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Background: Indwelling urinary catheters are frequently used in critically ill patients. Approximately 66% of patients in intensive care have a urinary catheter in place. Catheter-associated urinary tract infection (CAUTI) is a significant cause of morbidity and mortality, affecting all ages. Antibiotic resistance is one of the biggest public health challenges of our time. Infection with antibiotic-resistant bacteria has become an increasingly complex problem in ICU. Objective: To identify catheter-associated uropathogens and their antimicrobial susceptibility pattern by VITEK2 automated system in intensive care unit patients in Rajshahi Medical College Hospital. Material and Method: A cross-sectional descriptive study was conducted in the Microbiology department of Rajshahi Medical College, the Intensive Care Unit of Rajshahi Medical College Hospital, and a commercial laboratory in Rajshahi during the period of January 2021 to December 2021. The specimen (urine) was inoculated in blood agar, nutrient agar, and MacConkey's agar media and incubated aerobically at 37˚C for 24 hours. Bacterial isolations and susceptibility tests were done by VITEK2 automated system. Result: Out of the total 96 samples, culture yielded growth was 36 (37.50%), and culture-negative cases were 60(62.50%). In all age groups, males were predominant, totaling 63 (66.20%). A maximum of 33 cases were found in the age group of 18-30 years where males 23(69.70%) and females 10(30.30%). Among the culture-positive isolates, gram-negative organisms were higher (87.17%) than gram-positive (12.82%). Among 39 isolates, Escherichia coli was the predominant organism of 12(30.76%). Other isolates were Klebsiella spp. 10(25.64%), Pseudomonas spp. 5(12.82%), Acinetobacter spp. 4(10.25%), Enterobacter spp. 2(05.12%), CoNS 3(07.69%) respectively. Regarding the antimicrobial susceptibility test, gram-negative organisms were highly susceptible to Colistin, followed by Ertapenem, Imipenem, Meropenem, and Amikacin. The most effective drugs for Gram-positive were Linezolid. Other susceptible drugs against Gram-positive bacteria were Vancomycin and Tigecycline. Conclusion: Most of the isolated bacteria are multidrug resistant. Determining antimicrobial susceptibility by VITEK2 will aid the physician in choosing appropriate antibiotics and treating multidrug-resistant cases. TAJ 2022; 35: No-2: 43-49

Salmonella enterica serovars typhi is a contributing typhoid agent, leading to untreatable infections based upon the rising prevalence of antimicrobial resistance in the said agent. Consequently, the main concern of the health service providers to treat expansively drug-resistant (XDR) enteric fever has been dependent on the only remaining oral drug, Azithromycin, for creating emerging resistance against it. Therefore, a cross-sectional descriptive study was conducted in the Microbiology Department of Rajshahi Medical College, Rajshahi, to identify Salmonella species by Fastidious Antibiotic Neutralization (FAN) method in suspected enteric fever cases along with its antimicrobial susceptibility pattern and molecular detection of Azithromycin resistant R717Q gene. Samples were collected purposively. Regarding the population's age distribution, out of 127 specimens, the predominant 37(29.1%) were found within the age group of 35-44 years. Automated blood culture was found positive in 64(50.39%) population; out of them, Salmonella spp were 38(59.37%) of the population. Among them 29(76.31%) have travel history, took street food 25(65.7%), used tap water for drinking 21(55.2%) and had kancha latrine 24(63.1%). It was found that 18.43% were sensitive and 81.57% resistant to Azithromycin. Azithromycin-resistant Salmonella spp. were detected in 31(81.57%), and among Azithromycin resistant R717Q gene was identified in 9(29.03%). The azithromycin-resistant R717Q gene was identified by conventional PCR. Because of its oral course of administration, Azithromycin is considered the widely used drug in Bangladesh, which is used once on a dose basis a day. In order to contribute to the development of this drug resistance, there could be many reasons, and among them there are the availability over the counter and the imperfectly done treatment. Thus, this study would be helpful to formulate a regional hospital empirical therapy by antimicrobial sensitivity and resistance pattern of the gene for Azithromycin resistance in Rajshahi Medical College Hospital. TAJ 2022; 35: No-2: 67-73

