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INTRODUCTION: Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors. METHODS: Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions. RESULTS: The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (ß = 0.61), mode of birth (ß = -0.60), admission timing (ß = -0.41), continuity of midwifery care (ß = -0.43), physician's gender (ß = -0.62), active labour duration (ß = 0.37), and pain management (ß = -0.33) to be the key determinants of the overall quality gap in intrapartum care. CONCLUSION: Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan. PATIENT OR PUBLIC CONTRIBUTION: This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.
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Qualidade da Assistência à Saúde , Humanos , Feminino , Jordânia , Adulto , Gravidez , Satisfação do Paciente , Inquéritos e Questionários , Adulto Jovem , Empatia , Percepção , Parto Obstétrico/normas , Parto Obstétrico/psicologia , Assistência Perinatal/normasRESUMO
Cold shock proteins (Csp) are pivotal nucleic acid binding proteins known for their crucial roles in the physiology and virulence of various bacterial pathogens affecting plant, insect, and mammalian hosts. However, their significance in bacterial pathogens of teleost fish remains unexplored. Aeromonas salmonicida subsp. salmonicida (hereafter A. salmonicida) is a psychrotrophic pathogen and the causative agent of furunculosis in marine and freshwater fish. Four csp genes (cspB, cspD, cspA, and cspC) have been identified in the genome of A. salmonicida J223 (wild type). Here, we evaluated the role of DNA binding proteins, CspB and CspD, in A. salmonicida physiology and virulence in lumpfish (Cyclopterus lumpus). A. salmonicida ΔcspB, ΔcspD, and the double ΔcspBΔcspD mutants were constructed and characterized. A. salmonicida ΔcspB and ΔcspBΔcspD mutants showed a faster growth at 28°C, and reduced virulence in lumpfish. A. salmonicida ΔcspD showed a slower growth at 28°C, biofilm formation, lower survival in low temperatures and freezing conditions (-20°C, 0°C, and 4°C), deficient in lipopolysaccharide synthesis, and low virulence in lumpfish. Additionally, ΔcspBΔcspD mutants showed less survival in the presence of bile compared to the wild type. Transcriptome analysis revealed that 200, 37, and 921 genes were differentially expressed in ΔcspB, ΔcspD, and ΔcspBΔcspD, respectively. In ΔcspB and ΔcspBΔcspD virulence genes in the chromosome and virulence plasmid were downregulated. Our analysis indicates that CspB and CspD mostly act as a transcriptional activator, influencing cell division (e.g., treB), virulence factors (e.g., aexT), and ultimately virulence.
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Aeromonas salmonicida , Proteínas de Bactérias , Doenças dos Peixes , Animais , Aeromonas salmonicida/patogenicidade , Aeromonas salmonicida/genética , Aeromonas salmonicida/metabolismo , Virulência , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Doenças dos Peixes/microbiologia , Proteínas e Peptídeos de Choque Frio/genética , Proteínas e Peptídeos de Choque Frio/metabolismo , Regulação Bacteriana da Expressão Gênica , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/veterinária , Fatores de Virulência/genética , Fatores de Virulência/metabolismo , Perciformes/microbiologia , Furunculose/microbiologiaRESUMO
OBJECTIVE: The English-language Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure for postpartum anxiety (PPA), but its 51-item length is a limitation. Consequently, the PSAS Working Group developed the PSAS Research Short-Form (PSAS-RSF), a statistically robust 16-item tool that effectively assesses PPA. This study aimed to assess and validate the reliability of an Arabic-language version of the PSAS-RSF in Jordan (PSAS-JO-RSF). METHODS: Using a cross-sectional methodological design, a sample of Arabic-speaking mothers (N = 391) with infants aged up to 6 months were recruited via convenience sampling from a prominent tertiary hospital in northern Jordan. Factor analysis, composite reliability (CR), average variance extracted (AVE), McDonald's ω, and inter-item correlation measures were all examined. RESULTS: Explanatory factor analysis revealed a four-factor model consistent with the English-language version of the PSAS-RSF, explaining a cumulative variance of 61.5%. Confirmatory factor analysis confirmed the good fit of the PSAS-JO-RSF (χ2/df = 1.48, CFI = 0.974, TLI = 0.968, RMSEA = 0.039, SRMR = 0.019, p < 0.001). The four factors demonstrated acceptable to good reliability, with McDonald's ω ranging from 0.778 to 0.805, with 0.702 for the overall scale. The CR and AVE results supported the validity and reliability of the PSAS-JO-RSF. CONCLUSION: This study establishes an Arabic-language version of the PSAS-JO-RSF as a valid and reliable scale for screening postpartum anxieties in Jordan.
