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

Vulnerability to fatal drowning among the population in Southern Bangladesh: Findings from a cross-sectional household survey

© 2019 Author(s). Objectives This study aimed to determine the fatal drowning burden and associated risk factors in Southern Bangladesh. Settings The survey was conducted in 39 subdistricts of all 6 districts of the Barisal division, Southern Bangladesh. Participants All residents (for a minimum 6 months prior to survey) of the Barisal division, Southern Bangladesh. Intervention/methods A cross-sectional, divisionally representative household survey was conducted in all six districts of the Barisal division between September 2016 and February 2017, covering a population of 386 016. Data were collected by face-to-face interview with adult respondents using handheld electronic tablets. International Classification of Diseases (ICD)-v. 10 (ICD-10) Chapter XX: External causes of morbidity and mortality codes for drowning, W65-W74, X36-X39, V90, V92, X71 or X92, were used as the operational definition of a drowning event. Results The overall fatal drowning rate in Barisal was 37.9/100 000 population per year (95% CI 31.8 to 43.9). The highest fatal drowning rate was observed among children aged 1-4 years (262.2/100 000/year). Mortality rates among males (48.2/100 000/year) exceeded that for females (27.9/100 000/year). A higher rate of fatal drowning was found in rural (38.9/100 000/year) compared with urban areas (29.3/100 000/year). The results of the multivariable logistic regression identified that the factors significantly associated with fatal drowning were being male (OR 1.7, 95% CI 1.2 to 2.3), aged 1-4 years (OR 3.0, 95% CI 1.4 to 6.4) and residing in a household with four or more children (four or more children OR 1.8, 95% CI 1.1 to 2.9; and five or more children OR 2.1, 95% CI 1.2 to 3.7). Conclusion Drowning is a public health problem, especially for children, in the Barisal division of Southern Bangladesh. Male gender, children 1-4 years of age and residing in a household with four or more children were associated with increased risk of fatal drowning events. The Barisal division demands urgent interventions targeted at high-risk groups identified in the survey

Seasonal and Altitudinal Prevalence of Fascioliasis in Buffalo in Eastern Nepal

Buffalo is the most important livestock commodities for milk, meat production and several other multipurpose uses distributed densely from southern tarai to northern mid-hills in Nepal. Among several internal parasitic diseases fascioliasis is highly economic one caused by Fasciola in buffaloes. However, there are only few studies carried on prevalence of fascioliasis emphasizing buffaloes in relation to seasonal (summer and rainy, and winter) and altitudinal variations. Therefore, we examined prevalence of fascioliasis seasonally and vertically. For the purpose, we selected two districts of eastern Nepal and sampled from low altitude area known as Madhesha ranging from 175-200, Dhankuta from 800-1200 m, and Murtidhunga from 1800-2200 m elevation from the sea level, representing tarai, mid hills and high hills, respectively. Altogether from February 2013 to January 2014 at every two months interval we collected 798 fecal samples from buffaloes; 282 from Murtidhunga, 239 from Dhankuta and 277 from Madhesha. The samples were examined microscopically for the presence of Fasciola eggs using sedimentation technique. Results showed that overall prevalence of fascioliasis in buffaloes was 39.9% (319/798), ranging highest 42.6%in Madhesha followed by 39.7% in Murtidhunga and 37.2% in Dhankuta, respectively. The prevalence of fascioliasis was found to be significantly (p <0.05) high in winter (44.9%) comparing to rainy season (34.4%). The prevalence of fascioliasis in buffaloes was relatively higher in low altitude than high altitude, although it was not statistically significant (p <0.05). In our findings the female buffaloes showed higher prevalence for fascioliasis than in male. Since the fascioliasis in buffaloes is highly endemic, thus strategic deworming in high risk period is recommended along with measure to prevent pasture contamination with buffalo feces

Influence of glass fiber content on tensile properties of polyamide-polypropylene based polymer blend composites

In recent years, the rapid development of polymer composites is replacing the use of metals and alloys in high performance engineering applications, particularly in automotive and aerospace industries. In this research study, influence of glass fiber (GF) content on tensile properties of polyamide-polypropylene (PA-PP) based blend composites was investigated. Considering, 0%, 3%, 6%, 9% and 12% GF content, PA6-PP-GF composites of five compositions were prepared through injection molding method. In the experiments, tensile tests were performed under strain rate of 5 mm/min for all types of composite specimens. Test results show that tensile properties of composites of five different compositions are influenced by glass fiber content. In general, tensile strength of composite increases gradually with increase in fiber content. On the other hand, tensile modulus increases significantly with increase in fiber content. Experimental data also revealed that yield strength, strength at fracture and strain at break of the composites are influenced by the content of glass fiber. Test data also show that tensile strain at maximum load almost corresponds to the tensile strain at break for all composite specimens

Investigation on microstructure and hardness of aluminium-Aluminium oxide functionally graded material

