Epidemiology of non-fatal burn injuries in children: evidence from Bangladesh Health and Injury Survey 2016.

BACKGROUND: Burn is a major cause of childhood injury-related morbidity and mortality. Global estimates suggest that 90% of all cases occur in low-income and middle-income countries and over half of the disability-adjusted life-years are lost from fire-related burns in children. In Bangladesh, there is a scarcity of data on childhood burn injuries. The goal of the study was to describe the epidemiology of non-fatal burns in Bangladeshi children, including incidence estimates and identify high-risk groups. METHODS: Bangladesh Health and Injury Survey 2016 was a large scale cross-sectional survey. The survey was conducted among 299 216 population utilising a multistage cluster sampling method. Among the 100 842 children, there were 437 non-fatal burn cases. RESULTS: Among different injury mechanisms in children, burn was ranked fifth (7.4%). The overall yearly incidence rate (IR) of burns was 866.7 per 100 000 children (95% CI 785.6 to 947.8) in Bangladesh. The incidence was highest among 1-4 years old children (IR 2028.3, 95% CI 1761.1 to 2334.7) and had a 3.5 times higher risk of burns compared with the 15-17 years age group. Females had a much higher IR of non-fatal burns than males between the ages of 10-15 years (1655.2 vs 482.2). About 70% of burns occurred in rural areas. Hot liquid (44.7%), flames (32.5%) and hot objects (20.7%) were identified as the main causes of burns. The kitchen (60.9%), yards (20.8%) and bedroom and living room (10.5%) were the three most common places for burns. According to the study, 34.8% of burn incidences occurred between the hours of 7:00 and 10:00. CONCLUSION: Children in Bangladesh suffer from a high rate of non-fatal burns. The high-risk category was identified as preschool-aged boys and adolescent girls. The majority of the incidents occurred in the morning and inside the kitchen. These findings will help raise awareness and create intervention measures to reduce the high incidence of non-fatal childhood burns in Bangladesh.

Disability-friendly healthcare at public health facilities in Bangladesh: a mixed-method study to explore the existing situation.

BACKGROUND: Several strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the country's total population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities. This study aimed to explore the disability-friendliness of healthcare facilities, and the challenges of people with disabilities in terms of access to 1) information and communication, 2) access to infrastructure, and 3) providers' capacity in Bangladesh. METHODS: An explanatory sequential mixed-method study was conducted, including a cross-sectional survey of healthcare facilities, followed by structured-interview with people with disabilities and healthcare managers, and qualitative interviews among people with disabilities or their caregivers, healthcare providers (HCPs), policymakers, and community leaders. Data were collected from 150 public healthcare (primary-to-tertiary) facilities and from 300 people with disabilities in 16 districts across Bangladesh between January-December 2019. An observational checklist and structured questionnaires were used to assess the situation of healthcare facilities, and literature-guided guidelines were used for qualitative interviews. During analysis, the disability-friendliness of healthcare facilities were quantified through a scoring system, and thematic analysis of qualitative data was performed to identify the challenges of implementing disability-friendly healthcare (DFHC). RESULTS: The score for providing DFHC was low across all the four objectives in the healthcare facilities. The highest score (mean percentage) was observed in the infrastructure domain: 29.3 ± 20.5, followed by communication: 18.2 ± 4.8, and information: 14.6 ± 6.22, and the lowest (0.93 ± 7.1) score was for capacity of the HCPs to provide DFHC. Mean percentage scores for access to 13 infrastructure points were low, and extremely low scores were found in areas such as access to elevators (5.6 ± 5.0), ticket counters (7.3 ± 17.7) and toilets (10.6 ± 9.3). Furthermore, about 59.1% of people with disabilities expressed dissatisfaction regarding access to information and communication. The majority (98.2%) recommended that training of HCPs can improve the situation. CONCLUSION: This study revealed that most of the public health facilities in Bangladesh were not disability-friendly. Findings can inform development of a national disability-friendly policy with implementation guidelines.

