Nawshad Ahmed | Child Health Research Foundation (original) (raw)

Papers by Nawshad Ahmed

Journal of Health, Population and Nutrition, 2021

BackgroundTopical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonata... more BackgroundTopical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants <33 weeks’ gestational age in Bangladesh. We sought to determine whether the emollient treatments improved neurodevelopmental outcomes during early childhood.Methods497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points.Results123 children completed at least one follow-up visit. Lowess gra...

Pulse, 2011

Background: Preterm very low birth weight babies are at increased risk of perinatal, neonatal and... more Background: Preterm very low birth weight babies are at increased risk of perinatal, neonatal and postnatal mortality and morbidity, mainly due to infections and complications of prematurity. Mortality of VLBW neonates is 30 times more than that of normal weight. Outcomes of such infants have been reported extensively from developed countries, but less is known from developing countries like Bangladesh though prematurity is very common.Objective: To determine the morbidities associated with preterm VLBW neonates with particular emphasis on sepsis. Methods: A prospective cohort study was done in Special Care Baby Unit of a tertiary care teaching hospital from July 2009 to December 2009. Preterm VLBW neonates admitted within 7 days of age comprised the cohort for the study. Detailed physical findings and information on pregnancy, delivery and immediate postnatal period were recorded on enrolment. Sepsis workup was done whenever sepsis was suspected clinically. Daily follow-up was give...

PLOS ONE, Mar 24, 2010

Background: To evaluate a delivery strategy for newborn interventions in rural Bangladesh. Method... more Background: To evaluate a delivery strategy for newborn interventions in rural Bangladesh. Methods: A cluster-randomized controlled trial was conducted in Mirzapur, Bangladesh. Twelve unions were randomized to intervention or comparison arm. All women of reproductive age were eligible to participate. In the intervention arm, community health workers identified pregnant women; made two antenatal home visits to promote birth and newborn care preparedness; made four postnatal home visits to negotiate preventive care practices and to assess newborns for illness; and referred sick neonates to a hospital and facilitated compliance. Primary outcome measures were antenatal and immediate newborn care behaviours, knowledge of danger signs, care seeking for neonatal complications, and neonatal mortality. Findings: A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm, respectively. High coverage of antenatal (91% visited twice) and postnatal (69% visited on days 0 or 1) home visitations was achieved. Indicators of care practices and knowledge of maternal and neonatal danger signs improved. Adjusted mortality hazard ratio in the intervention arm, compared to the comparison arm, was 1.02 (95% CI: 0.80-1.30) at baseline and 0.87 (95% CI: 0.68-1.12) at endline. Primary causes of death were birth asphyxia (49%) and prematurity (26%). No adverse events associated with interventions were reported. Conclusion: Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation, and improvements in targeted newborn care practices suggests the intervention did not adequately address risk factors for mortality. The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions. Programs must ensure skilled care during childbirth, including management of birth asphyxia and prematurity, and curative postnatal care during the first two days of life, in addition to essential newborn care and infection prevention and management.

SAS journal of medicine, Dec 14, 2020

Original Research Article Background: Mechanical Ventilation (MV) has become frequently used life... more Original Research Article Background: Mechanical Ventilation (MV) has become frequently used life-supportive management in Pediatric Intensive Care Units (PICU). But very little data is available from developing countries regarding the outcome analysis coupled with demographic status and clinical details which is a challenge for the modern day intensivists. Objective: To determine the characteristics and outcome of ventilated patients in the pediatrics medical intensive care unit in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh. Methods: A prospective descriptive study was conducted on ventilated children admitted to PICU from January to December 2019. The factors studied included demographic and clinical profile, length of stay on ventilator, indications for ventilation and the final outcome. Results: A total of 144 (23%) cases admitted in PICU were ventilated over the period of one year. Male to female ratio was 1.36: 1. Neurological (27.8%) and respiratory (25.6%) causes were found to be the commonest indicators of ventilation in the study. The average ventilator stay was 2.4 days and hospital stay was 9.71 days. 51% of ventilated cases were infants and 81% of total deaths occurred under five years age group.49.3% of ventilated cases were successfully discharged and neurological cases had a better outcome (64%) among all the cases. Conclusion: This study provides an insight into the present status of PICU in Dhaka Shishu (Children) Hospital analyses the limitations and recommends the need to strengthen PICU to improve the quality care for the better survival of critically ill children.