Chest CT scans of 200 symptomatic patients infected with COVID 19 from different health facilities and home were reviewed for common CT findings in relationship with their clinical symptoms, comorbidities and the time between symptom onset and the initial CT scan was studied in this cross-sectional study. Cases were categorized into three groups according to the timing of HRCT, 10 cases were in early (0-2days), 56 cases in intermediate (3-5days) and 110 cases were in late (6-12days) groups. Chest CT scan images showed bilateral peripheral ground glass opacities 96.63%, pulmonary consolidations 15.9%. Notably 29.54% patient had normal CT scan chest and 60% of them were imaged at early phase. With a longer duration of symptoms, chest CT findings were more typical including GGO, consolidation with greater total lung involvement. Bilateral peripheral GGO was observed in 20% patients at early phase while 53.57% and 64.54% were observed at intermediate and late phase of illness. Among the symptoms cough and dyspnea were observed more related with typical CT changes (95%). Diabetes and Hypertension (58% of patients) were the leading comorbidities that were found related with GGO and other typical CT findings. Mean time duration between symptom onset and positive RT PCR, CT scan changes were 4.79 and 7.55 respectively. Central Medical College Journal Vol 5 No 2 Jul 2021 PP 70-75

Portal hypertensive gastropathy (PHG) is a common endoscopic finding in patients of cirrhosis of liver. The cause and pathogenesis of PHG in cirrhotic patients is poorly understood. Some studies showed, association of Helicobacter pylori (H. Pylori) with portal hypertensive gastropathy in cirrhosis of liver, but the evidence is not robust. The aim of this study was to assess the association of H. pylori infection and PHG in patients with cirrhosis of liver. This case control study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from April 2016 to August 2018. A total of 230 patients with cirrhosis of liver were included in this study. There were 115 cirrhotic patients with PHG as cases and 115 cirrhotic patients without PHG as controls. Upper gastrointestinal Endoscopy and 13C Urea Breath Test (UBT) was done in both cases and controls. In this study, out of 230 cases, 147 (63.91%) found to have H. pylori infection. Among cirrhotic patients with PHG case, 77 (66.95%) was positive in UBT. Out of these 77 UBT positive cases, 55 had mild PHG whereas 22 cases had severe form of PHG. Among 38 cases of cirrhosis with PHG who had negative UBT, 23 had mild PHG and 15 cases had severe form of PHG. The risk of positive urea breath test was not statistically significant in cirrhotic patients with PHG in comparison with cirrhotic patients without PHG (P=0.337, OR 1.303, 95% CI 0.759-2.235). In this study, statistically significant association was not found between H. Pylori and PHG in cirrhotic patients. Bangladesh Med J. 2021 May; 50(2) : 21-27

Background: Dermatophytosis is considered one of the most common public health problems in the world and is the most commonly diagnosed skin disease in Bangladesh. The prevalence and types of dermatophyte infections vary with climate conditions, age, lifestyle, and population migration patterns. Depending upon the anatomical site of the lesion, dermatophytes are classified into different varieties. Objective: To isolate dermatophytes and their antifungal susceptibility pattern by agar-based disc diffusion method in the Rajshahi region. Materials and Methods: Clinical samples (e.g., skin scrapings, nail clipping, and hair plucking) were collected under aseptic precautions. The identification of dermatophytes was performed through a microscopic examination using 10% KOH mount, mycological culture, and species identification by lactophenol cotton blue mount from culture. In addition, all dermatophytes isolates were subjected to antifungal susceptibility testing using the agar-based disc diffusion method. Results: Out of 171 samples, Trichophyton rubrum was the predominant dermatophyte species with 76(71.7%), followed by T.mentagrophyte were 15(14.2%), E. floccosum were 12(11.3%), and M. canis were 03(2.8%). Voriconazole and Itraconazole were more effective drugs. Griseofulvin was the least effective drug, followed by Fluconazole. Conclusion: Despite several treatment options being available for cutaneous fungal infections, Due to the increasing trend of antifungal drug resistance among dermatophytes, treatment should be based on antifungal sensitivity testing. The disc diffusion method is a simple and valuable method for the evaluation of antifungal susceptibility of dermatophytes. TAJ 2022; 35: No-1: 99-106