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Aeromonas salmonicida, a widely distributed aquatic pathogen causing furunculosis in fish, exhibits varied virulence, posing challenges in infectious disease and immunity studies, notably in vaccine efficacy assessment. Lumpfish (Cyclopterus lumpus) has become a valuable model for marine pathogenesis studies. This study evaluated several antigen preparations against A. salmonicida J223, a hypervirulent strain of teleost fish, including lumpfish. The potential immune protective effect of A. salmonicida bacterins in the presence and absence of the A-layer and extracellular products was tested in lumpfish. Also, we evaluated the impact of A. salmonicida outer membrane proteins (OMPs) and iron-regulated outer membrane proteins (IROMPs) on lumpfish immunity. The immunized lumpfish were intraperitoneally (i.p.) challenged with 104 A. salmonicida cells/dose at 8 weeks-post immunization (wpi). Immunized and non-immunized fish died within 2 weeks post-challenge. Our analyses showed that immunization with A. salmonicida J223 bacterins and antigen preparations did not increase IgM titres. In addition, adaptive immunity biomarker genes (e.g., igm, mhc-ii and cd4) were down-regulated. These findings suggest that A. salmonicida J223 antigen preparations hinder lumpfish immunity. Notably, many fish vaccines are bacterin-based, often lacking efficacy evaluation. This study offers crucial insights for finfish vaccine approval and regulations.
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Imunidade Adaptativa , Aeromonas salmonicida , Vacinas Bacterianas , Doenças dos Peixes , Infecções por Bactérias Gram-Negativas , Animais , Aeromonas salmonicida/imunologia , Doenças dos Peixes/imunologia , Doenças dos Peixes/prevenção & controle , Doenças dos Peixes/microbiologia , Infecções por Bactérias Gram-Negativas/veterinária , Infecções por Bactérias Gram-Negativas/imunologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Vacinas Bacterianas/imunologia , Furunculose/imunologia , Furunculose/prevenção & controle , Furunculose/microbiologia , Perciformes/imunologia , Antígenos de Bactérias/imunologiaRESUMO
Renibacterium salmoninarum causes Bacterial Kidney Disease (BKD) in several fish species. Atlantic lumpfish, a cleaner fish, is susceptible to R. salmoninarum. To profile the transcriptome response of lumpfish to R. salmoninarum at early and chronic infection stages, fish were intraperitoneally injected with either a high dose of R. salmoninarum (1 × 109 cells dose-1) or PBS (control). Head kidney tissue samples were collected at 28- and 98-days post-infection (dpi) for RNA sequencing. Transcriptomic profiling identified 1971 and 139 differentially expressed genes (DEGs) in infected compared with control samples at 28 and 98 dpi, respectively. At 28 dpi, R. salmoninarum-induced genes (n = 434) mainly involved in innate and adaptive immune response-related pathways, whereas R. salmoninarum-suppressed genes (n = 1537) were largely connected to amino acid metabolism and cellular processes. Cell-mediated immunity-related genes showed dysregulation at 98 dpi. Several immune-signalling pathways were dysregulated in response to R. salmoninarum, including apoptosis, alternative complement, JAK-STAT signalling, and MHC-I dependent pathways. In summary, R. salmoninarum causes immune suppression at early infection, whereas lumpfish induce a cell-mediated immune response at chronic infection. This study provides a complete depiction of diverse immune mechanisms dysregulated by R. salmoninarum in lumpfish and opens new avenues to develop immune prophylactic tools to prevent BKD.
