Age and sex-specific disability-free life expectancy in urban and rural settings of Bangladesh

BACKGROUND

Disability-free life expectancy (DFLE) has been used to gain a better understanding of the population's quality of life.

OBJECTIVES

The authors aimed to estimate age and sex-specific disability-free life expectancy (DFLE) for urban and rural areas of Bangladesh, as well as to investigate the differences in DFLE between males and females of urban and rural areas.

METHODS

Data from the Bangladesh Sample Vital Statistics-2016 and the Bangladesh Household Income and Expenditure Survey (HIES)-2016 were used to calculate the disability-free life expectancy (DFLE) of urban and rural males and females in Bangladesh in 2016. The DFLE was calculated using the Sullivan method.

RESULTS

With only a few exceptions, rural areas have higher mortality and disability rates than urban areas. For both males and females, statistically significant differences in DFLE were reported between urban and rural areas between the ages of birth and 39 years. In comparison to rural males and females, urban males and females had a longer life expectancy (LE), a longer disability-free life expectancy, and a higher share of life without disability.

CONCLUSION

This study illuminates stark urban-rural disparities in LE and DFLE, especially among individuals aged < 1-39 years. Gender dynamics reveal longer life expectancy but shorter disability-free life expectancy for Bangladeshi women compared to men, emphasizing the need for targeted interventions to address these pronounced health inequalities.

Measuring the impact of responsible factors on CO2 emission using generalized additive model (GAM)

The indicators of economic and sustainable development ultimately significantly depend on carbon dioxide (CO2) emissions in every country. In Bangladesh, there is an increasing trend in population, industrialization, as well as electricity demand generated from different sources, ultimately increasing CO2 emissions. This study explores the relationship between CO2 emissions and other significant relevant indicators. Moreover, the authors aimed to identify which model is effective at predicting CO2 emissions and assess the accuracy of the prediction of different models. The secondary data from 1971 to 2020, was collected from the World Bank and the Bangladesh Road Transport Authority's publicly accessible website. The generalized additive model (GAM), the polynomial regression (PR), and multiple linear regression (MLR) were used for modeling CO2 emissions. The model performance is evaluated using the Bayesian information criterion (BIC), Akaike information criterion (AIC), Root mean square error (RMSE), R-square, and mean square error (MSE). Results revealed that there are few multicollinearity problems in the datasets and exhibit a nonlinear relationship among CO2 emissions. Among the models considered in this study, the GAM model has the lowest value of RMSE = 0.008, MSE = 0.000063, AIC = -303.21, BIC = -266.64 and the highest value of R-squared = 0.996 compared to the MLR and PR models, suggesting the most appropriate model in predicting CO2 emissions in Bangladesh. Findings revealed that the total CO2 emissions and other relevant risk factors is non-linear. The study suggests that the Generalized additive model regression technique can be used as an effective tool for predicting CO2 emissions in Bangladesh. The authors believed that the findings would be helpful to policymakers in designing effective strategies in the areas of a low-carbon economy, encouraging the use of renewable energy sources, and focusing on technological advancement that reduces CO2 emissions and ensures a sustainable environment in Bangladesh.

Investigating time to first birth among women of reproductive age in Bangladesh: a survival analysis of nationwide cross-sectional survey data

BACKGROUND

The birth of the first child is an important turning point in a woman's life as it is the starting point of the demanding responsibilities of motherhood and childcare. This study aimed to explore the waiting time and the significant indicators of time to the first birth of aged 15-49 years of ever-married women in Bangladesh.

METHODS

The study considered the most recent country-representative data collected from Bangladesh Demographic and Health Survey (BDHS) in 2017/18. The log-rank test was used to assess the statistical significance of the observed difference between waiting time to first birth and various socio-economic and demographic factors. The Cox proportional hazard model is applied to identify the influential factors for waiting time to first birth.

RESULTS

About 55% of the respondents' age at their first birth was less than 18 years. More than 21% of them were 20 years and above at their first birth. Findings revealed a higher mean age at first birth in urban areas than in rural areas. Also, in Dhaka and Sylhet region, women have a higher age at first than in other regions of Bangladesh. Results show that the place of residence, region, age at first marriage, age at first sex, respondent's education, employment status, contraceptive use, and mass media exposure were found to be statistically significant determinants of the age of respondents at the time of first birth. Findings also show that a woman from rural areas was likely to be 5% smaller in age at the time of first birth than their counterpart (aHR 1.05; 95% CI 1.01-1.10). The age at first birth of a woman in Chattogram was 24% shorter, while in Rangpur and Barishal, that age was increased by 14% and 8%, respectively. A woman with no education, primary, and secondary education had 28%, 38%, and 29%, respectively, shorter age at first birth than that of the higher educated women. Mass media unexposed women were shorter aged at first birth by 27% (aHR 1.27; 95% CI 1.10-1.47) compared to the women who were mass media exposed.

CONCLUSION

It is necessary to increase the age of mothers at first birth which may help to reduce the prevalence of child marriage in Bangladesh. The study findings will be helpful to the policymakers in identifying the gap and designing the programmes targeting the early timing of first birth to reduce child mortality as well as poor maternal outcomes which will be beneficial for achieving the Sustainable Development Goal-3 in Bangladesh.

Initial Six Month's Study of Neonatal Covid-19 in a Tertiary Care Hospital of Bangladesh

The pandemic Covid-19 affects mainly adult causing fatal illness specially who have co-morbidities. But as days pass by with increasing surveillances it's gradually obvious that this devastating disease also affects the children as well as neonates with greater number. The aim of study was to determine the Covid-19 in neonates. So, we can give proper emphasis on neonatal Covid-19. This cross-sectional study was conducted from April 2020 to September 2020 at Dhaka Shishu (Children) Hospital in Bangladesh. Neonates with suspected Covid-19 were tested for SARS-CoV-2 by RT- PCR. Newborn who had suspected or confirmed COVID-19 mother, exposed to relatives infected with Covid-19, related with cluster outbreak or with abnormal clinical courses such as respiratory distress, not responded to conventional treatment and also abnormal chest x-ray was selected for Covid-19 test. Data regarding gestational age, birth weight, gender, positive cases and other findings were collected and analyzed. Statistics analysis was done by SPSS version 26.0. Forty three cases were Covid-19 positive. Among them 28(65.1%) cases were male and 15(34.9%) female. Term was 39(90.6%) cases and preterm 4(9.4%). Twenty nine (67.5%) cases were belonged to medicine and 14(32.6%) surgical cases. Fourteen (32.5%) cases with Covid-19 lived in Dhaka and 29(67.5%) cases in outside of Dhaka. Eleven (25.5%) cases were positive for SARS -CoV-2 by RT- PCR within 3 days, among them 5 (11.6%) cases were within 24 hours of age. Nine (20.9%) and 23(53.5%) cases were test positive at day 4-7 and 8-28 days respectively. The main symptoms at admission were respiratory difficulty (12/43, 27.9%), fever (8/43, 18.6%), convulsion (8/43, 18.6%) and reluctance to feed (7/43, 16.6%). In neonate two or more diseases coexist in same cases. Sepsis was present in 20 (46.5%) cases with COVID-19. Perinatal asphyxia was present in 10(23.3%) and pneumonia in 8 (18.6%) cases. In laboratory findings low Hb% was present in 2/43(4.7%) cases, leukopenia in 4/43(9.3%), leukocytosis in 2/43(4.7%) and thrombocytopenia in 5/43(11.6%). Elevated CRP was present in 14/29 (32.6%) cases, hypernatremia in 10/33 (30.3%), hyponatremia in 1/33(3%), increased serum creatinine in 10/18(55.6%), and prolonged PT, aPTT in 2/2(100%). Hyperglycaemia was found in 1/15(6.7%) cases and hypoglycaemia in 2/15(13.3%). No organism was found in blood C/S. In chest X-ray, one showed patchy opacities in right lower lobe, another showed bilateral ground-glass opacity and third one revealed few patchy opacities in the right perihilar region. Among 43 cases 21(48.9%) were discharged with advice, 12(27.9%) cases referred to Covid-19 designated hospital, 2(4.7%) cases LAMA (Leave against medical advice) and 8(18.6%) cases died including one surgical case. A good number (43) of Covid-19 cases were found in this study. In neonates the clinical features could not be differentiated properly between Covid-19 or associated diseases unlike children and adult. The neonate may be a source of transmission of this disease. So, we should give proper emphasis on test, tracing and management of neonatal Covid-19.

Trends and long-term variation explaining nutritional determinants of child linear growth: analysis of Bangladesh Demographic and Health Surveys 1996-2018

OBJECTIVE

To examine the height-for-age z-score (HAZ) of 0-35 months' children along with stunting prevalence to identify trends, changes and available nutrition-sensitive and specific determinants that could help explain the long-term variation in child linear growth using successive Bangladesh Demographic and Health Surveys (BDHS) data from 1996 to 2018.

DESIGN

The BDHS pooled data are used for determining the key outcome variables HAZ, stunting and severe stunting. Trends, kernel-weighted local polynomial smoothing illustrations, pooled multivariable linear probability model (LPM), ordinary least squares method (OLS) and regression decomposition were used.

PARTICIPANTS

Mothers having 0-35 months' children, the most critical age range for growth faltering.

