May Measurement Month 2021: an analysis of blood pressure screening results from Bangladesh.

Previous studies have shown that among Bangladeshi adults, one-fifth have hypertension. The National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) campaigns in 2017, 2018, 2019, as well as in 2021 as a part of a global initiative aimed at raising awareness of high blood pressure (BP) and to act as a temporary solution to the lack of nationwide screening programmes. This opportunistic screening of voluntary participants aged ≥18 years was carried out from May to July 2021. Data were collected from more than 150 screening sites in all 64 districts in Bangladesh. Blood pressure measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Data on 28 355 individuals were finally analysed. Among the participants, 17 941 (63.3%) were female. After multiple imputation, 11 194 (39.5%) had hypertension. Among the 11 194 participants with hypertension, 78.8% were aware of having hypertension and 65.6% were on antihypertensive medication. Among 11 194 participants with hypertension, 7340 participants (65.6%) were on antihypertensive medication and 43.8% had controlled BP (<140/90 mmHg). Of those on antihypertensive medication, 66.8% had controlled BP. A voluntary BP screening programme can identify significant numbers of people with raised BP and thus contributes importantly to the prevention of cardiovascular diseases.

May Measurement Month 2019: an analysis of blood pressure screening results from Bangladesh.

According to the Non-communicable disease Risk Factors Survey of 2018, more than one-fifth (21.0%) of adults aged 25 years or older have hypertension and one-third of the adults did not have their blood pressure (BP) measured in their lifetime in Bangladesh. The National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) 2017 and 2018 as well as this 2019 as a part of a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. This opportunistic screening of voluntary participants aged ≥18 years was carried out from May to July 2019. Data were collected from 100 screening sites in 16 districts in Bangladesh. BP measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Data on 24 941 individuals were analysed. Among the participants, 12 658 (50.8%) were female. After multiple imputation, 6990 (28.0%) had hypertension. Among the 6990 participants with hypertension, 5007 (71.6%) were on antihypertensive medication and 5331 (76.3%) were aware of having hypertension. Among 6990 participants with hypertension, 3217 (46.0%) had controlled BP (<140/90 mmHg) and among the participants with hypertension and on antihypertensive medication, 64.2% had controlled BP. Opportunistic BP screening can identify significant numbers of people with raised BP and thus assist in the prevention of cardiovascular diseases.

May Measurement Month 2018: an analysis of blood pressure screening results from Bangladesh.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. According to Non-communicable disease (NCD) Risk Factors Survey Bangladesh 2010, one-fifth (21.9%) of adults aged 25 years or more have hypertension. Almost one-third of the adult population did not have their BP measured in their lifetime in Bangladesh. National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) 2018 as a part of a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes nationally. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2018. Blood pressure measurement, the definition of hypertension and statistical analysis followed the MMM protocol. Data were collected from 10 screening sites in 9 districts in Bangladesh. A total of 5208 individuals were screened during MMM18. After multiple imputation, 1750 (33.6%) had hypertension. Among the 1750 participants with hypertension, 1312 (75.0%) were aware of having hypertension. Among those that were not on antihypertensive medication, 15.2% were hypertensive and among those that were on antihypertensive medication 33.6% had uncontrolled hypertension. The present study showed that opportunistic screening can identify significant numbers of people with raised BP. A periodic public health programme at a national level needs to be initiated to increase hypertension detection and control rates and thus for prevention of cardiovascular diseases.

Towards reducing behavioral risk factors of non-communicable diseases among adolescents: protocol for a school-based health education program in Bangladesh.

