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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-11-2021
DOI: 10.1161/CIRCULATIONAHA.121.057042
Abstract: Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified s le size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and in iduals assigned to placebo equaled 1281 of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52–0.99] P =0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39–0.89] P =0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39–0.90] P =0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50–1.46] P =0.57) in the influenza vaccine and placebo groups, respectively. Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. URL: www.clinicaltrials.gov Unique identifier: NCT02831608.
Publisher: MDPI AG
Date: 24-08-2021
DOI: 10.3390/ANTIBIOTICS10091032
Abstract: Irrational and inappropriate use of antibiotics in commercial chicken and aquaculture industries can accelerate the antibiotic resistance process in humans and animals. In Bangladesh, the growing commercial chicken and aquaculture industries are playing significantly important roles in the food value chain. It is necessary to know the antibiotic usage practices and antibiotic resistance in food animal production to design rational policies, guidelines, and interventions. We conducted a narrative review to understand the level of antibiotic usage and resistance in food animal production in Bangladesh. Information about antibiotic usage in different food animal production systems, including commercial chickens and aquaculture in Bangladesh is inadequate. Only a few small-scale studies reported that the majority (up to 100%) of the broiler and layer chicken farms used antibiotics for treating and preventing diseases. However, numerous studies reported antibiotic-resistant bacteria of public health importance in commercial chicken, fish, livestock, and animal origin food. The isolates from different pathogenic bacteria were found resistant against multiple antibiotics, including quinolones, the third or fourth generation of cephalosporins, and polymyxins. Veterinary practitioners empirically treat animals with antibiotics based on presumptive diagnosis due to inadequate microbial diagnostic facilities in Bangladesh. Intensive training is helpful to raise awareness among farmers, feed dealers, and drug sellers on good farming practices, standard biosecurity practices, personal hygiene, and the prudent use of antibiotics. Urgently, the Government of Bangladesh should develop and implement necessary guidelines to mitigate irrational use of antibiotics in food animals using a multi-sectoral One Health approach.
Publisher: MDPI AG
Date: 14-02-2022
DOI: 10.3390/ANTIBIOTICS11020247
Abstract: 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.
Publisher: Authorea, Inc.
Date: 06-06-2023
DOI: 10.22541/AU.168606254.46333247/V1
Abstract: Background: Several studies imply that influenza and other respiratory illness could lead to acute myocardial infarction (AMI), but data from low-income countries are scarce. We investigated the prevalence of recent respiratory illnesses and confirmed influenza in AMI patients, while also exploring their relationship with infarction severity as defined by ST-elevation MI (STEMI) or high troponin levels. Methods: This cross-sectional study, held at a Dhaka tertiary hospital from May 2017 to October 2018, involved AMI inpatients. The study examined self-reported clinical respiratory illnesses (CRI) in the week before AMI onset and confirmed influenza using baseline qRT-PCR. Results: Of 744 patients, 11.3% reported a recent CRI, most prominently during the 2017 influenza season (35.7%). qRT-PCR testing found evidence of influenza in 1.5% of 546 patients, with all positives among STEMI cases. Frequencies of CRI were higher in patients with STEMI and in those with high troponin levels, although these associations were not statistically significant after adjusting for other variables. The risk of STEMI was significantly greater during influenza seasons in unadjusted analysis (RR: 1.09, 95% CI: 1.02- 1.18), however, this relationship was not significant in the adjusted analysis (aRR: 1.03, 95% CI: 0.91- 1.16). Conclusions: In Bangladesh, many AMI patients had a recent respiratory illness history, with some showing evidence of influenza. However, these illnesses showed no significant relationship to AMI severity. Further research is needed to understand these associations better and to investigate the potential benefits of infection control measures and influenza vaccinations in reducing AMI incidence.
