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Ahmed A, Akter E, Sayeed A, Rahman F, Hanson M, Saha N, Refat Uz Zaman Sajib M, Hossain L, Tanvir KM, Hossain AT, Rana R, Tahura Ether S, Ameen S, Jabeen S, Rumayan Hasan AM, El Arifeen S, Ehsanur Rahman A, Moshfiqur Rahman S. Factors influencing delivery-related complications and their consequences in hard-to-reach areas of Bangladesh. Sex Reprod Healthc 2024; 40:100973. [PMID: 38678678 DOI: 10.1016/j.srhc.2024.100973] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND AND OBJECTIVES Bangladesh's high maternal mortality ratio is exacerbated by delivery-related complications, particularly in hard-to-reach (HtR) areas with limited healthcare access. Despite this, few studies have explored delivery-related complications and factors contributing to these complications among the disadvantaged population. This study aimed to investigate the factors contributing to delivery-related complications and their consequences among the mothers residing in the HtR areas of Bangladesh. METHODS Data were collected using a cross-sectional study design from 13 HtR sub-districts of Bangladesh between September 2019 and October 2019. Data from 1,290 recently delivered mothers were analysed. RESULTS Around 32% (95% CI: 29.7-34.8) of the mothers reported at least one delivery-related complication. Prolonged labour pain (21%) was the highest reported complication during the delivery, followed by obstructive labour (20%), fever (14%), severe headache (14%). Mothers with higher education, a higher number of antenatal care (ANC) visits, complications during ANC, employed, and first-time mothers had higher odds of reporting delivery-related complications. More than one-half (51%) of these mothers had normal vaginal delivery. Nearly one-fifth (20%) of mothers who reported delivery-related complications were delivered by unskilled health workers at homes. On the other hand, about one-fifth (19%) of the mothers without any complications during delivery had a caesarean delivery. Nine out of ten of these caesarean deliveries were done at the private facilities. CONCLUSION Delivery-related complications are significantly related to a woman's reproductive history and other background characteristics. Unnecessary caesarean delivery is prominent at private facilities.
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Affiliation(s)
- Anisuddin Ahmed
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Sweden; Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Ema Akter
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Sayeed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fariya Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Molly Hanson
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Sweden
| | - Nondo Saha
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Refat Uz Zaman Sajib
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, IL, United States
| | - Lubna Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K M Tanvir
- Institute of Statistical Research & Training (ISRT), Dhaka University, Dhaka, Bangladesh
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ritu Rana
- Indian Institute of Public Health, Gandhinagar 382042, Gujarat, India
| | - Saraban Tahura Ether
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sabrina Jabeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syed Moshfiqur Rahman
- Global Health and Migration Unit, Department of Women's and Children's Health, Uppsala University, Sweden
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Hasan AMR, Selim MA, Anne FI, Escobar-DeMarco J, Ireen S, Kappos K, Ash D, Rasheed S. Opportunities and challenges in delivering maternal and child nutrition services through public primary health care facilities in urban Bangladesh: a qualitative inquiry. BMC Health Serv Res 2023; 23:1172. [PMID: 37891649 PMCID: PMC10612189 DOI: 10.1186/s12913-023-10094-6] [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: 11/30/2022] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Public primary health facilities are an important source of nutrition services for the urban areas in Bangladesh. We aimed to understand the challenges and facilitators of delivering maternal and child nutrition services through public sector from the perspectives of the users and service providers. METHOD The study was conducted in selected public primary health care facilities and their catchment area in Dhaka city from April-July 2019. We carried out 15 free listing exercises and 43 semi-structured interviews (SSI) with pregnant women and mothers of 0-24 months old children; 6 key informant interviews (KII) with facility managers and healthcare providers; and observed service delivery in 8 health facilities. RESULTS Findings reveal that public primary health facilities address some economic and cultural barriers to access such as cost and provision of female service providers for maternal and child health services but challenges such as distance, waiting time, and cleanliness remained. In terms of service provision, there were gaps in provision of anthropometric measurement and counseling, and healthcare providers had inadequate training and therefore, knowledge of nutrition. The low priority given to nutrition services during program design hampered the delivery of nutrition services provided through urban public sector health facilities. CONCLUSIONS There were important gaps in terms of service provision and capacity of healthcare providers, and therefore, the quality of nutrition service provided through public primary health care facilities. To maximize the coverage of quality nutrition services in the urban areas, it is important to think through the design of nutrition service delivery and allocate adequate resources to fill the material and capacity gaps.
