Hands-free smartphone-based diagnostics for simultaneous detection of Zika, Chikungunya, and Dengue at point-of-care.

Infectious diseases remain the world's top contributors to death and disability, and, with recent outbreaks of Zika virus infections there has been an urgency for simple, sensitive and easily translatable point-of-care tests. Here we demonstrate a novel point-of-care platform to diagnose infectious diseases from whole blood samples. A microfluidic platform performs minimal sample processing in a user-friendly diagnostics card followed by real-time reverse-transcription loop-mediated isothermal amplification (RT-LAMP) on the same card with pre-dried primers specific to viral targets. Our point-of-care platform uses a commercial smartphone to acquire real-time images of the amplification reaction and displays a visual read-out of the assay. We apply this system to detect closely related Zika, Dengue (types 1 and 3) and Chikungunya virus infections from whole blood on the same pre-printed chip with high specificity and clinically relevant sensitivity. Limit of detection of 1.56e5 PFU/mL of Zika virus from whole blood was achieved through our platform. With the ability to quantitate the target nucleic acid, this platform can also perform point-of-care patient surveillance for pathogen load or select biomarkers in whole blood.

Improvement of Liver Function, Quality of Life and Survival after Insertion of Endoprosthesis in Advance Malignant Biliary Obstruction.

Obstructive jaundice due to advance malignancy is a fatal problem. It most commonly occurs at the distal common bile duct or at the hilum of liver. Magnetic Resonance Cholangio Pancreatography (MRCP) and Computed Tomography (CT) are most useful in identifying the underlying cause as well as localize the position of the stricture. For those patients with unresectable disease, progressive jaundice constitutes an immediate threat to their survival, in addition to significant loss to their quality of life secondary to pruritus, malaise and cholangitis. Effective and lasting decompression of the biliary tree is a priority and consists of positioning of a biliary endoprosthesis (stent). To observe the improvement of liver function, quality of life and survival after successful insertion of endoprosthesis (stenting) in malignant biliary obstruction, a study was performed in the department of surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2013 to August 2014, in 50 patients with clinically visible jaundice and unresectable disease. There were significant (p<0.001) reductions in the levels of serum bilirubin, serum alkaline phosphatase, serum SGPT and Prothrombin time from the time of admission to 2 weeks and 3 weeks after stenting. Physical and functional quality of life was greatly improved 2-4 weeks after stenting, where emotional quality remained the same throughout the study period. Successful palliation by stenting of malignant biliary obstruction is a priority to achieve improvements in liver function, quality of life and prolong survival. Endoscopic stent placement appears to be safe, well tolerated and can be offered without delay as a primary treatment option for all patients with unresectable malignant biliary lesion.

Smoking has declined but not for all: findings from a study in a rural area of Bangladesh.

UNLABELLED: Smoking is one of the leading causes of death and two-thirds of the world's smokers live in 10 countries, including Bangladesh. This study examines the trend and differentials in smoking in Chakaria, Bangladesh. Data from 2 surveys conducted in 1994 and 2008 in Chakaria were used. RESULTS: showed that smoking declined from 41% in 1994 to 27% in 2008. However, the decline was lower among the poor and the rate remained the same for the female illiterate. Interventions to prevent smoking need to be designed such that they are effective in disadvantaged groups and do not contribute to widening of socioeconomic inequalities in smoking prevalence and tobacco-related ill health and death.

Calculation of costs of pregnancy- and puerperium-related care: experience from a hospital in a low-income country.

Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services.

Ethical issues in surgical intervention in medical college hospitals.

