The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh

Background: Low‐and middle‐income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. Methods: The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016–2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service‐related factors with patients' preferences for healthcare services. Results: The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%) and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio [RRR] = 0.71; 0.56–0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80–9.86) or affordability of healthcare services (RRR = 3.13; 2.25–4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15–1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70–5.04) than the quality of treatment in the health facility, when compared with private service providers. Conclusions: Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. Patient or Public Contribution: Our research team includes four researchers (co‐authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases

Application of new host biomarker profiles in quantitative point-of-care tests facilitates leprosy diagnosis in the field

Background: Transmission of Mycobacterium leprae, the pathogen causing leprosy, is still persistent. To facilitate timely (prophylactic) treatment and reduce transmission it is vital to both early diagnose leprosy, and identify infected individuals lacking clinical symptoms. However, leprosy-specific biomarkers are limited, particularly for paucibacillary disease. Therefore, our objective was to identify new biomarkers for leprosy and assess their applicability in point-of-care (POC) tests. Methods: Using multiplex-bead-arrays, 60 host-proteins were measured in a cross-sectional approach in 24-h whole blood assays (WBAs) collected in Bangladesh (79 patients; 54 contacts; 51 endemic controls (EC)). Next, 17 promising biomarkers were validated in WBAs of a separate cohort (55 patients; 27 EC). Finally, in a third cohort (36 patients; 20 EC), five candidate markers detectable in plasma were assessed for application in POC tests. Findings: This study identified three new biomarkers for leprosy (ApoA1, IL-1Ra, S100A12), and confirmed five previously described biomarkers (CCL4, CRP, IL-10, IP-10, αPGL-I IgM). Overnight stimulation in WBAs provided increased specificity for leprosy and was required for IL-10, IL-1Ra and CCL4. The remaining five biomarkers were directly detectable in plasma, hence suitable for rapid POC tests. Indeed, lateral flow assays (LFAs) utilizing this five-marker profile detected both multi- and paucibacillary leprosy patients with variable immune responses. Interpretation: Application of novel host-biomarker profiles to rapid, quantitative LFAs improves leprosy diagnosis and allows POC testing in low-resource settings. This platform can thus aid diagnosis and classification of leprosy and also provides a tool to detect M.leprae infection in large-scale contact screening in the field

Prototype multi-biomarker test for point-of-care leprosy diagnostics

To end the decade-long, obstinately stagnant number of new leprosy cases, there is an urgent need for field-applicable diagnostic tools that detect infection with Mycobacterium leprae, leprosy's etiologic agent. Since immunity against M. leprae is characterized by humoral and cellular markers, we developed a lateral flow test measuring multiple host proteins based on six previously identified biomarkers for various leprosy phenotypes. This multi-biomarker test (MBT) demonstrated feasibility of quantitative detection of six host serum proteins simultaneously, jointly allowing discrimination of patients with multibacillary and paucibacillary leprosy from control individuals in high and low leprosy endemic areas. Pilot testing of fingerstick blood showed similar MBT performance in point-of-care (POC) settings as observed for plasma and serum. Thus, this newly developed prototype MBT measures six biomarkers covering immunity against M. leprae across the leprosy spectrum. The MBT thereby provides the basis for immunodiagnostic POC tests for leprosy with potential for other (infectious) diseases as well.Diagnostic Technique in Health Technology; Applied Microbiology; Biotechnolog

Temporal Shifts in the Dominance of Serotypes of Shigella dysenteriae from 1999 to 2002 in Dhaka, Bangladesh

A total of 358 Shigella dysenteriae strains isolated from patients attending the Dhaka treatment center of the International Centre for Diarrheal Disease Research, Bangladesh, between the years 1999 and 2002 were included in this study. S. dysenteriae type 1, the dominant serotype in 1999 (76.4%), declined to 6.5% in 2002. On the other hand, S. dysenteriae types 2 to 12 were isolated with increasing frequencies of 19, 67, 73.5, and 87% in 1999, 2000, 2001, and 2002, respectively. Of these, types 2 and 4 were the most dominant serotypes, accounting for more than 18.7 and 28.5% of the total isolates, respectively. There was no isolation of serotypes 5, 7, 8, and 13 during this period. Twenty-eight (7.8%) of the isolates were atypical and agglutinated only with the polyvalent antiserum of S. dysenteriae. More than 98% of type 1 strains isolated between 1999 and 2001 were resistant to ampicillin, sulfamethoxazole-trimethoprim, and nalidixic acid. Among other serotypes of S. dysenteriae, Nal(r) type 2 strains were isolated in 2001 and 2002. Although heterogeneous plasmid profiles were obtained depending on the presence or absence of a single plasmid, core plasmids were defined for particular serotypes. On the other hand, the same plasmid profile was found to be shared by different serotypes. Interestingly, plasmid patterns of types 2 and 4 were almost identical except that a middle-range plasmid of 70 to 60 MDa was present in type 4 in addition to the core plasmids. All the strains harboring the 140-MDa plasmid were positive for the ipaH gene, had Congo red binding abilities, and were positive by the Sereny test, demonstrating their invasive properties

