Identifying regional disparities of infant mortality rates in Bangladesh: insights from nationwide cross-sectional studies and a statistical modelling approach using linear mixed effects model with temporal variability.

OBJECTIVE: The major objective of this project is to find the best suitable model for district-wise infant mortality rate (IMR) data of Bangladesh over the period 2014-2020 that captures the regional variability and overtime variability of the data. DESIGN, SETTING AND PARTICIPANTS: Data from seven consecutive cross-sectional surveys that were conducted in Bangladesh between 2014 and 2020 as a part of the Sample Vital Registration System (SVRS) were used in this study. The study included a total of 13 173 (with 390 infant deaths), 17 675 (with 512 infant deaths), 17 965 (with 501 infant deaths), 23 205 (with 556 infant deaths), 23 094 (with 498 infant deaths), 23 090 (with 497 infant deaths) and 23 297 (with 495 infant deaths) complete cases from SVRS datasets for each respective year. METHOD: A linear mixed effects model (LMM) with a quadratic trend over time in the fixed effects part and a nested random intercept, as well as a nested random slope for a linear trend over time in the part of the random effect, was implemented to describe the situation. This model was selected based on two popular selection criteria: Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). RESULTS: The LMMs analysis results demonstrated statistically significant variations in IMR across different districts and over time. Examining the district-specific area under the logarithm of the IMR curves yielded valuable insights into the disparities in IMR among different districts and regions. Furthermore, a significant inverse relationship was observed between IMR and life expectancy at birth, underscoring the significance of mitigating IMR as a means to enhance population health outcomes. CONCLUSION: This study accentuates district-wise and temporal variability when modelling IMR data and highlights regional heterogeneity in infant mortality rates in Bangladesh. Area-based programmes should be created for mothers residing in locations with a higher risk of IMR. Further research can examine socioeconomic elements generating these discrepancies.

Determinants of life satisfaction among women of reproductive age (15-49 years) in Bangladesh: A cross-sectional analysis.

The life satisfaction of women is an essential component of their subjective well-being. It is an indicator of a woman's life quality based on personal perception. Considering the importance of women's subjective well-being, the United Nations (UN) has recognized this as one of its Sustainable Development Goals (SDGs). To the best of our knowledge, no study has been done yet for Bangladeshi women aged 15-49 years using nationally represented data. This study is the first study, to our knowledge, that will identify the determinants of life satisfaction and investigate the association between these determinants and life satisfaction among women of reproductive age (15-49 years) in Bangladesh. This study examined the overall life satisfaction and impact of some personal and sociodemographic characteristics on it among the women aged 15 to 49 years in Bangladesh using the Multiple Indicator Cluster Survey (MICS) 2019 data, a cross-sectional data. In our study, information regarding life satisfaction was available for a sample of 64,283 women after categorizing the variable overall life satisfaction and adjusting the missing values. The variable overall life satisfaction was categorized into three categories, namely low (0-3), moderate (4-6), and high (7-10), according to the Organisation for Economic Co-operation and Development (OECD) guidelines. Results showed that 14.67% of women are low satisfied, 50.65% are moderately satisfied, and 34.68% are highly satisfied with their lives. A bivariate analysis was applied in this study to show the significant association between the determinants and life satisfaction. The multinomial logistic regression analysis was performed to draw valid conclusions about the effects of the potential determinants on life satisfaction. The study revealed that satisfaction increases with age, education level, and wealth status. For the variable marital status, which has three categories: currently married, formerly married, and never married, current marriage was strongly associated with higher life satisfaction. In contrast, a former marriage and a never marriage were associated with lower life satisfaction. Migration status was also significantly associated with life satisfaction, where women who changed their location were more satisfied than those who never changed their current location. Bangladesh aims to achieve the Sustainable Development Goals (SDGs) by 2030. To achieve the Sustainable Development Goal (SDG) 3, which promotes well-being, and the goal 5, to empower all women and girls, addressing the issues related to life satisfaction and applying appropriate intervention is a must.

Unani Formulation Habb-e-Suranjan: A Treasure of Biological Activities.

Habb-e-Suranjan (HES), an Unani formulation, has been studied for its anti-inflammatory properties in both in vitro and in vivo experiments. HES is recommended for arthritis, gout, and joint pain. The current endeavor is an attempt to put it to the test and verify its efficacy scientifically. It was tested for DPPH, hydroxyl, and nitric oxide scavenging activities. It was shown that HES had the greatest TAC and FRAC values when compared to catechin and ascorbic acid. HES exhibited DPPH and hydroxyl radical scavenging activity that was dose-dependent. Incubation of sodium nitroprusside solutions in PBS at 25°C for 150 min resulted in the production of nitric oxide. Nitric oxide production was effectively decreased by HES. Anti-inflammatory medications boosted the migration of PMN cells toward the chemoattractant FMLP in an agarose experiment of PMN chemotaxis. In carrageenan-induced rat paw edema, in the HES-treated group, paw thickness was 3.021 ± 0.084 at t = 0, but it showed an increase in paw inflammation after one hour, i.e., 3.195 ± 0.082 cm which again showed a decrease in paw thickness up to 4th hour, i.e., 3.018 ± 0.078, 2.98 ± 0.032, and 2.684 ± 0.061 at t = 2, 3, and 4, respectively. It showed again getting back to the normal thickness of paw at t = 24 hrs, i.e., 3.029 ± 0.118 cm. It is concluded that the formulation is potent enough and can be used effectively for the treatment of inflammation and associated health issues. Moreover, there is much scope to evaluate its effectiveness using different in vitro and in vivo models.

