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Background The current burden of >5 million deaths yearly is the focus of the Sustainable Development Goal (SDG) to end preventable deaths of newborns and children under 5 years old by 2030. To accelerate progression toward this goal, data are needed that accurately quantify the leading causes of death, so that interventions can target the common causes. By adding postmortem pathology and microbiology studies to other available data, the Child Health and Mortality Prevention Surveillance (CHAMPS) network provides comprehensive evaluations of conditions leading to death, in contrast to standard methods that rely on data from medical records and verbal autopsy and report only a single underlying condition. We analyzed CHAMPS data to characterize the value of considering multiple causes of death. Methods and findings We examined deaths identified from December 2016 through November 2020 from 7 CHAMPS sites (in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa), including 741 neonatal, 278 infant, and 241 child, In an analysis of data from the Child Health and Mortality Prevention Surveillance (CHAMPS) network, Robert Breiman, Dianna Blau, and colleagues investigate how considering all conditions in the causal chain leading to death informs the identification of deaths attributable to various diagnoses., Author summary Why was this study done? More than 5 million deaths occur annually in children

- Label: BACKGROUND NlmCategory: BACKGROUND content: "Sub-Saharan Africa and south Asia contributed 81% of 5\xC2\xB79 million under-5 deaths and 77% of 2\xC2\xB76 million stillbirths worldwide in 2015. Vital registration and verbal autopsy data are mainstays for the estimation of leading causes of death, but both are non-specific and focus on a single underlying cause. We aimed to provide granular data on the contributory causes of death in stillborn fetuses and in deceased neonates and children younger than 5 years, to inform child mortality prevention efforts." - Label: METHODS NlmCategory: METHODS content: "The Child Health and Mortality Prevention Surveillance (CHAMPS) Network was established at sites in seven countries (Baliakandi, Bangladesh; Harar and Kersa, Ethiopia; Siaya and Kisumu, Kenya; Bamako, Mali; Manhi\xC3\xA7a, Mozambique; Bombali, Sierra Leone; and Soweto, South Africa) to collect standardised, population-based, longitudinal data on under-5 mortality and stillbirths in sub-Saharan Africa and south Asia, to improve the accuracy of determining causes of death. Here, we analysed data obtained in the first 2 years after the implementation of CHAMPS at the first five operational sites, during which surveillance and post-mortem diagnostics, including minimally invasive tissue sampling (MITS), were used. Data were abstracted from all available clinical records of deceased children, and relevant maternal health records were also extracted for stillbirths and neonatal deaths, to incorporate reported pregnancy or delivery complications. Expert panels followed standardised procedures to characterise causal chains leading to death, including underlying, intermediate (comorbid or antecedent causes), and immediate causes of death for stillbirths, neonatal deaths, and child (age 1-59 months) deaths." - Label: FINDINGS NlmCategory: RESULTS content: Between Dec 10, 2016, and Dec 31, 2018, MITS procedures were implemented at five sites in Mozambique, South Africa, Kenya, Mali, and Bangladesh. We screened 2385 death notifications for inclusion eligibility, following which 1295 families were approached for consent; consent was provided for MITS by 963 (74%) of 1295 eligible cases approached. At least one cause of death was identified in 912 (98%) of 933 cases (180 stillbirths, 449 neonatal deaths, and 304 child deaths); two or more conditions were identified in the causal chain for 585 (63%) of 933 cases. The most common underlying causes of stillbirth were perinatal asphyxia or hypoxia (130 [72%] of 180 stillbirths) and congenital infection or sepsis (27 [15%]). The most common underlying causes of neonatal death were preterm birth complications (187 [42%] of 449 neonatal deaths), perinatal asphyxia or hypoxia (98 [22%]), and neonatal sepsis (50 [11%]). The most common underlying causes of child deaths were congenital birth defects (39 [13%] of 304 deaths), lower respiratory infection (37 [12%]), and HIV (35 [12%]). In 503 (54%) of 933 cases, at least one contributory pathogen was identified. Cytomegalovirus, Escherichia coli, group B Streptococcus, and other infections contributed to 30 (17%) of 180 stillbirths. Among neonatal deaths with underlying prematurity, 60% were precipitated by other infectious causes. Of the 275 child deaths with infectious causes, the most common contributory pathogens were Klebsiella pneumoniae (86 [31%]), Streptococcus pneumoniae (54 [20%]), HIV (40 [15%]), and cytomegalovirus (34 [12%]), and multiple infections were common. Lower respiratory tract infection contributed to 174 (57%) of 304 child deaths. - Label: INTERPRETATION NlmCategory: CONCLUSIONS content: Cause of death determination using MITS enabled detailed characterisation of contributing conditions. Global estimates of child mortality aetiologies, which are currently based on a single syndromic cause for each death, will be strengthened by findings from CHAMPS. This approach adds specificity and provides a more complete overview of the chain of events leading to death, highlighting multiple potential interventions to prevent under-5 mortality and stillbirths. - Label: FUNDING NlmCategory: BACKGROUND content: Bill & Melinda Gates Foundation.

