Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh.

INTRODUCTION: Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. METHODS: This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. RESULTS: Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. CONCLUSION: While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.

Screening and quantification of antibiotic residues in poultry products and feed in selected areas of Bangladesh.

Background and Aim: Antibiotic residues in livestock farming have been identified as a potential cause of antimicrobial resistance in humans and animals. This study aimed to determine whether antibiotic residues were present in the chicken meat, eggs, feces, and feed collected from all four districts in the Mymensingh division of Bangladesh. Materials and Methods: To detect antibiotic residues in the collected samples, qualitative thin-layer chromatography (TLC) and quantitative high-performance liquid chromatography (HPLC) were used. A total of 230 samples were analyzed for antibiotic residues of commonly used 11 antibiotics. Out of these, 40 meat and 40 feces samples were collected from broilers and layers, 30 egg samples from ducks and layers, and 120 feed samples from broilers and layers from the study area. Thin-layer chromatography was used to screen the presence of antibiotic residues; TLC-positive samples were then subjected to further HPLC analysis to determine the residue concentrations. Results: Thin-layer chromatography analysis revealed that 23.5% of the tested samples contained residues from six different antibiotic classes (tetracyclines, quinolones, beta-lactams, sulfonamides, aminoglycosides, and macrolides). Thin-layer chromatography analysis showed that 35% and 25% of the meat samples were positive for residues from the broiler and layer, respectively. About 15% and 30% of layer and duck egg samples had positive residues, respectively. Out of 120 feed samples analyzed, about 15.8% had various antibiotic residues. In addition, feces samples from broilers and layers had 50% and 35% antibiotic residues, respectively. A total of 2.5% meat and 3.3% egg samples had antibiotic residues above the maximum residue limit (MRL). Based on the findings of this study, the highest percentage of oxytetracycline, followed by doxycycline and ciprofloxacin, were detected in feed samples, and oxytetracycline was detected in meat and egg samples. Conclusion: This study clearly showed the misuse of antibiotics in the poultry sector in Bangladesh. Although antibiotic residues below the MRL level are suitable for human consumption, they may result in antimicrobial drug resistance to pathogens.

A Survey on Knowledge, Attitude, and Practices of Large-Animal Farmers towards Antimicrobial Use, Resistance, and Residues in Mymensingh Division of Bangladesh.

The widespread and indiscriminate use of antimicrobials in food animals is a key contributor to antimicrobial resistance and antimicrobial residue, which have become a growing public and animal health concern in developing countries such as Bangladesh. This study was aimed to assess the knowledge, attitude, and practices (KAP) of large-animal farmers towards antimicrobial use (AMU), antimicrobial resistance (AMR), and antimicrobial residue (AR) with their correlation. A cross-sectional survey was conducted with a structured and pretested questionnaire in the Mymensingh division of Bangladesh. A total of 212 large-animal farmers (dairy, beef fattening, buffalo, sheep, and goat farmers) were surveyed. Results showed that most of the farmers are male (85.8%) and belong to the 18-30 age group (37.3%). About 20.3% had no formal education, and nearly half of the participants (48.1%) received training regarding antibiotic use and resistance. Penicillin is the most common class of antibiotic used (61.8%) in the study area, followed by other antimicrobials. Only 37.7% of the farmers used antimicrobials on the recommendation of their veterinarian. Overall, 41.5%, 42.5%, and 21.7% of farmers possess adequate knowledge and a satisfactory attitude and perform desirable practices, respectively. Farmers in the 31-40 age group have adequate knowledge, attitude, and ability to implement desired practices compared to farmers in the 18-30 age group. Farmers having a graduate or post-graduate degree scored better in relation to knowledge, attitude, and practice than other farmers. Analysis revealed that farmers who received training on AMU and AMR had 10.014 times (OR = 10.014, 95% CIs: 5.252-19.094), 9.409 times (OR = 9.409, 95% CIs: 4.972-17.806), and 25.994 times (OR = 25.994, 95% CIs: 7.73-87.414) better knowledge, attitude, and performance, respectively, compared to their counterparts. A significant proportion of farmers (97.2%) dispose of leftover antibiotics inappropriately. The findings of the present study will be used to intervene in the education and training of the farmers, which will help to limit the indiscriminate and irrational use of antimicrobials, leading to reducing the chances of developing AMR.

Screening of antibiotic residue in transported live fish and water collected from different fish markets in Mymensingh district of Bangladesh.

