Factors associated with public awareness of the crown health program in the Al-Jouf region

A community-based intervention, the Crown Health Project [CHP], was developed by the Ministry of Health. It was implemented on a small-scale in Al-Jouf Region in Northern Kingdom of Saudi Arabia to assess its feasibility and effectiveness so that it can be scaled up. This study primarily aimed at investigating factors associated with the awareness of CHP in order to improve subsequent campaigns for the program in Al-Jouf and other regions. A secondary aim was to assess possible changes of public awareness during intensification of the awareness campaign between October 2011 and May 2012. A pre- and post-questionnaire cross-sectional approach was undertaken, and the intervention was an awareness campaign. Variables collected included demographic characteristics [e.g., age, gender, education, occupation, urban/rural residence] and CHP awareness [its existence, sources of knowledge about CHP, its goals and objectives, its target diseases, location of activities, participation in such activities]. Logistic regression was used to analyze the awareness of the program according to participant characteristics, with a time of the survey as a variable. Awareness of the program was found to be 11 times higher among postsurvey respondents than presurvey respondents. Respondents of the second survey were better at correctly identifying "health education" as the main goal of the CHP [odds ratio [OR], 4.1; 95% confidence interval [CI], 3.1-5.5], "noncommunicable diseases" as the main diseases targeted [OR, 4.8; 95% CI, 3.6-6.4] and "attention to health" as the purpose [OR, 6.0; 95% CI, 4.0-8.9]. The different activities of the CHP were successful in dramatically increasing awareness of the CHP program in Al-Jouf

Prevalence of Rheumatic Fever and Rheumatic Heart Disease in School Children of Bharateswari Homes of Bangladesh.

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) continue to affect millions of people around the world, including Bangladesh. Children and adolescents are especially susceptible to this disease. Classical risk factors, i.e. poverty, overcrowding, ignorance and insufficient health care services are responsible for the high incidence and prevalence of these diseases. To assess the prevalence of RF and RHD among children, a school survey was conducted in Bharateswari Homes, in the district of Tangail, Bangladesh. Methods: A total of 947 students were examined. Revised Jones’ criteria (1992), and clinical examination were used for the diagnosis of RF and RHD. Results: Four cases of RF/RHD were found giving the prevalence of 4.22/1000. This is lower than the prevalence reported in eighties, but is consistent with those found in nineties. Conclusion: Among the school children, there is a declining trend in the prevalence of RF/RHD.

Annual risk of tuberculosis infection in a rural population of South India and its relationship with prevalence of smear positive pulmonary tuberculosis.

Background: We conducted a tuberculin survey to estimate the annual risk of tuberculous infection (ARTI) among children in a sub-division of rural Bangalore district. A TB disease survey was conducted in the same area around the same time and has already been published. DOTS strategy is being implemented in the study area since 2002. Methods: The tuberculin survey was conducted during 2010-2011 among 3838, 5-9-year-old children attending 147 schools selected by simple random sampling. Children were tuberculin tested with 2TU PPD RT23 with Tween 80 and maximum diameter of induration was measured between 48-96 hours. ARTI was computed from prevalence of infection estimated by mirror-image technique. Prevalence of smear positive pulmonary TB estimated during the disease prevalence survey in 2008-10 was used to find out its relationship with ARTI. Results: Using the observed mode of tuberculin reaction sizes at 19 mm, among surveyed children, prevalence of infection was estimated at 7.3% (CI: 6.5-8.1); ARTI was computed at 1.05%. Considering the mean age of children, estimated ARTI most closely approximated to the year 2008. Every one per cent ARTI was found to correspond to a prevalence of 103 sputum smear positive patients of PTB, which was similar to the ratio of 106 found in the same study area during 1960s. Conclusion: There has been no change in the relationship between ARTI and prevalence of smear positive pulmonary TB from the pre-DOTS era and thus in the number of children infected by each adult point prevalent case of smear positive pulmonary TB each year suggesting the need for early case detection and treatment.

Use of fluorescein diacetate (FDA) staining to detect viable Mycobacterium tuberculosis.

