A comparison of the random-effects pattern mixture model with last-observation-carried-forward (LOCF) analysis in longitudinal clinical trials with dropouts

The last-observation-carried-forward imputation method is commonly used for imputting data missing due to dropouts in longitudinal clinical trials. The method assumes that outcome remains constant at the last observed value after dropout, which is unlikely in many clinical trials. Recently, random-effects regression models have become popular for analysis of longitudinal clinical trial data with dropouts. However, inference obtained from random-effects regression models is valid when the missing-at-random dropout process is present. The random-effects pattern-mixture model, on the other hand, provides an approach that is valid under more general missingness mechanisms. In this article we describe the use of random-effects pattern-mixture models under different patterns for dropouts. First, subjects are divided into groups depending on their missing-data patterns, and then model parameters are estimated for each pattern. Finally, overall estimates are obtained by averaging over the missing-data patterns and corresponding standard errors are obtained using the delta method. A typical longitudinal clinical trial data set is used to illustrate and compare the above methods of data analyses in the presence of missing data due to dropouts.

Factors influencing patients' satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interviews

There is a paucity in current literature about the level of patients’ satisfaction and factors influencing it in Bangladesh health system. We aimed to measure the level of patients’ satisfaction across different types and levels of healthcare facilities and to determine which factors influence this satisfaction level. A patient exit interview was carried out among 2207 patients attending selected health facilities in two administrative divisions of Bangladesh, namely Rajshahi and Sylhet. Information on healthcare experience and satisfaction with received care was collected through an electronic structured questionnaire. Information about ‘overall satisfaction with healthcare’ was collected on a 10-point scale and then dichotomized based on the median-split. Binomial logistic regressions, both simple and multivariable, were conducted to identify which factors contribute significantly to patients’ satisfaction. We found that 63.2% of the participants were satisfied with the healthcare service they received. Patients attending the private facilities had the highest level of satisfaction (i.e. 73%) and patients attending the primary care facilities had the lowest level of satisfaction (i.e. 52%). Factors like convenient opening hours, asking related questions to the providers, facility cleanliness and privacy settings were significantly associated with patients’ satisfaction. Being satisfied with facility cleanliness (multivariable OR 4.30; 95% CI: 3.29–5.62) and privacy settings (multivariable OR 1.68; 95% CI: 1.28–2.21) were the strongest predictors of patients’ satisfaction. In conclusion, a significant portion of the patients in Bangladesh are not satisfied with their received care. Patients’ satisfaction can be increased by focusing on improving facility cleanliness, privacy settings and providers’ interpersonal skills.

Evaluation of impact of measles rubella campaign on vaccination coverage and routine immunization services in Bangladesh

Background

Like other countries in Asia, measles-rubella (MR) vaccine coverage in Bangladesh is suboptimal whereas 90–95 % coverage is needed for elimination of these diseases. The Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh implemented MR campaign in January-February 2014 to increase MR vaccination coverage. Strategically, the MOHFW used both routine immunization centres and educational institutions for providing vaccine to the children aged 9 months to <15 years. The evaluation was carried out to assess the impact of the campaign on MR vaccination and routine immunization services.

Methods

Both quantitative and qualitative evaluations were done before and after implementation of the campaign. Quantitative data were presented with mean (standard deviation, SD) for continuous variables and with proportion for categorical variables. The overall and age- and sex-specific coverage rates were calculated for each region and then combined. Categorical variables were compared by chi-square statistics. Multiple logistic regression analysis were performed to estimate odds ratios (OR) and 95 % confidence intervals (CI) of coverage associated with covariates, with adjustment for other covariates. Qualitative data were analyzed using content analysis.

Results

The evaluations found MR coverage was very low (<13 %) before the campaign and it rose to 90 % after the campaign. The pre-post campaign difference in MR coverage in each stratum was highly significant (p < 0.001). The campaign achieved high coverage despite relatively low level (23 %) of interpersonal communication with caregivers through registration process. Child registration was associated with higher MR coverage (OR 2.91, 95 % CI 1.91–4.44). Children who attended school were more likely to be vaccinated (OR 8.97, 95 % CI 6.17–13.04) compared to those who did not attend school. Children of caregivers with primary or secondary or higher education had higher coverage compared to children of caregivers with no formal education. Most caregivers mentioned contribution of the campaign in vaccination for the children not previously vaccinated.

