Pathways to care of patients with mental health problems in Bangladesh

Background: Health systems in Bangladesh are not fully organized to provide optimal care services to patients with mental health problems. There is both a lack of resources and a disproportional distribution of the available resources. To design an equitable health system and plan interventions to improve access to care, a better understanding of mental health care-seeking behavior and care pathways are crucial. Methods: A facility-based cross-sectional study was conducted using a mixed-method design at the National Institute of Mental Health (NIMH), in Bangladesh. A total of 40 patients (or their attendants) visiting the outpatient department of NIMH were selected by purposive sampling. Results: As their first contact point for care services, 27.5% of the patients consulted a psychiatric care provider, 30% went to non-medical provider, and the majority, 42.5%, went to non-psychiatric medical care providers. Only 32.5% of the patients had been advised to go to NIMH by a private physician, hospital personnel or psychiatrist. Among all individual categories of providers, private psychiatrists were the most frequent caregivers (n = 12), followed by traditional healers (n = 9). A total of 70% of the patients had chosen a provider within 20 km. In three out of four of the cases, the family had decided on the first provider. From the start of the symptoms the median delay in the first contact with any provider was 6 months, and in reaching any psychiatric care provider was 1 year. The most common reasons for a delay in seeking care were a lack of knowledge about mental health problems, a lack of information about the place for appropriate care, and not considering the problem as serious enough to seek care. Each of those reasons were mentioned by one in every four respondents. Conclusions: The majority of the patients with mental health problems in Bangladesh access various categories of providers before reaching a psychiatric care provider, and use a diverse range of pathways and loops, which results in a delay or missing appropriate care. We hope that our findings are useful for planning interventions to improve access to mental health care in general, in Bangladesh, and improving referral policies and structures in particular

Experience and perceived quality of care of patients and their attendants in a specialized mental hospital in Bangladesh

Background: A person’s perception of health service quality depends on his or her expectations and priorities. If the perception of care is good, then it eventually enhances future health service utilization, adherence to treatment and desired outcomes. Understanding a patient’s perspective is key for delivering a better quality patient-centred health care service. This study explored experience and perception of patients and their attendants of mental health care services at the National Institute of Mental Health (NIMH) which is the only national level mental health institute in Bangladesh. NIMH is located in the capital city and provides specialized mental health care services for the whole population. Methods: A facility-based cross-sectional study was conducted using a mixed-method design at the NIMH. A total of 40 respondents (patients, or their attendants if the patient was minor or unable to respond due to lack of mental stability) visiting the outpatient department (OPD) of NIMH were selected by purposive sampling. For each of the ten ICD 10 categories (10th revision of International Classification of Diseases by the World Health Organization [WHO]) for mental disorders, four patients were chosen. Finally, 13 patients and 27 attendants (on behalf of 17 minor patients and 10 adult patients unable to respond) participated in the interview. Results: The respondents rated 34 short statements clustered around four dimensions of care (accessibility, interpersonal communications, condition of the waiting and consultation rooms, and general quality of OPD services) and we interpreted those scores as follows: 7.6–10 very satisfied/very good quality, 5.1–7.5 satisfied/good quality, 2.6–5.0 dissatisfied/poor quality and 1.0–2.5 completely dissatisfied/very poor quality. For accessibility and interpersonal communications, the patients perceived care as very good (average scores on a Likert scale of 1–10 were 8.3 and 7.6, respectively). The respondents considered the condition of the waiting and consultation rooms and general quality of OPD care as good (average scores 5.8 and 7.1, respectively). NIMH had serious lack of resources in terms of functional medical equipment and physicians appointed, which negatively impacted on the service quality. Conclusions: Patients receiving services from the NIMH OPD had a positive perception of the quality of care in general. But, at an individual level, some respondents expressed dissatisfaction. Our findings are informative for quality improvement and client-oriented care service planning at NIMH, Bangladesh

A 30-day follow-up study on the prevalence of SARS-COV-2 genetic markers in wastewater from the residence of COVID-19 patient and comparison with clinical positivity

