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The article discusses a 2021 report on the occurrence of leaf spot symptoms on Hopea adorata trees in Bangladesh caused by Colletotrichum fragariae. It states that such spots reduce the photosynthetic area of the leaves which eventually hamper the trees' growth. Also noted is the need for management strategies to prevent the spread of the disease.

Guillain-Barré syndrome (GBS), a life-threatening autoimmune disorder, triggered by an antecedent infection mostly by Campylobacter jejuni through molecular mimicry against host nerve gangliosides. Apart from humoral immunity, innate and cell-mediated immunity, are equally involved initiating this autoimmunity. Mechanical ventilation (MV) is required by 30% patients and 20% of patients had poor prognosis after 6 months. Identifying inflammatory markers to predict GBS severity and MV in early disease stage, lead to ameliorate disease prognosis and improve clinical management. We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. The disease severity and MV were assessed by GBS- disability score (GBS-DS) and neutrophil and lymphocyte count were measured using automated hematology analyser. The median (IQR) age was 35 (21) years with male predominance (71%); 73% patients had preceding events and 34% had cranial nerves involvement, 88% were severity affected (GBS-DS> 3) and 32% required MV. The median of neutrophil count and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients compared to mild patients (P=0.005 and 0.001), however, no differences were found for platelet lymphocyte ratio (PLR) and monocyte lymphocyte ratio (MLR). NLR and MLR revealed moderate positive correlation with disease severity at enrolment (r=0.538 and 0.417) and with poor prognosis at 4 weeks (r=0.423 and 0.429). Multiple logistic regression revealed, NLR, an autonomous risk factor with 2.9 times higher risk of increasing severity and 1.6 times for MV (95% CI=1.29-6.64 and 1.15-2.18). ROC curve revealed, cut-off value of NLR was 2.432, with 71% sensitivity and 75% specificity for predicting disease severity (AUC=0.750, 95% CI=0.651-0.849, P=0.001). The cut-off of NLR with 4.4423, can predict MV with 65.9% sensitivity, 81.7% specificity (AUC=0.804, 95% CI=0.724-0.884; P= <0.001). In conclusion, NLR, can be an independent predictor of the progression of disability and requirement of MV at the early stage of GBS. [ABSTRACT FROM AUTHOR]

Evaluation of nine exotic cabbage varieties and a local variety commenced at the Research Field of the Department of Agriculture, Noakhali Science and Technology University (NSTU), Bangladesh, following a randomized complete block design (RCBD) with three replications. This study aimed to identify the most suitable exotic varieties based on morphophysiological and biochemical traits compared with a check variety. Significant variations (P < 0.01) for all the characteristics, except chlorophyll content, emerged from the study. A highly significant positive association (r ≥ 0.75) was evident for the head diameter of cabbage varieties with head width, stump thickness, core length, and weight with folded and unfolded leaves. On cluster analysis, varieties V2, V3, and V10 were in the same clusters. About the PCA, PC1 accounted for 50.29% of the total variation. However, the maximum plant diameter (65 cm) occurred in V10, and the widest leaf petiole length (8.13 cm) was visible in V3. Yet, the highest head length (13.16 cm), head diameter (19.51 cm), head width (18.33 cm), weight with unfolded leaves (2.00 kg), and weight with folded leaves (1.44 kg) appeared in V10, which are very close to V2 and V3. Also, genetic parameters estimation and heatmap analysis revealed high genetic advance and positive variation, respectively, regarding head diameter, head width, and weight with folded and unfolded leaves. Finally, V2 and V3 varieties could better serve for further genetic improvement for cabbage growers and plant breeders in Bangladesh. [ABSTRACT FROM AUTHOR]

