Cystic Fibrosis Diagnosed Using Indigenously Wrapped Sweating Technique: First Large-Scale Study Reporting Socio-Demographic, Clinical, and Laboratory Features among the Children in Bangladesh A Lower Middle Income Country

Arm Luthful Kabir; Sudipta Roy; Rahat Bin Habib; Kazi Selim Anwar; Md Abid Hossain Mollah; Ruhul Amin; Al Amin Mridha; Jasim Uddin Majumder; Md Delwar Hossain; Nazmul Haque; Shakil Ahmed; Mohammod Jobayer Chisti

doi:10.1177/2333794X20967585

Cystic Fibrosis Diagnosed Using Indigenously Wrapped Sweating Technique: First Large-Scale Study Reporting Socio-Demographic, Clinical, and Laboratory Features among the Children in Bangladesh A Lower Middle Income Country

Glob Pediatr Health. 2020 Oct 30:7:2333794X20967585. doi: 10.1177/2333794X20967585. eCollection 2020.

Authors

Affiliations

¹ Ad-din Women's Medical College Hospital, Dhaka, Bangladesh.
² Director General Health Services, Dhaka, Bangladesh.
³ IUHW, Narita, Chiba, Japan.
⁴ Dhaka Medical College, Dhaka, Bangladesh.
⁵ Institute of Child Health (BICH), Dhaka, Bangladesh.
⁶ Shaheed Shuhrawardy Medical College, Dhaka, Bangladesh.
⁷ East West Medical College, Dhaka, Bangladesh.
⁸ Institute of Child and Mother Health (ICMH), Dhaka, Bangladesh.
⁹ International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

Abstract

Due to lack of robust data on childhood cystic fibrosis (CF) in Bangladesh we sought to evaluate their clinico-epidemiology. A cross-sectional observation was conducted adopting CF-foundation consensus-panel-diagnostic criteria in 3 tertiary-care-hospitals in Bangladesh from 2000 to 2017. Clinically suspected 95 CF-cases were subjected to sweat-chloride testing using locally-developed a fast, cheap and effective indigenously body-wrapped sweating technique measured by US-Easy Lyte-automated microprocessor-controlled analyzer marking ≥60 mmol/L as positive. Mean-age of CF-cases at disease-onset was 16.9 ± 26.6 months that significantly differed with age-at-diagnosis (P < .02). Pulmonary syndromes included chronic wet cough in 100%, respiratory distress in 90.5%, digital-clubbing in 78%, mucopurulent-sputum in 74%-cases, and crepitation in 82%. Radio-imaging revealed bronchiectasis in 60%, hyperinflation/peribronchial-thickening in 22% and, pan-sinusitis in 89%-cases. While 37% had history-of malabsorption, high-fecal-fat revealed in 53%-cases. Malnutrition prevailed as severe-underweight in 87%-cases and all CF-cases (100%) had high sweat-chloride (mean = 118 ± 53.34 mmol/L). Thus, children with pulmonary features coupled with severe malnutrition and associated radio-imaging bronchiectasis should be screened for CF with a fast, cheap and effective sweat test in resource poor settings.

Keywords: Bangladesh; Cystic fibrosis; children; first large-scale report; indigenously wrapped sweating technique.