Background Household air pollution is a leading health risk for global morbidity and mortality and a major health risk in South Asia. However, there are no prospective investigations of the impact of household air pollution on perinatal morbidity and mortality. Our trial aims to assess the impact of liquefied petroleum gas (LPG) for cooking to reduce household air pollution exposure on perinatal morbidity and mortality compared to usual cooking practices in Bangladesh. Hypothesis In a community-based cluster randomised controlled trial of pregnant women cooking with LPG throughout pregnancy, perinatal mortality will be reduced by 35% compared with usual cooking practices in a rural community in Bangladesh. Methods A two-arm community-based cluster randomised controlled trial will be conducted in the Sherpur district, Bangladesh. In the intervention arm, pregnant women receive an LPG cookstove and LPG in cylinders supplied throughout pregnancy until birth. In the control or usual practice arm, pregnant women continue their usual cooking practices, predominately traditional stoves with biomass fuel. Eligible women are pregnant women with a gestational age of 40–120 days, aged between 15 and 49 years, and permanent residents of the study area. The primary outcome is the difference in perinatal mortality between the LPG arm and the usual cooking arm. Secondary outcomes include (i) preterm birth and low birth weight, (ii) personal level exposure to household air pollution, (iii) satisfaction and acceptability of the LPG stove and stove use, and (iv) cost-effectiveness and cost-utility in reducing perinatal morbidity and mortality. We follow up all women and infants to 45 days after the birth. Personal exposure to household air pollution is assessed at three-time points in a sub-sample of the study population using the MicroPEM™. The total required sample size is 4944 pregnant women. Discussion This trial will produce evidence of the effectiveness of reduced exposure to household air pollution through LPG cooking to reduce perinatal morbidity and mortality compared to usual cooking practices. This evidence will inform policies for the adoption of clean fuel in Bangladesh and other similar settings. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001214224. Prospectively registered on 19 July 2019