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Doenças dos Peixes , Perfilação da Expressão Gênica , Rim Cefálico , Imunidade Inata , Renibacterium , Transcriptoma , Animais , Rim Cefálico/imunologia , Doenças dos Peixes/imunologia , Doenças dos Peixes/microbiologia , Renibacterium/imunologia , Renibacterium/genética , Imunidade Inata/genética , Proteínas de Peixes/genética , Proteínas de Peixes/metabolismo , Imunidade Adaptativa/genética , Peixes/imunologia , Peixes/microbiologia , Doença Crônica , Perciformes/imunologia , Perciformes/microbiologia , Infecções por Bactérias Gram-Negativas/imunologia , Nefropatias/imunologia , Nefropatias/microbiologia , Nefropatias/genética , Nefropatias/veterinária , Micrococcaceae/genética , Micrococcaceae/imunologiaRESUMO
BACKGROUND: Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh. METHODOLOGY: Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated. RESULTS: River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters. CONCLUSION: The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.
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Inundações , Desastres Naturais , Humanos , Feminino , Adulto , Idoso , Bangladesh/epidemiologia , Estudos Transversais , Atenção à Saúde , Doença CrônicaRESUMO
Personal Mobility Devices (PMDs) have witnessed an extraordinary surge in popularity, emerging as a favored mode of urban transportation. This has sparked significant safety concerns, paralleled by a stark increase in PMD-involved crashes. Research indicates that PMD user behavior, especially in urban areas, is crucial in these crashes, underscoring the need for an extensive investigation into key factors, particularly those causing fatal/severe outcomes. Remarkably, there exists a noticeable gap in the research concerning the analysis of determinants behind fatal/severe PMD crashes, specifically in PMD rider-at-fault collisions. This study addresses this gap by identifying uniform groups of PMD rider-at-fault crashes and investigating cluster-specific key factor associations and determinants of fatal/severe crash outcomes using Seoul's PMD rider-at-fault crash data from 2017 to 2021. A comprehensive two-step framework, integrating Cluster Correspondence Analysis (CCA) and Association Rules Mining (ARM) techniques is employed to segment PMD rider-at-fault crash data into homogeneous groups, revealing unique risk factor patterns within each cluster and further exploring the combination of factors associated with fatal/severe PMD rider-at-fault crash outcomes. CCA revealed three distinct groups: PMD-vehicle, PMD-pedestrian, and single-PMD crashes. From the ARM, it was found that fatal/severe crashes were linked to dry road conditions, male PMD users, and weekdays, irrespective of the cluster. Whereas speeding violations and side collisions were associated with fatal/severe PMD-vehicle rider-at-fault crashes, traffic control violations were related to fatal/severe PMD-pedestrian rider-at-fault crashes at pedestrian crossings. Unsafe riding practices predominantly caused single-PMD crashes during daytime hours. From the findings, engineering improvements, awareness campaigns, education, and law enforcement actions are recommended. The new insights gleaned from this research provide a foundation for informed decision-making and the implementation of policies designed to enhance PMD safety.
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Acidentes de Trânsito , Mineração de Dados , Masculino , Humanos , Análise por Conglomerados , Escolaridade , Fatores de RiscoRESUMO
BACKGROUND: There is a dearth of evidence on the trends and inequalities in utilizing cesarean section (CS) among women in Bangladesh. Hence, this study aimed to estimate the socioeconomic and geographical inequalities in delivery by CS among Bangladeshi women from 2004 to 2017. METHODS: Data from Bangladesh Demographic and Health Survey 2004, 2007, 2011, 2014, and 2017 were analyzed using the WHO's Health Equity Assessment Toolkit (HEAT) software. Inequalities were measured using four summary measures: Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF), and Ratio (R). Socioeconomic inequalities were assessed using two equity dimensions: household wealth status, and level of education, while geographical disparities were measured using two equity dimensions: place of residence, and sub-national regions. For each measure, point estimates and their 95% confidence intervals were reported. RESULTS: An increasing trend in the prevalence (weighted) of CS in Bangladesh use was found from 4.50% in 2004 to 32.73% in 2017 We found significant socioeconomic inequalities in CS in every survey point, with a higher concentration of CS among the rich (in 2017, PAR = 28.57; 95% CI: 26.69-30.46) indicating a pro-rich inequality, and higher educated (in 2017, PAF = 23.97; 95% CI: 12.26-35.68) sub-groups. We also identified significant geographical disparities in CS with a higher concentration of CS among people from urban areas (in 2017, PAR = 10.99; 95% CI: 10.19-11.79), and a coastal region (Khulna division) (in 2017, PAF: 30.48 (95% CI: 18.66-42.30). CONCLUSION: We observed both socioeconomic and geographical inequalities in CS exist in Bangladesh, though the trends of these inequalities were curved over time. Thus, it is important to comprehend these pro-rich and geographical inequalities better and implement appropriate interventions and policies to alleviate them.
