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Background: There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox's Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting.Methods and Findings: Orbis International and local secondary facility Cox's Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox's Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5-11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18-29 years: 4.67% versus 1.80%, P = 0.0019; 30-39: 7.61% versus 2.39%, P < 0.001; and 40-49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease.Conclusions: The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations. [ABSTRACT FROM AUTHOR]

Sustainability of brackishwater shrimp farming is of paramount importance for socio-economic development of southwest coastal Bangladesh. Here, shrimp farming is predominantly traditional, which is more vulnerable to climate change. Lack of understanding exists regarding the adaptation measures of local shrimp farmers in response to emerging impacts of changing climatic variables. This study provides the perceptions and adaptations of shrimp farmers in changing climatic context. A systematic random sampling method was employed to conduct a total of 240 questionnaire surveys and 60 key informant interviews from six sub-districts (Upazila) of southwest coastal Bangladesh to collect primary data. Changes in climate variables largely affect the shrimp yield by increasing frequency of shrimp disease, causing physical damage to farm structure and deteriorating quality of water. Shrimp farmers try to adapt to those changes in various ways, including increasing pond depth, exchanging tidal water, providing shade using aquatic plants, strengthening earthen dike and netting and fencing around the dike. Shrimp mixed cultivation is the most popular form of shrimp farming in the study area. More emphasis on implementing polyculture shrimp farming is necessary to improve climate change adaptation and to promote sustainability of this aquaculture practice in southwest coastal Bangladesh. [ABSTRACT FROM AUTHOR]

Shrimp ( Penaeus monodon) farming is a traditional aquaculture in southwest coastal Bangladesh. Changes in both the farming practice and yield of shrimp since the advent of commercial production in this area are evident in scientific studies. We assessed the historical perspective of shrimp farming indicating the major phase changes and present situation of the shrimp farming practice including recent changes in yield and cost-benefit. A systematic random sampling method was employed to conduct a total of 240 questionnaire surveys, 24 focused group discussions, and 60 key informant interviews in six sub-districts (upazila) from southwest coastal Bangladesh. We identified four major phase changes in the history of shrimp farming in southwest coastal Bangladesh and found that shrimp mixed culture is the most preferable form of extensive cultivation at present. Shrimp farmers' perceptions about changes in shrimp yield and changes in availability of ecosystem services represent declining trends over the last two decades. For 2015, shrimp yield was not significantly different with respect to salinity levels. The net benefit from shrimp mixed culture in 2015 was 121,000 taka/ha, which is 2.35 times higher compared to the net benefit from only shrimp (51,500 taka/ha). In this context, promoting shrimp mixed cultivation could be a management solution for sustainable development of shrimp farming in southwest coastal Bangladesh. The National Shrimp Policy of the government also emphasized on promoting environment-friendly shrimp mixed cultivation for sustainable development of shrimp farming. However, more institutional support such as training, extension support, technical assistance, and credit facility is required to implement the policy. [ABSTRACT FROM AUTHOR]

The fisheries sector is crucial to the Bangladeshi economy and wellbeing, accounting for 4.4% of national gross domestic product and 22.8% of agriculture sector production, and supplying ca. 60% of the national animal protein intake. Fish is vital to the 16 million Bangladeshis living near the coast, a number that has doubled since the 1980s. Here, we develop and apply tools to project the long-term productive capacity of Bangladesh marine fisheries under climate and fisheries management scenarios, based on downscaling a global climate model, using associated river flow and nutrient loading estimates, projecting high-resolution changes in physical and biochemical ocean properties, and eventually projecting fish production and catch potential under different fishing mortality targets. We place particular interest on Hilsa shad (Tenualosa ilisha), which accounts for ca. 11% of total catches, and Bombay duck (Harpadon nehereus), a low price fish that is the second highest catch in Bangladesh and is highly consumed by low-income communities. It is concluded that the impacts of climate change, under greenhouse emissions scenario A1B, are likely to reduce the potential fish production in the Bangladesh exclusive economic zone by ,10%. However, these impacts are larger for the two target species. Under sustainable management practices, we expect Hilsa shad catches to show a minor decline in potential catch by 2030 but a significant (25%) decline by 2060. However, if overexploitation is allowed, catches are projected to fall much further, by almost 95% by 2060, compared with the Business as Usual scenario for the start of the 21st century. For Bombay duck, potential catches by 2060 under sustainable scenarios will produce a decline of ,20% compared with current catches. The results demonstrate that management can mitigate or exacerbate the effects of climate change on ecosystem productivity. [ABSTRACT FROM AUTHOR]