Background: Carbapenem resistance is a major and ongoing public health problem globally and locally. It occurs mainly among Gram-negative pathogens such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Most of the carbapenemase-producing bacteria are multidrug resistant, including 3rd generation of cephalosporin and carbapenems. It may be intrinsic or mediated by transferable carbapenemase-encoding genes. This type of resistance gene is already widespread in certain parts of the world, mainly Europe, Asia, and South America. Objective: To isolate and identify WHO-declared carbapenemase-producing deadliest drug resistance bacteria with their antibiogram in the Rajshahi region. Materials Method: Cross sectional descriptive study was done from July 2017 to June 2018. Wound swab was collected in different surgical and burn units of Rajshahi Medical College Hospital. The specimens were inoculated in blood agar, nutrient agar, and MacConkey's agar media and incubated aerobically at 370 C for 24 hours. Susceptibility tests of the bacterial isolates were done by using the modified Kirby Bauer disk diffusion method on Mueller Hinton agar media. Carbapenemase-producing bacteria were identified by using the modified Hodge test. Results: Out of the total 250 samples, culture yielded growth in 213(85.2%) cases, and 37(14.8%) yielded no increase. Females were predominant 146(58.4%) in comparison to males 104(41.6%), with a male-female ratio of 1: 1.4. A maximum of 47.2% of cases were between 19-30 years old. Among the culture-positive isolates, gram-negative organisms were higher (58.8%) than gram-positive (41.2%). S. aureus was the predominant organism 71(30.8%), followed by P. aeruginosa 47(20.3%), E.coli 43(18.7%), and Acinetobacter baumannii 07 (3%). Among seven isolated Acinetobacter baumannii, 47 isolated P. aeruginosa, and 82 isolated Enterobacteriaceae: 6(85.7%), 33(70.2%), and 53(64.6%) were MDR; and 4(57.1%), 12(25.5%) and 14(17%) were carbapenemase-producers respectively. Conclusion: Most of the isolated carbapenemase-producing bacteria are multidrug resistant, and they tend to cause complicated infections. In addition, the expression of specific virulent factors, difficulty in diagnosis, and the non-availability of newer generation antibiotics make them one of the deadliest bacteria. TAJ 2022; 35: No-1: 91-98

Background: Drowning is an important cause of mortality among children in rural Bangladesh. This study was done to find out the sociodemographic characteristics of drowning affected children. Materials and methods : It is a descriptive study among the victim of drowning admitted in the Department of Pediatrics, Chittagong Medical College Hospital, Chattogram during the period of January 2014 to December 2014. One hundred victims were selected for the study. History and face to face interview were taken, the sociodemographic characteristics were analyzed statistically. Results: Of 100 patients in this study, age ranged from 6 month to 12 years, largest number (76%) of victims belonged to 1-4 years age group. Most of the drowning events occurred in rural area (82%). Almost all (87%) of rural drowning occurred in pond, 8% drowning occurred in bucket, all of which were urban. April to October (88%) were found to be high risk months for drowning. Almost all (96%) of the victims were found unable to swim and in 100% cases, there is no fencing present around pond. Most (82%) of the victim survived without morbidity, 6% died, 4% survived with morbidity. Conclusion: Children of 1-4 years old, rural children,children of poor socioeconomic background are vulnerable to drowning. Drowning mostly occurs during daylight, lack of supervision of child is strongly associated with drowning. Drowning has specific seasonal pattern. Busy mother with a large family, illiterate mother, lack of pond fencing or door fencing, and lack of swimming ability are also associated with drowning. IAHS Medical Journal Vol 5(1), June 2022; 38-44