RESULTS

The mean HAZ increased by 0·91(±1·53) with 0·041 annual average change, while the percentages of stunting (-26·63 ± 0·54) and severe stunting (-21·12 ± 0·48) showed a reduction with 1·21 and 0·96 average annual changes, respectively. The average HAZ improvement (0·42 ± 1·56) in urban areas was less than the rural areas (1·16 ± 1·44). Similar patterns followed for stunting and severe stunting. The prenatal doctor visits (3064·65 %), birth in a medical facility (1054·32 %), breastfeeding initiation (153·18 %) and asset index (144·73 %) demonstrated a huge change. The findings of OLS, LPM and regression decomposition identified asset index, birth order, paternal and maternal education, bottle-fed, prenatal doctor visit, birth in a medical facility, vaccination, maternal BMI and ever-breastfed as influencing factors to predict the long-term changes of stunting and severe stunting.

CONCLUSION

The nutrition-sensitive and specific factors identified through regression decomposition describing long-term variation in child linear growth should be focused further to attain the sustainable development goals.

Association of dietary diversity of 6-23 months aged children with prenatal and postnatal obstetric care: evidence from a nationwide cross-sectional study

BACKGROUND

Dietary diversity is a key determinant of infant and young child eating patterns for a variety of food groups taken by children between the ages of 6-23 months. The study aimed to examine the association between prenatal and postnatal obstetric care factors of mother and child's dietary diversity, and specific food practices in Bangladesh.

METHODS

This study analyzed the data of 2497 children between the age of 6-23 extracted from the latest countrywide Bangladesh Demographic Health Survey 2017-2018 and explored relationships between prenatal and postnatal obstetric care received by mother and dietary diversity score (DDS), minimum dietary diversity (MDD), and introduction of solid, semi-solid, and soft foods (ISSSF) of their children.

RESULTS

Findings revealed that ≥ 4 antenatal care (ANC) visits care visits increased the DDS (adjusted [Formula: see text]: 0.32, 95% CI [0.21, 0.43]), increased the likelihood of MDD (AOR 1.54, 95% CI [1.23, 1.93]), and ISSSF (AOR 1.24, 95% CI [1.08, 1.48]), consuming eggs (AOR 1.47, 95% CI [1.23, 1.76]), and vitamin A vegetables and fruits (AOR 1.38, 95% CI [1.15, 1.66]). Moreover, DDS (adjusted β: 0.05, 95% CI [0.00, 0.11]) and MDD (AOR 1.66, 95% CI [1.31, 2.11]) are linked to childbirth in a medical facility. The C-section delivery influences the DDS (adjusted [Formula: see text]: 0.05, 95% CI [0.00, 0.10]), MDD (AOR 1.39, 95% CI [1.10, 1.75]), and ISSSF (AOR 1.22, 95% CI [1.02, 1.48]). Besides, postnatal visits within 48 h of delivery linked to MDD (AOR 0.66, 95% CI [0.49, 0.89]) and ISSSF (AOR 0.76, 95% CI [0.59, 0.97]), and physicians or professionals providing postnatal checkups were significantly associated with DDS (adjusted [Formula: see text]: 0.09, 95% CI [0.02, 0.16]), MDD (AOR 1.69, 95% CI [1.26, 2.26]), and ISSSF (AOR 1.30, 95% CI [1.04, 1.62]).

CONCLUSION

Knowledge of child nutritional feeding should emphasize during prenatal and postnatal obstetric care of mother, particularly during antenatal and postnatal visits, C-section delivery, and birth in a healthcare facility to eradicate malnutrition and establish healthy child feeding practices.

Influence of cyber-victimization and other factors on depression and anxiety among university students in Bangladesh

BACKGROUND AND OBJECTIVES

Cyber-victimization is closely linked with mental health problems such as anxiety, depression, etc., and has become a growing concern among university students in Bangladesh. In the era of globalization, smart gadgets, the internet, and other online resources are readily available, and these tools and devices have now become the primary method for cyberbullying. The authors aim to explore the impacts of cyber-victimization and other factors on anxiety and depression among university students in Bangladesh.

METHODS

The primary data for this cross-sectional study were collected using a well-structured questionnaire. This study employs three widely used scales such as cyberbullying inventory, general anxiety disorder-7 (GAD-7), and patient health questionnaire-9 (PHQ-9). Descriptive statistics and multivariable logistic regression analyses are carried out to identify the factors associated with depression and anxiety among university students in Bangladesh.

RESULTS

Findings depict that the prevalence of depression and anxiety among university students was 52.5% and 44.0%, respectively. Depressed respondents were considerably more likely to have difficulty sleeping (p < 0.001), spend more time on social media (p = 0.002), have suicidal thoughts (p < 0.001), and have a high cyber-victimization score (p < 0.001) compared to non-depressed respondents. In comparison with non-anxious respondents, anxious respondents were significantly more likely to: have sleeping difficulties (p < 0.001); spend more time on social media (p = 0.031); have suicidal thinking (p < 0.001); and have a comparatively high cyber-victimization score (p < 0.001). Multivariable logistic regression analysis identified that a one-unit increase in the cyber-victimization score results in a 1.24 times higher chance of experiencing depression (AOR: 1.24, 95% CI 1.17-1.31, p < 0.001), and a one-unit increase in the cyber-victimization score results in a 1.23 times higher chance of experiencing anxiety (AOR: 1.23, 95% CI 1.17-1.30, p < 0.001).

CONCLUSION

University students are struggling with cyberbullying, which can lead to depression and anxiety levels. Promoting more cyberbullying awareness is necessary since failing to do so could result in a sustained or increased prevalence of anxiety and depression levels among students, which could have disastrous repercussions.

Effectiveness of "Physician Prompt Clinical Decision Criteria" in Weaning Outcome Prediction for Neurocritical Patients

Endotracheal intubation and invasive mechanical ventilation are fundamental components for the resuscitation of neurocritically ill patients to achieve various goals which include ensuring the protection of the airway, participating in tissue oxygen delivery and indirectly modulating cerebral vascular reactivity. The neurocritical patients demand special attention to their systemic involvement regarding weaning. Physician prompt clinical decision criteria (PPC) can play a better role in weaning of such patients. The aim of this study was to evaluate the effectiveness of 'Physician prompt clinical decision criteria' for successful weaning in neurocritical patients. This prospective observational study was conducted in the ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from March 2018 to April 2020. In total 100 neurocritical patients who fulfilled the inclusion criteria were taken as samples by informed written consent. The outcome was observed as successful weaning or as failed weaning. Finally, the existence of Standard extubation criteria (SEC) was compared with Physician prompt clinical decision criteria (PPC). Weaning was succeeded in 80.0% of patients and failed in 20.0% according to the Standard extubation criteria (SEC) while weaning was succeeded in 85.7% of patients and failed in 14.28% according to the Physician prompt clinical decision criteria (PPC). There were some differences in results but no significant differences were observed statistically between the groups in predicting the weaning outcome. Physician prompt clinical decision criteria were found to be 75.0% sensitive and specificity was 50.0%. Positive predictive value for Physician prompt clinical decision criteria was 85.70% with a Positive likelihood ratio for these criteria was 1.5 times. So, according to the study findings, accuracy of Physician prompt clinical decision criteria was 70.0%. According to the findings of this current study we can conclude that Physician prompt clinical decision criteria are an effective weaning readiness predictor in neurocritical patients.

Determinants of early sexual initiation among female adolescents in Bangladesh: evidence from a countrywide cross-sectional survey

OBJECTIVES

Early sexual initiation (ESI), defined as sexual activity that begins before 15 or 18 years of age, is one of the risky sexual behaviours that has been linked to increased likelihood of adverse consequences, such as sexually transmitted diseases, unintended pregnancies and unsafe abortions. However, to date, there are no studies investigating the prevalence and factors influencing ESI among adolescent females (aged 10-19 years) in Bangladesh. Thus, this study aimed to identify the potential determinants of ESI among adolescent females in Bangladesh based on data that are representative of the country.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Based on the availability of the data, the analysis included a weighted sample of 2051 adolescent females aged 15-19 years from the Bangladesh Demographic and Health Survey 2017/18. Initial selection of predictor variables was based on the bivariate analysis using the Chi-squared test. Univariate and multivariable logistic regression modelling were performed to measure the crude and adjusted effect of the selected predictor variables on ESI using the odds ratio (OR). The elasticity of the effects was calculated by their 95% confidence intervals (CIs).

RESULTS

Approximately 22% and 85% of female adolescents experienced ESI before the age of 15 and 18 years, respectively. Findings revealed that illiteracy (adjusted OR [AOR]: 3.61, 95% CI: 1.82-7.18), primary education (AOR: 2.08, 95% CI: 1.60-2.69), working status (AOR: 1.25, 95% CI: 0.98-1.60), living in Chittagong (AOR: 0.46, 95% CI: 0.27-0.79), living in Sylhet (AOR: 0.21, 95% CI: 0.08-0.56), reading newspapers (AOR: 0.63, 95% CI: 0.40-1.01), earlier marriage preference (AOR: 3.30, 95% CI: 2.31-4.71) and later marriage preference (AOR: 4.10, 95% CI: 3.01-5.59) were significantly linked with ESI before the age of 15 years. ESI before the age of 18 years was significantly association with primary education (AOR: 1.47, 95% CI: 1.01-2.13), religion (AOR: 0.55, 95% CI: 0.32-0.94), female household head (AOR: 1.93, 95% CI: 1.17-3.19), living in Rajshahi (AOR: 1.97, 95% CI: 0.95-4.08), being in the 'poorest' wealth category (AOR: 2.43, 95% CI: 1.45-4.07), being in the 'poorer' wealth category (AOR: 1.70, 95% CI: 1.06-2.72), being in the 'middle' wealth category (AOR: 1.76, 95% CI: 1.12-2.77), being in the 'richer' wealth category (AOR: 1.58, 95% CI: 1.02-2.44), earlier marriage preference (AOR: 15.71, 95% CI: 9.09-27.14), later marriage preference (AOR: 12.62, 95% CI: 8.82-18.06) and heard about family planning (AOR: 0.70, 95% CI: 0.47-1.04).