Publisher: Oxford University Press (OUP)
Date: 14-02-2023
DOI: 10.1093/EURHEARTJSUPP/SUAC123
Abstract: COVID-19 is an independent risk factor for cardiovascular disease. COVID-19 vaccination may prevent this, but in some cases, COVID-19 vaccination may cause myocarditis or pericarditis. Patients with COVID-19 may present with non-specific symptoms that have a cardiac origin. This review examines the cardiovascular complications of COVID-19 infection and the impact of COVID-19 vaccination. COVID-19 cardiovascular complications include myocardial injury, pericarditis, coagulopathy, myocardial infarction, heart failure, arrhythmias, and persistent post-acute risk of adverse cardiovascular outcomes. Diagnostic and referral pathways for non-specific symptoms, such as dyspnoea and fatigue, remain unclear. COVID-19 vaccination is cardioprotective overall but is associated with myopericarditis in young males, though at a lower rate than following SARS-CoV-2 infection. Increased awareness among primary care physicians of potential cardiovascular causes of non-specific post-COVID-19 symptoms, including in younger adults, such as fatigue, dyspnoea, and chest pain, is essential. We recommend full vaccination with scheduled booster doses, optimal management of cardiovascular risk factors, rapid treatment of COVID-19, and clear diagnostic, referral, and management pathways for patients presenting with non-specific symptoms to rule out cardiac complications.
Publisher: Public Library of Science (PLoS)
Date: 04-02-2020
Publisher: Wiley
Date: 09-2023
DOI: 10.1111/IRV.13201
Publisher: Authorea, Inc.
Date: 07-03-2023
DOI: 10.22541/AU.167817061.19875512/V1
Abstract: Pregnant women with their infants are considered at higher risk for influenza-associated complications, and the WHO recommends influenza vaccination during pregnancy to protect them, including their infants (0-6 months). There are limited data on the influenza burden among pregnant women and their infants (0-6 months), and there is no routine influenza vaccination in Bangladesh. Five annual cohorts (2013-2017) of pregnant women were enrolled from 8 sub-districts of Bangladesh before the influenza season (May-September) contacted weekly to identify new onset of influenza-like illness (ILI) (subjective or measured fever and cough) and acute respiratory illness (ARI) (at least two of: cough, rhinorrhea, or difficulty breathing) among their infants from birth to 6 months of age. We collected nasopharyngeal swabs from ILI and ARI cases, tested by rRT-PCR for influenza virus (including types and subtypes) and estimated influenza incidence (95% CI) /10,000 pregnancy-months or infant-months, respectively. We enrolled 9,020 pregnant women, followed for 26,709 pregnancy-months and detected 1,241 ILI episodes. We also followed 8,963 infants for 51,518 infant-months and identified 5,116 ARI episodes. Influenza positivity was 23% for ILI and 3% for ARI cases. The overall incidence (2013-2017) of influenza among pregnant women was 158.5/10,000 pregnancy-months (95% CI: 141.4-177.6), and that among infants was 21.9/10,000 infant-months (95% CI: 18.2-26.5). Although the data was collected more than five years ago, as the only baseline data, our findings illustrate evidence of influenza burden among pregnant women and infants (0-6 months) which may support preventive policy decisions in Bangladesh.
Publisher: BMJ
Date: 04-2021
DOI: 10.1136/OPENHRT-2021-001617
Abstract: We aimed to determine the prevalence and outcome of occult infection with SARS-CoV-2 and influenza in patients presenting with myocardial infarction (MI) without COVID-19 symptoms. We conducted an observational study from 28 June to 11 August 2020, enrolling patients admitted to the National Institute of Cardiovascular Disease Hospital, Dhaka, Bangladesh, with ST-segment elevation MI (STEMI) or non-ST-segment elevation MI who did not meet WHO criteria for suspected COVID-19. S les were collected by nasopharyngeal swab to test for SARS-CoV-2 and influenza virus by real-time reverse transcriptase PCR. We followed up patients at 3 months (13 weeks) postadmission to record adverse cardiovascular outcomes: all-cause death, new MI, heart failure and new percutaneous coronary intervention or stent thrombosis. Survival analysis was performed using the Kaplan-Meier method. We enrolled 280 patients with MI, 79% male, mean age 54.5±11.8 years, 140 of whom were diagnosed with STEMI. We found 36 (13%) to be infected with SARS-CoV-2 and 1 with influenza. There was no significant difference between mortality rate observed among SARS-CoV-2 infected patients compared with non-infected (5 (14%) vs 26 (11%) p=0.564). A numerically shorter median time to a recurrent cardiovascular event was recorded among SARS-CoV-2 infected compared with non-infected patients (21 days, IQR: 8–46 vs 27 days, IQR: 7–44 p=0.378). We found a substantial rate of occult SARS-CoV-2 infection in the studied cohort, suggesting SARS-CoV-2 may precipitate MI. Asymptomatic patients with COVID-19 admitted with MI may contribute to disease transmission and warrants widespread testing of hospital admissions.