Background: Only a few studies investigated the association of a positive blood culture with mortality in the pediatric population, the predictive significance of a positive blood culture in children admitted to the Pediatric Intensive Care Unit (PICU) remains uncertain. This study aimed at evaluating the characteristics and outcomes of negative blood culture compared to those of positive blood culture in children admitted to the PICU of Chittagong Medical College Hospital (CMCH). Materials and methods: A retrospective cohort study was conducted at the PICU of CMCH. All pediatric patients, from 1 month to 12 years of age, admitted between October 2021 and March 2022were included in the study. All blood culture samples sent from patients hospitalized in the PICU of CMCH between October 2021 and March 2022, were evaluated retrospectively. Information collected includes the demographic data, Primary diagnosis, and outcome of the patients. Results: Of the 214 patients, 29 (13.6%) had a positive blood culture whereas 185 (86.4%) had a negative bacterial blood culture. Pneumonia was extremely common, present in 65.5% and 34% of the patients, respectively in culture positive and negative patients, and tended to result in a positive culture (p

Bangladesh has been facing a new crisis to provide shelter to the Rohingyas who were forcibly repatriated from Myanmar. Though Rohingyas taking shelter in Bangladesh started in 1978, the last massive influx of the Rohingyas occurred on 25 August 2017, when more than 7,00,000 Rohingya refugees fled to Bangladesh due to massive crime against humanity in Myanmar. More than a million Rohingya refugees live in Rohingya camps in Cox's Bazar, wherein, in most cases, the Rohingyas are exploited in many ways for many reasons, and the personal security of the Rohingya in the camps are under threat in many ways. Therefore, this paper explores two issues. First, the paper argues that the overall fundamental human rights of the Rohingya in the camps are undermined; and second, in other ways, Rohingya also creates challenges for Bangladesh as the host country.

Avian mycoplasmosis in commercial chicken is a serious problem around the world, and responsible for high economic losses and decreased poultry productivity. This study aimed to characterize the mycoplasma infection macroscopically and microscopically in commercially important poultry like broiler and layer in Barishal, Bangladesh. Diagnosis of mycoplasmosis was made on the basis of history, clinical signs, necropsy findings and histopathology of the suspected organs. The study was conducted on a total no. of 460 birds (broiler n=237; layer n=223) of 20 different farms of three different upazillas of Barishal district in Bangladesh. The overall prevalence of micoplasmosis was 26.52%. Layer chicken (30.04%) was more susceptible to mycoplasmosis than broiler chicken (23.20%). The highest prevalence of mycoplasmosis was observed in 3-6 weeks-aged chicken in both broiler (54.55%) and layer (35.82%) chicken. A significant difference (p

Noncompliance is one of the major issues with the treatment of tuberculosis (TB), which can lead to treatment failure. A short-course of chemotherapy as recommended by World Health Organization under the umbrella term of Directly Observed Treatment Short Course (DOTS) therapy seems to be effective. The main aim in present study was done to evaluate the efficacy of short term intermittent chemotherapy in DOTS regimen in patients with extra spinal osteoarticular TB. The present prospective study was conducted in the Department of Ortho & Spine Surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh over a period of one year between January 2018 to February 2019. 21 patients included in our Study. All the patients were given the DOTS regime as recommended by WHO and followed up at intervals of one month during the treatment for assessing the clinical improvement and compliance of the patient. The results in present study, there were 85.71% males and 14.29% were females. 42.86% were students followed by the labourer (28.57%). Hip (47.62%) was the most commonly involved joint followed by short bones of hand and foot (19.5%). All (100%) patients had an elevated ESR at the time of presentation. Eighty percent patients had shown increase in weight at the end of 6 month of treatment. All patients of extra spinal osteoarticular TB showed improvement. Treatment was found sufficient for 80% of the patients. In 20% cases treatment duration was extended. In discussion the Short term intermittent chemotherapy in DOTS regimen was optimum for the treatment of extra spinal osteoarticular TB and was associated with good compliance.