CONCLUSIONS

In Bangladesh, the prevalence of ESI among female adolescents is a public health concern. Due to the detrimental impact of ESI on the well-being of adolescents, it is crucial that policymakers consider the factors influencing ESI that have been identified in this study when designing health strategies. The findings from this study will help the development of evidence-based effective initiatives by policymakers in collaboration with governmental and non-governmental organisations.

Corrigendum to "Impact of COVID-19 pandemic on the mental health of children in Bangladesh: A cross-sectional study" [Child. Youth Serv. Rev. 117 (2020) 105277]

[This corrects the article DOI: 10.1016/j.childyouth.2020.105277.].

Influencing factors associated with maternal delivery at home in urban areas: a cross-sectional analysis of the Bangladesh Demographic and Health Survey 2017-2018 data

BACKGROUND

The associated factors and patterns of giving birth in home settings of rural areas have been extensively studied in Bangladeshi literature. However, urban areas still need to be explored, particularly with recent data. Therefore, the authors aimed to investigate the influential determinants of delivery at home in urban areas of Bangladesh.

MATERIALS AND METHODS

In this study, 1699 urban-dwelling women who had given birth within the previous 60 months of the survey and lived in urban areas were used. The secondary data were extracted from the latest Bangladesh Demographic and Health Survey 2017-2018. Descriptive statistics and logistic regression were applied along with the association among selected variables were examined by the Chi-square test.

RESULTS

Findings depict that 36.49% of women who lived in urban areas of Bangladesh delivered at home, whereas, 63.51% delivered at different govt. and private health care facilities. Women who lived in Chittagong [adjusted odds ratio (AOR) = 2.11, 95% CI 1.24-3.60], Barisal [AOR = 2.05, 95% CI 1.16-3.64] and Sylhet [AOR = 1.92, 95% CI 1.08-3.43] divisions have more likelihood to deliver at home (36.85%). Urban women following Christian religion [AOR = 10.71, 95% CI 1.32-86.68] have higher odds of delivering child at home (0.47%). Urban women having three or more children before her latest delivery (22.37%) and who are employed (29.37%) have more likelihood to deliver at home. However, women aged between 25 and 34 years (43.50%), who have higher education (25.90%), play the role of household head (9.06%), have parity of more than two births (2.24%), and read daily newspapers (68.69%) had a lower chance of delivery at home. Furthermore, women from wealthier families (89.12%) and more antenatal care (ANC) visits (94.93%) were less likely to have a delivery at home.

CONCLUSION

Despite significant progress in women and reproductive health in Bangladesh, the proportion of delivery in the home in urban areas is alarming and should be emphasized more. The authors believe the identified factors will help design interventions and policy development on this issue.

Outcomes of Varus Derotation Femoral Osteotomy By Angle Blade Plate in Legg-Calve-Perthes Disease for Patient Above Eight Years of Age in The Lateral Pillar B or B/C Group

Legg-Calve-Perthes disease (LCPD) that starts after 8 years (late onset) usually follow more aggressive course and the long-term outcome is also poor. Treatment method of LCPD that will produce best results is controversial particularly if the patients are with late-onset presentation. This prospective study was conducted from January 2015 to January 2019 at Dhaka Medical College Hospital and Health N Hope Hospital, Dhaka, Bangladesh. We evaluated the radiographic outcomes for patients who had varus derotation femoral osteotomy (VDRO). We followed up 16 patients who had femoral varus osteotomy. All patients were above 8 years of age at clinical onset. The involvement of femoral epiphysis was in either in B or B/C in lateral pillar classification. All patients had MRI done to confirm radiological diagnosis and classification. The mean age was 9.5 years (range, 8 to 12 years). Final outcome was evaluated by using the Stulberg classification which was radiological. Important exclusion criteria were patient with bilateral involvement and requirement of femoral varus >30 degree. We had 81.25% of our patient with satisfactory outcomes. Among them there were Stulberg grade I, 0 cases; Stulberg grade II, 13 cases (81.25%); Stulberg III, 3 cases (18.75%), Stulberg IV and V both 0 case each. The surgical outcomes for varus derotation femoral osteotomy in late onset LCPD patients over 8 years old were showing the good results than other modalities of non surgical and surgical methods.

Prevalence, determinants and consequences of problematic smartphone use among preschoolers (3-5 years) from Dhaka, Bangladesh: A cross-sectional investigation

The problematic smartphone use (PSU) has been becoming a challenging health issue for preschoolers aged 3-5 years as it has severe adverse effect on their psychological, physical, and cognitive development. The scarcity of scientific research on this issue in the context of Bangladesh motivated the authors for conducting this cross-sectional study to explore the prevalence of PSU with its influential factors and adverse effects on preschooler's psychological and physical development based on primary data collected from 400 mothers. The multivariable ordinal logistic regression (OLR) was used to compute the adjusted likelihoods. The estimated prevalence of PSU was approximately 86 %, where about 29 % were severely problematic user. The likelihood of preschoolers' PSU was observed to increase with >1 h/day usage of smartphone by children (Adjusted Odds Ratio (AOR): 3.92). Other important factors were parental smartphone use, education, profession, family income, and mother's age. Both of moderate and severe PSU had adverse effect on preschoolers' health- severe PSU was found to increase the likelihood of psychological and physical problems by 6.03 and 3.29 times, respectively. The preschoolers with PSU reported to suffer from many physical and mental health problems such as attention deficit and hyperactivity disorder (ADHD), emotional instability, aggressiveness, depression, lack of control, impaired vision and hearing, obesity, body imbalance, and lack of brain development. It is now prime time to undertake strategic policies considering the findings for limiting the preschoolers' usage of smartphone, which will make Bangladesh susceptible to protect its future generation from harmful effects of PSU.

Relationships between total reserve and financial indicators of Bangladesh: Application of generalized additive model

BACKGROUND

The reserve of a country is a reflection of the strength of fulfilling its financial liabilities. However, during the past several years, a regular variation of the total reserve has been observed on a global scale. The reserve of Bangladesh is also influenced by several economic and financial indicators such as total debt, net foreign assets, net domestic credit, inflation GDP deflator, net exports (% of GDP), and imports of goods and services (% of GDP), as well as foreign direct investment, GNI growth, official exchange rate, personal remittances, and so on. Therefore, the authors aimed to identify the nature of the relationship and influence of economic indicators on the total reserve of Bangladesh using a suitable statistical model.

METHODS AND MATERIALS

To meet the objective of this study, the secondary data set was extracted from the World Bank's website which is openly accessible over the period 1976 to 2020. Moreover, the model used the appropriate splines to describe the non-linearity. The performance of the model was evaluated by the Akaike information criterion (AIC), Bayesian information criterion (BIC), and adjusted R-square.

RESULTS

The total reserve of Bangladesh gradually increased since 2001, and it reached its peak in 2020 which was 43172 billion US dollars. The data were first utilized to build a multiple linear regression model as a base model, but it was later found that the model has severe multicollinearity problems, with a maximum value of VIF for GNI of 499.63. Findings revealed that total debt, inflation, import, and export are showing a non-linear relationship with the total reserve in Bangladesh. Therefore, the authors applied the Generalized Additive Model (GAM) model to take advantage of the nonlinear relationship between the reserve and the selected covariates. The overall response, which is linearly tied to the net foreign asset in the GAM model, will change by 14.43 USD for every unit change in the net foreign asset. It is observed that the GAM model performs better than the multiple linear regression.

CONCLUSION

A non-linear relationship is observed between the total reserve and different economic indicators of Bangladesh. The authors believed that this study will be beneficial to the government, monetary authorities also to the people of the country to better understand the economy.

Prevalence and risk factors of underweight among under-5 children in Bangladesh: Evidence from a countrywide cross-sectional study

BACKGROUND

Underweight is one of the important anthropometric components of malnutrition among under-five children and is a major public health concern in Bangladesh because it contributes to mortality as well as morbidity. In designing suitable health programs and policies with the goal of attaining UN SDG Goals, it is necessary to identify the critical risk factors of under-five malnutrition. It is evident that the quantile regression produces robust estimates in the presence of outliers. However, in the context of Bangladesh, no study has been conducted considering the sequential quantile regression on this topic. Therefore, the authors aimed to find the determinants of underweight among under-5 children in Bangladesh considering the latest country representative dataset.

METHODS AND MATERIALS

The paper considers a weighted sample of size 7762 children are used and data were extracted from the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 data. Multivariable simultaneous quantile regression models were used to fulfill the objectives of this study.