Objectives: The objective of this study was to evaluate the persistence of oxytetracycline (OTC) residue in common fish species (Catla, Rui, Mrigal, and Pangas) available in local fish markets and the corresponding transport water of the Mymensingh region. Materials and Methods: Live fish and corresponding transport water samples were analyzed by thin layer chromatography (TLC) and high-performance liquid chromatography for qualitative and quantitative detection of OTC residue, respectively. A total of 240 fish samples and 60 water samples were randomly collected from three local fish markets during the summer and winter seasons. Results: OTC residues were detected in 18 samples (13 fish and 5 water samples) in the summer and 8 samples (only fish samples) in the winter. The overall percentage of antibiotic residue positive in fish samples was 5.42%, and in water samples, it was 8.33%. In fish, OTC concentrations of TLC-positive samples ranged from 34.7 to 56.85 parts per billion (ppb) in Catla, 23.45-35.37 in Rui, 11.02-26.80 in Mrigal, and 10.80-77.55 in Pangas during summer. The concentrations were 18.5 ppb in Catla, 15-16.09 in Rui, 10-14.63 in Mrigal, and 21.02-40.11 in Pangas during the winter season. On the other hand, the range of OTC concentrations of TLC-positive samples for water was 12.9-59.18 ppb during summer and below the detection level during winter. The highest prevalence of antibiotic residues among fish samples was found in Pangas (16.67%). The highest percentage of samples (15% in the fish sample and 30% in the water sample) found to be positive were collected from Mechua Bazar. The comparison between the summer and winter seasons showed that the percentage of positive antibiotic residue in the summer season (10.38% for fish and 16.67% for water) is higher than that of the winter season (6.67% for fish samples only). This variation indicates that fish transporters use more antibiotics during the summer than in the winter season. The difference between the means of fish species and water samples was not statistically significant (p > 0.05). In addition, no samples exceeded the maximum residue limits (MRL) of OTC (100 ppb) in fish set by the European Commission. Conclusion: Although the concentrations of antibiotic residues in fish edible tissues are below MRL values, the presence of antibiotic residues in transported water may lead to the development of antimicrobial resistance bacteria that are detrimental to humans, animals, and aquatic animals.

Prevalence, risk factors, and interventions for chronic obstructive pulmonary disease in South Asia: a scoping review protocol.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is increasingly contributing to the disease burden in South Asia. This review will summarize the prevalence and risk factors of COPD in South Asia and the interventions regarding COPD that have been introduced in South Asian countries. METHOD: This scoping review will primarily follow Arksey and O'Malley's six steps of scoping review methodology. Additionally, it will follow the recent upgradation of the scoping review methodology by Levac et al., and the Joanna Briggs Institute. Research questions were already identified at the beginning of the proposed scoping review. Electronic databases will be searched (PubMed, Web of Science, and ProQuest) using search terms. Studies will be screened independently by two reviewers through a two-stage screening process using pre-developed inclusion criteria for this scoping review. Eligible studies will be abstracted and charted in a standardised form. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used to report the result. Additionally, feedback from South Asia's experienced COPD researchers on the final literature list will be collected for gap identification in literature search. Two independent reviewers will assess the quality of each included study's design using the Joanna Briggs Institute's tool. DISCUSSION: The proposed scoping review will map the evidence on COPD in South Asia through literature review, and it will focus on prevalence, risk factors, and interventions. This review will contribute to the advancement of research on COPD and will be beneficial for policy-makers, public health specialists, and clinicians.

Effect of discriminate and indiscriminate use of oxytetracycline on residual status in broiler soft tissues.

AIM: This study aimed to evaluate the effects of discriminate and indiscriminate use of oxytetracycline on hematological parameters, residual status in soft tissue of broiler and of thermal effect on oxytetracycline residual status. MATERIALS AND METHODS: Eighteen, day-old male broiler chickens were purchased and were divided into three different groups (control group, discriminate group, and indiscriminate group). The control group received no antibiotics. The discriminate group received oxytetracycline 1 g/L drinking water for 5 consecutive days, and 10 days' withdrawal period was maintained before sacrifice. The indiscriminate group received oxytetracycline 1 g/L drinking water till the sacrificed day. Blood samples were collected before sacrificing for hematological analysis. After sacrificing liver, kidney, spleen, and muscle samples were collected for analysis of oxytetracycline residues in raw soft tissues. Since meat is used to cook by traditional method in Bangladesh before consumption that is why positive meat samples were cooked by traditional cooking method to evaluate the thermal effect on oxytetracycline residual status as well. Thin-layer chromatography (TLC) was done for screening of oxytetracycline residues in soft tissues. RESULTS: Mean differences of total erythrocyte count (million/mm3), hemoglobin estimation (gm%), and packed cell volume (%) estimation were not statistically significant among the groups. TLC analysis of raw samples showed 100% positive results of all samples collected from the indiscriminate group. In contrast, samples collected from the discriminate group were negative for oxytetracycline residues. In the control group, all samples were negative for oxytetracycline residue. There was a significant (p<0.05) relationship of oxytetracycline residues among three different groups for liver, kidney, spleen, and muscle samples. Positive liver and muscle samples from the indiscriminate group were subjected to thermal treatment by traditional cooking method of Bangladesh. Oxytetracycline residues had found in cooked meat, liver, and juice part, suggesting that antibiotic residues disseminated to juice part from flesh part after cooking. CONCLUSION: Evidence suggests that proper maintenance of withdrawal period would minimize oxytetracycline residues in broiler soft tissues, whereas antibiotics retained in soft tissues of broiler in case of indiscriminate use. Traditional cooking does not change oxytetracycline residual status in edible tissues. Therefore, awareness regarding the proper maintenance of withdrawal period after antibiotic treatment of broiler is one of the best strategies which may positively reduce the risk of antimicrobial drugs residue in meat.

