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Cutaneous Leishmaniasis is a rare disease in South-East Asian countries like Bangladesh, often presenting as skin lesions, ulcers or granulomatous plaques on the arm or back. As the disease is uncommon, high index of suspicion is required for the diagnosis. We are presenting a case of cutaneous Leishmaniasis in a migrant Bangladeshi worker in the Kingdom of Saudi Arabia (KSA). The case was initially treated with antibiotics, emollients and systemic steroid for a long time. However, the disease progressed, and the patient developed features of iatrogenic Cushing syndrome. The diagnosis was confirmed with a skin biopsy, which revealed Leishmania parasite. He received treatment with Injectable liposomal Amphotericin B (LAmB) and oral Miltefosine with promising clinical response. Clinicians should be vigilant while treating non-healing ulcers, and consider CL when there is history of travelling to CL endemic areas. [ABSTRACT FROM AUTHOR]

Niemann Pick disease is a rare lysosomal storage disease of infancy which occurs due to accumulation of sphingomyelin in various tissues of the body. This leads to characteristic features of failure to thrive, marked organomegaly and neurodegenerative regression. The disease is uncommon in South East Asia and here we present this case as it is rarely found in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: A sensitive, accurate and precise method was developed and validated in regard to Council Directive 333/2007/EC, Commission Decision 657/2002/EC, ISO/IEC 17025:2005 and EURACHEM 1998 for the trace level determination of Lead (Pb), Cadmium (Cd) and Chromium (Cr) in fish feed samples using Graphite Furnace Atomic Absorption Spectrometry (GF-AAS). Methods: For method validation, selectivity, working and linear ranges, limit of detection (LoD), limit of quantification (LoQ), trueness (recovery) and precision (repeatability and reproducibility) have been assessed as performance criteria. Results: The method LoDs for Pb, Cd and Cr were found to be 0.078, 0.010 and 0.022 μg/g respectively, whereas, the method LoQs were obtained at 0.156, 0.021 and 0.044 μg/g respectively. Moreover, the recovery of the analytes was 90 - 104% and the RSD values for precision were 4.90 - 9.60% respectively. Conclusions: The method validation performance criteria indicate the method's suitability for trace level quantification of Pb, Cd, and Cr in fish feed samples. [ABSTRACT FROM AUTHOR]

Bats of the genus Pteropus (P.) under the class Mammalia are important ecologically as pollinators, but little is known about their basic physiology. For this, serum biochemical values of healthy wild captured frugivorus bats (P. giganteus) were determined for providing baseline information and health care assessments in zoological setting. Ninety clinically healthy large frugivorous bats were captured from the wild and anesthetized for 2 hours following capture for blood collection from brachial vein. Serum glucose, total protein (TP), triglyceride (TG), cholesterol, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), creatinine phosphokinase (CPK), urea, uric acid, calcium and phosphorus were determined using biochemical analyzer. No major differences were observed in the serum biochemical values between male and female bats, juvenile and adults or fair and good health-state bats except significant variation in the AST (p < 0.05), ALP (p < 0.05) and CPK (p < 0.05) between adult and juvenile bats, calcium (p< 0.01) and phosphorus (p < 0.01) between the good and fair health-state bats. The values from this study can be used to create reference intervals of serum biochemistry of bat found in Indian subcontinent, and they can make up the first comprehensive biochemical study for this highly endangered species. [ABSTRACT FROM AUTHOR]

Bilateral adrenal masses caused by histoplasmosis is a rare condition. To our knowledge this is the first case report of bilateral adrenal enlargement by histoplasmosis in Bangladesh. We report a case of 75 years old man who presented with low grade fever, night sweating, anorexia and progressive weight loss for 9 months prior to admission in Square Hospital. Clinical profile was unremarkable apart from low grade fever (with maximum temperature recorded up to 101°F) and low blood pressure with significant postural drop. Plasma cortisol (morning and evening) and glucose were normal but short ACTH stimulation test revealed low plasma cortisol response. Abdominal ultrasound gave a definite clue of left adrenal mass which was later found as bilateral adrenal masses of significant size by abdominal CT scan. Initially Gomori's Methenamine Silver (GMS) stain of CT guided FNAC of the left adrenal mass showed small budding yeast morphologically consistent with histoplasmosis. A second CT guided FNAC of both adrenal masses also showed similar findings which was finally confirmed by fungus culture as Histoplasma capsulatum. The patient was then treated with injection amphotericin-B followed by oral itraconazole and fludrocortisone and he responded well. [ABSTRACT FROM AUTHOR]

The use of chemotherapeutic agents has been questioned for disease management in shrimp aquaculture due to the emergence of drug-resistant bacteria and enduring residual effects in the environments. Instead, microbial interventions in sustainable aquaculture have been proposed, and among them, the use of probiotics as an alternative to antibiotics has gained considerable attention. Earlier, we short-listed nineteen isolates out of ninety six bacteria, isolated from shrimp ghers of coastal areas of Bangladesh that exhibited antagonistic potential against pathogenic vibrios, and non-hemolytic property, presumably indicating their harmless behavior in mammalian system at least in vitro. This prompted us to study their cytotoxic effect in vivo using brine shrimp Artemia franciscana. Six isolates were found having higher lethal values compared with others. Four of them, identified as Pseudomonas and Bacillus spp. exhibited the lowest inhibition against Artemia and were considered safe. Further, in a co-culture experiment it was evident that the isolated probiotic bacteria were shown to outcompete the growth of pathogenic Vibrio harveyi due to their antagonistic properties. The probionts can now therefore be tested in culture environment of Bangladesh in order to understand the effectiveness of microbial control of bacterial diseases in shrimp aquaculture. [ABSTRACT FROM AUTHOR]

A total of 7 (seven) cases of uterine prolapse and retained placenta of cow was corrected during the period of Nov'07 to Jan'08 at Thana Veterinary Hospital in Madhukhali Upazila under Faridpur district of Bangladesh. Most of the uterine prolapsed and retained placenta was found immediately or within one (1) hour of calving. In this study 4 cases of uterine prolapse, 1 cases of uterine prolapsed with retained placenta and 2 cases of retained placenta were corrected. Replacement of everted organ of uterine prolapse and retained placenta was done manually following proper precautionary measure. Among them all cases of uterine prolapse and retained placenta was completely recovered. [ABSTRACT FROM AUTHOR]

