Sexually transmitted infections and risk factors among truck stand workers in Dhaka, Bangladesh.

OBJECTIVE: This study was conducted to determine the prevalence of selected sexually transmitted infections (STIs) and their risk factors among workers in and near a truck stand in Dhaka, Bangladesh. STUDY DESIGN: A random sample of 696 men and 206 women were recruited into a cross-sectional study using a census that enumerated transport agents, motor mechanics, laborers, and vendors in Tejgaon truck stand. RESULTS: The prevalence rates of syphilis (rapid plasma reagin and Treponema pallidum hemagglutination), gonorrhea (polymerase chain reaction [PCR]), and chlamydial infections (PCR) among men were 4.1%, 7.7%, and 2.3%, respectively, and among women were 2.9%, 8.3%, and 5.2%. Multivariable analysis revealed that having >or=2 sex partners in the last month, never using a condom with sex workers, and ever injecting narcotics were significant predictors of STI among men. Being never married, working as a laborer, older age, and living within the truck stand were significant predictors of practicing high-risk behaviors among men, but none predicted infection with STIs. CONCLUSIONS: Both behavioral and STI data suggest that truck stand workers should be included in the STI/HIV intervention programs.

Measles in rural Bangladesh: issues of validation and age distribution.

In the Third World, scientists have described thoroughly the pattern of measles in Africa. In Asia, however, the epidemiology of measles has been poorly described. In 1989, a measles surveillance system was initiated in Matlab, rural Bangladesh in order to monitor measles incidence in the area. The population (100,000), which has relatively low immunization coverage, has an excellent demographic surveillance system which allows accurate follow-up. The system works through trained community health workers who visit all households every fortnight and report possible cases of measles. Medical doctors review a proportion of index cases and cases in infants soon after the appearance of the rash. Of the 4673 cases reported in all age groups, 18% were visited by medics. Confirmation of diagnosis was related to the age at onset and overreporting by community health workers is documented. The incidence of measles was estimated at 43% of children < 5 years old. Of cases < 5 years of age, 14% occurred below the age at vaccination (incidence rate = 5.5%). A strong seasonal pattern is reported. Case-fatality rates are low. This is the first report which shows the effect of age on reliability of reported measles. It shows the misclassification likely to occur when reporting measles in large-scale surveys, particularly in infants. It also shows that the pattern of measles in this community resembles the pattern reported for African communities and calls for a review of immunization strategies with vaccination below 9 months of age.

Epidemiological and clinical characteristics of acute and persistent diarrhoea in rural Bangladeshi children.

A community-based longitudinal study of acute and persistent diarrhoea in 705 children less than five years old was carried out for a year in a rural area of Bangladesh. Diarrhoea morbidity data were collected from each study child every fourth day by home visit. Clinical features of diarrhoeal episodes and diarrhoeal management information were documented. The overall diarrhoeal incidence rate in the study children was 4.6 episodes per child per year. The incidence of persistent diarrhoea was 34/100 child-years. Persistent diarrhoea was positively associated with young age and more severe illness, characterized by the presence of clinical dehydration or blood in the stool in the first week. Use of ORT in the first week was positively associated and use of an antibiotic was negatively associated with the occurrence of persistent diarrhoea. Reduced breast-feeding and consumption of cow's milk at some time during the episode were also positively associated with persistence. This would suggest that appropriate fluid and dietary management for all episodes should be the goal. Children with more severe initial illness characterized by the presence of blood in the stool or clinical dehydration should have more careful follow-up to identify persistent episodes and adverse nutritional effects. Breastfeeding should be continued during acute diarrhoea, but the role of ORT, antibiotics and cow's milk deserves further investigation.

Biotype as determinant of natural immunising effect of cholera.

To test the hypothesis that clinical Vibrio cholerae O1 infections protect against recurrent cholera, treated cholera episodes in a rural Bangladesh population of 188,153 people who were followed between 1985 and 1988 were analysed. Of the 2214 people with initial episodes of cholera, 7 had a second episode. The incidence of cholera was 61% lower in subjects who had had an earlier episode than in those without such an episode. Whereas initial episodes of classical cholera were associated with complete protection against subsequent cholera, initial episodes of El Tor cholera were associated with negligible protection.

Surveillance of patients attending a rural diarrhoea treatment centre in Bangladesh.

