Background: There is increasing concern around the use of antibiotics in animal food production and the risk of transmission of antimicrobial resistance within the food chain. In many low and middle-income countries, including Bangladesh, the commercial poultry sector comprises small-scale producers who are dependent on credit from poultry dealers to buy day-old chicks and poultry feed. The same dealers also supply and promote antibiotics. The credit system is reliant upon informal relationships among multiple actors as part of social capital. This paper aims to describe dependencies and relationships between different actors within unregulated broiler poultry production systems to understand the social and contextual determinants of antibiotic use in low-resource settings. Methods: We used a cross-sectional qualitative design including in-depth interviews among purposefully selected commercial poultry farmers (n = 10), poultry dealers (n = 5), sales representatives of livestock pharmaceutical companies (n = 3) and the local government livestock officer as a key-informant (n = 1). We describe the food production cycle and practices relating to credit purchases and sales using social capital theory. Findings: Poultry dealers provide credit and information for small-scale poultry farmers to initiate and operate their business. In return for credit, farmers are obliged to buy poultry feed and medicine from their dealer and sell their market-ready poultry to that same dealer. All farms applied multiple antibiotics to poultry throughout the production cycle, including banned antibiotics such as colistin sulfate. The relationship between dealers and poultry farmers is reciprocal but mostly regulated by the dealers. Dealers were the main influencers of decision-making by farmers, particularly around antibiotic use as an integral part of the production cycle risk management. Our findings suggest that strategies to improve antibiotic stewardship and responsible use should exploit the patron-client relationship which provides the social and information network for small-scale farmers. Masud et al. Antibiotic Use in Poultry Production Conclusion: Social capital theory can be applied to the patron-client relationship observed among poultry farmers and dealers in Bangladesh to identify influences on decision making and antibiotic use. Within unregulated food production systems, strategies to promote the prudent use of antibiotics should target commercial feed producers and livestock pharmaceutical manufacturers as a first step in developing a sustainable poultry value chain.

The effect of zinc supplementation on intestinal permeability changes and protein loss was studied in 32 children aged between 1 Zinc is a micronutrient that is commonly deficient in children in developing countries. Loss of zinc occurs in infants with acute diarrhoea.7 Furthermore, hypozincaemia and low rectal mucosal zinc concentrations have been shown in cases of childhood chronic diarrhoea,8 9 although it was not clear whether the mucosal injury associated with these conditions resulted in such a loss. Zinc supplementation in patients with diarrhoea has been shown, however, to improve the mucosal integrity and is associated with significant reduction in diarrhoea attack rates, duration of diarrhoea, and stool volume, particularly when the patients are undernourished.6 The present study also aimed to explore the inter-relationship between gut permeability changes and enteric protein loss and to determine if zinc supplementation affects these changes. MethodsForty three boys and girls aged 1-12 years with a history of bloody mucoid diarrhoea of less than three days' duration were initially enrolled in the study. Microscopic examination of the stools of these patients suggested shigellosis.10 Children with obvious systemic illness -for example, pneumonia, meningitis, leukaemoid reaction,11 severe malnutrition (<65% weight for age according to the National Center for Health Statistics), otitis media, and distension of the abdomen -were excluded from the study. All An intestinal permeability test using a freshly prepared solution containing 5 g lactulose with 0 5 g lactose (7.5 ml of Duphalac, Duphar Labs, Southampton, UK) and 1 g mannitol made up to 20 ml with 1% chloroform water was performed using the method described by Behrens et al,13 starting soon after admission when rehydration had been accomplished. All patients were hydrated and were made to empty their bladder before the test dose was offered. Adhesive paediatric urine bags (Downs Ltd, London, UK) containing a drop of 20% (vol/vol) chlorhexidine gluconate to prevent bacterial degradation of the probes were applied to the clean perineum to collect all urine samples over the next five hour period for subsequent measurement of the markers by an automated enzyme assay using Cobas-bio (Switzerland).After this test, two charcoal tablets (500 mg, homogenised in 15 ml water) were given orally. Once the charcoal marker had appeared in the stool and the patients were clinically settled after full rehydration, a 48 hour balance study (first balance study), as previously described,4 was begun with a diet of known compositions (Table I). Food was weighed to an accuracy of 0-1 g on a Toledo scale (Ohaus, Dial Og) and was offered freely. The amounts offered and left over were measured and the difference was recorded as the amount consumed. None of our patients was breast fed. All patients received nalidixic acid (55 mg/kg per day in four divided doses for five days), as Shigella species isolated from their stools or rectal swabs, or both, were sensiti...

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Helicobacter pylori is a genetically diverse bacterial species, which has facilitated adaptation to new hosts and persists worldwide. The main objective of this study was to explore intra-familial transmission of H. pylori in Bangladesh. We characterized H. pylori in 35 families including 138 family members using random amplified polymorphic DNA (RAPD) fingerprinting. Forty-six percent of H. pylori isolated from the mother shared a related genotype with strains isolated from their children. Twenty-nine percent of H. pylori isolates of the mother are related to the youngest children. Only 6% of the parents shared related genotype of H. pylori. These findings suggest that mother-to-child transmission occurs in early childhood and is the most probable route of transmission of H. pylori in Bangladesh.

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Whole gut transit time (TT) was measured in 68 children aged up to 5 years (29 cholera, 17 rotavirus, 13 enterotoxigenic Escherichia coli, and 9 Shigella) during acute stages of diarrhoea and 2 weeks after recovery. Absorption of calories, fat, protein, and carbohydrates contained in a normal Bangladeshi diet was studied for 72 h after the first appearance of a charcoal marker in the stool, both during acute diarrhoea and 2 weeks after recovery. Mean TT varied from 5.5 to 7.3 h during the acute stage and from 14.1 to 15.5 h during the recovery period of diarrhoea of all aetiologies; the increase in the TT was significant as expected (P less than 0.001). Correlation coefficients were calculated between TT and the coefficients for absorption of fat, nitrogen, calories, and carbohydrates in the acute and recovery stages of cholera, rotavirus, E. coli, and Shigella. No significant relation was found between TT and absorption of nutrients in any stage of diarrhoea of any aetiology. The results of this study suggest that the mechanism for absorption of nutrients is independent of the whole-gut transit time. Further studies are necessary to identify the role of transit of a meal and its absorption along the whole gut.