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Objective: To understand the extent to which adolescent awareness of and attitudes about anaemia and anaemia prevention can be changed by nutrition messages received at school. Design: Mixed-methods pre–post intervention study Setting: Three Government schools in Bagalkot, Belagavi and Raichur districts of Karnataka, India Population or Sample: Students of grade six and seven and teachers involved in implementing the intervention. Methods: An education intervention was co-developed by school teachers and nutrition experts using locally adapted resource materials that consisted of lectures, role play and practical demonstrations. Seven half-hour educational sessions were delivered by school teachers over seven weeks to 455 students. Pre- and post-intervention tests measured changes in adolescents’ knowledge about anaemia. In-depth interviews with teachers and focus groups with students explored reactions to the intervention. Main outcome measures: Knowledge score related to anaemia Results: The percentage of children with correct scores increased by 7.3 - 49.0 percentage points for the tested questions after implementation of the intervention. The mean knowledge score increased by 3.67±0.17(pConclusions: Educational interventions carried out for adolescents by teachers in schools are effective in improving awareness and attitude related to anaemia.

Drowning was one of the most prevalent causes of death worldwide for children under five in 2020. Drowning was the second leading cause of death for children under five in Bangladesh, while 58% of all deaths in the 1–5 years old age group resulted from drowning. Adult supervision helps prevent child drowning in rural areas where water bodies are easily accessible and located very close to homes. This paper aims to assess caregivers’ compliance and perception of community daycare centers in rural Bangladesh, piloted as a child drowning prevention intervention. In this longitudinal study, each child enrolled in the daycare intervention was visited and data on compliance and satisfaction with the daycare were collected. Descriptive statistics on daycare attendance, patterns of supervision, and caregivers’ perceptions about daycare were reported. When inquired about daycare attendance (n = 226,552), a total of 77.4% of children (n = 175,321) were found to attend daycare. The distance from homes and an adult’s unavailability to take the child to daycare were the most common reasons for not attending or discontinuing enrollment. The majority of children (76.4%) were supervised by their mothers during daycare closures. A total of 67.7% of respondents perceived daycare to be a safe place, where children also developed cognitive (51.7%) and social skills (50.6%). There were no incidences of drowning among children while attending daycare. Rural families were found to be compliant with the daycare and professed it to be a safe place protecting children from drowning and other injuries, while allowing them to focus on household chores or income-generating activities. These findings indicate a potential for the expansion of this intervention in rural Bangladesh and similar settings.

Background The home is the most common location for fatal injuries in Bangladesh with 60% of deaths occurring in and around the home. This paper describes the epidemiology of fatal home injuries in rural Bangladesh Methods A census and baseline survey was conducted as part of the Saving of Lives from Drowning (SoLiD) project in 7 purposively sampled rural sub-districts of Bangladesh. Information on socio-demographic characteristics, injury mortality and morbidity were collected from 1.2 million people between June and November, 2013. Descriptive analyses were done to quantify the burden of unintentional fatal home injuries. Results 267 injury deaths were recorded over the 1-year recall period in the home environment (mortality rate was 23 [95% CI 20–26] per 100000 population per year). Leading causes of home injury deaths were drowning (53.7%), suicide (10.8%), falls (12.3%) and burns (9.3%). Children aged 1–4 years (97 [95% CI 78–120] per 100000) and adults older than 65 years (81 [95% CI 62–105] per 100000) were at high risk for injuries in the home (p Recommendation Interventions need to be promoted to ensure safer behaviours and help change home environments for families especially children in rural Bangladesh.

Additional file 1. Details about methods and results.

Additional file 2: Table 2. Involvement of husbands during pregnancy, childbirth, and following birth: preferences of women and engagement of husbands (N = 1367).

Additional file 3: Questionnaire used in this study.

Additional file 1: Appendix 1. Instructions to caregivers on the use of the playpens.

Additional file 1: Table 1. Summary of three sub-districts’ population, administrative structure and health systems details.

