Summary Background Typhoid fever remains a major cause of morbidity and mortality in low-income and middle-income countries. Vi-tetanus toxoid conjugate vaccine (Vi-TT) is recommended by WHO for implementation in high-burden countries, but there is little evidence about its ability to protect against clinical typhoid in such settings. Methods We did a participant-masked and observer-masked cluster-randomised trial preceded by a safety pilot phase in an urban endemic setting in Dhaka, Bangladesh. 150 clusters, each with approximately 1350 residents, were randomly assigned (1:1) to either Vi-TT or SA 14-14-2 Japanese encephalitis (JE) vaccine. Children aged 9 months to less than 16 years were invited via parent or guardian to receive a single, parenteral dose of vaccine according to their cluster of residence. The study population was followed for an average of 17·1 months. Total and overall protection by Vi-TT against blood culture-confirmed typhoid were the primary endpoints assessed in the intention-to-treat population of vaccinees or all residents in the clusters. A subset of approximately 4800 participants was assessed with active surveillance for adverse events. The trial is registered at www.isrctn.com , ISRCTN11643110. Findings 41 344 children were vaccinated in April–May, 2018, with another 20 412 children vaccinated at catch-up vaccination campaigns between September and December, 2018, and April and May, 2019. The incidence of typhoid fever (cases per 100 000 person-years) was 635 in JE vaccinees and 96 in Vi-TT vaccinees (total Vi-TT protection 85%; 97·5% CI 76 to 91, p<0·0001). Total vaccine protection was consistent in different age groups, including children vaccinated at ages under 2 years (81%; 95% CI 39 to 94, p=0·0052). The incidence was 213 among all residents in the JE clusters and 93 in the Vi-TT clusters (overall Vi-TT protection 57%; 97·5% CI 43 to 68, p<0·0001). We did not observe significant indirect vaccine protection by Vi-TT (19%; 95% CI −12 to 41, p=0·20). The vaccines were well tolerated, and no serious adverse events judged to be vaccine-related were observed. Interpretation Vi-TT provided protection against typhoid fever to children vaccinated between 9 months and less than 16 years. Longer-term follow-up will be needed to assess the duration of protection and the need for booster doses. Funding The study was funded by the Bill & Melinda Gates Foundation.

Background COVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients. Methodology/Principal findings This longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases. Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases. Conclusion/Significance We report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection.

BackgroundMissing from the huge literature on women’s attitudes and beliefs concerning specific contraceptive methods is any detailed quantitative documentation for all major methods in low- and middle-income countries. The objectives are to provide such a documentation for women living in Matlab (rural Bangladesh), Nairobi slums and Homa Bay (rural Kenya) and to compare the opinions and beliefs of current, past and never users towards the three most commonly used methods (oral contraceptives, injectables and implants).MethodsIn each site, 2424 to 2812 married women aged 15–39 years were interviewed on reproduction, fertility preferences, contraceptive knowledge and use, attitudes and beliefs towards family planning in general and specific methods. We analysed the data from round one of the prospective cohort study.ResultsWhile current users typically expressed satisfaction and held more positive beliefs about their method than past or never users, nevertheless appreciable minorities of current users thought the method might pose serious damage to health, might impair fertility and was unsafe for prolonged use without taking a break. Larger proportions, typically between 25% and 50%, associated their method with unpleasant side effects. Past users of pills and injectables outnumbered current users and their beliefs were similar to those of never users. In all three sites, about half of past injectable users reported satisfaction with the method and the satisfaction of past implant users was lower.ConclusionsHigh levels of contraceptive use can clearly co-exist with widespread misgivings about methods, even those that are widely used. Serious concerns about damage to health, long term fertility impairment, and dangers of prolonged use without taking a break were particularly common in the Kenyan sites and these beliefs may explain the high levels of discontinuation observed in Kenya and elsewhere in Africa. This documentation of beliefs provides useful guidance for counselling and informational campaigns. The generally negative views of past users imply that programmes may need not only to improve individual counselling but also strengthen community information campaign to change the overall climate of opinion which may have been influenced by dissatisfaction among past users.Electronic supplementary materialThe online version of this article (10.1186/s12978-018-0514-7) contains supplementary material, which is available to authorized users.

