Change in cyclone disaster vulnerability and response in coastal Bangladesh

The number of deaths owing to tropical cyclones in Bangladesh has significantly reduced. Category 4 Cyclone Gorky in 1991 and Sidr in 2007 caused 147,000 and 4,500 deaths respectively, whereas Category 1 Cyclone Mora in 2017 resulted in six. Face-to-face interviews with 362 residents, participant observation, and focus-group discussions answer a research question about how change in coastal areas has contributed to this outcome. The study considered institutional approaches of disaster risk management through legal frameworks, administrative arrangements, cyclone preparedness activities, cyclone detection and early warning dissemination, construction of shelter centres, strengthening of various types of coastal embankments, paved roads, and pre-cyclone evacuation. The findings indicate significant improvement in house structures and design, income levels and diversification, education, awareness, individual capacity, poverty reduction, and lowering dependency on agriculture-based earning. Furthermore, the availability of mobile telephones, radio, television, and social media platforms enhanced social connectivity and greater gender equality and empowerment helped to facilitate disaster preparedness, evacuation, and response.

Source identification and potential health risks from elevated groundwater nitrate contamination in Sundarbans coastal aquifers, India

In recent years groundwater contamination through nitrate contamination has increased rapidly in the managementof water research. In our study, fourteen nitrate conditioning factors were used, and multi-collinearity analysis is done. Among all variables, pH is crucial and ranked one, with a value of 0.77, which controls the nitrate concentration in the coastal aquifer in South 24 Parganas. The second important factor is Cl-, the value of which is 0.71. Other factors like-As, F-, EC and Mg2+ ranked third, fourth and fifth position, and their value are 0.69, 0.69, 0.67 and 0.55, respectively. Due to contaminated water, people of this district are suffering from several diseases like kidney damage (around 60%), liver (about 40%), low pressure due to salinity, fever, and headache. The applied method is for other regions to determine the nitrate concentration predictions and for the justifiable alterationof some management strategies.

Hydro-chemical based assessment of groundwater vulnerability in the Holocene multi-aquifers of Ganges delta

Determining the degree of high groundwater arsenic (As) and fluoride (F-) risk is crucial for successful groundwater management and protection of public health, as elevated contamination in groundwater poses a risk to the environment and human health. It is a fact that several non-point sources of pollutants contaminate the groundwater of the multi-aquifers of the Ganges delta. This study used logistic regression (LR), random forest (RF) and artificial neural network (ANN) machine learning algorithm to evaluate groundwater vulnerability in the Holocene multi-layered aquifers of Ganges delta, which is part of the Indo-Bangladesh region. Fifteen hydro-chemical data were used for modelling purposes and sophisticated statistical tests were carried out to check the dataset regarding their dependent relationships. ANN performed best with an AUC of 0.902 in the validation dataset and prepared a groundwater vulnerability map accordingly. The spatial distribution of the vulnerability map indicates that eastern and some isolated south-eastern and central middle portions are very vulnerable in terms of As and F- concentration. The overall prediction demonstrates that 29% of the areal coverage of the Ganges delta is very vulnerable to As and F- contents. Finally, this study discusses major contamination categories, rising security issues, and problems related to groundwater quality globally. Henceforth, groundwater quality monitoring must be significantly improved to successfully detect and reduce hazards to groundwater from past, present, and future contamination.

Bioaccumulation and sources of metal(loid)s in fish species from a subtropical river in Bangladesh: a public health concern

Toxic metals and freshwater fish's metalloid contamination are significant environmental concerns for overall public health. However, the bioaccumulation and sources of metal(loids) in freshwater fishes from Bangladesh still remain unknown. Thus, the As, Pb, Cd, and Cr concentrations in various freshwater fish species from the Rupsha River basin were measured, including Tenualosa ilisha, Gudusia chapra, Otolithoides pama, Setipinna phasa, Mystus vittatus, Glossogobius giuris, and Pseudeutropius atherinoides. An atomic absorption spectrophotometer was used to determine metal concentrations. The mean concentrations of metal(loids) in the fish muscle (mg/kg) were found to be As (1.53) > Pb (1.25) > Cr (0.51) > Cd (0.39) in summer and As (1.72) > Pb (1.51) > Cr (0.65) > Cd (0.49) in winter. The analyzed fish species had considerably different metal(loid) concentrations with seasonal variation, and the distribution of the metals (loids) was consistent with the normal distribution. The demersal species, M. vittatus, displayed the highest bio-accumulative value over the summer. However, in both seasons, none of the species were bio-accumulative. According to multivariate statistical findings, the research area's potential sources of metal(loid) were anthropogenic activities linked to geogenic processes. Estimated daily intake, target hazard quotient (THQ), and carcinogenic risk (CR) were used to assess the influence of the risk on human health. The consumers' THQs values were < 1, indicating that there were no non-carcinogenic concerns for local consumers. Both categories of customers had CRs that fell below the permissible range of 1E - 6 to 1E - 4, meaning they were not at any increased risk of developing cancer. The children's group was more vulnerable to both carcinogenic and non-carcinogenic hazards. Therefore, the entry of metal(loids) must be regulated, and appropriate laws must be used by policymakers.

