Production and use of estimates for monitoring progress in the health sector: the case of Bangladesh

Background: In order to support the progress towards the post-2015 development agenda for the health sector, the importance of high-quality and timely estimates has become evident both globally and at the country level

Shonjibon cash and counselling : a community-based cluster randomised controlled trial to measure the effectiveness of unconditional cash transfers and mobile behaviour change communications to reduce child undernutrition in rural Bangladesh

Background: Undernutrition is strongly associated with poverty - levels of undernutrition are higher in poor countries than in better-off countries. Social protection especially cash transfer is increasingly recognized as an important strategy to accelerate progress in improving maternal and child nutrition. A critical method to improve nutrition knowledge and influence feeding practices is through behaviour change communication intervention. The Shonjibon Cash and Counselling study aims to assess the effectiveness of unconditional cash transfers combined with a mobile application on nutrition counselling and direct counselling through mobile phone in reducing the prevalence of stunting in children at 18 months. Method: The study is a longitudinal cluster randomised controlled trial, with two parallel groups, and cluster assignment by groups of villages. The cohort of mother-child dyads will be followed-up over the intervention period of approximately 24 months, starting from recruitment to 18 months of the child’s age. The study will take place in north-central Bangladesh. The primary trial outcome will be the percentage of stunted children at 18 m as measured in follow up assessments starting from birth. The secondary trial outcomes will include differences between treatment arms in (1) Mean birthweight, percentage with low birthweight and small for gestational age (2) Mean child length-for age, weight for age and weight-for-length Z scores (3) Prevalence of child wasting (4) Percentage of women exclusively breastfeeding and mean duration of exclusive breastfeeding (5) Percentage of children consuming > 4 food groups (6) Mean child intake of energy, protein, carbohydrate, fat and micronutrients (7) Percentage of women at risk of inadequate nutrient intakes in all three trimesters (8) Maternal weight gain (9) Household food security (10) Number of events for child suffering from diarrhoea, acute respiratory illness and fever (11) Average costs of mobile phone BCC and cash transfer, and benefit-cost ratio for primary and secondary outcomes. Discussion: The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of mobile phone nutrition behavior change communication, combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. Trial registration: The study has been registered in the Australian New Zealand Clinical Trials Registry (ACTRN12618001975280)

District level external quality assurance (EQA) of malaria microscopy in Pakistan: pilot implementation and feasibility

Background Prompt, quality assured laboratory diagnosis is key to effective malaria case management and control, especially since the introduction of the more expensive artemisinin combination therapy (ACT). The malaria programme and its non-government partners, on the basis of WHO recommended Lot Quality Assurance methods, have developed a district level external quality assurance (EQA) system. This study was designed to assess the feasibility, under programme conditions, of an integrated district level external quality assurance and supervision approach for malaria microscopy. Design and Methods A prospective study conducted over seven months period (May-November 2007). In addition to the standard WHO EQA elements, three operational innovations were introduced, with the a district laboratory supervisor: a) onsite re-checking of slides, b) in ensuring uninterrupted availability of laboratory reagents and supplies at diagnostic centers, and c) supervision of administrative and technical components. The quantitative data for the study came from the service records/documents, whereas the qualitative data came from the key informant interviews. Results During the seven month period in four districts, a total of 8,118 slides were examined of which 209 (2.6%) were found positive for malaria parasites (slide positivity range between1.6% to 6.0%). The District Laboratory Supervisors in four districts reexamined a total of 1,770 slides (22%). The proportion of slides found discordant ranged from 0.5% to 1%. The quality of smear preparation was found acceptable in 73% slides. Conclusions A district-based EQA, based on lot quality assurance methods was implemented, using context-specific operational guidelines, tools and training modules, and other inputs from the malaria control programme and partners. This EQA and supervision approach was found to be feasible and acceptable to those involved. Further study is required on the microscopy quality and cost-effectiveness of adding external quality assurance and supervision to district malaria microscopy services

Out-of-pocket expenditure for seeking health care for sick children younger than 5 years of age in Bangladesh: findings from cross-sectional surveys, 2009 and 2012

Background: Bangladesh has committed to universal health coverage, and options to decrease household out-of-pocket expenditure (OPE) are being explored. Understanding the determinants of OPE is an essential step. This study aimed to estimate and identify determinants of OPE in seeking health care for sick under-five children. Methods: Cross-sectional data was collected by structured questionnaire in 2009 (n = 7362) and 2012 (n = 6896) from mothers of the under-five children. OPE included consultation fees and costs of medicine, diagnostic tests, hospital admission, transport, accommodation, and food. Expenditure is expressed in US dollars and adjusted for inflation. Linear regression was used for ascertaining the determinants of OPE. Results: Between 2009 and 2012, the median OPE for seeking care for a sick under-five child increased by ~ 50%, from USD 0.82 (interquartile range 0.39\u20131.49) to USD 1.22 (0.63\u20132.36) per child/visit. Increases were observed in every component OPE measured, except for consultation fees which decreased by 12%. Medicine contributed the major portion of overall OPE. Higher overall OPE for care seeking was associated with a priority illness (20% increase), care from trained providers (90% public/~ 2-fold private), residing in hilly/wet lands areas (20%) , and for mothers with a secondary education (19%). Conclusion: OPE is a major barrier to quality health care services and access to appropriate medicine is increasing in rural Bangladesh. To support the goal of universal health care coverage, geographic imbalances as well as expanded health financing options need to be explored