Introduction: A high pace of urbanization and improvised high-velocity motor vehicles are the leading factors for high energy lower limbs trauma in a middle-income country, Bangladesh resulting in a common compound fracture and dislocation at the level of knee; the proximal and middle third of the leg in the salvageable limb. Among the coverage options, gastrocnemius muscle flap (GMF) and proximally based sural fasciocutaneous flap (PBSFC flap) were used for a long period to meet the good reconstructive goals. Aims and objectives: The study aims to compare between gastrocnemius muscle flaps and proximally based sural artery fasciocutaneous flaps for coverage of soft tissue defect on proximal and middle third of leg with the exposed tibia and/or knee joint in terms of operating time, flap viability and its complications, donor site morbidity, time taken for bone healing. Methods and materials: This study is a retrospective study of 22 cases of those who came with soft tissue defects on knee and proximal and middle third of leg requiring flap coverage in Rajshahi Medical College Hospital from August 2019 to July 2021. Here we harvested medial gastrocnemius muscle flap for coverage of knee and proximal third of the leg and PBSFC flap based on median sural artery was done for the defect on knee to proximal two third of leg. All the donor sites of PBSFC flaps were covered by split thickness skin graft, whereas, in case of GMF, the donor site was tried for direct closure. Results and discussion: 13 GMF and 09 PBSFC flap were done in the study period. All collected data were analyzed in GMF group and PBSFC flap group and made the comparison between two groups by standardized analytic testing tools. Conclusion: In comparisons of two different flaps of the study, none was superior in terms of survivability of the flap, rate wound infection control, bone healing.

To satisfy the requirements of label-free detection, low cost, fast response of a lab-on-chip biosensor, a nanodot enhanced metal-insulator-metal ( MIM ) waveguide based refractive index sensor coupled with three rectangular cavities, is proposed in this work. Numerical investigation of the transmission spectra, employing the finite element method ( FEM ), exhibits a linear correspondence with the refractive index, which is used to sense the unknown materials. Imposing a sequential optimization of the structural parameters and enhancing light-matter interaction by loading nanodots at the high ${E}$ -field confined areas, desired sensitivity ( ${S}$ ) and figure of merit ( FOM ) are upgraded to $7564\,\, nmRI{U^{ - 1}} $ and 120, respectively. Additionally, the maximum temperature sensitivity of $3.40\,\, nm{}^{0}{C^{ - 1}} $ operating from $20{}^{0} {C} $ to $70{}^{0} {C} $ is also recorded for ploydimethylsiloxane ( PDMS ) sensing media. Prior to the selective detection of $Na^{\mathrm{ +}}$ , $K^{\mathrm{ +}}$ , and glucose concentration in the human blood, a sample preparation model combining purification, molecular separation, and concentration enhancement is proposed. Furthermore, a refractive index model is developed that exposes a maximum shift of 0.83 nm , 1.23 nm , and 8.72 nm of the transmittance peak for the concentration variation of $1\,\, mgd{L^{ - 1}} $ in $Na^{\mathrm{ +}}$ , $K^{\mathrm{ +}}$ , and glucose solution easily differentiable by the modern spectrometer. With such excellent performance metrics, compact size, and simple to use features, the proposed sensor is expected to bring a notable solution in the point-of-care detection.