Wastewater based epidemiology (WBE) is an important tool to fight against COVID-19 as it provides insights into the health status of the targeted population from a small single house to a large municipality in a cost-effective, rapid, and non-invasive way. The implementation of wastewater based surveillance (WBS) could reduce the burden on the public health system, management of pandemics, help to make informed decisions, and protect public health. In this study, a house with COVID-19 patients was targeted for monitoring the prevalence of SARS-CoV-2 genetic markers in wastewa-ter samples (WS) with clinical specimens (CS) for a period of 30 days. RT-qPCR technique was employed to target non-structural (ORF1ab) and structural-nucleocapsid (N) protein genes of SARS-CoV-2, according to a validated experimental protocol. Physiological, environmental, and biological parameters were also measured following the American Public Health Association (APHA) standard protocols. SARS-CoV-2 viral shedding in wastewater peaked when the highest number of COVID-19 cases were clinically diagnosed. Throughout the study period, 7450 to 23,000 gene copies/1000 mL were detected, where we identified 47 % (57/120) positive samples from WS and 35 % (128/360) from CS. When the COVID-19 patient number was the lowest (2), the highest CT value (39.4; i.e., lowest copy number) was identified from WS. On the other hand, when the COVID-19 patients were the highest (6), the lowest CT value (25.2 i.e., highest copy numbers) was obtained from WS. An advance signal of increased SARS-CoV-2 viral load from the COVID-19 patient was found in WS earlier than in the CS. Using customized primer sets in a traditional PCR approach, we confirmed that all SARS-CoV-2 variants identified in both CS and WS were Delta variants (B.1.617.2). To our knowledge, this is the first follow-up study to determine a temporal relationship be-tween COVID-19 patients and their discharge of SARS-CoV-2 RNA genetic markers in wastewater from a single house including all family members for clinical sampling from a developing country (Bangladesh), where a proper sewage system is lacking. The salient findings of the study indicate that monitoring the genetic markers of the SARS-CoV-2 virus in wastewater could identify COVID-19 cases, which reduces the burden on the public health system during COVID-19 pandemics.Peer reviewe

Wastewater-based epidemiological surveillance to monitor the prevalence of SARS-CoV-2 in developing countries with onsite sanitation facilities

Wastewater-based epidemiology (WBE) has emerged as a valuable approach for forecasting disease outbreaks in developed countries with a centralized sewage infrastructure. On the other hand, due to the absence of well-defined and systematic sewage networks, WBE is challenging to implement in developing countries like Bangladesh where most people live in rural areas. Identification of appropriate locations for rural Hotspot Based Sampling (HBS) and urban Drain Based Sampling (DBS) are critical to enable WBE based monitoring system. We investigated the best sampling locations from both urban and rural areas in Bangladesh after evaluating the sanitation infrastructure for forecasting COVID-19 prevalence. A total of 168 wastewater samples were collected from 14 districts of Bangladesh during each of the two peak pandemic seasons. RT-qPCR commercial kits were used to target ORF1ab and N genes. The presence of SARS-CoV-2 genetic materials was found in 98% (165/168) and 95% (160/168) wastewater samples in the first and second round sampling, respectively. Although wastewater effluents from both the marketplace and isolation center drains were found with the highest amount of genetic materials according to the mixed model, quantifiable SARS-CoV-2 RNAs were also identified in the other four sampling sites. Hence, wastewater samples of the marketplace in rural areas and isolation centers in urban areas can be considered the appropriate sampling sites to detect contagion hotspots. This is the first complete study to detect SARS-CoV-2 genetic components in wastewater samples collected from rural and urban areas for monitoring the COVID-19 pandemic. The results based on the study revealed a correlation between viral copy numbers in wastewater samples and SARS-CoV-2 positive cases reported by the Directorate General of Health Services (DGHS) as part of the national surveillance program for COVID-19 prevention. The findings of this study will help in setting strategies and guidelines for the selection of appropriate sampling sites, which will facilitate in development of comprehensive wastewater-based epidemiological systems for surveillance of rural and urban areas of low-income countries with inadequate sewage infrastructure.This research was supported by Water Aid Bangladesh, North South University, Dhaka, COVID-19 Diagnostic Lab, Department of Microbiology, Noakhali Science and Technology University (NSTU), Noakhali, Bangladesh, the International Training Network of Bangladesh University of Engineering and Technology (ITN-BUET) - Centre for Water Supply and Waste Management, and KTH Royal Institute of Technology, Sweden. We acknowledge the sincere help and support of the staff and volunteers of NSTU-COVID-19 Diagnostic Lab, Noakhali Science and Technology University, Bangladesh during the different phases of the study. PB and MTI acknowledge the Life Science Technology Platform, Science for Life Laboratory for the seed funding to initiate the wastewater-based epidemiological studies for SARS-CoV-2 in Bangladesh. We would also like to acknowledge the two anonymous reviewers for their critical comments as well as their thoughtful insights, which has significantly improved the manuscript.Peer reviewe

