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M Munirul Islam
Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh

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Public health
Published: 09 June 2021 in BMJ Open
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Introduction There is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women’s empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women’s empowerment. Evidence suggests that women’s empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women’s empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources. Objective This study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women’s empowerment in rural Bangladesh. Methods and analysis We will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women’s empowerment using a composite indicator based on the Project-Level Women’s Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women’s empowerment and the linkages between the intervention and women’s empowerment outcomes. This paper describes the study protocol to evaluate women’s empowerment in a nutrition-specific and sensitive intervention using internationally validated, innovative tools and will help fill the evidence gap on pathways of impact, highlighting areas to target for future programming. Ethics and dissemination Ethical approval has been obtained from the International Centre for Diarrhoeal Disease Research (Ref. PR 17106) and The University of Sydney (Ref: 2019/840). Findings from this study will be shared in Bangladesh with dissemination sessions in-country and internationally at conferences, and will be published in peer-reviewed journals.

ACS Style

Elizabeth K Kirkwood; Michael John Dibley; John Frederick Hoddinott; Tanvir Huda; Tracey Lea Laba; Tazeen Tahsina; Mohammad Mehedi Hasan; Afrin Iqbal; Jasmin Khan; Nazia Binte Ali; Saad Ullah; Nicholas Goodwin; Sumithra Muthayya; M Munirul Islam; Gulshan Ara; Kingsley Emwinyore Agho; Shams E Arifeen; Ashraful Alam. Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol. BMJ Open 2021, 11, e044263 .

AMA Style

Elizabeth K Kirkwood, Michael John Dibley, John Frederick Hoddinott, Tanvir Huda, Tracey Lea Laba, Tazeen Tahsina, Mohammad Mehedi Hasan, Afrin Iqbal, Jasmin Khan, Nazia Binte Ali, Saad Ullah, Nicholas Goodwin, Sumithra Muthayya, M Munirul Islam, Gulshan Ara, Kingsley Emwinyore Agho, Shams E Arifeen, Ashraful Alam. Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol. BMJ Open. 2021; 11 (6):e044263.

Chicago/Turabian Style

Elizabeth K Kirkwood; Michael John Dibley; John Frederick Hoddinott; Tanvir Huda; Tracey Lea Laba; Tazeen Tahsina; Mohammad Mehedi Hasan; Afrin Iqbal; Jasmin Khan; Nazia Binte Ali; Saad Ullah; Nicholas Goodwin; Sumithra Muthayya; M Munirul Islam; Gulshan Ara; Kingsley Emwinyore Agho; Shams E Arifeen; Ashraful Alam. 2021. "Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol." BMJ Open 11, no. 6: e044263.

Study protocol
Published: 25 November 2020 in BMC Public Health
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Background Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. Method The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. Discussion The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. Trial registration The study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280).

ACS Style

Tanvir M. Huda; Ashraful Alam; Tazeen Tahsina; Mohammad Mehedi Hasan; Afrin Iqbal; Jasmin Khan; Gulshan Ara; Nazia Binte Ali; Saad Ullah Al Amin; Elizabeth K. Kirkwood; Tracey-Lea Laba; Nicholas Goodwin; Sumithra Muthayya; Munirul Islam; Kingsley Emwinyore Agho; John Hoddinott; Shams El Arifeen; Michael J. Dibley. Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh. BMC Public Health 2020, 20, 1 -14.

AMA Style

Tanvir M. Huda, Ashraful Alam, Tazeen Tahsina, Mohammad Mehedi Hasan, Afrin Iqbal, Jasmin Khan, Gulshan Ara, Nazia Binte Ali, Saad Ullah Al Amin, Elizabeth K. Kirkwood, Tracey-Lea Laba, Nicholas Goodwin, Sumithra Muthayya, Munirul Islam, Kingsley Emwinyore Agho, John Hoddinott, Shams El Arifeen, Michael J. Dibley. Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh. BMC Public Health. 2020; 20 (1):1-14.

Chicago/Turabian Style

Tanvir M. Huda; Ashraful Alam; Tazeen Tahsina; Mohammad Mehedi Hasan; Afrin Iqbal; Jasmin Khan; Gulshan Ara; Nazia Binte Ali; Saad Ullah Al Amin; Elizabeth K. Kirkwood; Tracey-Lea Laba; Nicholas Goodwin; Sumithra Muthayya; Munirul Islam; Kingsley Emwinyore Agho; John Hoddinott; Shams El Arifeen; Michael J. Dibley. 2020. "Shonjibon cash and counselling: a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh." BMC Public Health 20, no. 1: 1-14.

Journal article
Published: 30 March 2020 in JMIR Research Protocols
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Diarrhea is the second-leading cause of death in children under 5 years of age. In low- and middle-income countries, 3%-20% of acute diarrheal episodes become persistent diarrhea (PD) (ie, duration ≥14 days), which results in 36%-56% of all diarrheal deaths. In Bangladesh, PD causes >25% of diarrhea-related deaths. Commensal gut microbiota dysbiosis is increasingly recognized in the pathogenesis of PD. Hospital-based management of PD requires a hospital stay, which increases the risk of infection and hospital costs. The higher cost of treatment and high case-fatality rates reiterate PD as an important public health problem. At the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), for the last two decades, a consensus-based guideline has been followed for PD. Observation has revealed that green banana helps in the resolution of diarrhea. However, no larger prospective study has been conducted to evaluate the efficacy of green banana in the management of PD among children older than 6 months of age. Our objective is to assess the efficacy of full-strength rice suji (semolina) with and without green banana compared to three-quarter-strength rice suji in the management of PD in children aged 6-36 months at the Dhaka Hospital of the icddr,b. This open-labeled, randomized controlled study aims to enroll a total of 145 children with PD who have not been improving on a diet of milk suji. Children will be randomized into three different diet-specific groups: full-strength rice suji containing green banana, full-strength rice suji alone, and three-quarter-strength rice suji. The primary outcome is the percentage of children who recovered from diarrhea by day 5. Recruitment and data collection began in December 2017 and were completed in November 2019. Results are expected by April 2020. This study is expected to provide insights into the incorporation of green banana into the dietary management of PD. This would be the first study to investigate the role of microbiota and metabolomics in the pathogenesis of PD. ClinicalTrials.gov NCT03366740; https://clinicaltrials.gov/ct2/show/NCT03366740 DERR1-10.2196/15759

ACS Style

Christel Weiß; Khairun Nain Bin Nor Aripin; Monira Sarmin; Iqbal Hossain; Shoeb Bin Islam; Nur Haque Alam; Shafiqul Alam Sarker; M Munirul Islam; Mohammod Jobayer Chisti; S M Rafiqul Islam; Mustafa Mahfuz; Tahmeed Ahmed. Efficacy of a Green Banana–Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial. JMIR Research Protocols 2020, 9, e15759 .

