Young Children In Rural Bangladesh Research Articles

Behaviour Problems in Young Children in Rural Bangladesh

To determine the prevalence of child behaviour problems reported by parents in rural Bangladesh. A total of 4,003 children aged 2-9 years were identified during a population-based survey of 2,231 households. A predetermined sample of 499 was selected, of which health professionals saw 453 (90.8%) for structured physical and neurological examination, standardized testing of cognition and adaptive behaviour and parent report of developmental history and behaviour problems. The prevalence of behaviour impairments was 14.6% (95% CI 11.4, 17.9). The majority involved somatic complaints, including nocturnal enuresis and pica. Problems such as aggression or restlessness were infrequently reported. Behaviour impairments were significantly associated with malnutrition (prevalence ratio 2.1, 95% CI 1.2, 3.6, p < 0.01) and cognitive, motor or seizure disabilities (prevalence ratio 1.8, 95% CI 1.1, 2.9, p < 0.05). The prevalence and nature of reported behaviour impairments in rural Bangladesh have implications for public health planning and delivery of health services.

Appropriate infant feeding practices result in better growth of infants and young children in rural Bangladesh

BackgroundThe World Health Organization and the United Nations International Children's Emergency Fund recommend a global strategy for feeding infants and young children for proper nutrition and health. ObjectiveWe evaluated the effects of following current infant feeding recommendations on the growth of infants and young children in rural Bangladesh. DesignThe prospective cohort study involved 1343 infants with monthly measurements on infant feeding practices (IFPs) and anthropometry at 17 occasions from birth to 24 mo of age to assess the main outcomes of weight, length, anthropometric indexes, and undernutrition. We created infant feeding scales relative to the infant feeding recommendations and modeled growth trajectories with the use of multilevel models for change. ResultsMean (±SD) birth weight was 2697 ± 401 g; 30% weighed < 2500 g. Mean body weight at 12 and 24 mo was 7.9 ± 1.1 kg and 9.7 ± 1.3 kg, respectively. More appropriate IFPs were associated (P < 0.001) with greater gain in weight and length during infancy. Prior IFPs were also positively associated (P < 0.005) with subsequent growth in weight during infancy. Children who were in the 75th percentile of the infant feeding scales had greater (P < 0.05) attained weight and weight-for-age z scores and lower proportions of underweight compared with children who were in the 25th percentile of these scales. ConclusionsOur results provide strong evidence for the positive effects of following the current infant feeding recommendations on growth of infants and young children. Intervention programs should strive to improve conditions for enhancing current infant feeding recommendations, particularly in low-income countries.

Household Food Security was Associated with Growth of Infants and Young Children in Rural Bangladesh

The association between household food security (HHFS) and growth of infants and young children has not been adequately studied, particularly in developing countries. To investigate this, we followed 1343 children from birth to 24 mo of age who were born in the Maternal and Infant Nutrition Intervention in Matlab study in Bangladesh. A food‐security scale was created from the data collected on HHFS from the mothers during pregnancy. Data on weight and length were collected monthly in the first year and quarterly in the second year of life. Anthropometric indices were calculated relative to the 2006 WHO child growth standards. Growth trajectories were modeled using multilevel models for change. HHFS was associated (P &lt; 0.05) with greater weight and length gain in this cohort. Attained weight, length, and anthropometric indices from birth to 24 mo were higher (P &lt; 0.001) among those who were in food‐secure households. Proportions of underweight and stunting were significantly lower in food‐secure households. These results suggest that HHFS is a determinant of child growth in this population, and that it may be necessary to ensure household food security of these rural poor households to prevent highly prevalent undernutrition in this population. (Fogarty NIH Training Grant (5 D 43 TW).

Prevention of Malnutrition among Young Children in Rural Bangladesh by a Food-Health-Care Educational Intervention: A Randomized, Controlled Trial

As a result of inappropriate feeding, poor health and hygiene, and poor caring practices, the nutritional status of many young infants deteriorates with advancing age. To explore the effectiveness of a nutrition education package to prevent malnutrition among young children. A community-based, randomized, controlled trial was conducted among 605 normal and mildly malnourished children aged 6 to 9 months in 121 Community Nutrition Centers (CNCs) of the Bangladesh Integrated Nutrition Project (BINP) in four regions of Bangladesh from 2000 to 2002. The intervention group received weekly nutrition education based on the nutrition triangle concept of UNICEF for 6 months, whereas the control group received regular BINP services. Both groups were observed for a further 6 months to assess the sustainability of the effects. Information on socioeconomic status, feeding patterns, morbidity, and anthropometric features was collected. A significant increase in the frequency of complementary feeding was observed in the intervention group as compared with the control group, and the increase was sustained throughout the observation period. The intervention group had a higher weight gain than the control group after the end of the intervention (0.86 vs. 0.77 kg, p = 0.053) and after the end of the observation period (1.81 vs. 1.39 kg, p < .001). The proportion of normal and mildly malnourished children was greater in the intervention group than in the control group after the end of the observations (88.9% vs. 61.5%, p < .001). Nutrition education successfully prevented malnutrition in all the areas. Variation in the outcome of nutrition education among the regions was observed. This culturally appropriate nutrition education package based on the nutrition triangle model effectively prevented growth faltering and malnutrition among young children.

Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh. A sample of 362 children (haemoglobin (Hb)>or=70 g l(-1)) aged 6-24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention. Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (P<0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P=0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (P<0.05). The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.

Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh

The effectiveness of commonly suggested public health interventions to control childhood iron-deficiency anemia has been low. To determine whether iron provided in Sprinkles daily or in a higher dose once weekly affected hemoglobin, serum ferritin levels, and serum transferrin receptor levels, and to determine whether there were differences in the effects of the two regimens. In this cluster-randomized, community-based trial conducted in rural areas of Bangladesh, 136 children aged 12 to 24 months with mild to moderate anemia (hemoglobin 70-109 g/L) were randomly allocated to receive Sprinkles daily (12.5 mg of elemental iron, n = 79) or once weekly (30 mg of elemental iron, n = 73) for 8 weeks. Hemoglobin, serum ferritin, and serum transferrin receptor were assessed at the start and end of the intervention. In both groups, there were significant increases in hemoglobin and serum ferritin and a significant decrease in serum transferrin receptor (p < .01). There were no significant differences between the groups in the increases in hemoglobin (16.1 +/- 13.2 g/L for the group receiving Sprinkles daily and 12.3 +/- 13.3 g/L for the group receiving Sprinkles once weekly) and serum ferritin (10.6 and 5.7 microg/L, respectively). The decrease in serum transferrin receptor also did not significantly differ between the groups (median, -2.5 and -1.8 mg/L, respectively). The prevalence rates of iron-deficiency anemia, depleted iron stores, and tissue iron deficiency decreased significantly within each group (p < .01), with no significant differences between the groups. Home fortification of complementary foods with Sprinkles given either daily or once weekly improved iron-deficiency anemia and iron status among young children.

Longitudinal Growth of Infants and Young Children in Rural Bangladesh

Longitudinal Growth of Infants and Young Children in Rural Bangladesh

Diarrheal illness in a cohort of children 0–2 years of age in rural Bangladesh: I. Incidence and risk factors

To describe clinical characteristics and age- and season-specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease. A total of 252 infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993-1996. Demographic and household determinants were linked to the probability of illness using logistic regression models. The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6-11-mo and 12-17-mo age groups. Diarrheal rates peaked during the spring and summer. Among host-related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea. Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea-related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated.

Diarrheal illness in a cohort of children 0–2 years of age in rural Bangladesh: I. Incidence and risk factors

Abstract Aim: To describe clinical characteristics and age‐ and season‐specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease. Methods: A total of 252 infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993–1996. Demographic and household determinants were linked to the probability of illness using logistic regression models. Results: The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6–11‐mo and 12–17‐mo age groups. Diarrheal rates peaked during the spring and summer. Among host‐related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea. Conclusion: Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea‐related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated.

Screening methods for childhood hearing impairment in rural Bangladesh

The purpose of this study was to determine a feasible strategy for screening young children in rural Bangladesh for hearing impairments. Trained community health workers (CHWs) screened 4003 children between the ages of 2 and 9 years using conditioned play audiometry (CPA) and a subset of 569 of these children (ages 2-5 years), using physiologic (otoacoustic emissions [OAEs] and tympanometry). Measures of frequency and cross-tabulations are presented to describe results. Hearing screening using CPA was feasible for most children in the 6-9 years age range, but not for the younger children due to shyness and lack of cooperation. More than two thirds of the younger children were untestable on CPA. In response to this limitation, OAEs and tympanometry, requiring less cooperation on the part of the child, was implemented for a sample of younger children. Of the 569 children who received both CPA and OAE/tympanometry, 69% were untestable using CPA and 8.9% were untestable using OAE and tympanometry. These results suggest that hearing screening using CPA for older (6-9 years) and OAE/tympanometry for younger (2-5 years) children is feasible. Using the physiologic measures of OAE/tympanometry significantly reduced the number of untestable children, resulting in fewer referrals for diagnostic assessments. Thus, if only one methodology could be implemented, physiologic measure would be preferred. This is important because trained audiologists are scarce in Bangladesh. Technology is available and feasible for hearing screening in developing countries. Focus needs now to center on increasing the number of trained audiologists in developing countries to ensure better follow-up and accessibility to audiological services.

