The Impact of COVID-19 on Healthcare Services in Bangladesh: A Qualitative Study on Healthcare Providers'Perspectives.

Objectives: The objective of this study was to explore healthcare providers' experiences in managing the coronavirus disease 2019 (COVID-19) pandemic and its impact on healthcare services. Methods: A qualitative study was conducted with 34 healthcare professionals across 15 districts in Bangladesh. Among the participants, 24 were health managers or administrators stationed at the district or upazila (sub-district) level, and 10 were clinicians providing care to patients with COVID-19. The telephone interviews were conducted in Bangla, audio-recorded, transcribed, and then translated into English. Data were analyzed thematically. Results: Most interviewees identified a range of issues within the health system. These included unpreparedness, challenges in segregating COVID-19 patients, maintaining isolation and home quarantine, a scarcity of intensive care unit (ICU) beds, and ensuring continuity of service for non-COVID-19 patients. The limited availability of personal protective equipment, a shortage of human resources, and logistical challenges, such as obtaining COVID-19 tests, were frequently cited as barriers to managing the pandemic. Additionally, changes in the behavior of health service seekers, particularly increased aggression, were reported. The primary motivating factor for healthcare providers was the willingness to continue providing health services, rather than financial incentives. Conclusions: The COVID-19 pandemic presented a unique set of challenges for health systems, while also providing valuable lessons in managing a public health crisis. To effectively address future health crises, it is crucial to resolve a myriad of issues within the health system, including the inequitable distribution of human resources and logistical challenges.

Understanding the impact of COVID-19 on the informal sector workers in Bangladesh.

The COVID-19 pandemic put dents on every sector of the affected countries, and the informal sector was no exception. This study is based on the quantitative analyses of the primary data of 1,867 informal workers of Bangladesh to shed light on the impact of the pandemic-induced economic crisis on this working class. The survey was conducted between 8 July and 13 August 2020 across the eight administrative divisions of the country. Analysis points out that about ninety percent of these workers faced an income and food expenditure drop during the lockdown. The effect was higher in males, particularly among the urban-centric and educated males engaged in services and sales. The findings suggest that policy support is needed for the informal workers to face such a crisis.

Health, illness and healthcare-seeking behaviour of the street dwellers of Dhaka City, Bangladesh: qualitative exploratory study.

OBJECTIVE: This study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention. DESIGN: A qualitative exploratory study of a sample of street dwellers of Dhaka City. SETTING: Samples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population. PARTICIPANTS: Fifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January-June 2019 to elicit necessary data. PRIMARY OUTCOME MEASURES: Qualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems. RESULTS: We focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost. CONCLUSIONS: The street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.

Maternal nutrition intervention and maternal complications in 4 districts of Bangladesh: A nested cross-sectional study.

