Socio-economic factors explain differences in public health-related variables among women in Bangladesh: A cross-sectional study

Khan MH, Krämer A. Socio-economic factors explain differences in public health-related variables among women in Bangladesh: A cross-sectional study. BMC Public Health. 2008;8(1): 254.Background: Worldwide one billion people are living in slum communities and experts projected that this number would double by 2030. Slum populations, which are increasing at an alarming rate in Bangladesh mainly due to rural-urban migration, are often neglected and characterized by poverty, poor housing, overcrowding, poor environment, and high prevalence of communicable diseases. Unfortunately, comparisons between women living in slums and those not living in slums are very limited in Bangladesh. The objectives of the study were to examine the association of living in slums (dichotomized as slum versus non-slum) with selected public health-related variables among women, first without adjusting for the influence of other factors and then in the presence of socio-economic variables. Methods: Secondary data was used in this study. 120 women living in slums (as cases) and 480 age-matched women living in other areas (as controls) were extracted from the Bangladesh Demographic and Health Survey 2004. Many socio-economic and demographic variables were analysed. SPSS was used to perform simple as well as multiple analyses. P-values based on t-test and Wald test were also reported to show the significance level. Results: Unadjusted results indicated that a significantly higher percent of women living in slums came from country side, had a poorer status by household characteristics, had less access to mass media, and had less education than women not living in slums. Mean BMI, knowledge of AIDS indicated by ever heard about AIDS, knowledge of avoiding AIDS by condom use, receiving adequate antenatal visits (4 or more) during the last pregnancy, and safe delivery practices assisted by skilled sources were significantly lower among women living in slums than those women living in other areas. However, all the unadjusted significant associations with the variable slum were greatly attenuated and became insignificant (expect safe delivery practices) when some socio-economic variables namely childhood place of residence, a composite variable of household characteristics, a composite variable of mass media access, and education were inserted into the multiple regression models. Taken together, childhood place of residence, the composite variable of mass media access, and education were the strongest predictors for the health related outcomes. Conclusion: Reporting unadjusted findings of public health variables in women from slums versus non-slums can be misleading due to confounding factors. Our findings suggest that an association of childhood place of residence, mass media access and public health education should be considered before making any inference based on slum versus non-slum comparisons

Numerical Analysis of Effect of Crack Location on the Crack Breathing Behavior

In this work, a three-dimensional finite element model was developed to investigate the crack breathing behavior at different crack locations considering the effect of unbalance force. A two-disk rotor with a crack is simulated using ABAQUS. The duration of each crack status (open, closed and partially open/closed) during a full shaft rotation was examined to analyse the crack breathing behavior. Unbalanced shaft crack breathing behavior was found to be different at different crack locations. The breathing behavior of crack along the shaft length is divided into different regions depending on the unbalance force and crack location. The simulated results in this work can be further utilised to obtain the time-varying stiffness matrix of the cracked shaft element under the influence of unbalance force

Tackling Fluid Overload in a High-transporter Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

Introduction: Diabetic patients on continuous ambulatory peritoneal dialysis (CAPD) are more prone to fluid overload than non-diabetic patients, but the use of hypertonic glucose solutions to improve their ultrafiltration (UF) may hamper their glycemic control. Maintaining euvolemia in such patients may be tricky and needs special care. Case report: A 72 year old diabetic and hypertensive patient presented with severe fluid overload shortly after initiation of CAPD despite producing more than one liter of urine per day. He only achieved modest ultrafiltration (UF) during the day, and had a negative UF during the long hypertonic night dwell. Peritoneal equilibration tests (PET) confirmed that he was a high transporter, and his weekly Kt/V was found to be 1.36. Since automated peritoneal dialysis (APD) is not yet available in Sudan, the PD prescription was modified to comprise five short cycles during the day, including two short hypertonic daytime dwells, and a dry abdomen at night. This approach succeeded in improving his fluid status, but required the addition of intra-peritoneal soluble insulin to his regular subcutaneous insulin in order to achieve acceptable blood sugar control. After 8 months his residual renal function (RRF) had declined remarkably and he began to suffer from intermittent fluid overload of variable degrees. Nevertheless, we managed to maintain him satisfactorily on CAPD for 14 months. Conclusion: Simple measures such as omitting the night dwell and using five short cycles during the day, including two short hypertonic dwells, can be effective in controlling fluid overload in diabetic patients who have a high transporter status. Key words: CAPD, diabetes mellitus, fluid overload, residual renal Functio

