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Abnormal vaginal discharge is a common symptom of genital infection in women. The aim of the present study was to evaluate the various causes of vaginal discharge in sexually active females. A cross-sectional study was undertaken among women aged 15 to 45 years with abnormal vaginal discharge, with or without itching attended at Sir Salimullah Medical College, Dhaka for a period of 6 months. After making the clinical diagnosis, appropriate tests for diagnosing candidiasis, trichomoniasis, gonorrhea and bacterial vaginosis were done. Among all patients, organisms responsible for abnormal vaginal discharges were found in 94.8% of the cases, of which vaginal candidiasis (53.6%) was the most common, followed by bacterial vaginosis (29.2%), trichomoniasis (10.8%), gonorrhea (1.2%) and non-specific other urogenital causes (5.2%). The most common age groups affected by vaginal candidiasis, bacterial vaginosis and trichomoniasis were 26-35 years (64.9%), 26-35 years (27.6%) and 15-25 years (52%) respectively. Gonorrhea was recorded in the age group of 15-25 years (66.7%). Most of the organisms were isolated in the age group of 30-40 years. The causative agent of vaginal candidiasis was the leading cause of vaginal discharge in the age group of sexually active women and next to it was the bacterial vaginosis. A lower rate of Trichomonas vaginalis was found in our study in comparison to other studies. DOI: http://dx.doi.org/10.3329/seajph.v1i1.13211 South East Asia Journal of Public Health 2011:1:35-39

BackgroundIn November 2011, a government hospital physician in Shibganj sub-district of Bangladesh reported a cluster of patients with fever and joint pain or rash. A multi-disciplinary team investigated to characterize the outbreak; confirm the cause; and recommend control and prevention measures.MethodsShibganj's residents with new onset of fever and joint pain or rash between 1 September and 15 December 2011 were defined as chikungunya fever (CHIKF) suspect cases. To estimate the attack rate, we identified 16 outpatient clinics in 16 selected wards across 16 unions in Shibganj and searched for suspect cases in the 80 households nearest to each outpatient clinic. One suspect case from the first 30 households in each ward was invited to visit the nearest outpatient clinic for clinical assessment and to provide a blood sample for laboratory testing and analyses.ResultsWe identified 1,769 CHIKF suspect cases from among 5,902 residents surveyed (30%). Their median age was 28 (IQR:15−42) years. The average attack rate in the sub-district was 30% (95% CI: 27%−33%). The lowest attack rate was found in children <5 years (15%). Anti-CHIKV IgM antibodies were detected by ELISA in 78% (264) of the 338 case samples tested. In addition to fever, predominant symptoms of serologically-confirmed cases included joint pain (97%), weakness (54%), myalgia (47%), rash (42%), itching (37%) and malaise (31%). Among the sero-positive patients, 79% (209/264) sought healthcare from outpatient clinics. CHIKV was isolated from two cases and phylogenetic analyses of full genome sequences placed these viruses within the Indian Ocean Lineage (IOL). Molecular analysis identified mutations in E2 and E1 glycoproteins and contained the E1 A226V point mutation.ConclusionThe consistently high attack rate by age groups suggested recent introduction of chikungunya in this community. Mosquito control efforts should be enhanced to reduce the risk of continued transmission and to improve global health security.

Abstract.Recurrent outbreaks of acute encephalitis syndrome (AES) among children in lychee growing areas in Asia highlight the need to better understand the etiology and the context. We conducted a mixed-methods study to identify risk factors for disease, and behaviors and practices around lychee cultivation in an AES outbreak community in northern Bangladesh in 2012. The outbreak affected 14 children; 13 died. The major symptoms included unconsciousness, convulsion, excessive sweating, and frothy discharge. The median time from illness onset to unconsciousness was 2.5 hours. The outbreak corresponded with lychee harvesting season. Multiple pesticides including some banned in Bangladesh were frequently used in the orchards. Visiting a lychee orchard within 24 hours before onset (age-adjusted odds ratio [aOR] = 11.6 [1.02–109.8]) and 3 days (aOR = 7.2 [1.4–37.6]), and family members working in a lychee orchard (aOR = 7.2 [1.7–29.4]) and visiting any garden while pesticides were being applied (aOR = 4.9 [1.0–19.4]) in 3 days preceding illness onset were associated with illness in nearby village analysis. In neighborhood analysis, visiting an orchard that used pesticides (aOR = 8.4 [1.4–49.9]) within 3 days preceding illness onset was associated with illness. Eating lychees was not associated with illness in the case–control study. The outbreak was linked to lychee orchard exposures where agrochemicals were routinely used, but not to consumption of lychees. Lack of acute specimens was a major limitation. Future studies should target collection of environmental and food samples, acute specimens, and rigorous assessment of community use of pesticides to determine etiology.

Abstract.Bangladesh introduced hepatitis B vaccine in a phased manner during 2003–2005 into the routine childhood vaccination schedule. This study was designed to evaluate the impact of the introduction of hepatitis B vaccine in Bangladesh by comparing hepatitis B surface antigen (HBsAg) prevalence among children born before and after vaccine introduction and to estimate the risk of vertical transmission of chronic hepatitis B virus (HBV) infection from mother to infant. We also evaluated the field sensitivity and specificity of an HBsAg point-of-care test strip. We selected a nationally representative sample of 2,100 prevaccine era and 2,100 vaccine era children. We collected a 5-mL blood sample from each child. One drop of blood was used to perform rapid HBsAg testing. If a child had a positive HBsAg test result with the rapid test, a blood sample was collected from the mother of the HBsAg-positive child and from the mothers of two subsequently enrolled HBsAg-negative children. All samples were tested for serologic markers of HBV infection using standard enzyme-linked immunosorbent assay. One (0.05%) child in the vaccine era group and 27 (1.2%; 95% confidence interval [CI]: 0.8–1.7%) children in the prevaccine era group were HBsAg positive. Mothers of HBsAg-positive children were more likely to be HBsAg positive than mothers of HBsAg-negative children (odds ratios = 4.7; 95% CI: 1.0–21.7%). Sensitivity of the HBsAg rapid test was 91.2% (95% CI: 76.6–98.1%) and specificity was 100% (95% CI: 99.9–100%). The study results suggest that even without a birth dose, the hepatitis B vaccine program in Bangladesh was highly effective in preventing chronic HBV infection among children.