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.

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.

Factors affecting knowledge, attitude, and practice of COVID-19: A study among undergraduate university students in Bangladesh.

The global expansion of the COVID-19 outbreak is one of the worst disasters the world has faced in recent decades. This study explored various factors of knowledge, attitude, and practice regarding COVID-19 among Bangladeshi undergraduate university students. In addition, we also look at how COVID-19 based knowledge, attitude, and practice influence each other. Using a random sampling technique and a self-administered structured questionnaire survey, this study collected data from 167 private university students in Bangladesh from 1st October to 30th October 2020. Data were analyzed using descriptive statistics (including frequencies, percentages, and means), binary logistic regression, bivariate regression analysis, and factor analysis. The findings suggest that most of the students learned about COVID-19 from various sources, including news media (TV, radio, newspapers, etc.), international organizations (WHO, UN, etc.), various government programs, or from their friends, family members, or neighbors. Most of the students were concerned about becoming sick, keeping social distance, and family members' job insecurity, followed by the university shutdown and the subsequent quarantine. Many students believe Bangladesh's media, government, medical sector, and religious organizations played a significant role during COVID-19. Binary logistic regression demonstrates that students' gender, department, and residency significantly explained their COVID-19 knowledge. In addition, students' attitudes significantly vary with their religion and place of residence. Students' departments and semesters found significant in explaining their practice regarding COVID-19. Moreover, factor analysis results also identified several crucial factors in explaining students' overall knowledge, attitude, and practice of COVID-19. Finally, we found a statistically significant relationship between knowledge, attitude, and practice.

Post-discharge quality of life of COVID-19 patients at 1-month follow-up: A cross-sectional study in the largest tertiary care hospital of Bangladesh.

There is increasing evidence of the post-COVID-19 suffering and decreased quality of life in the COVID-19 patients. This study aimed to assess the quality of life and associated factors of COVID-19 patients at one month after discharge from the hospital. This was a cross-sectional study that was conducted at the post-covid clinic of Dhaka Medical College Hospital (DMCH) where RT-PCR-confirmed adult COVID-19 recovered patients were enrolled one month after discharge from the same hospital. They were consecutively selected from January 01 to May 30. A pretested semi-structured questionnaire was used for the data collection for clinical variables. The generic multi-attributable utility instrument EQ-5D-5L was used for assessing health-related quality of life (HRQoL). A total of 563 patients were enrolled in the study. The patients had a mean age with standard deviation (±SD) of 51.18 (±13.49) years and 55.95% were male. The mean (SD) EQ-5D-5L index score and EQ-VAS scores were 0.78 (±0.19) and 70.26 (±11.13), respectively. Overall, 45.77%, 50.99%, 52.79%, 55.14% and 62.16% had problems (slight to extreme) in the mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions, respectively. Patients aged ≥60 years had significant problem in mobility (odds ratio [OR] 3.24, 95% confidence interval [CI]: 1.07-9.77). Female participants were 5.50 times (95% CI: 2.22-13.62) more likely to have problems in their usual activities. In comparison to urban area, living in a peri-urban setting was significantly associated with problems in mobility (OR 1.89, 95% CI: 1.13-3.20), pain/discomfort (OR 1.82, 95% CI: 1.04-3.12) and anxiety/depression (OR 2.16, 95% CI: 1.22-3.84). Comorbid patients were 1.75 times (95% CI: 1.07-2.85) more likely to report problems in the pain/discomfort dimension. Presence of symptom(s) was associated with problems in self-care (OR 3.27, 95%CI: 1.31-8.18), usual-activity (OR 3.08, 95%CI: 1.21-7.87), pain/discomfort dimensions (OR 2.75, 95%CI: 1.09-6.96) and anxiety/depression (OR 3.35, 95%CI: 1.35-8.30). Specific management strategies should be planned to address the factors associated with low health-related quality of life in post-acute care of COVID-19 patients.

Investigating problematic uses of Facebook and other Internet activities among university students in Bangladesh during the COVID-19 pandemic.

