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Sujon H, Sarker MHR, Uddin A, Banu S, Islam MR, Amin MR, Hossain MS, Alahi MF, Asaduzzaman M, Rizvi SJR, Islam MZ, Uzzaman MN. Beyond the regulatory radar: knowledge and practices of rural medical practitioners in Bangladesh. BMC Health Serv Res 2023; 23:1322. [PMID: 38037022 PMCID: PMC10688090 DOI: 10.1186/s12913-023-10317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Informal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service. METHODS We conducted a cross-sectional study in 2015-16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline. RESULTS We invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together. CONCLUSIONS Inappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.
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Affiliation(s)
- Hasnat Sujon
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Public Health Foundation of Bangladesh, Dhaka, Bangladesh
- faith Bangladesh, Dhaka, Bangladesh
| | - Shakila Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Rafiqul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Ruhul Amin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Translational Biology, Medicine, and Health Graduate Programme, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Md Shabab Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Fazle Alahi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Asaduzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mohammad Zahirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- The University of Queensland, Brisbane, Australia
| | - Md Nazim Uzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Sarker MHR, Das SK, Sujon H, Moriyama M, Rahman MM, Uzzaman MN, Banu S, Shahid ASMSB, Das J, Khan SH, Chisti MJ, Faruque ASG, Ahmed T. Changing Water-Sanitation Determinants of Cholera over Two Decades in Bangladesh. Am J Trop Med Hyg 2023; 109:368-375. [PMID: 37277103 PMCID: PMC10397457 DOI: 10.4269/ajtmh.22-0575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/10/2023] [Indexed: 06/07/2023] Open
Abstract
Cholera is a leading global public health threat, especially in developing countries. This study aimed to determine the changing determinants of cholera related to water-sanitation practices between 1994-1998 and 2014-2018 in Dhaka, Bangladesh. Data of all cause diarrhea cases were extracted from the Diarrheal Disease Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, and analysis was performed among three groups: Vibrio cholerae detected as sole pathogen, V. cholerae detected as mixed infection, and detection of no common enteropathogen in stool specimens (reference). Using sanitary toilet, drinking tap water, drinking boiled water, family size greater than five, and slum dwelling were the main exposures. Overall, 3,380 (20.30%) and 1,290 (9.69%) patients were positive for V. cholerae during 1994-1998 and 2014-2018, respectively. In 1994-1998, use of sanitary toilet (adjusted odds ratio [aOR]: 0.86, 95% CI: 0.76-0.97) and drinking tap water (aOR: 0.81, 95% CI: 0.72-0.92) were found to be negatively associated and in 2014-2018, drinking tap water (aOR: 1.47, 95% CI: 1.21-1.78) and slum dwelling (aOR: 1.43, 95% CI: 1.10-1.86) were found to be positively associated with V. cholerae infection after adjusting for age, sex, monthly income, and seasonality. Because the determinants of cholera such as drinking tap water can change over time in developing cities, ameliorating the water, sanitation, and hygiene (WASH) situation is of paramount importance. In addition, in settings such as urban slums, where long-term WASH monitoring might be difficult to achieve, mass vaccination with oral cholera vaccine should be introduced to control cholera.
