Prevalence and predictors of diabetes distress among adults with type 2 diabetes mellitus: a facility-based cross-sectional study of Bangladesh
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Brief description: Diabetes distress (DD) is common and has considerable impacts on diabetes management. Unfortunately, DD is less discussed and frequently underestimated. This study evaluated the prevalence and predictors of DD in adults with type 2 diabetes mellitus (T2DM). A cross-sectional study was conducted at several specialized endocrinology outpatient clinics in Bangladesh from July 2019 to June 2020; 259 adults with T2DM participated. Participants’ DD and depression were measured using the 17-item Diabetes Distress Scale (DDS-17) and 9-item Patient Health Questionnaire (PHQ-9), respectively. DDS-17 scores ≥2 and PHQ-9 scores ≥10 were the cutoffs for DD and significant depression, respectively. The mean (±SD) age of the participants was 50.36 (±12.7) years, with the majority (54.8%) being male; their median (IQR) duration of diabetes was 6 (3-11) years. Among the study participants, 52.5% had DD (29.7% moderate and 22.8% high DD). The prevalence of emotional burden, physician-related distress, regimen-related distress, and interpersonal distress was 68.7, 28.6, 66, and 37.7%, respectively. Depression was present in 40.5%; 28.6% of the participants had DD and depression. The total DDS-17 score was positively correlated with the PHQ-9 score (r = 0.325, p < 0.001). Rural residence (OR 1.94), presence of any diabetic complication (OR 3.125), insulin use (OR 2.687), and presence of major depression (OR 4.753) were positive predictors of DD. In contrast, age ≥ 40 years at diabetes diagnosis (OR 0.047) and diabetes duration of > 10 years (OR 0.240) were negative predictors of DD (p < 0.05 in all instances). The prevalence of DD in our setting is notably high; DD and depression frequently overlap. Screening for diabetes distress may be considered, especially in high-risk patients.
Constraints and current practices of menstrual hygiene among Rohingya adolescent girls
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Publication status: Published
Brief description: Although half of Rohingya refugees are women and adolescent girls, the sexual and reproductive health issues of these vulnerable groups are still unexplored. The aim of this study was to review and describe menstrual hygiene management (MHM) along with the existing challenges of MHM among Rohingya adolescent girls. This concurrent mixed methods study was conducted among adolescents aged 13–18 years living in Kutupalong refugee camps in Ukhiya, Cox’s Bazar, Bangladesh. Camp-based surveys along with focus group discussions were performed for data collection. The findings of a total of 12 FGDs and 101 survey responses were included for data analysis. Descriptive statistics were used for quantitative data analysis, and thematic analysis was considered for the qualitative data. Approximately one-fourth of the adolescent girls (28.71%) had premenstrual knowledge. Only 8% had “Good” knowledge, and 12% had a basic understanding. Half of the women used cloths during menstruation, while others (20.79%) used homemade clean pads, disposable sanitary pads (17.82%), and used only underwear without absorbance (10.89%). The frequency of changing sanitary pads varied, but the majority of respondents (48.51%) changed padding at least once daily. Common disposal places were inside the toilet (30.69%), open spaces (17.82%), dustbins (6.93%) and water sources (3.96%). An inadequate and irregular supply of sanitary napkins or absorbents leads to poor MH practices. Limited cleaning and disposal facilities, lack of privacy in camps or informal settlements, confined and crowded places and nonsupportive environments in the camp were also factors affecting the use of pads and disposal. Family and cultural beliefs, stigma, restrictions, and fear of sexual violence were also noted within typical day-to-day activities during menstruation. The provision of adolescent-friendly wash facilities, appropriate information and adequate menstrual supplies is needed to improve the MH response in an emergency context. Despite some limitations, this study could lead to future changes relative to MH for women and adolescents in Rohingya.
Clinico-Epidemiological Characteristics of Pediatric COVID-19 Patients in Bangladesh
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Brief description: Background To delineate the clinico-epidemiological characteristics of pediatric coronavirus disease-2019 (COVID-19) patients was the objective of the study. Method This observational study included 290 pediatric patients with a definite diagnosis of COVID-19 admitted to Dhaka Shishu Hospital, Bangladesh, from April 2021 to October 2021. Clinical and epidemiological characteristics were analyzed based on demographic data, medical history, laboratory tests, and outcome information. Data analysis was performed with SPSS 26. Ethical measures were taken in compliance with the current declaration of Helsinki, and final analysis was performed using SPSS 26. Result Of all, 42 (14.5%) were neonates (< 28 days), 88 (30.3%) were infants (28 days to < 1 year) and 160 (55.2%) were children (1–17 years). The median age of the children was 18 (0.3–204) months, 58.3% were male, 62% had malnutrition, and presented with various clinical presentations. The main symptoms were fever (5.7%) and breathlessness (20%). Approximately 22% of children were asymptomatic, and 57% had at least one comorbidity. Fever and abdominal pain were predominant presenting symptoms in children compared with neonates and infants (p < .01 for both), while cough and breathlessness were more frequent in infants (p < .01 for both). The infants suffered significantly from neutropenia and lymphocytosis than neonates and children (p < .001 for both). The discharge and death rates were 77.8% with 6.9%. Overall case fatality was higher among neonates than others. Conclusion Compared to other pediatric groups, neonatal case fatality was higher, and COVID-19 in neonates, infants, and children has similar epidemiological and clinical manifestations. The findings from this study might help to guide the development of measures to prevent and treat this ongoing global pandemic of these particular age groups.
