Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES: Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS: We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION: There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION: This study is registered under NCT04934020.

Mitigating the risks of child safety during COVID-19 through blended awareness campaigns

ContextThe global health pandemic has affected children disproportionately across the globe. The closure of child drowning intervention amplified the child drowning risk while children stayed at home since parents were busy undertaking household duties despite the pandemic. The project Bhasa implemented blended awareness-raising campaigns to mitigate the risks of COVID-19 infections and child drowning in Bangladesh.ProcessMultiple awareness-raising campaigns of drowning and COVID-19 prevention were undertaken for targeting different communities in the project sites. For religious communities’ awareness, religious leaders campaigned at religious gatherings. The loudspeaker campaigns were conducted to aware hard to reach communities. The SMS campaigns targeted parents utilizing a mobile platform. The cable network campaign and community radio show were executed for mass communities. Additionally, caregivers visited those children who were comparatively at higher risk of drowning. Finally, an alternative play-based community supervision service was delivered while the intervention was closed.PurposeThe purpose of the delivering blended awareness campaigns was to minimize the risks of child safety during Covid-19 pandemic.AnalysisThe religious leader campaign reach outnumbered (112,575) its targeted reach was 68,820. The community radio campaign’s reach was 250,000 mass community people, whereas the TV cable network campaign’s reach was double (54,000) than its target (24,000). Loudspeaker campaign’s reach exceeded (804,024) its targeted beneficiaries (2,00000). The SMS campaign beneficiary reach was lower (6,635) than the projection (6862). A total of 450 children received alternative play-based community supervision services through 60 centers. Bad weather conditions, transportations, power cuts, weak phone signals, and busy work schedules were the main challenges reported during the campaigns.OutcomesOverall, the campaigns were able to reach and aware its targeted beneficiaries and mass communities beyond the project implementation sites. Altering schedules, using alternative vehicles, continuing to follow by phone calls, utilizing community volunteers for monitoring field activities, alternative community daycare models were some applied mitigating actions to ensure children’s safety during the pandemic.Learning OutcomesBlended campaigns and their mitigating actions could be replicated to raise awareness among different communities in an emergency.

COVID-19’s impact on child-drowning prevention activities in rural communities of Bangladesh

BackgroundDrowning is the leading cause of death among 1–4 years-old children in Bangladesh. The COVID-19 pandemic significantly altered personal and family behaviors that may directly or indirectly impact drowning-prevention activities. The CIPRB is intervening with a package consisting of the Anchals (community-daycare centers), family-education, community-sensitization, and stakeholder-awareness to prevent child-drowning <5children in rural Bangladesh. Due to the closure of over 3,000 Anchals in pandemic, approximately 70,000 rural children were unable to access Anchal supervision services. The study’s aim was to examine the COVID-19 impact of child-drowning in rural Bangladesh before and during the pandemic.MethodsBetween March 2019-February 2021, passive surveillance was conducted in 45-unions in rural Bangladesh, covering nearly one-million people. Information on fatal-drowning events was collected by using a pre-tested structured questionnaire.ResultsCompared to the pre-pandemic year, fatal-drowning rates were 70.8% higher. Before the pandemic, the under-5 fatal-drowning rate was 16.6/100,000/year;95% CI 10.2–26.9, while during the pandemic, the rate was 38.4/100,000/year;95% CI 27.8–52.9. Boys (61.4%) had higher rates, and the majority of drownings happened near dwellers’ homes. Ponds and ditches were the most common drowning locations (69.1%), and nearly all drownings (98%) happened throughout the day between 09:00–17:00.ConclusionThe fatal-drowning rate during the pandemic was consistently higher compared to the rates in the intervening areas before the pandemic. The absence of child supervision services might have caused higher rates of child-drowning.Learning OutcomesUsing this study approach could provide a means to quantify the pre-and-post COVID-19 impact on drowning globally.