Conclusions

The results of the evaluation indicated that the campaign was successful in terms of improving MR coverage and routine immunization services. The evaluation provided an important guideline for future evaluation of similar efforts in Bangladesh and elsewhere.

Multiple imputation compared with some informative dropout procedures in the estimation and comparison of rates of change in longitudinal clinical trials with dropouts

Statistical analysis based on multiple imputation (MI) of missing data when analyzing data with missing observations is gaining popularity among statisticians because of availability of computing softwares; it might be tempting to use MI whenever data is missing. An important assumption behind MI is the "ignorability of missingness." In this paper, we demonstrate the use of MI in conjunction with random effects models and several other methods that are devised to handle nonignorable missingness (informative dropouts). We then compare the results to assess sensitivity to underlying assumptions. Our focus is primarily to estimate and compare rates of change (of a primary variable). The application dataset has a high dropout rate and has features to suggest informativeness of the dropout process. The estimates obtained under random effects modeling with multiple imputation were found to differ substantially from those obtained by methods devised to handle informative dropouts.

A state of the art review on electrochemical technique for the remediation of pharmaceuticals containing wastewater

Pharmaceutical wastewater is a frequent kind of wastewater with high quantities of organic pollutants, although little research has been done in the area. Pharmaceutical wastewaters containing antibiotics and high salinity may impair traditional biological treatment, resulting in the propagation of antibiotic resistance genes. The potential for advanced oxidation processes (AOPs) to break down hazardous substances instead of present techniques that essentially transfer contaminants from wastewater to sludge, a membrane filter, or an adsorbent has attracted interest. Among a variety of AOPs, electrochemical systems are a feasible choice for treating pharmaceutical wastewater. Many electrochemical approaches exist now to remediate rivers polluted by refractory organic contaminants, like pharmaceutical micro-pollutants, which have become a severe environmental problem. The first part of this investigation provides the bibliometric analysis of the title search from 1970 to 2021 for keywords such as wastewater and electrochemical. We have provided information on relations between keywords, countries, and journals based on three fields plot, inter-country co-authorship network analysis, and co-occurrence network visualization. The second part introduces electrochemical water treatment approaches customized to these very distinct discarded flows, containing how processes, electrode materials, and operating conditions influence the results (with selective highlighting cathode reduction and anodic oxidation). This section looks at how electrochemistry may be utilized with typical treatment approaches to improve the integrated system's overall efficiency. We discuss how electrochemical cells might be beneficial and what compromises to consider when putting them into practice. We wrap up our analysis with a discussion of known technical obstacles and suggestions for further research.

The economic burden of diarrhea in children under 5 years in Bangladesh

BACKGROUND

Diarrhea is a leading cause of morbidity and mortality among under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden on households and health systems. The aim of this study was to estimate the cost of illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh.

METHOD

A cross-sectional study with an ingredient-based costing approach was conducted in 48 healthcare facilities in Bangladesh. In total, 899 caregivers of under-five children with diarrhea were interviewed face-to-face between August 2017 and May 2018, followed up over phone after 7-14 days of discharge, to capture all expenses and time costs related to the entire episode of diarrhea.

RESULTS

The average cost per episode for caregivers was US$62, with $29 direct and $34 indirect costs. From the societal perspective, average cost per episode of diarrhea was $71. In 2018, an estimated $79 million of economic costs were incurred for treating diarrhea in Bangladesh. Using 10% of income as threshold, over 46% of interviewed households faced catastrophic expenditure from diarrheal disease.

CONCLUSION

The economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.

Implementation of the World's largest measles-rubella mass vaccination campaign in Bangladesh: a process evaluation

BACKGROUND

Gavi, the Vaccine Alliance, supported a mass vaccination Measles-Rubella Campaign (MRC) in Bangladesh during January-February 2014.

