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Background: Efficient healthcare delivery and access to specialized care rely heavily on a well-established healthcare sector referral system. However, the referral system faces significant challenges in developing nations like Bangladesh. This study aimed to assess self-referral prevalence among patients attending tertiary care hospitals in Bangladesh and identify the associated factors. Methods: This cross-sectional study was conducted at two tertiary care hospital, involving 822 patients visiting their outpatient or inpatient departments. A semi-structured questionnaire was used for data collection. The patients' mode of referral (self-referral or institutional referral) was considered the outcome variable. Results: Approximately 58% of the participants were unaware of the referral system. Of all, 59% (485 out of 822) of patients visiting tertiary care hospitals were self-referred, while 41% were referred by other healthcare facilities. The primary reasons for self-referral were inadequate treatment (28%), inadequate facilities (23%), critical cases (14%), and lack of expert physicians (8%). In contrast, institutional referrals were mainly attributed to inadequate facilities to treat the patient (53%), inadequate treatment (47%), difficult-to-treat cases (44%), and lack of expert physicians (31%) at the time of referral. The private facilities received a higher proportion of self-referred patients compared to government hospitals (68% vs. 56%, p < 0.001). Among patients attending the study sites through institutional referral, approximately 10% were referred from community clinics, 6% from union sub-centers, 25% from upazila health complexes, 22% from district hospitals, 22% from other tertiary care hospitals, and 42% from private clinics. Patients visiting the outpatient department (adjusted odds ratio [aOR] 3.3, 95% confidence interval [CI] 2.28–4.82, p < 0.001), residing in urban areas (aOR 1.29, 95% CI 1.04–1.64, p = 0.007), belonging to middle- and high-income families (aOR 1.34, 95% CI 1.03–1.62, p = 0.014, and aOR 1.98, 95% CI 1.54–2.46, p = 0.005, respectively), and living within 20 km of healthcare facilities (aOR 3.15, 95% CI 2.24–4.44, p-value < 0.001) exhibited a higher tendency for self-referral to tertiary care facilities. Conclusions: A considerable number of patients in Bangladesh, particularly those from affluent urban areas and proximity to healthcare facilities, tend to self-refer to tertiary care centers. Inadequacy of facilities in primary care centers significantly influences patients to opt for self-referral. [ABSTRACT FROM AUTHOR]

Soil erosion due to anthropogenic interventions is an emerging threat to the south-eastern coastal districts of Bangladesh. In the recent decade, land degradation intensified this process in this region due to the settlement of the Forcibly Displaced Myanmar Nationals popularly known as 'Rohingya', who fled from Myanmar in 2017. To control soil erosion, it is necessary to identify the soil erosion locations and their intensity. The present study has attempted to quantify the regional soil loss (from 2015 to 2020) using the Revised Universal Soil Loss Equation model. In this method, soil erosion risk assessments are carried out by integration of different physiographic parameters in the spatial dimension. Results showed that the year 2015 and 2020 witnessed mean soil erosion at a rate of around 58.2 and 59 t ha− 1 yr− 1, respectively in the Cox's Bazar district in which 20–21% of the study area was highly subjected to soil erosion. But in the Rohingya camps mean soil erosion for these periods is 59 and 78 t ha− 1 yr− 1, respectively with a cumulative increase of 32%. The sub-districts adjacent to the Rohingya refugee camps (Ramu, Ukhia, and Teknaf) have experienced intense erosion compared to the others. From 2015 to 2020, a large increase of about 4.54 (6%) t ha− 1 yr− 1 is observed in the Palongkhali union whereas a maximum decrease of about − 8.08 (23%) t ha− 1 yr− 1 is observed in the Pokkhali union. In Rohingya camps, the worst soil erosion-affected areas are the camps 8E, 10, 14, 15, 16, and 17 having more than 100 t ha− 1 yr− 1 mean soil loss. The geographic detector method is used to identify the influence of different factors on soil erosion. Land use change is found to be the major contributing factor to soil erosion increase from 2015 to 2020. The spatial variations are significantly controlled by slope and elevation factors. This work can help to understand the dynamics of soil erosion and the knowledge can be used for conservation planning in the Cox's Bazar and Rohingya camp areas. [ABSTRACT FROM AUTHOR]

Drug addiction has spread at a frightening rate in the whole world, especially in the South Asian countries such as Bangladesh which needs to be analyzed, discussed and eradicated. This present survey based study was conducted with an aim to discover the scenery of drug addiction in northern region of Bangladesh. Researchers also uncovered the factors, problems and effects of drug addiction, age of first drug used, source of money to buy drugs and effective measures to prevent this problem etc. Total 600 youngsters from Pabna, a northern part of Bangladesh were directly interviewed by using self-construct questionnaire. Age range of the participants was between 12 and 35. Result showed, low income participants were highly addicted (58.62%) and family problems (43.93%) were the most prevalent cause of addiction. Participants involved in sports had lower drug addiction propensity (36.38%). Addicted young consumed more nicotine (95.04%), alcohol (63.93%) and marijuana (44.28%). Among addicts, youngs started using drugs mostly between 15 to 18 years age. Parent's income (42%) was the prime source of money to buy drugs and 91% of addicted young faced complications. Counseling (71.2%) and systematic penalty (66.4%) were the best preventive measures for drug addiction. The young generations of Bangladesh are cankering their crucial youth time in addiction and they should be rescued by counseling, monitoring and treating them with care and affection from the parents, society and government. [ABSTRACT FROM AUTHOR]

