Success of health cell approach in improving knowledge, attitude and practice related to COVID-19: difference-in-differences analyses of a community-based quasi-experimental trial.

OBJECTIVES: There remain hesitations and miscommunication regarding appropriate public health behaviours and conceptions related to COVID-19. We tested the effectiveness of the community-based health cell approach in improving knowledge, attitude and practice (KAP) related to COVID-19. SETTING: Households of the Bauniabadh slum area in Mirpur, Dhaka, Bangladesh. PARTICIPANTS: Household heads (HHs) and homemakers (HMs) of intervention (n=211) and comparison households (n=209). INTERVENTIONS: Behaviour change communication delivered at the community level in a quasi-experimental manner through small-scale community meetings and home visits. OUTCOME VARIABLES AND METHODS: The outcomes of interest were before-after mean and per cent changes in KAP scores. Data were collected from HHs and HMs before and after the intervention and difference-in-differences (DID) analysis technique was applied. RESULTS: We found statistically significant (p<0.05) before-after differences in the responses to the KAP questions made by the intervention groups. The DID models estimated the improvements in COVID-19-related KAP of HHs by 16.58 (95% CI: 14.05, 19.12), 20.92 (95% CI: 18.17, 23.67) and 28.45 (95% CI: 23.84, 33.07) per cent points, respectively. The DID estimates of KAP in HMs were 17.8 (95% CI: 15.09, 20.51), 22.33 (95% CI: 19.47, 25.19) and 28.06 (95% CI: 23.18, 32.93) per cent points, respectively. Overall, 20.91 (95% CI: 18.87, 22.94) and 21.81 (95% CI: 19.68, 23.94) per cent points of improvement were observed among HHs and HMs, respectively. The DID estimates of before-after mean changes in different KAP domains ranged from 2.24 to 2.68 units and the overall changes in KAP scores among HHs and HMs were 7.11 (95% CI: 6.42, 7.8) and 7.42 (95% CI: 6.69, 8.14) units. CONCLUSION: Scientifically valid information disseminated at the community level using the health cell approach could bring positive changes in KAP related to COVID-19.

Sunlight, dietary habits, genetic polymorphisms and vitamin D deficiency in urban and rural infants of Bangladesh.

We conducted an observational study to assess the prevalence and risk factors of vitamin D deficiency in 12-24 months old children living in urban and rural Bangladesh. Serum 25-hydroxyvitamin D (free 25(OH)D) level, socio-demographic status, anthropometric status, dietary intake, exposure to sunlight and single nucleotide polymorphisms in vitamin-D pathway genes were measured in 208 children. Vitamin D deficiency (free 25(OH)D < 50 nmol/l) was reported in 47% of the children. Multivariable logistic regression model identified duration to sunlight exposure (regression coefficient, ß = - 0.01; 95% CI 0.00, - 0.02; p-value < 0.05), UV index (ß = - 0.36; 95% CI 0.00, - 0.02; p-value < 0.05) and breast-feeding (ß = - 1.15; 95% CI - 0.43, - 1.86; p-value < 0.05) to be negatively associated with vitamin D deficiency. We measured the role of single nucleotide polymorphisms in pathway genes (GC-rs7041 T > G, rs4588 C > A, CYP2R1-rs206793 A > G, CYP27B1-rs10877012 A > C and DHCR7-rs12785878 G > T) and found statistically significant differences in serum vitamin D levels between various genotypes. SNPs for CYP27B1 (CA & CC genotype) had statistically significant positive association (ß = 1.61; 95% CI 2.79, 0.42; p-value < 0.05) and TT genotype of GC-rs7041 had negative association (ß = - 1.33; 95% CI - 0.02, - 2.64; p-value < 0.05) with vitamin-D deficiency in the surveyed children.

Gut biomolecules (I-FABP, TFF3 and lipocalin-2) are associated with linear growth and biomarkers of environmental enteric dysfunction (EED) in Bangladeshi children.

In the current world, a major challenge to diagnose environmental enteric dysfunction (EED) is the lack of validated non-invasive biomarkers. Intestine derived molecules, including intestinal fatty acid binding protein (I-FABP), trefoil factor-3 (TFF3), lactoferrin, lipocalin-2 (LCN2), and mucin-2, have been reported as indicators of intestinal inflammation and gut health. Therefore, we aimed to investigate the levels of these bio-molecules as biomarkers of EED among under-2 children in Bangladesh. A total of 140 children were recruited in a case-control design. All the biomarkers were measured by ELISA. Spearman's rank correlation was performed to see the correlation between the biomarkers and the EED score. Moreover, multivariable linear regression was performed to investigate the association of biomarkers with length-for-age z-score (LAZ). TFF3 correlates positively with myeloperoxidase (r = 0.26, p < 0.05) and EED score (r = 0.17, p < 0.05). Likewise, LCN2 correlates positively with myeloperoxidase (r = 0.37, p < 0.05), neopterin (r = 0.33, p < 0.05) and EED score (r = 0.31, p < 0.05). Moreover, multivariable linear regression revealed a negative association of I-FABP with LAZ of the study participants. Our results imply that TFF3 and LCN2 might be promising biomarkers to diagnose intestinal inflammation and EED, while I-FABP is negatively associated with linear growth of Bangladeshi children.

Acute food insecurity and short-term coping strategies of urban and rural households of Bangladesh during the lockdown period of COVID-19 pandemic of 2020: report of a cross-sectional survey.

INTRODUCTION: We conducted a cross-sectional survey to assess the extent and to identify the determinants of food insecurity and coping strategies in urban and rural households of Bangladesh during the month-long, COVID-19 lockdown period. SETTING: Selected urban and rural areas of Bangladesh. PARTICIPANTS: 106 urban and 106 rural households. OUTCOME VARIABLES AND METHOD: Household food insecurity status and the types of coping strategies were the outcome variables for the analyses. Multinomial logistic regression analyses were done to identify the determinants. RESULTS: We found that around 90% of the households were suffering from different grades of food insecurity. Severe food insecurity was higher in urban (42%) than rural (15%) households. The rural households with mild/moderate food insecurity adopted either financial (27%) or both financial and food compromised (32%) coping strategies, but 61% of urban mild/moderate food insecure households applied both forms of coping strategies. Similarly, nearly 90% of severely food insecure households implemented both types of coping strategies. Living in poorest households was significantly associated (p value <0.05) with mild/moderate (regression coefficient, ß: 15.13, 95% CI 14.43 to 15.82), and severe food insecurity (ß: 16.28, 95% CI 15.58 to 16.97). The statistically significant (p <0.05) determinants of both food compromised and financial coping strategies were living in urban areas (ß: 1.8, 95% CI 0.44 to 3.09), living in poorest (ß: 2.7, 95% CI 1 to 4.45), poorer (ß: 2.6, 95% CI 0.75 to 4.4) and even in the richer (ß: 1.6, 95% CI 0.2 to 2.9) households and age of the respondent (ß: 0.1, 95% CI 0.02 to 0.21). CONCLUSION: Both urban and rural households suffered from moderate to severe food insecurity during the month-long lockdown period in Bangladesh. But, poorest, poorer and even the richer households adopted different coping strategies that might result in long-term economic and nutritional consequences.