Challenges in providing emergency response during COVID-19 at coastal areas of Bangladesh

BackgroundFirst aid is an emergency response to a victim for injury before the provision of medical treatment to prevent worsening of the victim’s condition. During the COVID-19, first-aider faced challenges to provide the emergency response to the victims.AimTo explore the challenges to providing an emergency response by community first aid volunteers among the victims.MethodA total of 2842 first-aid volunteers served among 2,81,000 populations under a drowning prevention project. In-depth interviews were conducted with first aid master trainers, first-aid responders, and service recipients, where thematic and content analysis was performed. In addition, injury event data were analyzed for 2-years periods of time, before and during the COVID-19 pandemic.ResultOnly 10.3% got an emergency response during COVID-19 compared to prior normal situations. Volunteers followed the proper preventive mechanism of COVID-19 during first-aid service as and when required. In the normal situation from 2018–19 received services by 3283 persons whereas, during the pandemic, only 336 persons received first-aid service. So at least 2947 people did not get an emergency response during the pandemic. 89.7% of those were supposed to receive the emergency response they deteriorated and worsened the injury and increased further damage resulting in more suffering and economic cost.ConclusionDue to COVID-19, the possibility of life risk becomes high due to emergency response limits. The preventive mechanism works to some extent.Learning outcomesAn adaptive mechanism can be developed to provide service during pandemics.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

BACKGROUND AND PURPOSE: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. METHODS: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). RESULTS: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. CONCLUSIONS: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

A Rapid Ethnographic Assessment of Cultural and Social Perceptions and Practices About COVID-19 in Bangladesh: What the Policy Makers and Program Planners Should Know.

Anthropological literature on health beliefs and practices related to COVID-19 is scarce, particularly in low and middle-income countries. We conducted a qualitative research on perceptions of COVID-19 among slum residents of Dhaka, Bangladesh from November 2020 through January, 2021. Methods included in-depth interviews and photo elicitation with community residents. Interviews were transcribed and analyzed thematically. Results show scientific explanations of COVID-19 conflicted with interviewees' cultural and spiritual beliefs such as: coronavirus is a disease of rich, sinful people; the virus is a curse from Allah to punish sinners. Interviewees rejected going to hospitals in favor of home remedies, and eschewed measures such as mask-wearing or social distancing instead preferring to follow local beliefs. We have highlighted a gap between community beliefs about the pandemic and science-led interventions proposed by health professionals. For public health policy to be more effective it requires a deeper understanding of and response to community perceptions.

Did COVID-19 impact stroke services? A multicenter study.

BACKGROUND: It has been reported that acute stroke services were compromised during COVID-19 due to various pandemic-related issues. We aimed to investigate these changes by recruiting centers from different countries. METHODS: Eight countries participated in this cross-sectional, observational, retrospective study by providing data from their stroke data base. We compared 1 year before to 1 year during COVID-19 as regards onset to door (OTD), door to needle (DTN), door to groin (DTG), duration of hospital stay, National Institute of Health Stroke Scale (NIHSS) at baseline, 24 h, and at discharge as well as modified Rankin score (mRS) on discharge and at 3 months follow-up. RESULTS: During the pandemic year, there was a reduction in the number of patients, median age was significantly lower, admission NIHSS was higher, hemorrhagic stroke increased, and OTD and DTG showed no difference, while DTN time was longer, rtPA administration was decreased, thrombectomy was more frequent, and hospital stay was shorter. mRS was less favorable on discharge and at 3 months. CONCLUSION: COVID-19 showed variable effects on stroke services. Some were negatively impacted as the number of patients presenting to hospitals, DTN time, and stroke outcome, while others were marginally affected as the type of management.

Impact of the COVID-19 lockdown on intimate partner violence: Issues of non-reporting in Bangladesh.

INTRODUCTION: COVID-19 pandemic induced lockdown as prevention and control measure, forced people globally to limit their movements and to stay at home for extended period of time. The objective of this study was to analyze the impact of lockdown on intimate partner violence in Bangladesh. METHODS: We conducted a secondary research by employing a Poisson regression model to estimate the effect of pandemic-led lockdown policy on the change in the number of intimate partner violence-related calls during pandemic using national emergency helpline 999 call logs. Data from January 2019 to May 2020 for 64 districts produced 1088 district-month-year observations which had been used for the main analysis. RESULTS: We found a 46% decrease in the incidence rate of intimate partner violence-related calls during the pandemic after adjusting for year, month, district fixed-effects-suggesting, non-reporting of the violence might have exacerbated during lockdown. CONCLUSION: While increasing rate of intimate partner violence is one side of issue, non-reporting of it has received less attention and during the lockdown non-reporting might grow large and have severe health impacts for women.

Mental health condition of physicians working frontline with COVID-19 patients in Bangladesh.