Objective: Drug resistant tuberculosis has long been a common problem prevailing in developing countries including Bangladesh. Present study focused on the rapid identification of live Mycobacterium tuberculosis among treatment failure cases. Materials and Methods: Sputum samples from a total of 100 category-I and category-II treatment failure cases, assumed as multidrug resistant tuberculosis, were studied through fluorescein diacetate (FDA) staining under light emitting diode (LED) fluorescence microscope. Considering culture method as gold standard, we also compared the results of FDA staining with that of auramine O staining. Results: A total of 85% acid-fast bacilli were detected by FDA staining, 82% by auramine O staining and a total of 85% isolates were detected in Lowenstein-Jensen (LJ) culture. The sensitivity of FDA staining (96.47%) was estimated to be slightly higher than that of auramine O staining (91.76%). Moreover, 76.47% cases were detected as multidrug resistant tuberculosis (MDR-TB). Conclusion: Taken together, FDA staining method has been proposed to be appropriate for the rapid diagnosis of drug resistant tuberculosis.

Evaluation of Efficacy and Tolerability of Perindopril 8 mg in Bangladeshi Hypertensive Patients: Results from an Open-label, Observational, Multi-center Study (CONTROL).

Background: The CONTROL (COversyl in Newly diagnosed stage-II & unconTROlled hypertensive patients triaL) was performed with an objective to evaluate the blood pressure (BP) lowering efficacy and tolerability of Perindopril 8mg in newly diagnosed stage II patients and uncontrolled hypertensive patients among Bangladeshi population. Methods: This was an open-label, observational, multi-center study conducted in consultation centers for out-patients located in different cities of Bangladesh. Adults, aged above 18 years with newly diagnosed stage-II hypertension or uncontrolled hypertension, were recruited. Patients were treated with Perindopril 4mg daily for first 1 week, afterwards uptitrated to Perindopril 8 mg daily and continued treatment for 12 weeks. Patients were followed-up at week-1, week-4, week-8 and week-12. Results: In total, 245 patients were enrolled. Among them, 88 were newly diagnosed stage-II (Group- I) and 157 were uncontrolled (Group-II) hypertensive patients. Male and female distribution was 57% and 43% respectively. Mean age of patients was 54.5 ±11.7 years. After 12 weeks treatment, there was a significant reduction in BP from baseline (p<0.001) in overall population as well as in Group I and in Group II. In overall population, the mean BP reduction was -31/-15 mmHg (from 163.7/96.8 mmHg to 132.4/81.7 mmHg. In Group I, the reduction was -33/-16 mmHg (from 166.5/98.2 mmHg to 133.4/82.0 mmHg) and in Group II, -30/-14 mmHg (from 159.3/ 95.6 mmHg to 129.1/81.6 mmHg). 10 patients (4.1%) had to discontinue the treatment due to adverse effects. Dry cough (2%) and hypotension (1.2%) were the main cause of discontinuation. Perindopril 8mg was well tolerated as indicated by the high proportion of physicians (81%) reporting ‘good’ to ‘excellent’ tolerability at week 12. Conclusion: This study suggests that Perindopril 8mg is effective and safe in the treatment of hypertension in Bangladeshi patients.

Utilization of RNTCP services in rural areas of Bellary District, Karnataka, by gender, age and distance from health centre.

Background: Knowledge on utilization pattern of RNTCP shall provide important inputs towards its strengthening in rural areas. Aims: To find out the utilization of RNTCP services by age, sex and distance from residence to designated microscopy centres and treating health centres. Methods: The study was carried out in Sandur TU of Bellary District, Karnataka. Information on age, sex and residence of persons with pulmonary symptoms and detected new sputum smear positive cases during third quarter 2003 to second quarter 2004; and their treatment outcome was obtained from the respective RNTCP records. Age and sex distribution of out-patients was collected from OPD registers of one randomly selected DMC and its PHCs. Results: A lesser number of males accessed the health care services. However, larger number of males with pulmonary symptoms and new sputum smear positive cases utilized RNTCP services than females in the ratio of 1.6:1 and 2.5:1 respectively. This was due to higher prevalence of persons with pulmonary symptoms and sputum positivity rate among males. Sputum positivity rates were also lower among the elderly. Male symptomatics and cases were on an average older than females. About 70% symptomatics and 53% cases resided at more than four kilometers from the respective DMCs and treating health centres. Treatment outcome was poorer among males with higher proportion of initial defaulters and among those residing at more than 20 kms. Conclusion: There is need to make health services available to the male working population at convenient hours and to be more vigilant to screen persons with pulmonary symptoms among the elderly. Collection of sputum specimen from eligible persons may be undertaken at PHCs which may later be transported to DMC. Supervision and motivation of treatment for male TB cases and those residing more than 20 kms from the treating health centres requires to be strengthened.

