Barriers, facilitators, perceptions and impact of interventions in implementing antimicrobial stewardship programs in hospitals of low-middle and middle countries: a scoping review.

BACKGROUND: Antimicrobial stewardship programs (ASPs) are pivotal components of the World Health Organization's Global Action Plan to combat antimicrobial resistance (AMR). ASPs advocate rational antibiotic usage to enhance patient-centered outcomes. However, existing evidence on ASPs and their determinants is largely limited to well-equipped hospitals in high-income nations. OBJECTIVE: This scoping review aimed to examine the current state of hospital-based ASPs in low- and middle-income countries (LMICs), shedding light on barriers, facilitators, prescribers' perceptions and practices, and the impact of ASP interventions. DESIGN: Scoping review on ASP. METHODS: Adhering to PRISMA guidelines, we conducted electronic database searches on PubMed, Scopus, and Google Scholar, covering ASP articles published between January 2015 and October 2023. Our review focused on four key domains: barriers to ASP implementation, facilitators for establishing ASP, ASP perceptions and practices of prescribers, and the impact of ASP interventions. Three reviewers separately retrieved relevant data from the included citations using EndNote 21.0. RESULTS: Among the 7016 articles searched, 84 met the inclusion criteria, representing 34 LMICs. Notably, 58% (49/84) of these studies were published after 2020. Barriers to ASP implementation, including human-resources shortage, lack of microbiology laboratory support, absence of leadership, and limited governmental support, were reported by 26% (22/84) of the studies. Facilitators for hospital ASP implementation identified in five publications included the availability of antibiotic guidelines, ASP protocol, dedicated multidisciplinary ASP committee, and prompt laboratory support. The majority of the research (63%, 53/84) explored the impacts of ASP intervention on clinical, microbiological, and economic aspects. Key outcomes included increased antibiotic prescription appropriateness, reduced antimicrobial consumption, shorter hospital stays, decreased mortality rate, and reduced antibiotic therapy cost. CONCLUSIONS: The published data underscores the imperative need for widespread antimicrobial stewardship in LMIC hospital settings. Substantial ASP success can be achieved through increasing human resources, context-specific interventions, the development of accessible antibiotic usage guidelines, and heightened awareness via training and education.

Prevalence and determinants of hypertension among older adults: A comparative analysis of the 6th and 8th national health surveys of Bangladesh.

BACKGROUND: Hypertension is a major public health concern in low-and middle-income countries. A nationwide Health, Population, and Nutrition Sector Development Program in Bangladesh has been shown to be effective in resource-poor settings. This article aims to investigate whether the prevalence and determinants of adult hypertension changed from 2011 to 2018. METHODS: The determinants of adult hypertension were assessed in 2011 and 2018 data of Bangladesh Demographic and Health surveys. These two surveys included both men and women over the age of 34 years and measured their blood pressure, weight, height, and other covariates. For both surveys, we estimated the age-standard prevalence of hypertension and relative, attributable and mediated risk of determinants of hypertension using hierarchical mixed-effects sequential Poisson regression models. RESULTS: The prevalence of adult hypertension increased by 10.9% from 29.5% in 2011 to 40.4% in 2018. The nationwide awareness program on the Health, Population and Nutrition Sector changed the risks associated with hypertension determinants over the years. During 2011, Socio-economic status (SES) was a major distal determinant of adult hypertension, explaining 21% of population-attributable risk (ART). However, other factors accounted for 90% of risk, mainly by excessive body weight (51%) and awareness of hypertension (39%). In contrast, SES only explained 16% of ART risk, with 97% of the risk mediated by excessive body weight (55%) and awareness of hypertension (41%). CONCLUSION: The study results highlight that hypertension among older adult was significantly increased over the six-year period. Specially, the socio-economic status, awareness of hypertension and excessive body weight were the significant determinants. Being awareness of hypertension and excessive body weight changed the causal pathways of socio-economic status. The results also highlight the value of studying the effect of non-communicable disease awareness programs to enhance our comprehension of factors influencing health.

Factors contributing to antibiotic use among children younger than five years old with fever, acute respiratory illness, and diarrhea in Bangladesh.