Guillain-Barre syndrome (GBS), an immune-mediated polyneuropathy with variable clinical manifestation, prognosis and outcome. Despite of the proven efficacy of intravenous immunoglobulin (IVIg), 20% patients remain disabled with 2-19% mortality. Biomarker associated with clinical prognosis and outcome of GBS is needed to improve clinical management and effective treatment at early stage of GBS. In this study, we assessed the association between serum albumin levels, a relatively easily measurable biomarker of health and inflammation, and the clinical prognosis of GBS. We included 140 GBS patients in a prospective cohort study during 2019-2022 in Bangladesh. Detailed neurological examinations and measurement of serum albumin were done at baseline and pre-defined follow-up. Statistical comparisons between serum albumin and disease prognosis were performed using spearman correlation, ANOVA and student t-test. The median (IQR) age of 140 patients was 35 (21) years with male predominance (71%); 53 patients treated with IVIg, 29 with plasmapheresis and 58 with supportive care. Severity was higher (88%) and 48 patients required mechanical ventilation (32%). The median of serum albumin was significantly lower in severely affected patients compared to the mild cases (media [IQR]; 39.04 [7.9] vs. 42.14 [5.32], P = 0.001). Serum albumin levels had strong negative correlation with GBS disability score at enrolment (r= -0.663, P <0.0001) and moderate negative correlation at 4 weeks (r= -0.484, P <0.0001). Serum albumin level declined significantly at 2 weeks (P =0.002) and gradually increased significantly at 13 weeks (P<0.0001) and 26 weeks (P <0.0001) after treated with IVIg or plasmapheresis. Hypoalbuminemia (<34.0 g/L) was significantly associated with severity (P =0.010), mechanical ventilation and poor prognosis at 13 weeks (P =0.001) and 26 weeks (P <0.0001). In conclusion, serum albumin can be a strong prognostic biomarker to predict the disease severity and prognosis of GBS. Large sample size is required to validate the clinical relevance of the biomarkers in future. [ABSTRACT FROM AUTHOR]

From July 2015 to December 2016, the presence of rickettsial pathogens was investigated for 414 patients with unknown fever in eight places in all the divisions of Bangladesh. Rickettsia felis was identified in blood samples from all the regions (overall detection rate, 19.6%), suggesting nationwide prevalence of R. felis infections. [ABSTRACT FROM AUTHOR]

COVID-19 vaccines have been effective in preventing severe illness, hospitalization and death, however, the effectiveness diminishes with time. Here, we evaluated the longevity of antibodies generated by COIVD-19 vaccines and the risk of (re)infection in Bangladeshi population. Adults receiving two doses of AstraZeneca, Pfizer, Moderna or Sinopharm vaccines were enrolled at 2-4 weeks after second dosing and followed-up at 4-monthly interval for 1 year. Data on COVID-like symptoms, confirmed COVID-19 infection, co-morbidities, and receipt of booster dose were collected; blood was collected for measuring spike (S)- and nucleocapsid (N)-specific antibodies. S-specific antibody titers reduced by ~ 50% at 1st follow-up visit and continued to decline unless re-stimulated by booster vaccine dose or (re)infection. Individuals infected between follow-up visits showed significantly lower S-antibody titers at preceding visits compared to the uninfected individuals. Pre-enrolment infection between primary vaccination dosing exhibited 60% and 50% protection against reinfection at 5 and 9 months, respectively. mRNA vaccines provided highest odds of protection from (re)infection up to 5 months (Odds Ratio (OR) = 0.08), however, protection persisted for 9 months in AstraZeneca vaccine recipients (OR = 0.06). In conclusion, vaccine-mediated protection from (re)infection is partially linked to elevated levels of S-specific antibodies. AstraZeneca vaccine provided the longest protection., (© 2024. The Author(s).)