Annual risk of tuberculous infection in Andhra Pradesh, India.

BACKGROUND: There is paucity of information on epidemiological situation of Tuberculosis (TB) in Andhra Pradesh. The DOTS strategy under the Revised National Tuberculosis Control Programme (RNTCP) was introduced in the year 2000 to cover the entire State by 2005. OBJECTIVES: To estimate the prevalence of tuberculous infection among children 5-9 years of age and to compute the average Annual Risk of Tuberculosis Infection (ARTI) from the estimated prevalence. METHODS: A cluster-sample house-based tuberculin survey was carried out in a representative sample of children between 5-9 years of age. The clusters were selected by a two-stage sampling procedure. At first stage, five districts were selected by probability proportional to population size (PPS) method. Depending upon child population ratio, 32 clusters allocated to each district were further sub-divided into rural and urban clusters selected by simple random sampling. A total of 3636 children, irrespective of their BCG scar status, were tuberculin tested using one TU PPD RT23 with Tween 80 and the maximum transverse diameter of induration was measured about 72 hours later. RESULTS: The prevalence of infection estimated by mirror-image technique using observed mode of reactions attributable to infection with tubercle bacilli at 20mm was 9.6% (95% CI: 8.0-11.2). The ARTI was computed at 1.4% (95% CI: 1.1-1.6). CONCLUSION: Survey findings indicate a fairly high rate of transmission of tubercle bacilli.

Management of external hernias: analysis of 1020 [corrected] cases.

A prospective study was done to find out the incidence of different external hernias, identify the predisposing factors and type of repair performed. Over a period of 8 years, 1020 patients were admitted with different varieties of external hernias in Chittagong Medical College Hospital. Among them 743 patients had inguinal hernia, 130 had incisional hernia, 58% had indirect inguinal hernia, 29% had direct inguinal hernia, Bilateral inguinal hernia was present in 13% cases. 272 (32.08%) presented with complications like, irreducibility, obstruction, strangulation, 576 (67.92%) was admitted from out-patient department for elective operation. 97.04% of patients with inguinal hernia were male, 2.96% of patients were female. But among incisional hernia 77.70% are female and 22.30% are male patients. The highest incidence of both inguinal hernia and incisional hernia were found in 4th decade of life. Predisposing factors could be identified in 42.06% cases. 90.76% patients approached doctors for advice after 6 months of noticing hernia only 36.37% could mention the cause of delay. Out of 1020 patients (812) 72.18% patients underwent different operations. 2.5% patients were inoperable due to associated disease like Ca-liver, IHD, renal transplant, CLD, uncontrolled DM. Others refused or absconded, being afraid of operation. Effort for post operative follow up was not very satisfactory as only a small number could be followed for a limited period.

Effects of the black cumin seeds [nigella sativa linn.] on endometrial mucins of mature rats; histochemical study