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Affiliation(s)
- A M Rumayan Hasan
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Mohammad Abdus Selim
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Faugia Islam Anne
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh
| | - Jessica Escobar-DeMarco
- Department of Public Health Sciences, The University of North Carolina Charlotte, Charlotte, NC, USA
| | - Santhia Ireen
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Kristen Kappos
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Deborah Ash
- FHI Solutions / Family Health International 360, Washington, DC, USA
| | - Sabrina Rasheed
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, 68 Shaheed Tajuddin Ahmed Sarani, 1212, Mohakhali, Dhaka, Bangladesh.
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Gourab G, Sarwar G, Khan MNM, Hasan AMR, Irfan SD, Saha TK, Rahman L, Rana AKMM, Khan SI. Correction to: Are we ready for a sustainable approach? A qualitative study of the readiness of the public health system to provide STI services to the key populations at risk of HIV in Bangladesh. BMC Health Serv Res 2023; 23:1076. [PMID: 37814293 PMCID: PMC10563252 DOI: 10.1186/s12913-023-10093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023] Open
Affiliation(s)
- Gorkey Gourab
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Golam Sarwar
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
- Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - A M Rumayan Hasan
- Universal Health Coverage, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tarit Kumar Saha
- Institute of Public Health (IPH), Dhaka, Bangladesh
- Ministry of Health and Family Welfare, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Lima Rahman
- HIV/AIDS Programme, Health, Nutrition and HIV/AIDS Sector, Save the Children, House 35, Road 43, Gulshan-2, Dhaka, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Gourab G, Sarwar G, Khan MNM, Hasan AMR, Irfan SD, Saha TK, Rahman L, Rana AKMM, Khan SI. Are we ready for a sustainable approach? A qualitative study of the readiness of the public health system to provide STI services to the key populations at risk of HIV in Bangladesh. BMC Health Serv Res 2023; 23:979. [PMID: 37697263 PMCID: PMC10496154 DOI: 10.1186/s12913-023-09996-2] [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: 04/12/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
INTRODUCTION In Bangladesh, sexually transmitted infection (STI) services are available for all populations in public health facilities. However, STI services for key populations (KPs) at risk of HIV need specifically designed approaches that are predominantly administered to KPs through donor-supported service centers operated by non-government organizations (NGOs) and community-based organisations (CBOs). However, the steady decline in donor funding warrants a sustainable transition of STI services for the KPs into public health facilities. This article aimed to explore the service availability and readiness of public health facilities to provide STI services for the KPs. METHODS This qualitative study explored the service availability and readiness of public health facilities in three districts of Bangladesh by adapting the Service Availability and Readiness Assessment tool. We conducted 34 in-depth interviews,11 focus group discussions with KPs, and 29 key-informant interviews with healthcare providers, researchers, programme implementers and policy planners, in addition to series of direct observations at the public healthcare facilities. Data were analysed through thematic analysis, and categorised in relation to the WHO building blocks. RESULTS This study revealed that the public health system was generally not ready to serve the KPs' needs in terms of providing them with quality STI services. The 'service delivery' component, which is the most crucial facet of the public health system, was not ready to provide STI services to KPs. Findings also indicated that health workforce availability was limited in the primary and secondary healthcare layers but adequate in the tertiary layer, but needed to be oriented on providing culturally sensitised treatment. Counseling, an essential component of STI services, was neither ready nor available. However, health information systems and a few other components were partially ready, although this warrants systematic approaches to address these challenges. CONCLUSION The findings show that public health facilities are yet to be fully ready to render STI services to KPs, especially in terms of service delivery and human and health resources. Therefore, it is not only integral to mobilize communities towards the uptake of public health services, but health systems need to be prepared to cater to their needs.
