Xpert MTB/RIF Ultra for the rapid diagnosis of extrapulmonary tuberculosis in a clinical setting of high tuberculosis prevalence country and interpretation of 'trace' results.

To evaluate the diagnostic performance of Xpert MTB/RIF Ultra (Ultra) for the diagnosis of extrapulmonary tuberculosis (EPTB) from different types of extrapulmonary specimens in comparison with culture and composite microbiological reference standard (CRS). A total of 240 specimens were prospectively collected from presumptive EPTB patients between July 2021-January 2022 and tested by Ultra, Xpert, culture and acid-fast bacilli (AFB) smear microscopy. Out of 240 specimens, 35.8 %, 20.8 %, 11.3 %, and 7.1 % were detected as Mycobacterium tuberculosis complex by Ultra, Xpert, culture and AFB microscopy, respectively. An additional 15.0 % cases were detected by Ultra compared to Xpert MTB/RIF (Xpert) assay. A total of 28 (11.7 %) cases were identified as 'trace' category by Ultra with indeterminate rifampicin resistance result; of which 36.4 % were clinically confirmed as EPTB. Compared to culture, the sensitivity and specificity of Ultra and Xpert were 100 % and 72.3 %; 92.6 % and 88.3 %, respectively. In comparison with CRS, these were respectively: 98.9 % and 100 %; 57.5 % and 100 %. For individual category of specimens, sensitivity of Ultra was 100 % with varying specificity. We found that Ultra was highly sensitive for the rapid diagnosis of EPTB and has extensive potential over current diagnostics in high TB burden countries, but 'trace' results should be interpreted with caution.

Dialysis capacity and nutrition care across Bangladesh: A situational assessment.

Hemodialysis (HD) is a treatment for ensuring the survival of end-stage kidney disease (ESKD) patients, and nutrition care is integral to their management. We sent questionnaires to evaluate the total dialysis service capacity and nutrition services across all dialysis facilities (DF) in Bangladesh, with responses from 149 out of 166 active DFs. Survey results revealed that 49.7% of DFs operated two shifts, and 42.3% operated three shifts daily, with 74.5% holding between one and ten dialysis machines. Sixty-three percent of DFs served between one and 25 patients per week, and 77% of patients received twice-weekly dialysis. The average cost for first-time dialysis was 2800 BDT per session (range: 2500-3000 BDT), but it was lower if reused dialyzers were used (2100 BDT, range: 1700-2800 BDT). Nutritionists were available in only 21% of the DFs. Parameters related to nutritional health screening (serum albumin, BMI, MIS-malnutrition inflammation assessment, and dietary intakes) were carried out in 37.6%, 23.5%, 2%, and 2% of the DFs, respectively, only if recommended by physicians. Nutrition education, if recommended, was provided in 68.5% of DFs, but only in 17.6% of them were these delivered by nutritionists. The recommendation for using renal-specific oral nutrition supplements (ONS) is not a familiar practice in Bangladeshi DFs and, therefore, was scarcely recommended. Dialysis capacity across Bangladesh is inadequate to meet current or projected needs and nutrition education and support across the DFs to benefit improving patients' quality of life is also inadequate.

Identifying Challenges and Potential Solutions for Sustainable Kidney Nutrition Care Delivery in Selected Asian Countries.

BACKGROUND: Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries. OBJECTIVE: This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia. METHOD: Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients. RESULTS: We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described. CONCLUSIONS: We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.

Diagnostic Performance of Different Laboratory Methods for the Detection of Extrapulmonary Tuberculosis.

Accurate and appropriate extrapulmonary tuberculosis (EPTB) diagnosis remains challenging due to its paucibacillary nature, requirement of invasive collection procedures, and lack of sensitive tests. This study investigated the diagnostic performance of different methods for the diagnosis of EPTB. A total of 1340 EPTB specimens were collected from presumptive EPTB patients from four different hospitals between November 2015 and March 2017. The collected specimens were tested with AFB microscopy, culture, Xpert MTB/RIF assay (Xpert), and MTBDRplus assay. Among the 1340 EPTB specimens, 49 (3.66%), 141 (10.52%), 166 (12.39%), and 154 (11.49%) were positive in AFB microscopy, culture, Xpert MTB/RIF, and MTBDRplus assay, respectively. A total of 194 (14.9%) cases were found positive in at least one of these methods. Using culture as a reference standard, the sensitivity and specificity of AFB microscopy, Xpert MTB/RIF, and MTBDRplus assay were: 27.0%/99.1%, 83.7%/96.0%, and 79.4%/96.5%, respectively. Compared to the composite reference standard, the sensitivity of culture, AFB microscopy, Xpert MTB/RIF, and MTBDRplus assay was 72.7%, 25.3%, 85.6%, and 79.4%, respectively, with a specificity of 100% for all the methods. The Xpert MTB/RIF assay showed the highest sensitivity compared to other methods. Considering the short turnaround time and promising findings, Xpert MTB/RIF assay should be integrated into national TB guidelines as a routine diagnostic test.

