Iqbal Kabir

Breast-feeding protects against arsenic exposure in Bangladeshi infants.

Background Chronic arsenic exposure causes a wide range of health effects, but little is known about critical windows of exposure. Arsenic readily crosses the placenta, but the few available data on postnatal exposure to arsenic via breast milk are not conclusive. Aim Our goal was to assess the arsenic exposure through breast milk in Bangladeshi infants, living in an area with high prevalence of arsenic-rich tube-well water. Methods We analyzed metabolites of inorganic arsenic in breast milk and infant urine at 3 months of age and compared them with detailed information on breast-feeding practices and maternal arsenic exposure, as measured by concentrations in blood, urine, and saliva. Results Arsenic concentrations in breast-milk samples were low (median, 1 μg/kg; range, 0.25–19 μg/kg), despite high arsenic exposures via drinking water (10–1,100 μg/L in urine and 2–40 μg/L in red blood cells). Accordingly, the arsenic concentrations in urine of infants whose mothers reported exclusive breast-feeding were low (median, 1.1 μg/L; range, 0.3–29 μg/L), whereas concentrations for those whose mothers reported partial breast-feeding ranged from 0.4 to 1,520 μg/L (median 1.9 μg/L). The major part of arsenic in milk was inorganic. Still, the infants had a high fraction (median, 87%) of the dimethylated arsenic metabolite in urine. Arsenic in breast milk was associated with arsenic in maternal blood, urine, and saliva. Conclusion Very little arsenic is excreted in breast milk, even in women with high exposure from drinking water. Thus, exclusive breast-feeding protects the infant from exposure to arsenic.

Determinants of Infant and Young Child Feeding Practices in Bangladesh: Secondary Data Analysis of Demographic and Health Survey 2004

Background In Bangladesh, poor infant and young child feeding practices are contributing to the burden of infectious diseases and malnutrition. Objective To estimate the determinants of selected feeding practices and key indicators of breastfeeding and complementary feeding in Bangladesh. Methods The sample included 2,482 children aged 0 to 23 months from the Bangladesh Demographic and Health Survey of 2004. The World Health Organization (WHO)-recommended infant and young child feeding indicators were estimated, and selected feeding indicators were examined against a set of individual-, household-, and community-level variables using univariate and multivariate analyses. Results Only 27.5% of mothers initiated breastfeeding within the first hour after birth, 99.9% had ever breastfed their infants, 97.3% were currently breastfeeding, and 22.4% were currently bottle-feeding. Among infants under 6 months of age, 42.5% were exclusively breastfed, and among those aged 6 to 9 months, 62.3% received complementary foods in addition to breastmilk. Among the risk factors for an infant not being exclusively breastfed were higher socioeconomic status, higher maternal education, and living in the Dhaka region. Higher birth order and female sex were associated with increased rates of exclusive breastfeeding of infants under 6 months of age. The risk factors for bottle-feeding were similar and included having a partner with a higher educational level (OR = 2.17), older maternal age (OR for age ≥ 35 years = 2.32), and being in the upper wealth quintiles (OR for the richest = 3.43). Urban mothers were at higher risk for not initiating breastfeeding within the first hour after birth (OR = 1.61). Those who made three to six visits to the antenatal clinic were at lower risk for not initiating breastfeeding within the first hour (OR = 0.61). The rate of initiating breastfeeding within the first hour was higher in mothers from richer households (OR = 0.37). Conclusions Most breastfeeding indicators in Bangladesh were below acceptable levels. Breastfeeding promotion programs in Bangladesh need nationwide application because of the low rates of appropriate infant feeding indicators, but they should also target women who have the main risk factors, i.e., working mothers living in urban areas (particularly in Dhaka).