METHODS

We conducted a mixed-method process evaluation to understand the successes and challenges in implementation of the MRC. We reviewed documents for the MRC and the immunization programme in Bangladesh; observed meetings, vaccination sessions, and health facilities; and conducted 58 key informant interviews, 574 exit interviews with caregivers and 156 brief surveys with stakeholders involved in immunization. Our theory of Change for vaccination delivery guided our assessment of ideal implementation milestones and indicators to compare with the actual implementation processes.

RESULTS

We identified challenges relating to country-wide political unrest, administrative and budgetary delays, shortage of transportation, problems in registration of target populations, and fears about safety of the vaccine. Despite these issues, a number of elements contributed to the successful launch of the MRC. These included: the comprehensive design of the campaign; strong partnerships between immunization authorities in the government system, Alliance partners, and civil society actors; and motivated and skilled health workers at different levels of the health system.

CONCLUSIONS

The successful implementation of the MRC in spite of numerous contextual and operational challenges demonstrated the adaptive capacity of the national immunization programme and its partners that has positive implications for future introductions of Gavi-supported vaccines.

Vulnerability of Bangladeshi street-children to HIV/AIDS: a qualitative study

Background

Children living on the streets are an underprivileged population of Bangladesh and are likely to be more vulnerable to STIs/HIV for their day-to-day risky behaviours and lifestyles. This study assessed the vulnerability of Bangladeshi street-children to HIV/AIDS using qualitative participatory methods.

Methods

This ethnographic participatory, qualitative study was conducted during February 2010– December 2011 among children aged 5–12 years, who live and/or work on the streets in Dhaka, the capital city of Bangladesh. Data were collected in three phases: (a) social mapping (n = 493), (b) participatory group discussions (n = 119), and (c) individual interviews (n = 36).

Results

Results showed that street-children were engaged in behaviour that entails risk of exposure to HIV/AIDS. They possessed poor knowledge of the transmission of disease and of the benefits of using condoms; most of them reported never using a condom. The experience of selling sex for money and a variety of sexual activities, like anal, vaginal and oral sex, were commonly reported. The children also reported that they were regular users of one or more types of drugs, including those taken by injection.

Conclusions

The deplorable living conditions of street children, with no obvious rights or way out, make them highly vulnerable to HIV/AIDS. Urgent attention of the policy- makers to implement services addressing issues relating to social conditions, sexual health, and drug-use is warranted to prevent the possible epidemic of HIV/AIDS among this group of population.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2458-14-1151) contains supplementary material, which is available to authorized users.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh

Background

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation.

Methods

A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities.

Results

The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of sufficient funding and resources (antigen) for training programs.

Conclusions

Our study suggested that health facilities suffered from lack of readiness in various aspects, most notably in diagnostic capacity. Conversely, with very few challenges, nearly all the health facilities designated to provide immunization services were ready to deliver routine childhood immunization services as well as newly introduced PCV and IPV.

The economic burden of measles in children under five in Bangladesh

BACKGROUND

This study estimated the economic cost of treating measles in children under-5 in Bangladesh from the caregiver, government, and societal perspectives.

METHOD

We conducted an incidence-based study using an ingredient-based approach. We surveyed the administrative staff and the healthcare professionals at the facilities, recording their estimates supported by administrative data from the healthcare perspective. We conducted 100 face-to-face caregiver interviews at discharge and phone interviews 7 to 14 days post-discharge to capture all expenses, including time costs related to measles. All costs are in 2018 USD ($).

RESULTS

From a societal perspective, a hospitalized and ambulatory case of measles cost $159 and $18, respectively. On average, the government spent $22 per hospitalized case of measles. At the same time, caregivers incurred $131 and $182 in economic costs, including $48 and $83 in out-of-pocket expenses in public and private not-for-profit facilities, respectively. Seventy-eight percent of the poorest caregivers faced catastrophic health expenditures compared to 21% of the richest. In 2018, 2263 cases of measles were confirmed, totaling $348,073 in economic costs to Bangladeshi society, with $121,842 in out-of-pocket payments for households.

