A review of the applicability of Environmental Management Systems in waste management in the medical sector of Zimbabwe.

Environmental Management Systems (EMS) are currently the cornerstone of achieving sustainability globally. Nevertheless, the question is applicability of EMS in the medical sector. Hence, the review focused on applicability of EMS in medical waste management Zimbabwe. EMS involves overall processes that facilitate reduction of dire impacts of company's activities while increasing performance. EMS framework consists of environmental policy, planning, implementation, checking, review and improvement stages. To examine applicability of EMS in management of medical sector waste, published secondary sources with information related to the topic were utilised. Analysis of strengths and opportunities of EMS was used as a base to examine its applicability in medical waste management. Zimbabwean medical sector consist of hospitals and primary healthcare facilities. Medical waste includes pathological, pharmaceutical, cytotoxic, radioactive, chemical, sharp, infectious and general waste. However, twenty-first century witnessed expansion of medical institutions to accommodate COVID-19 patients, resulting in generation of construction and demotion waste. Medical institutions in Zimbabwe are accountable for solid waste management at generation source although municipalities are responsible for conveying solid waste to landfills. Solid waste from medical sector is disposed through traditional strategies namely landfilling, incineration, open pits and open burning, resulting in water, air, and soil contamination. However, EMS can reduce quantity of solid waste disposed through waste reuse, recycle and recovery. Moreover, achievement of integrated approach, effective legislation, policies and inclusive participation in medical waste management is adopted through use of EMS. Therefore, EMS were utilised to develop an integrated sustainable medical waste management model to achieve sustainability.

Environmental risk caused by drug waste in the city of Rio de Janeiro, Brazil, during the SARS-Cov19 pandemic. / Risco ambiental provocado por resíduos de medicamentos na cidade do Rio de Janeiro, Brasil, durante a pandemia por SARS-Cov19.

The relationship between the distribution of medicines used in the Pandemic by SARS-COV-19 in the municipality of Rio de Janeiro and the estimated level of environmental risk caused by their residues was evaluated. The amount of medicines distributed by primary health care (PHC) units between 2019 and 2021 were collected. The risk quotient (RQ) corresponded to the ratio between the estimated predictive environmental concentration (PECest) obtained by the consumption and excretion of each drug and its non-effective predictive concentration (PNEC). Between 2019 and 2020, the PECest of azithromycin (AZI) and ivermectin (IVE) increased between 2019 and 2020, with a decrease in 2021 probably due to shortages. Dexchlorpheniramine (DEX) and fluoxetine (FLU) fell, returning to growth in 2021. While the PECest of diazepam (DIA) increased over these 3 years, ethinylestradiol (EE2) decreased possibly due to the prioritization of PHC in the treatment of COVID-19. The largest QR were from FLU, EE2 and AZI. The consumption pattern of these drugs did not reflect their environmental risk because the most consumed ones have low toxicity. It is worth noting that some data may be underestimated due to the incentive given during the pandemic to the consumption of certain groups of drugs.

Foi avaliada a relação entre a distribuição de medicamentos usados na pandemia por SARS-COV-19 no município do Rio de Janeiro e o nível de risco ambiental estimado provocado por seus resíduos. Foi coletada a quantidade de medicamentos distribuídos pelas unidades de atenção primária à saúde (APS) entre 2019 e 2021. O quociente de risco (QR) correspondeu à razão entre a concentração ambiental preditiva estimada (PECest), obtida pelo consumo e excreção de cada fármaco, e a sua concentração preditiva não efetiva (PNEC). Os PECest da azitromicina e da ivermectina aumentaram entre 2019 e 2020, tendo uma queda em 2021 provavelmente devido ao desabastecimento. Já o da dexclorfeniramina (DEX) e da fluoxetina (FLU) tiveram uma queda, retornando o crescimento em 2021. Enquanto o PECest do diazepam (DIA) aumentou ao longo desses três anos, o etinilestradiol (EE2) diminuiu, possivelmente pela priorização da APS no tratamento da COVID-19. Os maiores QR foram de FLU, EE2 e AZI. O padrão de consumo desses medicamentos não refletiu seu risco ambiental, pois os mais consumidos possuem baixa toxicidade. Vale destacar que alguns dados podem estar subestimados devido ao incentivo que foi dado durante a pandemia para o consumo de determinados grupos de fármacos.