Problematic use of Internet (PUI) and problematic use of Facebook (PUF) has been linked to escalating behavioral health issues among university students and has increased during the COVID-19 pandemic. This study estimated the prevalence of and explored associated factors for PUI and PUF among Bangladeshi university students during the COVID-19 pandemic. A cross-sectional online survey was undertaken among 1101 Bangladeshi university students between November and December 2020. The Internet Addiction Test and Facebook Addiction Scale were used to assess PIU and PUF, respectively. A multiple linear regression analysis was performed to adjust for confounders. Among the participants, PUI and PUF were found in 39.3% and 37.1%, respectively. The multiple linear regression model indicated PUI was significantly associated with participants residing in a village, arts majors, those unsatisfied with their major, having mediocre parental relationships, failure in romantic relationships, physical comorbidities, longer use of the Internet, using the Internet for purposes other than education, using social media, and downloading movies/TV series. PUF was significantly associated with village residence, lower income, arts majors, failure in romantic relationships, longer use of the Internet, using the Internet for purposes other than education, and downloading movies/TV series. Both PUI and PUF have been prevalent among Bangladeshi university students during the COVID-19 pandemic. Longitudinal & exploratory studies are warranted in the future to identify causal factors for PUI and PUF and appropriate interventions should be designed quickly for this population.

SARS-CoV-2 Infection after Vaccination: A Comparative Profile between Dose 1 and Dose 2.

Since the initial shipment of vaccination campaign against SARS-CoV-2 infection, it was a major concern all over the world regarding appropriate gapping between the first and second dose and also the necessity of booster dose after being vaccinated with the second dose. This cross-sectional type of comparative study was conducted at Kuwait Bangladesh Friendship Government Hospital, from the period of March 01 2021 to August 31 2021, on 148 hospitalized patients who were vaccinated with Astra Zeneca. They were divided into two groups on the background of 1st dose and 2nd dose. Collected data were entered into SPSS-26 version and after data cleaning, descriptive analysis was done with frequency distribution. To find out the significant difference between the two groups considering clinico-demographic information, disease severity, and duration of the last dose of vaccine; the Pearson Chi-square test was done with a significance level ≤0.05. The patients from both groups were mostly male and above 60 years. There were no significant age or sex variations between the two groups. SARS-CoV-2 infection was common after 38 days of dose 1 and after 63 days of dose 2. Fever, cough, running nose, shortness of breath, fatigue, nausea, vomiting, lower oxygen saturation, radiological involvement were comparatively more in patients who got only a single dose. Mild pneumonia (70.7%) was the commonest presentation in both doses of vaccinated patients and single dose vaccinated patients mostly (45.5%) presented with severe pneumonia. Elderly clinically risks group patients were mostly hospitalized with infection after 1 month of the 1st dose and on the other hand after 2 months of completing the 2nd dose. Symptomatic infection and disease severity were more in 1st dose vaccine recipients in comparison to 2nd dose.

Clinico-epidemiological Characteristics of Asymptomatic and Symptomatic COVID-19-Positive Patients in Bangladesh.

As of August 15, 2020, Bangladesh lost 3591 lives since the first Coronavirus disease 2019 (COVID-19) case announced on March 8. The objective of the study was to report the clinical manifestation of both symptomatic and asymptomatic COVID-19-positive patients. An online-based cross-sectional survey was conducted for initial recruitment of participants with subsequent telephone interview by the three trained physicians in 237 adults with confirmed COVID-19 infection in Bangladesh. The study period was 27 April to 26th May 2020. Consent was ensured before commencing the interview. Collected data were entered in a pre-designed case record form and subsequently analyzed by SPSS 20.0. The mean±SD age at presentation was 41.59±13.73 years and most of the cases were male (73.0%). A total of 90.29% of patients reside in urban areas. Among the positive cases, 13.1% (n=31) were asymptomatic. Asymptomatic cases were significantly more common in households with 2 to 4 members (p=0.008). Both symptomatic and asymptomatic patients shared similar ages of presentation (p=0.23), gender differences (p=0.30) and co-morbidities (p=0.11). Only 5.3% of patients received ICU care during their treatment. The most frequent presentation was fever (88.3%), followed by cough (69.9%), chest pain (34.5%), body ache (31.1%), and sore throat (30.1%). Thirty-nine percent (n=92) of the patients had co-morbidities, with diabetes and hypertension being the most frequently observed. There has been an upsurge in COVID-19 cases in Bangladesh. Patients were mostly middle-aged and male. Typical presentations were fever and cough. Maintenance of social distancing and increased testing are required to meet the current public health challenge.

