GLIMPSE VOL. II-No.-6-NOVEMBER-DECEMBER-1989.pdf

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extracted text
Volume 11

Number

6

ISSN

November--------------------------------December

Identification of Potentially
Malnourished Children
More than half of the deaths of young children in
Bangladesh are associated with poor nutritional status.
Diarrhoea and other diseases substantially increase the
risk of dying in these nutritionally vulnerable children.
Prevention of malnutrition is, therefore, a priority in
any child survival programmes.

To combat the problem of malnutrition, there
should be an effective way to identify children who
are likely to become malnourished, and ideally such
children should be identified before they become
severely malnourished. Too often interventions are
directed at children who are already malnourished,
missing the opportunity to treat children when the
most severe nutritional deficit is actually occurring,
but the effects are not yet visible.
Growth monitoring is increasingly being used to
detect children at risk of malnutrition. Although
growth charts were developed to record the health of
individual children they are also recommended as a
tool to identify potentially malnourished children who
need nutritional help. The underlying assumption is
that children who experience poor weight gain are at
risk of becoming malnourished. This is an appealing
concept and has been applied by several major inter­
national organisations to target nutritional interven­
tions.

A recent study tested whether regular monitoring
of weight is an efficient way to detect children at risk
L
of becoming malnourished (Henry FJ, Briend A,
Cooper E. Targeting nutritional interventions: is there
a role for growth monitoring? Health Policy Plann
fj
1989 Dec; 4(4);295-300). The study examined the
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relationship between weight changes and the subse ia Bquent weight of children in an attempt to determine
^■whether there might not be a more practical and
effective indicator of future malnutrition than monthly
^^Llveighing.
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0253-7508

1939

Two cohorts of child
Caribbean were studied Fen In Bangladesh and the
The .results showed that ^TsPecdvefy f°r 18 months.
weight was more closelv r % °ne year of a8e’ bodX
months of age than
with weight at six
previous 3 months m Wei8ht changes during the
months was more ciosHv°\e°Veir’ body weiSht at six
than with birth weight ^rrelaled with later weight
providing nutritional sunnort kv flndi,n8s “dicate that
6-month-old childrejwhoSU.Pple“Taiy f°°d.tO
ing lowAirth ^igKadreTT8 "
. fr P, lse warning of nutritional deficiencies in
infants than momtonng their monthly weight changes
later in lite. The advantage of single against repeated
monthly measurements is also obvious. The children
monitored at around 6 months of age may not neces­
sarily be malnourished at the time, but they are likely
to be the children who will be at the highest risk
later.
Another purpose of growth monitoring is to rein­
force the feeding and hygienic practices of mothers
who have children growing well. In the two cohorts of
children studied in Bangladesh and the Caribbean, the
data show that children who have a high
weight - for - age in early life are also likely to be
better nourished later.
The benefits and limitations of growth monitoring
have been discussed before, but most attention has
been paid to the operational issues involved. In this
paper, the authors question the importance of growth
monitoring as a tool to identify children at the highest
risk of malnutrition, and suggest that it is significantly
and substantially weaker than measuring weight at 6
months Another recent study (see Glimpse. vol. 11
no 4 1989) questioned the relevance of growth
no. 4, tyay; 4
children with a high risk of
monitoring to
<how that the measurement of
death. The results show Wat
their body weight at sixth momu

(continued on page 4)

ICDDR,B Board
Meeting Held
The twenty-first meeting of the Board of Trustees of
the International Centre for Diarrhoeal Disease
Research, Bangladesh (ICDDR,B) was held in Dhaka
from December 14 to 16, 1989. The Chairman of the
Board, Dr Peter Sumbung presided over the meeting.
The Trustees considered and approved the reports
of the Board’s Programme, Personnel and Selection,
and Finance Committees. Thb meeting commended
the Director and his staff for preparing the Centre’s
five-year Strategic Plan which details the priorities
and programmes of ICDDR,B for the 1990-1994
period and approved its implementation.

The Strategic Plan is the result of substantial ef­
forts on the part of the Centre’s management and will
serve as a working guide and integrating mechanism
to the staff, as a terms of reference and framework
upon which to build for the Trustees, and as an
illuminating introduction to potential donors and a

Ason A i

SEAS®RBSEaRCH. RANR
;
TRUSTEES

The members of the ICDDR,B Board of Trustees are s<

clear statement of goals, paths and progress to cur­
rent donors.

The Board also approved the Centre’s budget for
1990. The current estimates indicate that there will
be a shortfall in income of approximately US $ 1.2
million which must be raised to meet the 1990 ex­
penditure.