Implications of health care provision on acute lower respiratory infection mortality in Bangladeshi children

This study uses a geographic information system to evaluate the effects of health care provision on acute lower respiratory infection (ALRI) mortality in very young children in rural Bangladesh. Since 1988, an ALRI control program has been operating in a rural area of Bangladesh in an effort to decrease morbidity and mortality of children suffering from ALRI. ALRI-specific mortality data for very young children (<2 years of age) were obtained from a surveillance system of the area from 1988 to 1993. The ALRI mortality data were aggregated by clusters of households called baris. In order to avoid bias in the population size of baris, spatial moving averages of ALRI-specific death rates were calculated. The relationships between ALRI death rates and several environmental and health service provision variables were measured using regression analysis. The results show that the ALRI mortality rate was 54% lower in the community-based ALRI control program area than in a comparison area where there was no intervention. Greater access to allopathic practitioners was related to lower ALRI mortality rates while access to indigenous practitioners was related to higher mortality. In conclusion, the benefit of the community-based ALRI control program, using a simple case management strategy and improved access to allopathic practitioners, should be replicated in other rural areas of Bangladesh in an effort to reduce child ALRI mortality.

Recent contributions of behavioural and biomedical scientists in applied anthropology of hygiene practices and management of diarrhoea in Bangladesh

In the past few years anthropologists, sociologists and biostatisticians have made contributions on hygiene practices and management of diarrhoea in relation to young children in rural Bangladesh. The cultural practices of caregivers with regard to washing hands after cleansing the anus of young children following defectation and disposing of the stool often do not fulfil the biomedical criteria for prevention of the transmission of diarrhoea-causing pathogens. These practices, being important determinants of prevention of transmission, were studied in the rural communities of Matlab, Bangladesh. Data were collected by observing the practices of caregivers of 404 children with diarrhoea chosen from 444 community cases recruited from the neighbourhood of the 218 hospitalized index cases. Observations were made regarding the cleansing of the anus of these children, washing of the hands of the caregivers, and disposal of the stool. It was observed that all the caregivers used bare hands and most used only water in cleaning the anus of the child. Also following the cleaning, most of the caregivers used only water to wash the soiled hand. Most of them used water collected in a pot, and only a small proportion used water from the direct source. The majority of caregivers disposed of the faeces in an unhygienic way.

Socioeconomic and anthropometric status, and mortality of young children in rural Bangladesh.

This article investigates the interrelationship of socioeconemic status, anthropometric status and mortality of young children in rural Bangladesh. Data for this study come from Matlab, the vital registration area of the International Centre for Diarrhoeal Disease Research, Bangladesh, where anthropometric and socioeconomic data concerning 1976 children aged 12-23 months were collected in November-December 1975. From these data, anthropometric indices are created, and the relationships of socioeconomic status measured by dwelling space and anthropometric indices with mortality during the 2 years following measurement of these children are investigated. It is found that both socioeconomic status and anthropometric indices are related to mortality. However, the relationship of anthropometric indices is much stronger. Among the anthropometric indices considered, weight-for-age, height-for-age and arm circumference reflect socioeconomic status better than weight-for-height does; and, the first three indices are equally good, and individually better than weight-for-height, as predictors of mortality. The degree of the effect of socioeconomic status (dwelling space) on mortality explained by the best performing anthropometric index, weight-for-age, was not more than 25%. It is concluded that an anthropometric index that can classify socioeconomic status more efficiently is a better predictor of 2-year mortality than any other anthropometric index.

Patterns of physical growth in a longitudinal study of young children in rural Bangladesh

Longitudinal field studies of the physical growth of 197 children between 6 and 60 months of age have been completed in two rural villages of Bangladesh. The distribution of weights by age indicated that 90% of the village girls and boys weighed less than the National Center for Health Statistics 5th percentile by 8 and 15 months of age, respectively. Of the children 90% were shorter than the reference population 10th percentile length by age by 10 to 13 months of age. Since the children's patterns of growth differed from those of the reference populations from North America and Europe, internal standards were created for the village girls and boys by fitting curves to their data for weight by age, length by age, arm circumference by age, triceps skinfold thickness by age, and weight by length. The village references enabled age-independent comparisons of children within the study population by relating their actual anthopometric status to the village norms. Comparisons of the village standards with the international reference data showed the period of poorest nutritional status of the village children persisted from shortly after birth to approximately 2 yr of age.

Acquisition of serum antibody to Norwalk Virus and rotavirus and relation to diarrhea in a longitudinal study of young children in rural Bangladesh.

Serum antibodies to Norwalk virus and to rotavirus were measured during longitudinal studies of infectious diseases and nutrition in rural Bangladesh. Initially, the prevalence of antibody to Norwalk virus was 7% in children younger than six months and increased to 80% in children two to five years of age. The incidence of titer increases was highest in one- and two-year-olds and in children who had low or undetectable levels of antibody. Some Norwalk virus infections appeared to result in diarrhea. Nearly all children had serum antibodies to rotavirus at the beginning of the study; however, children with the lowest levels of antibody to rotavirus had the greatest risk of rotavirus diarrhea. Over half of the children had a fourfold increase in titer of antibody to rotavirus during the year, and 7% had increases in two of the three study periods during the year. Most increases in titer of antibody to rotavirus appeared to result from subclinical infections.