AMA Style

Christel Weiß, Khairun Nain Bin Nor Aripin, Monira Sarmin, Iqbal Hossain, Shoeb Bin Islam, Nur Haque Alam, Shafiqul Alam Sarker, M Munirul Islam, Mohammod Jobayer Chisti, S M Rafiqul Islam, Mustafa Mahfuz, Tahmeed Ahmed. Efficacy of a Green Banana–Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial. JMIR Research Protocols. 2020; 9 (3):e15759.

Chicago/Turabian Style

Christel Weiß; Khairun Nain Bin Nor Aripin; Monira Sarmin; Iqbal Hossain; Shoeb Bin Islam; Nur Haque Alam; Shafiqul Alam Sarker; M Munirul Islam; Mohammod Jobayer Chisti; S M Rafiqul Islam; Mustafa Mahfuz; Tahmeed Ahmed. 2020. "Efficacy of a Green Banana–Mixed Diet in the Management of Persistent Diarrhea: Protocol for an Open-Labeled, Randomized Controlled Trial." JMIR Research Protocols 9, no. 3: e15759.

Original contribution
Published: 31 July 2019 in European Journal of Nutrition
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To assess the efficacy and safety of F-100, diluted F-100 (F100D), and infant formula (IF) for dietary management in the rehabilitation phase of severe acute malnutrition (SAM) of infants aged under 6 months (u6m). Double-blind randomized clinical trial was conducted to assess the efficacy and safety of F-100, F-100D, and IF at the Nutrition Rehabilitation Unit, icddr,b. Infants (n = 153) u6m with SAM were enrolled and randomly assigned to any of the three diets after stabilization. Two ml blood was collected on study days 1, 3, and 7 for measuring serum electrolytes, creatinine and osmolality, urine samples for specific gravity and osmolality creatinine ratio. Renal Solute Load (RSL) and Potential Renal Solute Load (PRSL) were calculated. Infants were discharged when gained 15% of the admission bodyweight or had edema-free weight-for-length Z-score ≥ − 2. Infants fed F-100 and F-100D had higher weight gain than infants who received IF. Mean difference between F-100 and IF was 4.6 g/kg/d (95% CI 1.5–7.6, P = 0.004) and between F-100D and IF was 3.1 g/kg/d (95% CI 0.6–5.5, P = 0.015). Total energy intake from study diet and breast milk was significantly higher in infants fed F-100 compared with other two diets (P = 0.001 in each case). RSL was highest in infants fed F-100 but serum sodium showed no sign of elevation. Urinary specific gravity and serum sodium values were within normal range. F-100 can be safely used in the rehabilitation phase for infants u6m with SAM and there is no need to prepare alternative formulations.

ACS Style

M. Munirul Islam; Sayeeda Huq; Iqbal Hossain; A. M. Shamsir Ahmed; Ann Ashworth; Abid Hossain Mollah; Tahmeed Ahmed. Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial. European Journal of Nutrition 2019, 59, 2183 -2193.

AMA Style

M. Munirul Islam, Sayeeda Huq, Iqbal Hossain, A. M. Shamsir Ahmed, Ann Ashworth, Abid Hossain Mollah, Tahmeed Ahmed. Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial. European Journal of Nutrition. 2019; 59 (5):2183-2193.

Chicago/Turabian Style

M. Munirul Islam; Sayeeda Huq; Iqbal Hossain; A. M. Shamsir Ahmed; Ann Ashworth; Abid Hossain Mollah; Tahmeed Ahmed. 2019. "Efficacy of F-100, diluted F-100, and infant formula as rehabilitation diet for infants aged < 6 months with severe acute malnutrition: a randomized clinical trial." European Journal of Nutrition 59, no. 5: 2183-2193.

Validation study
Published: 26 July 2019 in Nutrients
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Human-milk-targeted metabolomics analysis offers novel insights into milk composition and relationships with maternal and infant phenotypes and nutritional status. The Biocrates AbsoluteIDQ® p180 kit, targeting 40 acylcarnitines, 42 amino acids/biogenic amines, 91 phospholipids, 15 sphingolipids, and sum of hexoses, was evaluated for human milk using the AB Sciex 5500 QTRAP mass-spectrometer in liquid chromatography-tandem mass-spectrometry (LC-MS/MS) and flow-injection analysis (FIA) mode. Milk ( 18.5; n = 12) and (B) Bangladeshi mothers of stunted infants (height-for-age Z (HAZ)-score <−2; n = 13) was analyzed. Overall, 123 of the possible 188 metabolites were detected in milk. New internal standards and adjusted calibrator levels were used for improved precision and concentration ranges for milk metabolites. Recoveries ranged between 43% and 120% (coefficient of variation (CV): 2.4%–24.1%, 6 replicates). Milk consumed by stunted infants vs. that from mothers with BMI > 18.5 was lower in 6 amino acids/biogenic amines but higher in isovalerylcarnitine, two phospholipids, and one sphingomyelin (p < 0.05 for all). Associations between milk metabolites differed between groups. The AbsoluteIDQ® p180 kit is a rapid analysis tool suitable for human milk analysis and reduces analytical bias by allowing the same technique for different specimens. More research is needed to examine milk metabolite relationships with maternal and infant phenotypes.

ACS Style

Daniela Hampel; Setareh Shahab-Ferdows; Muttaquina Hossain; M. Munirul Islam; Tahmeed Ahmed; Lindsay H. Allen; Shahab- Ferdows. Validation and Application of Biocrates AbsoluteIDQ® p180 Targeted Metabolomics Kit Using Human Milk. Nutrients 2019, 11, 1733 .