Prevalence and predictors of pornography exposure during the third wave of the COVID-19 pandemic: A web-based cross-sectional study on students in Bangladesh.

Background: Pornography exposure, particularly among students, in Bangladesh, has increased in the twenty-first century. However, pornography exposure during the COVID-19 pandemic, when people were compelled to "stay at home" and relied extensively on the internet for all forms of activities, including academia, socializing, and communication, has remained unexplored. The present study aimed to assess the prevalence of pornography exposure among students during the third wave of the COVID-19 pandemic and to determine the associated predictors. Methods: A web-based cross-sectional study was carried out among students with certain specifications, i.e., current students at high school/college/university with access to the internet and valid social media accounts. By administering a semi-structured e-questionnaire using Google Forms, a total of 646 valid responses were retained for this study. The data were analyzed in two phases by Pearson's Chi-square and multiple logistic regression model, using IBM SPSS Statistics, version 25. The results were expressed as an adjusted odds ratio (AOR) with a 95% confidence interval (95% CI). Results: The findings suggest that 75.9% of students were exposed to pornography during the third wave of the COVID-19 pandemic and preferred to watch the amateur/professional genre of pornography. Pornography exposure was significantly associated with age and relationship status, as students aged 22-24 years (95% CI: 1.01-2.41; p = 0.045) and over 25 years (95% CI: 1.61-10.03; p = 0.003) were more likely to watch pornography, while married students and those in relationships (95% CI: 1.24-3.49; p = 0.006) also watched pornography during the pandemic. In contrast, students who were living alone (95% CI: 0.38-0.92; p = 0.021), were living in the Khulna division (95% CI: 0.16-0.52; p < 0.001) or had a negative attitude toward pornography (95% CI: 0.94-0.99; p = 0.002) were less likely to be exposed to pornography. Conclusion: Pornography exposure was higher among students in Bangladesh during the COVID-19 pandemic, and religiosity and disapproving attitudes toward pornography negatively influenced the pornography exposure. For a better understanding of the complex dynamics of socio-demographic issues with pornography exposure among students, extensive research is required for policymakers to devise appropriate strategies and interventions to ensure healthy and safe sex life for the younger population.

Longevity of memory B cells and antibodies, as well as the polarization of effector memory helper T cells, are associated with disease severity in patients with COVID-19 in Bangladesh.

The longevity of immune responses induced by different degrees of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection provides information important to understanding protection against coronavirus disease 2019 (COVID-19). Here, we report the persistence of SARS-CoV-2 spike receptor-binding domain (RBD) specific antibodies and memory B cells recognizing this antigen in sequential samples from patients in Bangladesh with asymptomatic, mild, moderate and severe COVID-19 out to six months following infection. Since the development of long-lived memory B cells, as well as antibody production, is likely to be dependent on T helper (Th) cells, we also investigated the phenotypic changes of Th cells in COVID-19 patients over time following infection. Our results show that patients with moderate to severe COVID-19 mounted significant levels of IgG antibodies out to six months following infection, while patients with asymptomatic or mild disease had significant levels of IgG antibodies out to 3 months following infection, but these then fell more rapidly at 6 months than in patients with higher disease severity. Patients from all severity groups developed circulating memory B cells (MBCs) specific to SARS-CoV-2 spike RBD by 3 months following infection, and these persisted until the last timepoint measured at 6 months. A T helper cell response with an effector memory phenotype was observed following infection in all symptomatic patients, while patients with asymptomatic infection had no significant increases in effector Th1, Th2 and Th17 effector memory cell responses. Our results suggest that the strength and magnitude of antibody and memory B cells induced following SARS-CoV-2 infection depend on the severity of the disease. Polarization of the Th cell response, with an increase in Th effector memory cells, occurs in symptomatic patients by day 7 following infection, with increases seen in Th1, Th2, Th17 and follicular helper T cell subsets.

