The role of self-efficacy in women's autonomy for health and nutrition decision-making in rural Bangladesh.

BACKGROUND: Agency - including the sub-domains of intrinsic agency, instrumental agency, and collective agency - is a critical component of the women's empowerment process. Self-efficacy (a component of intrinsic agency) may operate as a motivational influence for women to make choices according to their own preferences or goals, such that higher self-efficacy would be associated with more autonomous decision-making (a key component of instrumental agency). METHODS: We examine these relationships using mixed methods. We developed a series of decision-making autonomy indices, which captured alignment between the woman's reported and preferred roles in health and nutrition decisions. Using ordinal logistic regression, we assessed the relationship between generalized self-efficacy and decision-making autonomy. RESULTS: There was a consistently positive association across all categories of decision-making, controlling for a number of individual and household-level covariates. In a sub-sample of joint decision-makers (i.e., women who reported making decisions with at least one other household member), we compared the association between generalized self-efficacy (i.e., one's overall belief in their ability to succeed) and decision-making autonomy to that of domain-specific self-efficacy (i.e., one's belief in their ability to achieve a specific goal) and decision-making autonomy. Across all decision-making categories, domain-specific self-efficacy was more strongly associated with decision-making autonomy than generalized self-efficacy. In-depth interviews provided additional context for interpretation of the regression analyses. CONCLUSIONS: The results indicate the importance of the role of self-efficacy in the women's empowerment process, even in the traditionally female-controlled areas of health and nutrition decision-making. The development of the decision-making autonomy index is an important contribution to the literature in that it directly recognizes and captures the role of women's preferences regarding participation in decision-making.

Insights into isotherms, kinetics, and thermodynamics of adsorption of acid blue 113 from an aqueous solution of nutraceutical industrial fennel seed spent.

Research studies have been carried out to accentuate Fennel Seed Spent, a by-product of the Nutraceutical Industry, as an inexpensive, recyclable and operational biosorbent for bioremediation of Acid Blue 113 (AB113) in simulated water-dye samples and textile industrial effluent (TIE). The physical process of adhesion of AB113 on the surface of the biosorbent depends on various parameters, such as the initial amount of the dye, amount and expanse of the biosorbent particles, pH of the solution and temperature of the medium. The data obtained was analyzed using three two-parameter and five three-parameter adsorption isotherm models to glean the adsorbent affinities and interaction mechanism of the adsorbate molecules and adsorbent surface. The adsorption feature study is conducted employing models of Weber-Morris, pseudo 1st and 2nd order, diffusion film model, Dumwald-Wagner and Avrami model. The study through 2nd order pseudo and Avrami models produced complementary results for the authentication of experimental data. The thermodynamic features, ΔG0, ΔH0, and ΔS0 of the adsorption process are acclaimed to be almost spontaneous, physical in nature and endothermic in their manifestation. Surface characterization was carried out using Scanner Electron Microscopy, and identification and determination of chemical species and molecular structure was performed using Infrared Spectroscopy (IR). Maximum adsorption evaluated using statistical optimization with different combinations of five independent variables to study the individual as well as combined effects by Fractional Factorial Experimental Design (FFED) was 236.18 mg g-1 under optimized conditions; pH of 2, adsorbent dosage of 0.500 g L-1, and an initial dye concentration of 209.47 mg L-1 for an adsorption time of 126.62 min with orbital shaking of 165 rpm at temperature 49.95 °C.

Diagnosing norms and norm change in rural Bangladesh: an exploration of gendered social norms and women's empowerment.

