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Roshid MM, Rahman MM, Alam MN, Banu B, Eity KF, Shahin RR, Shaba SSE, Rahman MJ, Sarker MHR, Okamura H. Combined Effects of the Mobile Health (mHealth) Psychoeducation and Benson Relaxation Technique in Reducing the Caregiving Burden of Cancer Patients in Bangladesh: A Protocol for a Randomized Controlled Trial. Cureus 2024; 16:e55520. [PMID: 38576646 PMCID: PMC10993085 DOI: 10.7759/cureus.55520] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Chronic and noncommunicable diseases, including cancer, are a significant global public health concern. Family members or friends who serve as caregivers significantly contribute to supporting cancer patients without formal medical training. In most cases in Bangladesh, women perform caregiving activities with household responsibilities and lack adequate support from the family and healthcare systems; consequently, they face a significant burden as caregivers. This study aims to assess the effectiveness of combined mobile health (mHealth) psychoeducation and the Benson relaxation technique (BRT) on the caregiving burden among female informal caregivers of cancer patients in Bangladesh. METHODS We shall conduct a prospective, open-label, two-arm (1:1), randomized controlled trial in a hospital, focusing on the burden of informal female caregivers of cancer patients in Bangladesh. The combined intervention will be delivered to the intervention group through mHealth starting April 2024 and will span six months. Participants' data will be collected through face-to-face interviews using the Zarit Burden Interview (ZBI), the Hospital Anxiety Depression Scale, and the World Health Organization Quality of Life Bangla Short Instrument. Outcomes will be assessed at the baseline, midline, and endline. We shall employ descriptive statistics such as frequencies, percentages, means, and standard deviations. The t-test or Mann-Whitney U test will be used to compare continuous variables. Additionally, a two-way repeated-measures analysis of variance will be employed to evaluate the outcomes. RESULTS Participant enrollment began in January 2024, and recruitment is ongoing. The results of this study will be disseminated through publications and conferences. No external professional writers were involved in writing this manuscript. CONCLUSION This study addresses the gap in the assessment of combined interventions for caregiver burden in Bangladesh. These outcomes may provide valuable insights into caregivers' well-being, caregiving responsibilities, and the potential for integrated interventions to reduce the burden, especially among women. If effective, we recommend the national integration of psychoeducation and BRT using mHealth.
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Affiliation(s)
- Md Marufur Roshid
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Md Moshiur Rahman
- Department of Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Md Nazmul Alam
- Department of Oncology, Khwaja Yunus Ali Medical College and Hospital, Sirajganj, BGD
| | - Bilkis Banu
- Department of Public Health, Northern University, Dhaka, BGD
| | - Kaniz Fateema Eity
- Department of Oncology, Khwaja Yunus Ali Medical College and Hospital, Sirajganj, BGD
| | - Rafiur Rahman Shahin
- Department of Oncology, Khwaja Yunus Ali Medical College and Hospital, Sirajganj, BGD
| | - Syeda Sabrina Easmin Shaba
- Department of Public Health and Health Policy, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Md Jiaur Rahman
- Department of Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | | | - Hitoshi Okamura
- Department of Psychosocial Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Aivey SA, Rahman MM, Fukushima Y, Ahmed A, Prihanto JB, Sarker MHR, Hawlader MDH, Moriyama M. Nutritional status and prevalence of helminthic infection among primary school children in Bangladesh: A cross-sectional study. Jpn J Nurs Sci 2024; 21:e12568. [PMID: 37800657 DOI: 10.1111/jjns.12568] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/01/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Abstract
AIM Malnutrition and infectious diseases, such as helminthic infections, are widespread among primary school children, especially in low- and middle-income countries. However, there are limited studies on school health in Bangladesh, particularly in rural settings. This study aimed to explore the nutritional status and prevalence of helminthic infections in relation to associated health behavior, awareness, and knowledge regarding malnutrition and helminthic infections which were evaluated by school nurses among primary school children in Bangladesh. METHODS This was a descriptive, cross-sectional survey study with a total duration of 1 month, from September to October, 2021. This study formed part of a school nurse project as a cluster non-randomized clinical trial in Bangladesh. Selected variables from that clinical trial were analyzed and reported in the results section. The study participants were primary school children from four schools in rural Bangladesh. RESULTS In total, 604 children participated in the baseline survey and health checkups. Among them, 163 (27.0%) children were classified as malnourished according to the World Health Organization growth reference standard 2007. The prevalence of helminthic infections was 53 (8.8%). Approximately >50% of the children responded that they never/rarely practiced hygiene-related behaviors and had no awareness and knowledge regarding malnutrition and helminthic infections. However, differences between the variables were not statistically significant. CONCLUSION Children's nutritional status and prevalence of helminthic infections with related deprived health behaviors, and minimal awareness and knowledge, reinforce the importance of implementing educational interventions in the future.
