The Promise of Teleconsultation in the Era of Pandemic: A Case from Bangladesh.

Background: In 2016, the Government of Bangladesh (GoB) established a teleconsultation service called Shastho Batayon to increase access to physicians. During COVID-19 pandemic, health care access became limited due to movement restrictions. In response, GoB made Shastho Batayon toll free, publicized the number through media, increased the number of call center doctors, introduced automated messages on COVID-19 preventive measures, and developed a scoring system to classify risk groups for COVID-19. Objectives and Methods: In this case report, we describe how an existing national teleconsultation service can be utilized in a low- and middle-income country to address primary health care needs during a public health emergency. We conducted secondary analysis of Shastho Batayon service data from January to April 2020. Results: The total calls for doctor's consultation increased during the pandemic. Prepandemic, Shastho Batayon received less than 20,000 calls per month. In March 2020, when the first cases of COVID-19 were confirmed, Shastho Batayon services received 60,811 calls for doctor's consultation, which increased to 125,660 calls in April, 2020. The doctor's consultation for primary care has increased for all conditions. Shastho Batayon services screened 28,944 patients with the influenza-like illness or COVID-19-like symptoms in March and April, 2020, provided preventive measures, advice, and referral to designated hospitals based on a national guideline. Conclusions: In public health emergencies such as COVID-19 pandemic, teleconsultation services can help provide prevention guidelines, debunk misinformation, identify risk categories, and refer people to appropriate service and facilities in a timely manner.

Psychosocial health of school-going adolescents during the COVID-19 pandemic: Findings from a nationwide survey in Bangladesh.

BACKGROUND: Common psychosocial health problems (PHPs) have become more prevalent among adolescents globally during the COVID-19 pandemic. However, the psychosocial health of school-going adolescents has remained unexplored in Bangladesh due to limited research during the pandemic. The present study aimed to estimate the prevalence of PHPs (i.e., depression and anxiety) and assess associated lifestyle and behavioral factors among school-going adolescents in Bangladesh during the COVID-19 pandemic. METHODS: A nationwide cross-sectional survey was conducted among 3,571 school-going adolescents (male: 57.4%, mean age: 14.9±1.8 years; age range: 10-19 years) covering all divisions, including 63 districts in Bangladesh. A semi-structured e-questionnaire, including informed consent and questions related to socio-demographics, lifestyle, academics, pandemic and PHPs, was used to collect data between May and July 2021. RESULTS: The prevalence of moderate to severe depression and anxiety were 37.3% and 21.7%, respectively, ranging from 24.7% in the Sylhet Division to 47.5% in the Rajshahi Division for depression, and from 13.4% in the Sylhet Division to 30.3% in the Rajshahi Division for anxiety. Depression and anxiety were associated with older age, reports of poor teacher cooperation in online classes, worries due to academic delays, parental comparison of academic performance with other classmates, difficulties coping with quarantine situations, changes in eating habits, weight gain, physical inactivity and having experienced cyberbullying. Moreover, being female was associated with higher odds of depression. CONCLUSIONS: Adolescent psychosocial problems represent a public health problem. The findings suggest a need for generating improved empirically supported school-based psychosocial support programs involving parents and teachers to ensure the well-being of adolescents in Bangladesh. School-based prevention of psychosocial problems that promote environmental and policy changes related to lifestyle practices and active living should be developed, tested, and implemented.

Mental healthcare-seeking behavior of women in Bangladesh: content analysis of a social media platform.

BACKGROUND: Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification. METHOD: A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8th March 2020 and 7th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach. RESULT: The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services. CONCLUSION: The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital.

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.

Seroprevalence of SARS-CoV-2 infection and associated factors among Bangladeshi slum and non-slum dwellers in pre-COVID-19 vaccination era: October 2020 to February 2021.