Publisher: SAGE Publications
Date: 06-2021
Abstract: We explored the maternal characteristics that mediate the effect of household poverty on childhood undernutrition. We used the population-based Bangladesh Demographic Health Survey data from 2014 for demographic characteristics, child and maternal factors. Of the 7173 under-5 children, 3456 (48.2%) had undernutrition. The prevalence of undernutrition was less common in wealthy households (poorest vs richest: adjusted prevalence ratio [aPR] = 1.37), mothers having history of antenatal care (ANC) visits (no visit vs ≥ 4 visits: aPR = 1.22), maternal higher education (no education vs higher education: aPR = 1.54), and mothers with good nutritional status (underweight vs healthy: aPR = 1.13). The risk of undernutrition (37.1%) was attributed to household wealth, mediated 55% by maternal factors of which 20% by maternal education, 21% by ANC visits, and 14% by maternal nutritional status. Our study findings outlined higher maternal education, ≥ 4 ANC visits and good maternal nutritional status in mediating the impact of household wealth on childhood nutrition.
Publisher: MDPI AG
Date: 29-08-2021
DOI: 10.3390/ANTIBIOTICS10091052
Abstract: The general population has been excessively using antibiotics during the COVID-19 pandemic. Therefore, the use of antibiotics for any reported illnesses in the preceding four weeks and knowledge of antibiotics among the general population in the community were assessed for possible interventions. A mobile phone survey among a general population across eight administrative isions of Bangladesh was conducted during January–March 2021. Reported illness episodes irrespective of COVID-19 in the preceding four weeks of the interview, use of antibiotics for the illnesses, and knowledge on antibiotics among the general population were recorded. Descriptive analyses were performed. We randomly interviewed 1854 participants, with a mean age of 28.5 years (range: 18–75 years) 60.6% were male. Among all participants, 86.3% (95% CI: 84.7–87.8) heard names of antibiotics, but only 12.1% reported unspecified harmful effects, and 3.5% reported antimicrobial resistance when antibiotics were taken without a physician’s prescription. Among 257 (13.9%) participants, who consumed medicines for their recent illness episode, 32.7% (95% CI: 27.2–38.6) reported using antibiotics. Of those who could recall the names of antibiotics prescribed (n = 36), the most frequently used was azithromycin (22.2%) followed by cefixime (11.1%) and ciprofloxacin (5.6%). Our findings show an increased antibiotic use for illnesses reported in the preceding four weeks and an elevated knowledge at the community level during the COVID-19 pandemic compared with the pre-pandemic period.
Publisher: Public Library of Science (PLoS)
Date: 17-10-2022
DOI: 10.1371/JOURNAL.PONE.0276158
Abstract: Irrational and inappropriate use of antibiotics in commercial chicken production can contribute to the development of antimicrobial resistance. We aimed to assess antibiotic usage in commercial chicken production in Bangladesh, and identify factors associated with this practice. We conducted a large-scale cross-sectional study to collect information on antibiotic usage in commercial chickens from January to May 2021. Structured interviews were conducted with 288 broiler, 288 layer and 192 Sonali (locally-produced cross-bred) farmers in 20 sub-districts across Bangladesh. The frequency of antibiotic usage, the types of antibiotics and purpose of usage were estimated for each production type. Adjusted odds ratios (aOR) were calculated to measure the association between antibiotic usage and factors related to the characteristics of the farms and farmers using multivariable logistic regression models. The proportion of farms, irrespective of their production type, reporting usage of antibiotics in the 24 hours preceding the interview was 41% (n = 314, 95% CI: 37–44%). Forty-five percent (n = 344, 41–48%) reported antibiotic usage in the last 72 hours, 86% (n = 658, 83–88%) in the last 14 days, and almost all farms, 98% (n = 753, 97–99%), had used antibiotics since the start of their production cycle. Use of antibiotics in the 24 hours preceding an interview was more frequently reported in broiler (OR 1.91, 95% CI: 1.36–2.69) and Sonali (OR 1.94, 95% CI: 1.33–2.33) than layer farms. Oxytetracycline (23–31%, depending on production type), doxycycline (18–25%), ciprofloxacin (16–26%) and amoxicillin (16–44%) were the most frequently used antibiotics. Antibiotics were reported to be used for both treatment and prophylactic purposes on most farms (57–67%). Usage of antibiotics in the 24h preceding an interview was significantly associated with the occurrence of any illnesses in chickens (aOR broiler: 41.22 [95% CI:13.63–124.62], layer: aOR 36.45[9.52–139.43], Sonali: aOR 28.47[4.97–162.97]). Antibiotic usage was mainly advised by veterinary practitioners (45–71%, depending on production type), followed by feed dealers (21–40%) and farmers (7–13%). Improvement of chicken health through good farming practices along with changes in key stakeholders (feed dealers and practitioners) attitudes towards antibiotic recommendations to farmers, may help to reduce the levels of antibiotic usage and thus contribute to mitigate antimicrobial resistance.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2021
DOI: 10.1186/S12872-021-01896-9
Abstract: There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of all-cause death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE. A total of 601 patients, mean age 51.6 ± 10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8 ± 2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65 95% CI 1.64–13.23). A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.