Knowledge, attitudes, and practices (KAP) of nutrition among school teachers in Bangladesh: A cross-sectional study.

BACKGROUND: Teachers play a pivotal role in imparting nutritional knowledge to their students. This research aimed to evaluate the nutrition-related knowledge, attitudes, and practices (KAP) of selected Bangladeshi school teachers across the country. METHODS: A cross-sectional study was performed using a multistage sampling method. A pretested and structured questionnaire was used to collect data. Statistical analyses, including descriptive statistics, multiple regression analysis, and ANOVA tests, were performed to carry out the study. RESULTS: Among the 280 participants, only 9.9% were happy with their understanding of childhood nutrition requirements, around 54.2% were familiar with basic nutrition-related knowledge, and overall, 97.7% of participants had a positive attitude towards learning about nutrition-related knowledge focusing on the well-being of children. Moreover, only 38.7% had training in pediatric nutrition. Age, type of school, type of residence, professional training of school teachers, and the intent of having ever taken part or paying attention to nutrition-related knowledge significantly impacted the respondents' nutrition knowledge score (p<0.05). CONCLUSION: Adequate planning and intervention measures should be developed to improve teachers' understanding, behavior, and practice that encourage the growth of optimal nutrition-related behavior among school-aged children to establish a healthy nation.

Current knowledge, attitude, and practice (KAP) towards physical activity (PA) and its impact on obesity management in Bangladesh: A cross-sectional study.

Background and Aims: The purpose of this study was to evaluate the Bangladeshi people's current knowledge, attitude, and practice (KAP) on obesity and physical activity (PA), as well as the associated factors. Methods: The KAP was evaluated using a standard questionnaire among 429 individuals, of whom 75.5% were men and had a mean age (±SD) of 28.9 ± 7.9 years. Using a mobile-based KoBo toolbox v.25.0 program, information was gathered from respondents who resided in various districts. A Chi-square test and a linear regression test were performed to determine the relationship between the variables, and a one-way analysis of variance (ANOVA) was conducted to the determine differences in means. Results: The study showed that more than 95% of participants had good knowledge level, although the attitude and practice levels were low. Based on ANOVA test, the mean knowledge score was significantly different (p < 0.05) with age, marital status, and education; attitude levels with education and body mass index (BMI); and practice levels with education, residence, marital status, and BMI. Linear regression analysis exhibited: the level of knowledge was associated with age (ß = -5.34), BMI (ß = 3.67), and attitude (ß = 0.46) while the level of attitude was associated with education (ß = 2.26), BMI (ß = -2.42), knowledge (ß = 0.2) and practice levels (ß = 0.18); and finally, the level of practice was associated with education (ß = -3.29), BMI (ß = -4.5) and attitude (ß = 0.35). Conclusion: The increased prevalence of obesity among the Bangladeshi population was indicated by optimal levels of knowledge but inadequate levels of attitude and practice toward PA. So, proper initiatives should be taken to educate people on the importance of regular PA to manage obesity by policymakers and the government.

Effect of stevia leaves (Stevia rebaudiana Bertoni) on diabetes: A systematic review and meta-analysis of preclinical studies.

