Dataset Information

Temporal trends in severe malaria in Chittagong, Bangladesh.

ABSTRACT:

Background

Epidemiological data on malaria in Bangladesh are sparse, particularly on severe and fatal malaria. This hampers the allocation of healthcare provision in this resource-poor setting. Over 85% of the estimated 150,000-250,000 annual malaria cases in Bangladesh occur in Chittagong Division with 80% in the Chittagong Hill Tracts (CHT). Chittagong Medical College Hospital (CMCH) is the major tertiary referral hospital for severe malaria in Chittagong Division.

Methods

Malaria screening data from 22,785 inpatients in CMCH from 1999-2011 were analysed to investigate the patterns of referral, temporal trends and geographical distribution of severe malaria in Chittagong Division, Bangladesh.

Results

From 1999 till 2011, 2,394 malaria cases were admitted, of which 96% harboured Plasmodium falciparum and 4% Plasmodium vivax. Infection was commonest in males (67%) between 15 and 34 years of age. Seasonality of malaria incidence was marked with a single peak in P. falciparum transmission from June to August coinciding with peak rainfall, whereas P. vivax showed an additional peak in February-March possibly representing relapse infections. Since 2007 there has been a substantial decrease in the absolute number of admitted malaria cases. Case fatality in severe malaria was 18% from 2008-2011, remaining steady during this period.A travel history obtained in 226 malaria patients revealed only 33% had been to the CHT in the preceding three weeks. Of all admitted malaria patients, only 9% lived in the CHT, and none in the more remote malaria endemic regions near the Indian border.

Conclusions

The overall decline in admitted malaria cases to CMCH suggests recent control measures are successful. However, there are no reliable data on the incidence of severe malaria in the CHT, the most endemic area of Bangladesh, and most of these patients do not reach tertiary health facilities. Improvement of early treatment and simple supportive care for severe malaria in remote areas and implementation of a referral system for cases requiring additional supportive care could be important contributors to further reducing malaria-attributable disease and death in Bangladesh.

SUBMITTER: Maude RJ

PROVIDER: S-EPMC3544696 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Publications

Temporal trends in severe malaria in Chittagong, Bangladesh.

Maude Richard James RJ Hasan Mahtab Uddin MU Hossain Md Amir MA Sayeed Abdullah Abu AA Kanti Paul Sanjib S Rahman Waliur W Maude Rapeephan Rattanawongnara RR Vaid Nidhi N Ghose Aniruddha A Amin Robed R Samad Rasheda R Yunus Emran Bin EB Rahman M Ridwanur MR Bangali Abdul M AM Hoque M Gofranul MG Day Nicholas P J NP White Nicholas J NJ White Lisa J LJ Dondorp Arjen M AM Faiz M Abul MA

Malaria journal 20120912

<h4>Background</h4>Epidemiological data on malaria in Bangladesh are sparse, particularly on severe and fatal malaria. This hampers the allocation of healthcare provision in this resource-poor setting. Over 85% of the estimated 150,000-250,000 annual malaria cases in Bangladesh occur in Chittagong Division with 80% in the Chittagong Hill Tracts (CHT). Chittagong Medical College Hospital (CMCH) is the major tertiary referral hospital for severe malaria in Chittagong Division.<h4>Methods</h4>Malar ...[more]

