4G mobile phone radiation alters some immunogenic and vascular gene expressions, and gross and microscopic and biochemical parameters in the chick embryo model.

BACKGROUND: The risks to human health have grown over the past 10 years due to the excessive use of mobile phones. OBJECTIVES: The study was designed to determine the harmful effects of 4G mobile phone radiation on the expression of immunogenic and vascular genes and gross, microscopic and biochemical alterations in the development of chicken embryos. METHODS: Sixty individuals in the exposure group were subjected to mobile phones with a specific absorption rate of 1.4 W/kg and a frequency of 2100 MHz positioned at a distance of 12 cm in the incubator for 60 min/night for 14 days. The histopathological examination involved hematoxylin and eosin staining, whereas cresyl violet staining was used to evaluate the condition and number of neurons in the brain. The biochemical parameters of amniotic fluid were analysed using the photometry method, and the expression of VEGF-A and immunity genes (AvBD9, IL6) was measured using the real-time PCR (qPCR) technique. RESULTS: Compared to the control, the exposure group's body weight and length significantly decreased (p < 0.05). Subcutaneous bleeding was seen in the exposure group. Urea, creatinine, alkaline phosphatase, aspartate aminotransferase and alanine aminotransferase levels were all significantly higher than in the control group (p < 0.05). The exposed group showed pathological lesions in the liver and degenerated neurons with lightly stained nuclei in the cerebral cortex. Hyperchromatic neurons were significantly higher in the exposure group (58.8 ± 2.28) compared to the control (6.6 ± 0.44) (p < 0.05). 4G exposure reduced lymphocyte count in the caecal tonsil (86.8 ± 5.38) compared to the control (147.2 ± 9.06) (p < 0.05). Vascular gene mRNA expression was higher, but immune gene expression was lower in the exposed group. CONCLUSION: Exposure to mobile phone radiation may result in gross, microscopic and biochemical changes, as well as alterations in gene expression that could hinder embryonic development.

Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trial.

Background: We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods: This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2-59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings: In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, -3.9 percentage point; 95% confidence interval (CI), -4.8 to -1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation: In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding: UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.

Participatory approaches in primary health care related implementation research in low-and middle-income countries: A narrative review.

Objectives: Primary Health Care (PHC) oriented health systems are crucial to accelerate the achievement of Universal Health Coverage. Previous studies have suggested the importance of participatory approaches to improve PHC. This review aimed to identify the available published implementation research in PHC considering participatory approaches in Low and Middle-Income Countries (LMICs). Study design: A narrative review was conducted following the standard guidelines. Methods: Three electronic databases were searched where keywords were combined using Boolean operators. Studies were included considering the pre-specified inclusion and exclusion criteria through two-phase screening. The quality of the included studies was assessed using the Joanna Briggs Institution's critical appraisal tools. Data were presented using a narrative synthesis approach. Results: A total of 13 articles were included that focused on community-based approaches in PHC service, maternal and newborn care, family planning, tuberculosis, and mental health. Three studies focused on mental health and demonstrated the efficacy of community support groups, peer volunteers, and community-based mental education in promoting mental health services. Two studies described community participation to ensure patient safety and risk reduction. Other studies explored the effectiveness of community-based, directly observed treatment for tuberculosis; community health worker-based maternal and child health care; and a community-based package for family planning. Eleven studies were conducted in Africa and the rest were in South Asia. Conclusion: This review reveals the gap in implementation research incorporating participatory approaches in the field of PHC. Limited studies have been conducted which indicate the need and scope of implementation research with participatory approaches in the PHC field. Prospero registration: CRD42020150749.

Antibiotic usage practices and its drivers in commercial chicken production in Bangladesh.