Exploring impacts and livelihood vulnerability of riverbank erosion hazard among rural household along the river Padma of Bangladesh

Abstract Background Riverbank erosion has both direct and indirect effects on human life and socio-economy of Bangladesh. The present study investigated the riverbank erosion hazard in study area, its impacts on local people and livelihood vulnerability due to land loss. Methods To evaluate the riverbank erosion hazard in the study area, data have been collected from relevant scientific literatures, different government and non-government organizations, informal interview, questionnaire survey and Focused Group Discussion; and analyzed through different computer program and index. Results From the study, it was found that from 1973 to 2011, about 189.4 km2 lands was eroded from the left bank section and only 23.66 km2 was accreted with a net loss of 155 km2. Instead, right bank of the Padma River behaved in the opposite manner with 166.53 km2 erosion and 134.45 km2 accretions. Comparing to the right bank, left bank was more vulnerable to erosion which destroyed the permanent stable lands. However, the value of the newly accreted char land is very low compare to the main land. Thus this hazard creates a great loss in the local economy. Within the studied time range the monetary loss is about 1414.81 million BDT (17,422,937.16 $). Many wealthy farmers of the study area turn into marginal farmer and even landless due to the erosional hazard. Agricultural land becomes barren land by huge siltation and the cropping pattern has been changed significantly. In addition, the infrastructure and property losses are enormous. From the results of vulnerability index (IPCC-VI) it suggests that the most vulnerable areas are identified as Boyra (0.061), Kanchanpur (0.062), Lesragonj (0.064), Azimnagar (0.067), Sutalori (0.071) and Dhulsonra (0.076) because of more sensitivity and less adaptive capacity. On the other hand, Balara (− 0.017) and Balla (− 0.019) are comparatively least vulnerable comparing to the previous sites. Conclusions As, riverbank erosion is one of the most hazardous disasters in the study area; so treating independent separate policies and program for the vulnerable areas might helpful to support the affected community

A Soil Health Card (SHC) for soil quality monitoring of agricultural lands in south-eastern coastal region of Bangladesh

Abstract Background The present study introduces an alternate tool of laboratory analysis named Soil Health Card (SHC) for soil quality monitoring and routine field observations by farmers. Results Different physicochemical and nutrient contents of soil, i.e. pH, electric conductivity, soil organic matter, organic carbon, total nitrogen, phosphorous, sulfur and boron were assessed by laboratory analysis collected from the different fields of Noakhali district of Bangladesh. These parameters were scored according to the soil fertility standards according to Bangladesh Agriculture Research Council. Results found that, the soil quality of all the studied fields are medium category. Again, a SHC was prepared using soil structure, subsurface compaction, aggregate stability, status of ground cover, soil smell, soil pH, color, organic matter content, drainage capacity, diversity of micro-life, earthworm contents, infiltration rate, soil aeration, crop coverage and leaf color. The result of SHC is interestingly similar to the laboratory experiment results. Conclusions Analyzing these two methods it was found that, the SHC is truly representative, much convenient, precise, coast effective and easily understandable to the marginal farmers. However, SHC can be an alternative to farmer for sustainable farm management