Stevia (Stevia rebaudiana Bertoni) is a natural herb with biological activities such as anticancer, antidiabetic, anticardiovascular disease, anti-inflammatory, and antimicrobial. The current systematic review and meta-analysis of previously published data were performed to assess the antidiabetic effect of stevia leaves. Three electronic databases (PubMed, CENTRAL, and DOAJ) had been used for searching articles published before September 2020. Meta-analysis via random-effect model had been performed to assess the effects of different doses of stevia on blood glucose level (BGL) and studies were weighted according to an estimate of the standard mean difference (SMD). Overall, 16 eligible studies were selected for qualitative analysis and 9 were included for quantitative analysis. The results of the meta-analysis for BGL showed that at the doses of 200, 300, and 400 mg/kg of stevia leaves there was a significant difference in means of BGL between the intervention and control group and the dose of 500 mg/kg showed no significance (Standard mean difference (SMD): -3.84 (-9.96, 2.27); p = .22). Based on the duration of intervention, subgroup analysis of articles showed a significant difference between the groups (p < .001). The results of the meta-analysis support the hypothesis that stevia leaf has an antihyperglycemic effect and reduces the blood glucose level at doses of 200, 300, and 400 mg/kg. Therefore, more clinical trials on animals and humans have to be done to investigate the antidiabetic and antihyperglycemic effects along with the efficacy and safety of these medicinal leaves.

Diagnostic Yield of Xpert MTB/RIF Assay Using Bronchoalveolar Lavage Fluid in Detecting Mycobacterium tuberculosis among the Sputum-Scarce Suspected Pulmonary TB Patients.

Tuberculosis (TB) remains one of the leading causes of death worldwide and is caused by the single infectious agent Mycobacterium tuberculosis (Mtb). Although sputum is the most common specimen for pulmonary TB detection, some other respiratory specimens, such as bronchoalveolar lavage (BAL) fluid, gastric lavage (GL), and induced sputum (IS), are also collected from patients who are unable to deliver sputum. In this study, we aimed to evaluate the diagnostic performances of different test methods for TB diagnosis using BAL fluid specimens from sputum-scarce pulmonary TB patients. In this current study, a total of 210 BAL fluid specimens were collected and subjected to culture on Lowenstein-Jensen (L-J) medium, using an N-acetyl-L-cysteine-Sodium Hydroxide decontamination and digestion method, Xpert MTB/RIF (Xpert, Cepheid, Sunnyvale, CA, USA) assay, and acid-fast bacilli (AFB) microscopy with a Ziehl-Neelsen staining method for the detection of pulmonary TB. The sensitivity and specificity of these methods were then analyzed against the composite reference standard (CRS). Additionally, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of these assays. Among the 210 specimens, 39 (18.6%), 27 (12.8%), and 12 (5.7%) were found positive with Xpert assay, culture, and AFB microscopy, respectively. Considering the CRS, 42 (20%) were positive as the final diagnosis. The Xpert assay had a significantly higher sensitivity (92.9%, 95% CI: 80.5-98.5) compared to culture (64.3%, 95% CI: 48.0-78.4) and AFB microscopy (28.6%, 95% CI: 15.7-44.6) against the CRS. Additionally, the area under the ROC curve (AUC) for the Xpert assay, culture, and AFB microscopy accounted for 0.964, 0.821, and 0.655, respectively, when using CRS as the reference. In conclusion, our study findings demonstrated that the Xpert assay conferred a considerable diagnostic potential compared to other conventional methods for the diagnosis of pulmonary TB from BAL fluid specimens.

Protein Energy Wasting in a Cohort of Maintenance Hemodialysis Patients in Dhaka, Bangladesh.

Malnutrition is associated with high rates of mortality among patients with end stage kidney disease (ESKD). There is a paucity of data from Bangladesh, where around 35,000−40,000 people reach ESKD annually. We assessed protein-energy wasting (PEW) amongst 133 patients at a single hemodialysis setting in Dhaka. Patients were 49% male, age 50 ± 13 years, 62% were on twice-weekly hemodialysis. Anthropometric, biochemical, and laboratory evaluations revealed: BMI 24.1 ± 5.2 kg/m2, mid-arm muscle circumference (MAMC) 21.6 ± 3.6 cm, and serum albumin 3.7 ± 0.6 g/dL. Based on published criteria, 18% patients had PEW and for these patients, BMI (19.8 ± 2.4 vs. 25.2 ± 5.2 kg/m2), MAMC (19.4 ± 2.4 vs. 22.2 ± 3.8 cm), serum albumin (3.5 ± 0.7 vs. 3.8 ± 0.5 g/dL), and total cholesterol (135 ± 34 vs. 159 ± 40 mg/dL), were significantly lower as compared to non-PEW patients, while hand grip strength was similar (19.5 ± 7.6 vs. 19.7 ± 7.3 kg). Inflammatory C-reactive protein levels tended to be higher in the PEW group (20.0 ± 34.8 vs. 10.0 ± 13.9 p = 0.065). Lipoprotein analyses revealed PEW patients had significantly lower low density lipoprotein cholesterol (71 ± 29 vs. 88 ± 31 mg/dL, p < 0.05) and plasma triglyceride (132 ± 51 vs. 189 ± 103 mg/dL, p < 0.05), while high density lipoprotein cholesterol was similar. Nutritional assessments using a single 24 h recall were possible from 115 of the patients, but only 66 of these were acceptable reporters. Amongst these, while no major differences were noted between PEW and non-PEW patients, the majority of patients did not meet dietary recommendations for energy, protein, fiber, and several micronutrients (in some cases intakes were 60−90% below recommendations). Malnutrition Inflammation Scores were significantly higher in PEW patients (7.6 ± 3.1 vs. 5.3 ± 2.7 p < 0.004). No discernible differences were apparent in measured parameters between patients on twice- vs. thrice-weekly dialysis. Data from a larger cohort are needed prior to establishing patient-management guidelines for PEW in this population.