The meeting of the ICDDR,B Board was followed
by the meeting of the ICDDR,B Donors Support
Group on 17 December 1989. The donors expressed
their satisfaction with the positive changes and direc­
tions taken by the Centre and with the Strategic Plan
that was presented to them. The donors discussed
ways in which they could assist the Centre to achieve
a more sustainable and financially secure base.
It may be mentioned here that the Centre is
governed by a Board of Trustees consisting of 17
members, including 3 from Bangladesh. The present
members are from Australia, Bangladesh, Canada,
Ethiopia, India, Indonesia, Jamaica, Japan, Saudi
Arabia, Sweden, U.K., U.S.A., UNICEF and the
World Health Organization. Three new members
from Australia, Canada, and Saudi Arabia joined the
Board in the current meeting.
•

ABSTRACTS of
ICDDR.B Publications
Phillips JF, Simmons R, Koenig MA, Chakraborty J.
Determinants of reproductive change in a traditional
society: evidence from Matlab, Bangladesh. Stud Fam
Plann 1988 Nov - Dec;19(6):313 - 34.

"A decade ;has elapsed since a project was
launched in Matlab, Bangladesh to test the hypothesis
that contraceptive services can induce and sustain
fertility decline in a rural traditional population. The
demographic impact of this project has been pro­
nounced, lending support to the view that supplyside policies can succeed even where institutional
supports for demand are weak. This paper reviews the
relationship between the Bangladesh climate of
demand and the Matlab system of supply with the
aim of explaining how such effects arise. A sociologi­
cally appropriate system of supply can induce fertility
change in a society where such change would not
spontaneously arise. The study of programs and the
"sociology of the supply side" thus deserve the same
degree of rigor accorded to research on the "sociology
of demand."

Nessa F, Rahman S. The effect of nutrition and
breast feeding on fertility. Bangladesh J Nutr 1988
Dec;2(l):26 - 30.
'’Undemutrition/malnutrition plays a very important
role in reduction of fecundity and fertility and acts as
natural contraception. The major effect is seen in
delayed puberty and secondary amenorrhoea.
Under-fed women has more abortion, foetal wastage
and immature births-leading to high neonatal mortali­
ty. Desire for replacement of child leads to frequent
pregnancy and more malnutrition leading to more
foetal wastage and maternal death which affects fertili ty pattern. Breast-feeding has a considerable impact
on fertility in general and birth intervals in particular.
Lactation achieves its birth spacing effect by delaying
the resumption of ovulation."
£
Islam MS, Drasar BS, Bradley DJ. Attachment of
toxigenic Vibrio cholerae 01 to various freshwater
plants and survival with a filamentous green alga,
Rhizoclonium fontanum. J Trop Med Hyg 1989 Dec;
92(6) :396 - 401.

"In Bangladesh, cholera epidemics occur twice a
year. V.cholrae 01 are readily isolated from the envi­
ronment only during epidemics. The interepidemic
reservoirs or sites of survival and multiplication of V.
cholerae are still unknown. Investigations were carried
out with various fresh-water plants as possible reser­
voirs of V. cholerae in the environment. Attachment
to and acute population changes of V. cholerae on
various plant surfaces was used as a screening tech­
nique to screen a particular plant species for survival
studies. Five plant species, Anabaena variabilis,

Rhizoclonium fontanum, Cladophora sp., Fontinalis
antipyretica and Elodea canadensis were used for
attachment experiments. AmorigThese plants, R.
fontanum showed the best attachment. On the basis
of attachment results, survival experiments were car­
ried out with R. fontanum. At 0.05% salinity toxigen ic V. cholerae 01 survive longer in the presence of R.
fontanum than in medium without algae."

Sayeed S, Sack DA, Qadri F. Cross - reacting anti­
gens between Plesiomonas shigelloides &.Y1 and Shigel­
la sonnei. Bangladesh J Microbiol 1989 Dec;6(2):712.
"Plesiomonas shigelloides, a member of the family
Vibrionaceae, has been reported sporadically as a
possible diarrhoeal agent from different parts of the
world. However, the actual mechanism of pathogene­
sis is unknown. Only one serovar (0:17) shares a
common 0-antigen with that of Shigella sonnei phase
I variants and can agglutinate with anti-0 S. sonnei
serum. In this study, hyperimmune antiserum was
raised in rabbits against whole cell - lysates of S.
sonnei.
In crossed - immunoelectrophoresis, multiple
bands were detected against P. shigelloides SVC 01
antigens. The major cross - reacting antigen was a
dark band near the sample well, typical of lipopoly­
saccharides. On heating, the mobility of the antigen
increased although the antigenicity remained intact.
Purified lipopolysaccharide obtained from P. shigel­
loides SVC 01 showed a similar pattern on crossed immunoelectrophoresis indicating that the lipopolysac­
charide is the only heat-stable cross - reacting anti­
gen between the two species."
(continued on page 4)