Pediatric Infectious Disease Journal, Aug 1, 2019

Background: Pediatric recipients of hematopoietic stem cell and solid organ transplants are at in... more Background: Pediatric recipients of hematopoietic stem cell and solid organ transplants are at increased risk of invasive pneumococcal infections (IPI). Data on IPI in this population is scarce. To our knowledge, this is the first study describing the epidemiology of IPI among pediatric transplant recipients in the pneumococcal conjugate vaccine (PCV) era. Methods: We identified transplant recipients with IPI at 8 children's hospitals in the U.S. from our surveillance database (2000-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Categorical variables were analyzed by Fisher's exact test and continuous variables with nonparametric tests. Indirect cohort study design was used to calculate vaccine effectiveness. Results: We identified 65 episodes of IPI in transplant recipients. Recurrent IPI was observed in 10% of transplant recipients. The IPI crude incidence rate in solid organ transplant recipients was higher than in the general population. Most IPI episodes occurred > 6 months after transplantation. Bacteremia and pneumonia were the most common presentations.

Scholars journal of applied medical sciences, Dec 14, 2020

Original Research Article Background: Antimicrobial resistance is one of the major public health ... more Original Research Article Background: Antimicrobial resistance is one of the major public health emergencies worldwide, and this trend didn't spare developing countries like Bangladesh.

Saudi journal of medical and pharmaceutical sciences, Dec 14, 2020

Introduction: Incidence of dengue infection has increased around the world in recent decades and ... more Introduction: Incidence of dengue infection has increased around the world in recent decades and has become a major international public health concern. Early diagnosis is essential and clinical suspicion is based on the frequency of symptoms in the population. The exact clinical profile is important for management and prognosis. Objective: This study is an attempt to describe the Clinical Characteristics & Observation of Hospitalized Cases of Dengue Fever: A Study in Tertiary Care Hospital, Dhaka, Bangladesh. Materials and Methods: A hospital-based prospective study was undertaken in the Paediatrics Dept. in Tertiary Care Hospital, Dhaka, Bangladesh (July-October 2018). NS1 antigen and IgM dengue antibody-positive cases were included. These patients were admitted with fever, myalgia, headache, vomiting, abdominal pain or bleeding manifestations. NS1 antigen and IgM dengue antibody was estimated using capture ELISA. The diagnosis of dengue fever, dengue hemorrhagic fever and dengue shock syndrome was based on the WHO (World Health Organization) criteria. Results: The study enrolled 101 patients of suspected dengue fever of whom 51 (50.49%) were serologically confirmed to have dengue infection. 28 (55.0%) patients were males and 23 (45.0%) were females. 38 (37.62%) patients had classic dengue fever while 12 (11.88%) fulfilled the criteria of dengue hemorrhagic fever. Of those patients with dengue hemorrhagic fever, 6 patients had developed dengue shock syndrome. Conclusion: Dengue presents as a highly unspecific illness and is hardly recognized as a clinical entity by primary health care physicians. Dengue infection can have potentially fatal consequences, and to date, vector control methods to prevent the spread of the virus have been unsuccessful. Although there are promising vaccine candidates in development, further studies are required for a greater understanding of the humoral immune responses to Dengue infection and observation disease pathogenesis.

