Disaster Coping Strategy Practiced by the Affected People for their Livelihood Due to Climate Change

The purpose of the study were to (i) determine the disaster coping strategy practiced by the affected people (ii) assess the socio-economic profile of the respondents, (iii) ascertain the contribution of selected characteristics of the people and (iv) identify the constraints of disaster coping strategy practiced by the affected people. The study was conducted at Gangachara Upazila of Rangpur District. Data were collected from a sample of 302 respondents, randomly selected from disaster affected population. Age, education, family size, farm size, disaster affected land, annual income, training received, extension media contact, knowledge on disaster coping strategy, environmental awareness, household assets, credit facilities, IGAs, water and sanitation condition, risk orientation, awareness about SSNP, perception of Climate Change (CC), perception of disasters and scope of work in vulnerable situation constituted the independent variables, while disaster coping strategy practiced was the dependent variable. For measuring the disaster coping strategy practices, a 4-point rating scale was used against 50 items taking 10 items from each of five components of human needs e.g. 1) food preservation, collection and management, 2) agricultural products protection, 3) maintaining social network, 4) safeguard of health and sanitation, and 5) protection of housing and shelter. Numerical values and scales were used to measure the personal attributes. Regression and path analysis were employed to determine the contribution among the variables. For exploring relationship between the two variables Pearson’s Product Moment Correlation (r) was used. The majority (77.8 per cent) of the respondents had regular coping strategies compared to 22.2 per cent were found to have occasional coping strategies in the study area. Among 19 independent variables 16 were found significant relationship with the dependent variable. Stepwise multiple regression revealed that six variables namely education (23 per cent), participation in IGAs (3.6 percent), awareness of SSNPs (2.9 percent), disaster affected land (1.2 percent), farm size (1.9 percent) and perception of CC (1 percent) were the important contributing variables which combined explained 33.6 of the total variation of practice of coping strategy. Path analysis indicated that disaster affected land (0.589) had the highest positive direct effect while farm size (0.643) had the highest positive indirect effect to the disaster coping strategy practice. The major constraints for practicing disaster coping strategy in the study area were ‘Lack of knowledge and skills of affected people‘, ‘Lack of relief materials during disaster‘, ‘Lack of technologies‘, ‘Weak weather forecasting‘, ‘Less motivation’, ‘Low sanitation & health coverage’ and ‘Lack of communication during disasters’,. To cope up with the challenges of the disasters, the people used reduction of food intake per meal, putting goods above flood level, keeping women and children in safer places, using boiled and tube well water, providing health care support to the sick family members, transfer important documents to the safer places, increasing level of homestead with soil, taking relief, credit, religious fasting, using mosque/temple as campaigning center, borrowing principal food from neighbor, use savings, migration, livestock sell, and social interconnectedness as the major coping strategies to survive the situation and improve their livelihood.

A Comparative Study of Oral Ivermectin and Topical 5% Permethirn Cream in the Treatment of Scabies in Patient Suffering from Diabetes Mellitus.

Scabies is one of the commonest diseases among all age groups. Topical permethrin is a widely used treatment option for scabies. Ivermectin is a newer oral agent for the treatment of scabies. This study was done to compare the efficacy of permithrin and oral Ivermectin in the treatment of Scabies in patient suffering from Diabetes mellitus. This comparative clinical trial was carried out in the outpatient department of Dermatology & Venereology, Diabetic Association Medical College Hospital (DAMCH), Faridpur from January 2012 to December 2012. A total 60 cases were enrolled purposively and divided into 2 groups. Group I received 2 doses oral Ivermectin and group II treated with 5% permethirn cream. Patients were followed up at the 3rd and 4th week. Total 86.6% patients of Ivermectin group and 90% of permethrin group were cured. Though permethrin showed somewhat more effective, the difference was not statistically significant. The study found that both ivermectin and permethrin were similarly effective in the treatment of scabies in patients suffering from Diabetes Mellitus.

Current Pattern in Antimicrobial Susceptibility in Enteric Fever In A Private Medical College.