Using two rounds of serosurveillance, we aimed to observe the COVID-19 vaccination status and the dynamics of antibody responses to different vaccines among urban slum and non-slum populations of Bangladesh. Adults (>18 years) and children (10-17 years) were enrolled in March and October 2022. Data including COVID-19 vaccine types and dosage uptake were collected. SARS-CoV-2 spike (S)-specific antibodies were measured in blood. The proportion of vaccinated children was significantly lower among slum than non-slum populations. Two doses of vaccines showed an increase in the level of anti-S-antibodies up to 2 months, followed by reduced levels at 2-6 months and a resurgence at 6-12 months. Children showed significantly higher anti-S-antibodies after two doses of the Pfizer-BioNTech vaccine than adults; however, after 6 months, the level of antibodies declined in younger children (10 - < 12 years). In a mixed vaccine approach, mRNA vaccines contributed to the highest antibody response whether given as the first two doses or as the third dose. Our findings emphasized the need for increasing the coverage of COVID-19 vaccination among slum children and booster dosing among all children. The use of mRNA vaccines in the mixed vaccination approach was found to be useful in boosting the antibody response to SARS-CoV-2.

To assess the efficiency of genetic improvement programs, it is essential to assess the genetic trend in long-term data. The present study estimates the genetic trends for grain yield of rice varieties released between 1970 and 2020 by the Bangladesh Rice Research Institute. The yield of the varieties was assessed from 2001-2002 to 2020-2021 in multi-locations trials. In such a series of trials, yield may increase over time due to (i) genetic improvement (genetic trend) and (ii) improved management or favorable climate change (agronomic/non-genetic trend). In both the winter and monsoon seasons, we observed positive genetic and non-genetic trends. The annual genetic trend for grain yield in both winter and monsoon rice varieties was 0.01 t ha -1 , while the non-genetic trend for both seasons was 0.02 t ha -1 , corresponding to yearly genetic gains of 0.28% and 0.18% in winter and monsoon seasons, respectively. The overall percentage yield change from 1970 until 2020 for winter rice was 40.96%, of which 13.91% was genetic trend and 27.05% was non-genetic. For the monsoon season, the overall percentage change from 1973 until 2020 was 38.39%, of which genetic and non-genetic increases were 8.36% and 30.03%, respectively. Overall, the contribution of non-genetic trend is larger than genetic trend both for winter and monsoon seasons. These results suggest that limited progress has been made in improving yield in Bangladeshi rice breeding programs over the last 50 years. Breeding programs need to be modernized to deliver sufficient genetic gains in the future to sustain Bangladeshi food security., (© 2023. The Author(s).)

This study was carried out in the department of cardiac surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2014 to April 2016. This study aims to evaluate the inadvertent effect of cardiopulmonary bypass on complete blood count and coagulation profile. This study was also compared the hemostatic parameters between patients undergoing elective cardiac surgery with CPB and without CPB. A total of 55 patients were included in this study. Among them 20 patients (Group A) were selected for elective cardiac surgery without cardiopulmonary bypass (CPB), 20 patients (Group B) with cardiopulmonary bypass time less than 90 minutes and 15 patients (Group C) were included with cardiopulmonary bypass time either 90 minutes or more. The mean age were 51.5±4.7 years ranging from 40-57 years in Group A, 33.2±10.2 years ranging from 18-50 years in Group B and 34.2±11.4 years ranging from 18-57 years in Group C. The difference of age was statistically significant (p<0.05) among three groups. The difference of post-operative mean hemoglobin and RBC value, WBC and Platelet count on arrival at the intensive care unit, at 48 hours and at 7 days after surgery were statistically significant (p<0.05) in the three groups. However, on arrival at Intensive Care Unit, after 48 hours and at 7 days after surgery, the change of coagulation profile like mean fibrinogen level, bleeding time, clotting time and prothrombin time were statistically significant (p<0.05) among the groups. Patient with long cardiopulmonary bypass time had shown blood and coagulation profile abnormality and it can be minimized if we can curtail the bypass time.

