Acceptability, cost-effectiveness, and capacity of a facility-based seasonal influenza vaccination among high-risk groups: a study protocol in selected tertiary care hospitals of Bangladesh.

BACKGROUND: In Bangladesh, seasonal influenza imposes considerable disease and economic burden, especially for those at high-risk of severe disease. The most successful approach for influenza prevention is the administration of a vaccine. Many poor and middle-income nations, including Bangladesh, do not have a national strategy or program in place for seasonal influenza vaccines, despite the World Health Organization's (WHO) advice to prioritize high-risk populations. Additionally, there is a scarcity of substantial data on the cost-effectiveness of seasonal influenza vaccination in these countries. The aim of our study is to determine acceptability, health beliefs, barriers, and intention of receiving influenza vaccine among high-risk populations, assess the cost-effectiveness of implementing a facility-based seasonal influenza vaccination programme, and investigate the required capacity for a potential seasonal influenza vaccination programme. METHODS: We will undertake this study following STROBE guidelines. We will conduct the study in inpatient and outpatient departments of three selected tertiary-level hospitals leveraging the ongoing hospital-based influenza surveillance (HBIS) platform. The study population will include the WHO-defined four high-risk groups excluding healthcare workers: children six months to eight years, pregnant women, elderly ≥ 60 years, and adults with chronic diseases. We will collect quantitative data on participants' acceptability, health beliefs, barriers, and vaccination intentions using the health belief model (HBM) from patients meeting the criteria for high-risk populations attending two public tertiary-level hospitals. In one of the two public tertiary-level hospitals, we will arrange an influenza vaccination campaign before the influenza season, where the vaccine will be offered free of cost to high-risk patients, and in the second hospital, vaccination will not be offered. Both the vaccinated and unvaccinated participants will then be followed-up once a month for one year to record any influenza-like illness, hospitalization, and death. Additional data for objective two will be collected from patients with symptoms of influenza-like illness (ILI) and severe acute respiratory infection (SARI) at one public and one private hospital to determine both direct and indirect costs associated with influenza illness. We will estimate the required number of influenza vaccines, safe injections, and total storage volume utilizing secondary data. We will use a deterministic Markov decision-analytic model to estimate the cost-effectiveness of facility-based influenza vaccination in Bangladesh. DISCUSSION: The results of this study will enable the National Immunization Technical Advisory Group and the Ministry of Health & Family Welfare of Bangladesh to decide what steps to take to develop and implement an influenza vaccination strategy targeting high-risk populations. TRIAL REGISTRATION: The Clinicaltrials.gov registration number is NCT05996549. The registration for the protocol version 2.0 took place in August 2023, with the initial participant being enrolled in March 2022.

Generalized anxiety disorder among Bangladeshi university students during COVID-19 pandemic: gender specific findings from a cross-sectional study.

In the current COVID-19 pandemic there are reports of deteriorating psychological conditions among university students in lower-middle-income countries (LMICs), but very little is known about the gender differences in the mental health conditions on this population. This study aims to assess generalized anxiety disorder (GAD) among university students using a gender lens during the COVID-19 pandemic. A cross-sectional study was conducted using web-based Google forms between May 2020 and August 2020 among 605 current students of two universities in Bangladesh. Within the total 605 study participants, 59.5% (360) were female. The prevalence of mild to severe anxiety disorder was 61.8% among females and 38.2% among males. In the multivariable logistic regression analysis, females were 2.21 times more likely to have anxiety compared to males [AOR: 2.21; CI 95% (1.28-53.70); p-value: 0.004] and participants' age was negatively associated with increased levels of anxiety (AOR = 0.17; 95% CI = 0.05-0.57; p = 0.001). In addition, participants who were worried about academic delays were more anxious than those who were not worried about it (AOR: 2.82; 95% CI 1.50-5.31, p = 0.001). These findings of this study will add value to the existing limited evidence and strongly advocate in designing gender-specific, low-intensity interventions to ensure comprehensive mental health services for the young adult population of Bangladesh.

Antibiotic Prescribing Practices for Treating COVID-19 Patients in Bangladesh.

Although national and international guidelines have strongly discouraged use of antibiotics to treat COVID-19 patients with mild or moderate symptoms, antibiotics are frequently being used. This study aimed to determine antibiotics-prescribing practices among Bangladeshi physicians in treating COVID-19 patients. We conducted a cross-sectional survey among physicians involved in treating COVID-19 patients. During September-November 2021, data were collected from 511 respondents through an online Google Form and hardcopies of self-administered questionnaires. We used descriptive statistics and a regression model to identify the prevalence of prescribing antibiotics among physicians and associated factors influencing their decision making. Out of 511 enrolled physicians, 94.13% prescribed antibiotics to COVID-19 patients irrespective of disease severity. All physicians working in COVID-19-dedicated hospitals and 87% for those working in outpatient wards used antibiotics to treat COVID-19 patients. The majority (90%) of physicians reported that antibiotics should be given to COVID-19 patients with underlying respiratory conditions. The most prescribed antibiotics were meropenem, moxifloxacin, and azithromycin. Our study demonstrated high use of antibiotics for treatment of COVID-19 patients irrespective of disease severity and the duty ward of study physicians. Evidence-based interventions to promote judicious use of antibiotics for treating COVID-19 patients in Bangladesh may help in reducing an overuse of antibiotics.