Background: Very little is known about female injecting drug users (IDU) in Bangladesh but anecdotal evidence suggests that they are hidden and very vulnerable to HIV through both their injection sharing and sexual risk behaviors. In order to better understand the risks and vulnerability to HIV of female IDU, a cohort study was initiated through which HIV prevalence and risk behaviors was determined. Methods: All female IDU (those who had injected in the last six months and were 15 years or older) who could be identified from three cities in the Dhaka region were enrolled at the baseline of a cohort study. The study was designed to determine risk behaviors through interviews using a semi-structured questionnaire and measure prevalence of HIV, hepatitis C and syphilis semiannually. At the baseline of the cohort study 130 female IDU were recruited and female IDU selling sex in the last year (sex workers) versus those not selling sex (non-sex workers) were compared using descriptive statistics and logistic regression. Results: Of the 130 female IDU enrolled 82 were sex workers and 48 were non-sex workers. None had HIV but more sex workers (60%) had lifetime syphilis than non-sex workers (37%). Fewer sex worker than non-sex worker IDU lived with families (54.9% and 81.3% respectively), but more reported lending needles/syringes (29.3% and 14.6% respectively) and sharing other injection paraphernalia (74.4% and 56.3% respectively) in the past six months. Although more sex workers used condoms during last sex than non-sex workers (74.4% and 43.3% respectively), more reported anal sex (15.9% and 2.1% respectively) and serial sex with multiple partners (70.7% and 0% respectively). Lifetime sexual violence and being jailed in the last year was more common in sex workers. Conclusion: Female IDU are vulnerable to HIV through their injection and sexual risk behaviors and sex worker IDU appear especially vulnerable. Services such as needle exchange programs should become more comprehensive to address the needs of female IDU. [ABSTRACT FROM AUTHOR]

Purpose: This study assesses the prevalence and the causes of visual impairment among bus drivers undergoing screening in Bangladesh and associations with self-reported crashes., Methods: Eye health screenings including refraction and questionnaires were conducted at 10 bus terminals in 7 districts of Bangladesh from June through August 2019. Presenting near and distance visual impairment and self-reported road traffic crashes were recorded., Results: Among 700 participants, nearly 1 in 5 (n = 126, 18.0%) had presented visual acuity (VA) in the better-seeing eye ≤6/9, not meeting the vision standard of Bangladesh for bus drivers. A majority of drivers (n = 492, 70.3%) had near or distance refractive error, and most who failed to reach the driving standard (88.1%, n = 111) could be improved with readily available treatment, either glasses or cataract surgery. A history of 1 or more road traffic crashes while driving a bus or minibus was reported by 62 (8.97%) participants. In multivariable models, factors significantly associated with near or distance visual impairment included older age [odds ratio (OR) per year 1.15, 95% confidence interval (CI): 1.12-1.18, P < 0.0001] and having no driver's license (OR 1.80, 95% CI: 1.04-3.13, P = 0.037). Self-reported history of a motor vehicle crash was associated with near or distance visual impairment (OR 2.45, 95% CI: 1.09-5.49, P = 0.030), even when adjusting for other factors such as age and weekly miles are driven., Conclusions: Ensuring that bus drivers are screened to meet the required visual standards for driving while referring those who do not for treatment, can contribute to safer roads in this high-risk setting., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)

Purpose: To assess the prevalence of near and correctable distance visual impairment among screened participants in the garment industry and to explore associations with income, age, and urban versus rural residence., Methods: Vision screenings were conducted at 4 garment factories, 2 urban and 2 rural locations during September and October 2019. Distance vision impairment was the presence of uncorrected vision of <6/12 in either eye, correctable to ≥6/7.5 with distance refraction. Near vision impairment was defined as 1 or more of the following: 1) either eye with presenting near vision 6/12 in the same eye; 2) having been prescribed near add spectacle power in examination records; and/or 3) clinical diagnosis of presbyopia at the time of screening. Demographic information and monthly income were self-reported by questionnaire completion., Results: Among 915 participating workers (100% female, 18 to 70 years), 29.2% (n = 267) and 26.8% (n = 245) had correctable distance and near vision impairment respectively. Prevalence of near vision impairment was significantly higher among rural residents (34.2%, n = 160), compared to urban (19.0%, n = 85, P < 0.0001) with the largest differences in the 35 to 39 (68.2% vs 44.2%, P = 0.0019) and 40+ (85.9 vs 48.9%, P < 0.0001) year age ranges. Prevalence of near vision impairment was already high among urban (20.4%, n = 20) and rural (23.0%, n = 17) workers aged 30 to 34 years. In simple linear regression models, participants with near vision impairment earned $13.3 [standard error (SE) 2.44, P < 0.0001] less per month than those without, while urban residents earned $40.6 (SE 1.74, P < 0.0001) more than rural dwellers. In the final multivariate linear model, both near vision impairment ($6.51 lower monthly earnings, SE 1.84, P = 0.0004) and urban residence ($43.2 higher monthly earnings, SE 2.39, P < 0.0001) remained significantly associated with income., Conclusions: This study found high rates of near vision impairment among female garment workers, particularly rural dwellers, and at a younger age than expected. The high prevalence and association between near vision impairment and lower income suggest that focusing on industries with a high proportion of female workers, such as readymade garments, may be effective in addressing gender disparities in vision impairment and its economic impact., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2022 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.)