CONCLUSION

The resurgence of measles outbreaks is a substantial cost for society, requiring significant short-term public expenditures, putting households into a precarious financial situation. Improving vaccination coverage in areas where it is deficient (Sylhet division in our study) would likely alleviate most of this burden.

Linear structural equation model in analyzing quality-of-life-data from clinical trials

Assessment of quality of life (QOL) in clinical trials becomes a challenging task from the viewpoint of clinical biostatistics. The responses of the items for measuring QOL indices usually vary widely from patient to patient and from time to time. Measurement errors might be present in the responses of the items, and they might be correlated. Hence, in analyzing QOL data, the usual assumption that there are no measurement errors in responses is too liberal. Because the QOL indices are likely to be correlated, separate analysis of each index might not be efficient from the point of view of statistical methodology. We apply linear structural equation modeling (LISREL) in assessing the QOL data obtained from a clinical trial. A basic premise of the LISREL approach is that the abstract concepts (latent constructs) that are not directly measurable can be studied. LISREL is a statistical procedure for conceiving and testing structural hypotheses that cannot be tested adequately with other statistical procedures. It allows us to specify relations between unobserved and observed variables while controlling for measurement errors and correlations among both the measurement errors and the latent constructs.

CuO improved energy band of AgO/fibrous SiO2-ZrO2 for optimized simultaneous photocatalytic redox of chromium (VI) and p-cresol using response surface methodology

Ternary CuO/AgO/FSZr photocatalysts were fabricated via the hydrothermal and electrochemical methods with three different CuO loading (1, 3 and 5 wt%), indicated as 1CuO/AgO/FSZr, 3CuO/AgO/FSZr and 5CuO/AgO/FSZr. The photocatalytic reaction was tested towards simultaneous chromium (VI) photoreduction and p-cresol photooxidation and the performance in order as follow: 3CuO/AgO/FSZr > 5CuO/AgO/FSZr > 1CuO/AgO/FSZr > AgO/FSZr > FSZr. CuO/AgO/FSZr photocatalysts showed an improvement in photocatalytic activity compared to AgO/FSZr and FSZr due to the reduction potential of chromium (VI) aligned closer to the conduction band of CuO and provided abundant free active electrons (e^-) and holes (h⁺) with efficient transportation and migration. Interestingly, the 3CuO/AgO/FSZr was established as the best photocatalyst with 98% reduction of chromium (VI) and 83% oxidation of p-cresol simultaneously, owing to its strong corporation between the metal oxides and support and higher total pore volume. The Langmuir-Hinshelwood model were employed for kinetics which followed the pseudo-first-order kinetics model well. Based on the simultaneous photocatalytic mechanism, chromium (VI) and p-cresol were directly reduced and oxidized by e^- and h⁺, respectively. The response surface methodology (RSM) discovered that the quadratic term initial concentration of chromium (VI) is the main significant factor in photocatalytic performance. The optimum parameters for simultaneous photoredox of chromium (VI) and p-cresol predicted from RSM are 9.6 mg L^-1 of chromium (VI) concentration, 9.8 mg L^-1 of p-cresol concentration and 0.32 g L^-1 of catalyst dosage. Under these conditions the error between the predicted and experimental values is only 3.7%. The 3CuO/AgO/FSZr sustained the photocatalytic performance after reused for five cycles and could oxidized various organic pollutants as well as reduced chromium (VI) simultaneously.

Studies of the presence of rabies virus among stray dogs in Dhaka City

One hundred and thirty one stray dogs were captured from Dhaka City. Anti-mortem as well post-mortem examination of the dogs for rabies were conducted. Microscopic studies and biological tests were carried-out with dog's brain for the detection of rabies virus. One dog was found to have rabies virus in its brain. The stray dogs under Dhaka Municipal Corporation area therefore, seem to harbour rabies virus in their brains and could be a source of potential danger to the community after the full development of the disease.

