Research bioethics training in Bangladesh.

The Bangladesh Medical Research Council is implementing a training program on research bioethics under International Bioethics Education and Career Development Award of Fogarty International Center of National Institutes of Health (NIH), USA. The ultimate goal of the program is to improve ethical practice in implementation of health research through capacity strengthening of the professionals involved in health research in Bangladesh. The duration of the program is 4 years and it has started from the year 2002. The first year (2002-2003) was assigned for curriculum development. Several workshops, focus group discussions and consultative meetings were organized during 2002-2003 and curriculum was developed. Under this training program every year 2 Certificate Courses on Research Bioethics (CCRB) with a duration of 10 weeks will be conducted for 40 participants (20 participants in each batch). Each year one Advance Course on Research Bioethics (ACRB) will be organized for 10 participants with a duration of 6 days. The courses are to be conducted during 2nd, 3rd and 4th year. The Certificate Course on Research Bioethics is intended for multidisciplinary participants having previous experience in research methodology while the Advance Course on Research Bioethics will target for training the members of Ethics Review Committees of the country. Through this program one hundred fifty Bangladeshi professionals will get adequate training on research bioethics. The training program will be implemented by national experts with technical assistance from distinguished international scientists in the field.

Quality of health care from patient perspectives.

The quality of health care is the consequence of strong link between service providers and user of the services. Perceived quality is one of the principal determinant of utilisation and non-utilisation of health services, a major issue in developing countries. Considering this, the present study was aimed to assess the quality of care in in-patient and outpatient departments of rural and urban government hospitals in Bangladesh. A total of 2420 patients were interviewed. The patients were selected by using systematic random sampling technique. Results revealed that age, waiting time, time spent for patient examination, place of treatment, income, years of schooling and male sex appeared to be independent predictors of patient satisfaction (p<0.001). Age, waiting time and years of schooling were negatively related with level of satisfaction indicating younger patients, less waiting time and patients with less education were more satisfied, whereas time spent for examination, income were positively related with patient's satisfaction. Patients attending at the urban hospitals and male sex were also significantly associated with patient's satisfaction. The study recommends that both short and long-term policy action should be adopted for quality assurance of the existing health care facilities in Bangladesh.

Energy intake and expenditure of obese and non-obese urban Bangladeshi children.

A case control study was conducted in Dhaka city to measure the energy intake and expenditure among 220 obese children of 4-10 years age group and 220 randomly selected age and sex matched controls. A 24 hour dietary recall was used to assess the energy intake. Data on energy expenditure was obtained by 24 hour physical activity recall. The mean energy intake of obese children (2056 +/- 751 kcal/d) was found to be significantly higher (P<0.001) compared to the non obese (1508 +/- 529 kcal/d). No sex difference was found in both obese and non obese groups. Mean energy expenditure of the obese children (1868 +/- 313 kcal/d vs 1495 +/- 200 kcal/d) was significantly higher than the non-obese (P<0.001). Of the obese, boys expended more energy than the girls (P=0.01). Furthermore, physical activity level (1.40 +/- 0.09 vs 1.35 +/- 0.14) was significantly higher among the non obese than their obese counterpart (P<0.001). However, energy balance was significantly higher among the obese (P<0.001). Dose response of energy balance shows the estimated relative risk of obesity increases with higher level of energy balance (P<0.001). The findings of this study revealed that energy balance as a result of higher energy intake and lower energy expenditure was one of the important risk factors for the development of obesity among the children of Dhaka city. Thus, appropriate interventions like behavioural change regarding food habits and physical activities are recommended.

Cerebral malaria--a study of 104 cases.

One hundred and four adult cases of cerebral malaria (73 male, 31 female) were studied between July 1995 to June 1996 in Chittagong Medical College Hospital. Diagnosis of cerebral malaria was based on unrousable coma or any neurological manifestation in a febrile patient with asexual Plasmodium falciparum in blood film. Intermittent fever (83%), vomiting (80%), headache (75%), convulsion (60%) and history of travel or residence in malaria endemic area were important features noted in patients with cerebral malaria. Most of the patients (69%) were admitted within 25 to 48 hours following unconsciousness. The factors are more common in cases with high mortality with diastolic blood pressure (DBP) below 60 mm of Hg, anaemia, persistence of Glasgow Coma Score below 5 on day 2, high parasite count at presentation, proteinuria and high level of serum urea. Out of 104 cases of cerebral malaria 66 patients (63.5%) recovered without sequelae, 34 patients (32.7%) died and 4 patients (3.8%) recovered with some residual sequelae. Establishment of intensive care unit in tertiary level hospitals is necessary to take appropriate measure for severe cerebral malaria cases for reduction of mortality.

Sero-epidemiological study of hepatitis B virus infection in a village.

A cross-sectional study was conducted in a randomly selected village of Rangpur district from June '94 to May '95. Serum from 1000 human subjects irrespective of age and sex were screened for hepatitis B surface antigen (HBsAg). Among the respondents 661 were male and 339 female. The overall seroprevalence of HBsAg was 6.4%. It was 6.66% in male and 5.89% in female. Age, sex, religion, income, occupation, education and marital status did not show any relationship with HBsAg status. Among 64 sero-positive cases, 16 (25%) had no history of exposure to known risk factors and 48 (75%) had one or more exposure to known risk factors (p < 0.05). This study did not depict the national scenario. Well designed studies with more sensitive serological methods are recommended to get the epidemiological information of hepatitis B virus (HBV) infection in our community.