Background: Health care systems in limited resource settings may not meet the needs of pregnant women where the burden of diabetes and hypertension is rapidly increasing. We described screening and diagnosis of diabetes or hypertension among recently pregnant women in rural Bangladesh and the antenatal care received.Methods: We asked recently pregnant women about ever having been screened for or diagnosed with hypertension or diabetes and their antenatal care-seeking experiences in a cross-sectional survey in the Baliakandi, Bangladesh. We used chi-squared tests and logistic regression to test the associations between self-reported coverage of hypertension and diabetes screening, diagnoses, and elements of antenatal care by age, wealth, educational attainment, and gravidity. Results: Among 4,692 respondents, 97% reported having been screened and 10% of screened women reported a diagnosis of hypertension. Women 30–39 years of age (aOR 3.02, 95% CI 2.00, 4.56) or in the top wealth quintile (aOR 1.70, 95% CI 1.18, 2.44) were more likely to be diagnosed with hypertension compared to reference groups. Any hypertension diagnosis was associated with reporting four or more antenatal care contacts (44% vs. 35%, p < 0.01), blood pressure measurements (85% vs. 79%, p < 0.01), and urine (71% vs. 61%, p < 0.01) tests conducted during antenatal care visits.For diabetes, 46% of respondents reported having been screened and 3% of screened women reported a diagnosis. Women 30–39 years of age were more likely to be diagnosed with diabetes (aOR 8.19, 95% CI 1.74, 38.48) compared to the reference group. Any diabetes diagnosis was associate with reporting four or more antenatal care contacts (48% vs. 36%, p = 0.04) and having blood testing during pregnancy (83% vs. 66%, p < 0.01). However, the frequency and quality of antenatal care was below the national guidelines among all groups.Conclusion: Focused efforts to ensure that women receive the recommended number of antenatal care contacts, coupled with improved compliance with antenatal care guidelines (including universal screening for diabetes at 24–28 weeks of pregnancy), would improve awareness of hypertension and diabetes among women in Bangladesh.

ObjectivesTo describe temporal trends in child marriage between 1990 and 2019 in a rural sub-district of Bangladesh and characterize relationships between age, time to pregnancy, complications during delivery, and perinatal mortality.DesignHealth and demographic surveillance system.SettingBaliakandi sub-district, Bangladesh.Participants56,155 female residents.Main outcome measuresAnnual proportion of marriages to female residents under 18 years of age, time between first marriage and pregnancy, proportion of births with complications during delivery, and odds of perinatal mortality.ResultsBetween 1990 and 2010, the proportion of marriages to female residents under 18 years of age decreased from 71% to 57%. Most notably, marriages to females aged 10 to 12 years dropped from 22% of all marriages to 3%. In 2019, 53% of all marriages were to females under 18 years. The estimated time between first marriage and pregnancy did not differ by female age at marriage. By 365 days after marriage, the cumulative incidence of pregnancy was approximately 50% for each age group. Adolescent girls were more likely to experience complications during delivery with at least one complication reported for 36% of mothers aged 13 to 15 years, 32% of mothers aged 16 to 17 years, and 23% of mothers aged 18 to 34 years (χ2 test, PConclusionsChild marriage persists in Baliakandi. Over half of all marriages were to child brides and only minor reductions were seen over the past decade. Pregnancies were common among adolescent girls with no evidence of delayed pregnancy after marriage. Compared to adults, adolescents were more likely to experience complications during delivery and perinatal death. Preventing child marriage has substantial social and health benefits for girls and, by doing so, will also contribute to Bangladesh’s commitment to reduce child mortality.

Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.

Soil salinization is a major problem for low-elevation countries like Bangladesh and is expected to worsen due to global warming and associated sea level rise. A constant monitoring of salinity affected areas is imperative to prevent land degradation, agricultural and livelihood losses. With this aim, we developed three soil salinity models with direct, indirect and a combination of both of these soil salinity measurement techniques, for south-western Bangladesh. The five salinity indexes (direct) and eleven environmental variables (indirect) were integrated using Principal Component Analysis, and the predictability of the models was evaluated against ground-based soil salinity measurements from soil survey and land cover maps generated during the model development. Delineation based solely on salinity indexes yielded results that contradicted with models developed from indirect variables and combining all the variables. Results suggest that the salinity model developed by combining direct and indirect techniques has the highest prediction capacity and can also be explained in terms of land cover changes. Therefore, an integrated approach yielded better delineation of salt-affected areas, characterized by active hydrological processes and vegetation cover. The findings and maps produced from this study would provide a new contextual planning tool to policymakers, for devising adaptation strategies in affected areas of Bangladesh.