Background and context: Rotary International (RI) is an international service organization whose stated purpose is to bring together business and professional leaders to provide humanitarian services, encourage high ethical standards in all vocations, and to advance goodwill and peace around the world. The Rotary Club of Dhaka Mavericks, with the notion to work on cancer care has partnered with an US-based organization to bring cancer care specialists from the US. These 2 partners mainly work with the National Institute of Cancer Research and Hospital, the government-owned tertiary level cancer care and research institute in Bangladesh, to transfer the skills and provide vocational training to Bangladeshi oncologists, nurses and allied health professionals by oncologists, nurses and allied health professionals from the US. Aim: The overall aim of this project is to create a cadre of cancer care professionals - oncologists, nurses and allied health professionals - in Bangladesh who would have the vocational skills through on-the-job training and skills transfer session from experienced and skilled oncologists, nurses and allied health professionals from the US. Strategy/Tactics: The international platform of RI has been used to reach out to a US-based not-for-profit organization Partners for World Health. This US-based organization has sourced in cancer care professionals from the US and brought them to Bangladesh using the partnership of 1 rotary club in the US and another rotary club in Dhaka. Later on, these 2 Rotary Clubs and Partners for World Health collaborated with the National Institute of Cancer Research and Hospital, where this long-term skills transfer and vocational sessions are taking place. Program process: In this partnership, the Rotary Clubs and the US-based organization arranged all necessary funding and relevant permission and accreditation, while the National Institute of Cancer Research and Hospital patients - who were served - and oncologists, nurses and allied health professionals - who were trained. Outcomes: This partnership is currently for 5 years starting from October of 2017. The plan is to have 2-week vocational and skills transfer session every 6 months. The first session took place in October of 2017 and the second one on March of 2018. The third session will take place on October of 2018. In the October 2018 session, total 100 doctors and 35 nurses were trained on US standard cancer treatment protocols and chemotherapy administration. Number of complicated surgical techniques were also taught to the Bangladeshi surgeons by the US team. During the March session, the focus was on radiation oncology. A total of 100 radiation oncologists were trained on March of 2018. [ABSTRACT FROM AUTHOR]

Background: Bangladesh, a developing country from southeast Asia has the population of 160 million and currently ranks as being the 7th most populated country in the world. Like many other developing countries, Bangladesh is going through an epidemiologic transition, with significant reductions in mortality due to acute, infectious, and parasitic diseases and increases in noncommunicable, degenerative, and chronic diseases over the last 20 years. In this course, of transition, the deaths due to cancer is also on the rise. Among all adult deaths, cancer the third leading cause of death and accounts for one fifth of all mortality in Bangladesh. However, for women the proportions are even higher. Aim: This abstract looks into the datasets of 2 national surveys - Bangladesh maternal mortality and health care survey 2010 and 2016 - and assess the cause of death among women from reproductive age in Bangladesh. The 2010 survey covered over 150,000 households around Bangladesh, while the 2016 survey covered over 310,000 households from the whole of Bangladesh. Methods: Both the survey followed the same clustering process and sampling procedure, to ensure the compatibility among the surveys. Though the main objective of the survey was to look into the status of maternal mortality and corresponding health service seeking behavior, the surveys also shed lights on overall cause of death for women of reproductive age in Bangladesh. The death cases were assessed by verbal autopsy - using WHO process - and the cause of deaths were classified following ICD 10. The particular deaths due to cancer or neoplasm were separated from the main datasets and then it was looked by demographic information of the respondents. Results: The comparison between the national datasets reveals that, in 2010, 21% Bangladeshi women of reproductive age (15-49 years) were dying due to cancer, meaning 1 in 5 Bangladeshi women from reproductive age is dying due to cancer. However, in 2016 the proportion of death due to cancer raised up to 24% women of reproductive age (15-49 years), meaning 1 in 4 Bangladeshi women from reproductive age is dying due to cancer. Age segregated data shows that, only within this 6 years of timespan, more women from younger age (40-45 vs 50-55 years) are dying out of cancer. Conclusion: The findings of this comparison between the 2 national survey shows that, deaths due to cancer among women of reproductive age in Bangladesh is on the rise. Though Bangladesh has developed a National Cancer Control Strategy and Action Plan with the aim of delivering a universal, quality-based and timely service, the initiative are still boutique. A comprehensive preventive approach through tobacco control, health promotion and vaccination program, in addition to, early detection needs to be established with effective referral chain. [ABSTRACT FROM AUTHOR]

A few communities collect date palm sap throughout the year to ferment and consume. This study's objective was to characterize Pteropus bats' sap feeding behavior around the year to identify the potential for sap contamination with bat excreta. We used infrared cameras to observe bats' feeding behavior for 28 tree-nights per month for 22 months from March 2013 to December 2014. We placed the cameras at 4 sap-producing date palm trees focused on the sap- producing surface and collection pot from 5:00 PM to 6:00 AM for seven consecutive nights. We extracted the number and duration of bat visits and duration of contact with date palm sap from the images. We recorded a total of 26,870 bat visits (5% Pteropus, 90% non- Pteropus and 5% unidentified) from 616 observation tree-nights. Median duration of each visit was higher for Pteropus bats than non-Pteropus bats (8 versus 0.03 minutes, P< 0.001). Median duration of contact with date palm sap was higher for Pteropus bats (0.67 versus 0.03 minutes, P<0.001) for each visit. The average number of Pteropus bat visits per night was the highest during spring (17) followed by winter (14), post-monsoon (6), and monsoon (3). Even when date palm sap is harvested year-round, Pteropus bats visit the date palm trees more frequently during the spring and winter, perhaps due to lack of other available food. Feeding behavior could be one reason why the risk of Nipah infection to people has been concentrated in the winter season, even when fermented sap is consumed year-round. Sap harvesters should regularly use skirts to prevent bats from contaminating the date palm sap to prevent Nipah virus and other bat associated zoonoses. [ABSTRACT FROM AUTHOR]

This study aimed to assess the biochemical parameters of household chickens at crop and blood levels and measure the body weight. For this purpose, 350 Deshi (local) and 27 Fayoumi day old chicks were reared in 2 separate brooders within a house for 15 days. Body weight, serum total protein and calcium levels of these chicks were evaluated on day 0 and 15. After control house trial, birds were distributed among the selected households. Again, body weights and certain biochemical parameters were assessed from randomly selected birds at 60, 120 and 180 days of age. Fayoumi birds gained higher weight (P<0.001) than at control trial, whereas Deshi birds attained better weight (P<0.001) at household. Crop contents were dominated by carbohydrate. The level of crude proteins and calcium in crop contents increased along with age regardless of bird types. The average phosphorous in the crop contents was 0.3% (60 days), 2.6% (120) and 0.7% (180) regardless of bird types. Both serum total protein (P<0.05) and calcium (P<0.05) were significantly difference in between bird types at control house study. In conclusion, Deshi birds attained higher weight at household. The crude protein was below standard. Calcium and Phosphorous levels in the crop contents varied with ages, regardless of bird types. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes., Methods: We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120-129 and dBP < 80), stage 1 hypertension (sBP 130-139 or dBP 80-89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group., Results: From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes., Conclusion: The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension., (© 2024. The Author(s).)