Subduction initiation and the rise of the Shillong Plateau

Discrepancies between geodetically and geologically estimated thrust fault slip rates are generally viewed as a methodological problem. Even when slip rate is steady over geological time, a discrepancy may exist because each method is sensitive to different deformation processes. However, this offers a tool to estimate the partitioning of convergence between footwall and hanging wall deformation, and therefore a way to discriminate among orogenic styles. Here we investigate one such discrepancy for the Shillong Plateau, a basement-cored contractional orogen within the Himalayan foreland basin. Using a regional block model to explain the modern geodetic velocity field and explicit uncertainty analysis of the geologic rates, we show that this discrepancy cannot be reconciled simply by invoking uncertainties in individual methods. Our results indicate that the Shillong Plateau is not an ongoing forward break of the Bhutan Himalayas, as was believed until recently. Instead, the observed inter-plate convergence and plateau uplift in this region may be driven primarily by an attempt of the negatively buoyant Indian passive margin lithosphere (the Surma Basin), south of the plateau, to initiate subduction. As a result, the uplift history of the plateau, which constrains the geologic rate, is significantly lower than expected given the geodetic convergence rate. We propose that this convergence is largely accommodated by the transport of the footwall into the mantle. This geodynamic scenario has important regional seismotectonic implications: (1) the cold and brittle sinking passive margin may have enabled the deep extent (∼30 km) and therefore large magnitude of the MW 8+ Shillong Earthquake of 1897; (2) the collapse of the Indian lithosphere into the mantle may have created the anomalously deep (∼20 km) Surma Basin; and (3) this subsidence may also drive accelerated post-Miocene westward propagation of the Indo-Burman Wedge. We propose that the Shillong Plateau is the only modern example of passive margin collapse, and can serve as a natural laboratory to study the earliest phase of subduction.Ministry of Education (MOE)Nanyang Technological UniversityNational Research Foundation (NRF)Published versionThis research was supported by the Earth Observatory of Singapore and the National Research Foundation Singapore and the Singapore Ministry of Education under the Research Centres of Excellence initiative, and by a Singapore National Research Foundation Investigatorship awarded to EMH (Proposal ID NRF2018NRF-NRFI001-21)

Ecosystems, livelihood assets and willingness to pay for wetland conservation in Bangladesh

Wetland ecosystem services have come under severe threat globally due to environmental changes and anthropogenic impacts. Understanding the trend and usages of the ecosystem services with associated reasons, conservation attitude and determinants of payment responses of local inhabitants based on wetland proximity can benefit the adjacent communities and policy makers. The major contribution of the present study is that the study investigated the patterns of use and livelihood significance of wetland ecosystem services in data-deficit regions of north-eastern Bangladesh through evaluating the perceptions of local experts and community people. In addition, we examined the willingness to pay (WTP) attitudes using two payment vehicles and three payment versions as well as examined the effect of livelihood assets on their WTP. Results showed that the ecosystem services satisfy the subsistence, semi-commercial, commercial and beneficial requirements of the adjacent communities. Amongst the twenty-nine identified species, a few were locally extinct, and the availability of a number of other species decreased substantially. Conservation attitudes revealed that 25% of the respondents were interested in cash payment of which 16% expressed exact amount, whilst 9% mentioned interval values. However, 45% respondents were willing to volunteer a given number of days per annum of which 27% and 18% elicited exact and interval values, respectively. Interval regression results showed that WTP for conservation of the ecosystem services was sensitive to livelihood capitals. The study suggests proximity-based policies, declaring the wetland as an ecologically critical area, and utilising volunteering efforts by local inhabitants for conservation

Altering Trends in the Dominance of Shigella flexneri Serotypes and Emergence of Serologically Atypical S. flexneri Strains in Dhaka, Bangladesh

Of 469 recently isolated Shigella flexneri strains, 452 agglutinated with Shigella flexneri-specific monoclonal antibodies. Of these, 396 could be assigned to 10 of the currently recognized 15 serotypes, with S. flexneri 2b dominating (23.2%). Of the 56 untypeable strains which showed invasive properties, 17 were serologically atypical and the remaining 39 belonged to a new serotype

