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Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh's 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach. [ABSTRACT FROM AUTHOR]

The document is a correction notice for an article on the impact of water, sanitation, and hygiene practices and deworming on the nutritional status of unmarried adolescent girls in rural Bangladesh. The authors identified errors in Tables 2 and 3 of the original article, which have been corrected in the notice. The corrected tables provide information on the average nutrient intake and nutritional status of the girls in the study. The first table shows the average intake of various nutrients, while the second table compares the physical measurements and hemoglobin levels of girls in different groups. The corrected tables can be found in the correction article. [Extracted from the article]

Background: Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery. Methods: We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization. Results: We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10–1.40; CRB 2.46, 95% CI 1.39–4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08–1.59; newborn ESBL-PB 1.34, 95% CI 1.09–1.64; newborn CRB 1.73, 95% CI 1.20–2.47). Conclusions: In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms. [ABSTRACT FROM AUTHOR]

Background: In Bangladesh, undernutrition and anemia are more occurrent among adolescent girls. BRAC, the largest non-governmental organization (NGO), has been implementing a community-based nutrition education service package targeting adolescent girls for reducing their undernutrition and anemia. Objective: We aimed to explore the underlying factors associated with nutritional status and anemia among adolescent girls under the BRAC nutrition program areas to improve their existing intervention package. Methodology: We conducted a cross-sectional and comparative study in 2016, in 24 upazilas of Bogra, Barguna, Comilla, Dinajpur, Feni, Jessore, and Meherpur districts where the BRAC nutrition program was implemented while the remaining 27 upazilas of those districts were selected as comparison area. We followed a multistage cluster random sampling for selecting 1620 unmarried adolescent girls aged 10–19 years for interviewing in the intervention and comparison areas. Data were collected on socio-demographic information, dietary intake, morbidity, water, sanitation, and hygiene (WASH) practice, anthropometry, and serum hemoglobin (Hb) level by using a pre-structured questionnaire. The nutritional status of the adolescent girls was expressed as height-for-age Z (HAZ) and body mass index-for-age Z (BMIZ) score, while anemia referred to the serum Hb at the level of below 12 g/dl for adolescent girls. All statistical analyses were done in STATA version 17 (Chicago Inc.). Findings: The prevalence of stunting (22.9% vs. 22.5%), thinness (12% vs. 14%), and anemia (34.5% vs. 37.3%) exhibited similarities between the intervention and comparison regions. Stunting and thinness were predictors for each other for this population group. Our findings indicated that adolescent girls who were not washing hands with soap after defecation were likely to be stunted [AOR 1.51 (95% CI 1.12–2.04)], and who did not utilize sanitary latrines had an increased likelihood of being thin [AOR 2.38 (95% CI 1.11–5.08)]. Conversely, those who did not watch television [AOR 1.69 (95% CI 1.12–2.56)] and did not have deworming tablets [AOR 1.33 (95% CI 1.07–1.64)] in the 6 months leading up to the interview had a 69% and 33% higher probability of being anemic, respectively. Conclusion: For sustainable improvement in the undernutrition and anemia of adolescent girls, integration of WASH, consistent administration of deworming tablets and broadcasting awareness programs through television are urgent to scale up the nutrition intervention programs in similar settings like Bangladesh. [ABSTRACT FROM AUTHOR]

Metals, particularly Zn, Cu, Fe, and Mn are distributed amongst several geochemical forms, influencing their solubility, mobility and toxicity in soil-water systems. In this study, Sundarbans mangrove forest soils were analyzed by sequential fractionation to understand the distribution of these metals into exchangeable (Exch), organically bound (OrgB), Mn-oxide bound (MnOB), amorphous Fe-oxide bound (AFeOB), crystalline Fe-oxide bound (CrFeOB) and residual (Res) fractions. Soil Fe was predominately present in the residual fraction (55–73%), and manganese was primarily bounded in residual (29–58%) and MnOB (5–31%) fractions. The Res, CrFeOB and AFeOB fractions of Cu account for more than 80% of the total Cu. Zinc was mostly concentrated in the residual fraction and varied between 57 to 78% of the total Zn. Principal Component Analysis (PCA) and correlation studies revealed that exchangeable and organically bound fractions of these metals were significantly correlated, and their concentrations were highly dependent on soil pH, soil texture, organic carbon and redox potential (p < 0.05). Despite low total concentration, ratio of secondary phase and primary phase (RSP) and risk assessment code (RAC) studies showed that Cu (RSP is 1–2.64 and RAC is 1–2.89) and Mn (RSP is 1–2.42 and RAC is 1–16.66) were at low to moderate contamination risk and Fe maintained no contamination (RSP and RAC < 1) in almost all the soils. In contrast, Zn showed low contamination risk in some areas. This contamination can cause adverse effects on the plants and soil-dwelling organisms of Sundarbans mangrove forest due to higher availability. [ABSTRACT FROM AUTHOR]

This article examines the position of Bangladesh in the field of international social work with women. It explores the country's women's development initiatives in the context of the global debate over indigenization, universalization and imperialism. To identify the strategic position, the article examines the literature on social work, the evolution of social work and the web contents of some development agencies in Bangladesh. The findings reveal that Bangladesh follows a process of reconciliation in the indigenization–internationalization dispute by employing both top-down (think globally, act locally) and bottom-up (act locally, proceed globally) approaches to international social work and women's development. [ABSTRACT FROM AUTHOR]

Adolescent pregnancies, a risk factor for obstetric complications and perinatal mortality, are driven by child marriage in many regions of South Asia. We used data collected between 2017–2019 from 56,155 married adolescents and women in a health and demographic surveillance system to present a population-level description of historical trends in child marriage from 1990–2019 as well as epidemiologic associations between maternal age and pregnancy outcomes in Baliakandi, a rural sub-district of Bangladesh. For pregnancies identified between 2017–2019, we used Kaplan-Meier estimates to examine timing of first pregnancies after first marriage and multinomial logistic regression to estimate associations between maternal age and perinatal death. We described the frequency of self-reported obstetric complications at labor and delivery by maternal age. In 1990, 71% of all marriages were to female residents under 18 years of age. This decreased to 57% in 2010, with the largest reduction among females aged 10–12 years (22% to 3%), and to 53% in 2019. Half of all newly married females were pregnant within a year of marriage, including adolescent brides. Although we observed a decline in child marriages since 1990, over half of all marriages in 2019 were to child brides in Baliakandi. In this same population, adolescent pregnancies were more likely to result in obstetric complications (13–15 years: 36%, 16–17 years: 32%, 18–34 years: 23%; χ2 test, p<0.001) and perinatal deaths (13–15 years: stillbirth OR 2.23, 95% CI 1.01–2.42; 16–17 years: early neonatal death OR 1.57, 95% CI: 1.01–2.42) compared to adult pregnancies. Preventing child marriage can improve the health of girls and contribute to Bangladesh's commitment to reducing child mortality. [ABSTRACT FROM AUTHOR]

Objective: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. Methods: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. Results: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6-12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. Conclusions: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.