Enhancing landslide risk reduction strategies in Southeast Bangladesh

Since 2000, landslides in southeast Bangladesh have resulted in over 700 deaths, most of which were in informal settlements. For instance, the 2007 landslides in informal settlements in Chittagong and the 2017 landslides in Rangamati took 127 and 150 lives, respectively. Although the government of Bangladesh claims to implement risk reduction, the number of deaths associated with landslides is increasing. Hence, this study investigated the ways to enhance landslide risk reduction interventions by addressing several scientific and technical issues related to disaster risk reduction. This study conducted focus group discussions, key informant interviews and expert interviews with key stakeholders in landslide risk management to collect qualitative data. Moreover, the historical accounts of settlements, media reporting, institutional action plans and policies were reviewed.

Contribution

By integrating primary and secondary data, this study found that several political-economic aspects are major anthropogenic contributors to the recent increase in landslides in the region. The contributing factors included the following: policy and action plans to raise regional population; land management; illegal deforestation; plans to establish hydroelectricity in hilly areas; ownership of settlements; manipulation of water, gas and electricity supply to illegal settlements; commercial plantations; lack of risk governance; unplanned development activities; natural population rise; increased settlement along hill slopes. This study identified and discussed lessons learned from previous landslide disasters, the weakness of early warning systems and their dissemination and ways to improve evacuation, rescue, relief and risk reduction. Finally, this study formulated recommendations for the effective implementation of landslide risk reduction in southeast Bangladesh.

Correction: Climate change in Bangladesh: Temperature and rainfall climatology of Bangladesh for 1949-2013 and its implication on rice yield

[This corrects the article DOI: 10.1371/journal.pone.0292668.].

Climate change in Bangladesh: Temperature and rainfall climatology of Bangladesh for 1949-2013 and its implication on rice yield

Bangladesh has been ranked as one of the world's top countries affected by climate change, particularly in terms of agricultural crop sector. The purpose of this study is to identify spatial and temporal changes and trends in long-term climate at local and national scales, as well as their implications for rice yield. In this study, Modified Mann-Kendall and Sen's slope tests were used to detect significant trends and the magnitude of changes in temperature and rainfall. The temperature and rainfall data observed and recorded at 35 meteorological stations in Bangladesh over 65-years in the time span between the years 1949 and 2013 have been used to detect these changes and trends of variation. The results show that mean annual Tmean, Tmin, and Tmax have increased significantly by 0.13°C, 0.13°C, and 0.13°C/decade, respectively. The most significant increasing trend in seasonal temperatures for the respective Tmean, Tmin, and Tmax was 0.18°C per decade (post-monsoon), 0.18°C/decade (winter), and 0.23°C/decade (post-monsoon), respectively. Furthermore, the mean annual and pre-monsoon rainfall showed a significant increasing trend at a rate of 4.20 mm and 1.35 mm/year, respectively. This paper also evaluates climate variability impacts on three major rice crops, Aus, Aman, and Boro during 1970-2013. The results suggest that crop yield variability can be explained by climate variability during Aus, Aman, and Boro seasons by 33, 25, and 16%, respectively. Maximum temperature significantly affected the Aus and Aman crop yield, whereas rainfall significantly affected all rice crops' yield. This study sheds light on sustainable agriculture in the context of climate change, which all relevant authorities should investigate in order to examine climate-resilient, high-yield crop cultivation.

Coupling of machine learning and remote sensing for soil salinity mapping in coastal area of Bangladesh

Soil salinity is a pressing issue for sustainable food security in coastal regions. However, the coupling of machine learning and remote sensing was seldom employed for soil salinity mapping in the coastal areas of Bangladesh. The research aims to estimate the soil salinity level in a southwestern coastal region of Bangladesh. Using the Landsat OLI images, 13 soil salinity indicators were calculated, and 241 samples of soil salinity data were collected from a secondary source. This study applied three distinct machine learning models (namely, random forest, bagging with random forest, and artificial neural network) to estimate soil salinity. The best model was subsequently used to categorize soil salinity zones into five distinct groups. According to the findings, the artificial neural network model has the highest area under the curve (0.921), indicating that it has the most potential to predict and detect soil salinity zones. The high soil salinity zone covers an area of 977.94 km2 or roughly 413.51% of the total study area. According to additional data, a moderate soil salinity zone (686.92 km2) covers 30.56% of Satkhira, while a low soil salinity zone (582.73 km2) covers 25.93% of the area. Since increased soil salinity adversely affects human health, agricultural production, etc., the study's findings will be an effective tool for policymakers in integrated coastal zone management in the southwestern coastal area of Bangladesh.