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Affiliation(s)
- Gorkey Gourab
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Golam Sarwar
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
- Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - A M Rumayan Hasan
- Universal Health Coverage, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tarit Kumar Saha
- Institute of Public Health (IPH), Dhaka, Bangladesh
- Ministry of Health and Family Welfare, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Lima Rahman
- HIV/AIDS Programme, Health, Nutrition and HIV/AIDS Sector, Save the Children, House 35, Road 43, Gulshan-2, Dhaka, Bangladesh
| | - A K M Masud Rana
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Hasan AMR, Smith G, Selim MA, Khatun F, Mahmood SS, Reidpath DD, Rasheed S. Qualitative exploration of the impact of COVID-19 on the food environment of urban informal settlements of Dhaka, Bangladesh. BMJ Open 2023; 13:e067652. [PMID: 37527892 PMCID: PMC10394537 DOI: 10.1136/bmjopen-2022-067652] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Our study explored the impact of the COVID-19 pandemic on the food environment from the perspective of the urban poor and food vendors. DESIGN This was a qualitative study conducted during September 2020 and February 2021. SETTING The study was carried out in two purposively selected informal settlements of Dhaka City, Bangladesh. PARTICIPANTS We conducted 21 in-depth interviews with residents of informal settlements and 10 key informant interviews with food vendors and food aid workers. RESULT The availability of staple foods was not disrupted during the pandemic but some perishables foods became more expensive due to supply chain disruptions and increased transportation costs. Limited market hours affected market access and mobility restrictions adversely affected local vendors. Cart vendors selling perishables incurred business losses they could ill afford. Demand for food reduced as employment disruption lead to reduced purchasing power and, therefore, reduction of quantity, quality and desirability of foods purchased. Respondents reported skipping meals and going hungry. The aid received was considered inadequate to meet needs. CONCLUSION The food environment of the urban poor was disrupted from both supply and demand sides and the organisational response (both government and non-government) was severely inadequate. The social safety net needs to be extended and redesigned to ensure food security and health for the urban working poor in the future.
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Affiliation(s)
- A M Rumayan Hasan
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Mohammad Abdus Selim
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Fatema Khatun
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Daniel D Reidpath
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Hasan MZ, Hasan AMR, Rabbani MG, Selim MA, Mahmood SS. Knowledge, attitude, and practice of Bangladeshi urban slum dwellers towards COVID-19 transmission-prevention: A cross-sectional study. PLOS Glob Public Health 2022; 2:e0001017. [PMID: 36962862 PMCID: PMC10021697 DOI: 10.1371/journal.pgph.0001017] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/12/2022] [Indexed: 11/19/2022]
Abstract
The first COVID-19 case in Bangladesh was detected on March 8, 2020. Since then, efforts are being made across the country to raise awareness among the population for preventing the spread of this virus. We aimed to examine the urban slum dwellers' knowledge, attitude, and practice (KAP) towards COVID-19 transmission-prevention. A phone-based cross-sectional survey was conducted in five slums of Dhaka City. Total 476 adult slum dwellers were interviewed between October 31 to December 1, 2020 using a pre-tested questionnaire. During an interview, information was collected on participants' demographic characteristics and KAP items towards COVID-19. We used quartiles for categorization of knowledge and practice score where the first quartile represents poor, the second and third quartiles represent average while the fourth quartile represents good. Attitude score was standardized using z-score and identified as positive and negative attitude. Multiple linear regression models were used separately to identify the socioeconomic predictors of the KAP scores. The results showed that 25% of the respondents had good knowledge and 25% had poor knowledge, 48% had a positive attitude and 52% had a negative attitude, and 21% maintained good practice and 33% maintained poor practice towards COVID-19 transmission-prevention. About 75% respondents relied on television for COVID-19 related information. Regression results showed that knowledge and attitude scores were significantly higher if respondents had primary or secondary and above level of education compared to the uneducated group. Female respondents maintained significantly good practice compared to their male counterparts (β = 6.841; p<0.01). This study has found that one third of the studied slum dwellers maintained poor practice and one fourth had poor knowledge towards COVID-19 transmission-prevention. As KAP domains are significantly correlated, efforts are needed to raise awareness of COVID-19 particularly targeting individuals with average and lower knowledge to improve attitude and practice for the prevention of COVID-19.