PMID: 22970881

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Project description:Bangladesh experiences some of the highest malnutrition rates in the world, and efforts are being made to increase food security and overall health status. One of the largest constrains on increasing food security is endemic diseases among livestock and poultry populations. Newcastle Disease (ND) is one of these viral endemic diseases reducing food security. However, the sero- and viro-prevalence of ND has not been thoroughly studied in rural poultry in Bangladesh. Knowledge of farm management practices and their effect on ND sero and viro-prevalence is needed before interventions can occur, and efforts to improve the endemic state of ND cannot begin without a baseline study. This cross-sectional study randomly sampled 129 rural households with 245 chickens for the sero-prevalence and active infection rate of rural chickens in two selected upazilas (sub-districts) of the Chittagong district. ELISA was used for the detection of sero-prevalence, and cloacal samples were analyzed for ND presence using one-step RT-PCR. The aims of this study were to describe farmer demography, determine the ND sero-prevalence at the household and individual chicken level, estimate the proportionate ND prevalence at the individual chicken level, determine potential risk factors for ND sero-prevalence at the household level, and determine challenges farmers face with household chicken farming. The overall household level ND sero-prevalence based on ELISA was 31.8% (41/129) (95% CI: 23.9-40.6%), whereas the overall bird level ND sero-prevalence based on ELISA was 21.2% (52/245) (95% CI: 16.5-26.8%). ND prevalence based on RT-PCR was 12.5% (4/32) (95% CI: 3.5-29.0%). The odds of ND sero-positivity was significantly higher in farms belonging to Rangunia than in farms belonging to Anowara with an odds ratio (OR) of 7.8 (95% CI: 3.3-18.6%). The odds of ND sero-positivity was significantly lower in poultry house cleaning frequency of once or twice weekly compared with once daily cleaning (OR = 0.3; 95% CI: 0.1-0.8%). High cleaning frequency may produce excessive stress on poultry predisposing them to infection. Poultry rearing is different between Anowara and Rangunia. Anowara (coastal) scavenging areas become restricted because of regular tide flow allowing small fishes and other aquatic animals to be the dominant scavengers in Anowara. The incoming tide also removes viral reservoirs such as feces and dead birds that may otherwise be readily accessed by healthy chickens.

Project description:Brucellosis is a neglected endemic zoonosis in Bangladesh and has a significant impact on public health and animal welfare of dairy farming as well as dairy farm economics. A cross-sectional study was conducted to evaluate the seroprevalence of and risk factors for brucellosis in dairy cattle in the Chittagong metropolitan area (CMA) of Chittagong, Bangladesh. We collected serum samples (n = 158) from six randomly selected dairy farms in the CMA between February and November, 2015. The Rose Bengal Plate Test (RBPT) and a competitive ELISA (cELISA) were used as the screening and confirmatory tests respectively. Farm level and animal level demographic and risk factor data were collected using a questionnaire. The risk factors were analysed using a multivariable logistic regression with random effects. The overall seroprevalences of antibodies against brucellosis in cattle were 21.5% (34/158) and 7.6% (12/158) based on parallel and serial interpretation of the two tests respectively. Our results revealed that 20.3% (32/158) samples were positive using the RBPT and 8.9% (14/158) were positive using the cELISA. The within-herd seroprevalence ranged from 10% to 26.3% and 5 to 20.7% using the RBPT and cELISA tests respectively. The odds of seropositivity were significantly higher in lactating cows (OR: 2.59; 95% CI: 1.02-6.55), cows producing less than 2 litres of milk (OR: 29.6; 95% CI: 4.3-353.8), cow producing 2-12 litres of milk (OR: 4.8; 95% CI: 1.1-33.4) and cows with reproductive disorders (OR: 3.2; 95% CI: 1.2-10.1). About 7.6% (12/158) and 1.3% (2/158) of cattle were found to be infected with acute and chronic brucellosis respectively. Based on these results, we suggest that cows that have reproductive disorders and are producing little milk should be prioritized for brucellosis screening in CMA. The screening tests should be used to control brucellosis in cattle in order to protect animal welfare, human health and to minimize the economic losses.

Project description:The proportion of Plasmodium vivax malaria among all malarias is increasing worldwide. Treatment with 8-aminoquinolines remain the only radical cure. However, 8-aminoquinolines can cause severe hemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient patients. The population of the multi-ethnic Chittagong Hill Tracts (CHT) carry the highest malaria burden within Bangladesh. As in many countries the national treatment guidelines recommend 8-aminoquinoline based radical cure without routine G6PD deficiency (G6PDd) testing to guide treatment. Aim of this study was to determine the need for routine testing within a multi-ethnic population by assessing the prevalence of G6PDd among the local population. Participants from 11 ethnicities were randomly selected and malaria status was assessed by microscopy, rapid diagnostic test (RDT) and polymerase chain reaction (PCR). G6PD status was determined by spectrophotometry and G6PD genotyping. The adjusted male median (AMM) was defined as 100% G6PD activity, participants were categorized as G6PD deficient (<30% activity), G6PD intermediate (30% to 70% activity) or G6PD normal (>70% activity). Median G6PD activities between ethnicities were compared and the association between G6PD activity and malaria status was assessed. 1002 participants were enrolled and tested for malaria. G6PD activity was measured by spectrophotometry in 999 participants and host G6PD genotyping undertaken in 323 participants. Seven participants (0.7%) had peripheral parasitaemia detected by microscopy or RDT and 42 by PCR (4.2%). Among 106 participants (32.8%) with confirmed genotype, 99 (93.4%) had the Mahidol variant. The AMM was 7.03U/gHb with 90 (9.0%) G6PD deficient participants and 133 (13.3%) with intermediate G6PD activity. Median G6PD activity differed significantly between ethnicities (p<0.001), proportions of G6PD deficient individuals ranged from 2% to 26% but did not differ between participants with and without malaria. The high G6PDd prevalence and significant variation between ethnicities suggest routine G6PDd testing to guide 8-aminoquinoline based radical in the CHT and comparable settings.