OCCUPATIONAL HEALTH AND SAFETY PRACTICES AMONG WORKERS IN BLOCK/CONCRETE CONSTRUCTION INDUSTRIES IN GOMBE METROPOLIS, GOMBE STATE, NORTHEAST, NIGERIA

Introduction

The block/concrete industry is often seen as a driver of economic growth in developing countries. A wide range of people mainly unskilled form the bulk of workers in these industries. According to the International Labor Organization, about 60,000 fatal accidents occur annually on these construction sites. This study aimed to determine the knowledge of hazards and practices of occupational safety measures among the workers in these industries.

Methodology

A descriptive cross-sectional study was done among 295 respondents selected using a multi-stage sampling technique. A structured, interviewer-administered-electronic questionnaire was used to obtain information from the respondents. Data were analyzed using SPSS version 23. Quantitative variables were summarized using tables and charts. The chi-square test was used to examine the relationship between socio-demographic characteristics and knowledge and practice. Statistical significance was determined at a p-value of ≤0.05.

Results

All the respondents were males, with a mean age of 28.9 ± 6.9 years. Most (70%) of the respondents have good knowledge while 49% have good practices in occupational safety. The age, level of education, and status of the worker were associated with knowledge of occupational hazards and practices. There was a statistically significant relationship between the knowledge of hazards and the practice of occupational safety (p = 0.000).

Conclusion

The knowledge of occupational hazards among the study participants was high while safety practices were not adequate. Therefore, the health authorities should educate workers on safety practices and encourage the management of the factories to provide safety measures to protect the workers.

Synthesis of ionizable lipopolymers using split-Ugi reaction for pulmonary delivery of various size RNAs and gene editing

We present an efficient approach for synthesizing cationic poly(ethylene imine) derivatives using the multicomponent split-Ugi reaction to rapidly create a library of complex functional ionizable lipopolymers. We synthesized a diverse library of 155 polymers, formulated them into polyplexes to establish structure-activity relationships crucial for endosomal escape and efficient transfection. After discovering a lead structure, lipopolymer-lipid hybrid nanoparticles are introduced to preferentially deliver to and elicit effective mRNA transfection in lung endothelium and immune cells, including T cells with low in vivo toxicity. The lipopolymer-lipid hybrid nanoparticles showed 300-fold improvement in systemic mRNA delivery to the lung compared to in vivo -JetPEI ® . Lipopolymer-lipid hybrid nanoparticles demonstrated efficient delivery of mRNA-based therapeutics for treatment of two different disease models. Lewis Lung cancer progression was significantly delayed after treatment with loaded IL-12 mRNA in U155@lipids after repeated i.v. administration. Systemic delivery of human CFTR (hCFTR) mRNA resulted in production of functional form of CFTR protein in the lungs. The functionality of hCFTR protein was confirmed by restoration of CFTR- mediated chloride secretion in conductive airway epithelia in CFTR knockout mice after nasal instillation of hCFTR mRNA loaded U155@lipids. We further showed that, U155@lipids nanoparticles can deliver complex CRISPR-Cas9 based RNA cargo to the lung, achieving 5.6 ± 2.4 % gene editing in lung tissue. Moreover, we demonstrated successful PD-1 gene knockout of T cells in vivo . Our results highlight a versatile delivery platform for systemic delivering of mRNA of various sizes for gene therapy for a variety of therapeutics.

Prevalence of and factors associated with zero-dose and under-immunized children in selected areas of Bangladesh: Findings from Lot Quality Assurance Sampling Survey

BACKGROUND

In the era of Gavi's 5.0 vision of "leaving no one behind with immunization", childhood routine vaccination in missed communities is considered as a priority concern. Despite having a success story at the national level, low uptake of immunization is still persistent in selected pocket areas of Bangladesh. However, prevalence and the associated factors of zero-dose (ZD) and under-immunization (UI) are still unknown at those geo-pockets of Bangladesh. Thus, the study aims to report and identify the factors associated with ZD and UI in selected geographical locations.