Journal of Bangladesh College of Physicians and Surgeons, 1970

Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms ... more Neonatal sepsis is defined as a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 28 days of life. Of newborns with early-onset sepsis, 85% present within 24 hours, 5% present at 24-48 hours, and a smaller percentage present within 48-72 hours. The present study included 38 septic neonates. They were divided into two groups: Group with early onset neonatal sepsis (29) and another group with late onset neonatal sepsis (9). The study group with early-onset sepsis showed 18 (62.1%) males, 11 (37.9%) females, mean gestational age (weeks) 34.28±4.7, mean body weight (gm) 2.1±0.8, mean Apgar score at 1 min. 6.7±1.8. 21 (72.4%) delivered by CS, 8 (27.6%) delivered by NVD. E. coli was the commonest organism identified in blood culture of septic neonates. Maternal anemia, PROM, and fever were significant risk factors for neonatal sepsis. Prematurity and low birth weights were among the most common neonatal risk factors. Respiratory manifestations were the commonest manifestations of neonatal sepsis in both groups. Treating maternal anemia during pregnancy will help to reduce the incidence of neonatal sepsis E. coli is still an important cause of early-onset neonatal sepsis. Blood cultures need to be done strictly before the start of the first dose of antibiotic.

PLOS Medicine

Background There is limited data on antibiotic treatment in hospitalized neonates in low- and mid... more Background There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. Methods and findings Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa). Prospective daily observational data was collected on clinical signs, supportive care, antibiotic treatment, microbiology, and 28-day mortality. Two prediction models were developed for (1) 28-day mortality from baseline variables (baseline NeoSep Severity Score); and (2) daily risk of death on IV antibiotics from daily updated assessments (NeoSep Recovery Score). Multivariable Cox regression models included a randomly selected 85% of infants, with 15% for validation. A total of 3,204 infants were enrolled,...

Antibiotics

Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income count... more Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income countries. To deliver high-quality data studies and inform future trials, it is crucial to understand the challenges encountered when managing global multi-centre research studies and to identify solutions that can feasibly be implemented in these settings. This paper provides an overview of the complexities faced by diverse research teams in different countries and regions, together with actions implemented to achieve pragmatic study management of a large multi-centre observational study of neonatal sepsis. We discuss specific considerations for enrolling sites with different approval processes and varied research experience, structures, and training. Implementing a flexible recruitment strategy and providing ongoing training were necessary to overcome these challenges. We emphasize the attention that must be given to designing the database and monitoring plans. Extensive data collection too...

BackgroundSepsis severity scores are used in clinical practice and trials to define risk groups. ... more BackgroundSepsis severity scores are used in clinical practice and trials to define risk groups. There are limited data to derive hospital-based sepsis severity scores for neonates and young infants in high-burden low- and middle-income country (LMIC) settings where trials are urgently required. We aimed to create linked sepsis severity and recovery scores applicable to hospitalized neonates and young infants in LMIC which could be used to inform antibiotic trials.Methods & FindingsA prospective observational cohort study was conducted across 19 hospitals in 11 countries in sub-Saharan Africa, Asia, Latin America and Europe. Infants aged <60 days with clinical sepsis fulfilling at least two clinical or laboratory criteria (≥1 clinical) were enrolled. Primary outcome was 28-day mortality. Two prediction models were developed for 1) 28-day mortality from factors at sepsis presentation (baseline NeoSep Severity Score), and 2) daily risk of death on IV antibiotics from daily updated ...

Journal of Bangladesh College of Physicians and Surgeons, 2017

Prematurity is a common neonatal problem in developing countries and is associated with high mort... more Prematurity is a common neonatal problem in developing countries and is associated with high mortality and both immediate and long-term morbidities. More a baby is premature more is the chance of mortality. With the advent of modern supportive care favorable outcome has been observed in extremely premature babies in developed countries, but the outcome is not satisfactory in developing countries. Recently, an incredibly low birth weight (456 grams) micro preemie was successfully managed in Dhaka Shishu Hospital. With round the clock care at the hospitals Neonatal Intensive Care Unit she was tipping the scales and discharged at the age of three months, weighing 1128 grams. To the best of our knowledge, this is the lowest birth weight baby survived in our country, an exceptional achievement and a milestone in newborn care in Bangladesh.J Bangladesh Coll Phys Surg 2017; 35(3): 142-146