Publisher: MDPI AG
Date: 24-09-2021
DOI: 10.3390/ANTIBIOTICS10101153
Abstract: 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.
Publisher: BMJ
Date: 12-2021
DOI: 10.1136/BMJOPEN-2021-055169
Abstract: To establish a hospital-based platform to explore the epidemiological and clinical characteristics of patients screened for COVID-19. Hospital-based surveillance. This study was conducted in four selected hospitals in Bangladesh during 10 June–31 August 2020. In total, 2345 patients of all age (68% male) attending the outpatient and inpatient departments of surveillance hospitals with any one or more of the following symptoms within last 7 days: fever, cough, sore throat and respiratory distress. The outcome measures were COVID-19 positivity and mortality rate among enrolled patients. Pearson’s χ 2 test was used to compare the categorical variables (sign/symptoms, comorbidities, admission status and COVID-19 test results). Regression analysis was performed to determine the association between potential risk factors and death. COVID-19 was detected among 922 (39%) enrolled patients. It was more common in outpatients with a peak positivity in second week of July (112, 54%). The median age of the confirmed COVID-19 cases was 38 years (IQR: 30–50), 654 (71%) were male and 83 (9%) were healthcare workers. Cough (615, 67%) was the most common symptom, followed by fever (493, 53%). Patients with diabetes were more likely to get COVID-19 than patients without diabetes (48% vs 38% OR: 1.5 95% CI: 1.2 to 1.9). The death rate among COVID-19 positive was 2.3%, n=21. Death was associated with age ≥60 years (adjusted OR (AOR): 13.9 95% CI: 5.5 to 34), shortness of breath (AOR: 9.7 95% CI: 3.0 to 30), comorbidity (AOR: 4.8 95% CI: 1.1 to 21.7), smoking history (AOR: 2.2, 95% CI: 0.7 to 7.1), attending the hospital in days of symptom onset due to critical illness (AOR: 4.7 95% CI: 1.2 to 17.8) and hospital admission (AOR: 3.4 95% CI: 1.2 to 9.8). COVID-19 positivity was observed in more than one-third of patients with suspected COVID-19 attending selected hospitals. While managing such patients, the risk factors identified for higher death rates should be considered.
Publisher: Public Library of Science (PLoS)
Date: 09-2022
DOI: 10.1371/JOURNAL.PONE.0273902
Abstract: Understanding the distribution of pathogens causing acute febrile illness (AFI) is important for clinical management of patients in resource-poor settings. We evaluated the proportion of AFI caused by specific pathogens among outpatients in Bangladesh. During May 2019-March 2020, physicians screened patients aged ≥2 years in outpatient departments of four tertiary level public hospitals. We randomly enrolled patients having measured fever (≥100.4°F) during assessment with onset within the past 14 days. Blood and urine s les were tested at icddr,b through rapid diagnostic tests, bacterial culture, and polymerase chain reaction (PCR). Acute and convalescent s les were sent to the Centers for Disease Control and Prevention (USA) for Rickettsia and Orientia ( R/O ) and Leptospira tests. Among 690 patients, 69 (10%) had enteric fever ( Salmonella enterica serotype Typhi or Salmonella enterica serotype Paratyphi), 51 (7.4%) Escherichia coli , and 28 (4.1%) dengue detected. Of the 441 patients tested for R/O , 39 (8.8%) had rickettsioses. We found 7 (2%) Leptospira cases among the 403 AFI patients tested. Nine patients (1%) were hospitalized, and none died. The highest proportion of enteric fever (15%, 36/231) and rickettsioses (14%, 25/182) was in Rajshahi. Dhaka had the most dengue cases (68%, 19/28). R/O affected older children and young adults (IQR 8–23 years) and was detected more frequently in the 21–25 years age-group (17%, 12/70). R/O was more likely to be found in patients in Rajshahi region than in Sylhet (aOR 2.49, 95% CI 0.85–7.32) between July and December (aOR 2.01, 1.01–5.23), and who had a history of recent animal entry inside their house than not (aOR 2.0, 0.93–4.3). Gram-negative Enterobacteriaceae were the most common bacterial infections, and dengue was the most common viral infection among AFI patients in Bangladeshi hospitals, though there was geographic variability. These results can help guide empiric outpatient AFI management.