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Affiliation(s)
- Md. Zahid Hasan
- Health Economics and Financing Research Group, Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - A. M. Rumayan Hasan
- Health Economics and Financing Research Group, Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md. Golam Rabbani
- Health Economics and Financing Research Group, Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Mohammad Abdus Selim
- Health Economics and Financing Research Group, Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Economics and Financing Research Group, Health System and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Tariqujjaman M, Sheikh SP, Smith G, Hasan AMR, Khatun F, Kabir A, Rashid MH, Rasheed S. Determinants of Double Burden of Malnutrition Among School Children and Adolescents in Urban Dhaka: A Multi-Level Analyses. Front Public Health 2022; 10:926571. [PMID: 35910935 PMCID: PMC9335281 DOI: 10.3389/fpubh.2022.926571] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Bangladesh faces a double burden of malnutrition, with a rising prevalence of overweight and obesity among children and adolescents parallel to existing undernutrition. Objective The current study was designed to assess the determinants of double burden of malnutrition among urban school children and adolescents from Dhaka, Bangladesh. Methods A cross-sectional survey was conducted among 2,690 students from 14 schools in Dhaka city from January to June 2018. Anthropometric measurements were taken during school hours, and self-administered questionnaires were sent to the parents. We performed multi-level multiple logistic regression analyses to assess the determinants of underweight, overweight, and obesity. Findings The prevalence of overweight (33%) and obesity (23%) was highest among children and adolescents from high tuition schools but the prevalence of underweight (4%) was lowest compared to those from low (underweight 19%, overweight 17%, and obesity 6%) and medium (underweight 18%, overweight 15%, and obesity 6%) tuition schools. Children and adolescents from high-tuition schools had higher odds of being overweight/ obese (AOR: 2.92; 95% CI: 1.90, 4.49). Parental NCDs and overweight were negatively associated with underweight but positively associated with overweight and obesity among children and adolescents. Lack of physical activity inside schools was positively associated (AOR: 1.26; 95% CI: 1.02, 1.55) with overweight and obesity among school children and adolescents. Conclusion Our results point to opportunities in and outside schools to address the rising prevalence of underweight, overweight, and obesity among urban school children and adolescents.
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Affiliation(s)
- Md. Tariqujjaman
- Nutrition and Clinical Services Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Sifat Parveen Sheikh
- Health Systems and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | | | - A. M. Rumayan Hasan
- Health Systems and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Fatema Khatun
- Health Systems and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Ashraful Kabir
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Md. Harunor Rashid
- Health Systems and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division, International Center for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
- *Correspondence: Sabrina Rasheed
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Mahmood SS, Hasan MZ, Hasan AMR, Rabbani MG, Begum F, Yousuf TB, Hanifi SMA, Reidpath DD, Rasheed S. Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study. BMJ Open 2022; 12:e057402. [PMID: 35197355 PMCID: PMC8882639 DOI: 10.1136/bmjopen-2021-057402] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE We aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh. DESIGN Setting and participantsA cross-sectional survey among 476 households was conducted during October-December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted. OUTCOME MEASURES Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19. RESULTS About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. CONCLUSION The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.