INTRODUCTION: Increasing antibiotic usage is a leading health threat that develops antibiotic resistance. The current practice of antibiotic use among under-five children are unavailable in Bangladesh. We aim to identify the factors of antibiotic use among under-five children with infectious diseases. METHODOLOGY: A cross-sectional multiple indicators cluster survey (MICS) was conducted in 2019 across Bangladesh. This survey of 23,099 children under the age of five was randomly selected by using a two-stage stratified sampling method. The first stage involved randomly selecting 32,200 enumeration clusters. In second stage, households where 15-45-years-old women lived were randomly selected from within each cluster. The Poisson regression models were performed to estimate the prevalence ratio (PR). RESULTS: We found 36.7% (8447/23,099) under-five children with infectious diseases. The proportion of antibiotic use was reported as 32.6%. Antibiotic use was associated with wealth (poorest vs. rich adjusted prevalence ratio (APR) = 1.07; 95% CI: 0.94-1.22) and mother's education (pre-primary vs. higher: APR = 1.14; 95% CI: 1.03-1.27). Oral and injectable antibiotics were used in cases of fever (30.5%), diarrhea (4.5%), fever with cough (47.6%). Cotrimoxazole (31.0%) and amoxicillin (29.0%) were consumed for fever with cough while cotrimoxazole (14.0%) and amoxicillin (11.0%) were consumed for fever with diarrhea. They received antibiotics from drug stores (71.9%) without prescription and private healthcare (52.1%). CONCLUSIONS: Overall, one-third of the under-five children in Bangladesh consumed antibiotics to treat infectious diseases. Multiple factors contribute to the prevalence of antibiotic use. The results highlight the need to regulate antibiotic use and prioritize national intervention programs.

Knowledge, attitudes, and practices of female health care service providers on female genital mutilation in Somalia: A cross-sectional study.

BACKGROUND: Despite a strong international standpoint against female genital mutilation, the prevalence of female genital mutilation in Somalia is extremely high. OBJECTIVES: This study assessed the knowledge, attitude, and practice of female genital mutilation among female health care service providers in order to formulate appropriate policies and programs to eliminate this harmful practice. DESIGN: Facility-based cross-sectional survey conducted in 2019 among female doctors and nurses working in Banadir Hospital, Mogadishu, Somalia. METHODS: A total of 144 female health care service providers were randomly selected, and data were collected through a pre-tested, semi-structured questionnaire. Quantitative data were analyzed by using the statistical software SPSS (Version 21), and qualitative data were analyzed thematically in accordance with the objectives of the study. RESULTS: The study found that about three-fifths of the respondents had undergone some forms of female genital mutilation during their life. An overwhelming majority believed that female genital mutilation practices were medically harmful, and a majority of them expressed their opinion against the medicalization of the practice of female genital mutilation. The study also observed a significant association between participants' age and their negative attitudes regarding the legalization of female genital mutilation. CONCLUSION: Health care service providers' effort is critical to eliminating this harmful practice from the Somalian society. Strong policy commitment and a comprehensive health-promotion effort targeting the parents and community leaders are essential to avert the negative impact of female genital mutilation.

Uptake of Influenza Vaccine and Factors Associated with Influenza Vaccination among Healthcare Workers in Tertiary Care Hospitals in Bangladesh: A Multicenter Cross-Sectional Study.

Influenza, highly contagious in hospital settings, imposes a substantial disease burden globally, and influenza vaccination is critical for healthcare workers (HCWs) to prevent this illness. This study assessed influenza vaccine uptake, including its associated factors among HCWs of tertiary care hospitals in Bangladesh. Between September and December 2020, this multicenter study included 2046 HCWs from 11 hospitals. Face-to-face interviews were conducted using a semi-structured questionnaire to collect data from physicians, nurses, and cleaning and administrative staff for the survey. Only 13.8% (283/2046) of HCWs received the influenza vaccine, of which the majority (76.7%, 217/283) received it for free from the hospital. Nurses had the highest (20.0%, 187/934) influenza vaccine coverage, followed by physicians at 13.5% (71/526), whereas cleaning staff had the lowest at 6.0% (19/318). Among unvaccinated HCWs, the desire to get vaccinated was high (86.2%), with half of the respondents even being willing to pay for it. The HCWs who were aware of the influenza vaccine were over five times more likely to get the vaccine (OR 5.63; 95% CI: 1.04, 1.88) compared to those who were not. HCWs in Bangladesh were vaccinated against influenza at a very low rate. Free and mandatory influenza vaccination programs should be initiated to optimize vaccine coverage among HCWs.

Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional survey.