Recurrent Transvaginal Leak of Dialysate as a Complication of Peritoneal Dialysis Catheter Tip Capture by Fallopian Tube after Tubal Occlusion

Introduction: Peritoneal dialysis (PD) catheter malfunction may result from obstruction by various intra-peritoneal structures. Such obstruction may rarely be caused by fallopian tubes, in which case it may present as out flow failure and/or per vaginum (PV) leak of dialysate. Case report: A 46 years old female developed early out-flow obstruction while maintaining adequate dialysate inflow soon after PD catheter insertion. The patient also had PV leak of the dialysate that was misinterpreted by the patient as urine incontinence. Fluoroscopic catheterogram confirmed catheter patency and outlined the right fallopian tube. Magnetic Resonance Imaging (MRI) revealed the presence of fluid in vagina with no obvious peritoneo-vaginal fistulous track. Laparoscopy was performed, at which time examination under anesthesia excluded the presence of peritoneo-vaginal fistula. During laparoscopy, the catheter tip was found to be captured by the fimbriae of the right fallopian tube. The catheter tip was released and right tubal occlusion was performed, after which adequate flow was restored. Three month later, the catheter was replaced because of fungal peritonitis. Vaginal leak recurred six weeks after insertion of the new catheter through the same occluded tube. Mini laparotomy and tubal ligation with catheter removal were done and the patient was maintained on hemodialysis until she received a kidney transplant four months later. Conclusion: Vaginal leak of dialysate can occur as an early complication of PD secondary to fallopian tube capture of PD catheter tip. It is important to distinguish between tubal capture of the catheter tip which can be treated laparoscopically and peritoneo-vaginal fistula which often requires laparotomy for fistulous tract debridement and repair. Key words: Peritoneal Dialysis, Dialysate, Transvaginal leak, Fallopian tub

Seasonal variations of all-cause and cause-specific mortality by age, gender, and socioeconomic condition in urban and rural areas of Bangladesh

<p>Abstract</p> <p>Background</p> <p>Mortality exhibits seasonal variations, which to a certain extent can be considered as mid-to long-term influences of meteorological conditions. In addition to atmospheric effects, the seasonal pattern of mortality is shaped by non-atmospheric determinants such as environmental conditions or socioeconomic status. Understanding the influence of season and other factors is essential when seeking to implement effective public health measures. The pressures of climate change make an understanding of the interdependencies between season, climate and health especially important.</p> <p>Methods</p> <p>This study investigated daily death counts collected within the Sample Vital Registration System (VSRS) established by the Bangladesh Bureau of Statistics (BBS). The sample was stratified by location (urban vs. rural), gender and socioeconomic status. Furthermore, seasonality was analyzed for all-cause mortality, and several cause-specific mortalities. Daily deviation from average mortality was calculated and seasonal fluctuations were elaborated using non parametric spline smoothing. A seasonality index for each year of life was calculated in order to assess the age-dependency of seasonal effects.</p> <p>Results</p> <p>We found distinctive seasonal variations of mortality with generally higher levels during the cold season. To some extent, a rudimentary secondary summer maximum could be observed. The degree and shape of seasonality changed with the cause of death as well as with location, gender, and SES and was strongly age-dependent. Urban areas were seen to be facing an increased summer mortality peak, particularly in terms of cardiovascular mortality. Generally, children and the elderly faced stronger seasonal effects than youths and young adults.</p> <p>Conclusion</p> <p>This study clearly demonstrated the complex and dynamic nature of seasonal impacts on mortality. The modifying effect of spatial and population characteristics were highlighted. While tropical regions have been, and still are, associated with a marked excess of mortality in summer, only a weakly pronounced secondary summer peak could be observed for Bangladesh, possibly due to the reduced incidence of diarrhoea-related fatalities. These findings suggest that Bangladesh is undergoing an epidemiological transition from summer to winter excess mortality, as a consequence of changes in socioeconomic conditions and health care provision.</p

Six Cases of Fungal Peritonitis Complicating Peritoneal Dialysis in a Single Center in Sudan