BACKGROUND: Developing strategies aimed at reducing behavioral risk factors and hence the prevalence of non-communicable diseases (NCDs) is a major challenge to the policy makers today. Like the same age group worldwide, the prevalence of obesity, unhealthy dietary habit, physical inactivity, smoking and alcohol intake is high among the adolescents of Bangladesh. Studies showed promising results of an early intervention at adolescent age in reducing the likelihood of NCDs at adult age. So, this study is designed to implement a behavior change intervention and evaluate the effectiveness of the intervention in reducing the behavioral risk factors of NCDs among the adolescents of Bangladesh. METHODS: A before-after designed intervention study will be conducted in two randomly selected secondary schools- one will be selected randomly as intervention school and the another as control school. A baseline survey will be conducted among the students of both schools by a pre-tested questionnaire to attain their current status of knowledge, attitude and practices related to NCDs. Afterward, students will be enrolled in the intervention group who will meet the eligibility criteria from the intervention school. The intervention will be given through a health promotion session to a group of students, not more than 25 at a time, by trained facilitators. A post-intervention end line survey will be conducted among all the participants from both schools using the same questionnaire 3 months after the baseline survey. DISCUSSION: An intervention has been developed based on some principals of two psychosocial theory- Motivational Interview and Social Cognitive Theory. Emphasis will be given on motivating the adolescents towards a healthy lifestyle, supporting self-efficacy to be changed, guiding self-regulatory ways along with facilitating desired changing process by empowering them with choices about the preventive measures of NCDs. This intervention is expected to increase awareness by equipping the adolescents with specific knowledge and skills and thus, facilitate an eventual change in their practiced risk behaviors. Besides, this intervention will address multiple behaviors at a time, and will be delivered to a group of adolescents, to attain the cost-effectiveness and thereby making it more realistic in the resource-poor context of Bangladesh. TRIAL REGISTRATION: ClinicalTrials.gov NCT03975335, registered on 01.06.2019. Retrospectively registered.

Postharvest Supply Chain with Microbial Travelers: a Farm-to-Retail Microbial Simulation and Visualization Framework.

Fresh produce supply chains present variable and diverse conditions that are relevant to food quality and safety because they may favor microbial growth and survival following contamination. This study presents the development of a simulation and visualization framework to model microbial dynamics on fresh produce moving through postharvest supply chain processes. The postharvest supply chain with microbial travelers (PSCMT) tool provides a modular process modeling approach and graphical user interface to visualize microbial populations and evaluate practices specific to any fresh produce supply chain. The resulting modeling tool was validated with empirical data from an observed tomato supply chain from Mexico to the United States, including the packinghouse, distribution center, and supermarket locations, as an illustrative case study. Due to data limitations, a model-fitting exercise was conducted to demonstrate the calibration of model parameter ranges for microbial indicator populations, i.e., mesophilic aerobic microorganisms (quantified by aerobic plate count and here termed APC) and total coliforms (TC). Exploration and analysis of the parameter space refined appropriate parameter ranges and revealed influential parameters for supermarket indicator microorganism levels on tomatoes. Partial rank correlation coefficient analysis determined that APC levels in supermarkets were most influenced by removal due to spray water washing and microbial growth on the tomato surface at postharvest locations, while TC levels were most influenced by growth on the tomato surface at postharvest locations. Overall, this detailed mechanistic dynamic model of microbial behavior is a unique modeling tool that complements empirical data and visualizes how postharvest supply chain practices influence the fate of microbial contamination on fresh produce.IMPORTANCE Preventing the contamination of fresh produce with foodborne pathogens present in the environment during production and postharvest handling is an important food safety goal. Since studying foodborne pathogens in the environment is a complex and costly endeavor, computer simulation models can help to understand and visualize microorganism behavior resulting from supply chain activities. The postharvest supply chain with microbial travelers (PSCMT) model, presented here, provides a unique tool for postharvest supply chain simulations to evaluate microbial contamination. The tool was validated through modeling an observed tomato supply chain. Visualization of dynamic contamination levels from harvest to the supermarket and analysis of the model parameters highlighted critical points where intervention may prevent microbial levels sufficient to cause foodborne illness. The PSCMT model framework and simulation results support ongoing postharvest research and interventions to improve understanding and control of fresh produce contamination.

Health Literacy Among Non-Communicable Disease Service Seekers: A Nationwide Finding from Primary Health Care Settings of Bangladesh.

BACKGROUND: Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. OBJECTIVE: Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. METHODS: In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. KEY RESULTS: Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. CONCLUSIONS: NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12-e20.].

PLAIN LANGUAGE SUMMARY: This study is the first to address the knowledge gap regarding the state of NCD-related health literacy in Bangladesh. The findings of this study can be used by policymakers to create initiatives that will improve the health literacy of people seeking primary health care for NCDs.

Quality of Life, Coping Strategies, and Psychosocial Support Status of Caregivers Having Children With Neurodevelopmental Disabilities: A Cross-Sectional Study From Bangladesh.

