Finding children who are blind.

Children who are blind need to be found as early as possible so they can be examined, treated, referred, or rehabilitated. This is crucial if they are to have the best possible chance of proper childhood development, education, and participation in broader social life

Childhood Cataract: Home to Hospital

Globally, there are 190,000 children who are blind from cataract.1 Cataract in children may be present at birth (congenital cataract) or may appear anytime during the first few years of life (developmental cataract). Childhood cataract is the most common treatable cause of childhood blindness, being responsible for 10-30% of all childhood blindness. A recent national study in Bangladesh showed that 1 in every 3 blind children is unnecessarily blind from congenital/developmental cataract

Bridging the 10/90 gap: can Bangladesh provide a developing world model for influenza and pneumonia research?

Despite the fact that developing countries carry more than 90 global disease burden, only a small fraction of global medical research addresses their problems. It is interesting to note that even in the field of acute respiratory tract infections, a leading cause of mortality in poor settings, there has been disproportionately little research performed in developing countries. Using Bangladesh as an example, we discuss how clinical trials to address the most important health problems of the developing world (that are also of relevance to the developed world) have been and can continue to be conducted in resource poor countries. To start with, we propose to conduct, in partnership with colleagues from resource rich countries, an influenza vaccine trial in Bangladesh to assess the efficacy of trivalent influenza vaccine, with and without the addition of supplementary measures like the promotion of hand hygiene in reducing pneumonia mortality among children under 5 years of age. Such research may produce a win-win situation for both developed and developing countries

Prevalence and associated factors of suicidal behaviors among Bangladeshi rural community people: Findings from the 'BD ComMen Study'.

BackgroundSuicide is considered as one of the major public health concerns, which can be prevented with cost-effective and timely intervention. In Bangladesh, very few studies assessed the suicidal behavior of rural community people. Thus, this Bangladesh Community Mental Health Study (BD ComMen Study) attempted to understand the current situation of suicidality in Bangladeshi rural community people considering three-time frames: lifetime, past year, and past month.MethodsA cross-sectional study was conducted in a rural community in Bangladesh between May 17 and 31, 2022, using a cluster sampling technique. Information on socio-demographics, COVID-19-related factors, depression, anxiety, insomnia, and suicidal behaviors was collected. The Chi-square test or Fisher's exact test and logistic regression were used to analyze the data.ResultsDuring their lifetime, 33.1% of the rural community people had suicidal thoughts, whereas 5.5% made a plan for suicide and 1.8% attempted suicide. The prevalence of past-year suicidal ideation was 3.9%, whereas 1.4% had a suicide plan. In addition, 0.6% had past-month suicidal thoughts, although none of them had planned or attempted suicide. The factors associated with suicidal behaviors included males, lower age, lower educational grade, low-earning jobs, living in a government-provided house, family history of mental health and suicide, and suffering from anxiety and insomnia.ConclusionsSuicidal behaviors among the rural community people are of great concern as most of the rural people in Bangladesh do not have enough mental health literacy for treatment-seeking due to a high level of mental health-related stigma. Thus, this study would likely help to initiate further studies and stimulate suicide prevention programs, because most suicide can be prevented

ComMen data.

(SAV)</p

The Key Informant method (KIM) - a novel means of ascertaining blind children in Bangladesh

BACKGROUND: Most information on the causes of blindness has come from examining children in special education. To obtain a more representative population-based sample of children, a novel method was developed for ascertaining severe visually impaired (SVI) or blind (BL) children by training local volunteers to act as key informants (KIs). OBJECTIVE: To compare the demography and cause of blindness in children recruited by KIs with other ascertainment methods. METHOD: Children with SVI/BL were recruited in all 64 districts of Bangladesh. Three sources for case ascertainment were utilised: schools for the blind (SpEdu), community-based rehabilitation (CBR) programmes and KIs. All data were recorded using the standard WHO/PBL Eye Examination Record. RESULTS: 1935 children were recruited. Approximately 800 KIs were trained. The majority of the children were recruited by the KIs (64.3%). Children recruited by KIs were more likely to be female (odds ratio (OR) 1.6, p<0.001), of pre-school age (OR 14.1, p<0.001), from rural areas (OR 5.9, p<0.001), be multiply impaired (OR 3.1, p = 0.005) and be suffering from treatable eye diseases (OR 1.3, p = 0.005) when compared with those in SpEdu. Overall a child with an avoidable causes of SVI/BL had 40% (adjusted CI 1.1 to 1.7, p = 0.015) and 30% (CI 1.0 to 1.7, p = 0.033) higher odds of being ascertained using the KIs compared with SpEdu and CBR methods, respectively. CONCLUSION: Using this innovative approach has resulted in one of the largest studies of SVI/BL children to date. The findings indicate that KIs can recruit large numbers of children quickly, and that the children they recruit are more likely to be representative of all blind children in the community