The aim of this study was to investigate the ethical issues of the patients selected for surgical interventions. A total of 105 patients were selected consecutively on the basis of defined criteria at the Department of Surgery and the Department of Gynecology & Obstetrics of Sir Salimullah Medical College Mitford Hospital, Dhaka from March 2007 to November 2007. Results showed that 76.19% of the patients were found to be literate and 23.81% were illiterate. In profession, 53.34% of the patients were found to be involved in household works, 16.19% were service holders, 12.38% were businessmen, 9.52% were cultivators, 5.71% were students and the rest were day laborers. Nearly 60.0% of the patients had no monthly income. Most of the patients were adults of age ranges from 16-70 years. Results about ethical issues showed that 52.38% of the patients had no knowledge about surgical treatment of their diseases prior to operation, 26.67% had poor knowledge and 20.95% had sufficient knowledge. Adequate counseling earlier to surgical intervention were ensured for 11.43% (n=12) patients only. Rest of the patients (88.57%) was not experienced counseling before operation. Nearly 81.0% of the patients did not understand about their treatment by surgical intervention. About 94.0% of the patients and their close relatives had no knowledge about informed consent and its importance as well as procedure of obtains but they sign it just before operation. Around 91.0% of the informed consents were not taken in presence of any witness. In postoperative counseling, 88.57% of the patients had not counseled. Nearly 66.0% of the patients did not satisfy about their treatment. In conclusion, truth-telling through counseling and informed consent were not found to be exercised properly in most of the patients undergoing surgical interventions in medical college hospitals.

The effect of an energy drink containing glucose and caffeine on human corticospinal excitability.

Glucose- and caffeine-containing energy drinks are said to influence the cognitive and cellular function within the brain. In this study, we have used the size of motor-evoked potentials (MEPs) produced in response to transcranial magnetic stimulation (TMS) of the motor cortex as an index of corticospinal excitability after ingestion of Lucozade and control drinks of glucose-containing or caffeine-containing carbonated water or carbonated water alone. With local ethical approval and informed consent, 10 healthy volunteers took part; surface electromyographic (EMG) recordings were taken from the thenar muscles of the dominant hand. In each assessment, 15 TMS stimuli were delivered over the motor cortex at an intensity of 1.1 T. Six subjects ingested a 380-ml bottle of carbonated Lucozade drink containing 68 g of glucose and 46 mg caffeine. Four subjects took part in three control trials drinking: (A) carbonated water with caffeine, (B) carbonated water with glucose and (C) carbonated water alone. Assessments were made before and at 30-min intervals after each drink. Mean fasting blood glucose concentrations and mean areas of MEPs rose after the Lucozade, remaining elevated for 90 min. Similar rises in MEP areas were seen in trials after drinking carbonated water with caffeine or with glucose, but not after drinking carbonated water alone. No change was seen in the M-wave evoked by electrical stimulation of the ulnar nerve. We conclude that Lucozade can affect the size of MEPs to activation of the motor cortex with fixed-intensity TMS. The underlying mechanism is likely to relate to the combined effects of caffeine and glucose on the brain.

Leech bite: a rare gynecologic emergency.

Vaginal bleeding as the result of a leech bite is a rare occurrence. We report 2 cases of vaginal bleeding in young girls that resulted from a leech bite and required treatment. Clinical presentation and management for young girls is described. Health professionals working in rural areas where leech infestation is common should be aware that children are at risk for leech bites in the genital region; a high index of suspicion is of great help to make an early diagnosis and ensure prompt treatment.

Policy of universal salt iodization in Bangladesh: do coastal people benefit?

Iodine deficiency disorders (IDD) are a serious public-health problem in Bangladesh and in other countries. Use of iodized salt has been promoted to solve the problem. A study was conducted in eight unions of Chakaria upazila in the Cox's Bazar district of Bangladesh during 1997-1998 to determine the prevalence of use of iodized salt, explore the reasons behind nonuse, and identify the socioeconomic correlates of its use. A quantitative survey was conducted to collect information from 21,190 households on socioeconomic status, demographic characteristics, and the kind of salt used. In-depth interviews and focus-group discussions were also conducted to understand the situation further. The results revealed that only 1.9% of the households used iodized salt. Strong barriers that limit their use of iodized salt included the wide availability of coarse salt, lack of knowledge about the link between iodized salt and IDD, and the high cost of iodized salt. Households in the salt-producing localities and those that are economically disadvantaged tend to use iodized salt less than others. Understanding of the prevalent situation will allow the policy-makers to take measures to improve the situation in the salt-producing areas.

