Demographic risk factors for extra-pulmonary tuberculosis: a rising public health threat in Bhutan.

BACKGROUND: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. METHODS: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. RESULTS: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB. CONCLUSION: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.

Flood prediction and vulnerability assessment at the south-western region of Bangladesh.

Flood is a frequent experience for the people living in Bangladesh, especially in the south-western region. But due to its complexity and multidisciplinary nature, flood management remains a very difficult task. This research focused on finding the most vulnerable areas to flooding for each polder within the Khulna and Satkhira districts since those areas can be identified as one of the most vulnerable areas to flooding. Water level data from fourteen stations of seven rivers (Sibsa, Rupsa-Pasur, Kobadak, Bhadra, Kobadak, Ichamati (Western Border), Betna-Kholpetua, and Satkhira Khal) were analyzed to calculate water levels for 2, 5, 10, 25, and 100-year return period applying normal distribution, extreme value type-I (EV-I), and log person type-III (LP-III) distribution methods. The EV-I distribution method was showing the best fit. The study revealed that station SW243 (Rupsa-Pasur River) in the Dacope region has the most extreme water level, station SW259 (Sibsa River) has the second-highest water level, and station SW254.5 (Satkhira Khal) in Satkhira Sadar has the third-highest water level for the return period of 100 years. A flood inundation map was prepared using the EV-I method's 10-year return period value. The Analytic Hierarchy Process (AHP) was used to demonstrate the polders' vulnerability depending on several factors. Overall, polder15 (Ghubra, Satkhira) is the most vulnerable polder, while polder 33 and polder 32 respectively are the second and third most vulnerable polders for flooding, both located in the Dacope region.

Knowledge, attitudes and practices of healthcare professionals toward the novel coronavirus during the early stage of COVID-19 in a lower-and-middle income country, Bangladesh.

Healthcare workers (HCWs) are at an increased risk of COVID-19 infection because of their direct exposure to suspected and confirmed coronavirus patients in healthcare facilities. This condition is even more acute in low-and lower-middle-income countries (LMICs). Given the poor healthcare settings of Bangladesh, it is challenging to halt the spread of infection without proper knowledge, attitudes, and good behavioral practices (KAPs). Therefore, this study conducted a cross-sectional study from May 5 to 31, 2020, with 203 healthcare professionals to determine the knowledge, attitudes, and practices (KAP) toward COVID-19. Participants were doctors, nurses, dentists, and allied health professionals. A self-administered questionnaire including several KAP-related items aligned with the World Health Organization (WHO) guidelines was distributed over various online platforms to collect data. Bivariate and multivariable logistic regression analyses were conducted to determine the factors influencing KAP levels. The majority of participants were male (52.22%). The prevalence of high knowledge levels, positive attitudes, and good practices were 51.23, 45.81, and 49.75%, respectively. Social media was the most common source for seeking coronavirus information. Workers at private institutions were less likely (OR = 0.56, 95% CI = 0.30-0.95, p < 0.05) to be knowledgeable than workers at public institutions. Doctors had more positive attitudes than other healthcare professionals. Older participants showed high rates of good behavioral practices (OR = 1.05, 95% CI = 1.06-1.32, p < 0.05) than younger ones. Workers at private institutions had a better practice level toward COVID-19 (OR = 2.11, 95% CI = 1.17-3.83) than those at public institutions. These results point to the necessity for proper training programs for medical professionals that help them gain confidence to deliver the correct treatment to their patients and the need to implement preventative steps during pandemics.

COVID-19 Vaccine Acceptance Rate and Its Factors among Healthcare Students: A Systematic Review with Meta-Analysis.

