A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh

<p>Abstract</p> <p>Background</p> <p>Understanding injection practices is crucial for evidence-based development of intervention initiatives. This study explored the extent of injection use and injection safety practices in primary care hospitals in Bangladesh.</p> <p>Methods</p> <p>The study employed both quantitative and qualitative research methods. The methods used were - a retrospective audit of prescriptions (n = 4320), focus group discussions (six with 43 participants), in-depth interviews (n = 38) with a range service providers, and systematic observation of the activities of injection providers (n = 120), waste handlers (n = 48) and hospital facilities (n = 24). Quantitative and qualitative data were assessed with statistical and thematic analysis, respectively, and then combined.</p> <p>Results</p> <p>As many as 78% of our study sample (n = 4230) received an injection. The most commonly prescribed injections (n = 3354) including antibiotics (78.3%), IV fluids (38.6%), analgesics/pain killers (29.4%), vitamins (26.7%), and anti-histamines (18.5%). Further, 43.7% (n = 1145) of the prescribed antibiotics (n = 2626) were given to treat diarrhea and 42.3% (n = 600) of IV fluids (n = 1295) were used to manage general weakness conditions. Nearly one-third (29.8%; n = 36/120) of injection providers reported needle-stick injuries in the last 6 months with highest incidences in Rajshahi division followed by Dhaka division. Disposal of injection needles, syringes and other materials was not done properly in 83.5% (n = 20/24) of the facilities. Health providers' safety concerns were not addressed properly; only 23% (n = 28/120) of the health providers and 4.2% (n = 2/48) of the waste handlers were fully immunized against Hepatitis B virus. Moreover, 73% (n = 87/120) of the injection providers and 90% (n = 43/48) of the waste handlers were not trained in injection safety practices and infection prevention. Qualitative data further confirmed that both providers and patients preferred injections, believing that they provide quick relief. The doctors' perceived injection use as their prescribing norm that enabled them to prove their professional credibility and to remain popular in a competitive health care market. Additionally, persistent pressure from hospital administration to use up injections before their expiry dates also influenced doctors to prescribe injections regardless of actual indications.</p> <p>Conclusions</p> <p>As far as the patients and providers' safety is concerned, this study demonstrated a need for further research exploring the dynamics of injection use and safety in Bangladesh. In a context where a high level of injection use and unsafe practices were reported, immediate prevention initiatives need to be operated through continued intervention efforts and health providers' training in primary care hospitals in Bangladesh.</p

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Heat transfer augmentation in a circular tube with perforated double counter twisted tape inserts

© 2016 Elsevier Ltd.The present study explored the effects of perforated double counter twisted tapes on heat transfer and fluid friction characteristics in a heat exchanger tube. The twisted tapes with four different porosities of Rp = 1.2, 4.6, 10.4 and 18.6% were used as counter-swirl flow generators in the test section. The experiments were conducted in a circular tube in turbulent flow regime with Reynolds number ranging from 7200 to 50,000 using air as the working fluid under uniform wall heat flux boundary condition. The experimental results demonstrated that the Nusselt number, friction factor and thermal enhancement efficiency were increased with decreasing porosity except porosity of 1.2%. The results also revealed that the heat transfer rate of the tube fitted with tapes were significantly increased with corresponding increase in friction factor. In the range of the present investigation, heat transfer rate and friction factor were obtained to be around 80 to 290% and 111 to 335% higher than those of the plain tube values, respectively. Based on constant blower power, the highest thermal enhancement efficiency of 1.44 was achieved. In addition, the empirical correlations of Nusselt number, friction factor and thermal enhancement efficiency were developed based on the experimental data

Original Articles CYTOTOXIC ACTIVITY OF TWO LIMONOIDS ISOLATED FROM SWIETENIA MAHAGONI BY USING BRINE SHRIMP LETHALITY BIOASSAY