AMA Style

Daniela Hampel, Setareh Shahab-Ferdows, Muttaquina Hossain, M. Munirul Islam, Tahmeed Ahmed, Lindsay H. Allen, Shahab- Ferdows. Validation and Application of Biocrates AbsoluteIDQ® p180 Targeted Metabolomics Kit Using Human Milk. Nutrients. 2019; 11 (8):1733.

Chicago/Turabian Style

Daniela Hampel; Setareh Shahab-Ferdows; Muttaquina Hossain; M. Munirul Islam; Tahmeed Ahmed; Lindsay H. Allen; Shahab- Ferdows. 2019. "Validation and Application of Biocrates AbsoluteIDQ® p180 Targeted Metabolomics Kit Using Human Milk." Nutrients 11, no. 8: 1733.

Original article
Published: 25 June 2019 in Maternal & Child Nutrition
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Information on the association between stunting and child development is limited from low‐income settings including Bangladesh where 36% of under‐five children are stunted. This study aimed to explore differences in early childhood development (ECD) between stunted [Length‐for‐age z score (LAZ) <‐2] and non‐stunted (LAZ ≥‐2) children in Bangladesh. Children (n=265) aged 6‐24 months who participated in the MAL‐ED birth cohort study were evaluated by trained psychologists at 6, 15, and 24 months of age using the Bayley Scales of Infant and Toddler Development‐III; child length and weight were measured using standard procedures. ECD scores (z‐scores derived from cognitive, motor, language and socio‐emotional skills) were compared between stunted, underweight (Weight‐for‐Age z‐score <‐2) and wasted (Weight‐for‐Length z‐score <‐2) children, controlling for child age and sex; maternal age, education, body mass index (BMI) and depressive symptoms. Stunted children had significantly lower ECD scores than their non‐stunted peers on cognitive (0.049), motor (P<0.001), language (P<0.001) and social‐emotional (0.038) scales where boys had significantly lower fine motor skills compared to girls (0.027). Mother's schooling and BMI were significant predictors of ECD. Similar to stunting, underweight children had developmental deficits in all domains (cognitive: 0.001; fine motor: 0.039, and P<0.001 for both gross motor and total motor; expressive communication: 0.032; total language: 0.013; social‐emotional development: 0.017). Wasted children had poor motor skills (0.006 for the fine motor; P<0.001 for both gross motor and total motor development) compared to the non‐wasted peers. Early childhood stunting and underweight were associated with poor developmental outcomes in Bangladesh.

ACS Style

Baitun Nahar; Muttaquina Hossain; Mustafa Mahfuz; M. Munirul Islam; Iqbal Hossain; Laura E. Murray‐Kolb; Jessica C. Seidman; Tahmeed Ahmed. Early childhood development and stunting: Findings from the MAL‐ED birth cohort study in Bangladesh. Maternal & Child Nutrition 2019, 16, e12864 .

AMA Style

Baitun Nahar, Muttaquina Hossain, Mustafa Mahfuz, M. Munirul Islam, Iqbal Hossain, Laura E. Murray‐Kolb, Jessica C. Seidman, Tahmeed Ahmed. Early childhood development and stunting: Findings from the MAL‐ED birth cohort study in Bangladesh. Maternal & Child Nutrition. 2019; 16 (1):e12864.

Chicago/Turabian Style

Baitun Nahar; Muttaquina Hossain; Mustafa Mahfuz; M. Munirul Islam; Iqbal Hossain; Laura E. Murray‐Kolb; Jessica C. Seidman; Tahmeed Ahmed. 2019. "Early childhood development and stunting: Findings from the MAL‐ED birth cohort study in Bangladesh." Maternal & Child Nutrition 16, no. 1: e12864.

Article
Published: 01 January 2019 in Obstetrical & Gynecological Survey
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(Abstracted from N Engl J Med 2018;379:535–546) It is unclear whether maternal vitamin D supplementation during pregnancy and lactation improves fetal and infant growth in regions where vitamin D deficiency is common.

ACS Style

Daniel E. Roth; Shaun K. Morris; Stanley Zlotkin; Alison Gernand; Tahmeed Ahmed; Shaila S. Shanta; Eszter Papp; Jill Korsiak; Joy Shi; M. Munirul Islam; Ishrat Jahan; Farhana K. Keya; Andrew R. Willan; Rosanna Weksberg; Minhazul Mohsin; Qazi S. Rahman; Prakesh S. Shah; Kellie E. Murphy; Jennifer Stimec; Lisa G. Pell; Huma Qamar; Abdullah Al Mahmud. Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth. Obstetrical & Gynecological Survey 2019, 74, 1 -2.

AMA Style

Daniel E. Roth, Shaun K. Morris, Stanley Zlotkin, Alison Gernand, Tahmeed Ahmed, Shaila S. Shanta, Eszter Papp, Jill Korsiak, Joy Shi, M. Munirul Islam, Ishrat Jahan, Farhana K. Keya, Andrew R. Willan, Rosanna Weksberg, Minhazul Mohsin, Qazi S. Rahman, Prakesh S. Shah, Kellie E. Murphy, Jennifer Stimec, Lisa G. Pell, Huma Qamar, Abdullah Al Mahmud. Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth. Obstetrical & Gynecological Survey. 2019; 74 (1):1-2.

Chicago/Turabian Style

Daniel E. Roth; Shaun K. Morris; Stanley Zlotkin; Alison Gernand; Tahmeed Ahmed; Shaila S. Shanta; Eszter Papp; Jill Korsiak; Joy Shi; M. Munirul Islam; Ishrat Jahan; Farhana K. Keya; Andrew R. Willan; Rosanna Weksberg; Minhazul Mohsin; Qazi S. Rahman; Prakesh S. Shah; Kellie E. Murphy; Jennifer Stimec; Lisa G. Pell; Huma Qamar; Abdullah Al Mahmud. 2019. "Vitamin D Supplementation in Pregnancy and Lactation and Infant Growth." Obstetrical & Gynecological Survey 74, no. 1: 1-2.