Vegetables and fruits retailers in two urban areas of Bangladesh: Disruption due to COVID- 19 and implications for NCDs.

Bangladesh is experiencing an increasing prevalence of diet-related non-communicable diseases (NCDs). Considering daily total requirement of 5 servings as minimum recommended amount, 95.7% of people do not consume adequate fruit or vegetables on an average day in the country. Imposition of lockdown during COVID-19 created disturbance in fresh fruits and vegetable production and their retailing. This incident can make these dietary products less affordable by stimulating price and trigger NCDs. However, little is known about the supply chain actors of healthy foods such as vegetables and fruits in urban areas, and how they were affected due to pandemic. Aiming toward the impact of COVID-19 on the business practices and outcomes for the vegetables and fruits retailers in Bangladesh, a survey of 1,319 retailers was conducted in two urban areas, namely Dhaka and Manikganj from September 2021 to October 2021. To comprehend the impact of COVID-19 on the profit margin of the retailers and on the percentage change in sales, a logistic and an Ordinary Least Squares (OLS) regression were estimated. Significant difference in the weekly business days and daily business operations was observed. The average daily sales were estimated to have a 42% reduction in comparison to pre-COVID level. The daily average profit margin on sales was reportedly reduced to 17% from an average level of 21% in the normal period. Nevertheless, this impact is estimated to be disproportionate to the product type and subject to business location. The probability of facing a reduction in profit margin is higher for the fruit sellers than the vegetable sellers. Contemplating the business location, the retailers in Manikganj (a small city) faced an average of 19 percentage points less reduction in their sales than those in Dhaka (a large city). Area-specific and product-specific intervention are required for minimizing the vulnerability of retailers of vegetables and fruits and ensuring smooth supply of fruits and vegetables and increasing their uptake to combat diet related NCD.

Implementation barriers and facilitators to a COVID-19 intervention in Bangladesh: The benefits of engaging the community for the delivery of the programme.

BACKGROUND: BRAC (Bangladesh Rural Advancement Committee), the largest NGO globally, implemented a community-based comprehensive social behavior communication intervention to increase community resilience through prevention, protection, and care for COVID-19. We conducted implementation research to assess fidelity and explore the barriers and facilitators of this intervention implementation. METHODS: We adopted a concurrent mixed-method triangulation design. We interviewed 666 members of 60 Community Corona Protection Committees (CCPCs) and 80 members of 60 Community Support Teams (CSTs) through multi-stage cluster sampling using a structured questionnaire. The qualitative components relied on 54 key informant interviews with BRAC implementers and government providers. RESULTS: The knowledge about wearing mask, keeping social distance, washing hands and COVID-19 symptoms were high (on average more than 70%) among CCPC and CST members. While 422 (63.4%) CCPC members reported they 'always' wear a mask while going out, 69 (86.3%) CST members reported the same practice. Only 247 (37.1%) CCPC members distributed masks, and 229 (34.4%) donated soap to the underprivileged population during the last two weeks preceding the survey. The key facilitators included influential community members in the CCPC, greater acceptability of the front-line health workers, free-of-cost materials, and telemedicine services. The important barriers identified were insufficient training, irregular participation of the CCPC members, favouritism of CCPC members in distributing essential COVID-19 preventive materials, disruption in supply and shortage of the COVID-19 preventative materials, improper use of handwashing station, the non-compliant attitude of the community people, challenges to ensure home quarantine, challenges regarding telemedicine with network interruptions, lack of coordination among stakeholders, the short duration of the project. CONCLUSIONS: Engaging the community in combination with health services through a Government-NGO partnership is a sustainable strategy for implementing the COVID-19 prevention program. Engaging the community should be promoted as an integral component of any public health intervention for sustainability. Engagement structures should incorporate a systems perspective to facilitate the relationships, ensure the quality of the delivery program, and be mindful of the heterogeneity of different community members concerning capacity building. Finally, reaching out to the underprivileged through community engagement is also an effective mechanism to progress through universal health coverage.

