Community-based intervention for managing hypertension and diabetes in rural Bangladesh.

BACKGROUND: Approximately 80% of non-communicable diseases (NCDs) have been reported in low- and middle-income countries (LMICs). However, studies on the usefulness of educational interventions run by non-healthcare workers in combating NCDs in resource-limited areas in rural parts of LMICs are limited. This study aimed to identify the effectiveness of a community-based simple educational program run by non-healthcare trained staff for several outcomes associated with NCDs in a resource-limited area. METHODS: Six villages in the Narail district in Bangladesh were selected, two each in the first and second intervention and the control groups, in the Narail district in Bangladesh were selected. Pre- and post-intervention survey data were collected. The first intervention group received the "strong" educational intervention that included a checklist poster on the wall, phone call messages, personalized advice papers, seminar videos, and face-to-face seminars. The second intervention group received a "weak" intervention that included only a checklist poster on the wall in their house. The outcome was the proportion of NCDs and changes in systolic blood pressure and blood sugar level. Confidential fixed-effects logistic regression and multiple linear regression were performed to identify the effectiveness of the intervention. RESULTS: Overall, 600 participants completed the baseline survey and the follow-up survey. The mean systolic blood pressure reduced by 7.3 mm Hg (95% confidence interval [CI] 4.6-9.9) in the first intervention group, 1.9 mm Hg (95% CI - 0.5-4.2) in the second intervention group, and 4.7 mm Hg (95% CI 2.4-7.0) in the control group. Multiple linear regression analysis showed that the between-group differences in the decline in systolic blood pressure were significant for the first intervention versus control (p = 0.001), but not for the second intervention versus control (p = 0.21). The between-group differences in the reduction in blood glucose after the intervention, were not significant on multiple linear regression analysis. CONCLUSIONS: Community-based educational interventions for NCDs provided by non-healthcare staff improved the outcomes of hypertension and risk behaviors. Well-designed community-based educational interventions should be frequently implemented to reduce NCDs in rural areas of low- and middle-income countries. Trial registration UMIN Clinical Trials Registry (UMIN-CTR; UMIN000050171) retrospectively registered on January 29, 2023.

Examination of Cluster Groups of Risk Behaviors and Beliefs Associated with Non-Communicable Diseases with Latent Class Analysis: A Cross-Sectional Study in Rural Bangladesh.

This cross-sectional observational study examined the cluster groups of risk behaviors and beliefs associated with non-communicable diseases (NCDs) and the demographic factors that influence these cluster groups. The questionnaire survey was conducted in Lohagara Upazila in Narail District, Bangladesh and included basic demographics and items associated with NCDs. The inclusion criteria for the participants in this study included those who were aged between 20 and 80 years and both sexes. The survey items were based on risk behavior, belief, and improvement behavior. To identify the several cluster groups based on NCD-related behavior and belief patterns, a log-likelihood latent class analysis was conducted. Then, a multinomial regression analysis was performed to identify the factor associated with each cluster group. Of the 600 participants, 231 (38.5%) had hypertension, 87 (14.5%) had diabetes, and 209 (34.8%) had a body mass index of 25 or more. Finally, risk behaviors and beliefs associated with NCDs were classified into three cluster groups: (1) very high-risk group (n = 58); (2) high-risk group (n = 270); and (3) moderate-risk group (n = 272). The very high-risk group was significantly associated with female gender, older age, fewer years spent in education, and the absence of daily medication compared to the moderate-risk group. Educational interventions in rural Bangladesh should be immediately implemented to improve the risk behaviors and beliefs associated with NCDs.

Maternal and child health handbook to improve continuum of maternal and child care in rural Bangladesh: Findings of a cluster randomized controlled trial.

This study aimed to evaluate the effectiveness of maternal and child health handbook (MCH) enhanced by mobile tools and to generate evidence informing the adoption of the program in Bangladesh. A cluster randomized controlled trial (RCT) has been implemented in Lohagora of Narail District and Dhamrai of Dhaka District. Unions of the study settings were randomly allocated in either one of three groups: (1) Intervention 1 using both mobile platform and MCH, (2) Intervention 2 using MCH alone, or (3) the Control. A total of 3,002 participants were recruited. The interventions were designed to promote two-way communications between pregnant women/their families and community health workers by an empowering approach. A total of 3,002 pregnant women were recruited. As the results, the interventions both significantly improved the utilization of CoC, although the overall proportion of CoC was relevantly low: 2.79% in the Control (95% CI: 1.37-3.54%), 6.16% in Intervention 2 (95% CI: 4.67-7.86%), and 7.89% in Intervention 1 (95% CI: 6.29-9.90%). Neonatal mortality rate with and without CoC was 5.43 per 1,000 (95% CI: 3.63-9.57 per 1,000) and 34.8 per 1,000 (95% CI: 24.3-45.4 per 1,000), respectively. Our study indicated the effectiveness of the interventions by leveraging MCH and a mobile platform to promote uptake of CoC throughout prepartum, intrapartum and postpartum/neonatal periods, potentially bringing long-lasting benefits to mothers and their offspring. The explicit approach is expected to guide policy makers to adopt MCH interventions in primary healthcare strengthening at the community level. Trial registration: UMIN000025628 Registered June 13, 2016.