Background: In 2016, the Government of Bangladesh (GoB) established a teleconsultation service called Shastho Batayon to increase access to physicians. During COVID-19 pandemic, health care access became limited due to movement restrictions. In response, GoB made Shastho Batayon toll free, publicized the number through media, increased the number of call center doctors, introduced automated messages on COVID-19 preventive measures, and developed a scoring system to classify risk groups for COVID-19. Objectives and Methods: In this case report, we describe how an existing national teleconsultation service can be utilized in a low- and middle-income country to address primary health care needs during a public health emergency. We conducted secondary analysis of Shastho Batayon service data from January to April 2020. Results: The total calls for doctor's consultation increased during the pandemic. Prepandemic, Shastho Batayon received less than 20,000 calls per month. In March 2020, when the first cases of COVID-19 were confirmed, Shastho Batayon services received 60,811 calls for doctor's consultation, which increased to 125,660 calls in April, 2020. The doctor's consultation for primary care has increased for all conditions. Shastho Batayon services screened 28,944 patients with the influenza-like illness or COVID-19-like symptoms in March and April, 2020, provided preventive measures, advice, and referral to designated hospitals based on a national guideline. Conclusions: In public health emergencies such as COVID-19 pandemic, teleconsultation services can help provide prevention guidelines, debunk misinformation, identify risk categories, and refer people to appropriate service and facilities in a timely manner. [ABSTRACT FROM AUTHOR]

The study assessed the status of water quality parameters for an urban water body (Hatirjheel Lake) in Dhaka, the Capital city of Bangladesh. Nine different water samples were collected from nine points of the lake during the dry season in January 2021. Water quality parameters such as pH, electrical conductivity (EC), total dissolved solids (TDS), total suspended solids (TSS), total alkalinity, total acidity, total hardness, Ca2+ hardness, free CO2, and dissolved oxygen (DO) were determined for the samples. The status of the parameters is pH (6.51- 7.05), EC (510-600 μS.cm-1), TDS (450-590 ppm), TSS (0.0-0.034 mg.L-1), total alkalinity (80- 392 mg.L-1), total acidity (224-500 mg.L-1), total hardness (348-452 mg.L-1), Ca2+ hardness (74-162 mg.L-1), free CO2 (730-1170 mg.L-1), DO (2.7-5.5 mg.L-1). However, the DO value at some points of the lake is too less (2.7 mg.L-1 and 3.7 mg.L-1) than the standard value (> 5-6 mg.L-1) of ECR, DoE, which might not be healthy for any water body and aquatic ecosystem. Other water quality parameters are within the permissible limit of WHO and ECR, DoE. [ABSTRACT FROM AUTHOR]

Introduction: Despite high prevalence of malnutrition little is known about the quality of nutrition services provided through urban health systems. This study aimed to fill in knowledge gaps on quality of nutrition service provision at public primary health care facilities in urban Dhaka. Method: This cross-sectional study was conducted from April-July 2019 in Dhaka City. Fifty-three health facilities were sampled following NetCode protocol. Quality of nutrition services was assessed in terms of structural readiness, process, and client satisfaction. Structural readiness included equipment, guidelines, and registers, and knowledge of health professionals (n = 130). For process, client provider interaction was observed (ANC: n = 159, Pediatric: n = 150). For outcome assessment, client's satisfaction with nutrition service provision was measured through interviews with pregnant women (n = 165) and caregivers of 0–24 month-old children (n = 162). Bivariate and multivariate analyses were conducted using SPSS. Results: There were gaps in availability of equipment and guidelines in health facilities. Only 30% of healthcare providers received basic nutrition training. The mean knowledge score was 5.8 (range 0–10) among ANC providers and 7.8 for pediatric service providers. Process: Only 17.6% health facilities had dedicated space for counselling, 48.4% of pregnant women received four key nutrition services; 22.6% of children had adequate growth monitoring; and 38.7% of caregivers received counselling on exclusive breastfeeding. Outcome: The mean satisfaction with services was 4.3 for ANC and 4.0 for paediatric visits (range 1–5). Participants attending public facilities had significantly lower satisfaction compared to those attending private and NGO health facilities. Conclusion: There were gaps in facility readiness, and implementation of nutrition services. The clients were more satisfied with services at private facilities compared to public. The gaps in nutrition service delivery need to be adequately addressed to ensure promotion of good nutrition and early detection and management of malnutrition among pregnant women and children in urban Bangladesh. [ABSTRACT FROM AUTHOR]

Irrational and inappropriate use of antibiotics in commercial chicken production can contribute to the development of antimicrobial resistance. We aimed to assess antibiotic usage in commercial chicken production in Bangladesh, and identify factors associated with this practice. We conducted a large-scale cross-sectional study to collect information on antibiotic usage in commercial chickens from January to May 2021. Structured interviews were conducted with 288 broiler, 288 layer and 192 Sonali (locally-produced cross-bred) farmers in 20 sub-districts across Bangladesh. The frequency of antibiotic usage, the types of antibiotics and purpose of usage were estimated for each production type. Adjusted odds ratios (aOR) were calculated to measure the association between antibiotic usage and factors related to the characteristics of the farms and farmers using multivariable logistic regression models. The proportion of farms, irrespective of their production type, reporting usage of antibiotics in the 24 hours preceding the interview was 41% (n = 314, 95% CI: 37–44%). Forty-five percent (n = 344, 41–48%) reported antibiotic usage in the last 72 hours, 86% (n = 658, 83–88%) in the last 14 days, and almost all farms, 98% (n = 753, 97–99%), had used antibiotics since the start of their production cycle. Use of antibiotics in the 24 hours preceding an interview was more frequently reported in broiler (OR 1.91, 95% CI: 1.36–2.69) and Sonali (OR 1.94, 95% CI: 1.33–2.33) than layer farms. Oxytetracycline (23–31%, depending on production type), doxycycline (18–25%), ciprofloxacin (16–26%) and amoxicillin (16–44%) were the most frequently used antibiotics. Antibiotics were reported to be used for both treatment and prophylactic purposes on most farms (57–67%). Usage of antibiotics in the 24h preceding an interview was significantly associated with the occurrence of any illnesses in chickens (aOR broiler: 41.22 [95% CI:13.63–124.62], layer: aOR 36.45[9.52–139.43], Sonali: aOR 28.47[4.97–162.97]). Antibiotic usage was mainly advised by veterinary practitioners (45–71%, depending on production type), followed by feed dealers (21–40%) and farmers (7–13%). Improvement of chicken health through good farming practices along with changes in key stakeholders (feed dealers and practitioners) attitudes towards antibiotic recommendations to farmers, may help to reduce the levels of antibiotic usage and thus contribute to mitigate antimicrobial resistance. [ABSTRACT FROM AUTHOR]