INTRODUCTION: Hospital-acquired infections endanger millions of lives around the world, and nurses play a vital role in the prevention of these infections. Knowledge of infection prevention and control (IPC) best practices among nurses is a prerequisite to maintaining standard precautions for the safety of patients. AIM: The study aims to assess knowledge, attitudes, and practices (KAP) towards IPC including associated factors among the nurses of a tertiary care hospital in Bangladesh. METHODS: We conducted this hospital-based cross-sectional study from October 2017 to June 2018 at Dhaka Medical College Hospital among 300 nurses working in all departments. We calculated three KAP scores for each participant reflecting their current state of knowledge and compliance towards IPC measures. Descriptive, bivariate and multivariable analyses were conducted to determine KAP scores among nurses and their associated factors. RESULTS: Average scores for knowledge, attitudes, and practices were 18.6, 5.4, and 15.5 (out of 26, 7, and 24), respectively. The study revealed that the majority (85.2%) of the nurses had a good to moderate level of knowledge, half (51%) of them showed positive attitudes, and only one fifth (17.1%) of the nurses displayed good practices in IPC. The respondents' age, education, monthly income and years of experience were found to have statistical associations with having moderate to adequate level of KAP scores. Aged and experienced nurses were found more likely to have poor knowledge and unfavorable attitude toward IPC practices. CONCLUSION: The majority of nurses had good IPC knowledge, but their practices did not reflect that knowledge. In particular, nurses needed to improve the proper IPC practice for better patient care and to protect themselves. Regular IPC training and practice monitoring can enhance the IPC practice among nurses.

Hospitalization and Mortality by Vaccination Status among COVID-19 Patients Aged ≥ 25 Years in Bangladesh: Results from a Multicenter Cross-Sectional Study.

The COVID-19 pandemic has inflicted a massive disease burden globally, involving 623 million confirmed cases with 6.55 million deaths, and in Bangladesh, over 2.02 million clinically confirmed cases of COVID-19, with 29,371 deaths, have been reported. Evidence showed that vaccines significantly reduced infection, severity, and mortality across a wide age range of populations. This study investigated the hospitalization and mortality by vaccination status among COVID-19 patients in Bangladesh and identified the vaccine's effectiveness against severe outcomes in real-world settings. Between August and December 2021, we conducted this cross-sectional survey among 783 RT-PCR-confirmed COVID-19 hospitalized patients admitted to three dedicated COVID-19 hospitals in Bangladesh. The study used a semi-structured questionnaire to collect information. We reviewed the patient's records and gathered COVID-19 immunization status from the study participants or their caregivers. Patients with incomplete or partial data from the record were excluded from enrollment. Logistic regression analyses were performed to determine the association between key variables with a patient's vaccination status and mortality. The study revealed that overall hospitalization, severity, and morality were significantly high among unvaccinated study participants. Only one-fourth (25%) of hospitalized patients were found COVID-19 vaccinated. Morality among unvaccinated COVID-19 study participants was significantly higher (AOR: 7.17) than the vaccinated (11.17% vs. 1.53%). Severity was found to be seven times higher among unvaccinated patients. Vaccination coverage was higher in urban areas (29.8%) compared to rural parts (20.8%), and vaccine uptake was lower among female study participants (22.7%) than male (27.6%). The study highlighted the importance of COVID-19 vaccines in reducing mortality, hospitalization, and other severe consequences. We found a gap in vaccination coverage between urban and rural settings. The findings would encourage the entire population toward immunization and aid the policymakers in the ground reality so that more initiatives are taken to improve vaccination coverage among the pocket population.

Infection prevention and control in tertiary care hospitals of Bangladesh: results from WHO infection prevention and control assessment framework (IPCAF).