Background: Psoriasis is a chronic, recurring inflammatory disease of the skin with an unpredictable course and variable prognosis. Palms and/or soles are involved in 10% to 21.1% of all psoriasis cases. Palmo-plantar psoriasis is a therapeutically challenging condition that can significantly impact quality of life. It is frequently resistant to traditional topical therapies, such as potent steroids, calcipotriol and anthralin but show good response to photochemotherapy (PUVA). Aim of the study was to compare the efficacy and safety of bath PUVA versus oral PUVA in patients with chronic palmo-plantar psoriasis.Methods: This randomized clinical open trial was conducted in the department of dermatology and venereology, BSMMU, Dhaka from 1st September 2007 to 28th February 2008. Patients clinically diagnosed with chronic palmo-plantar psoriasis were selected by simple random sampling. A sample size of 50 patients was taken, 25 for bath PUVA and 25 for oral PUVA group. Psoriasis area and severity index (PASI) score was used to determine the percentage of reduction of Palmo-plantar psoriasis in both groups. Data were analysed with computer-based program SPSS version.Results: Reduction of psoriasis at 1st follow-up in bath PUVA and oral PUVA were 29.85±8.95 and 31.93±11.55 respectively. At 2nd follow-up were 85.86±7.33 and 28.48±39.32 respectively. Significantly higher improvement was observed in Bath PUVA group than oral PUVA group, both at 1st and 2nd follow-up (p=0.001).Conclusions: Bath PUVA was significantly more effective at reducing Palmo-plantar psoriasis than oral PUVA.

Drowning accounts for 43% of childhood mortality among 1–4 years old in Bangladesh. The Saving of Lives from Drowning (SoLiD) project was implemented in seven rural sub-districts of Bangladesh to assess the effectiveness of child drowning prevention interventions including community creches. Objective The objective of this paper is to describe utilization and acceptability of community creches implemented in four sub-districts of rural Bangladesh. Approximately 27 000 children aged 9–36 months were enrolled in the creche intervention in the four sub-districts. Information on utilization of creches were collected from caregivers every 4–6 months. This paper describes information on utilization collected between March – November 2015 from 25 742 caregivers. Around 59% of the caregivers reported that their child was currently attending creches, 21% reported that their children formerly attended creches whilst 32% mentioned that their child did not attend creches even after being enrolled. Among those currently attending, 56% and 32% of children attended creches regularly (20 or more days) or often (10–19 days), respectively in the past month. The main reasons for sending children to creches included child education and early childhood development (81%), child safety (70%), caregivers remain tension free (66%), ability of caregivers to carry out household chores (59%). The main reasons for children dropping out or never attending creches included the creche being too far, none to take the child to the creche and the child not willing to leave the mother. This study demonstrated that the utilization of creches were high and considered to be beneficial to caregivers. However, care should be taken in selecting the creches as well as mechanisms need to be initiated to ensure attendance. Given the benefits of creches in preventing injury and early childhood development, initiatives should be undertaken to sustain creches in the community.

Drowning is the second leading cause of injury-related deaths among children. In Bangladesh, drowning accounts for nearly 43% of all deaths among children between 1–4 years. With the support from Bloomberg Philanthropies, the Johns Hopkins International Injury Research Unit in collaboration with the Centre for Injury Prevention and Research, Bangladesh and International Centre for Diarrheal Disease Research, Bangladesh implemented the ‘Saving of Lives from Drowning’ (2012 – 2015) study in seven rural sub-districts of Bangladesh. The overall goal of the SoLiD study was to assess effectiveness and cost-effectiveness of playpens and enrollment in creche or both for preventing drowning among children aged 9–36 months. Nearly, 1.2 million people were covered in the SoLiD baseline injury survey and surveillance, and about 70 000 children received SoLiD interventions. Nearly 50 000 playpens were distributed and more than 3000 creches were established. While it is important to implement research on a large scale to generate evidence on effectiveness, this can present several implementation challenges. Some of the challenges experienced included: 1) collection of multiple streams of data – baseline survey, surveillance and compliance, 2) community mobilization and engagement, 3) manufacturing playpens locally that met international standards, 4) retention of trained human resources, 5) implementing complex intervention such as creche, and 5) frequent strikes and political instability. Lessons from this study can help in planning and implementing large-scale community-based injury prevention interventions in LMICs.

