We describe mothers' perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers' perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers (n = 24) could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia.

Background: Depression is a chronic disorder, which often remains undiagnosed. There is a gross lack of evidence-based information about depressive illnesses among adult individuals from rural Bangladesh. Objective: The present study aimed to determine the factors that are associated with depressive illness but remain undiagnosed among rural healthy adult individuals. Methodology: A cross-sectional study was conducted in the Demographic Surveillance System area of rural Mirzapur sub-district, during April to September 2010. A total of 130 apparently healthy individuals [no history of hypertension, cardiovascular diseases, hepatic (serum alanine transaminase; ALT) or renal (serum creatinine) dysfunction; diabetic mellitus (fasting blood sugar)] aged 40 years and above were randomly selected from the DSS database. Level of depression was assessed using 30-item Geriatric Depression Scale. Results: Forty-two percent of the healthy participants were found to have mild depression, 17% were severely depressed. In multivariate analysis, females had a 2.79 [95% CI-0.94-8.26] times higher risk for depression compared to males. Healthy elderly individuals (≥60 years) had a 2.79 [0.94-8.33] times higher risk for depression compared to their middle-aged counterparts (40-59 years). Furthermore, individuals who consumed a vegetable-based diet were at 2.47 [0.85-7.15] times higher risk for depression; individuals with low monthly income were at 2.57 [0.94-7.01] times higher, and those with poor wealth index were 1.55 [1.07-2.25] times more likely to suffer from depression compared to their counterparts after adjusting for vitamin B12, folic acid, ALT, and blood hemoglobin. Conclusion: Healthy elderly individuals from rural Bangladesh were more depressed than middle-aged adults; and females with poor socioeconomic status were at higher risk for depression than males.

Objective: The present study determined trends in malnutrition among under-5 children in urban and rural areas of Bangladesh. Design: Surveillance. Setting: The study was conducted in the urban Dhaka and the rural Matlab hospitals of the International Centre for Diarrhoeal Disease Research, Bangladesh, where every fiftieth patient and all patients coming from the Health and Demographic Surveillance System were enrolled. Subjects: A total of 28 816 under-5 children were enrolled at Dhaka from 1993 to 2012 and 11 533 at Matlab between 2000 and 2012. Results: In Dhaka, 46 % of the children were underweight, 39 % were stunted and 28 % were wasted. In Matlab, the corresponding figures were 39 %, 31 % and 26 %, respectively. At Dhaka, 0·5 % of the children were overweight and obese when assessed by weight-for-age Z-score >+2·00, 1·4 % by BMI-for-age Z-score >+2·00 and 1·4 % by weight-for-height Z-score >+2·00; in Matlab the corresponding figures were 0·5 %, 1·4 % and 1·4 %, respectively. In Dhaka, the proportion of underweight, stunting and wasting decreased from 59 % to 28 % (a 53 % reduction), from 54 % to 22 % (59 % reduction) and from 33 % to 21 % (36 % reduction), respectively, between 1993 and 2012. In Matlab, these indicators decreased from 51 % to 27 % (a 47 % reduction), from 36 % to 25 % (31 % reduction) and from 34 % to 14 % (59 % reduction), respectively, from 2000 to 2012. On the other hand, the proportion of overweight (as assessed by BMIfor-age Z-score) increased significantly over the study period in both Dhaka (from 0·6 % to 2·6 %) and Matlab (from 0·8 % to 2·2 %). Conclusions: The proportion of malnourished under-5 children has decreased gradually in both urban and rural Bangladesh; however, the reduction rates are not in line with meeting Millennium Development Goal 1. Trends for increasing childhood obesity have been noted during the study period as well. Keywords Bangladesh Malnutrition Overweight and obesityRural and urban Under-5 childrenEconomic improvement and reduction in poverty, both in developed and developing countries, have been observed within the last couple of decades; however, the pace is not sufficient to meet Millennium Development Goal 1 ('eradicate extreme poverty and hunger') (1) . Improvement has also occurred in meeting basic health needs such as the prevention and treatment of infectious and communicable diseases (2) , and efforts have been made to ensure provision of safe drinking-water and improved sanitation practices to reduce diarrhoeal episodes (2,3) . According to WHO, globally about 27 % of children are stunted (4) and 17 % are underweight (5) . The scenario is even worse in the Asian subcontinent and sub-Saharan Africa (2) . Despite efforts to reduce childhood malnutrition through various interventions, it remains a great public health challenge (2) . The other components of malnutrition, such as overweight and obesity, are emerging public health concerns (6,7) . In 2011, WHO reported that over 40 million children under the age of 5 years (under-5s) were ove...

Abstractobjectives To determine and compare socio-demographic, nutritional and clinical characteristics of children under five with diarrhoea living in slums with those of children who do not live in slums of Dhaka, Bangladesh.methods From 1993 to 2012, a total of 28 948 under fives children with diarrhoea attended the Dhaka Hospital of icddr,b. Data were extracted from the hospital-based Diarrhoea Disease Surveillance System, which comprised 17 548 under fives children from slum and non-slum areas of the city. conclusions Slum-dwelling children are more malnourished, have lower immunisation rates (measles vaccination and vitamin A supplementation) and higher rates of measles, are more susceptible to diarrhoeal illness due to V. cholerae and suffer from severe dehydration more often than children from non-slum areas. Improved health and nutrition strategies should give priority to children living in urban slums.

The objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23-0·35, P < 0·001] and elderly (aOR 0·15, 95% CI 0·11-0·20, P < 0·001) patients were more likely to present to rural diarrhoeal disease facilities than urban ones. Vibrio cholerae was the most commonly isolated pathogen (16%) of the four pathogens tested followed by rotavirus (5%), enterotoxigenic Escherichia coli (ETEC) (4%), and Shigella (4%). Of these pathogens, V. cholerae (19% vs. 11%, P < 0·001), ETEC (9% vs. 4%, P < 0·001), and rotavirus (5% vs. 3%, P = 0·013) were more commonly detected from patients presenting to urban hospitals than rural hospitals, but Shigella was more frequently isolated from patients presenting to rural hospitals than urban hospitals (7% vs. 2%, P < 0·001). The isolation rate of Shigella was higher in the elderly than in younger adults (8% vs. 3%, P < 0·001). Some or severe dehydration was higher in urban adults than rural adults (P < 0·001). Our findings indicate that despite economic and other progress made, conditions facilitating transmission of V. cholerae and Shigella prevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.