Introduction: Hypertension may be an important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. Methods: This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Findings: Among 191 cases and 934 matched controls, hypertension prevalence was 14∙1% among cases and 7∙7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2∙90, 95% CI 1∙29, 6∙57), but not among women with diagnosis during pregnancy (OR 1∙68, 95% CI 0∙98, 2∙98). We found no association between the number of antenatal care contacts and perinatal death (p=0∙66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Interpretation: Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh. Funding Information: The Bill and Melinda Gates Foundation. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Ethical approval for the study was provided by the Ethical Review Committee of the International Centre for Diarrhoeal Disease Research, Bangladesh.

BACKGROUND Effective health policy formulation requires sound information of numbers and causes of deaths in the population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. While the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of death were reported within the timeframe in 2020. This study adopted an innovative digital notification approach to improving coverage of registration of these events at the community level. OBJECTIVE Our primary objective was to assess-i) the proportion of events identified by the new notification systems (success rate), and contribution of different notifiers individually and in combination (completeness), and ii) the proportion of events notified within specific time limits (timeliness of notifications), after introducing the innovative approach METHODS We conducted a pilot study in 2016 in two sub-districts of Bangladesh to understand whether accurate, timely and complete information on births and deaths can be collected and notified by facility-based service providers, community health workers, including those who routinely visit households, local government authorities and key informants from the community. We designed a mobile phone technology-based platform; an application and a call centre through which the notification was provided. All notifications were verified through the confirmation of events by family members during a visit to the concerned household. We undertook a household survey-based assessment at the end of the notification period. RESULTS Our innovative system gathered a total of 13,377 notifications for births and deaths from all channels including duplicate reports from multiple sources. Project workers were able to verify 92% of births and 93% of deaths through household visits. The household survey conducted among a sub-sample of the project population identified 1,204 births and 341 deaths. After matching notification with the household survey we found that the system was able to capture over 87% of births in the survey areas. Health Assistants (HAs) and Family Welfare Assistants were the primary sources of information. Notification from facilities was very low for both events. CONCLUSIONS The global investment plan for CRVS scaling up 2015 to 2024 and the World Health Organization (WHO) reiterated the importance of building an evidence base for improving CRVS. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to notify births and deaths as a first step to ensure registration. HAs could capture more than half of the notifications as a standalone source. CLINICALTRIAL

Background The Global Network for Women’s and Children’s Health Research (Global Network, GN) has established the Maternal Newborn Health Registry (MNHR) to assess MNH outcomes over time. Bangladesh is the newest country in the GN and has implemented a full electronic MNH registry system, from married women surveillance to pregnancy enrollment and subsequent follow ups. Method Like other GN sites, the Bangladesh MNHR is a prospective, population-based observational study that tracks pregnancies and MNH outcomes. The MNHR site is in the Ghatail and Kalihati sub-districts of the Tangail district. The study area consists of 12 registry clusters each of ~ 18,000–19,000 population. All pregnant women identified through a two-monthly house-to-house surveillance are enrolled in the registry upon consenting and followed up on scheduled visits until 42 days after pregnancy outcome. A comprehensive automated registry data capture system has been developed that allows for married women surveillance, pregnancy enrollment, and data collection during follow-up visits using a web-linked tablet-PC-based system. Result During March–May 2019, a total of 56,064 households located were listed in the Bangladesh MNH registry site. Of the total 221,462 population covered, 49,269 were currently married women in reproductive age (CMWRA). About 13% CMWRA were less susceptible to pregnancy. Large variability was observed in selected contraceptive usage across clusters. Overall, 5% of the listed CMWRAs were reported as currently pregnant. Conclusion In comparison to paper-pen capturing system electronic data capturing system (EDC) has advantages of less error-prone data collection, real-time data collection progress monitoring, data quality check and sharing. But the implementation of EDC in a resource-poor setting depends on technical infrastructure, skilled staff, software development, community acceptance and a data security system. Our experience of pregnancy registration, intervention coverage, and outcome tracking provides important contextualized considerations for both design and implementation of individual-level health information capturing and sharing systems.