RESULTS

Findings depict that undernutrition affects the majority of children in the population as compared to the reference population. The WAZ-score of the child increases by 0.202 points at the 10th quantile of the conditional distribution, and by 0.565 points at the 90th quantile as we move from children of underweight to overweight women. Moreover, the WAZ scores of children from the richest families in the 10th, 50th, and 75th quantiles, respectively, are increased by 0.171, 0.016, and 0.084 points.

CONCLUSION

Quantile regression revealed the results of several socioeconomic and demographic factors acting differently across the WAZ distribution. Therefore, policymakers may consider the identified risk factors to lessen malnutrition among under-5 children in Bangladesh.

Estimating the potato farming efficiency: A comparative study between stochastic frontier analysis and data envelopment analysis

BACKGROUND

The government of Bangladesh has been trying to encourage potato consumption to reduce pressure on rice consumption and earn foreign currency along with ensuring zero hunger that helps to achieve the Sustainable Development Goal. It is necessary to use farmers' resources and current technology more efficiently to meet the demand. Therefore, the authors aimed to evaluate the farm-level efficiency of potato farming in Bangladesh.

METHODS AND MATERIALS

The Cobb-Douglas Stochastic Frontier Analysis (SFA) and the input-oriented Data Envelopment Analysis (DEA) methods are used to compute farm-level technical, allocative, and economic efficiencies and inefficiency of potato farming. The primary data were collected through interviews of 300 potato farmers from Munshigonj, Rangpur, Dinajpur, and Joypurhat districts of Bangladesh.

RESULTS

The findings revealed that the efficiency score of the SFA model is higher than the DEA model, which implies that the SFA frontier fits better than the DEA frontier. In the case of DEA, variable returns to scale (VRS) technical efficiency (TE) enveloped data more closely than constant returns to scale (CRS) TE. Results of efficiency suggest significant economic, technical, and allocative inefficiencies in potato farming and there is a scope to increase potato production levels through efficiency improvement. Inefficiency analysis shows that infrastructure and socio-economic factors jointly influence potato production variability.

CONCLUSIONS

The authors suggest for using the SFA to find efficiencies in the agriculture sector. To achieve efficiency in potato production, the government needs to pay attention for improving the allocative and economic efficiencies along with emphasizing to choose the appropriate technology and efficient use of resources for the scale of operation.

Risk factors of caesarean deliveries in urban-rural areas of Bangladesh

Background and aims

The key interest of this research is to identify the causes of the ongoing increasing trends in caesarean section or C-section (CS) deliveries in both urban and rural areas of Bangladesh.

Methods

This study analyzed all Bangladesh Demographic and Health Survey (BDHS) datasets through Chi-square and z tests and the multivariable logistic regression model.

Results

CS deliveries were found to be more prevalent in urban than in rural areas of Bangladesh. Mothers above 19 years, above 16 years at first birth, overweight mothers, those with higher educational levels, those who received more than one antenatal care (ANC) visit, fathers having secondary/higher education degrees and employed as workers or in business, and mothers living in wealthy households in the cities of Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions had a significantly higher likelihood of CS deliveries in urban areas. Contrastingly, mothers with ages between 20 and 39 years, above 20 years at first birth, normal weight/overweight mothers, those with primary to higher level of education, those in the business profession, fathers who also received primary to higher education, mothers who received more than one ANC visit, and those living in wealthy households in Dhaka, Khulna, Mymensingh, Rajshahi, and Rangpur divisions were more likely to have CS deliveries in rural areas. The 45-49 age group mothers had a five times higher likelihood of CS deliveries [odds ratio (OR): 5.39] in urban areas than in rural areas. Wealthy mothers were more likely to be CS-delivered in urban (OR: 4.84) than in rural areas (OR: 3.67).

Conclusion

The findings reveal a gradual upward alarming trend in CS deliveries with an unequal contribution of significant determinants in urban and rural areas of Bangladesh. Therefore, integrated community-level awareness programs are an urgent need in accordance with the findings on the risks of CS and the benefits of vaginal deliveries in this country.

Exploration of the physical properties of the newly synthesized kagome superconductor LaIr3Ga2 using different exchange-correlation functionals

LaIr₃Ga₂ is a kagome superconductor with a superconducting temperature (T_c) of 5.16 K. Here, we present the physical properties of the LaIr₃Ga₂ kagome superconductor computed via the DFT method wherein six different exchange-correlation functionals were used. The lattice parameters obtained using different functionals are reasonable, with a slight variation compared to experimental values. The bonding nature was explored. The elastic constants (C_ij), moduli (B, G, Y), and Vickers hardness (H_v) were computed to disclose the mechanical behavior. The H_v values were estimated to be 2.56-3.16 GPa using various exchange-correlation functionals, indicating the softness of the kagome material. The Pugh ratio, Poisson's ratio, and Cauchy pressure revealed the ductile nature. In addition, mechanical stability was ensured based on the estimated elastic constants. The anisotropic mechanical behavior was confirmed via different anisotropic indices. The Debye temperature (Θ_D), melting temperature (T_m), and minimum thermal conductivity (k_min) were calculated to characterize the thermal properties and predict the potential of LaIr₃Ga₂ as a thermal barrier coating material. The electronic density of states was investigated in detail. The McMillan equation was used to estimate T_c, and the electron-phonon coupling constant (λ) was calculated to explore the superconducting nature. The important optical constants were also calculated to explore its possible optoelectronic applications. The values of reflectivity in the IR-visible region are about 62% to 80%, indicating that the compound under study is suitable as a coating to reduce solar heating. The obtained parameters were compared with previously reported parameters, where available.

Burden of COVID‐19 on health and wellbeing, education, and economy of Bangladesh

The long‐term impact of this pandemic will continue in almost all sectors of a country such as health, economic situations, education, mental health, and violence. Therefore, the authors intended to discuss the prolonged effect of COVID‐19 on the health along with wellbeing, education, and economy of Bangladesh through a mixed approach. To assess the possible scenario in health sector of Bangladesh, we conducted a short survey through online with a structured questionnaire. The impact of the pandemic is highlighted by graphical presentations and discussed the issues in light of the existing literature. It is realized that health care services and resources are always essential for predominant health conditions and fatal diseases patients. Mental health has also been impacted a lot during this pandemic. Moreover, students of only those schools located in urban areas are attended some online classes but due to the internet interruption and scarcity of devices students from rural areas cannot attend the classes and it will widen the gap between pupils from urban areas and those who live in remote rural areas. Additionally, many students terminate school. The country's youth unemployment is projected to intensify as a result of the economic effects, which would promote antisocial behavior and cause social discontent among young people. Also, the flow of remittances greatly declined in the last couple of months and a many people were jobless abroad, and the majority of them were sent back home. The demographic dividend's intended results are expected to be negatively impacted by COVID‐19's overall effect as well as sustainable development goals (SDGs) in Bangladesh. Therefore, many social services systems need strategic backup resources at community, national, and global levels if any basic system may collapse due to COVID‐19 and socio‐economic as well as geopolitical negligence in handling post‐pandemic challenges.

Does knowledge and attitude of healthcare professionals working in critical care areas affect their willingness to offer the option of organ donation? results of a tertiary hospital survey

INTRODUCTION

Organ donation (OD) rates in Malaysia have remained suboptimal for decades. Healthcare professionals (HCPs) working in critical care areas are responsible for diagnosing brain death (BD) and initiating the OD process. Impact of their knowledge and attitudes on willingness to offer the option of OD to families of potential donors is unknown.

METHODS

Knowledge and attitudes about BD, OD, and organ transplantation (OT) of critical care HCPs in a Malaysian transplant centre were studied using a validated questionnaire. Responses were analysed using multivariable analysis with willingness to offer the option of OD to families of potential donors as dependent variable.

RESULTS

Age (p = 0.04), profession (doctors > nurses, p < 0.001), religion (Buddhists > others, p = 0.013) [but not ethnicity], higher knowledge scores for Brain Death Test, Brain Death Knowledge, Organ Donation and Transplantation, and overall knowledge score (p < 0.001) were associated with greater odds of offering OD to families. Belief in the reliable diagnosis of BD, confidence in explaining BD, and belief that OD will not affect religious services were significantly associated with willingness to offer OD, while HCPs who were willing to personally donate organs had greatest odds (p < 0.001). Other factors that significantly influenced HCPs' willingness to offer included their perception about families' willingness to donate, body disfigurement, and confidence in OT.

CONCLUSIONS

Overall, HCPs had highly positive attitudes. However, potential barriers in offering OD to families were identified. Proven interventions from international experience could help address these issues and likely improve OD rates in Malaysia.