Ordeal of women for induced abortion in a rural area of Bangladesh.

The study was carried out to document the context of induced abortion, nature of its management, and post-abortion complications in Matlab, Bangladesh. The study included all 91 cases of induced abortion that took place in the study area from July to October 1995. Information was collected from women within 60 days after the abortion. A physician carried out in-depth interviews and physical examinations of 20 randomly-selected cases. The findings depicted a complex context, within which the women had to go for an abortion. In most cases, the complete lack of use or lack of use-effectiveness of family-planning methods resulted in unwanted pregnancies. The women in desperation sought abortion services from traditional sources first. When their conditions worsened, they contacted the available modern service facilities. At times, it was too late and led to serious health consequences. Limited access to safe abortion services, together with an absence of social support, put women in a life-threatening situation. Prevention of unwanted pregnancies and access to safe abortion services are needed to improve the situation.

Family-planning services in a low-performing rural area of Bangladesh: insights from field observations.

This paper mainly reports the results of an observational study carried out during 1994-1995 in five rural unions of Bangladesh to identify the barriers to adoption of family-planning methods. At the time of the survey, one-fifth of 1,889 mothers with a living child, aged less than five years, were practising modern family-planning methods. Of the methods used, oral pill was the most common (50%), followed by injectables (20%), female sterilization (13%), IUD (11%), and condom (4%). Various factors that were responsible for the low performance of the family-planning programme included: inadequacy of motivational work by the field workers, poor counselling on the management of contraceptive-related side-effects, inadequate response to the needs of clients, irregular field visits, and poor supervision and monitoring. The efficiency of the programme needs to be improved to meet the demand for family-planning methods in Chakaria, Bangladesh.

Correlates of perceived malarial episodes and treatment-seeking behavior in a malaria-endemic rural area in Bangladesh.

Malaria is one of the most serious diseases of developing countries. In Bangladesh the estimated population at risk of malaria was calculated to be 103.7 million. This study, carried out in 1995 in villages of the malaria-endemic south-eastern part of Bangladesh aimed to identify the correlates of perceived malarial episodes and healthcare-seeking behavior. Data were collected from villagers and healthcare providers by interviewing. Seventeen percent of the study population reported an episode of malaria during the two months prior to the survey. Males reported more malarial episodes than females; irregular visitors to the jungle and day laborers reported higher prevalence of illness than their regular counterparts. Ninety-nine percent of those who reported suffering from malaria consulted a village healthcare provider within 21 days of the onset of symptoms. Contact rate was higher for those living in highlands, the economically better-off and those aged 10-14 years. The education of the household head, location of the house, the age of the individual, the duration of treatment and the kind of medication suggested were significantly associated with treatment compliance. There is a need to raise awareness about prevention and appropriate management of malarial episodes.

Gender, socioeconomic development and health-seeking behaviour in Bangladesh.

In efforts to reduce gender and socioeconomic disparities in the health of populations, the provision of medical services alone is clearly inadequate. While socioeconomic development is assumed important in rectifying gender and socioeconomic inequities in health care access, service use and ultimately, outcomes, empirical evidence of its impact is limited. Using cross-sectional data from the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper examines the impact of membership in BRAC's integrated Rural Development Programme (RDP) on gender equity and health-seeking behaviour. Differences in health care seeking are explored by comparing a sample of households who are BRAC members with a sample of BRAC-eligible non-members. Individuals from the BRAC member group report significantly less morbidity (15-day recall) than those from the non-member group, although no gender differences in the prevalence of self-reported morbidity are apparent in either group. Sick individuals from BRAC member households tend to seek care less frequently than non-members. When treatment is sought, BRAC members rely to a greater extent on home remedies, traditional care, and unqualified allopaths than non-member households. While reported treatment seeking from qualified allopaths is more prevalent in the BRAC group, non-members use the para-professional services of community health care workers almost twice as frequently. In both BRAC member and non-member groups, women suffering illness report seeking care significantly less often than men. The policy and programmatic implications of between group and gender differences in care seeking are discussed with reference to the literature.

