Promotion of livelihood opportunities to address food insecurity in Rohingya refugee camps of Bangladesh.

The world is facing a tremendous problem in the form of food insecurity that is posing a great challenge to achieving sustainable development goal 2 of creating a hunger-free world. Refugees and displaced populations are particularly vulnerable to food insecurity and malnutrition, who lack any productive assets and depend on aid. Rohingya refugees, displaced from Myanmar and took refuge in Cox's Bazar, Bangladesh, live in a crowded unhealthy environment and are severely vulnerable to food insecurity and malnutrition. In our recent study, we found that only 21.6% of the households in Rohingya refugee camps had acceptable food security status. Interestingly, this study further revealed that acceptable food security status was significantly higher among the households that had some additional income aside from aid, compared to those relying on aid alone. This shows the importance of promoting livelihood opportunities to improve food security status among the camp dwellers. In this paper, we presented our views on promoting livelihood opportunities to address the overwhelming food insecurity crisis among the Rohingya refugees in Bangladesh.

The burden of non-disabled frailty and its associated factors among older adults in Bangladesh.

OBJECTIVE: The present study aims to measure the prevalence of non-disabled frailty and its associated factors among Bangladeshi older adults. METHODS: This cross-sectional study was conducted during September and October 2021 among 1,045 Bangladeshi older adults (≥60 years). Telephone interviews, using a semi-structured questionnaire, were undertaken to collect data on participants' characteristics and level of frailty. The non-disabled frailty was measured using the 'Frail Non-Disabled (FiND)' questionnaire. A multinomial logistic regression model assessed the factors associated with frailty among the participants. RESULTS: Around a quarter of the participants (24.8%) were frail. The multinomial regression analysis showed that older participants aged ≥80 years (RRR = 3.23, 95% CI: 1.41-7.37) were more likely to be frail compared to participants aged 60-69 years. Likewise, the participants living in a large family with ≥4 members (RRR = 1.39, 95% CI: 1.01-1.92) were more likely to be frail compared to those living in smaller families. Also, participants having memory or concentration problems (RRR = 1.56, 95% CI: 1.12-2.17) were more likely to be frail compared to those who were not suffering from these problems. Moreover, participants whose family members were non-responsive to their day-to-day assistance (RRR = 1.47, 95% CI: 1.06-2.03) were more likely to be frail compared to those whose family members were responsive. Furthermore, participants who were feeling lonely (RRR = 1.45, 95% CI: 1.07-1.98) were more likely to be frail than their counterparts who were not feeling lonely. CONCLUSIONS: The findings of the present study suggest developing tailored interventions to address the burden of frailty among the older populations in Bangladesh. In particular, providing long-term care and health promotion activities can be of value in preventing frailty and reducing adverse health outcomes among this vulnerable population group.

Prevalence and determinants of self-reported functional status among older adults residing in the largest refugee camp of the world.

BACKGROUND: The older adults of refugee camps might be vulnerable to exhibiting limited functional abilities because of the limited resources available to create a supportive environment for older population in the camps. This study aims to explore the prevalence and determinants of self-reported functional status among the older adults residing in the Rohingya refugee camp in Bangladesh. METHODS: This cross-sectional study was conducted on 864 older adults aged 60 years and above living in five selected sub-camps of Rohingya refugee camp in Cox's Bazar, Bangladesh. Data were collected through face-to-face interviews of the participants between November-December 2021. Functional status was measured using the Barthel Index. Information on participants' sociodemographic characteristics, self-reported chronic diseases and lifestyle characteristics were also collected. A multiple logistic regression model was used to assess the factors associated with self-reported functional abilities among the participants. RESULTS: The overall percentage of people having limited self-reported functional ability was 26.5% (male: 22.6% and female: 31.5%) with inability most found in grooming (33.2%), bathing (31.8%), stair using (13.2%) and mobility (10.7%). In the final adjusted model, having age of 80 years or more (aOR = 2.01,95% CI: 1.08,3.75), being female (aOR = 1.44, 95% CI: 1.04,2.0), having low memory or concentration (aOR = 1.83, 95% CI: 1.30,2.56), loneliness (aOR = 2.89, 95% CI:1.74,4.80) and living with aid alone (aOR = 2.89, 95% CI: 1.74,4.80) were found to be associated with self-reported limited functional ability. CONCLUSION: The findings of this study highlight the need for attention from policymakers and public health practitioners on addressing functional limitations among older adults residing in the Rohingya refugee camp. Our findings emphasize the need for the development of comprehensive interventions that can address the wider unmet needs (e.g., ensuring family/caregiver support, engaging in social and physical activities, providing nutritional support packages, etc.) to improve the health and well-being of older Rohingya adults.

Anxiety and Stress Related to COVID-19 Among the Community Dwelling Older Adults Residing in the Largest Refugee Camp of the World.

The current cross-sectional study was conducted among 864 older adults aged ≥ 60 years residing in Rohingya refugee camp through face-to-face interviews during November-December 2021. COVID-19-related anxiety was measured using the five-point Coronavirus Anxiety Scale (CAS) and perceived stress using the 10-point Perceived Stress Scale (PSS). The linear regression model identified the factors associated with COVID-19-related anxiety and perceived stress. The prevalence of COVID-19-related anxiety and perceived stress was 68% and 93%, respectively. The average COVID-19-related anxiety score expected to be significantly higher among those who were physically inactive, concerned about COVID-19, had a close friend/family member diagnosed with COVID-19, and had some difficulty in getting food and routine medical care during the COVID-19 pandemic. Meanwhile, the average perceived stress score was expected to be significantly higher among those without partners, who were feeling overwhelmed by COVID-19, and who experienced COVID-19-related anxiety during the pandemic. The findings suggest providing immediate psychosocial support to older Rohingya adults.