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Affiliation(s)
- Sadia Alam Aivey
- 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
| | - Yasuko Fukushima
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ashir Ahmed
- Faculty of Information Science and Electrical Engineering, Kyushu University, Japan
| | - Junaidi Budi Prihanto
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Physical Education, Universitas Negeri Surabaya (State University of Surabaya), Surabaya, Indonesia
| | - Mohammad Habibur Rahman Sarker
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | | | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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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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Rahman MJ, Rahman MM, Kakehashi M, Matsuyama R, Sarker MHR, Ali M, Promitee SK, Prihanto JB, Ahmed A, Shimpuku Y. Impact of eHealth education to reduce anemia among school-going adolescent girls in rural Bangladesh: Study protocol of a randomized controlled trial. J Family Med Prim Care 2023; 12:2569-2575. [PMID: 38186809 PMCID: PMC10771192 DOI: 10.4103/jfmpc.jfmpc_1010_23] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 01/09/2024] Open
Abstract
Adolescent girls are highly vulnerable to developing anemia due to reproductive immaturity, poor personal hygiene, and lack of nutritional intake and health education in rural Bangladesh. Digital health technology is a promising tool to overcome barriers and provide appropriate health guidelines. We aim to evaluate eHealth education's impact and changes in adolescent girls' knowledge, attitude, and practice regarding anemia. A 1:1 parallel randomized control trial was conducted among school-going adolescent girls in rural Bangladesh. A total of 138 anemic (mild and moderate) participants were enrolled. We randomized schools to reduce the health education bias through a simple coin toss technique, then allocated participants to the intervention group (n = 69) and control group (n = 69) by stratified random sampling technique. The intervention group received two online counseling sessions and 8-month eHealth education through mobile phone calls and short message service regarding anemia. The control group received the usual care. The primary endpoint changes the anemic level through changing knowledge, healthy lifestyle behavior, and an iron-rich food dietary plan. Per-protocol analysis will utilize to compare the control and intervention groups using SPSS software. Descriptive statistics (frequencies, percentages, mean, SD) will be employed, and continuous variables will be compared using the t-test/Mann-Whitney test. Two-way analysis of variance will assess outcome variables at baseline, 4 months, and 8 months. The 8-month intervention is designed from May 2022 to February 2023. Participants' age range of 10-14 years was 60.9% in the intervention group and 56.5% in the control group. Among the participants, 89.9% and 88.4% were mild anemic; 11.11 (SD ± 0.80) and 11.06 (SD ± 0.96) were mean hemoglobin in the intervention and control groups, respectively. eHealth education is expected to be an effective way to increase knowledge and healthy behavioral change, which can reduce the anemia burden among adolescent girls.
