Sanitation coverage in Bangladesh since the millennium: consistency matters

Household surveys in Bangladesh between 1994 and 2009 assessed sanitation access using questions that differed significantly over time, resulting in apparently inconsistent findings. Applying the WHO and UNICEF Joint Monitoring Programme's 2008 definition for open defecation and improved sanitation facilities excluding shared facilities to the compiled data set, sensible sanitation coverage trends emerge. The percentage of households openly defecating declined at a rate of about 1.8% per year from 30% in 1994 to 6.8% in 2009, primarily due to changes in rural areas. Access to individual improved sanitation facilities nearly doubled from about 30% in 2006 to 57% in 2009, with both rural and urban areas showing impressive progress. Access to shared improved latrines also nearly doubled from about 13% in 2006 to 24% in 2009, with the urban slums recording the greatest gain from 17% in 2006 to 65% in 2009. Shared improved latrines are only slightly less clean than individual ones. Dependence on shared improved latrines increases with population density. In 2007, 20% of the poorest households still openly defecated, although more of them (38%) shared a latrine of any type. A poverty reduction program is recommended to address this equity issue, although applying consistent definitions is crucial to documenting progress

Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study

Background: Leprosy is remaining prevalent in the poorest areas of the world. Intensive control programmes with multidrug therapy (MDT) reduced the number of registered cases in these areas, but transmission of Mycobacterium leprae continues in most endemic countries. Socio-economic circumstances are considered to be a major determinant, but uncertainty exists regarding the association between leprosy and poverty. We assessed the association between different socio-economic factors and the risk of acquiring clinical signs of leprosy. Methods and Findings: We performed a case-control study in two leprosy endemic districts in northwest Bangladesh. Using interviews with structured questionnaires we compared the socio-economic circumstances of recently diagnosed leprosy patients with a control population from a random cluster sample in the same area. Logistic regression was used to compare cases and controls for their wealth score as calculated with an asset index and other socio-economic factors. The study included 90 patients and 199 controls. A recent period of food shortage and not poverty per se was identified as the only socio-economic factor significantly associated with clinical manifestation of leprosy disease (OR 1.79 (1.06-3.02); p = 0.030). A decreasing trend in leprosy prevalence with an increasing socio-economic status as measured with an asset index is apparent, but not statistically significant (test for a trend: OR 0.85 (0.71-1.02); p = 0.083). Conclusions: Recent food shortage is an important poverty related predictor for the clinical manifestation of leprosy disease. Food shortage is seasonal and poverty related in northwest Bangladesh. Targeted nutritional support for high risk groups should be included in leprosy control programmes in endemic areas to reduce risk of disease

Factors that provide protection against intimate partner physical violence among married adolescents in Bangladesh

Background: Intimate partner violence (IPV), and especially intimate partner physical violence (IPPV), perpetrated by husbands, and within adolescence marriage are pervasive in Bangladesh. Younger women are more vulnerable to IPPV. Objectives: We examined factors associated with IPPV experienced by married adolescents ages 15–19 and tested four hypotheses: (1) adolescent girls married to relatively older husbands, (2) adolescents living in extended families with parents or parents-in-law, (3) adolescents who are minimally controlled by husbands, and (4) adolescents who have a child after marriage are protective of IPPV. Methods: We analyzed IPPV data from 1,846 married girls ages 15–19 obtained from a national adolescent survey conducted in 2019–20. IPPV is defined as the respondent having physical violence perpetrated by her husband at least once in the last 12 months. We implemented logistic regression models to test our hypotheses. Results: Sixteen percent of married adolescent girls experienced IPPV. Girls living with parents-in-law or parents had adjusted odds ratio (AOR) of 0.56 (p < 0.001) of IPPV compared to those girls who lived with husband alone. Girls with husbands ages 21–25 years and 26 years or older had AORs of 0.45 (p < 0.001) and 0.33 (p < 0.001) of IPPV compared to those girls with their husband ages 20 and younger. Married adolescent girls who did not own a mobile phone (an indicator of spousal power dynamics) had an AOR of 1.39 (p < 0.05) compared to those girls who had a phone. IPPV risk increases with an increased duration of marriage for those with no living children (p < 0.001) but not for those with at least one living child; the risk was higher among those who had a child within the 1st year of marriage than those who had not yet had a child. At a duration of 4 years and longer, IPPV risk was higher among those with no living children than those with children. Discussion: Findings related to those living with parents-in-law or parents, girls married to relatively older boys/men, having the ability to communicate with outside world, and having a child are protective of IPPV in Bangladesh are new, to our knowledge. Strictly adhering to the law that requires men waiting until the age of 21 to marry can reduce married girls' risk of IPPV. Raising girls' legal marriage age can minimize adolescents' IPPV and other health risks associated with adolescent childbearing

