Genetic Analysis of Dengue Virus in Severe and Non-Severe Cases in Dhaka, Bangladesh, in 2018-2022.

Dengue virus (DENV) infections have unpredictable clinical outcomes, ranging from asymptomatic or minor febrile illness to severe and fatal disease. The severity of dengue infection is at least partly related to the replacement of circulating DENV serotypes and/or genotypes. To describe clinical profiles of patients and the viral sequence diversity corresponding to non-severe and severe cases, we collected patient samples from 2018 to 2022 at Evercare Hospital Dhaka, Bangladesh. Serotyping of 495 cases and sequencing of 179 cases showed that the dominant serotype of DENV shifted from DENV2 in 2017 and 2018 to DENV3 in 2019. DENV3 persisted as the only representative serotype until 2022. Co-circulation of clades B and C of the DENV2 cosmopolitan genotype in 2017 was replaced by circulation of clade C alone in 2018 with all clones disappearing thereafter. DENV3 genotype I was first detected in 2017 and was the only genotype in circulation until 2022. We observed a high incidence of severe cases in 2019 when the DENV3 genotype I became the only virus in circulation. Phylogenetic analysis revealed clusters of severe cases in several different subclades of DENV3 genotype I. Thus, these serotype and genotype changes in DENV may explain the large dengue outbreaks and increased severity of the disease in 2019.

Exploring mental health challenges and coping strategies in university students during the COVID-19 pandemic: A case study in Dhaka city, Bangladesh.

Background: Mental health challenges have emerged worldwide during the COVID-19 pandemic. University students experienced changes in their lifestyles, academic life, family relationships, earning capacity, and support systems. This study explores the common mental health challenges in university students and their coping strategies using social support in the first wave of lockdowns in Dhaka city in 2020. By learning from young people's impacts and coping responses, we can help build an improved strategy for future events of this magnitude. Methods: A qualitative study design was employed to conduct 20 in-depth interviews and two focus group discussions with students from purposively selected three public and three private universities in Dhaka city and five key informant interviews with different stakeholders. We used inductive reflexive thematic analysis and applied six phases of the thematic analysis. Codes retrieved from two differently prepared codebooks were merged and compared to identify themes for a fair interpretation of the underlying data. Data were manually indexed, summarized, and interpreted to categorize codes into sub-themes leading to themes. Results: Financial constraints, academic pressure, learning resources shortages, losing confidence, relationship breakup, excessive internet dependency, and traumatic experiences challenged the mental health conditions of the students unevenly across universities during the COVID-19 pandemic. Expressed mental health well-being impacts ranged from anxiety, stress, and depression to self-harm and suicidal ideation. Family bonding and social networking appeared as robust social support mechanisms to allow students to cope with anxiety, stress, and depression. Partial financial subsidies, soft loans to purchase electronic resources, faculty members' counseling, and sessional health counseling contributed to minimizing the mental health impacts of COVID-19. Conclusion: Mental health is still not a resourced area of health and well-being in Bangladesh. Concentration on developing strong social support and improving increased financial subsidies, including learning resources, can be effective in assisting students in coping with the common mental health burdens during pandemic periods. A national intervention plan should be immediately designed and implemented by engaging different stakeholders including healthcare professionals and establishing effective mental healthcare support centers at universities to avoid immediate and prolonged negative mental health impacts.

Challenges and Strategies in Conducting Population Health Research during the COVID-19 Pandemic: Experience from a Nationwide Mixed-Methods Study in Bangladesh.