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Affiliation(s)
| | - Md Zahid Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Golam Rabbani
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Farzana Begum
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Tariq Bin Yousuf
- Urban Resilience Project, Dhaka North City Corporation, Dhaka, Bangladesh
| | | | - Daniel D Reidpath
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Hasan AMR, Smith G, Rashid MH, Selim MA, Rasheed S. Promoting healthy foods among urban school children in Bangladesh: a qualitative inquiry of the challenges and opportunities. BMC Public Health 2021; 21:1029. [PMID: 34074273 PMCID: PMC8168019 DOI: 10.1186/s12889-021-11085-0] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bangladesh overweight and obesity among urban school children are on the rise. Urban school children tend to consume foods dense in calories and few fruits and vegetables which is associated with overweight and obesity. The current study explored the barriers and opportunities for promoting healthy diets among school children from the perspective of teachers and parents in Dhaka, Bangladesh. METHODS We conducted 14 key informant interviews with teachers and principals, six focus group discussions with 31 mothers of school children (5 to 15 year old) and 14 structured observations of the school food environment. Inductive thematic analysis was performed manually. RESULTS Schools were important for development of food preferences of children, however, most school cafeterias provided foods based on profit rather than health considerations. A shift in food culture resulted in making eating out acquire many meanings beyond convenience. Mothers, especially those who were employed, struggled to prepare healthy foods due to time pressure. Mothers were generally concerned about chemicals added to raw foods in markets which led to limited fruit and vegetable consumption. CONCLUSIONS There were many challenges to promoting healthy foods to school children within and outside the school. It is important to formulate policies and guidance to create a supportive environment for healthy foods in and in the proximity of schools. It is also important to educate consumers about identifying and choosing healthy foods. Laws related to food safety should be adequately implemented to boost the population's confidence in safety of available healthy foods in the food system.
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Affiliation(s)
- A M Rumayan Hasan
- Universal Health Coverage, Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Md Harunor Rashid
- Universal Health Coverage, Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Abdus Selim
- Universal Health Coverage, Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Sabrina Rasheed
- Universal Health Coverage, Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Khan SI, Khan MNM, Irfan SD, Rumayan Hasan AM, Ross AG, Horng LMS, Lachowsky N, Knudson G, Azim T. The Effects of Methamphetamine Use on the Sexual Lives of Gender and Sexually Diverse People in Dhaka, Bangladesh: A Qualitative Study. Arch Sex Behav 2021; 50:479-493. [PMID: 32239362 PMCID: PMC7529687 DOI: 10.1007/s10508-020-01674-2] [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] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine use has increased among gender and sexually diverse people in several countries, including Bangladesh. This study aimed to explore the effects of methamphetamine on the sexual lives of these people in Dhaka, Bangladesh. An exploratory qualitative study was conducted, comprising 30 in-depth interviews with gender and sexually diverse people including males having sex with males, male sex workers, and transgender women (hijra) under HIV intervention coverage. Ten key informant interviews were also conducted with individuals who have expertise in relevant disciplines such as drug use, harm reduction, and HIV and AIDS. Digitally recorded data were manually analyzed under the thematic analysis framework. Findings indicated that many participants reported that methamphetamine brought changes in their sexual lives such as increased sexual drive, engagement in group sex, the increased ability to perform serial sex, transactional sex, impulsive and coercive sex, initiation and switching of male-to-male sexual practices, and limited condom use. Key informants noted that there is a dearth of methamphetamine-related services in Bangladesh. Methamphetamine use was found to lead to diverse effects on the sexual lives of gender and sexually diverse people, thus making it a driving force for shaping sexual practices and, hence, sexual risks. Therefore, it is essential for policy-level stakeholders and program managers to consider the risks of methamphetamine use due to their negative ramifications on sexual health, including HIV risks.