INTRODUCTION: Infection prevention and control (IPC) in healthcare settings is imperative for the safety of patients as well as healthcare providers. To measure current IPC activities, resources, and gaps at the facility level, WHO has developed the Infection Prevention and Control Assessment Framework (IPCAF). This study aimed to assess the existing IPC level of selected tertiary care hospitals in Bangladesh during the COVID-19 pandemic using IPCAF to explore their strengths and deficits. METHODS: Between September and December 2020, we assessed 11 tertiary-care hospitals across Bangladesh. We collected the information from IPC focal person and/or hospital administrator from each hospital using the IPCAF assessment tool.. The score was calculated based on eight core components and was used to categorize the hospitals into four distinct IPC levels- Inadequate, Basic, Intermediate, and Advanced. Key performance metrics were summarized within and between hospitals. RESULTS: The overall median IPCAF score was 355.0 (IQR: 252.5-397.5) out of 800. The majority (73%) of hospitals scored as 'Basic' IPC level, while only 18% of hospitals were categorized as 'Intermediate'. Most hospitals had IPC guidelines as well as environments, materials and equipments. Although 64% of hospitals had IPC orientation and training program for new employees, only 30% of hospitals had regular IPC training program for the staff. None of the hospitals had an IPC surveillance system with standard surveillance case definitions to track HAIs. Around 90% of hospitals did not have an active IPC monitoring and audit system. Half of the hospitals had inadequate staffing considering the workload. Bed occupancy of one patient per bed in all units was found in 55% of hospitals. About 73% of hospitals had functional hand hygiene stations, but sufficient toilets were available in only 37% of hospitals. CONCLUSION: The majority of sampled tertiary care hospitals demonstrate inadequate IPC level to ensure the safety of healthcare workers, patients, and visitors. Quality improvement programs and feedback mechanisms should be implemented to strengthen all IPC core components, particularly IPC surveillance, monitoring, education, and training, to improve healthcare safety and resilience.

Rationale and guidance for strengthening infection prevention and control measures and antimicrobial stewardship programs in Bangladesh: a study protocol.

BACKGROUND: Hospital-acquired infections (HAIs) and antimicrobial resistance (AMR) are major global health challenges. Drug-resistant infectious diseases continue to rise in developing countries, driven by shortfalls in infection control measures, antibiotic misuse, and scarcity of reliable diagnostics. These escalating global challenges have highlighted the importance of strengthening fundamental infection prevention and control (IPC) measures and implementing effective antimicrobial stewardship programs (ASP). This study aims to present a framework for enhancing IPC measures and ASP efforts to reduce the HAI and AMR burden in Bangladesh. METHODS: This implementation approach will employ a mixed-methods strategy, combining both quantitative and qualitative data from 12 tertiary hospitals in Bangladesh. A baseline assessment will be conducted using the Infection Prevention and Control Assessment Framework (IPCAF) developed by the WHO. We will record IPC practices through direct observations of hand hygiene, personal protective equipment (PPE) utilization, and hospital ward IPC infrastructure. Additionally, data on healthcare providers' knowledge, attitudes, and practices regarding IPC and antibiotic prescribing will be collected using both structured questionnaires and qualitative interviews. We will also assist the hospital leadership with establishing and/or strengthening IPC and ASP committees. Based on baseline assessments of each healthcare facility, tailored interventions and quality improvement projects will be designed and implemented. An end-line assessment will also be conducted after 12 months of intervention using the same assessment tools. The findings will be compared with the baseline to determine changes in IPC and antibiotic stewardship practices. DISCUSSION: Comprehensive assessments of healthcare facilities in low-resource settings are crucial for strengthening IPC measures and ASP activities,. This approach to assessing existing IPC and ASP activities will provide policy-relevant data for addressing current shortfalls. Moreover, this framework proposes identifying institutionally-tailored solutions, which will ensure that response activities are appropriately contextualized, aligned with stakeholder priorities, and offer sustainable solutions. CONCLUSION: Findings from this study can guide the design and implementation of feasible and sustainable interventions in resource-constrained healthcare settings to address gaps in existing IPC and ASP activities. Therefore, this protocol will be applicable across a broad range of settings to improve IPC and ASP and reduce the burden of hospital-acquired infections and AMR.

Assessing impact of ventilation on airborne transmission of SARS-CoV-2: a cross-sectional analysis of naturally ventilated healthcare settings in Bangladesh.