Healthcare students are clinicians-in-training likely to come into contact with COVID-19 as much as other frontline healthcare professionals. It is therefore necessary to prioritize vaccinations for this group. We conducted a global systematic assessment of COVID-19 vaccine acceptance rates and related factors among healthcare students using the PubMed, Scopus, and Web of Science databases and keyword searches in March of 2022. We found 1779 articles with relevant information and 31 articles that matched our inclusion criteria. We performed a random-effects meta-analysis and quality assessment using the eight-item Joanna Briggs Institute Critical Appraisal test for cross-sectional studies. A total of 30,272 individuals from 16 countries were studied. Most of the studies were carried out in the U.S. (n = 6), China (n = 5), Poland (n = 5), India (n = 2), Italy (n = 2), and Israel (n = 2). The prevalence of the COVID-19 vaccine acceptance rate was 68.8% (95% confidence interval [CI]: 60.8-76.3, I2 = 100%), and the prevalence of the vaccine hesitancy rate was 25.8% (95% CI: 18.5-33.8, I2 = 99%). In country-specific analyses, Romania showed the highest acceptance rate (88.0%, 95% CI: 44.5-100%), while Iraq showed the lowest acceptance rate (66.2%, 95% CI: 35.5-90.8%). In time-trend analyses, we found that acceptance rates among healthcare students decreased over time. Students concerned about potentially serious side effects of the vaccine were less willing to accept the vaccine. National and international interventions should be adopted to reduce COVID-19 vaccination hesitancy rates among these important frontline workers.

Psychological Distress Among Healthcare Professionals During the Early Stages of the COVID-19 Outbreak in Low Resource Settings: A Cross-Sectional Study in Bangladesh.

The COVID-19 pandemic has been very destructive to and compromised the functioning of all nations' public health systems. In the absence of a vaccine, healthcare workers have been employed to relentlessly fight against COVID-19. The psychological status of healthcare workers during the pandemic in countries with limited resources, notably Bangladesh, remains unclear. The present study aimed to investigate the psychological states of frontline and non-frontline Bangladeshi healthcare workers during the early stages of the COVID-19 outbreak. An online cross-sectional study was conducted from May 5 to 31, 2020 with 203 respondents. Psychological states were measured with a self-reported numerical scale of fear, the Generalized Anxiety Disorder (GAD-7) scale, and the Patient Health Questionnaire (PHQ-9). The prevalence rates of fear, anxiety, and depression were 60.6, 71.9, and 55.2%, respectively. Compared to non-frontline workers, frontline workers reported higher rates of anxiety (79.0 vs. 67.2%) and depression (65.4 vs. 48.4%). Multivariate logistic regression models showed that working in a public institution, being employed for <5 years, and being over-worked were risk factors for developing psychological distress. Our findings emphasize the need for timely psychological interventions to support the mental well-being of healthcare professionals in Bangladesh.

Determinants of COVID-19 Vaccine Acceptance among the Adult Population of Bangladesh Using the Health Belief Model and the Theory of Planned Behavior Model.

Vaccination is undoubtedly one of the most effective strategies to halt the COVID-19 pandemic. The current study aimed to investigate the acceptance of COVID-19 vaccination and its associated factors using two health behavior change frameworks: the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). A total of 639 Bangladeshi adults (mean age: 24 years) participated in a cross-sectional online study between July and August 2021. The questionnaire covered questions regarding vaccine intentions, sociodemographic features, health status, perceived trust in/satisfaction with health authorities, reasons for vaccine hesitancy, and factors related to the health behavior change frameworks. Hierarchical logistic regression was employed to determine associations between these predictors and vaccine acceptance. The intention to get a COVID-19 vaccination was expressed among 85% of the participants. In fully adjusted models, students and respondents with more normal body weights reported higher intentions to get vaccinated. Respondents were also more likely to seek vaccination if they reported greater levels of perceived susceptibility, benefits, and cues to action, as well as lower levels of barriers and self-efficacy. Fear of future vaccine side effects was the most common reason for COVID-19 vaccine hesitancy and was expressed by 94% of the vaccine-hesitant respondents. These factors should be considered by health authorities in Bangladesh and perhaps other countries when addressing the plateauing COVID-19 vaccination rates in many populations.

Astaxanthin ameliorates prenatal LPS-exposed behavioral deficits and oxidative stress in adult offspring.