ObjectiveThis paper presents the effect of the early phase of COVID-19 on the coverage of essential maternal and newborn health (MNH) services in a rural subdistrict of Bangladesh.DesignCross-sectional household survey with random sampling.SettingBaliakandi subdistrict, Rajbari district, Bangladesh.ParticipantsData were collected from women who were on the third trimester of pregnancy during the early phase of the pandemic (111) and pre-pandemic periods (115) to measure antenatal care (ANC) service coverage. To measure birth, postnatal care (PNC) and essential newborn care (ENC), data were collected from women who had a history of delivery during the early phase of the pandemic (163) and pre-pandemic periods (166).ExposureEarly phase of the pandemic included a strict national lockdown between April and June 2020, and pre-pandemic was defined as August–October 2019.Outcome of interestChanges in the coverage of selected MNH services (ANC, birth, PNC, ENC) during the early phase of COVID-19 pandemic compared with the pre-pandemic period, estimated by two-sample proportion tests.FindingsAmong women who were on the third trimester of pregnancy during the early phase of the pandemic period, 77% (95% CI: 70% to 85%) received at least one ANC from a medically trained provider (MTP) during the third trimester, compared with 83% (95% CI: 76% to 90%) during the pre-pandemic period (p=0.33). Among women who gave birth during the early phase of the pandemic period, 72% (95% CI: 66% to 79%) were attended by an MTP, compared with 63% (95% CI: 56% to 71%) during the pre-pandemic period (p=0.08). Early initiation of breast feeding was practised among 38% (95% CI: 31% to 46%) of the babies born during the early phase of the pandemic period. It was 37% (95% CI: 29% to 44%) during the pre-pandemic period (p=0.81). The coverage of ANC, birth, PNC and ENC did not differ by months of pandemic and pre-pandemic periods; only the coverage of at least one ANC from an MTP significantly differed among the women who were 7 months pregnant during the early phase of the pandemic (35%, 95% CI: 26% to 44%) and pre-pandemic (49%, 95% CI: 39% to 58%) (p=0.04).ConclusionThe effect of the early phase of the pandemic including lockdown on the selected MNH service coverage was null in the study area. The nature of the lockdown, the availability and accessibility of private sector health services in that area, and the combating strategies at the rural level made it possible for the women to avail the required MNH services.

Bangladesh has historically been cholera endemic, with seasonal cholera outbreaks occurring each year. In collaboration with the government of Bangladesh, the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) initiated operational research to test strategies to reach the high-risk urban population with an affordable oral cholera vaccine (OCV) “ShancholTM” and examine its effectiveness in reducing diarrhea due to cholera. Here we report a sub-analysis focusing on the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. We described how the vaccination program was planned, prepared and implemented using different strategies to deliver oral cholera vaccine to a high-risk urban population in Dhaka, Bangladesh based on administrative data and observations made during the program. The objective of this study is to evaluate the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. OCV administration by trained local volunteers through outreach sites and mop-up activities yielded high coverage of 82% and 72% of 172,754 targeted individuals for the first and second dose respectively, using national Expanded Program on Immunization (EPI) campaign mechanisms without disrupting routine immunization activities. The cost of delivery was low. Safety and cold chain requirements were adequately managed. The adopted strategies were technically and programmatically feasible. Current evidence on implementation strategies in different settings together with available OCV stockpiles should encourage at-risk countries to use OCV along with other preventive and control measures.