Irrational and inappropriate use of antibiotics in commercial chicken production can contribute to the development of antimicrobial resistance. We aimed to assess antibiotic usage in commercial chicken production in Bangladesh, and identify factors associated with this practice. We conducted a large-scale cross-sectional study to collect information on antibiotic usage in commercial chickens from January to May 2021. Structured interviews were conducted with 288 broiler, 288 layer and 192 Sonali (locally-produced cross-bred) farmers in 20 sub-districts across Bangladesh. The frequency of antibiotic usage, the types of antibiotics and purpose of usage were estimated for each production type. Adjusted odds ratios (aOR) were calculated to measure the association between antibiotic usage and factors related to the characteristics of the farms and farmers using multivariable logistic regression models. The proportion of farms, irrespective of their production type, reporting usage of antibiotics in the 24 hours preceding the interview was 41% (n = 314, 95% CI: 37-44%). Forty-five percent (n = 344, 41-48%) reported antibiotic usage in the last 72 hours, 86% (n = 658, 83-88%) in the last 14 days, and almost all farms, 98% (n = 753, 97-99%), had used antibiotics since the start of their production cycle. Use of antibiotics in the 24 hours preceding an interview was more frequently reported in broiler (OR 1.91, 95% CI: 1.36-2.69) and Sonali (OR 1.94, 95% CI: 1.33-2.33) than layer farms. Oxytetracycline (23-31%, depending on production type), doxycycline (18-25%), ciprofloxacin (16-26%) and amoxicillin (16-44%) were the most frequently used antibiotics. Antibiotics were reported to be used for both treatment and prophylactic purposes on most farms (57-67%). Usage of antibiotics in the 24h preceding an interview was significantly associated with the occurrence of any illnesses in chickens (aOR broiler: 41.22 [95% CI:13.63-124.62], layer: aOR 36.45[9.52-139.43], Sonali: aOR 28.47[4.97-162.97]). Antibiotic usage was mainly advised by veterinary practitioners (45-71%, depending on production type), followed by feed dealers (21-40%) and farmers (7-13%). Improvement of chicken health through good farming practices along with changes in key stakeholders (feed dealers and practitioners) attitudes towards antibiotic recommendations to farmers, may help to reduce the levels of antibiotic usage and thus contribute to mitigate antimicrobial resistance.

Antibiotics usage practices in aquaculture in Bangladesh and their associated factors.

Background: Irrational and inappropriate use of antibiotics in aquaculture can contribute to the development of antibiotic resistance. Objectives: In this study, we aimed to assess antibiotic usage in inland and coastal fish farms in Bangladesh and identify factors associated with this practice. Methods: We conducted a cross-sectional study to collect antibiotic usage information from 672 fish farmers in Bangladesh. The frequency of use, the types of antibiotics, the purpose of usage, and antibiotic prescribing practices were estimated. Adjusted odds ratios (aOR) were calculated to measure the association between antibiotic usage and factors related to the characteristics of the farms and farmers using multivariable logistic regression models. Results: Twenty-two farms reported using antibiotics in the last 24 h preceding the interview (3%, 95% CI: 2-5%); 36 farms (5%, 95% CI: 4-7%) in the last 72 h, 141 farms (21%, 95% CI: 18-24%) in the last 14 days, and 478 farms (71%, 68-75%) reported antibiotic usage at least once since the start of their production cycle. Antibiotics usage in the last 14 days preceding the interviews was higher in freshwater fish farms (98%) than in brackish water farms (2%). Oxytetracycline, ciprofloxacin, and amoxicillin were the most frequently used antibiotics. Most of the antibiotics were reported to be used for both therapeutic and prophylactic purposes (71%, 95% CI: 63-78%). Antibiotics used within the last 14 days were mainly advised by feed dealers or drug sellers (51%, 95% CI: 43-60%), followed by farmers themselves (31%, 95% CI: 23-38%) and local service providers (18%, 95% CI, 12-25%). Fish farms having history of antibiotic use within the last 14 days preceding interviews was significantly associated with illness in fish (aOR 1.98, 95% CI:1.21-3.29) compared to farms with healthy fish and fishes cultured in ponds (aOR 9.34, 95% CI: 3.69-23.62) compared to enclosure cultures. Conclusions: Improvement of fish health through better farming practices and changes in feed dealers' and farmers' attitudes towards self-prescription of antibiotic without veterinarian diagnostics may help to reduce the levels of antibiotic usage and thus contribute to mitigating antimicrobial resistance.