The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections. [ABSTRACT FROM AUTHOR]

At present, there are growing concerns over the increasing release of trace metals in the Sundarbans mangrove areas in Bangladesh due to nearby shipbreaking and metallurgical industries, untreated waste discharge, navigation activities, and other natural processes that deposit trace metals into soils. The current study investigated the spatial distribution, contamination level, and ecotoxicity of eight trace metals (Fe, Mn, Cu, Zn, Pb, Cd, Cr, Ni) in Sundarbans soils. Results revealed that all the trace metals except Cr were present in higher concentrations compared to Earth's shale and/or upper continental crust. Principal component analysis and Pearson correlation showed strong positive correlations (p < 0.05) between Fe, Mn, Cu, and Zn; Ni with Mn and Cr. There were significant associations (p < 0.05) of % clay and total organic carbon (TOC) with Pb-Ni-Cr and negative correlations of pH with all the trace metals. The hierarchical cluster analysis grouped Pb, Ni, and Cd into one distinct cluster, suggesting they are derived from the same sources, possibly from anthropogenic activities. Geo accumulation index (I-geo), enrichment factor (EF), contamination factor (CF), and spatial distribution showed moderately polluted soils with Ni, Pb, and Cd (EF = 3–7.4, CF = 1–2.8, I-geo = 0–0.9) and low pollution by Zn, Cu, Fe, and Mn (EF < 3, CF < 1, I-geo < 0). The ecological risk index (RI) revealed that S-4 (RI = 114.02) and S-5 (RI = 100.04) belonged to moderate risk, and other areas posed a low risk (RI < 95). The individual contribution of Cd (25.9–73.7%), Pb (9.2–29.1%), and Ni (9.6–26.4%) to RI emphasized these metals were the foremost concern in the Sundarbans mangroves due to their long persistence time and high toxicity, even if they were present in low concentrations. [ABSTRACT FROM AUTHOR]

This study aims to identify blood biomarkers for rapidly predicting progression and severity assessment of COVID-19 in type 2 diabetic (DM) and non-DM (NDM) patients. Among 211 hospitalized patients suspected of COVID-19, 98 were confirmed COVID-19 by rRT-PCR. The COVID-19 positive group contained 58 DM and 40 NDM patients with total death 9 of which 7 were males and 6 were DM, indicating males and DM individuals as more susceptible to COVID-19. Blood biomarkers notably serum ferritin, CRP, D-dimer, ALT, troponin I, and Hb1Ac were significantly (p < 0.05) higher in COVID-19 patients. Ferritin and HbA1c levels were significantly (p < 0.05) higher in DM than NDM COVID-19 patients. The present study suggests that ferritin and HbA1c levels for DM patients, and ferritin, D-dimer, ALT for NDM patients could be routinely used as biomarkers for progression and severity assessment of COVID-19. CRP and Troponin-I could be the predictor only for poor prognosis of COVID-19. [ABSTRACT FROM AUTHOR]

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use. [ABSTRACT FROM AUTHOR]

Background: Documenting perpetrators of human rights violations enables effective prosecution and can help prevent future atrocities. Doing so calls for collecting reliable data using verifiable and transparent methodology. We present methods used to document crimes and identify alleged perpetrators implicated in the 2017 attacks against Rohingya civilians in Myanmar. The findings and lessons-learned have relevance to contemporary crises with widespread atrocities. Methods: A mixed-methods assessment conducted from May to July 2018 included: (1) cross-sectional quantitative surveys among leaders of affected hamlets in northern Rakhine State, (2) qualitative interviews to record hamlet-level accounts, and (3) clinical evaluations of survivors of violence. Survey respondents who reported violence and destruction in each hamlet were asked to identify perpetrators of those acts, including known role or affiliation. The reported names were reviewed for clarity and divergent spellings, repeated references were aggregated, and the names and roles were analyzed and classified by location and affiliation. Results: 143 individuals were implicated in atrocities committed across three Northern Rakhine townships. Each was independently identified by at least three separate survey respondents as directly committing violence or destruction in their hamlet of origin, or as witnessed while fleeing to Bangladesh. Two-thirds (69%) of identified perpetrators were reported by four or more participants and 47% by five or more. Some form of additional identifying information, was provided for 85% of names. The most common affiliations were: Myanmar army (n = 40), Border Guard Police (n = 32), Village Tract Administrators (n = 17), and extremists (n = 25). Conclusions: The methodology presented here yielded a unique record of individuals purported to have directly committed acts of violence and destruction in Rakhine State in August 2017, forming the most extensive record of individuals implicated in ground-level perpetration of those crimes. This methodology can play a key role in accountability mechanisms for the Rohingya, and in other settings in which perpetrators are many and documentation of their crimes is difficult. The use of survey methods and standardized data collection amongst affected populations to comprehensively characterize crimes committed and to identify individuals implicated in those crimes can serve as a key tool in documentation and an important component of accountability. [ABSTRACT FROM AUTHOR]