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Affiliation(s)
| | - Sumon Kumar Das
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Hasnat Sujon
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Infectious Disease and One Health Program, Hannover Medical School, Hannover, Germany
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md. Nazim Uzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Shakila Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abu SMSB Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jui Das
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Soroar Hossain Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - ASG Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Uzzaman MN, Hammersley V, McClatchey K, Sheringham J, Habib GMM, Pinnock H. Asynchronous digital health interventions for reviewing asthma: A mixed-methods systematic review protocol. PLoS One 2023; 18:e0281538. [PMID: 36758039 PMCID: PMC9910732 DOI: 10.1371/journal.pone.0281538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION People living with asthma require regular reviews to address their concerns and questions, assess control, review medication, and support self-management. However, practical barriers to attending face-to-face consultations might limit routine reviews. Reviewing asthma using asynchronous digital health interventions could be convenient for patients and an efficient way of maintaining communication between patients and healthcare professionals and improving health outcomes. We, therefore, aim to conduct a mixed-methods systematic review to assess the effectiveness of reviewing asthma by asynchronous digital health interventions and explore the views of patients and healthcare professionals about the role of such interventions in delivering asthma care. METHODS We will search MEDLINE, Embase, Scopus, PsycInfo, CINAHL, and Cochrane Library from 2001 to present without imposing any language restrictions. We are interested in studies of asynchronous digital health interventions used either as a single intervention or contributing to mixed modes of review. Two review authors will independently screen titles and abstracts, and retrieve potentially relevant studies for full assessment against the eligibility criteria and extract data. Disagreements will be resolved by discussion with the review team. We will use 'Downs and Black' checklist, 'Critical Appraisal Skills Programme', and 'Mixed Methods Appraisal Tool' to assess methodological quality of quantitative, qualitative, and mixed-methods studies respectively. After synthesising quantitative (narrative synthesis) and qualitative (thematic synthesis) data separately, we will integrate them following methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions. CONCLUSION The findings of this review will provide insights into the role of asynchronous digital health interventions in the routine care of people living with asthma. TRIAL REGISTRATION Systematic review registration: PROSPERO registration number: CRD42022344224.
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Affiliation(s)
- Md. Nazim Uzzaman
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Vicky Hammersley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jessica Sheringham
- Institute of Epidemiology & Health, University College London, London, England, United Kingdom
| | - G. M. Monsur Habib
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
- * E-mail:
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Uzzaman MN, Agarwal D, Chan SC, Patrick Engkasan J, Habib GMM, Hanafi NS, Jackson T, Jebaraj P, Khoo EM, Mirza FT, Pinnock H, Shunmugam RH, Rabinovich RA. Effectiveness of home-based pulmonary rehabilitation: systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/165/220076. [PMID: 36130789 DOI: 10.1183/16000617.0076-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/14/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Despite proven effectiveness for people with chronic respiratory diseases, practical barriers to attending centre-based pulmonary rehabilitation (centre-PR) limit accessibility. We aimed to review the clinical effectiveness, components and completion rates of home-based pulmonary rehabilitation (home-PR) compared to centre-PR or usual care. METHODS AND ANALYSIS Using Cochrane methodology, we searched (January 1990 to August 2021) six electronic databases using a PICOS (population, intervention, comparison, outcome, study type) search strategy, assessed Cochrane risk of bias, performed meta-analysis and narrative synthesis to answer our objectives and used the Grading of Recommendations, Assessment, Development and Evaluations framework to rate certainty of evidence. RESULTS We identified 16 studies (1800 COPD patients; 11 countries). The effects of home-PR on exercise capacity and/or health-related quality of life (HRQoL) were compared to either centre-PR (n=7) or usual care (n=8); one study used both comparators. Compared to usual care, home-PR significantly improved exercise capacity (standardised mean difference (SMD) 0.88, 95% CI 0.32-1.44; p=0.002) and HRQoL (SMD -0.62, 95% CI -0.88--0.36; p<0.001). Compared to centre-PR, home-PR showed no significant difference in exercise capacity (SMD -0.10, 95% CI -0.25-0.05; p=0.21) or HRQoL (SMD 0.01, 95% CI -0.15-0.17; p=0.87). CONCLUSION Home-PR is as effective as centre-PR in improving functional exercise capacity and quality of life compared to usual care, and is an option to enable access to pulmonary rehabilitation.
