Introduction: All children, no matter where they born, deserve a healthy start in life. But harsh reality is that, in year 2012, 6.6 million children died in Bangladesh before their fifth birthday. The children constitute a large proportion of the total population of Bangladesh. They are 15 million, the vulnerable or special risk group; deserve exceptional health care as the child mortality and morbidity risks are much higher than their later life. Child morbidity is determined by several complex and inter-related factors in Bangladesh, specially in rural area.Objectives: The objective of this study was to find out the pattern of morbidity of under five children, health seeking behaviour of their parents and the socio-demographic factors affecting those under five children's morbidity.Materials and Methods: This descriptive type of cross sectional study was carried out at Madhupur Thana under a rural area of Tangail District during January 2012 to June 2012 to find out the pattern of morbidities of under five children and health seeking behaviour of their parents. Total 170 mothers were selected purposively to carry out this study.Results: Among the cases of morbidities, 611(100%) sufferings of under five children were recorded from 170 respondents. The highest frequency (133, 21.76%) of sufferings of under five children were from cold, almost the similar number (132, 21.6%) of sufferings were from fever and 116(16.69%) sufferings were from diarrhoea. In this study, health care seeking behaviour for their children were found towards blessings from religious person (Jarphuk/Tabiz-11.77%), spiritual healer (Kobiraj-8.82%), herbal(7.06%), village doctor(20%) drug seller (17.06%), homeopath (12.94%), paramedic (4.71%), MBBS doctors (9.41%) and 8.23% did not take any treatment. Monthly income level of 51.8% respondents were from Taka 5000/- to Taka 10,000/-. On the other hand, only 07 respondents had highest level income of Taka 20,000/- to Taka 30,000/-. The mean income of the mother of under five children was Tk 10,064/- (SD= ± 5709.06). This study revealed that 14 respondents out of 170 did not take any treatment for their under five children. Out of these 14 respondents, 02(14.28%) even did not know the existence of treatment for the morbidity of their under five children. Again, 05(35.71%) respondents had the belief that their children would get cured without any medicine, 04 (28.57%) respondents had no health care centre nearby and 03(21.42%) respondents were unable to bear the treatment cost.Conclusion: Education and awareness of the parents about child health care are important components to reconsider for developing new strategy for improving existing situation of health seeking behaviour of parents for their under-5 children.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 59-63

Background: Down syndrome or trisomy 21 is one of the most common chromosomal disorders with moderate intellectual disability. In addition to mental retardation, this syndrome is associated with different congenital anomalies and characteristic dysmorphic features. Affected individuals are more susceptible to congenital heart disease and digestive anomalies, pulmonary complications, immune and endocrine system disorders. While several international studies have shown association of co-morbidities with trisomy 21, there is insufficient data available in Bangladesh.The present study aimed to evaluate the associated co-morbidities in children with Down syndrome. Methods: A cross-sectional study was conducted among pediatric cases with Down syndrome who attended the endocrine outpatient department (OPD) of BIRDEM General Hospital from June 2006 to December 2016. The cases were diagnosed either by Karyotyping or by characteristic phenotypes.The clinical and laboratory data of the patients were collected from outpatient history records for analysis. Results: There were total 42 children with Down syndrome, with mean age 4.2 years at assessment and female predominance (1.47:1). Thyroid dysfunction was the most common (69%) followed by congenital heart disease (57%). Among the thyroid disorders, acquired hypothyroidism was found in 55% cases, congenital hypothyroidism in 41% cases and only one had hyperthyroidism. Isolated patent ductus arteriosus (PDA) and atrial septal defect (ASD) comprised the commonest single congenital heart disease found in 53% and combined atrioventricular septal defect was the commonest among complex congenital cardiac defect observed in our study. Both thyroid dysfunction and congenital heart disease were found more in female children with Down syndrome than their male counterpart and it was found statistically significant. Fifty percent of our Down syndrome cases were referred from other healthcare centers to address developmental delay. Conclusion: Hypothyroidism and congenital heart disease are frequently associated in Down syndrome children in Bangladesh. This calls for developing awareness among health professionals to diagnose comorbidities at an early stage and to form recommendations for long term follow up. BIRDEM Med J 2021; 11(3): 191-196

Introduction: 46 XY disorders of sexual development (DSD) include a wide sphere of phenotypes which can be ambiguous male genitalia with or without hypospadias, unambiguous female genitalia or dysgenetic gonads or any combination of them. Management of these patients depends on the aetiology, age at presentation, gender orientation and advancement in feminization. Objectives: To assess the clinical, biochemical, radiological and chromosomal profile of the paediatric patients with suspected DSD attending a tertiary level healthcare centre and plan for appropriate management. Materials and Methods: This cross-sectional study was carried out among 30 cases of 46XY DSD attending the paediatric endocrine unit of Bangladesh Institute of Research and Rehabilitation in Diabetes Endocrine and Metabolic Disorders (BIRDEM) General Hospital from May 2016 to April 2017. Clinical, biochemical, radiological and chromosomal evaluations were done to identify the cause of DSD. Results: The mean age of the patients recruited in the study was 3.51 (±5.03) years ranging from 13 days old to 13 years old. Among these 30 patients, the chief complaint was ambiguous genitalia in 29 (96.7%) cases, 1 (3.3%) case with Micropenis and 1 (3.3%) case with absence of development of secondary sexual characteristics. The gender of rearing was male in 23 (76.7%) cases and rest as female. Among the patients 5 (16.67%) patients were diagnosed with PAIS, 5 (16.67%) patients with CAIS, 3 (10%) patients had a deficiency of 5αRD and gonadal dysgenesis was found in 5 (16.67%) patients. The corrective surgery was done in 5(16.67%) patients, 16 (53.3%) patients referred to surgeon for operative treatment and 7(23.3%) patients were prescribed to administer testosterone. Conclusions: The early presentation, correct identification of the cause and initiation of cause-based treatment can abate the physical and psychosocial complications and may support better gender orientation related adjustability. Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 134-138

Van Wyk-Grumbach Syndrome (VWGS) is presented by juvenile hypothyroidism, delayed bone age and isosexual precocious puberty. All of the features will be reversed with treatment of the underlying thyroid hormone deficiency. It has been described, a 3- year-old girl with Down Syndrome who presented with per vaginal bleeding. Physical examination showed typical morphologic features of Down Syndrome and hypothyroidism. Pubertal developments in tanner stages were: breast at stage II and pubic hair at stage I. Serum TSH level was very high. Serum FSH, LH and Estrogen level were also high for her age. On radiological examination her bone age was 2 years. Her pelvic sonogram revealed enlarged uterus with ovarian cysts. These findings confirmed the diagnosis of VWGS. Treatment with Levothyroxine, her vaginal bleeding did not recur and ovarian cyst size decreased after 4 weeks and disappeared after 2 months. In conclusion, thyroid hypo-function must be investigated in children who have precocious puberty with multicystic enlarged ovaries. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 97-99