Circular economy of medical waste: novel intelligent medical waste management framework based on extension linear Diophantine fuzzy FDOSM and neural network approach.

Environmental pollution has been a major concern for researchers and policymakers. A number of studies have been conducted to enquire the causes of environmental pollution which suggested numerous policies and techniques as remedial measures. One such major source of environmental pollution, as reported by previous studies, has been the garbage resulting from disposed hospital wastes. The recent outbreak of the COVID-19 pandemic has resulted into mass generation of medical waste which seems to have further deteriorated the issue of environmental pollution. This necessitates active attention from both the researchers and policymakers for effective management of medical waste to prevent the harm to environment and human health. The issue of medical waste management is more important for countries lacking sophisticated medical infrastructure. Accordingly, the purpose of this study is to propose a novel application for identification and classification of 10 hospitals in Iraq which generated more medical waste during the COVID-19 pandemic than others in order to address the issue more effectively. We used the Multi-Criteria Decision Making (MCDM) method to this end. We integrated MCDM with other techniques including the Analytic Hierarchy Process (AHP), linear Diophantine fuzzy set decision by opinion score method (LDFN-FDOSM), and Artificial Neural Network (ANN) analysis to generate more robust results. We classified medical waste into five categories, i.e., general waste, sharp waste, pharmaceutical waste, infectious waste, and pathological waste. We consulted 313 experts to help in identifying the best and the worst medical waste management technique within the perspectives of circular economy using the neural network approach. The findings revealed that incineration technique, microwave technique, pyrolysis technique, autoclave chemical technique, vaporized hydrogen peroxide, dry heat, ozone, and ultraviolet light were the most effective methods to dispose of medical waste during the pandemic. Additionally, ozone was identified as the most suitable technique among all to serve the purpose of circular economy of medical waste. We conclude by discussing the practical implications to guide governments and policy makers to benefit from the circular economy of medical waste to turn pollutant hospitals into sustainable ones.

Determinants of proper disposal of single-use masks: knowledge, perception, behavior, and intervention measures.

Background: Although many studies testify to consumer behavior's role in the context of waste-related sustainability objectives, little research examined what people know, think, and feel about the environmental impacts of their personal protective equipment (PPE) or their behavior towards them, in general. Therefore, the present article complements existing information about the public perceptions, knowledge, and behavior of single-use masks in a context where the pandemic has put increasing pressure on waste management public services. From February to June 2020, municipal solid waste increased ten times in Romania. The study identified the factors that predicted the proper disposal of single-use masks and the measures preferred to prevent or minimize the negative impact of single-use mask waste. Method: Data from a representative sample of 705 Romanians were collected using a structured questionnaire. The data were analyzed with SPSS and SmartPLS. The Cochran's Q test was run to determine the existence of differences between percentages of people who preferred various measures. Dunn's test with a Bonferroni correction was used to identify the exact pair of groups where the differences were located. The study utilized structural equation models (SEM) based on at least partial squares with SmartPLS software (3.2.8) to investigate causal links between constructs. The model considered that the dependent variable (environmentally friendly behavior: proper disposal of single-use masks) could be influenced by the knowledge, perception, behavior, and demographics variables. Results: The findings indicated that knowledge of the type of material of single-use masks had a direct positive (ß = 0.173) and significant effect on their proper disposal. The perception of mask waste impact has a negative and significant (ß = -0.153, p < 0.001) impact on the proper disposal of single-use masks. This path coefficient illustrates that the worse the perceived impact of single-use masks on waste management activity, the higher the proper disposal of single-use masks. Gender has a positive (ß = 0.115) and significant (p < 0.001) effect on the proper disposal of single-use masks. Conclusions: It was concluded that the 5Rs waste management approach should be reconsidered for single-use mask waste. For example, "Reuse" and the classic "Recycle" have limited applications since they may lead to virus transmission and possible infection. "Reducing" the use of single-use masks could have repercussions on one's health. Summing up, the study outlined recommendations for effective interventions for the proper disposal of single-use masks from the perspective of behavioral studies.

Prevalence of SARS-CoV-2 infection among urban cleaning and solid waste management workers during transmission of the Omicron variant in Brazil.