Spatial and population drivers of persistent cholera transmission in rural Bangladesh: Implications for vaccine and intervention targeting

We identify high risk clusters and measure their persistence in time and analyze spatial and population drivers of small area incidence over time. The geographically linked population and cholera surveillance data in Matlab, Bangladesh for a 10-year period were used. Individual level data were aggregated by local 250 × 250 m communities. A retrospective space-time scan statistic was applied to detect high risk clusters. Generalized estimating equations were used to identify risk factors for cholera. We identified 10 high risk clusters, the largest of which was in the southern part of the study area where a smaller river flows into a large river. There is persistence of local spatial patterns of cholera and the patterns are related to both the population composition and ongoing spatial diffusion from nearby areas over time. This information suggests that targeting interventions to high risk areas would help eliminate locally persistent endemic areas

Gestational age data completeness, quality and validity in population-based surveys: EN-INDEPTH study.

BACKGROUND: Preterm birth (gestational age (GA) <37 weeks) is the leading cause of child mortality worldwide. However, GA is rarely assessed in population-based surveys, the major data source in low/middle-income countries. We examined the performance of new questions to measure GA in household surveys, a subset of which had linked early pregnancy ultrasound GA data. METHODS: The EN-INDEPTH population-based survey of 69,176 women was undertaken (2017-2018) in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda. We included questions regarding GA in months (GAm) for all women and GA in weeks (GAw) for a subset; we also asked if the baby was 'born before expected' to estimate preterm birth rates. Survey data were linked to surveillance data in two sites, and to ultrasound pregnancy dating at <24 weeks in one site. We assessed completeness and quality of reported GA. We examined the validity of estimated preterm birth rates by sensitivity and specificity, over/under-reporting of GAw in survey compared to ultrasound by multinomial logistic regression, and explored perceptions about GA and barriers and enablers to its reporting using focus group discussions (n = 29). RESULTS: GAm questions were almost universally answered, but heaping on 9 months resulted in underestimation of preterm birth rates. Preference for reporting GAw in even numbers was evident, resulting in heaping at 36 weeks; hence, over-estimating preterm birth rates, except in Matlab where the peak was at 38 weeks. Questions regarding 'born before expected' were answered but gave implausibly low preterm birth rates in most sites. Applying ultrasound as the gold standard in Matlab site, sensitivity of survey-GAw for detecting preterm birth (GAw <37) was 60% and specificity was 93%. Focus group findings suggest that women perceive GA to be important, but usually counted in months. Antenatal care attendance, women's education and health cards may improve reporting. CONCLUSIONS: This is the first published study assessing GA reporting in surveys, compared with the gold standard of ultrasound. Reporting GAw within 5 years' recall is feasible with high completeness, but accuracy is affected by heaping. Compared to ultrasound-GAw, results are reasonably specific, but sensitivity needs to be improved. We propose revised questions based on the study findings for further testing and validation in settings where pregnancy ultrasound data and/or last menstrual period dates/GA recorded in pregnancy are available. Specific training of interviewers is recommended

Haemorrhage-related maternal mortality in Bangladesh: levels, trends, time of death, and care-seeking practices based on nationally representative population-based surveys