Background Depression is a major morbidity and the most common mental disorder among the medical students in medical schools globally. Undergraduate students suffer stress more due to their academic curriculum than the students of other faculties. In low-resource settings like Bangladesh, there is a dearth in research on the mental health of undergraduate medical students. This pilot study was conducted to add to the existing limited evidence by reporting the prevalence of depression and describing sleeping pattern and suicidal tendencies among medical students. Relevantly, we have investigated the overall mental health status among the medical students in Bangladesh. Methods This cross-sectional study was conducted in two medical colleges of Dhaka between July 2013 and December 2013, among 221 Bangladeshi medical students from first to fifth year. By the convenience sampling technique, data were collected by a pretested, structured, self-administered questionnaire and analysis was done by SPSS version 18.0. Depression was assessed by the validated Patient Health Questionnaire-9 (PHQ-9) tool among the respondents. Goldberg's General Health Questionnaire (GHQ-28) was used for assessing overall mental health status. Results Depression was found in 38.9% of participants, with 3.6%, 14.5%, and 20.8% being severe, moderate, and mild depression, respectively. 17.6% of medical students had suicidal tendency or attempted suicide at least once after attending medical school. The sleeping hours were inadequate and altered after starting this stressful academic course. 33.5% of medical students had poor mental health status. There was a statistically significant association between poor mental health status in the age group less than 22 years old and initial academic study year (1st to 3rd of MBBS). Conclusion The findings are suggestive of a higher prevalence of depression among early-year medical students and marginal predominance in males. Suicidal tendency is also higher. This calls for further investigation with situation analysis, qualitative explorations, and surveys to explore the burden of such disorders in Bangladesh.

Background: Cholera remains a major public health threat in low-and middle-income countries. The World Health Organization (WHO) has recently launched a global initiative to end preventable cholera by 2030. Key to the success of this initiative will be the elimination of cholera transmission in cholera 'hotspots' with regularly recurrent disease; this can be achieved via improved surveillance to define hotspot populations, through the use of oral cholera vaccines, and through the implementation of improved water, sanitation, and hygiene (WASH). Methods: This study was performed to analyze the trend in cholera incidence during the years 1974-2018 in Matlab, Bangladesh (defined population of about 200 000) that has been recognized as one of the world's cholera hotspots. During this period, Matlab has maintained a demographically defined population and comprehensive, culture-based surveillance for cholera, supplemented by periodic surveys to characterize the socioeconomic status of the population, as well as water sources and facilities for defecation. Results: Cholera transmission has nearly been eliminated in Matlab, despite a continuing high cholera burden in many other parts of Bangladesh and despite trends of increasing ambient and sea surface temperatures, which are known to increase cholera incidence. Concomitantly, the socioeconomic status of the population has increased modestly, and the use of simple tubewells for drinking water has reached 95% and the installation of sanitary latrines has reached 85%. Conclusions: The factors responsible for the decline in cholera are difficult to pinpoint precisely, but this decline has occurred with the installation of inexpensive improvements in water sources and latrines and despite environmental factors that should have augmented cholera incidence. These observations lend optimism to the current global initiative to end preventable cholera by 2030.

Pharmacy workers in Bangladesh need to be trained on legal time limits for MR services provision, on providing accurate information on disbursed medicine, and on proper referral mechanisms. A strong monitoring and regulatory system for pharmacy provision of MRM in pharmacies should be established.

Background In Sunamganj there are fewer than four skilled providers per 10,000 population and just 27% of births are assisted by a skilled attendant. We evaluate a private community skilled birth attendant (P-CSBA) model, developed through the GSK-CARE Frontline Health Worker Programme, designed to address this gap and report on changes in service utilization and health outcomes from baseline to three years post-baseline. Methods This analysis presents the results of a pre-post cross sectional design. A baseline survey (n = 1800) was conducted using a multistage cluster sampling approach. Three years postbaseline a second cross-sectional survey (n = 1755) was conducted across the same project area. To describe demographic characteristics of the study participants descriptive statistical techniques were used as appropriate. Logistic and multiple logistic regression, controlling for a comprehensive set of covariates, were used to assess odds ratios for key maternal health behaviors and outcomes. Results Birth planning and the use of key maternal health services improved from baseline to followup. There was a dramatic increase in the proportion of respondents reporting skilled attendance at birth (aOR: 2.18, p = .001). Women also reported significantly fewer complications

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