Clinical Infectious Diseases, 2020

Background Enteric fever causes substantial morbidity and mortality in low- and middle-income cou... more Background Enteric fever causes substantial morbidity and mortality in low- and middle-income countries. Here, we analyzed Surveillance for Enteric Fever in Asia Project (SEAP) data to estimate the burden of enteric fever hospitalization among children aged <15 years and identify risk factors for hospitalization in Bangladesh. Methods SEAP used hospital surveillance paired with a community-based health-care utilization assessment. In SEAP hospital surveillance, blood was obtained for culture from children aged <15 years with ≥3 days of fever. In the hospital catchment area, a health-care utilization survey (HCUS) was conducted to estimate the proportion of febrile children hospitalized at the study hospitals. We analyzed hospital surveillance and HCUS data to estimate the health care–adjusted incidence of enteric fever hospitalization, and conducted univariable and multivariable logistic regressions. Results From July 2017 through June 2019, 2243 laboratory-confirmed enteric f...

Scholars Journal of Applied Medical Sciences, 2020

Original Research Article Background: Nutritional rickets remains a public health problem in many... more Original Research Article Background: Nutritional rickets remains a public health problem in many countries, despite dramatic declines in the prevalence of the condition in many developed countries since the discoveries of vitamin D and the role of ultraviolet light in prevention. It is very important in treating patients with nutritional rickets to know about the clinical presentation and etiology of this disease. Aim of the study: The aim of this study was to evaluate the clinical presentation and etiology of nutritional rickets among 0-5 year's children of Bangladesh. Methods: The prospective observational study was conducted in in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh during the period from August 2015 to July 2017. Child aged 1-5 years attending in the mentioned with complaints bowing of leg and/or clinical symptoms consistent with rickets were approached. Suspected rickets cases were investigated further and total 100 cases were analyzed. Informed consent and ethical measures were ensured in each cases. Result: In this study we found, 52.22% participants were with bow leg whereas 25.56% were with knock knee, 7.78% were with sabre tibia and 16.67% were with double malleolus. On the other hand, as upper limb deformities we found 27.78% with swelling and/or widening wrists, 11.11% with craniotabes and 12.22% with wide anterior. Besides these, as other deformities we found 26.67% with rib beading, 25.56% with pectus carinatum, 26.67% with delayed growth and 21.11% with delayed dentition. In analyzing the factors of nutritional rickets we found the skin color was fair, medium and dark of 10%, 46.67% and 43.33% respectively. On the other hand, 73.33% child got exclusive breastfeeding for 4-6 months and 26.67 got less than 4 months. In total 40% child got sunlight exposure for more than 30 minutes/day whereas 60% got it less than 30 minutes/day. Conclusion: Our study indicates that, nutritional rickets is a significant health burden that deserves special attention. The findings of this study may be helpful for the researchers in further studies on the same issues and in the treatment procedure of nutritional rickets.

Infectious Diseases, 2017

Background: Bacterial meningitis is a significant burden of disease and mortality in all age grou... more Background: Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. Methods: We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. Results: We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. Conclusions: As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease.

The Pediatric Infectious Disease Journal, 2016

A centralized data management system was developed for data collection and processing for the Aet... more A centralized data management system was developed for data collection and processing for the Aetiology of Neonatal Infection in South Asia (ANISA) study. ANISA is a longitudinal cohort study involving neonatal infection surveillance and etiology detection in multiple sites in South Asia. The primary goal of designing such a system was to collect and store data from different sites in a standardized way to pool the data for analysis. We designed the data management system centrally and implemented it to enable data entry at individual sites. This system uses validation rules and audit that reduce errors. The study sites employ a dual data entry method to minimize keystroke errors. They upload collected data weekly to a central server via internet to create a pooled central database. Any inconsistent data identified in the central database are flagged and corrected after discussion with the relevant site. The ANISA Data Coordination Centre in Dhaka provides technical support for operations, maintenance and updating the data management system centrally. Password-protected login identifications and audit trails are maintained for the management system to ensure the integrity and safety of stored data. Centralized management of the ANISA database helps to use common data capture forms (DCFs), adapted to site-specific contextual requirements. DCFs and data entry interfaces allow on-site data entry. This reduces the workload as DCFs do not need to be shipped to a single location for entry. It also improves data quality as all collected data from ANISA goes through the same quality check and cleaning process.