Project description:BackgroundGlucose-6-phosphate-dehydrogenase-deficiency (G6PDd) is a major risk factor for primaquine-induced haemolysis. There is a need for improved point-of-care and laboratory-based G6PD diagnostics to unsure safe use of primaquine.MethodsG6PD activities of participants in a cross-sectional survey in Bangladesh were assessed using two novel quantitative assays, the modified WST-8 test and the CareStart™ G6PD Biosensor (Access Bio), The results were compared with a gold standard UV spectrophotometry assay (Randox). The handheld CareStart™ Hb instrument (Access Bio) is designed to be a companion instrument to the CareStart™ G6PD biosensor, and its performance was compared to the well-validated HemoCue™ method. All quantitative G6PD results were normalized with the HemoCue™ result.ResultsA total of 1002 individuals were enrolled. The adjusted male median (AMM) derived by spectrophotometry was 7.03 U/g Hb (interquartile range (IQR): 5.38-8.69), by WST-8 was 7.03 U/g Hb (IQR: 5.22-8.16) and by Biosensor was 8.61 U/g Hb (IQR: 6.71-10.08). The AMM between spectrophotometry and WST-8 did not differ (p = 1.0) but differed significantly between spectrophotometry and Biosensor (p<0.01). Both, WST-8 and Biosensor were correlated with spectrophotometry (rs = 0.5 and rs = 0.4, both p<0.001). The mean difference in G6PD activity was -0.12 U/g Hb (95% limit of agreement (95% LoA): -5.45 to 5.20) between spectrophotometry and WST-8 and -1.74U/g Hb (95% LoA: -7.63 to 4.23) between spectrophotometry and Biosensor. The WST-8 identified 55.1% (49/89) and the Biosensor 19.1% (17/89) of individuals with G6PD activity <30% by spectrophotometry. Areas under the ROC curve did not differ significantly for the WST-8 and Biosensor irrespective of the cut-off activity applied (all p>0.05). Sensitivity and specificity for detecting G6PD activity <30% was 0.55 (95% confidence interval (95%CI): 0.44-0.66) and 0.98 (95%CI: 0.97-0.99) respectively for the WST-8 and 0.19 (95%CI: 0.12-0.29) and 0.99 (95%CI: 0.98-0.99) respectively for the Biosensor. Hb concentrations measured by HemoCue™ and CareStart™ Hb were strongly correlated (rs = 0.8, p<0.001, mean difference = 0.09 g Hb/dL, 95% LoA: -2.15 to 2.34).ConclusionWST-8 and the CareStart™ G6PD Biosensor represent advances in G6PD diagnostics in resource poor settings, but will require further development before clinical deployment. The CareStart™ Hb instrument produced a precise measure of haemoglobin concentration.

Project description:Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ?38.0 °C and symptoms of up to 14 days' duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative's multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)-5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in decision-making and travel to a lack of money (P<0.001), and more likely to face catastrophic expenditure of more than 25% of monthly household income (P<0.001). We conclude that multidimensional poverty is associated with greater pre-hospital delays and expenditure in this setting. Closer links between health and development agendas could address these consequences of poverty and streamline access to adequate healthcare.

Dataset Information

Temporal trends in severe malaria in Chittagong, Bangladesh.

Background

Methods

Results

Conclusions

Publications

Temporal trends in severe malaria in Chittagong, Bangladesh.

Similar Datasets

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