Bangladesh positioned as third rice producing country in the world. In Bangladesh, regional growth and trend in rice production determinants, disparities and similarities of rice production environments are highly desirable. In this study, the secondary time series data of area, production, and yield of rice from 1969-70 to 2019-20 were used to investigate the growth and trend by periodic, regional, seasonal and total basis. Quality checking, trend fitting, and classification analysis were performed by the Durbin-Watson test, Exponential growth model, Cochrane-Orcutt iteration method and clustering method. The production contribution to the national rice production of Boro rice is increasing at 0.97% per year, where Aus and Aman season production contribution significantly decreased by 0.48% and 0.49% per year. Among the regions, Mymensingh, Rangpur, Bogura, Jashore, Rajshahi, and Chattogram contributed the most i.e., 13.9%, 9.8%, 8.6%, 8.6%, 8.2%, and 8.0%, respectively. Nationally, the area of Aus and Aman had a decreasing trend with a -3.63% and -0.16% per year, respectively. But, in the recent period (Period III) increasing trend was observed in the most regions. The Boro cultivation area is increasing with a rate of 3.57% per year during 1984-85 to 2019-20. High yielding variety adoption rate has increased over the period and in recent years it has found 72% for Aus, 73.5% for Aman, and 98.4% for Boro season. As a result, the yield of the Aus, Aman, and Boro seasons has been found increasing growth for most of the regions. We have identified different cluster regions in different seasons, indicating high dissimilarities among the rice production regions in Bangladesh. The region-wise actionable plan should be taken to rapidly adopt new varieties, management technologies and extension activities in lower contributor regions to improve productivity. Cluster-wise, policy strategies should be implemented for top and less contributor regions to ensure rice security of Bangladesh., Competing Interests: The authors have declared that no competing interests exist.

Every year Bangladesh faces enormous damages due to flooding. Facing these damages the Government adopts various recovery approaches. However, the psychological dimension of any disaster is generally overlooked in disaster management. Researchers have found that the spatial distribution of post-disaster mental health can help the authorities to apply recovery procedures where they are most needed. For this research, Posttraumatic Stress Checklist (PCL-5), Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to estimate posttraumatic stress, major depressive disorder and anxiety following three episodes of severe floods in 2017 that affected at least 8 million people. To better understand the spatial pattern of psychological vulnerability and reach a comprehensive scenario of post-disaster mental health, Moran's I was applied for spatial autocorrelation and Pearson's correlation and regression analysis for a study of the relationship between the psychological aspects. It was found that psychological vulnerability showed a spatial clustering pattern and that there was a strong positive linear relationship among psychological aspects in the study area. This research might help to adopt disaster management policies that consider the psychological dimension and spatial distribution of various psychological aspects to identify areas characterized by high vulnerability and risk so that they can be reached without delay.

The aim of this research was to test the hypothesis that people in a typical high-transport zone are particularly vulnerable with respect to transmission of coronavirus disease 2019 (COVID-19), a new contagious disease that has rapidly developed into a highrisk global problem. A case study was carried out in Savar Upazila, a sub-district of the capital city Dhaka in Bangladesh, which is traversed by a prominent national highway (Dhaka- Aricha-N5) that also passes the concentric industrial export processing zone surrounding Dhaka. This municipality is thus part of a high-density transport network with extensive economic activities. COVID-19 data were collected from local records at the Upazila Health Complex, while spatial data of the Savar Upazila, including the pertinent road network, were identified and digitized using geographical information systems software. The presence of COVID-19 in in Savar Upazila was found to be strongly associated with the reach and mechanism of transport networks (Pearson correlation = 0.76 with 99% confidence interval).