This study estimated the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in urban cleaning and solid waste management workers during the transmission of the Omicron variant in one of the poorest regions of Brazil (the state of Sergipe). Nasopharyngeal swabs were collected from 494 workers, and the presence of SARS-CoV-2 RNA was tested by quantitative reverse-transcriptase polymerase chain reaction. Data on socio-demographic characteristics, comorbidities, vaccination status, mask use, and use of public transport to commute to the workplace were collected. The prevalence with a 95% confidence interval (CI) was calculated from the proportion of SARS-CoV-2 positive cases among the total number of individuals tested. The prevalence ratio (PR) with a 95% CI was the measure of association used to evaluate the relationship between SARS-CoV-2 infection and the exposure variables. The prevalence of SARS-CoV-2 infection was 22.5% (95% CI, 19.0 to 26.4). Individuals under the age of 40 had a higher prevalence of infection (PR, 1.53; 95% CI, 1.03 to 2.30) as well as those who did not believe in the protective effect of vaccines (PR, 1.78; 95% CI, 1.05 to 2.89). Our results indicate the need for better guidance on preventive measures against coronavirus disease 2019 among urban cleaning and solid waste management workers.

The Impact of COVID-19 on Waste Infrastructure: Lessons Learned and Opportunities for a Sustainable Future.

The onset of the COVID-19 pandemic posed many global challenges, mainly in the healthcare sector; however, the impacts on other vital sectors cannot be overlooked. The waste sector was one of the significantly impacted sectors during the pandemic, as it dramatically changed the dynamics of waste generation. Inadequate waste management practices during COVID-19 shed light on the opportunities for developing systematic, sustainable, and resilient waste infrastructure in the future. This study aimed to exploit the learnings of COVID-19 to identify any potential opportunities in post-pandemic waste infrastructure. A comprehensive review on existing case studies was conducted to understand the waste generation dynamics and the waste management strategies during COVID-19. Infectious medical waste from healthcare facilities had the largest influx of waste compared with non-medical waste from residential and other sectors. This study then identified five key opportunities from a long-term operational perspective: considering healthcare waste sector as a critical area of focus; encouraging the integration and decentralization of waste management facilities; developing systematic and novel approaches and tools for quantifying waste; shifting towards a circular economy approach; and modernizing policies to improve the effectiveness of the post-pandemic waste management infrastructure.

Quantitative analysis of healthcare waste generation and composition in Antalya, Turkey.

Health-care waste (HCW) may pose a risk to human health and the environment because of its infectious and/or toxic properties. This study was conducted to evaluate the quantity and composition of all the HCW generated by different producers in Antalya, Turkey, using data obtained from two online systems. Accordingly, this study explored the trends in healthcare waste generation (HCWG) between 2010 and 2020 and the impact of COVID-19 on HCWG by comparing the post- and pre-COVID-19 patterns based on the data obtained from 2,029 different producers. The collected data were based on the waste codes reported by the European Commission, were characterised based on the definition of the World Health Organization, and were further analysed according to the healthcare types defined by the Turkish Ministry of Health to characterize HCW. The findings indicate that the main HCW contributor was infectious waste (94.62 %), most of which was generated by hospitals (80 %). This is due to the inclusion of only HCW fractions in this study and to the definition of infectious waste considered. This study indicates that the categorisation into the type of HCSs may be a good option to assess the increase of HCW quantities, in accordance with the service type, size, and the effects of COVID-19. The correlation results for hospitals offering primary HCS revealed a strong relationship between the HCWG rate and the population per year. This approach may help estimate future trends to promote better HCW management practices for the specific cases considered, and it can even be applied to other cities.

Current status of industrialized aquaculture in China: a review.

Industrialized aquaculture is an essential trend for aquaculture development in China, owing to its considerable advantages in lower water consumption, higher productivity, and sustainability. However, information on its current status has been scarce up to now. This paper reviewed the current status and has identified existing problems as well as proposing possible solutions for the development of industrialized aquaculture in China. This field is still at an early stage of development and is mainly distributed in coastal regions. Major constraints on industrialized aquaculture include high capital and operational costs, the uncompetitive market price of aquatic products, uneven distribution of production and farming areas, a lack of suitably experienced managers and operators for recirculating aquaculture systems, and the coronavirus disease 2019 (COVID-19) pandemic. Possible solutions to these problems include technological innovations in systems optimization, the use of renewable energy sources and biofloc technology, the pollution-free certification of industrial aquaculture products, increased numbers of professionals in water quality control and waste management, and the financial assistance to companies and farmers along the aquaculture industrial chain.