Background and objectives: Enteric fever continues to be an important health problem in Bangladesh. Emerging drug resistance adds magnitude to this problem. Only surveillance studies can help form guidelines for therapy under such a situation. The present study was undertaken to determine the current pattern in antimicrobial susceptibility of enteric fever cases in a private medical college and to find out the incidence of multidrug resistant (MDR) cases.

Unmet Need for Family Planning among Married Women: Experience from Rural and Urban Communities.

Unmet need for family planning is the key indicator to achieve Millennium Development Goal by the year 2015. Bangladesh Government has a great success in family planning sector but population has almost doubled in recent years. This study was carried out among married women to compare the determinants of unmet need for family planning among rural and urban communities during the period from July 2010 to June 2011. Unmet need for family planning in rural community was found 18(12%) and in urban community it was 38(25.3%). Among rural women unmet need for limiter was 13(8.6%) and spacer was 5(3.4%) while limiter 29(19.4%) and spacer 9(5.9%) found among urban women. Mean age at marriage was found 17.97(SD±2.66) years and mean age at first child birth was 19.91(SD±2.71) years among rural women. Among urban women mean age at marriage was found 20.43(SD±4.08) years and mean age at first child birth was 22.55(SD±4.3) years. Current contraceptive users among rural women was 79(52.7%) while it was 61(40.7%) among urban women. In this study, association between unmet need for family planning and freedom of choice of contraceptives was highly significant (p=0.001). To increase contraceptive prevalence rate and reduction of unplanned pregnancy, more emphasis should be given on unmet need for family planning.

Evaluation of Efficacy and Tolerability of Perindopril 8 mg in Bangladeshi Hypertensive Patients: Results from an Open-label, Observational, Multi-center Study (CONTROL).

Background: The CONTROL (COversyl in Newly diagnosed stage-II & unconTROlled hypertensive patients triaL) was performed with an objective to evaluate the blood pressure (BP) lowering efficacy and tolerability of Perindopril 8mg in newly diagnosed stage II patients and uncontrolled hypertensive patients among Bangladeshi population. Methods: This was an open-label, observational, multi-center study conducted in consultation centers for out-patients located in different cities of Bangladesh. Adults, aged above 18 years with newly diagnosed stage-II hypertension or uncontrolled hypertension, were recruited. Patients were treated with Perindopril 4mg daily for first 1 week, afterwards uptitrated to Perindopril 8 mg daily and continued treatment for 12 weeks. Patients were followed-up at week-1, week-4, week-8 and week-12. Results: In total, 245 patients were enrolled. Among them, 88 were newly diagnosed stage-II (Group- I) and 157 were uncontrolled (Group-II) hypertensive patients. Male and female distribution was 57% and 43% respectively. Mean age of patients was 54.5 ±11.7 years. After 12 weeks treatment, there was a significant reduction in BP from baseline (p<0.001) in overall population as well as in Group I and in Group II. In overall population, the mean BP reduction was -31/-15 mmHg (from 163.7/96.8 mmHg to 132.4/81.7 mmHg. In Group I, the reduction was -33/-16 mmHg (from 166.5/98.2 mmHg to 133.4/82.0 mmHg) and in Group II, -30/-14 mmHg (from 159.3/ 95.6 mmHg to 129.1/81.6 mmHg). 10 patients (4.1%) had to discontinue the treatment due to adverse effects. Dry cough (2%) and hypotension (1.2%) were the main cause of discontinuation. Perindopril 8mg was well tolerated as indicated by the high proportion of physicians (81%) reporting ‘good’ to ‘excellent’ tolerability at week 12. Conclusion: This study suggests that Perindopril 8mg is effective and safe in the treatment of hypertension in Bangladeshi patients.

Pulmonary Hypertension in Hemodialysis Patients.