Publisher: Public Library of Science (PLoS)
Date: 07-01-2022
DOI: 10.1371/JOURNAL.PONE.0262391
Abstract: Bacillus Calmette-Guérin (BCG) vaccination has recently been found to have beneficial effects among children infected other than Mycobacterium tuberculosis . Due to the paucity of data on the outcomes of children who had successful BCG vaccination following Expanded Programme on Immunization (EPI) schedule, we aimed to investigate the characteristics of such children and their outcomes who were hospitalized for severe malnutrition. A prospective observational study was conducted to determine the viral etiology of pneumonia in severely malnourished children those were admitted to the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between April 2015 and December 2017, constituted the study population. Using a case-control design for the analysis, children having BCG vaccination prior hospital admission were treated as cases (n = 611) and those without vaccination, constituted as controls (n = 83). Bi-variate analysis was conducted using socio-demographic, clinical, laboratory, and treatment characteristics on admission and outcomes during hospitalization. Finally, log-linear binomial regression analysis was done to identify independent impact of BCG vaccination. The cases more often presented with older age, have had lower proportion of maternal illiteracy, higher rate of breastfeeding, severe wasting and lower rate of hypoglycemia, compared to the controls. The cases were also found to have lower risk of severe sepsis and deaths, compared to the controls (for all, p .05). However, in log-linear binomial regression analysis, after adjusting for potential confounders, BCG vaccination following EPI schedule (RR:0.54 95%CI = 0.33–0.89 p = 0.015) and breastfeeding (RR:0.53 95%CI = 0.35–0.81 p = 0.003) were found to be protective for the development of severe sepsis. BCG vaccination and breastfeeding were found to be protective for the development of severe sepsis in hospitalized severely malnourished under-five children which underscores the importance of continuation of BCG vaccination at birth and breastfeeding up to two years of age.
Publisher: Research Square Platform LLC
Date: 09-10-2020
DOI: 10.21203/RS.3.RS-87528/V1
Abstract: Background: There is a paucity of data regarding acute phase (in-hospital and 30-day) major adverse cardiac events (MACE) following ST-segment elevation myocardial infarction (STEMI) in Bangladesh. This study aimed to document MACE during the acute phase post-STEMI to provide information. Methods: We enrolled STEMI patients of the National Institute of Cardiovascular Disease, Dhaka, Bangladesh, from August 2017 to October 2018 and followed up through 30 days post-discharge for MACE, defined as the composite of total death, myocardial infarction, and coronary revascularization. Demographic information, cardiovascular risk factors, and clinical data were registered in a case report form. The Cox proportional hazard model was used for univariate and multivariate analysis to identify potential risk factors for MACE. Results: A total of 601 patients, mean age 51.6±10.3 years, 93% male, were enrolled. The mean duration of hospital stay was 3.8±2.4 days. We found 37 patients (6.2%) to experience an in-hospital event, and 45 (7.5%) events occurred within the 30 days post-discharge. In univariate analysis, a significantly increased risk of developing 30-day MACE was observed in patients with more than 12 years of formal education, diabetes mellitus, or a previous diagnosis of heart failure. In a multivariate analysis, the risk of developing 30-day MACE was increased in patients with heart failure (hazard ratio = 4.65 95% CI, 1.64–13.23). Conclusions: A high risk of in-hospital and 30-day MACE in patients with STEMI exists in Bangladesh. Additional resources should be allocated providing guideline-recommended treatment for patients with myocardial infarction in Bangladesh.