Journal article
Published: 26 September 2018 in International Breastfeeding Journal
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Despite the substantial impact on child and maternal health, breastfeeding practices for infants remain at the suboptimum level in Bangladesh. Yet the understanding of why these practices are suboptimal, especially surrounding urban slum dwelling mothers, is unclear. The purpose of this study was to assess early infant feeding practices, examine associations with maternal factors, and uncover the facilitators and barriers to early feeding practices in selected slums of Dhaka, Bangladesh. A mixed method study was conducted from June to September 2016 using both quantitative and qualitative methods among mothers with children under the age of 6 months. The survey included 342 mother-infant pairs and 18 in-depth interviews were conducted. Univariate and multiple logistic regression was used to determine status of early infant feeding practices and factors associated with exclusive breastfeeding (EBF) within the previous 24 h. Transcripts were coded to uncover the facilitators and barriers surrounding early infant feeding practices. Sixty four percent (220/342) of mothers initiated breastfeeding within 1 h, 96.5% (330/342) reported feeding colostrum, and 36.3% (124/342) infants were EBF in the last 24 h. After adjusting for child gender, maternal age, education, diet and household income; infant’s age (adjusted odds ratio (AOR) for 61–120 days 6.42; 95% CI 3.42, 12.1; AOR for 121–180 days 45.6; 95% CI 18.33, 113.45), prelacteal feeding (AOR 2.53; 95% CI 1.14, 4.58), lack of planning for EBF during pregnancy (AOR 4.06; 95% CI 1.09, 15.12) and infants delivered by cesarean section (AOR 2.76; 95% CI 1.34, 5.67) were negatively associated with EBF. During the 18 interviews, eight mothers reported a cesarean delivery and none of these mothers initiated breastfeeding within 1 h or exclusively breastfed. Moreover, all eight mothers gave their infants prelacteal feeds. The status of early infant feeding practices in Dhaka’s slums was poor. The negative impact of cesarean section on all early infant feeding practices was evident in both quantitative and qualitative analysis.

ACS Style

Halima Khatun; Carly A Comins; Rajesh Shah; M Munirul Islam; Nuzhat Choudhury; Tahmeed Ahmed. Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka’s slums: a mixed method study. International Breastfeeding Journal 2018, 13, 1 -11.

AMA Style

Halima Khatun, Carly A Comins, Rajesh Shah, M Munirul Islam, Nuzhat Choudhury, Tahmeed Ahmed. Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka’s slums: a mixed method study. International Breastfeeding Journal. 2018; 13 (1):1-11.

Chicago/Turabian Style

Halima Khatun; Carly A Comins; Rajesh Shah; M Munirul Islam; Nuzhat Choudhury; Tahmeed Ahmed. 2018. "Uncovering the barriers to exclusive breastfeeding for mothers living in Dhaka’s slums: a mixed method study." International Breastfeeding Journal 13, no. 1: 1-11.

Original article
Published: 14 September 2018 in Maternal & Child Nutrition
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Mothers are often responsible for preparing nutritious foods in their households. However, the quality of mother's diets is often neglected, which may affect both mother's and child's nutrition. Because no single food contains all necessary nutrients, diversity in dietary sources is needed to ensure a quality diet. We aimed to study the association between mother's dietary diversity and stunting in children <2 years attending Dhaka Hospital of icddr,b, a diarrhoeal disease hospital in Dhaka, Bangladesh. A case-control study (n = 296) was conducted from November 2016 to February 2017. Data were collected from mothers of stunted children <2 years (length-for-age z score [LAZ] < -2) as "cases" and nonstunted (LAZ ≥ -1) children <2 years as "controls." Mothers were asked to recall consumption of 10 defined food groups 24 hr prior to the interview as per Guidelines for Minimum Dietary Diversity for Women. Among the mothers of cases, 58% consumed <5 food groups during the last 24 hr, compared with 45% in control mothers (P = 0.03). Children whose mothers consumed <5 food groups were 1.7 times more likely to be stunted than children whose mothers consumed ≥5 food groups (P = 0.04). Intake of food groups such as pulses, dairy, eggs, and vitamin A rich fruit was higher in control mothers. Proportion of mother's illiteracy, short stature, monthly family income

ACS Style

Mahamudul Hasan; M. Munirul Islam; Eman Mubarak; Ahshanul Haque; Nuzhat Choudhury; Tahmeed Ahmed. Mother's dietary diversity and association with stunting among children <2 years old in a low socio-economic environment: A case-control study in an urban care setting in Dhaka, Bangladesh. Maternal & Child Nutrition 2018, 15, e12665 .

AMA Style

Mahamudul Hasan, M. Munirul Islam, Eman Mubarak, Ahshanul Haque, Nuzhat Choudhury, Tahmeed Ahmed. Mother's dietary diversity and association with stunting among children <2 years old in a low socio-economic environment: A case-control study in an urban care setting in Dhaka, Bangladesh. Maternal & Child Nutrition. 2018; 15 (2):e12665.

Chicago/Turabian Style

Mahamudul Hasan; M. Munirul Islam; Eman Mubarak; Ahshanul Haque; Nuzhat Choudhury; Tahmeed Ahmed. 2018. "Mother's dietary diversity and association with stunting among children <2 years old in a low socio-economic environment: A case-control study in an urban care setting in Dhaka, Bangladesh." Maternal & Child Nutrition 15, no. 2: e12665.

Journal article
Published: 02 August 2018 in The American Journal of Tropical Medicine and Hygiene
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Environmental enteric dysfunction (EED) causes gut inflammation and increased intestinal permeability leading to deficiencies in micronutrients such as zinc and iron. Fecal markers such as myeloperoxidase (MPO), neopterin (NEO), and alpha-1-anti-trypsin (AAT) can predict EED. The aim of this study was to examine the association between fecal markers of EED with zinc and iron status among children at first 2 years of life. Malnutrition and Enteric Disease Study Bangladeshi birth cohort data were used to conduct this analysis. Multivariable analyses using generalized estimating equations were performed to test the association between individual fecal markers with zinc or iron status of the children. A total of 265 children were enrolled in the study (male:female = 1:1). Of the 627 stool samples collected (N = 222 children), 535, 511, and 577 were accompanied by zinc, ferritin, and soluble transferrin receptor values, respectively. Median (interquartile range [IQR]) values of AAT, MPO, and NEO were 0.33 (0.18–0.62) mg/g, 3,895.42 (1,563.76–8,432.82) ng/mL, and 890.81 (331.57–2,089.04) nmol/L, respectively. Overall, 60%, 71%, and 97% of samples were above the values considered normal in nontropical settings for AAT, MPO, and NEO, respectively. High AAT levels were significantly associated with low ferritin values after adjusting for age and gender (coefficient = −5.85; 95% confidence interval = −11.23 to −0.47; P value = 0.03). No such association was found between AAT and plasma zinc status. Myeloperoxidase and NEO were not associated with plasma zinc or iron status. The study results imply the importance of enteric protein loss in contributing to reduced ferritin levels at first 2 years of life.

