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BackgroundIn Bangladesh, preventive chemotherapy targeting soil-transmitted helminth (STH) infections in school-age children has been implemented since 2008. To evaluate the success of this strategy, surveys were conducted between 2017 and 2020 in 10 out of 64 districts. We estimate the geographic distribution of STH infections by species at high spatial resolution, identify risk factors, and estimate treatment needs at different population subgroups.MethodologyBayesian geostatistical models were fitted to prevalence data of each STH species. Climatic, environmental, and socioeconomic predictors were extracted from satellite images, open-access, model-based databases, and demographic household surveys, and used to predict the prevalence of infection over a gridded surface at 1 x 1 km spatial resolution across the country, via Bayesian kriging. These estimates were combined with gridded population data to estimate the number of required treatments for different risk groups.Principal findingsThe population-adjusted prevalence of Ascaris lumbricoides, Trichuris trichiura, and hookworm across all ages is estimated at 9.9% (95% Bayesian credible interval: 8.0-13.0%), 4.3% (3.0-7.3%), and 0.6% (0.4-0.9%), respectively. There were 24 out of 64 districts with an estimated population-adjusted STH infection prevalence above 20%. The proportion of households with improved sanitation showed a statistically important, protective association for both, A. lumbricoides and T. trichiura prevalence. Precipitation in the driest month of the year was negatively associated with A. lumbricoides prevalence. High organic carbon concentration in the soil's fine earth fraction was related to a high hookworm prevalence. Furthermore, we estimated that 30.5 (27.2; 36.0) million dosages of anthelmintic treatments for school-age children were required per year in Bangladesh.Conclusions/significanceFor each of the STH species, the prevalence was reduced by at least 80% since treatment was scaled up more than a decade ago. The current number of deworming dosages could be reduced by up to 61% if the treatment strategy was adapted to the local prevalence.

BackgroundSoil-transmitted helminth (STH) infections are caused by roundworms (Ascaris lumbricoides), whipworms (Trichuris trichiura), and hookworms (Necator americanus and Ancylostoma duodenale). In Uganda, baseline surveys conducted during the late 1990s and early 2000s suggested STH infections were common, with prevalence >50% among surveyed schoolchildren. In 2003, a national program was launched with mass preventative chemotherapy (PC) and health education for children 1-14 years old. Little evidence is available to show the impact of national deworming.MethodsWe conducted population-based, cross-sectional household surveys in five districts (Buikwe, Kassanda, Kiryandongo, Kisoro, and Rubanda) in March and May 2022. Our primary objective was to estimate STH prevalence by species due to infections of any intensity and infections of moderate-to-heavy intensity among preschool-aged children (PSAC, 1-4 years old), school-aged children (SAC, 5-14 years old), and women of reproductive age (WRA, 15-49 years old). Laboratory technicians used duplicate Kato-Katz microscopy to determine fecal egg count.ResultsOverall, 3,352 PSAC; 3,884 SAC; and 1,226 WRA provided stool samples. The prevalence of any infection remained high in Kisoro at or above ~50% within all risk groups. In other districts, the prevalence of any infection ranged from approximately 5 to 16% among PSAC, 6 to 23% among SAC, and 12 to 19% among WRA. Moderate-to-heavy intensity infection prevalence was highest in Kisoro (~15-26%), followed by Rubanda (ConclusionsThe STH prevalence has decreased markedly in three districts in Uganda. Based on our findings, the national deworming program should consider decreasing PC distribution frequency in these districts per the World Health Organization guidelines. Efforts are needed to understand why the Kisoro and Rubanda districts did not demonstrate similar gains.

In Sierra Leone, nationally powered school-based surveys have documented significant progress in the control of soil-transmitted helminthiasis (STH) and schistosomiasis. In order to assess the district-level prevalence and intensity of infection among key at-risk groups outside of school age children (SAC), we conducted a multi-stage, cluster-sample household survey in Bo and Kenema districts in May 2018. From both districts, we examined 1,282 pre-school age children (PSAC), 730 school age children (SAC), and 517 adults over 14 years (including 387 women of reproductive age, or WRA) for STH and Schistosoma mansoni infection using Kato Katz technique. In Bo, STH prevalence was 8.0% (95% Upper Confidence Limit 10.2%) in PSAC, 6.4% (95% Upper Confidence Limit 9.0%) in SAC, 14.1% (95% Upper Confidence Limit 17.4%) in all adults and 11.9% (95% Upper Confidence Limit 17.4%) in WRA. In Kenema, STH prevalence was 18.1% (95% Upper Confidence Limit 20.5%) in PSAC, 17.3% (95% Upper Confidence Limit 20.7%) in SAC, and 16.9% (95% Upper Confidence Limit 20.5%) in all adults and 16.9% (95% Upper Confidence Limit 22.6%) in WRA. Hookworm species were the most prevalent of STH in both districts overall. The overall prevalence of S. mansoni was

In 2008, Bangladesh initiated Preventive Chemotherapy (PCT) for school-age children (SAC) through bi-annual school-based mass drug administration (MDA) to control Soil-Transmitted Helminth (STH) infections. In 2016, the Ministry of Health and Family Welfare's Program on Lymphatic Filariasis Elimination and STH (ELFSTH) initiated district-level community impact assessments with Children Without Worms (CWW) using standardized, population-based sampling to measure the post-intervention STH burden across all ages (≥ 1 yr) for the three STH species. The Integrated Community-based Survey for Program Monitoring (ICSPM) was developed by CWW and was used to survey 12 districts in Bangladesh from 2017-2020. We excluded the first two district data as piloting caused some sampling errors and combined the individual demographic and parasite-specific characteristics from the subsequent 10 districts, linking them with the laboratory data for collective analysis. Our analysis identified district-specific epidemiologic findings, important for program decisions. Of the 17,874 enrolled individuals, our results are based on 10,824 (61.0%) stool samples. Overall, the prevalence of any STH species was substantially reduced to 14% from 79.8% in 2005. The impact was similar across all ages. STH prevalence was 14% in 10 districts collectively, but remained high in four districts, despite their high reported PCT coverage in previous years. Among all, Bhola district was unique because it was the only district with high T.trichuris prevalence. Bangladesh successfully lowered STH prevalence across all ages despite targeting SAC only. Data from the survey indicate a significant number of adults and pre-school age children (PSAC) were self-deworming with purchased pills. This may account for the flat impact curve across all ages. Overall prevalence varied across surveyed districts, with persistent high transmission in the northeastern districts and a district in the central flood zone, indicating possible service and ecological factors. Discrepancies in the impact between districts highlight the need for district-level data to evaluate program implementation after consistent high PCT coverage.

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching.

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanities