Summary Animal antimicrobial use and husbandry practices increase risk of emerging zoonotic disease and antibiotic resistance. We surveyed 700 households to elicit information on human and animal medicine use and husbandry practices. Households that owned livestock ( n = 265/459, 57.7%) reported using animal treatments 630 times during the previous 6 months; 57.6% obtained medicines, including antibiotics, from drug sellers. Government animal healthcare providers were rarely visited (9.7%), and respondents more often sought animal health care from pharmacies and village doctors (70.6% and 11.9%, respectively), citing the latter two as less costly and more successful based on past performance. Animal husbandry practices that could promote the transmission of microbes from animals to humans included the following: the proximity of chickens to humans (50.1% of households reported that the chickens slept in the bedroom); the shared use of natural bodies of water for human and animal bathing (78.3%); the use of livestock waste as fertilizer (60.9%); and gender roles that dictate that females are the primary caretakers of poultry and children (62.8%). In the absence of an effective animal healthcare system, villagers must depend on informal healthcare providers for treatment of their animals. Suboptimal use of antimicrobials coupled with unhygienic animal husbandry practices is an important risk factor for emerging zoonotic disease and resistant pathogens.
Background: Several metals act as endocrine disruptors, but there are few large longitudinal studies about associations with puberty onset. Objectives: We evaluated whether early life cadmium, lead, and arsenic exposure was associated with timing of menarche. Methods: In a mother–child cohort in rural Bangladesh (n=935), the exposure was assessed by concentrations in maternal erythrocytes in early pregnancy and in girls' urine at 5 and 10 years of age using inductively coupled plasma mass spectrometry. The girls were interviewed twice, at average ages 13.3 [standard deviation (SD)=0.43] and 13.8 (SD=0.43) y, and the date of menarche, if present, was recorded. Associations were assessed using Kaplan–Meier analysis and multivariable-adjusted Cox regression. Results: In total, 77% of the girls (n=717) had reached menarche by the second follow-up. The median age of menarche among all girls was 13.0 y (25th–75th percentiles: 12.4–13.7 y). At 10 years of age, median urinary cadmium was 0.25μg/L (5th–95th percentiles: 0.087–0.72μg/L), lead 1.6μg/L (0.70–4.2μg/L), and arsenic 54μg/L (19–395μg/L). Given the same age, girls in the highest quartile of urinary cadmium at 5 and 10 years of age had a lower rate of menarche than girls in the lowest quartile, with an adjusted hazard ratio of (HR) 0.80 (95% CI: 0.62, 1.01) at 5 years of age, and 0.77 (95% CI: 0.60, 0.98) at 10 years of age. This implies that girls in the highest cadmium exposure quartile during childhood had a higher age at menarche. Comparing girls in the highest to the lowest quartile of urinary lead at 10 years of age, the former had a higher rate of menarche [adjusted HR = 1.23 (95% CI: 0.97, 1.56)], implying lower age at menarche, whereas there was no association with urinary lead at 5 years of age. Girls born to mothers in the highest quartile of erythrocyte arsenic during pregnancy were less likely to have attained menarche than girls born to mothers in the lowest quartile [adjusted HR= 0.79 (95% CI: 0.62, 0.99)]. No association was found with girls' urinary arsenic exposure. Discussion: Long-term childhood cadmium exposure was associated with later menarche, whereas the associations with child lead exposure were inconclusive. Maternal exposure to arsenic, but not cadmium or lead, was associated with later menarche. https://doi.org/10.1289/EHP11121
Introduction The high burden of stillbirths and neonatal deaths is driving global initiatives to improve birth outcomes. Discerning stillbirths from neonatal deaths can be difficult in some settings, yet this distinction is critical for understanding causes of perinatal deaths and improving resuscitation practices for live born babies. Methods We evaluated data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network to compare the accuracy of determining stillbirths versus neonatal deaths from different data sources and to evaluate evidence of resuscitation at delivery in accordance with World Health Organization (WHO) guidelines. CHAMPS works to identify causes of stillbirth and death in children <5 years of age in Bangladesh and 6 countries in sub-Saharan Africa. Using CHAMPS data, we compared the final classification of a case as a stillbirth or neonatal death as certified by the CHAMPS Determining Cause of Death (DeCoDe) panel to both the initial report of the case by the family member or healthcare worker at CHAMPS enrollment and the birth outcome as stillbirth or livebirth documented in the maternal health record. Results Of 1967 deaths ultimately classified as stillbirth, only 28 (1.4%) were initially reported as livebirths. Of 845 cases classified as very early neonatal death, 33 (4%) were initially reported as stillbirth. Of 367 cases with post-mortem examination showing delivery weight >1000g and no maceration, the maternal clinical record documented that resuscitation was not performed in 161 cases (44%), performed in 14 (3%), and unknown or data missing for 192 (52%). Conclusion This analysis found that CHAMPS cases assigned as stillbirth or neonatal death after DeCoDe expert panel review were generally consistent with the initial report of the case as a stillbirth or neonatal death. Our findings suggest that more frequent use of resuscitation at delivery and improvements in documentation around events at birth could help improve perinatal outcomes.