Performance of WHO-Endorsed Rapid Tests for Detection of Susceptibility to First-Line Drugs in Patients with Pulmonary Tuberculosis in Bangladesh.

The fast and accurate detection of susceptibility in drugs is a major challenge for a successful tuberculosis (TB) control programme. This study evaluated the performance of WHO-endorsed rapid diagnostic tools, such as BACTEC MGIT 960 SIRE (MGIT SIRE), GenoType MTBDRplus (MTBDRplus) and Xpert MTB/RIF (Xpert), for detecting susceptibility to first-line anti-TB drugs among pulmonary TB patients in Bangladesh. A total of 825 sputum samples with results from drug susceptibility testing (DST) against first-line anti-TB drugs in the MGIT SIRE, MTBDRplus and Xpert assays were evaluated and compared with the gold standard proportion susceptibility method of the Lowenstein-Jensen (LJ) medium. The overall sensitivities of MGIT SIRE were 97.6%, 90.0%, 61.3% and 44.9%, while specificities were 89.9%, 94.5%, 91.3% and 92.2% for detection of susceptibility to isoniazid (INH), rifampicin (RIF), streptomycin (STR) and ethambutol (EMB), respectively. For MTBDRplus, the sensitivities were 88.0% and 88.7%, and the specificities were 97.4% and 97.8% for the detection of susceptibility to INH and RIF, respectively. Xpert demonstrated a sensitivity and specificity of 94.8% and 99.5%, respectively, for the detection of RIF susceptibility. All tests performed significantly better in retreated TB patients compared with primary TB cases. For detection of RIF and INH susceptibility, all three assays showed almost perfect agreement with the LJ method, although MGIT SIRE exhibited low agreement for STR and EMB. Considering the high performance, shorter turnaround time and ease of use, molecular-based approaches Xpert and MTBDRplus can be widely implemented throughout the country for the rapid detection of drug-resistant TB.

Provision of renal-specific nutrition knowledge for changing dietary practice in Bangladeshi hemodialysis patients.

Objective: Studies show that provision of nutrition knowledge help renal patients make informed food choices. This study aimed to evaluate the impact of nutrition knowledge for changing dietary practice among Bangladeshi dialysis patients. Methods: Following development of a renal-specific nutrition booklet, a pilot study was conducted among 50 hemodialysis patients from a single dialysis setting. Demographic, anthropometric, clinical, biochemical, dietary data, and a 10-item MCQ on renal-specific nutrition information were collected before and 3 months after the provision of the booklet. Results: 52% of the participants were male, 54% had twice weekly dialysis, age 53 ± 12 years, and dialysis vintage was 46 ± 25 months. Serum potassium and phosphorous, dietary potassium, phosphorous, and phosphorous to protein ratio were significantly reduced after the provision of the booklet. Additionally, patients consuming >3 meals/day increased to 66% while adherence to renal-specific cooking method and vegetable preference were significantly increased to 70% and 62%, respectively. Conclusion: Provision of knowledge via renal-specific nutrition booklet was able to improve patients' dietary practice and enhance their dietary adherence to renal specific recommendations. Innovation: The booklet was developed using locally available food items in local language and was found beneficial in low-resource settings where overall health care facilities, including nutrition support are limited.

Factors associated with the timely initiation of antenatal care: findings from a cross-sectional study in Northern Bangladesh.