Worldwide, there were about 8 03 900 suicides in 2012 making it the 15th most common cause of death for all ages. Three-fourths of the global suicides occur in low and middle-income countries (LMICs). Also, for every adult who commits suicide, there are indications that there are 10–20 more who attempt a suicide. The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts of Bangladesh encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Information on fatal and non-fatal suicidal behaviours were collected over a 1 year and 6 month recall period, respectively. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 1 00 000 person-years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15–17 and 4.04 times among 18–24 olds compared to 25–64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married. Students had significantly lower risk of non-fatal suicidal behavior and among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. Compared to Chandpur/Comilla district the risk of suicide was higher in Narshingdi while the risk of non-fatal suicide was lower in Sherpur. The common methods used were hanging and poisoning. Suicide is a serious public health problem in Bangladesh especially among high-risk individuals such as adolescents and married women. There is a need to develop targeted national strategies, action plans, prevention programs and conduct further research to learn more and reduce the rate of suicide in the country.

Globally, drowning is a major cause of injury-related deaths among under-five children. Nearly, 90% of these deaths occur in low- and middle-income countries. However, there is limited evidence on effectiveness of childhood drowning prevention interventions from LMICs. Some of the interventions for child drowning prevention have been tested. These include barriers (fencing, door barriers, playpen), creches, swimming lessons, rescue and resuscitation and personal flotation device. While removing or covering water hazard and isolation fencing around pools have been found to be effective in preventing childhood drowning, there is insufficient evidence for effectiveness of playpens and door barriers. Creches/day care centers provide supervision of children especially when caregivers are busy. These have been found to be effective for childhood drowning. Swimming may reduce the risk of drowning among children. However, there is insufficient evidence whether this can be effective for very young children. In event of drowning, safe rescue and immediate resuscitation can save life. However, personal flotation device although effective may not be practical in a LMIC setting where most drowning occurs closer to home and in natural bodies of water. To generate evidence on large scale effectiveness of playpens and creches, the the Johns Hopkins International Injury Research Unit in collaboration with the Centre for Injury Prevention and Research, Bangladesh and International Centre for Diarrheal Disease Research, Bangladesh with the support from Bloomberg Philanthropies, implemented the ‘Saving of Lives from Drowning’ (2012 – 2015) study in seven rural sub-districts of Bangladesh. Nearly, 1.2 million people were covered in the SoLiD baseline injury survey and surveillance, and about 70 000 children received SoLiD interventions.

icddr,b in collaboration with JH-IIRU implemented a study to evaluate the effectiveness of interventions including community creches in preventing drowning and other injuries among under-5 children in Bangladesh, 2013-till date. As part of the project different approaches were tested for sustaining community creches. This paper describes the initiatives taken and challenges faced in sustaining creches in four sub-districts of rural Bangladesh. Tested three models include – A. Pay-for-service (subsidized and unsubsidized), B. Parent-led cooperative agreement, C. Integration into primary health care centre (PHC)/primary schools. Feasibility was measured by the ability to generate partial or full funds to cover variable and fixed costs and support for overseeing creche activities. A total of 174 creches were sustained for six months. In the pay-for-service subsidized model, the expenditure for 65 selected creches was shared by the project and community. Community essentially funded the variable costs. In the unsubsidized model, 68 creches were completely commercial and supported by community leaders. Model B was not tested as parents did not agree to form a defined cooperative. In model C, Creches could not be integrated with any GoB programme, but 41 creches were personally monitored by union chairmen, councilors, school teachers. The average attendance in the creches across all the models was about 65%. Communities expressed need for additional interventions such as monthly health check-up for children, issuing health card to help avail GoB healthcare services, training of creche mothers on first-aid, government basic health worker package. Other challenges included inability to involve a central ministry, lack of MoU with GoB and insufficient enthusiasm from PHC and primary schools. In conclusion, to sustain creches a multi-sectoral approach is required with a ministry to champion the activities. This requires development of plans detailing funding, partnerships, and approaches.