Rare earth ions (La3+, Nd3+) substituted cobalt–strontium spinel ferrites for photocatalytic degradation of textile dyes

In the industrial sector, productive and effective treatment of toxic dye-based color pollutants is a key issue. Lanthanum and neodymium substituted cobalt–strontium (Co–Sr) spinel ferrite (Co0.5Sr0.5RExFe2-xO4, x = 0.00 and 0.06) catalysts were synthesized and used to degrade Congo red and rhodamine B dyes from an aqueous solution mixture in this study. For this specific purpose, RE3+ ions substituted Co–Sr spinel ferrite nanoparticles with photocatalytic degradation ability were prepared through sol–gel method. The degradation of CR and RhB in recently synthesized nanoferrites was also examined. SEM and XRD were used to characterize the prepared samples. The optical band gap values of synthesized spinel ferrites were examined with the help of Tauc plots by using UV-visible absorption. It was determined that the energy bandgap ranged from 2.91 to 2.52 eV. For Co0.5Sr0.5Fe2O4, Co0.5Sr0.5La0.06Fe1.94O4, and Co0.5Sr0.5Nd0.06Fe1.94O4 nanoferrites, the rates of CR and RhB dye degradation were 73–90% and 45–85%, respectively, at pH 5–7. The kinetics models successfully described the degradation reaction as pseudo-first-order kinetics. It was, therefore, concluded that the prepared samples can be used as effective photocatalysts in order to eliminate hazardous pollutants present in wastewater. HIGHLIGHTS Rare-earth ion substitution spinel ferrite.; Ferrite for degradation of dyes.; Suitable band gap for photocatalytic purpose.

Phenolic Acids-Mediated Regulation of Molecular Targets in Ovarian Cancer: Current Understanding and Future Perspectives

Cancer is a global health concern with a dynamic rise in occurrence and one of the leading causes of mortality worldwide. Among different types of cancer, ovarian cancer (OC) is the seventh most diagnosed malignant tumor, while among the gynecological malignancies, it ranks third after cervical and uterine cancer and sadly bears the highest mortality and worst prognosis. First-line treatments have included a variety of cytotoxic and synthetic chemotherapeutic medicines, but they have not been particularly effective in extending OC patients’ lives and are associated with side effects, recurrence risk, and drug resistance. Hence, a shift from synthetic to phytochemical-based agents is gaining popularity, and researchers are looking into alternative, cost-effective, and safer chemotherapeutic strategies. Lately, studies on the effectiveness of phenolic acids in ovarian cancer have sparked the scientific community’s interest because of their high bioavailability, safety profile, lesser side effects, and cost-effectiveness. Yet this is a road less explored and critically analyzed and lacks the credibility of the novel findings. Phenolic acids are a significant class of phytochemicals usually considered in the nonflavonoid category. The current review focused on the anticancer potential of phenolic acids with a special emphasis on chemoprevention and treatment of OC. We tried to summarize results from experimental, epidemiological, and clinical studies unraveling the benefits of various phenolic acids (hydroxybenzoic acid and hydroxycinnamic acid) in chemoprevention and as anticancer agents of clinical significance

Association of food security and other socio-economic factors with dietary diversity and nutritional statuses of children aged 6-59 months in rural Bangladesh.

IntroductionDietary diversity score (DDS) is a proxy indicator for measuring nutrient adequacy. In this study, we aimed to identify the nutritional statuses and current patterns of DDS among children between 6-59 months old and their associations with different individual and household level factors in rural Bangladesh.MethodsThe Nobokoli programme of World Vision Bangladesh was implemented in Mymensingh, Sherpur, Rangpur, Dinajpur, Thakurgaon, Panchagar, and Nilphamari districts of Bangladesh between 2014 and 2017. A cross-sectional community household survey was administered between July and October 2014 to collect baseline data to evaluate the Nobokoli programme. A total of 6,468 children between 6-59 months old were included in the final analysis. Anthropometric data was collected following WHO guidelines on using wooden height and digital weight scales. We collected food intake information for the past 24 hours of the survey. The WHO's child growth standard medians were used to identify the nutritional indices of stunting, wasting, and underweight. Food items consumed were categorized into nine food groups and the DDS was constructed by counting the consumption of food items across these groups during the preceding 24 hour period. The association of DDS and nutritional status (stunting, wasting and underweight) with sociodemographic factors and household food security status were examined using multivariable models; linear regression and logistics regression respectively.ResultsThe prevalence of stunting, wasting and underweight among children aged 6-59months were 36.8%, 18.2% and 37.7% respectively. Our findings revealed that almost all children ate any form of starch followed by consumption of milk or milk products (76%) and fleshy meat /fish (61%) respectively. The mean DDS among children was 3.93(sd 1.47). Forty percent of the children obtained a DDS score less than 4. Multivariable analysis suggested that children whose mothers had higher educational attainment and are skilled workers had higher DDS (15% and 48% respectively) compared to their counterparts. The DDS showed strong positive association with household wealth status. Children from food secure households had 26% higher DDS compared to children from food insecure households. Similarly, increasing maternal education and household wealth were found to be protective against childhood stunting and undernutrition.DiscussionOur findings reiterate the need for improving household socioeconomic factors and household food security status for improving dietary diversity practices and nutritional status of children. Evidence-based solutions are needed to be implemented and expanded at scale to ensure appropriate dietary practices and improve nutritional status of the children in local context