Clinico-Epidemiological Characteristics of Children with Cystic Fibrosis: A Tertiary Care Experience
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Brief description: Cystic fibrosis (CF) is considered to be rare among individuals from Bangladesh. The objective of the study was to delineate the clinico-epidemiological characteristics of pediatric cystic fibrosis cases. This observational study included pediatric patients (up to 14 years of age) with a clinical diagnosis of CF. Data were collected within the period from February 2021 and October 2021. Written informed consent was obtained from the accompanying parent. Clinical and epidemiological characteristics were analyzed on the basis of demographic data, medical history, laboratory tests, and outcome information. Data analysis was done with SPSS 26. A total of 50 patients (66% male) with a mean age of 39.7 ±30.75 (SD) months were included. Twenty-eight patients (57.14%) had siblings with CF, and 41.67% of parents had a history of consanguineous marriage. The majority of them were stunted (86%) and underweight (86%), and half of them had wasting (54%). Median disease duration was 12 months (range: 2 – 72). Cough (100%) and purulent sputum (100%) were the predominant respiratory symptoms, while failure to thrive (98%) and bulky offensive stools (86%) were prime gastrointestinal symptoms. Among the signs, malnutrition (94%), short stature (72%), digital clubbing (64%), and bronchiectasis (40%) were most frequent. Pulmonary hypertension (48%, n=24) was the most common comorbidity identified in the study participants. In hospital, mortality was 16% (n=8). Digital clubbing, bronchiectasis, pancreatic insufficiency, and abnormal liver function tests were significantly higher in the patient who died. Children with cystic fibrosis most commonly present with undernutrition and respiratory symptoms. Failure to thrive was almost a global phenomenon. Pulmonary hypertension was the most common complication found in echocardiography.
Health problems among Forcibly Displaced Myanmar Nationals (FDMNs) admitted to the Medicine ward of Cox’s Bazar Medical College Hospital
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Publication status: Published
Brief description: Forcibly Displaced Myanmar Nationals (FDMNs) or Rohingya refugees are one of the vulnerable groups suffering from different kinds of health problems but have been less reported yet. Therefore, the study was designed to delineate the health problems among FDMNs admitted to Cox’s Bazar Medical College Hospital. This hospital-based cross-sectional study was conducted at the Medicine ward, Cox’s Bazar Medical College Hospital, for a six-month period following approval. Rohingya refugees who were admitted during the study period were approached for inclusion. Informed written consent was ensured prior to participation. A structured questionnaire was used during data collection. Collected information was recorded in case record form. A total of 290 subjects were interviewed. Analysis was performed using the statistical package for social science (SPSS) version 20. The mean age of the participants was 48.76 ± 18.67 years (range: 16-91), with a clear male predominance (60.7%). Family size ranged 6-8. All of the participants reported at least one of the illnesses. Of all, 29.66% patients had disease of the respiratory system, and 26.9% had disease of the gastrointestinal and hepatobiliary system. Accidental injury or injury due to electrocution or thin falls or snake bites was present in 10.4% of the cases. Among the single most common diseases, COPD (20%) was the most frequently observed, and the rest of them were chronic liver disease (13.1%), pulmonary TB (5.5%), ischemic stroke (5.5%), CAP (4.1%), acute coronary syndrome (3.4%), thalassaemia (3.4%) and hepatocellular carcinoma (3.4%). Among the top 6 diagnosed diseases, PTB was more common in elderly individuals (p = 0.29). The disease pattern was similar across the sexes among the refugees except community acquisition pneumonia (CAP), which was commonly observed among males (p = .004). Considering different age groups, genitourinary problems were more common in males aged >60 years, and rheumatology and musculoskeletal problems were equally affected in females aged between 40 and 60 years. COPD, CLD and CAP were the most prevalent diseases in FDMN patients who attended the Medicine ward of Cox’s Bazar Medical College Hospital. Further exploration is warranted before any policy making and comprehensive plan.