Background: Pulmonary hypertension (PH) has been reported to be high among maintenance dialysis patients. There is a paucity of data on the incidence and prevalence of pulmonary hypertension in chronic kidney disease(CKD) in Bangladeshi patients. Materials and Methods: A total 70 CKD patients (male 47,female 23), who were on conservative management and maintenance hemodialysis were studied for the presence of pulmonary hypertension. The variables studied were hypertension, diabetes, duration of dialysis and the hemoglobin, serum creatinine and serum bicarbonate levels. Results: 68.6% of the patients on maintenance hemodialysis had pulmonary hypertension compared to 8.6% of the prediadysis CKD patients. 97.1% of maintenance dialysis patients had anaemia (Hb <10gm/dl) and 42.9% of patients had metabolic acidosis. Conclusion: The incidence of pulmonary hypertension was highest in the hemodialysis group. Significant Pearson’s correlation was found between pulmonary arterial systolic pressure with the duration of hemodialysis, hemoglobin level, serum creatinine, blood sugar and serum bicarbonate level in maintenance hemodialysis patients.

Effect of Oral Zinc Supplementation on the Growth of Preterm Infants.

Objective: To compare the effect of oral zinc supplementation on growth of preterm infants. Design: Randomized controlled trial. Setting: Dhaka Shisu Hospital (Tertiary care hospital). Subjects: 100 appropriate for date preterm infants weighing between 1000 to 2500g were randomized to receive zinc and multivitamin supplement (Group I; n=50) or only multivitamin supplement (Group II). Intervention: Zinc supplementation was given 2mg/kg/ day for 6 weeks along with multivitamin in Group I and only multivitamin to Group II. Primary outcome variable: Increment of weight and length. Results: At enrollment, serum zinc (62.1±12.4μg/dL in Group I and 63.1±14.6μg/dL in Group II) and hemoglobin levels (14.9±2.4g/dL in Group I and 14.4±1.7g/dL in Group II) were almost similar in both groups. Serum zinc levels were in lower limit of normal range. After supplementation, serum zinc and hemoglobin levels were significantly higher in Group I (105±16.5μg/dL) than Group II (82.2±17.4μg/dL) (P<0.05). Weight, length and head circumference were comparable in both groups at enrollment. Significant differences in weight gain and increment in length were found in first and second follow up between two groups but OFC increments were not significant (P>0.05). Reduction of morbidity was apparent in zinc supplemented group. No serious adverse effect was noted related to supplementation therapy. Conclusion: Zinc supplementation for preterm low birth weight babies is found effective to enhance the growth in early months of life.

Efficacy, Safety and Tolerability Of Valsartan Plus HCTZ in Patients With Essential Hypertension: A Multicentre Observational Study in Bangladesh.

Background: Valsartan is an established drug for treatment of essential hypertension. It blocks the action of Angiotensin II irrespective of its sources. A large proportion of patients need additional treatment with two or more drugs of different pharmacological classes for achieving target blood pressure. Published evidence demonstrated synergistic effect of Thiazides with ARB. Coadministration of valsartan and Hydrochlorothiazide has the potential to reverse the untoward effect of each other. Current study aimed at evaluating the efficacy, safety and tolerability of Valsartan plus Hydrochlorothiazide combination, and thus validating the regimen in the treatment of essential hypertension in Bangladeshi population, a population significantly different from Caucasian population where most studies were done. Methods: Current study is a prospective interventional study involving 404 Adult, patients, with Stage I (SBP 140-159 mmHg/DBP 90-99 mmHg) or Stage II (SBP>160 mmHg/DBP >100 mmHg) essential hypertension or patients uncontrolled on current mono-therapy or other combination therapy. Valsartan plus HCTZ 80/12.5 mg once daily tablet were prescribed to continue till the following visit or for the remainder of the study. In case of inadequate control increment in dose was made on the following visit. Patients were assessed at baseline, at 4th weeks, 12th week and 24th week. One of the major outcome parameter set for the study was the percentage of participant having BP controlled that is a SBP <140 mmHg and DBP <90 mmHg or a reduction >10 mmHg for DBP and/ or >20 mmHg SBP versus baseline values at 24 weeks. At final follow-up, in addition to repetition of the baseline measurements and examinations, data on Safety of the drug was collected by enquiring and recording all adverse events or serious adverse events. Global assessment of efficacy and tolerability of treatment was also done by both the physicians and patients on a 4-point scale. Result: The percentage of participant having BP controlled at the end of the trial was 91%. Besides, Significant reduction in mean SBP and mean DBP was also evident (P<.001) through paired comparison from baseline to end of the study. Average reduction of 32.4 ± 19.5 mmHg was seen in systolic BP and 17.4 ± 9.3 mmHg in diastolic BP. Global assessment based on both physician and patients reported greater satisfaction with the efficacy of treatment modality. Total adverse event reported by only six (1.5%) participants. Of the six cases three of the adverse effect was reported at 3rd visit and another three were reported at 4th visit. Total five dropouts (1.24%) were reported of which 1 in 3rd visit and 4 in 4th visit. Among the dropout patient three were withdrawn from the study and two didn’t attend the final follow-up. Global assessment of safety and tolerability based on both physician and patient’s opinion reveals greater satisfaction level with the safety and tolerability of combination treatment. Conclusion: The combination of valsartan and hydrochlorothiazide is an effective treatment for patients with essential hypertension. The combination is also effective in patients not responding to monotherapy with either agent. The drug is found to be well tolerated with minimal adverse event during the course of treatment.