Background: Infection and Diabetes often coexist, making each other the worse for it. Patients with diabetes have a greater frequency and severity of many common infections such as urinary, pulmonary, soft tissue infections. This study aims to describe the bacterial agents and determine the antimicrobial susceptibility of diabetic foot infections (DFI) and pneumonia in the Rajshahi region. Materials and Methods: A descriptive study was performed over a period of one year in a tertiary care hospital that involved 120 patients. The aerobic bacterial agents were isolated, their antimicrobial susceptibility patterns were determined from wound swab and sputum samples. Results: A total of 106 microorganisms were isolated among 95 culture-positive cases. The microorganism isolated were 50.94% (n = 54) GN (Gram-negative) and 49.06% (n = 52) GP (Gram-positive). GN microorganisms include Pseudomonas spp. (25.47%), E. coli (14.15%), Klebsiella spp. (9.43%), and Proteus spp. (1.89%). S. aureus (38.68%) were predominant among GP, followed by S. pyogens (3.77%) and Enterococcus spp. (1.89%). About 4.72% were Coagulase Negative Staphylococcus (CoNS). S. aureus showed 95.12% sensitivity to Vancomycin and 90.24% to Imipenem. On the other hand, Pseudomonas spp. showed highest 85.19% sensitivity to Meropenem. Conclusion: Gram-negative (GN) microorganisms were predominantly isolated from DFIs and pneumonia, but S. aureus was the most frequently isolated organism. They showed a wide range of susceptibility towards different antimicrobials. TAJ 2021; 34: No-1: 09-15

An experiment was carried out to determine the effect of replacing dietary fish meal protein with earthworm meal protein on growth performance, whole-body composition, and hematology of butter catfish (Ompok pabda). This experiment was conducted in 15 glass aquaria (200 L) with five treatments, each having three replications. Each of the aquaria was stocked with 40 fishes (average weight 0.62 g). The fish were fed with iso-nitrogenous diets having 35% protein (21% protein from fish meal and/or earthworm meal) twice a day up to satiation with the experimental diets, where fish meal protein was replaced by earthworm meal protein at 0% (control), 25%, 50%, 75%, and 100% in the treatments E0, E25, E50, E75, and E100, respectively. At the end of the 8-week rearing period, the best growth performances including weight gain (5.23 ± 0.14 g), percent weight gain (844.15 ± 6.38%), and specific growth rate (4.00 ± 0.11% day−1), and best feed utilization parameters, viz., feed conversion ratio (1.57 ± 0.03) and protein efficiency ratio (2.87±0.04), were found in treatment E75, where 75% of fish meal protein in the diet was replaced with earthworm meal protein. The hematological parameters showed no abnormality due to supplementation of earthworm meal in the diets. At the end of the experiment, whole-body carcass composition, viz., protein, lipid, and ash contents (15.93 ± 0.19%, 7.22 ± 0.60% and 2.14 ± 0.10%, respectively), of O. pabda was higher in treatment E75 compared to control (14.8 2± 0.34, 6.16 ± 0.27, 1.89 ± 0.10, respectively). The results imply that earthworm meal can be used as a protein-rich source to replace fish meal, the major protein source, in the diet of O. pabda up to 75% level without compromising growth, immunity, and body composition.

Humanity has been confronted with the concept and criteria of death for millennia and the line between life and death sustains to be debated. The profound change caused by life support technology and transplantation continues to challenge our notions of life and death. Despite scientific progress in the previous few decades, there remain big variations in diagnosis criteria applied in each country. Death is a process involving cessation of physiological function and determination of death is the final event in that process. Legally, a patient could be declared dead due to lack of brain function, and still may have a heartbeat when on a mechanical ventilator. Though there is no point in supporting ventilation in a dead person, withdrawing a ventilator before the legal criteria for death may involve the physician in both civil and criminal proceedings. To identify the moment of death is vital to avoid the use of unnecessary medical intervention on a patient who has already died and to ensure the organ donation process, clear and transparent. The age-old standard of determination of death is somatic standard and cardiopulmonary standard. Harvard report (1968) defines irreversible coma as a replacement criterion for death and prescribed clinical criteria for the permanently nonfunctioning brain. The current unifying concept of death: irreversible loss of the capacity for consciousness combined with irreversible loss of the capacity to breathe. WHO (2014) adopted minimum determinant death criteria, acceptable for medical practice globally, achieving international consensus on clinical criteria to maintain public trust and promote ethical practices that respect fundamental rights of individuals and minimize philosophical and biomedical debate in human death. AAN (2019) endorses that the brain death is the irreversible loss of all functions of the entire brain and equivalent to circulatory death.