Healthcare waste in Bangladesh: Current status, the impact of Covid-19 and sustainable management with life cycle and circular economy framework.

COVID-19 has accelerated the generation of healthcare (medical) waste throughout the world. Developing countries are the most affected by this hazardous and toxic medical waste due to poor management systems. In recent years, Bangladesh has experienced increasing medical waste generation with estimated growth of 3 % per year. The existing healthcare waste management in Bangladesh is far behind the sustainable waste management concept. To achieve an effective waste management structure, Bangladesh has to implement life cycle assessment (LCA) and circular economy (CE) concepts in this area. However, inadequate data and insufficient research in this field are the primary barriers to the establishment of an efficient medical waste management systen in Bangladesh. This study is introduced as a guidebook containing a comprehensive overview of the medical waste generation scenario, management techniques, Covid-19 impact from treatment to testing and vaccination, and the circular economy concept for sustainable waste management in Bangladesh. The estimated generation of medical waste in Bangladesh without considering the surge due to Covid-19 and other unusual medical emergencies would be approximately 50,000 tons (1.25 kg/bed/day) in 2025, out of which 12,435 tons were predicted to be hazardous waste. However, our calculation estimated that a total of 82,553, 168.4, and 2300 tons of medical waste was generated only from handling of Covid patients, test kits, and vaccination from March 2021 to May 2022. Applicability of existing guidelines, and legislation to handle the current situation and feasibility of LCA on medical waste management system to minimize environmental impact were scrutinized. Incineration with energy recovery and microwave sterilization were found to be the best treatment techniques with minimal environmental impact. A circular economy model with the concept of waste minimizaton, and value recovery was proposed for sustainable medical waste management. This study suggests proper training on healthcare waste management, proposing strict regulations, structured research allocation, and implementation of public-private partnerships to reduce, and control medical waste generation for creating a sustainable medical waste management system in Bangladesh.

Drivers of Solid Waste Segregation and Recycling in Kampala Slums, Uganda: A Qualitative Exploration Using the Behavior Centered Design Model.

Solid-waste management is a challenge in many cities, especially in low-income countries, including Uganda. Simple and inexpensive strategies such as solid-waste segregation and recycling have the potential to reduce risks associated with indiscriminate waste management. Unfortunately, these strategies have not been studied and adopted in slums in low-income countries. This cross-sectional qualitative study, therefore, used the behavioral-centered design model to understand the drivers of recycling in Kampala slums. Data were coded using ATLAS ti version 7.0, and content analysis was used for interpreting the findings. Our findings revealed that the study practices were not yet habitual and were driven by the presence of physical space for segregation containers, and functional social networks in the communities. Additionally, financial rewards and awareness related to the recycling benefits, and available community support were found to be critical drivers. The availability of infrastructure and objects for segregation and recycling and the influence of politics and policies were identified. There is, therefore, need for both the public and private sector to engage in developing and implementing the relevant laws and policies on solid waste recycling, increase community awareness of the critical behavior, and create sustainable markets for waste segregated and recycled products.

COVID-19: An Accelerator for Global Plastic Consumption and Its Implications.

Plastic has been ingrained in our society. Repercussions on the usage of nonbiodegradable plastics and their problems have been recently realized. Despite its detrimental environmental impact, the COVID-19 epidemic has compelled worldwide citizens to increase their plastic use due to affordability and availability. The volume of hospital solid waste, particularly plastics, is overgrowing due to an unexpected increase in medical waste, culminating in the global waste management catastrophe. Henceforth, adopting good waste management practices along with appropriate technologies and viewing the current issue from a fresh perspective would be an opportunity in this current scenario. Accordingly, this review study will focus on the plastic waste scenario before and during the COVID-19 epidemic. This review also disseminates alternative disposal options and recommends practical solutions to lessen human reliance on traditional plastics. Further, the responsibilities of various legislative and regulatory authorities at the local, regional, and worldwide levels are addressed.

The Impact of COVID-19 on the Sustainable Development Goals: Achievements and Expectations.