Dependency of sanitation infrastructure on the discharge of faecal coliform and SARS-CoV-2 viral RNA in wastewater from COVID and non-COVID hospitals in Dhaka, Bangladesh.

The detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA in wastewater can be used as an indicator of the presence of SARS-CoV-2 infection in specific catchment areas. We conducted a hospital-based study to explore wastewater management in healthcare facilities and analyzed SARS-CoV-2 RNA in the hospital wastewater in Dhaka city during the Coronavirus disease (COVID-19) outbreak between September 2020-January 2021. We selected three COVID-hospitals, two non-COVID-hospitals, and one non-COVID-hospital with COVID wards, conducted spot-checks of the sanitation systems (i.e., toilets, drainage, and septic-tank), and collected 90 untreated wastewater effluent samples (68 from COVID and 22 from non-COVID hospitals). E. coli was detected using a membrane filtration technique and reported as colony forming unit (CFU). SARS-CoV-2 RNA was detected using the iTaq Universal Probes One-Step kit for RT-qPCR amplification of the SARS-CoV-2 ORF1ab and N gene targets and quantified for SARS-CoV-2 genome equivalent copies (GEC) per mL of sample. None of the six hospitals had a primary wastewater treatment facility; two COVID hospitals had functional septic tanks, and the rest of the hospitals had either broken onsite systems or no containment of wastewater. Overall, 100 % of wastewater samples were positive with a high concentration of E. coli (mean = 7.0 log10 CFU/100 mL). Overall, 67 % (60/90) samples were positive for SARS-CoV-2. The highest SARS-CoV-2 concentrations (median: 141 GEC/mL; range: 13-18,214) were detected in wastewater from COVID-hospitals, and in non-COVID-hospitals, the median SARS-CoV-2 concentration was 108 GEC/mL (range: 30-1829). Our results indicate that high concentrations of E. coli and SARS-CoV-2 were discharged through the hospital wastewater (both COVID and non-COVID) without treatment into the ambient water bodies. Although there is no evidence for transmission of SARS-CoV-2 via wastewater, this study highlights the significant risk posed by wastewater from health care facilities in Dhaka for the many other diseases that are spread via faecal oral route. Hospitals in low-income settings could function as sentinel sites to monitor outbreaks through wastewater-based epidemiological surveillance systems. Hospitals should aim to adopt the appropriate wastewater treatment technologies to reduce the discharge of pathogens into the environment and mitigate environmental exposures.

Evaluation of COVID-19 vaccine acceptance and uptake in rural Bangladesh: a cross-sectional study.

OBJECTIVE: The objective of this study was to evaluate the acceptance and uptake of COVID-19 vaccines in rural Bangladesh. DESIGN: This was a cross-sectional study conducted between June and November 2021. SETTING: This study was conducted in rural Bangladesh. PARTICIPANTS: People older than 18 years of age, not pregnant and no history of surgery for the last 3 months were eligible to participate. PRIMARY AND SECONDARY OUTCOMES: The primary outcomes were proportions of COVID-19 vaccine acceptance and roll-out participation among the rural population. The secondary outcome was identification of correlates which contributed to COVID-19 vaccine acceptance and roll-out participation. Χ2 tests and multivariable logistic regression analyses were performed to identify relevant correlates such as sociodemographic factors, clinical conditions and COVID-19-related factors. RESULTS: A total of 1603 participants were enrolled. The overall COVID-19 vaccine acceptance was very high (1521/1601, 95%), and half of the participants received at least one dose of the COVID-19 vaccine. Majority of participants wanted to keep others safe (89%) and agreed to the benefits of COVID-19 vaccines (88%). To fulfil the requirement of online registration for the vaccine at the time, 62% of participants had to visit an internet café and only 31% downloaded the app. Over half (54%) of participants were unaware of countries they knew and trust to produce the COVID-19 vaccine. Increased age, being housewives, underweight and undergraduate education level were associated with vaccine acceptance, while being female, increased age and being overweight/obese were associated with vaccine uptake. Trust in the health department and practical knowledge regarding COVID-19 vaccines were positively associated with both vaccine acceptance and uptake. CONCLUSION: This study found a very high COVID-19 vaccine acceptance in rural Bangladesh. Policymakers should support interventions aimed at increasing vaccine and general health literacy and ensure ongoing vaccine supply and improvement of infrastructure in rural areas.