Background Although caregiving is considered a normal phenomenon for parents, delivering care to a child with neurodevelopmental disabilities can be taxing and disastrously impact parents' quality of life (QoL). This study explored the relationship between QoL, coping strategies, and psychosocial support status of caregivers of children with neurodevelopmental disabilities. Methodology This cross-sectional study included 906 caregivers of children having neurodevelopmental disabilities utilizing the World Health Organization Quality of Life Brief and Perceived Stress Scale. A tailored questionnaire gauged coping strategies and psychosocial support. Linear regression was used to identify significant contributors. Results Most caregivers (78.8%) experienced a moderate level of stress, and their QoL scores were 14.4 (SD = 2.5) for physical health, 12.0 (SD = 2.4) for psychological health, 14.6 (SD = 1.9) for social relationships, and 12.1 (SD = 2.1) for the environment. Mothers had the lowest QoL of all caregivers. Negative influences on QoL encompassed caregiver and child age, perceived stress, and lower socioeconomic status. A higher coping score positively predicted a high health-related QoL score. Gender differences were observed in psychosocial support sources. Conclusions The study underscores the need for policymaking considering findings to develop psychosocial intervention programs for enhancing the QoL of caregivers of children with neurodevelopmental disabilities.

Commonly consumed processed packaged foods in Bangladesh are unhealthy and their nutrient contents are not in conformity with the label declaration.

The present study was undertaken to identify the major nutrient content in processed foods commonly consumed in Bangladesh, their label conformity healthiness, and percent daily nutrient contribution. Twenty-four nationally representative composite samples were analyzed using AOAC and other standard methods. Results were compared with label information using a restrictive approach and EU tolerance guidelines. The healthiness of the products was evaluated in terms of the Health Star Rating (HSR) scheme and the UK traffic light labeling system. Among the analyzed samples, fried pulse, chanachur, lozenge, and fried peas had the highest amount of protein, fat, carbohydrates, and dietary fiber, respectively. Biscuits and milk chocolate had high levels of trans fatty acids (TFA) and saturated fatty acids (SFA). It was observed that around half of the products lacked information about saturated fatty acid (46%), followed by total dietary fiber and trans-fat (38% each). Other information was missing in one-fifth of the products, namely protein (17%), total fat (17%), available carbohydrate (17%), energy (17%), sugar (21%), and salt (21%). Label compliance analysis according to the restrictive approach revealed that none of the products accurately reported the salt, sugar, saturated fat, and trans fat content on the label. According to the EU tolerance guideline, approximately half of the products had protein (58%), fat (54%), and carbohydrate (42%) levels that fell within the EU tolerance limit. However, only around one-third of the samples had sugar (21%), salt (38%), and saturated fat (33%) levels that met the EU tolerance limit. In terms of healthiness analysis, according to the HSR, the range of stars was between 0.5 and 2.5 of the foods where fried peas got the highest rating (2.5 stars), while in terms of the UK traffic light system, none of the samples got all green signals. The lozenge got green lights for fat, SFA, and salt contents. It was also found that consumption of 100 g of fried peas or pulse would exceed the acceptable daily limit of salt, sugar, and SFA compared to the daily maximum allowable intake for the 2000 kcal diet recommended by the WHO. However, according to the serving size, biscuits were major contributors of TFA, sugar, and SFA, whereas fried pulse was a key contributor of sodium/salt. Proper regulatory actions should be introduced to promote healthy processed foods with user-friendly front-of-the-pack labeling and monitor their quality to prevent non-communicable diseases (NCDs).

Evaluation of the World Health Organization-HEARTS hypertension control package in Bangladesh: a quasi-experimental trial.