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Cesárea , Disparidades em Assistência à Saúde , Humanos , Gravidez , Feminino , Bangladesh , Fatores Socioeconômicos , EscolaridadeRESUMO
In the U.S., the interstate highway system is categorized as a controlled-access or limited-access route, and it is unlawful for pedestrians to enter or cross this type of highway. However, pedestrian-vehicle crashes on the interstate highway system pose a distinctive safety concern. Most of these crashes involve 'unintended pedestrians', drivers who come out of their disabled vehicles, or due to the involvement in previous crashes on the interstate. Because these are not 'typical pedestrians', a separate investigation is required to better understand the pedestrian crash problem on interstate highways and identify the high-risk scenarios. This study explored 531 KABC (K = Fatal, A = Severe, B = Moderate, C = Complaint) pedestrian injury crashes on Louisiana interstate highways during the 2014-2018 period. Pedestrian injury severity was categorized into two levels: FS (fatal/severe) and IN (moderate/complaint). The random parameter binary logit with heterogeneity in means (RPBL-HM) model was utilized to address the unobserved heterogeneity (i.e., variations in the effect of crash contributing factors across the sample population) in the crash data. Some of the factors were found to increase the likelihood of pedestrian's FS injury in crashes on interstate highways, including pedestrian impairment, pedestrian action, weekend, driver aged 35-44 years, and spring season. The interaction of 'pedestrian impairment' and 'weekend' was found significant, suggesting that alcohol-involved pedestrians were more likely to be involved in FS crashes during weekends on the interstate. The obtained results can help the 'unintended pedestrians' about the crash scenarios on the interstate and reduce these unexpected incidents.
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Pedestres , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/prevenção & controle , Modelos Logísticos , População Rural , Louisiana , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Although many studies were conducted on COVID-19 knowledge, attitude, and practice (KAP) among the general population in many countries, very little is known about refugees, particularly Rohingya refugees in Cox's Bazar. A vast array of risk communication and community engagement (RCCE) interventions were implemented in Cox's Bazar with the intent of reducing disease transmission by empowering the community to adopt public health measures. OBJECTIVES: The study aimed to assess the level of knowledge, attitude and practice (KAP) of COVID-19 preventive measures among the Rohingya refugees in Cox's Bazar, and to identify their socio-demographic determinants. MATERIALS AND METHODS: A cross-sectional study was conducted with 500 Rohingya individuals. Participants in the study were Rohingya refugees residing in five randomly selected camps where International Organization for Migration (IOM) Health was operating. Using a structured questionnaire, skilled community health workers surveyed the Rohingya population. In addition to the survey on knowledge, attitude, and practice, the study gathered information on the perspectives and relevance of sociodemographic factors that influence KAP. RESULTS: The study findings indicate that the mean scores for knowledge, attitude, and practice were 9.93, 7.55, and 2.71 respectively. Association was found between knowledge and practice level and age group-the elderly age group (>/ = 61 years) had less level of knowledge (AOR 0.42, P value = 0.058) and the late mid-age group (46-60 years) had better practice level (AOR 2.67, P value <0.001). CONCLUSIONS: Our study found that the Rohingya refugee community in Cox's Bazar has improved knowledge and attitude toward COVID-19 preventive measures. However, the practice level of these measures remains low compared to the knowledge and positive attitude. The reason behind the poor practice of preventive measures needs to be identified and addressed engaging the community in similar future outbreaks.