The COVID-19 pandemic has had a significant impact on almost all the Sustainable Development Goals (SDGs), leaving no country unaffected. It has caused a shift in political agendas, but also in lines of research. At the same time, the world is trying to make the transition to a more sustainable economic model. The research objectives of this paper are to explore the impact of COVID-19 on the fulfilment of the SDGs with regard to the research of the scientific community, and to analyze the presence of the Circular Economy (CE) in the literature. To this end, this research applies bibliometric analysis and a systematic review of the literature, using VOSviewer for data visualization. Five clusters were detected and grouped according to the three dimensions of sustainability. The extent of the effects of the health, economic and social crisis resulting from the pandemic, in addition to the climate crisis, is still uncertain, but it seems clear that the main issues are inefficient waste management, supply chain issues, adaptation to online education and energy concerns. The CE has been part of the solution to this crisis, and it is seen as an ideal model to be promoted based on the opportunities detected.

Waste Management and the Perspective of a Green Hospital-A Systematic Narrative Review.

The concept of a "green hospital" is used in reference to a hospital that includes the environment as part of its quality services and one that pays attention to the sustainable design of buildings. Waste disposal represents a potential risk for the environment; therefore, waste collection from healthcare centers is a key environmental issue. Our study aims to systematically review the experiences acquired in worldwide nosocomial settings related to the management of healthcare waste. Nineteen studies, selected between January 2020 and April 2022 on Scopus, MEDLINE/PubMed and Web of Science databases were included in our systematic narrative review. Operating room and hemodialysis activities seem to be the procedures most associated with waste production. To deal with waste production, the 5Rs rule (reduce, reuse, recycle, rethink and research) was a common suggested strategy to derive the maximum practical benefit while generating the minimum amount of waste. In this context, the COVID-19 pandemic slowed down the greening process of nosocomial environments. Waste management requires a multifactorial approach to deal with medical waste management, even considering the climate change that the world is experiencing. Education of health personnel and managers, regulation by governmental institutions, creation of an "environmental greening team", and awareness of stakeholders and policymakers are some of the measures needed for the greening of healthcare facilities.

Does the creation of healthy cities promote municipal solid waste management? Empirical research in 284 cities in China.

In the context of the COVID-19 pandemic, the creation of healthy cities has become an important measure to deal with global public diseases and public health emergencies, and has had a profound impact on the management of municipal solid waste (MSW). This study exploits the Healthy Cities pilot (HCP) program established in 2016 as a natural experiment, and evaluates its impact on MSW management using the difference-in-difference (DID) method. The estimates show that the collection amount and harmless treatment capacity of MSW were increased by 15.66 and 10.75%, respectively, after the cities were established as pilot healthy cities. However, the harmless treatment rate was decreased by 3.544. This conclusion remains valid in a series of robustness tests, including parallel trend test, placebo test, propensity score matching (PSM)-DID, eliminating the interference of other policies, and eliminating the non-randomness of the policy. Mechanism analysis shows that the HCP program increased the collection amount and harmless treatment capacity of MSW by increasing the expenditure on MSW treatment. However, after a city was established as a pilot healthy city, the unsustainable high expenditure of local government on municipal sanitation led to the decrease in the harmless treatment rate of MSW. Moreover, heterogeneity analysis shows that the HCP program had a stronger impact on MSW management in cities with higher administrative levels, more obvious location advantages, and a larger size. Therefore, it is advisable to use the creation of healthy cities as an important tool to gradually improve MSW management, so as to realize the coordinated development of city construction and human health.

Identifying and Predicting Healthcare Waste Management Costs for an Optimal Sustainable Management System: Evidence from the Greek Public Sector.

The healthcare sector is an ever-growing industry which produces a vast amount of waste each year, and it is crucial for healthcare systems to have an effective and sustainable medical waste management system in order to protect public health. Greek public hospitals in 2018 produced 9500 tons of hazardous healthcare wastes, and it is expected to reach 18,200 tons in 2025 and exceed 18,800 tons in 2030. In this paper, we investigated the factors that affect healthcare wastes. We obtained data from all Greek public hospitals and conducted a regression analysis, with the management cost of waste and the kilos of waste as the dependent variables, and a number of variables reflecting the characteristics of each hospital and its output as the independent variables. We applied and compared several models. Our study shows that healthcare wastes are affected by several individual-hospital characteristics, such as the number of beds, the type of the hospital, the services the hospital provides, the number of annual inpatients, the days of stay, the total number of surgeries, the existence of special units, and the total number of employees. Finally, our study presents two prediction models concerning the management costs and quantities of infectious waste for Greece's public hospitals and proposes specific actions to reduce healthcare wastes and the respective costs, as well as to implement and adopt certain tools, in terms of sustainability.