Aim: To determine the prevalence and causes of blindness, vision impairment and cataract surgery coverage among Rohingya refugees aged ≥ 50 years residing in camps in Cox's Bazar, Bangladesh., Methods: We used the Rapid Assessment of Avoidable Blindness (RAAB) methodology to select 76 clusters of 50 participants aged ≥ 50 years with probability proportionate to size. Demographic and cataract surgery data were collected using questionnaires, visual acuity was assessed per World Health Organization criteria and examinations were conducted by torch, and with direct ophthalmoscopy in eyes with pinhole-corrected vision <6/12. RAAB software was used for data entry and analysis., Results: We examined 3,629 of 3800 selected persons (95.5%). Age and sex adjusted prevalence of blindness (<3/60), severe visual impairment (SVI; >3/60 to ≤6/60), moderate visual impairment (MVI; >6/60 to ≤6/18), and early visual impairment (EVI; >6/18 to ≤6/12) were 2.14%, 2.35%, 9.68% and 14.7% respectively. Cataract was responsible for 75.0% of blindness and 75.8% of SVI, while refractive error caused 47.9% and 90.9% of MVI and EVI respectively. Most vision loss (95.9%) was avoidable. Cataract surgical coverage among the blind was 81.2%. Refractive error was detected in 17.1% (n = 622) of participants and 95.2% (n = 592) of these did not have spectacles. In the full Rohingya cohort of 76,692, approximately 10,000 surgeries are needed to correct all eyes impaired (<6/18) by cataract, 12,000 need distance glasses and 73,000 require presbyopic correction., Conclusion: The prevalence of blindness was lower than expected for a displaced population, in part due to few Rohingya being ≥60 years and the camp's good access to cataract surgery. We suggest the United Nations High Commissioner for Refugees include eye care among recommended health services for all refugees with long-term displacement., Competing Interests: The authors have declared that no competing interest exist.

Deltas are home to a large and growing proportion of the world's population, often living in conditions of extreme poverty. Deltaic ecosystems are ecologically significant as they support high biodiversity and a variety of fisheries, however these coastal environments are extremely vulnerable to climate change. The Ganges-Brahmaputra-Meghna (Bangladesh/India), the Mahanadi (India), and the Volta (Ghana) are among the most important and populous delta regions in the world and they are all considered at risk of food insecurity and climate change. The fisheries sector is vital for populations that live in the three deltas, as a source of animal protein (in Bangladesh and Ghana around 50-60% of animal protein is supplied by fish while in India this is about 12%) through subsistence fishing, as a source of employment and for the wider economy. The aquaculture sector shows a rapid growth in Bangladesh and India while in Ghana this is just starting to expand. The main exported species differ across countries with Ghana and India dominated by marine fish species, whereas Bangladesh exports shrimps and prawns. Fisheries play a more important part in the economy of Bangladesh and Ghana than for India, both men and women work in fisheries, with a higher proportion of women in the Volta then in the Asian deltas. Economic and integrated modelling using future scenarios suggest that changes in temperature and primary production could reduce fish productivity and fisheries income especially in the Volta and Bangladesh deltas, however these losses could be mitigated by reducing overfishing and improving management. The analysis provided in this paper highlights the importance of applying plans for fisheries management at regional level. Minimizing the impacts of climate change while increasing marine ecosystems resilience must be a priority for scientists and governments before these have dramatic impacts on millions of people's lives., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aquatic ecosystems are of global importance for maintaining high levels of biodiversity and ecosystem services, and for the number of livelihoods dependent on them. In Bangladesh, coastal and delta communities rely on these systems for a livelihood, and the sustainability of the productivity is seriously threatened by both climate change and unsustainable management. These multiple drivers of change shape the livelihood dependence and adaptation responses, where a better understanding is needed to achieve sustainable management in these systems, while maintaining and improving dependent livelihoods. This need has been addressed in this study in the region of Satkhira, in the southwest coast of Bangladesh, where livelihoods are highly dependent on aquatic systems for food supply and income. Traditional wild fish harvest in the rivers and aquaculture systems, including ghers, ponds, and crab points have been changing in terms of the uses and intensity of management, and suffering from climate change impacts as well. By means of six focus groups with 50 participants total, and validated by expert consultations, we conduct an analysis to understand the main perceived impacts from climate and human activities; and the adaptation responses from the aquatic system livelihoods. We find that biodiversity has decreased drastically, while farmed species have increased and shrimp gher farming turned more intensive becoming the main source of income. All these changes have important implications for food supply in the region and environmental sustainability. Dramatic responses taken in the communities include exit the fisheries and migration, and more adaptive responses include species diversification, crab fattening and working more on the pond and gher infrastructure. This study evidences the results of the combination of multiple stressors in productive systems and the barriers to adaptation in aquatic ecosystem dependent communities., (Copyright © 2018 Elsevier B.V. All rights reserved.)