Experience in managing severe malnutrition in a government tertiary treatment facility in Bangladesh.

Children with severe acute malnutrition, defined as weight-for-height <70% of the reference median or bilateral pedal oedema or mid-arm circumference <110 mm having complications, were managed in the Nutrition Unit of the Chittagong Medical College Hospital (CMCH) following the guidelines of the World Health Organization, with support from Concern Worldwide Bangladesh and ICDDR,B. In total, 171 children aged less than five years (mean +/- SD age 23.5 +/- 15.3 months) were admitted during June 2005-May 2006. Of them, 66% were aged less than two years, and 84.2% belonged to households with a monthly income of less than US$ 40. The main reason for bringing children by their families to the hospital was associated major illnesses: bronchopneumonia (33%), oedema (24%), diarrhoea (11%), pulmonary tuberculosis (9%), or other conditions, such as meningitis, septicaemia, and infections of the skin, eye, or ear. The exit criteria from the Nutrition Unit were: (a) for children admitted without oedema, an absolute weight gain of > or = 500 and > or = 700 g for children aged less than two years and 2-5 years respectively; and for children admitted with oedema, complete loss of oedema and weight-for-height >70% of the reference median, and (b) the mother or caretaker has received specific training on appropriate feeding and was motivated to follow the advice given. Of all the admitted children, 7.6% of parents insisted for discharging their children early due to other urgent commitments while 11.7% simply left with their children against medical advice. Of the 138 remaining children, 88% successfully graduated from the Nutrition Unit with a mean weight gain of 10.6 g/kg per day (non-oedematous children) and loss of -1.9 g/kg per day (oedematous children), 86% graduated in less than three weeks, and the case-fatality rate was 10.8%. The Nutrition Unit of CMCH also functions as a training centre, and 197 health functionaries (82 medical students, 103 medical interns, and 12 nurses) received hands-on training on management of severe malnutrition. The average cost of overall treatment was US$ 14.6 per child or approximately US$ 1 per child-day (excluding staff-cost). Food and medicines accounted for 42% and 58% of the total cost respectively. This study demonstrated the potential of addressing severe acute malnutrition (with complications) effectively with minimum incremental expenditure in Bangladesh. This public-private approach should be used for treating severe acute malnutrition in all healthcare facilities and the treatment protocol included in the medical and nursing curricula.

Vitamin A deficiency in children with acute diarrhoea: a community-based study in Bangladesh.

The prevalences of nightblindness and xerophthalmia were assessed in 400 children, aged 6-59 months, with acute diarrhoea in a rural community in Bangladesh. The prevalences of nightblindness, conjunctival xerosis, and Bitot's spot were 7.8%, 9.5%, and 2.7% respectively. Fifty-two percent of the children who complained of nightblindness had ocular signs of vitamin A deficiency compared to 9% of those without nightblindness (p < 0.000). The nightblindness was significantly higher among the male children, aged 24-59 months, who were dysenteric and undernourished, did not consume vitamin A-containing foods daily, and were not breastfed. The coverage of periodic administration of vitamin A capsule was inversely related to the prevalence of nightblindness. This finding was determined by logistic regression analysis of data indicating that a combination of male sex, history of dysentery, absence of periodic administration of vitamin A treatment, and daily intake of vitamin A-containing foods gave the best-fitted model with an overall prediction of 92.5% of being nightblind. The findings of the study suggest that mothers should be educated to observe their diarrhoeal children about development of nightblindness and to seek treatment for it. The locally-relevant nutrition education should also be offered to them.

Mothers' skills in preparing oral rehydration salt solution.

This was a community based thirty cluster survey, carried out in rural Chittagong district, Bangladesh during 1996 with the objective to assess the skill of mothers in preparing packet ORS solution. A total of 420 mothers whose children had been suffering from acute diarrhoea were investigated. There were 377 (89.8%) mothers who demonstrated the preparation of ORS and 43 (10.2%) mothers never ever prepared the solution and were unable to demonstrate the preparation. One hundred and forty (33.3%) mothers were able to demonstrate the preparation correctly and the rest 237 (56.4%) demonstrated the preparation incorrectly. The incorrect preparation was found to be associated significantly with the refusal of ORS solution by the children (p < 0.01). None of the maternal factors were found to be associated with the correctness of preparation of ORS solution except previous exposure of the mother to the demonstration of ORS solution preparation (p < 0.000). Therefore, demonstration of preparation of ORS solution to the mothers should be in built in the health education package of oral rehydration therapy for diarrhoeal diseases.

Limiting factors of ORS intake.

This was a thirty cluster survey; carried out to identify the factors which limit ORS intake during a diarrhoeal episode in rural Bangladesh. 420 mother-child pairs were investigated. In addition to the verbal interview, the index child was examined physically and mother's skill of preparing ORS was assessed. The ORS was known to more than 95% mothers but used by only 33.3%. The average intake of ORS was 320 ml per diarrhoea day. The correct amount of oral rehydration fluid was received by 145(34.5%) cases. Twenty eight socio-demographic-maternal-host(child)-environmental factors were studied for their probable influence on intake of correct amount of oral rehydration fluid. In bivariate analysis, fourteen factors were found to be associated significantly with oral rehydration fluid intake (P < 0.05-< 0.0001). These fourteen factors were treated with stepwise logistic regression analysis. Sensitivity and specificity were the key measures for decision of best fitted model. A combination of child age, mother's education, socio-economic condition and method of feeding ORS provide the maximum sensitivity (90.20%) and specificity (74.19%) for predicting oral rehydration fluid intake. The study emphasized the need for further strengthening of health education incorporating the findings of the research to ensure required amount of oral rehydration fluid intake during diarrhoeal episode.

Birth weight, length, head and chest circumference and haemoglobin level of new born.

The birth weight, length, head and chest circumference and haemoglobin level of 1002 full term new born babies (506 males and 496 females) were determined. The results were compared with similar data from other countries. The birth weight of the present series of newborns were similar to those of newborns from India, the crown-heel length agreed favourably with the data from India and Indonesia, and the head circumference were almost equal to those of the newborns from Sri Lanka, Jamaica and India.