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INTRODUCTION: There is a growing focus on researching the management of children with COVID-19 admitted to hospital, especially among developing countries with new variants alongside concerns with the overuse of antibiotics. Patient care can be improved with guidelines, but concerns with the continued imprudent prescribing of antimicrobials, including antibiotics, antivirals, and antimalarials. OBJECTIVE: Consequently, a need to document the current management of children with COVID-19 across India. Key outcome measures included the percentage of prescribed antimicrobials, adherence to current guidelines, and mortality. METHODOLOGY: A point prevalence study using specially developed report forms among 30 hospitals in India. RESULTS: The majority of admitted children were aged between 11 and 18 years (70%) and boys (65.8%). Reasons for admission included respiratory distress, breathing difficulties, and prolonged fever. 75.3% were prescribed antibiotics typically empirically (68.3% overall), with most on the Watch list (76.7%). There were no differences in antibiotic prescribing whether hospitals followed guidelines or not. There was also appreciable prescribing of antimalarials (21.4% of children), antivirals (15.2%), and antiparasitic medicines (27.2%) despite limited evidence. The majority of children (92.2%) made a full recovery. CONCLUSION: It was encouraging to see low hospitalization rates. However, concerns about high empiric use of antibiotics and high use of antimalarials, antivirals, and antiparasitic medicines exist. These can be addressed by instigating appropriate stewardship programs.
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There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.
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BACKGROUND: Violence affects 15-75% of women across the globe and has a significant impact on their health, well-being, and rights. While quantitative research links it to poor mental health, there is a lack of qualitative enquiry in how women experience it, and how it is related to the mental disorders in Bangladesh. This information is important in understanding the situation and structuring a locally appropriate and culturally sensitive program. METHODS: We adopted a phenomenological approach and conducted 16 in-depth interviews, three informal interviews, one focus group discussion, and one key informant interview. We also reviewed published reports and documents. We followed criterion sampling in selecting women with mental disorders who experienced violence. We explored their experiences and understanding of the issues and described the phenomenon. RESULTS: We found that Bangladesh society was largely controlled by men, and marriage was often forced on women. Women often were blamed for any mishap in the family and married women were under social and emotional pressure to keep the marital relationship going even when painful. We found all forms of violence (physical, emotional, sexual etc.) and most of the time found more than one type in women with mental disorders. Sexual violence is a reality for some women but rarely discussed. We found the society very tolerant with mental disorder patients and those who resorted to violence against them.We identified four theoretical understandings about the role of violence in mental disorders. Sometimes the violence predisposed the mental illness, sometimes it precipitated it, while other times it maintained and was a consequence of it. Sometimes the violence may be unrelated to the mental illness. The relationships were complex and depended on both the type of mental disorder and the nature and intensity of the violence. We found most of the time that more than one type of violence was involved and played more than one role, which varied across different types of mental disorders. Interestingly, not all violence that mentally disordered women faced was because they were women, but because of mental disorders, which brought violence to them as a consequence. CONCLUSIONS: The findings of this first ever qualitative study into the experiences of violence by women with mental disorder in Bangladesh can be used in developing a culturally specific intervention to reduce both violence and mental disorders in women.
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OBJECTIVES: Substance use disorders have become a major public health problem in Bangladesh. We sought to assess the pattern of substance use and related factors among hospitalized patients. METHODS: This was a descriptive study that included 105 patients. All patients who were admitted to a private drug de-addiction clinic in Dhaka, Bangladesh, between 1 July and 31 December 2013 and diagnosed with substance use disorder were enrolled in the study. Data was collected via face-to-face interviews using a semi-structured questionnaire and the information was complemented by the case-notes. RESULTS: Almost all (90.5%) respondents were male and were poly-substance users (91.4%). The mean age of respondents was 28.8±8.0 years. Most (27.6%) respondents used three types of substances. Smoking or inhalation was the route used by most (90.5%) respondents. More than three-fourths (81.0%) of respondents used nicotine. Among the other substances, the majority (79.0%) used opioids, followed by cannabinoids (55.2%), and alcohol (41.0%). Curiosity, peer pressure, and for fun were identified as the common reasons for initiating substance use. CONCLUSIONS: A high proportion of poly-substance use was found in the study population. Our findings could help in the management and development of prevention strategies for substance use in Bangladesh.
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The prevalence, intensity and morpho-variants of new species of haemosporida (Haemoproteus and Plasmodium) from the rock pigeon, Columba livia are described and illustrated for the first time from Uttar Pradesh state of India. Thin blood smears from 266 C. livia indicated 55.63% (Haemoproteus) and 6.76% (Plasmodium) prevalence and 1-6 pars/100 RBC's (Haemoproteus) and 1-2 pars/100 RBC's (Plasmodium) intensity of infection. The fully grown intracellular gametocytes of Haemoproteus were differentiated into microgametocyte (14.0 × 4.3 µm) and macrogametocyte (13.9 × 4.7 µm). Extracorpuscular gametocyte (15.0-17.8 µm in length, 3.9-7.3 µm in width) were occasionally visible. Nuclear displacement ratio was 0.2. Plasmodium species was characterized by rounded schizonts and elongated microgametocyte (7.8 × 7.6 µm) and macrogametocyte (7.8 × 7.7 µm) with irregular margins. Cells containing schizonts are often rounded and enlarged and those parasitized by gametocytes may be somewhat distorted in shape by lateral hypertrophy. Host cell nuclei are also displaced. Double gametocyte infection of Haemoproteus occasionally present but that of Plasmodium lacking.
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During 39 months of sampling, the prevalence of apicomplexan parasites (Haemoproteus and Plasmodium) was studied in Columba livia Gmelin of Rohilkhand region, UP, India, according to the sex of the host, different seasons and host localities. Out of 266 pigeons sampled, 148 pigeons were positive for Haemoproteus at a prevalence of 55.63%. Only 18 pigeons (2.67%) had a dual Haemoproteus and Plasmodium infection and 130 pigeons (48.87%) had Haemoproteus infection. No pigeons were positive for Plasmodium alone. Parasite incidence in relation to the sex of the host indicated a higher infestation in females (62.79%) as compared to males (57.65%). The overall highest infectivity of parasites was recorded during the summer season (82.85%) followed by spring season (59.37%) and least in the winter season (42.30%). It was also observed that Haemoproteus occurred at diverse infectivity in C. livia from different localities (Badaun 51.35%, Bareilly 57.14%, and Shajahanpur 58.06%) whereas Plasmodium was recorded at 11.18% only from Bareilly. The intensity of the parasite was highest (2.77/100 RBC) at Shahjahanpur.