Coronary Angiographic Characteristics of Patients with First Myocardial Infarction Admitted in a Tertiary Care Cardiac Hospital in Bangladesh.

Background: Coronary artery lesion characteristics of patients with First myocardial infarction (First MI) of Indian subcontinent origin in UK, is different from indigenous white population. The present study was aimed to observe coronary angiographic profile of first MI patients, hospitalized in a tertiary care hospital, in Bangladesh and to compare the results with published data of study done home and abroad. Methods: This is a prospective observational study. A total of 100 cases of First MI patients were included in this study. Clinical history, physical examination, major risk factors, relevant investigations including ECG & Echocardiogram and coronary angiogram of all patients were recorded. Results: The coronary angiographic features of 100 patients revealed that 88% of the study population had significant coronary artery lesion (stenosis e”70%). Normal coronary arteriogram was found in 5 patients (5%); although they had myocardial infarction previously. Insignificant lesion (stenosis < 70%) was detected in 7 patients (7%). Left anterior descending (LAD) arteries were affected in most of the patients (78%), followed by right coronary artery (62%) and left circumflex artery (55%). Single vessel disease (33%) and triple vessel diseases were equally prevalent among the study population. Conclusion: Present study observed that triple vessel disease, diffuse pattern of lesions and combined type of lesions were more prevalent among the first MI patients. Increase in the number of risk factors was associated with progressive increase in severity of disease as defined by number of significant stenosis. Comparison of results of present study population with that of study done abroad shows that single vessel disease was more prevalent among European white patients who had first MI but triple vessel disease was more prevalent among our patients.

Role of Micro-ESR and I/T Ratio in the Early Diagnosis of Neonatal Sepsis.

This prospective study was undertaken in Dhaka Shishu Hospital from 15th March 2005 to 15th October 2006 to determine the role of micro-ESR and immature and total neutrophil (I/T) ratio in early diagnosis of neonatal septicaemia. Eighty suspected cases of septicaemia admitted in neonatal ward of Dhaka Shishu Hospital were included in this study. Patients those who had history of perinatal asphyxia, infant of diabetic mother, congenital cyanotic heart disease etc. were excluded from the study. Thirty neonates without sign symptoms of septicaemia admitted for other causes like jaundice, feeding problems etc. were taken as a control group. After taking informed consent data were collected in structured questionnaire. Following hematological investigations like total WBC count, differential count, absolute neutrophil count, band cell count, platelet count, CRP, blood culture were done. Micro-ESR was done as bed side test. I/T ratio detected from total neutrophil and band form count. Patients with positive blood culture were categorized as definite sepsis. Patients with negative blood culture but abnormal hematological report suggestive of sepsis were categorized as probable sepsis. Those who had no signs of sepsis were categorized as control group. Micro-ESR more than age of the patient in days + 3mm in 1st hour were considered significant for sepsis. I/T ratio more than 0.2 was considered positive for sepsis. Sensitivity and specificity of micro-ESR was 63.3% and 60% respectively. Sensitivity and specificity of I/T ratio was 70% and 56% respectively. Combination of micro-ESR and I/T ratio showed high sensitivity (80%) and specificity (70%).