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COVID-19 , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Transversais , Campos de Refugiados , COVID-19/epidemiologia , COVID-19/prevenção & controle , IntençãoRESUMO
Winter ulcer disease is a health issue in the Atlantic salmonid aquaculture industry, mainly caused by Moritella viscosa. Although vaccination is one of the effective ways to prevent bacterial outbreaks in the salmon farming industry, ulcer disease related to bacterial infections is being reported on Canada's Atlantic coast. Here, we studied the immune response of farmed immunized Atlantic salmon to bath and intraperitoneal (ip) M. viscosa challenges and evaluated the immunogenicity of M. viscosa cell components. IgM titers were determined after infection, post boost immunization, and post challenge with M. viscosa. IgM+ (B cell) in the spleen and blood cell populations were also identified and quantified by 3,3 dihexyloxacarbocyanine (DiOC6) and IgM-Texas red using confocal microscopy and flow cytometry. At 14 days post challenge, IgM was detected in the serum and spleen. There was a significant increase in circulating neutrophils 3 days after ip and bath challenges in the M. viscosa outer membrane vesicles (OMVs) boosted group compared to non-boosted. Lymphocytes increased in the blood at 7 and 14 days after the ip and bath challenges, respectively, in OMVs boosted group. Furthermore, a rise in IgM titers was detected in the OMVs boosted group. We determined that a commercial vaccine is effective against M. viscosa strain, and OMVs are the most immunogenic component of M. viscosa cells.
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BACKGROUND: Evaluating the effects of cancer diagnosis and treatment on a patient's overall well-being is crucial and health-related quality of life (HRQoL) is a reliable metric for assessing this impact. Little is known about HRQoL among cancer survivors across various stages and treatments. The study examined individual and clinical factors influencing HRQoL among cancer survivors. METHODS: A cross-sectional study was conducted in two specialised cancer care hospitals in Dhaka, Bangladesh. Cancer-diagnosed adults receiving treatment at selected hospitals from January to May 2022 were enrolled. The 5-level EuroQol-5 Dimensions version (EQ-5D-5L) instrument was used to collect HRQoL data. HRQoL scores were derived using UK value sets. The investigation used a multivariable Tobit regression model to determine the association between independent variables and HRQoL scores. RESULTS: A total of 607 adult patients were enrolled, with 55% being females and 66% aged 36 to 64 years. Reported health problems in five EQ-5D domains include mobility (11%), self-care (11%), usual daily activities (19%), pain/discomfort (21%), and anxiety/depression (46%). Patients with throat, brain, lung, blood, and liver cancer had lower utility scores. Advanced-stage cancer survivors had lower utility scores (ß = -49 units, 95% codfidence interval [CI]: -0.75 to -0.22) compared to early-stage survivors. Physically inactive survivors had lower utility scores by 0.41 units (95% CI: -0.51 to -0.30) compared to their counterparts. Private hospital patients had higher utility scores, whereas patients belonged to poor socioeconomic groups scored worse than wealthier ones. CONCLUSIONS: This study highlights the impact of clinical and individual characteristics on HRQoL among cancer survivors. These findings advocate for an enhanced Bangladeshi cancer patient care model through timely interventions or programs, early detection or diagnosis, tailored treatments, and the promotion of physical activity to bolster HRQoL outcomes.