The Ganges-Brahmaputra river system at the Bengal Basin carries large amounts of sediments on the way to finally deposit at the Bay of Bengal. Those river - transported sediments form bar deposits during dry season in many areas of Bangladesh and accumulate economic mineral depositions at suitable geological environments. Dredging is a must for most of those rivers for proper navigation, as well as protecting bank erosion, which generates millions of tons of waste sand. The dredged materials from river beds are mostly composed of silicate minerals, especially quartz and feldspar along with several dark colored heavy minerals. Like the industrial processing of heavy minerals from bulk sands, various physical separation techniques can be utilized for the beneficiation of silica from those river-born silicate minerals in dredged sands. Those silica have been successfully upgraded to near-glass sand grade in the laboratory, however, they have yet to be utilized for any kind of commercial venture. The present study attempts characterization of several river sands through physical separation and laboratory analysis. The upgraded silica was successfully compared with several quality glass sands and laboratory production of glasses. This experimental production of glass from upgraded silica could potentially be economical considering its industrial application with positive environmental consequences through minimizing the dredging cost, increasing the navigability of the river and ecological balance along the flood plain. [ABSTRACT FROM AUTHOR]

Background: Bangladesh is declared as "Digital Bangladesh" however, medical students are least acquainted with the necessary information and communication technology (ICT) knowledge in the context of medical education. We have conducted a survey to know about digital equipment ownership, therefore, carried out a self-reported assessment of knowledge and utilization of ICT in relation to educational and clinical development. Materials and Methods: A cross-sectional, multi-centered questionnaire survey was conducted among the medical students during the period of October 2019. Results and Discussions: In total 467 medical students responded to the questionnaire in which 92% of the students owned a Google android smartphone and accessed the Internet on their devices. Sixty-nine percent of students have (1–5) medical-related apps in their device and drug formulary apps most commonly used 43%. Fifty-nine percent of students have gained their present computer knowledge through self-learning. For study work with fellow student, 90% of students preferred Facebook group, WhatsApp, and Viber. While there was a range of variation in the usage of nonacademic search engines 72% of Google and no usages were found for more dedicated academic services such as PubMed and Medscape. According to 74% of students, inadequate integration of ICT knowledge into their syllabus culminated in insufficient future professional skills. All students were keen on a basic ICT learning program at the beginning of their medical courses. Conclusion: The study revealed that to prepare medical students for using ICT in their academic work adequately, introducing ICT training at the initial stage of the undergraduate program and designing the curriculum to develop a multiplicity of skills is essential in addition to an integrated teaching method. [ABSTRACT FROM AUTHOR]

In recent years, cadmium (Cd) contamination in agricultural soils and its subsequent transfer to crops is one of the high-priority environmental and public health issues of global concern, especially in densely populated developing countries like Bangladesh. However, no effective strategy has been introduced or implemented yet to manage Cd-contaminated soils in order to sustain agricultural production with no human health risks. In this study, agricultural soil samples were collected from 60 locations of 10 upazilas from Tangail district to assess the extent of soil Cd contamination. The Cd concentration ranged from 0.83 to 4.08 mg kg−1 with a mean of 2.17 mg kg−1 in topsoil (0–15 cm), and from 0.67 to 3.74 mg kg−1 with a mean of 2.10 mg kg−1 in subsoil (16–30 cm). The values of contamination factor (CF) indicated that all the sampling locations were found to be highly contaminated with Cd. Pot trials with the application of different doses of biochar and vermicompost in Cd-contaminated soil (0.8 mg kg−1 Cd) revealed that integrated application of biochar (5 t ha−1) and vermicompost (5 t ha−1) was the best treatment that significantly (p < 0.05) reduced plant Cd concentration (72%) and increased the biomass of experimental crop, Red amaranth (Amaranthus cruentus). This combined treatment also significantly reduced the uptake of Cr (37%) when co-contamination was present. The study suggests the application of biochar (5 t ha−1) in combination with vermicompost (5 t ha−1) to reduce human health risk and increase crop production when the soil is loamy sand in texture. [ABSTRACT FROM AUTHOR]

The increase of pathogens in milk is threatening for the human beings. This is an investigation on overall microbiological analysis of raw and pasteurized milk as well as the milk-based beverages and also determining the antibiotic resistance pattern of isolated Escherichia coli and Staphylococcus aureus. A total of 100 samples (raw milk, pasteurized milk, mattha, lassi and laban) were taken from various locations of the capital city of Bangladesh, Dhaka. Total Viable Count, Total Coliform Count and Yeast and Moulds Count were performed as the microbiological inspection of selected samples. E.coli and Staphylococcus aureus were identified by conducting morphological analysis, gram-staining and biochemical tests. Antibiotic resistance pattern of isolated Escherichia Coli and Staphylococcus aureus were also detected with 11 commonly used antibiotics by conducting disc-diffusion method, following the CLSI guideline. The TVC range was the highest in raw milk samples (3.8×104 - 4.1×108 cfu/ ml), and the lowest in pasteurized milk samples (1.2×10² - 5.4×10³ cfu/ml), while 70% raw milk and 10% pasteurized milk samples strains were above the acceptable limit of Food and Drug Administration (FDA). Thirty-six Escherichia coli and thirty-two Staphylococcus aureus were isolated from all the 100 milk and milk-based beverage samples. The isolated Escherichia coli strains were most resistant to Penicillin G (81.58%), Erythromycin (78.94%) and Ampicillin (73.68%), and isolated Staphylococcus aureus strains were most resistant to Penicillin G (90.62%), Ampicillin (81.25%) and Methicillin (71.87%). respectively. Public awareness is needed to reduce the redundant use of antibiotics. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is a gynecologic cancer type that develops in the cervix, accounting for 8% mortality of all female cancer patients. Infection with specific human papillomavirus (HPV) types is considered the most severe risk factor for cervical cancer. In the context of our socioeconomic conditions, an increasing burden of this disease and high mortality rate prevail in Bangladesh. Although several researches related to the epidemiology, HPV vaccination, and treatment modalities were conducted, researches on the mutation profiles of marker genes in cervical cancer in Bangladesh remain unexplored.Methods: In this study, five different genomic regions within the top three most frequently mutated genes (EGFR, KRAS and PIK3CA) in COSMIC database with a key role in the development of cervical cancers were selected to study the mutation frequency in Bangladeshi patients. In silico analysis was done in two steps: nucleotide sequence analysis and its corresponding amino acid analysis.Results: DNA from 46 cervical cancer tissue samples were extracted and amplified by PCR, using 1 set of primers designed for EGFR and 2 sets of primers designed for two different regions of both PIK3CA and KRAS gene. In total, 39 mutations were found in 26 patient samples. Eleven different mutations (23.91%), twenty-four different mutations (52.17%) and four mutations (8.7%) were found in amplified EGFR, PIK3CA and KRAS gene fragments, respectively; among which 1 (EGFR) was common in seven patient samples and 2 (PIKCA) were found in more than 1 patient. Our study shows that except for KRAS, the frequency of observed mutations in our patients is higher than those reported earlier in other parts of the world. Most of the exonic mutations were found only in the PIK3CA and EGFR genes.Conclusions: The study can be used as a basis to build a mutation database for cervical cancer in Bangladesh with the possibility of targetable oncogenic mutations. Further explorations are needed to establish future diagnostics, personalized medicine decisions, and other pharmaceutical applications for specific cancer subtypes. [ABSTRACT FROM AUTHOR]

