Children In Rural Bangladesh Research Articles

Mothers' perception and healthcare seeking behavior of pneumonia children in rural bangladesh.

We describe mothers' perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers' perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers (n = 24) could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia.

Contaminated turmeric is a potential source of lead exposure for children in rural Bangladesh.

Background. During the conduct of a cohort study intended to study the associations between mixed metal exposures and child health outcomes, we found that 78% of 309 children aged 20–40 months evaluated in the Munshiganj District of Bangladesh had blood lead concentrations ≥5 µg/dL and 27% had concentrations ≥10 µg/dL. Hypothesis. Environmental sources such as spices (e.g., turmeric, which has already faced recalls in Bangladesh due to high lead levels) may be a potential route of lead exposure. Methods. We conducted visits to the homes of 28 children randomly selected from among high and low blood lead concentration groups. During the visits, we administered a structured questionnaire and obtained soil, dust, rice, and spice samples. We obtained water samples from community water sources, as well as environmental samples from neighborhood businesses. Results. Lead concentrations in many turmeric samples were elevated, with lead concentrations as high as 483 ppm. Analyses showed high bioaccessibility of lead. Conclusions. Contamination of turmeric powder is a potentially important source of lead exposure in this population.

Ascaris lumbricoids Infection as a Risk Factor for Asthma and Atopy in Rural Bangladeshi Children.

Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5–60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated Ascaris infection was defined by the presence of anti-Ascaris IgE ≥ 0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥ 0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥ 5 mm). Anti-Ascaris IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14–3.04, highest vs. lowest quartile; P for trend 0.016). Anti-Ascaris IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52–15.00, highest vs. lowest; P for trend < 0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01–2.81, highest vs. lowest, P for trend 0.076). These findings suggest that repeated Ascaris infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.

Measles vaccination coverage estimates from surveys, clinic records, and immune markers in oral fluid and blood: a population-based cross-sectional study

BackgroundRecent outbreaks of measles and polio in low-income countries illustrate that conventional methods for estimating vaccination coverage do not adequately identify susceptible children. Immune markers of protection against vaccine-preventable diseases in oral fluid (OF) or blood may generate more accurate measures of effective vaccination history, but questions remain about whether antibody surveys are feasible and informative tools for monitoring immunization program performance compared to conventional vaccination coverage indicators. This study compares six indicators of measles vaccination status, including immune markers in oral fluid and blood, from children in rural Bangladesh and evaluates the implications of using each indicator to estimate measles vaccination coverage.MethodsA cross-sectional population-based study of children ages 12–16 months in Mirzapur, Bangladesh, ascertained measles vaccination (MCV1) history from conventional indicators: maternal report, vaccination card records, ‘card + history’ and EPI clinic records. Oral fluid from all participants (n = 1226) and blood from a subset (n = 342) were tested for measles IgG antibodies as indicators of MCV1 history and compared to conventional MCV1 coverage indicators.ResultsMaternal report yielded the highest MCV1 coverage estimates (90.8%), followed by EPI records (88.6%), and card + history (84.2%). Seroprotection against measles by OF (57.3%) was significantly lower than other indicators, even after adjusting for incomplete seroconversion and assay performance (71.5%). Among children with blood results, 88.6% were seroprotected, which was significantly higher than coverage by card + history and OF serostatus but consistent with coverage by maternal report and EPI records. Children with vaccination cards or EPI records were more likely to have a history of receiving MCV1 than those without cards or records. Despite similar MCV1 coverage estimates across most indicators, within-child agreement was poor for all indicators.ConclusionsMeasles IgG antibodies in OF was not a suitable immune marker for monitoring measles vaccination coverage in this setting. Because agreement between conventional MCV1 indicators was mediocre, immune marker surveillance with blood samples could be used to validate conventional MCV1 indicators and generate adjusted results that can be compared across indicators.