Publisher: BMJ
Date: 11-2021
DOI: 10.1136/BMJOPEN-2021-053768
Abstract: To estimate the proportion of SARS-CoV-2 and influenza virus coinfection among severe acute respiratory infection (SARI) cases-patients during the first wave of COVID-19 pandemic in Bangladesh. Descriptive study. Nine tertiary level hospitals across Bangladesh. Patients admitted as SARI (defined as cases with subjective or measured fever of ≥38 C° and cough with onset within the last 10 days and requiring hospital admission) case-patients. Proportion of SARS-CoV-2 and influenza virus coinfection and proportion of mortality among SARI case-patients. We enrolled 1986 SARI case-patients with a median age: 28 years (IQR: 1.2–53 years), and 67.6% were male. Among them, 285 (14.3%) were infected with SARS-CoV-2 175 (8.8%) were infected with the influenza virus, and five (0.3%) were coinfected with both viruses. There was a non-appearance of influenza during the usual peak season (May to July) in Bangladesh. SARS-CoV-2 infection was significantly more associated with diabetes (14.0% vs 5.9%, p .001) and hypertension (26.7% vs 11.5%, p .001). But influenza among SARI case-patients was significantly less associated with diabetes (4.0% vs 7.4%, p=0.047) and hypertension (5.7% vs 14.4%, p=0.001). The proportion of in-hospital deaths among SARS-CoV-2 infected SARI case-patients were higher (10.9% (n=31) vs 4.4% (n=75), p .001) than those without SARS-CoV-2 infection the proportion of postdischarge deaths within 30 days was also higher (9.1% (n=25) vs 4.6% (n=74), p=0.001) among SARS-CoV-2 infected SARI case-patients than those without infection. No in-hospital mortality or postdischarge mortality was registered among the five coinfected SARI case-patients. Our findings suggest that coinfection with SARS-CoV-2 and influenza virus was not very common and had less disease severity considering mortality in Bangladesh. There was no circulating influenza virus during the influenza peak season during the COVID-19 pandemic in 2020. Future studies are warranted for further exploration.
Publisher: MDPI AG
Date: 16-06-2022
DOI: 10.3390/ANTIBIOTICS11060810
Abstract: For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.
Publisher: MDPI AG
Date: 18-06-2021
DOI: 10.3390/ANTIBIOTICS10060738
Abstract: 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.
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/ASH.2021.226
Abstract: Baseline assessment of standard precaution relating to infection prevention and control (IPC) preparedness to fight health crisis within healthcare facilities at different levels and its associated factors in Bangladesh remains unknown. We analyzed the nationally representative Bangladesh health facility survey (BHFS) data conducted by the Ministry of Health and Family Welfare (MoHFW) during July–October 2017. We used the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) manual to determine the standard precautions related to the IPC readiness index. Using a conceptual framework and multivariable linear regression, we identified the factors associated with the readiness index. We analyzed data for 1,524 surveyed healthcare facilities. On average, only 44% of the standard precaution elements were available in all facilities. Essential elements, such as guidelines for standard precautions (30%), hand-washing soap (29%), and pedal bins (38%), were not readily available in all facilities. The tuberculosis service area was least prepared, with 85% of elements required for standard precaution deficient in all facilities. Significantly lower readiness indexes were observed in the rural healthcare facilities (mean difference, −13.2), healthcare facilities administered by the MoHFW (mean difference, −7.8), and private facilities (mean difference, −10.1) compared to corresponding reference categories. Our study revealed a severe lack of standard precaution elements in most healthcare facilities, particularly in rural health centers. These data can provide a baseline from which to measure improvement in infection prevention and control (IPC) in these facilities and to identify areas of gaps for targeted interventions to improve IPC strategies that can improve the Bangladesh health system.