Background Haemorrhage is a major cause of maternal deaths globally, most of which are preventable and predominantly happen in low and middle-income countries, including Bangladesh. We examine the current levels, trends, time of death, and care-seeking practices for haemorrhage-related maternal deaths in Bangladesh. Methods We conducted a secondary analysis with data from the nationally representative 2001, 2010, and 2016 Bangladesh Maternal Mortality Surveys (BMMS). The cause of death information was collected through verbal autopsy (VA) interviews using a country-adapted version of the standard World Health Organization VA questionnaire. Trained physicians reviewed the VA questionnaire and assigned the cause of death using the International Classification of Diseases (ICD) codes. Results Haemorrhage accounted for 31% (95% confidence interval (CI) = 24-38) of all maternal deaths in 2016 BMMS, which was 31% (95% CI = 25-41) in 2010 BMMS and 29% (95% CI = 23-36) in 2001 BMMS. The haemorrhage-specific mortality rate remained unchanged between 2010 BMMS (60 per 100 000 live births, uncertainty range (UR) = 37-82) and 2016 BMMS (53 per 100 000 live births, UR = 36-71). Around 70% of haemorrhage-related maternal deaths took place within 24 hours of delivery. Of those who died, 24% did not seek health care outside the home and 15% sought care from more than three places. Approximately two-thirds of the mothers who died due to haemorrhage gave birth at home. Conclusions Postpartum haemorrhage remains the primary cause of maternal mortality in Bangladesh. To reduce these preventable deaths, the Government of Bangladesh and stakeholders should take steps to ensure community awareness about care-seeking during delivery

Izolacija i sposobnost hvatanja slobodnih radikala cijanidin 3-O-glikozida iz plodova Ribes biebersteinii Berl.

The reversed-phase preparative high performance liquid chromatographic purification of the methanol extract of the fruits of Ribes biebersteinii Berl. (Grossulariaceae) afforded five cyanidin glycosides, 3-O-sambubiosyl-5-O-glucosyl cyanidin (1), cyanidin 3-O-sambubioside (2), cyanidin 3-O-glucoside (3), cyanidin 3-O-(2G-xylosyl)-rutinoside (4) and cyanidin 3-O-rutinoside (5). They showed considerable free-radical-scavenging properties in the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay with the RC50 values of 9.29 × 106, 9.33 × 106, 8.31 × 106, 8.96 × 106 and 9.55 × 106 mol L1, respectively. The structures of these compounds were elucidated by various chemical hydrolyses and spectroscopic means. The total anthocyanin content was 1.9 g per 100 g dried fruits on cyanidin 3-glucoside basis.Pet cijanidin glikozida, 3-O-sambubiozil-5-O-glukozil cijanidin (1), cijanidin 3-O-sambubiozid (2), cijanidin 3-O-glukozid (3), cijanidin 3-O-(2G-ksilozil)-rutinozid (4) i cijanidin 3-O-rutinosid (5) izolirani su iz metanolnog ekstrakta plodova Ribes biebersteinii Berl. (Grossulariaceae) koristeći reverzno-faznu preparativnu tekućinsku kromatografiju visoke učinkovitosti. Cijanidin glikozidi pokazali su sposobnost hvatanja slobodnih radikala u pokusu s 2,2-difenil-1-pikrilhidrazilom (DPPH). Dobivene su sljedeće RC50 vrijednosti: 9,29 × 106, 9,33 × 106, 8,31 × 106, 8,96 × 106, odnosno 9,55 × 106 mol L1. Strukture glikozida određene su kemijskom hidrolizom i spektroskopijom masa. Ukupni sadržaj antocijanina bio je 1,9 g na 100 g suhih plodova preračunato na cijanidin 3-glukozid

'The girl with her period is the one to hang her head' Reflections on menstrual management among schoolgirls in rural Kenya

