Characteristics of young foster children in the urban slums of Bangladesh.

AIM: To identify the reasons for the fostering of children, and to describe their feeding practices and assess their health and nutritional status. METHODS: Forty-six pairs of mothers and their young foster children (up to 24 mo of age) were interviewed in a cross-sectional study in the urban slums of Dhaka, Bangladesh. Another 82 pairs of mothers and their biological children of a similar age group were interviewed for comparison. RESULTS: Sixty-five percent of the children were fostered because of the death of their biological mothers. Eighty-three percent of the biological mothers died because of complications during delivery or the immediate postpartum period and the remainder died after the postpartum period of diseases unrelated to their pregnancies. More than half (52%) of the foster mothers were childless and a quarter (24%) fostered children for reasons of gender preference. Almost a quarter (24%) of the children were placed in foster homes because of extreme parental poverty. Divorce or separation of the biological parents accounted for only 7% of children fostered. Approximately 90% of the foster children were given animal and/or formula milk in their first month of life while all children in the comparison group were given breast milk. Among the foster children, 58% were given semisolid or solid food before completion of 4 mo compared with 14% in the comparison group. Significantly more children in the foster group suffered from diarrhoea and acute respiratory infection than in the comparison group. CONCLUSION: Maternal death, poverty and childlessness and child gender preference of foster mothers were important factors in fostering of children in the study group. Inappropriate feeding practices compounded by diseases may have contributed to the poor nutritional status of the foster children.

Impact of lactational performance on bone mineral density in marginally-nourished Bangladeshi women.

This cross-sectional study, carried out during July 1997-June 1998, evaluated the effects of prolonged breast-feeding and lactational amenorrhoea on bone mineral density (BMD) in 400 marginally-nourished Bangladeshi women aged 20-81 years. A bone densitometer was used for measuring BMD in the distal and ultra-distal end of radius and ulna. The results showed that the women who breastfed for 60 months or less had a higher mean BMD compared to those who breastfed for 61-120 months and for over 120 months. There was a significantly higher BMD in the women who had a shorter duration of lactational amenorrhoea compared to those having a longer duration of lactational amenorrhoea. BMD was significantly and negatively correlated with total duration of lactational amenorrhoea (slope -0.024, p<0.05) after controlling for parity, physical workload, and total duration of breast-feeding. The study concluded that there was a negative correlation between longer duration of breast-feeding and BMD, but it was not found when other factors were controlled in multivariate analysis. The duration of lactational amenorrhoea, which is a proxy indicator of breast-feeding, showed a negative correlation with BMD. It is recommended that all lactating women be given diet with adequate calcium to support breast-feeding for maintaining good nutrition of their bones.

A randomized controlled clinical trial of zinc, vitamin A or both in undernourished children with persistent diarrhea in Bangladesh.

UNLABELLED: In a double-blind randomized controlled clinical trial, moderately malnourished Bangladeshi children (61-75% of the median weight/age) were studied for the effect of zinc and/or vitamin A supplementation on the clinical outcome of persistent diarrhea. Children 6 mo to 2 y of age with diarrhea for more than 14 d were randomly allocated into 4 groups of 24 receiving a multivitamin syrup and (i) zinc (20 mg elemental), (ii) vitamin A, (iii) both zinc and vitamin A, or (iv) neither, in 2 doses daily for 7 d. Clinical data on recovery and on stool output, consistency and frequency were recorded for 7 d, and weight change from day 1 to day 7 was assessed. The baseline characteristics of the four study groups were comparable. The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups, but not in the vitamin A group, in comparison with the control group. In children receiving zinc, the cumulative stool weight in the 7 d was 39% less than in the control group (p < 0.001) and 32% less than in the vitamin A group (p = 0.006). The cumulative stool weight in the zinc plus vitamin A group was 24% less than in the control group (p < 0.001), but the 14% lower output than in the vitamin A group was not statistically different. The change in body weight over the 7 d study period was significantly different between the group receiving zinc and the control group (+111 g vs -90 g, p = 0.045). The rate of clinical recovery of children within 7 d was significantly greater in the zinc group (88%) compared with the control group (46%, p = 0.002) or vitamin A group (50%, p = 0.005), but not statistically different from the zinc plus vitamin A group (67%, p = 0.086). CONCLUSION: The results indicate that zinc, but not vitamin A, supplementation in persistent diarrhea reduces stool output, prevents weight loss and promotes earlier recovery.

Comparison of bone mineral density between premenopausal and postmenopausal women in Bangladesh.

This cross sectional study was conducted in the department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mujib Medical University, Dhaka during July 1997 to June 1998. Two hundred and twenty (220) Bangladeshi premenopausal and post-menopausal women aged from 35 to 55 years were studied to compare the effect of age, parity, socioeconomic status and nutritional status on bone mineral density (BMD) of distal and ultra distal ends of radius and ulna. A bone densitometer (Single photon X-ray absorptiometry, DTX100, USA) was used to measure the BMD. BMD was calculated by taking the mean of the two sites and is expressed in g/cm2. Bone mineral density in post-menopausal women (0.48 +/- 0.1 g/cm2) was significantly lower than pre-menopausal women (0.61 +/- 0.06 g/cm2, p<0.001). Parity and number of family members were significantly greater in post-menopausal women compared to pre-menopausal women (6.5 +/- 2.9 vs. 4.2 +/- 2.3 and 8.1 +/- 2.5 vs. 6.2 +/- 2.3 respectively, p<0.001). Height was significantly lower in post-menopausal women (148.6 +/- 6.9 vs. 151.8 +/- 5.7 cm, p<0.001). After adjustment of various biological factors in multiple linear regression, body mass index (BMI) showed negative relationship with age (slope -0.0068, p<0.001) and positive relationship with weight (slope 0.0011, p<0.05). Peak BMD was observed upto the age of 40 years and thereafter declined and sharply after menopause. The study concluded that bone mineral density is greater in pre-menopausal women than post-menopausal women and remains high up to 35-40 years of age, and declines to older age. BMD positively correlates with weight of women. Premenopausal women have higher height than postmenopausal women though height does not have correlation with BMD in this study.