Health in urban slums: Challenges and opportunities for public health research. Example of Dhaka, Bangladesh

Zanuzdana A. Health in urban slums: Challenges and opportunities for public health research. Example of Dhaka, Bangladesh. Bielefeld: Universität Bielefeld; 2019

Combined Clinical, Epidemiological, and Genome-Based Analysis Identified a Nationwide Outbreak of Burkholderia cepacia Complex Infections Caused by Contaminated Mouthwash Solutions

Background: In September 2018, Burkholderia cepacia complex (BCC) infections in 3 patients associated with exposure to a mouthwash solution (MWS) were reported to the Robert Koch Institute (RKI). As the product was still on the market and the scale of the outbreak was unclear, a nation-wide investigation was initiated. Methods: We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories, and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme. Results: In total, 36 patients from 6 hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed 2 distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from 4 hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia). Conclusions: The combined clinical, epidemiological, and microbiological investigation, including whole-genome analysis, allowed for uncovering a supraregional BCC outbreak in health care settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018, the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.Peer Reviewe

Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011

Khan MH, Zanuzdana A, Krämer A. Levels, Trends and Disparities in Public-Health-Related Indicators among Reproductive-Age Women in Bangladesh by Urban-Rural and Richest-Poorest Groups, 1993-2011. PLoS ONE. 2013;8(9): e75261.BACKGROUND AND OBJECTIVES: Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. METHODS: The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. RESULTS: The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. CONCLUSION: The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further

Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events

Determinants of Diarrhoea in 'Urban' Slums of Dhaka and Adjacent Rural Areas: a Household-level Analysis

Khan MH, Zanuzdana A, Burkart K, Krämer A. Determinants of Diarrhoea in 'Urban' Slums of Dhaka and Adjacent Rural Areas: a Household-level Analysis. Population Space and Place. 2014;20(6):498-511.Diarrhoeal diseases constitute an important public health problem in many developing countries including Bangladesh. This study aimed to report the household-level determinants of diarrhoea using the baseline information of cohort studies conducted in 2008 and 2009. The variation of diarrhoea by 3-month period was also reported. A total of 3,207 households were systematically selected from 12 slums in Dhaka and three rural villages located nearby. The highest prevalence of diarrhoea was found during the period of September to November (22.7%) and the lowest during December to February (9.2%). Slum households were more affected by diarrhoea as compared with the rural households (OR=1.49; 95% CI=1.06-2.08; p=0.020). Other determinants namely provisional house, sharing water source, and sanitary, and use of surface water were also associated with a higher risk of diarrhoea. In conclusion, slum house holds suffered more from diarrhoea than rural populations. Moreover, the higher burden of diarrhoea were found to be strongly and persistently associated with adverse housing and environmental conditions. Public health strategies based on our findings are required to reduce the burden of diarrhoea in the study population. Particularly multilevel interdisciplinary actions are needed to improving the quality of housing, water, and sanitation facilities in urban slums of Dhaka, and similar settings elsewhere. Copyright (C) 2013 John Wiley & Sons, Ltd

Factors associated with high prevalence of coughs, colds and fever among urban slum dwellers in Dhaka, Bangladesh

Zanuzdana A, Khan MMH, Brinkel JK, Kraemer A. Factors associated with high prevalence of coughs, colds and fever among urban slum dwellers in Dhaka, Bangladesh. South East Asia Journal of Public Health. 2014;3(2):58-65

A-F: Urban-rural disparity for selected demographic and ANC indicators.

<p>A-F: Urban-rural disparity for selected demographic and ANC indicators.</p

Contact Investigation for Imported Case of Middle East Respiratory Syndrome, Germany

On March 19, 2013, a patient from United Arab Emirates who had severe respiratory infection was transferred to a hospital in Germany, 11 days after symptom onset. Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) was suspected on March 21 and confirmed on March 23; the patient, who had contact with an ill camel shortly before symptom onset, died on March 26. A contact investigation was initiated to identify possible person-to-person transmission and assess infection control measures. Of 83 identified contacts, 81 were available for follow-up. Ten contacts experienced mild symptoms, but test results for respiratory and serum samples were negative for MERS-CoV. Serologic testing was done for 53 (75%) of 71 nonsymptomatic contacts; all results were negative. Among contacts, the use of FFP2/FFP3 face masks during aerosol exposure was more frequent after MERS-CoV infection was suspected than before. Infection control measures may have prevented nosocomial transmission of the virus

Vaccination of Health Care Workers to protect patients at increased risk for acute respiratory disease

Health care workers (HCWs) may transmit respiratory infection to patients. We assessed evidence for the effectiveness of vaccinating HCWs to provide indirect protection for patients at risk for severe or complicated disease after acute respiratory infection. We searched electronic health care databases and sources of gray literature by using a predefined strategy. Risk for bias was assessed by using validated tools, and results were synthesized by using a narrative approach. Seventeen of the 12,352 identified citations met the full inclusion criteria, and 3 additional articles were identified from reference or citation tracking. All considered influenza vaccination of HCWs, and most were conducted in long-term residential care settings. Consistency in the direction of effect was observed across several different outcome measures, suggesting a likely protective effect for patients in residential care settings. However, evidence was insufficient for us to confidently extrapolate this to other at-risk patient groups