BACKGROUND: The World Health Organization (WHO) promotes the HEARTS technical package for improving hypertension control worldwide, but its effectiveness has not been rigorously evaluated. OBJECTIVE: To compare hypertension outcomes in clinics implementing HEARTS versus clinics continuing usual hypertension care in rural Bangladesh. METHODS: A matched-pair cluster quasi-experimental trial in Upazila Health Complexes (UHCs; primary healthcare facilities) was conducted in rural Bangladesh. A total of 3935 patients (mean age 52.3 years, 70.5% female) with uncontrolled hypertension (blood pressure (BP) ≥140/90 mm Hg regardless of treatment history) were enrolled: 1950 patients from 7 HEARTS UHCs and 1985 patients from 7 matched usual care UHCs. The primary outcome was systolic BP at 6 months measured at the patient's home; secondary outcomes were diastolic BP, hypertension control rate (<140/90 mm Hg) and loss to follow-up. Multivariable mixed-effects linear and Poisson models were conducted. RESULTS: Baseline mean systolic BP was 158.4 mm Hg in the intervention group and 158.8 mm Hg in the usual care group. At 6 months, 95.5% of participants completed follow-up. Compared with usual care, the intervention significantly lowered systolic BP (-23.7 mm Hg vs -20.0 mm Hg; net difference -3.7 mm Hg (95% CI -5.1 to -2.2)) and diastolic BP (-10.2 mm Hg vs -8.3 mm Hg; net difference -1.9 mm Hg (95% CI -2.7 to -1.1)) and improved hypertension control (62.0% vs 49.7%, net difference 12.3% (95% CI 9.0 to 16.8)). Rate of missed clinic visits was lower in the intervention group (8.8% vs 39.3%, p<0.001). CONCLUSIONS: After WHO-HEARTS package implementation in rural Bangladesh, BP was lowered and hypertension control improved significantly compared with usual care. TRIAL REGISTRATION NUMBER: NCT04992039.

Text messaging to improve retention in hypertension care in Bangladesh.

Visit non-attendance is a common barrier to hypertension control in low and middle-income countries (LMICs). We aimed to evaluate the effectiveness of mobile text messaging in improving visit attendance among patients with hypertension in primary healthcare facilities in Bangladesh. A randomized A/B testing study was conducted with two patient groups: (1) patients regularly attending visits (regular patients) and (2) patients overdue for their follow-up clinic visit (overdue patients). Regular patients were randomized into three groups: a cascade of three text reminders, a single text reminder, or no text reminder. Overdue patients were randomized into two groups: a single text reminder or no text reminder. 20,072 regular patients and 12,708 overdue patients were enrolled. Among regular patients, visit attendance was significantly higher in the cascade reminder group and the single reminder group compared to the no reminder group (78.2% and 76.6% vs. 74.8%, p < 0.001 and 0.027, respectively). Among overdue patients, the single reminder group had a 5.8% higher visit attendance compared to the no reminder group (26.5% vs. 20.7%, p < 0.001). The results remained consistent in multivariable analysis; adjusted prevalence ratio (PR) was 1.04 (95% CI 1.02-1.06) for the cascade reminder group and 1.02 (95% CI 1.00-1.05) for the single reminder group among regular patients. The adjusted PR for the single reminder group vs. the no reminder group among overdue patients was 1.23 (95% CI 1.15-1.33). Text message reminders are an effective strategy for improving retention of patients in hypertension treatment in LMICs, especially for patients overdue to care.

Assessment of atrial septal defects using 3-dimensional transthoracic echocardiography prior to percutaneous device closure: first report from Bangladesh.

BACKGROUND: Secundum atrial septal defect (ASD) is treated following trans-catheter closure in alternative to surgical treatment. Per-intervention selection of device size with balloon occlusive diameter (BOD) often cause tearing or enlarging, causing arrhythmias and hypotension. We assessed the suitability of percutaneous device closure for ASD using 3-dimensional transthoracic echocardiography (3DTTE). OBJECTIVES: This study was conducted to investigate if 3DTTE could be an alternative of balloon sizing for selection of device size in atrial septal defect device closure. DESIGN: It was a cross-sectional comparative study. METHODS: This study was conducted at the department of Pediatric Cardiology, Bangabandhu Sheikh Mujib Medical University for a period of 2 years. Thirty-three purposively selected secundum ASD patients suitable for device closure were included in the study. Ethical permission was taken from the Institutional Review Board and written consent was taken from each patient's guardian. In this study, 3DTTE derived ASD diameter and BOD were compared with that of deployed device size using correlation analysis. RESULTS: Out of 33 patients, 63.6% were female and 36.4% were males had a mean age of 18.07 ± 14.58 years (range 2-55 years). Mean diameter of ASD measured by 2-dimensional (2D) and 3-dimensional (3D) echocardiography were 17.09 ± 6.08 mm and 21.30 ± 6.56 mm, respectively, yielding a significant difference (p < 0.001). 3D echocardiography derived ASDs diameter were highly correlated with device size than BOD and 2D echocardiography derived diameter (2D echocardiography: r = 0.796, p = <0.001, 3D echocardiography: r = 0.960, p = <0.001, BOD: r = 0.840, p = <0.001). CONCLUSION: 3DTTE can accurately measure ASD diameter and can be used as an alternate, effective, and safe method to select device size.

