Prevalence of exclusive breastfeeding in Bangladesh and its association with diarrhoea and acute respiratory infection: results of the multiple indicator cluster survey 2003.

The objective of this study was to investigate the association between the prevalence of exclusive breastfeeding and morbidity (diarrhoeal diseases and acute respiratory infection) in infants aged 0-3 month(s) using the Multiple Indicator Cluster Survey (MICS) 2003 data from Bangladesh. The study population included 1633 infants aged 0-3 month(s). The prevalence of diarrhoea and acute respiratory infection was compared using the chi-square tests between infants aged 0-3 month(s) who were exclusively breastfed and infants who were not exclusively breastfed. Logistic regression was used to adjust for confounders and for calculating adjusted odds ratios. To adjust for cluster sampling and reduced variability, the adjusted chi-square value was divided by the design effect, and a re-estimated p value was calculated. The prevalence of diarrhoea and acute respiratory infection in this sample of 0-3-month old infants in Bangladesh was 14.3% and 31.2% respectively. The prevalence of both illnesses was significantly associated with lack of exclusive breastfeeding. The adjusted odds ratio for diarrhoea was 0.69 (95% confidence interval [CI] 0.49-0.98, p = 0.039), and the adjusted odds ratio for acute respiratory infection was also 0.69 (95% CI 0.54-0.88, p = 0.003). Only 192 infants (11.7% of total sample) were exclusively breastfed at the time of interview, and 823 infants (50.3%) were never exclusively breastfed. The prevalence of prelacteal feeding was 66.6%. The results confirmed a protective effect of exclusive breastfeeding against infectious diseases-related morbidity in infancy and showed that frequently-collected cross-sectional datasets could be used for estimating effects. The low prevalence of exclusive breastfeeding in Bangladesh needs to be improved to decrease child morbidity.

A tool for rapid socioeconomic assessment.

OBJECTIVE: To validate a simple wealth index scale (WIS) based assessment of socioeconomic status and compare it with existing kuppuswamy(KUP) scale. METHODS: Families of 300 children aged 6 to 59 months of acute diarrhoea enrolled in a cross-sectional study were interviewed for socio economic status using both 8 item ownership scale (WIS) and Kuppuswamy (KUP) scale, validated against a reference standard Income Scale (IS). RESULTS: Out of 111 people classified as low based on Income scale (IS), 17% were identified by WIS, and 21% by KUP. In the upper low, 69.4% were identified by WIS and 84.3 % by KUP. Amongst the low middle group the WIS identified 27.6% while KUP identified 10.6% and amongst upper middle patients 30% were identified by WIS and 15 % by KUP. There were none in the upper income of WIS or KUP category. The WIS performed well in all income categories whereas the KUP was better for upper low and low income categories. The agreement between WI and KUP was 55.56%. CONCLUSION: KUP scale is lengthy and difficult to administer by pediatric students and biased towards professional qualifications and education, rather than actual standard of living. It can be replaced by a simple 8 item ownership scale (WI) which is robust for all income groups and also shows good agreement with KUP.

Factors affecting utilization of health care services by mothers of children ill with diarrhea in rural Vietnam.

To examine the use of health services for the treatment of childhood diarrhea in three southern provinces of Vietnam, and identified household, maternal, child and health service characteristics associated with this use, a cross-sectional household survey was conducted between November 1998 and January 1999. Women with a pre-school aged child living at home were the primary respondents for the survey questionnaires. Respondents were asked to recall diarrheal disease events experienced by their child during the two weeks prior to interview, and their responses to these events. Prevalence ratios (PR) were used to identify associations between maternal age, education, occupation, ethnicity, knowledge about diarrhea, feeding practises during diarrhea, household residence and economic status, disease severity, use of oral rehydration solution (ORS), time to nearest health care facility and overall satisfaction with local medical services, and the use of health care services for children ill with diarrhea. The two-week period prevalence of childhood diarrhea was 10% and varied by the province and ethnicity of the child's mother. Forty-three percent of mothers reported using ORS during diarrheal episodes. Seventy percent of mothers sought advice or treatment when their child became ill with diarrhea. After controlling for potential confounders in regression models, maternal ethnicity, maternal high school education (in comparison to no education or incomplete primary education), more severe disease and the use of ORS were factors associated with increased utilization of health care services. There was a low level of the utilization of ORS to treat children with diarrhea, especially by ethnic minority mothers. A high percentage of mothers reported low levels of satisfaction with medical services, especially those from ethnic minorities. Mothers from ethnic minorities and those with lower levels of education were less likely to seek advice or treatment. These findings suggest the need for programs to promote the use of ORS and use of appropriate services for the treatment of childhood diarrheal disease. Interventions are needed to improve the access of ethnic minority children to child health care services for the treatment of diarrhea.