Routine Exposure Versus Non-Exposure of Recurrent Laryngeal Nerve during Thyroid Surgery: Our Experience of 300 Cases

The technique of thyroidectomy has been in evolution for many years. It is a basic rule of surgery that an important structure of a human body must be recognized certainly during the surgical procedure in order to prevent its damage. The purpose of this study was to evaluate our routine identification and without identification of recurrent laryngeal nerve during thyroidectomy aiming to lessen the inadvertent injury of the recurrent laryngeal nerve. This retrospective clinical controlled study was performed in the Department of ENT and Head-Neck Surgery, BIRDEM General Hospital and the Department of General Surgery, BIRDEM General Hospital, Dhaka, Bangladesh from January 2014 to December 2018. Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cords were included in this study. Patients were excluded like containing hoarseness voice, abnormal movements of vocal cord. The total number of patients was 300 and these patients were randomly divided into two groups of 150 each using random number tables. In Group A the recurrent laryngeal nerves were identified by exposing the inferior thyroid artery and markedly seen in its entire course. Where as, in Group B, nerves were not identified during the operation. Immediate post operative direct laryngoscopy was performed by a surgeon with the help of an Anesthesiologist for the assessment of vocal cords. Patients with either persistent hoarseness of voice or not were followed up with indirect laryngoscopy or fiber optic laryngoscopy (FOL) at three and six months. In Group A, out of 150 patients, 6(4%) patients developed transient unilateral paralysis, resulting in slight hoarseness of voice postoperatively. The voice improved within 6 weeks. While 2(1.3%) patients developed permanent unilateral paralysis of recurrent laryngeal nerve. The voice and cord movement did not return to normal even after 6 months in one case while other one improved within the period of 6 months. In Group B, out of 150 patients, 14(9.3%) patients developed transient paralysis. Out of 14 transient paralysis 11 were unilateral and 3 were bilateral nerve paralysis. The voice was improved within 6 months in all of unilateral and bilateral transient paralyzed cases. While 6(4%) patients developed permanent paralysis of recurrent laryngeal nerve. Out of 6 permanent paralysis 2 cases were of bilateral recurrent laryngeal nerve paralysis required immediate tracheostomy. Rest 4 cases of unilateral permanent nerve paralysis, hoarseness of voice occurred but improved in 2 cases during the period varying from 2 to 6 months while in other 2 cases, it persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in Group A as compared to Group B. This difference remained statistically significant (p=0.046) between the two groups in terms of type of thyroid diseases, type of surgeries and number of surgeries. For essentially eliminating the risk of nerve injury during surgery, recurrent laryngeal nerve should be exposed and identified routinely in its entire course.

Trends and determinants of vaccination among children aged 06-59 months in Bangladesh: country representative survey from 1993 to 2014

Background

Vaccination has important consequences for childhood development, mortality, and inequalities in health and well-being. This research explores the trend of vaccinations coverage from 1993 to 2014 and determines the significant factors for vaccinations coverage in Bangladesh, considering geospatial, socioeconomic, and demographic characteristics.

Methods

This study uses a secondary dataset extracted from the Bangladesh Demographic and Health Survey (BDHS) from 1992 to 93 to 2014. The association between selected independent variables and vaccination coverage of children was examined through the Chi-square test. In addition, unadjusted and adjusted logistic regression approaches were applied to determine the effects of covariates on vaccination status by using the BDHS-2014 dataset.

Results

The results reveal that the trend of the vaccination coverage rate has gradually been increased over the study period. The coverage rate of BCG is observed maximum while the lowest for Measles vaccination among all types of vaccinations. The findings revealed that the significantly lower coverage of all vaccination had been observed in the Sylhet region. Children of higher educated mothers (OR 10.21; CI: 4.10–25.37) and father (OR 8.71; CI: 4.03–18.80), born at health facilities (OR 4.53; CI: 2.4–8.55) and whose mother has media exposure (OR 3.20; CI: 2.22–4.60) have more chance of receiving BCG vaccine. For DPT vaccination coverage, there is a significant difference from children whose mothers have primary (OR 1.7; CI: 1.35–2.15), secondary (OR 3.5; CI: 2.75–4.45), and higher (OR 9.6; CI: 5.28–17.42) educational qualification compared to children of illiterate mothers. Findings demonstrated that children born in wealthier households have a higher likelihood of being immunized against DPT, Polio, and Measles vaccination than children born in the poorest households.

Conclusions

The findings reveal that to enhance and make sustainable the overall country’s vaccination coverage, we should pay more attention to the mother’s education, socioeconomic condition, children’s age, birth order number, having media exposure, place of residence, and religion. The authors think that this finding would be helpful to accelerate the achievement target of Sustainable Development Goals (SDGs) for children’s health in Bangladesh.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11576-0.

Rural-urban determinants of vitamin a deficiency among under 5 children in Bangladesh: Evidence from National Survey 2017-18

Background

Vitamin A supplementation reduces child morbidity, mortality, and blindness of people, especially in developing countries like Bangladesh. This study explores significant determinants of vitamin A deficiency among preschool children in rural and urban areas of Bangladesh.

Methods

The data set was extracted from a nationally representative survey based on a cross-sectional study, the BDHS-2017-18. The base survey was conducted using a two-stage stratified sample of households. A sample of 8364 (urban 2911, rural 5453) children under-5 years old was analyzed using bivariate and multivariate statistical techniques.

Results

Results have demonstrated that 73.9 and 73.2% of children have had a vitamin A supplementation from urban and rural areas, respectively. Logistic regression analysis showed that parents’ education plays a vital role in consuming vitamin A supplements in urban and rural areas. Children whose mothers have secondary (OR: 1.17, CI: 0.76–1.81) and higher (OR: 1.21, CI: 0.72–2.04) education were more likely to consume vitamin A supplementation than children whose mothers were illiterate in urban areas. However, in rural areas, children whose mothers have secondary education were about 24% and higher education with 60% more likely to consume vitamin A supplementation than children whose mothers were illiterate. Child’s age, regional variation and wealth index also contributing factors for vitamin A deficiency in Bangladesh.

Conclusions

These findings indicated that the consumption of vitamin A does not cover the target of sustainable development goals. Thus special national and community level efforts are required to ensure the coverage of the national vitamin A program is increased adequately to the most vulnerable groups of children in Bangladesh.

Evaluation of Surgical Correction of Adolescent Idiopathic Scoliosis by Transpedicular Screws and Rods

Transpedicular screw fixation is a challenging procedure for the correction of deformity of Adolescent Idiopathic Scoliosis (AIS) in the dorso-lumbar spine. The inadvertently misplaced screws have a high risk of complications. The exactness of the pedicle screws is normally distinct as the screws axis being fully enclosed within the cortices of the pedicle. Evaluation of the surgical correction of adolescent idiopathic scoliosis by transpedicular screws and rods was done in single posterior dynamic approach. This prospective observational study was conducted in the National Institute of Traumatology and Orthopedic Rehabilitation, Dhaka and different Hospitals in Dhaka, Bangladesh from July 2015 to March 2017. Ten patients at the age >9 years and <19 years who were admitted with a diagnosis of AIS during the period of study. The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods in single posterior approach. In every case fusion was done in selected segments. In this study out of 10 patients 7(70.0%) were 10 to 14 years of age and 3(30.0%) were 15 to 18 years. Mean age 9.51±2.13 years. Minimum 10 years and maximum 18 years. Majority 7(70.0%) of the patients were female and the rest 3(30.0%) male. Five (50.0%) presented with level of involvement, 3(30.0%) patients thoracic and 2(20.0%) patients had lumbar. Maximum 7(70.0%) presented right sided involvement and rest 3(30.0%) left sided involvement. Before surgical intervention 100% patients had rib hump and positive Adams forward bending test, 70.0% patients had asymmetry of shoulder and uneven hip and also 50% patients had pain. After surgical treatment with transpedicular screws and rods through posterior approach, 70% of patients improved in terms of deformity. The average major curve deformity as defined by Cobb angle measurements was measured to be 54.9°±9.9° (40°-68°) in pre-surgery. After surgery this deformity corrected to 16.0°±4.9° (10°-24°) on average as measured in erect posture posterior anterior and lateral view. This represents significant improvement average of 71.4±4.3% (64.6-75.09) (p<0.001). This correction was maintained at 24 months after surgery. Functional results assessed by Modified Macnab criteria, significant number of 7(70.0%) patients had excellent outcome, 2(20.0%) patients had good outcome, 1(10.0%) patients had fair outcome and no poor outcome. Ninety percent (90%) patients had satisfactory results. No patient deteriorates neurologically after surgery. It is concluded that satisfactory curve correction and maintenance thereof is possible in adolescent idiopathic scoliosis, with posterior instrumentation by transpedicular screw and rods with effective reduction of cost and associated risks.

Pattern of Neonatal Danger Signs and its Related Factors in a Tertiary Level Hospital

Considering very limited information in the pattern of neonatal danger signs with associated risk factors in our perspective, the aim of the study was to understand the country-context pattern of neonatal danger signs and its related factors in a tertiary level hospital. This cross-sectional study was conducted among 259 mothers and their neonates in Dhaka Medical College Hospital, Dhaka, Bangladesh from 01 January 2015 to 31 December 2015. Data were collected by face to face interview from mother by pre-tested semi structure questionnaire which was adopted from WHO-UNICEF list of newborn danger signs. Measurement of weight was taken from hospital record. Observation of danger signs were done by following check list. Data analysis was done by SPSS 20.0. Of all, majority (41.6%) was in the age group of 20-24 years & was educated up to secondary level (42.47%). More than half of the participants (54.1%) had family income >10,000 BDT. Sixty percentage of mother took ANC visit <3 times during their pregnancy period. About 42.1% had ≥1 co-morbidities. Hospital was the predominate place of birth with 48.3% caesarean delivery. At least one neonatal danger sign was present in 20.1% while 39.4% had at least 2 danger signs. Rest of the child had ≥2 danger signs at a time. The distribution of danger signs were not feeding since birth or stop feeding 206(79.5%), severe chest in drawing 145(56.1%) respiratory rates 60 or more 126(48.6%), convulsion 72(27.8%), yellow soles 68(26.3%). Factors like 'fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age (8-28 days), presence of injury at birth, and cutting of umbilical cord by blade during delivery were associated with higher number of danger signs (p<0.05 in all cases). About 80% neonate in our setting had ≥1 sign and had association with fail to identify with an expert health assistant', trial of delivery at home, delivery at home, older neonatal age, presence of injury at birth, and cutting of umbilical cord by blade during delivery.