ACS Style

Shah Mohammad Fahim; Subhasish Das; Kazi Istiaque Sanin; Amran Gazi; Mustafa Mahfuz; M. Munirul Islam; Tahmeed Ahmed. Association of Fecal Markers of Environmental Enteric Dysfunction with Zinc and Iron Status among Children at First Two Years of Life in Bangladesh. The American Journal of Tropical Medicine and Hygiene 2018, 99, 489 -494.

AMA Style

Shah Mohammad Fahim, Subhasish Das, Kazi Istiaque Sanin, Amran Gazi, Mustafa Mahfuz, M. Munirul Islam, Tahmeed Ahmed. Association of Fecal Markers of Environmental Enteric Dysfunction with Zinc and Iron Status among Children at First Two Years of Life in Bangladesh. The American Journal of Tropical Medicine and Hygiene. 2018; 99 (2):489-494.

Chicago/Turabian Style

Shah Mohammad Fahim; Subhasish Das; Kazi Istiaque Sanin; Amran Gazi; Mustafa Mahfuz; M. Munirul Islam; Tahmeed Ahmed. 2018. "Association of Fecal Markers of Environmental Enteric Dysfunction with Zinc and Iron Status among Children at First Two Years of Life in Bangladesh." The American Journal of Tropical Medicine and Hygiene 99, no. 2: 489-494.

Original article
Published: 04 July 2018 in Maternal & Child Nutrition
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Severe acute malnutrition (SAM) affects ~4 million infants under 6 months (u6m) worldwide, but evidence underpinning their care is “very low” quality. To inform future research and policy, the objectives of our study were to identify risk factors for infant u6m SAM and describe the clinical and anthropometric outcomes of treatment with current management strategies. We conducted a prospective cohort study in infants u6m in Barisal district, Bangladesh. One group of 77 infants had SAM (weight‐for‐length Z‐score [WLZ] <−3 and/or bipedal oedema); 77 others were “non‐SAM” (WLZ ≥−2 to <+2, no oedema, mid‐upper‐arm circumference ≥125 mm). All were enrolled at 4–8 weeks of age and followed up at 6 months. Maternal education and satisfaction with breastfeeding were among factors associated with SAM. Duration of exclusive breastfeeding was shorter at enrolment (3·9 ± 2.1 vs. 5.7 ± 2.2 weeks, P < 0.0001) and at age 6 months (13.2 ± 8.9 vs. 17.4 ± 7.9 weeks; P = 0.003) among SAM infants. Despite referral, only 13 (17%) reported for inpatient care, and at 6 months, 18 (23%) infants with SAM still had SAM, and 3 (3.9%) died. In the non‐SAM group, one child developed SAM, and none died. We conclude that current treatment strategies have limited practical effectiveness: poor uptake of inpatient referral being the main reason. World Health Organization recommendations and other intervention strategies of outpatient‐focused care for malnourished but clinically stable infants u6m need to be tested. Breastfeeding support is likely central to future treatment strategies but may be insufficient alone. Better case definitions of nutritionally at‐risk infants are also needed.

ACS Style

M. Munirul Islam; Yasir Arafat; Nichola Connell; Golam Mothabbir; Marie McGrath; James A. Berkley; Tahmeed Ahmed; Marko Kerac. Severe malnutrition in infants aged <6 months—Outcomes and risk factors in Bangladesh: A prospective cohort study. Maternal & Child Nutrition 2018, 15, e12642 .

AMA Style

M. Munirul Islam, Yasir Arafat, Nichola Connell, Golam Mothabbir, Marie McGrath, James A. Berkley, Tahmeed Ahmed, Marko Kerac. Severe malnutrition in infants aged <6 months—Outcomes and risk factors in Bangladesh: A prospective cohort study. Maternal & Child Nutrition. 2018; 15 (1):e12642.

Chicago/Turabian Style

M. Munirul Islam; Yasir Arafat; Nichola Connell; Golam Mothabbir; Marie McGrath; James A. Berkley; Tahmeed Ahmed; Marko Kerac. 2018. "Severe malnutrition in infants aged <6 months—Outcomes and risk factors in Bangladesh: A prospective cohort study." Maternal & Child Nutrition 15, no. 1: e12642.

Journal article
Published: 10 April 2018 in BMC Health Services Research
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Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh. The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context. The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition. There is an enabling environment for CMAM intervention in Bangladesh although health system strengthening is needed considering the barriers that have been identified. Training of facility based health staff, government community workers, and ensuring uninterrupted supply of medicines and logistics to the functional facilities should be the immediate priorities. Availability of ready-to-use therapeutic food (RUTF) is a critical component of CMAM and government should promote in-country production of RUTF for effective integration of CMAM into the health system in Bangladesh.

ACS Style

Santhia Ireen; Mohammad Jyoti Raihan; Nuzhat Choudhury; M. Munirul Islam; Iqbal Hossain; Ziaul Islam; S. M. Mustafizur Rahman; Tahmeed Ahmed. Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study. BMC Health Services Research 2018, 18, 256 .

AMA Style

Santhia Ireen, Mohammad Jyoti Raihan, Nuzhat Choudhury, M. Munirul Islam, Iqbal Hossain, Ziaul Islam, S. M. Mustafizur Rahman, Tahmeed Ahmed. Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study. BMC Health Services Research. 2018; 18 (1):256.

Chicago/Turabian Style

Santhia Ireen; Mohammad Jyoti Raihan; Nuzhat Choudhury; M. Munirul Islam; Iqbal Hossain; Ziaul Islam; S. M. Mustafizur Rahman; Tahmeed Ahmed. 2018. "Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study." BMC Health Services Research 18, no. 1: 256.