Spatiotemporal analysis and predicting rainfall trends in a tropical monsoon-dominated country using MAKESENS and machine learning techniques

Spatiotemporal rainfall trend analysis as an indicator of climatic change provides critical information for improved water resource planning. However, the spatiotemporal changing behavior of rainfall is much less understood in a tropical monsoon-dominated country like Bangladesh. To this end, this research aims to analyze spatiotemporal variations in rainfall for the period 1980-2020 over Bangladesh at seasonal and monthly scales using MAKESENS, the Pettitt test, and innovative trend analysis. Multilayer Perception (MLP) neural network was used to predict the next 8 years' rainfall changes nationally in Bangladesh. To investigate the spatial pattern of rainfall trends, the inverse distance weighting model was adopted within the ArcGIS environment. Results show that mean annual rainfall is 2432.6 mm, of which 57.6% was recorded from July to August. The Mann-Kendall trend test reveals that 77% of stations are declining, and 23% have a rising trend in the monthly rainfall. More than 80% of stations face a declining trend from November to March and August. There is a declining trend for seasonal rainfall at 82% of stations during the pre-monsoon, 75% during the monsoon, and 100% during the post-monsoon. A significant decline trend was identified in the north-center during the pre-monsoon, the northern part during the monsoon, and the southern and northwestern portions during the post-monsoon season. Predicted rainfall by MLP till 2030 suggests that there will be little rain from November to February, and the maximum fluctuating rainfall will occur in 2025 and 2027-2029. The ECMWF ERA5 reanalysis data findings suggested that changing rainfall patterns in Bangladesh may have been driven by rising or reducing convective precipitation rates, low cloud cover, and inadequate vertically integrated moisture divergence. Given the shortage of water resources and the anticipated rise in water demand, the study's findings have some implications for managing water resources in Bangladesh.

Assessment of soil heavy metal pollution and associated ecological risk of agriculture dominated mid-channel bars in a subtropical river basin

The elevated concentrations of heavy metals in soil considerably threaten ecological and human health. To this end, the present study assesses metals pollution and its threat to ecology from the mid-channel bar's (char) agricultural soil in the Damodar River basin, India. For this, the contamination factor (CF), enrichment factor (EF), geoaccumulation index (I_geo), pollution index, and ecological risk index (RI) were measured on 60 soil samples at 30 stations (2 from each station, i.e., surface and sub-surface) in different parts of the mid-channel bar. The CF and EF indicate that both levels of char soil have low contamination and hence portray a higher potential for future enrichment by heavy metals. Moreover, I_geo portrays that soil samples are uncontaminated to moderately contaminated. Further, pollution indices indicate that all the samples (both levels) are unpolluted with a mean of 0.062 for surface soils and 0.048 for sub-surface soils. Both levels of the char have a low potentiality for ecological risk with an average RI of 0.20 for the surface soils and 0.19 for the sub-surface soils. Moreover, Technique for order preference by similarity to ideal solution (TOPSIS) indicates that the sub-surface soils have lower pollution than the surface soils. The geostatistical modeling reveals that the simple kriging technique was estimated as the most appropriate interpolation model. The present investigation exhibits that reduced heavy metal pollution is due to the sandy nature of soils and frequent flooding. However, the limited pollution is revealed due to the intensive agricultural practices on riverine chars. Therefore, this would be helpful to regional planners, agricultural engineers, and stakeholders in a basin area.

Factors of cyclone disaster deaths in coastal Bangladesh

Bangladesh's success in disaster risk management is often evidenced by referencing the reduction of deaths caused by tropical cyclones - the Cyclone Gorky 1991 caused 147,000 deaths, the Cyclone Sidr 2007 caused 4500 deaths and only 6 deaths by the Cyclone Mora in 2017. This raises questions of how deaths occurred by tropical cyclones in the past and what factors still might contribute towards deaths from cyclone hazards? This study answers these questions through face-to-face interviews with 362 residents, field visits and observations across coastal Bangladesh. The findings indicate that there have been improvements in house structures and design, warning responses and evacuation processes to public cyclone shelters and informal cyclone shelter centres. In the past, due to a lack of built infrastructure, strong residential houses and public cyclone shelters, deaths occurred whilst living in fragile houses; attempting to survive through holding trees and floating in storm surges. The top ten factors that may still cause deaths by tropical cyclones include: (1) Living adjacent to the coast without an embankment or lack of embankment, or the failure of an established embankment; (2) the repeat of a 1991-like cyclone; (3) non-evacuation following early warning; (4) poor roads in remote areas to facilitate mass movement; (5) distance to and insufficient number of public cyclone shelters; (6) lack of protective measures for the rising number of elderly and disabled people; (7) community's unawareness; (8) communication failure during the emergency period; (9) failure to evacuate people from remote locations; and (10) Poor radio signal and mobile network issues resulting in no warning information being effectively and timely communicated. This study provides several key recommendations addressing these factors of deaths, to be implemented by individual, community, private sectors, non-government organisations (NGOs) and public sectors across coastal Bangladesh.

Knowledge, Attitude and Practices Towards Dengue Fever Among Slum Dwellers: A Case Study in Dhaka City, Bangladesh

Objectives: This study intends to evaluate Dhaka city slum dwellers' responses to Dengue fever (DF). Methods: 745 individuals participated in a KAP survey that was pre-tested. Face-to-face interviews were performed to obtain data. Python with RStudio was used for data management and analysis. The multiple regression models were applied when applicable. Results: 50% of respondents were aware of the deadly effects of DF, its common symptoms, and its infectious nature. However, many were unaware that DF could be asymptomatic, a previously infected person could have DF again, and the virus could be passed to a fetus. Individuals agreed that their families, communities, and authorities should monitor and maintain their environment to prevent Aedes mosquito breeding. However, overall 60% of the study group had inadequate preventative measures. Many participants lacked necessary practices such as taking additional measures (cleaning and covering the water storage) and monitoring potential breeding places. Education and types of media for DF information were shown to promote DF prevention practices. Conclusion: Slum dwellers lack awareness and preventative activities that put them at risk for DF. Authorities must improve dengue surveillance. The findings suggest efficient knowledge distribution, community stimulation, and ongoing monitoring of preventative efforts to reduce DF. A multidisciplinary approach is needed to alter dwellers' behavior since DF control can be done by raising the population's level of life. People and communities must perform competently to eliminate vector breeding sites.

