Association of Postpartum Maternal Morbidities with Children’s Mental, Psychomotor and Language Development in Rural Bangladesh.

Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children’s development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children’s developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children’s milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children’s development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children’s language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children’s development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children’s development.

A comparative clinical trial of artemether and quinine in children with severe malaria.

OBJECTIVE: To compare the efficacy of artemether and quinine in the treatment of severe malaria in hospitalized children. STUDY DESIGN: Open randomized trial. SETTING: Pediatric ward of a tertiary care center. METHODS: All children admitted with clinical manifestations of severe malaria (as per WHO criteria) and asexual forms of Plasmodium falciparum demonstrated on peripheral smear were randomized to receive either artemether or quinine. Their clinical status and smears for parasite count were assessed every 12 hours until two successive blood films were negative. The primary end point of the study was death in the hospital and residual damage to the organ involved. The secondary end points were clearance of parasites and fever, length of time of recovery from coma and normal functions of the involved system. RESULTS: Forty-six cases completed the study protocol, 23 assigned to each drug group. Cerebral malaria was the commonest manifestation (76.1%). Mean age in artemether versus quinine group (6.6 +/- 3.5 and 5.8 +/- 2.4 years) as well as degree of parasitemia at admission (55,800 and 60,300 per microlitre) were comparable. The overall mortality rate was 23.9% with no significant difference between the two groups. Twenty six cases (56.5%) presented with more than one manifestations of severe malaria. The mortality rate was 100% with four coexisting manifestations of severe malaria. Fever clearance time in artemether and quinine group was 44.5 and 45.9 hours respectively (P >0.05). Parasite clearance time was significantly shorter in artemether group (40.9 vs. 51.9 hours; P<0.001). Recovery from coma was shorter in artemether group (34.8 vs. 38.1 hours; P<0.05). CONCLUSION: Cerebral malaria is the most common manifestation of severe malaria in children. Artemether is a good alternative drug to quinine for P. falciparum malaria. Mortality rate is directly proportional to the number of coexisting manifestations of severe malaria.

Nutritional status and birth outcomes of the diabetic and non-diabetic pregnant women.

This cross sectional study compares the nutritional status and birth outcomes of 357 diabetic and non-diabetic pregnant women (203 DM and 154 NDM as control). Uncomplicated diabetic and non-diabetic pregnant women of singleton pregnancies with age range of 19-35 years were enrolled at term in BIRDEM hospital. Maternal anthropometry and neonatal anthropometric measurements were taken following standard techniques. Educational level was significantly different between the groups. The diabetic mothers were found significantly less educated (p<0.0001) compared to non-diabetic mothers. Highly significant differences were observed between the groups on mean maternal age, weight at term, height, body mass index (BMI), mid arm circumference (MAC), and hemoglobin concentration (p values for all: <0.001) with higher values for the DM group. Most of the DM pregnant mothers were either overweight (BMI: 26.0-29.0) or obese (BMI: >29.0), on the other hand most of the NDM pregnant mothers were within normal range (BMI: 19.8-26.0). DM pregnant mothers were found more anemic (45.8% vs. 23.4%; p<0.001). Mean birth weight of the infants of DM & NDM groups were 3100g +/- .500g and 2850g +/- 360g respectively. The mean chest circumference of the infants of DM mothers was found significantly higher for diabetic group (p<0.01). DM mothers delivered most of the preterm babies (16.3% vs. 5.8%; p<0.002) and macrosomy babies were found only in this group (5.9%). Significant correlation was observed between birth weight and maternal MAC (p<0.001) in both the groups. Head circumference was found significantly correlated with maternal MAC and age in the DM group only. Diabetic pregnant women were significantly different compared to the non-diabetic group by nutritional status. The DM group experienced more anemia and preterm deliveries and macrosomic babies were born only in them.

Plasma level of antioxidant nutrients (retinol and alphatocopherol) in cases with different grades of cervical carcinoma.

A study was conducted on 23 patients on various grades of cervical cancer, selected purposely from Dhaka Medical College Hospital. Vitamin A and E level of this histologically proved cases showed mean serum level of vitamin A was 0.41 +/- 0.19 and that vitamin E was 4.21 +/- 2.15, and these low level was constant in all Histopathological grading of cervical cancer. Contraceptive user and smoker had very low level of vitamin A and E. Majority (51%) of the cases, were from lower middle class and 49% were from lower class, seventy seven percent were illiterate, 97% were married before 18 years, 57% had more than 6 children, 71% did not use contraceptive. The availability of vitamin A rich food were within reach of lower income group, than the food source of vitamin E which are usually of animal origin. It is concluded that in cervical cancer had low level of antioxidant vitamins A and E. Further study is indicated for understanding detail antioxidant nutrients role in aetiopathology of cervical cancer in Bangladesh.