Multicenter study
Published: 29 March 2018 in PLoS ONE
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The prevalence of stunting among children below 5 years of age is higher in the slum-dwelling population of Bangladesh compared to that in both urban and rural areas. Studies have reported that several factors such as inadequate nutrition, low socio-economic status, poor hygiene and sanitation and lack of maternal education are the substantial predictors of childhood stunting. Almost all these factors are universally present in the slum-dwelling population of Bangladesh. However, few studies have prospectively examined such determinants of stunting among slum populations. In this paper, we reveal the findings of a cohort study with an aim to explore the status of micronutrient adequacy among such vulnerable children and establish its association with stunting along with other determinants. Two-hundred-sixty-five children were enrolled and followed since birth until 24 months of age. We collected anthropometric, morbidity and dietary intake data monthly. We used the 24-hour multiple-pass recall approach to collect dietary intake data from the age of 9 months onward. Micronutrient adequacy of the diet was determined by the mean adequacy ratio (MAR) which was constructed from the average intake of 9 vitamins and 4 minerals considered for the analysis. We used generalized estimating equation (GEE) regression models to establish the determinants of stunting between 12–24 months of age in our study population. The prevalence of low-birth-weight (LBW) was about 28.7% and approximately half of the children were stunted by the age of 24 months. The average micronutrient intake was considerably lower than the recommended dietary allowance and the MAR was only 0.48 at 24 months of age compared to the optimum value of 1. However, the MAR was not associated with stunting between 12–24 months of age. Rather, LBW was the significant determinant (AOR = 3.03, 95% CI: 1.69–5.44) after adjusting for other factors such as age (AOR = 2.12, 95% CI: 1.45–3.11 at 24 months and AOR = 1.97, 95% CI: 1.49–2.59 at 18 months, ref: 12 months) and sex (AOR = 1.98, 95% CI: 1.17–3.33, ref: female). Improving the nutritional quality of complementary food in terms of adequacy of micronutrients is imperative for optimum growth but may not be adequate to mitigate under-nutrition in this setting. Further research should focus on identifying multiple strategies that can work synergistically to diminish the burden of stunting in resource-poor settings.

ACS Style

Kazi Istiaque Sanin; M. Munirul Islam; Mustafa Mahfuz; A. M. Shamsir Ahmed; Dinesh Mondal; Rashidul Haque; Tahmeed Ahmed. Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh. PLoS ONE 2018, 13, e0195072 .

AMA Style

Kazi Istiaque Sanin, M. Munirul Islam, Mustafa Mahfuz, A. M. Shamsir Ahmed, Dinesh Mondal, Rashidul Haque, Tahmeed Ahmed. Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh. PLoS ONE. 2018; 13 (3):e0195072.

Chicago/Turabian Style

Kazi Istiaque Sanin; M. Munirul Islam; Mustafa Mahfuz; A. M. Shamsir Ahmed; Dinesh Mondal; Rashidul Haque; Tahmeed Ahmed. 2018. "Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh." PLoS ONE 13, no. 3: e0195072.

Journal article
Published: 30 January 2018 in BMC Public Health
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Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

ACS Style

M. Munirul Islam; Kazi Istiaque Sanin; Mustafa Mahfuz; A. M. Shamsir Ahmed; Dinesh Mondal; Rashidul Haque; Tahmeed Ahmed. Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study. BMC Public Health 2018, 18, 197 .

AMA Style

M. Munirul Islam, Kazi Istiaque Sanin, Mustafa Mahfuz, A. M. Shamsir Ahmed, Dinesh Mondal, Rashidul Haque, Tahmeed Ahmed. Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study. BMC Public Health. 2018; 18 (1):197.

Chicago/Turabian Style

M. Munirul Islam; Kazi Istiaque Sanin; Mustafa Mahfuz; A. M. Shamsir Ahmed; Dinesh Mondal; Rashidul Haque; Tahmeed Ahmed. 2018. "Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study." BMC Public Health 18, no. 1: 197.

Protocol
Published: 26 January 2018 in Nutrients
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Zinc is essential to supporting growth in young children especially for tissues undergoing rapid cellular differentiation and turnover, such as those in the immune system and gastrointestinal tract. Therapeutic zinc supplementation has been initiated in low-income countries as part of diarrhea treatment programs to support these needs for young children, but the effects of preventive supplemental zinc as a tablet or as a multiple micronutrient powder (MNP) on child growth and diarrheal disease are mixed and pose programmatic uncertainties. Thus, a randomized, double-blind community-based efficacy trial of five different doses, forms, and frequencies of preventive zinc supplementation vs. a placebo was designed for a study in children aged 9–11 months in an urban community in Dhaka, Bangladesh. The primary outcomes of this 24-week study are incidence of diarrheal disease and linear growth. Study workers will conduct in-home morbidity checks twice weekly; anthropometry will be measured at baseline, 12 weeks and 24 weeks. Serum zinc and other related biomarkers will be measured in a subsample along with an estimate of the exchangeable zinc pool size using stable isotope techniques in a subgroup. Therapeutic zinc will be provided as part of diarrhea treatment, in accordance with Bangladesh’s national policy. Therefore, the proposed study will determine the additional benefit of a preventive zinc supplementation intervention. The protocol has been approved by the Institutional Review Boards (IRBs) of icddr,b and Children’s Hospital Oakland Research Institute (CHORI). The IRB review process is underway at the University of Colorado Denver as well.

ACS Style

M. Munirul Islam; Christine M. McDonald; Nancy F. Krebs; Jamie Westcott; Ahmed Ehsanur Rahman; Shams El Arifeen; Tahmeed Ahmed; Janet C. King; Robert E. Black. Study Protocol for a Randomized, Double-Blind, Community-Based Efficacy Trial of Various Doses of Zinc in Micronutrient Powders or Tablets in Young Bangladeshi Children. Nutrients 2018, 10, 132 .

AMA Style

M. Munirul Islam, Christine M. McDonald, Nancy F. Krebs, Jamie Westcott, Ahmed Ehsanur Rahman, Shams El Arifeen, Tahmeed Ahmed, Janet C. King, Robert E. Black. Study Protocol for a Randomized, Double-Blind, Community-Based Efficacy Trial of Various Doses of Zinc in Micronutrient Powders or Tablets in Young Bangladeshi Children. Nutrients. 2018; 10 (2):132.

