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BackgroundGlobally, about 15 million neonates are born preterm and about 85% of global preterm birth occurs in Asia and Africa regions. We aimed to estimate the incidence and risk factors for preterm birth in a rural Bangladeshi cohort.MethodsBetween June 2007 and September 2009, community health workers prospectively collected data from 32,126 mother-live-born baby pairs on household socio-demographic status, pregnancy history, antenatal care seeking and newborn gestational age determined by recall of date of last menstrual period.ResultsAmong all live births, 22.3% were delivered prior to 37 weeks of gestation (i.e. preterm); of which 12.3% were born at 35–36 weeks of gestation (late preterm), 7.1% were born at 32–34 weeks (moderate preterm), and 2.9% were born at 28–31 weeks of gestation (very preterm). Overall, the majority of preterm births (55.1%) were late preterm. Risk of preterm birth was lower among women with primary or higher level of education (RR: 0.92; 95% CI: 0.88, 0.97), women who sought antenatal care at least once during the index pregnancy (RR: 0.86; 95% CI: 0.83, 0.90), and women who had completed all birth preparedness steps (RR: 0.32; 95% CI: 0.30, 0.34). In contrast, risk of preterm birth was higher among women with a history of child death (RR: 1.05; 95% CI: 1.01, 1.10), who had mid-upper arm circumference (MUAC) ≤250 mm, indicative of under nutrition (for women having MUAC <214 mm the risk was higher; RR: 1.26; 95% CI: 1.17, 1.35), who reported an antenatal complication (RR: 1.32; 95% CI: 1.14, 1.53), and who received iron-folic acid supplementation for 2–6 months during the index pregnancy (RR: 1.33; 95% CI: 1.24, 1.44).ConclusionsIn resource poor settings with high burden of preterm birth, alike Bangladesh, preterm birth risk could be reduced by close monitoring and/or frequent follow-up of women with history of child death and antenatal complications, by encouraging women to seek antenatal care from qualified providers, to adopt birth preparedness planning and to maintain good nutritional status. Additional research is needed to further explore the associations of antenatal iron supplementation and maternal nutritional status on preterm birth.

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BackgroundDespite the increased burden of preterm birth and its complications, the dearth of care seeking data for preterm newborns remains a significant knowledge gap. Among preterm babies in rural Bangladesh, we examined: 1) determinants and patterns of care seeking, and 2) risk analysis for care-seeking from qualified and unqualified providers.MethodTrained community health workers collected data prospectively from 27,460 mother-liveborn baby pairs, including 6,090 preterm babies, between June 2007 and September 2009. Statistical analyses included binomial and multinomial logistic regressions.ResultsOnly one-fifth (19.7%) of preterm newborns were taken to seek either preventive or curative health care. Among care-seeker preterm newborns, preferred providers included homeopathic practitioners (50.0%), and less than a third (30.9%) sought care from qualified providers. Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies, compared to male babies [Relative Risk Ratio (RRR) for unqualified care: 0.68; 95% Confidence Interval (CI): 0.58, 0.80; RRR for qualified care: 0.52; 95% CI: 0.41, 0.66]. Among preterm babies, care-seeking was significantly higher among caregivers who recognized symptoms of illness [RR: 2.14; 95% CI: 1.93, 2.38] or signs of local infection (RR: 2.53; 95% CI: 2.23, 2.87), had a history of child death [RR: 1.21; 95% CI: 1.07, 1.37], any antenatal care (ANC) visit [RR: 1.41; 95% CI: 1.25, 1.59]. Birth preparedness (RRR: 1.24; 95% CI: 1.09, 1.68) and any ANC visit (RRR: 1.73; 95% CI: 1.50, 2.49) were also associated with increased likelihood of care seeking for preterm babies from qualified providers.ConclusionTo improve care seeking practices for preterm babies and referral of sick newborns to qualified providers/facilities, we recommend: 1) involving community-preferred health care providers in community-based health education and awareness raising programs; 2) integrating postnatal care seeking messages into antenatal counselling; and 3) further research on care seeking practices for preterm babies.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-417) contains supplementary material, which is available to authorized users.