Forthcoming International
Meetings and Conferences
INTERNATIONAL SYMPOSIUM ON AEROMONAS AND PLESIOMONAS, Helsingor,
Denmark, September 5 - 6, 1990. Dr A Ljungh or
Dr T Wadstrom, Lund University, Department of
Medical Microbiology, Solvegatan 23, S - 223 62
Lund, Sweden.

33RD SEAMEO - TROPMED REGIONAL
SEMINAR ON EMERGING PROBLEMS IN
FOOD - BORNE PARASITIC ZOONOSIS:
IMPACT ON AGRICULTURE AND PUBLIC
HEALTH, Chiang Mai, Thailand, November 14 —
17, 1990. For further information contact: Prof
Chamlong Harinasuta, Coordinator, SEAMEO TROPMED Project, 420/6 Rajbithi Road, Bangkok
10 400, Thailand.

4

Malnourished children
(continued from page 1)
children at most risk of death than monitoring the
changes in their weight over time.

These findings suggest that, for a primary health
care intervention, choosing children who are in the
lower portion of the weight distribution at 6 months
of age could be a better and more economical way to
identify children at the highest risk of malnutrition.
The proportion of children to be selected to get addi tional nutrition will depend on the type of interven­
tion to be implemented and the resources available. •

ABSTRACTS of
ICDDR,B Publications
(continued from page 3)

Rahim Z, Suthienkul O, Aziz KMS, Echeverria P.
Aeromonas and other indicator bacteria in aquatic
sources in Thailand. Bangladesh J Bot 1989 Dec;
18(2):197 - 204.
"Aeromonas sp., faecal coliforms (FC), and Klebsi­
ella sp. were counted in water samples collected from
one lake, three ponds, and six points of the Chao
Phraya river passing through three important places of
Thailand: Bangkok city, Nonburi and' Samutprakan
province. Counts of Aeromonas sp., FC‘and Klebsiel­
la sp., ranged from 1.5xl03 to 2.6xl04, 1.3xl02 to
l.lxlO4 and 1.7xl03 to 1.5xl04 per 100 ml of water
respectively. Highest Aeromonas sp. and FC counts
were recorded in the water samples collected from
the Chao Phraya river at the Samutprakan province
and from a pond at the National Zoo respectively.
Variation of electrical conductivity, pH and salinity
was noted in the waters of different sampling sites.
The highest salinity 10.3 parts per thousand, pH (7.6)
and electrical conductivity (1.4xl04 micro ohm/cm)
were recorded in the brackish water of the Chao
Phraya river in Samutprakan province."

or accumulation of liver fat (steatosis) was associated
with the development of hypoglycaemia in children
with fatal diarrhoeal illnesses, a case —control study
was carried out comparing 17 children who had blood
sugars <30 mg/dl with 17 age matched control chil­
dren who had blood sugars >59 mg/dl. The most
common causes of diarrhoea in the hypoglycaemic
children were Shigella sp. and Vibrio cholerae. The
mean duration of diarrhoea before admission for the
hypoglycaemic children, 7.8 d, was shorter than the
20.7 d for the controls (P<0.01). Most children in
both groups showed signs of malnutrition, metabolic
acidosis, and pneumonia. Liver specimens were
obtained at post - mortem examination and stained
with haematoxylin and eosin for general assessment
and with periodic acid - Schiff stain for glycogen.
Glycogen depletion was detected in 9 hypoglycaemic
children and in only 3 control children (P<0.05).
Hepatic steatosis, on the other hand, occurred with
equal frequency in both groups but was associated
with severe malnutrition in the hypoglycaemic patients
(P<0.05). This result suggested that hypoglycaemia
develops during acute diarrhoeal illnesses because
gluconeogenesis fails to maintain the blood sugar
concentration after depletion of liver glycogen.
Frequent feeding of children with diarrhoea might
help to prevent this complication."
•

Journal of Diarrhoeal
Diseases Research (JDDR)
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on diarrhoeal disease —
related subjects.
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Butler T, Arnold M, Islam M. Depletion of hepatic
glycogen in the hypoglycaemia of fatal childhood
diarrhoeal illnesses. Trans R Soc Trop Med Hyg 1989
Nov - Dec;83(6):839 - 43.

"To determine whether depletion of liver glycogen

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