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Sobreviventes de Câncer , Neoplasias Hepáticas , Adulto , Feminino , Humanos , Masculino , Qualidade de Vida , Estudos Transversais , Bangladesh/epidemiologia , Inquéritos e Questionários , Nível de SaúdeRESUMO
INTRODUCTION: Pedestrian safety at nighttime is an ongoing critical traffic safety concern. Although poor visibility is primarily associated with nighttime pedestrian crashes, other contributing factors such as humans, vehicles, roadways, and environmental factors interact with each other to cause a crash. Additionally, the pattern of nighttime pedestrian crashes differs significantly according to the intersection and segment location, which requires further exploration. DATA: This study applied Association Rules Mining (ARM), a rule-based machine learning method, to reveal the association of nighttime pedestrian crash risk factors according to the intersection and segment locations using 2,505 nighttime pedestrian fatal and injury crashes in Louisiana (2015-2019). RESULTS AND CONCLUSIONS: Based on the generated rules, the results show that nighttime pedestrian crashes at the intersection are associated with right-turn vehicle movement, older drivers (>64â¯years) at the high-speed intersection, senior pedestrians (>64â¯years) in rainy weather conditions, violation by pedestrian age group '<15â¯years', and alcohol-intoxicated pedestrian violation in business/industrial areas. Additionally, 'careless operation' at the intersection is associated with alcohol-involved drivers. Most of the nighttime pedestrian crashes at segments are associated with roadways with no physical separation and the absence of streetlights. Driver alcohol involvement and their physical condition (inattentive/distracted) are also associated with pedestrian crashes associated at the segment location at night. Other segment pedestrian crashes are linked to the interstate in dark conditions, open country locations, and high-speed roadways. Additionally, the crash site investigation identified several critical pedestrian safety concerns including the lack of crosswalk facilities, high driveway density, and pedestrian behavioral patterns (e.g., crossing at roadway segments close to the intersection location). PRACTICAL APPLICATIONS: The findings of this study can be used for selecting the appropriate countermeasures based on a case-by-case basis. The exposure patterns can be used in educational campaigns to strategically reduce nighttime pedestrian crashes.
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Pedestres , Ferimentos e Lesões , Humanos , Adolescente , Acidentes de Trânsito , Fatores de Risco , Tempo (Meteorologia) , AlgoritmosRESUMO
Self-medication with antibiotics is a growing public health concern. Antibiotics are easily accessible on requested from pharmacies throughout the majority of developing countries. The present study aimed to determine the prevalence of self-medication with antibiotics among university students in Bangladesh, as well as to evaluate their knowledge and practices related to antibiotics and its resistance. A structured questionnaire was administered to 1000 students over a month in January 2022 at three universities of Bangladesh. The results showed that 61.0% of the participants had self-medicated with antibiotics in the last six months. In regards to the participants' level of knowledge and practice, a significant proportion, 60.0% exhibited a substandard understanding of antibiotic resistance and appropriate antibiotic usage. Male students (61.7%) were found to self-medicate more often than female students (38.3%). The highest prevalence of self-medication was observed in the age group of 22-25 years (32.2%). The most common reasons for self-medication were previous experience with the illness (40.9%) and the belief that the illness was not serious (36.2%). The most common illnesses for which self-medication was practiced were fever (40.9%) and cough and cold (29.3%). During multivariate logistic regression analyses age, gender, maintaining diet chart, and habit of exercising regularly were found to be associated with the increased risk of self-medication with antibiotics. The study highlighted the critical need for targeted interventions to promote responsible antibiotic use, enhance knowledge about antibiotic resistance, and discourage self-medication among university students in Bangladesh. Addressing these factors would enable the government to mitigate risks associated with self-medication, prevent antibiotic resistance, and alleviate the burden on health and the economy at large.