Introduction: Globally, the coronavirus (COVID-19) pandemic poses fundamental challenges in everyday life. Various controlling measures, including nationwide lockdowns, movement restrictions, travel bans, social distancing, and improved hygiene practices, have been widely introduced to curtail transmission of the disease. Notably, these measures have affected the execution of population health research that typically involves face-to-face data collection. This paper details a subjective reflective account of the challenges and mitigating strategies in conducting a nationwide study during the COVID-19 pandemic in 2021. Challenges and strategies: The research team faced a wide range of challenges in conducting this study. The major categories of challenges were defined as follows: (i) challenges relating to the COVID-19 pandemic, such as insufficient access to field sites; (ii) challenges related to contextual factors, such as cultural and gender sensitivity and extreme weather events; and (iii) challenges related to data quality and validity. The key mitigating strategies to overcoming these challenges included engaging a local-level field supervisor, hiring data collectors from respective study sites, incorporating team members' reviews of literature and experts' views to develop research instruments, modifying original research instruments, organizing regular meetings and debriefing, adjusting field operation plans, building gender-sensitive teams, understanding local norms and adopting culturally appropriate dress codes, and conducting interviews in local languages. Conclusions: This paper concludes that despite several COVID-19-related challenges coupled with contextual factors, data were successfully collected through timely and successful adaptations of several mitigating strategies. The strategies adopted in this study may be useful for overcoming unforeseeable challenges in planning and conducting future population-based health research in similar circumstances elsewhere.

Coronavirus pandemic in the South Asia region: Health policy and economy trade-off.

Background: The South Asian Association for Regional Cooperation (SAARC) covers Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. We conducted a comparative analysis of the trade-off between the health policies for the prevention of COVID-19 spread and the impact of these policies on the economies and livelihoods of the South Asia populations. Methods: We analyzed COVID-19 data on epidemiology, public health and health policy, health system capacity, and macroeconomic indicators from January 2020 to March 2021 to determine temporal trends by conducting joinpoint regression analysis using average weekly percent change (AWPC). Results: Bangladesh had the highest statistically significant AWPC for new COVID-19 cases (17.0; 95% CI = 7.7-27.1, P < 0.001), followed by the Maldives (12.9; 95% CI = 5.3-21.0, P < 0.001) and India (10.0; 95% CI = 8.4-11.5, P < 0.001). The AWPC for COVID-19 deaths was significant for India (6.5; 95% CI = 4.3-8.9, P < 0.001) and Bangladesh (6.1; 95% CI = 3.7-8.5, P < 0.001). Nepal (55.79%), and India (34.91%) had the second- and third-highest increase in unemployment, while Afghanistan (6.83%) and Pakistan (16.83%) had the lowest. The rate of change of real GDP had the highest decrease for Maldives (557.51%), and India (297.03%); Pakistan (46.46%) and Bangladesh (70.80%), however, had the lowest decrease. The government response stringency index for Pakistan had a see-saw pattern with a sharp decline followed by an increase in the government health policy restrictions that approximated the test-positivity trend. Conclusions: Unlike developed economies, the South Asian developing countries experienced a trade-off between health policy and their economies during the COVID-19 pandemic. South Asian countries (Nepal and India), with extended periods of lockdowns and a mismatch between temporal trends of government response stringency index and the test-positivity or disease incidence, had higher adverse economic effects, unemployment, and burden of COVID-19. Pakistan demonstrated targeted lockdowns with a rapid see-saw pattern of government health policy response that approximated the test-positivity trend and resulted in lesser adverse economic effects, unemployment, and burden of COVID-19.

Geographical variations of food insecurity and its associated factors in Bangladesh: Evidence from pooled data of seven cross-sectional surveys.

Food insecurity has multiple negative effects on maternal and child health and nutritional outcomes. There is a dearth of up-to-date evidence on the prevalence of food insecurity in Bangladesh based on geographical variations. We investigated the prevalence of food insecurity based on geographical variations and its associated factors. We pooled data from seven cross-sectional surveys conducted in 15,009 households from March 2015 to May 2018. This study was a part of the evaluation of the Maternal Infant Young Child Nutrition Phase 2 programme implemented by BRAC, one of the largest international non-governmental organizations located in Bangladesh that covered rural areas in 26 districts and two urban slums in Dhaka, Bangladesh. We used Household Food Insecurity Access Scale (a widely used scale to measure household food insecurity) to estimate the food insecurity status from the data collected through a face-to-face interview using a structured questionnaire. Hot spot analysis was conducted using the Getis-Ord Gi* statistic. The multiple logistic regression model was applied to explore the associated factors of food insecurity. The food insecurity hotspots were in the northwestern, central-southwestern, and coastal districts of Bangladesh. The overall prevalence of mild, moderate, and severe food insecurity were 12.7%, 13.8%, and 3.5%, respectively. In the adjusted model, household heads and caregivers of children with five or more years of schooling had respectively 42% (adjusted odds ratio (AOR): 0.58, 95% confidence interval (CI): 0.52, 0.64) and 46% (AOR: 0.54; 95% CI: 0.49, 0.61) less likelihood to suffer from food insecurity. Households in the middle (AOR: 0.58, 95% CI: 0.52, 0.65) and rich (AOR: 0.32, 95% CI: 0.28, 0.36) wealth status had lower odds of food insecurity. Food insecurity is widely spread in rural districts of Bangladesh and the degree of vulnerability is higher among the households of the northwestern, central-southwestern, and coastal areas of Bangladesh. Comprehensive interventions including strategies for poverty reduction and education for all might be effective to reduce food insecurity at rural households in Bangladesh.

Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh.

BACKGROUND: Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions. METHODS: This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers. RESULTS: A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity. CONCLUSIONS: Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.

Modifiable and nonmodifiable factors associated with anxiety, depression, and stress after one year of the COVID-19 pandemic.

BACKGROUND: People worldwide have experienced various mental health issues during the COVID-19 pandemic. This study investigates the modifiable and nonmodifiable predictors of anxiety, depression, and stress among Bangladeshi participants after one year of the pandemic. METHOD: A large group of adult participants (N = 1897), recruited from eight administrative divisions in Bangladesh, completed an online survey in May and June 2021 when the Movement Control Order was in place. We used the Beck Anxiety Inventory, Patient Health Questionnaire-9, and Perceived Stress Scale-4 to assess the participants' anxiety, depression, and stress. We also gave the Mindful Attention Awareness Scale and Life-Orientation Test-Revised to assess mindfulness and optimism. RESULTS: The results revealed that the prevalence rates for anxiety and depression were 62.5% and 45.3%, respectively. Multivariate analyses showed that several nonmodifiable factors, such as those who were students, unmarried and females, and those living in the Northern region (Rajshahi and Mymensingh division) and dwelling in the rural areas, suffered from worse mental health (accounted for 5%-23% of the variances in the mental health outcome scores). Modifiable factors accounted for an additional 10%-25% of the variances in the same outcome variables. Adults with higher mindfulness and optimism, living in the country's Southern region (Chattogram division) and those who took both vaccine doses and had no history of mental illness reported better mental health. CONCLUSION: Anxiety, depression, and stress remained high in Bangladeshi adults after one year of the pandemic. The community-based interventions should aim to increase the mindfulness and optimism levels among the sufferers. More accelerated vaccination programs across the country could protect people from suffering from overall mental distress.

Antibody response to different COVID-19 vaccines among the migrant workers of Bangladesh.

Background: Due to the ongoing COVID-19 pandemic, various host countries such as Singapore, imposed entry requirements for migrant workers including pre-departure COVID-19 seroconversion proof. To combat COVID-19 worldwide, several vaccines have acquired conditional approval. This study sought to assess antibody levels after immunization with different COVID-19 vaccines among the migrant workers of Bangladesh. Methods: Venous blood samples were collected from migrant workers who were vaccinated with different COVID-19 vaccines (n=675). Antibodies to SARS-CoV-2 spike protein (S) and nucleocapsid protein (N) were determined using Roche Elecsys® Anti-SARS-CoV-2 S and N immunoassay, respectively. Results: All participants receiving COVID-19 vaccines showed antibodies to S-protein, while 91.36% were positive for N-specific antibodies. The highest anti-S antibody titers were found among the workers who completed booster doses (13327 U/mL), received mRNA vaccines Moderna/Spikevax (9459 U/mL) or Pfizer-BioNTech/Comirnaty (9181 U/mL), and reported SARS-CoV-2 infection in the last six months (8849 U/mL). The median anti-S antibody titers in the first month since the last vaccination was 8184 U/mL, which declined to 5094 U/mL at the end of six months. A strong correlation of anti-S antibodies was found with past SARS-CoV-2 infection (p < 0.001) and the type of vaccines received (p <0.001) in the workers.Conclusion: Bangladeshi migrant workers receiving booster doses of vaccine, vaccinated with mRNA vaccines, and having past SARS-CoV-2 infection, mounted higher antibody responses. However, antibody levels waned with time. These findings suggest a need for further booster doses, preferably with mRNA vaccines for migrant workers before reaching host countries.