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Affiliation(s)
- Md Jiaur Rahman
- Global Health Nursing, Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryota Matsuyama
- Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | | | - Mohammad Ali
- Department of Medicine, Comilla Medical College, Cumilla, Bangladesh
| | - Sumaita Kabir Promitee
- Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Chandpur, Bangladesh
| | - Junaidi Budi Prihanto
- Physical Education, Health and Recreation, Sport Science Faculty, Universitas Negeri Surabaya, Indonesia
| | - Ashir Ahmed
- Department of Advanced Information Technology, Graduate School of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Yoko Shimpuku
- Global Health Nursing, Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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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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Sarker MHR, Moriyama M, Rashid HU, Rahman MM, Chisti MJ, Das SK, Saha SK, Arifeen SE, Ahmed T, Faruque ASG. Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial. J Med Internet Res 2022; 24:e37314. [PMID: 35969429 PMCID: PMC9412733 DOI: 10.2196/37314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/05/2022] [Accepted: 06/13/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. OBJECTIVE This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. METHODS This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. RESULTS The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). CONCLUSIONS The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/30191.
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Affiliation(s)
- Mohammad Habibur Rahman Sarker
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Samir Kumar Saha
- Child Health Research Foundation, Dhaka, Bangladesh
- Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Haque MMA, Jahan Y, Khair Z, Moriyama M, Rahman MM, Sarker MHR, Shaima SN, Chowdhury S, Matin KF, Karim IJ, Ahmed MT, Hossain SZ, Masud MAH, Nabi MG, Aziz AB, Sharif M, Chowdhury MFI, Shams KL, Nizam NB, Ananta TT, Amin MR, Hawlader MDH. Perceptions about Telemedicine among Populations with Chronic Diseases amid COVID-19: Data from a Cross-Sectional Survey. Int J Environ Res Public Health 2022; 19:ijerph19074250. [PMID: 35409932 PMCID: PMC8998658 DOI: 10.3390/ijerph19074250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 12/27/2022]
Abstract
Chronic diseases, including non-communicable diseases (NCDs), have arisen as a severe threat to health and socio-economic growth. Telemedicine can provide both the highest level of patient satisfaction and the lowest risk of infection during a pandemic. The factors associated with its usage and patient adherence are not visible in Bangladesh’s resource-constrained settings. Therefore, this study aimed to identify perceptions about telemedicine among populations with chronic diseases amid the COVID-19 pandemic. A closed-ended self-reported questionnaire was created, and the questionnaire was written, reviewed, and finalized by a public health investigator, a psychiatrist, and an epidemiologist. The data for this study were collected from individuals using simple random sampling and snowball sampling techniques. Ethics approval was granted, and written/verbal consent was taken before interviews. Most of the participants showed a positive attitude towards telemedicine. People aged 35–54 years old and a higher level of education were less frequently associated with willingness to receive telemedicine services for current chronic disease (WRTCCD) than their counterparts. People living in urban areas and lower-income participants were more strongly associated with WRTCCD. Additionally, people who did not lose their earnings due to the pandemic were less strongly associated with WRTCCD. However, the main strength of this research is that it is a broad exploration of patient interest in several general forms of telehealth. In Bangladesh, there are many opportunities for telemedicine to be integrated into the existing healthcare system, if appropriate training and education are provided for healthcare professionals.
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Affiliation(s)
- Miah Md. Akiful Haque
- Department of Public Health, North South University, Dhaka 1229, Bangladesh; (M.M.A.H.); (K.F.M.); (M.D.H.H.)
- Public Health Professional Development Society (PPDS), Dhaka 1215, Bangladesh
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
| | - Zara Khair
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
| | - Md. Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
- Correspondence: ; Tel.: +81-82-257-5391
| | - Mohammad Habibur Rahman Sarker
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
| | - Shamsun Nahar Shaima
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh;
| | - Sajeda Chowdhury
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan; (Y.J.); (Z.K.); (M.M.); (M.H.R.S.); (S.C.)
| | - Kazi Farhana Matin
- Department of Public Health, North South University, Dhaka 1229, Bangladesh; (M.M.A.H.); (K.F.M.); (M.D.H.H.)
