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      Vulnerability of Newborns to Environmental Factors: Findings from Community Based Surveillance Data in Bangladesh

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          Abstract

          Infection is the major cause of neonatal deaths. Home born newborns in rural Bangladeshi communities are exposed to environmental factors increasing their vulnerability to a number of disease agents that may compromise their health. The current analysis was conducted to assess the association of very severe disease (VSD) in newborns in rural communities with temperature, rainfall, and humidity. A total of 12,836 newborns from rural Sylhet and Mirzapur communities were assessed by trained community health workers using a sign based algorithm. Records of temperature, humidity, and rainfall were collected from the nearest meteorological stations. Associations between VSD and environmental factors were estimated. Incidence of VSD was found to be associated with higher temperatures (odds ratios: 1.14, 95% CI: 1.08 to 1.21 in Sylhet and 1.06, 95% CI: 1.04 to 1.07 in Mirzapur) and heat humidity index (odds ratios: 1.06, 95% CI: 1.04 to 1.08 in Sylhet and, 1.03, 95% CI: 1.01 to 1.04 in Mirzapur). Four months (June–September) in Sylhet, and six months in Mirzapur (April–September) had higher odds ratios of incidence of VSD as compared to the remainder of the year (odds ratios: 1.72, 95% CI: 1.32 to 2.23 in Sylhet and, 1.62, 95% CI: 1.33 to 1.96 in Mirzapur). Prevention of VSD in neonates can be enhanced if these interactions are considered in health intervention strategies.

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          Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial.

          Abdullah Baqui, Shams El-Arifeen, Gary Darmstadt … (2008)
          Neonatal mortality accounts for a high proportion of deaths in children under the age of 5 years in Bangladesh. Therefore the project for advancing the health of newborns and mothers (Projahnmo) implemented a community-based intervention package through government and non-government organisation infrastructures to reduce neonatal mortality. In Sylhet district, 24 clusters (with a population of about 20 000 each) were randomly assigned in equal numbers to one of two intervention arms or to the comparison arm. Because of the study design, masking was not feasible. All married women of reproductive age (15-49 years) were eligible to participate. In the home-care arm, female community health workers (one per 4000 population) identified pregnant women, made two antenatal home visits to promote birth and newborn-care preparedness, made postnatal home visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick neonates. In the community-care arm, birth and newborn-care preparedness and careseeking from qualified providers were promoted solely through group sessions held by female and male community mobilisers. The primary outcome was reduction in neonatal mortality. Analysis was by intention to treat. The study is registered with ClinicalTrials.gov, number 00198705. The number of clusters per arm was eight. The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and comparison arms, respectively, with 14 769, 16 325, and 15 350 livebirths, respectively. In the last 6 months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and comparison arms, respectively. Neonatal mortality was reduced in the home-care arm by 34% (adjusted relative risk 0.66; 95% CI 0.47-0.93) during the last 6 months versus that in the comparison arm. No mortality reduction was noted in the community-care arm (0.95; 0.69-1.31). A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality.
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            Seasonality of infectious diseases.

            David N Fisman (2007)
            Seasonality, a periodic surge in disease incidence corresponding to seasons or other calendar periods, characterizes many infectious diseases of public health importance. The recognition of seasonal patterns in infectious disease occurrence dates back at least as far as the Hippocratic era, but mechanisms underlying seasonality of person-to-person transmitted diseases are not well understood. Improved understanding will enhance understanding of host-pathogen interactions and will improve the accuracy of public health surveillance and forecasting systems. Insight into seasonal disease patterns may be gained through the use of autocorrelation methods or construction of periodograms, while seasonal oscillation of infectious diseases can be easily simulated using simple transmission models. Models demonstrate that small seasonal changes in host or pathogen factors may be sufficient to create large seasonal surges in disease incidence, which may be important particularly in the context of global climate change. Seasonality represents a rich area for future research.
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              Local understandings of vulnerability and protection during the neonatal period in Sylhet District, Bangladesh: a qualitative study.

              Peter Winch, M. Ashraful Alam, Afsana Akther … (2005)
              Understanding of local knowledge and practices relating to the newborn period, as locally defined, is needed in the development of interventions to reduce neonatal mortality. We describe the organisation of the neonatal period in Sylhet District, Bangladesh, the perceived threats to the well-being of neonates, and the ways in which families seek to protect them. We did 39 in-depth, unstructured, qualitative interviews with mothers, fathers, and grandmothers of neonates, and traditional birth attendants. Data on neonatal knowledge and practices were also obtained from a household survey of 6050 women who had recently given birth. Interviewees defined the neonatal period as the first 40 days of life (chollish din). Confinement of the mother and baby is most strongly observed before the noai ceremony on day 7 or 9, and involves restriction of movement outside the home, sleeping where the birth took place rather than in the mother's bedroom, and sleeping on a mat on the floor. Newborns are seen as vulnerable to cold air, cold food or drinks (either directly or indirectly through the mother), and to malevolent spirits or evil eye. Bathing, skin care, confinement, and dietary practices all aim to reduce exposure to cold, but some of these practices might increase the risk of hypothermia. Although fatalism and cultural acceptance of high mortality have been cited as reasons for high levels of neonatal mortality, Sylheti families seek to protect newborns in several ways. These actions reflect a set of assumptions about the newborn period that differ from those of neonatal health specialists, and have implications for the design of interventions for neonatal care.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (publisher-id): 101238455
                Title: International Journal of Environmental Research and Public Health
                Publisher: Molecular Diversity Preservation International (MDPI)
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Print): August 2011
                Publication date (Electronic): 22 August 2011
                Volume: 8
                Issue: 8
                Pages: 3437-3452
                Affiliations
                [1 ] Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E8138, Baltimore, MD 21205, USA; E-Mails: ychoi@ 123456usaid.gov (Y.C.); anastasia.coutinho@ 123456gmail.com (A.J.C.); mohshah@ 123456jhsph.edu (R.S.); pwinch@ 123456jhsph.edu (P.J.W.); gdarmsta@ 123456jhsph.edu (G.L.D.); abaqui@ 123456jhsph.edu (A.H.B.)
                [2 ] Save the Children, H 1(A) 2, Road 91, Dhaka 1212, Bangladesh
                [3 ] International Center for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh; E-Mails: atiquei@ 123456icddrb.org (A.I.C.); moshfiq@ 123456icddrb.org (S.M.R.); habibur.seraji@ 123456adelaide.edu.au (H.R.S.); bari@ 123456icddrb.org (S.B.); shams@ 123456icddrb.org (S.E.A.)
                Author notes
                [* ] Author to whom correspondence should be addressed: E-Mail: ismannan@ 123456savechildren.org ; Tel.: +88-01730327515.
                Article
                Publisher ID: ijerph-08-03437
                DOI: 10.3390/ijerph8083437
                PMC ID: 3166752
                PubMed ID: 21909316
                SO-VID: e52ae868-115f-440f-ad4b-b3b368205f6f
                Copyright © © 2011 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/3.0/).

                History
                Date received : 6 May 2011
                Date revision received : 12 August 2011
                Date accepted : 16 August 2011
                Categories
                Subject: Article

                ScienceOpen disciplines: Public health
                Keywords: heat humidity index,neonatal,infection,community health workers,sepsis,environment,bangladesh
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: heat humidity index, neonatal, infection, community health workers, sepsis, environment, bangladesh

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