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.

Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare): an updated study protocol for a parallel arm cluster randomised controlled trial.

The "Diabetes: Community-led Awareness, Response and Evaluation" (D:Clare) trial aims to scale up and replicate an evidence-based participatory learning and action cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control.The trial was originally designed as a stepped-wedge cluster randomised controlled trial, with the interventions running from March 2020 to September 2022. Twelve clusters were randomly allocated (1:1) to implement the intervention at months 1 or 12 in two steps, and evaluated through three cross-sectional surveys at months 1, 12 and 24. However, due to the COVID-19 pandemic, we suspended project activities on the 20th of March 2020. As a result of the changed risk landscape and the delays introduced by the COVID-19 pandemic, we changed from the stepped-wedge design to a wait-list parallel arm cluster RCT (cRCT) with baseline data. We had four key reasons for eventually agreeing to change designs: equipoise, temporal bias in exposure and outcomes, loss of power and time and funding considerations.Trial registration ISRCTN42219712 . Registered on 31 October 2019.

Real-time sewage surveillance for SARS-CoV-2 in Dhaka, Bangladesh versus clinical COVID-19 surveillance: a longitudinal environmental surveillance study (December, 2019-December, 2021).

BACKGROUND: Clinical surveillance for COVID-19 has typically been challenging in low-income and middle-income settings. From December, 2019, to December, 2021, we implemented environmental surveillance in a converging informal sewage network in Dhaka, Bangladesh, to investigate SARS-CoV-2 transmission across different income levels of the city compared with clinical surveillance. METHODS: All sewage lines were mapped, and sites were selected with estimated catchment populations of more than 1000 individuals. We analysed 2073 sewage samples, collected weekly from 37 sites, and 648 days of case data from eight wards with varying socioeconomic statuses. We assessed the correlations between the viral load in sewage samples and clinical cases. FINDINGS: SARS-CoV-2 was consistently detected across all wards (low, middle, and high income) despite large differences in reported clinical cases and periods of no cases. The majority of COVID-19 cases (26 256 [55·1%] of 47 683) were reported from Ward 19, a high-income area with high levels of clinical testing (123 times the number of tests per 100 000 individuals compared with Ward 9 [middle-income] in November, 2020, and 70 times the number of tests per 100 000 individuals compared with Ward 5 [low-income] in November, 2021), despite containing only 19·4% of the study population (142 413 of 734 755 individuals). Conversely, a similar quantity of SARS-CoV-2 was detected in sewage across different income levels (median difference in high-income vs low-income areas: 0·23 log10 viral copies + 1). The correlation between the mean sewage viral load (log10 viral copies + 1) and the log10 clinical cases increased with time (r = 0·90 in July-December, 2021 and r=0·59 in July-December, 2020). Before major waves of infection, viral load quantity in sewage samples increased 1-2 weeks before the clinical cases. INTERPRETATION: This study demonstrates the utility and importance of environmental surveillance for SARS-CoV-2 in a lower-middle-income country. We show that environmental surveillance provides an early warning of increases in transmission and reveals evidence of persistent circulation in poorer areas where access to clinical testing is limited. FUNDING: Bill & Melinda Gates Foundation.

Knowledge, attitudes and practices of COVID-19 in rural Bangladesh: a cross-sectional study.