- Public Health Professional Development Society (PPDS), Dhaka 1215, Bangladesh
| | - Ishrat Jahan Karim
- Sylhet MAG Osmani Medical College, Sylhet 3100, Bangladesh; (I.J.K.); (M.T.A.)
| | | | - Syed Zakir Hossain
- Dhaka Medical College, Dhaka 1000, Bangladesh; (S.Z.H.); (M.S.); (M.R.A.)
| | - Md. Adnan Hasan Masud
- Haematology Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka 1000, Bangladesh;
| | | | - Asma Binte Aziz
- International Vaccine Institute, Seoul 08826, Korea; (A.B.A.); (M.F.I.C.)
| | - Mohiuddin Sharif
- Dhaka Medical College, Dhaka 1000, Bangladesh; (S.Z.H.); (M.S.); (M.R.A.)
| | | | - Kaniz Laila Shams
- Bangladesh Institute of Health Sciences (BIHS) General Hospital, Dhaka 1207, Bangladesh; (K.L.S.); (N.B.N.)
| | - Nusrat Benta Nizam
- Bangladesh Institute of Health Sciences (BIHS) General Hospital, Dhaka 1207, Bangladesh; (K.L.S.); (N.B.N.)
| | | | - Md. Robed Amin
- Dhaka Medical College, Dhaka 1000, Bangladesh; (S.Z.H.); (M.S.); (M.R.A.)
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Parvin I, Das SK, Ahmed S, Rahman A, Shahid ASMSB, Shahrin L, Afroze F, Ackhter MM, Alam T, Jahan Y, Palit P, Sarker MHR, Das J, Hoque ME, Magalhães RJS, Mamun AA, Faruque ASG, Ahmed T, Chisti MJ. Toxoplasma gondii Infection Is Associated with Low Birth Weight: Findings from an Observational Study among Rural Bangladeshi Women. Pathogens 2022; 11:pathogens11030336. [PMID: 35335660 PMCID: PMC8954211 DOI: 10.3390/pathogens11030336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Gestational Toxoplasma gondii (T. gondii) infection may cause substantial adverse effects on developing fetuses, newborns and also mothers. This study aims to estimate the seroprevalence of T. gondii among rural Bangladeshi pregnant women and determine the risk of a low birth weight (LBW). We followed a longitudinal design where 208 pregnant women were followed until the birth of their infants. Levels of IgG and IgM of T. gondii were assessed using chemiluminescent immunoassay. Modified Poisson regression was used to estimate crude and adjusted associations and multiple regression analysis was performed to understand the confounding and modifying effects of the variables. Thirty-nine (19%) children were born with LBW, among whom 15 (39%) mothers were positive for T. gondii IgG during pregnancy. After adjusting for several confounders and modifiers, pregnant women with T. gondii IgG or IgM seropositivity were significantly associated with LBW of infants (aRR: 2.00, 95% CI: 1.17–3.42). The strength of this association increased after adjusting for maternal education (aRR: 4.88, 95% CI: 1.74–13.69). The final model had an AROC of 0.84 with a sensitivity of 36% and specificity of 97%. Although causality is yet to be established, the study observed an association between T. gondii infection during pregnancy among rural Bangladeshi women and LBW of newborns.
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Affiliation(s)
- Irin Parvin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Sumon Kumar Das
- Menzies—School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Shahnawaz Ahmed
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Aminur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Lubaba Shahrin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Farzana Afroze
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mst. Mahmuda Ackhter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Tahmina Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Parag Palit
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammad Habibur Rahman Sarker
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Jui Das
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Mohammad Enamul Hoque
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW 2006, Australia;
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Ricardo J. Soares Magalhães
- UQ Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia;
- Children’s Health and Environment Program, UQ Child Health Research Centre, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD 4067, Australia;
| | - Abu Syed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
- Correspondence: or (S.K.D.); (A.S.G.F.)
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh; (I.P.); (A.R.); (A.S.M.S.B.S.); (L.S.); (F.A.); (M.M.A.); (T.A.); (Y.J.); (P.P.); (M.H.R.S.); (T.A.); (M.J.C.)
