COVID-19 preventive measures in Rohingya refugee camps: An assessment of knowledge, attitude and practice.

BACKGROUND: Although many studies were conducted on COVID-19 knowledge, attitude, and practice (KAP) among the general population in many countries, very little is known about refugees, particularly Rohingya refugees in Cox's Bazar. A vast array of risk communication and community engagement (RCCE) interventions were implemented in Cox's Bazar with the intent of reducing disease transmission by empowering the community to adopt public health measures. OBJECTIVES: The study aimed to assess the level of knowledge, attitude and practice (KAP) of COVID-19 preventive measures among the Rohingya refugees in Cox's Bazar, and to identify their socio-demographic determinants. MATERIALS AND METHODS: A cross-sectional study was conducted with 500 Rohingya individuals. Participants in the study were Rohingya refugees residing in five randomly selected camps where International Organization for Migration (IOM) Health was operating. Using a structured questionnaire, skilled community health workers surveyed the Rohingya population. In addition to the survey on knowledge, attitude, and practice, the study gathered information on the perspectives and relevance of sociodemographic factors that influence KAP. RESULTS: The study findings indicate that the mean scores for knowledge, attitude, and practice were 9.93, 7.55, and 2.71 respectively. Association was found between knowledge and practice level and age group-the elderly age group (>/ = 61 years) had less level of knowledge (AOR 0.42, P value = 0.058) and the late mid-age group (46-60 years) had better practice level (AOR 2.67, P value <0.001). CONCLUSIONS: Our study found that the Rohingya refugee community in Cox's Bazar has improved knowledge and attitude toward COVID-19 preventive measures. However, the practice level of these measures remains low compared to the knowledge and positive attitude. The reason behind the poor practice of preventive measures needs to be identified and addressed engaging the community in similar future outbreaks.

The assessment of geriatric malnutrition, geriatric depression and associated co-morbidities among forcibly displaced Myanmar nationals in Bangladesh.

OBJECTIVE: To assess the nutritional status and depression of the elderly forcibly displaced Myanmar nationals (FDMN) in Bangladesh and determine the associated factors of geriatric depression (GD). DESIGN: This was a community-based, cross-sectional study among elderly FDMN. The Mini Nutritional Assessment Short-Form (MNA@-SF) and Geriatric Depression Scale Short-Form (GDS-15 SF) were used to determine malnutrition and GD, respectively. SETTING: The study was conducted between November 2021 and March 2022 in Kutupalong Refugee Camp, Cox's Bazar, Bangladesh. PARTICIPANTS: The study participants were elderly FDMN aged ≥ 60 years (n 430). RESULTS: The mean age and BMI were 71·7(±7·8) years and 21·94(±2·6) kg/m2, respectively. There was a high prevalence of self-reported diabetes mellitus (32·1 %), hypertension (26·7 %), hypotension (20 %), skin diseases (28·4 %) and chronic obstructive pulmonary disease (16·5 %). The prevalence of malnutrition was 25·3 %, and another 29·1 % were at risk. The prevalence of GD was 57·9 %, and co-occurrences of GD and malnutrition were seen in 17·5 % of participants. GD was significantly higher among elderly people with malnutrition (adjusted OR, AOR = 1·71, 95 % CI: 1·01, 2·89). FDMN aged ≥ 80 years were at higher risk of GD (AOR = 1·84, 95 % CI: 1·01, 3·37), and having fewer than five members in the household was an independent predictor of GD. Diabetes mellitus (AOR = 1·95, 95 % CI: 1·24, 3·08) and hypotension (AOR = 2·17, 95 % CI: 1·25, 2·78) were also significantly associated with an increased risk of GD. CONCLUSION: A high prevalence of GD and malnutrition was observed among elderly FDMN in Bangladesh. The agencies working in Cox's Bazar should focus on geriatric malnutrition and GD for the improvement of the health situation of FDMN in Bangladesh.

Understanding the challenges and gaps in community engagement interventions for COVID-19 prevention strategies in Rohingya refugees: a qualitative study with frontline workers and community representatives.

Background: Rohingya refugees in Bangladesh are vulnerable to infectious diseases such as COVID-19 due to the crowded living conditions with fragile shelters, and limited water, sanitation and hygiene facilities and practices. While risk communication and community engagement (RCCE) is the cornerstone of outbreak control, there is limited evidence available on the effectiveness of the RCCE strategies in this setting. Objectives: The goal of this study is to evaluate the effectiveness of RCCE strategies and to explore the challenges and community recommendations in relation to COVID-19 preventive measures in the context of Rohingya refugee camps in Bangladesh. Materials and methods: It was a qualitative study. Methods used were (a) observation of RCCE intervention by 3 clinical supervisors accompanying 25 Community Health Workers (CHWs) and (b) 5 focus group discussions engaging 60 community representatives. Data were analyzed using a thematic analysis approach, separately for observation and focus group discussions. Results: The study identified a number of good practices of RCCE, including selecting CHWs from the local community, engaging female CHWs, using local dialect, and collaborating with community/religious leaders. Certain good practices need scaling up, such as utilization of multiple communication methods and interpersonal communication skills. Some areas need improvement, such as CHWs being overburdened with multiple tasks, less effort to active listening, repeated delivery of same messages, inadequate linkage to culture, context, and resources, and less effort to empower the community. Engaging the community, five critical themes were identified in relation to poor COVID-19 preventive practices: culture, religion, and language; local context and resources; community trust and interaction with aid workers; communication methods; and gender and social inclusion. Religious misinterpretation, cultural barriers, physical barriers, lack of resources, breach of trust between the community and aid workers, inconsistent/complex messages, lack of gender and social inclusion, and stigmatization are among some key factors. Some key actions were recommended to improve COVID-19 RCCE strategy. Conclusion: We urge the RCCE partners to make use of the findings and recommendations to develop a robust RCCE strategy relevant to local culture and context, responsive to people's concerns and needs, and inclusive of gender, age and social vulnerabilities.

Availability and use of technology for e-learning: to what extent do these impact Bangladeshi university students? A cross-sectional study.

Background: E-learning is making education globally and conveniently attainable with the deliverance of advanced technology. However, this mode of academia is still not commonly practiced locally. Thus, the study aimed to investigate technological availability, usability, and association to university students' perceived stress due to e-learning curriculum. Methods: A cross-sectional study commenced among Bangladeshi university students enrolled in the e-learning curriculum. A total of 1162 university students were included. The main explanatory variables were related to the availability of technology and the use of technology. The outcome variable was perceived e-learning stress. In statistical analysis, p-value < 0.05 was considered statistically significant with a 95% confidence interval. Results: In this study, lack of technological availability and usability were associated with higher level of perceived e-learning stress. Being female, living in rural areas, and outside of Dhaka division were found the associated factors in the lack of technological availability and usability. Conclusions: A significant association between the availability and usability of technology with perceived e-learning stress was observed. Thus, measures should be taken to initialize e-learning adaptivity by increasing technological growth across the nation, considering educational preparedness for future catastrophes.