Introduction: A national program of continuous ambulatory peritoneal dialysis (CAPD) has only recently been established in Sudan. In the head center of this national program, six of the 67 peritonitis episodes that were diagnosed during its 30 months of function were fungal in origin (9% of all episodes, 0.12 episode per year at risk). Here we describe the clinical features, predisposing factors, and outcomes of these six cases. Case series: Clinical presentation of fungal peritonitis did not differ from other cases of peritonitis. Among the six cases that were diagnosed in our center, five cases were due to Candida species and only one was due to Aspergillus. All patients had received antibiotic therapy within one month of diagnosing fungal peritonitis; five of them had received intraperitoneal (IP) antibiotics for a previous episode of bacterial peritonitis and one patient had received a course of oral antibiotics for exit site infection. Two of the patients were diabetic. All patients were treated with oral fluconazole, 200 mg daily, for three weeks, and all had their dialysis catheter removed. One patient died, and the others were transferred permanently to hemodialysis (HD). Two patients developed encysted intra-abdominal fluid collections 15 and 48 days after catheter removal. Conclusion: Fugal peritonitis complicating CAPD is not uncommon in our center, which serves a major portion of the CAPD population in the Sudan. Most patients responded to oral fluconazole treatment and catheter removal, but two of them suffered from late complications. Keywords: fungal peritonitis, peritoneal dialysis, Suda

A spatial epidemiological analysis of self-rated mental health in the slums of Dhaka

Grübner O, Khan MH, Lautenbach S, et al. A spatial epidemiological analysis of self-rated mental health in the slums of Dhaka. International Journal of Health Geographics. 2011;10(1): 36.Background: The deprived physical environments present in slums are well-known to have adverse health effects on their residents. However, little is known about the health effects of the social environments in slums. Moreover, neighbourhood quantitative spatial analyses of the mental health status of slum residents are still rare. The aim of this paper is to study self-rated mental health data in several slums of Dhaka, Bangladesh, by accounting for neighbourhood social and physical associations using spatial statistics. We hypothesised that mental health would show a significant spatial pattern in different population groups, and that the spatial patterns would relate to spatially-correlated health-determining factors (HDF). Methods: We applied a spatial epidemiological approach, including non-spatial ANOVA/ANCOVA, as well as global and local univariate and bivariate Moran's / statistics. The WHO-5 Well-being Index was used as a measure of self-rated mental health. Results: We found that poor mental health (WHO-5 scores = 15) was prevalent in all slum settlements. We detected spatially autocorrelated WHO-5 scores (i.e., spatial clusters of poor and good mental health among different population groups). Further, we detected spatial associations between mental health and housing quality, sanitation, income generation, environmental health knowledge, education, age, gender, flood non-affectedness, and selected properties of the natural environment. Conclusions: Spatial patterns of mental health were detected and could be partly explained by spatially correlated HDF. We thereby showed that the socio-physical neighbourhood was significantly associated with health status, i.e., mental health at one location was spatially dependent on the mental health and HDF prevalent at neighbouring locations. Furthermore, the spatial patterns point to severe health disparities both within and between the slums. In addition to examining health outcomes, the methodology used here is also applicable to residuals of regression models, such as helping to avoid violating the assumption of data independence that underlies many statistical approaches. We assume that similar spatial structures can be found in other studies focussing on neighbourhood effects on health, and therefore argue for a more widespread incorporation of spatial statistics in epidemiological studies

The growth and characterization of GaInSe2 single Crystals

GalnSe(2) single crystals have been grown and characterized by experimental techniques such as high-resolution transmission electron microscopy, x-ray diffraction, x-ray photoelectron spectroscopy and optical and electrical measurements. The samples were prepared in single-crystal form from a melt. The structural analysis indicates that GalnSe(2) has a hexagonal structure, and confirms the high quality of the produced single crystals. Quantitative information on electrical and optical properties of single-crystalline GalnSe(2) was obtained by investigating the resistivity and photoluminescence as a function of the temperature and excitation intensity

Comparative Effects of Different Feeds on Production and Reproduction of Crossbred Heifers in Gangachara Upazila, Rangpur, Bangladesh