In-person training on COVID-19 case management and infection prevention and control: Evaluation of healthcare professionals in Bangladesh.

BACKGROUND: As COVID-19 was declared a global pandemic, the major focus of healthcare organizations shifted towards preparing healthcare systems to handle the inevitable COVID-19 burden at different phases and levels. A series of in-person training programs were operated in collaboration with government and partner organizations for the healthcare workers (HCW) of Bangladesh. This study aimed to assess the knowledge of HCWs regarding SARS-CoV-2 infection, their case management, infection prevention and control to fight against the ongoing pandemic. METHODS: As a part of the National Preparedness and Response Plan for COVID-19 in Bangladesh, the training program was conducted at four district-level hospitals and one specialized hospital in Bangladesh from July 1, 2020 to June 30, 2021. A total of 755 HCWs participated in the training sessions. Among them, 357 (47%) were enrolled for the evaluation upon completion of the data, collected from one district hospital (Feni) and one specialized hospital (National Institute of Mental Health). RESULTS: The mean percentage of pre-test and post-test scores of all the participants were found to be 57% (95% CI 8.34-8.91; p 0.01) and 65% (95% CI 9.56-10.15; p <0.001) respectively. The difference of score (mean) between the groups was significant (p<0.001). After categorizing participants' knowledge levels as poor, average and fair, doctors' group has shown to have significant enhancement from level of average to fair compared to that of the nurses. Factors associated with knowledge augmentation of doctors were working in primary health care centers (aOR: 4.22; 95% CI: 1.80, 9.88), job experience less than 5 years (aOR: 4.10; 95% CI: 1.01, 16.63) and experience in caring of family member with COVID-19 morbidity (aOR: 2.06; 95% CI: 1.03, 4.10), after adjusting for relevant covariates such as age, sex and prior COVID-19 illness. CONCLUSION: Considering the series of waves of COVID-19 pandemic with newer variants, the present paper underscores the importance of implementing the structured in-person training program on case management, infection prevention and control for the HCWs that may help for successful readiness prior to future pandemics that may further help to minimize the pandemic related fatal consequences.

Midwifery centers as enabled environments for midwifery: A quasi experimental design assessing women's birth experiences in three models of care in Bangladesh, before and during covid.

BACKGROUND: The midwifery model of care is a human rights-based approach (HRBA) that is unique and appropriate for the majority of healthy pregnant women, yet full expression may be limited within the medical model. Midwifery centers are facilities designed specifically to enable the practice of midwifery. In high resource countries, they have been shown to be cost effective, evidence-based, avoid over medicalization, and provide safe, efficient and satisfying care. METHODS: A quasi-experimental design was used to assess the impact of three models of care on women's experiences of respect, and trust in maternity care provision, both before and during the pandemic in Bangladesh, as well as their fear and knowledge around COVID-19, during the pandemic. The models were: "fully enabled midwifery" ("FEM") in freestanding midwifery centers; "midwifery and medicine" ("MAM") in medical facilities with midwives working alongside nurses and doctors; and "no midwifery" ("NoM") in medical facilities without midwives. Phone survey data were collected and analyzed from all women (n = 1,191) who delivered from Jan 2020-June 2020 at seven health care facilities in Bangladesh. Comparison of means, ANOVA, post hoc Tukey, and effect size were used to explore the differences in outcomes across time periods. FINDINGS: Pre-pandemic, women served by the FEM model reported significantly higher rates of trust and respect (p<0·001) compared to the NoM model, and significantly higher rates of trust (p<0·001) compared to MAM. During the pandemic, in the FEM model, the experiences of respect and trust did not change significantly from the pre-pandemic rates, and were significantly higher than both the MAM and NoM models (p < 0·001). Additionally, during the pandemic, women served by the FEM model had the lowest experience of COVID fear (p<0·001). INTERPRETATION: Fully enabled midwifery in midwifery centers had a significantly positive effect on woman's experience of respect and trust in care compared to the other models, even in the context of a pandemic.