The Pediatric infectious disease journal, 2016

The multisite community-based study, Aetiology of Neonatal Infection in South Asia (ANISA), uses ... more The multisite community-based study, Aetiology of Neonatal Infection in South Asia (ANISA), uses blood culture as the gold standard for identifying the etiology of neonatal infection. Considering the importance of this age-old diagnostic tool and the risk of contamination, ANISA has employed rigorous measures to prevent contamination at all stages of blood collection, processing and culture. Because contamination may still occur, an independent expert group evaluates the routinely collected clinical and laboratory data to determine whether a blood culture isolate is a contaminant or a true pathogen. This article describes the methodology used by ANISA to determine whether a blood culture isolate is likely to be a true pathogen or a contaminant in neonatal sepsis.

Clinical Infectious Diseases, Mar 1, 2009

Background. Streptococcus pneumoniae infection is recognized as a global priority public health p... more Background. Streptococcus pneumoniae infection is recognized as a global priority public health problem, and conjugate vaccines have been shown to prevent vaccine-type invasive pneumococcal disease (IPD) in children. However, better estimates of the disease burden and reliable population-based data on serotype composition are needed for vaccine development and implementation in developing countries. Methods. We initiated a population-based surveillance in the rural Bangladesh community of Mirzapur, covering a population of ∼144,000. Village health care workers made weekly visits to ∼12,000 children 1-59 months of age in the study area. Children with reported fever, cough, or difficulty breathing were assessed by the village health care workers using a clinical algorithm and were referred to the hospital if required. Children from the study area who were seen in the hospital underwent clinical examination and laboratory testing if they met standardized case definitions. IPD was confirmed by blood and/or cerebrospinal fluid culture results. Isolates were identified, tested for susceptibility to antibiotics, and serotyped in accordance with standard laboratory methods. We present here the results from the first 3 years of the surveillance (July 2004-June 2007). Results. Village health care workers identified 5020 cases of possible severe pneumonia and/or very severe disease (165 cases per 1000 child-years)and 9411 cases of possible pneumonia (310 cases per 1000 child-years) as well as 2029 cases of suspected meningitis and/or very severe disease (67 cases per 1000 child-years) and 8967 cases of high fever and/or possible bacteremia (295 cases per 1000 child-years). Pneumonia was the single most common form of illness observed among 2596 hospitalizations (found in 977 [38%] of cases). We recovered 26 S. pneumoniae isolates (25 isolates from 6925 blood cultures and 1 isolate from 41 cerebrospinal fluid cultures), which gave an overall IPD incidence of 86 cases per 100,000 child-years. Invasive pneumococcal infection was common during infancy (with infants accounting for 23 of the 26 cases), and 50% of the total isolates were obtained from nonhospitalized patients who received a diagnosis of upper respiratory tract infection and fever. The most prevalent pneumococcal serotypes were serotypes 1, 5, 14, 18C, 19A, and 38. Ten of the 26 isolates were completely resistant to trimethoprim-sulfamethoxazole, and another 10 isolates had intermediate resistance. Conclusions. IPD contributes substantially to childhood morbidity in rural Bangladesh. S. pneumoniae can cause invasive but nonsevere disease in children, and IPD incidence can be seriously under reported if such cases are overlooked. The emerging high resistance to trimethoprim-sulfamethoxazole should be addressed. Data on serotype distribution would help to guide appropriate pneumococcal conjugate vaccine formulation. Acute respiratory infections are still among the leading causes of childhood mortality in developing countries,