BACKGROUND: Maternal morbidity is common in Bangladesh, where the maternal mortality rate has plateaued over the last 6 years. Maternal undernutrition and micronutrient deficiencies contribute to morbidity, but few interventions have measured maternal outcomes. We compared reported prevalence of antepartum, intrapartum, and postpartum complications among recently delivered women between maternal nutrition intervention and control areas in Bangladesh. METHODS AND FINDINGS: We conducted a cross-sectional assessment nested within a population-based cluster-randomized trial comparing a nutrition counseling and micronutrient supplement intervention integrated within a structured home-based maternal, newborn, and child health (MNCH) program to the MNCH program alone in 10 sub-districts each across 4 Bangladesh districts. Eligible consenting women, delivering within 42-60 days of enrollment and identified by community-level health workers, completed an interviewer-administered questionnaire detailing the index pregnancy and delivery and allowed review of their home-based care register. We compared pooled and specific reported antepartum, intrapartum, and postpartum complications between study groups using hierarchical logistic regression. There were 594 women in the intervention group and 506 in the control group; overall, mean age was 24 years, 31% were primiparas, and 39% reported facility-based delivery, with no significant difference by study group. There were no significant differences between the intervention and control groups in household-level characteristics, including reported mean monthly income (intervention, 6,552 taka, versus control, 6,017 taka; p = 0.48), having electricity (69.6% versus 71.4%, p = 0.84), and television ownership (41.1% versus 38.7%, p = 0.81). Women in the intervention group had higher recorded iron and folic acid and calcium supplement consumption and mean dietary diversity scores, but reported anemia rates were similar between the 2 groups (5.7%, intervention; 6.5%, control; p = 0.83). Reported antepartum (69.4%, intervention; 79.2%, control; p = 0.12) and intrapartum (41.4%, intervention; 48.5%, control; p = 0.18) complication rates were high and not significantly different between groups. Reported postpartum complications were significantly lower among women in the intervention group than the control group (33.5% versus 48.2%, p = 0.02), and this difference persisted in adjusted analysis (adjusted odds ratio [AOR] = 0.51, 95% CI 0.32-0.82; p < 0.001). For specific conditions, odds of retained placenta (AOR = 0.35, 95% CI 0.19-0.67; p = 0.001), postpartum bleeding (AOR = 0.37, 95% CI 0.15-0.92; p = 0.033), and postpartum fever/infection (AOR = 0.27, 95% CI 0.11-0.65; p = 0.001) were significantly lower in the intervention group in adjusted analysis. There were no significant differences in reported hospitalization for antepartum (49.8% versus 45.1%, p = 0.37), intrapartum (69.9% versus 59.8%, p = 0.18), or postpartum (36.1% versus 29.9%, p = 0.49) complications between the intervention and control groups. The main limitations of this study are outcome measures based on participant report, non-probabilistic selection of community-level workers' catchment areas for sampling, some missing data for variables derived from secondary sources (e.g., dietary diversity score), and possible recall bias for reported dietary intake and supplement use. CONCLUSIONS: Reported overall postpartum and specific intrapartum and postpartum complications were significantly lower for women in intervention areas than control areas, despite similar rates of facility-based delivery and hospitalization for reported complications, in this exploratory analysis. Maternal nutrition interventions providing intensive counseling and micronutrient supplements may reduce some pregnancy complications or impact women's ability to accurately recognize complications, but more rigorous evaluation is needed for these outcomes.

The impact of frying aerosol on human brain activity.

Knowledge on the impact of the exposure to indoor ultrafine particles (UFPs) on the human brain is restricted. Twelve non-atopic, non-smoking, and healthy adults (10 female and 7 male, in average 22 years old) were monitored for brain physiological responses via electroencephalographs (EEGs) during cooking. Frying ground beef meat in sunflower oil using electric stove without ventilation was conducted. UFPs, particulate matter (PM) (PM1, PM2.5, PM4, PM10), CO2, indoor temperature, RH, oil and meat temperatures were monitored continuously throughout the experiments. The UFP peak concentration was recorded to be approximately 2.0 × 105 particles/cm3. EEGs were recorded before exposure, at end of cooking when PM peak concentrations were observed, and 30 min after the end of the cooking session (post-exposure). Brain electrical activity statistically significantly changed during post-exposure compared to the before exposure, suggesting the translocation of UFPs to the brain, occurring solely in the frontal and temporal lobes of the brain. Study participants older than 25 were more susceptible to UFPs compared to those younger than 25. Also, the brain abnormality was mainly driven by male rather than female study participants. The brain slow-wave band (delta) decreased while the fast-wave band (Beta3) increased similar to the pattern found in the literature for the exposure to smoking fumes and diesel exhaust.

A simple and rapid pre-confirmation method to distinguish endogenous human haemoglobin from synthetic haemoglobin-based oxygen carriers in doping control.

A specific, sensitive and rapid analytical procedure based on capillary electrophoresis with UV/Vis detection at 405 and 415 nm was developed and validated to detect human haemoglobin and haemoglobin-based oxygen carriers (Hemopure®, Oxyglobin® and Polyheme®) in blood samples collected for doping control. The electrophoretic separation, based on capillary dynamic coating, was achieved in less than 10 min. The effects of capillary temperature, injection conditions and initial ramping were investigated. The optimum separation voltage was 25 kV with a capillary temperature of 20 °C, initial ramping of 1 kV/s and an injection pressure of 0.5 psi for 10 s. The removal of haptoglobin using anti-human haptoglobin antibody prior to the analysis was mandatory to increase the specificity of the analysis. Sufficient resolution between endogenous haemoglobin variants and the three haemoglobin-based oxygen carriers here investigated was obtained, thus allowing discrimination between a normal haemolysed sample and a sample in which Oxyglobin®, Hemopure® or Polyheme® is present. Good repeatability of migration times (CV% less than 1), peak resolution and adequate sensitivity (limit of detection: 2.5 mg/mL) was obtained.