Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean±SD age 23.5±15.3 months) were admitted during June 2005–May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of ≥500 and ≥700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of −1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.
Objective: The present study was undertaken to evaluate the problems and immediate outcome of infants of diabetic mothers (IDMs) in early neonatal period and to compare the results between infants of gestational and pregestational diabetic mothers. Design: A hospital based prospective study. Setting: The study was done in Chittagong Medical College Hospital, a tertiary hospital in Chittagong city. Method: Within one hour of delivery 52 infants of diabetic [pregastational & gestational] mothers consecutively admitted were enrolled in the study. Study period was January 2002 to August 2002. Results: Total number of IDMs were 52. Among them 31 were gestational and 21 were of pregestational diabetic mothers. Significant number 82.6% of IDMs were delivered by caesarean section. The mean birth weight of IDMs was significantly high (3212±563g), 21% of IDMs had birth weight>4000 g. Total 23% of the IDMs developed perinatal asphyxia. The 23% of IDMs developed hypoglycaemia. The incidence of hypoglycaemia was higher in infants of pregestational diabetic mothers as compared to that of gestational diabetic mothers (38.09% and 12.9% respectively), the difference was statistically significant (P<0.05).In majority (66%) of IDMs cases hypoglycaemia was symptomatic. Significant number (19.2%) of IDMs had hypocalcaemia. The incidence of polycythaemia was higher in infants of gestatational diabetic mothers(GDMs) as compared to infants of pregestational diabetic mothers (25.8% and 9.5% respectively), difference was statistically significant (P<0.001). 3(5.7%) out of 52 IDMs had congenital malformation (each one in number polydactyly, cleft palate & preauricular skin tag). Total death was 3 (5.7%) all of them died within 72 hours of birth. Causes of death 1 each number: perinatal asphyxia, respiratory distress syndrome and meconium aspiration syndrome. 11 IDM was macrosomic, among them 1 had birth injury ( Erb's palsy), hypoglycaemia and meconium aspiration syndrome and expired within first 24 hours of life. Conclusion: Among the important problems the present study revealed perinatal asphyxia, hypoglycaemia, hypocalcaemia, polycythaemia top the list. These babies should be delivered at hospitals where special neonatal care available for management of high risks babies to reduce the morbidity and mortality. Screening for GDMs should be performed in all pregnant women. All diabetic women should have planned pregnancy and proper antenatal care in order to maintain strict glycaemic control, to have a satisfactory outcome in infants of diabetic mothers. DOI: 10.3329/jbcps.v26i2.4183 J Bangladesh Coll Phys Surg 2008; 26: 62-72
Background: Birth weight is the single most important determinant of survival and subsequent growth and development of the newborn. In Bangladesh there is high prevalence of low birth weight (LBW) babies and most of them are small for gestational age. The study was conducted to identify the proportion and category of the small for gestational age babies and determination of the short-term outcome with the aim to the reduction of neonatal mortality and morbidity by problem-wise intervention. Methods: This cross sectional study was conducted in the Neonatal Unit of Chittagong Medical College Hospital, Chittagong between December 2000 and July 2001. Neonates admitted into this unit weighing less than 10th percentile of weight for gestational age were included. On admission the weight was taken and gestational age was calculated using last menstrual period and Ballard score. The infants were monitored daily till discharge or death. Result: A total of 200 SGA babies were included in the study. Among 200 cases 114 were male and 86 were female. All cases were included within 24 hours of age. The anthropometric analysis of the SGA babies showed more than 80% of the SGA babies were normal in length whereas 19.5% fell below 10th percentile of normal. Seventy three percent of SGA babies were asymmetrically (disproportionate) and 27% of babies were symmetrically (proportionate) growth retarded. The main problems associated with the SGA babies were perinatal asphyxia (65.5%), sepsis (54%), jaundice (42.0%), hypothermia (31%), apnea (29%), hypoglycemia (25%), and bleeding manifestations (9%). Asymmetrical SGA babies were at higher risk of infection and jaundice. Present study revealed the mortality of SGA babies were 17% and mortality was significantly higher among the neonates from low socio-economic status and having very low birth weight, hypothermia, apnea, sepsis, bleeding manifestations, and polycythemia. Conclusion: Findings in this study could be important in identifying the areas requiring attention to improve perinatal care in order to prevent SGA babies and also to manage the problems associated with them. DOI: 10.3329/bjch.v31i1.6066 Bangladesh Journal of Child Health 2007; Vol.31(1-3): 1-7
This was a community based thirty cluster survey, carried out in rural Chittagong district, Bangladesh during 1996 with the objective to assess the skill of mothers in preparing packet ORS solution. A total of 420 mothers whose children had been suffering from acute diarrhoea were investigated. There were 377 (89.8%) mothers who demonstrated the preparation of ORS and 43 (10.2%) mothers never ever prepared the solution and were unable to demonstrate the preparation. One hundred and forty (33.3%) mothers were able to demonstrate the preparation correctly and the rest 237 (56.4%) demonstrated the preparation incorrectly. The incorrect preparation was found to be associated significantly with the refusal of ORS solution by the children (p < 0.01). None of the maternal factors were found to be associated with the correctness of preparation of ORS solution except previous exposure of the mother to the demonstration of ORS solution preparation (p < 0.000). Therefore, demonstration of preparation of ORS solution to the mothers should be in built in the health education package of oral rehydration therapy for diarrhoeal diseases.
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