BACKGROUND: Gender-transformative public health programs often aim to address power inequities between men and women and promote women's empowerment. However, to achieve transformative change, it is necessary to first identify the underlying norms that perpetuate these power imbalances. The objective of our study was to use Bicchieri's theory of social norms and model of norm change to identify gendered norms and evidence of norm change amongst participants of the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in rural Sylhet Division, Bangladesh. METHODS: We conducted ten life history interviews, 16 key informant interviews, and four focus group discussions with women and men in communities within the FAARM study site in rural, north-eastern Bangladesh. We performed a thematic analysis as well as a relational analysis of the data. RESULTS: We found that social norms dictated the extent and ways in which women participated in household decisions, the locations they could visit, and their autonomy to use household resources. We also found evidence of changes to gendered social norms over time and the desire amongst some men and women to abandon restrictive norms. Certain intersecting factors, such as education and employment, were identified as facilitators and barriers to women's empowerment and the related gendered expectations. CONCLUSIONS: Our findings corroborate existing norms literature, which highlights the strong role social norms play in influencing women's empowerment and behaviour. Our study provides an example of rigorous qualitative methodology that others may follow to assess gendered social norms that can be targeted for transformative change.

Effect of silicon carbide on kerf convergence and irregularity of the surface during abrasive water jet machining of fiber-metal hybrid composites.

The traditional way to machine hybrid composites is hard because they tend to break, have a high retraction, have a high service temperature, and have an uneven surface irregularity. For high-strength fiber/metal composite constructions, alternative machining methods have drawn interest as a solution to these problems. Current research focuses on enhancing the Abrasive Water Jet Machining process by optimizing its variables using a composite material of epoxy reinforced with silicon carbide, stainless steel wire mesh, and Kevlar. The variables assessed are the Nozzle-to-substrate gap (S), the Abrasive discharge molding and different percentages of silicon carbide (SiC) filler (0%, 3%, and 6% by weight), three different types of hybrid laminates (H1, H2, and H3) were produced. The response surface method (RSM) was utilized in this learning, specifically on a central composite design, to calculate and optimize machining variables based on the Kerf convergence ratio (Kt) and Surface irregularity (Ra) as responses. According to the results, the traverse feed velocity, Abrasive discharge proportion, and Nozzle-to-substrate gap are the critical factors in determining Surface irregularity and Kerf convergence width (H1 laminate) for a fiber/metal laminate with 0%, 3% and 6% weight fraction. In the case of a 3% weight fraction H2 laminate, the traverse feed velocity was identified as the primary factor affecting the Kerf convergence ratio. In contrast, traverse feed velocity and Nozzle-to-substrate gap had the most significant influence on Surface irregularity. The findings also indicated that S, followed by Abrasive discharge proportion and traverse feed velocity, are the variables that have the most significant influence when cutting 6 wt% SiC filler particle fiber/metal laminate (H3 laminate). For Surface irregularity, the combination of traverse feed velocity and Nozzle-to-substrate gap had the most significant impact. To validate the optimization results, confirmatory tests was conducted, and the findings were very similar to the experimental values, indicating the accuracy and effectiveness of the optimization process. To better understand the manufacturing processes, a scanning electron microscope was used to examine the morphological features of the machined surfaces, such as delamination, fibre breakage, and fibre pull-out.

Experimental and numerical assessment of the flexural response of banana fiber sandwich epoxy composite.

Recently, most service or product-oriented industries have been focusing on their activities to uphold the green and sustainable environment protocol owing to the increased environmental pollution. Concerning this issue, industries are now concentrating on developing recyclable or waste materials products. This research advocates developing and validating a banana fiber sandwich composite to promote the beneficial usage of bio-waste. The composite sandwich specimens were fabricated with resin-impregnated woven banana fiber mat as a skin, and the core was reinforced with three different weight percentages (5, 7.5 and 10%) of chopped banana fiber. The sandwich specimens were pressed into a three-point bending test to validate the structural integrity. The flexural characteristics like flexural strength and modulus were examined experimentally, whereas the key strength indices like flexural stiffness and core shear modulus were evaluated analytically. Post-fracture surfaces were studied through a scanning electron microscope to investigate the failure mechanism. The experimental and analytical results indicate that 10% banana fiber content in the sandwich core increases the flexural strength and flexural modulus to 225% and 147%, respectively, compared to the neat epoxy core. The numerical simulation was also performed through FEA to validate the experimental findings. The numerical results are in good concurrence with the experimental one.

Development of sustainable biomass residues for biofuels applications.