Effect of zinc on growth of preterm babies.

Zinc is being recognized increasingly as an important element in human growth, development and immunological function. It is probably the most intensely studied microelement in newborn nutrition. Zinc deficiency is common in young infants in the developing world and is associated with reduced immunocompetence and increased rates of serious disease. Preterm neonates are especially vulnerable because of preterm delivery and low birth weight. The preterm baby has very limited stored energy and needs an adequate supply of nutrient. Preterm infant have high zinc dietary requirements as 60% fetal zinc is acquired during third trimester of pregnancy. Low concentration of zinc was found in pre-term low birth weight babies in different studies. Studies showed that before supplementation serum zinc level in perterm low birth weight babies were 62+/-12.4mugm/dl, 65mugm/dl, 54+/-14.4mugm/dl and after supplementation serum zinc level were 105.8+/-16.6mugm/dl, 86.4+/-24.7mugm/dl respectively. At the same time mean weight & length of supplementation and without supplementation group were 6084 gm vs. 5280gm, 2779+/-638.7gm vs. 2474.6+/-441.8gm and length 23.7cm vs. 21.4cm, 46.49+/-2.6cm vs. 44.1+/-2.8cm respectively. So supplementation of zinc in preterm babies causes improved growth and development. Various reports showed beneficial effect of long supplement in early growth of pre-term babies. However long term follow up studies are needed to evaluate the beneficial effect of zinc supplementation on growth of preterm babies.

High prevalence of hepatitis A virus antibody among Bangladeshi children and young adults warrants pre-immunization screening of antibody in HAV vaccination strategy.

Serum samples from 465 subjects aged between 1 and 25 years were tested for antibody against hepatitis A virus (HAV) [anti-HAV IgG and IgM] to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the general population of Bangladesh. A high prevalence of anti-HAV (74.8%) was observed in the study population; the whole study population was found positive for anti-HAV by the age of 25 years. On performing the cost-benefit analysis, it was found that the cost for vaccination with screening for anti-HAV was almost three times cheaper than vaccination without screening. Thus, in the present socioeconomic condition of Bangladesh, a policy based on screening for HAV antibody before vaccination is recommended.

Unusual presentation of progressive systemic sclerosis.

A female 38 years old, housewife, presented to the Department of Dermatology and Venereology, Mymensingh Medical College Hospital (MMCH) on 08.04.07 with the complaints of i) pain and reduced movement of hand, knee, shoulder and neck joints for 1 year and 9 months ii) tightness of skin over face, neck, limbs and trunk for 1 year and 6 months iii) patchy depigmentation over same areas for 1 year and 3 months iv) deformity of hands with flexion contractures for 6 months and v) dysphagia to solid food for 3 months. She had no complaints of Raynaud's phenomenon. On general examination, she was ill looking, anemic and nutritionally poor. Examination of integumentary system showed smooth, shiny, thick, hard and hidebound skin with pigmentary alteration of 'salt and pepper' appearance over fingers, hands, limbs, face, neck and trunk. Hands appear claw like but more on the right side than the left and there were no other obvious changes suggestive of digital ischaemia (atrophy, ulceration, scarring, gangrene etc). Face has got suggestive features of scleroderma. Examination of the respiratory system showed restriction of chest movement and reduced expansibility of chest wall. No other abnormality was found on examination of other systems. Laboratory investigations showed histopathology typical of scleroderma. X-ray of hands and feet showed suggestive changes, lung function test-showed restrictive lung disease. Barium swallow x-ray of esophagus in supine position showed mild dilation of lower oesophagus. But serology was non-reactive (negative ANA, Negative RA test, Negative VDRL). So, she was diagnosed as a case of progressive systemic sclerosis (PSS) with some atypicality.