Background: Hypertension is a major cause of death worldwide. Although arsenic exposure has been associated with the risk of hypertension, this association appears nonuniform due to inconsistent results from studies conducted in different populations. Moreover, hypertension is a complex condition with multiple underlying mechanisms and factors. One factor is impaired production and bioavailability of vascular nitric oxide (NO). However, the implications of the effects of arsenic exposure on circulating NO and its association with hypertension in humans are largely unknown., Objective: We investigated the dose-response relationship between arsenic exposure and hypertension with vascular NO levels as a potential mediator of arsenic-related hypertension in individuals exposed to a broad range of arsenic., Methods: A total of 828 participants were recruited from low- and high-arsenic exposure areas in Bangladesh. Participants' drinking water, hair, and nail arsenic concentrations were measured by inductively coupled plasma mass spectroscopy. Hypertension was defined as a systolic blood pressure (SBP) value of ≥ 140 and a diastolic (DBP) value of ≥ 90  mmHg . Serum NO levels reflected by total serum nitrite concentrations were measured by immunoassay. A formal causal mediation analysis was used to assess NO as a mediator of the association between arsenic level and hypertension., Results: Increasing concentrations of arsenic measured in drinking water, hair, and nails were associated with the increasing levels of SBP and DBP. The odds of hypertension were dose-dependently increased by arsenic even in participants exposed to relatively low to moderate levels ( 10 - 50 μ g / L ) of water arsenic [odds ratios (ORs) and 95% confidence intervals (CIs): 2.87 (95% CI: 1.28, 6.44), 2.67 (95% CI: 1.27, 5.60), and 5.04 (95% CI: 2.71, 9.35) for the 10 - 50 μ g / L , 50.01 - 150 μ g / L , and > 150 μ g / L groups, respectively]. Causal mediation analysis showed a significant mediating effect of NO on arsenic-related SBP, DBP, and hypertension., Conclusion: Increasing exposure to arsenic was associated with increasing odds of hypertension. The association was mediated through the reduction of vascular NO bioavailability, suggesting that impaired NO bioavailability was a plausible underlying mechanism of arsenic-induced hypertension in this Bangladeshi population. https://doi.org/10.1289/EHP13018.

This investigation delineates an exhaustive analysis of the clinical, immunological, and genomic landscapes of hepatitis B virus (HBV) infection across a cohort of 22 verified patients. The demographic analysis unveiled a pronounced male bias (77.27%), with patient ages spanning 20 to 85 years and durations of illness ranging from 10 days to 4 years. Predominant clinical manifestations included fever, fatigue, anorexia, abdominal discomfort, and arthralgia, alongside observed co-morbidities such as chronic renal disorders and hepatocellular carcinoma. Antigenic profiling of the HBV envelope proteins elucidated significant heterogeneity among the infected subjects, particularly highlighted by discordances in the detection capabilities of small and large HBsAg assays, suggesting antigenic diversity. Quantitative assessment of viral loads unveiled a broad spectrum, accompanied by atypical HBeAg reactivity patterns, challenging the reliability of existing serological markers. Correlative studies between viral burden and antigenicity of the envelope proteins unearthed phenomena indicative of diagnostic evasion. Notably, samples demonstrating robust viral replication were paradoxically undetectable by the large HBsAg ELISA kit, advocating for more sophisticated diagnostic methodologies. Genotypic examination of three HBV isolates classified them as genotype D (D2), with phylogenetic alignment to strains from various global origins. Mutational profiling identified pivotal mutations within the basic core promoter and preS2/S1 regions, associated with an augmented risk of hepatocellular carcinoma. Further, mutations discerned in the small HBsAg and RT/overlap regions were recognized as contributors to vaccine and/or diagnostic escape mechanisms. In summation, this scholarly discourse elucidates the intricate interplay of clinical presentations, antigenic diversity, and genomic attributes in HBV infection, accentuating the imperative for ongoing investigative endeavors to refine diagnostic and therapeutic modalities., Competing Interests: Declaration of competing interest The authors affirm no known financial conflicts or personal relationships that might have influenced the work presented in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Japanese encephalitis (JE) is associated with an immense social and economic burden. Published cost-of-illness data come primarily from decades-old studies. To determine the cost of care for patients with acute JE and initial and long-term sequelae from the societal perspective, we recruited patients with laboratory-confirmed JE from the past 10 years of JE surveillance in Bangladesh and categorized them as acute care, initial sequalae, and long-term sequelae patients. Among 157 patients, we categorized 55 as acute, 65 as initial sequelae (53 as both categories), and 90 as long-term sequelae. The average (median) societal cost of an acute JE episode was US $929 ($909), of initial sequelae US $75 ($33), and of long-term sequelae US $47 ($14). Most families perceived the effect of JE on their well-being to be extreme and had sustained debt for JE expenses. Our data about the high cost of JE can be used by decision makers in Bangladesh.