Comparisons of complementary feeding indicators and associated factors in children aged 6-23 months across five South Asian countries

Improving infant and young child feeding practices will help South Asian countries achieve the Millennium Development Goal of reducing child mortality. This paper aims to compare key indicators of complementary feeding and their determinants in children aged 6-23 months across five South Asian countries - Bangladesh, India, Nepal, Pakistan and Sri Lanka. The latest Demographic and Health Survey and National Family Health Survey India data were used. The analyses were confined to last-born children aged 6-23 months - 1728 in Bangladesh, 15,028 in India, 1428 in Nepal, 2106 in Sri Lanka and 443 infants aged 6-8 months in Pakistan. Introduction of solid, semi-solid or soft foods, minimum dietary diversity, minimum meal frequency and minimum acceptable diet, and their significant determinants were compared across the countries. Minimum dietary diversity among children aged 6-23 months ranged from 15% in India to 71% in Sri Lanka, with Nepal (34%) and Bangladesh (42%) in between. Minimum acceptable diet among breastfed children was 9% in India, 32% in Nepal, 40% in Bangladesh and 68% in Sri Lanka. The most consistent determinants of inappropriate complementary feeding practices across all countries were the lack of maternal education and lower household wealth. Limited exposure to media, inadequate antenatal care and lack of post-natal contacts by health workers were among predictors of inappropriate feeding. Overall, complementary feeding practices among children aged 6-23 months need improvement in all South Asian countries. More intensive interventions are necessary targeting the groups with sup-optimal practices, while programmes that cover entire populations are being continued.

Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: secondary data analysis of Demographic Health Survey 2007

Suboptimal and inappropriate complementary feeding practices are one of the major causes of child undernutrition in the first 2 years of life in South Asian countries including Bangladesh. The aim of this study was to use the newly developed World Health Organization infant feeding indicators to identify the potential risk factors associated with inappropriate complementary feeding practices. We used data for 1728 children aged 6-23 months obtained from nationally representative data from the 2007 Bangladesh Demographic and Health Survey to assess the association between complementary feeding and other characteristics using multivariate models. Only 71% of infants were consuming soft, semi-solid and solid food by 6-8 months of age. In the multivariate analysis, mothers who had no education had a higher risk for not introducing timely complementary feeds [adjusted odds ratio (AOR)=2.14; 95% confidence interval (CI): 1.08-4.23, P=0.03], not meeting the minimum dietary diversity (AOR=1.69; 95% CI: 1.14-2.54, P=0.01), minimum acceptable diet (AOR=1.70, 95% CI: 1.09-2.67, P=0.02) and minimum meal frequency (AOR=1.73; 95% CI: 1.20-2.49, P=0.003) than the mothers who had secondary or higher education. Infants born in Sylhet, Chittagong and Barisal division had higher risks for not meeting minimum dietary diversity, meal frequency and acceptable diet (P<0.001). The poorest two quintiles had poor levels of minimum meal frequency but dietary quality improved with age. In Bangladesh addressing the fourth Millennium Development Goal (MDG) target will require substantial improvement in complementary feeding practices. Appropriate Infant and Young Child feeding massages should to be development and delivered through existing health system.

Effects of prenatal food and micronutrient supplementation on child growth from birth to 54 months of age: a randomized trial in Bangladesh

BackgroundThere is a lack of information on the optimal timing of food supplementation to malnourished pregnant women and possible combined effects of food and multiple micronutrient supplementations (MMS) on their offsprings growth. We evaluated the effects of prenatal food and micronutrient interventions on postnatal child growth. The hypothesis was that prenatal MMS and early invitation to food supplementation would increase physical growth in the offspring during 0-54 months and a combination of these interventions would further improve these outcomes.MethodsIn the large, randomized MINIMat trial (Maternal and Infant Nutrition Interventions in Matlab), Bangladesh, 4436 pregnant women were enrolled between November 2001 and October 2003 and their children were followed until March 2009. Participants were randomized into six groups comprising 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F) or MMS combined with either an early (immediately after identification of pregnancy) or a later usual (at the time of their choosing, i.e., usual care in this community) program invitation to food supplementation. The anthropometry of 3267 children was followed from birth to 54 months, and 2735 children were available for analysis at 54 months.ResultsThere were no differences in characteristics of mothers and households among the different intervention groups. The average birth weight was 2694 g and birth length was 47.7 cm, with no difference among intervention groups. Early invitation to food supplementation (in comparison with usual invitation) reduced the proportion of stunting from early infancy up to 54 months for boys (p = 0.01), but not for girls (p = 0.31). MMS resulted in more stunting than standard Fe60F (p = 0.02). There was no interaction between the food and micronutrient supplementation on the growth outcome.ConclusionsEarly food supplementation in pregnancy reduced the occurrence of stunting during 0-54 months in boys, but not in girls, and prenatal MMS increased the proportion of stunting in boys. These effects on postnatal growth suggest programming effects in early fetal life.Trial registration numberISRCTN: ISRCTN16581394