OBJECTIVES: Understanding the knowledge, attitudes and practices (KAP) of COVID-19 within distinct populations may aid further public health messaging. This study's aims were to explore KAP towards COVID-19 in rural Bangladesh and identify any potential links to sociodemographics, existing clinical conditions and sources of information. DESIGN: Cross-sectional community-based study. SETTING: Participants were recruited from 18 villages using multistage cluster random sampling. METHODS: Data were collected through face-to-face interviews, from June to November 2021, using a structured questionnaire. Data included sociodemographics, clinical conditions, sources of information and KAP of COVID-19 questions. Χ2 test, multiple logistic regression and correlation analyses were performed. RESULTS: A total of 1603 participants were included with mean ages of 42.3±14.2 years, ranging from 18 to 60 years. Of these, 51% were male, 42.2% had secondary education and 45% had comorbidities. Television was the main source of COVID-19 information (55.8%). The overall correct response rate of KAP questions was 90%, 78% and 59%, respectively. In stepwise multiple logistic regression, good knowledge was associated with higher education (adjusted OR (AOR): 4.61, 95% CI: 2.40 to 8.85, p<0.001), employment, high body mass index (overweight and obese) and trust in the sources of information. Being female (AOR: 1.48, 95% CI: 1.19 to 1.85, p<0.001), having depression (AOR: 1.80, 95% CI: 1.34 to 2.43, p<0.001), being a past smoker and sources of information (family members/friends/relatives/neighbours) were associated with positive attitudes. Good practices were associated with older age (AOR: 1.52, 95% CI: 1.10 to 2.11, p=0.01), higher education (AOR: 2.78, 95% CI: 1.58 to 4.89, p<0.001) and having anxiety, while current smokers and fully vaccinated people were less likely to be engaged in good practices. Positive significant correlations between domains of KAP were observed as well as between past vaccination KAP and COVID-19 KAP. CONCLUSION: This study uncovered gaps in understanding and practices, and identified targeted intervention especially for young and less educated people using mass media to promote updated knowledge regarding COVID-19 and the efficacy of preventive practices.

SARS-CoV-2 infection alters the gut microbiome in diabetes patients: A cross-sectional study from Bangladesh.

Populations of different South Asian nations including Bangladesh reportedly have a high risk of developing diabetes in recent years. This study aimed to investigate the differences in the gut microbiome of COVID-19-positive participants with or without type 2 diabetes mellitus (T2DM) compared with healthy control subjects. Microbiome data of 30 participants with T2DM were compared with 22 age-, sex-, and body mass index (BMI)-matched individuals. Clinical features were recorded while fecal samples were collected aseptically from the participants. Amplicon-based (16S rRNA) metagenome analyses were employed to explore the dysbiosis of gut microbiota and its correlation with genomic and functional features in COVID-19 patients with or without T2DM. Comparing the detected bacterial genera across the sample groups, 98 unique genera were identified, of which 9 genera had unique association with COVID-19 T2DM patients. Among different bacterial groups, Shigella (25%), Bacteroides (23.45%), and Megamonas (15.90%) had higher mean relative abundances in COVID-19 patients with T2DM. An elevated gut microbiota dysbiosis in T2DM patients with COVID-19 was observed while some metabolic functional changes correlated with bidirectional microbiome dysbiosis between diabetes and non-diabetes humans gut were also found. These results further highlight the possible association of COVID-19 infection that might be linked with alteration of gut microbiome among T2DM patients.

Evidence of mental health-related morbidities and its association with socio-economic status among previously hospitalized patients with symptoms of COVID-19 in Bangladesh.

Introduction: The long-term impact of COVID-19 on mental health, particularly in relation to socio-economic vulnerabilities, has received little attention. This study reports the prevalence of mental health-related symptoms among previously hospitalized patients after recovery from COVID-19, and its association with socio-economic status (SES). Methods: Data collection of this cross-sectional study was conducted during February-April 2021, among previously hospitalized patients with COVID-19 like symptoms, on average six months after their discharge from the hospital. Using DASS-21, a validated scale to document symptoms of depression, anxiety, and stress, information on mental health-related symptoms were recorded from 481 respondents along with sociodemographic and economic information through telephone interviews. Chi-square tests were performed to identify significant group differences. Multinomial logistic regression analyzed the association between the changes in socioeconomic characteristics and mental health-related symptoms. Relative index of inequality (RII), slope index of inequality (SII), and concentration index (CIX) were applied to capture relevant inequalities in relation to mental health-related symptoms. Results: Eleven percent of the respondents reported changes in employment status, nearly half changes in income and expenditure. Forty-five percent reported symptoms of depression, anxiety and/or stress, and 12% reported coexistence of all three symptoms. Women [Adjusted Odds Ratio, AOR: 2.95; 95% Confidence Interval, CI: 1.39-5.68], and those who reported changes in occupation [AOR: 3.04; 95% CI: 1.01-9.08] and expenditure [AOR: 2.46; 95% CI: 1.12-5.37] were more likely to report all three mental health-related symptoms compared to men and those without changes in occupation and expenditure. The older age group was less likely [AOR: 0.96; 95%CI: 0.93-0.99] to report coexistence of all three symptoms compared to their younger counterparts. Negative values of concentration index (CIX) indicate that any one mental health-related symptom was significantly concentrated among those with lower expenditure and poor SES. Conclusion: This study will help in addressing mental health-related challenges after recovery from COVID-19 among the identified vulnerable groups through relevant community-based and clinical response, including counseling services, in Bangladesh and similar LMIC contexts.