Implementation status of non-communicable disease control program at primary health care level in Bangladesh: Findings from a qualitative research.

Objective: Bangladesh has 67% of estimated deaths caused by non-communicable diseases (NCDs). The country aimed to reduce NCD-related premature deaths by one-third by 2030. This study aimed to explore the overall implementation status of the NCD control program at the primary health care (PHC) level in Bangladesh, explore the challenges, and identify the way forward for better implementation. Study design: Qualitative study. Methods: Key informant interviews and observations of NCD service delivery at Upazila Health Complexes (UzHC) were conducted. Data were analyzed using framework analysis. Results: NCD is prioritized in policy documents however, implementation remains weak. The operational plan indicators focus mostly on the process, which is hampering the quality of care. The primary health care (PHC) facilities are not yet fully ready to deliver all ranges of NCD care including mental health. The national NCD management protocol for PHC addressed health workforce scarcity through task shifting and team-based care which is yet to be scaled up nationwide. Record-keeping is poor as it is done manually. District health information software (DHIS2) is not yet capturing NCD monthly service provision data and not tracking indicators. Awareness for NCD screening at community clinics, and referral to the NCD corner of UzHC is operational in around 66 Upazilas of 31 districts, which needs to scale up nationwide. Conclusions: NCD management protocol implementation, availability of drugs, diagnostics, electronic database development, updated DHIS2 to track indicators, and engagement of stakeholders to influence public policies on shared risk factors are important to achieve universal primary care for NCDs.

Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh.

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15-64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh.

The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate antibiotic stewardship and optimal use. In Bangladesh, data on antibiotic dispensing in pharmacies according to the AWaRe classification are scarce. We aimed to explore antibiotic dispensing pattern in pharmacies according to the WHO AWaRe classification to aid pharmacy-targeted national antibiotic stewardship program (ASP). From January to July 2021, we interviewed drug-sellers from randomly selected pharmacies and randomly selected customers attending the pharmacies. We collected data on demographics and medicines purchased. We classified the purchased antibiotics into the Access, Watch, and Reserve groups among 128 pharmacies surveyed, 98 (76.6%) were licensed; 61 (47.7%) drug-sellers had pharmacy training. Of 2686 customers interviewed; 580 (21.6%) purchased antibiotics. Among the 580 customers, 523 purchased one, 52 purchased two, and 5 purchased three courses of antibiotics (total 642 courses). Of the antibiotic courses, the Watch group accounted for the majority (344, 53.6%), followed by the Access (234, 36.4%) and Reserve (64, 10.0%) groups. Approximately half of the antibiotics (327/642, 50.9%) were purchased without a registered physician's prescription. Dispensing of non-prescribed antibiotics was higher in the Access group (139/234, 59.4%), followed by Watch (160/344, 46.5%) and Reserve (28/64, 43.8%) groups. These findings highlight the need to implement strict policies and enforce existing laws, and pharmacy-targeted ASP focusing on proper dispensing practices to mitigate antimicrobial resistance in Bangladesh.

Implementation research on kangaroo mother care, Bangladesh.

OBJECTIVE: To describe the implementation, coverage and performance of the national kangaroo mother care programme in Bangladesh. METHODS: Kangaroo mother care services for clinically stable babies with birth weight under 2000 g were set up in government-run health-care facilities in rural and urban areas of Bangladesh. Each facility provided counselling on kangaroo mother care, ensured adequate nutrition, and followed up mothers and babies. We studied implementation of the programme from January 2016 to March 2020 using data from the national database. We tracked the number of eligible babies enrolled and their outcomes, mortality and post-discharge follow-up. FINDINGS: The numbers of kangaroo mother care facilities increased from 16 in 2016 to 108 in 2020. Over the 4-year period 64 426 babies weighing under 2000 g were born in these facilities, 6410 of whom received kangaroo mother care. The quarterly percentage of eligible babies receiving kangaroo mother care increased from 4.7% (37/792) during the first quarter to 21.7% (917/4226) during the last five quarters of the programme. Deaths of babies receiving kangaroo mother care showed a downward trend over the study period. The overall mortality was 1.2% (77/6410), with large quarterly fluctuations in mortality. Post-discharge follow-up was low and only 15-20% of babies received four follow-up visits. CONCLUSION: Implementation of kangaroo mother care interventions is feasible in low-resource settings. Such care has the potential to reduce mortality among low-birth-weight and premature babies. Challenges include low coverage, expanding the programme to the community and strengthening the monitoring system.