Study protocol of a 4- parallel arm, superiority, community based cluster randomized controlled trial comparing paper and e-platform based interventions to improve accuracy of recall of last menstrual period (LMP) dates in rural Bangladesh

Abstract Background Gestational age (GA) is a key determinant of newborn survival and long-term impairment. Accurate estimation of GA facilitates timely provision of essential interventions to improve maternal and newborn outcomes. Menstrual based dating, ultrasound based dating, and neonatal estimates are the primarily used methods for assessing GA; all of which have some strength and weaknesses that require critical consideration. Last menstrual period (LMP) is simple, low-cost self-reported information, recommended by the World Health Organization for estimating GA but has issues of recall mainly among poorer, less educated women and women with irregular menstruation, undiagnosed abortion, and spotting during early pregnancy. Several studies have noted that about 20–50% of women cannot accurately recall the date of LMP. The goal of this study is therefore to improve recall and reporting of LMP and by doing so increase the accuracy of LMP based GA assessment in a rural population of Bangladesh where antenatal care-seeking, availability and utilization of USG is low. Method We propose to conduct a 4- parallel arm, superiority, community based cluster randomized controlled trial comparing three interventions to improve recall of GA with a no intervention arm. The interventions include (i) counselling and a paper based calendar (ii) counselling and a cell phone based SMS alert system (iii) counselling and smart-phone application. The trial is being conducted among 3360 adolescent girls and recently married women in Mirzapur sub-district of Bangladesh. Discussion Enrolment of study participants continued from January 24, 2017 to March 29, 2017. Data collection and intervention implementation is ongoing and will end by February, 2019. Data analysis will measure efficacy of interventions in improving the recall of LMP date among enrolled participants. Results will be reported following CONSORT guideline. The innovative conventional & e-platform based interventions, if successful, can provide substantial evidence to scale-up in a low resource setting where m-Health initiatives are proliferating with active support from all sectors in policy and implementation. Trial registration ClinicalTrials.gov NCT02944747. The trial has been registered before starting enrolment on 24 October 2016

Prevalence and factors associated with caesarean section in four Hard-to-Reach areas of Bangladesh: Findings from a cross-sectional survey.

BackgroundCaesarean section (C-section) is a major obstetric life-saving intervention for the prevention of pregnancy and childbirth related complications. Globally C-section is increasing, as well as in Bangladesh. This study identifies the prevalence of C-section and socio-economic and health care seeking related determinants of C-section among women living in hard-to-reach (HtR) areas in Bangladesh.MethodsA cross-sectional survey was conducted using a structured questionnaire between August and December 2017 at four distinct types of HtR areas of Bangladesh, namely coastal, hilly, haor (wetland), and char areas (shallow land-mass rising out of a river). Total 2,768 women of 15-49 years of age and who had delivery within one year prior to data collection were interviewed. For the analysis of determinants of C- section, the explanatory variables were maternal age, educational status of women and their husbands, women's religion, employment status and access to mobile phone, wealth index of the household, distance to the nearest health facility from the household, the number of ANC visits and presence of complications during pregnancy and the last childbirth. Logistic regression model was run among 850 women, who had facility delivery. Variables found significantly associated with the outcome (C-section) in bivariate analysis were included in the multivariable logistic model. A p-value ResultsOf the 2,768 women included in the study, 13% had C-sections. The mean (±SD) age of respondents was 25.4 (± 0.1) years. The adjusted prevalence of C-section was 13.1 times higher among women who had their delivery in private facilities than women who delivered in public facilities (Adjusted Odds Ratio, AOR: 13.1; 95% CI 8.6-19.9; p-value: ConclusionsThe study identifies that the prevalence of C-sections in four HtR areas of Bangladesh in substantially below the national average, although, the prevalence was higher in coastal areas than three other HtR regions. Both public and private health services for C-section should be made available and accessible in remote HtR areas for women with pregnancy complications. Establishment of an accreditation system for regulating private hospitals are needed to ensure rational use of the procedure