Chicago/Turabian Style

M. Munirul Islam; Christine M. McDonald; Nancy F. Krebs; Jamie Westcott; Ahmed Ehsanur Rahman; Shams El Arifeen; Tahmeed Ahmed; Janet C. King; Robert E. Black. 2018. "Study Protocol for a Randomized, Double-Blind, Community-Based Efficacy Trial of Various Doses of Zinc in Micronutrient Powders or Tablets in Young Bangladeshi Children." Nutrients 10, no. 2: 132.

Journal article
Published: 02 January 2018 in International Journal of Environmental Research and Public Health
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Data is scarce on early life exposure to arsenic and its association with malnutrition during infancy. This study followed the nutritional status of a cohort of 120 infants from birth to 9 months of age in an arsenic contaminated area in Bangladesh. Anthropometric data was collected at 3, 6 and 9 months of the infant’s age for nutritional assessment whereas arsenic exposure level was assessed via tube well drinking water arsenic concentration at the initiation of the study. Weight and height measurements were converted to Z-scores of weight for age (WAZ-underweight), height for age (HAZ-stunting), weight for height (WHZ-wasting) for children by comparing with WHO growth standard. Arsenic exposure levels were categorized as <50 μg/L and ≥50 μg/L. Stunting rates (<−2 SD) were 10% at 3 months and 44% at both 6 and 9 months. Wasting rates (<−2 SD) were 23.3% at 3 months and underweight rates (<−2 SD) were 25% and 10% at 3 and 6 months of age, respectively. There was a significant association of stunting with household drinking water arsenic exposure ≥50 μg/L at age of 9 months (p = 0.009). Except for stunting at 9 months of age, we did not find any significant changes in other nutritional indices over time or with levels of household arsenic exposure in this study. Our study suggests no association between household arsenic exposure and under-nutrition during infancy; with limiting factors being small sample size and short follow-up. Difference in stunting at 9 months by arsenic exposure at ≥50 μg/L might be a statistical incongruity. Further longitudinal studies are warranted to establish any association.

ACS Style

Abul Hasnat Milton; John Attia; Mohammad Alauddin; Mark McEvoy; Patrick McElduff; Sumaira Hussain; Ayesha Akhter; Shahnaz Akter; M. Munirul Islam; Am Shamsir Ahmed; Vasu Iyengar; Rafiqul Islam. Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure. International Journal of Environmental Research and Public Health 2018, 15, 57 .

AMA Style

Abul Hasnat Milton, John Attia, Mohammad Alauddin, Mark McEvoy, Patrick McElduff, Sumaira Hussain, Ayesha Akhter, Shahnaz Akter, M. Munirul Islam, Am Shamsir Ahmed, Vasu Iyengar, Rafiqul Islam. Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure. International Journal of Environmental Research and Public Health. 2018; 15 (1):57.

Chicago/Turabian Style

Abul Hasnat Milton; John Attia; Mohammad Alauddin; Mark McEvoy; Patrick McElduff; Sumaira Hussain; Ayesha Akhter; Shahnaz Akter; M. Munirul Islam; Am Shamsir Ahmed; Vasu Iyengar; Rafiqul Islam. 2018. "Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure." International Journal of Environmental Research and Public Health 15, no. 1: 57.

Research article
Published: 01 January 2018 in Clinical Medicine Insights: Pediatrics
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Background: World Health Organization guidelines advise community-based care (CBC) for “uncomplicated” severe acute malnutrition (SAM) infants Methods: The methods used in this study are as follows: in-depth interviews and focus group discussions (FGDs) in southern Bangladesh, thematic analysis of transcripts, and sample size by data saturation. Results: We conducted 5 FGDs with 29 caregivers, 4 with 29 health care workers, 4 key informant interviews each with community leaders and health supervisors. Five themes emerged. 1) Identification of SAM infants and care-seeking behavior: malnutrition was not noticed until severe, caregivers focused on clinical symptoms. Both allopathic and traditional healers were consulted. (2) Perceived causes of infant malnutrition: underlying illness, poor feeding practices, poverty, and local superstitions. (3) Views and preferences on treatment: hospitals and doctors were perceived as offering the best treatment, health care workers were also important, and respondents highlighted the need care of the caregiver/mother along with the infant. (4) Perceived benefits and risks of CBC: lower cost and greater accessibility were appreciated but worried about quality. (5) Community networks: wider family and social support networks were considered important aspects of care. Conclusions: There is considerable potential for CBC but needs to be better and earlier identification of at-risk infants, strengthening of health systems to avoid community options being perceived as “second best,” engagement with families and communities to tackle “upstream” determinants of SAM, and care for mother-infant pairs.

ACS Style

Yasir Arafat; M Munirul Islam; Nicki Connell; Golam Mothabbir; Marie McGrath; James A Berkley; Tahmeed Ahmed; Marko Kerac. Perceptions of Acute Malnutrition and Its Management in Infants Under 6 Months of Age: A Qualitative Study in Rural Bangladesh. Clinical Medicine Insights: Pediatrics 2018, 12, 1 .

AMA Style

Yasir Arafat, M Munirul Islam, Nicki Connell, Golam Mothabbir, Marie McGrath, James A Berkley, Tahmeed Ahmed, Marko Kerac. Perceptions of Acute Malnutrition and Its Management in Infants Under 6 Months of Age: A Qualitative Study in Rural Bangladesh. Clinical Medicine Insights: Pediatrics. 2018; 12 ():1.

Chicago/Turabian Style

Yasir Arafat; M Munirul Islam; Nicki Connell; Golam Mothabbir; Marie McGrath; James A Berkley; Tahmeed Ahmed; Marko Kerac. 2018. "Perceptions of Acute Malnutrition and Its Management in Infants Under 6 Months of Age: A Qualitative Study in Rural Bangladesh." Clinical Medicine Insights: Pediatrics 12, no. : 1.