BACKGROUND: Prenatal maternal lipopolysaccharide (LPS) exposure leads to behavioral deficits such as depression, anxiety, and schizophrenia in the adult lives. LPS-exposure resulted in the production of cytokines and oxidative damage. On the contrary, astaxanthin is a carotenoid compound, showed neuroprotective properties via its antioxidant capacity. This study examines the effect of astaxanthin on the prenatal maternal LPS-induced postnatal behavioral deficit in mice. RESULTS: We found that prenatal LPS-exposed mice showed extensive immobile phase in the tail suspension test, higher frequent head dipping in the hole-board test and greater hypolocomotion in the open field test. All these values were statistically significant (p < 0.05). In addition, a marked elevation of the level of lipid peroxidation, advanced protein oxidation product, nitric oxide, while a pronounced depletion of antioxidant enzymes (superoxide dismutase, catalase and glutathione) were observed in the adult offspring mice that were prenatally exposed to LPS. To the contrary, 6-weeks long treatment with astaxanthin significantly improved all behavioral deficits (p < 0.05) and diminished prenatal LPS-induced oxidative stress markers in the brain and liver. CONCLUSIONS: Taken together, these results suggest that prenatal maternal LPS-exposure leads to behavioral deficits in the adults, while astaxanthin ameliorates the behavioral deficits presumably via its antioxidant property.

Effects of organic extracts of six Bangladeshi plants on in vitro thrombolysis and cytotoxicity.

BACKGROUND: Thrombus formed in blood vessels lead to atherothrombotic diseases such as myocardial or cerebral infarction. Thrombolytic agents are used to dissolve the already formed clots in the blood vessels; however, these drugs sometimes cause serious and fatal consequences. Herbal preparations have been used since ancient times for the treatment of several diseases although they show little toxicity in some cases. Aqueous extracts of herbs used in thrombolysis have been reported before with cytotoxic data, however, the organic extracts of herbs have not been documented. This study aims to investigate whether organic extracts possess thrombolytic properties with minimal or no toxicity. METHODS: An in vitro thrombolytic model was used to check the clot lysis effect of six Bangladeshi herbal extracts viz., Ageratum conyzoides L., Clausena suffruticosa, Leea indica (Burm.f.) Merr., Leucas aspera Willd., Senna sophera L. Roxb., and Solanum torvum Swartz. using streptokinase as a positive control and water as a negative control. Briefly, venous blood drawn from twenty healthy volunteers was allowed to form clots which were weighed and treated with the test plant materials to disrupt the clots. Weight of clot after and before treatment provided a percentage of clot lysis. Cytotoxicity was screened by brine shrimp lethality bioassay using vincristine sulfate as positive control. RESULTS: Using an in vitro thrombolytic model, Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed 18.12 ± 2.34%, 48.9 ± 2.44%, 39.30 ± 0.96%, 37.32 ± 2.00%, 31.61 ± 2.97% and 31.51 ± 0.57% and clot lysis respectively. Among the herbs studied Clausena suffruticosa, Leea indica and Leucas aspera showed very significant (p < 0.0001) percentage (%) of clot lysis compared to reference drug streptokinase (75.00 ± 3.04%). In brine shrimp cytotoxic assay, the extracts Ageratum conyzoides, Clausena suffruticosa, Leea indica, Leucas aspera, Senna sophera and Solanum torvum showed LC50 values 508.86 ± 6.62,41.16 ± 1.26, 2.65 ± 0.16, 181.67 ± 1.65, 233.37 ± 7.74 and 478.40 ± 3.23 µg/ml, respectively, with reference to vincristine sulfate (LC50 0.76 ± 0.04). CONCLUSION: Through our study it was found that Clausena suffruticosa, Leea indica and Leucas aspera possessed effective thrombolytic properties whereas Senna sophera and Solanum torvum showed moderate to mild thrombolytic effects while Ageratum conyzoides showed no significant effect. No extract was found cytoxic compared to positive control. Clausena suffruticosa, Leea indica and Leucas aspera could be incorporated as a thrombolytic agent with in vivo effects to improve the atherothrombotic patients. However, Clausena suffruticosa could be the best one to use in this purpose.