Sleep duration during the COVID-19 pandemic in Bangladesh: A GIS-based large sample survey study.

Although several studies have been conducted in Bangladesh regarding sleep problems during the COVID-19 pandemic, none have utilized a large nationwide sample or presented their findings based on nationwide geographical distribution. Therefore, the aim of the present study was to explore the total sleep duration, night-time sleep, and daily naptime and their associated factors as well as geographic information system (GIS) distribution. A cross-sectional survey was carried out among 9730 people in April 2020, including questions relating to socio-demographic variables, behavioral and health factors, lockdown, depression, suicidal ideation, night sleep duration, and naptime duration. Descriptive and inferential statistics, both linear and multivariate regression, and spatial distribution were performed using Microsoft Excel, SPSS, Stata, and ArcGIS software. The results indicated that 64.7% reported sleeping 7-9 h a night, while 29.6% slept less than 7 h nightly, and 5.7% slept more than 9 h nightly. 43.7% reported 30-60 min of daily nap duration, whereas 20.9% napped for more than 1 h daily. Significant predictors of total daily sleep duration were being aged 18-25 years, being unemployed, being married, self-isolating 4 days or more, economic hardship, and depression. For nap duration, being aged 18-25 years, retired, a smoker, and a social media user were at relatively higher risk. The GIS distribution showed that regional division areas with high COVID-19 exposure had higher rates of non-normal sleep duration. Sleep duration showed a regional heterogeneity across the regional divisions of the country that exhibited significant associations with a multitude of socioeconomic and health factors.

An Assessment of a Rapid SARS-CoV-2 Antigen Test in Bangladesh.

Early detection of SARS-CoV-2 infection is crucial to prevent its spread. This study aimed to document test sensitivity/specificity, correlation with cycle threshold value from polymerase chain reaction (PCR), fitness-for-use in different populations and settings, and user perspectives that could inform large-scale implementation. In this study, we evaluated the performance of a rapid antigen detection test, BD Veritor, and compared this (and another rapid test, Standard Q) against reverse transcription PCR (RT-PCR) in terms of sensitivity and specificity in 130 symptomatic and 130 asymptomatic adults. In addition, we evaluated the suitability and ease of use of the BD Veritor test in a subsample of study participants (n = 42) and implementers (n = 5). At 95% confidence interval, the sensitivity of the BD Veritor and Standard Q test were 70% and 63% in symptomatic and 87% and 73% in asymptomatic individuals, respectively, regarding positive SARS-CoV-2 RT-PCR results. Overall, the BD Veritor test was 78% sensitive and 99.5% specific compared with RT-PCR irrespective of the cycle threshold. This warrants large field evaluation as well as use of the rapid antigen test for quick assessment of SARS-CoV-2 for containment of epidemics in the country.

Correlation of antigen-specific immune response with disease severity among COVID-19 patients in Bangladesh.