Prevalence of Vibrio cholerae in Coastal Alternative Supplies of Drinking Water and Association with Bacillus-Like Spore Formers.

The scarcity of hygienic drinking water is a normal phenomenon in the coastal areas of Bangladesh due to the high salinity of ground water. The inhabitants of this locality, therefore, live on alternative supplies of water including rain-fed pond water, and rainwater with persistent complex microbial interactions therein, often contaminated with life-threatening pathogens. Hence, this study was aimed at analyzing the prevalence of Vibrio cholerae (Vc) in the alternative drinking waters of Mathbaria, a coastal subdistrict neighboring the Bay of Bengal, the efficacy of pond sand filter (PSF) and the co-association among Bacillus-like spore formers (Sf) and Vc. Vc presumably entrapped into the membrane filter was enriched in alkaline peptone water medium and was isolated on selective thiosulfate-citrate-bile salts-sucrose and taurocholate-tellurite-gelatin agar media. They were finally identified by immunochromatographic one step rapid test and serology test. A total of 26% Vc positive samples were obtained out of 100 [ponds-48, household (HH)-29, and PSFs-23] where 13% cases were pathogenic (Vc O1) and 13% were non-pathogenic (Vc non-O1/non-O139). The distribution of Vc as observed was 33, 26, and 13.8% in waters derived from pond surface, PSF, and HH reservoirs, respectively, and for pathogenic type, it was 62.5%, 50%, and nil, respectively. Although none of the samples was identified with pathogenic Vc O139, the statistics represents a significant and augmentative risk of cholera outbreak in the focused area. The antibiotic sensitivity pattern in this study resembled the trend observed during last few years for Vc. The PSF demonstrated its inability to remove Vc from any of the samples and in addition, the filter itself was evidenced to be the source of pathogens and spores in further contamination and transmission. The development of biofilm in the PSF could be hypothesized as the reservoir in contaminating pathogen-free water samples. From the test of homogeneity, the risk levels of alternative water sources were estimated equal regarding Vc. Simultaneously, it was determined statistically that the prevalence of Vc, by no means, is influenced by Bacillus-like Sf be it for pond surface, HH, or PSF derived water.

Development of a new dipstick (Cholkit) for rapid detection of Vibrio cholerae O1 in acute watery diarrheal stools.

Recognizing cholera cases early, especially in the initial phase of an outbreak and in areas where cholera has not previously circulated, is a high public health priority. Laboratory capacity in such settings is often limited. To address this, we have developed a rapid diagnostic test (RDT) termed Cholkit that is based on an immunochromatographic lateral flow assay for the diagnosis of cholera cases using stool. Cholkit contains a monoclonal antibody (ICL-33) to the O-specific polysaccharide (OSP) component of V. cholerae O1 lipopolysaccharide, and recognizes both Inaba and Ogawa serotypes. We tested the Cholkit dipstick using fresh stool specimens of 76 adults and children presenting with acute watery diarrhea at the icddr,b hospital in Dhaka, Bangladesh. We compared Cholkit's performance with those of microbial culture, PCR (targeting the rfb and ctxA genes of V. cholerae) and the commercially available RDT, Crystal VC (Span Diagnostics; Surat, India). We found that all stool specimens with a positive culture for V. cholerae O1 (n = 19) were positive by Cholkit as well as Crystal VC. We then used Bayesian latent class modeling to estimate the sensitivity and specificity of each diagnostic assay. The sensitivity of Cholkit, microbiological culture, PCR and Crystal VC was 98% (95% CI: 88-100), 71% (95% CI: 59-81), 74% (95% CI: 59-86) and 98% (95% CI: 88-100), respectively. The specificity for V. cholerae O1 was 97% (95% CI: 89-100), 100%, 97% (95% CI: 93-99) and 98% (95% CI: 92-100), respectively. Of note, two Crystal VC dipsticks were positive for V. cholerae O139 but negative by culture and PCR in this area without known circulating epidemic V. cholerae O139. In conclusion, the Cholkit dipstick is simple to use, requires no dedicated laboratory capacity, and has a sensitivity and specificity for V. cholerae O1 of 98% and 97%, respectively. Cholkit warrants further evaluation in other settings.