This study investigated the microstructure and hardness of aluminium-aluminium oxide (Al-Al2O3) functionally graded material (FGM). Preparation of metal-ceramic functionally graded material was carried out following powder metallurgy (PM) route. Four-layered aluminium-aluminium oxide (Al-Al2O3) graded composite structure was processed using 0%, 5%, 10% and 15% (from first layer to fourth layer) aluminium oxide as ceramic concentration. A cylindrical steel die was used for the fabrication process of the FGM green compact. The green compact was prepared by applying cold pressing technique using a hydraulic press. The sintering process was implemented at 600 °C sintering temperature and 3 h sintering time using 2-step cycle. Microstructural characterization of the sample was conducted layer by layer using high resolution optical microscopy (OM). Hardness of the sample was also performed layer by layer using Vickers microhardness tester. The obtained results revealed that there is a uniform ceramic particle distribution within the metallic phase. From the microstructural observation it was clear that smooth transition occurred from one layer to next layer and each interface was distinct. It was also observed that there is a steady increase in layer hardness with the increase in ceramic concentration

Emergence of mcr-1 mediated colistin resistant Escherichia coli from a hospitalized patient in Bangladesh

Introduction: The emergence of plasmid mediated mcr in bacteria has become global public health threat. Herein, we report a mcr-1 positive E. coli in normal human flora from a patient admitted in Dhaka Medical College Hospital (DMCH). Methodology: In total, 700 non-duplicate rectal swabs were collected from DMCH during 13th May to 12th June 2018. E. coli from rectal swabs were isolated on chromogenic UTI media containing vancomycin 10mg/l (Liofilchem, Italy) and confirmed by MALDI-TOF. Minimum inhibitory concentrations (MIC) were determined by agar dilution and interpreted according to EUCAST breakpoints. Genomic analysis of mcr positive E. coli (MCRPEC) was performed by Illumina MiSeq sequencing and pulsed field gel electrophoresis (PFGE) using S1 nuclease DNA digests and blamcr-1 probing. Transferability of blamcr-1 were determined by conjugation assays. Results: We found one MCRPEC from 700 rectal swab screening which was isolated from the rectal swab culture of a 17-year boy who was admitted to the burns ICU, DMCH with 53% flame burn involving much of the trunk and face. Genome sequencing revealed that mcr-1 was present on an IncH12 plasmid of 257,243 bp and flanked by ISApaI1. The colistin resistance can be transferred to the recipient Klebsiella varricola with a frequency of 8.3 × 10-5. Transconjugants were more resistant to colistin than donor (MIC 32 µg/mL). Conclusions: This is the first human associated mcr in Bangladesh. These data indicate the need for a systematic “one health” surveillance in the country

Clinical Spectrum and Management of Diabetic Ketoacidosis: Experience in A Tertiary Care Hospital

Abstract Background: Diabetic ketoacidosis (DKA) is an acute metabolic complication of diabetes mellitus (DM). It may be the presenting feature in type 1 DM, but more commonly it complicates previously diagnosed diabetic patients, both type 1 and type 2. If not recognized early and treated in a judicious way the outcome is often fatal

Insights on Lymphedema Self-Care Knowledge and Practice in Filariasis and Podoconiosis-Endemic Communities in Bangladesh and Ethiopia

Lymphedema is a life-long sequelae to several neglected tropical diseases (NTD). In Bangladesh the main cause is lymphatic filariasis (LF) and Ethiopia is endemic for both LF and podoconiosis. The World Health Organization (WHO) recommends daily self-care including meticulous washing and drying of affected skin and attention to entry lesions, limb exercises and elevation. Adherence to this regime reduces secondary infections which cause disabling episodes of acute dermato-lymphangitis (ADL). Self-care practices must be integrated into family life, supported by community and monitored by health staff; however, little is known about the influence of personal and socio-demographic factors on adherence. People affected by lymphedema (n=272), adult caregivers (n=272), and health workers (n=68) in Bangladesh and Ethiopia were trained in lymphedema management according to WHO recommendations. Surveys on the causes and management of lymphedema were collected at baseline and 24-weeks, and patients completed a daily journal of self-care activities and symptoms. At baseline knowledge on causes and management of lymphedema was greater among health workers (&amp;gt;70%) than patients and caregivers (&amp;lt;20%) in both countries, and there were significant between-country differences in patient reported use of limb washing (Bangladesh = 7.7%. Ethiopia = 51.1%, p = 0.001). At 24-weeks knowledge on lymphedema causes and management had increased significantly among patients and caregivers, there was &amp;lt;70% adherence to limb washing and exercises, but lesser use of limb elevation in both countries. A range of patient characteristics were associated with significant variation in self-care, except for limb washing. Performance of fewer leg exercises was significantly associated with increased age or severe lymphedema in Bangladesh, and with being female or in paid work in Ethiopia. Patient journals recorded ADL symptoms and working days lost due to lymphedema more frequently than were reported by recall during the 24-week survey. Core elements of lymphedema self-care education, training and monitoring are the same for multiple etiologies. This creates opportunities for cross-cutting implementation of integrated service delivery across several skin NTDs. Sustainability will depend on community level ownership and research on factors affecting adherence to lymphedema self-care are urgently needed.</jats:p