METHODS

This study used data from a Lot Quality Assurance Sampling (LQAS) survey where 504 households from 18 clusters of four hard to reach (HTR) and one urban slum were included. Caregivers of children aged 4.5 to 23 months were interviewed. Three outcome variables- ZD, UI and ZD/UI were considered and several related attributes were considered as independent variables. Data were analyzed through bivariate analysis, binary logistic regression and dominance analysis.

RESULTS

Overall, 32% of the children were either ZD (8%) or UI (26%) in the selected areas. The adjusted odds of ZD/UI for urban slum and haor (wetlands) areas were 5.62 and 3.61 respectively considering coastal areas as reference. However, distance of nearest EPI center, availability of EPI card, age of caregivers, education and occupation of mother and number of earning members in household were influential factors for ZD/UI. According to dominance analysis, availability of EPI card can explain the most of the variation of ZD/UI in this study.

CONCLUSION

The study findings highlight the high prevalence ZD/UI in certain geo-pockets of the country. It provided a powerful insight of current situation and associated factors in regards to ZD/UI in the country which will help policy-makers and programme managers in designing programmes to reduce missed communities in Bangladesh.

Dorsalis pedis artery: variations and clinical significance

A variation not particularly common in the dorsalis pedis artery was noted in routine classroom dissection. The artery was found to be replaced by a large perforating branch of the peroneal artery instead of the terminal part of anterior tibial artery. This variation has got high clinical significance.

RELATIONSHIP OF MEAN PLATELET VOLUME TO SEVERITY AND SHORT-TERM OUTCOME OF ACUTE ISCHEMIC STROKE

Introduction

Despite the considerable number of clinical studies conducted, questions on the importance of the determinants of outcome after ischaemic stroke still exits.

Methodology

Eighty consenting acute ischaemic stroke patients presenting to the emergency unit of Federal Teaching Hospital Gombe, along with 80 age and sex-matched controls were recruited. All the subjects were examined after relevant clinical history and stroke severity was determined using the NIHSS score. A brain imaging computed tomography or magnetic resonance imaging (CT/MRI) was performed for each patient and the stroke outcome of each patient was documented at the end of 30 days. MPV was assayed using the Sysmex KX-21N automated haematology analyser.

Result

The mean age of patients 59.74±14.44 years was similar to the mean age of controls 59.80±14.08 years; P=0.947. The gender distribution between the two groups was also similar (p=0.436). Systemic hypertension was the most common modifiable risk factor for stroke accounting for 58.8%. The MPV of stroke patients 10.51 ± 0.88fl was significantly higher than that of controls 9.86±0.88fl p=0.0001 with a reference interval of 9.10-10.62fl using controls. Patients with MPV ≥10.62fl were categorized as high MPV range. The majority of patients in the high MPV category had significantly severe stroke with NIHSS score >16 p=0.001. No significant relationship was observed between the high MPV category and functional outcome based on mRS category p=0.101, The effect of MPV in the prediction of mortality remained significant (OR: 4.58, P= 0.012) in the multivariate regression model after controlling for other factors associated with mortality in acute ischemic stroke. A significant relationship was observed between MPV and infarct volume on the ROC curve and the area under the curve was 0.684 and an MPV value of 9.85fl was determined at 90% sensitivity and specificity of 50%.

Conclusion

The study shows that MPV is associated with stroke severity and can be used as a marker to predict mortality in acute ischaemic stroke.

Identifying the zero-dose and under-immunized children in Bangladesh: Approaches and experiences

This paper presents and elaborates on empirical methods and approaches used to identify Zero-Dose (ZD) and Under-immunized (UI) children as well as the communities that these children reside in within Bangladesh. This paper also describes demand- and supply side-barriers that lead to children being ZD and UI in the country. Time period for the study was December 2022-May 2023. The study methodology encompassed secondary data analysis using data from national surveys, primary data collection and analysis via a lot quality assurance sampling (LQAS) survey and also, qualitative data collection and analysis. Study population included caregivers of children aged 4.5 months (4 months 15 days) to 23 months for the LQAS survey. The qualitative component included policymakers, program managers and service providers working in immunization as well as mothers in the selected study areas who had a living child aged less than 2 years as the study population. Our data analysis confirms existence of ZD and UI children in areas which were categorized into haor (wetlands), hilly, char (sandy/silty land surrounded by water), coastal, plain land and urban slums. Determinant analysis showed that the mother's level of education, antenatal visits made, and access to media were significantly associated with children being ZD or UI. Reproductive autonomy emerged as a key factor that had prominent impact on a child being ZD. The qualitative analysis indicated the importance of population migration, health workforce shortages and lack of access to transportation as prominent barriers to immunization. Notably, the methods and approaches used in this study are both effective and easily replicable to identify ZD and UI children. The drivers of ZD and UI along with the barriers to immunization provide potential areas for intervention by policy-makers and can apprise about interventions to be tested in future implementation research.