Background: Depending on race, ethnicity, and region, genetic variants determine human height by 65% to 80%, while the remaining variance of 20% to 35% is influenced by nutrition and other individual or environmental exposures in the early years of life. An improvement in nutrition and health in the early years in a population underprivileged in health and nutrition will likely increase the group's average height. Due to outstanding improvements in these areas in recent decades, we hypothesised that the average height of Bangladeshi women has increased. Moreover, because pregnancy at an early age affects women's health and nutrition, we hypothesised that women who began childbearing early would experience growth retardation compared to women who had pregnancies at a later age., Methods: We used data from five national surveys conducted between 2004 and 2018 that collected height data from ever-married women aged 15-49 years. We analysed the height of women aged 20-29 years (born between 1974 and 1998) and examined the mean height by birth years, age at first birth (AFB), economic status, religion and region. We conducted multiple linear regression models, controlling for the differential effects of the socio-demographic characteristics on women's height over time and by AFB., Results: The average height of women born between 1974 and 1998 significantly increased by 0.03 cm annually, with fluctuations between 150.3 and 151.6 cm. We also found an association between age at childbearing and height in adulthood - women who began childbearing before age 17 were approximately one centimetre shorter in adulthood than those who began childbearing at a later age., Conclusions: We found evidence of an increasing trend in women's height in Bangladesh and an inhibiting effect of early teenage childbearing on attaining the potential growth of women. The findings call for further studies to investigate early childbearing and its consequences on women's and their children's growth in diverse settings, considering socio-cultural customs influencing early marriage and childbearing., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Despite improvements in many health indicators, maternal mortality has plateaued in Bangladesh. Achieving the global target of reductions in maternal mortality and the associated Sustainable Development Goals will not be possible without actions to prevent deaths due to preeclampsia/eclampsia. Here we examined the levels, trends, specific causes, timing, place, and care-seeking behaviours of women who died due to these two causes., Methods: We used nationally representative Bangladesh Maternal Mortality and Health Care Surveys (BMMSs) conducted in 2001, 2010, and 2016 to examine levels and trends of deaths due to preeclampsia/eclampsia. We based the analysis of specific causes, timing, and place of preeclampsia/eclampsia deaths, and care seeking before the deaths on 41 such deaths captured in the 2016 survey. We also used BMMS 2016 survey verbal autopsy (VA) questionnaire to highlight stories that put faces to the numbers., Results: The preeclampsia/eclampsia-specific mortality ratio decreased from 77 per 100 000 live births in the 2001 BMMS to 40 per 100 000 live births in the 2010 BMMS, yet halted in the 2016 BMMS at 46 per 100 000 live births. Although preeclampsia/eclampsia accounted for around one-fifth of all maternal deaths in the 2010 BMMS, in the 2016 BMMS, the percentage contribution reached the 2001 BMMS level of 24%. An analysis of the VA questionnaire's open section showed that almost all such death cases left their homes to seek care; however, most had to visit more than one facility before they died, indicating an unprepared health system., Conclusions: A cluster of preeclampsia/eclampsia-specific mortality observed during the first trimester, during delivery, and within 48 hours of birth indicates a need for preconception health check-ups and strengthened facility readiness. Awareness of maternal complications, proper care seeking, and healthy reproductive practices, like family planning to space and limit pregnancy through client-supportive counselling, may be beneficial. Improving regular and emergency maternal services readiness is also essential., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Despite a notable decline in recent decades, maternal mortality in Bangladesh remains high. A thorough understanding of causes of maternal deaths is essential for effective policy and programme planning. Here we report the current level and major causes of maternal deaths in Bangladesh, focusing on care-seeking practices, timing, and place of deaths., Methods: We analysed data from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS), conducted with nationally representative sample of 298 284 households. We adapted the World Health Organization's 2014 verbal autopsy (VA) questionnaire. Trained physicians reviewed the responses and assigned the cause of death based on the International Classification of Diseases (ICD-10). We included 175 maternal deaths in our analysis., Results: The maternal mortality ratio was 196 (uncertainty range = 159-234) per 100 000 live births. Thirty-eight per cent of maternal deaths occurred on the day of delivery and 6% on one day post-delivery. Nineteen per cent of the maternal deaths occurred at home, another 19% in-transit, almost half (49%) in a public facility, and 13% in a private hospital. Haemorrhage contributed to 31% and eclampsia to 23% of the maternal deaths. Twenty-one per cent of the maternal deaths occurred due to indirect causes. Ninety-two per cent sought care before dying, of which 7% sought care from home. Thirty-three per cent of women who died due to maternal causes sought care from three or more different places, indicating they were substantially shuttled between facilities. Eighty per cent of the deceased women who delivered in a public facility also died in a public facility., Conclusions: Two major causes accounted for around half of all maternal deaths, and almost half occurred during childbirth and by two days of birth. Interventions to address these two causes should be prioritised to improve the provision and experience of care during childbirth. Significant investments are required for facilitating emergency transportation and ensuring accountability in the overall referral practices., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant information interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Eclampsia, haemorrhage, and other direct causes are the primary burden of maternal mortality in Bangladesh, often reducing attention given to indirect maternal deaths (IMDs). However, Sustainable Development Goals may not be achieved without actions to prevent IMDs. We examined the levels, trends, specific causes, timing, place, and care-seeking, and explored the barriers to IMD prevention., Methods: We used three nationally representative surveys conducted in 2001, 2010, and 2016 to examine levels and trends in IMDs. The analysis of specific causes, timing, and place of IMDs, and care-seeking before the deaths was based on 37 IMDs captured in the 2016 survey. Finally, we used thematic content analysis of the open history from the 2016 survey verbal autopsy (VA) questionnaire to explore barriers to IMD prevention., Results: After increasing from 51 deaths per 100 000 live births in 2001 to 71 in 2010, the indirect maternal mortality ratio (IMMR) dropped to 38 deaths per 100 000 live births in 2016. In 2016, the indirect causes shared one-fifth of the maternal deaths in Bangladesh. Stroke, cancer, heart disease, and asthma accounted for 80% of the IMDs. IMDs were concentrated in the first trimester of pregnancy (27%) and day 8-42 after delivery (32%). Public health facilities were the main places for care-seeking (48%) and death (49%). Thirty-four (92%) women who died from IMDs sought care from a health facility at least once during their terminal illness. However, most women experienced at least one of the "three delays" of health care. Other barriers were financial insolvency, care-seeking from unqualified providers, lack of health counselling, and the tendency of health facilities to avoid responsibilities., Conclusions: IMMR remained unchanged at a high level during the last two decades. The high concentration of IMDs in pregnancy and the large share due to chronic health conditions indicate the need for preconception health check-ups. Awareness of maternal complications, proper care-seeking, and healthy reproductive practices may benefit. Improving regular and emergency maternal service readiness is essential., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Haemorrhage is a major cause of maternal deaths globally, most of which are preventable and predominantly happen in low and middle-income countries, including Bangladesh. We examine the current levels, trends, time of death, and care-seeking practices for haemorrhage-related maternal deaths in Bangladesh., Methods: We conducted a secondary analysis with data from the nationally representative 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys (BMMS). The cause of death information was collected through verbal autopsy (VA) interviews using a country-adapted version of the standard World Health Organization VA questionnaire. Trained physicians reviewed the VA questionnaire and assigned the cause of death using the International Classification of Diseases (ICD) codes., Results: Haemorrhage accounted for 31% (95% confidence interval (CI) = 24-38) of all maternal deaths in 2016 BMMS, which was 31% (95% CI = 25-41) in 2010 BMMS and 29% (95% CI = 23-36) in 2001 BMMS. The haemorrhage-specific mortality rate remained unchanged between 2010 BMMS (60 per 100 000 live births, uncertainty range (UR) = 37-82) and 2016 BMMS (53 per 100 000 live births, UR = 36-71). Around 70% of haemorrhage-related maternal deaths took place within 24 hours of delivery. Of those who died, 24% did not seek health care outside the home and 15% sought care from more than three places. Approximately two-thirds of the mothers who died due to haemorrhage gave birth at home., Conclusions: Postpartum haemorrhage remains the primary cause of maternal mortality in Bangladesh. To reduce these preventable deaths, the Government of Bangladesh and stakeholders should take steps to ensure community awareness about care-seeking during delivery., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding authors) and disclose no relevant interest., (Copyright © 2023 by the Journal of Global Health. All rights reserved.)

Background: Intimate partner violence (IPV), and especially intimate partner physical violence (IPPV), perpetrated by husbands, and within adolescence marriage are pervasive in Bangladesh. Younger women are more vulnerable to IPPV., Objectives: We examined factors associated with IPPV experienced by married adolescents ages 15-19 and tested four hypotheses: (1) adolescent girls married to relatively older husbands, (2) adolescents living in extended families with parents or parents-in-law, (3) adolescents who are minimally controlled by husbands, and (4) adolescents who have a child after marriage are protective of IPPV., Methods: We analyzed IPPV data from 1,846 married girls ages 15-19 obtained from a national adolescent survey conducted in 2019-20. IPPV is defined as the respondent having physical violence perpetrated by her husband at least once in the last 12 months. We implemented logistic regression models to test our hypotheses., Results: Sixteen percent of married adolescent girls experienced IPPV. Girls living with parents-in-law or parents had adjusted odds ratio (AOR) of 0.56 ( p < 0.001) of IPPV compared to those girls who lived with husband alone. Girls with husbands ages 21-25 years and 26 years or older had AORs of 0.45 ( p < 0.001) and 0.33 ( p < 0.001) of IPPV compared to those girls with their husband ages 20 and younger. Married adolescent girls who did not own a mobile phone (an indicator of spousal power dynamics) had an AOR of 1.39 ( p < 0.05) compared to those girls who had a phone. IPPV risk increases with an increased duration of marriage for those with no living children ( p < 0.001) but not for those with at least one living child; the risk was higher among those who had a child within the 1 st year of marriage than those who had not yet had a child. At a duration of 4 years and longer, IPPV risk was higher among those with no living children than those with children., Discussion: Findings related to those living with parents-in-law or parents, girls married to relatively older boys/men, having the ability to communicate with outside world, and having a child are protective of IPPV in Bangladesh are new, to our knowledge. Strictly adhering to the law that requires men waiting until the age of 21 to marry can reduce married girls' risk of IPPV. Raising girls' legal marriage age can minimize adolescents' IPPV and other health risks associated with adolescent childbearing., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Rahman, Jamil, Nahar, Chakraborty, Haider and Khan.)