OBJECTIVE: This paper explored the factors that influence the timely initiation of antenatal care (ANC) in Bangladesh. DESIGN: This was a cross-sectional survey. SETTING: This study conducted in two rural subdistricts and one urban area from three Northern districts of Bangladesh from August to November 2016. PARTICIPANTS: Women who had a live birth in the last 1 year prior to data collection were enrolled for this study. In each study area, around 900 women were interviewed, and finally, we completed 2731 interviews. PRIMARY OUTCOME MEASURES: The primary outcome was timely first ANC from a Medically Trained Provider (MTP). RESULTS: About 43% of pregnancies were detected at their earliest time. The majority of participants (82%) received at least one ANC from an MTP. Only 11% received timely first ANC from an MTP as per the WHO FANC model. The women who detected pregnancy earlier were more likely (adj.OR 1.99, 95% CI 1.31 to 3.01) to receive the timely first ANC. The urban women were more likely (adj.OR 1.78, 95% CI 1.13 to 2.80) to receive the timely first ANC from an MTP than those of the rural women. Besides, their husbands' educational status (adj.OR 1.61, 95% CI 1.0 to 2.60) was significantly associated with the timely first ANC. CONCLUSION: Apart from sociodemographic factors, early pregnancy detection was strongly associated with the timely first ANC visit. Timely initiation of ANC is an opportunity to adhere to all the WHO recommended timely ANC visits for a pregnant woman. The findings suggest maternal, neonatal, and child health programmes to focus on the early detection of pregnancy to ensure universal ANC coverage and its timeliness.

A Food Frequency Questionnaire for Hemodialysis Patients in Bangladesh (BDHD-FFQ): Development and Validation.

Diet is a recognized risk factor and cornerstone for chronic kidney disease (CKD) management; however, a tool to assess dietary intake among Bangladeshi dialysis patients is scarce. This study aims to validate a prototype Bangladeshi Hemodialysis Food Frequency Questionnaire (BDHD-FFQ) against 3-day dietary recall (3DDR) and corresponding serum biomarkers. Nutrients of interest were energy, macronutrients, potassium, phosphate, iron, sodium and calcium. The BDHD-FFQ, comprising 132 food items, was developed from 606 24-h recalls and had undergone face and content validation. Comprehensive facets of relative validity were ascertained using six statistical tests (correlation coefficient, percent difference, paired t-test, cross-quartiles classification, weighted kappa, and Bland-Altman analysis). Overall, the BDHD-FFQ showed acceptable to good correlations (p < 0.05) with 3DDR for the concerned nutrients in unadjusted and energy-adjusted models, but this correlation was diminished when adjusted for other covariates (age, gender, and BMI). Phosphate and potassium intake, estimated by the BDHD-FFQ, also correlated well with the corresponding serum biomarkers (p < 0.01) when compared to 3DDR (p > 0.05). Cross-quartile classification indicated that <10% of patients were incorrectly classified. Weighted kappa statistics showed agreement with all but iron. Bland-Altman analysis showed positive mean differences were observed for all nutrients when compared to 3DDR, whilst energy, carbohydrates, fat, iron, sodium, and potassium had percentage data points within the limit of agreement (mean ± 1.96 SD), above 95%. In summary, the BDHD-FFQ demonstrated an acceptable relative validity for most of the nutrients as four out of the six statistical tests fulfilled the cut-off standard in assessing dietary intake of CKD patients in Bangladesh.

Correlation of gyr Mutations with the Minimum Inhibitory Concentrations of Fluoroquinolones among Multidrug-Resistant Mycobacterium tuberculosis Isolates in Bangladesh.

Fluoroquinolone (FQ) compounds-moxifloxacin (MOX), levofloxacin (LEV), and ofloxacin (OFL)-are used to treat multidrug-resistant tuberculosis (MDR-TB) globally. In this study, we investigated the correlation of gyr mutations among Mtb isolates with the MICs of MOX, LEV, and OFL in Bangladesh. A total of 50 MDR-TB isolates with gyr mutations, detected by the GenoType MTBDRsl assay, were subjected to drug susceptibility testing to determine the MICs of the FQs. Spoligotyping was performed to correlate the genetic diversity of the gyr mutant isolates with different MIC distributions. Among the 50 isolates, 44 (88%) had mutations in the gyrA gene, one (2%) had a mutation in the gyrB gene, and five (10%) isolates had unidentified mutations. The substitutions in the gyrA region were at A90V (n = 19, 38%), D94G (n = 16, 32%), D94A (n = 4, 8%), D94N/D94Y (n = 4, 8%), and S91P (n = 1, 2%), compared to the gyrB gene at N538D (n = 1.2%). D94G mutations showed the highest MICs for MOX, LEV, and OFL, ranging between 4.0 and 8.0 µg/mL, 4.0 and 16.0 µg/mL, and 16.0 and 32.0 µg/mL, respectively; while the most common substitution of A90V showed the lowest ranges of MICs (1.0-4.0 µg/mL, 2.0-8.0 µg/mL, and 4.0-32.0 µg/mL, respectively). Spoligotyping lineages demonstrated no significant differences regarding the prevalence of different gyr mutations. In conclusion, the substitutions of codon A90V and D94G in the gyr genes were mostly responsible for the FQs' resistance among Mtb isolates in Bangladesh. Low levels of resistance were associated with the substitutions of A90V, while the D94G substitutions were associated with a high level of resistance to all FQs.