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Affiliation(s)
- Sharful Islam Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh.
| | - Mohammad Niaz Morshed Khan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - A M Rumayan Hasan
- Programme for HIV and AIDS, Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Avenue, Mohakhali, Dhaka, Bangladesh
| | - Allen G Ross
- Infectious Diseases Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Nathan Lachowsky
- Faculty of Human and Social Development, School of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada
| | - Gail Knudson
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Tasnim Azim
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Hasan AMR, Smith G, Selim MA, Akter S, Khan NUZ, Sharmin T, Rasheed S. Work and breast milk feeding: a qualitative exploration of the experience of lactating mothers working in ready made garments factories in urban Bangladesh. Int Breastfeed J 2020; 15:93. [PMID: 33160366 PMCID: PMC7648991 DOI: 10.1186/s13006-020-00338-0] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Bangladesh 65% of children under 6 months of age were exclusively breastfed with maternal employment being a risk factor that has jeopardized exclusive breastfeeding. As Ready Made Garment (RMG) factories have been the largest employer of low income women in Bangladesh, the objective of our study was to explore the barriers and facilitators of breastfeeding and perceptions about use of expressed breast milk among mothers who worked in the RMG sector. METHODS This formative research was conducted during July-September 2015 in two slums of Dhaka among RMG workers who were mothers and the caregivers of 0-12 month old infants. Qualitative data was obtained from purposively selected participants of 8 in-depth interviews and 4 focus group discussions (mothers and caregivers), and 2 key informant (RMG factory official) interviews. Mothers were from multiple RMG factories while factory officials were from a single factory. Thematic analysis was conducted. RESULTS The main themes of qualitative exploration were knowledge and experience of breastfeeding; structural barriers (home and workplace); consequences of inadequate breastfeeding; and perception and experience of using expressed breast milk. Despite knowledge both of the benefits of breast milk and of the importance of breastfeeding for 6 months, most mothers introduced formula as early as 2 months to prepare for their return to work. Barriers such as excessive workload, inadequate crèche facilities at work, and lack of adequate caregivers at home impeded exclusive breastfeeding. Mothers and caregivers had very little knowledge about the use of expressed breast milk and were concerned about contamination. CONCLUSION As RMG factories are the largest employer of low-income women in Bangladesh, facilitating RMG factory working mothers' ability to use breast milk could help to promote infant health and help women remain in the workforce.
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Affiliation(s)
- A M Rumayan Hasan
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Mohammad Abdus Selim
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahinoor Akter
- Faculty of Health and Medicine, Schools of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Department of Anthropology, Jagannath University, Dhaka, Bangladesh
| | - Nazib Uz Zaman Khan
- Schools of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Tamanna Sharmin
- Monitoring Evaluation Research and Learning (MERL), Plan International, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division (HSPSD), icddr,b, Universal Health Coverage, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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Hasan AMR, Rashid MH, Smith G, Selim MA, Rasheed S. Challenges of promoting physical activity among school children in urban Bangladesh: A qualitative inquiry. PLoS One 2020; 15:e0230321. [PMID: 32176722 PMCID: PMC7075558 DOI: 10.1371/journal.pone.0230321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Physical activity (PA) confers a multitude of health benefits. Unfortunately, Bangladeshi school children get little PA. The current study assessed the barriers to promoting PA from the perspectives of school authorities and parents in urban Bangladesh. MATERIALS AND METHODS This study was conducted between January-June 2018 in Dhaka city. Fourteen schools were sampled to represent different school types. We used qualitative methods: 14 key Informant interviews (teachers), six focus group discussions (parents), and 14 observations of school environments. Thematic analysis was performed. RESULTS PA was not prioritized at most schools for two primary reasons: 1) there was a general lack of understanding of the importance of PA; and 2) physical education classes did not contribute to grades. Little time and resources were allotted for physical education classes because little priority was given to PA by school authorities. Outside school, lack of adequate safe open spaces undermined access to PA. Further, there were social barriers to PA including lack of parental support due to concerns about tiredness and injury and the perception that PA was detrimental to academic achievement. Many parents chose screen-based activities for children over PA. CONCLUSION Despite policies that mandate PA, PA lost out to school and parental priorities for academic achievement. Parental concerns about tiredness, injury and safe spaces impeded children's access to PA outside of school. Steps should be taken to enforce existing policies that mandate effective PA for school children, and parents and teachers should be educated about the need for and benefits of PA.