Summary Background Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and effectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective effect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefit of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting. Methods We did this cluster-randomised open-label trial in Dhaka, Bangladesh. We randomly assigned 90 clusters (1:1:1) to vaccination only, vaccination and behavioural change, or no intervention. The primary outcome was overall protective effectiveness, assessed as the risk of severely dehydrating cholera during 2 years after vaccination for all individuals present at time of the second dose. This study is registered with ClinicalTrials.gov, number NCT01339845. Findings Of 268 896 people present at baseline, we analysed 267 270: 94 675 assigned to vaccination only, 92 539 assigned to vaccination and behavioural change, and 80 056 assigned to non-intervention. Vaccine coverage was 65% in the vaccination only group and 66% in the vaccination and behavioural change group. Overall protective effectiveness was 37% (95% CI lower bound 18%; p=0·002) in the vaccination group and 45% (95% CI lower bound 24%; p=0·001) in the vaccination and behavioural change group. We recorded no vaccine-related serious adverse events. Interpretation Our findings provide the first indication of the effect of delivering an oral killed whole-cell cholera vaccine to poor urban populations with endemic cholera using routine government services and will help policy makers to formulate vaccination strategies to reduce the burden of severely dehydrating cholera in such populations. Funding Bill & Melinda Gates Foundation.

Introduction Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled ‘Interrupting Pathways to Sepsis Initiative’ (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Materials and Method Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite ‘Program Coaches’, facilitating triage and rapid transfer of patients through ‘Welcoming Persons’ and enabling rapid treatment through ‘Task Shifting’ from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. Results From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30%) were referred to higher level facilities than post-neonates (6%) (p

A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic.Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline.A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, -39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, -49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups.A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207.).

Infection is the major cause of neonatal deaths. Home born newborns in rural Bangladeshi communities are exposed to environmental factors increasing their vulnerability to a number of disease agents that may compromise their health. The current analysis was conducted to assess the association of very severe disease (VSD) in newborns in rural communities with temperature, rainfall, and humidity. A total of 12,836 newborns from rural Sylhet and Mirzapur communities were assessed by trained community health workers using a sign based algorithm. Records of temperature, humidity, and rainfall were collected from the nearest meteorological stations. Associations between VSD and environmental factors were estimated. Incidence of VSD was found to be associated with higher temperatures (odds ratios: 1.14, 95% CI: 1.08 to 1.21 in Sylhet and 1.06, 95% CI: 1.04 to 1.07 in Mirzapur) and heat humidity index (odds ratios: 1.06, 95% CI: 1.04 to 1.08 in Sylhet and, 1.03, 95% CI: 1.01 to 1.04 in Mirzapur). Four months (June-September) in Sylhet, and six months in Mirzapur (April-September) had higher odds ratios of incidence of VSD as compared to the remainder of the year (odds ratios: 1.72, 95% CI: 1.32 to 2.23 in Sylhet and, 1.62, 95% CI: 1.33 to1.96 in Mirzapur). Prevention of VSD in neonates can be enhanced if these interactions are considered in health intervention strategies.

The study was conducted aiming at the isolation and identification of Salmonella and Escherichia coli ( E. coli ) from different brands of poultry feeds sold in Savar, Dhaka, Bangladesh. Seven different poultry feeds were subjected to microbiological analysis. All these samples were analyzed by culturing in different media such as nutrient broth (NB), nutrient Agar (NA), SS Agar (Salmonella-Shigella Agar), BGA (brilliant-green Agar), Mac Conkey, DHL and EMB (eosin methylene blue) media. Total bacterial colonies of all the samples were counted separately on the nutrient Agar media. Hence, bacteria were counted as 9.5×10 5 in the feed sample C (Layer) which was found to be the highest in number among the poultry feeds. Total viable count (TVC) of Salmonella and E. coli in the feed samples were as 0 to 6.75×10 4 and 0 to 3.05×10 4 respectively. Both organisms were found in 71.43% and 57.14% of the analyzed feed samples, respectively. The highest number of Salmonella was found in sample C (Layer) feeds and that of E. coli was found in sample B (Grower) feeds. The widespread occurrence of Salmonella and E. coli in poultry feeds reinforces the need for effective control measures, hygiene in processing and handling of feeds. Keywords : Salmonella; Escherichia coli ; Poultry feeds; Total viable count; Contamination; Hygiene. © 2011 JSR Publications. ISSN: 2070-0237 (Print); 2070-0245 (Online). All rights reserved. doi:10.3329/jsr.v3i2.7128 J. Sci. Res. 3 (2), 403-411 (2011)

Background A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project. Methods A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities. Results Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased. Conclusions The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.

