COVID-19 pandemic in Bangladesh: A scoping review of governance issues affecting response in public sector

Background

On January 30, 2020, WHO declared COVID-19 as a Global Public Health Emergency. The first three COVID-19 cases in Bangladesh were confirmed on March 8, 2020. Thus, Bangladesh got substantial time to prepare the people and the health systems to respond to the outbreak However, neither the health ministry nor the government was found to rise to the occasion and provide the necessary stewardship for a coordinated and comprehensive response.

Objective

The importance of governance to mount an evidence-based pandemic response cannot be overemphasised. This study presents critical reflections on the Bangladesh government's COVID-19 response through a review of selected papers, with expert deliberations on the review findings to consolidate emerging lessons for future pandemic preparedness.

Study design

A scoping review approach was taken for this study.

Methods

Documents focusing on COVID-19 governance were selected from a repository of peer-reviewed articles published by researchers using data from Bangladesh (n = 11).

Results

Findings reveal Bangladesh's COVID-19 response to be delayed, slow, and ambiguous, reflecting poorly on its governance. Lack of governance capability in screening for COVID-19, instituting quarantine and lockdown measures in the early weeks, safety and security of frontline healthcare providers, timely and equitable COVID-19 testing, and logistics and procurement were phenomenal. The pandemic unmasked the weaknesses of the health system in this regard and "created new opportunities for corruption." The failure to harmonise coordination among the government's different agencies for the COVID-19 response, along with poor risk communication, which was not culture-sensitive and context-specific. Over time, the government initiated necessary actions to mitigate the pandemic's impact on the lives and livelihoods of the people. Diagnostic and case management services gained strength after some initial faltering; however, the stewardship functions were not seamless.

Conclusions

Shortage of healthcare workers, incapability of health facilities to cater to COVID-19 suspects and cases, absence of health system resilience, and corruption in procurement and purchases were limited the government's COVID-19 response. These need urgent attention from policymakers to better prepare for the next epidemic/pandemic.

Health sector corruption in the times of COVID-19 pandemic in Bangladesh: Newspapers as mirrors of society

Objective

This paper aimed to identify and explore the major areas of health-sector corruption during COVID-19 pandemic as revealed in the print media. Findings are expected to mitigate health sector corruption in the country and contribute to strengthening the health systems.

Method

2588 news articles on health topics were identified through scanning six leading newspapers in Bangladesh during Mar. 2020 to Mar. 2021. Of these, 97 news articles focusing on corruption in health system were selected for analysis.

Findings

Findings reveal an all-embracing corruption at every stage, starting from procurement of medical supplies, to testing for COVID-19 to treatment and management of COVID-19 cases. The news papers reported about the low quality and general-purpose masks given to the frontline health workers, putting their personal protection from the virus at risk. Due to lack of stewardship and an effective monitoring system, quite a few private facilities were providing fake COVID-19 certificates, medicines and medical equipment at very high prices. For example, one particular hospital provided almost two thousand COVID-19 test certificates without testing. Although PPEs were originally sold at BDT 2000 per piece, double the amount was proposed for buying PPEs. Meropenem injection of the same quality was purchased by different government hospitals at unusually high prices. Among the measures taken to contain corruption during COVID-19 included filing cases, issuing arrest warrants and asking for submission of wealth statement and source of income of the accused persons. However, some of the accused eventually got released on bail.

Conclusion

The media, as a mirror of the society, successfully made visible the underhand corruption that was happening even during the pandemic, fulfilling its obligations to the society. They faced quite some challenges in revealing related news, especially from the government whose initial reaction was of denial and indifference.Due to lack of transparency and accountability in the sector, the patients as well as the healthcare providers had to suffer a lot.

Knowledge, Attitude and Practice of Undergraduate Medical Students of Bangladesh Regarding COVID-19 and its Vaccination

Medical students are one of the socially active, reliable, and persuading population of information, prevention and control, and incentive of vaccination to stop the current pandemic situation. Consequently, knowing the status of medical students' knowledge, about symptoms, and transmission of disease, prevention of COVID-19 and their attitudes towards a vaccine is important. This multi-center cross-sectional descriptive study was one of the first ones in Bangladesh among the undergraduate medical students who completed pathology, microbiology, and pharmacology. The study was conducted from March to April 2021, using a convenience sampling method in twelve government and non-government medical colleges. Among 1132 who completed the questionnaire, and 15 students from different centers were excluded from the pre-testing and face validation. The age of the 1117 respondents were 22 to 23 years, of which the majority of the respondents were female 749 (67.0%), and 368 (33.0%) were male. Almost all participants had correct knowledge (84.1%) about the symptoms of COVID-19. But 59.2% had wrong knowledge about transmission of disease by an afebrile person. Above 60.0 % of the participants have worn a facial mask when contacting people, refrained from shaking hands, washed hands, avoided people with signs and symptoms suggestive of COVID-19, and avoided crowded places as a practice of prevention. 37.6% of medical students showed positive attitudes about the participation of management of a COVID-19 patient. Most of the participants' decided to have a vaccine depending on its availability. But 31.5% had trust in natural immunity rather than vaccination. Most undergraduate Medical college students understood the basic information, possessed a positive attitude, and presented good practice towards the COVID-19 and vaccination. They play a crucial role in motivation and acceptance of vaccines among the general citizen to fight back against the pandemic in the country with limited resources.