Arsenic Exposure Affects Plasma Insulin-Like Growth Factor 1 (IGF-1) in Children in Rural Bangladesh

BackgroundExposure to inorganic arsenic (As) through drinking water during pregnancy is associated with lower birth size and child growth. The aim of the study was to assess the effects of As exposure on child growth parameters to evaluate causal associations. Methodology/FindingsChildren born in a longitudinal mother-child cohort in rural Bangladesh were studied at 4.5 years (n=640) as well as at birth (n=134). Exposure to arsenic was assessed by concurrent and prenatal (maternal) urinary concentrations of arsenic metabolites (U-As). Associations with plasma concentrations of insulin-like growth factor 1 (IGF-1), calcium (Ca), vitamin D (Vit-D), bone-specific alkaline phosphatase (B-ALP), intact parathyroid hormone (iPTH), and phosphate (PO4) were evaluated by linear regression analysis, adjusted for socioeconomic factor, parity and child sex. Child U-As (per 10 µg/L) was significantly inversely associated with concurrent plasma IGF-1 (β=-0.27; 95% confidence interval: -0.50, -0.0042) at 4.5 years. The effect was more obvious in girls (β=-0.29; -0.59, 0.021) than in boys, and particularly in girls with adequate height (β=-0.491; -0.97, -0.02) or weight (β=-0.47; 0.97, 0.01). Maternal U-As was inversely associated with child IGF-1 at birth (r=-0.254, P=0.003), but not at 4.5 years. There was a tendency of positive association between U-As and plasma PO4 in stunted boys (β=0.27; 0.089, 0.46). When stratified by % monomethylarsonic acid (MMA, arsenic metabolite) (median split at 9.7%), a much stronger inverse association between U-As and IGF-1 in the girls (β=-0.41; -0.77, -0.03) was obtained above the median split. ConclusionThe results suggest that As-related growth impairment in children is mediated, at least partly, through suppressed IGF-1 levels.

No Place is Safe: Sexual Abuse of Children in Rural Bangladesh

During July 2007 to June 2010, BRAC, a nongovernment organization in Bangladesh, reported 713 incidents of rape and attempted rape of children (< 18 years) in rural Bangladesh. This study explores these 713 incidents to identify possible patterns related to the victims, perpetrators, and different dynamics of the incidents. Rape and attempted rape, particularly of young girls, constituted 64% of all reported incidents of violence against children. Children were found to be abused by men from all walks of life, mainly by non-family-members (83%). Similar diversity was seen in the location, time, and context of the incidents. The present study attempts to put forward an overall picture of the depth of the problem of child sexual abuse in rural Bangladesh, linking the incidents with the socially constructed gender relations of power and how it perpetuates sexual abuse of children, especially girls.

Severity of Diarrhea and Malnutrition among Under Five-Year-Old Children in Rural Bangladesh

Enteric pathogens are commonly associated with diarrhea among malnourished children. This study aimed to determine the association between the severity of diarrheal illnesses and malnutrition among under 5-year-old children. During 2010 and 2011, we studied 2,324 under 5-year-old diarrheal children with mild disease (MD) and moderate-to-severe disease (MSD) attending a hospital in Bangladesh. Children with MSD were more likely to be malnourished compared with children with MD (35% versus 24%, P < 0.001). In multivariate analysis, malnutrition (odds ratio [95% confidence interval] = 1.53 [1.22, 1.92]), age of the child (24-59 months; 1.67 [1.28, 2.19]), fever (1.65 [1.28, 2.12]), abdominal pain (1.87 [1.48, 2.37]), straining (5.93 [4.80, 7.33]), and infection with Shigella (3.26 [2.38, 4.46]) and Vibrio cholerae (2.21 [1.07, 4.58]) were shown to be significantly associated with MSD. Factors significantly associated with malnutrition were disease severity (1.56 [1.24, 1.95]), age (24-59 months; 1.75 [1.38, 2.22]), mother's schooling (1.54 [1.16, 2.04]), and monthly household income (1.71 [1.42, 2.07]). Childhood malnutrition was associated with dysentery and dehydrating diarrhea.

Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development

A stratified cluster design was used to evaluate a 10-month parenting program delivered to mothers of children in rural Bangladesh. Intervention mothers through a combination of group meetings and home visits received messages along with an illustrative card concerning hygiene, responsive feeding, play, communication, gentle discipline, and nutritious foods. Control mothers received the standard government care. Three months prior, 463 children between 4 and 14 months in a subdistrict of western Bangladesh were administered the cognitive, receptive language and expressive language Bayley III subtests, their length was taken and past week illness recorded. Gross motor milestones were reported by the mother and verified through observation. Mothers were interviewed concerning their practices: preventive health practices, dietary diversity, home stimulation, and knowledge about development milestones. Maternal depressive symptoms were assessed as a measure of emotional availability. Family sociodemographic variables included maternal education, family assets, decision-making and mobility autonomy. One month after the end of the program, mothers and their children were again assessed. Comparisons were made between intervention and control children who were under-12 months vs. 12 months and older at the start of the program. This may be a critical age, when children begin to be upright and mobile enough to explore on their own and be less dependent on parenting stimulation. Analyses yielded strong intervention effects on the three Bayley subtests and on parenting practices related to stimulation and knowledge of development milestones. Age effects were found only for dietary diversity in that younger children in the program benefited more than older ones. However, all children became more stunted. Findings are discussed in terms of theories of behaviour change and parenting, critical ages for parenting programs, and implications for program delivery.

Nutritional status and childhood wheezing in rural Bangladesh.

To investigate the association between current childhood nutritional status and current wheezing among pre-school children in rural Bangladesh. Cross-sectional study. Matlab region, rural Bangladesh. Children (n 912) aged 4·5 years. Anthropometric measurements of the mothers and their children were taken during a 1-year period from December 2007 to November 2008. Current wheezing was identified using the International Study of Asthma and Allergies in Childhood questionnaire. Serum total IgE was measured by human IgE quantitative ELISA. IgE specific antibody to dust mites (Dermatophagoides pteronyssinus) was measured by the CAP-FEIA system (Phadia AB, Uppsala, Sweden). Wheezing at 4·5 years old was significantly associated with stunting (OR = 1·58; 95 % CI 1·13, 2·22) and underweight (OR = 1·39; 95 % CI 1·00, 1·94). The association with stunting remained significant after adjustment for sex, birth weight, birth length, gestational age at birth, mother's parity, maternal BMI, family history of asthma, socio-economic status, season of birth and intervention trial arm (OR = 1·74; 95 % CI 1·19, 2·56). Stunting was a significant risk factor for wheezing among rural Bangladeshi children. Further studies will be required to confirm the relationship between nutritional status and allergic illnesses in developing countries.

Very low micronutrient intake adequacy of young children in rural Bangladesh is explained by limited diversity of nutrientrich foods

Documentation of micronutrient intake inadequacies among children in developing countries is important for planning food‐based interventions. This study quantified and assessed adequacy of micronutrient intakes of young children in rural Bangladesh. We measured 24‐h dietary intakes on two non‐consecutive days in a representative sample of 480 children ages 24–48 months using weighed food records and recall in homes. We calculated the probability of adequacy of usual intakes of 11 micronutrients, an overall mean probability of micronutrient adequacy (MA), and evaluated dietary diversity by counting the total number of nine food groups consumed. The relationship between overall adequacy of micronutrient intakes and dietary diversity scores or food group indicators was determinate using multivariate regression analyses. The overall mean prevalence of MA was 43% ± 16%. Fewer than 10% of children had adequate intakes of calcium, folate, and vitamin A, and &lt; 50% of children had adequate intakes of iron, riboflavin, and vitamin B–12. Overall MA was primarily explained by energy intake and diet diversity. Food groups that explained variance in MA were dairy, eggs, meats, and vitamin A‐rich fruits and vegetables. Micronutrient adequacy among young children in rural Bangladesh is alarmingly low, and targeted food‐based interventions are warranted.

Risk factors for nonfatal drowning in children in rural Bangladesh: a community-based case-control study.