Availability of Hypertension and Diabetes Mellitus Care Services at Subdistrict Level in Bangladesh.

BACKGROUND: In Bangladesh, the rapid rise of noncommunicable diseases (NCDs) has become a significant public health concern. This study assesses the readiness of hypertension (HTN)- and diabetes mellitus-related services at primary health-care facilities in Northeast Bangladesh. METHODOLOGY: A cross-sectional survey using a semi-structured interview was conducted between April 2021 and May 2021 among 51 public primary health-care facility staff (upazila health complexes [UHCs]). The NCD-specific service readiness was assessed using an adapted questionnaire from the WHO manual of Service Availability and Readiness Assessment and included four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. For each domain, the mean readiness index score was calculated. Facilities with a readiness score of above 70% were considered to be ready. RESULTS: The diagnostic capacity of the UHCs ranged from 0% to 88.9%, the availability of essential medicine and basic equipment varied between 15.4%-69.2% and 36.4%-100%, respectively, whereas the score in availability of basic amenities was between 57.1% and 100%. The score for the protocol drugs used to manage HTN was 52.9%, whereas for diabetes, it was 88.2%. The average general service readiness score for the facilities was 59.1%. Overall 17.6% of the facilities were assessed to be ready. CONCLUSION: Currently, primary health-care facilities are not ready to implement the national guidelines for diagnosing and treating diabetes and HTN due to shortages of medications, staff, and diagnostic materials.

Comparison of three spot urine formulae and their validation using 24-hour urine sodium for estimation of daily salt intake: a cross-sectional study among Bangladeshi adults.

OBJECTIVE: This study aimed to assess the validity of three commonly used (Tanaka, Kawasaki, INTERSALT) methods based on spot urinary sodium excretion against the 24-hour urinary sodium excretion to estimate the dietary salt intake in Bangladesh. DESIGN: A population-based cross-sectional survey. SETTING: A cross-sectional survey was done in an urban and a rural area of Bangladesh in 2012-2013. PARTICIPANTS: 418 community living residents aged 40-59 years participated in the survey and data of 227 subjects who had complete information were analysed for this validation study. OUTCOME MEASURES: The Bland-Altman method was used to evaluate the agreement between the estimated and measured 24-hour urinary sodium. The estimated average salt intake from Tanaka, Kawasaki and INTERSALT methods were plotted against 24-hour urinary sodium excretion. RESULTS: The mean 24-hour estimated salt intake was 10.0 g/day (95% CI 9.3 to 10.6). The mean estimated urinary salt by Tanaka, Kawasaki and INTERSALT methods were 8.5 g/day (95% CI 8.2 to 8.8), 11.4 g/day (95% CI 10.8 to 12.0) and 8.8 g/day (95% CI 8.6 to 9.0), respectively. Compared with the estimated mean salt intake from 24-hour urine collection, the Bland-Altman plot indicated the mean salt intake was overestimated by the Kawasaki method and underestimated by Tanaka and INTERSALT methods. The linear regression line showed the Kawasaki method was the least biased and had the highest intraclass correlation coefficient (0.57, 95% CI 0.45 to 0.67). CONCLUSION: Tanaka, Kawasaki and INTERSALT methods were not appropriate for the estimation of 24-hour urinary sodium excretion from spot urine samples to assess dietary salt intake in Bangladesh. Among the three methods, the Kawasaki method has the highest agreement with the 24-hour urinary sodium excretion concentration in this population.

Prevalence of chronic obstructive pulmonary disease (COPD) among rural population: A national survey in Bangladesh.