Prevalence and Factors Associated with Overweight and Obesity among Primary School Children (9-14 Years) in a Selected Area of Dhaka, Bangladesh: A Cross-Sectional Study.

INTRODUCTION: Childhood obesity is a threat worldwide; notably, some Asian nations are experiencing a shift toward obesity at a younger age. The context of overweight/obesity remains unexplored, more among younger age groups in Bangladesh. This study assessed prevalence and factors associated with overweight/obesity among 9-14-year-old school-going children studying in public and private primary schools in a selected area of Dhaka, Bangladesh. MATERIALS AND METHODS: This descriptive cross-sectional study involved 150 children recruited from four purposively selected primary schools, following simple random sampling technique. Body mass index was assessed to classify children following the Centers for Disease Control and Prevention age and sex-specific cutoff points. Data were analyzed using SPSS, version 20, and Chi-square/Fisher's exact test was done to determine association. RESULTS: A higher prevalence of overweight/obesity was observed among boys (67.1%) compared to girls, and the mean age was 11.6 years. Overweight and obesity were prevalent among girls (35.7% and 17.9%, respectively) in public schools and boys (38.8% and 32.7%, respectively) in private schools. The magnitude was higher (>80.0%) among those not participating in sports at school (P = 0.002) or outside school (P < 0.001). They exposed (97.5%) to sedentary behaviors (P < 0.001) and preferred fast food (60.8%) as regular meals (P = 0.001). Their dietary chart lacked an adequate serving of vegetables and fruits in a week. CONCLUSIONS: Overweight/obesity is prevalent among 9-14-year-old school-going children, and behavior factors are major determinants of childhood obesity. Effective public health interventions are required to address this emerging health problem.

Time dependent screening of antibiotic residues in milk of antibiotics treated cows.

OBJECTIVE: To analyze the presence of selective antibiotic residues (oxytetracycline, amoxicillin, and ciprofloxacin) in milk during the antibiotic treatment course, and to evaluate the thermal effect on antibiotics residual status in milk of antibiotic-treated cows. MATERIALS AND METHODS: The raw fresh milk was collected from 18 lactating cows before antibiotics treatment, which were brought to the veterinary hospital and suffered from either mastitis, foot and mouth disease, fever, local wound, or non-specific diarrhea, and so on. Out of the 18 lactating cows, six were treated with oxytetracycline, six were treated with amoxicillin, and six were treated with ciprofloxacin parenterally. Milk samples were also collected at 2nd day during treatment and final collection was done after maintaining the withdrawal period. Since milk is heated before consumption, it was boiled at 100°C for 20 min to evaluate the thermal effect on antibiotics residual status. Thin-layer chromatography was done for screening of antibiotics residue before and after boiling of the milk. RESULTS: At day 0 (before antibiotic treatment), no antibiotics (oxytetracycline, ciprofloxacin and amoxicillin) residue was detected in raw milk of antibiotic treated cows. In contrast, on day 2 (during antibiotic treatment), 100% raw milk samples showed positive for antibiotics residue. After boiling, all milk samples showed positive for such specific antibiotics residue. On the other hand, no antibiotics residues were detected on day 9, which indicates the completion of the withdrawal period of the respective antibiotic. The intensities of bands for antibiotic on thin-layer chromatography plate of antibiotic residues in milk samples (oxytetracycline, amoxicillin, and ciprofloxacin) expressed that the respective antibiotic residual status was higher in the boiled milk compare to the raw milk. CONCLUSION: Proper maintenance of withdrawal period after antibiotic treatment would minimize the risk of antibiotic residues in milk, and boiling does not change these specific antibiotics residual status in milk. Therefore, awareness regarding the proper maintenance of withdrawal period after antibiotic treatment in lactating cows is one of the best strategies that may positively reduce the risk of antimicrobial drugs residue in milk.