Exploration of fruit tree-based agroforestry systems is essential for Bangladesh's agriculture in the era of climate change scenarios and shrinking agricultural land in order to ensure food and nutrition security at household and national levels. In the present study, a traditional jujube/apple kul (Zizyphus mauritiana) orchard was converted into an agroforestry system by including summer vegetables (okra and Indian spinach) and spices (ginger and turmeric) with a view to achieving greater economic return, maximizing land use and providing food and nutritional support. Results revealed that heavily pruned jujube trees in the summer season displayed negligible loss of light accessibility to understory okra and Indian spinach, which contributed to their higher yields. Conversely, the growing canopy of jujube trees exerted moderate shade at the later stages of growth that helped to attain improved yield from ginger and turmeric, which are shade loving crops. Intriguingly, jujube trees were able to utilize a substantial amount of the fertilizers and irrigation applied to the understory crops, which eliminated the need for additional inputs for jujube trees under the agroforestry system. Soil nutrient dynamics also improved in the agroforestry system as crop residues and leaf litter were left in the field. Importantly, nutritionally-rich, sweet-tasting, attractively-colored apple kul has a greater market value and the lack of vegetable productionin the summer season triggered a higher market price for Indian spinach and okra. This collectively heightened the benefit–cost and land equivalent ratios. Concisely, the current study concluded that the jujube-based agroforestry system could be endorsed as a model approach throughout Bangladesh for upgrading food, nutrition and income security. [ABSTRACT FROM AUTHOR]

Background We examined the effect of maternal vitamin D supplementation during pregnancy and lactation on risk of acute respiratory infection (ARI) in infants up to 6 months of age in Bangladesh. Methods This study was nested in a randomized, double-blind, placebo-controlled, 5-arm dose-ranging trial of prenatal and postpartum vitamin D supplementation. One group of women received 0 IU vitamin D per week during pregnancy and for 26 weeks post delivery ("placebo" group), one group received high-dose prenatal vitamin D supplementation of 28 000 IU per week and 26 weeks post delivery, and there were 3 additional dose-ranging groups receiving vitamin D supplementation during pregnancy only (4200, 16 800, and 28 000 IU per week, respectively). Episodes of ARI were identified by active and passive surveillance. The primary outcome was microbiologically confirmed ARI, and the primary analysis compared the high-dose prenatal plus postpartum vitamin D vs placebo groups. Results In total, 1174 mother-infant pairs were included. Among infants born to mothers in the placebo group, 98% had a venous umbilical cord 25(OH)D level below 30 nmol/L compared with none in the high-dose prenatal plus postdelivery vitamin D group. Incidence of microbiologically confirmed ARI in the high-dose prenatal plus postpartum vitamin D (1.21 episodes per 6 person-months; N = 235) and placebo groups (1.07 episodes per 6 person-months; N = 234) was not significantly different (hazard ratio of 1.12 [95% confidence intervals: 0.90-1.40]). There were no differences in the incidence of microbiologically confirmed or clinical ARI, upper, lower, or hospitalized lower respiratory tract infection between high-dose prenatal plus postpartum vitamin D and placebo groups. Conclusions Despite a high prevalence of maternal baseline vitamin D deficiency and significant effects of maternal vitamin D supplementation on infant vitamin D status, the intervention did not reduce the risk of microbiologically confirmed ARI in infants up to 6 months of age. [ABSTRACT FROM AUTHOR]

• Ivermectin, an FDA-approved anti-parasitic agent, was found to be an inhibitor of SARS-CoV-2 replication in the laboratory. • Ivermectin may be effective for the treatment of early-onset mild COVID-19 in adult patients. • Early viral clearance of SARS-CoV-2 was observed in ivermectin treated patients. • Remission of fever, cough and sore throat did not differ among treatment groups. No severe adverse event was observed. • Larger trials will be needed to confirm these preliminary findings. Ivermectin, a US Food and Drug Administration-approved anti-parasitic agent, was found to inhibit severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication in vitro. A randomized, double-blind, placebo-controlled trial was conducted to determine the rapidity of viral clearance and safety of ivermectin among adult SARS-CoV-2 patients. The trial included 72 hospitalized patients in Dhaka, Bangladesh, who were assigned to one of three groups: oral ivermectin alone (12 mg once daily for 5 days), oral ivermectin in combination with doxycycline (12 mg ivermectin single dose and 200 mg doxycycline on day 1, followed by 100 mg every 12 h for the next 4 days), and a placebo control group. Clinical symptoms of fever, cough, and sore throat were comparable among the three groups. Virological clearance was earlier in the 5-day ivermectin treatment arm when compared to the placebo group (9.7 days vs 12.7 days; p = 0.02), but this was not the case for the ivermectin + doxycycline arm (11.5 days; p = 0.27). There were no severe adverse drug events recorded in the study. A 5-day course of ivermectin was found to be safe and effective in treating adult patients with mild COVID-19. Larger trials will be needed to confirm these preliminary findings. [ABSTRACT FROM AUTHOR]