Background: In Bangladesh, there is a scarcity of nationally representative data on the burden of chronic obstructive pulmonary disease (COPD). Methods: To estimate the COPD prevalence in rural settings, this cross-sectional, population-based study was conducted in all eight administrative divisions of Bangladesh, and involved adults aged 40 years and above. By using multi-stage random sampling, 2,458 individuals were enrolled. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines were used to diagnose COPD based on post-bronchodilator lung function, while additional participant data was gathered through computer-assisted personal interviews. Results: A 2% COPD prevalence (95% CI: 1.45, 2.55) was found in the study sample with a statistically significant difference between males (2.7%; 95% CI: 1.8, 3.6) and females (1.2%; 95% CI: 0.59, 1.81). Increasing age significantly inflated the odds of having COPD irrespective of sex (OR: 1.03; 95% CI: 1.00, 1.05; P value < 0.05). Furthermore, prevalence of COPD was higher among manual workers, cigarette smokers, and those that used the indoor kitchen and did not have a primary education. Sex-based analysis showed that smokeless tobacco consumption was significantly associated with COPD occurrence among males (OR: 2.14; 95% CI: 1.05, 4.37; P value < 0.05), but not females. Further, using an indoor kitchen increased the odds of developing COPD by 400% among female participants (OR: 4.39; 95% CI: 1.37, 14.10; P value < 0.05). Conclusion: This study provides a comprehensive sex-based estimation of COPD prevalence among rural population and imparts significant contribution to the growing database on COPD prevalence in Bangladesh.

Fruit and vegetables consumption among school-going adolescents: Findings from the baseline survey of an intervention program in a semi-urban area of Dhaka, Bangladesh.

INTRODUCTION: Interventions aimed at promoting healthy eating habits in adolescence can help prevent chronic diseases and promote healthy ageing. The aim of this paper is to describe the fruit and vegetables consumption habits of adolescents in Dhaka, Bangladesh as well as to identify the socio-environmental, personal, and behavioral factors that influence these habits. MATERIALS AND METHODS: The baseline data from an intervention study involving 823 grade ten students from two randomly selected secondary schools in a semi-urban area of Dhaka were analyzed. The intake of fruit and vegetables was measured in terms of serving size per day. Hierarchical multiple regression was used to assess the ability of socio-environmental factors such as social support, perceived barriers, and living with patient with chronic diseases; personal factors such as knowledge, self-rated practice, behavioral intention, and body mass index; and behavioral factors such as physical activity, sedentary hours, and sleep duration to predict the level of daily fruit and vegetables intake, after controlling the effect of demographic characteristics of adolescents. RESULTS: The average daily consumption of fruit and vegetables was 1.22 and 1.99 servings, respectively. Only one-fifth of the respondents (21%) reported eating five servings of fruit and vegetables a day. Inaccessibility at home was reported as the most perceived barrier for both fruit and vegetables intake. Adolescents' higher fruit and vegetables intake was found to be associated with higher maternal educational attainment, more social support, adequate self-rated practice, positive behavioral intention, higher body mass index, better physical activity, and adequate daily sleeping. CONCLUSION: The findings revealed insufficient fruit and vegetables intake among adolescents in a semi-urban area of Bangladesh and associated socio-environmental, personal, and behavioral factors that were utilized in developing an intervention program for this transient age group. TRIAL REGISTRATION: Trial was registered at ClinicalTrials.gov (NCT03975335) https://clinicaltrials.gov/ct2/show/NCT03975335 on June 01, 2019.

Role of serum uric acid in ischemic stroke: A case-control study in Bangladesh.

INTRODUCTION: Increased level of serum uric acid (SUA) is often considered a risk factor for ischemic stroke. This study was conducted to examine the association of SUA level with ischemic stroke and assessed gender-based differences, if any. METHODS: In this case-control study, neuroimaging-confirmed ischemic stroke patients were recruited as cases within three days of an incident from neurology in-patient department, and as controls, patients without stroke history were recruited from neurology out-patient department. Blood was collected from the respondents of both groups to assess SUA level, lipid profile and oral glucose tolerance test. Binary logistic regression was done for estimating the risks of ischemic stroke. RESULTS: A total of 338 participants were recruited, where 169 were cases and 169 were controls. Around 60 percent respondents of both case and control groups were male. Mean SUA levels for cases and controls were 6.03 (SD 1.84) mg/dl and 4.04 (SD 1.46) mg/dl, respectively. After adjustment for age, tobacco consumption status, diabetes, hypertension, coronary heart disease and dyslipidemia, elevated SUA level was found to be significantly associated with ischemic stroke only in females (OR = 1.49; 95% CI = 1.01-2.19; p<0.05). Overall, each unit increase in SUA level exhibits 25 percent increment in odds of having ischemic stroke (OR = 1.25; 95% CI = 1.02-1.5372; p<0.05). CONCLUSION: This study concluded that elevated SUA level is significantly associated with the acute phase of an ischemic stroke and gender-specific analysis demonstrates this association only in females.