Pattern of Antibiotic Dispensing at Pharmacies According to the WHO Access, Watch, Reserve (AWaRe) Classification in Bangladesh.

The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate antibiotic stewardship and optimal use. In Bangladesh, data on antibiotic dispensing in pharmacies according to the AWaRe classification are scarce. We aimed to explore antibiotic dispensing pattern in pharmacies according to the WHO AWaRe classification to aid pharmacy-targeted national antibiotic stewardship program (ASP). From January to July 2021, we interviewed drug-sellers from randomly selected pharmacies and randomly selected customers attending the pharmacies. We collected data on demographics and medicines purchased. We classified the purchased antibiotics into the Access, Watch, and Reserve groups among 128 pharmacies surveyed, 98 (76.6%) were licensed; 61 (47.7%) drug-sellers had pharmacy training. Of 2686 customers interviewed; 580 (21.6%) purchased antibiotics. Among the 580 customers, 523 purchased one, 52 purchased two, and 5 purchased three courses of antibiotics (total 642 courses). Of the antibiotic courses, the Watch group accounted for the majority (344, 53.6%), followed by the Access (234, 36.4%) and Reserve (64, 10.0%) groups. Approximately half of the antibiotics (327/642, 50.9%) were purchased without a registered physician's prescription. Dispensing of non-prescribed antibiotics was higher in the Access group (139/234, 59.4%), followed by Watch (160/344, 46.5%) and Reserve (28/64, 43.8%) groups. These findings highlight the need to implement strict policies and enforce existing laws, and pharmacy-targeted ASP focusing on proper dispensing practices to mitigate antimicrobial resistance in Bangladesh.

A Survey on Depressive Symptoms and Its Correlates Amongst Physicians in Bangladesh During the COVID-19 Pandemic.

Aim: The aim of this study was to determine the presence of depressive symptoms and understand the potential factors associated with these symptoms among physicians in Bangladesh during the COVID-19 pandemic. Methods: A cross-sectional study using an online survey was conducted in between April 21 and May 10, 2020, among physicians living in Bangladesh. Participants completed a series of demographic questions, COVID-19-related questions, and the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics (frequency, percentage, mean and standard deviation), test statistics (chi-squared test and logistic regression) were performed to explore the association between physicians' experience of depression symptoms and other study variables. Stepwise binary logistic regression was followed while conducting the multivariable analysis. Result: A total of 390 physicians completed the survey. Of them, 283 (72.6%) were found to be experiencing depressive symptoms. Predictors which were significantly associated with depressive symptoms were gender (with females more likely to experience depression than males), the presence of sleep disturbance, being highly exposed to media coverage about the pandemic, and fear around (a) COVID-19 infection, (b) being assaulted/humiliated by regulatory forces and (c) by the general public, while traveling to and from the hospital and treating patients during the countrywide lockdown. Conclusion: The findings of this study demonstrate that there is a high prevalence of depressive symptom among physicians especially among female physicians in Bangladesh during the COVID-19 pandemic. Immediate, adequate and effective interventions addressing gender specific needs are required amid this ongoing crisis and beyond.

Antibiotic Use for Febrile Illness among Under-5 Children in Bangladesh: A Nationally Representative Sample Survey.

Fever in children under five years of age is a common and predominantly self-limiting sign of illness. However, in low- and middle-income countries, antibiotics are frequently used in febrile children, although these children may not benefit from antibiotics. In this study, we explored the prevalence of, and factors associated with, antibiotic use in children under five years old with febrile illness in Bangladesh. We analysed data from the 2017-2018 Bangladesh Demographic and Health Survey to determine the prevalence of antibiotic use in children under five years of age with a febrile illness. We used a causal graph and performed a multivariable logistical regression to identify the factors associated with antibiotic use in children under five years old with febrile illness in Bangladesh. Of the 2784 children aged less than five years with fever included in our analysis, 478 (17%, 95% CI 15% to 19%) received antibiotics. Unqualified sources, including unqualified providers and pharmacies, contributed to 60% of antibiotic prescriptions in children with fever, followed by the private medical sector (29%) and the public sector (23%). The highest use of antibiotics was found in children under six months of age (25%). Children with parents who completed secondary or higher education were more likely to receive antibiotics (adjusted OR (aOR): 2.61 (95% CI 1.63 to 4.16)) than children whose parents did not complete primary education. Educational interventions promoting rational use of antibiotics and improved regulations governing over the counter purchase of antibiotics in Bangladesh may improve antibiotic dispensing practices.

Use of Antimicrobials among Suspected COVID-19 Patients at Selected Hospitals, Bangladesh: Findings from the First Wave of COVID-19 Pandemic.