Awareness Among Parents About Pneumococcal Conjugate Vaccine in Routine Immunization Program to Prevent Pneumococcal Pneumonia in Bangladesh.

Introduction This study was conducted in two purposively selected slums of Dhaka to assess parents' awareness of pneumococcal conjugate vaccine (PCV) in reducing the occurrence of death due to pneumococcal pneumonia. Methods Using a semi-structured questionnaire, face-to-face interviews were conducted with 150 parents. Data were analyzed using Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) and Chi-square (χ2) test performed to determine associations. Results About 35% of parents were found to be aware of PCV; of them, 92.5% were informed by health service providers, and 81.1% mentioned benefits of PCV. Most parents were unaware of the PCV vaccination status of children, and no significant association was found between vaccination status and parents' socioeconomic status. Aware parents vaccinated their children, and the association of awareness with vaccination status was statistically significant for PCV-1 (P = 0.04) and PCV-2 (P < 0.001). Although 7.4% of parents did not vaccinate their child with PCV-3 due to a child's sickness or other priorities in household work, the association was significant (P = 0.01). Conclusion Strengthened efforts by health service providers, prioritizing dissemination of key messages on PCV, its benefits, and side-effects, can motivate parents and reduce dropout rates.

'Feminization' of physician workforce in Bangladesh, underlying factors and implications for health system: Insights from a mixed-methods study.

BACKGROUND: Bangladesh is currently faced with an emerging scenario of increased number of female physicians in the health workforce which has health system implications. For a health system to attract and retain female physicians, information is needed regarding their motivation to choose medical profession, real-life challenges encountered in home and workplaces, propensity to choose a few particular specialties, and factors leading to drop-out from the system. This exploratory mixed-methods study attempted to fill-in this knowledge gap and help the policy makers in designing a gender-sensitive health system. METHODS: Three-hundred and fifteen final year female medical students from four purposively selected medical colleges of Dhaka city (two each from public and private colleges) were included in a quantitative survey using self-administered questionnaire. Besides, 31 in-depth interviews with female students, their parents, and in-service trainee physicians, and two focus group discussions with female students were conducted. Gender disaggregated data of physicians and admitted students were also collected. Data were analysed using Stata version 13 and thematic analysis method, as appropriate. RESULTS: During 2006-2015, the female physicians outnumbered their male peers (52% vs. 48%), which is also supported by student admission data during 2011-2016 from the sampled medical colleges, (67% in private compared to 52% in public). Majority of the female medical graduates specialized in Obstetrics and Gynaecology (96%). Social status (66%), respect for medical profession (91%), image of a 'noble profession' (91%), and prospects of helping common people (94%) were common motivating factors for them. Gender disparity in work, career and work environment especially in rural areas, and problems of work-home balance, were a few of the challenges mentioned which forced some of them to drop-out. Also, this scenario conditioned them to crowd into a few selected specialties, thereby constraining health system from delivering needed services. CONCLUSIONS: Increasing number of female physicians in health workforce, outnumbering their male peers, is a fact of life for health system of Bangladesh. It's high time that policy makers pay attention to this and take appropriate remedial measures so that women can pursue their career in an enabling environment and serve the needs and priorities of the health system.

Women's Preferences for Maternal Healthcare Services in Bangladesh: Evidence from a Discrete Choice Experiment.

Despite substantial improvements in several maternal health indicators, childbearing and birthing remain a dangerous experience for many women in Bangladesh. This study assessed the relative importance of maternal healthcare service characteristics to Bangladeshi women when choosing a health facility to deliver their babies. The study used a mixed-methods approach. Qualitative methods (expert interviews, focus group discussions) were initially employed to identify and develop the characteristics which most influence a women's decision making when selecting a maternal health service facility. A discrete choice experiment (DCE) was then constructed to elicit women's preferences. Women were shown choice scenarios representing hypothetical health facilities with nine attributes outlined. The women were then asked to rank the attributes they considered most important in the delivery of their future babies. A Hierarchical Bayes method was used to measure mean utility parameters. A total of 601 women completed the DCE survey. The model demonstrated significant predictive strength for actual facility choice for maternal health services. The most important attributes were the following: consistent access to a female doctor, the availability of branded drugs, respectful provider attitudes, a continuum of maternal healthcare including the availability of a C-section delivery and lesser waiting times. Attended maternal healthcare utilisation rates are low despite the access to primary healthcare facilities. Further implementation of quality improvements in maternal healthcare facilities should be prioritised.