Introduction: Disparities in health outcomes and access to maternal neonatal and child health (MNCH) are apparent among urban poor compared with national, rural or urban averages. A fundamental first step in addressing inequities in MNCH services is knowing what services exist in urban areas, where these are located, who provides them and who uses them. This study aims to institutionalise the Urban Health Atlas (UHA)-a novel information and communications technology (ICT) tool-to strengthen health service delivery and oversight and generate critical evidence to inform health policy and planning in urban Bangladesh., Methods and Analysis: This mixed-method implementation research will be conducted in four purposively selected urban sites representing larger and smaller cities. Research activities will include an assessment of information needs and task review analysis of information users, stakeholder mapping and cost estimation. To document stakeholder perceptions and experiences, key informant interviews and in-depth interviews will be conducted along with desk reviews to understand MNCH planning and referral decisions. The UHA will be refined to increase responsiveness to user needs and capacities, and hands-on training will be provided to health managers. Cost estimation will be conducted to assess the financial implications of UHA uptake and scale-up. Systematic documentation of the implementation process will be undertaken. Policy decision-making and ICT health policy process flowcharts will be prepared using desk reviews and qualitative interviews. Thematic analysis of qualitative data will involve both emergent and a priori coding guided by WHO PATH toolkit and Policy Engagement Framework. Stakeholder analysis will apply standard techniques and measurement scales. Descriptive analysis of quantitative data and cost estimation analysis will also be performed., Ethics and Dissemination: The study has been approved by the Institutional Review Board of icddr,b (# PR-16057). Study findings will be disseminated through national and international workshops, conferences, policy briefs and peer-reviewed publications., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Backgrounds: Approximately, half of the population in the world including tropical and sub-tropical climates region is at risk of dengue. Being an endemic country, Bangladesh has experienced the largest dengue epidemic in 2019. The present study aimed at evaluating the clinical and laboratory profile of dengue patients in northern Bangladesh during the epidemic., Methods: This cross-sectional study included 319 serologically confirmed dengue patients admitted in Shaheed Ziaur Rahman Medical College Hospital in Bogra district. It is one of the main tertiary care hospitals in northern Bangladesh. Data were collected from July to September 2019. Patients' clinical and laboratory data were extracted from clinical records. Patients were classified into two classes according to the WHO 2009 dengue classification such as (i) non-severe dengue and (ii) severe dengue. Chi-square test and independent t-test were used in this study., Results: Of the 319 patients, 94.1% had non-severe dengue and the remaining 5.9% had severe dengue (severe plasma leakage 68.4%, severe organ involvement 68.4%, and severe clinical bleeding 10.5%). Most of the patients were suffering from primary dengue infection. The most common clinical presentation was fever followed by headache and myalgia. Vomiting and abdominal pain were the most prevalent warning signs. The common hematological findings on admission were leukopenia (63.3%), thrombocytopenia (30.4%) and increased hematocrit (26.6%). Raised serum ALT or AST was observed in 14.1% cases whereas raised serum creatinine was observed in 6.6% cases. Signs of plasma leakage (pleural effusion, respiratory distress, and ascites, rise of hematocrit >20% during hospital stay) and hepatic or renal involvement (serum ALT >42UI/L or serum creatinine >1.2 mg/dL) on admission were mostly associated with severe dengue., Conclusion: The study provides clinical evidence on presentation as well as hematological and biochemical profile of dengue patients in northern Bangladesh that should be implicated in effective patient management., Competing Interests: The authors have declared that no competing interests exist.

Background: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017., Methods: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning., Results: Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531 956 (uncertainty interval (UI): 484 107 to 572 854) to 295 210 (284 493 to 306 187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100 000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45 434 (40 850 to 50 539) YLLs per 100 000 across both sexes., Conclusions: There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries., Competing Interests: Competing interests: Dr. Franklin reports receiving airfare reimbursement from Royal Life Saving Society - Australia, during the conduct of the study. Dr. Bhaumik reports grants from Royal National Lifeboat Institution, UK, outside the submitted work. Dr. Driscoll reports grants from World Health Organization, during the conduct of the study. Dr. Ivers reports grants from Royal National LifeBoat Institute, outside the submitted work. Dr. Khubchandani reports grants from Merck Research Laboratories, outside the submitted work. Dr. James reports grants from Sanofi Pasteur, outside the submitted work., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours., Methods: Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a "distance matrix" which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled., Results: The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5-1.9 km (p < 0.05) compared to 2.5-2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City's major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor., Conclusions: For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City's largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