OBJECTIVES: To evaluate the risk of exposure to SARS-CoV-2 in naturally ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling. STUDY DESIGN: Cross-sectional study. STUDY SETTING AND STUDY SAMPLE: The study sample included nine hospitals in Dhaka, Bangladesh. Ventilation characteristics and air samples were collected from 86 healthcare spaces during October 2020 to February 2021. PRIMARY OUTCOME: Risk of cumulative SARS-CoV-2 infection by type of healthcare area. SECONDARY OUTCOMES: Ventilation rates by healthcare space; risk of airborne detection of SARS-CoV-2 across healthcare spaces; impact of room characteristics on absolute ventilation; SARS-CoV-2 detection by naturally ventilated versus mechanically ventilated spaces. RESULTS: The majority (78.7%) of naturally ventilated patient care rooms had ventilation rates that fell short of the recommended ventilation rate of 60 L/s/p. Using a modified Wells-Riley equation and local COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (7.7%). SARS-CoV-2 RNA was most frequently detected in air samples from non-COVID wards (50.0%) followed by outpatient departments (42.9%). Naturally ventilated spaces (22.6%) had higher rates of SARS-CoV-2 detection compared with mechanically ventilated spaces (8.3%), though the difference was not statistically significant (p=0.128). In multivariable linear regression with calculated elasticity, open door area and cross-ventilation were found to have a significant impact on ventilation. CONCLUSION: Our findings provide evidence that naturally ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID-designated spaces, but improving parameters of ventilation can mitigate this risk.

Hepatitis B Vaccination Coverage among Bangladeshi Healthcare Workers: Findings from Tertiary Care Hospitals.

Healthcare workers (HCWs) are at a four-fold higher risk of being infected with the hepatitis B virus in hospital settings. This study investigated the hepatitis B vaccination coverage among Bangladeshi HCWs in selected tertiary care hospitals. Between September 2020 to January 2021, a multicenter cross-sectional study was conducted in 11 hospitals across Bangladesh. Participants included physicians, nurses, cleaners, and administrative staff. A semi-structured questionnaire was used to collect data through face-to-face interviews. Descriptive and multivariate statistics were used to analyze the data. The overall hepatitis B vaccination coverage was 66.6% (1363/2046) among HCWs, with cleaning staff having the lowest at 38.8%. Among the unvaccinated, 89.2% of HCWs desired to receive the free vaccine in the near future. In the last year, over one-fourth of staff (27.9%) had at least one history of needlestick injury. Only 9.8% HCWs were found to have attended training on hepatitis B virus prevention and management in the previous two years. Multivariate analysis revealed that physicians (AOR: 7.13, 95% CI: 4.94-10.30) and nurses (AOR: 6.00, 95% CI: 4.09-8.81) were more likely to be vaccinated against hepatitis B than cleaners and administrative staff. Low uptake of hepatitis B vaccination among HCWs suggests policies that require vaccination are needed to achieve optimum vaccine coverage.

COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence.

INTRODUCTION: Rumors and conspiracy theories, can contribute to vaccine hesitancy. Monitoring online data related to COVID-19 vaccine candidates can track vaccine misinformation in real-time and assist in negating its impact. This study aimed to examine COVID-19 vaccine rumors and conspiracy theories circulating on online platforms, understand their context, and then review interventions to manage this misinformation and increase vaccine acceptance. METHOD: In June 2020, a multi-disciplinary team was formed to review and collect online rumors and conspiracy theories between 31 December 2019-30 November 2020. Sources included Google, Google Fact Check, Facebook, YouTube, Twitter, fact-checking agency websites, and television and newspaper websites. Quantitative data were extracted, entered in an Excel spreadsheet, and analyzed descriptively using the statistical package R version 4.0.3. We conducted a content analysis of the qualitative information from news articles, online reports and blogs and compared with findings from quantitative data. Based on the fact-checking agency ratings, information was categorized as true, false, misleading, or exaggerated. RESULTS: We identified 637 COVID-19 vaccine-related items: 91% were rumors and 9% were conspiracy theories from 52 countries. Of the 578 rumors, 36% were related to vaccine development, availability, and access, 20% related to morbidity and mortality, 8% to safety, efficacy, and acceptance, and the rest were other categories. Of the 637 items, 5% (30/) were true, 83% (528/637) were false, 10% (66/637) were misleading, and 2% (13/637) were exaggerated. CONCLUSIONS: Rumors and conspiracy theories may lead to mistrust contributing to vaccine hesitancy. Tracking COVID-19 vaccine misinformation in real-time and engaging with social media to disseminate correct information could help safeguard the public against misinformation.

Familial and socio-cultural barriers in maintaining tobacco-free homes in Bangladesh: a comparative cross-sectional study.

