No abstract

Prospective field data were employed to examined the effect of child malnutrition on the subsequent risk of diarrhea among preschool children in rural Bangladesh. A total of 2019 children aged 12-23 months were classified according to weight-for-age, weight-for-height, and height-for-age of the Harvard median standard. Over a 24-month prospective period, diarrheal hospitalization rates among the children were matched to the initial anthropometric assessment. No differences in diarrheal hospitalization rates were noted for the children according to initial nutritional status. Another group of 207 children under five years of age were classified according to weight-for-age and their diarrheal attack rate in the field was followed prospectively for one year after nutritional assessment. Again, no differences in field diarrheal attack rates were noted between children of varying nutritional status categories. The nutritional status of the 207 children was then defined as monthly growth velocity (kilogram change in body weight, per cent change of initial body weight, and per cent change in weight-for-age) and the diarrheal attack rate for the subsequent one month period was observed. No differences in attack rates were noted between nutritional groups. The study failed to demonstrate that nutritional status defined by anthropometry was associated with the subsequent risk of diarrheal diseases.

It has been recognized for some time that nutrient intakes show large day-to-day variations within the same individual in industrialized countries. However, little attention has been given to the quantification of within-and between-person components of the variation in developing countries. Within-person variability determines the number of measurements of dietary intake per person that will be needed to adequately represent the dietary intake of an individual over a period of time. A large within-person variation relative to the variation between persons in the intake of a nutrient decreases the strength of the observed association of the latter with an outcome of interest.This study quantified components of variation for 834 people of both sexes and various age groups and found that, although the diet in rural Bangladesh includes a limited number of food items-over 80% of calorie and protein intakes are provided by cereals, with rice being the main staple-the daily variability of nutrient intake in each individual over a year was as large as that reported for industrialized countries. The authors estimate that about seven days would be needed to assess total energy and protein intakes adequately, while much longer measurement periods would be needed for animal protein.

We sought to examine the factors associated with bacteraemia and their outcome in children with pneumonia and severe acute malnutrition (SAM). All SAM children of either sex, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh with radiologically confirmed pneumonia from April 2011 to July 2012 were enrolled (n = 405). Comparison was made between pneumonic SAM children with (cases = 18), and without (controls = 387) bacteraemia. The death rate was significantly higher in cases than controls (28% vs. 8%, P < 0·01). In logistic regression analysis, after adjusting for potential confounders, the SAM children with pneumonia and bacteraemia more often had a history of lack of bacillus Calmette-Guérin (BCG) vaccination (odds ratio 7·39, 95% confidence interval 1·67-32·73, P < 0·01). The results indicate the importance of continuation of BCG vaccination which may provide benefit beyond its primary purpose.

Colicin typing, biotyping, phase typing and in vitro antimicrobial susceptibility testing were performed on clinical isolates of Shigella sonnei from three different geographical locations. Results of 93 strains from Kuwait, 61 strains from Saudi Arabia and 23 strains from Bangladesh were compared. Of 169 strains of S. sonnei tested, 75% belonged to colicin type 6/11. It was the most common colicin type in all three countries. However, differences in antimicrobial susceptibility patterns were observed. The resistance pattern in 62% of resistant strains from Kuwait was tetracycline – trimethoprim/sulpha-methoxazole – trimethoprim (TE-TMP/SMZ-TMP). Saudi Arabian strains were of the same resistance pattern with additional resistance to ampicillin (AM) AM-TE-TMP/SMZ-TMP (34%) which was seem more often than TE-TMP/SMZ-TMP (26%). Most of the strains (65%) from Bangladesh were sensitive to all the antimicrobial agents against which they were tested. Of the 8 strains which showed resistance, 50% were resistant to tetracycline alone. Study of carbohydrate fermentation of 12 sugars which were incubated for 21 days did not aid in discriminating different biotypes.