Preterm birth (<37 weeks), low birth weight (2500 g), small-for-gestational-age (birth weight <10th percentile of a given reference), and large-for-gestational-age (birth weight >90th percentile of a given reference) are indicators of vulnerable infants and risk factors for neonatal mortality. We estimated the prevalence and risk of neonatal mortality associated with these phenotypes and their mutually exclusive phenotypes in rural Bangladesh. We conducted a prospective cohort study in five rural districts of Bangladesh using data collected from births in the Shonjibon Trial from 2013 to 2015. We estimated the prevalence of preterm birth, low birth weight, small-for-gestational-age, and large-for-gestational-age infants, individually and for mutually exclusive phenotypes, using a combination of these phenotypes. Neonatal mortality associated with preterm birth, low birth weight, small-for-gestational-age, large-for-gestational-age, and mutually exclusive phenotypes were calculated using Kaplan-Meier survival analysis and Poisson regression for adjusted relative risks (aRR) with 95% confidence intervals (CI). We included 24,314 live births in this study. The prevalence of preterm birth, low birth weight, small-for-gestational-age, and large-for-gestational-age was 26.2%, 22.9%, 41.7%, and 8.2%, respectively. The prevalence of babies born appropriate for gestational age, with term gestation (≥37 weeks) and normal birth weight (≥2500 g) was 33.3%. For individual phenotypes, the neonatal mortality risk was approximately 3-fold for preterm, low birth weight, and large-for-gestational-age newborns and 1.5-fold for small-for-gestational-age newborns compared with appropriate-for-gestational-age, term, and normal birth weight newborns. The risk of neonatal mortality for mutually exclusive phenotypes was highest in small-for-gestational-age, preterm, and low birth weight newborns (aRR = 6.3, 95% CI 4.1-9.6) relative to appropriate for gestational age, term, and normal birth weight newborns. In rural Bangladesh, most infants are born with one or more vulnerable phenotypes associated with an increased risk of neonatal mortality. Our findings highlight the value of categorising newborns using mutually exclusive vulnerable phenotypes and their neonatal mortality risks, which can be used to tailor interventions to improve survival.
It is unclear how large amount of supplemental iron is required to reach maximum hemoglobin concentration in pregnancy and whether addition of multiple micronutrients modify supplement efficacy In the MINIMat prenatal nutrition trial in Bangladesh ( ISRCTN16581394 ) 4436 pregnant women were randomised into 3 types of supplement; either 30 mg Fe and 400 μg folic acid (FE30), or 60 mg Fe and 400 μg folic acid (FE60), or a multiple micronutrient supplement (MMS) containing a daily allowance of 15 micronutrients including 30 mg Fe and folic acid starting at around 14 wk. Adherence was monitored by use of a drug container equipped with an electronic device (eDEM; Aprex). Number of capsules taken between wk14 and wk30 were converted to amount of iron before dose‐response on hemoglobin concentrations at wk30 of gestation were evaluated using adjusted multivariate regression analyses. All 3 types of supplement produced a significant dose effect up to a similar intake of iron (about 2400 mg) after which no further significant effect was observed. In the intake range below 2400mg and evaluated per mg iron ingested ; efficacy of Fe60 was higher then Fe30 and higher than MMS. There was no such difference between Fe30 and MMS. The results showed that a lower total amount of iron than commonly recommended is required for maximum hemoglobin response and addition of multiple micronutrients did not modify efficacy. Main source of funds came from icddr,b Bangladesh, UNICEF, and Sida Sweden
Abstract Background Worldwide, a significant number of girls become mothers during adolescence. In Bangladesh, adolescent childbirth is highly prevalent and has adverse effects on children’s health and undernutrition. We aimed to identify the relationship between the undernutrition of children and adolescent motherhood, the factors associated with adolescent mothers’ age at first birth, and to examine the programmatic factors and gaps influencing children’s undernutrition in Bangladesh. Methods We analysed the ‘Bangladesh Demographic and Health Survey’ BDHS-17-18 data and desk review. To examine the factors associated with adolescent motherhood and its impact on child undernutrition, data from 7,643 mother-child pairs were selected. Child stunting, wasting, and underweight were measured according to the World Health Organisation (WHO) median growth guidelines based on z-scores − 2. Univariate, bivariate, simple, and multiple logistic regressions were used for analyse. We followed the systematic procedures for the literature review. Results Approximately, 89% of adolescents aged ≤ 19 years were married and 71% of them gave their first childbirth. Children of adolescent mothers (≤ 19 years) were significantly 1.68 times more wasted (aOR: 1.68; 95% CI: 1.08 to 2.64), 1.37 times more underweight (aOR: 1.37; 95% CI: 1.01 to 1.86) and either form 1.32 times more stunting, wasting or underweight (aOR:1.32; 95% Cl: 1.05 to 1.66) compared to the children of adult mothers (> 19 years) after adjusting potential confounders. The factors associated with mothers’ first childbirth during adolescence were the age gap between husband and wife 5–10 years (aOR: 1.81; 95% Cl: 1.57–2.10) and age gap > 10 years (aOR: 2.41; 95% Cl: 1.96–2.97) compared with the age group < 5 years, and husbands’ education (aOR: 1.29; 95% Cl: 1.04–1.61) compared with the uneducated husbands. In the literature review, we found potential gaps in focusing on the Adolescent Sexual and Reproductive Health (ASRH) program in Bangladesh, from thirty-two programmes only half of them focused on adolescents aged 10–19 years, and eleven programmes focused only on girls. Conclusion Children of adolescent mothers are at risk of wasting, underweight, and any form of undernutrition. For effective policies and interventions in Bangladesh, it is important to emphasise delaying adolescent pregnancy and prioritising child undernutrition.
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