OBJECTIVES: Children, pregnant women and the elderly at a global level are all being dangerously exposed to tobacco use in the household (HH). However, there is no understanding of the familial and socio-cultural factors that provide barriers to ensuring tobacco-free homes in Bangladesh either in urban or rural areas (U&RAs). This study therefore investigates those barriers to help enable a move towards tobacco-free homes in Bangladesh. DESIGN: Comparative cross-sectional study. SETTINGS: Data were collected from both urban and rural settings in Bangladesh. PARTICIPANTS: A probability proportional sampling procedure was used to select 808 participants in U&RAs out of a total of 3715 tobacco users. Semi-structured interviews through the use of a questionnaire were conducted with the participants followed by a multivariate logistic regression analysis of the data in order to explore the familial and socio-cultural factors associated with tobacco use at home. RESULTS: The prevalence of tobacco use at home was 25.7% in urban areas and 47.6% in rural areas. In urban areas: marital status (adjusted OR (AOR)=3.23, 95% CI 1.37 to 6.61), education (AOR=2.14, 95% CI 1.15 to 3.99), the smoking habits of elderly family members (AOR=1.81, 95% CI 0.91 to 2.89), offering tobacco as a traditional form of leisure activity at home (AOR=1.85, 95% CI 0.94 to 2.95) and lack of religious practices (AOR=2.39, 95% CI 1.27 to 4.54) were identified as significant socio-cultural predictors associated with tobacco use at home. In rural areas: age (AOR=5.11, 95% CI 2.03 to 12.83), extended family (AOR=3.08, 95% CI 1.28 to 7.38), lack of religious practices (AOR=4.23, 95% CI 2.32 to 7.72), using children to buy or carry tobacco (AOR=3.33, 95% CI 1.11 to 9.99), lack of family guidance (AOR=4.27, 95% CI 2.45 to 7.42) and offering tobacco as a traditional form of leisure activity at home (AOR=3.81, 95% CI 2.23 to 6.47) were identified as significant determinants for tobacco use at home. CONCLUSION: This study concludes that socio-cultural traditions and familial norms in Bangladesh provide significant barriers for enabling tobacco-free homes. The identification of these barriers can aid policymakers and programme planners in Bangladesh in devising appropriate measures to mitigate the deadly consequences of tobacco use in the home. The consequences also include the dangers involved in family members being exposed to secondhand smoke.

Knowledge and attitudes associated with menopause among women aged 45 to 60 years: a pilot study among rural and urban women in Bangladesh.

OBJECTIVE: To assess knowledge and attitudes associated with the menopause transition among women in Bangladesh. METHODS: A cross-sectional survey was conducted among women (age range 45-60 y), 160 participants were selected from both urban and rural settings using a systematic sampling procedure. We used face-to-face interview techniques employing a semistructured questionnaire. Bivariate and multivariate regression analyses were done to assess the associated factors. RESULTS: Around one-fourth (23%) of the participants did not have a basic understanding about symptoms of menopause. Knowledge about menopause increased proportionately with higher education levels (primary education, risk ratio [RR] = 3.91, 95% confidence interval [CI] = 0.66-22.92; secondary education, RR = 6.10, 95% CI = 1.26-29.41; higher education, RR = 6.74, 95% CI = 1.33-34) and was more common among urban than rural women (P = 0.001). In addition, women who were service holders had greater knowledge about menopause compared with women who worked in the home (RR = 8.67, 95% CI = 1.94-38.58). Most of the women (96%) suffered from different kinds of depression during the menopause transition. Key barriers to gaining knowledge about menopause included access to information (63%), social stigma (57%), and shame (52%). CONCLUSIONS: Menopause is a neglected issue in Bangladesh. Accurate and appropriate information regarding premenopause and menopause can help women cope with this life transition. Social and familial support may also play a role in minimizing isolation and depression. Public health messaging to increase awareness and knowledge about menopause should be undertaken to overcome the stigma and shame associated with menopause in Bangladesh. : Video Summary:http://links.lww.com/MENO/A556.

Video Summary:http://links.lww.com/MENO/A556.

Prevailing familial, social and cultural obstacles in keeping tobacco-free homes in urban areas of Bangladesh: A mixed-method study.