Integrated Nutritional Supports for Diabetic Patients During COVID-19 Infection: A Comprehensive Review.

BACKGROUND: Diabetes mellitus is an endocrine metabolic disorder, which affects the major organs in human and comorbid with others. Besides, diabetic patients are more prone to various infectious diseases as well as COVID-19 sporadic infection which is a high risk for patients with diabetes mellitus. To combat these infections and comorbid situations, an integrated balanced nutritional supportive could help in maintaining sound health and increase immunity for prevention and management of such type of viral infections. OBJECTIVES: While information regarding nutritional supports in COVID-19 pandemic in diabetic patients is not available, this review aimed to accumulate the evidence from previous publications where studied about nutrition-based supports or interventions for viral diseases with special emphasis on respiratory infections. METHODS: For reviewing, searches are done for getting journal articles into Google Scholar, Pub Med/Medline, Database of Open Access Journal and Science Direct for relevant data and information. RESULTS: Integrated nutritional supports of both macronutrients and micronutrients guidelines, including home-based physical exercise schedule, is summarized in this comprehensive review for possible prevention and management of diabetic patients in COVID-19 infections. The immuneboosting benefits of some vitamins, trace elements, nutraceuticals and probiotics in viral infections of diabetic patients are also included. CONCLUSION: There is an urgent need for a healthy diet and integrated nutritional supports with home-based physical activities for diabetic patients during the self-isolation period of COVID-19 Infection.

Antibiotics Use and Its Knowledge in the Community: A Mobile Phone Survey during the COVID-19 Pandemic in Bangladesh.

The general population has been excessively using antibiotics during the COVID-19 pandemic. Therefore, the use of antibiotics for any reported illnesses in the preceding four weeks and knowledge of antibiotics among the general population in the community were assessed for possible interventions. A mobile phone survey among a general population across eight administrative divisions of Bangladesh was conducted during January-March 2021. Reported illness episodes irrespective of COVID-19 in the preceding four weeks of the interview, use of antibiotics for the illnesses, and knowledge on antibiotics among the general population were recorded. Descriptive analyses were performed. We randomly interviewed 1854 participants, with a mean age of 28.5 years (range: 18-75 years); 60.6% were male. Among all participants, 86.3% (95% CI: 84.7-87.8) heard names of antibiotics, but only 12.1% reported unspecified harmful effects, and 3.5% reported antimicrobial resistance when antibiotics were taken without a physician's prescription. Among 257 (13.9%) participants, who consumed medicines for their recent illness episode, 32.7% (95% CI: 27.2-38.6) reported using antibiotics. Of those who could recall the names of antibiotics prescribed (n = 36), the most frequently used was azithromycin (22.2%) followed by cefixime (11.1%) and ciprofloxacin (5.6%). Our findings show an increased antibiotic use for illnesses reported in the preceding four weeks and an elevated knowledge at the community level during the COVID-19 pandemic compared with the pre-pandemic period.

Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Thousands of Rohingya refugee mothers at the world's largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. OBJECTIVE: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers' mental health status. METHODS: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox's Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention's acceptability and feasibility. RESULTS: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. CONCLUSIONS: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention's sustainability. TRIAL REGISTRATION: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25047.

Chemical composition and in vitro antioxidant properties of water-soluble extracts obtained from Bangladesh vegetables.