Measurement of Placental Index in Different Gestational Age Groups in Bangladeshi Women

Placenta is the mirror of maternal and fetal status; it reflects the changes due to complications in pregnancy of mother. The growth and survival of the fetus in utero is directly related to formation, development and maturation of the placenta. Placental index was correlated to poor pregnancy outcomes. Placental index can help to identify fetal growth restriction which is result of placental insufficiency and is characterized by insufficient trasnsplacental transport of nutrients and oxygen. This cross sectional descriptive study would provide information about the ratio of placental index in different gestational age group in Bangladeshi women. To achieve this aim the study was performed on 60 human placenta and corresponding fetuses and gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), Group C (38-40). These sample and information were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% formal saline, study was done in Department of Anatomy in Mymensingh Medical College. In this study, the mean±SD placental index was in Group A (0.187±0.113), Group B (0.153±0.025) and Group C (0.166±0.025) and also observed that mean placental index decreased with age up to certain level then increase in Group C. The mean placental index was maximum in Group A (0.187±0.113) and was minimum in Group B (0.153±0.025). The mean difference of placental index between Groups A&B, A&C and B&C was statistically not significant. Observed findings of this study were compared with those of Western and Bangladeshi researches.

High abundance of the colistin resistance gene mcr-1 in chicken gut-bacteria in Bangladesh

Colistin is considered a last-resort reserved drug for the treatment of critical human infections by Gram-negative bacteria. Phenotypic colistin-resistance is strongly associated with plasmid-mediated mobile colistin resistance (mcr) genes. The mcr-bearing Enterobacteriaceae have been detected in many countries from environments, animals, and humans. This study investigated phenotypic colistin-resistance and the distribution of mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes in chicken-gut bacteria in Bangladesh. Bacteria were isolated from poultry- and native-chicken droppings, and their susceptibilities to colistin were determined by agar dilution and E-test minimal inhibitory concentration (MIC) measurements. Multiplex polymerase chain reactions detected mcr-1 to mcr-5 genes. Overall, 61.7% (92/149) of the isolates showed colistin resistance by agar dilution assessment (MIC > 2.0 μg/mL). The phenotypic resistance was observed considerably higher in poultry-chicken isolates (64.6%, 64/99) than in native-chicken isolates (56%, 28/50; p = 0.373). All the resistant isolates showed MIC levels between > 2 and > 128 μg/mL. The mcr-genes (mcr-1and mcr-2 combined) were detected more in poultry gut bacteria (36.4%) than native-chicken isolates (20%, p = 0.06). Despite bacteria sources, mcr-genes appeared to be significantly associated with phenotypic colistin-resistance phenomena (p < 0.001). Prior colistin usage led to a substantial increase in the proportion of bacteria with mcr-genes and phenotypic resistance (p < 0.001).

Impact of COVID-19 pandemic on the mental health of children in Bangladesh: A cross-sectional study

COVID-19 pandemic poses a significant mental health threat among children in Bangladesh. This study aims to explore the impact of COVID-19 on the mental health of children during the lockdown in Bangladesh. An online cross-sectional study was conducted from 25th April to 9th May 2020 among 384 parents having at least one child aged between 5-15 years using non-probability sampling. K-means clustering used to group children according to mental health score and confirmatory factor analysis (CFA) performed to identify the relationship among the parental behavior and child mental health, and also these associations were assessed through chi-square test. Children were classified into four groups where 43% of child had subthreshold mental disturbances (mean Major Depressive Disorder (MDD)-10; 2.8), 30.5% had mild (mean MDD-10; 8.9), 19.3% suffered moderately (mean MDD-10; 15.9), and 7.2% of child suffered from severe disturbances (mean MDD-10; 25.2). The higher percentage of mental health disturbances of children with the higher education level of parents, relative infected by COVID-19 (yes), parents still need to go the workplace (yes), and parent's abnormal behavior but lower to their counterparts. This paper demonstrates large proportions of children are suffering from mental health disturbances in Bangladesh during the period of lockdown. Implementation of psychological intervention strategies and improvement in house-hold financial conditions, literacy of parents, taking care of children, and job security may help in improving the psychological/mental status of children and the authors believe that the findings will be beneficial to accelerate the rate of achieving the Sustainable Development Goal (SDG) linked to health status in Bangladesh.

0953 The Maintenance of Wakefulness Test (MWT) in Pediatric Hypersomnia

Introduction

The Maintenance of Wakefulness Test (MWT) is a recommended procedure to evaluate the efficacy of treatment for hypersomnia. Limited data have been published on the use of the MWT in children and adolescents. This study aims to describe the clinical characteristics, MWT findings and their implication in the management of children with hypersomnia.

Methods

This study reviewed the charts of children with hypersomnia who had MWT performed at Cincinnati Children’s Hospital Medical Center (CCHMC) between January 1, 2007 and January 31, 2018. Demographics, clinical characteristics, MWT findings, diagnoses and managements of children with hypersomnia were obtained.

Results

Fifty-three patients with hypersomnia who had MWT were included (mean age 17.29 years, range 12.5-22.75 years), 32 (60%) were male, and 40 (75%) were Caucasian. The diagnosis included narcolepsy (41, 77%), idiopathic hypersomnia (7, 13.2%), narcolepsy with OSA (11, 20%) and OSA (4, 7.5%). A mean sleep latency for all studies was 23.24 minutes (range 1.25-40 minutes). Twenty seven (50.9%) patients had mean sleep latency &gt;20 minutes (passed MWT) which indicate adequate control of treatment, while 26 (49.1%) had mean sleep latency &lt;20 minutes (failed MWT) including 5 (9.4%) with mean sleep latency &lt;8 minutes. There was no difference between patients who had passed MWT and failed MWT in the mean of Epworth sleepiness scale (12 vs 11), age (16.8 vs 17.6 years), or BMI (29.2 vs 26.3). Higher percentage of narcolepsy with cataplexy was found in patients who failed MWT (46.2% vs 22.2%, P 0.06). Findings from the MWT caused the changes of management in 25/26 (96.1%) who failed MWT, and 8/27 (29.6%) who passed MWT (P&lt;0.001).

Conclusion

Our result suggests that the MWT has clinical usefulness in evaluating responses to treatment for conditions associated with hypersomnia in children. Changes in management occurred in almost all patient who failed MWT. Interesting, there was no difference in subjective sleepiness between adolescents who passed and failed MWT, indicating the need to obtain objective data in this population. Future study is required to explore normative MWT data in pediatric population and to compare MWT with other tools such as driving simulation test.

Support

None

Optimization of bio-cement production from cement kiln dust using microalgae

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CKD with microalgae sp. Chlorella kessleri is investigated for maximum bio-cement yields.

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A predictive quadratic model was developed for CaCO₃ yield with R² value of c.a. 92%.

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Low temperature and high pH were found to be important parameters in RSM study.

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Under optimal set, a maximum of 96% Ca was extracted experimentally from CKD.

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FTIR, XRD and EDS analysis confirmed the produced bio-cement compound.

The main aim of this study was to maximize bio-cement (CaCO₃) production through a waste feedstock of cement kiln dust (CKD) as a source of calcium by deployment of microalgae sp. Chlorella kessleri. The effect of process parameters such as temperature, pH and time-intervals of microalgae cultivation, were set as criteria that ultimately subscribe to a process of optimization. In this regard, a single factor experiments integrated with response surface methodology (RSM) via central composite design (CCD) was considered. A quadratic model was developed to predict the maximum CaCO₃ yield. A ceiling of 25.18 g CaCO₃ yield was obtained at an optimal set of 23 °C, pH of 10.63 and day-9 of microalgae culture. Under these optimized conditions, maximum 96% calcium was extracted from CKD. FTIR, XRD and EDS analyses were conducted to characterize the CaCO₃ precipitates. Compressive modes of mechanical testing seemed to hold conventional cement complimented by CaCO₃ co-presence markedly superior to mere cement performance as far as compressive strength is concerned. The latter criterion exhibited further increase in correspondence with rise in cement to bio-cement ratio. This investigative endeavour at hand offers a simple pivotal platform on the basis of which a scale-up of microalgae-infested bio-cement production might be facilitated in conjunction with the added benefit of alleviation in environmental pollution through cement waste utilization.

Demographics of healthcare professionals' knowledge and attitude toward deceased organ donation: Survey of critical care areas in a tertiary hospital

INTRODUCTION

Organ donation rate in Malaysia is amongst the lowest in the World. Healthcare professionals (HCPs) working in critical care areas play an important role in the deceased organ donation (DOD) process. This study seeks to identify the demographics of HCPs working in the critical care areas and their knowledge and attitudes toward the DOD process.

METHOD

A cross-sectional survey on the demographics, knowledge and attitudes of the doctors and nurses working in critical care areas was undertaken by the random sampling method, using a validated, structured questionnaire. HCP's knowledge and attitudes towards brain death (BD), DOD, organ transplantation (OT), and possession of organ donor card were compared against their demographics.