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Despite substantial progress, Bangladesh still has a high rate of maternal deaths owing to difficulties during pregnancy, delivery, and the postpartum period. Increasing facility delivery is mandatory to reach the goal of bringing down the MMR to <70 deaths/100,000 live births by 2030. In the era of digitalization, the introduction of e-registration and mHealth may aid the government in reaching this target. The southern part of Bangladesh is a hazard-prone area, where service uptake from institutions is low. This study aims to determine the effect of an e-registration tracking system and mHealth counseling on institutional deliveries to pregnant mothers in hazard-prone areas of southern Bangladesh. We will conduct an open-label, two-arm, non-randomized controlled cluster trial for six months and use three hazard-prone areas for intervention and another three hazard-prone areas for control. We will collect data at baseline and end-line of the study period using a structured questionnaire. We will enroll at least 268 pregnant mothers from the intervention and 268 pregnant mothers from the control areas after screening based on the inclusion and exclusion criteria. Pregnancy information will be obtained from the Family Welfare Assistant register. The respondents of the intervention arm will be registered in the e-Registration system, and receive voice call and text messages from the midwives to have their deliveries done in healthcare facilities. We will follow the participants until their delivery and exclude those respondents from the study who will have post-dated delivery, migrate out, lost to follow-up, or die during the study period. Random-intercept mixed-effect logistic regression will be performed to explain the relationship of e-registration and mHealth package with institutional delivery. Institutional delivery is still uncommon in Southern Bangladesh despite several interventions. Innovative approaches like e-registration and mHealth counseling may be helpful to bring women to health facilities. The findings from the study might enable the policy makers of Bangladesh to integrate the intervention package into the existing healthcare system. This experiment is registered in the open science framework. Clinical trial registration: Registration number: DOI 10.17605/OSF.IO/YZE5C) and https://www.clinicaltrials.gov/ (registration number: NCT05398978.
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Telecomunicações , Telemedicina , Gravidez , Humanos , Feminino , Bangladesh/epidemiologia , Pessoal Administrativo , Instalações de SaúdeRESUMO
Suicidal ideation is a complex phenomenon influenced by several predisposing, contextual, and mediating factors that seem more common among healthcare workers, especially nurses. We investigated the association of bullying and burnout with suicidal ideation among Bangladeshi nurses and identified the associated factors. We conducted a cross-sectional study among 1264 nurses in Bangladesh between February 2021 and July 2021. We applied a modified Poisson regression model with robust error variance to determine the association of bullying and burnout with suicidal ideation. Among 1264 nurses, the female was 882 (70.02%), and the mean age was 28.41 (SD = 5.54) years. The prevalence of high levels of suicidal ideation was 13.26%. In the Poison regression model, high risk bullying (RR = 6.22, 95% CI 3.13-12.38), targeted to bullying (RR = 7.61, 95% CI 3.53-16.38), and burnout (RR = 8.95, 95% CI 2.84-28.20) were found to be significantly associated with suicidal ideation. Furthermore, we found significant interaction between workplace bullying and burnout with suicidal ideation (p < 0.05). The high prevalence of bullying, burnout, suicidal ideation, and their association indicate an unsafe workplace for the nurses. Initiatives are needed to make a favorable work environment to improve nurses' overall mental health and reduce suicide ideation.
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Enfermeiras e Enfermeiros , Estresse Ocupacional , Feminino , Humanos , Adulto , Bangladesh , Ideação Suicida , Estudos Transversais , Esgotamento PsicológicoRESUMO
BACKGROUND: Secondhand smoke (SHS) poses a high health risk to those living in multiunit housing (MUH) since it can easily spread from unit to unit and throughout the building's communal areas. MUH residents in Bangladesh are particularly vulnerable to SHS due to the absence of smoking restrictions within a housing complex. Therefore, this study aimed to assess the prevalence of SHS exposure and its associated factors among MUH residents living in seven divisional cities of Bangladesh- Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. METHODS: From April 2019 to November 2019, a cross-sectional survey was conducted with 616 MUH residents aged 18 or older who had been residing in MUH for at least two years in the seven divisional cities of Bangladesh. A multivariable logistic regression model was performed to determine the associated factors of SHS exposure. RESULTS: In MUH complexes, more than half (54.9%) of the 616 respondents were exposed to SHS. The key factors positively associated with SHS exposure were females (aOR: 1.8, 95% CI:1.236-2.681), residents with a low monthly family income (aOR: 1.9, 95% CI: 1.162-3.220), those whose family members smoked (aOR: 2.4, 95% CI: 1.537-3.746), and Dhaka city residents (aOR: 1.9, 95% CI: 1.013-3.440). CONCLUSIONS: This study revealed a high prevalence of SHS exposure among Bangladeshi MUH residents. Therefore, a smoking ban is needed in and around MUH complexes to protect non-smoking residents from SHS exposure.