A comprehensive understanding of physiochemical properties, thermal degradation behavior and chemical composition is significant for biomass residues before their thermochemical conversion for energy production. In this investigation, teff straw (TS), coffee husk (CH), corn cob (CC), and sweet sorghum stalk (SSS) residues were characterized to assess their potential applications as value-added bioenergy and chemical products. The thermal degradation behavior of CC, CH, TS and SSS samples is calculated using four different heating rates. The activation energy values ranged from 81.919 to 262.238 and 85.737-212.349 kJ mol-1 and were generated by the KAS and FWO models and aided in understanding the biomass conversion process into bio-products. The cellulose, hemicellulose, and lignin contents of CC, CH, TS, and SSS were found to be in the ranges of 31.56-41.15%, 23.9-32.02%, and 19.85-25.07%, respectively. The calorific values of the residues ranged from 17.3 to 19.7 MJ/kg, comparable to crude biomass. Scanning electron micrographs revealed agglomerated, irregular, and rough textures, with parallel lines providing nutrient and water transport pathways in all biomass samples. Energy Dispersive X-ray spectra and X-ray diffraction analysis indicated the presence of high carbonaceous material and crystalline nature. FTIR analysis identified prominent band peaks at specific wave numbers. Based on these findings, it can be concluded that these residues hold potential as energy sources for various applications, such as the textile, plastics, paints, automobile, and food additive industries.

Understanding the behavioral determinants that predict barriers and enablers of screening and treatment behaviors for diabetic retinopathy among Bangladeshi women: findings from a barrier analysis.

BACKGROUND AND AIM: While early detection and timely treatments can prevent diabetic retinopathy (DR) related blindness, barriers to receiving these DR services may cause permanent sight loss. Despite having similar prevalence to diabetes and DR, women are less likely than men to perform these behaviors due to multi-faced barriers in screening and receiving follow-up treatments for DR. This study, therefore, aimed at identifying the barriers to - and enablers of - screening and follow-up treatments behaviors for DR among women aged more than 40 years with diabetes from the behavioral perspectives in Bangladesh. METHODS: This Barrier Analysis study interviewed 360 women (180 "Doers" and 180 "Non-doers") to explore twelve behavioral determinants of four DR behaviors including screening, injection of anti-vascular endothelial growth factor (anti-VEGF medication), laser therapy and vitro-retinal surgery. The data analysis was performed to calculate estimated relative risk to identify the degree of association between the determinants and behaviors, and to find statistically significant differences (at p < 0.05) in the responses between the Doers and Non-doers. RESULTS: Access to healthcare facilities was the major barrier impeding women from performing DR behaviors. Difficulty in locating DR service centers, the need to travel long distances, the inability to travel alone and during illness, challenges of paying for transportation and managing workload significantly affected women's ability to perform the behaviors. Other determinants included women's perceived self-efficacy, perceived negative consequences (e.g. fear and discomfort associated with injections or laser treatment), and cues for action. Significant perceived enablers included low cost of DR treatments, supportive attitudes by healthcare providers, government policy, and perceived social norms. CONCLUSION: The study found a host of determinants related to the barriers to and enablers of DR screening and treatment behaviors. These determinants included perceived self-efficacy (and agency), positive and negative consequences, perceived access, perceived social norms, culture, and perceived risk. Further investments are required to enhance the availability of DR services within primary and secondary health institutions along with health behavior promotion to dispel misconceptions and fears related to DR treatments.

A comparative study on characteristics of composite (Cr3C2-NiCr) clad developed through diode laser and microwave energy.