Most studies of drowning in Bangladeshi populations to date have described mortality and trends. We sought to identify associations between socioeconomic status and child-care practices and nonfatal drowning in rural Bangladeshi children. This community-based case-control study was conducted in rural children aged 1-5 years in Raiganj subdistrict of Bangladesh. 122 cases and 134 age-matched controls were recruited and their mothers were interviewed by use of a structured questionnaire. Univariate analyses and logistic regression were done to analyse the data. Child nonfatal drowning was significantly associated with mothers: With low educational status (P < 0.001), of younger age (P < 0.005), of single status (P < 0.001) and with more than three children (P < 0.001). Nonfatal drowning was 12 and five times more likely in children of illiterate mothers than in children of mothers with academic knowledge equivalent to sixth to tenth grade (OR [95% CI] 0.08 [0.02-0.26]) and above tenth grade (OR [95% CI] 0.21 [0.04-0.95]) (P < 0.001), respectively. Low socioeconomic status, indicated by lower family expenditure (P < 0.001) and no house (P < 0.05; OR [95% CI] 0.58 [0.17-0.99]), were found to be risk factors for childhood nonfatal drowning. Improved child care, as measured by a child-care index, was associated with significantly lower non-fatal drowning (P < 0.001). Child care improved with higher educational attainment of mothers (P < 0.005) and increased socioeconomic status. Nonfatal drowning was more common when the main caregiver was not the mother (P < 0.001). Forward likelihood ratio logistic regression indicated mothers' lower educational status as the best predictor of nonfatal drowning. Better child care and prevention of nonfatal drowning might be ensured through increasing mothers' educational attainment and improvements in socioeconomic status.

Risk factors for road traffic injuries among school children in rural Bangladesh

IntroductionRoad traffic injuries (RTIs) are a major health problem internationally, causing illness, deaths and disabilities among young people. Research on RTIs in developing countries has been limited.ObjectiveThe objective of the...

Understanding road traffic injuries and prevention measures for children in rural Bangladesh: a qualitative study of community members' views

IntroductionRoad traffic injury (RTI) was the second leading cause of injury mortality and fourth leading of injury morbidity in Bangladesh. For both mortality and morbidity most the vulnerable age group...

The flood disaster in rural Bangladesh: magnitude of injuries and parental violence in children

BackgroundViolence and injuries are under-reported in developing countries, especially during natural disasters such as floods. During 2007 Bangladesh experienced two consecutive floods which affected almost one-third of the country.ObjectivesThe objective...

LOOKING BEYOND UNIVERSAL PRIMARY EDUCATION

This paper addresses gender equity in parents' educational investments in children in rural Bangladesh. The authors analyse correlates of time spent in school, studying outside school and work, using a dataset on time-use patterns of school-going children. The authors find that time spent at work varies inversely with the amount of time spent studying at home. Time spent in school is insensitive to factors such as poverty and gender. Time spent studying outside school is strongly influenced by household decisions that favour boys, who appear to have about 30 minutes more discretionary study time than girls.

Associations between oxidative parameters in pregnancy and birth anthropometry in a cohort of women and children in rural Bangladesh: The MINIMat-cohort

Oxidative stress is suggested as a potential mechanism in impaired foetal growth, smaller birth size and thus subsequently adult chronic diseases. We have investigated associations between oxidative stress in pregnancy and birth anthropometry (weight, height, head and chest circumferences). In the MINIMat-trial (Maternal and Infant Nutrition Interventions, Matlab) in rural Bangladesh, free 8-iso-prostaglandin F2α (lipid peroxidation) was analysed in pregnancy week 14 and 30 and 8-Hydroxy-2 -Deoxyguanosine (DNA oxidation) in week 19. We found that higher levels of lipid peroxidation in early pregnancy were associated with larger infant size (birth length and chest circumference). In late pregnancy, no clear pattern of associations was found. Increasing level of DNA oxidation was associated with lower birth length in girls but no other associations were found. In conclusion, a higher level of lipid peroxidation in early (but not late) pregnancy was associated with a favourable larger birth size suggesting that timing of lipid peroxidation is of importance.