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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, Rashid HU, Rahman MM, Chisti MJ, Das SK, Jahan Y, Saha SK, Arifeen SE, Ahmed T, Faruque ASG. Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30191. [PMID: 34806998 PMCID: PMC8663577 DOI: 10.2196/30191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 02/06/2023] Open
Abstract
Background Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID) DERR1-10.2196/30191
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Affiliation(s)
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Yasmin Jahan
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samir Kumar Saha
- Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - A S G Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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11
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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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Sarker MHR, Moriyama M, Rashid HU, Chisti MJ, Rahman MM, Das SK, Uddin A, Saha SK, Arifeen SE, Ahmed T, Faruque A. Community-based screening to determine the prevalence, health and nutritional status of patients with CKD in rural and peri-urban Bangladesh. Ther Adv Chronic Dis 2021; 12:20406223211035281. [PMID: 34377387 PMCID: PMC8326824 DOI: 10.1177/20406223211035281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/11/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Studies have labelled chronic kidney disease (CKD) among the adult population in urban Bangladesh. To address knowledge gaps on CKD, we aimed to generate data on prevalence, health and nutrition of CKD individuals living in rural and peri-urban Bangladesh. Methods: Participants were recruited from the Mirzapur Demographic Surveillance System by age-stratified random sampling. We screened participants by measuring serum creatinine and urine albumin to creatinine ratio, and collected socio-demographic, lifestyles and health information (phase I). After 3 months (phase II), we repeated the urine and blood tests as per the Kidney Disease Outcomes Quality Initiative guidelines. The glomerular filtration rate was calculated using the CKD Epidemiology Collaboration equation. Results: Among 928 participants, 872 completed the study. In phase I, probable CKD cases were 281 (32.2%); in phase II, confirmed cases were 192 (22.0%) (stage 1, 4.0%; stage 2, 11.8%; stage 3, 5.5%; stage 4, 0.6%; stage 5, 0.1%). In multivariable analysis, associated factors for prevalent CKD included aged ⩾60 years [adjusted odds ratio (aOR) 5.02; 95% confidence interval (CI) 1.85–13.65], hypertension (aOR 3.08; 95% CI 2.07–4.59), diabetes (aOR 2.52; 95% CI 1.60–3.96), presence of red blood cell in urine (aOR 3.20; 95% CI 1.71–5.98) and anemia (aOR 2.50; 95% CI 1.63–3.84). Conclusions: This is the first ever research on CKD prevalence in rural and peri-urban Bangladesh and recorded about 22%, which is higher than urban settings. Monitoring systems are needed to evaluate the overall burden and to mitigate risk factors with an emphasis on the rural and peri-urban population.
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Affiliation(s)
- Mohammad Habibur Rahman Sarker
- Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Michiko Moriyama
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Harun Ur Rashid
- Kidney Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Md Moshiur Rahman
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sumon Kumar Das
- Menzies - School of Health Research, Charles Darwin University, Darwin, Australia
| | - Aftab Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Asg Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh
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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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Das SK, Chisti MJ, Sarker MHR, Das J, Ahmed S, Shahunja KM, Nahar S, Gibbons N, Ahmed T, Faruque ASG, Rahman M, J Fuchs G, Al Mamun A, John Baker P. Long-term impact of changing childhood malnutrition on rotavirus diarrhoea: Two decades of adjusted association with climate and socio-demographic factors from urban Bangladesh. PLoS One 2017; 12:e0179418. [PMID: 28877163 PMCID: PMC5587254 DOI: 10.1371/journal.pone.0179418] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background There is strong association between childhood rotavirus, diarrhoea, climate factors and malnutrition. Conversely, a significant nutritional transition (reduced under-nutrition) with a concurrent increasing trend of rotavirus infection in last decade was also observed among under 5 children, especially in developing countries including Bangladesh. Considering the pathophysiology of rotavirus, there might be an interaction of this nutrition transition which plays a pivotal role in increasing rotavirus infection in addition to climate and other man-made factors in urban areas such as Dhaka, Bangladesh. Methods Relevant monthly data from 1993–2012 were extracted from the archive of the Diarrhoeal Disease Surveillance System of icddr, b and linked with data collected from the Dhaka station of the Bangladesh Meteorological Department (mean temperature, rainfall, sea level pressure and humidity). Seasonal autoregressive integrated moving average time series models were deployed to determine the association between the monthly proportion of rotavirus infection and underweight, stunting and wasting adjusting for climate, socio-demographic and sanitation factors. Finding The proportion of rotavirus cases among all causes diarrhoea increased from 20% in 1993 to 43% in 2012 (Chi squared for trend p = 0.010). In contrast, underweight, stunting and wasting decreased from 59%-29% (p<0.001); 53%-21% (p<0.001) and 32%-22% (p<0.001) respectively over the same period. Mean ambient temperature increased from 25.76°C-26.62°C (p = 0.07); mean rainfall, sea level pressure and mean humidity decreased from 234.92–111.75 mm (p = 0.5), 1008.30–1006.61 mm of hg (p = 0.02) and 76.63%-70.26% (p<0.001), respectively. In the adjusted model, a decrease in monthly proportion of underweight [coef.: -0.189 (95% CI:-0.376, -0.003)] and wasting [-0.265 (-0.455, -0.075)] were significantly and inversely associated with rotavirus infection. However, an inverse but insignificant association was observed for stunting [-0.070 (-0.249, 0.109)]. Interpretation The reduction of acute childhood malnutrition is significantly associated with increasing rotavirus diarrhoea among under-5 children. Thus mass vaccination in addition to interventions directed at man-made modifiable predictors for prevention and control is warranted.
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Affiliation(s)
- Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
- * E-mail: ,
| | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Jui Das
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shawnawaz Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Nora Gibbons
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syed Golam Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - George J Fuchs
- University of Kentucky College of Medicine, Lexington, United States of America
| | - Abdullah Al Mamun
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Peter John Baker
- School of Public Health, The University of Queensland, Brisbane, Australia
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Shahunja KM, Ahmed T, Hossain MI, Das SK, Faruque ASG, Islam MM, Shahid ASMSB, Das J, Sarker MHR, Chisti MJ. Factors Associated With Pneumonia Among Overweight and Obese Under-Five Children in an Urban Hospital of a Developing Country. Glob Pediatr Health 2016; 3:2333794X16672528. [PMID: 27790628 PMCID: PMC5072332 DOI: 10.1177/2333794x16672528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/20/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022] Open
Abstract
To our knowledge, there are no data on the role of overweight and obesity in childhood pneumonia. We sought to determine that impact of overweight and obesity in such children. In this retrospective chart analysis, we enrolled hospitalized children aged 6 to 59 months in the Dhaka Hospital of the icddr,b, Bangladesh (International Centre for Diarrhoeal Disease Research, Bangladesh), from January 2010 to June 2014. Children with pneumonia having overweight and obesity (body mass index Z score [BMIZ] >2.00) constituted cases (n = 25), and those who had pneumonia without overweight and obesity (BMIZ -2.00 to 2.00) constituted controls (n = 75). Controls were 3-fold of the cases and were randomly selected. Demographic, clinical, and laboratory data of the cases and the controls were compared. The cases more often had diarrhea and dehydration (36% vs 12%, P = .013), hypoxemia (SpO2 < 90% in room air; 28% vs 7%, P = .009) on admission, and required to change antibiotics (32% vs 11%, P = .023) during hospitalization compared to the controls. However, in logistic regression analysis the cases were independently associated with diarrhea (P < .001) and hypoxemia (P = .024) on admission. Our data suggest that overweight and obesity in children with pneumonia is prone to be associated with hypoxemia on admission, which may guide clinicians in promptly managing pneumonia in order to evade its ramification in such children. However, future research with larger samples is imperative to consolidate or refute our observation.