Impact of the COVID-19 Pandemic on Elderly Medical Admissions and Outcomes in a Tertiary Hospital in Northeastern Nigeria: A Comparative Retrospective Study

BACKGROUND

The coronavirus infectious disease 2019 (COVID-19) has been shown to be more lethal in the elderly (>65 years), especially those with co-morbidities. This study examined the impact of the pandemic lockdown period on trends in elderly medical admissions and deaths.

METHODOLOGY

This is a retrospective study of elderly medical admissions and deaths in the medical wards of a Nigerian hospital. Data for the months of March, April, May, June, and July of 2020 was compared to the same months before (2019) and after (2021). Analysis was done using STATA version 15.0.

RESULTS

During the study period, two hundred and seventy-six elderly patients were admitted, with a mean age (±SD) of 73.4 ± 7.4 years. The most common diagnoses at admission were chronic kidney disease (CKD) (26.85%, n=74) and hypertensive heart disease (HHD) (21.7%, n=60). The highest admission was in 2021, with a total of 99 (35.9%). Overall, 60 mortalities were recorded, with a proportional mortality rate of 21.7%, which was highest in 2020 (25.0%) and lowest in 2021 (17.1%). There was no difference between the mortality rates of 2019 versus 2020 (P=0.82) and 2020 versus 2021(P=0.18). Sepsis (35.0%) and CKD (25.0%) were the major contributors in 2019.

CONCLUSION

CKD and HHD were the most common diagnoses at admission, whereas sepsis, CKD, and CVD were the commonest causes of death. The Covid-19 pandemic did not significantly alter the elderly admission pattern in our setting.

Disparities in COVID-19 vaccine uptake among rural hard-to-reach population and urban high-risk groups of Bangladesh

BACKGROUND

Vaccination has been an indispensable step in controlling the coronavirus disease pandemic. In early 2021, Bangladesh launched a mass vaccination campaign to boost the COVID-19 vaccination rate when doses were available and immunized millions in the country. Although deemed a success, disparities became conspicuous in vaccination coverage across population of different socioeconomic background.

METHODS

The purpose of this cross-sectional study was to assess the vaccination coverage for three doses and detect disparities in uptake of the COVID-19 vaccine among rural population of hard-to-reach areas and urban individuals belonging to the high-risk group -defined in our study as individuals from elusive population such as floating population/street dwellers, transgender, addicts and disabled population. We conducted household survey (n = 12,298) and survey with high risk group of people (2,520). The collected primary data were analysed using descriptive statistical analysis.

RESULTS

Our findings show that coverage for the first dose of COVID-19 vaccination was high among respondents from both rural Hard-to-reach (HTR) (92.9%) and non-HTR (94.6%) areas. However, the coverage for subsequent doses was observed to reduce significantly, especially for third dose (52.2% and 56.4% for HTR and non-HTR, respectively).

CONCLUSION

Vaccination coverage among urbanites of high-risk group was found to be critically low. Vaccine hesitancy was also found to be high among individuals of this group. It is essential that the individuals of urban high-risk group be prioritized. Individuals from this group could be provided incentives (transport for disabled, monetary incentive to transgenders; food and medicine for drug user and floating people) and vaccination centers could be established with flexible schedule (morning/afternoon/evening sessions) so that they receive vaccine at their convenient time. Community engagement can be used for both high-risk group and rural population to enhance the COVID-19 vaccination coverage and lower disparities in uptake of the vaccine doses nationwide.