Objectives: Depression is a leading contributor to the global burden of disease, and often starts at a young age. Depression in young people can increase the risk of unhealthy lifestyle behaviour and can lead to substantial disability, social problems, poor health, and suicide. Other research has examined depressive symptoms among adult populations in Bangladesh, but little is known about other age groups. The aim of this study was to assess the prevalence and socio-demographic correlates of depressive symptoms among secondary school children of Dhaka city, Bangladesh. Design: A self-completed questionnaire was administered to 898 students from eight secondary schools of Dhaka, the capital City of Bangladesh. Of the respondents, 755 (372 males, 383 females; average age 14.26 years; SD 1.15) completed the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). A score of 10 or more was used to indicate depressive symptoms. Parents completed a separate questionnaire to provide individual and household/family-level data. Generalized Estimating Equations (GEE) was used to assess sociodemographic and lifestyle factors associated with adolescent depressive symptoms. Results: Among the responding adolescents, 25% reported depressive symptoms with prevalence more common among females than males (30% vs. 19%). Factors significantly associated with symptoms of depression included being female, aged 15-16 years, self-perception of non-normal weight, feeling unsafe at school, sleep disturbance, low life satisfaction, high intake of sugary drinks, and regularly skipping breakfast. Conclusion: Depressive symptoms are prevalent among secondary school children in urban Bangladesh. Interventions for adolescents with depressive symptoms could focus on lifestyle practices such as weight management, personal safety, sleep hygiene and healthy eating.

Introduction: Rohingya diaspora are one of the most vulnerable groups seeking refuge in camps of Cox's Bazar, Bangladesh, arising an acute humanitarian crisis. More than half of the Rohingya refugees are women and adolescent girls requiring quality sexual and reproductive health (SRH) services. Minimum initial service package of SRH are being rendered in the refugee camps; however, WHO is aiming to provide integrated comprehensive SRH services to meet the unmet needs of this most vulnerable group. For sustainable and successful implementation of such comprehensive SRH service packages, a critical first step is to undertake a situation analysis and understand the current dimensions and capture the lessons learnt on their SRH-specific needs and implementation challenges. This situation analysis is pertinent in current humanitarian condition and will provide an overview of the needs, availability and delivery of SRH services for adolescent girls and women, barriers in accessing and providing those services in Rohingya refugee camps in Cox's Bazar, Bangladesh, and similar humanitarian contexts., Methods and Analysis: A concurrent mixed-methods design will be used in this study. A community-based household survey coupled with facility assessments as well as qualitative in-depth interviews, key informant interviews and focus group discussions will be conducted with community people of Rohingya refugee camps and relevant stakeholders providing SRH services to Rohingya population in Cox's Bazar, Bangladesh. Survey data will be analysed using univariate, bivariate and multivariable regression statistics. Descriptive analysis will be done for facility assessment and thematic analysis will be conducted with qualitative data., Ethics and Dissemination: Ethical approval from Institutional Review Board of BRAC James P Grant School of Public Health (2018-017-IR) has been obtained. Findings from this research will be disseminated through presentations in local, national and international conferences, workshops, peer-reviewed publications, policy briefs and interactive project report., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Objectives: This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access., Methods: This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients., Results: Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised such as aspirations to serve the disadvantaged, personal ambition, desire for greater social status, obligations to continue family business and adverse family events.The discussion of private sector motivations and strategies is framed using the Business Policy Model. This model is comprised of three components: products and services , and efforts to make these attractive including patient-friendly discounts and service-packages, and building 'good' doctor-patient relationships; the market environment , cultivated using medical brokers and referral fees to bring in fresh clientele, and receipt of pharmaceutical incentives; and finally, organisational capabilities , in this case overcoming human resource shortages by relying on medical staff from the public sector, consultant specialists, on-call and less experienced doctors in training, unqualified nursing staff and referring complicated cases to public facilities., Conclusions: In the context of low public sector capacity and growing healthcare demands in urban Bangladesh, private for-profit engagement is critical to achieving universal health coverage (UHC). Given the informality of the sector, the nascent state of healthcare financing, and a weak regulatory framework, the process of engagement must be gradual. Further research is needed to explore how engagement in UHC can be enabled while maintaining profitability. Incentives that support private sector efforts to improve quality, affordability and accountability are a first step in building this relationship., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Sanitation improvements have had limited effectiveness in reducing the spread of fecal pathogens into the environment. We conducted environmental measurements within a randomized controlled trial in Bangladesh that implemented individual and combined water treatment, sanitation, handwashing (WSH) and nutrition interventions (WASH Benefits, NCT01590095). Following approximately 4 months of intervention, we enrolled households in the trial's control, sanitation and combined WSH arms to assess whether sanitation improvements, alone and coupled with water treatment and handwashing, reduce fecal contamination in the domestic environment. We quantified fecal indicator bacteria in samples of drinking and ambient waters, child hands, food given to young children, courtyard soil and flies. In the WSH arm, Escherichia coli prevalence in stored drinking water was reduced by 62% (prevalence ratio = 0.38 (0.32, 0.44)) and E. coli concentration by 1-log (Δlog 10 = -0.88 (-1.01, -0.75)). The interventions did not reduce E. coli along other sampled pathways. Ambient contamination remained high among intervention households. Potential reasons include noncommunity-level sanitation coverage, child open defecation, animal fecal sources, or naturalized E. coli in the environment. Future studies should explore potential threshold effects of different levels of community sanitation coverage on environmental contamination.

Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. We aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. We measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0-60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea (3 or more loose stools in a 24-h period) was positively associated with the concentration of E. coli on child hands measured on the first visit (incidence rate ratio [IRR] = 1.23, 95% CI 1.06, 1.43 for a log 10 increase), while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. Our findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh.

Fecal-oral pathogens are transmitted through complex, environmentally mediated pathways. Sanitation interventions that isolate human feces from the environment may reduce transmission but have shown limited impact on environmental contamination. We conducted a study in rural Bangladesh to (1) quantify domestic fecal contamination in settings with high on-site sanitation coverage; (2) determine how domestic animals affect fecal contamination; and (3) assess how each environmental pathway affects others. We collected water, hand rinse, food, soil, and fly samples from 608 households. We analyzed samples with IDEXX Quantitray for the most probable number (MPN) of E. coli. We detected E. coli in source water (25%), stored water (77%), child hands (43%), food (58%), flies (50%), ponds (97%), and soil (95%). Soil had >120 000 mean MPN E. coli per gram. In compounds with vs without animals, E. coli was higher by 0.54 log 10 in soil, 0.40 log 10 in stored water and 0.61 log 10 in food (p < 0.05). E. coli in stored water and food increased with increasing E. coli in soil, ponds, source water and hands. We provide empirical evidence of fecal transmission in the domestic environment despite on-site sanitation. Animal feces contribute to fecal contamination, and fecal indicator bacteria do not strictly indicate human fecal contamination when animals are present.

Critical flicker frequency (CFF) of 40 men, 20 mentally retarded whose mean age was 22.0 yr. and 20 normal whose mean age was 21.5 yr., was measured under binocular viewing using the Lafayette Visual Perception Control with a display unit. Subjects had been previously tested for visual acuity and color blindness. Analysis showed a significant difference in CFF between mentally retarded persons and normal individuals, the former having lower CFF than the latter. This finding suggests lower perceptual sensitivity of the mentally retarded persons. Further research with provision for EEG recordings is suggested.

Two hundred and fifty paucibacillary (PB) leprosy patients were treated with WHO recommended multidrug therapy (MDT) and followed up them for four years. The paucibacillary MDT regimen (PBR) was well accepted and tolerated by the patients. Clinical regression was attained in 60% patients after 6 doses of PBR. Reversal reaction occurred in 14% cases and relapse were found in 1.6% cases 18-24 months after completing the treatment. The incidence of reversal reaction was high in patients with more than 2 thickened nerve trunks associated with more than 5 patches.