The aim of this study was to evaluate the nutritional value and antioxidant properties of aqueous extracts of some Bangladesh vegetables using fruits of ash gourd, bitter gourd, brinjal, okra, ridge gourd, snake gourd, and leaves of Indian spinach, kangkong, and stem amaranth. Proximate composition showed that the dried extracts were composed mainly of crude protein (14.6%-46.7%) and non-fibre carbohydrates (26.4%-53.5%). With the exception of stem amaranth, all the extracts had >40% DPPH radical scavenging ability at 0.5 mg/ml. In contrast metal chelation was lower, except in Indian spinach with ~46%. The ferric reducing antioxidant power (FRAP) was highest for the kangkong (10.9 mM Fe3+ reduced), which is similar to the 9.9 mM for butylated hydroxytoluene (BHT). All the extracts suppressed linoleic acid oxidation better than BHT within the first 5 days of the incubation period. We conclude that the Indian spinach, kangkong, and okra could be considered as the most promising sources of antioxidant compounds. PRACTICAL APPLICATIONS: Vegetables are commonly consumed as part of a regular diet but the high water and fiber contents usually mean that large quantities are required to provide long-term health benefits. Therefore, in this work, aqueous extracts of nine Bangladesh vegetables were prepared to provide a more concentrated form of nutrients and bioactive compounds. The extracts had strong nutritional value based on the high contents of crude protein, potassium, iron, and non-fibre carbohydrates. The high content of polyphenolic compounds in the extracts can also provide health benefits, which was demonstrated through strong free radical scavenging, metal chelation, ferric iron reduction, and inhibition of linoleic acid oxidation. These vegetable extracts have the potential to be used as sources of bioactive compounds to prevent or treat non-communicable diseases that are associated with high oxidative stress.

A Rapid Assessment of Health Literacy and Health Status of Rohingya Refugees Living in Cox's Bazar, Bangladesh Following the August 2017 Exodus from Myanmar: A Cross-Sectional Study.

BACKGROUND: A survey was conducted among Rohingya refugees to assess their overall health literacy and health status. METHODS: A questionnaire was developed to conduct face to face interviews among Rohingya refugees in Cox's Bazar, Bangladesh in November-December 2017. Families were selected using convenience sampling from four large refugee camps. RESULTS: Primary respondents aged 10-90 (median 32) years, 56% male, representing 1634 families were interviewed and provided data of themselves and 6268 additional family members, 4163 (66.4%) of whom were children aged <18 years. Of all, only 736 (45%) primary respondents knew how to appropriately treat diarrhoea, 882 (54%) relied on unqualified village "doctors" for treatment, 547 (33.5%) reported a family member suffering injuries in the previous six months, with 8% (42/547) of injuries fatal. One hundred and ninety two (11.8%) primary respondents also reported deaths within their family in the preceding 12 months, with the majority (70% [134/192]) occurring in males, and 44% (85/192) of all deaths were claimed to be homicidal. CONCLUSION: This survey highlights overall poor health literacy, limited access to qualified health care, and a high rate of injuries and assaults among Rohingyas. However, these data come from an anecdotal survey that excluded some sensitive but important questions.

Inhibitory Activities of Polyphenolic Extracts of Bangladeshi Vegetables against α-Amylase, α-Glucosidase, Pancreatic Lipase, Renin, and Angiotensin-Converting Enzyme.

The aim of the study was to determine the in vitro enzyme inhibition activities of aqueous polyphenolic extracts of nine popular Bangladeshi vegetables, namely ash gourd, bitter gourd, brinjal, Indian spinach, kangkong, okra, ridge gourd, snake gourd, and stem amaranth. Polyphenolic glycosides were the major compounds present in the extracts. Inhibition of α-amylase (up to 100% at 1 mg/mL) was stronger than α-glucosidase inhibition (up to 70.78% at 10 mg/mL). The Indian spinach extract was the strongest inhibitor of pancreatic lipase activity (IC50 = 276.77 µg/mL), which was significantly better than that of orlistat (381.16 µg/mL), a drug. Ash gourd (76.51%), brinjal (72.48%), and snake gourd (66.82%) extracts were the most effective inhibitors of angiotensin-converting enzyme (ACE), an enzyme whose excessive activities have been associated with hypertension. Brinjal also had a significantly higher renin-inhibitory activity than the other vegetable extracts. We conclude that the vegetable extracts may have the ability to reduce enzyme activities that have been associated with hyperglycemia, hyperlipidemia, and hypertension.