BRAC Bangladesh trains community health workers to communicate about nutrition in its Maternal, Newborn and Child Health programme. We estimate the programme's impact on nutrition outcomes among rural Bangladeshi children of two years and younger. We find positive effects on dietary diversity, and show that the programme reduces stunting with 7 percentage points using data from 1600 households in 40 beneficiary mouzas and 40 comparison mouzas. We find larger effects for households where primary caregivers have finished primary school. We did not find effects on wasting, which in contrast to stunting is higher among children with primary caregivers without education. [ABSTRACT FROM AUTHOR]

Globally, more than 5 million stillbirths and neonatal deaths occur annually. For many, the cause of death (CoD) is unknown. Minimally invasive tissue sampling (MITS) has been increasingly used in postmortem examinations for ascertaining the CoD in stillbirths and neonates. Our study compared the counseling and consent methods used in MITS projects in five countries in Africa and south Asia. Key informant interviews were conducted with researchers to describe the characteristics and backgrounds of counselors, the environment and timing of consent and perceived facilitators and barriers encountered during the consent process. Counselors at all sites had backgrounds in social science, psychology and counseling or clinical expertise in obstetrics/gynecology or pediatrics. All counsellors received training about techniques for building rapport and offering emotional support to families; training duration and methods differed across sites. Counselling environments varied significantly; some sites allocated a separate room, others counselled families at the bedside or nursing stations. All counsellors had a central role in explaining the MITS procedure to families in their local languages. Most sites did not use visual aids during the process, relying solely on verbal descriptions. In most sites, parents were approached within one hour of death. The time needed for decision making by families varied from a few minutes to 24 h. In most sites, extended family took part in the decision making. Because many parents wanted burial as soon as possible, counsellors ensured that MITS would be conducted promptly after receiving consent. Barriers to consent included decreased comprehension of information due to the emotional and psychological impact of grief. Moreover, having more family members engaged in decision-making increased the complexity of counselling and achieving consensus to consent for the procedure. While each site adapted their approach to fit the context, consistencies and similarities across sites were observed. [ABSTRACT FROM AUTHOR]

The transformation of the BRAC MANOSHI programme from humanitarian to a social enterprise model, has made it increasingly urgent to enumerate the minimum number of door-to-door antenatal care (ANC) visits by community health workers (CHWs), for the purpose of effectively improving facility delivery. Thus prevent social exclusion of poor slum communities in Bangladesh with regard to safe motherhood and essential newborn care (ENC). This cross-sectional study was conducted, during March–July, 2015 in slums of Chittagong, Dhaka and Sylhet city corporations of Bangladesh. A census was conducted among 25,700 households covering 10 branch offices of MANOSHI to identify women with a delivery outcome in the preceding three years of the survey. A total of 1100 respondents were interviewed randomly through a structured questionnaire. These women were stratified into three categories-1, 2 & 3, consisting of 497, 205 and 398 women respectively. Women in category-1 did not receive any ANC checkup from the BRAC CHWs, while women in category-2 and category-3 received one to three and ≥four ANC checkups from BRAC CHWs respectively. Data was analysed using STATA Version 13 (Chicago Inc.). Findings revealed that women, who received ≥four ANC checkups from BRAC CHWs, are 25% more likely to avail facility delivery [adjusted Prevalence Ratio (aPR) 1.25; 95% confidence interval (CI) (1.01–1.54)] compared to the women who did not receive any ANC from BRAC CHWs. Women in category-2 [aPR3.64; 95% CI (1.76–7.54)] and in category-3 [aPR5.92; 95% CI (3.04–11.53)] respectively had four and six folds higher tendency to receive postnatal care (PNC) within 48 hours after delivery. Furthermore, facility delivery improved PNC assisted by medically trained providers (MTPs) within 48 hours after delivery and ENC in both categories 2 & 3. The evidence shows that at least four ANC visits of BRAC CHWs can increase institutional delivery, and which can further facilitate PNC and ENC visits. At present, the BRAC MANOSHI programme needs to implement feasible strategies to include pregnant women in the slums in receiving at least four ANC checkups by BRAC CHWs for ensuring safe motherhood and newborn care. [ABSTRACT FROM AUTHOR]

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Dietary fibre is known to provide health benefit and protect against degenerative chronic diseases. Thus, the present study reports the total dietary fibre (TDF) content of sixty-nine selected ethnic and unconventional vegetables and fruits growing in Bangladesh. The samples were collected from different locations of Bangladesh and mixed together to ensure sample representativeness. Dietary fibre assay kit according to the AOAC method was utilized for the analysis of TDF in selected vegetables and fruits. In the ethnic varieties, the TDF content ranged from 1.02 ±0.16 to 7.16 ±0.16 g for leafy (LV), 0.18 ±0.01 to 6.71 ±0.49 g for non-leafy vegetables (NLV) and 1.21 ±0.12 to 5.29 ±0.20 g for fruits per 100 g edible portion (EP). In the unconventional items, it arrayed from 3.08 ±0.34 g to 7.75 ±0.13 g for LV and 1.02 ±0.06 to 8.82 ±0.40 g for NLV per 100 g EP. Among the analysed samples, the highest and lowest content of TDF was found in Orohordal and Mairabokong, respectively. The unconventional vegetables contained much higher content of TDF than the ethnics and the commonly consumed similar varieties. Data on TDF content in underutilized vegetables and fruits of Bangladesh is sparse. Thus, the finding of this study would fill up the data gap in the existing food composition table of Bangladesh and also would aware the people to take vegetables and fruits rich in fibres. [ABSTRACT FROM AUTHOR]