A typical ferrite/martensitic heat-resistant steel (T91) is widely used in reheaters, superheaters and power stations. Cr3C2-NiCr-based composite coatings are known for wear-resistant coatings at elevated temperature applications. The current work compares the microstructural studies of 75 wt% Cr3C2- 25 wt% NiCr-based composite clads developed through laser and microwave energy on a T91 steel substrate. The developed clads of both processes were characterized through a field emission scanning electron microscope (FE-SEM) attached with energy-dispersive X-ray spectroscopy (EDS), X-ray diffraction (XRD) and assessment of Vickers microhardness. The Cr3C2-NiCr based clads of both processes revealed better metallurgical bonding with the chosen substrate. The microstructure of the developed laser clad shows a distinctive dense solidified structure, with a rich Ni phase occupying interdendritic spaces. In the case of microwave clad, the hard chromium carbide particles consistently dispersed within the soft nickel matrix. EDS study evidenced that the cell boundaries are lined with chromium where Fe and Ni were found inside the cells. The X-ray phase analysis of both the processes evidenced the common presence of phases like chromium carbides (Cr7C3, Cr3C2, Cr23C6), Iron Nickel (FeNi3) and chromium-nickel (Cr3Ni2, CrNi), despite these phases iron carbides (Fe7C3) are observed in the developed microwave clads. The homogeneous distributions of such carbides in the developed clad structure of both processes indicated higher hardness. The typical microhardness of the laser-clad (1142 ± 65HV) was about 22% higher than the microwave clad (940 ± 42 HV). Using a ball-on-plate test, the study analyzed microwave and laser-clad samples' wear behavior. Laser-cladding samples showed superior wear resistance due to hard carbide elements. At the same time, microwave-clad samples experienced more surface damage and material loss due to micro-cutting, loosening, and fatigue-induced fracture.

Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys.

OBJECTIVE: To examine the association between household access to water, sanitation and handwashing (WaSH) facilities and child undernutrition in Bangladesh. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study of children less than 5 years using data collected from the 2019 Multiple Indicator Cluster Survey (MICS) and the 2017-2018 Bangladesh Demographic and Health Survey (BDHS). OUTCOME MEASURES: Stunting, wasting and underweight, defined as a Z-score <-2 SD for height-for-age, weight-for-height and weight-for-age, respectively. We applied hierarchical multiple binary logistic regression models. RESULTS: Among 30 514 children 0-59 months, there was a high prevalence of child undernutrition (MICS: 28.0% stunted, 9.8% wasted, 22.6% underweight; BDHS: 30.8% stunted, 8.4% wasted, 21.7% underweight). Most children came from households lacking basic sanitation (MICS: 39.1%, BDHS: 55.3%) or handwashing facilities (MICS: 43.8%, BDHS: 62.6%). Children from households without access to WaSH facilities experienced the highest rates of undernutrition. Exposure-specific adjusted logistic regression models showed that a lack of access to improved water sources was associated with greater odds of wasting (MICS: adjusted OR (AOR) 1.36, 95% CI 1.00 to 1.85, p<0.05); basic sanitation facility with higher rates of stunting (MICS: 1.13, 1.04 to 1.23, p<0.01) and underweight (BDHS: 1.18, 1.02 to 1.37, p<0.05); and a lack of handwashing facilities with stunting (BDHS: 1.27, 1.10 to 1.48, p<0.01) and underweight (MICS: 1.10, 1.01 to 1.19, p<0.05). In fully adjusted models, no basic sanitation facility was associated with higher odds of stunting (MICS: AOR 1.12, 1.03 to 1.22, p<0.01) and a lack of handwashing facilities with higher odds of underweight (BDHS: AOR 1.30, 1.10 to 1.54, p<0.01;MICS: AOR 1.09, 1.01 to 1.19, p<0.05). CONCLUSION: These findings demonstrate a significant association between poor household WaSH facilities and high prevalence of child undernutrition. Improving WaSH may help reduce child undernutrition in Bangladesh.

Biochemical investigation of Bangladeshi black tea and their correlation to organoleptic quality evaluation.

Black tea samples were investigated for theaflavin (TF), thearubigin (TR), highly polymerized substances (HPS), total liquor color (TLC), color index (CI), caffeine (CAF), total polyphenol content (TPC), antioxidant activity (DPPH) and organoleptic evaluation. The objectives of the study was to perform the biochemical analysis and organoleptic test of various black tea and develop a correlation between them. Overall correlation study showed that TF:TR and total liquor color, are significantly (p < 0.01) and positively correlated with the total quality score where the correlation coefficient was 0.970 and 0.969 respectively. Additionally, statistical analysis revealed a significant (p < 0.01) and positive correlation between total phenol contents and antioxidant scavenging activity (0.986), supporting the notion that TPC accounts for most of the antioxidants in tea extract. Qualitative characteristics and organoleptic tests were shown identical outcomes in this study.