BACKGROUND: Millions of children and others across the world are being dangerously exposed to tobacco smoke and toxins in their own homes. Whilst there is limited interest in laws and interventions controlling tobacco use in public places in Bangladesh, no attention has been given to preventing tobacco-use inside homes. This study explores the familial and socio-cultural factors that provide obstacles for ensuring tobacco-free homes in Bangladesh. MATERIALS AND METHODS: A mixed-method design was adopted and from among the 1,436 tobacco users identified in a population of 11,853, 400 (tobacco users) were selected for cross-sectional survey. This survey involved a probability proportional sampling procedure, and 24 In-Depth Interviews. Multivariate logistic regression was performed to explore the association of familial and socio-cultural factors with tobacco-use at home adjusted by other demographic characteristics. Thematic content analysis was done on the qualitative data, and then inferences were drawn out collectively. RESULTS: This study revealed that the prevalence of tobacco-use in the home was 25.7% in urban residential areas in Bangladesh. Multivariate logistic regression analysis identified that familial and socio-cultural factors were significantly associated with tobacco-use at home: marital status (OR 3.23, 95% CI: 1.37-6.61), education (OR 2.14, 95% CI: 1.15-3.99), smoking habits of older family members (OR 1.81 95% CI: 0.91-2.89), tobacco being offered as hospitality and for entertainment (OR 1.85, 95% CI: .94-2.95) and lack of religiosity practice (OR 2.39, 95% CI: 1.27-4.54). Qualitative findings indicated that social customs, lack of religious practice, tobacco-use of older family members, and lack of family guidance were key obstacles for enabling tobacco-free homes in urban areas. CONCLUSION: Use of tobacco at home is continuing as part of established familial and socio-cultural traditions. If tobacco-use at home is not addressed seriously by the authorities then the emerging threat of second-hand smoke exposure and harmful consequences of tobacco- use will be exacerbated.

Role of Qualified Physicians as Antenatal Care Providers in Reducing Birth Complications in Home-delivered Rural Women in Bangladesh.

Introduction Bangladesh has made significant strides in maternal and neonatal death by ensuring qualified antenatal care (ANC) visits during the pregnancy period of women. To ensure this qualified ANC, the government of Bangladesh has increased the number of qualified physicians and skilled birth attendants at health facilities and encouraged pregnant women to take this eligible ANC during pregnancy. Despite this progress, the majority of deliveries among rural women still occur at home, assisted by traditional birth attendants. These traditional birth attendants at home or even skilled birth attendants at the health facility or home are not always cable of helping women to overcome severe delivery complications. Proper birth preparation before pregnancy through qualified ANC might be a solution here. Taking advice for appropriate birth preparation from a qualified physician (medical doctor) would ensure qualified ANC. In this study, we examined how ANC from a qualified physician, as compared to other trained providers, influences rural women delivering at home to prepare for birth and reduces severe delivery complications. Methods The data of 1554 rural women who delivered at home were extracted from the 2014 Bangladesh Demographic and Health Survey data. A mixed-effects logistic regression model was carried out for the binary delivery complications data, to assess the influence of qualified physicians as ANC providers on delivery complications by adjusting the effect of other socio-demographic covariates and clustering. Results Of the women from rural areas who delivered at home, 42% reported delivery complications. Those who received ANC from a qualified physician were 32% less likely (OR 0.68; 95% CI 0.50, 0.91) to report facing delivery complications as compared to those who had received ANC from other trained or unqualified providers adjusted by socio-demographic determinants in Bangladesh. Conclusions Developing a sustained and effective strategy could be a precedent for promoting ANC from qualified physicians for rural women delivering at home, to decrease delivery complications as well as creating healthy environments for safe deliveries.

Traditional healing practices in rural Bangladesh: a qualitative investigation.

BACKGROUND: Traditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh. METHODS: During July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers. RESULTS: Majority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive. CONCLUSIONS: Traditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

Factors Influencing the Initiation of Smokeless Tobacco Consumption Among Low Socioeconomic Community in Bangladesh: A Qualitative Investigation.

This study explored factors influencing the initiation of smokeless tobacco (SLT) consumption in a low socioeconomic urban community in Bangladesh. The study conducted four focus group discussions among 33 informants involves school teachers, community leaders, women, and betel-nut shops owners. The results were prepared by thematic analysis of the transcripts where informants mean age was 30 ( SD ± 6.8) years with varying level of education. Tradition of hospitality, curiosity, offer from an elderly person, and avoiding nausea during pregnancy and at time of quitting smoking were key factors for the initiation of SLT consumption. The results also revealed most people were aware about the danger of SLT consumption but, in practice, consumed frequently. The research suggested that doctors might advise people not to use any form of SLT while they seeking health services. Furthermore, community-based awareness program could minimize the wider use of SLT among low-income community in Bangladesh.