Background: The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh Methods: We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b). Findings: In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04–5.38, p < .001 and in phase 2: 15.20 CI: 6.36–36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother’s education, husband’s education, and fetal sex Conclusion: The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh. Trial registration: ClinicalTrials.gov . [ABSTRACT FROM AUTHOR]

Fifty-two maternal deaths occurred between September 2017 and August 2018 in the Rohingya refugee camps in Ukhia and Teknaf Upazilas, Cox's Bazar District, Bangladesh. Behind every one of these lives lost is a complex narrative of historical, social, and political forces, which provide an important context for reproductive health programming in Rohingya camps. Rohingya women and girls have experienced human rights violations in Myanmar for decades, including government-sponsored sexual violence and population control efforts. An extension of nationalist, anti-Rohingya policies, the attacks of 2017 resulted in the rape and murder of an unknown number of women. The socio-cultural context among Rohingya and Bangladeshi host communities limits provision of reproductive health services in the refugee camps, as does a lack of legal status and continued restrictions on movement. In this review, the historical, political, and social contexts have been overlaid below on the Three Delays Model, a conceptual framework used to understand the determinants of maternal mortality. Attempts to improve maternal mortality among Rohingya women and girls in the refugee camps in Bangladesh should take into account these complex historical, social and political factors in order to reduce maternal mortality. [ABSTRACT FROM AUTHOR]

Infections by methicillin-resistant Staphylococcus aureus (MRSA) are gradually increasing in the community. In this study, we investigated a total of 162 food samples including 112 ready-to-eat (RTE) foods and 40 processed raw meat and fish samples collected from retail vendors in Dhaka, Bangladesh and determined the occurrence of toxigenic S. aureus and MRSA. Around 22% of samples were positive for S. aureus , RTE foods being more positive (23%) than the processed raw meat/fish samples (18%). Among 35 S. aureus isolates, 74% were resistant to erythromycin, 49% to ciprofloxacin and around 30% to oxacillin and cefoxitin. Around 37% of isolates were resistant to ≥3 classes of antibiotics and 26% of isolates (n = 9) were identified as MRSA. Majority of the isolates were positive for enterotoxin genes (74%), followed by pvl gene (71%), toxic shock syndrome toxin (tsst) gene (17%) and exfoliative toxin genes (11%). Multi locus sequence typing (MLST) of 9 MRSA isolates identified four different types such as ST80 (n = 3), ST6 (n = 2), ST239 (n = 2) and ST361 (n = 2). spa typing of MRSA isolates revealed seven different types including t1198 (n = 2), t315 (n = 2), t037 (n = 1), t275 (n = 1), t304 (n = 1), t8731 (n = 1) and t10546 (n = 1). To our knowledge, this is the first report entailing baseline data on the occurrence of MRSA in RTE foods in Dhaka highlighting a potential public health risk to street food consumers. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of structured training given to dedicated family planning counsellors on postpartum intrauterine device (PPIUD) services across six tertiary hospitals in Bangladesh. Methods: Family planning counsellors underwent structured training on postpartum family planning, PPIUD in particular, over a four‐day period. Impact of training was evaluated by comparing PPIUD counselling rates, consent rates, insertion rates, and removal rates five months before and five months after the training, using data from women delivering in the participating facilities. Results: A total of 27 622 women were included in this analysis: 11 263 (40.8%) before the training intervention and 16 359 (59.2%) after it. There was an increase in the proportion of women who were counselled (from 75.3% to 83.8%, P<0.001), and a small decrease in the proportion of women agreeing to have a PPIUD inserted following counselling (13.7% vs 12.9%, P=0.03). Overall insertion rate was similar before and after training (9.5% vs 9.8%, P=0.42), while removal rate reduced from 2.8% to 1.8% (P=0.41). Conclusion: Structured training had no impact on overall PPIUD insertion rate. However, it did impact numbers of women receiving counselling, perceived quality of the counselling received, and overall removal rates. Although structured training had no impact on overall insertion rate, it did impact numbers of women receiving counselling, perceived quality of counselling, and overall removal rates. [ABSTRACT FROM AUTHOR]

Breast cancer survival rates in lower-income countries like Bangladesh are approximately 50%, versus over 80% in high income countries. Anecdotal reports suggest that, beyond economic and health system barriers, sociocultural factors may influence a woman's care-seeking behavior and resultant early stage diagnoses. To understand these barriers, we conducted 63 interviews (43 women with breast cancer symptoms and 20 men) in Khulna, Bangladesh. We identified socio-cultural barriers like neglect and indifference toward women, women's lack of power to use resources and reduced support from family due to stigma. Interventions must address these barriers and improve the status of women in Bangladesh. [ABSTRACT FROM AUTHOR]

Introduction: Every year around 150,000 pilgrims from Bangladesh perform Umrah and Hajj. Emergence and continuous reporting of MERS-CoV infection in Saudi Arabia emphasize the need for surveillance of MERS-CoV in returning pilgrims or travelers from the Middle East and capacity building of health care providers for disease containment. The Institute of Epidemiology, Disease Control & Research (IEDCR) under the Bangladesh Ministry of Health and Family welfare (MoHFW), is responsible for MERS-CoV screening of pilgrims/ travelers returning from the Middle East with respiratory illness as part of its outbreak investigation and surveillance activities. Methods: Bangladeshi travelers/pilgrims who returned from the Middle East and presented with fever and respiratory symptoms were studied over the period from October 2013 to June 2016. Patients with respiratory symptoms that fulfilled the WHO MERS-CoV case algorithm were tested for MERS-CoV and other respiratory tract viruses. Beside surveillance, case recognition training was conducted at multiple levels of health care facilities across the country in support of early detection and containment of the disease. Results: Eighty one suspected cases tested by real time PCR resulted in zero detection of MERS-CoV infection. Viral etiology detected in 29.6% of the cases was predominantly influenza A (H1N1 and H3N2), and influenza B infection (22%). Peak testing occurred mostly following the annual Hajj season. Conclusions: Respiratory tract infections in travelers/pilgrims returning to Bangladesh from the Middle East are mainly due to influenza A and influenza B. Though MERS-CoV was not detected in the 81 patients tested, continuous screening and surveillance are essential for early detection of MERS-CoV infection and other respiratory pathogens to prevent transmissions in hospital settings and within communities. Awareness building among healthcare providers will help identify suspected cases. [ABSTRACT FROM AUTHOR]