Change in prevalence over time and factors associated with depression among Bangladeshi older adults during the COVID-19 pandemic.

BACKGROUND: Globally, the COVID-19 pandemic seriously affected both physical and mental health conditions. This study aims to assess changes in the prevalence of depression among older adults during the COVID-19 pandemic in Bangladesh and explore the correlates of depression in pooled data. METHODS: This study followed a repeated cross-sectional design and was conducted through telephone interviews on two successive occasions during the COVID-19 pandemic (October 2020 and September 2021) among 2077 (1032 in 2020-survey and 1045 in 2021-survey) older Bangladeshi adults aged 60 years and above. Depression was measured using the 15-item Geriatric Depression Scale (GDS-15). The binary logistic regression model was used to identify the factors associated with depression in pooled data. RESULTS: A significant increase in the prevalence of depression was noted in the 2021 survey compared to the 2020 survey (47.2% versus 40.3%; adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.11-1.75). Depression was significantly higher among participants without a partner (aOR 1.92, 95% CI 1.45-2.53), with a monthly family income of <5000 BDT (aOR: 2.65, 95% CI 1.82-3.86) or 5000-10 000 BDT (aOR: 1.30, 95% CI 1.03-1.65), living alone (aOR 2.24, 95% CI 1.40-3.61), feeling isolated (aOR 3.15, 95% CI 2.49-3.98), with poor memory/concentration (aOR 2.02, 95% CI 1.58-2.57), with non-communicable chronic conditions (aOR 1.34, 95% CI 1.06-1.69), overwhelmed by COVID-19 (aOR 1.54, 95% CI 1.18-2.00), having difficulty earning (aOR 1.49, 95% CI 1.15-1.92) or obtaining food (aOR 1.56, 95% CI 1.17-2.09) during COVID-19 pandemic, communicating less frequently (aOR 1.35, 95% CI 1.07-1.70) and needing extra care (aOR 2.28, 95% CI 1.75-2.96) during the pandemic. CONCLUSIONS: Policymakers and public health practitioners should provide immediate mental health support initiatives for this vulnerable population during the COVID-19 pandemic and beyond. Policymakers should also invest in creating safe places to practise mindful eating, exercise, or other refuelling activities as a means of preventing and managing depression.

A tale of osteoarthritis among older adults during the COVID-19 pandemic in Bangladesh: A repeated cross-sectional study.

BACKGROUND: Due to restrictions in social gatherings imposed due to the COVID-19 pandemic, physical and other daily activities were limited among the older adults. The present study aimed to estimate the change in osteoarthritis prevalence among older adults during the COVID-19 pandemic in Bangladesh. METHODS: This repeated cross-sectional study was conducted through telephone interviews among older adults aged 60 years and above on two successive occasions (October 2020 and September 2021) during the COVID-19 pandemic in Bangladesh. The prevalence of osteoarthritis was measured by asking the participants if they had osteoarthritis or joint pain problems. RESULTS: A total of 2077 participants (1032 in 2020-survey and 1045 in 2021-survey) participated in the study. The prevalence of self-reported joint pains or osteoarthritis significantly increased from 45.3% in 2020 to 54.7% in 2021 (P = 0.006), with an increasing odd in the adjusted analysis (aOR 1.27, 95% CI 1.04-1.54). We also found that osteoarthritis prevalence significantly increased among the participants from the Chattogram and Mymensingh divisions, aged 60-69 years, males, married, rural residents, and living with a family. A significant increase was also documented among those who received formal schooling, had a family income of 5000-10000 BDT, resided with a large family, were unemployed or retired, and lived away from a health facility. CONCLUSIONS: Our study reported a significant increased prevalence of osteoarthritis among older adults from 2020 to 2021 during this pandemic in Bangladesh. This study highlights the need for the development and implementation of initiatives for the screening and management of osteoarthritis through a primary health care approach during any public health emergencies.

Implications of updated protocol for classification of childhood malnutrition and service delivery in world's largest refugee camp amid this COVID-19 pandemic.

OBJECTIVES: During the COVID-19 pandemic, the authorities made a change in the classification of malnutrition and concomitant service delivery protocol among the Rohingya children, residing in world's largest refugee camp, located in Cox's Bazar, Bangladesh. In this paper, we discussed the potential implications of this updated protocol on the malnutrition status among children residing in the Rohingya camps. DESIGN: This paper reviewed relevant literature and authors' own experience to provide a perspective of the updated protocol for the classification of malnutrition among the children in the Rohingya camps and its implication from a broader perspective. SETTING: Rohingya refugee camps, Bangladesh. PARTICIPANTS: Children aged less than five years residing in the Rohingya camps. RESULTS: Major adaptation during this COVID-19 was the discontinuation of using weight-for-height z-score (WHZ) and the use of only mid upper arm circumference (MUAC) and presence of oedema for admission, follow-up and discharge of malnourished children in the camps. However, evidence suggests that use of MUAC only can underestimate the prevalence of malnutrition among the children in Rohingya camps. These apparently non-malnourished children are devoid of the rations that they would otherwise receive if classified as malnourished, making them susceptible to more severe malnutrition. CONCLUSIONS: Our analysis suggests that policymakers should consider using the original protocol of using both MUAC and WHZ to classify malnutrition and retain the guided ration size. We also believe that it would not take an extra effort to adopt the original guideline as even with MUAC only guideline, certain health measures needed to adopt during this pandemic.