BACKGROUND: The impact of the unpredictable COVID-19 pandemic had triggered new challenges for mental health. This quick survey aimed to identify the mental health status of physicians who served the people during COVID-19 in Bangladesh. METHODOLOGY: The cross sectional survey was conducted adopting a quantitative approach and using an online questionnaire through Facebook Platform Group. Data was collected from August-October, 2020, on socio-demographic status, information on COVID-19 and questionnaires about Depression Anxiety Stress Scale (DASS-21). A total of 395 participants were enrolled from all eight administrative divisions of Bangladesh. RESULT: Our study reported a higher prevalence of depression (55.3%), anxiety (35.2%), and stress (48.4%) among 347 participants. Female physicians were found to have more stress (OR = 2.16, 95% CI: 1.09 - 4.30) compared to the male. Physicians who were previously diagnosed as mentally ill were found to be significantly more depressed (OR = 3.45, 95% CI: 1.07 - 11.10) and stressed (OR = 4.22, 95% CI: 1.48 - 12.02) compared to them who did not. Along with that, having a chronic disease, working in non-government and COVID hospitals significantly contributed to poor mental health outcomes. CONCLUSION: The study findings denoted that, the mental health of physicians was deeply affected by the pandemic situation. The availability of appropriate mental health support will help foster resilience by giving them the ability and confidence to manage crisis moments like the COVID-19 pandemic.

Exploring the lived experiences of pregnant women and community health care providers during the pandemic of COVID-19 in Bangladesh through a phenomenological analysis.

BACKGROUND: Like many countries, the government of Bangladesh also imposed stay-at-home orders to restrict the spread of severe acute respiratory syndrome coronavirus-2 (COVID-19) in March, 2020. Epidemiological studies were undertaken to estimate the early possible unforeseen effects on maternal mortality due to the disruption of services during the lockdown. Little is known about the constraints faced by the pregnant women and community health workers in accessing and providing basic obstetric services during the pandemic in the country. This study was conducted to explore the lived experience of pregnant women and community health care providers from two southern districts of Bangladesh during the pandemic of COVID-19. METHODS: The study participants were recruited through purposive sampling and non-structured in-depth interviews were conducted. Data was collected over the telephone from April to June, 2020. The data collected was analyzed through a phenomenological approach. RESULTS: Our analysis shows that community health care providers are working under tremendous strains of work load, fear of getting infected and physical and mental fatigue in a widely disrupted health system. Despite the fear of getting infected, the health workers are reluctant to wear personal protective suits because of gender norms. Similarly, the lived experience of pregnant women shows that they are feeling helpless; the joyful event of pregnancy has suddenly turned into a constant fear and stress. They are living in a limbo of hope and despair with a belief that only God could save their lives. CONCLUSION: The results of the study present the vulnerability of pregnant women and health workers during the pandemic. It recognizes the challenges and constraints, emphasizing the crucial need for government and non-government organizations to improve maternal and newborn health services to protect the pregnant women and health workers as they face predicted waves of the pandemic in the future.

Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future.

Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.

Availability and price changes of potential medicines and equipment for the prevention and treatment of covid-19 among pharmacy and drug stores in bangladesh;findings and implications

Objective: There are concerns with increased prices and drug shortages for pertinent medicines and personal protective equipment (PPE) to prevent and treat COVID-19 enhanced by misinformation. Community pharmacists and drug stores play a significant role in disease management in Bangladesh due to high co-payments. Consequently, a need to review prices and availability in the pandemic. Materials and Methods: Multiple approach involving a review and questionnaire among pharmacies and stores early March to end May 2020. Results and Discussion: 170 pharmacies and drug stores took part, giving a response rate of 63.9%. Encouragingly, no change in utilization of antimalarial medicines in 51.2% of stores despite global endorsements. However, increased utilisation of antibiotics (70.6%), analgesics (97.6%), vitamins (90.6%) and PPE (over 95%). Encouragingly, increases in purchasing of PPE. No increase in prices among 50% of the stores for antimalarials, with a similar situation for antibiotics (65.3%), analgesics (54.7%), and vitamins (51.8%). However, price increases typically for PPE (over 90% of stores). Shortages also seen for medicines and PPE, again greater for PPE. Conclusions: The pandemic has impacted on the supply and prices of medicines and PPE in Bangladesh. Key stakeholder groups can play a role addressing misinformation, with enhanced local production helping address future shortages and prices.