This study focuses on investigating the use of mobile phones among young drivers by employing an online questionnaire survey data. Ordinal logistic regression model was used for modelling the probabilities of crashes due to different uses of mobile phone while driving. Moreover, binary logistic regression models were used for predicting the probabilities of different uses of mobile phone. Logistic regression models revealed that texting and internet use have the same likelihood of causing crashes. Drivers having prior experience of being fined for mobile phone use, also showed a higher tendency to be involved in 2 crashes. Moreover, these drivers had a higher likelihood of being involved in texting, as compared to other uses of mobile phones. Drivers with more education had a higher tendency for internet use during driving. Drivers who use mobile phone for long periods during driving have a lesser tendency to get involved in texting, internet use or GPS navigation. Moreover, drivers with a previous crash record have less likelihood of being involved in texting. The models of this study can be useful in developing effective road safety measures. Clustering was also applied in this study which reinforced the findings of the statistical analysis and models.

Background: Pneumonia is the leading cause of under-five child deaths globally and in Bangladesh. Hypoxaemia or low (Methods: Based on literature review and expert consultations, we developed a conceptual framework, which guided the planning and implementation of a 4-step stakeholder engagement process. Desk review, key informant interviews, consultative workshops and onsite demonstration were the key methods to involve and engage a wide range of stakeholders. In the first step, a comprehensive desk review and key informant interviews were conducted to identify stakeholder organisations and scored them based on their power and interest levels regarding IMCI implementation in Bangladesh. In the second step, two national level, two district level and five sub-district level sensitisation workshops were organised to orient all stakeholder organisations having high power or high interest regarding the importance of using pulse oximetry for pneumonia assessment and classification. In the third step, national and district level high power-high interest stakeholder organisations were involved in developing a joint action plan for introducing pulse oximetry in routine IMCI services. In the fourth step, led by a formal working group under the leadership of the Ministry of Health, we updated the national IMCI implementation package, including all guidelines, training manuals, services registers and referral forms in English and Bangla. Subsequently, we demonstrated its use in real-life settings involving various levels of (national, district and sub-district) stakeholders and worked alongside the government leaders towards carefully resuming activities despite the COVID-19 pandemic.Results: Our engagement process contributed to the national decision to introduce pulse oximetry in routine child health services and update the national IMCI implementation package demonstrating country ownership, government leadership and multi-partner involvement, which are steppingstones towards scalability and sustainability. However, our experience clearly delineates that stakeholder engagement is a context-driven, time-consuming, resource-intensive, iterative, mercurial process that demands meticulous planning, prioritisation, inclusiveness, and adaptability. It is also influenced by the expertise, experience and positionality of the facilitating organization.Conclusions: Our experience has demonstrated the value and potential of the approach that we adopted for stakeholder engagement. However, the approach needs to be conceptualised coupled with the allocation of adequate resources and time commitment to implement it effectively.

Near-surface disposal is anticipated to be the preferred option for the disposal of low and intermediate levels of radioactive waste in Bangladesh. A geographic information system (GIS) and a multi-criteria analysis were used for screening all of Bangladesh to identify potential areas to establish a near-surface disposal facility (NSDF). Five main data criteria, namely geology, hydrology, climatology, pedology and socio-economy, were used in the analysis and were further sub-divided into 14 sub-criteria. Layers of these sub-criteria graded on a scale of 0–5 were used as raw data for the analysis, where 0, 1, 2, 3, 4 and 5 indicate excluded area, completely unsuitable, unsuitable, moderately suitable, suitable and most suitable, respectively. Finally, a suitability map was generated using the analytic hierarchy process and GIS software, which indicated about 1.78% (2621.88 km2) of the total area to be most suitable for the construction of a NSDF in Bangladesh.