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Affiliation(s)
- A. M. Rumayan Hasan
- Health Systems and Population Studies Division(HSPSD), icddr,b, Universal Health Coverage, Mohakhali, Dhaka, Bangladesh
| | - Md. Harunor Rashid
- Health Systems and Population Studies Division(HSPSD), icddr,b, Universal Health Coverage, Mohakhali, Dhaka, Bangladesh
| | | | - Mohammad Abdus Selim
- Health Systems and Population Studies Division(HSPSD), icddr,b, Universal Health Coverage, Mohakhali, Dhaka, Bangladesh
| | - Sabrina Rasheed
- Health Systems and Population Studies Division(HSPSD), icddr,b, Universal Health Coverage, Mohakhali, Dhaka, Bangladesh
- * E-mail:
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Gourab G, Khan MNM, Hasan AMR, Sarwar G, Irfan SD, Reza MM, Saha TK, Rahman L, Rana AKMM, Khan SI. The willingness to receive sexually transmitted infection services from public healthcare facilities among key populations at risk for human immunodeficiency virus infection in Bangladesh: A qualitative study. PLoS One 2019; 14:e0221637. [PMID: 31483809 PMCID: PMC6726367 DOI: 10.1371/journal.pone.0221637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 08/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. Methods A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. Results Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. Conclusion KPs’ willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.
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Affiliation(s)
- Gorkey Gourab
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
- * E-mail:
| | | | - A. M. Rumayan Hasan
- Universal Health Coverage, Health System and Population Studies Division, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Golam Sarwar
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Samira Dishti Irfan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Md. Masud Reza
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Lima Rahman
- HIV/AIDS Program, Health, Nutrition and HIV/AIDS Sector, Save the Children, Dhaka, Bangladesh
| | - A. K. M. Masud Rana
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Sharful Islam Khan
- Programme for HIV and AIDS, International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
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Khan SI, Khan MNM, Hasan AMR, Irfan SD, Horng LMS, Chowdhury EI, Azim T. Understanding the reasons for using methamphetamine by sexual minority people in Dhaka, Bangladesh. Int J Drug Policy 2019; 73:64-71. [PMID: 31344562 DOI: 10.1016/j.drugpo.2019.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/10/2018] [Revised: 05/09/2019] [Accepted: 07/02/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Internationally, methamphetamine use is prevalent among males who have sex with males (MSM) and transgender women (hijra), with studies showing its association with risky sexual behaviours leading to HIV transmission. This study aimed to explore the underlying reasons for methamphetamine use among MSM and hijra in Bangladesh. METHODS We conducted 30 in-depth interviews with MSM and hijra and six focus groups with MSM, hijra and service providers. Data were thematically analysed using manual data analysis procedures. FINDING Reasons cited for using methamphetamine varied across feminized MSM (i.e. kothis), masculine MSM (i.e. panthis), male sex workers and hijra. For sex workers, increased sexual pleasure and consequent ability to take more clients increased their income. For panthis, methamphetamine enhanced feelings of masculinity and sexual prowess. Kothis were able to feel more feminine due to their ability to receive multiple partners each night. For all participants, methamphetamine restored self-esteem and relieved the stress resulting from stigma. CONCLUSIONS Findings indicate that reasons for using methamphetamine are not only rooted in the individual's psyche but also grounded in the socio-cultural expectations about masculinities and femininities in Bangladeshi society. Limited knowledge about the complexities concerning methamphetamine use mean that appropriate counselling and treatment services are non-existent in Bangladesh. The study findings can be used to refine national and international harm reduction policies so as to incorporate and address methamphetamine use.
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Affiliation(s)
- Sharful Islam Khan
- Program for HIV and AIDS, Infectious Diseases Division, icddr,b, Bangladesh.
| | | | - A M Rumayan Hasan
- Program for HIV and AIDS, Infectious Diseases Division, icddr,b, Bangladesh
| | | | - Lily Ming-Sha Horng
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, United States
| | | | - Tasnim Azim
- BRAC James P. Grant School of Public Health, BRAC University, Bangladesh
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