged 24-59 months, who were dysenteric and undernourished, did not consume vitamin A-containing foods daily, and were not breastfed. The coverage of periodic administration of vitamin A capsule was inversely related to the prevalence of nightblindness. This finding was determined by logistic regression analysis of data indicating that a combination of male sex, history of dysentery, absence of periodic administration of vitamin A treatment, and daily intake of vitamin A-containing foods gave the best-fitted model with an overall prediction of 92.5% of being nightblind. The findings of the study suggest that mothers should be educated to observe their diarrhoeal children about development of nightblindness and to seek treatment for it. The locally-relevant nutrition education should also be offered to them.
Relationship between feeding practices and weanling diarrhoea in northeast Thailand.
(2000-09-01) Cao, X; Rawalai, K; Thompson, A J; Hartel, G; Thompson, S; Paterson, J H; Chusilp, K
Diarrhoea is a major public health problem in Thailand. During November 1998-January 1999, a cross-sectional survey and a nested qualitative study were conducted to understand the relationship between feeding practices and weanling diarrhoea, and to describe the related local beliefs and practices in a subdistrict of northeast Thailand. A cluster-sampling method was used for selecting 156 weanlings aged 3-24 months. A structured interview was conducted with the main caregivers of these weanlings. The questionnaire used for the interview included items about feeding practices and diarrhoea-history of the weanlings in 2 months prior to the interview. Seven focus-group discussions with an opportunistic sample of the caregivers were held in the villages. A series of vignettes and unstructured questions were used for eliciting the local beliefs about weanling diarrhoea and its causes. Thirty-six (23%) of the 156 weanlings had diarrhoea in 2 months prior to the interview. The factors that were significantly related to reported weanling diarrhoea included consumption of unboiled water by weanlings (OR = 10, p = 0.03), not covering perishable foods (OR = 3, p = 0.02), and washing feeding utensils of weanlings without dishwashing detergent (OR = 3.1, p = 0.02), 'Su' and 'tongsia'--two common local terms--were used for describing different types of weanling diarrhoea. Many caregivers considered 'su' a natural occurrence in a child's development. The results suggest that some poor feeding practices may contribute to the higher risk of weanling diarrhoea in northeast Thailand. Some local beliefs about weanling diarrhoea may mask the true causes, and mislead messages about its prevention.
Poverty among widows of Kinshasa, Congo.
(2000-09-01) D'Souza, S
The linkages between poverty and death in the family in a sector of the city of Kinshasa, capital of the Democratic Republic of Congo (previously Zaire) were studied. The poor people have been identified using 3 convergent norms, described in the Methods of Materials section, based on total expenditure, calorie consumption in food, and proportion of expenditure for food. Family histories were recorded to understand the difficult situation of widow-headed households identified within the sample area. The relationship between death in the family and poverty was bi-directional: on the one hand, death of the breadwinner can accelerate the level of poverty; and on the other, poverty conditions can result in further deaths in the family.
User-fees for family-planning methods: an analysis of payment behaviour among urban contraceptors in Bangladesh.
(2000-09-01) Routh, S; Thwin, A A; Kane, T T; Hel Baqui, A
The study was carried out to review the experience with the existing user-fee (pricing) strategies and examine the socioeconomic and demographic factors associated with payment behaviour among contraceptors in urban Bangladesh for selected contraceptive methods, such as injectables, pill, and condom. Data for the study were drawn from a survey of more than 5,000 married women of reproductive age in Zone 3 of Dhaka city, Bangladesh, within the sample frame of the Urban Panel Survey of the ICDDR,B's former Urban MCH-FP Extension Project. The findings of the study showed that most (80%) urban contraceptors have been paying for selected family-planning services. This indicates the existence of a notable demand for contraceptives which suggests that there is scope for improved financial sustainability of the family-planning programme through charging appropriate user-fees for contraceptives with proper analyses of willingness-to-pay among the contraceptors and price elasticities of demand. Higher socioeconomic status of households, marked by higher levels of education and house rent, and location of residence in non-slum areas, is predictive of paying for contraception. Households having 1-3 living child(ren) are also more likely to make payment for the selected contraceptive services.
Intestinal amoebiasis: delayed-type hypersensitivity response in mice.
(2000-09-01) Ghosh, P K; Gupta, S; Ortiz-Ortiz, L
Delayed-type hypersensitive (DTH) response was evaluated in C3H/HeJ mice intestinally infected with Entamoeba histolytica. Infected and non-infected control mice were challenged with amoebic antigen on day 5, 10, 15, 20, 25, 30, 40, 50, and 60 post-infection. Maximum footpad swelling was observed after 24 hours of the challenge. The E. histolytica-infected mice exhibited a DTH response on day 5, 15, 20, 25, 40 and 60 post-infection. However, on day 10, 30, and 50, such response was similar to that of the non-infected control mice. The mice developed an evident DTH response late in the course of infection (25 days post-infection). The infected mice did not show any alteration to their DTH response against heterologous unrelated antigen (sheep red blood cells), suggesting that cellular anergy was antigen-specific.
Perceived causes and management of diarrhoea in young children by market women in Enugu State, Nigeria.
(2000-09-01) Ene-Obong, H N; Iroegbu, C U; Uwaegbute, A C
The aim of the study was to determine the perceptions of mothers regarding the causes and management of diarrhoea of their children aged 0-24 months. In Enugu State, Nigeria, 80 market women whose children had diarrhoea during last 6 months were interviewed fortnightly. When possible, the children were observed to determine the types of diarrhoea and treatments given. Fifty-three of the women brought their children to market, and 27 left their children at home. Seventy-one percent of the mothers perceived that diarrhoea was caused by teething. The most common types of diarrhoea occurring in these children were watery diarrhoea (59%) and the so-called teething diarrhoea (29%). Dysentery (6%) and jedi jedi or frothy and mucoid stools (4%) occurred less frequently. In 68% of the cases, drugs were used alone or in conjunction with salt-sugar solution (SSS) or other forms of treatment. These drugs were prescribed by medical personnel (40%), patent medicine dealers (23%), or mothers themselves (30%). About 26% and 39% of the mothers treated, respectively, watery and teething diarrhoeas with drugs only, while 23% used SSS alone. The drugs used were mainly antimicrobials (34%) and a combination of antimicrobial, antimalarial, antacid, analgesic, and some local herbal preparations (21%). The results of the study showed the evidence of unnecessary use of drugs and ignorance about their potential adverse effects. These underscore the need for appropriate primary care education among the market women in Nigeria.

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