Randomized controlled trial
Published: 19 December 2017 in Food and Nutrition Bulletin
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Background: With a prevalence of 3.1%, approximately, 450 000 children in Bangladesh are having severe acute malnutrition (SAM). There is currently no national community-based program run by government to take care of these children, one of the reasons being lack of access to ready-to-use therapeutic food (RUTF). Objective: To develop RUTF using locally available food ingredients and test its acceptability. Methods: A checklist was prepared for all food ingredients available and commonly consumed in Bangladesh that have the potential of being used for developing a RUTF. Linear programming was used to identify the combinations of nutrients that would result in an ideal RUTF. To test the acceptability of 2 local RUTFs compared to the prototype RUTF, Plumpy’Nut, a clinical trial with a crossover design was conducted among 30 children in the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. The acceptability was determined by using the mean proportion of offered food consumed by the children themselves. Results: Two RUTFs were developed, one based on chickpea and the other on rice–lentils. The total energy content of 100 g of chickpea and rice–lentil-based RUTF were 537.4 and 534.5 kcal, protein 12.9 and 13.5 g, and fat 31.8 and 31.1 g, respectively, without any significant difference among the group. On an average, 85.7% of the offered RUTF amount was consumed by the children in 3 different RUTF groups which implies that all types of RUTF were well accepted by the children. Conclusion: Ready-to-use therapeutic foods were developed using locally available food ingredients—rice, lentil, and chickpeas. Chickpea-based and rice–lentil-based RUTF were well accepted by children with SAM.

ACS Style

Nuzhat Choudhury; Tahmeed Ahmed; Iqbal Hossain; M. Munirul Islam; Shafiqul A. Sarker; Mamane Zeilani; John David Clemens. Ready-to-Use Therapeutic Food Made From Locally Available Food Ingredients Is Well Accepted by Children Having Severe Acute Malnutrition in Bangladesh. Food and Nutrition Bulletin 2017, 39, 116 -126.

AMA Style

Nuzhat Choudhury, Tahmeed Ahmed, Iqbal Hossain, M. Munirul Islam, Shafiqul A. Sarker, Mamane Zeilani, John David Clemens. Ready-to-Use Therapeutic Food Made From Locally Available Food Ingredients Is Well Accepted by Children Having Severe Acute Malnutrition in Bangladesh. Food and Nutrition Bulletin. 2017; 39 (1):116-126.

Chicago/Turabian Style

Nuzhat Choudhury; Tahmeed Ahmed; Iqbal Hossain; M. Munirul Islam; Shafiqul A. Sarker; Mamane Zeilani; John David Clemens. 2017. "Ready-to-Use Therapeutic Food Made From Locally Available Food Ingredients Is Well Accepted by Children Having Severe Acute Malnutrition in Bangladesh." Food and Nutrition Bulletin 39, no. 1: 116-126.

Dataset
Published: 09 November 2017 in Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines
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ACS Style

M Munirul Islam; Nichola Connell. Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines. Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines 2017, 1 .

AMA Style

M Munirul Islam, Nichola Connell. Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines. Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines. 2017; ():1.

Chicago/Turabian Style

M Munirul Islam; Nichola Connell. 2017. "Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines." Management of Acute Malnutrition in Infants aged <6 months: Improving the evidence underlying new WHO Malnutrition Guidelines , no. : 1.

Journal article
Published: 04 October 2017 in The American Journal of Clinical Nutrition
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Background: In clinical settings, wasting in childhood has primarily been assessed with the use of a weight-for-height z score (WHZ), and in community settings, it has been assessed via the midupper arm circumference (MUAC) with a cutoff <115 mm for severe wasting and <115–125 mm for moderate wasting. Our recent experience indicates that many wasted children were not identified when these cutoffs for MUAC were used. Objective: We determined the cutoffs for MUAC to detect wasting in Bangladeshi children aged 6–60 mo. Design: A secondary analysis was carried out on data from 27,767 children aged 6–59 mo. This analysis comprised 1) 9131 children across Bangladesh and 2) 18,636 children enrolled in a surveillance study in the Dhaka Hospital of icddr,b during 1996–2014. The area under the receiver operating curve was used to indicate the most appropriate choice for cutoffs that related MUAC with WHZ. Results: The mean ± SD age for the entire group was 21 ± 14 mo, WHZ was −1.18 ± 1.23, height-for-age z score was −1.63 ± 1.39, MUAC was 136 ± 14 mm, and 45% of subjects were girls. MUAC correlated with the WHZ (r: 0.618, P < 0.001). Age-stratified analyses revealed that, for ages 6–24 mo, MUAC cutoffs were <120 mm for a WHZ <−3 and <125 mm for a WHZ <−2 with a sensitivity of 72.9% and 63.2%, respectively, and a specificity of 84.7% and 85.3%, respectively; for ages 25–36 mo, MUAC cutoffs were <125 mm for a WHZ <−3 and <135 mm for a WHZ <−2 with a sensitivity of 55.0% and 71.7%, respectively, and a specificity of 92.8% and 78.7% respectively; and for ages 37–60 mo, MUAC cutoffs were <135 mm for a WHZ <−3 and <140 mm for a WHZ <−2 with a sensitivity of 71.4% and 70.4%, respectively, and a specificity of 84.6% and 80.3%, respectively. Conclusion: The respective cutoffs for MUAC to better capture the vulnerability and risk of severe (WHZ <−3) and moderate (WHZ <−2) wasting would be <120 and <125 mm for ages 6–24 mo, <125 and <135 mm for ages 25–36 mo, and <135 and <140 mm for ages 37–60 mo.

ACS Style

Iqbal Hossain; Tahmeed Ahmed; Shams El Arifeen; Sk Masum Billah; Asg Faruque; M Munirul Islam; Alan A Jackson. Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6–60 mo: an analytical study. The American Journal of Clinical Nutrition 2017, ajcn139881 .

AMA Style

Iqbal Hossain, Tahmeed Ahmed, Shams El Arifeen, Sk Masum Billah, Asg Faruque, M Munirul Islam, Alan A Jackson. Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6–60 mo: an analytical study. The American Journal of Clinical Nutrition. 2017; ():ajcn139881.

Chicago/Turabian Style

Iqbal Hossain; Tahmeed Ahmed; Shams El Arifeen; Sk Masum Billah; Asg Faruque; M Munirul Islam; Alan A Jackson. 2017. "Comparison of midupper arm circumference and weight-for-height z score for assessing acute malnutrition in Bangladeshi children aged 6–60 mo: an analytical study." The American Journal of Clinical Nutrition , no. : ajcn139881.