Gender inequality and severe malnutrition among children in a remote rural area of Bangladesh.

Bangladesh typifies many south-eastern countries where female children experience inferior health and uncertain survival, especially after the neonatal period. This paper attempts to study the gender inequality in nutritional status and the effects of various socioeconomic, demographic, and health-programme factors on gender inequality in a remote rural area of Bangladesh. Measurements of mid-upper arm circumference (MUAC) were taken from 2,016 children aged less than 5 years (50.8% male, 49.2% female) in 1994. Children were characterized as severely malnourished if MUAC was < 125 mm. Independent variables included various characteristics of children, households, and mothers. Average MUAC for all children was 130 mm; 33% were severely malnourished. Of the severely-malnourished children, 54.2% were female, and 45.8% were male. The gender gap persisted in the multivariate situation, with female 1.44 times more likely to be severely malnourished. Other variables with a statistically significant relationship included the age of children, acceptance of DPT1, and education of household heads. The persistence of such a gender discrimination now when the country has achieved a lot in terms of child survival is striking. The issue is important and demands appropriate corrective actions.

The immunization programme in Bangladesh: impressive gains in coverage, but gaps remain.

The paper reviews the achievements in tetanus immunization coverage and child immunization in Bangladesh. It uses data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and non-programmatic factors that influence the coverage of tetanus (TT) immunization during pregnancy, and full immunization among children 12-23 months old in rural Bangladesh. The purpose of this analysis is to identify the areas that need further programme attention. The logistic regression results show that the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health/family planning fieldworkers and the proximity to outreach clinics had larger influences on TT coverage of poorer households compared to those better-off. The effect of distance to static clinics varied by regions. Among children, full immunization coverage (coverage of all of BCG, DPT1, DPT2, DPT3, Polio1 Polio2, Polio3) was significantly associated with distance to outreach clinics, the greater the distance to the clinics, the less the likelihood of immunization.

PIP: The authors review the achievements in tetanus immunization coverage and child immunization in Bangladesh, using data from the 1993-94 Bangladesh Demographic and Health Survey to identify and examine the programmatic and nonprogrammatic factors which influence the coverage of tetanus immunization (TT) during pregnancy, and full immunization among children aged 12-23 months old in rural Bangladesh. The research was conducted to identify which areas need additional program attention. According to logistic regression analysis, the coverage of TT immunization was significantly associated with proximity to outreach clinics and the presence of a health worker in the community. Home visits by health and family planning field workers, and the proximity to outreach clinics had more influence upon the TT coverage of poorer households than they did upon those which were more affluent. The effect of distance to static clinics varied by regions. Among children, full immunization coverage was significantly associated with distance to outreach clinics, with greater distance to the clinics reducing the likelihood of immunization.

Chronic energy deficiency in women from rural Bangladesh: some socioeconomic determinants.