Psychosocial Impact of COVID-19 among Young Bangladeshi Adults (18-34 years): An Online-Based Cross-Sectional Study.

OBJECTIVES: COVID-19 pandemic is at the fourth stage of boundless local transmission in Bangladesh. The objective of this study was to assess the psychosocial impact of COVID-19 on adult Bangladeshi population. DESIGN: Online-based cross-sectional study. SETTINGS: Data were collected from different parts of the Bangladesh. PARTICIPANTS: Information was collected from 213 young adults who were aged 18-34 years old using convenient sampling technique. RESULTS: More than 90% of participants were responded to possess a good awareness of COVID-19. However, the behavioral characteristics of young individuals in Bangladesh were not impressive. In this cohort, 24.4% of participants showed moderate change and 5.2%-little changes in their behavior due to COVID-19. Approximately 58.2% of participants had some symptoms of mental distress while 59.7% of participants were somewhat worried about COVID-19. CONCLUSION: In order to control the spread of Covid-19, existing unconsciousness in young adult could turn this situation into a disaster throughout the nation which therefore must be understood by the government and policymakers to incorporate successful measures.

Impact of knowledge, attitude, and practice on iodized salt consumption at the household level in selected coastal regions of Bangladesh.

BACKGROUND: Iodine deficiency disorder is one of the major hidden hunger for poverty-stricken coastal rural areas of Bangladesh. Despite various programs, including universal salt iodization, IDD is significantly persistent due to poverty, inadequate knowledge, poor attitude, and practice of iodized salt consumption. The present study aimed to determine iodine concentration in salt at the household level as well as the magnitude of knowledge, attitude, and practice related to iodized salt utilization and iodine deficiency disorders (IDDs). MATERIAL AND METHOD: A population-based cross-sectional study was carried out using multistage sampling among 400 households in four coastal districts in Bangladesh. A standard pretested questionnaire was used to determine the knowledge, attitude, and practice towards iodized salt consumption. The iodine level was measured using the gold standard iodometric titration technique in the collected salt samples from the selected households. RESULT: The study results revealed that almost half of the participants had good knowledge regarding a balanced diet, whereas the positive attitude and practice of balanced diet consumption was relatively low (only 16.2% and 11.3%, respectively). The respondents' education profile and age were strongly correlated with knowledge and attitude; however, the practice was not significantly correlated with age and education. The concentration of iodine in salt at household levels was strongly associated with the practice of using iodized salt. Use of adequate iodized salt was 2.838 times (OR: 2.838, 95% CI: 1.7-4.735) and 3.884 times (OR: 3.884, 95%CI: 2.029-7.433) more likely to have a positive attitude and good practice towards iodized salt and IDDs respectively. CONCLUSION: Proper knowledge about iodized salt and IDDs should be introduced to all public education premises levels. Interventions and programs can be formulated to enhance knowledge, attitude, and practice at the household level so that the consumption of adequate iodized salt can be ensured to reduce iodine deficiency problems.

Does higher body mass index increase COVID-19 severity? A systematic review and meta-analysis.