Predicted changes in future precipitation and air temperature across Bangladesh using CMIP6 GCMs

Understanding spatiotemporal variability in precipitation and temperature and their future projections is critical for assessing environmental hazards and planning long-term mitigation and adaptation. In this study, 18 Global Climate Models (GCMs) from the most recent Coupled Model Intercomparison Project phase 6 (CMIP6) were employed to project the mean annual, seasonal, and monthly precipitation, maximum air temperature (Tmax), and minimum air temperature (Tmin) in Bangladesh. The GCM projections were bias-corrected using the Simple Quantile Mapping (SQM) technique. Using the Multi-Model Ensemble (MME) mean of the bias-corrected dataset, the expected changes for the four Shared Socioeconomic Pathways (SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5) were evaluated for the near (2015-2044), mid (2045-2074), and far (2075-2100) futures in comparison to the historical period (1985-2014). In the far future, the anticipated average annual precipitation increased by 9.48%, 13.63%, 21.07%, and 30.90%, while the average Tmax (Tmin) rose by 1.09 (1.17), 1.60 (1.91), 2.12 (2.80), and 2.99 (3.69) °C for SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5, respectively. According to predictions for the SSP5-8.5 scenario in the distant future, there is expected to be a substantial rise in precipitation (41.98%) during the post-monsoon season. In contrast, winter precipitation was predicted to decrease most (11.12%) in the mid-future for SSP3-7.0, while to increase most (15.62%) in the far-future for SSP1-2.6. Tmax (Tmin) was predicted to rise most in the winter and least in the monsoon for all periods and scenarios. Tmin increased more rapidly than Tmax in all seasons for all SSPs. The projected changes could lead to more frequent and severe flooding, landslides, and negative impacts on human health, agriculture, and ecosystems. The study highlights the need for localized and context-specific adaptation strategies as different regions of Bangladesh will be affected differently by these changes.

Non-state initiatives on enhancing counter-trafficking of Rohingya influx in Cox's Bazar of Bangladesh

Human trafficking is the third most lucrative form of trafficking in the world (following drugs and counterfeit goods). Multiple outbreaks of unrest between October 2016 and August 2017 in the Rakhine State of Myanmar triggered ~745,000 influxes of Rohingyas crossing into Bangladesh through the border boundaries at Teknaf and Ukhiya sub-districts of Cox's Bazar. In this regard, the media confirmed that over a thousand Rohingya people, particularly women and girls, were victims of human trafficking. This research aims to explore the underlying causes of human trafficking (HT) during emergency responses and seeks to understand how the knowledge and capacity of the refugee, local administration, and law enforcement agencies in Bangladesh can be improved in promoting counter-trafficking (CT) and safe migration processes. In order to achieve the objectives, this study reviews acts, rules, policies, and action plans of the Government of Bangladesh on the HT, CT, and safe migration processes. Then, a case study has been applied to present the ongoing CT and safe migration programs of an NGO called Young Power in Social Action (YPSA), which received funding and technical support from the International Organization of Migration (IOM) for this purpose. This study also evaluates the effectiveness of the program through conducting key informant interviews (KIIs) and focus group discussions (FGDs) with the beneficiary and non-beneficiary participants including refugees, law-enforcing agencies (LEAs), and NGOs in Teknaf and Ukhyia. Thus, this study identifies program-level strengths and weaknesses in relation to the CT and safe migration process and provides key directions on how they can be improved. It concludes that non-state actors have a significant role in preventing HT and promoting CT and safe migration for Rohingyas in Bangladesh.

Limitations of COVID-19 testing and case data for evidence-informed health policy and practice

BACKGROUND

Coronavirus disease 2019 (COVID-19) became a pandemic within a matter of months. Analysing the first year of the pandemic, data and surveillance gaps have subsequently surfaced. Yet, policy decisions and public trust in their country's strategies in combating COVID-19 rely on case numbers, death numbers and other unfamiliar metrics. There are many limitations on COVID-19 case counts internationally, which make cross-country comparisons of raw data and policy responses difficult.

PURPOSE AND CONCLUSIONS

This paper presents and describes steps in the testing and reporting process, with examples from a number of countries of barriers encountered in each step, all of which create an undercount of COVID-19 cases. This work raises factors to consider in COVID-19 data and provides recommendations to inform the current situation with COVID-19 as well as issues to be aware of in future pandemics.

Dengue Fever Responses in Dhaka City, Bangladesh: A Cross-Sectional Survey

Objectives: This study intends to evaluate the Dhaka city residents’ individual views toward DF.