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Affiliation(s)
- Md Nazim Uzzaman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
| | - Dhiraj Agarwal
- Vadu Rural Health Program, KEM Hospital and Research centre, Pune, India
| | - Soo Chin Chan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - G M Monsur Habib
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
| | - Paul Jebaraj
- Rural Unit for Health and Social Affairs, Christian Medical College, Vellore, India
| | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), The University of Edinburgh, Edinburgh, UK
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Sujon H, Uzzaman MN, Banu S, Islam MR, Asaduzzaman M, Ahmed A, Uddin A, Sarker MHR. Professional Development of Health Researchers During the COVID-19 Pandemic: Challenges and Prospects of Synchronous Online Learning. J Contin Educ Health Prof 2022; 42:e1-e2. [PMID: 35001044 PMCID: PMC8876413 DOI: 10.1097/ceh.0000000000000407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Sarker MHR, Moriyama M, Rahman MM, Das SK, Uzzaman MN, Das J, Uddin A, Banu S, Khan SH, Shahid ASMSB, Shahunja KM, Chisti MJ, Faruque ASG, Ahmed T. Characteristics of Rotavirus, ETEC, and Vibrio Cholerae Among Under 2-year Children Attending an Urban Diarrheal Disease Hospital in Bangladesh. J Prim Care Community Health 2021; 12:21501327211049118. [PMID: 34632833 PMCID: PMC8512248 DOI: 10.1177/21501327211049118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Information on comparative clinical and host characteristics of under-2
children with watery diarrhea caused by rotavirus, Enterotoxigenic
Escherichia coli (ETEC), and Vibrio cholerae
as single pathogens is lacking. We sought to investigate the
sociodemographic, clinical, and host characteristics of under-2 children
hospitalized due to these pathogens. Methodology We conducted a hospital-based case-control study using the icddr,b Diarrheal
Diseases Surveillance System. Children of either sex, <2 years with
diarrhea, who attended the hospital during 2014 to 2018, constituted the
study population. Stool specimens having a single pathogen like rotavirus,
ETEC, or Vibrio cholerae constituted the cases and stool
specimens having no detectable common enteropathogens comprised the
controls. Multinomial logistic regression analysis was done where control
was the reference group. Results A total of 14 889 patients were enrolled, 6939 of whom were under-2 children,
and 5245 (76%) constituted our study population. Among them 48% (n = 2532),
3% (n = 148) and 1% (n = 49) had rotavirus, ETEC, and Vibrio
cholera, respectively. A control group (diarrhea without these
3 or Shigella, Salmonella,
Aeromonas) accounted for 48% (n = 2516). In multinomial
regression model, children with rotavirus (adjusted odds ratio [aOR], 1.36;
95% confidence interval [95% CI], 1.19-1.55) less often presented with
dehydrating diarrhea compared to those with ETEC (aOR, 1.54; 95% CI,
1.05-2.26) and cholera (aOR, 2.25; 95% CI, 1.11-4.57). Rotavirus diarrhea
was associated (aOR, 1.25; 95% CI, 1.07-1.46) with those who received
antimicrobials prior to hospital admission and protectively associated with
drinking tap water (aOR, 0.84; 95% CI, 0.73-0.95); however, ETEC diarrhea
had protective association (aOR, 0.62; 95% CI, 0.43-0.92) with children who
received antimicrobials prior to hospital admission and was associated with
drinking tap water (aOR, 1.78; 95% CI, 1.19-2.66). Use of intravenous fluid
was associated with cholera (aOR, 10.36; 95% CI, 4.85-22.16) and had
protective association with rotavirus episodes (aOR, 0.64; 95% CI,
0.45-0.91). Conclusions Clinical presentations and host characteristics of rotavirus, ETEC, and
Vibrio cholerae diarrhea differed from each other and
the information may be helpful for clinicians for better understanding and
proper management of these children.
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Affiliation(s)
- Mohammad Habibur Rahman Sarker
- Hiroshima University, Hiroshima,
Japan
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | | | | | - Md Nazim Uzzaman
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Jui Das
- The University of Queensland, Brisbane,
Australia
| | - Aftab Uddin
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shakila Banu
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Soroar Hossain Khan
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Abu SMSB Shahid
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- Mohammod Jobayer Chisti, Nutrition and
Clinical Services Division (NCSD), 68, Shaheed Tajuddin Ahmed Sarani Mohakhali,
Dhaka 1212, Bangladesh.