First principles pseudopotential calculations have been performed for the first time to investigate the phonon dispersion, thermodynamic and optical properties including charge density, Fermi surface, Mulliken population analysis, theoretical Vickers hardness of predicted MAX phase Sc2InC. We revisited the structural, elastic and electronic properties of the compound which assessed the reliability of our calculations. The analysis of the elastic constants and the phonon dispersion along with phonon density of states indicates the mechanical stability and dynamical stability of the MAX phase. The Helmholtz free energy, internal energy, entropy specific heat capacity and Debye temperature have also been calculated from the phonon density of states. Mulliken population analysis indicates the existence of prominent covalency in chemical bonding of Sc2InC. The electronic charge density mapping shows a combination of ionic, covalent and metallic bonding in the compound. The Fermi surface is comprised due to the low dispersive Sc 3d and C 2p states from the [ScC] blocks. The phase is expected to be a soft material and easily mechinable due to its low Vicker hardness value. Furthermore, the analysis of various optical properties (such as dielectric function, refractive index, photoconductivity, absorption coefficients, loss function and reflectivity) suggests that the nanolaminate Sc2InC is a promising candidate for optoelectronic devices in the visible and ultraviolet energy regions and as a coating material to avoid solar heating., Comment: Submitted for publication, 15 pages, 6 figure

Background Streptococcus pneumoniae is a leading cause of meningitis in countries where pneumococcal conjugate vaccines (PCV) targeting commonly occurring serotypes are not routinely used. However, effectiveness of PCV would be jeopardized by emergence of invasive pneumococcal diseases (IPD) caused by serotypes which are not included in PCV. Systematic hospital based surveillance in Bangladesh was established and progressively improved to determine the pathogens causing childhood sepsis and meningitis. This also provided the foundation for determining the spectrum of serotypes causing IPD. This article reports an unprecedented upsurge of serotype 2, an uncommon pneumococcal serotype, without any known intervention. Methods and Findings Cases with suspected IPD had blood or cerebrospinal fluid (CSF) collected from the beginning of 2001 till 2009. Pneumococcal serotypes were determined by capsular swelling of isolates or PCR of culture-negative CSF specimens. Multicenter national surveillance, expanded from 2004, identified 45,437 patients with suspected bacteremia who were blood cultured and 10,618 suspected meningitis cases who had a lumber puncture. Pneumococcus accounted for 230 culture positive cases of meningitis in children

EnterotoxigenicEscherichia coli(ETEC) is the most common bacterial cause of childhood diarrhoea in Bangladesh. Among the virulence factors of ETEC, toxins and colonization factors (CFs) play a major role in pathogenesis. UnlikeVibrio cholerae, the relationship between ETEC and ETEC-specific phages is poorly understood and the possible role of ETEC phages in the evolution of ETEC strains in the environment is yet to be established. This study was designed specifically to isolate phages that are specific for ETEC virulence factors. Among the 49 phages isolated from 12 different surface water samples, 13 were tested against 211 ETEC strains collected from clinical and environmental sources. One phage, designated IMM-001, showed a significant specificity towards CS7 CF as it attacked all the CS7-expressing ETEC. Electron microscopic analyses showed that the isolated phage possessed an isomeric hexagonal head and a long filamentous tail. An antibody blocking method and phage neutralization assay confirmed that CS7 pilus is required for the phage infection process, indicating the role of CS7 fimbrial protein as a potential receptor for IMM-001. In summary, this study showed the presence of a lytic phage in environmental water that is specific for the CS7 CF of ETEC.