Experimental investigation on a solar parabolic collector using water-based multi-walled carbon-nanotube with low volume concentrations.

A limited experimental work was on multi-walled carbon nanotube (MWCNT)-water nanofluid with surfactant in the solar parabolic collector at low volume concentrations. At high-volume concentrated nanofluid, the pressure drop was more due to an increase in the viscosity of the working fluid and an increase in the nanoparticle cost; hence it is not economical. This report attempted to use Sodium Dodecyl Benzene Sulfonate (SDBS) surfactant in the low-volume concentrated MWCNT-water nanofluid to establish effective heat transfer in solar parabolic collector applications. The stable MWCNT-water nanofluid was prepared at 0.0158, 0.0238, and 0.0317 volume concentrations. The experiments were conducted from 10:00 to 16:00 at 6, 6.5 and 7 L/min flow rates concerning ASHRAE Standards. At the 7 L/min flow rate of the working fluid, having a minimum temperature difference between the working fluid and absorber tube leads to better heat transfer. The increased volume concentration of MWCNT in the water enhances the surface area interaction between water and MWCNT nanoparticles. This results in maximum solar parabolic collector efficiency at 0.0317 vol% with a 7 L/min flow rate and 10-11% higher than the distilled water.

Use of designing for behaviour change framework in identifying and addressing barriers to and enablers of animal source feeding to children ages 8-23 months in Bandarban Hill District in Bangladesh: Implications for a nutrition-sensitive agriculture programme.

Inadequate diet quality is a cause of undernutrition among children 6-23 months of age in Bangladesh, particularly in remote and isolated areas such as Bandarban District. Feeding animal source foods can help to combat stunting and wasting problems among children, but it may not be accessible or acceptable. A barrier analysis using the Designing for Behavior Change Framework was conducted in Bandarban district with participants from 4 ethnic groups, to explore potential barriers and key motivators by examining 12 behavioural determinants of consumption of animal-source food in complementary feeding for children 8-23 months. Data were collected from 45 mothers of children 8-23 months, who provided animal-source foods to their children (doers), and from 45 mothers who did not (non-doers), for a total of 90 interviews. Nine determinants were statistically significantly different between doers and non-doers as follows: self-efficacy, positive consequences, negative consequences, social norms, access, reminders, perceived risk, perceived severity and perceived action efficacy. Nearby access to purchase animal-source foods, rearing poultry or livestock at home and the support of household and community members are enablers to feeding animal-source food. In contrast, these same factors are barriers for non-doers. The lack of money to spend on animal-source foods is also a barrier. An integrated nutrition-sensitive and gender-transformative animal-based food production, and inclusive market programme could increase access to meat and eggs at the household level, increase opportunities to earn income and support gender-equitable household workloads and decision-making for optimal child feeding.

Energy, exergy and economic (3E) analysis of flat-plate solar collector using novel environmental friendly nanofluid.

The use of solar energy is one of the most prominent strategies for addressing the present energy management challenges. Solar energy is used in numerous residential sectors through flat plate solar collectors. The thermal efficiency of flat plate solar collectors is improved when conventional heat transfer fluids are replaced with nanofluids because they offer superior thermo-physical properties to conventional heat transfer fluids. Concentrated chemicals are utilized in nanofluids' conventional synthesis techniques, which produce hazardous toxic bi-products. The present research investigates the effects of novel green covalently functionalized gallic acid-treated multiwall carbon nanotubes-water nanofluid on the performance of flat plate solar collectors. GAMWCNTs are highly stable in the base fluid, according to stability analysis techniques, including ultraviolet-visible spectroscopy and zeta potential. Experimental evaluation shows that the thermo-physical properties of nanofluid are better than those of base fluid deionized water. The energy, exergy and economic analysis are performed using 0.025%, 0.065% and 0.1% weight concentrations of GAMWCNT-water at varying mass flow rates 0.010, 0.0144, 0.0188 kg/s. The introduction of GAMWCNT nanofluid enhanced the thermal performance of flat plate solar collectors in terms of energy and exergy efficiency. There is an enhancement in efficiency with the rise in heat flux, mass flow rate and weight concentration, but a decline is seen as inlet temperature increases. As per experimental findings, the highest improvement in energy efficiency is 30.88% for a 0.1% weight concentration of GAMWCNT nanofluid at 0.0188 kg/s compared to the base fluid. The collector's exergy efficiency increases with the rise in weight concentration while it decreases with an increase in flow rate. The highest exergy efficiency is achieved at 0.1% GAMWCNT concentration and 0.010 kg/s mass flow rate. GAMWCNT nanofluids have higher values for friction factor compared to the base fluid. There is a small increment in relative pumping power with increasing weight concentration of nanofluid. Performance index values of more than 1 are achieved for all GAMWCNT concentrations. When the solar thermal collector is operated at 0.0188 kg/s and 0.1% weight concentration of GAMWCNT nanofluid, the highest size reduction, 27.59%, is achieved as compared to a flat plate solar collector with water as a heat transfer fluid.