Introduction: Dyslipidemia and hyperglycemia are metabolic abnormalities commonly found in young patients with Type 1 diabetes mellitus (T1DM) and both increase the risk of cardiovascular disease. Methods: This cross-sectional study was aimed to evaluate the pattern of dyslipidemia and its relationship with other risk factors in children and adolescents with T1DM. A total of 576 T1DM patients aged 10-18 years who attended Changing Diabetes in Children, a pediatric diabetes clinic in Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders over 1 year period from July 2015 to June 2016 were included in this study. Results: The overall frequency of dyslipidemia was 65%. The high triglyceride, high cholesterol, high low-density lipoprotein (LDL) and low high-density lipoprotein were found in 50%, 66%, 75%, and 48%, respectively. Compared to patients without dyslipidemia, patients with dyslipidemia had significantly lower mean body mass index (kg/m2) (18.4 [interquartile range; 16.2-21.4] vs. 19.5 [17.3-21.5] (P = 0.005)); significantly higher median fasting blood sugar (12.7 [9.9-15.2] vs. 10.6 [7.9-12.6] (P < 0.0001)) and higher median glycosylated hemoglobin (9.8 [8.4-11.8] vs. 7.9 [9.3-10.5] (P < 0.0001)). Hypertension was significantly higher in dyslipidemic patients (9.4% vs. 2.5% P < 0.002). Conclusion: More than half (65%) of our children and adolescents with T1DM had dyslipidemia, among them high LDL was the most common. These findings emphasize the screening of lipid profile in T1DM children and adolescents. [ABSTRACT FROM AUTHOR]

Objective: Using data from the national micronutrients survey 2011-2012, the present study explored the status of subclinical vitamin A nutrition and the underlying determinants in the Bangladeshi population. Design: A nationwide cross-sectional study. Settings: The survey covered 150 clusters; fifty in each of rural, urban and slum strata. Subjects: Three population groups: (i) pre-school age children (6-59 months; PSAC); (ii) school age children (6-14 years; SAC); and (iii) non-pregnant nonlactating women (15-49 years; NPNLW). Results: National prevalence of subclinical vitamin A deficiency was 20·5, 20·8 and 5·3% in PSAC, SAC and NPNLW, respectively. Slum populations had higher prevalence compared with urban (PSAC: 38·1 v. 21·2%, P <0·001; SAC: 27·1 v. 22·1%, P =0·004; NPNLW: 6·8 v. 4·7%, P=0·01). Dietary vitamin A met up to 27·1-46·0% of daily needs; plant-source vitamin A constituted 73-87% of the intakes. Multivariable regression analyses showed that higher consumption of animal foods was associated with higher retinol status in PSAC (ß=0·27; P<0·001); and living in urban area was related to higher retinol status in NPNLW (ß=0·08, P =0·004) and PSAC (ß=0·11, P=0·04). Increased intake of leafy vegetables was associated with lower retinol status in SAC (ß =-0·08, P =0·02). Vitamin A supplementation in PSAC did not significantly influence serum retinol within one year post-supplementation (P>0·05 for differences in ß between <3 months v. 3-6 months, 6-9 months and 9-12 months). Conclusions: Prevalence of subclinical vitamin A deficiency was high in children in Bangladesh. Intakes of animal-source foods and leafy vegetables were associated with higher and lower retinol status, respectively. Increased food diversity through animal-source foods is required. [ABSTRACT FROM AUTHOR]

The situation of rights of children of tea garden workers in Bangladesh is bad, giving the children relatively vulnerable and disadvantageous social position compared to their counterparts in the mainstream community. Children in the tea gardens are found to be deprived of their rights as human being due to multifarious reasons underlying the socio-economic conditions of the family, limited human right facilities in terms of available education, health, hygiene and nutrition, work, and social services provided for the promotion of their lives. Moreover, some structural factors associated to the management system of the tea companies are largely considered responsible for the deprivation of basic rights of children in the garden. Social work is a professional practice that particularly works for ensuring human rights and social justice in the society. Therefore, this paper comes up with some policy recommendations for protection of child rights from social work perspective. [ABSTRACT FROM AUTHOR]

The article discusses the public health photography (photo) contest in Bangladesh with the theme titled "Explore Public Health and Your Hidden Talent in Photography." Photographs that won the competition, including "Spoiling the Next Generation?" by Preyenka Mahmud Rathi, "Waste Management and Pollution," by Kaisar Mahmud and "Rohingya Children Collecting Drinking Water ," by Ashish Chandra Deb Nath.

Background: Infertility is defined as the failure in pregnancy after one year of unprotected intercourse. Several centers have reported different causes of infertility. The most common causes of infertility include: Female factors such as ovulation dysfunction and tubal factor; male factors like sperm disturbance as well as ; both male and female factors and unexplained infertility. The aim of this study was to find out the etiologic factors of infertility in BSMMU (Bangabandhu Sheik Mujib Medical University, Dhaka, Bangladesh). Methods: This cross sectional study was done at the Out Patient Department (OPD) of infertility in BSMMU during the period of December 2004 to March 2005. One hundred infertile couples with necessary investigations were reviewed for the study. Results: In this study the frequency of primary and secondary infertility was 56% and 44% respectively. Among 100 couples 57% had female factor, 25% had both male and female factors and in 3% had male factor and in 15% of couple, the causes of infertility were unknown. Among women, different infertility factors included: Tubal factor 33%, Ovarian factor 12% and endometriosis 11%. In this study tubal blockage were detected in 50% cases of female secondary subfertility following Menstruation Regulation (M/R). Result showed 82% of men had normal spermogram 28%, had sperm disturbance including Oligospermia, Asthenospermia, Oligoasthenospermia and teratospermia. Conclusion: Although female factor was the most common cause of infertility in BSMMU, we can not conclude that this factor is the most common causes of infertility in Bangladesh. Since this centre is considered as referral centre especially for female infertility. We suggest performance of similar researches with big sample size in different institution to evaluate most common causes of infertility in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: A continuous influx of poor people to urban slums poses a challenge to Bangladesh’s health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the ‘MANOSHI’ programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area. Methods: This cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15–49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data. Results: The activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; p<0.000) and PNC (48% vs. 39%; p<0.01) coverage in the intervention slums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services from medically trained providers (MTPs). The poorest had a lower likelihood of receiving services from MTPs during delivery complications. Conclusion: The MANOSHI programme service coverage for delivery care and PNC-checkup for women who prefer home delivery needs to be improved. For sustainable improvement of maternal health outcomes in urban slums, the programme needs to facilitate access to services for poor and illiterate women. [ABSTRACT FROM AUTHOR]