Clinical profile and demographic characteristics of moderate and severe hemophilia patients in a tertiary care hospital of Bangladesh
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Brief description: Hemophilia is one of the commonest inherited bleeding disorders which may lead to chronic bleeding tendencies and life-long disabilities if not properly managed. Knowing the pattern of the disease aids in the prevention of disability and improvement of quality of life in hemophilia. However, there is a dearth of literature on the issue in Bangladesh. So, this study was designed to explore the frequency and site of spontaneous bleeding in moderate and severe hemophilia patients visiting in a tertiary level hospital. This descriptive cross-sectional study was conducted at the department of Hematology and Bone Marrow Transplantation (BMT) Center in Dhaka Medical College Hospital, Dhaka between February 2020 and August 2020. A total of 44 diagnosed cases of moderate to severe hemophilia were included in the study according to inclusion criteria. A detailed inquiry of history, thorough physical examination and relevant investigations were done and were recorded in case-record form. Informed written consent was taken from patients or their guardians where appropriate. All procedures were done according to Declaration of Helsinki. After entry and checking, data was analysed using SPSS version 26. Out of 44 participants, 25 (56.8%) and 19 (43.2%) had moderate and severe hemophilia. Mean age of the study population was 21.31 (± 9.78) years with the majority aged between 11 and 20 years (45.5%). All sociodemographic features were similar across severity. Hemophilia A and B was found in 90.9% and 9.1%, respectively. However, all type B patients severe hemophilia making it statistically significantly different from type A (p = 0.029). The median age of first bleeding was 3.5 years and median age of first diagnosis was 5 years. Nevertheless, approximately 67.4% patients were diagnosed as a case of hemophilia at the time of their first diagnosis. The median spontaneous bleedings episodes among all patients was 32 (range: 0–97) which did not different significantly between severe and moderate patients. The most common affected (target) joint was knee joint (88.6%) followed by elbow joint (64%) among all patients. The knee joint was more commonly involved in severe than moderate disease. This study observed the variations in pattern and frequency of spontaneous bleeding in patients with hemophilia. Severe disease was more frequent in hemophilia B than A and knee joint was the most frequent site of bleeding. However, further extensive studies are recommended.
Constraints and current practices of menstrual hygiene among Rohingya adolescent girls
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Publication status: Published
Brief description: Although half of Rohingya refugees are women and adolescent girls, the sexual and reproductive health issues of these vulnerable groups are still unexplored. The aim of this study was to review and describe menstrual hygiene management (MHM) along with the existing challenges of MHM among Rohingya adolescent girls. This concurrent mixed methods study was conducted among adolescents aged 13–18 years living in Kutupalong refugee camps in Ukhiya, Cox’s Bazar, Bangladesh. Camp-based surveys along with focus group discussions were performed for data collection. The findings of a total of 12 FGDs and 101 survey responses were included for data analysis. Descriptive statistics were used for quantitative data analysis, and thematic analysis was considered for the qualitative data. Approximately one-fourth of the adolescent girls (28.71%) had premenstrual knowledge. Only 8% had “Good” knowledge, and 12% had a basic understanding. Half of the women used cloths during menstruation, while others (20.79%) used homemade clean pads, disposable sanitary pads (17.82%), and used only underwear without absorbance (10.89%). The frequency of changing sanitary pads varied, but the majority of respondents (48.51%) changed padding at least once daily. Common disposal places were inside the toilet (30.69%), open spaces (17.82%), dustbins (6.93%) and water sources (3.96%). An inadequate and irregular supply of sanitary napkins or absorbents leads to poor MH practices. Limited cleaning and disposal facilities, lack of privacy in camps or informal settlements, confined and crowded places and nonsupportive environments in the camp were also factors affecting the use of pads and disposal. Family and cultural beliefs, stigma, restrictions, and fear of sexual violence were also noted within typical day-to-day activities during menstruation. The provision of adolescent-friendly wash facilities, appropriate information and adequate menstrual supplies is needed to improve the MH response in an emergency context. Despite some limitations, this study could lead to future changes relative to MH for women and adolescents in Rohingya.