Assessing service availability and readiness of healthcare facilities to manage diabetes mellitus in Bangladesh: Findings from a nationwide survey.

INTRODUCTION: Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) standard tool. METHODS: This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as 'ready' to manage diabetes at each facility level. RESULTS: The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level. CONCLUSIONS: The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.

Impact and variability of social determinants of health on the transmission and outcomes of COVID-19 across the world: a systematic review protocol.

INTRODUCTION: The COVID-19 pandemic has exacerbated health inequalities across the globe, disproportionately affecting those with poor social determinants of health (SDOHs). It is imperative to understand how SDOH influences the transmission and outcomes (positive case, hospitalisation and mortality) of COVID-19. This systematic review will investigate the impact of a wide range of SDOHs across the globe on the transmission and outcomes of COVID-19. METHODS AND ANALYSIS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. We will search three electronic bibliographical databases (MEDLINE via PubMed, Embase and Scopus), as well as the WHO COVID-19 Global Research on Coronavirus Disease database. We will consider observational studies that report statistical relationships between the SDOHs (as listed in PROGRESS-Plus and Healthy People 2020) and COVID-19 transmission and outcomes. There will be no limitation on the geographical location of publications. The quality of included observational studies will be assessed using a modified version of the Newcastle-Ottawa Scale. A narrative synthesis without meta-analysis reporting standards will be used to report the review findings. ETHICS AND DISSEMINATION: This review will be based on published studies obtained from publicly available sources, and therefore, ethical approval is not required. We will publish the results of this review in a peer-reviewed journal, as well as present the study findings at a national conference. PROSPERO REGISTRATION NUMBER: CRD42021228818.

Challenges in Preventive Practices and Risk Communication towards COVID-19: A Cross-Sectional Study in Bangladesh.

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. A cross-sectional survey was conducted between December 2020 and January 2021 involving 1382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate handwashing and sanitation facilities (17.6%), and negative influences on family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01, 1.7), rural residents (OR = 1.5, 95% CI = 1.2, 2), respondents with a low level of education: no schooling vs. ≥higher secondary (OR = 3.5, 95% CI = 2.3, 5.2), primary vs. ≥higher secondary (OR = 2.5, 95% CI = 1.7, 3.8), respondents engaged in agricultural (OR = 1.7, 95% CI = 1.2, 2.4), laboring (OR = 3.2, 95% CI = 2, 5), and domestic works (OR = 1.6, 95% CI = 1.07, 2.5), and people with disabilities (OR = 1.7, 95% CI = 1.1, 2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents' education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. A substantial percentage of Bangladeshi adults have difficulty practising COVID-19 protective behaviours and have poor comprehension of risk communications, particularly in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

COVID-19 Transmission due to Mass Mobility Before and After the Largest Festival in Bangladesh: An Epidemiologic Study.

Festivals traditionally result in mass public mobility from large cities to rural or semi-urban areas in low- and middle-Income Countries (LMIC), which are inadequately prepared for tackling the consequences of the COVID-19 pandemic. This study aimed to explore the trend of COVID-19 infection in a peripheral region of Bangladesh during one of the largest festivals to develop an evidence-based hypothesis for its influence on the transmission rate of COVID-19. This study conducted a quantitative analysis of secondary data on COVID-19 collected from the Directorate General of Health Services Bangladesh (DGHS) and divisional director's office in the Mymensingh division. To explore the influence of one of the biggest festivals (Eid-ul-Adha) on the trend of COVID-19 infection, we analyzed data from a week before the festival to 2 weeks following the festival. The infection rate (positive cases per million of the population) and the test positivity rate (positive cases among the total number of conducted diagnostic tests) of each day during this period were calculated both for the Mymensingh region and national level. Both the test positivity rate (TPR) and infection rates in the Mymensingh region demonstrated an increasing trend. The mean test positivity rate of the Mymensingh region on the week before the festival was 9.5%. It increased to a mean test positivity rate of 13% in the following week and further rose to a rate of 17% in the next week. The infection rate of Mymensingh also increased more than 2 folds from the day of the festival (2.0-5.3 cases per million) within the next 2 weeks. The TPR and infection rate on the national level remained similar throughout the study period. Mass mobility during Eid-ul-Adha influences the increased transmission of COVID-19 among the peripheral regions of Bangladesh from the central capital city Dhaka. The findings will help policymakers plan and implement travel restrictions during festivals during the pandemic in LMICs.

Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage.

BACKGROUND: Although the approved COVID-19 vaccine has been shown to be safe and effective, mass vaccination in Bangladeshi people remains a challenge. As a vaccination effort, the study provided an empirical evidence on willingness to vaccinate by sociodemographic, clinical and regional differences in Bangladeshi adults. METHODS: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on hesitancy and reluctance of vaccination for COVID-19. RESULTS: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a fee, while 8.5% were reluctant to vaccinate. With a minimum fee, 46.5% of the respondents showed intent to vaccinate. Among the respondents, 16.8% reported adequate adherence to health safety regulations, and 35.5% reported high confidence in the country's healthcare system. The COVID-19 vaccine refusal was significantly high in elderly, rural, semi-urban, and slum communities, farmers, day-laborers, homemakers, low-educated group, and those who had low confidence in the country's healthcare system. Also, the prevalence of vaccine hesitancy was high in the elderly population, low-educated group, day-laborers, people with chronic diseases, and people with low confidence in the country's healthcare system. CONCLUSION: A high prevalence of vaccine refusal and hesitancy was observed in rural people and slum dwellers in Bangladesh. The rural community and slum dwellers had a low literacy level, low adherence to health safety regulations and low confidence in healthcare system. The ongoing app-based registration for vaccination increased hesitancy and reluctancy in low-educated group. For rural, semi-urban, and slum people, outreach centers for vaccination can be established to ensure the vaccine's nearby availability and limit associated travel costs. In rural areas, community health workers, valued community-leaders, and non-governmental organizations can be utilized to motivate and educate people for vaccination against COVID-19. Further, emphasis should be given to the elderly and diseased people with tailored health messages and assurance from healthcare professionals. The media may play a responsible role with the vaccine education program and eliminate the social stigma about the vaccination. Finally, vaccination should be continued without a fee and thus Bangladesh's COVID vaccination program can become a model for other low and middle-income countries.

Health and wellbeing of indigenous older adults living in the tea gardens of Bangladesh.

BACKGROUND: There are currently 1.5 million indigenous people in Bangladesh, constituting 1.8% of the total population and representing one of the country's most deprived communities. This study explores the health status and quality of life along with their determinants among indigenous older people in Bangladesh in order to fill the knowledge and evidence gap on this topic. METHODS: A mixed-methods approach was deployed in October 2019 in the Sylhet division of Bangladesh which involved a cross-sectional survey among 400 indigenous older adults (200 males, 200 females) from 8 tea gardens using a pre-tested semi-structured questionnaire. Ten in-depth interviews were also conducted with providers of the tea garden health facilities. Descriptive analysis, multiple logistic and multi-nominal linear regression were performed to explore associated factors around health and quality of life. RESULTS: Of the total respondents, the majority (79.5%) had chronic diseases, with visual difficulty being predominant (74%) among the conditions. Almost all (94%) of the respondents experienced delays in receiving treatment and poverty was identified by most (85%) as the primary cause of those delays. Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having a chronic condition and extreme age were found to be significantly associated with a low quality of life. Health service providers identified lack of logistical support in the health facilities, the economic crisis and lack of awareness as the major causes of poor health status and poor health seeking behaviour of the indigenous older adults. CONCLUSION: Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them.