Methods: A cross-sectional survey used google forms for collecting data. Python and RStudio were used for data management and analysis. Kruskal-Wallis or Mann-Whitney U test and logistic regression models were performed, where appropriate.

Results: In total 1008 individuals participated in a pre-tested KAP survey. More than 20% reported being affected by DF before the survey, where they rated their current places as being moderately safe (43%). In terms of DF control, 65% had good knowledge, and 68% reported good practice, whereas they demonstrated an overall good attitude. The increased knowledge of individuals could contribute to behavioral changes regarding DF. Female residents demonstrated better DF attitudes (OR: 0.69; p &lt; 0.05) and practices (OR: 0.66; p &lt; 0.01) compared to male residents. Mixed unit residents had poor KAP levels. Educational attainment can also play an essential role in enhancing the attitude level.

Conclusion: Overall, dengue surveillance activities with sufficient campaigns are required for behavioral change in Dhaka city. This information could be integrated into other DF-affected countries’ strategies against dengue outbreaks.

Knowledge, Attitude, and Practices towards Dengue Fever among University Students of Dhaka City, Bangladesh

Dhaka has become the worst affected city in Bangladesh regarding dengue fever (DF). A large number of university students are residing in this city with a high DF risk. This cross-sectional study was conducted to assess the DF status and responses among these students through their Knowledge, Attitude, and Practices (KAP) survey. A total of 625 students participated in an online self-reported survey. Statistical analyses were performed to assess the status and KAP regarding DF. University students from the city perceived their living places as moderately safe (45.28%) against DF, whereas about 20% reported their DF infection history. Some of these students had exemplary DF knowledge (66.72%), attitude (89.28%), and practices (68.32%). However, many of them were also observed with a lack of knowledge about this disease’s infectious behavior, recognizing Aedes mosquito breeding sites, multiple infection cases, and the risk of DF viral infection during pregnancy. Fair correlations (p < 0.001) were determined in the KAP domain. Gender, residential unit, major, and dengue-relevant subjects were found to be significant predictors (p < 0.05) of KAP level in the univariate analysis. Major subject and residential units remained significant predictors of overall KAP level in further multiple analysis. This study revealed the urgency of infectious disease-related subjects and the relevant demonstration into the university curriculum. The study’s findings can assist the university, government and non-governmental organizations, and the health and social workers to prepare a comprehensive dengue response and preparedness plan.

Public Confidence in COVID-19 Prevention and Response in Bangladesh

Community confidence in institutional approaches to emergency management directs how they cooperate and comply with public policy responses. In the context of emerging COVID-19 pandemic risk management, this study aims to assess public confidence in the Government of Bangladesh (GoB) and private sector entities for the activities undertaken during preparedness, prevention, and response phases. A survey was conducted with 307 respondents who willingly took part in the study. Cronbach's alpha was calculated to assess the internal reliability and the Mann-Whitney U test was conducted to estimate the mean score difference between the observations. A confirmatory factor analysis (CFA) was applied in the study. The findings suggest that the participants were highly positive about the GoB efforts to organize and provide PPE for doctors in time as a safeguard against COVID-19 and coordination and informed decision making in relation to facing COVID-19. Overall, the participants showed a lower-level confidence in the preparedness and response measures taken by authorities in Bangladesh. The results explored how the GoB failed to reach the public satisfaction level regarding provision of food and financial support to low income and middle income people. A lack of collaboration and coordination among different inter-GoB and private sectors makes mitigation and recovery process difficult. This research provides a set of policy recommendations for future public health emergency management based on the participants' concerns and suggestions, and a review of consequences of policy responses in the early stage.

Public Trust in COVID-19 Prevention and Responses Between January and May 2020 in Bangladesh

BACKGROUND AND AIMS

Although the Government of Bangladesh (GoB) developed some policy initiatives during the first phase of COVID-19, their efforts were questioned due to indecision, late policy decisions and implementation, and a proliferation of fake testing and fake news. As such, this research aims to examine public trust in preparedness and response measures undertaken by both the GoB and private sector organisations in Bangladesh between January and May 2020.

METHODS

A cross-sectional survey method was applied to a sample of Bangladeshi residents using a questionnaire distributed between April and June 2020. Three hundred and seven respondents participated in an online questionnaire that was disseminated on online outlets, such as e-mail, Facebook Messenger, and WhatsApp. The survey questionnaire was distributed to potential respondents, and continuous-chain messages were provided. Data were analyzed using exploratory factor analysis (EFA).

FINDINGS

Of the 307 participants, 77% were male and 23% were female. Findings suggest that the participants showed greater approval of private sector responses than of governmental preparedness and response activities. For preparedness activities, participants were negative about both the GoB efforts to organize and provide personal protective equipment (PPE) for doctors in time as a safeguard against COVID-19, and also the lack of coordination and informed decision-making in relation to facing COVID-19. Respondents were asked to share their perception of the suitability of GoB pandemic management plans, as evidenced by plan effectiveness during the COVID-19 pandemic.

CONCLUSION

A lower level of trust was demonstrated by the Bangladeshis with regard to preparedness and response measures taken in Bangladesh. Based on participants' concerns and suggestions and a review of drawback of policy responses in the early stage, a set of recommendations are provided for future pandemics like public health emergency risk management in Bangladesh.