Solvent partitioning followed by column chromatography of the MeOH extract of the seeds of Swietenia mahagoni afforded two limonoids, swietenolide (compound 1) and 2-hydroxy-3-O-tigloylswietenolide (compound 2), later one is new compound. The compounds were identified by spectroscopic means. The cytotoxic activity of these compounds was assessed by using the conventional brine shrimp lethality bioassay. While both compounds were found to have moderate cytotoxic activity, compound 2 displayed overall more potent activity than compound 1

Safe placement of Central Venous Catheter via right Internal Jugular Vein: Calculation of insertion depth by individual body height

Background: Cardiac tamponade is a serious complication of central venous catheter (CVC) placement. Current guidelines strongly suggest that CVC tip should lie in the superior vena cava (SVC) outside the pericardial sac. Various landmarks and sophisticated techniques such as right atrial electrocardiography (ECG) and transoesophageal echocardiography (TEE) have been recommended to decide a proper insertion depth (ID) of CVC. The purpose of this study was to devise a simple formula to determine the proper insertion depth based on an individual patient&rsquo;s height when cannulation is via the right internal jugular vein (RIJV).Patients and Methods: We studied 100 patients. The right internal jugular vein was punctured by an anterior approach using the sternocleidomastoid muscle as a landmark midway between the mastoid process and the sternal notch. Insertion depth was theoretically determined as one-tenth of the patient&rsquo;s height in cm. Post insertion bedside chest x-ray (CXR) was done to see the CVC tip position in relation to the level of the carina.Results: In 74.22% of the cases the tips of the CVCs were at or above the level of the carina. In the rest of the 25.78% patients the tips were within 2 cm below the level of carina. The standard error of proportion (SEP) between these two groups of observations was 4.4. It means the tip of the CVC will be positioned at or above the level of carina in 65% to 83% of the population (95% CI). Conclusion: Thus to place all the CVC tips above the pericardial reflection we propose a simple formula as: Insertion Depth in cm = (Patient&rsquo;s height in cm/10) - 2cm, for cannulation via the right internal jugular vein when the puncture site is midway between the mastoid process and the sternal notch.Keywords: central venous catheter, internal jugular vein, insertion depth, carin

Improving coverage of civil registration and vital statistics, Bangladesh

Problem: Bangladesh has no national system for registering deaths and determining their causes. As a result, policy-makers lack reliable and complete data to inform public health decisions. Approach: In 2016, the government of Bangladesh introduced a pilot project to strengthen the civil registration and vital statistics system and generate cause of death data in Kaliganj Upazila. Community-based health workers were trained to notify births and deaths to the civil registrar, and to conduct verbal autopsy interviews with family members of a deceased person. International experts in cause-of-death certification and coding trained master trainers on how to complete the international medical certificate of cause of death. These trainers then trained physicians and coders. Local setting: Kaliganj Upazila has an estimated population of 304 600, and 5600 births and 1550 deaths annually. Health assistants and family welfare assistants make regular visits to households to track certain health outcomes. Relevant changes: Following the start of the project in 2016, the number of births registered within 45 days rose from 873 to 4630 in 2018. The number of deaths registered within 45 days increased from 458 to 1404. During this period, health assistants conducted 7837 verbal autopsy interviews. Between January 2017 and December 2018, 105 master trainers and more than 7000 physicians were trained to complete the international medical certificate of cause of death and they completed more than 12 000 certificates. Lessons learnt: Training community-based health workers, physicians and coders were successful approaches to improve death registration completeness and availability of cause-of-death data

Routine mortality surveillance to identify the cause of death pattern for out-of-hospital adult (aged 12+years) deaths in Bangladesh: introduction of automated verbal autopsy

BACKGROUND: In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh. METHODS: Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool. RESULTS: Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates. CONCLUSIONS: Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems

Systematic review of interventions to improve prescribing

The number of systematic reviews (SRs) of nursing interventions is increasing in China. Authors of such studies are encouraged to use a risk of bias tool for assessing individual studies. Therefore, it is important to know how these tools have been applied in SRs in Chinese nursing