Binocular Visual Discomfort after First Eye Cataract Surgery: An Inattentive Burning Issue

Cataract surgery is the most frequent surgical procedure performed among the elderly. Aniseikonia and anisometropia increased after the first eye cataract surgery. The study was performed to evaluate unwanted visual status after first eye cataract surgery. It was an observational and cross-sectional study performed among the cataract surgery patients attending in out patient department (OPD) of Dr K Zaman BNSB Eye Hospital, Mymensingh from July 2018 to September 2018 for post-operative follow up. Five hundred patients were selected randomly. Patients with gross corneal diseases were excluded from the study. Three hundred forty one patients (68.2%) were with first eye cataract surgery, among them 319 patients (63.8%) had different degree of cataract in other eye. One hundred forty three patients (44.7%) had good presenting vision (≥6/18) in operated eye and much reduced vision in other eye due to cataract, experienced binocular visual discomfort when opened two eyes, which was not experienced by the patients who had reduced vision in both eyes or good vision in both eyes. Cataractous eye interfered with visual function of the pseudophakic eye. So, cataract Surgery for both eyes in separate events is the appropriate treatment for the patients with bilateral cataract to eliminate visual disability and to achieve comfortable visual outcome.

Antibiotic Resistance: New Challenge in the Management of Bacterial Eye Infections

Ophthalmologists are still facing difficulties in managing bacterial eye infections. The study was designed for the isolation and identification of bacteria from infected eyes and observation of the sensitivity and resistant pattern. This cross sectional study was performed among 160 patients of suspected bacterial eye infection at Dr. K. Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh from March, 2010 to June, 2014. After collection of the samples from suspected infected eyes, it was nourished into nutrient broth in shaking incubator for three hours and then cultured into nutrient agar media followed by Mannitol salt agar, MacConkey's agar and blood agar. Bacteria were categorized by colony characteristics and Gram staining. Antibiogram was performed by disc diffusion method on Mueller Hinton agar media. McFarland Equivalence Turbidity Standard was maintained. The efficacy of the drug was evaluated by measuring the diameter of the zone of inhibition surrounding the disc. Ten percent Staphylococcus species isolates was resistant to Gatifloxacin, Gentamicin, Tobramycin and Cloxacillin, 26.0% to Ciprofloxacin, 40.0% to Azythromycin and Moxifloxacin, 58.0% to Cefixime and 64.0% to Cephalexin. Methicillin resistant Staphylococcus aureus was 62.8%. About 24.0% Streptococcus species isolates was resistant to Gatifloxacin, 33.3% to Azythromycin, Ciprofloxacin, Gentamycin, Moxifloxacin and Tobramycin, 52.4% to Cefixime and 71.4% to Cephalexin. About 9.0% of Pseudomonas species was resistant to Gatifloxacin and Tobramycin, 14.7% to Ciprofloxacin, 26.5% to Cefixime, 29.4% to Gentamicin and Moxifloxacin, 44.1% to Azythromycin and 82.3% to Cephalexin and Cloxacillin. Rational use of antibiotics and proper attentions of concerned authorities are necessary to overcome the emergent ocular situation leaded by antibiotic resistant.

Management of Infective Corneal Ulcer: Epidemiology Needs To Be Evaluated As Priority Basis

Because of known and unknown etiology, management of ocular devastating situation like corneal ulcer is still a challenge for the Ophthalmologists. The cross sectional study was designed for detection of predisposing factor and identification of causal agent. To serve the above purpose, a cross sectional study was performed among 140 patients of the corneal ulcer at Dr K Zaman BNSB Eye Hospital, Mymensingh and Department of Microbiology and Hygiene, Bangladesh Agricultural University, Mymensingh, Bangladesh. Detail history of patient was taken and recorded in a pretest questionnaire sheet. Two pieces of sample were collected from each corneal ulcer patient. One sample was examined in KOH wet mount for fungus. Other sample was nourished into nutrient broth and for further culture and identification. Bacterial corneal ulcer was higher among the patient of age group ≥46 years (61.9%) followed by 31-45 years (21.5%). P value is 0.261. Males were found predominant (58.5%). P value is 0.13. Agricultural related work was identified as most risky occupation in 83.1% of the total bacteria positive samples. P value is 0.01. Trauma was noted as most predominant influencing factor (56.9%). P value is <0.05. Bacteria were identified in 65(46.4%) and fungus in 40(28.6%) samples. Pseudomonas species were predominant (52.3%) followed by Staphylococcus species (26, 2%) and Streptococcus species (21.5%). No mixed infection was identified. For easier and earlier diagnosis of corneal ulcer, information about epidemiology is very essential. History should be taken meticulously followed by the laboratory procedures.

