SummaryBackgroundMost malaria deaths occur in rural areas. Rapid progression from illness to death can be interrupted by prompt, effective medication. Antimalarial treatment cannot rescue terminally ill patients but could be effective if given earlier. If patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate can be given before referral and acts rapidly on parasites. We investigated whether this intervention reduced mortality and permanent disability.MethodsIn Bangladesh, Ghana, and Tanzania, patients with suspected severe malaria who could not be treated orally were allocated randomly to a single artesunate (n=8954) or placebo (n=8872) suppository by taking the next numbered box, then referred to clinics at which injections could be given. Those with antimalarial injections or negative blood smears before randomisation were excluded, leaving 12 068 patients (6072 artesunate, 5996 placebo) for analysis. Primary endpoints were mortality, assessed 7–30 days later, and permanent disability, reassessed periodically. All investigators were masked to group assignment. Analysis was by intention to treat. This study is registered in all three countries, numbers ISRCTN83979018, 46343627, and 76987662.ResultsMortality was 154 of 6072 artesunate versus 177 of 5996 placebo (2·5% vs 3·0%, p=0·1). Two versus 13 (0·03% vs 0·22%, p=0·0020) were permanently disabled; total dead or disabled: 156 versus 190 (2·6% vs 3·2%, p=0·0484). There was no reduction in early mortality (56 vs 51 deaths within 6 h; median 2 h). In patients reaching clinic within 6 h (median 3 h), pre-referral artesunate had no significant effect on death after 6 h or permanent disability (71/4450 [1·6%] vs 82/4426 [1·9%], risk ratio 0·86 [95% CI 0·63–1·18], p=0·35). In patients still not in clinic after more than 6 h, however, half were still not there after more than 15 h, and pre-referral rectal artesunate significantly reduced death or permanent disability (29/1566 [1·9%] vs 57/1519 [3·8%], risk ratio 0·49 [95% CI 0·32–0·77], p=0·0013).InterpretationIf patients with severe malaria cannot be treated orally and access to injections will take several hours, a single inexpensive artesunate suppository at the time of referral substantially reduces the risk of death or permanent disability.FundingUNICEF/UNDP/World Bank Special Programme for Research and Training in Tropical Diseases (WHO/TDR); WHO Global Malaria Programme (WHO/GMP); Sall Family Foundation; the European Union (QLRT-2000-01430); the UK Medical Research Council; USAID; Irish Aid; the Karolinska Institute; and the University of Oxford Clinical Trial Service Unit (CTSU).

Combined efforts of farmers, rice scientists, extension personnel and Government of Bangladesh have yielded clean rice growth rate of 0.34 million ton (MT) year -1 during 2009-10 to 2013-14 in the country. In 2014-15, the country acquired a rice surplus of about 2 MT. However, maintaining the current surplus of rice in the coming decades is a great challenge. Authentic estimation of future rice requirement and future resource availability would guide to way forward. This paper presents rice vision for Bangladesh leading to 2050 and beyond. In this study, secondary data from different government-owned statistics and research institutes were collected, analyzed and synthesized to develop models and/or model parameters to generate outputs such as future population, rice production and rice requirement. Population of Bangladesh will reach 215.4 million in 2050, when 44.6 MT of clean rice will be required. With the pace of rice-production-increase in the last five years, production can reach 47.2 MT, having a surplus of 2.6 MT in 2050. The study sets 2.6 MT as the target for clean rice surplus every year leading to 2050 and beyond. Several hurdles, such as increasing population, decreasing resources and increasing climate vulnerability, can hinder achieving the target. Three major interventions-accelerating genetic gain, minimizing yield gap and curtailing adoption lag-are proposed to break the barriers to achieve the target. Major challenges to implement the interventions include shrinking net cropped area, decreasing availability of irrigation water and increasing pressure on soil fertility. Smart technology such as, location specific variety, profitable cropping sequences, innovative cultural management, and mechanization coupled with smart dissemination using multiple means would ease production barriers. We recommend a number of measures, such as, guaranteeing a minimum cropped area, accelerating the rate of genetic gain in varietal development and intensifying collaboration among the stakeholders to reduce adoption lag of newly released promising rice varieties, to achieve the rice vision of Bangladesh leading to 2050 and beyond.

Fifty-two women with a rectovaginal fistula were managed over a period of 15 years. All the fistulae were caused by obstetric injury commonly resulting from breakdown of the repair of complete perineal tears or from unrecognised injury during forceps or precipitate delivery. In five patients the fistula healed spontaneously within 12 weeks of the injury. Thirty-nine patients underwent transvaginal purse-string repair by standard technique and eight patients had perineoproctotomy and sphincteroplasty for large fistulae associated with anal incontinence. Surgical repair was successful in all the 47 patients including two patients who had previous failed repair elsewhere. The routine postoperative follow-up period of the patients ranged between 6 months and 8 years. There were no residual symptoms of anal sphincter weakness in the patients treated with transvaginal purse-string repair. Two of the patients who underwent perineoproctotomy and sphincteroplasty complained of varying degrees of postoperative incontinence of flatus that resolved by 8 weeks postoperation. In our experience the transvaginal purse-string method of repair for small, low rectovaginal fistulae proved highly satisfactory with 100% cure rate. Perineoproctotomy and sphincteroplasty for larger fistulae associated with anal incompetence was equally successful with minimal postoperative morbidity.