The present study was conducted from January to June 2014, in Gangachara Upazila of Rangpur District, Bangladesh. A sample of 60 cross-bred dairy cows: Local × Holstein Friesian (L×HF) = 30 and Local × Sahiwal (L×Sh) = 30 were selected for in depth study. The average age at first heat, services per conception, age at first calving, post-partum heat period, the average milk production, the average lactation period were observed after feeding three types of feed: type-I (Sweet jamboo grass), type-II (Jomjom Dairy feed) and type-III (Advance Chemical Industry) feeding system. Local × Holstein Friesian (L×HF) cross and Local × Sahiwal (L×Sh) cross cows showed significantly (

Normalizing Community Mask-Wearing: A Cluster Randomized Trial in Bangladesh

Background: A growing body of scientific evidence suggests that face masks can slow the spread of COVID-19 and save lives, but mask usage remains low across many parts of the world, and strategies to increase mask usage remain untested and unclear. Methods: We conducted a cluster-randomized trial of community-level mask promotion in rural Bangladesh involving 341,830 adults in 600 villages. We employed a series of strategies to promote mask usage, including free household distribution of surgical or cloth masks, distribution and promotion at markets and mosques, mask advocacy by Imams during Friday prayers, role modeling by local leaders, promoters periodically monitoring passers-by and reminding people to put on masks, village police accompanying those mask promoters, providing monetary rewards or certificates to villages if mask-wearing rate improves, public signaling of mask-wearing via signage, text message reminders, messaging emphasizing either altruistic or self-protection motives for mask-wearing, and extracting verbal commitments from households. The primary objective was to assess which of these interventions would increase proper (covering nose and mouth) wearing of face masks, and secondarily, whether mask promotion unintentionally creates moral hazard and decreases social distancing. This analysis is part of larger study evaluating the effect of mask-wearing on transmission of SARS-CoV-2. Results: There were 64,937 households in the intervention group and 64,183 households in the control group; study recruitment has ended. In the control group, proper mask-wearing was practiced by 13% of those observed across the study period. Free distribution of masks along with role modeling by community leaders produced only small increases in mask usage during pilot interventions. Adding periodic monitoring by mask promoters to remind people in streets and public places to put on the masks we provided increased proper mask-wearing by 29.0 percentage points (95% CI: 26.7% - 31.3%). This tripling of mask usage was sustained over all 10 weeks of surveillance, which includes a period after intervention activities ended. Physical distancing, measured as the fraction of individuals at least one arm’s length apart, also increased by 5.2 percentage points (95% CI: 4.2%-6.3%). Beyond the core intervention package comprised of free distribution and promotion at households/mosques/markets, leader endorsements plus periodic monitoring and reminders, several elements had no additional effect on mask wearing, including: text reminders, public signage commitments, monetary or non-monetary incentives, altruistic messaging or verbal commitments, or village police accompanying the mask promoters (the last not cross-randomized, but assessed in panel data). No adverse events were reported during the study period. Conclusions: Our intervention demonstrates a scalable and cost-effective method to promote mask adoption and save lives, and identifies a precise combination of intervention activities that were necessary. Comparisons between pilots shows that free mask distribution alone is not sufficient to increase mask-wearing, but adding periodic monitoring in public places to remind people to wear the distributed masks had large effects on behavior. The absence of any further effect of the village police suggests that the operative mechanism is not any threat of formal legal sanctions, but shame and people’s aversion to a light informal social sanction. The persistence of effects for 10 weeks and after the end of the active intervention period, as well as increases in physical distancing, all point to changes in social norms as a key driver of behavior change. Our cross-randomizations suggest that improved mask-wearing norms can be achieved without incentives that require costly monitoring, that aesthetic design choices and colors can influence mask-wearing, and that surgical masks with a substantially higher filtration efficiency can be a cost-effective alternative to cloth masks (1/3 the cost) and are equally or more likely to be worn. Implementing these interventions – including distribution of free masks, and the information campaign, reminders, encouragement – cost $2.30-$3.75 per villager, or between $8 and$13 per person adopting a mask. Combined with existing estimates of the efficacy of masks in preventing COVID-19 deaths, this implies that the intervention cost $28,000-$66,000 per life saved. Beyond reducing the transmission of COVID-19, mask distribution is likely to be a cost-effective strategy to prevent future respiratory disease outbreaks