Association between infant feeding patterns and diarrhoeal and respiratory illness: A cohort study in Chittagong, Bangladesh

BackgroundIn developing countries, infectious diseases such as diarrhoea and acute respiratory infections are the main cause of mortality and morbidity in infants aged less than one year. The importance of exclusive breastfeeding in the prevention of infectious diseases during infancy is well known. Although breastfeeding is almost universal in Bangladesh, the rates of exclusive breastfeeding remain low. This cohort study was designed to compare the prevalence of diarrhoea and acute respiratory infection (ARI) in infants according to their breastfeeding status in a prospective cohort of infants from birth to six months of age.MethodsA total of 351 pregnant women were recruited in the Anowara subdistrict of Chittagong. Breastfeeding practices and the 7-day prevalence of diarrhoea and ARI were recorded at monthly home visits. Prevalences were compared using chi-squared tests and logistic regression.ResultsA total of 272 mother-infant pairs completed the study to six months. Infants who were exclusively breastfed for six months had a significantly lower 7-day prevalence of diarrhoea [AOR for lack of EBF = 2.50 (95%CI 1.10, 5.69), p = 0.03] and a significantly lower 7-day prevalence of ARI [AOR for lack of EBF = 2.31 (95%CI 1.33, 4.00), p < 0.01] than infants who were not exclusively breastfed. However, when the association between patterns of infant feeding (exclusive, predominant and partial breastfeeding) and illness was investigated in more detail, there was no significant difference in the prevalence of diarrhoea between exclusively [6.6% (95% CI 2.8, 10.4)] and predominantly breastfed infants [3.7% (95% CI 0.09, 18.3), (p = 0.56)]. Partially breastfed infants had a higher prevalence of diarrhoea than the others [19.2% (95% CI 10.4, 27.9), (p = 0.01)]. Similarly, although there was a large difference in prevalence in acute respiratory illness between exclusively [54.2% (95%CI 46.6, 61.8)] and predominantly breastfed infants [70.4% (95%CI 53.2, 87.6)] there was no significant difference in the prevalence (p = 0.17).ConclusionThe findings suggest that exclusive or predominant breastfeeding can reduce rates of morbidity significantly in this region of rural Bangladesh.

Single dose vitamin A treatment in acute shigellosis in bangladeshi children : randomised double blind controlled trial

Abstract Objective: To evaluate the efficacy of a single large oral dose of vitamin A in treating acute shigellosis in children in Bangladesh. Design: Randomised double blind controlled clinical trial. Setting: Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh. Subjects: 83 children aged 1–7 years with bacteriologically proved shigellosis but no clinical signs of vitamin A deficiency; 42 were randomised to treatment with vitamin A and 41 formed a control group. Intervention: Children were given a single oral dose of 200 000 IU of vitamin A plus 25 IU vitamin E or a control preparation of 25 IU vitamin E. Main outcome measures: Clinical cure on study day 5 and bacteriological cure. Results: Baseline characteristics of the subjects in the two treatment groups were similar. Significantly more children in the vitamin A group than in the control group achieved clinical cure (19/42 (45%) v 8/14 (20%); χ2=5.14, 1 df, P=0.02; risk ratio=0.68 (95% confidence interval: 0.50 to 0.93)). When cure was determined bacteriologically, the groups had similar rates (16/42 (38%) v 16/41 (39%); χ2=0.02, 1 df, P=0.89; risk ratio=0.98 (0.70 to 1.39)). Conclusions: Vitamin A reduces the severity of acute shigellosis in children living in areas where vitamin A deficiency is a major public health problem. Key messages A single oral dose of 200 000 IU vitamin A acts as an adjunct in the treatment of acute shigellosis among the children in geographical areas where vitamin A deficiency is a major public health problem Vitamin A supplementation hastens clinical cure in acute shigellosis Vitamin A supplementation during acute shigellosis has no effect on bacteriological clearance Vitamin A may reduce the severity of acute shigellosis by promoting repair of the colonic mucosa and stimulating the immune system