Assuntos
Habitação , Poluição por Fumaça de Tabaco , Feminino , Humanos , Masculino , Bangladesh/epidemiologia , Cidades , Estudos TransversaisRESUMO
BACKGROUND: The vaccination of the Rohingya refugees and host communities against COVID-19 in Cox's Bazar started in August 2021. Government authorities and Non-Government Organisation partners implemented a project around the initial period of vaccination to improve awareness and access to target beneficiaries. We conducted formative research to understand the programmatic approach of this project and identify potential challenges and community perceptions regarding immunisation against COVID-19. METHODOLOGY: This was formative research in which we used a qualitative method of data collection. Purposively chosen 12 key-informant interviews and conveniently chosen 20 in-depth interviews were conducted using semi-structured interview guidelines from August to September 2022 in the Rohingya camp and host communities of Cox's Bazar District, Bangladesh. Ethical approval was obtained from the North South University Institutional Review Board, and written informed consent was obtained from all the participants. We used a thematic analysis approach to analyse the data. RESULTS: The project neither provided any promotional or tailored messages regarding the COVID-19 vaccine nor conducted any vaccine hesitancy surveys before implementing the project. The project did not provide any storage facilities for the vaccines' cold chain management but provided transport support to carry the vaccines from the district to the sub-district level. Community leaders were included in the decision-making process during local-level planning of the vaccination programme. The project supported the reporting of any adverse effects following immunisation from community members to the government health authorities. Vaccine hesitancy among participants was high in the early stages, but mass campaigns and vaccination of frontline health workers increased their acceptance. The major challenges reported by the informants were low budget and lower salaries of field staff, stacking of the registration process at the beginning, reluctance of participants, inadequate transportation and manpower, and inadequate baby feeding corners at vaccination centers. CONCLUSION: The findings from our study will help policymakers from the Government, the UN, and other humanitarian agencies to adapt and better address the issue of vaccine acceptance and strengthen the vaccination programme.
Assuntos
COVID-19 , Refugiados , Lactente , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Bangladesh/epidemiologia , VacinaçãoRESUMO
Background: Rohingya refugees in Bangladesh are vulnerable to infectious diseases such as COVID-19 due to the crowded living conditions with fragile shelters, and limited water, sanitation and hygiene facilities and practices. While risk communication and community engagement (RCCE) is the cornerstone of outbreak control, there is limited evidence available on the effectiveness of the RCCE strategies in this setting. Objectives: The goal of this study is to evaluate the effectiveness of RCCE strategies and to explore the challenges and community recommendations in relation to COVID-19 preventive measures in the context of Rohingya refugee camps in Bangladesh. Materials and methods: It was a qualitative study. Methods used were (a) observation of RCCE intervention by 3 clinical supervisors accompanying 25 Community Health Workers (CHWs) and (b) 5 focus group discussions engaging 60 community representatives. Data were analyzed using a thematic analysis approach, separately for observation and focus group discussions. Results: The study identified a number of good practices of RCCE, including selecting CHWs from the local community, engaging female CHWs, using local dialect, and collaborating with community/religious leaders. Certain good practices need scaling up, such as utilization of multiple communication methods and interpersonal communication skills. Some areas need improvement, such as CHWs being overburdened with multiple tasks, less effort to active listening, repeated delivery of same messages, inadequate linkage to culture, context, and resources, and less effort to empower the community. Engaging the community, five critical themes were identified in relation to poor COVID-19 preventive practices: culture, religion, and language; local context and resources; community trust and interaction with aid workers; communication methods; and gender and social inclusion. Religious misinterpretation, cultural barriers, physical barriers, lack of resources, breach of trust between the community and aid workers, inconsistent/complex messages, lack of gender and social inclusion, and stigmatization are among some key factors. Some key actions were recommended to improve COVID-19 RCCE strategy. Conclusion: We urge the RCCE partners to make use of the findings and recommendations to develop a robust RCCE strategy relevant to local culture and context, responsive to people's concerns and needs, and inclusive of gender, age and social vulnerabilities.