Depression, anxiety and stress among caregivers of adolescents with cerebral palsy in rural Bangladesh

Purpose: Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver’s mental health. Methods: Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed. Results: Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05). Conclusions: Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development

The sexual and reproductive health of adolescents with cerebral palsy growing up in rural Bangladesh : a qualitative analysis

Adolescents with disability in the Global South have unique sexual and reproductive health (SHR) experiences and needs; however, they are rarely included in SRH discourse. This qualitative study, conducted in rural Bangladesh, used semi-structured interviews to understand how adolescents with cerebral palsy (CP) experience their SRH. Participants were recruited from the Bangladesh Cerebral Palsy Register and included 24 adolescents with CP (n = 12 female; n = 12 male) and 76 parents (n = 56 mothers, n = 17 fathers, n = 3 other relatives). Data were analyzed using reflexive thematic analysis. Findings highlighted heterogeneity among adolescents with CP including differences for adolescent men versus women. For some adolescent men with CP, sexual maturity was viewed as bringing new opportunities, whereas for other men, adolescence affirmed exclusions and some transgressed sociocultural norms as they struggled to navigate their pubescent body alongside new privacy requirements. For adolescent women with CP, sexual maturity was associated with new domestic responsibilities, silence and secrecy regarding menstruation, and increased vulnerability to sexual violence and abuse. Adolescent men and women with CP spoke about marriage as something “everybody wants,” however, was deemed “impossible” for those with more impairment-related support needs. Both adolescent men and women with CP lacked access to SRH information and support. Mothers positioned providing care to their adolescent child with CP after puberty as “shameful.” Our findings suggest that disability, health, and education services in rural Bangladesh need to adopt a life-course approach that incorporates the SRH of adolescents with CP. We recommend the provision of SRH education that addresses the physical, cognitive, and social needs of adolescents with CP

The epidemiology of childhood blindness and severe visual impairment in Indonesia

Background: The magnitude of blindness among children in Indonesia is unknown. In this study, we aimed to define the magnitude and aetiology of childhood blindness in two parts of Indonesia. Method: Children aged 0-15 years, identified through key informant method and from special schools and community-based rehabilitation programme in Sumba and Yogyakarta, were assessed following WHO protocol and definitions for ophthalmological assessment and classification of visual impairment and blindness among children. Results: Out of 195 children assessed, 113 had blindness/severe visual impairment (BL/SVI), 48 had visual impairment (VI) and 34 had no VI. 43.4% children with BL/SVI were female. The main anatomical site of BL/SVI was lens (n=35, 31.0%), followed by retina (n=13, 11.5%) and cornea (n=9, 8.0%). Among the known aetiologies, childhood factors predominated (n=14, 12.4%), followed by hereditary diseases (n=12, 10.6%) where parental consanguinity was found among 33.3% (n=4) of them. Overall, 77.8% (n=88) had avoidable causes of BL/SVI: 69.0% (n=78) treatable and 8.8% (n=10) preventable causes. The estimated prevalence of BL/SVI was 0.25 (95% CI 0.19 to 0.32) and 0.23 (95% CI 0.18 to 0.29) per 1000 children in Sumba and Yogyakarta, respectively. The estimated prevalence of cataract was 0.07 per 1000 children (95% CI 0.04 to 0.12) in Sumba and 0.05 per 1000 children (95% CI 0.03 to 0.09) in Yogyakarta. Based on our conservative estimates, there are 17 241 children with BL/SVI in Indonesia; 4270 are blind due to cataract. Conclusion: The magnitude of childhood BL/SVI in Sumba and Yogyakarta is high. Our study suggests that a large proportion of childhood BL/SVI in Indonesia is avoidable