Access to skilled care at home during pregnancy and childbirth: Dhaka Bangladesh.

In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.

Calcium and conjugated linoleic acid reduces pregnancy-induced hypertension and decreases intracellular calcium in lymphocytes.

BACKGROUND: The aim of the present study was to determine whether the beneficial effect of oral supplementation with calcium and conjugated linoleic acid (CLA) in the reduction of the incidence of pregnancy-induced hypertension (PIH) is related with changes in plasma levels of prostanoids, renin, angiotensin II, calciotropic hormones, and plasma and intracellular ionized free calcium. METHODS: These mediators were determined using the blood samples obtained from a randomized, double-blind, placebo-controlled trial that included 48 healthy primigravidas with a family history of preeclampsia and with diastolic notch, recruited from four outpatient clinics from two developing countries. Participants were randomized to daily oral doses of elemental calcium and CLA or lactose-starch placebo from week 18 to week 22 of gestation until delivery. RESULTS: The incidence of PIH was significantly reduced in women receiving the supplement (2 women [8.3%]) compared with placebo (10 women [41.7%]) (relative risk = 0.20, 95% confidence interval 0.05-0.82, P = .01). There were no significant differences in the plasma concentrations of ionized calcium, prostaglandin E(2), renin, angiotensin II, parathormone,and calcitonine. The concentration of intracellular ionized free calcium presented a significant reduction after interventions (92.0 nmol/L [range 62.5 to 220 nmol/L] v 62.5 nmol/L [range 28 to 200 nmol/L; P = .01) in the supplemented group but not in the placebo group. The women who developed PIH (n = 12) presented a significant increase in the concentrations of intracellular calcium after interventions (120 nmol/L [range 89.2 to 240 nmol/L] v 137.5 nmol/L [range 89.2 to 138 nmol/L; P = .02). CONCLUSIONS: Calcium and CLA supplementation during pregnancy reduces the incidence of PIH, and decreases the intracellular concentration of ionized free calcium in peripheral blood lymphocytes.

Calcium plus linoleic acid therapy for pregnancy-induced hypertension.

OBJECTIVE: To determine the effect of dietary supplementation of calcium plus conjugated linoleic acid (calcium-CLA) in reducing the incidence of vascular endothelial dysfunction in pregnant women at high risk of developing pregnancy-induced hypertension (PIH). PATIENTS AND METHODS: This randomized, double-blind, placebo-controlled trial conducted at 4 outpatient clinics in 2 developing countries recruited 48 healthy primigravidas younger than 19 years or older than 35 years who had a family history of pre-eclampsia and diastolic notch. Twenty-four participants received daily elemental calcium (600 mg) plus CLA (450 mg) and 24 received placebo from week 18 to 22 of pregnancy until delivery. RESULTS: Calcium-CLA supplementation reduced significantly the incidence of PIH (2 cases [8%] in the study group vs. 10 cases [42%] in the placebo group; relative risk, 0.20; 95% confidence interval, 0.05-0.82; P=.01). Endothelial dysfunction was also significantly reduced after calcium-CLA supplementation (in 18 women [75%] vs. 4 women [17%]; P<.001), compared with the placebo group (in 15 [63%] vs. 9 women [38%]; P=.08). CONCLUSION: In pregnant women at high risk for PIH, calcium-CLA supplementation decreases the incidence of PIH and improves endothelial function.

Adolescent nutrition in a rural community in Bangladesh.

The objective of this study was to assess the nutritional status of adolescent boys and girls in a rural community in Bangladesh. Between December 1996 and January 1997, a cross-sectional survey was carried out in 803 households, each containing at least one adolescent, sampled consecutively from four purposely-selected villages in Rupganj Thana, Narayanganj district. Initially, the guardians of 1483 healthy and unmarried 10-17 year old adolescents (51% boys and 49% girls) were interviewed about family structure and socio-economic status. Out of these children, 906 (47% boys and 53% girls) from 597 households were weighed, had their height and MUAC measured and were clinically examined. Blood was then collected from 861 adolescents for haemoglobin estimation. The median monthly income per person in these 597 families was approximately Taka 554 (US $12). Twenty seven per cent of the household heads were labourers, 21% were solvent farmers, 14% ran small scale businesses and 6% were unemployed. Sixty seven per cent of adolescents were thin (defined as BMI < 5th centile of WHO recommended reference) with 75% boys and 59% girls being affected. The percentage of thin adolescents fell from 95% at age 10 years to 12% at age 17 years. The prevalence of stunting (height for age < 3rd centile NCHS/WHO) was 48% for both boys and girls and rose from 34% at age 10 to 65% at age 17. On clinical examination angular stomatitis was present in 46%, 27% had glossitis, 38% had pallor, 11% had dental caries, 3.2% had an conspicuously enlarged thyroid and 2.1% had eye changes of vitamin A deficiency. According to INACG (International Nutritional Anaemia Consultative Group, 1985) cut-off values, 94% of the boys and 98% of the girls were anaemic. We conclude that rural Bangladesh adolescents suffer from high rates of malnutrition and almost universal anaemia. Nutritional interventions to target this population are urgently required.

Nutritional status and age at menarche in a rural area of Bangladesh.

The age at menarche and its association with nutritional status in a rural area of Bangladesh was determined. A cross-sectional study was conducted in four villages of Rupganj Thana of Narayanganj district. Data was collected through October to December 1996 using a pre-tested structured questionnaire interview schedule, and nutritional status was measured by weight, height, body mass index (BMI) and physical examination. Data were obtained on 436 adolescent girls aged 10-17 years. Among them, 165 (37.8%) girls had commenced menarche. The mean age at menarche as determined by retrospective recall was 13 years SD 0.89 (n = 165). The median age at menarche determined by the status quo method was 13.0. Among the adolescents 60.1% were thin (BMI < 5th centile WHO recommended reference) and 48.2% were stunted (< 3rd centile NCHS/WHO). The mean weight and BMI were significantly higher among the menstruating girls of 13, 14 and 15 years (p < 0.01) than non-menstruating girls. The mean height was found to be significantly higher at 11-14 years among the menstruating girls (p < 0.05). A lower prevalence of angular stomatitis was found among the menstruating adolescent girls compared with the non-menstruating girls, 36.4% versus 46.5%, although this was statistically non-significant (odds ratio = 0.66, 95% CI 0.43-1.00). For glossitis, no significant difference was found. Among the menstruating girls 12.1% were suffering from menorrhagia and 31.5% from dysmenorrhoea. We conclude that the age of menarche among this rural Bangladeshi community is not as delayed as expected. Not surprisingly, menarche is associated with better nutritional status. The surveyed population had extremely high rates of undernutrition which suggests that adolescents in this and similar situations require specific intervention programmes to improve their nutritional status.

Primary term ovarian pregnancy superimposed by intrauterine pregnancy: a case report.

A case of primary ovarian pregnancy proceeding upto term superimposed by another intrauterine pregnancy is presented. Compound extrauterine and intrauterine pregnancy is a rare obstetric phenomenon and still rarer is a primary ovarian pregnancy proceeding upto the term. The condition was diagnosed at laparotomy during the second trimester of current pregnancy. Diagnostic laparotomy was done because the ovarian pregnancy was mimicking an ovarian tumur. The ovarian pregnancy was successfully managed by surgery. Normal vaginal delivery of a term intrauterine pregnancy occurred in due time. The difficulty of diagnosing the heterotopic pregnancy is discussed and the clinico-pathological features of primary term ovarian pregnancy is emphasized, as it is a very rare condition.