RESULTS

Four hundred and twelve (72.9%) out of the total 565 HCPs in critical care areas responded of whom 163 (39.6%) were doctors and 249 (60.4%) were nurses. After adjusting for other factors, department of work and profession were highly correlated with the overall knowledge score (p<0.001 and p=0.003 respectively) and knowledge about BD (p<0.001 and p=0.013 respectively). HCPs from the neurosurgical intensive care unit (p<0.001) and doctors (p<0.001) had higher mean knowledge scores compared to their counterparts. Profession was most significantly correlated with having a positive attitude towards BD (p<0.001) and OT (p<0.001).

CONCLUSION

Department, profession and ethnicity were the demographic characteristics that correlated with knowledge and attitudes of HCPs on organ donation. Efforts to improve DOD rates in Malaysia should include targeted interventions to address the knowledge and attitudes of HCPs working in critical care areas.

Efficacy of Palonosetron as Antiemetic Prophylaxis for Post Operative Patients

Palonosetron is a new, potent and long-acting 5HT3-receptorsantagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. The objective of this study was to investigate and compare the prophylactic effects of intravenously administered palonosetron, ondansetron and granisetron on prevention of postoperative nausea and vomiting after general anesthesia. This randomized double blind prospective clinical study was carried out in the Department of Anaesthesia, DMCH, Dhaka, Bangladesh from January 2014 to December 2015. A total of 102 patients who underwent laparoscopic cholecystectomy under general anesthesia, out of which patients who received Palonosetron were in Group A (n=34), patients who received Ondansetron were in group B (n=34) and patients who received Granisetron were in group C (n=34) and also the patients were selected randomly by lottery method. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Nausea was found 3(8.8%) in group A, 8(23.5%) in group B and 6(17.6%) in group C. Vomiting was found 3(8.8%) in group A, 10(29.4%) in group B and 7(20.6%) in group C. Vomiting was significantly higher in group B compare with group A. For group B rescue anti-emetic injection motilon (metoclopramide hydrochloride) 5mg IV slowly was given. Palonosetron is effective prophylaxis against post operative nausea and vomiting.

Implementation of Q learning and deep Q network for controlling a self balancing robot model

In this paper, the implementations of two reinforcement learnings namely, Q learning and deep Q network (DQN) on the Gazebo model of a self balancing robot have been discussed. The goal of the experiments is to make the robot model learn the best actions for staying balanced in an environment. The more time it can remain within a specified limit, the more reward it accumulates and hence more balanced it is. We did various tests with many hyperparameters and demonstrated the performance curves.

Patterns, prevalence and determinants of environmental tobacco smoke exposure among adults in Bangladesh

Background

Exposure to environmental tobacco smoke (ETS) has been suggested as a risk factor for various health problems. Thus, this study examines the patterns and predictors of ETS exposure among adults at home, workplace and public places.

Methods

The dataset covered a nationally representative sample of 9629 respondents extracted from the Global Adult Tobacco Survey. Diamond-shaped equiponderant graphs were used to exhibit the prevalence of ETS. In Logistic regressions, ETS exposure at home, workplace and public places were used as response variables. Demographic and socioeconomic variables, health knowledge about ETS, attitude towards ETS, perception of smoking restrictions were considered as predictors.

Results

Adults in higher age groups and females were less exposed to ETS. Better education, high wealth status, better health knowledge on ETS, practice of no smoking at home, and support smoking restrictions were significantly associated with lower ETS exposure at home. Those residing in rural areas and living with many people together were more likely to be exposed to ETS at home. In contrast with home and workplace exposure, adults with higher education, better wealth status, good knowledge on ETS, and support smoking restrictions experienced a high level of exposure at public places. Interestingly, results suggest that those with high levels of ETS exposure at home and workplace had lower exposure to ETS in public places.

Conclusions

ETS control should not be overlooked in public health policy. Protection from ETS at home is particularly important, given its impact on the attitude towards and awareness about ETS exposure at all places.

Halotolerant bacteria belonging to operational group Bacillus amyloliquefaciens in biocontrol of the rice brown stripe pathogen Acidovorax oryzae

AIMS

The aim of this study was to evaluate the antagonistic activity of halotolerant bacteria against rice brown stripe pathogen Acidovorax oryzae.

METHODS AND RESULTS

Fifteen of 136 isolates of halotolerant bacteria exhibited strong in vitro and in vivo antagonistic activity against both strains of A. oryzae. The 15 antagonistic isolates were identified as 'operational group Bacillus amyloliquefaciens' based on physiological and biochemical features, fatty acid profiles as well as sequence analysis of 16S rRNA, gyrA and rpoB genes. Furthermore, this result indicated that the most effective antagonistic isolates K5-3 and PPB6 could produce siderophore in iron-limiting medium, and four kinds of secondary metabolites based on MALDI-TOF analysis. In addition, the culture filtrates of isolates K5-3 and PPB6 caused the damage of cell membrane evidenced by the TEM images, and resulted in 73-80% reduction in cell numbers, 55-65% reduction in biofilm formation, and 42-50% reduction in swimming ability of both strains of A. oryzae.

CONCLUSIONS

These isolates in particular K5-3 and PPB6 of halotolerant bacteria markedly inhibited the growth of A. oryzae.

SIGNIFICANCE AND IMPACT OF THE STUDY

To our knowledge, this is the first report on biological control of halotolerant bacteria against bacterial brown stripe of rice.

Improvement of the nutritional value of high-protein sunflower meal for broiler chickens using multi-enzyme mixtures

Two experiments were conducted to determine the effect of replacing soybean meal (SBM) with a high-protein sunflower meal (HiSFM) without or with multi-enzyme mixtures on growth performance, nutrient utilization, jejunal digesta viscosity, and excreta moisture in broiler chickens. In experiment 1, 400 chicks were divided into 40 replicates of 10 birds and fed for 35 d a corn-soybean meal (CSBM) control diet or CSBM with 25 (HiSFM25), 50 (HiSFM50), 75 (HiSFM75), or 100% (HiSFM100) of total SBM replaced by HiSFM. During d 0 to 35, increasing HiSFM content in diets linearly reduced (P < 0.0001) BW, FI, and BW gain (BWG). Feeding HiSFM25 or HiSFM50 resulted in similar growth performance as CSBM (P > 0.05). In experiment 2, 120 chicks were divided into 24 replicates of 5 birds and fed CSBM or HiSFM75 diet without or with enzyme A (supplying 4,000, 500, and 8,000 U/kg of xylanase, alpha-amylase, and protease, respectively) or enzyme B (supplying 1,700, 1,100, 240, 30, 1,200, 360, 1,500, and 120 U/kg of cellulase, pectinase, mannanase, galactanase, xylanase, glucanase, amylase, and protease, respectively) for 21 days. Excreta moisture content was determined weekly, and birds were euthanized on d 22 to collect jejunal and ileal digesta for viscosity and apparent ileal digestibility (AID) measurements, respectively. Compared with CSBM, feeding HiSFM75 reduced (P < 0.05) BWG and G: F, enzymes A and D alleviated BWG and G: F reduction (P < 0.05), and enzyme A reduced (P = 0.037) the excreta moisture content, whereas the treatments did not influence AID or jejunal digesta viscosity measurements. In conclusion, experiment 1 results show that HiSFM can replace up to 50% of SBM without depressing growth performance in either the starter or finisher phase, whereas experiment 2 shows that enzymes A and B supplementation can alleviate the growth depression associated with feeding HiSFM75. These results suggest that enzyme supplementation can enhance HiSFM inclusion in broiler diets without affecting productivity or barn hygiene management.

Zinc deficiency tolerance in maize is associated with the up-regulation of Zn transporter genes and antioxidant activities

Zinc (Zn) is an essential micronutrient for the growth and development of plants. However, Zn deficiency is a common abiotic stress causing yield loss in crop plants. This study elucidates the mechanisms of Zn deficiency tolerance in maize through physiological and molecular techniques. Maize lines tolerant (PAC) and sensitive (DAC) to Zn deficiency were examined physiologically and by atomic absorption spectrometry (AAS). Proteins, H₂ O₂ , SOD, POD, membrane permeability and gene expression (using real-time PCR) of roots and shoots of both maize lines were assessed. Zn deficiency had no significant effect on root parameters compared with control plants in PAC and DAC but showed a substantial reduction in shoot parameters in DAC. AAS showed a significant decrease in Zn concentrations in both roots and shoots of DAC but not PAC under Zn deficiency, implying that Zn deficiency tolerance mechanisms exist in PAC. Consistently, total protein and membrane permeability were significantly reduced in DAC but not PAC in both roots and shoots under Zn deficiency in comparison with Zn-sufficient plants. Real-time PCR showed that expression of ZmZIP1, ZmZIP4 and ZmIRT1 transporter genes significantly increased in roots of PAC, but not in DAC due to Zn deficiency compared with controls. The H₂ O₂ concentration dramatically increased in roots of DAC but not PAC. Moreover, tolerant PAC showed a significant increase in POD and SOD activity due to Zn deficiency, suggesting that POD- and SOD-mediated antioxidant defence might provide tolerance, at least in part, under Zn deficiency in PAC. This study provides an essential background for improving Zn biofortification of maize.