Serum zinc level in preterm low birth weight babies and its comparison between preterm AGA and preterm SGA babies.

Low birth weight (LBW) is a major child health problem in Bangladesh and continuing to great threat to child health and child survival in Bangladesh. LBW is a silent emergency but crisis is real and its persistence has profound and frightening impact on neonatal mortality. This observational study was conducted in Dhaka Shishu Hospital, Dhaka, Bangladesh during July 2004 to June 2005. Serum zinc levels were estimated between two groups: group-I preterm AGA (n=50), group II preterm SGA (n=50) babies. Blood samples were collected from the study population in neonatal unit and serum zinc levels were measured by flame atomic absorption spectrophotometry in Atomic Energy Center, Dhaka, Bangladesh. Observed data were made comparison among groups by Students 't' test. It was observed serum zinc level (60.2+/-15.2) in group I and (62.1+/-12.4) in group II. Serum zinc level was in lower limit of normal range in both groups with more lower level in preterm AGA babies but their difference was not statistically significant (p>0.05). So zinc supplementation may enhance the growth of preterm LBW babies in their early months of lives.

Pott's disease in a young child.

A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.

Carotid Duplex Ultrasound Findings in Patients with Coronary Artery Disease (CAD)- A Study in 50 Cases.

Background: Patients with angina pectoris or myocardial infarction are more likely to experience stroke. Ischaemic stroke has been found to develop in approximately 2-5% of patients in the first 1- 2 weeks after myocardial infarction Methods: Fifty patients with coronary artery disease admitted to the National Institute of Cardiovascular Diseases (NICVD), Dhaka, were screened for presence of carotid atherosclerosis by duplex ultrasound study during the period of July 98 to August 98. Results: Carotid lesion were found in 34 patients (68%) and normal carotids found in 16 patients (32%). Age range of patients with and without carotid lesions was 56±5.39 yrs and 47±7.91 yrs respectively. Out of 34 patients, 30 were male (88.2%) and 4 were female (11.7%). 29 patients (85.3%) were smokers, 22 patients (64.7%) were hypertensive and 9 patients (26.4%) were diabetic. Dyslipidaemia was found in 16 patients (47%) and a history of transient ischaemic attack (TIA) was found in 10 patients (29.4%). A coexistent CAD on coronary (CAG) was found in 31 patients (91.1%). Conclusion: Cortaid duplex ultrasound study findings of atherosclerotic lesions in Carotid arteries are good predictors of CAD.

Diagnostic efficacy of Aldehyde test in late cases of Kala-azar.

This case control study was carried out in the Paediatric wards of Mymensingh Medical College Hospital for a period of one year from April 2002 to March 2003 to determine the sensitivity, specificity and predictive values of Aldehyde test in the diagnosis of Kala-azar. A total of seventy five febrile cases of Kala-azar from Paediatric wards were enrolled in the study and Seventy five controls having splenomegaly with or without fever were also included from the same source. Aldehyde test was done in both cases and controls. Diagnosis of Kala-azar was confirmed by demonstration of Leish-man-Don-o-van body (LD) in bone marrow or splenic aspirates. Out of 75 parasitologically proven cases of Kala-azar, AT was positive in 56 cases. The sensitivity irrespective of duration of illness was 74.6%. We found sensitivity of AT increases with the duration of illness where AT was sensitive in 34.7% cases having fever for less than 3 months, 90.90% with fever for 3 months to less than 6 months and 100% with fever for 6 months or more in duration. Specificity of AT was calculated as 96% with positive and negative predictive values of 94.9% and 79.1% respectively. So AT is a very sensitive and specific test with high positive and negative predictive values. Considering the cost, availability, simplicity, sensitivity, and specificity we would recommend the Aldehyde test as an important diagnostic tool for field diagnosis of Kala-azar especially after three months of febrile illness.