Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study

AbstractBackground:Timely and appropriate evidence-based practices during antenatal care improve maternal andneonatal health. There is a lack of information on how pregnant women and families perceive antenatal care inBangladesh. The aim of our study was to develop targeted client communication via text messages for increasingantenatal care utilization, as part of an implementation of an electronic registry for maternal and child health.Methods:Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depthinterviews were conductedwithpregnantwomen(n= 10), lactating women (n=5),husbands(n= 5), and mothers-in-law(n= 4). The Health Belief Model (HBM) was used to guide the datacollection. Thematic analysis was carried out manuallyaccording to the HBM constructs. We used behavior change techniques to inform the development of targeted clientcommunication based on the thematic results.Results:Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary ifany complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancycomplications was low. Women reported avariety of reasons for not attending ANC, including the lack of information onthe timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and notbeing satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferredcommunication strategy when asked to choose between thephone call and text message, but saw text messages as afeasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increaseANC utilization.Conclusions:Pregnant women and family members had limited knowledge about antenatal care and pregnancycomplications. Effective health information through text messages could increase awareness of antenatal careamong the pregnant women in Bangladesh. This study presents an example of designing targeted clientcommunication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy ofbehavior change techniques.publishedVersio

Psychological distress during pandemic Covid-19 among adult general population: Result across 13 countries

The COVID-19 pandemics caused an unprecedented mortality, distress, and globally poses a challenge to mental resilience. To our knowledge, this is the first study that aimed to investigate the psychological distress among the adult general population across 13 countries. This cross-sectional study was conducted through online survey by recruiting 7091 respondents. Psychological distress was evaluated with COVID-19 Peritraumatic Distress Index (CPDI). The crude prevalence of psychological distress due to COVID-19 is highest in Vietnam, followed by Egypt, and Bangladesh. Through Multivariate Logistic Regression Analysis, the respondents from Vietnam holds the highest level of distress, while the respondents from Sri Lanka holds the lowest level of distress with reference to Nepal.Female respondents had higher odds of having reported psychological distress, and those with tertiary education were less likely to report psychological distress compared to those with lower level of education. The findings indicate that psychological distress is varies across different countries. Therefore, different countries should continue the surveillance on psychological consequences through the COVID-19 pandemic to monitor the burden and to prepare for the targeted mental health support interventions according to the need. The coping strategies and social support should be provided especially to the lower educational attainment group

An Electronic Registry for Improving the Quality of Antenatal Care in Rural Bangladesh (eRegMat): Protocol for a Cluster Randomized Controlled Trial

Background: Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization’s guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. Objective: The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. Methods: The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. Results: The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. Conclusions: This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs.publishedVersio

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Play-based Curriculum Introduced in Myanmar's Kindergartens: An Analysis of Classroom Practices, Teachers' Understanding, and Challenges

A play-based curriculum, one of the effective ways of promoting young childrenʼs development, was introduced to Myanmarʼs kindergartens for the first time in 2016. Although play is gaining popularity in early childhood education in the developing world, little is known about the transitional process from an academic learning-focused curriculum to a play-based curriculum in the contexts of developing countries. Therefore, this study aims to scrutinize the play-based curriculum in Myanmarʼs kindergartens by examining the extent of incorporating play in the intended curriculum, teachersʼ understanding of the new curriculum, the implemented curriculum inside classrooms, and the associated challenges. Qualitative methods are employed to answer these questions. Data are collected through semi-structured interviews with 27 teachers from five townships in central Myanmar and non-participant observations of 13 kindergarten classrooms in one of these townships. The results indicate that highly structured teacher-directed play constitutes most of play, both in the intended and the implemented curriculum, with little emphasis on free play. While teachers demonstrate a good understanding of the new curriculum principles, they apply them at very different levels within their classrooms. Even when practicing the play-based curriculum at a higher level, teachers plan and introduce play structurally, leaving few instances for childʼs initiatives. Much as teachers recognize the significance of play for child development, they seem to have merely replaced the academic learning activities of the previous curriculum with structured teacher-directed play. The major challenges to introducing the play-based curriculum include large class sizes, lack of parental understanding of the new curriculum, and inadequate support from inspectors, and some teachersʼ preference for the old curriculum. All this amounts to saying that Myanmarʼs kindergarten curriculum is still at the very onset of transition to a play-based curriculum, whose advanced forms should pay more attention and give value to who initiates and controls play