Genomic Insights Into the Mechanism of Carbapenem Resistance Dissemination in Enterobacterales From a Tertiary Public Heath Setting in South Asia.

SUMMARY: 10.6% patients were CRE positive. Only 27% patients were prescribed at least 1 antibiotic to which infecting pathogen was susceptible. Burn and ICU admission and antibiotics exposures facilitate CRE acquisition. Escherichia coli ST167 was the dominant CRE clone. BACKGROUND: Given the high prevalence of multidrug resistance (MDR) across South Asian (SA) hospitals, we documented the epidemiology of carbapenem-resistant Enterobacterales (CRE) infections at Dhaka Medical College Hospital between October 2016 and September 2017. METHODS: We enrolled patients and collected epidemiology and outcome data. All Enterobacterales were characterized phenotypically and by whole-genome sequencing. Risk assessment for the patients with CRE was performed compared with patients with carbapenem-susceptible Enterobacterales (CSE). RESULTS: 10.6% of all 1831 patients with a clinical specimen collected had CRE. In-hospital 30-day mortality was significantly higher with CRE [50/180 (27.8%)] than CSE [42/312 (13.5%)] (P = .001); however, for bloodstream infections, this was nonsignificant. Of 643 Enterobacterales isolated, 210 were CRE; blaNDM was present in 180 isolates, blaOXA-232 in 26, blaOXA-181 in 24, and blaKPC-2 in 5. Despite this, ceftriaxone was the most commonly prescribed empirical antibiotic and only 27% of patients were prescribed at least 1 antibiotic to which their infecting pathogen was susceptible. Significant risk factors for CRE isolation included burns unit and intensive care unit admission, and prior exposure to levofloxacin, amikacin, clindamycin, and meropenem. Escherichia coli ST167 was the dominant CRE clone. Clustering suggested clonal transmission of Klebsiella pneumoniae ST15 and the MDR hypervirulent clone, ST23. The major trajectories involved in horizontal gene transfer were IncFII and IncX3, IS26, and Tn3. CONCLUSIONS: This is the largest study from an SA public hospital combining outcome, microbiology, and genomics. The findings indicate the urgent implementation of targeted diagnostics, appropriate antibiotic use, and infection-control interventions in SA public institutions.

Behavioural Determinants of COVID-19-Vaccine Acceptance in Rural Areas of Six Lower- and Middle-Income Countries.