Antimicrobials are empirically used in COVID-19 patients resulting in increased antimicrobial resistance. Our objective was to assess antimicrobial use among suspected COVID-19 in-patients. From March to August 2020, we collected data from in-patients of 12 tertiary-level hospitals across Bangladesh. We identified suspected COVID-19 patients; collected information on antimicrobial received within 24 h before and on hospitalization; tested nasopharyngeal swab for SARS-CoV-2 using rRT-PCR. We used descriptive statistics and a regression model for data analysis. Among 1188 suspected COVID-19 patients, 69% were male, 40% had comorbidities, and 53% required oxygen. Antibiotics were used in 92% of patients, 47% within 24 h before, and 89% on admission. Patients also received antiviral (1%) and antiparasitic drugs (3%). Third-generation cephalosporin use was the highest (708; 60%), followed by macrolide (481; 40%), and the majority (853; 78%) who took antibiotics were SARS-CoV-2 negative. On admission, 77% mild and 94% moderately ill patients received antibiotics. Antibiotic use on admission was higher among severely ill patients (AOR = 11.7; 95% CI: 4.5-30.1) and those who received antibiotics within 24 h before hospital admission (AOR = 1.6; 95% CI: 1.0-2.5). Antimicrobial use was highly prevalent among suspected COVID-19 in-patients in Bangladesh. Initiating treatment with third-generation cephalosporin among mild to moderately ill patients was common. Promoting antimicrobial stewardship with monitoring is essential to prevent blanket antibiotic use, thereby mitigating antimicrobial resistance.

Antibiotic use for acute respiratory infections among under-5 children in Bangladesh: a population-based survey.

INTRODUCTION: Despite acute respiratory infections (ARIs) being the single largest reason for antibiotic use in under-5 children in Bangladesh, the prevalence of antibiotic use in the community for an ARI episode and factors associated with antibiotic use in this age group are unknown. METHODS: We analysed nationally representative, population-based, household survey data from the Bangladesh Demographic and Health Survey 2014 to determine the prevalence of antibiotic use in the community for ARI in under-5 children. Using a causal graph and multivariable logistical regression, we then identified and determined the sociodemographic and antibiotic source factors significantly associated with the use of antibiotics for an episode of ARI. RESULTS: We analysed data for 2 144 children aged <5 years with symptoms of ARI from 17 300 households. In our sample, 829 children (39%) received antibiotics for their ARI episode (95% CI 35.4% to 42.0%). Under-5 children from rural households were 60% (adjusted OR (aOR): 1.6; 95% CI 1.2 to 2.1) more likely to receive antibiotics compared with those from urban households, largely driven by prescriptions from unqualified or traditional practitioners. Private health facilities were 50% (aOR: 0.5; 95% CI 0.3 to 0.7) less likely to be sources of antibiotics compared with public health facilities and non-governmental organisations. Age of children, sex of children or household wealth had no impact on use of antibiotics. CONCLUSION: In this first nationally representative analysis of antibiotic use in under-5 children in Bangladesh, we found almost 40% of children received antibiotics for an ARI episode. The significant prevalence of antibiotic exposure in under-5 children supports the need for coordinated policy interventions and implementation of clinical practice guidelines at point of care to minimise the adverse effects attributed to antibiotic overuse.

The Prevalence and Associated Factors of Depressive Symptoms Among Medical Students in Bangladesh During the COVID-19 Pandemic: A Cross-Sectional Pilot Study.

Background: Whilst very limited studies have demonstrated a correlation between the COVID-19 pandemic and depressive symptoms amongst Bangladeshi medical students, the prevalence and associated factors of depressive symptoms as measured by the Patient Health Questionnaire (PHQ-9) remains widely unknown. Objective: The study aimed to investigate the prevalence and factors associated with depression symptoms among Bangladeshi medical students during the COVID-19 pandemic lockdown period. Method: In this web-based cross-sectional pilot study, medical students' data was collected using the Google Forms web survey platform after obtaining electronic informed consent. A total of 425 medical students were selected using a systematic sampling technique to accumulate depression symptoms and demographic and pandemic-related information. Depression was measured by a self-administered, validated English version of the Patient Health Questionnaire (PHQ-9) tool. The descriptive analysis utilized frequency and percentages, while the stepwise binary logistic regression analysis was performed to investigate the factors associated with depressive symptoms. Result: Among 425 medical students, 62.3% were female, 97.4% unmarried. Almost 80.2% of medical students had mild to severe levels of depressive symptoms as characterized by PHQ-9. A significantly higher probability of depression was found amongst female students (adjusted OR = 1.8), those who struggled to stay away from social media (adjusted OR = 1.8), those who tried to be optimistic for maintaining better psychology (adjusted OR = 11.1), and those who always had a sleeping difficulty in the last 4 weeks (adjusted OR = 8.9). Conclusion: A very high prevalence of depression symptoms among Bangladeshi medical students was found across the majority of socio-demographic variables. The alarming prevalence and associated factors of depression suggests the need for follow-intensity psychosocial interventions designed for medical students during the COVID-19 pandemic.