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal
Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
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Uzzaman MN, Chan SC, Shunmugam RH, Engkasan JP, Agarwal D, Habib GMM, Hanafi NS, Jackson T, Jebaraj P, Khoo EM, Liew SM, Mirza FT, Pinnock H, Rabinovich RA. Clinical effectiveness and components of Home-pulmonary rehabilitation for people with chronic respiratory diseases: a systematic review protocol. BMJ Open 2021; 11:e050362. [PMID: 34642195 PMCID: PMC8513265 DOI: 10.1136/bmjopen-2021-050362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Chronic respiratory diseases (CRDs) are common and disabling conditions that can result in social isolation and economic hardship for patients and their families. Pulmonary rehabilitation (PR) improves functional exercise capacity and health-related quality of life (HRQoL) but practical barriers to attending centre-based sessions or the need for infection control limits accessibility. Home-PR offers a potential solution that may improve access. We aim to systematically review the clinical effectiveness, completion rates and components of Home-PR for people with CRDs compared with Centre-PR or Usual care. METHODS AND ANALYSIS We will search PubMed, CINAHL, Cochrane, EMBASE, PeDRO and PsycInfo from January 1990 to date using a PICOS search strategy (Population: adults with CRDs; Intervention: Home-PR; Comparator: Centre-PR/Usual care; Outcomes: functional exercise capacity and HRQoL; Setting: any setting). The strategy is to search for 'Chronic Respiratory Disease' AND 'Pulmonary Rehabilitation' AND 'Home-PR', and identify relevant randomised controlled trials and controlled clinical trials. Six reviewers working in pairs will independently screen articles for eligibility and extract data from those fulfilling the inclusion criteria. We will use the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate the quality of evidence. We will perform meta-analysis or narrative synthesis as appropriate to answer our three research questions: (1) what is the effectiveness of Home-PR compared with Centre-PR or Usual care? (2) what components are used in effective Home-PR studies? and (3) what is the completion rate of Home-PR compared with Centre-PR? ETHICS AND DISSEMINATION Research ethics approval is not required since the study will review only published data. The findings will be disseminated through publication in a peer-reviewed journal and presentation in conferences. PROSPERO REGISTRATION NUMBER CRD42020220137.
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Affiliation(s)
- Md Nazim Uzzaman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Soo Chin Chan
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | - G M Monsur Habib
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
- Community Respiratory Centre, Bangladesh Primary Care Respiratory Society, Khulna, Bangladesh
| | | | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Ee Ming Khoo
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Su May Liew
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Roberto A Rabinovich
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Inflammation Research, QMRI, The University of Edinburgh, Edinburgh, UK
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Habib GM, Uzzaman MN, Malik P, Rabinovich R, Uddin A, Alam SR, Williams S, Pinnock H. Engaging with stakeholders in a research programme to promote implementation of pulmonary rehabilitation in Bangladesh: Challenges and opportunities. J Glob Health 2021; 10:020384. [PMID: 33282216 PMCID: PMC7688197 DOI: 10.7189/jogh.10.020384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gm Monsur Habib
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Md Nazim Uzzaman
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Poonam Malik
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Roberto Rabinovich
- ELEGI/Colt laboratory, Centre for Inflammation Research, QMRI, University of Edinburgh, Edinburgh, UK
| | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sm Rowshan Alam
- Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh.,Rangpur Medical College, Rangpur, Bangladesh
| | - Sian Williams
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.,International Primary Care Respiratory Group (IPCRG), Edinburgh, UK
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
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Uzzaman MN, Jackson T, Uddin A, Rowa-Dewar N, Chisti MJ, Habib GMM, Pinnock H. Continuing professional education for general practitioners on chronic obstructive pulmonary disease: feasibility of a blended learning approach in Bangladesh. BMC Fam Pract 2020; 21:203. [PMID: 32988371 PMCID: PMC7521769 DOI: 10.1186/s12875-020-01270-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
Background Continuing medical education (CME) is essential to developing and maintaining high quality primary care. Traditionally, CME is delivered face-to-face, but due to geographical distances, and pressure of work in Bangladesh, general practitioners (GPs) are unable to relocate for several days to attend training. Using chronic obstructive pulmonary disease (COPD) as an exemplar, we aimed to assess the feasibility of blended learning (combination of face-to-face and online) for GPs, and explore trainees’ and trainers’ perspectives towards the blended learning approach. Methods We used a mixed-methods design. We trained 49 GPs in two groups via blended (n = 25) and traditional face-to-face approach (n = 24) and assessed their post-course knowledge and skills. The COPD Physician Practice Assessment Questionnaire (COPD-PPAQ) was administered before and one-month post-course. Verbatim transcriptions of focus group discussions with 18 course attendees and interviews with three course trainers were translated into English and analysed thematically. Results Forty GPs completed the course (Blended: 19; Traditional: 21). The knowledge and skills post course, and the improvement in self-reported adherence to COPD guidelines was similar in both groups. Most participants preferred blended learning as it was more convenient than taking time out of their busy work life, and for many the online learning optimised the benefits of the subsequent face-to-face sessions. Suggested improvements included online interactivity with tutors, improved user friendliness of the e-learning platform, and timing face-to-face classes over weekends to avoid time-out of practice. Conclusions Quality improvement requires a multifaceted approach, but adequate knowledge and skills are core components. Blended learning is feasible and, with a few caveats, is an acceptable option to GPs in Bangladesh. This is timely, given that online learning with limited face-to-face contact is likely to become the norm in the on-going COVID-19 pandemic.