Background: In Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes., Objective: The aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes., Methods: The paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15-19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles., Results: Unmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6-7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Streatfield, Rahman, Khan, Haider, Rahman, Nahar and Jamil.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is readily transmitted from person to person. We evaluated the emerging landscape of SARS-CoV-2 variants in Bangladesh from a retrospective study of nasopharyngeal swabs collected from 130 SARS-CoV-2-positive cases randomly selected over 6 months. Mutation analysis of whole-genome sequencing of 130 SARS-CoV-2 variants revealed 528 unique coding mutations, of which 102 were deletions, 6 were premature stop codons, and the remaining were substitutions. The most common mutation in the cohort was ORF1b:P314L, with a frequency of 98.5%. A total of 132 unique coding mutations were observed in the spike protein gene. Fourteen mutations were mapped to the spike protein receptor binding domain (RBD). These mutations increase the affinity between the spike protein and its human receptor, angiotensin converting enzyme 2 (ACE2), thereby increasing SARS-CoV-2 transmissibility. This study will help understand the SARS-CoV-2 virus and ultimately aid in monitoring and combatting the COVID-19 pandemic by furthering research on appropriate therapies. Analysis of age revealed closer association of the Delta variant with older populations and of the Omicron variant with younger populations. This may have important implications on how we monitor infections, distribute vaccines, and treat patients based on their ages.

There is a paucity of recent research on direct water quantity measurement for personal and domestic hygiene. We aimed to measure the water quantity used for personal and domestic hygiene and to explore the reasons and determinants for variation of water usage. We conducted this study from September 2014 to June 2016 in a low-income urban community in Dhaka. In 12 households, the team conducted a day-long bimonthly ethnographic observation for one year to measure the volume of water used per activity per person. They conducted 28 in-depth interviews to explore the reasons for changes of water usage. Participants used a median of 75 L (61-100) of water per capita per day (LCPD) and of this 75 LCPD they used a median of 39 LCPD (26-58) for personal hygiene. Women used less water than men. Individual and social norms, beliefs, and weather determinants determined personal hygiene. Water availability determined domestic hygiene (e.g., washing dishes, toilets and bathrooms). This study helps to elucidate a range of determinants of water usage of the participants from the participants' perspective. The quantity of water used for domestic and personal hygiene and its relationship to fecal-oral transmitted disease can be explored in future research.

Background: Obstetric fistula, which develops after a prolonged or obstructed labour, is preventable and treatable. However, many women are still afflicted with the condition and remain untreated in low-income and middle-income countries. Concerns have also been raised that an increasing trend of caesarean sections is increasing the risk and share of iatrogenic obstetric fistula in these countries. The true prevalence of this condition is not known, which makes it difficult for health planners and policy makers to develop appropriate national health strategies to address the problem. The estimation of obstetric fistula with surveys is difficult because self-reporting of incontinence symptoms is subject to misclassification bias. In this study, we aimed to estimate the prevalence and burden of obstetric fistula in Bangladesh., Methods: For a valid estimation addressing misclassification bias, we implemented the study in two steps. First, we did the Maternal Morbidity Validation Study (MMVS) among a population of 65 740 women in Sylhet, Bangladesh, to assess the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values of the survey questions. This was done through confirmation of the diagnosis with clinical examinations of suspected cases by female physicians; a sample of women who screened positive for pelvic organ prolapse and other urinary incontinence symptoms were also examined and used as controls for clinical diagnosis confirmation. Second, we used the estimated diagnostic test values, after correcting for verification bias, to adjust the reported prevalence in the nationally representative Bangladesh Maternal Mortality and Health Care Survey 2016 for the unbiased estimation of obstetric fistula prevalence in Bangladesh., Findings: The MMVS, done from Aug 3 to Dec 9, 2016, identified 67 potential cases of obstetric fistula; of them, 57 (85%) women completed the clinical examination, and 19 were confirmed as obstetric fistula cases. The adjusted sensitivity of the self-reports of obstetric fistula was 100% (95% uncertainty interval [UI] 99·8-100) and the observed specificity was 99·9% (95% UI 99·9-100) among women aged 15-49 years. However, the PPV was low, at 31·6% (95% UI 19·2-46·2), suggesting that almost two thirds of the self-reported cases were not true obstetric fistula cases. We estimated an adjusted obstetric fistula prevalence rate of 38 (90% UI 25-58) per 100 000 women aged 15-49 years in Bangladesh. Nationally, we estimated about 13 376 (90% UI 8686-20 112) women of reproductive age living with obstetric fistula. Additionally, we estimated 4081 (1773-8790) women aged 50-64 years to be living with obstetric fistula in Bangladesh; overall, we estimated that there are 17 457 (10 459-28 902) women aged 15-64 years in Bangladesh with obstetric fistula., Interpretation: The burden of obstetric fistula is still high in Bangladesh. Prevention and provision of surgical treatment to so many women will need coordinated efforts, planning, allocation of resources, and training of surgeons., Funding: US Agency for International Development, Government of Bangladesh, and UKAid., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Improving hygiene practices is considered to be the single most cost-effective means of reducing the global health burden of infectious diseases. Hygiene promotion and disease prevention interventions often portray and promote "hygiene" from a biomedical perspective, which may not be optimally effective for achieving their goal of changing people's behaviors. This study aimed to educe the meaning of hygiene for the residents of a low-income community in Bangladesh and how that meaning shapes their personal hygiene practices. We conducted this study in the Tongi township in Dhaka, Bangladesh, from September 2014 to June 2016. The research team purposively selected 24 households. The team conducted day-long observations using the participant observation approach and in-depth interviews with specific members of the 24 households. The concept of "hygiene" had two separate meanings to the study participants: cleanliness and holiness. The participants reported that cleanliness was required to remove odors, grease, hot spices and dirt. The motivation for cleanliness was to feel fresh, avoid heavy feelings, feel light and feel comfortable. To maintain the holiness of the body, bathing and ablution needed to be performed following particular religious rules/rituals. The motivation of holiness was derived from their accountability to God. The participants also reported that the cleansing processes and methods for the body and the home for cleanliness reasons were also different from those for holiness reasons. The notion of "hygiene" was multidimensional for the residents of the low-income urban community in Bangladesh. Our study participants did not explicitly conceptualize a notion of hygiene that was based on the germ theory of diseases but rather a notion that was based on individual physical comfort and cultural belief systems. Future studies on the prevention of hygiene-related diseases should combine and link the biomedical aspect to religious and cultural rituals to promote improved hygiene practices.