BACKGROUND: Seroprevalence studies have been carried out in many developed and developing countries to evaluate ongoing and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data on this infection in marginalized populations in urban slums are limited, which may offer crucial information to update prevention and mitigation policies and strategies. We aimed to determine the seroprevalence of SARS-CoV-2 infection and factors associated with seropositivity in slum and non-slum communities in two large cities in Bangladesh. METHODS: A cross-sectional study was carried out among the target population in Dhaka and Chattogram cities between October 2020 and February 2021. Questionnaire-based data, anthropometric and blood pressure measurements and blood were obtained. SARS-CoV-2 serology was assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. RESULTS: Among the 3220 participants (2444 adults, ≥18 years; 776 children, 10-17 years), the overall weighted seroprevalence was 67.3% (95% confidence intervals (CI) = 65.2, 69.3) with 71.0% in slum (95% CI = 68.7, 72.2) and 62.2% in non-slum (95% CI = 58.5, 65.8). The weighted seroprevalence was 72.9% in Dhaka and 54.2% in Chattogram. Seroprevalence was positively associated with limited years of formal education (adjusted odds ratio [aOR] = 1.61; 95% CI = 1.43, 1.82), lower income (aOR = 1.23; 95% CI = 1.03, 1.46), overweight (aOR = 1.2835; 95% CI = 1.26, 1.97), diabetes (aOR = 1.67; 95% CI = 1.21, 2.32) and heart disease (aOR = 1.38; 95% CI = 1.03, 1.86). Contrarily, negative associations were found between seropositivity and regular wearing of masks and washing hands, and prior BCG vaccination. About 63% of the population had asymptomatic infection; only 33% slum and 49% non-slum population showed symptomatic infection. CONCLUSION: The estimated seroprevalence of SARS-CoV-2 was more prominent in impoverished informal settlements than in the adjacent middle-income non-slum areas. Additional factors associated with seropositivity included limited education, low income, overweight and pre-existing chronic conditions. Behavioral factors such as regular wearing of masks and washing hands were associated with lower probability of seropositivity.

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.

Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study.

OBJECTIVE: We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh. DESIGN: Setting and participantsA cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted. OUTCOME MEASURES: Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19. RESULTS: About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. CONCLUSION: The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.

Millions of Bangladeshi Children Missed Their Scheduled Vaccination Amidst COVID-19 Pandemic.

The Government of Bangladesh imposed a movement control order as a mass quarantine strategy to control the outbreak of coronavirus disease 2019 (COVID-19). Adherence to the home quarantine may put children at risk by missing routine vaccination. In this study, we investigated the impact of COVID-19 on child routine immunization in a rural area of Bangladesh and consider the broader implications. Data for this study comes from the Chakaria Health and Demographic Surveillance System (HDSS) of icddr,b with a population of 90,000 people residing in 16,000 households in 49 villages in a rural, coastal area of Southeast Bangladesh. We used an explanatory sequential mixed methods design which involved two phases between March 1, 2020, and May 31, 2020: first, we observed 258 outreach sessions of 86 EPI centers. We calculated the number of Expanded Program on Immunization (EPI) outreach sessions suspended and the number of children who missed their routine vaccination due to the COVID-19. We extrapolated the number of Bangladeshi children who missed their routine vaccination using Chakaria HDSS observations. Secondly, we conducted in-depth interviews to explain the quantitative results. The EPI outreach session (EOS) declined to 74.42% (95% CI 63.97-83.22), 10.45% (95% CI 5.00-18.94), and 3.45% (95% CI 1.00-9.75) from 2019 levels in March, April, and May 2020, respectively. By extrapolation, in Bangladesh, between March and May 2020, 3.2 million children missed their scheduled vaccination compared to 2019. Results from in-depth interviews showed that the unwillingness of villagers to hold EOS and the absenteeism of the vaccinators due to social distancing recommendations and lack of personal safety measures were the main reasons for the discontinuation of the EOS. Resuming EPI outreach sessions and introducing a special catch-up program is essential to prevent future outbreaks and deaths due to vaccine-preventable diseases in Bangladesh and the countries where children missed their routine vaccination due to COVID-19. This health system failure should be considered a factor in all future pandemic preparedness plans.

Anxiety and Insomnia Among Urban Slum Dwellers in Bangladesh: The Role of COVID-19 and Its Associated Factors.