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Affiliation(s)
- Md Nazim Uzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Tracy Jackson
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - G M Monsur Habib
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.,Bangladesh Primary Care Respiratory Society (BPCRS), Khulna, Bangladesh
| | - Hilary Pinnock
- NIHR Global Health Research Unit on Respiratory Health (RESPIRE), Usher Institute, University of Edinburgh, Edinburgh, UK.
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Uzzaman MN, Banu S, Habib GM, Hossain AE, Kabir MJ, Karim MR, Islam MR, Sarker MHR, Uddin MJ, Uddin A. Improving Physicians' Capacity for Chronic Obstructive Pulmonary Disease Care through Blended E-learning: A Pilot Study in Bangladesh. Cureus 2018; 10:e3808. [PMID: 30868022 PMCID: PMC6402724 DOI: 10.7759/cureus.3808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are often under diagnosed and managed without evidence-based approach in primary care settings. This may be due to gaps in knowledge and practice of using updated COPD guidelines by the physicians in public and private sectors in Bangladesh. To our knowledge, this is the first study in Bangladesh which aims to evaluate a blended e-learning approach for building capacity of physicians working at low-resource environments on COPD patient care. In total, 32 practicing physicians were enrolled where 16 received training via blended approach and 16 received training via traditional classroom-based approach. Using a standard examination procedure and assessment approach both groups were assessed and results were documented. No statistically significant differences were found in the scores of theory (knowledge) and in the total scores (theory plus practicum) of both groups indicating that learning objectives were achieved in both the groups though the scores were significantly higher in practicum of the traditional learning group. Besides, Likert-scale-based self-reported pre-post changes indicate that both the groups were confident (statistically significant) in the management of COPD. Most importantly, the blended group had a minimal disruption of their services as they attended face-to-face only during the practicum sessions. Overall, the blended e-learning appears to be a feasible approach of training for physicians on standard management of COPD especially in health human resource-poor settings in Bangladesh.
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Affiliation(s)
- Md Nazim Uzzaman
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Shakila Banu
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Gm Monsur Habib
- Internal Medicine, Bangladesh Primary Care Respiratory Society, Dhaka, USA
| | | | | | - Md Rizwanul Karim
- Epidemiology and Public Health, Directorate General of Health Services, Dhaka, BGD
| | | | | | - Md Jasim Uddin
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
| | - Aftab Uddin
- Epidemiology and Public Health, International Centre for Diarrhoeal Disease Research, Dhaka, BGD
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Zahirul Islam M, Rutherford S, Phung D, Uzzaman MN, Baum S, Huda MM, Asaduzzaman M, Talukder MRR, Chu C. Correlates of Climate Variability and Dengue Fever in Two Metropolitan Cities in Bangladesh. Cureus 2018; 10:e3398. [PMID: 30533332 PMCID: PMC6278996 DOI: 10.7759/cureus.3398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 12/02/2022] Open
Abstract
Dengue fever is a major public health concern in Bangladesh with increased incidence during monsoon. We aimed to assess the correlation of temperature, humidity, and rainfall on dengue fever in two dengue endemic cities in Bangladesh. It was a time series analysis of climate factors and dengue occurrence data in Dhaka and Chittagong cities from 1 January 2000 to 31 December 2009. Daily mean temperature, rainfall, and humidity data were obtained from the Bangladesh meteorological department and daily dengue cases data were obtained from the directorate general of health services (DGHS) of Bangladesh. The mean dengue incidence was 31.62 (SD 28.7) per 100,000 in Dhaka whereas it was 5.76 (SD 11.7) per 100,000 population in Chittagong. The incidence of dengue cases was found significantly associated with the monthly mean temperature, total rainfall, and mean humidity in Dhaka, though in Chittagong, the significantly associated factors were monthly total rainfall and mean humidity. The autoregressive integrated moving average (ARIMA) model identified monthly mean humidity and total rainfall as the most significant contributing factors for dengue cases in Dhaka and Chittagong, respectively. Our study reinforces the relationship of climate parameters with dengue fever, which will support policy-makers in developing a climate-based early warning system for dengue in Bangladesh.
