COVID-19 vaccine barriers and perception among rural adults: a qualitative study in Bangladesh.

OBJECTIVE: The COVID-19 pandemic continues to pose challenges for global public healthcare, even with the authorisation of several vaccines worldwide. To better understand rural communities' knowledge, attitudes, perceptions and barriers towards these vaccines, we conducted a qualitative cross-sectional study with adults in rural Bangladesh. SETTING: This cross-sectional study was conducted in the rural areas of Sylhet and Natore in Bangladesh from August 2021 to February 2022. PARTICIPANTS: Our study involved 15 in-depth interviews with rural adults and 2 key informant interviews with health workers. RESULTS: We analysed data thematically, resulting in four main themes: (1) knowledge and perception aspects, (2) myths and misconceptions, (3) practice and attitude and (4) barriers and challenges of COVID-19 vaccines. CONCLUSIONS: The findings indicate that rural populations lack sufficient knowledge about COVID-19 vaccines but have a more favourable attitude towards them. Misconceptions, beliefs and personal experiences were found to be the main reasons for vaccine avoidance. To address these challenges and dispel the spread of misinformation, health education programmes play a pivotal role in improving vaccine management. Policy-makers should initiate these programmes without delay to create a well-informed and enlightened community, given that the COVID-19 is still spreading.

Teachers' perspective on implementation of menstrual hygiene management and puberty education in a pilot study in Bangladeshi schools.

OBJECTIVE: To assess the perspectives of Bangladeshi teachers on the feasibility of delivery and potential for long-term sustainability of puberty and menstruation education in urban and rural schools. METHOD: We developed a multi-module puberty and menstrual hygiene management education curriculum that teachers piloted for six months in four urban and rural government and private schools in Bangladesh. We conducted monthly assessments during piloting, discussion for manual revision and four group discussions with 20 participating teachers to understand perceived benefits, barriers, and sustainability of puberty and menstruation education among school children. RESULTS: Teachers acknowledged the importance of school-based puberty and menstruation education to improve students' perception and preparedness. They found that the training and instructors' manual they received were useful tools for effectively communicating with students. Teachers noted school and community pressure to de-emphasize educational content not included on nationally standardized examinations, and insufficient time and pre-service training for teaching sensitive topics served as barriers to implementing the pilot curriculum. CONCLUSION: Pressure from school authorities and community may hinder the successful long-term delivery of school-based puberty and menstruation education programs that are external to the national curriculum. Our findings indicate that feasibly and sustainably improving education on these topics in Bangladeshi classrooms should be achieved through 1) revision of the current national curriculum to incorporate more comprehensive puberty and menstruation information including its physiology, management, and social context, 2) adequate training and support for teachers to deliver the content, and 3) incorporation of puberty and menstruation content into students' national examinations which may better ensure teachers are given the tools and opportunity to prioritize teaching this content.

Strategies to Connect Low-Income Communities with the Proposed Sewerage Network of the Dhaka Sanitation Improvement Project, Bangladesh: A Qualitative Assessment of the Perspectives of Stakeholders.

In Bangladesh, approximately 31% of urban residents are living without safely managed sanitation, the majority of whom are slum residents. To improve the situation, Dhaka Water Supply and Sewerage Authority (DWASA) is implementing the Dhaka Sanitation Improvement Project (DSIP), mostly funded by the World Bank. This study assessed the challenges and opportunities of bringing low-income communities (LICs) under a sewerage connection within the proposed sewerage network plan by 2025. We conducted nine key-informant interviews from DWASA and City Corporation, and 23 focus-group discussions with landlords, tenants, and Community Based Organisations (CBOs) from 16 LICs near the proposed catchment area. To achieve connections, LICs would require improved toilet infrastructures and have to be connected to main roads. Construction of large communal septic tanks is also required where individual toilet connections are difficult. To encourage connection in LICs, income-based or area-based subsidies were recommended. For financing maintenance, respondents suggested monthly fee collection for management of the infrastructure by dividing bills equally among sharing households, or by users per household. Participants also suggested the government's cooperation with development-partners/NGOs to ensure sewerage connection construction, operation, and maintenance and prerequisite policy changes such as assuring land tenure.

Toward a Scalable and Sustainable Intervention for Complementary Food Safety.

BACKGROUND: Contaminated complementary foods are associated with diarrhea and malnutrition among children aged 6 to 24 months. However, existing complementary food safety intervention models are likely not scalable and sustainable. OBJECTIVE: To understand current behaviors, motivations for these behaviors, and the potential barriers to behavior change and to identify one or two simple actions that can address one or few food contamination pathways and have potential to be sustainably delivered to a larger population. METHODS: Data were collected from 2 rural sites in Bangladesh through semistructured observations (12), video observations (12), in-depth interviews (18), and focus group discussions (3). RESULTS: Although mothers report preparing dedicated foods for children, observations show that these are not separate from family foods. Children are regularly fed store-bought foods that are perceived to be bad for children. Mothers explained that long storage durations, summer temperatures, flies, animals, uncovered food, and unclean utensils are threats to food safety. Covering foods, storing foods on elevated surfaces, and reheating foods before consumption are methods believed to keep food safe. Locally made cabinet-like hardware is perceived to be acceptable solution to address reported food safety threats. CONCLUSION: Conventional approaches that include teaching food safety and highlighting benefits such as reduced contamination may be a disincentive for rural mothers who need solutions for their physical environment. We propose extending existing beneficial behaviors by addressing local preferences of taste and convenience.