Training Peer Counselors to Promote and Support Exclusive Breastfeeding in Bangladesh

Exclusive breastfeedingis rare in Bangladesh. About 90% ofwomen have home deliveries, so the Baby-Friendly Hospital Initiative has no mechanism to reach them. Mother support groups do not exist, and community healthworkers do not have time to promote and support exclusive breastfeeding. To provide this kind of support at the community level, an area in Dhakawas selected for a peer-counselinginterv ention program. Usingcertain selection criteria, 1 woman from each community was trained as a peer counselor. The trainingw as based on the World Health Organization/United Nations International Childrens Emergency Fund 40-hour breastfeedingcounselingcourse and related books. Counselingskills were taught usingdemonstrations and role play, followed by practical trainingin the project area. The intervention was very successful, as 70% of the mothers in the project area breastfed their infants exclusively for 5 months compared to only 6% in the control area. The authors describe the peer counseling training, strategies used for peer counseling visits, and lessons learned.

Differential clinical features and stool findings in shigellosis and amoebic dysentery

To obtain information that could assist the clinician to differentiate between shigellosis and amoebic dysentery, we compared clinical features and stool findings in 58 adult male patients in Bangladesh. Mean values indicated that patients with invasive amoebiasis were older and had a longer prehospital illness, a lower body weight, less frequent fever, a lower haematocrit and a higher white blood cell count than patients with shigellosis. The mean number of faecal leucocytes per mm3 was significantly higher in shigellosis than in amoebiasis (28,700 vs 10,300) and correlated with the estimated number of faecal leucocytes per microscopic high power field in a wet mount preparation. Patients with shigellosis more often had over 50 white blood cells per high power field. Although the mean stool pH in amoebiasis was lower than in shigellosis (6.26 vs 6.60), the difference was not statistically significant. Concentrations of stool electrolytes did not differ between the two diseases. These findings indicate that age, duration of illness, the presence of fever and the number of faecal leucocytes may help to differentiate between shigellosis and amoebic dysentery.

Colonic Dysfunction During Cholera Infection

To study the function of the colon in cholera, 12 patients with acute cholera diarrhea were subjected to measurements of ileocecal flow rates, fecal flow rates, and ionic compositions of stool and ileocecal fluid. Subtraction of fecal flow rates from ileocecal flow rates was taken as a measure of net fluid absorption by the colon. Additionally, these patients underwent colonoscopic perfusion of the colon that measured net colonic absorption rates of water and ions. The mean ileocecal flow rate was 7.9 ml/min compared with a mean fecal flow rate of 7.6 ml/min, indicating a small mean net fluid absorption by the colon of +0.30 ml/min. By colonoscopic perfusion, 6 patients showed net colonic absorption of water and 6 patients net secretion of water with a slight mean net fluid secretion of -0.03 ml/min. The handling of ions by the colon showed mean net absorption of sodium (100 mu Eq/min) and chloride (127 mu Eq/min), and net secretions of potassium (-42 mu Eq/min) and bicarbonate (-112 mu Eq/min). During convalescence, 5 patients who were studied again all showed net colonic absorption of water, and the handling of potassium changed significantly from net secretion in acute disease to net absorption (p less than 0.05). These results showed that the colon contributes to the clinical expression of cholera by failing to absorb water normally, and by secreting potassium at high rates.