Objective To validate a Rapid Neurodevelopmental Assessment (RNDA) tool for use by child health professionals to determine neurodevelopmental impairments (NDIs) in young adolescents aged 10-16 years in Bangladesh. Study design In a convenience sample of community children ( n = 47), inter-rater reliability was determined between four testers, and concurrent validity was determined by simultaneous administration of an intelligence quotient (IQ) test (Wechsler Intelligence Scale for Children, Revised) by a child psychologist. Results Inter-rater reliability was excellent between the testers on the 47 children administered the RNDA (kappa = 1.00). Significantly lower IQ scores were obtained in those identified with 'any ( >1) NDI' ( n = 34) compared with those with no NDI ( n = 13) on Verbal IQ ( P-value < 0.0001), Performance IQ ( P-value < 0.0001) and Full-scale IQ ( P-value < 0.0001) scores on the Wechsler Intelligence Scale for Children, Revised. Conclusion The RNDA shows promise as a tool for use by child health professionals for identifying NDIs in young adolescents aged 10-16 years. A larger study sample is needed to determine its usefulness for identification of some impairments not found in the study population, i.e. gross motor, fine motor, hearing and seizures. [ABSTRACT FROM AUTHOR]

Background: During a fatal Nipah virus (NiV) outbreak in Bangladesh, residents rejected biomedical explanations of NiV transmission and treatment and lost trust in the public healthcare system. Field anthropologists developed and communicated a prevention strategy to bridge the gap between the biomedical and local explanation of the outbreak.Methods: We explored residents' beliefs and perceptions about the illness and care-seeking practices and explained prevention messages following an interactive strategy with the aid of photos showed the types of contact that can lead to NiV transmission from bats to humans by drinking raw date palm sap and from person-to-person.Results: The residents initially believed that the outbreak was caused by supernatural forces and continued drinking raw date palm sap despite messages from local health authorities to stop. Participants in community meetings stated that the initial messages did not explain that bats were the source of this virus. After our intervention, participants responded that they now understood how NiV could be transmitted and would abstain from raw sap consumption and maintain safer behaviours while caring for patients.Conclusions: During outbreaks, one-way behaviour change communication without meaningful causal explanations is unlikely to be effective. Based on the cultural context, interactive communication strategies in lay language with supporting evidence can make biomedical prevention messages credible in affected communities, even among those who initially invoke supernatural causal explanations. [ABSTRACT FROM AUTHOR]

Objective: Using data from the national micronutrients survey 2011-2012, the present study explored the determinants of Fe status and Hb levels in Bangladesh with a particular focus on groundwater Fe.Design: Cross-sectional study conducted at the nationwide scale. Settings The survey was conducted in 150 clusters, fifty in each of the three strata of rural, urban and slum.Subjects: Three population groups: pre-school age children (6-59 months; PSAC), school age children (6-14 years; SAC) and non-pregnant non-lactating women (15-49 years; NPNLW).Results: National prevalence of Fe deficiency was 10·7 %, 7·1 % and 3·9-9·5 % in PSAC, NPNLW and SAC, respectively. Prevalence of anaemia was 33·1 % (PSAC), 26·0 % (NPNLW) and 17·1-19·1 % (SAC). Multivariate regression analyses showed that the area with 'predominantly high groundwater Fe' was a determinant of higher serum ferritin levels in NPNLW (standardized β=0·19; P=0·03), SAC (standardized β=0·22; P=0·01) and PSAC (standardized β=0·20; P=0·03). This area also determined higher levels of Hb in PSAC (standardized β=0·14; P=0·01).Conclusions: National prevalence of Fe deficiency in Bangladesh is low, contrary to the widely held assumption. High Fe level in groundwater is associated with higher Fe status (all populations) and higher Hb level (PSAC). [ABSTRACT FROM AUTHOR]

Background: Growth faltering in the first 2 years of life is high in South Asia where prevalence of stunting is estimated at 40-50%. Although nutrition counselling has shown modest benefits, few intervention trials of food supplementation exist showing improvements in growth and prevention of stunting.Methods: A cluster-randomized controlled trial was conducted in rural Bangladesh to test the effect of two local, ready-to-use foods (chickpea and rice-lentil based) and a fortified blended food (wheat-soy-blend++, WSB++) compared with Plumpy'doz, all with nutrition counselling vs nutrition counselling alone (control) on outcomes of linear growth (length and length-for-age z-score, LAZ), stunting (LAZ < -2), weight-for-length z-score (WLZ) and wasting (WLZ < -2) in children 6-18 months of age. Children (n = 5536) were enrolled at 6 months of age and, in the food groups, provided with one of the allocated supplements daily for a year.Results: Growth deceleration occurred from 6 to 18 months of age but deceleration in LAZ was lower (by 0.02-0.04/month) in the Plumpy'doz (P = 0.02), rice-lentil (< 0.01), and chickpea (< 0.01) groups relative to control, whereas WLZ decline was lower only in Plumpy'doz and chickpea groups. WSB++ did not impact on these outcomes. The prevalence of stunting was 44% at 18 months in the control group, but lower by 5-6% (P ≤ 0.01) in those receiving Plumpy'doz and chickpea. Mean length and LAZ at 18 months were higher by 0.27-0.30 cm and 0.07-0.10 (all P < 0.05), respectively, in all four food groups relative to the control.Conclusions: In rural Bangladesh, small amounts of daily fortified complementary foods, provided for a year in addition to nutrition counselling, modestly increased linear growth and reduced stunting at 18 months of age. [ABSTRACT FROM AUTHOR]

Fortified blended foods (FBFs) are widely used to prevent undernutrition in early childhood in food-insecure settings. We field tested enhanced Wheat Soy Blend (WSB++)—a FBF fortified with micronutrients, milk powder, sugar, and oil—in preparation for a complementary food supplement (CFS) trial in rural northwestern Bangladesh. Formative work was conducted to determine the optimal delivery method (cooked vs. not) for this CFS, to examine mothers’ child feeding practices with and acceptance of the WSB++, and to identify potential barriers to adherence. Our results suggest WSB++ is an acceptable CFS in rural Bangladesh and the requirement for mothers to cook WSB++ at home is unlikely to be a barrier to its daily use as a CFS in this population. [ABSTRACT FROM AUTHOR]