POS0275-HPR CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE NURSE’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS USING DAS-28, CDAI AND SDAI IN SEVEN MIDDLE EASTERN ARAB COUNTRIES

Background:

Managing patients with chronic rheumatic diseases is increasingly relying on the collaboration of a multidisciplinary team, including the rheumatology nurse who can aid assessment of disease activity among other healthcare tasks.

However, this practice, although common in Europe and North America, is still poorly implemented in the Middle eastern Arab countries (MEAC).

Objectives:

To evaluate the concordance between the physician’s and the nurse’s assessment of disease activity in patients with rheumatoid arthritis (RA) in the MEAC.

Methods:

During a routine patient visit to one of 9 rheumatology clinics located in 7 Middle Eastern Arab countries, the physician and the rheumatology nurse (who was already working in the clinic) performed the disease activity score 28 (DAS), Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) in a blinded manner. The concordance regarding the 3 continuous scores was calculated using paired t-test. The agreement between physician- and nurse-DAS categories (remission, low, moderate and high disease activity) was calculated using weighted kappa for category comparison. Predictive factors of positive concordance between physician- and nurse-DAS were identified using binary logistic regression.

Results:

The study included 373 patients’ measurements over a period of two years (2018 to 2019). The mean age of the patients was 49.6 years (±28.2), 82.6% were females, and the mean disease duration was 11.3 years (±7.5).

The mean physician-DAS was slightly higher (3.97 (±1.52)) than the nurse-DAS (3.90 (±1.54)) (p=0.002), with a mean difference of +0.08 [95%CI 0.03; 0.12] (Table 1). The difference in the DAS individual items, the CDAI and the SDAI were not statistically significant.

Table 1.

Comparison of the disease activity measures reported by the physician and by the nurse.

PhysicianNursep-valueTotal Joint Count4.87 (2.26)5.02 (6.20)0.152Swollen Joint Count2.13 (3.88)2.15 (3.83)0.790Global Assessment3.30 (2.41)3.32 (2.43)0.702DAS-283.97 (1.52)3.90 (1.54)0.002CDAI14.26 (12.53)14.38 (12.59)0.515SDAI21.51 (23.57)21.61 (21.66)0.527

When analyzing DAS as a categorical 4-items variable, the agreement between the physician and the nurse was present in 79.36% of the cases (weighted kappa was 0.77 [95%CI 0.73;0.83] which is considered as excellent, and was higher in patients with high disease activity (Figure 1).

A positive concordance between the physician- and the nurse-DAS was associated with the country (higher in Egypt, p<0.001) and the status of higher disease activity (p<0.001).

Conclusion:

The agreement between the DAS-28 performed by the physician and by the nurse was excellent and was associated with the country and a higher disease activity. The present study confirms that the support of a trained nurse for evaluating disease activity in RA is feasible in the Arab countries and may save some valuable time in the clinic, whilst maintaining the quality of care for patients with RA.

Figure 1.

Agreement between physician- and nurse-DAS categories

Acknowledgements:

The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.

Disclosure of Interests:

None declared

AB0104 CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE PATIENT’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS: RESULTS OF THE AUTODAS-MEAC STUDY AT ONE YEAR

Background:

Involving the patients with rheumatoid arthritis (RA) in the assessment of their disease may increase their adherence to treatment, improve the disease outcomes and facilitate the application of telehealth. We previously reported an excellent concordance between the Disease Activity Score (DAS-28) performed by physicians and patients at the baseline visit of this prospective study (1).

Objectives:

To evaluate the persistence of the concordance between the physician’ and the patient’s assessment of disease activity in RA using DAS-28 after one year.

Methods:

At the baseline visit, patients with RA from 7 Middle Eastern Arab Countries (MEAC) were briefed about DAS-28 by their rheumatologist during a routine consultation and given smartphone access to a video in Arabic language explaining the performance of DAS-28. At 3, 6 and 12 months (± 3 months), the patients were asked to self-report DAS-28, blinded to the physician’s assessment. Concordance between the continuous DAS-28 at each visit was calculated using paired t-test numerically and the Bland-Altman method graphically. Agreement between physician- and patient-DAS categories (remission, low-, moderate- and high disease activity) was calculated at each visit using weighted kappa for category comparison. Weighted kappa of the different agreements were compared over time using their respective confidence intervals (CIs). Predictive factors of positive concordance between physician and patient-DAS were identified using binary logistic regression.

Results:

The study included 428 patients over a period of three years (2018 to 2020). The mean age of participants was 49.8 years, 82.5% were females, 44.3% had a university degree and the mean disease duration was 11.4 years.

At baseline, the average patient-DAS was higher (4.06 (±1.52)) than the physician-DAS (3.97 (±1.52)). The mean difference was -0.09 [95%CI -0.14; -0.04] and most of the pairs were within the limit of agreement in the Bland-Altman graph, indicating a good concordance, particularly in cases of remission.