The electrochemical redox behavior of Cu(II), and Cu(II) in presence of ascorbic acid has been investigated at glassy carbon electrode (GCE) in aqueous phosphate buffer solution (PBS) at various pH. In the studied pH range the voltammogram consists of a cathodic and an anodic peak. Cu(II) follows one step two-electron transfer electrochemical redox reaction. The intensities of both cathodic and anodic peak current increase with increasing scan rate that are consistent with Randles-Sevcik equation. The linear behavior of peak current with the square root of scan rate indicates that the electrochemical processes are diffusion controlled. In presence of ascorbic acid both of the cathodic and anodic peak current of Cu(II) is reduced and peak positions are shifted compared to those of Cu(II) alone. These observation suggest that Cu(II) undergoes a strong interaction with ascorbic acid in the studied medium.

Built on deep-rooted political and cultural heritage, ‘rice security’ is the foundation of ‘food security’ in Bangladesh. The country has been in production-surplus of rice in the current decade feeding over 165 million people. This on-going ‘selfsufficiency momentum’ would require to maintain to meet increased demand from growing future population. On developmental side, Bangladesh is placed among the three of the world’s fastest growing economies in the years through to 2050. Rice sector would need to match with the pace of this growth. In addition, agriculture sector, that includes rice, is to double the productivity as the government commits to meet the SDG goal 2.3.1. This study addresses those issues through scoping increased rice production and productivity in Bangladesh, developing a plan of work (POW) on translating the scope and designing implementation plans and actions, incorporating efficiency, resilience, stability and sustainability issues, to achieve the POW. The study has used brainstorming, and rigorous analysis to achieve the objectives. The productivity has been explained in terms of yield- and labour-productivity. The developed three-winged ‘doubling rice productivity (DRP)’ framework directs yield enhancement and production accumulation in unexplored spaces (Wing-1); increased adoption of mechanization to impact on labour productivity (Wing-2), and improvements in nutritional quality and rice-based product diversity, and stabilizing the farmgate price (Wing-3). Analyses show, from the baseline figure of 35.29 MT in 2015, rice production in the country can be raised to 46.90 MT in 2030, 54.09 MT in 2040 and 60.85 MT in 2050 with combined contributions of three pillars – yield improvements by enhanced varietal potential (Pillar 1), reduction in existing yield gap (Pillar 2) and production increase by exploring unexplored spaces for rice (Pillar 3) of Wing-1 of the DRP. This production will produce a surplus of 6.50, 10.29 and 13.65 MT in 2030, 2040 and 2050, respectively, over the production target (40.40, 43.80 and 47.20 MT in 2030 and 2050, respectively). Results further reveal that through scale-appropriate mechanization backed up by estimated fair price, labour productivity in rice will be doubled by 2029, meeting the SDG 2.3.1. Good number of released varieties have been identified to have specific nutritional trait, and value adding quality. We have emphasized on much needed actions on demand-driven research for varietal development and field-adoptable management, mechanization for transplanting and harvesting operations, accommodation of rice in unexplored spaces, farmer-based speedy seed multiplication and dissemination system, establishment of commission for agricultural costs and prices, input buffer stock terminals for managing production risk, long-term storage and export of surplus production, and research-publicity-market development for rice-based products through public-private partnership. It is concluded that efficiency, resilience and sustainability around the three wings of DRP in the rice production systems to be ensured to achieve the rice production, productivity and labour use estimates. Bangladesh Rice J. 24 (2): 1-47, 2021

Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.

ABSTRACT. Almost a half million fishers in Bangladesh are predominantly reliant on the hilsa shad (Tenualosa ilisha) fishery in the Meghna River and estuarine ecosystem. This paper adopts a broadened concept of social-ecological traps to frame the complex dynamics that emerge from social and ecological interactions in this highly natural resource-dependent social-ecological system (SES). We analyze how endogenous self-reinforcing processes in the system and poor initial conditions, particularly debt and lack of livelihood options outside fisheries, keep fishing households in poverty. We identify a policy decision in favor of incentive-based fisheries management as a critical juncture that influenced a trajectory of recovery in hilsa shad stocks in this complex adaptive system. Normative assessment of stakeholder perceptions indicates that fishers perceive a nominal improvement in well-being as a result of this policy. Compensation in return for compliance with a seasonal fishing ban in sanctuary areas does not, however, disrupt trap dynamics perpetuating the cycle of poverty, social exclusion, and political disempowerment in which fishing households are entrenched. Poverty and lack of alternative livelihood opportunities remain significant reasons for noncompliance with the ban as long as fishers do not have any meaningful representation in resource management and decision making. A secured tenure system through adaptive comanagement involving fishers in monitoring and enforcement of compliance with fishing bans, supported by sustainable finance for livelihood improvements outside of natural resource exploitation and predicated on responsive and accountable institutions for and by people who depend on the fishery, can form the foundation for local stewardship in a unique demonstration of contemporary largescale open-water fisheries governance in this complex SES.

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