INTRODUCTION: Obesity and higher BMI is one of the leading comorbidities to increase the risk of COVID-19 severity. This paper presents a systematic review and meta-analysis estimating the effects of overweight and obesity on COVID-19 disease severity. METHOD: Two electronic databases (Medline and Cochrane library) and one grey literature database (Grey Literature Report) were searched. The risks of bias of the selected studies were assessed by using the Navigation Guide method for human data. Both random and fixed effect meta-analyses were determined using Review Manager (RevMan) software version 5.4. RESULTS: After initial screening, 12 studies were fulfilled the eligibility criteria, comprising a total of 405359 patients, and included in the systematic review. The pooled risk of COVID-19 severity was 1.31 times higher based on both fixed and random effect model among those overweight patients, I 2 0% and 2.09 and 2.41 times higher based on fixed and random effect respectively among obese patients, I 2 42% compared to healthy individuals. CONCLUSION: Overweight and obesity are found to be risk factors for disease severity of COVID-19 patients. However, further assessment of metabolic parameters is required to estimate the risk factors of COVID-19 patients and understanding the mechanism between COVID-19 and body mass index.

Factors associated with calendar literacy and last menstrual period (LMP) recall: a prospective programmatic implication to maternal health in Bangladesh.

OBJECTIVE: To explore the prevalence and determinants of calendar literacy and last menstrual period (LMP) recall among women in Bangladesh. DESIGN: Cross-sectional survey. SETTINGS: Two rural subdistricts and one urban area from three Northern districts of Bangladesh. PARTICIPANTS: We interviewed 2731 women who had a live birth in the last 1 year. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was LMP recall and the secondary outcome was calendar literacy. RESULTS: The majority of participants (65%) correctly mentioned the current date according to the English calendar while 12% mentioned according to the Bengali calendar. During the interview sessions, we used three different calendars: Bengali, English and Hijri to assess calendar literacy. We asked women to mark the current date using the calendar on the day of the interview. Almost 61% women marked the English calendar, 16% marked the Bengali calendar and 4% marked the Hijri calendar correctly. Sixty-three per cent women were found as calendar literate who marked any of the calendars. Among the participants, 58% had calendars available at their home and only 10% of women used calendars to track their LMPs. Overall, 53% women were able to recall their recent LMP. Among the calendar literate, 60% could recall their LMPs. Factors found associated with recalling LMP were: completed eight or more years of schooling (adj.OR 1.39), primigravida (adj.OR 1.88), the richest wealth quintile (adj.OR 1.55) and calendar literacy (adj.OR 1.59). CONCLUSIONS: Despite having reasonable calendar literacy and availability, the use of calendars for tracking LMP found very low. Calendar literacy and sociodemographic characteristics were found as the key factors associated with LMP recall. Maternal, neonatal and child health programmes in low-resource settings can promote a simple tool like calendar and target the communities where ultrasound is not available to ensure accurate LMP recall for early pregnancy registration and timely antenatal care coverage.

Status of the WHO recommended timing and frequency of antenatal care visits in Northern Bangladesh.

OBJECTIVE: There is dearth of information on the timeliness of antenatal care (ANC) uptake. This study aimed to determine the timely ANC uptake by a medically trained provider (MTP) as per the World Health Organization (WHO) recommendations and the country guideline. METHODS: Cross-sectional survey was done with 2,731 women having livebirth outcome in last one year in Dinajpur, Nilphamari and Rajshahi districts, Bangladesh from August-November,2016. RESULTS: About 82%(2,232) women received at least one ANC from a MTP. Overall, 78%(2,142) women received 4 or more ANCs by any provider and 43%(1168) from a MTP. Only 14%(378) women received their first ANC at the 1st trimester by a MTP. As per 4 schedule visits by the WHO FANC model and the country guideline 8%(203) and 20%(543) women respectively received the first 2 timely ANC by a MTP; where only 1%(32) and 3%(72) received the first 3 visits timely and 0.6%(17) and 1%(29) received all the four timely visits. Factors significantly associated with the first two timely visits are: 10 or above years of schooling of women [adj. OR 2.13 (CI: 1.05, 4.30)] and their husbands [adj. OR 2.40 (CI: 1.31, 4.38)], women's employment [adj. OR 2.32 (CI: 1.43, 3.76)], urban residential status [adj. OR 3.49 (CI: 2.46, 4.95)] and exposure to mass media [adj. OR 1.58 (CI: 1.07, 2.34)] at 95% confidence interval. According to the 2016 WHO ANC model, only 1.5%(40) women could comply with the first two ANC contacts timely by a MTP and no one could comply with all the timely 8 contacts. CONCLUSION: Despite high coverage of ANC utilization, timely ANC visit is low as per both the WHO recommendations and the country guideline. For better understanding, further studies on the timeliness of ANC coverage are required to design feasible intervention for improving maternal and child health.