Background: Although mental health is an important part of health and wellbeing, very little is known about the impact of the COVID-19 pandemic on the mental health of marginalized communities like urban slum dwellers. Our study estimated the prevalence of generalized anxiety disorder and insomnia among the residents of the informal settlements of Dhaka, Bangladesh, during the COVID-19 pandemic. Methods: A cross-sectional phone-based survey was conducted from October to November 2020 among adult residents of five informal settlements of Dhaka city randomly chosen from an existing Urban Health and Demographic Surveillance Systems (UHDSS) run by icddr,b. Data on Generalized Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI) were collected. A multinomial logistic regression was performed to assess the associated factors of anxiety and insomnia. Results: Of the total 586 participants, the prevalence of mild to severe anxiety and insomnia were 53% and 43%, respectively. As per the multinomial regression analysis, participants with mild anxiety were significantly more likely to be older (>50 years) and afraid of COVID-19 infection. Likewise, participants with moderate/severe anxiety were significantly more likely to share less household facilities (e.g., toilet, kitchen, water) (OR: 2.23; 95% CI: 1.31-3.79), to have difficulties in food availability (OR: 2.76; 95% CI: 1.10-6.93), to be afraid of self (OR: 5.27; 95% CI: 2.82-9.88), and to worry about the family members (OR: 2.26; 95% CI: 1.23-4.17) getting infected. Participants with mild insomnia were significantly more likely to share fewer household facilities and be afraid of being infected with COVID-19 infection. Moreover, participants with moderate/severe insomnia were significantly more likely to be female (OR: 1.90; 95% CI: 1.02-3.56), to receive food aid (OR: 0.50; 95% CI: 0.29-0.88), to be afraid of self (OR: 3.85; 95% CI: 1.81-8.19), and to worry about someone like friends or neighbors (OR: 2.45; 95% CI: 1.07-5.58) getting infected with COVID-19. Conclusions: We found elevated prevalence of both anxiety and insomnia among the urban poor of Bangladesh in the context of COVID-19. This indicates the importance of integrating mental health in the mitigation and recovery efforts related to similar crises for the urban poor in the future.

Insights Into Excess Mortality During the First Months of the COVID-19 Pandemic From a Rural, Demographic Surveillance Site in Bangladesh.

Background: Coronavirus disease 2019 (COVID-19) has spread globally, and the government of each affected country is publishing the number of deaths every day. This official figure is an underestimate as it excludes anybody who did not die in a hospital, who did not test positive, who had a false result, or those who recovered on their own without a test. Objective: This study aimed to measure the community level excess mortality using health and demographic surveillance in a rural area of Bangladesh. Method: The study was conducted in Matlab, in a rural area of Bangladesh, with a Health and Demographic Surveillance System (HDSS) covering a population of 239,030 individuals living in 54,823 households in 142 villages. We examined the mortality in January-April from 2015 to 2020 and compared the mortality in 2020 with the historical trend of 2015-2019. Between 2015 and 2020, we followed 276,868 people until migration or death, whichever occurred first. We analyzed mortality using crude mortality rate ratio (MRR) and adjusted MRR (aMRR) from a Cox proportional hazard model. Mortality was analyzed according to age, sex, and period. Results: During follow-up, 3,197 people died. The mortality rate per 1,000 person-years increased from 10 in 2019 to 12 in 2020. Excess mortality was observed among the elderly population (aged 65 years and above). The elderly mortality rate per 1,000 person-years increased from 80 in 2019 to 110 in 2020, and the aMRR was 1.40 (95% CI: 1.19-1.64). Although an increasing tendency in mortality was observed between 2015 and 2019, it was statistically insignificant. Conclusions: The study reported a 28% increase in excess deaths among the elderly population during the first months of the pandemic. This all-cause mortality estimation at the community level will urge policymakers, public health professionals, and researchers to further investigate the causes of death and the underlying reasons for excess deaths in the older age-group.

A place-based analysis of COVID-19 risk factors in Bangladesh urban slums: a secondary analysis of World Bank microdata.

BACKGROUND: There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities. METHODS: In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities. RESULTS: The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m2 per person up to 67.7 m2 per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities. CONCLUSION: The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.

Preserve Global South's research capacity

Preserve Global South's research capacity The coronavirus disease 2019 (COVID-19) pandemic is pushing the world into a humanitarian crisis that will have devastating, long-term consequences for development.