Burnout syndrome among frontline doctors of secondary and tertiary care hospitals of Bangladesh during COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic, healthcare workers had a high workload and were exposed to multiple psychosocial stressors. However, a knowledge gap exists about the levels of burnout among Bangladeshi frontline doctors during this COVID-19 pandemic. The study investigated burnout syndrome (BOS) among frontline doctors in two public secondary and tertiary care hospitals in Chattogram, Bangladesh. MATERIALS & METHODS: This cross-sectional study involved frontline doctors working at two hospitals treating COVID-19 and non-COVID patients from June to August 2020. A self-administered questionnaire that included Maslach Burnout Inventory for Human Services Survey (MBI-HSS) was used to capture demographic and workplace environment information. ANOVA and t-test were used to determine the statistical differences in the mean values of the three dimensions of MBI-HSS. Scores for three domains of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were calculated. Post-hoc analysis was done to identify the significant pair-wise differences when the ANOVA test result was significant. Multiple logistic regression was performed to determine the influence of factors associated with BOS. RESULTS: A total of 185 frontline doctors were invited to participate by convenience sampling, and 168 responded. The response rate was 90.81%. The overall prevalence of BOS was 55.4% (93/168) (95% CI: 47.5% to 63.0%). Moderate to high levels of EE was found in 95.8% of the participants. High DP and reduced PA were observed in 98.2% and 97% of participants. Younger age (25-29 years), being female, and working as a medical officer were independently associated with high levels of burnout in all three domains. EE was significantly higher in females (P = 0.011). DP was significantly higher in medical officers, those at earlier job periods, and those working more than 8 hours per day. CONCLUSION: During the COVID-19 outbreak, BOS was common among Bangladeshi frontline doctors. Females, medical officers, and younger doctors tended to be more susceptible to BOS. Less BOS was experienced when working in the non-COVID ward than in the mixed ward.

COVID-19 related anxiety and its associated factors: a cross-sectional study on older adults in Bangladesh.

BACKGROUND: The COVID-19 pandemic has resulted in serious mental health conditions, particularly among older adults. This research explored the prevalence of COVID-19-related anxiety and its associated factors among older adults residing in Bangladesh. METHODS: This cross-sectional study was conducted among 1,045 older Bangladeshi adults aged ≥ 60 years through telephone interviews in September 2021. A semi-structured interview schedule was used to collect data on participants' characteristics and COVID-19-related anxiety. The anxiety level was measured using the Bengali version of the five-point Coronavirus Anxiety Scale (CAS). A linear regression model explored the factors associated with COVID-19-related anxiety. RESULTS: Overall, the prevalence of COVID-19-related anxiety was 23.2%. The regression analysis revealed that the average COVID-19-related anxiety score was significantly higher among females (ß: 0.43, 95% CI: 0.05 to 0.81), and among those who faced difficulty getting medicine (ß: 0.57, 95% CI: 0.16 to 0.97), felt isolated (ß: 0.60, 95% CI: 0.24 to 0.95), and felt requiring additional care during the pandemic (ß: 0.53, 95% CI: 0.16 to 0.91). Alternatively, the average COVID-19-related anxiety score was significantly lower among those who were widowed (ß: -0.46, 95% CI: -0.87 to -0.04) and living distant from the health centre (ß: -0.48, 95% CI: -0.79 to -0.17). CONCLUSION: The findings of the present study suggest providing immediate psychosocial support package to the older adults, particularly females and those who are vulnerable to receive health and social care support during the COVID-19 pandemic in Bangladesh.

