Childhood anemia and vitamin a deficiency in rural Bangladesh.

The study aimed to assess the prevalence of anemia and vitamin A deficiency in preschool children in rural Bangladesh. A cross-sectional study was done on eight randomly-selected sub-districts of rural Bangladesh. Children (n=1,302) aged 2-6 years were studied. Families of 43% of the study participants had a monthly household expenditure of US$ 60 or less. Fifty-six percent of the children were underweight, and 17% were severely underweight; 18% were wasted, and 1% were severely wasted; and 45% were stunted while 20% were severely stunted. The mean+/-SD serum retinol of the children was1.0+/-0.4 micromol/l, and 3% of them had serum retinol levels of <0.35 micromol/l, about one-fifth (20%) had a serum retinol level of <0.70 micromol/l and 55% had serum retinol levels of <1.05 pmol/l. The mean hemoglobin concentration of the children was 110+/-11 g/l, and 48% had a Hb of <11 g/l signifying anemia in this age group. Thirty-one percent (31 %) of children had low serum ferritin (<12 microg/l), and 14% had elevated CRP (> or = 15 mg/l) indicating the presence of a sub-clinical infection. Male and female children had similar nutritional status and biochemical profiles although boys tended to be heavier than girls (p=0.013). The proportion of children with anemia and iron deficiency anemia (IDA) declined significantly (p<0.001) with advancing age. Five percent of the study children had IDA and concomitant low serum retinol. The proportion of children with IDA and serum retinol also declined significantly with increasing age from 8% in children aged 35 months or younger, to 3% in children aged 60 months and more (p=0.025). Results of our study clearly demonstrated the public health importance of anemia and vitamin A deficiency among children of rural Bangladesh.

Analysis of fecal leukocytes and erythrocytes in Shigella infections in urban Bangladesh.

We evaluated the usefulness of enumeration of fecal leukocytes and erythrocytes in making an early diagnosis of Shigella infection, where Shigella is a leading cause of invasive diarrhea. Stool specimens from 561 invasive diarrhea patients were submitted for microscopic examination. A presumptive diagnosis of shigellosis based on microscopic examination was made in 389 of them; 227 had stool cultures positive for Shigella spp (Shigella patients). One hundred sixty-two patients with no detectable Shigella infection (non-Shigella invasive diarrhea cases) served as a comparison group. Two hundred twenty-seven randomly selected Shigella patients and 227 non-Shigella infectious diarrhea cases from the surveillance system database of the hospital constituted another group for comparative evaluation. The stool specimens of the patients were examined under the microscope, and isolation, biochemical characterization and serotyping of Shigella were performed. In comparison with non-Shigella invasive diarrhea cases, the presence of >50 WBC/hpf in association with any number of RBC in the fecal sample had a modest sensitivity of 67%, specificity of 59%, positive predictive value of 70%, negative predictive value of 56%, accuracy of 64%, and positive likelihood ratio of 1.6 in predicting shigellosis. Comparison between Shigella and non-Shigella infectious diarrhea patients revealed the presence of >20 WBC/hpf was a less accurate predictor of shigellosis (sensitivity 51%, specificity 88%, positive predictive value 81%, negative predictive value 64%, accuracy 69%, and positive likelihood ratio 4.1). Direct microscopical examination of stool specimens for the presence of WBC and RBC may facilitate the early diagnosis of shigellosis, and may be a cheap alternative to stool culture in this setting.