Manganese exposure from drinking water and children's academic achievement

Drinking water manganese (WMn) is a potential threat to children's health due to its associations with a wide range of outcomes including cognitive, behavioral and neuropsychological effects. Although adverse effects of Mn on cognitive function of the children indicate possible impact on their academic achievement little evidence on this issue is available. Moreover, little is known regarding potential interactions between exposure to Mn and other metals, especially water arsenic (WAs). In Araihazar, a rural area of Bangladesh, we conducted a cross-sectional study of 840 children to investigate associations between WMn and WAs and academic achievement in mathematics and languages among elementary school-children, aged 8–11 years. Data on As and Mn exposure were collected from the participants at the baseline of an ongoing longitudinal study of school-based educational intervention. Annual scores of the study children in languages (Bangla and English) and mathematics were obtained from the academic achievement records of the elementary schools. WMn above the WHO standard of 400μg/L was associated with 6.4% score loss (95% CI=−12.3 to −0.5) in mathematics achievement test scores, adjusted for WAs and other sociodemographic variables. We did not find any statistically significant associations between WMn and academic achievement in either language. Neither WAs nor urinary As was significantly related to any of the three academic achievement scores. Our finding suggests that a large number of children in rural Bangladesh may experience deficits in mathematics due to high concentrations of Mn exposure in drinking water.

Poisoning the mind: Arsenic contamination of drinking water wells and children's educational achievement in rural Bangladesh

Bangladesh has experienced the largest mass poisoning of a population in history owing to contamination of groundwater with naturally occurring inorganic arsenic. Prolonged drinking of such water risks development of diseases and therefore has implications for children's cognitive and psychological development. This study examines the effect of arsenic contamination of tubewells, the primary source of drinking water at home, on the learning outcome of school-going children in rural Bangladesh using recent nationally representative data on secondary school children. We unambiguously find a negative and statistically significant correlation between mathematics scores and arsenic-contaminated drinking tubewells at home, net of the child's socio-economic status, parental background and school specific unobserved correlates of learning. Similar correlations are found for an alternative measure of student achievement and subjective well-being (i.e. self-reported measure of life satisfaction), of the student. We conclude by discussing the policy implication of our findings in the context of the current debate over the adverse effect of arsenic poisoning on children.

Relationship of homestead food production with night blindness among children below 5 years of age in Bangladesh

To examine the relationship between homestead food production and night blindness among pre-school children in rural Bangladesh in the presence of a national vitamin A supplementation programme. A cross-sectional study. A population-based sample of six rural divisions of Bangladesh assessed in the Bangladesh Nutrition Surveillance Project 2001-2005. A total of 158 898 children aged 12-59 months. The prevalence rates of night blindness in children among those who did and did not receive vitamin A capsules in the last 6 months were 0·07 % and 0·13 %, respectively. Given the known effect of vitamin A supplementation on night blindness, the analysis was stratified by children's receipt of vitamin A capsules in the last 6 months. Among children who did not receive vitamin A capsules in the last 6 months, the lack of a home garden was associated with increased odds of night blindness (OR = 3·16, 95 % CI 1·76, 5·68; P = 0·0001). Among children who received vitamin A capsules in the last 6 months, the lack of a home garden was not associated with night blindness (OR = 1·28, 95 % CI 0·71, 2·31; P = 0·4). Homestead food production confers a protective effect against night blindness among pre-school children who missed vitamin A supplementation in rural Bangladesh.

Household Animal Production and Meat Consumption in Rural Bangladesh

Promotion of household (HH) animal production has been suggested as a strategy to improve diet quality among undernourished, rural populations by increasing meat consumption. This study examines the relationships between animal production and HH‐level meat consumption among 360 HHs with young children in rural Bangladesh. HH consumption of different types of meat and fish was modeled as a function of demographic and socio‐economic factors and animal production. Consumption of each type of meat among producers of the corresponding animal was modeled as a function of socio‐economic and demographic factors and descriptors of animal production. 85% of HHs produced at least one type of animal, including chicken (62%), cows (41%) and fish (37%). 81% of HHs consumed some meat or fish on the days of observation, but the quantities consumed were low (mdn 59 g/capita, IQR 113 g/capita). Adjusting for other HH traits, fish production was positively associated with fish consumption (p=0.05), but there were no significant relationships between production and consumption for other types of animal. HH wealth and the type of animal produced are related to meat consumption among animal producing HHs. With the possible exception of fish production, promoting animal production in rural Bangladesh may not be an effective means of increasing meat consumption. Research supported by the HarvestPlus Challenge Program.