Publisher: Cambridge University Press (CUP)
Date: 07-2021
DOI: 10.1017/ASH.2021.149
Abstract: Background: Healthcare personnel (HCP) in crowded and resource-poor countries (eg Bangladesh), might be at risk of exposure to and transmission of respiratory illnesses to coworkers, patients, and caregivers. The infection control practices in public hospitals are inadequate in Bangladesh. We estimated the incidence of respiratory illness episodes among HCP, and proportion of HCP who worked during respiratory illnesses, including influenza virus infection, at 2 tertiary-care public hospitals in Bangladesh. Methods: From May 2008 to February 2016, HCP (defined as physicians, nurses, interns, patient care assistant, cleaners, and administrative staff working in adult and pediatric medicine wards) were asked to self-report to study physicians when they experienced new onset of cough, rhinorrhea, difficulty breathing, or fever during the April–September influenza epidemic period each year. Study physicians followed HCP throughout their respiratory illness episodes and recorded respiratory symptoms, onset dates, duration of illness, and days of presenteeism and absenteeism during illness. Nasopharyngeal and oropharyngeal swabs were collected after informed written consent and were tested for influenza by rRT-PCR. We used hospital records to enumerate total HCP working in the study wards during influenza season and multiplied by 6-months follow-up per year to calculate person-time contribution for estimating respiratory illness incidence. Results: HCP self-reported 107 episodes of respiratory illness during 656 person years of follow-up, for an estimated incidence of 16.3 per 100 person years (95% CI, 13–20). Of 107 episodes, 33 (31%) included fever and cough. The mean illness length was 3.9 days (SD, ±1.8). HCP worked an average of 3.4 days (SD, ±1.4) while ill. HCP missed work for a median of 1 day (IQR, 1–2) during 29 (27%) of 107 illness episodes. HCP consented to collect swabs during 56 (52%) episodes, and among them 8 (14%) of 56 tested positive for influenza (flu-A, n = 5 flu-B, n = 3). Also, 63% of HCP with influenza reported fever and cough. HCP experiencing either respiratory illness or influenza worked for similar periods of days while ill: mean, 4 (SD, ±2.2) versus mean, 3.3 (SD, ±1.4) ( P = .257). HCP worked during 105 (98%) of 107 respiratory illness and 7 (88%) of 8 influenza episodes. Conclusions: Most HCP in Bangladesh, including those with influenza, worked during respiratory illnesses. The potential value of stay-at-home policies, compensation for sick days, and influenza vaccination in reducing HCP-associated respiratory pathogen transmission could be assessed in Bangladesh and similar settings. Funding: No Disclosures: None
Publisher: Public Library of Science (PLoS)
Date: 19-02-2021
DOI: 10.1371/JOURNAL.PONE.0246460
Abstract: Vitamin D is important for its immunomodulatory role and there is an independent association between vitamin D deficiency and pneumonia. We assessed the effect of vitamin D supplementation on the outcome in children hospitalized for severe pneumonia. This was a randomised, double blinded, placebo-controlled clinical trial in children aged –59 months with severe pneumonia attending Dhaka Hospital, icddr,b. Children received age-specific megadose of vitamin D 3 (20,000IU: months, 50,000 IU: 6–12 months, 100,000 IU:13–59 months) or placebo on first day and 10,000 IU as maintenance dose for next 4 days or until discharge (if discharged earlier) along with standard therapy. This trial is registered at ClinicalTrials.gov, number NCT02185196. We enrolled 100 children in placebo group and 97 in vitamin D group. On admission, 50 (52%) and 49 (49%) of children in vitamin D and placebo groups, respectively were vitamin D deficient. Among children with a sufficient serum vitamin D level on admission, a lower trend for duration of resolution of severe pneumonia in hours [72(IQR:44–96)vs. 88(IQR:48–132) = 0.07] and duration of hospital stay in days [4(IQR:3–5)vs.5(IQR:4–7) P = 0.09] was observed in vitamin D group compared to placebo. No beneficial effect was observed in vitamin D deficient group or irrespective of vitamin D status. Age-specific mega dose of vitamin D followed by a maintenance dose shown to have no statistical difference between the two intervention groups, however there was a trend of reduction of time to recovery from pneumonia and overall duration of hospital stay in under-five children with a sufficient serum vitamin D level on hospital admission.
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.AHJ.2022.10.005
Abstract: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI. A total of 2,571 participants were prospectively enrolled in the Influenza vaccination after myocardial infarction (IAMI) trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in eight countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2,467 participants with ST-segment elevation MI (STEMI, n = 1,348) or non-ST-segment elevation MI (NSTEMI, n = 1,119). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. Cumulative incidence of the primary and key secondary endpoints by randomized treatment and NSTEMI/STEMI was estimated using the Kaplan-Meier method. Treatment effects were evaluated with formal interaction testing to assess for effect modification. Baseline risk was higher in participants with NSTEMI. In the NSTEMI group the primary endpoint occurred in 6.5% of participants assigned to influenza vaccine and 10.5% assigned to placebo (hazard ratio [HR], 0.60 95% CI, 0.39-0.91), compared to 4.1% assigned to influenza vaccine and 4.5% assigned to placebo in the STEMI group (HR, 0.90 95% CI, 0.54-1.50, P = .237 for interaction). Similar findings were seen for the key secondary endpoints of all-cause death and cardiovascular death. The Kaplan-Meier risk difference in all-cause death at one year was more pronounced in participants with NSTEMI (NSTEMI: HR, 0.47 95% CI 0.28-0.80, STEMI: HR, 0.86 95% CI, 0.43-1.70, interaction P = .028). The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.