FACILITY ASSESSMENT FOR MATERNAL AND CHILD HEALTH SERVICES IN BANGLADESH USING SERVICE AVAILABILITY AND READINESS ASSESSMENT (SARA) TOOL: A CROSS-SECTIONAL PILOT STUDY

Background: To initiate journey towards the Universal Health Coverage (UHC) it is essential to assess the health facilities. Unfortunately, no health facility assessment has been conducted in Bangladesh so far using "Service Availability and Readiness Assessment (SARA)” tool. Therefore, we aimed to conduct a pilot study to assess health facilities for maternal and child health services using SARA tool so that we can scale-up this assessment throughout the country later. Aim: We aimed to assess the health facilities for maternal and child health services in Tangail, Bangladesh using service availability and readiness assessment (SARA) tool. Methods: A cross-sectional pilot study was conducted in Bashail and Shokhipur Upazilla of Tangail district. A sample of 14 health facilities was assessed purposefully for data collection using a modified version of the SARA tool. Data was collected from November 01 to November 15, 2013, using paper-based questionnaire. Finally, following data collection, data were documented into Microsoft Excel by data collectors. Data were analyzed using Microsoft Excel, version 2010. Results: General service readiness has been segregated into five domains and their readiness scores were basic amenities (53.06%), basic equipment (83.33%), standard precautions for infection prevention (55.56%), and basic equipment (58.93%) for included health facilities. Similarly, specific service readiness includes family planning (48.15%), child immunization (67.71%), preventive and curative care (71.43%), and basic surgery (93.33%). Conclusion: Since we are moving towards UHC, it is essential to know the current scenario of health facilities. This pilot study reveals the strength and weakness of the health facilities in providing the maternal and child health services. These findings will help us to resolve all the identified gaps through proper planning and action

Prevalence of work related musculoskeletal disorders (WMSDs) and ergonomic risk assessment among readymade garment workers of Bangladesh: A cross sectional study.

BACKGROUND:Work related Musculoskeletal Disorders (WMSDs) are one of the most common occupational diseases which mainly affects the lower back, neck and upper and lower extremities. The aim of this study was to determine prevalence of WMSDs in nine body regions among Ready Made Garment (RMG) workers in Bangladesh and ergonomics assessment of their exposure to risk factors for the development of WMSDs. METHODS:This cross-sectional study was conducted among 232 RMG employees (male: 46; female: 186; age: >18yrs) from nine RMG factories in Dhaka division during October 2015 to February 2016. Data were collected using a structured questionnaire consist of demographic questions, Nordic Musculoskeletal Questionnaire-Extended (NMQ-E) for WMSDs assessment in nine body regions and Quick Exposure Check (QEC) method for ergonomic assessment. Prevalence of WMSDs for each body region was determined. The association between WMSDs and ergonomic assessment of their exposure to risk factors were also analyzed. RESULTS:Respondents' mean age was 31.3 years (SD = 7). Their mean Body Mass Index (BMI) was 23.51 kg/m2 (SD = 3.74). Among 186 female respondents, 46 reported lower back pain (24.7%) and 44 reported neck pain (23.7%). Among 46 male respondents, 10 reported neck pain (21.7%) while 6 reported knee pain (13%). Statistically significant relationship was found between twelve month WMSDs in anatomical region in elbows (p = 0.02), hips (p = 0.01), knees (p = 0.01) and ankle (p = 0.05) with age; upper back (p = 0.001), elbows (p = 0.001), wrists (p = 0.03), hips (p = 0.001) and ankles (p = 0.01) with job experience; hips with BMI (p = 0.03); elbows (p = 0.04) with daily working hour. QEC assessment showed that level of exposure to WMSDs risk was high among 80% of the study population (p<0.003). CONCLUSION:The study found that lower back and neck were the most affected areas among RMG workers. Moreover, QEC findings warned the level of exposure to WMSDs risks is high and ergonomics intervention along with investigation and change to decrease exposure level is essential. Addressing musculoskeletal risk factors through ergonomic interventions in terms of working space, workers sitting/standing posture, seat and hand position during work and work-rest cycle are encouraged in RMG sector and policy makers