In May 1983, a surveillance system was set up at a rural diarrhoea treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to study a 20% systematic sample of all admissions. Between May 1983 and April 1984, 2,635 patients were studied. A recognized enteric pathogen was detected in 69% of the patients screened, 15% of whom had a mixed infection. Vibrio cholerae 0: 1 was the most common enteropathogen detected (39%), followed by enterotoxigenic Escherichia coli (ETEC) (14%), Shigella spp. (11%), and Campylobacter jejuni (11%). Detection of C. jejuni was highest in infants, Shigella spp. in children between 1-4 years and V. cholerae 0:1 in children between 3-9 years of age. 75% of patients presented with watery diarrhoea, a presentation that was significantly more common in patients infected with V. cholerae 0:1 (94%) and ETEC (88%). Bloody diarrhoea was the presenting complaint in 18% of all patients, but in 65% of patients in whom Shigella spp. was isolated. Although 91% of patients reported that they had prior experience of use of oral rehydration therapy (ORT), 54% of the patients came to the treatment centre with no or mild dehydration and more than half of them did not use ORT before coming to the treatment centre. Most of these patients could have been safely treated at home if ORT could be made available and acceptable.

Exclusion of clinically atypical or microbiologically mixed diarrhoeal episodes from outcome events in a field trial of oral cholera vaccines.

We investigated whether alternative clinical and microbiological criteria for outcome events affected estimates of vaccine efficacy in a randomized, double-blind field trial of B subunit-killed whole cell (BS-WC) and killed whole cell-only (WC) oral cholera vaccines among 62,285 rural Bangladeshi participants. At one year of follow-up estimates of vaccine protective efficacy (PE = 60%, P less than 0.0001 for BS-WC; PE = 54%, P less than 0.0001 for WC) against all treated diarrhoeal episodes associated with V. cholerae 01 were similar to estimates of efficacy against only those episodes which were clinically typical and unassociated with additional enteric pathogens (PE = 62%, P less than 0.0001 for BS-WC; PE = 52%, P less than 0.0001 for WC). In contrast, estimates of vaccine cross-protection against episodes associated with each of several agents antigenically related to V. cholerae 01 (LT-ETEC, non-cholera Vibrio sp, Aeromonas sp) were substantially reduced when mixed infections with V. cholerae 01 were excluded. We conclude that restrictive criteria intended to improve the specificity of the definition of cholera did not increase the detectability of vaccine efficacy against V. cholerae 01, but that exclusion of mixed infections with V. cholerae 01 was necessary to avoid false-positive conclusions about vaccine cross-protection against other potential target pathogens.

Oral rehydration therapy for treatment of rotavirus diarrhoea in a rural treatment centre in Bangladesh.

In November 1977, an enzyme-linked immunosorbent assay for detecting rotavirus antigen was introduced in the laboratory of a rural treatment centre in Bangladesh. During the next 40 days rotavirus without other pathogens was found in the stools of 216 (45%) of 480 children under age 5 years who visited the centre with a gastrointestinal illness. 188 (87%) of these children were treated with oral rehydration alone, using the solution currently recommended by the World Health Organisation, while 28 (13%) also required some intravenous rehydration; there were no deaths. Oral rehydration treatment was judged successful in 205 (95%) of the rotavirus patients and was not associated with any serious side effects. Oral rehydration treatment, with this solution, has been used extensively and successfully in the treatment of enterotoxin-mediated diarrhoea and can also safely be used for treating rotavirus diarrhoea in infants and young children.

PIP: The outcome of a rehydration treatment used during a 40-day period at a WHO Center in Bangladesh on 216 children under age 5 is reported. In addition, an enzyme-linked immunosorbentassay (ELISA) designed to detect rotavirus in stool specimens is described and its application explained. The ELISA assay was adaptable to use in a rural treatment center. In a 40-day period, using the new virus-detecting assay, rotavirus without other pathogens was found in stools of 216 (45%) of 480 children who attended the center with gastrointestinal illness. Of these 216 children with only rotavirus pathogen, 188 were treated with oral rehydration alone (oral glucose solution prepared according to WHO procedures); 28 required additional intravenous rehydration therapy. No deaths occurred. 95% of the cases were judged successful on oral rehydration alone for gastrointestinal effects of rotavirus infection. No serious side effects were reported. This oral glucose solution is now indcated in E. coli (enter otoxin)-mediated diarrhea as well as in rotavirus-induced diarrhea.