Study of the presence of rabies virus in indigenous bats

One hundred and thirteen fruit eating and insectivorous bats were captured from different parts of Bangladesh. Antemortem and post mortem examinations of the bats for rabies were conducted. Microscopic studies and biological tests were carried-out with bat's brain for the detection of rabies virus. The results were negative. It may therefore, be concluded that the insectivorous and fruit eating bats from different parts of Bangladesh do not act as the reservoir for rabies virus.

Factors affecting practices of recently delivered women on maternal and neonatal health care in selected rural areas of Bangladesh

Bangladesh has made laudable progress in maternal and child health (MCH). Maternal and child mortalities have reduced substantially accompanied by stellar rise in immunization and contraceptive prevalence rate (CPR). However, such success is distributed unevenly throughout and the country is among one of the top ten countries with highest number of neonatal and under-five children mortalities. Rural Bangladesh is home to more than half of the country's total population. Yet, disparity in access to healthcare services and information are overt in these areas. Utilization of maternal health services (MHS) is low whereas maternal and child mortalities are high in the rural areas. Thus, this cluster randomized cross sectional study was conducted with the aim to observe the practices that rural women followed in regards to maternal and child health and factors that affected these practices. Primary data was collected from 550 respondents using a structured questionnaire within the time period September-October 2019. All our participants were recently delivered women (RDW), defined in our study as women of reproductive age (15-49 years) who had delivered a child recently, i.e. 12 months prior (September 2018 - August 2019) the data collection. We conducted logistic regression and multivariate analysis to analyze data. Results from this study depict that while 96.3% of RDW opted for ANC visits and 99.1% fed colostrum to their newborn, fewer have had institutional deliveries and the number of RDW who had PNC was only 64.7%. Education was found to be the most prominent factor that affected practices employed by RDW. The more educated a respondent was, the greater the chance was of her engaging in appropriate maternal and child health practices. The RDW preferred and visited private facilities the most to obtain healthcare services with private medical doctors being one of the prime sources of healthcare information for the respondents. On the contrary, monthly expenditure exerted no statistically significant impact on the aforementioned practices. Thus, results of our study imply that interventions enhancing education and health knowledge of women and engaging private sector be designed for improving maternal and neonatal health care in rural areas of Bangladesh.

Promoting a well-dispersion of MoO3 nanoparticles on fibrous silica catalyst via one-pot synthesis for enhanced photoredox environmental pollutants efficiency

The coexistence of pharmaceutical compounds and heavy metals in the aquatic environment has resulted in complications in the treatment process and thus, causing uproar among the citizens. The radical-based photocatalysis technology has aroused as an excellent method to eliminate both heavy metal and pharmaceutical compounds in the water. Herein, reported the utilization of the microemulsion technique for the preparation of nanoporous fibrous silica-molybdenum oxide (FSMo) towards simultaneous photocatalytic abatement of hexavalent chromium (Cr(VI)) and tetracycline (TC). The FESEM analysis showed the spherical morphology of the FSMo catalyst with dendrimeric silica fiber. The synthesized FSMo catalyst exhibited narrowed bandgap, high crystallinity, and well Mo element dispersion for enhanced photo-redox of Cr(VI) and TC. Remarkably, simultaneous remediation of the Cr(VI) and TC over FSMo demonstrated superior photocatalytic efficiency, 69% and 75%, respectively, than in the individual system, possibly due to the effective separation of photoinduced charges. The introduction of the Mo element to the silica framework via microemulsion technique demonstrated better dispersion of Mo compared to the incipient wetness impregnation method and thus, yielded higher photocatalytic activity towards simultaneous removal of TC and Cr(VI). Besides, quenching experiments revealed the electrons and holes as the active species that play a dominant role in the simultaneous photo-redox of Cr(VI) and TC. Lastly, the FSMo catalyst demonstrated high stability after four continuous cycles of simultaneous photocatalysis reactions, implying its potential as a suitable material for practical wastewater treatments.