A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh

Ninety percent of lives claimed by injuries occur in low- and middle-income countries. This special issue, A Million Person Household Survey: Understanding the Burden of Injuries in Bangladesh, aims to assess these injuries—including falls, drowning, burns, road traffic injuries — to inform efforts to reduce the burden they cast on millions of people and families in a low income country. This issue offers a unique collection of research on the epidemiology of fatal and non-fatal injuries in Bangladesh. Based on a survey of more than one million people, this research—conducted by the International Injury Research Unit, Department of International Health at the Johns Hopkins Bloomberg School of Public Health and two Bangladesh partners, the Center for Injury Prevention and Research and the International Center for Diarrheal Disease Research, Bangladesh with funding from Bloomberg Philanthropies, was part of a large-scale, population-based, child-drowning prevention project called “Saving of Lives from Drowning in Bangladesh.” The project tested the large-scale effectiveness and cost-effectiveness of evidence-based interventions to reduce drowning related deaths for children less than five years of age (reported elsewhere). We hope this data will be useful to researchers, students, practitioners and national decision makers

Impact and effect mechanisms of mass campaigns in resource-constrained health systems : quasi-experimental evidence from polio eradication in Nigeria

Background: Mass campaigns are a key strategy for delivering life-saving interventions under Global Health Initiatives, especially in weak health system contexts. They are frequently designed parallel to the health system to rapidly achieve program targets such as vaccination coverage, but we lack quantitative evidence demonstrating their impact and effect mechanisms on health system performance at sub-/national level. This longitudinal study responds to this gap through an analysis of polio eradication campaigns in Nigeria. Methods: Using four rounds of Demographic and Health Surveys in Nigeria between 10/2000 and 12/2017, we created a longitudinal dataset containing 88,881 under-five children/pregnancies. We estimated the relationships between individuals’ campaign exposure and health system performance indices (full routine immunisation schedule attainment, maternal healthcare services utilisation, and child survival) using multi-level, mixed-effects regression models applied nationally, and stratified by the six geopolitical zones in Nigeria. Results: Nationally, high-frequency mass campaigns had detrimental health systems effects that potentially left 3.6 million children deprived of full immunisation. The frequency of campaigns was most concentrated in regions with weak health systems, where the operations of routine immunisation were disrupted, alongside negative effects on child survival and institutional delivery. In contrast, regions with relatively strong health systems and few campaigns experienced beneficial effects on maternal healthcare service utilisation. Conclusions: As we provide evidence that well-functioning health systems can benefit from mass campaigns under Global Health Initiatives, our work also challenges the established wisdom to intensify mass campaigns in weaker health systems to bypass service provision bottlenecks. Mass campaigns do not inherently benefit or damage a health system, but frequent campaigns in weak health system contexts can impede service provision. We call for an additional burden of proof and active efforts to integrate mass campaigns into routine health services by harmonizing implementation plans and service delivery in weak health system contexts

Effect of dietary feed additives on haematological and serum biochemical parameters of broiler chickens

This study was amid to evaluate the effect of supplementation of oxytetracylin (OTC), probiotic (Pro.), and citric acid (CA) separately on growth rate hematological, intestinal microflora and morphology of broiler chickens. A total of 270 one- day old male broiler chickens (Ross 308), were randomly kept into six groups floor pens consisting 3 replicates of 15 birds each. Treatment were as following: T1 (control diet without supplement), T2 supplementing with OTC (0.5 g/ kg); T3 and T4 supplementing with CA (1.0 or 1.5 g/ kg diet respectively), T5 and T6 supplementing with CA (1.0 or 1.5 g/ kg diet respectively). The results showed, there were significant increase in weight gain in broilers fed T3 and T4 dietary treatments, and no significant difference between the other treatments. Significant decrease in RBC, PCV and Hb, while increased in WBC, Lymphocytes, ALT and AST in birds supplemented with T2 dietary treatment. The diet containing OTC T2 and CA T6 caused reduced in micoflora count in jejunum area. There was significant increase in villi height and crypt depth for T6 while there was significant decrease in T2. In conclusion, probiotic and citric acid are good alternative to antibiotics in promoting growth, and beneficial modulation of intestinal micoflora and improve intestinal morphology

Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh

Background 90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. Methods In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. Findings The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1–4 years. Non-fatal injury rates were also highest in children aged 1–4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15–24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. Interpretation The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1–4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh

Uncovering the burden of intentional injuries among children and adolescents in the emergency department

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries.Results:Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders. Conclusion: Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention

A Framework for Addressing Implementation Gap in Global Drowning Prevention Interventions: Experiences from Bangladesh

Drowning is the commonest cause of injury-related deaths among under-five children worldwide, and 95% of deaths occur in low- and middle-income countries (LMICs) where there are implementation gaps in the drowning prevention interventions. This article reviews common interventions for drowning prevention, introduces a framework for effective implementation of such interventions, and describes the Saving of Lives from Drowning (SoLiD) Project in Bangladesh, which is based on this framework. A review of the systematic reviews on drowning interventions was conducted, and original research articles were pulled and summarized into broad prevention categories. The implementation framework builds upon two existing frameworks and categorizes the implementing process for drowning prevention interventions into four phases: planning, engaging, executing, and evaluating. Eleven key characteristics are mapped in these phases. The framework was applied to drowning prevention projects that have been undertaken in some LMICs to illustrate major challenges to implementation. The implementation process for the SoLiD Project in Bangladesh is used as an example to illustrate the practical utilization of the framework. Drowning interventions, such as pool fencing and covering of water hazards, are effective in high-income countries; however, most of these interventions have not been tested in LMICs. The critical components of the four phases of implementing drowning prevention interventions may include: (i) planning\u2014global funding, political will, scale, sustainability, and capacity building; (ii) engaging\u2014coordination, involvement of appropriate individuals; (iii) executing\u2014focused action, multisectoral actions, quality of execution; and (iv) evaluating\u2014rigorous monitoring and evaluation. Some of the challenges to implementing drowning prevention interventions in LMICs include insufficient funds, lack of technical capacity, and limited coordination among stakeholders and implementers. The SoLiD Project in Bangladesh incorporates some of these lessons and key features of the proposed framework. The framework presented in this paper was a useful tool for implementing drowning prevention interventions in Bangladesh and may be useful for adaptation in drowning and injury prevention programmes of other LMIC settings

A perspective on implementation outcomes and strategies to promote the uptake of COVID-19 vaccines

Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of lessons learned from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes

Diversifying Implementation Science: A Global Perspective.

We present a joint global perspective about the urgent need to diversify the loci of knowledge creation and sharing in global implementation science. We underscore the imperative of addressing implementation research questions relevant to practitioners, policy makers, and researchers from low- and middle-income countries

Mapping the activities of faith-based organizations in development in Nigeria

The nature, scale and activities of faith-based organizations (FBOs) remain poorly understood and documented in African countries. This paper reports on a preliminary 'mapping' of FBOs in development in Nigeria carried out as part of a larger research programme on Religions and Development