Background: Tetanus, a vaccine-preventable disease, is still occurring in the elderly population of low- and middle-income countries with a high case-fatality rate. The objective of the study was to elucidate the factors associated with in-hospital mortality of tetanus in Bangladesh., Methods: This prospective observational study, conducted in two specialized infectious disease hospitals, conveniently selected adult tetanus patients (≥18 years) for inclusion. Data were collected through a preformed structured questionnaire. Kaplan Meier survival analysis and univariate and multivariable Cox regression analysis were carried out to assess factors associated with in-hospital mortality among patients. All analysis was done using Stata (version 16) and SPSS (version 26)., Results: A total of 61 tetanus cases were included, and the overall in-hospital mortality rate was 34.4% (n = 21). Patients had an average age of 46.49 ±15.65 years (SD), and the majority were male (96.7%), farmers (57.4%), and came from rural areas (93.4%). Survival analysis revealed that the probability of death was significantly higher among patients having an age of ≥ 40 years, incubation time of ≤12 days, onset time of ≤ 4 days, and having complication(s). However, on multivariable Cox regression analysis, age (adjusted hazard ratio [aHR] 4.03, 95% Confidence Interval [CI] 1.07-15.17, p = 0.039) and onset time (≤4 days) (aHR 3.33; 95% CI 1.05-10.57, p = 0.041) came as significant predictors of in-hospital mortality after adjusting for incubation period and complications., Conclusion: Older age and short onset time are the two most important determinants of in-hospital mortality of tetanus patients. Hence, these patients require enhanced emphasis and care., Competing Interests: The authors have declared that no competing interests exist.

Background: Tobacco consumption is a major risk factor for many diseases including diabetes and has deleterious effects on oral health. Diabetic patients are vulnerable to developing certain oral conditions. So far, no studies have attempted to co-develop a tobacco cessation intervention to be delivered in dental clinics for people with diabetes in Bangladesh., Aim: To co-produce a tobacco cessation intervention for people with diabetes for use in dental clinics in Bangladesh., Objectives: To assess: (1) tobacco use (patterns) and perceptions about receiving tobacco cessation support from dentists among people with diabetes attending the dental department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) who smoke or use smokeless tobacco (ST) (2) current tobacco cessation support provision by the dentists of the dental department of BIRDEM (3) barriers and facilitators of delivering a tobacco cessation intervention at a dental clinic, and (4) to co-produce a tobacco cessation intervention with people with diabetes, and dentists to be used in the proposed context., Methods: The study was undertaken in two stages in the dental department of BIRDEM, which is the largest diabetic hospital in Bangladesh. Stage 1 (July-August 2019) consisted of a cross-sectional survey among people with diabetes who use tobacco to address objective 1, and a survey and workshop with dentists working in BIRDEM, and consultations with patients to address objectives 2 and 3. Stage 2 (January 2020) consisted of consultations with patients attending BIRDEM, and a workshop with dentists to co-produce the intervention., Result: All survey participants (n = 35) were interested in receiving tobacco cessation support from their dentist. We identified important barriers and facilitators to deliver tobacco cessation intervention within dental services. Barriers reported by dentists included lack of a structured support system and lack of training. As a facilitator, we identified that dentists were willing to provide support and it would be feasible to deliver tobacco cessation intervention if properly designed and embedded in the routine functioning of the dental department of BIRDEM. Through the workshops and consultations at stage 2, a tobacco cessation intervention was co-developed. The intervention included elements of brief cessation advice (using a flipbook and a short video on the harmful effects of tobacco) and pharmacotherapy., Conclusion: Incorporation of tobacco cessation within dental care for people with diabetes was considered feasible and would provide a valuable opportunity to support this vulnerable group in quitting tobacco., (© 2021. The Author(s).)

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household's income. Preventing diarrhea preserves health and supports financial livelihoods., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Drop-out before treatment completion is a vexing problem for all clubfoot clinics. We and others have previously identified better engagement with parents as a crucial method of ameliorating incomplete clubfoot treatment, which increases deformity relapse. Materials and methods: The novel use of community facilitators enabled an audit of over 300 families who had dropped-out from a child's clubfoot treatment. A questionnaire standardized the parent interviews. Parents were encouraged to present for clinical review of their child's clubfeet. Results: When treatment was discontinued for six months, 309 families were audited. A social profile of families was developed, showing that most lived in tin houses with one working family member, indicating low affluence. Family issues, brace difficulty, travel distances, and insufficient understanding of ongoing bracing and follow-up were the main reasons for discontinuing treatment. Overt deformity relapse was found in 9% of children, while half of the children recommenced brace use after review. Conclusions: Identifying families at risk of dropping out from clubfoot care enables support to be instigated. Our findings encourage clinicians to empathize with parents of children with clubfoot deformity. The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support.

Nipah virus (NiV) is an emerging bat-borne zoonotic virus that causes near-annual outbreaks of fatal encephalitis in South Asia-one of the most populous regions on Earth. In Bangladesh, infection occurs when people drink date-palm sap contaminated with bat excreta. Outbreaks are sporadic, and the influence of viral dynamics in bats on their temporal and spatial distribution is poorly understood. We analyzed data on host ecology, molecular epidemiology, serological dynamics, and viral genetics to characterize spatiotemporal patterns of NiV dynamics in its wildlife reservoir, Pteropus medius bats, in Bangladesh. We found that NiV transmission occurred throughout the country and throughout the year. Model results indicated that local transmission dynamics were modulated by density-dependent transmission, acquired immunity that is lost over time, and recrudescence. Increased transmission followed multiyear periods of declining seroprevalence due to bat-population turnover and individual loss of humoral immunity. Individual bats had smaller host ranges than other Pteropus species (spp.), although movement data and the discovery of a Malaysia-clade NiV strain in eastern Bangladesh suggest connectivity with bats east of Bangladesh. These data suggest that discrete multiannual local epizootics in bat populations contribute to the sporadic nature of NiV outbreaks in South Asia. At the same time, the broad spatial and temporal extent of NiV transmission, including the recent outbreak in Kerala, India, highlights the continued risk of spillover to humans wherever they may interact with pteropid bats and the importance of limiting opportunities for spillover throughout Pteropus 's range., Competing Interests: The authors declare no competing interest., (Copyright © 2020 the Author(s). Published by PNAS.)

Background: To design a maternal handwashing intervention for the newborn period, this qualitative study explored drivers of handwashing among mothers and other caregivers of neonates and infants in two rural areas of Bangladesh., Methods: We conducted 40 semi-structured observation sessions to observe handwashing behaviors of primiparous and multiparous mothers of neonates, and to understand the contextual factors that facilitated or hampered those behaviors. We then conducted 64 interviews with mothers of neonates and mothers of infants and 6 group discussions with mothers of infants, other female caregivers and fathers to explore perceptions, beliefs, and practices related to handwashing in the neonatal period. Based on a conceptual model and the Theory of Reasoned Action/Theory of Planned Behavior, we developed a conceptual model a priori, we performed thematic analysis to explain determinants of maternal handwashing behaviors., Results: We conducted 200 h of observation among mothers of neonates. The age range of participating mothers varied between 17 and 25 years and their maximum education was up to 10th grade of schooling. Mothers, other female caregivers and fathers perceived a need to wash hands with or without soap before eating or before feeding a child by hand to prevent diarrhea. Mothers expressed the importance of washing their hands before holding a baby but were rarely observed doing so. All respondents prioritized using soap for visible dirt or feces; otherwise, water alone was considered sufficient. Lack of family support, social norms of infrequent handwashing, perceptions of frequent contact with water as a health threat and mothers' restricted movement during first 40 days of neonate's life, and childcare and household responsibilities adversely impacted handwashing behavior., Conclusions: Addressing emotive drivers of handwashing within existing social norms by engaging family members, ensuring handwashing facilities and clarifying neonatal health threats may improve maternal handwashing behavior in the neonatal period.