Clinical Presentation, Management and In-Hospital Outcome of Healthcare Personnel With COVID-19 Disease.

Objective Healthcare personnel (HCP) are undoubtedly one of the major frontline fighters in the coronavirus disease 2019 (COVID-19) pandemic. Therefore, it comes as no surprise that many HCP have become infected by COVID-19 globally. The infection of HCP has received great attention in social media and is frequently reported from different parts of the world. However, there are few scientific reports addressing this aspect of the COVID-19 pandemic. The aim of this study was to evaluate the characteristics of clinical presentation, treatment, and outcome of COVID-19 infection among the HCP of our setting. Methods This cross-sectional study was performed in the National Heart Foundation Hospital & Research Institute of Bangladesh from April 29 to July 20, 2020. HCP employed in this hospital who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace were included in this study. The presence of COVID-19 disease was confirmed by real-time reverse transcriptase-polymerase chain reaction on nasopharyngeal samples. A total of 394 HCP were sampled and 139 had a positive corona test. Structured interviews were conducted to document symptoms for all HCP with confirmed COVID-19. Data analysis was performed in July 2020. Results Out of 1,409 HCP, 139 subjects tested positive for COVID-19. Among the HCP, infection rate was 9.86%. The mean age of the study population was 34.08±11.11 years (range: 20-69 yrs), of whom 82 (59%) were female. Most of this cohort were nurses (56 [40.3%]) and physicians (25 [18%]), and the remaining 58 (41.7%) were other staff. The mean duration of onset of symptoms to test was 2.89±2.07 days. The most common symptoms were fever (84.2%), fatigue (56.1%), cough (54%), body ache (39.6%), headache, and anosmia (38.8%). Most subjects had mild disease (125 [93%]), three (2.1%) of the HCP had moderate disease and one (0.7%) had severe disease. Ten of the HCP (7.2%) were asymptomatic. Most of them were treated either by ivermectin plus azithromycin or ivermectin plus doxycycline. Only 20 (14.4%) of the HCP were hospitalized, while others were treated either in home isolation (59.7%) or in institutional isolation (25.9%). Recovery was almost uneventful except one healthcare worker who died. Conclusion Most HCP had mild symptoms and a few of them were asymptomatic also. HCP with mild COVID-19 symptoms may be treated in home or institutional isolation. As they are a vulnerable group for infection, providing adequate protection to HCP is absolutely mandatory to safeguard them from this pandemic.

Prevalence of non-communicable disease risk factors among poor shantytown residents in Dhaka, Bangladesh: a community-based cross-sectional survey.

OBJECTIVES: This study aims to describe the prevalence of non-communicable disease (NCD) risk factors among the urban poor in Bangladesh. DESIGN: We conducted a community-based cross-sectional epidemiological study. SETTING: The study was conducted in a shantytown in the city of Dhaka. There were 8604 households with 34 170 residents in the community. Those households were categorised into two wealth strata based on the housing structure. PARTICIPANTS: The study targeted residents aged 18-64 years. A total of 2986 eligible households with one eligible individual were selected by simple random sampling stratified by household wealth status. A total of 2551 residents completed the questionnaire survey, and 2009 participated in the subsequent physical and biochemical measurements. OUTCOME MEASURES: A modified WHO survey instrument was used for assessing behavioural risk factors and physical and biochemical measurements, including glycated haemoglobin (HbA1c). The prevalence of NCD risk factors, such as tobacco use, fruit and vegetable intake, overweight/obesity, hypertension, diabetes (HbA1c ≥6.5%) and dyslipidaemia, was described according to household wealth status and gender differences. RESULTS: The prevalence of current tobacco use was 60.4% in men and 23.5% in women. Most of them (90.8%) consumed more than 1 serving of fruits and vegetables per day; however, only 2.1% consumed more than 5 servings. Overweight/obesity was more common in women (39.2%) than in men (18.9%), while underweight was more common in men (21.0%) than in women (7.1%). The prevalence of hypertension was 18.6% in men and 20.7% in women. The prevalence of diabetes was 15.6% in men and 22.5% in women, which was much higher than the estimated national prevalence (7%). The prevalence of raised total cholesterol (≥190 mg/dL) was 25.7% in men and 34.0% in women. CONCLUSION: The study identified that tobacco use, both overweight and underweight, diabetes, hypertension and dyslipidaemia were prevalent among the urban poor in Bangladesh.