<p>Abstract</p> <p>Background</p> <p>The onset of menstruation is a landmark event in the life of a young woman. Yet the complications and challenges that can accompany such an event have been understudied, specifically in resource-poor settings. As interventions aim to improve female attendance in schools, it is important to explore how menstruation is perceived and navigated by girls in the school setting. This research conveys rural Kenyan schoolgirls' perceptions and practices related to menstruation</p> <p>Methods</p> <p>Data were collected at six rural schools in the Nyanza Province of Western Kenya. Using focus group discussions, in-depth interviews, and field notes from observations, researchers collected information from 48 primary schoolgirls and nine teachers. Systematic analysis began with a reading of transcripts and debriefing notes, followed by manual coding of the narratives.</p> <p>Results</p> <p>Focus group discussions became opportunities for girls to share thoughts on menstruation, instruct one another on management practices and advise one another on coping mechanisms. Girls expressed fear, shame, distraction and confusion as feelings associated with menstruation. These feelings are largely linked to a sense of embarrassment, concerns about being stigmatized by fellow students and, as teachers explained, a perception that the onset of menstruation signals the advent of a girl's sexual status. Among the many methods for managing their periods, girls most frequently said they folded, bunched up or sewed cloth, including cloth from shirts or dresses, scraps of old cloth, or strips of an old blanket. Cloth was reported to frequently leak and cause chafing, which made school attendance difficult particularly as the day progressed. Attitudes and practices of girls toward menstruation have been arranged into personal, environmental and behavioural factors.</p> <p>Conclusion</p> <p>Further research on menstrual management options that are practical, sustainable and culturally acceptable must be conducted to inform future programs and policies that aim to empower young girls as they transition into womanhood. Stakeholders working within this and similar contexts must consider systematic mechanisms to explain to young girls what menstruation is and how to manage it. Providing sanitary supplies or guiding girls on how to create supplies serve as critical components for future interventions.</p

A multivariate morphometric investigation to delineate stock structure of gangetic whiting, Sillaginopsis panijus (Teleostei: Sillaginidae)

This study was conducted to delineate the stock structure of Sillaginopsis paniijus based on morphometric characters of the species. A total of 194 specimens were collected from the Meghna, Tentulia and Baleswar rivers located in the southern coastal zone of Bangladesh. Data were subjected to univariate ANOVA, multivariate ANOVA, discriminate function analysis (DFA), and principal component analysis. Mean variations of ten morphometric characters; HD, HBD, LBD, PsOL, ED, SnL, SPrDL, HAF, LSDB and LPB showed significant differences (p &lt; 0.05) among 27 morphometric traits that were selected for the study. In DFA, the overall assignments of individuals into their correctly classified original groups were 71.1 and 70.6 % for male and female, respectively. A scatter plot of the first two discriminant functions was used to visually depict the discrimination among the populations. The results showed different stocks of S. panijus in the rivers of Baleswar, Tentulia and Meghna in southwest coast of Bangladesh

Actinobacillus pleuropneumoniae encodes multiple phase-variable DNA methyltransferases that control distinct phasevarions

Actinobacillus pleuropneumoniae is the cause of porcine pleuropneumonia, a severe respiratory tract infection that is responsible for major economic losses to the swine industry. Many host-adapted bacterial pathogens encode systems known as phasevarions (phase-variable regulons). Phasevarions result from variable expression of cytoplasmic DNA methyltransferases. Variable expression results in genome-wide methylation differences within a bacterial population, leading to altered expression of multiple genes via epigenetic mechanisms. Our examination of a diverse population of A. pleuropneumoniae strains determined that Type I and Type III DNA methyltransferases with the hallmarks of phase variation were present in this species. We demonstrate that phase variation is occurring in these methyltransferases, and show associations between particular Type III methyltransferase alleles and serovar. Using Pacific BioSciences Single-Molecule, Real-Time (SMRT) sequencing and Oxford Nanopore sequencing, we demonstrate the presence of the first ever characterised phase-variable, cytosine-specific Type III DNA methyltransferase. Phase variation of distinct Type III DNA methyltransferase in A. pleuropneumoniae results in the regulation of distinct phasevarions, and in multiple phenotypic differences relevant to pathobiology. Our characterisation of these newly described phasevarions in A. pleuropneumoniae will aid in the selection of stably expressed antigens, and direct and inform development of a rationally designed subunit vaccine against this major veterinary pathogen