GNSS characterization of hydrological loading in South and Southeast Asia

The elastic response of the lithosphere to surface mass redistributions produces geodetically measurable deformation of the Earth. This deformation is especially pronounced in South and Southeast Asia, where the annual monsoon produces large-amplitude hydrological loads. The Myanmar–India–Bangladesh–Bhutan (MIBB) network of about 20 continuously operating Global Navigation Satellite Systems (GNSS) stations, established in 2011, provides an opportunity to study the Earth's response to these loads. In this study, we use GRACE temporal gravity products as an estimate of long-wavelength surface water distribution and use this estimate in an elastic loading calculation. We compare the predicted vertical deformation from GRACE with that observed with GNSS. We find that elastic loading inferred from the GRACE gravity model is able to explain the phase and much of the peak-to-peak amplitude (typically 2–3 cm) of the vertical GNSS oscillations, especially in northeast India and central Myanmar. GRACE-based corrections reduce the RMS scatter of the GNSS data by 30–45% in these regions. However, this approach does not capture all of the seasonal deformation in central Bangladesh and southern Myanmar. We show by a synthetic test that local hydrological effects may explain discrepancies between the GNSS and GRACE signals in these places. Two independent hydrological loading models of water stored in soil, vegetation, snow, lakes and streams display phase lags compared to the GRACE and GNSS observations, perhaps indicating that groundwater contributes to the observed loading in addition to near-surface hydrology. The results of our calculations have implications for survey-mode GNSS measurements, which make up the majority of geodetic measurements in this region. By using the GNSS data together with estimates of hydrological loading from independent observations and models, we may be able to more accurately determine crustal motions caused by tectonic processes in South and Southeast Asia, while also improving our ability to monitor the annual monsoon and resulting water storage changes in the region.Ministry of Education (MOE)National Research Foundation (NRF)Accepted versionThe authors thank the editor and two anonymous reviewers whose helpful comments greatly improved the manuscript. Many thanks to Christine Puskas at UNAVCO, who computed the GLDAS loading time-series. Thanks also to Yuning Fu for discussions and assistance. GRACE data are available at http://grace.jpl.nasa.gov as D. N. Wiese, D.-N. Yuan, C. Boening, F. W. Landerer, M. M. Watkins. 2018. JPL GRACE Mascon Ocean, Ice and Hydrology Equivalent Water Height Release 06 Coastal Resolution Improvement (CRI) Filtered Version 1.0. Ver. 1.0. PO.DAAC, CA, USA. Data set accessed [2020-05-02] at http://dx.doi.org/10.5067/TEMSC-3MJC6. Some figures were produced with the GMT software (Wessel et al. 2019). KM was supported by the National Science Foundation Graduate Research Fellowship Program and the EAPSI Singapore program. RB acknowledges support from award NNX17AE01G of the NASA Earth Surface and Interior program. The EOS authors and the installation and maintenance of the MIBB network were supported by the Earth Observatory of Singapore, the National Research Foundation of Singapore and the Singapore Ministry of Education under the Research Centres of Excellence initiative. EMH acknowledges support from a Singapore National Research Foundation Investigatorship award (NRF-NRFI05-2019-0009). The MIBB network is also supported by the staff of the EOS Center for Geohazards Observations and collaborators at the Department of Meteorology and Hydrology, Myanmar (Kyaw Moe Oo), Myanmar Earthquake Committee (U. Nyut Maung San), North Eastern Hill University (Devesh Walia), Geological Survey of Bangladesh (Aktarul Ahsan) and Sherubtse College, Royal University of Bhutan (Bimal Sharma). We also thank Syed Humayun Akhter at Dhaka University. This is EOS contribution number 308

Genetic relatedness of ciprofloxacin-resistant Shigella dysenteriae type 1 strains isolated in South Asia

Objectives: The aim of the present study was to determine the clonal relationships of ciprofloxacin-resistant Shigella dysenteriae type 1 strains isolated from south Asia, and S. dysenteriae 1 strains associated with epidemics in 1978, 1984 and 1994. Methods: The antimicrobial susceptibilities were examined by NCCLS methods. Molecular epidemiological characterization was performed by plasmid profiling, pulsed-field gel electrophoresis (PFGE) and mutation analysis of the quinolone resistance-determining region (QRDR) of gyrA by sequencing. Results: Plasmid patterns of the current ciprofloxacin-resistant strains from India, Nepal and Bangladesh were very similar to those of the 1978, 1984 and 1994 epidemic isolates of S. dysenteriae 1, except for the presence of a new plasmid of ~2.6?MDa, which was found in one recent ciprofloxacin-resistant strain isolated in Bangladesh. PFGE analysis showed that the ciprofloxacin-resistant strains isolated in Bangladesh, India and Nepal belonged to a PFGE type (type A), which was possibly related to that of the 1984 and 1994 clone of S. dysenteriae 1, but different from 1978 epidemic strains. The current ciprofloxacin-resistant strains belong to five subtypes (A3-A7), all of which were found in India, but in Bangladesh and Nepal, only A3 existed. Mutation analysis of the QRDR of gyrA revealed that amino acid substitutions at positions 83 and 87 of ciprofloxacin-resistant strains isolated in Bangladesh were similar to those of the strains isolated in Nepal, but different (at position 87) from ciprofloxacin-resistant strains isolated in India. Conclusions: PFGE and mutation analysis of gyrA showed differences between the current ciprofloxacin-resistant S. dysenteriae 1 strains isolated in south Asia and those associated with epidemics in 1978, 1984 and 1994