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Affiliation(s)
- K. M. Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md. Iqbal Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Md. Munirul Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Jui Das
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Shahid ASMSB, Ahmed T, Shahunja KM, Kabir S, Chowdhury F, Faruque ASG, Das SK, Sarker MHR, Bardhan PK, Chisti MJ. Factors Associated with Streptococcal Bacteremia in Diarrheal Children under Five Years of Age and Their Outcome in an Urban Hospital in Bangladesh. PLoS One 2016; 11:e0154777. [PMID: 27135829 PMCID: PMC4852900 DOI: 10.1371/journal.pone.0154777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 04/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Although Streptococcal bacteremia is common in diarrheal children with high morbidity and mortality, no systematic data are available on Streptococcal bacteremia in diarrheal children. We sought to evaluate the factors associated with Streptococcal bacteremia in diarrheal children under five years of age and their outcome. Methods We used an unmatched case-control design to investigate the associated factors with Streptococcal bacteremia in all the diarrheal children under five years of age through electronic medical record system of Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. We had simultaneously used a retrospective cohort design to further evaluate the outcome of our study children. All the enrolled children had their blood culture done between January 2010 and December 2012. Comparison was made among the children with (cases = 26) and without Streptococcal bacteremia (controls = 78). Controls were selected randomly from hospitalized diarrheal children under five years of age. Results Cases had proportionately higher deaths compared to controls, but it was statistically insignificant (15% vs. 10%, p = 0.49). The cases more often presented with severe dehydration, fever, respiratory distress, severe sepsis, and abnormal mental status compared to the controls (for all p<0.05). In the logistic regression analysis, after adjusting for potential confounders, it has been found that Streptococcal bacteremia in diarrheal children under five years of age was independently associated with nutritional edema (OR: 5.86, 95% CI = 1.28–26.80), hypoxemia (OR: 19.39, 95% CI = 2.14–175.91), fever (OR: 4.44, 95% CI = 1.13–17.42), delayed capillary refill time (OR: 7.00, 95% CI = 1.36–35.93), and respiratory distress (OR: 2.69, 95% CI = 1.02–7.12). Conclusions and Significance The results of our analyses suggest that diarrheal children under five years of age presenting with nutritional edema, hypoxemia, fever, delayed capillary refill time, and respiratory distress may be at risk of Streptococcal bacteremia. It underscores the importance of identification of these simple clinical parameters for the prompt recognition and management in order to reduce the morbidity and death of such children especially in resource limited settings.
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Affiliation(s)
| | - Tahmeed Ahmed
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Shahunja
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Senjuti Kabir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Syeed Golam Faruque
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Habibur Rahman Sarker
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition & Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Shahunja KM, Salam MA, Ahmed T, Bardhan PK, Sarker SA, Ashraf H, Faruque ASG, Hossain MI, Islam MM, Das SK, Sharifuzzaman M, Bin Shahid ASMS, Sarker MHR, Chisti MJ. Bacterial Isolates from Tracheal Aspirates and their Anti-microbial Susceptibility in Mechanically-Ventilated Children with Pneumonia Admitted to an Urban Critical Care Ward. ACTA ACUST UNITED AC 2015. [DOI: 10.3329/bccj.v2i2.24081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Aims: Data on Bacterial isolates from tracheal aspirates in children with severe pneumonia requiring intubation and mechanical ventilation especially in developing countries are very limited. We examined the microbial spectrum of bacteria isolated from tracheal aspirate of those children. The antibiotic susceptibility profiles of those bacteria were also examined.Methods: We evaluated the data of all mechanically ventilated children aged 0-59 months admitted to Intensive Care Unit (ICU) of Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2009 and July 2013 having their tracheal aspirate culture done. Data were extracted from electronic medical records of the Dhaka Hospital.Results: Among 836 