Nigella sativa Linn is a well-known herb that is used by different societies, as food additive and as a medicinal herb; it used as a galactagouge for lactating women, and has long been described as an abortifacient-emmenugouge is to investigate the effect of crude black seeds on the endometrium and the pattern of its mucins, during the different phases of the Estrus cycle, making use of some special stains for the histochemical demonstration of muczns. Crude Nigella sativa Linn seeds were administrated for ten days, by an orogastric tube, on single regular daily dosage to properly selected mature Norway albino female rats. Animals were subdivided into subgroups, according to phases of the estrus cycle. Utera of these animals were routinely processed for carbohydrate histochemical [d-PAS, d AB2.5-PASR and AB1.0] studies using carney's fixative paraffin embedded sections. Experimental specimens were compared with that of control subgroups. Results showed marked production of diastase fast-PAS reactive non-alcianophilic Neutral mucins, with inhibited production of sulphated highly acidic mucins among the surface lining and the glandular epithelial cells, at Estrus. Effects of such changes in the pattern of endometrial mucins on the state of fertility, was discussed. Nigella Sativa, Linn. Metrial gland Endometrial Histochemistry Sialomucins, Fucomucins, Sulphated mucins. d-PAS, AB2.5PAS, AB1.0

Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis.

Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children. The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci. Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh. We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat. From them we selected 2175 children, who were suffering from tonsillo-pharyngitis. This cross sectional study was conducted during March-December 1999. All statistical analysis was done by using statistical package SPSS windows version 8. The mean (SD) age of the children was 11.1 (3.3) years. Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children. Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G. These findings demonstrated the predominance of group G followed by A infection among school children. Therefore special attention should be paid not only to group A but also to group G. Further studies to determine prevalence of M serotypes are necessary.

Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection.

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Streptococcal antibodies among rural school children in Bangladesh.

The upper limit of normal values of group A streptococcal antibodies should be known for a population concerned because it is influenced by many local conditions. As yet the reference value of the these antibodies has not been determined by using a quantitative method among Bangladeshi children. We determined the reference value of anti-streptolysin O and anti-deoxyribonuclease B among 361 apparently healthy rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.2 years). Anti-streptolysin O was measured by an auto-analyzer and antideoxyribonuclease B was measured by microtitre method. The geometric mean titres for the entire group was 241 IU/ml and 222 IU/ml for anti-streptolysin O and anti-deoxyribonuclease B respectively. The upper limit of normal values (80th percentile) was 390 and 340 for anti-streptolysin O and anti-deoxyribonuclease B, respectively. These limits should be of value to physicians, epidemiologists and clinical laboratory personnel as well.

Aetiology of sensorineural hearing loss in children in Bahrain: a 10 years study

This study was carried out on chidren presented with deafness, speech delay or both to the hearing impaired [deaf-mute] children clinic at Salmaniya Medical Complex in Bahrain. Full detailed medical and family history including pre, peri and post-natal history relevant to hearing impairment were obtained. Otolaryngological and Audiological assessment were conducted and recorded on preset proforma. Assessment was also conducted by developmental paediatrician and child psychiatrist when indicated. A total of 196 cases were studied over 10 years period from 1986 to 1996. Children with positive family history of deafness constituted 37.8% of the cases [genetic group]. Other aetiological groups showed the following distribution: cause unknown 33.6%, pre-natal 3.0%, peri-natal 5.6%, post-natal 16.3% and miscellaneous group 3.6% Our study showed that the main aetiological factors for deafness in children in Bahrain were the Genetic and Unknown factors at 71.5% This might be attributed to recessive genes,probably due to the high rate of consanguineous marriages of 60.7% among the sample subjects

Humoral immune response in a sample of Bangladeshi children with rheumatic fever.

Several researchers have investigated cellular response, and antibody response to different antigens of group A beta-haemolytic streptococci, cardiac tissues and B cell alloantigen in rheumatic fever (RF). However, immunoglobulins (Ig) which may indicate general immune status did not receive attention. This study was done in the outpatient clinic of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, to compare Ig levels in subjects with and without RF who have had recent group A beta-haemolytic streptococcal infections. We have recruited 44 RF cases aged 5 to 20 years, and 44 subjects without RF were randomly matched for age and sex as controls. Convalescent blood samples were used to measure antistreptolysin O and IgG, IgM, and IgA levels. The cases, as compared with the controls, had significantly higher levels of antistreptolysin O (mean 399 versus 321 IU/ml), IgG (mean 2386 versus 1885 mg/dl), IgM (mean 286 versus 222 mg/dl) and IgA (mean 258 versus 184 mg/dl). It is not clearly known why the immune response is higher in the RF cases. We have to elucidate factors responsible for higher immune response in children with RF.