Analysis of hyperspectral imagery requires the extraction of certain basis spectra called endmembers, which are assumed to be the pure signatures in the image data. N-FINDR algorithm developed by Winter is one of the most widely used technique for endmember extraction. This algorithm is based on the fact that in L spectral dimensions, the L-dimensional volume contained by a simplex formed from the purest pixels is larger than any other volume formed from other combination of pixels. Recently proposed algorithm based on virtual dimensionality (VD) determines the number of endmembers present in the dataset, where an endmember initialization algorithm (EIA) is used to select an appropriate set of pixels for initializing the N-FINDR process. In this paper, we proposed a fast algorithm to implement the N-FINDR technique which has much better computational efficiency than the existing techniques. In the proposed technique, we used the VD to find the number of endmembers N. Then we reduced the dimensionality of the hyperspectral dataset to N−1 by using the principal component transformation (PCT) and divided all the pixels into N number of classes by using the spectral angle map (SAM). We extracted N number of the most pure pixels from each group by using the classical N-FINDR algorithm but with exhaustive search. Thus we get N2 pixels that are most likely to be the actual endmembers. The classical N-FINDR algorithm is then again applied on these selected pixels to find the final N endmember. Grouping the pixels into several classes makes the computation very fast. Since we extracted N number of pixels from each group by exhaustive search, there is no possibility of loosing any endmember due to classification.

This retrospective study was carried out in the Medicine Department of Khulna Medical College, the biggest tertiary hospital in the southern part of Bangladesh to observe the trends of poisoning in southern part of Bangladesh over four years including age and sex variation, mode of poisoning, type of poison used and outcome of poisoning. The hospital medical records of all patients, aged 10 years and above with history of acute poisoning from January, 2003 to December, 2006 were enrolled. Patients were categorized into four age group including Group (Gr.) I, Gr. II, Gr. III & Gr. IV having age range of 10-20, 21-30, 31-40 & >40 respectively. Underlying causes of poisoning were also observed totally and individually in different mode with male, female ratio and the percentage. Death cases according to mode of poisoning with demographic alignment were also observed. Statistical analysis were done using epi-info version 3.5.1 and measures were presented as proportion and percentage. Among 1903 cases, 1012 (53.1%) were male and 891 (46.8%) female with a ratio of 1.4: 1. The year wise total number of cases were progressively decreased from 627 (2003) to 353 (2006). Most commonly found toxic agent was Organo-Phosphate compound (526; 27.64%) with a very little sexual variation & this trend remained same in all study years. Poisoning with unknown substance was the second leading cause (16.03%) followed by Copper-sulphate (14.03%), Sedative (13.35%), Snakebite (12.93%) etc. Incidence of unknown poisoning, sedatives, snake-bite and corrosives were found to be gradually decreased over the study years. Male were found mostly affected in majority type of poisoning except Copper-sulphate, kerosene, puffer fish, paracetamol and other drugs category. Age group II (710; 37.3%) was the most vulnerable group with male (57.89%) preponderance followed by group I (643; 33.7%), III (329; 17.2%) and IV (221; 11.6%) respectively. Highest 1308 (68.7%) cases were suicidal in mode followed by 304 (15.9%) accidental and 291 (15.2%) homicidal. Out of 1903, 140 (7.3%) patients died. Death rate was highest in OPC poisoning (52.1%) followed by unknown substance (13.5%), snakebite and copper-sulphate (11.4%) etc. In an agro-based country like Bangladesh, it’s very difficult to reduce the poisoning cases and mortality. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of poisonings throughout Bangladesh, and would be very valuable for the determination of preventive measures. DOI: http://dx.doi.org/10.3329/bmrcb.v37i2.8436 BMRCB 2011; 37(2): 61-65