Delayed acceptance or refusal of COVID-19 vaccines may increase and prolong the threat to global public health and the economy. Identifying behavioural determinants is considered a critical step in explaining and addressing the barriers of vaccine refusal. This study aimed to identify the behavioural determinants of COVID-19-vaccine acceptance and provide recommendations to design actionable interventions to increase uptake of the COVID-19 vaccine in six lower- and middle-income countries. Taking into consideration the health belief model and the theory of reasoned action, a barrier analysis approach was employed to examine twelve potential behavioural determinants of vaccine acceptance in Bangladesh, India, Myanmar, Kenya, the Democratic Republic of the Congo (DRC), and Tanzania. In all six countries, at least 45 interviews with those who intended to get the vaccine ("Acceptors") and another 45 or more interviews with those who did not ("Non-acceptors") were conducted, totalling 542 interviews. Data analysis was performed to find statistically significant (p < 0.05) differences between Acceptors and Non-acceptors of COVID-19 vaccines and to identify which beliefs were most highly associated with acceptance and non-acceptance of vaccination based on the estimated relative risk. The analysis showed that perceived social norms, perceived positive and negative consequences, perceived risk, perceived severity, trust, perceived safety, and expected access to COVID-19 vaccines had the highest associations with COVID-19-vaccine acceptance in Bangladesh, Kenya, Tanzania, and the DRC. Additional behavioural determinants found to be significant in Myanmar and India were perceived self-efficacy, trust in COVID-19 information provided by leaders, perceived divine will, and perceived action efficacy of the COVID-19 vaccines. Many of the determinants were found to be significant, and their level of significance varied from country to country. National and local plans should include messages and activities that address the behavioural determinants found in this study to significantly increase the uptake of COVID-19 vaccines across these countries.

Antibiotics in the Community During the COVID-19 Pandemic: A Qualitative Study to Understand Users' Perspectives of Antibiotic Seeking and Consumption Behaviors in Bangladesh.

INTRODUCTION: The COVID-19 pandemic is thought to have led to increased "inappropriate" or "unjustified" seeking and consumption of antibiotics by individuals in the community. However, little reference has been made to antibiotic seeking and using behaviors from the perspectives of users in Bangladesh during this health crisis. PURPOSE: This study seeks to document how antibiotic medicines are sought and used during a complex health crisis, and, within different contexts, what are the nuanced reasons why patients may utilize these medicines sub-optimally. METHODS: We used an exploratory, qualitative design. Forty semi-structured telephone interviews were conducted with people diagnosed with COVID-19 (n=20), who had symptoms suggestive of COVID-19 (n=20), and who had received care at home in two cities between May and June 2021 in Bangladesh. In this study, an inductive thematic analysis was performed. RESULTS: The analysis highlighted the interlinked relationships of antibiotic seeking and consumption behaviors with the diversity of information disseminated during a health crisis. Antibiotic-seeking behaviors are related to previous experience of use, perceived severity of illness, perceived vulnerability, risk of infection, management of an "unknown" illness and anxiety, distrust of expert advice, and intrinsic agency on antimicrobial resistance (AMR). Suboptimal adherence, such as modifying treatment regimes and using medication prescribed for others, were found to be part of care strategies used when proven therapeutics were unavailable to treat COVID-19. Early cessation of therapy was found to be a rational practice to avoid side effects and unknown risks. CONCLUSION: Based on the results, we highly recommend the take up of a pandemic specific antimicrobial stewardship (AMS) program in the community. To deliver better outcomes of AMS, incorporating users' perspectives could be a critical strategy. Therefore, a co-produced AMS intervention that is appropriate for a specific cultural context is an essential requirement to reduce the overuse of antibiotics during the COVID-19 pandemic and beyond.

Knowledge, Attitudes, and Common Practices of Livestock and Poultry Veterinary Practitioners Regarding the AMU and AMR in Bangladesh.

Current evidence indicates that more than half of all antimicrobials are used in the animal food-producing sector, which is considered a significant risk factor for the development, spread, and existence of antimicrobial resistance (AMR) pathogens in animals, humans, and the environment. Among other factors, clinical etiology and the level of knowledge, attitudes, and practices (KAP) of veterinarians are thought to be responsible for inappropriate prescriptions in the animal-source protein production sector in lower-resource settings like Bangladesh. We performed this cross-sectional study to assess factors associated with veterinarians' antimicrobial prescription behavior and their KAP on antimicrobial use (AMU) and AMR in Bangladesh. Exploratory and multivariate logistic models were used to describe an association between knowledge, attitudes, and practices of AMU and AMR and demographic characteristics of veterinarians. The results demonstrated that when selecting an antimicrobial, there was no to minimal influence of culture and susceptibility tests and patients' AMU history but moderate to high influence of the farmer's economic condition and drug instructions among the veterinarians. The results also demonstrated that more than half of the veterinarians had correct KAP regarding AMU and AMR, while the rest had moderate or lower levels of KAP. The factor score analysis revealed that age, level of education, years of experience, gender, and previous training on AMU and AMR were the key influencing factors in their level of KAP. Adjusted logistic regression analysis showed that respondents' age, current workplace, and previous training on AMU and AMR had a positive association with increased KAP. Considering the results, it is imperative to include AMR issues on vet curricula, and to provide post-education training, awareness campaigns, easy access to, and dissemination of AMR resources. Increasing the veterinary services to the outreach areas of the country and motivating veterinarians to follow the national AMR guidelines could be some other potential solutions to tackle the over-prescriptions of antimicrobials.