admitted pneumonia children in the ICU, we identified 35 children who fulfilled the inclusion criteria. Among them 34 (97%) had positive bacterial growths: Klebseilla species in 14 (40%), Escherichia coli in 11 (31%), Acinetobacter in 8 (23%) and Streptococcus species in 8 (23%). Additionally, Enterococcus, Staphylococcus aureus, Pseudominas and Proteus species were identified in 6 (17%), 4 (11%), and 2 (6%) of the children respectively. The susceptibility of the gram-negatives, except Klebseilla, to ampicillin, cotrimoxazole, gentamycin, ciprofloxacin, azithromycin, and ceftriaxone ranged from 0- 54%, while that for ceftazidime and amikacin ranged from 12-80%. The sensitivity of Klebseilla to these antibiotics ranged from 0-100%.Conclusions: Our data suggests that gram-negative bacteria, Klebseilla followed by Escherichia coli, and Acenetobacter are the predominant bacteria associated with severe pneumonia in ventilated children. The increased number of infections caused by Gram-negative bacteria is being accompanied by rising rates of multi-drug resistance which underscores the importance of aggressive antimicrobial therapy in the management of such children.Bangladesh Crit Care J September 2014; 2 (2): 60-64
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Sarker MHR, Das SK, Ahmed S, Ferdous F, Das J, Farzana FD, Shahid ASMSB, Shahunja KM, Afrad MH, Malek MA, Chisti MJ, Bardhan PK, Hossain MI, Mamun AA, Faruque ASG. Changing characteristics of rotavirus diarrhea in children younger than five years in urban Bangladesh. PLoS One 2014; 9:e105978. [PMID: 25171098 PMCID: PMC4149481 DOI: 10.1371/journal.pone.0105978] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 07/28/2014] [Indexed: 11/25/2022] Open
Abstract
Background Childhood rotavirus diarrhea is still one of the major public health challenges. The present study aimed to determine changing characteristics of rotavirus diarrhea in under-5 children at two periods of time. Methods We enrolled 5,357 under-5 children with rotavirus positive in two different time periods; i) 1993-1997 (n = 2,493), and ii) 2008–2012 (n = 2,864) considering beginning and ending of two decades. These children were enrolled in the urban Dhaka Hospital of icddr,b. Results Overall, proportion of rotavirus was about 25% in 1993–97, which was 42% in 2008–12 (68% rise; p<0.001). Significant higher proportion of children were stunted [38% vs. 22%; aOR-1.33 (95% CI-1.09-1.62)], had vomiting [87% vs. 74%; aOR-2.58 (95% CI-2.02-3.28)], fever [10% vs. 8%; aOR-1.31 (95% CI-0.96-1.78)], family members >5 [38% vs. 35%; aOR-1.32 (95% CI-1.10-1.58)] required more intravenous fluid [9% vs. 3%; aOR-4.93 (95% CI-3.19-7.63)], had higher co-infection with Shigella [3% vs. 1%; aOR-3.36 (95% CI-1.61-7.03)], Vibrio cholerae [4% vs. 1%; aOR-3.70 (95% CI-2.12-6.46)]; and ETEC [13% vs. 7%; aOR-2.21 (95% CI-1.65-2.97)]; however, significantly lower proportion of them used sanitary toilets [54% vs. 78%; aOR-0.66 (95% CI-0.54-0.80)], boiled drinking water [16% vs. 38%; aOR-0.60 (95% CI-0.48-0.74)], used antimicrobial at home [63% vs. 82%; aOR-0.56 (95% CI-0.46-0.69)] and had some or severe dehydration [18% vs. 34%; aOR-0.15 (95% CI-0.12-0.20)] in 1st observation period compared to that of 2nd. Conclusion Proportion of episodes of under-5 rotavirus diarrhea increased over the period. Concomitant changes in host, socio-demographic and clinical characteristics, and co-infections were also observed. Thus, vaccination campaign which is prevailing in private sector should also be introduced in public sector.
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Affiliation(s)
| | - Sumon Kumar Das
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
- School of Population Health, The University of Queensland, Brisbane, Australia
- * E-mail:
| | - Shahnawaz Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Farzana Ferdous
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Jui Das
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Fahmida Dil Farzana
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - K. M. Shahunja
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Mokibul Hassan Afrad
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Mohammad Abdul Malek
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | | | - Pradip Kumar Bardhan
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Md Iqbal Hossain
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Abdullah Al Mamun
- School of Population Health, The University of Queensland, Brisbane, Australia
| | - Abu S. G. Faruque
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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