How comprehensive and effective are waste management policies during the COVID-19 pandemic? Perspectives from the Philippines.

This study presents a comprehensive analysis on policies governing the management of COVID-19 waste in the Philippines, highlighting gaps in pre-existing policies and opportunities for further policy development and adaptation in the context of present and future public health emergencies. A hybrid search strategy and consultative process identified fifty (50) policy documents directly impacting the management of wastes (general domestic, healthcare, and household healthcare waste) released prior to and during the pandemic. Content analysis revealed comprehensive policy coverage on managing general domestic waste and healthcare waste. However, there remains a dearth in policies for managing household healthcare waste, an emerging category for waste generated by patients isolating at home or in isolation facilities. Applicable, pre-existing policies were neither adequate nor specific to this category, and may therefore be subjected to variable interpretation and mismanagement when applied to this novel waste category. Assessment using the modified Cradle-to-End-Of-Life (CTEOL) framework revealed adequate policy coverage across the waste lifecycle stages. However, policies on reducing waste generation were relatively minimal and outdated, and policy gaps in waste segregation led to downstream inefficiencies and introduction of environmental health risks in waste collection, treatment, and disposal. The internal validity of policies was also evaluated against eleven (11) criteria adapted from Rütten et al. and Cheung et al. The criteria analysis revealed strong fulfillment of ensuring policy accessibility, goal clarity, provision of human resources, and strength of policy background, but weak fulfillment of criteria on providing adequate financing, organizational capacity building, monitoring and evaluation, and encouragement of opportunities for public participation. We conclude that existing waste management policies in the Philippines leave much room for improvement to ensure effective management of COVID-19 waste from various settings and circumstances. Hence, these policies are expected to adapt and evolve over time, utilizing the best available technology and environmental practices. Integrated, region-wide waste management systems, involving both government and society, and strengthened by equitable provisional support are needed for effective waste management that is both inclusive and resilient in the face of present and future pandemics.

Assessment of COVID-19 vaccination-related medical waste management practices in Bangladesh.

The COVID-19 pandemic forces people to be vaccinated as early as possible. The COVID-19 vaccination program certainly raised the medical waste volume all over the world, including in Bangladesh. Numerous recent reports showed a fragile medical waste management system in Bangladesh; during the pandemic, the situation became worse. In addition, the nation-wide ongoing COVID-19 vaccination processes have been posing an extra burden to the existing biomedical waste management in the country. Failing to proper management of this waste might be a threat to human and environmental health. Therefore, the study investigated the current COVID-19 vaccine waste management practices in Bangladesh and made a comparison to the proposed standard operating procedures of international organizations and vaccine waste management practices of two other countries (USA and India). The study was carried out through a mixed methodological approach such as qualitative and quantitative, including a questionnaire survey in 15 Upazila of 4 Districts (Dhaka, Narayanganj, Manikganj, and Gazipur) of Bangladesh. The article focused on a nation-wide legitimate COVID-19 vaccination waste estimation, strength, weakness, opportunity, and threat (SWOT) analysis and drivers, pressure, state, impact, and response (DPSIR) framework analysis to identify the present state of medical waste management in the study area. The study found an excellent segregation system (100%) but very poor waste handling (35.5%) along with very poor syringes and sharps disposal method (open burning without buried 46.6%) and poor vials disposal method (without disinfection/open dump 52%) of vaccine waste. It is estimated that about 58 and 257.85 tonnes of syringes (with needles and packaging) and vaccine vials (Sinopharm 2 doses) waste have been generated since the mass-vaccination program started. Upon SWOT analysis, good separation techniques, poor waste management (ex-situ), enough space for management, and environmental and human health concerns were mostly identified as a strength, weakness, opportunity, and threat, respectively. Finally, a DPSIR framework was prepared for vaccine waste generation and its consequences in the studied area. This study will be useful to prepare a suitable vaccination waste management system in Bangladesh.