Escherichia coli, a prominent waterborne pathogen, causes a variety of gastrointestinal and extraintestinal infections that depend on virulence determinants. To monitor natural aquatic systems for virulence-associated genes of E. coli, multiplex PCR was used in a survey covering 46 major natural water bodies in Bangladesh. DNA was extracted directly from water samples as well as from pre-enriched and enriched cultures during three successive seasons and assessed for E. coli virulotype distribution. From the five virulotypes, genes from the enterotoxigenic (ETEC), enteropathogenic (EPEC), and enterohaemorrhagic (EHEC) virulotypes were detected consistently, but genes from the enteroinvasive (EIEC) and enteroaggregative (EAEC) virulotypes were traced only occasionally. ETEC was the most prevalent virulotype, followed by EPEC. However, EIEC and EAEC virulotypes could not be detected in winter or the rainy season, respectively. Specific regional distribution patterns of different E. coli virulotypes and their temporal fluctuations were identified. These observations may assist with assessing seasonal risk and identifying vulnerable areas of the country prone to E. coli-associated outbreaks.

We conducted a cross-sectional study in 2009 to determine the seroprevalence and risk factors for highly pathogenic avian influenza A (H5N1) [HPAI H5N1] virus antibodies among poultry workers at farms and live bird markets with confirmed/suspected poultry outbreaks during 2009 in Bangladesh. We tested sera by microneutralization assay using A/Bangladesh/207095/2008 (H5N1; clade 2.2.2) virus with confirmation by horse red blood cell hemagglutination inhibition and H5-specific Western blot assays. We enrolled 212 workers from 87 farms and 210 workers from three live bird markets. One hundred and two farm workers (48%) culled poultry. One hundred and ninety-three farm workers (91%) and 178 market workers (85%) reported direct contact with poultry that died during a laboratory confirmed HPAI H5N1 poultry farm outbreak or market poultry die-offs from suspected HPAI H5N1. Despite exposure to sick poultry, no farm or market poultry workers were seropositive for HPAI H5N1 virus antibodies (95% confidence interval 0-1%).

Background: The usage of medicinal plants is traditionally rooted in Bangladesh and still an essential part of public healthcare. Recently, a dramatically increasing prevalence brought diabetes mellitus and its therapy to the focus of public health interests in Bangladesh. We conducted an ethnobotanical survey to identify the traditional medicinal plants being used to treat diabetes in Bangladesh and to critically assess their anti-diabetic potentials with focus on evidence-based criteria., Methods: In an ethnobotanical survey in defined rural and urban areas 63 randomly chosen individuals (health professionals, diabetic patients), identified to use traditional medicinal plants to treat diabetes, were interviewed in a structured manner about their administration or use of plants for treating diabetes., Results: In total 37 medicinal plants belonging to 25 families were reported as being used for the treatment of diabetes in Bangladesh. The most frequently mentioned plants were Coccinia indica, Azadirachta indica, Trigonella foenum-graecum, Syzygium cumini, Terminalia chebula, Ficus racemosa, Momordica charantia, Swietenia mahagoni., Conclusion: Traditional medicinal plants are commonly used in Bangladesh to treat diabetes. The available data regarding the anti-diabetic activity of the detected plants is not sufficient to adequately evaluate or recommend their use. Clinical intervention studies are required to provide evidence for a safe and effective use of the identified plants in the treatment of diabetes.

The purpose of this research was to analyze the underlying mechanisms and contributing factors related to the seasonal dynamic of harmful algal blooms in a shallow eutrophic pond, Bangladesh during September 2005-July 2006. Two conspicuous events were noted simultaneously throughout the study period: high concentration of phosphate-phosphorus (>3.03; SD 1.29 mg l(-1)) and permanent cyanobacterial blooms {>3,981.88×10(3) cells l(-1) (SD 508.73)}. Cyanobacterial blooms were characterized by three abundance phases, each of which was associated with different ecological processes. High nitrate-nitrogen (>2.35; SD 0.83 mg l(-1)), for example, was associated with high cyanobacterial abundance, while low nitrate-nitrogen (0.36; SD 0.2 mg l(-1)) was recorded during moderate abundance phase. Extremely low NO3-N/PO4-P ratio (>3.55, SD 2.31) was recorded, and all blooming taxa were negatively correlated with this ratio. Cyanobacterial blooms were positively correlated with temperature (r=0.345) and pH (0.833; p=0.05) and negatively correlated with transparency (r=-0.956; p=0.01). Although Anabaena showed similar relationship with water quality parameters as cyanobacteria, the co-dominant Microcystis exhibited negative relationship with temperature (r=-0.386) and nitrate-nitrogen (r=-0.172). This was attributed to excessive growth of Anabaena that suppressed Microcystis's growth. Planktothrix was the third most dominant taxa, while Euglena was regarded as opportunistic.

Bats are reservoirs for a wide range of zoonotic agents including lyssa-, henipah-, SARS-like corona-, Marburg-, Ebola-, and astroviruses. In an effort to survey for the presence of other infectious agents, known and unknown, we screened sera from 16 Pteropus giganteus bats from Faridpur, Bangladesh, using high-throughput pyrosequencing. Sequence analyses indicated the presence of a previously undescribed virus that has approximately 50% identity at the amino acid level to GB virus A and C (GBV-A and -C). Viral nucleic acid was present in 5 of 98 sera (5%) from a single colony of free-ranging bats. Infection was not associated with evidence of hepatitis or hepatic dysfunction. Phylogenetic analysis indicates that this first GBV-like flavivirus reported in bats constitutes a distinct species within the Flaviviridae family and is ancestral to the GBV-A and -C virus clades.

Background: Cryptosporidium species are a common cause of diarrhea, which can be severe and protracted in young children and immunocompromised individuals., Methods: A cohort of 226 Bangladeshi children aged 2-5 years was prospectively followed for >3 years to study the role of host genetics in susceptibility to infection, as well as the community impact of cryptosporidiosis on this population., Results: Ninety-six children (42.5%) received a diagnosis of Cryptosporidium infection. A total of 51 (22.6%) had asymptomatic infection. Fifty-eight (25.7%) had cryptosporidiosis, of whom 17 (29.3%) had recurrent disease. Children with cryptosporidiosis presented early, and most had abdominal pain and a short course of diarrhea. Infected children were more likely to carry the human leukocyte antigen (HLA) class II DQB1*0301 allele, particularly those with both asymptomatic and symptomatic infection (P = .009); a strong association was found between carriage of the DQB1*0301/DRB1*1101 haplotype and development of both asymptomatic and symptomatic infection (P = .009). Infected children were also more likely to carry the B*15 HLA class I allele., Conclusions: This is the first study to describe a possible genetic component of the immune response to Cryptosporidium infection, which includes HLA class I and II alleles. Cryptosporidiosis in Bangladeshi children aged 2-5 year is common and often recurrent, but the duration is shorter and the abdominal pain greater than that described in children aged <2 years.

