Suicidal behaviors among undergraduate medical students in Bangladesh

Background: Suicide among medical students is a global public health concern; however, it is often addressed poorly in developing countries like Bangladesh. This study aims to examine suicidal behaviors among undergraduate medical students in Bangladesh. Methods: This cross-sectional analytical study was conducted between February and July of 2019. Data were collected from 583 MBBS students at Bangladesh’s public and private medical colleges. A convenience sampling method was used, and data were collected through a pretested semi-constructed questionnaire. Results: A lifetime suicidal ideation was found among 23.8% of the participants. Significant associations were found among lifetime suicidal ideation, plan and attempt with depression, comorbidity, and family history. Multivariable logistic regression models revealed that a family history of suicide attempts or death by suicide increased the odds six-fold for ideation, over sixfold for a plan, and threefold for an attempt. Females were twice likely to be susceptible to suicide ideation, plan, and attempt. Conclusion: Suicidality appears high among medical students in Bangladesh. Levels of depression, comorbidities, as well as substance abuse affect lifetime suicide ideation. A previous history of attempting or committing suicide in the respondent’s family increases the individual risk for ideation, plan, and attempt. Females are more vulnerable than males

Ongoing efforts to improve the management of patients with diabetes in Bangladesh and the implications

Background: Prevalence rates of patients with diabetes are growing across countries, and Bangladesh is no exception. Associated costs are also increasing, driven by costs associated with the complications of diabetes including hypoglycaemia. Long-acting insulin analogues were developed to reduce hypoglycaemia as well as improve patient comfort and adherence. However, they have been appreciably more expensive reducing their affordability and use. Biosimilars offer a way forward. Consequently, there is a need to document current prescribing and dispensing rates for long-acting insulin analogues across Bangladesh, including current prices and differences, as a result of affordability and other issues. Methods: Mixed method approach including surveying prescribing practices in hospitals coupled with dispensing practices and prices among community pharmacies and drug stores across Bangladesh. This method was adopted since public hospitals only dispense insulins such as soluble insulins free-of-charge until funds run out and all long-acting insulin analogues have to be purchased from community stores. Results: There has been growing prescribing and dispensing of long-acting insulins in Bangladesh in recent years, accounting for over 80% of all insulins dispensed in a minority of stores. This has been helped by growing prescribing and dispensing of biosimilar insulin glargine at lower costs that the originator, with this trend likely to continue with envisaged growth in the number of patients. Consequently, Bangladesh can serve as an exemplar to other low- and middle-income countries struggling to fund long-acting insulins for their patients. Conclusions: It was encouraging to see continued growth in the prescribing and dispensing of long-acting insulin analogues in Bangladesh via the increasing availability of biosimilars. This is likely to continue benefitting all key stakeholder groups

Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000-17

Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce high-resolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation

Adiposity indicators lipid accumulation product and triglyceride-glucose index as alternate criteria for the diagnosis of metabolic obesity in adult

Metabolic obesity refers to the state of having metabolic syndrome irrespective of one’s body mass index. This study was aimed to elucidate the lipid accumulation product and triglyceride-glucose index as simple and alternate criteria for detecting metabolic obesity in adult. The study was conducted in 200 adult (age range: 19-45 years). According to lipid accumulation product and triglyceride-glucose index, the prevalence of metabolic obesity was 54.0% and 53.5% respectively. With a cutoff value of 45.5, the lipid accumulation product was found good to evaluate the metabolic obesity having area under receiver operating characteristic curve 0.9 (p=0.000), with sensitivity 90.9%, specificity 75.0%, positive predictive value 74.1%, and negative predictive value 91.3%. With a cutoff value of 8.7, the triglyceride-glucose index was found good to evaluate the metabolic obesity having area under receiver operating characteristic curve 0.9 (p=0.000), with sensitivity 95.5%, specificity 79.5%, positive predictive value 78.5%, and negative predictive value 95.7%. In conclusion, lipid accumulation product and triglyceride-glucose index are good as alternate criteria for diagnosing the metabolic obesity in adults

Adiposity indicators lipid accumulation product and triglyceride-glucose index as alternate criteria for the diagnosis of metabolic obesity in adult

Metabolic obesity refers to the state of having metabolic syndrome irrespective of one’s body mass index. This study was aimed to elucidate the lipid accumulation product and triglyceride-glucose index as simple and alternate criteria for detecting metabolic obesity in adult. The study was conducted in 200 adult (age range: 19-45 years). According to lipid accumulation product and triglyceride-glucose index, the prevalence of metabolic obesity was 54.0% and 53.5% respectively. With a cutoff value of 45.5, the lipid accumulation product was found good to evaluate the metabolic obesity having area under receiver operating characteristic curve 0.9 (p=0.000), with sensitivity 90.9%, specificity 75.0%, positive predictive value 74.1%, and negative predictive value 91.3%. With a cutoff value of 8.7, the triglyceride-glucose index was found good to evaluate the metabolic obesity having area under receiver operating characteristic curve 0.9 (p=0.000), with sensitivity 95.5%, specificity 79.5%, positive predictive value 78.5%, and negative predictive value 95.7%. In conclusion, lipid accumulation product and triglyceride-glucose index are good as alternate criteria for diagnosing the metabolic obesity in adults

Waist-to-height ratio as index of cardiometabolic risk among the doctors

The aim of this study was to see the cardiometabolic risk among doctors using waist-to-height ratio index as tool. Cardiometabolic risk is an umbrella term that includes all the risk factors of diabetes and cardiovascular disease. The study was conducted among 195 doctors. According to waist-to-height ratio index 167 (85.6%) doctors had cardiometabolic risk. Waist-to-height ratio index was found good (area under the curve >0.5, sensitivity 88.1%, specificity 23.2%, positive predictive value 53.9%, and negative predictive value 66.7%) for their predictive value of cardiometabolic risk. Age grouping was done and found that no age group was free from cardiometabolic risk

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease - Fig 2

<p>The economic impact of chikungunya infection on days misses from work (A) and rating versus income ranges as 100% staked column (B). Respondents were asked to rate the chikungunya healthcare expenditure on their economic conditions on a numeric rating scale of 1 to 10. Rating 8–10, 5–7, 2–4 and 1 is considered as extreme, moderate, mild and no impact on economic conditions of respondents, respectively. One column in B illustrates the relative percentage of cases from different income ranges. The exchange rate of 1 USD is about 82 BDT.</p

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease

<div><p>Background</p><p>Chikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh.</p><p>Methods</p><p>We conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life.</p><p>Results</p><p>A total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy.</p><p>Conclusions</p><p>This study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.</p></div

Clinical profile of chikungunya patients (n = 1326) in Bangladesh.

<p>Clinical profile of chikungunya patients (n = 1326) in Bangladesh.</p

Arthralgia profile of chikungunya patients (n = 1129, cases with past history of arthritis were excluded) in Bangladesh.

<p>Arthralgia profile of chikungunya patients (n = 1129, cases with past history of arthritis were excluded) in Bangladesh.</p