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Affiliation(s)
| | | | - Dung Phung
- Epidemiology and Public Health, Griffith University, Brisbane, AUS
| | - Md Nazim Uzzaman
- Epidemiology and Public Health, International Center for Diarrhoeal Disease Research, Dhaka, BGD
| | - Scott Baum
- Miscellaneous, Griffith University, Brisbane, AUS
| | - M Mamun Huda
- Epidemiology and Public Health, University of Queensland, Brisbane, AUS
| | - Muhammad Asaduzzaman
- Epidemiology and Public Health, International Center for Diarrhoeal Disease Research, Dhaka, BGD
| | | | - Cordia Chu
- Epidemiology and Public Health, Griffith University, Brisbane, AUS
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Asaduzzaman M, Chowdhury S, Shahed JH, Kafi MAH, Uzzaman MN, Flowra MT, Ahmed MM. Prevalence of Type 2 Diabetes Mellitus Among Urban Bihari Communities in Dhaka, Bangladesh: A Cross-sectional Study in a Minor Ethnic Group. Cureus 2018; 10:e2116. [PMID: 29593946 PMCID: PMC5871323 DOI: 10.7759/cureus.2116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The prevalence, disease progression, and treatment outcomes for patients with type 2 diabetes vary significantly between ethnic groups. The Bihari community constitutes one of the most vulnerable populations in Bangladesh on the basis of access to health services and other fundamental rights. Our study aimed at finding out the prevalence and risk factors of type 2 diabetes among the Bihari adults in Dhaka city. Methods This cross-sectional community-based study was carried out among stranded Pakistanis (known as Bihari) living in camps in the Mirpur area from July 2014 to June 2015. Laboratory-based oral glucose tolerance test (OGTT) was the basis for the diagnosis of type 2 diabetes mellitus (DM). Anthropometric measurements, blood pressure, biochemical tests, family history, and socioeconomic information were obtained to determine the risk factors. Results The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were estimated at 10.11%, 8.74%, and 4.55%, respectively. Increased diastolic blood pressure, serum triglyceride, and cholesterol level were observed to be significantly (p < 0.05) associated with diabetes. Also, the presence of diabetes, high blood pressure, and obesity among relatives significantly increased the probability of diabetes. Conclusions To the best of our knowledge, this is the first study on diabetes prevalence among the Bihari community in Bangladesh. The prevalence of type 2 diabetes mellitus was found to be higher among the Bihari community compared to the general population in Bangladesh. Health planners and policymakers should realize the alarming situation and identified risk factors and consider the minor ethnic groups during decision-making regarding prevention and control of diabetes and other noncommunicable diseases.
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Affiliation(s)
- Muhammad Asaduzzaman
- Laboratory Sciences & Services Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b)
| | - Shahanaz Chowdhury
- Department of Community Health, Bangladesh University of Health Sciences,dhaka,bangladesh
| | | | | | - Md Nazim Uzzaman
- Technical Training Unit, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,B)
| | | | - Msa Mansur Ahmed
- Department of Community Medicine, Bangladesh University of Health Sciences,dhaka,bangladesh
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