National TB Control Program of Bangladesh: System Failure and Loss of Effectiveness
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Publication status: Published
Brief description: The National Tuberculosis Control Program (NTP) is one of the largest programs run by the state with many successes. However, underreporting is considered a real flaw of the current program. To report the characteristics and outcomes of TB patients registered in an upazila health complex in Kazipur, Sirajganj district, Bangladesh between September 2018 and February 2019 under the control of NTP was the objective of the study. This retrospective cohort study was conducted using routinely collected program data from the aforementioned site. Data retrieved from the hospital record form. Formal permission was obtained from the local authority. Consent statements and ethical aspects were waived due to the retrospective nature of the study. Analysis was performed using SPSS 20.0. A total of 207 tuberculosis cases were included with an average age of presentation of 43 years. Approximately 82.0% had pulmonary tuberculosis (PTB) and the rest had extrapulmonary tuberculosis (EPTB). PTB was more common in males, whereas EPTB was common in females (p=0.01). Of all cases, 84.0% were diagnosed by a positive sputum smear and 16.0% were diagnosed clinically with a negative sputum smear. Attendance at follow-up was 82.12%, 70.04% and 68.59% at months 2, 5 and 6 following index admission respectively. Overall, the cure rate was higher in PTB than EPTB [146 (85.9%) vs. 5 (13.5%), p<0.001). The rate of treatment completion was 25.1% (n=52) and the death count was 1.4% (n=3) [PTB-1.2 (n=2) vs. EPTB-2.7% (n=1)]. A gradual decline in reporting or completion of treatment was observed in this setting. However, a nationwide study is warranted to explore this issue in detail.
Open Label Randomized Controlled Comparison of Three Alternative Regimes of Ciprofloxacin, Azithromycin and Cefixime for Treatment of Uncomplicated Typhoid Fever in Bangladesh
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Publication status: Published
Brief description: Multi-drug resistant Typhoid fever (resistant to previously used chloramphenicol, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole) has been commonly described in the South East Asia region and a recent report suggests that the salmonella typhi have reduced response to fluoroquinolones (nalidixic acid-resistant). The optimum treatment protocol for this type of serovar has not been established. This study compared different antimicrobial regimens for the treatment of uncomplicated typhoid fever which was conducted in the medicine ward of Dhaka Medical College Hospital (DMCH) and outdoor setting in private practice in Dhaka metropolitan city, Mymensingh and Sylhet town from January 2017 to December 2017. Bangladeshi adults with uncomplicated typhoid fever were included in this an open-label randomized controlled trial. Ciprofloxacin (20mg/kg of body weight/day for 14 days), azithromycin (20mg/kg/day for 14 days), and Cefixime (16mg/kg/day for 14 days) were compared. Of the 81 enrolled patients, 62 were eligible for analysis (61 S. enterica serovar Typhi, 1 Salmonella enterica serovar paratyphi A). Of the S enterica serovar Typhi isolates, 88.7% (55/62) were MDR and 93.5% (58/62) were nalidixic acid resistant (NAR). The clinical cure rate was 62% (13/21) with ciprofloxacin, 71% (15/21) with Cefixime, and 85% (17/20) with azithromycin (p=0.053). The mean (95% confidence interval [CI]) fever clearance time for patients treated with azithromycin (5.8 days [5.1 to 6.5 days]) was shorter than that for patients treated with cefixime (7.1 days [6.2 to 8.1 days]) and ciprofloxacin (8.2 days [7.2 to 9.2 days]) (p<0.001). All three antibiotics were well tolerated. A 7-day course of azithromycin can be successfully used in uncomplicated typhoid fever due to isolates of MDR S enterica serovar Typhi.
Risk Factor for Nutritional Rickets among 0-5 Years Children in Bangladesh
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Brief description: Nutritional rickets (NR)or vitamin D deficiency rickets remain prevalent in developing regions of the world and rank among the 5 most common diseases in children. In Bangladesh, it is the second most common micronutrient deficiency. Despite scope of abundant sun exposure, increasing number rickets incite the mind to search for the risk factors associated with it. Therefore, to evaluate the risk factor for nutritional rickets among 0-5 years children in Bangladesh was the objective of the study. This observational study was conducted in Dhaka Sishu (child) Hospital for 2-year period following formal ethical clearance. Total 120 children were include into the study. Of all, 60 children of NR were consideredas cases and another 60 age and sex matched children were taken as control. NR diagnosis was based on clinical, radiologic and biochemical parameters. In all cases, formal informed consent were taken from the parents. Detailed history taking were done based on a preformed questionnaire, which was made on the basis of prior studies in this topics. During interview, data collection was done in a separate case record form. Finally, recorded data was analyzed by a statistical software, SPSS 23. Among the 120 study children, mean age of cases and controls were 29.40±11.65 &28.66±13.57 months respectively. Significant difference were present in-between case and control for residence, parent’s education, occupation of the family head, monthly income and number of siblings. Moreover, exclusive breast-feeding (OR= 3.59, 95% CI:1.67-7.74, p<.001), sun exposure (OR=2.25, 95% CI:1.08-4.67, p<.03) and skin color (OR=2.76, 95% CI: 1.24-6.14, p<.01) were significantly associated with NR in comparison to control. Exclusive breast-feeding for >4 months, sunlight exposure <30 minutes/day, dark skin color, number of siblings, urban slum residence, deficit monthly income, and parent’s education are the risk factors for NR in Bangladeshi child.