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Background: Frontline healthcare workers (HCWs) were particularly vulnerable to contracting SARS-CoV-2 infection as a result of occupational exposure. There is a scarcity of data characterizing the risk of SARS-CoV-2 infection among HCWs, particularly in low-income hospital settings. This study aimed to assess the prevalence of COVID-19 among HCWs and identify associated risk factors., Methods: From July 2021 to July 2023, we enrolled HCWs from 13 primary, 2 secondary, and five tertiary care hospitals in four selected districts of Bangladesh. We collected information on demography and risk exposure in a face-to-face interview. We calculated the odds ratio to measure the risk using multivariable logistic regression., Results: We enrolled 3436 HCWs: 22% (747) physicians, 47% (1632) nurses, and 31% (1057) support staff. Most of the HCWs were female 67% (2292), and the mean age was 38.1, IQR = 29-44 years. Overall, 26% (889) of HCWs had lab-confirmed SARS-CoV-2 infection. Among HCWs, nurses accounted for the highest proportion of COVID-19 infections at 53% (473/1632). Physicians had a significantly higher risk of infection with an aOR of 3.08 (95% CI 2.42-3.93; p < .001) compared to support staff. HCWs who had direct exposure to COVID-19 patients were also at a higher risk, with a 1.93 times higher likelihood of infection ([aOR] = 1.93, 95% CI 1.50-2.47; p < .001), compared to HCWs who were not exposed., Conclusions: This study highlights the heightened vulnerability of HCWs to SARS-CoV-2 infection due to occupational exposure and indicates the risk of nosocomial transmission to patients and emphasizes the importance of implementing targeted infection control measures, such as improved workplace safety protocols and comprehensive training to tackle future pandemics of similar traits., Competing Interests: Declarations. Ethics approval and consent to participate: The institutional review board (IRB) of icddr,b reviewed and approved the study protocol (PR-22113). The Institutional Review Board at the Centers for Disease Control and Prevention (Atlanta, GA, USA) relied on icddr,b's approval. We obtained written informed consent from all study participants. The study team provided detailed oral and written information in the local language (Bangla) on research aims, objectives, risks and benefits of participation, maintaining confidentiality, the right not to participate and/or withdraw conflicts of interest, and compensation. After being reminded that their participation is entirely voluntary and that any information they provide will be kept strictly confidential, participants were asked to sign the consent form. Consent for publication: Not applicable. Competing interests: All the authors report no conflicts of interest., (© 2024. The Author(s).)

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.