During the study follow-up, 299 patients consulted for visit 2 (69.9% of the total population), 232 for visit 3 (54.2%) and 199 for visit 4 (46.5%). The weighted kappa was 0.80 [95%CI 0.76;0.85] at visit 1 and 0.79 [95%CI 0.72;0.88] at visit 4 (Figure 1 showing kappa for DAS-28, CDAI and SDAI as well). A minor numerical decrease in kappa was observed over time; however, the CIs were overlapping over the four visits and the agreement was considered stable, remaining in the excellent range. At visit 4, a positive concordance between the physician- and the patient-DAS was associated with the profession (lower in blue collar, p=0.001), the educational level (higher in high school and university, p=0.034) and the baseline physician’s DAS (higher in high disease activity, p=0.46).

Conclusion:

The agreement between the DAS-28 performed by the physician and by the patient was excellent at baseline and remained stable over one year. A positive concordance was associated with the profession, the educational level and the level of disease activity. The present study can help the rheumatologist make informed decisions about the patients who may be suitable for a remote evaluation of their disease activity, that can be of particular interest in the context of the COVID-19 pandemic.

References:

[1]Ziade N, Saad S, al Mashaleh M, et al. Perceptions of Patients with Rheumatoid Arthritis about Self-Assessment of Disease Activity after Watching an Educational Video: Qualitative Pilot Results from the Auto-DAS in Middle Eastern Arab Countries Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10).

Acknowledgements:

The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk.

Disclosure of Interests:

None declared

Cyclone disaster vulnerability and response experiences in coastal Bangladesh

For generations, cyclones and tidal surges have frequently devastated lives and property in coastal and island Bangladesh. This study explores vulnerability to cyclone hazards using first-hand coping recollections from prior to, during and after these events. Qualitative field data suggest that, beyond extreme cyclone forces, localised vulnerability is defined in terms of response processes, infrastructure, socially uneven exposure, settlement development patterns, and livelihoods. Prior to cyclones, religious activities increase and people try to save food and valuable possessions. Those in dispersed settlements who fail to reach cyclone shelters take refuge in thatched-roof houses and big-branch trees. However, women and children are affected more despite the modification of traditional hierarchies during cyclone periods. Instinctive survival strategies and intra-community cooperation improve coping post cyclone. This study recommends that disaster reduction programmes encourage cyclone mitigation while being aware of localised realities, endogenous risk analyses, and coping and adaptation of affected communities (as active survivors rather than helpless victims).

Prevalence of anxiety and depression among medical students of private university

OBJECTIVE

To assess anxiety and depression levels among medical students of a private university by using a self-administered anxiety and depression questionnaire.

METHODOLOGY

A cross sectional study was done on the students of Ziauddin Medical University, who had spent more than six months in the medical school. A self-administered questionnaire was given to the students, present in the class and willing to participate in the study. During the survey students of 5th year were not available. The instrument used to asses the anxiety and depression levels was the, Aga Khan University Anxiety and Depression Scale (AKUADS). Additional questions regarding socioeconomic variables were also included in the survey instrument, such as student's birth order, monthly income, number of siblings, and monthly expenditure on education. Data analysis was done on Epi info version 6.

RESULTS

There were 252 students in 4th year MBBS to 1st year MBBS. Of these 189 were present during the survey. Using anxiety and depression scale it was found out that 113 (60%) students had anxiety and depression. Prevalence of anxiety and depression in students of 4th year, 3rd year, 2nd year and 1st year was 49%, 47%, 73% and 66% respectively. It was significantly higher in 1st year and 2nd year, as compared to 3rd and 4th year (p < 0.05). It was seen that birth order, monthly income, number of siblings and monthly expenditure on education did not affect the prevalence of anxiety and depression.

CONCLUSION

This study suggests that medical students experience anxiety and depression, the finding is consistent with other western studies, however there is no local data available to support our findings. The study finding highlights the need of psychiatric counseling and support services available to vulnerable students. These findings should be further explored in longitudinal studies to identify the stressors leading to these outcomes and appropriate interventions.

Selection procedure as predictor of performance in university examination

OBJECTIVE

To determine the correlation of SSC, HSC, ZMU achievement test and interview scores with the scores achieved in MBBS 1st, 2nd and 3rd Professional Examinations.

METHOD AND PROCEDURE

The SSC, HSC, ZMU admission test and interview scores of 159 MBBS students admitted in 1995, 1996 and 1997 were correlated with the scores of the 1st, 2nd and 3rd professional examinations. Data analysis was done on SPSS Software.

RESULTS

No significant relationship was found between the SSC, HSC, ZMU admission test and interview scores and the scores obtained in the professional examinations. SSC scores did not correlate with any variables/matrices, whereas for batches 1 and 2 the HSC school leaving examination scores correlated significantly with ZMU interview score (p < 0.05). No correlation was found between ZMU test and ZMU interviews. Results showed significant relationship (p < 0.01) between all 1st, 2nd and 3rd professionals of all three batches.

CONCLUSION

None of the admission criteria (SSC, HSC, ZMU admission test and interview scores) predict the performance of medical students in the professional examinations.

Two weeks triple therapy with lansoprazole, amoxycillin and roxythromycin is better than dual therapy with lansoprazole and amoxycillin for H. pylori infection: a randomised, clinical trial

AIMS

To compare the efficacy of 2 weeks of dual therapy of Lansoprazole and Amoxycilline with triple therapy of Lansoprazole, Amoxycilline and Roxythromycin for H. pylori eradication.