Coronavirus disease 2019 (COVID-19) is a protean disease causing different degrees of clinical severity including fatality. In addition to humoral immunity, antigen-specific T cells may play a critical role in defining the protective immune response against SARS-CoV-2, the virus that causes this disease. As a part of a longitudinal cohort study in Bangladesh to investigate B and T cell-specific immune responses, we sought to evaluate the activation-induced marker (AIM) and the status of different immune cell subsets during a COVID-19 infection. We analyzed a total of 115 participants, which included participants with asymptomatic, mild, moderate, and severe clinical symptoms. We observed decreased mucosal-associated invariant T (MAIT) cell frequency on the initial days of the COVID-19 infection in symptomatic patients compared to asymptomatic patients. However, natural killer (NK) cells were found to be elevated in symptomatic patients just after the onset of the disease compared to both asymptomatic patients and healthy individuals. Moreover, we found a significant increase of AIM+ (both OX40+CD137+ and OX40+CD40L+) CD4+ T cells in moderate and severe COVID-19 patients in response to SARS-CoV-2 peptides (especially spike peptides) compared to pre-pandemic controls who are unexposed to SARS-CoV-2. Notably, we did not observe any significant difference in the CD8+ AIMs (CD137+CD69+), which indicates the exhaustion of CD8+ T cells during a COVID-19 infection. These findings suggest that patients who recovered from moderate and severe COVID-19 were able to mount a strong CD4+ T-cell response against shared viral determinants that ultimately induced T cells to mount further immune responses to SARS-CoV-2.

Sociodemographic, economic, physical, and mental health status of previously hospitalised patients with COVID-19 symptoms in Bangladesh: Protocol for a mixed-method study.

Introduction: Not much is known about the long-term consequences of COVID-19, popularly known as long COVID. This is particularly so in terms of patterns and clusters of symptoms over time, sociodemographic and economic characteristics of patients, and related clinical history. This is crucial for resource-constrained health systems such as Bangladesh to address long COVID as a forthcoming challenge. This protocol aims to investigate the consequences of COVID-19 over time for physical and mental health and how these are associated with demographic and socio-economic factors. Methods and analysis: This mixed-method study collected information on all patients with symptoms of COVID-19 admitted to and discharged after recovery from a COVID-19-dedicated hospital in Bangladesh (N = 942), from April to December 2020. The sources of data were admission records and discharge certificates from the hospital for clinical history, cross-sectional survey on physical and mental health (assessed by DASS21 scale)-related symptoms and socioeconomic changes after recovery, and qualitative in-depth interviews on experiences of COVID-19. Interviews were conducted over the phone. Quantitative analysis was done to estimate the prevalence of physical and mental health consequences of COVID-19 after recovery and the association with socio-economic and demographic information. The qualitative analysis was performed using a thematic analysis approach. Discussion: It is imperative to understand the post-COVID consequences and related health and non-health aspects to inform evidence-based policymaking, especially for resource-poor contexts such as Bangladesh. Given the dearth of evidence in this regard, the proposed study will contribute to bridging this knowledge gap. It is important to note that this study is one of the few which presents information on post-COVID-19 consequences in the context of low- and middle-income countries and the first in Bangladesh.

Outbreak of diarrheal diseases causes mortality in different geographical locations of Bangladesh during the 2021 COVID-19 era.

Objectives: Diarrhea is a major public health problem in low- and middle-income countries, including Bangladesh. Of the different spectrums of diarrheal diseases, cholera occurs every year, causing outbreaks and epidemics following a biannual seasonal pattern. Due to the COVID-19 pandemic, hospitalization for diarrheal diseases decreased in 2020 compared to the previous years. However, in 2021, massive outbreaks occurred in different geographical locations of the country. We described that an outbreak of diarrheal diseases causes mortality in different geographical locations in Bangladesh. Method: In this study, we present a report of diarrhea outbreaks that were reported in 2018-2021 in different parts of Bangladesh, and data have been captured from different sources such as print and electronic media as well as from a nationwide surveillance system. Results: Among these locations, districts of Barisal Division, Kishorganj, Noakhali, Gopalganj, Bandarban, and Chattogram were the major hotspots of the outbreaks where high morbidity due to acute watery diarrhea and even mortality, which is usually low in Bangladesh, were recorded. Conclusion: Early detection and prevention and strengthening of the surveillance system are needed to combat the diarrheal upsurge, take immediate control, and adopt preventive strategies.