Women's empowerment through homestead food production in rural Bangladesh.

BACKGROUND: Women in rural Bangladesh face multiple, inter-related challenges including food insecurity, malnutrition, and low levels of empowerment. We aimed to investigate the pathway towards empowerment experienced by women participating in a three-year nutrition-sensitive homestead food production (HFP) program, which was evaluated through the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized controlled trial. METHODS: We conducted 44 in-depth interviews and 12 focus group discussions with men and women in both intervention and control communities of the FAARM study site in rural, north-eastern Bangladesh. Using a modified grounded theory approach to data collection and analysis, we developed a framework to explain the pathway towards empowerment among HFP program participants. RESULTS: The analysis and resulting framework identified seven steps towards empowerment: 1) receiving training and materials; 2) establishing home gardens and rearing poultry; 3) experiencing initial success with food production; 4) generating social or financial resources; 5) expanding agency in household decision-making; 6) producing renewable resources (e.g. farm produce) and social resources; and 7) sustaining empowerment. The most meaningful improvements in empowerment occurred among participants who were able to produce food beyond what was needed for household consumption and were able to successfully leverage these surplus resources to gain higher bargaining power in their household. Additionally, women used negotiation skills with their husbands, fostered social support networks with other women, and developed increased self-efficacy and motivation. Meanwhile, the least empowered participants lacked support in critical areas, such as support from their spouses, social support networks, or sufficient space or time to produce enough food to meaningfully increase their contribution and therefore bargaining power within their household. CONCLUSIONS: This study developed a novel framework to describe a pathway to empowerment among female participants in an HFP intervention, as implemented in the FAARM trial. These results have implications for the design of future nutrition-sensitive agriculture interventions, which should prioritize opportunities to increase empowerment and mitigate the barriers identified in our study. TRIAL REGISTRATION: FAARM is registered with ClinicalTrials.gov ( NCT02505711 ).

Escalating SARS-CoV-2 circulation in environment and tracking waste management in South Asia.

The novel coronavirus disease of 2019 (COVID-19) pandemic has caused an exceptional drift of production, utilization, and disposal of personal protective equipment (PPE) and different microplastic objects for safety against the virus. Hence, we reviewed related literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected from household, biomedical waste, and sewage to identify possible health risks and status of existing laws, regulations, and policies regarding waste disposal in South Asian (SA) countries. The SARS-CoV-2 RNA was detected in sewage and wastewater samples of Nepal, India, Pakistan, and Bangladesh. Besides, this review reiterates the enormous amounts of PPE and other single-use plastic wastes generated from healthcare facilities and households in the SA region with inappropriate disposal, landfilling, and/or incineration techniques wind-up polluting the environment. Consequently, the Delta variant (B.1.617.2) of SARS-CoV-2 has been detected in sewer treatment plant in India. Moreover, the overuse of non-biodegradable plastics during the pandemic is deteriorating plastic pollution condition and causes a substantial health risk to the terrestrial and aquatic ecosystems. We recommend making necessary adjustments, adopting measures and strategies, and enforcement of the existing biomedical waste management and sanitation-related policy in SA countries. We propose to adopt the knowledge gaps to improve COVID-19-associated waste management and legislation to prevent further environmental pollution. Besides, the citizens should follow proper disposal procedures of COVID-19 waste to control the environmental pollution.