The Increase in Frequency of Protective Behavior against Pesticide Poisoning in Narail, Bangladesh through Use of an Easy Paper Checklist; an Interventional Study.

Protecting the health of farmworkers is a crucial issue. Previous studies report that safety training and educational interventions might increase farmworkers' protective behaviors. The present study aimed to investigate the effectiveness of distributing a checklist as an interventional measure for pesticide protection in rural Asia, where pesticide poisoning is a major problem. This study was a community-based interventional study, using the distribution of a checklist with pesticide protective habits in Narail district, Bangladesh, with a total of 100 eligible males. Two questionnaire surveys were conducted before distributing the checklist and 25 days after. Change between the baseline and follow-up surveys was measured by frequency scores of protective behavior. The average pesticide-protective behavioral score increased from 4.58 in the baseline survey to 8.11 in the follow-up. Additionally, the checklist was more effective in the group with higher education, the younger group, and the group with lower pesticide-protective behavioral scores in the baseline survey. The paper checklist on protective behaviors against pesticide poisoning was effective because of the increase in the frequency of such positive behavior among farmworkers. Thus, intervention measures should be implemented to increase the knowledge and awareness regarding pesticide protection habits to protect the health of farmworkers.

Antibacterial, Anti-Diarrhoeal, Analgesic, Cytotoxic Activities, and GC-MS Profiling of Sonneratia apetala (Buch.-Ham.) Seed.

Fruits of Sonneratia apetala (Buch.-Ham.), (English: mangrove apple, Bengali: keora) both seeds and pericarps, are largely consumed as food besides their enormous medicinal application. The fruit seeds have high content of nutrients and bioactive components. The seeds powder of S. apetala was successively fractionated using n-hexane, diethyl ether, chloroform, ethyl acetate, and methanol. The fractions were used to evaluate antibacterial, anti-diarrhoeal, analgesic, and cytotoxic activities. Methanol fraction of seeds (MeS) stronly inhibited Escherichia coli strains, Salmonella Paratyphi A, Salmonella Typhi, Shigella dysenteriae, and Staphylococcus aureus except Vibrio cholerae at 500 µg/disc. All the fractions strongly inhibited castor oil induced diarrhoeal episodes and onset time in mice at 500 mg extract/kg body weight (P<0.001). At the same concentration, MeS had the strongest inhibitory activity on diarrhoeal episodes, whereas the n-hexane fraction (HS) significantly (P<0.05) prolonged diarrhoeal onset time as compared to positive control. Similarly, HS (P<0.005) inhibited acetic acid induced writhing in mice at 500 mg extract/kg, more than any other fraction. HS and diethyl ether fractions of seed strongly increased reaction time of mice in hot plate test at 500 mg extract/kg. All the fractions showed strong cytotoxic effects in brine shrimp lethality tests. Gas chromatography-mass spectrometry analysis of HS led to the identification of 23 compounds. Linoleic acid (29.9%), palmitic acid (23.2%), ascorbyl palmitate (21.2%), and stearic acid (10.5%) were the major compounds in HS. These results suggest that seeds of S. apetala could be of great use as nutraceuticals.

Bacterial contaminants in carbonated soft drinks sold in Bangladesh markets.

A total of 225 carbonated soft drink (CSD) samples from nine brands, from various locations in five metropolitan cities of Bangladesh were examined to determine their bacteriological quality. Most samples were not in compliance with microbiological standards set by organizations like the World Health Organization (WHO). Pseudomonas aeruginosa was the predominant species with an incidence of 95%. Streptococcus spp. and Bacillus stearothermophilus were the next most prevalent with numbers ranging from 6 to 122 and 9 to 105 cfu/100 ml, respectively. Fifty four percent of the samples yielded Salmonella spp. at numbers ranging from 2 to 90 cfu/100 ml. Total coliform (TC) and faecal coliform (FC) counts were found in 68-100% and 76-100% of samples of individual brands, at numbers ranging from 5 to 213 and 3 to 276 cfu/100 ml, respectively. According to WHO standards 60-88% of samples from six brands and 32% and 40% of samples from two other brands belonged to the intermediate risk group with FC counts of 100-1000 cfu/100 ml. Heterotrophic plate counts, however, were under the permissible limit in all 225 samples. These findings suggest that carbonated soft drinks commercially available in Bangladesh pose substantial risks to public health.