This paper explores a number of socioeconomic factors thought to explain the wide prevalence of undernutrition among rural Bangladeshi women. The 1992 baseline survey data of the BRAC-ICDDR,B Joint Research Project at Matlab were used. Anthropometry was performed on a random sub-sample of 1462 currently married, non-pregnant women between 15 and 49 years of age. Women's nutritional status was defined in terms of Body Mass Index (BMI = wt in kg/ht in m2). Compared with women from better-off households, the mean weight (41.2 vs 43.0 kg; p < 0.0001), mid-upper arm circumference (MUAC) (22.1 vs 22.7; p < 0.0001), and BMI (18.5 vs 19.1; p < 0.0001) of poor women were consistently lower. However, no significant difference in mean height was found between the two groups. The results showed that women aged more than 35 years are twice as likely to have a BMI < 18.5 compared with younger women. Both years of schooling received and socioeconomic status are found to be important predictors of women's BMI. Women who have received one or more years of formal education are nearly half as likely to suffer chronic energy deficiency (BMI < 18.5) than women with no schooling. Again, better-off women are found to be 0.77 times less likely to have chronic energy deficiency than women from poor households. The implications of these findings in improving the nutritional status of rural Bangladeshi women are discussed.

PIP: This study measured undernutrition among a subsample of 1462 currently married, nonpregnant women in the Matlab Project Area of Bangladesh and examined socioeconomic determinants of women's nutritional status. Data were obtained from a 1992 Matlab Baseline Survey among randomly selected married, nonpregnant women aged 15-49 years. Anthropometric measurements were taken and a body mass index (BMI) was computed. Findings indicate that the mean BMI of poor women in 3 age groups ranged from 18.3 to 18.9. The range for better-off women was from 1.8 to 2.1. BMI declined with increasing age among both poor and better-off women. Chronic energy deficiency (CED) increased progressively among women with severe BMI (under 16.0) and moderate BMI (16.0-16.9), regardless of socioeconomic status. Factors unrelated to women suffering from mild CED (under 18.5) were religious affiliation, total number of living children, and involvement in income generation programs. Mild BMI was associated with no schooling and women who were widowed, divorced, abandoned, or married more than once. Logistic regression analysis found that age, years of schooling, and socioeconomic status predicted CED. Better-off women were 0.77 times less likely to have CED. Women in better-off groups had an average of 1.7 years of education compared to only 1.2 years among the poor. Findings indicate that nutritional status increased over time, but not parity. The lack of association with parity is explained by the potential for low parity women to be severely energy deficient.

The effect of divorce on child survival in a rural area of Bangladesh.

The data for this study come from Matlab, a rural area of Bangladesh, where a continuous registration of demographic events has been maintained by the International Centre for Diarrhoeal Disease Research, Bangladesh since 1966. A total of 11,951 first marriages of Muslims that took place in the area between 1975 and 1987 were followed until the end of 1989, to examine the relationship between parental marriage breakdown and survival of first live-born children. The impact of divorce on survival of children during infancy and childhood was examined, using hazard analysis. Other independent variables included age of mother at birth, and mother's education, year of birth, sex of children, and residence at the time of childbirth. It is shown that the net odds of death among children of divorced mothers in infancy and childhood were respectively 3.2 and 1.4 times higher than those of mothers whose marriages continued. The paper also discussed the possible mechanisms which link divorce and child survival.

The status of ORT (oral rehydration therapy) in Bangladesh: how widely is it used?

During 1980-1990 BRAC, a Bangladeshi non-governmental organization, taught over 12 million mothers how to prepare oral rehydration therapy (ORT) at home with lobon (common salt) and gur (unrefined brown sugar). This was followed by a strong promotion and distribution of prepackaged ORS by various agencies including the government. In 1993 we assessed knowledge of ORT preparation, its local availability and its use for the management of diarrhoea. Over 9000 households in 90 villages were revisited; 306 government outreach health workers, 296 drug sellers, and 237 village doctors were interviewed; 152 government facilities and 495 pharmacies/shops were visited. ORT prepared by mothers in a sub-sample of the households was analyzed for chloride content and interviewers collected information on use of ORT for diarrhoeal episodes occurring in the preceding two weeks. The data quality was assessed through a resurvey of sample respondents within two weeks of the first interview. Over 70% of the mothers could prepare a chemically 'safe and effective' ORS. A significant proportion of these mothers were very young at the time of the mass campaigns using house to house teaching, implying an intergenerational transfer of the knowledge on ORT. ORT was found to be used in 60% of all diarrhoeal episodes, but the rate varied with the type of diarrhoea, being highest for daeria (severe watery diarrhoea) and lowest for amasha (dysentery). Drug sellers and village doctors now recommend ORT much more frequently than before. Members of the medical profession (qualified and unqualified) still lag behind in prescribing the use of ORT. The availability of pre-packaged ORS in rural pharmacies has improved enormously. There is convincing evidence that the widescale promotion in the past of ORS for dehydration in diarrhoea has led to this marked improvement today. Nevertheless the use of rice-based ORS, culturally appropriate messages and the promotion of ORS with food offer opportunities to further improve the utilization of ORT.