icddr,b in collaboration with JH-IIRU implemented an electronic demographic and injury surveillance system (DISS) to measure 13 injuries as part of the Saving of Lives from Drowning (SoLiD) project in rural Bangladesh. The aim of this paper is to discuss the methodology, challenges and solutions in implementing the DISS. The electronic DISS was implemented in 4 sub-districts from 2014 to 2015 and covered 0.6 million population. A paperless data management software and system was developed for data collection, real time transmission to a central database server and monitoring and supervision. We used tablets with Android operating system (Samsung Galaxy Tab 7.0) and internet enabled SIM card for data collection and transmission to a central database server. The application in the Tablet was developed using JAVA and the data capture interface was in local language. Data were stored locally in the tablet during interview using SQLite. Microsoft SQL Server 2008 R2 was used for the Central data storage. Data were uploaded to the central server through the internet daily at the end of data collection. A monitoring website was developed using ASP.NET code behind C Sharp (C#) to review data collection progress in real-time using any web browser. Validation rules were set to prevent inconsistencies and other errors during data entry. Password-protected login identifications ensured the integrity and safety of data. The main benefits were reduced workload, increased efficiency, timeliness and completeness of collected data. Challenges included issues with data collection processes and operation of the system, internet availability which were resolved using appropriate technical support and training. The use of electronic DISS proved to be beneficial in terms of increasing efficiency, timeliness and completeness. We recommend surveillance practitioners and policymakers to explore the use of electronic systems to improve care provided to individuals.

The Developmental Study is part of a larger intervention on “saving of lives from drowning (SoLiD)” where children were enrolled either into crèches (daycare centers) or playpens to prevent drowning in rural Bangladesh. Sampling ~1000 children between the ages of 9–17 months, we compared problem-solving, communication, motor and personal-social outcomes assessed by the Ages and Stages Questionnaire in the two interventions. After controlling for variables such as home stimulation in multivariate regressions, children in crèches performed about a quarter of a standard deviation better in total scores (p < 0.10) and 0.45 standard deviations higher in fine motor skills (p < 0.05). Moreover, once the sample was stratified by length of exposure to the intervention, then children in crèches performed significantly better in a number of domains: those enrolled the longest (about 5 months) have higher fine motor (1.47, p < 0.01), gross motor (0.40, p < 0.05) and personal-social skills (0.95, p < 0.01) than children in playpens. In addition, children in crèches with the longer exposure (about 5 months) have significantly higher personal-social and problem-solving scores than those in crèches with minimum exposure. Enrollment in crèches of very young children may be positively associated with psychosocial scores after accounting for important confounding variables.

Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

Around 90% of all fatal and non-fatal unintentional injuries occur in low- and middle-income countries (LMICs). The magnitude of unintentional injuries is unclear due to limited research and data. This paper describes the burden of lesser-known injuries (LKIs&mdash, cut injuries, unintentional poisoning, machine injuries, electrocution, injury by blunt objects, and suffocation) in rural Bangladesh, using data from the Saving of Lives from Drowning (SoLiD) project in Bangladesh. Descriptive statistics were used to report counts and rates of injuries by socio-demographic factors, injury characteristics, and circumstantial details. The annual morbidity rate of LKIs was 6878 injuries per 100,000 persons, involving 3.4% (40,520) of the population. Cut injury (44,131.2/100,000 per year) and injury by blunt objects (19768.6/100,000 per year) attributed in large numbers to the overall burden of LKIs. Males (66.1%) suffered more injuries than females. More than half (52.9%) occurred among people aged 25 to 64 years. Those involved in agriculture suffered the most injuries, mainly cut injuries (9234.1/100,000 per year) and machine-related injuries (582.9/100,000 per year). Most injuries occurred in the home setting. Increased awareness about packaging, storage, and the proper handling of appliances can help lower the frequency of LKIs. Safe architecture and awareness about home injuries is required to reduce injuries occurring in the home environment.