Seroprevalence of SARS-CoV-2 antibodies among Forcibly Displaced Myanmar Nationals in Cox's Bazar, Bangladesh 2020: a population-based cross-sectional study.

OBJECTIVES: The study aimed to determine the seroprevalence, the fraction of asymptomatic infections, and risk factors of SARS-CoV-2 infections among the Forcibly Displaced Myanmar Nationals (FDMNs). DESIGN: It was a population-based two-stage cross-sectional study at the level of households. SETTING: The study was conducted in December 2020 among household members of the FDMN population living in the 34 camps of Ukhia and Teknaf Upazila of Cox's Bazar district in Bangladesh. PARTICIPANTS: Among 860 697 FDMNs residing in 187 517 households, 3446 were recruited for the study. One individual aged 1 year or older was randomly selected from each targeted household. PRIMARY AND SECONDARY OUTCOME MEASURES: Blood samples from respondents were tested for total antibodies for SARS-CoV-2 using Wantai ELISA kits, and later positive samples were validated by Kantaro kits. RESULTS: More than half (55.3%) of the respondents were females, aged 23 median (IQR 14-35) years and more than half (58.4%) had no formal education. Overall, 2090 of 3446 study participants tested positive for SARS-CoV-2 antibody. The weighted and test adjusted seroprevalence (95% CI) was 48.3% (45.3% to 51.4%), which did not differ by the sexes. Children (aged 1-17 years) had a significantly lower seroprevalence 38.6% (95% CI 33.8% to 43.4%) compared with adults (58.1%, 95% CI 55.2% to 61.1%). Almost half (45.7%, 95% CI 41.9% to 49.5%) of seropositive individuals reported no relevant symptoms since March 2020. Antibody seroprevalence was higher in those with any comorbidity (57.8%, 95% CI 50.4% to 64.5%) than those without (47.2%, 95% CI 43.9% to 50.4%). Multivariate logistic regression analysis of all subjects identified increasing age and education as risk factors for seropositivity. In children (≤17 years), only age was significantly associated with the infection. CONCLUSIONS: In December 2020, about half of the FDMNs had antibodies against SARS-CoV-2, including those who reported no history of symptoms. Periodic serosurveys are necessary to recommend appropriate public health measures to limit transmission.

Health-related quality of life and coping strategies adopted by COVID-19 survivors: A nationwide cross-sectional study in Bangladesh.

INTRODUCTION: This study aims to investigate the health-related quality of life and coping strategies among COVID-19 survivors in Bangladesh. METHODS: This is a cross-sectional study of 2198 adult, COVID-19 survivors living in Bangladesh. Data were collected from previously diagnosed COVID-19 participants (confirmed by an RT-PCR test) via door-to-door interviews in the eight different divisions in Bangladesh. For data collection, Bengali-translated Brief COPE inventory and WHO Brief Quality of Life (WHO-QoLBREF) questionnaires were used. The data collection period was from October 2020 to March 2021. RESULTS: Males 72.38% (1591) were more affected by COVID-19 than females 27.62% (607). Age showed significant correlations (p<0.005) with physical, psychological and social relationships, whereas gender showed only a significant correlation with physical health (p<0.001). Marital status, occupation, living area, and co-morbidities showed significant co-relation with all four domains of QoL (p<0.001). Education and affected family members showed significant correlation with physical and social relationship (p<0.001). However, smoking habit showed a significant correlation with both social relationship and environment (p<0.001). Age and marital status showed a significant correlation with avoidant coping strategies (p<0.001); whereas gender and co-morbidities showed a significant correlation with problem-focused coping strategies (p<0.001). Educational qualification, occupation and living area showed significant correlation with all three coping strategies(p<0.001). CONCLUSION: Survivors of COVID-19 showed mixed types of coping strategies; however, the predominant coping strategy was avoidant coping, followed by problem-focused coping, with emotion-focused coping reported as the least prevalent. Marital status, occupation, living area and co-morbidities showed a greater effect on QoL in all participants. This study represents the real scenario of nationwide health-associated quality of life and coping strategies during and beyond the Delta pandemic.