Immunogenicity of a killed bivalent whole cell oral cholera vaccine in forcibly displaced Myanmar nationals in Cox's Bazar, Bangladesh.

After the large influx of Rohingya nationals (termed Forcibly Displaced Myanmar National; FDMN) from Rakhine State of Myanmar to Cox's Bazar in Bangladesh, it was apparent that outbreaks of cholera was very likely in this setting where people were living under adverse water and sanitation conditions. Large campaigns of oral cholera vaccine (OCV) were carried out as a preemptive measure to control cholera epidemics. The aim of the study was to evaluate the immune responses of healthy adults and children after administration of two doses of OCV at 14 days interval in FDMN population and compare with the response observed in Bangladeshi's vaccinated earlier. A cross-sectional immunogenicity study was conducted among FDMNs of three age cohort; in adults (18+years; n = 83), in older children (6-17 years; n = 63) and in younger children (1-5 years; n = 80). Capillary blood was collected at three time points to measure vibriocidal antibodies using either plasma or dried blood spot (DBS) specimens. There was a significant increase of responder frequency of vibriocidal antibody titer at day 14 in all groups for Vibrio cholerae O1 (Ogawa/Inaba: adults-64%/64%, older children-70%/89% and younger children-51%/75%). There was no overall difference of vibriocidal antibody titer between FDMN and Bangladeshi population at baseline (p = 0.07-0.08) and at day 14, day 28 in all age groups for both serotypes. The seroconversion rate and geometric mean titer (GMT) of either serotype were comparable using both plasma and DBS specimens. These results showed that OCV is capable of inducing robust immune responses in adults and children among the FDMN population which is comparable to that seen in Bangladeshi participants in different age groups or that reported from other cholera endemic countries. Our results also suggest that the displaced population were exposed to V. cholerae prior to seeking shelter in Bangladesh.

Primary Care 2030: Creating an Enabling Ecosystem for Disruptive Primary Care Models to Achieve Universal Health Coverage in Low- and Middle-Income Countries.

Background: Forty years after Alma Ata, there is renewed commitment to strengthen primary health care as a foundation for achieving universal health coverage, but there is limited consensus on how to build strong primary health care systems to achieve these goals. Methods: We convened a diverse group of global stakeholders for a high-level dialogue on how to create an enabling ecosystem for disruptive primary care innovation. We focused our discussion on four themes: workforce innovation and strengthening; impactful use of data and technology; private sector engagement; and innovative financing mechanisms. Findings: Here, we present a summary of our convening's proceedings, with specific recommendations for strengthening primary health care systems within each of these four domains. Conclusions: In the wake of the Astana Declaration, there is global consensus that high-quality primary health care must be the foundation for universal health coverage. Significant disruptive innovation will be required to realize this goal. We offer our recommendations to the global community to catalyze further discourse and inform policy-making and program development on the path to Health for All by 2030.

Prevalence of Eye Problems among Young Infants of Rohingya Refugee Camps: Findings from a Cross-Sectional Survey.

Early detection of pediatric eye problems can prevent future vision loss. This study was to estimate the prevalence of common eye problems among infants born in a resource-constrained emergency setting with a broader aim to prevent future vision loss or blindness among them through early detection and referral. We conducted a cross-sectional survey among 670 infants (0-59 days old) born in Rohingya refugee camps in Bangladesh between March and June of 2019. The most common eye problem found was watering from the eye and accumulation of discharge by which 14.8% of the children were suffering (95% CI: 12.2-17.7). More than 5% of the infants had visual inattention (95% CI: 3.5-7.0), and 4% had redness in their eyes (95% CI: 2.7-5.8). Only 1.9% of infants (95% CI: 1-3.3) had whitish or brown eyeballs, and 1.8% of children might have whitish pupillary reflex (95% CI: 0.9-3.1). None of the eye problems was associated with the gender of the infants. The prevalent eye problems demand eye care set up for the screening of eye problems in the camps with proper referral and availability of referral centres with higher service in the districts.