SUBJECTS

Twenty-five suffering from dyspepsia and found H. pylori positive (CLO) during upper GI endoscopy.

METHODS

Patients were divided into 2 groups, one group received Lansoprazole (30 mg) once a day, and amoxycilline (500 mg) three times a day (group I), while the second group received Lansoparazole and amoxycillin in similar dosage with the addition of Roxythromycin (150 mg) twice a day (group II). H. pylori status was confirmed on endoscopy using CLO test at entry to the protocol and then at 4 weeks.

RESULTS

H. pylori eradication was 57% in group I and 86% in group II with healing of lesions in all cases.

CONCLUSION

Better response with triple therapy (group II) indicates enhanced eradication of the pathogens with triple therapy while using roxythromycin (JPMA 50:157, 2000).

Oesophageal carcinoma in Karachi

Between January, 1979 to August, 1990, 107 histologically proven cases of oesophageal carcinoma were seen. The ages of the patients ranged from 19-85 years (mean 55 +/- 14 years) with a male to female ratio of 1.2:1. Majority (70%) of the cases belonged to lower socioeconomic group and 56% were migrants from India. History of tobacco chewing or smoking was present in 78% cases. In 54%, the lesion was located in the middle third of the oesophagus, followed by lower third in 44%. Histology showed squamous cell carcinoma in 86% and adenocarcinoma in 10% cases. Of the 19 cases followed, 16 underwent surgery and 3 received chemotherapy. Two cases died within 7 months following surgery and in 6 carcinomas recurred. All cases receiving chemotherapy died within 8 months of treatment.

H2 receptor antagonist or H. pylori eradication?

To assess the healing and relapse rate of duodenal ulcer (DU) treated with H2 receptor antagonists in helicobacter pylori (HP) positive vs negative cases, we analysed 95 cases of endoscopically proven duodenal ulcer. H. pylori colonization was found in 73 (77%) patients before treatment. No difference was observed in the pre-treatment characteristics between patients with HP positive and HP negative duodenal ulcers. Healing rates with H2 receptor antagonist at 8 weeks were 90% and 91% respectively (NS). No difference in HP colonization was found between patients with and without healed ulcerie, 77% and 78% respectively. Relapse rate within 1 year was 50% in patients with HP positive vs 73% with HP negative cases. We conclude that duodenal ulcer healing and relapse rate is related to acid inhibition rather than HP colonization.

A double-blind study of misoprostol (SC-29333) in the healing of duodenal ulcer

In a double-blind randomized placebo controlled trial, 50 patients with endoscopically confirmed duodenal ulcer were treated with either misoprostol 200 micrograms or placebo in q.i.d. doses for 4-8 weeks. Of 25 patients in the placebo group, four defaulted and two were withdrawn due to worsening of symptoms. Of 25 misoprostol-treated cases, 17 cases (68%) and 21 cases (84%) healed at 4 and 8 weeks respectively, compared with three (14%) and five (24%) of the 21 placebo-treated cases (P less than 0.001). Except for diarrhoea in 2 patients in each group and itching in one with misoprostol, no serious side effects were noted.

Efficacy of oral propranolol and injection sclerotherapy in the long-term management of variceal bleeding

Three treatment regimens were tried in 145 portal hypertensives with bleeding oesophageal varices to test the efficacy of each regimen in the prevention of rebleeding. Forty-seven cases received oral propranolol, 57 sclerotherapy, while 41 who did not receive any treatment except conservative management served as controls. Patients were followed up at 6 weeks, 6 months, 1 and 2 years to see the frequency of bleeding with each regimen. No significant difference was seen at 6 weeks with either of the three regimens but at 6 months and 1 year the frequency of bleeding was significantly less (p less than 0.05) in the propranolol group than in the other two groups while at 2 years results were significantly better with both propranolol (p less than 0.05) and sclerotherapy (p less than 0.001) than in controls. Efficacy of propranolol when compared with sclerotherapy showed similar results. The results of the present study are different from most of the western reports where sclerotherapy was found to be superior to propranolol. Variations in the results are likely to be due to differences in the etiology of portal hypertension in different countries.

Clinical features, course, viral markers and follow-up in young versus adult nonalcoholic cirrhotics--a retrospective study

To determine the presenting features and prognosis of nonalcoholic cirrhosis, retrospective analysis was done in 145 cases. Of the total, 48 patients (33%) belonged to the young (less than or equal to 35 years), and 97 (67%) to the adult age group (greater than 35 years) with no predominance of either sex. The etiology of cirrhosis and the positivity of viral markers were similar in both groups. Adults had on presentation a higher frequency of anorexia while hematemesis was more frequent in the young group (p less than 0.001). During a mean follow-up (+/- SE) of 31.7 +/- 5.5 and 16.3 +/- 2.2 months in the young and adult group, respectively, 68 and 63% cases survived 5 years. Liver failure (53.8 and 44.4%) and variceal bleeding (23 and 11.1%) were the main causes of death in both groups, accounting for 27% mortality in each group.