Effect of nutrition education on exclusive breastfeeding for nutritional outcome of low birth weight babies

BACKGROUND/OBJECTIVES

Low birth weight (LBW), defined as the body weight at birth of less than 2500 g, is a major public health problem in Bangladesh, where 37% of the babies are born with LBW. The objective of this study is to see the impact of nutrition education on growth of LBW babies with early initiation and exclusive breastfeeding compared to control group.

SUBJECTS/METHODS

A total of 184 LBW babies and their mothers who attended the Maternal Care and Health Training Institute and Dhaka Medical College Hospital were randomly allocated to either intervention or control group. Enrollment of the study population started in May 2008 and was completed in October 2008. Nutrition education was given to mothers twice weekly for 2 months, on initiation of breastfeeding within 1 h, exclusive breastfeeding and increasing their dietary intake. Nutritional status of LBW babies was assessed for length and weight every 2 weeks. Data were analyzed using SPSS/Window's version 12. Comparison of mean of data was done using standard Student's t-test.

RESULTS

Mean initial body weight and length of LBW babies were similar in both groups (2261±198 g vs 2241±244 g, P=0.535 and 43.0±1.3 cm vs 43.0±1.7 cm, P=0.77). Body weight and length of the LBW babies after 2 months increased significantly (3620±229 g vs 3315±301 g, P<0.001 and 50.2±1.3 cm vs 48.7±1.6 cm, P<0.001). It was found that the intervention group suffered less from respiratory illness compared with the control group (39% vs 66%, P<0.001). The rate of early initiation of breastfeeding was also significantly higher with nutrition intervention (59.8% vs 37.2%, P<0.001). Exclusive breastfeeding rate was significantly higher in intervention group (59.8% vs 37%, P=0.003).

CONCLUSIONS

The present study showed that weight and length gain of LBW babies significantly increased by breastfeeding and nutrition education. Therefore, nutrition education on breastfeeding proves to be a strong tool to reduce the high risk of malnutrition and mortality of the LBW babies.

Subtypes of dissociative (conversion) disorder in two tertiary hospitals in Bangladesh

Dissociative (conversion) disorders are common among the patients attending in and out patients of Psychiatry Department of tertiary hospitals in Bangladesh. This study was done to see the subtypes of dissociative (conversion) disorder according to International Classification of Diseases, Tenth Revision (ICD-10). This is a descriptive, cross sectional study done on 100 consecutive patients from the Departments of Psychiatry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH). Study period was July 2005 to June 2006. Among the patients of dissociative (conversion) disorder, mixed dissociative (conversion) disorder was found highest 34%, followed by dissociative convulsion 33%, dissociative motor disorders 19%, dissociative anaesthesia and sensory loss 5%, dissociative amnesia 4%, dissociative fugue 3%. However, the researcher did not find any multiple personality disorder which is relatively common in North America. This finding reflected that there are differences in prevalence of sub types of dissociative disorders in Bangladesh and Western countries.

Critical flicker frequency of mentally retarded and normal persons

Critical flicker frequency (CFF) of 40 men, 20 mentally retarded whose mean age was 22.0 yr. and 20 normal whose mean age was 21.5 yr., was measured under binocular viewing using the Lafayette Visual Perception Control with a display unit. Subjects had been previously tested for visual acuity and color blindness. Analysis showed a significant difference in CFF between mentally retarded persons and normal individuals, the former having lower CFF than the latter. This finding suggests lower perceptual sensitivity of the mentally retarded persons. Further research with provision for EEG recordings is suggested.

Depression in deliberate self harm patients

One hundred consecutively admitted deliberate self-harm patients were studied. By using DSM III-R criteria for Major Depressive Episode (MDE) 38 were found to have major depressive disorder. Among them 27 were severe, 9 were moderate and only 2 were mild according to HRSD score which were entirely consistent with severity grading recorded by DSM III-R. Another 48 showed evidence of depressive symptoms which may be due to extreme subjective distress. All the depressed self-harm patients had depressed mood and almost all of them expressive somatization. Only 5 depressed self-harm patients were getting psychiatric treatment which indicate lack of awareness about the existence of depression among deliberate self-harm patients and poor referral service in the hospitals.

Pattern of depressive disorder among the permanent sterilized women

A prospective study was done on 100 permanent sterilized women (age 21 to 40 years) attending two model family planning clinics of Dhaka. By using DSM III-R criteria for major depressive episode, 19 were found to have depressive disorder. Among them 3 were severe, 8 were moderate and rest 8 were mild according to HRSD score. The average number of children in postligated depressive group was 5 in number. Almost all the depressives had considerable life events one year before ligation and relationship problem was the most frequent event. The time of occurrence of depressive disorder was within 2-3 months after ligation in 42.11% of the depressives. Only 2 cases of the depressives were getting psychiatric treatment which indicates lack of awareness about the existence of depression among postligated women.