Taxonomy And Phylogeny Of Some Species Belonging To Subfamily Papilionoideae From Popa Area, Kyaukpadaung Township

Taxonomy and phylogeny of some species from subfamily Papilionoideae found in Popa area, Kyaukpadaung Township within Mandalay Region were studied. Totally 7 species belonging to 7 genera were collected and identified from the year 2019. They are each species from the genus Cajanus, Flemingia, Gliricidia, Lablab, Pueraria, Sesbania and Tephrosia. The tree species are Gliricidia sepium (Jacq.) Walp., Sesbania grandiflora (L.) Poir. The other species are shrubs and herbs. The phenogram and cladogram for the phylogeny of all study species were constructed. Cajanus albicans (Wight & Arn.) Maesen, Lablab purpureus (L.) Sweet are more closely related and advanced among the study species because they have most similarity. The outstanding characteristics of all species were presented with their photographs of inflorescences. An artificial key to the study species was also constructed

Education Reforms in Myanmar before COVID-19: Basic and Teacher Education

Myanmar has tried to improve its basic and teacher education system since they are crucial for quality education. This article aims to comprehensively explain the reforms in Myanmar’s education, including basic and teacher education, before the COVID-19 pandemic. Specifically, this article explains the long and complex political history and describes how basic and teacher education have changed along with the political settings. The data are illustrated using document analysis focusing on the circumstances of basic and teacher education in Myanmar by capturing the situation before starting the reforms in 2016 and the education reforms based on the National Education Strategic Plan (NESP) (2016-21). In 2011, the civilian government conducted a comprehensive education sector review of the entire system after assuming political power that included an analysis of preschools, basic education, TVET, and higher education. The results of this review became a roadmap for establishing a quality education program called the NESP (2016-21). Based on this plan, many reforms were implemented in different educational sectors. First, basic education was reformed by improving access to quality inclusive education, curricula, and student assessments. Second, teacher education has been promoted by ensuring a teacher quality assurance system, upgrading pre-service teacher education in education degree colleges, establishing a teacher competence framework, and introducing short- and long-term revision programs for in-service teachers. Myanmar attempted to provide quality education through basic and teacher education reforms before COVID-19. If all the NESP targets had been achieved, all Myanmar’s children would have had access to quality learning through the relevant curriculum for the 21st century by qualified teachers

Risk-stratified breast cancer screening in Malaysia: challenges and opportunities

Introduction: Breast cancer is the commonest cancer among Malaysian women. Current clinical practice guidelines (CPG) by the Ministry of Health, Malaysia comprise recommendations based on a risk stratification approach. Aim: This paper reviewed and reflected on the challenges and uncertainties that needed to be considered regarding the implementation and delivery of risk-stratified breast cancer screening in Malaysia. Methods: Our iterative writing, discussions and reflections revolved around the results of a key relevant literature search of the Ministry of Health Malaysia website, PubMed, and Google Scholar, and on feedback from local clinical experts in the field of breast cancer screening practice. The articles related to risk-stratified breast cancer screening, genetic testing, screening guidelines for the Malaysia population, and published in English.Result: Further infrastructure and workforce capacity building is needed in order to achieve successful wider implementation e.g. genetic counselling and testing services are limited in Malaysia. Furthermore, there is a need to elicit Malaysian women’s views and evaluate their acceptance of risk-stratified breast cancer screening. The primary healthcare setting is an obvious potential avenue to introduce and deliver initial risk assessment and stratification. However, the workload and willingness of Malaysian primary healthcare doctors to practice risk-stratified screening is yet to be explored and a better understanding of their perspective is required. Conclusion and recommendation: Identifying a valid and appropriate risk model tailored to the population profile and needs of Malaysian women and conducting a pilot project of risk-stratified screening, guided by implementation science would provide lessons and insights for policymakers, health service managers, and public and primary health care professionals. The results of these activities would increase the likelihood that decisions and plans would lead to the successful implementation in Malaysia of a sustainable and effective breast cancer screening strategy that incorporates a patient-sensitive, risk-stratified approach.<br/