Measurement of Length of Umbilical Cord in Different Gestational Age Groups in Bangladesh

The umbilical cord and placental have been considered to significantly contribute to the perinatal outcome. Long or short cord can lead to intrauterine fetal demise. So this type of study in placenta and umbilical cord can yield information for immediate and later management of newborn. This information may also be essential for protecting the attending physician in the event of a fetal outcome. This Cross sectional descriptive study would provide information about the length of umbilical cord in different gestational age groups in Bangladesh. To fulfill this aim the study was performed on 60 human placentas and umbilical cords and Gestational age (in weeks) categorized as Group A (28-32), Group B (33-37), and Group C 38 weeks and above. These samples were collected from normal pregnancy in Gynecology and Obstetrics Department of Mymensingh Medical College Hospital from July 2009 to June 2010. After preservation in 10% normal saline, study was done in the department of Anatomy of Mymensingh Medical College. In this present study the mean±SD length of umbilical cord was found in different gestational age groups in Group A 63.00±5.40, Group B 63.69±8.80 and Group C 67.03±10.64cm and also observed that the mean length of umbilical cord increased with gestational age. The mean length of umbilical cord was maximum in Group C (67.03cm) and was minimum in Group A (63.00cm). The mean difference of length of umbilical cord among different groups was statistically not significant. Observed findings of this study were compared with those of western and Bangladeshi researches.

Abstract P5-07-14: miR-17-92 cluster, an oncogenic microRNA cluster acts as a context dependent tumour suppressor in breast cancer

Background: The miR-17-92 is an oncogenic miRNA cluster that generate six mature miRNAs: miR-17, miR-18a, miR-19a, miR-20a, miR-19b-1, and miR-92-1. Accumulating evidences indicate the oncogenic role of the miR-17-92 cluster in human cancers. Amplification of 13q31-q32, which is the locus of the miR-17-92 cluster, have been reported in haematopoietic malignancies, such as B cell lymphoma. In contrast, MIR17HG was deleted in 21.9% of breast cancers and loss of heterozygosity at 13q12-q13 was associated with poor prognosis in breast cancer. This oncogenic miRNA cluster is deferentially expressed in various cancer. Since, miR-17-92 cluster shows differential expression among the cancers types, it is hypothesized that biological function may also vary depending on the context. Indeed, this cluster has been shown to act a tumour suppressor in some cancers. However, the functional role of this cluster in the subtypes of breast cancer remains largely unknown.

Methods: The oncomine datasets were analysed for expression of MIR17HG in breast cancer at parameters p-value threshold of 0.01 with minimum 2-fold change. We generated stable sub-clones of MCF7, T47D, SKBR3 and MDA-MB231 cells overexpressing miR-17-92 cluster by transducing with lentivirus expressing miR-17-92. Proliferation was assessed by MTS assay and colony forming assay. Cell migration was tested using scratch method. Invasion potentiality was monitored by using matrigel Boyden chamber invasion assay. For drug response analysis, control and microRNA overexpressing sub-clones were exposed to different chemotherapeutic agents at different concentrations followed by MTS assay at different time intervals. Association of miRNAs belonging to miR-17-92 with outcome in breast cancer was determined by Kaplan-Meier analysis on METABRIC dataset.

Results: We observed that expression of MIR17HG was increased in tissues and cell lines from triple negative breast cancer (TNBC) but decreased in the tissues and cell lines from the estrogen receptor (ER)-positive breast cancer. Our results showed that ectopic expression of miR-17-92 cluster significantly suppressed cell proliferation, colony formation, migration and invasion of ER-positive (MCF7, T47D) and HER2-enriched (SKBR3) cells whereas it enhanced cell proliferation, colony formation, migration and invasion in (TNBC) MDA-MB 231 cells. Further, we found that expression of miR-17-92 cluster sensitized MCF7 cells whereas it rendered SKBR3 cells resistant to chemotherapeutic compounds. Higher expression of five miRNAs of this cluster was associated with better relapse free survival (RFS) in (miR-17, miR-19a, miR-20a, miR-19b and miR-92) Luminal A subtype whereas three miRNAs of this cluster were associated with poor RFS in (miR-17, miR-18a and miR-92) HER2-enriched and (miR-17, miR-19b and miR-92) TNBC subtypes.

Conclusions: Taken together our results suggest that miR-17-92 cluster acts as a tumour suppressor in ER-positive and HER2-enriched breast cancer cells but shows oncogenic role in TNBC. Our observations underscore the functional complexity of miR-17-92 in a context-dependent and cell type-dependent manner, and more investigations are warranted to fully explore the functional complexity of miR-17-92 in subtypes of breast cancer.

Citation Format: Hossain MM, Arabkari V, Barua D, Gupta A, Islam MN, Gupta S. miR-17-92 cluster, an oncogenic microRNA cluster acts as a context dependent tumour suppressor in breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-07-14.

Double Heterozygous For Haemoglobin S and Haemoglobin E

Here we present a Bangladeshi family where out of four family members two (mother and son) inherited both haemoglobin (HbS) S and haemoglobin (HbE) E gene confirming the diagnosis of double heterozygous state for HbS and HbE, presented in the Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh on the month of July 2016. Among other two members, one (daughter) inherited HbS and other (father) HbE. Double heterozygous state for HbS and HbE is a rare condition in this subcontinent especially in Bangladesh. HbS is rare but HbE is prevalent in Bangladesh. Co-inheritance of both HbS and HbE is therefore uncommon in this country in comparison to HbE/β - thalassaemia. Though the double heterozygous state for HbS and HbE is rare and the patients are usually asymptomatic but their documentation is important for genetic counseling and to determine the reproductive risk of the family.

Impact of Magnetic Resonance Imaging in the Diagnosis of Pituitary Adenoma

Pituitary adenoma is the third most common primary intracranial neoplasm involving the adult population with clinical features due to excess or deficient hormone secretion or due to its mass effect. Debate about the diagnostic accuracy, sensitivity and specificity of MRI imaging in detecting pituitary adenoma has been continuing. The study was aimed to evaluate the accuracy, sensitivity and specificity of MR imaging in detecting pituitary adenoma. This cross sectional study was conducted in the Department of Radiology and imaging, Bangabandhu Sheikh Mujib medical University (BSMMU) from July 2013 to August 2015. It was carried out in 50 pituitary adenoma cases of which, 28 male and 22 female to see the impact of MRI in the diagnosis of pituitary of adenoma. Out of 50 cases 43 cases were diagnosed by MRI, 3 were normal and 2 were pituitary apoplexy, one was immature teratoma as confirmed through histopathology. So, MRI has got major impact in the diagnosis of pituitary adenoma.

Effects of diet complexity and multicarbohydrase supplementation on growth performance, nutrient digestibility, blood profile, intestinal morphology, and fecal score in newly weaned pigs

To study the effects of diet complexity and multicarbohydrase (MC) supplementation, 144 piglets (6.70 ± 0.81 kg of BW) weaned at 21 ± 2 d of age (1:1 male to female ratio) were assigned to 1 of 6 dietary treatments in a 3 × 2 factorial arrangement based on diet complexity (complex1, complex2, and simple) and MC addition (0 vs. 0.1% of MC). Diets were provided in a 2-phase feeding program with phase I (d 1 to 14) and phase II diets (d 15 to 28). Complex1 was formulated to mimic a conventional weaner diet with blood plasma, fish meal, dried whey, and skim milk powder, whereas complex2 partially or totally replaced these ingredients with various plant-based ingredients. The simple diet primarily comprised corn, wheat, and soybean meal. No interactions were found between diet complexity and MC supplementation ( > 0.10), except for apparent total tract digestibility (ATTD) of ash and globulin concentration on d 28 ( < 0.05). Pigs fed the complex1 diet had greater ( < 0.01) ADG, ADFI, and G:F than those fed the other diets during the first week after weaning. However, no differences in ADG or ADFI were observed for pigs fed the complex1 and simple diets throughout the 28-d experimental period ( > 0.10), whereas the complex2 diet led to lower ADG and ADFI compared with the complex1 diet ( < 0.05). Overall, G:F was greater for pigs fed the simple diet compared with those fed the complex1 diet ( < 0.01). Pigs fed the simple diet showed ATTD of DM, OM, GE, and ash comparable to those fed the complex1 diet on d 14 ( > 0.10). In contrast, greater ATTD of DM, OM, NDF, GE, and ash was observed ( < 0.05) in pigs fed the complex1 diet than in those fed the complex2 diet or the simple diet on d 28. The simple diet increased the lymphocyte proportion in serum compared with the complex1 diet ( < 0.01) on d 14. Pigs fed the complex1 diet had a greater ( < 0.05) ratio of villus height (VH) to crypt depth (CD) in the ileum compared with the other diets. The complex2 diet decreased ( < 0.05) the fecal score during 3 wk of the postweaning period compared with the complex1 diet. Dietary MC supplementation increased ( < 0.05) G:F during the overall experimental period, VH in the ileum, VH:CD ratio in the duodenum, and ATTD of DM and GE but it reduced fecal score ( < 0.05). In conclusion, feeding a simple diet resulted in BW comparable to feeding the complex1 diet, but it led to inferior intestinal morphology and ATTD of nutrients on d 28. Also, MC supplementation could be beneficial regardless of diet complexity.