A total of 113 strains of Shigella dysenteriae type 2 isolated from patients attending the Dhaka diarrhoea treatment centre of ICDDR,B: Centre for Health and Population Research during the period 1999-2004 were studied. Serotype of the isolates was confirmed using commercially available antisera. Except for arabinose fermentation, all the strains had similar biochemical reactions. More than 60% of the strains were sensitive to commonly used antibiotics; only 6% (n=7) of the strains were resistant to nalidixic acid, and none of the strains were resistant to mecillinam and ciprofloxacin. All strains were invasive as demonstrated by the presence of a 140 MDa plasmid, ial, sen and ipaH genes, Congo Red absorption ability and by the Sereny test performed on representative strains. Plasmid patterns were heterogeneous but more than 50% of strains were confined to a single pattern. All strains possessed a 1.6 MDa plasmid and 87% of the strains contained a 4 MDa plasmid. Middle-range plasmids (90 MDa to 30 MDa) present in 36% of the strains were not associated with antibiotic resistance. All the strains were clustered within a single type with four subtypes by pulsed-field gel electrophoresis while ribotyping patterns of all the strains were identical.

Periodic monitoring of antimicrobial susceptibility of Neisseria gonorrhoeae is essential for early detection of emergence of drug resistance. A total of 343 gonococcal strains isolated from high-risk and general populations in Bangladesh from 1997 to 1999 were studied. The MICs of penicillin, tetracycline, ciprofloxacin, ceftriaxone, and spectinomycin for the isolates were determined by the agar dilution method. Of the isolates from 1997, 9% were resistant (MIC >or= 1.0 microg/ml) to ciprofloxacin, while 41 and 49% of the isolates from 1998 and 1999, respectively, were resistant to ciprofloxacin. Of the N. gonorrhoeae isolates from 1998 and 1999, 1.2 and 3.6%, respectively, both were penicillinase producing and displayed plasmid-mediated tetracycline resistance.

Studies have shown that various objects, such as utensils, toys, and clothes, can serve as vehicles for transmission of Shigella spp. Shigellae can become viable but non-culturable (VBNC) when exposed to various environmental conditions as shown in earlier studies. The present study was carried out to detect VBNC Shigella dysenteriae type 1 on various fomites by direct viable counting, polymerase chain reaction (PCR), and fluorescent antibody methods. S. dysenteriae type 1 was inoculated onto cloth, wood, plastic, aluminum, and glass objects. Results showed that 1.5-4.0 hours after inoculation, S. dysenteriae type 1 became non-culturable, and after five days, non-culturable but viable S. dysenteriae type 1 could be detected by both PCR and fluorescent antibody techniques. Fomites can be considered an important potential route of transmission of VBNC S. dysenteriae type 1 and a significant factor in the epidemiology of shigellosis.

Although ciprofloxacin is one of the recommended drugs of choice for the treatment of gonorrhea, in vitro resistance to this drug has been observed in surveillance studies and case reports from many parts of the world, including Bangladesh. However, to our knowledge, there have been no prospective studies of the correlation between in vitro response to the drug and treatment outcome. Therefore, a prospective study of 217 female sex workers in Dhaka, Bangladesh, was conducted to examine the correlation between the in vitro response of Neisseria gonorrhoeae and the outcome of ciprofloxacin treatment. Overall, 37.8% of the gonococcal isolates recovered from female sex workers were resistant to ciprofloxacin, and there was a good correlation between in vitro resistance and treatment failure. These findings suggest that in vitro resistance to ciprofloxacin is predictive of clinical treatment failure in patients with gonorrhea.

An etiological study of sexually transmitted infections (STIs) was conducted among female sex workers (FSWs) in Dhaka, Bangladesh. Endocervical swab and blood samples from 269 street-based FSWs were examined for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis as well as for antibodies to Treponema pallidum and herpes simplex virus 2 (HSV-2). Sociodemographic data and data regarding behavior were also collected. A total of 226 of the 269 FSWs (84%) were positive for the STI pathogens studied. Among the 269 FSWs, 35.5% were positive for N. gonorrhoeae, 25% were positive for C. trachomatis, 45.5% were positive for T. vaginalis, 32.6% were seropositive for T. pallidum, 62.5% were seropositive for HSV-2, and 51% had infections with two or more pathogens.

Survival and growth of Shigella flexneri were assessed in various foods, including boiled rice, lentil soup, milk, cooked beef, cooked fish, mashed potato, mashed brinjal, and raw cucumber. Growth at 25 and 37 degrees C and survival at 5 degrees C were observed by viable counts on MacConkey agar. The organism grew well in all tested foods and growth increased from 10(5) to 10(8) to 10(10) cells per ml or g within 6 to 18 h after inoculation at 25 and 37 degrees C.

Acute lower respiratory tract infections (ALRIs) are a major cause of death among young children in developing countries. A targeted programme designed to treat children with ALRI was implemented in 1988 in a primary health care project in rural Bangladesh. In the 2 years preceding the introduction of the programme (1986-87), non-ALRI-specific health services were provided, including promotion of oral rehydration therapy, family planning, immunization of children and mothers, distribution of vitamin A, referral of severely sick children to field clinics, and nutritional rehabilitation of malnourished children. The targeted ALRI programme, which was in place in 1988-89, was based on systematic ALRI case detection and management by community health workers, who were linked to a referral system for medical support. These two levels of intervention have been evaluated by comparing the ALRI-specific mortality in the programme area and a neighbouring control area during the two periods. During the first phase (1986-87), the ALRI mortality among under-5-year-olds was 28% lower in the intervention than in the comparison area (P less than 0.01). During the second phase (1988-89), the ALRI mortality was 32% lower in the intervention area than during the preceding phase, while there was no significant difference for the comparison area. These findings suggest that in the study region the combination of specific and nonspecific interventions can reduce ALRI mortality by as much as 50% and the overall mortality among under-5-year-olds by as much as 30%.

Plesiomonas shigelloides is considered to be a waterborne agent of human gastroenteritis. An ecological study was carried out in five ponds in Dhaka city over a period of one year to elucidate the distribution and seasonality of this organism in various components of pond ecosystems. Samples were collected from hydrophytes, water, phytoplankton and sediment every 15 days over 12 months and cultured for P. shigelloides. P. shigelloides was isolated from a total of 120 samples including 25 (20.8%), 16 (13.3%), 22 (18.3%) and 35 (29.2%) of hydrophytes, water, phytoplankton and sediment samples, respectively. Distinct seasonal patterns of isolation of P. shigelloides were observed in the four components with two distinct peaks. The highest peaks were observed in hydrophytes and water samples in May and in phytoplankton and sediment in November. P. shigelloides was isolated from all components from all ponds during the study period. These results suggest that P. shigelloides is an autochthonous member in the freshwater pond ecosystems in Dhaka, Bangladesh.