Chakaria Community Health Project: process-oriented community development initiative for health improvement.

PIP: The Chakaria Community Health Project (CCHP) was launched during late 1994 as part of the activities of the Public Health Sciences Division of the ICDDR,B. CCHP is based in 6 unions of Chakaria thana under Cox's Bazaar district, with 2 adjacent unions in the thana serving as comparison areas. CCHP's goal is to empower community members such that they are able to avoid and manage health problems through individual and collective actions for improved and sustained health. Major objectives are to develop strategies to ensure community participation in health activities; identify and establish a threshold-level external input which gives enough impetus to community initiatives without making them dependent upon external agencies; improve public health by raising awareness about health and health problems; promote appropriate preventive and curative measures; disseminate information upon available health-related resources in the locality; and study the impact of project activities upon community health.^ieng

Women's education and employment: Matlab experience.

PIP: Educational differentials in a broad range of socioeconomic and demographic characteristics were assessed among 9853 currently married women aged 15-49 years in 60 Matlab villages. The sample was comprised of a Bangladesh Rural Advancement Committee (BRAC)-eligible group of 6144 respondents and a BRAC-noneligible group of 3543 respondents. The average BRAC-eligible mother was 31.6 years old, attended school for only one year, and had three currently living children, but would have liked to have had at least one fewer child. The mean amount of loans extended to them was higher than their mean amount of savings. The BRAC-noneligible sample was almost identical with the eligible sample with regard to the number of living and desired children, but with a higher level of schooling and slightly older. Women in this latter sample had a higher level of savings than the value of loans they had taken out. The study found women's education to have a considerable influence upon the sociodemographic aspects of women's lives. Relative to less educated women, better educated women have a broader knowledge of the outside world, are more aware of beneficial health practices and hygiene, and give more emphasis to cleanliness. Attitude and outlook can also be changed by education. There is a substantial impact of women's education upon employment; multivariate results suggest that educated women are more likely to be employed outside of the home.^ieng

Impact of BRAC's socioeconomic development programme on fertility and mortality in Matlab.

PIP: The work was undertaken to assess whether participation in BRAC's development program promotes fertility control initiatives among women and enhances the chances for child survival. Around 10,000 currently married women of reproductive age, of whom 3000 are BRAC members, have been continuously followed up with regard to their demographic events through the Demographic Surveillance System of ICDDR,B since 1993. Children born alive to these women have also been followed up for survival and migration. The study has been carried out in Matlab and covers all four cells of the BRAC-ICDDR,B study. This paper reports results from experiences gained during 1992-94. Probability of a live birth and death of children was examined. The analysis revealed that the crude birth and death rates in the BRAC-ICDDR,B intervention cells are yet to show any impact of the development program. However, an analysis of the probability of a live birth during 1993-94 among the BRAC members and non-members showed lower probability among the BRAC members. The risk of death for children of BRAC member and non-member households was also found not to be different within the study period. Further follow-up and analysis are being carried out to understand the impact and its mechanisms. Women's participation in income-generating activities in Matlab has started to show impact on fertility; however, the impact on mortality is yet to be seen.^ieng