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Background: Women in the fisher communities in coastal regions of Bangladesh are engaged in a wide range of fishery activities. However, there is limited evidence available on the occupational hazards and risks experienced by them. Method: The study was conducted among fishing colonies in Cox's Bazar and Chattogram districts in Bangladesh. This was a cross-sectional study blending qualitative and quantitative approaches. The qualitative component comprised five focus group discussions to understand the occupational context, hazards, and risks faced by the fisherwomen, informing the questionnaire design for the subsequent survey. The quantitative survey involved a sample of 207 women from fisher communities, gathering socio-demographic information, occupational hazards, risks, and health and safety practices. Findings: The study found a high occurrence of occupational hazards, health risks and limited availability of preventive measures among the women in fisher communities. Occupational hazards include physical safety hazards such as slippery surfaces and fish cutting instruments, and physical hazards like prolonged sun exposure and noise. Chemical hazards like pesticides and saltwater, ergonomic hazards such as prolonged uncomfortable posture and heavy lifting, and biological hazards including inadequate sanitation facilities were prevalent. The study also identified the potential occupational risks, and the outcomes resulting from the hazards, including injuries (87.44%), musculoskeletal conditions (69.08%), skin diseases/conditions (56.52%), eye complaints (33.82%), severe respiratory distress (24.15%) and high incidence of self-reported communicable diseases. Most women (78.26%) did not use personal protective equipment, and the majority (93.72%) lacked a workplace first aid kit. Conclusion: The study revealed a high prevalence of occupational hazards and health risks, including injuries and diseases, among Bangladeshi women in fisher communities with insufficient safety measures. Collaboration among government, NGOs, development partners, fisheries stakeholders, and the community is imperative for targeted training, innovative procedures, ergonomic solutions, provision of protective equipment, and advocacy to enhance the well-being of these women. [ABSTRACT FROM AUTHOR]

Background Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. Methods and findings Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. Conclusions To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises., Author(s): Jonathan A. Polonsky 1,2,*, Melissa Ivey 3, Md. Khadimul Anam Mazhar 4, Ziaur Rahman 5, Olivier le Polain de Waroux 1,6,7,8,9, Basel Karo 6,10, Katri Jalava 4, Sirenda Vong [...]