Publisher: Wiley
Date: 08-2023
DOI: 10.1111/IRV.13175
Abstract: Pregnant women with their infants are considered at higher risk for influenza‐associated complications, and the World Health Organization (WHO) recommends influenza vaccination during pregnancy to protect them, including their infants (0–6 months). There are limited data on the influenza burden among pregnant women and their infants (0–6 months), and there are no routine influenza vaccinations in Bangladesh. Five annual cohorts (2013–2017) of pregnant women were enrolled from the eight sub‐districts of Bangladesh before the influenza season (May–September) they were contacted weekly to identify new onset of influenza‐like illness (ILI) (subjective or measured fever and cough) and acute respiratory illness (ARI) (at least two of these symptoms: cough, rhinorrhea, or difficulty in breathing) among their infants from birth to 6 months of age. We collected nasopharyngeal swabs from ILI and ARI cases, tested by real‐time reverse transcription polymerase chain reaction (rRT‐PCR) for influenza virus (including types and subtypes) and estimated influenza incidence (95% CI)/10000 pregnant women‐months or infant‐months, respectively. We enrolled 9020 pregnant women, followed for 26,709 pregnancy‐months, and detected 1241 ILI episodes. We also followed 8963 infants for 51,518 infant‐months and identified 5116 ARI episodes. Influenza positivity was 23% for ILI and 3% for ARI cases. The overall incidence (2013–2017) of influenza among pregnant women was 158.5/10000 pregnant women‐months (95% CI: 141.4–177.6) and that among infants was 21.9/10000 infant‐months (95% CI: 18.2–26.5). Although the data was collected more than 5 years ago, as the only baseline data, our findings illustrate evidence of influenza burden among pregnant women and infants (0–6 months), which may support preventive policy decisions in Bangladesh.
Publisher: Elsevier BV
Date: 12-2022
Publisher: Public Library of Science (PLoS)
Date: 03-08-2021
DOI: 10.1371/JOURNAL.PONE.0255646
Abstract: During the 2019 novel coronavirus infectious disease (COVID-19) pandemic in 2020, limited data from several countries suggested reduced seasonal influenza viruses’ circulation. This was due to community mitigation measures implemented to control the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used sentinel surveillance data to identify changes in the 2020 influenza season compared with previous seasons in Bangladesh. We used hospital-based influenza surveillance (HBIS) data of Bangladesh that are generated year-round and are population-representative severe acute respiratory infection (SARI) data for all age groups from seven public and two private tertiary care level hospitals data from 2016 to 2019. We applied the moving epidemic method (MEM) by using R language (v4.0.3), and MEM web applications (v2.14) on influenza-positive rates of SARI cases collected weekly to estimate an average seasonal influenza curve and establish epidemic thresholds. The 2016–2019 average season started on epi week 18 (95% CI: 15–25) and lasted 12.5 weeks (95% CI: 12–14 weeks) until week 30.5. The 2020 influenza season started on epi week 36 and ended at epi week 41, lasting for only five weeks. Therefore, influenza epidemic started 18 weeks later, was 7.5 weeks shorter, and was less intense than the average epidemic of the four previous years. The 2020 influenza season started on the same week when COVID-19 control measures were halted, and 13 weeks after the measures were relaxed. Our findings suggest that seasonal influenza circulation in Bangladesh was delayed and less intense in 2020 than in previous years. Community mitigation measures may have contributed to this reduction of seasonal influenza transmission. These findings contribute to a limited but growing body of evidence that influenza seasons were altered globally in 2020.
Start Date: 2019
End Date: 2021
Funder: Sanofi Pasteur Inc. USA
View Funded ActivityStart Date: 2020
End Date: 2021
Funder: World Health Organization
View Funded ActivityStart Date: 2019
End Date: 2021
Funder: Sanofi
View Funded Activity