We summarized epidemiological studies assessing sodium in drinking water and changes in blood pressure or hypertension published in English from 1960 to 2015 from PubMed, Scopus, and Web of Science. We extracted data on blood pressure level or prevalence of hypertension and calculated pooled estimates using an inverse variance weighted random-effects model. The pooled standardized mean difference (SMD) in 7 studies (12 data sets) comparing the low and high water sodium exposure groups for systolic blood pressure (SBP) was 0.08 (95% CI, -0.17 to 0.34) and for diastolic blood pressure (DBP) was 0.23 (95% CI, 0.09-0.36). Of the 3 studies that assessed the association between high water sodium and odds of hypertension, 2 recent studies showed consistent findings of higher risk of hypertension. Our systematic review suggests an association between water sodium and human blood pressure (more consistently for DBP) but remain inconclusive because of the small number of studies (largely in young populations) and the cross-sectional design and methodological drawbacks. In the context of climate-change-related sea level rise and increasing saltwater intrusion into drinking water sources, further research is urgently warranted to investigate and guide intervention in this increasingly widespread problem.

This study demonstrates the potential usefulness of a dengue prediction score scheme derived from complex statistical models for high-risk dengue clusters. We recommend a further study to examine the possibility of incorporating such a score scheme into the dengue early warning system in similar climate settings.

Background The human T-cell leukaemia virus type 1 (HTLV-1) subtype c is endemic to central Australia. We report the first large-scale, community-based, health survey of HTLV-1 and its disease associations in this setting. Methods Aboriginal community residents aged &gt;2 years in seven remote communities were invited to do a health survey that included a questionnaire, spirometry and clinical examination by a physician blinded to HTLV-1 status, clinical records and spirometry results. Blood was drawn for HTLV-1 serology and proviral load (PVL). Pulmonary disease was assessed clinically and spirometrically and, where records were available, radiologically after the clinical assessment. Associations between specific diseases and HTLV-1 status were determined using logistic regression, adjusting for available confounders. Results Overall, 579 residents (children aged 3-17, 164; adults, 415) were examined (37.7% of the estimated resident population). HTLV-1 prevalences for children and adults were 6.1% and 39.3%, respectively. No associations were found between HTLV-1 and any assessed clinical condition among children. Chronic pulmonary disease and gait abnormalities were more common among adults with HTLV-1 infection. Adjusted odds ratios (aOR)(95% CI) among participants with PVL ≥ 1000 per 10 5 PBL were 7.08 (2.67, 18.74; p&lt;0.001), 9.81 (3.52, 27.35; p&lt;0.001) and 14.4 (4.99, 41.69; p&lt;0.001) for clinically defined chronic pulmonary disease, moderate-severe expiratory airflow limitation and radiologically determined bronchiectasis/bronchiolitis, respectively, and 5.21 (1.50, 18.07; p=0.009) for gait abnormalities. Conclusion In the first study of HTLV-1 disease associations based on community recruitment and blinded assessment, HTLV-1 infection was strongly associated with pulmonary disease and gait abnormalities.

The evidence on the temperature and morbidity relationship is limited, especially from tropical regions including Vietnam. This study's objective was to examine the high temperature-hospitalisation relationship in northern Vietnam. To assess ambient temperature hospitalizations associations in seven provinces of northern Vietnam Generalized Linear and Distributed Lag Models were used. Overall risk for all causes, and infectious, cardiovascular, and respiratory admissions in study provinces was estimated using a random-effects meta-analysis. The pooled estimates showed a signi cant effect of high temperature on same day (Lag 0) hospitalizations. A 1°C increase in temperature was signi cantly associated with 1.1% (95% Con dence Interval-CI, 0.9-1.4%) increase in risk for all-cause, 2.4% (95% CI, 1.9-2.9%) increase in risk for infectious, 1.3% (95% CI, 0.9-1.6%) increase in risk for respiratory, and 0.5% (95% CI, 0.1-0.9%) increase in risk for cardiovascular disease admissions. However, the province speci c temperature-hospitalisation effect was variable and mostly inconsistent for cardiovascular diseases. Our research in northern Vietnam adds to the evidence of high temperatures associated with hospitalisations in a sub-tropical climate. Our ndings have important implications for promoting appropriate adaptation strategies to reduce climate change associated health impacts in similar settings.