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We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51% of the families (and 74% of those having a caesarean delivery) did not have enough money to pay; of these, 79% had to borrow from a money lender or relative. Surprisingly, 72% of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.

Antimicrobial susceptibility of 120 Helicobacter pylori isolates to metronidazole, tetracycline, clarithromycin, and amoxicillin was determined, and 77.5, 15, 10, and 6.6% of the isolates, respectively, were resistant. Only rdxA inactivation and both rdxA and frxA inactivation were responsible for metronidazole resistance in 66% (8 of 12) and 33% (4 of 12) of the isolates, respectively. Eradication ofHelicobacter pylori infection by treatment with two antimicrobial agents (clarithromycin and amoxicillin or metronidazole) and a proton pump inhibitor is recommended by various consensus groups (10,16,20). Antimicrobial resistance in H. pylori is a growing problem as it is the most important factor in determining treatment outcome. The prevalence of antimicrobial resistance varies with geographical regions (3, 25). Metronidazole resistance in H. pylori has been shown to be due to mutation in rdxA; mutation in frxA has also been shown to be associated with metronidazole resistance (11,12,23). In Bangladesh, the prevalences of H. pylori infection among infants, children, and adults are 61, 84, and 92%, respectively (1, 21, 22); however, information on antimicrobial susceptibility to commonly used drugs in H. pylori treatment is lacking. This study was conducted to evaluate (i) the prevalence of primary antibiotic resistance to commonly used antimicrobial agents and (ii) the genetic basis for metronidazole resistance in H. pylori isolates from Bangladesh.Consecutive patients attending the Gastroenterology Department of Dhaka Medical College Hospital for upper gastrointestinal endoscopy were enrolled during 1999 to 2001. Diagnosis of peptic ulcer (PU) and non-ulcer dyspepsia (NUD) or gastritis was based on endoscopic examination of the stomach and duodenum. Biopsy samples were taken from each patient for culture.Bacteria were grown in brain heart infusion agar with 7% sheep blood and incubated at 37°C in 5% O 2 , 10% CO 2 , and 85% N 2 for 3 to 6 days. The MICs of amoxicillin, clarithromycin, metronidazole, and tetracycline for the isolates were determined by the agar dilution method as described elsewhere (18,19). All tests were repeated twice, and H. pylori 26695 was used as a control. ␤-Lactamase production was tested by the chromogenic cephalosporin method (6). The molecular mechanism of susceptibility and resistance to metronidazole was studied in 12 isolates. Metronidazole-susceptible (Mtz s ) isolates were further studied (by inactivation of rdxA alone or rdxA and frxA for conversion into an Mtz r phenotype) by transformation of Mtz s isolates with plasmids pBS-rdxA-cam (rdxA::cat) and pBS-frxA-kan (frxA::kan) as described earlier (11,12).A total of 278 consecutive patients between 15 and 78 years of age were enrolled, and among them, 72.7% (202 patients) were male and 27.3% (76 patients) were female. Among the patients, 162 had PU and 116 had NUD and 62.6% (174 of 278) were culture positive for H. pylori. Among the culturepositive patients, 121 (69.5%) were male and 53 (30.4%) were female and 112 (64.3%) had PU ...

Background Healthcare workers (HCWs) who are in the frontline during the COVID-19 pandemic are often under significant pressures that may predispose them to symptoms of poor mental health. This study aimed to investigate the prevalence of anxiety and depression among HCWs and factors correlated with mental health concerns during the COVID-19 pandemic in Bangladesh. And, it also aimed to evaluate the psychometric properties of the Bangla version of the Hospital Anxiety and Depression Scale (HADS). Methods A cross-sectional survey was conducted between July and August, 2020. A self-reported online questionnaire was utilized to collect data. The survey included questions concerning socio-demographic, lifestyle, and work setting, as well as the HADS. A confirmatory factor analysis (CFA) and multiple linear regression analysis were performed. Results Data from 803 HCWs (50.7% male; mean age: 27.3 [SD = 6.9]; age range: 18-58 years) were included in the final analysis. The Bangla HADS was psychometrically sound, and demonstrated good internal consistency and reliability (α = 0.83), and excellent construct validity. Prevalence estimates of anxiety and depression were 69.5%, and 39.5%, respectively, for less severe symptomology (at least borderline abnormal), and 41.2% and 15.7% for more severe (at least abnormal) symptomology. Regression analyses with the total HADS score as a dependent variable revealed significant (p < 0.05) associations with female gender, moderate and poor health status, infrequent physical exercising, smoking, having had regrets about one’s profession because of the pandemic and associated experiences, not updating on the latest COVID-19-related research, experiencing discrimination in the workplace, and facing social problems due to working in a lab or hospital during the COVID-19 pandemic. Conclusions Symptoms of anxiety and depression are prevalent among HCWs during the COVID-19 pandemic in Bangladesh. The findings suggest a need for screening for mental health concerns, and employing early intervention to help these individuals.

BackgroundRecognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.MethodsThis cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed.ResultsThe median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.ConclusionsManoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

Longitudinal studies of the consumption of foods and nutrients by 70 children between 5 and 30 months of age have been completed, during 632 individual days of observation in rural village homes in Bangladesh. Foods and prepared menu items for each child were weighed before serving; leftover food was subtracted from portions served to determine the amounts consumed. Breast milk intakes were estimated by test-weighing of children before and after all feedings during 12-h daytime periods and were corrected to 24-h consumption. All children between 5 and 12 months of age and 85% of children between 24 and 30 months were breast-fed; the average amount of breast milk received by these age groups declined from 632 to 368 g/day. Concurrently, the rate of consumption of cereals increased from 54 to 100% of children, and the amount received increased from 35 to 94 g/day. The children received an average intake of energy between 63 to 71 kcal/kg body weight/day and an average intake of protein between 1.2 to 1.5 g protein/kg body weight/day in the various age and sex categories. The absolute consumption of energy and protein increased with age, but the amount of energy per kg of body weight and the percentage of energy requirement for the amount of energy per kg of body weight and the percentage of energy requirement for length-age remained constant or declined in older girls. Vitamin A consumption, mostly from breast milk, averaged between 152 and 249 micrograms retinol equivalents per day, with younger children receiving more than older ones and boys receiving more than girls. Breast milk was the major source of all nutrients for younger children. Cereals provided more protein and iron than mothers' milk in older boys, but breast milk remained an important source of nutrients for all children.

Background: Healthcare workers (HCWs) who are in the frontline during the COVID-19 pandemic are often under significant pressures which may predispose them to mental ill-health. This study aimed to investigate the prevalence of anxiety and depression among HCWs and factors correlated with mental problems during the COVID-19 pandemic in Bangladesh.Methods: A cross-sectional survey was conducted between July and August 2020. A self-reported online questionnaire was utilized to collect data. The survey included questions concerning socio-demographic, lifestyle, and work setting and the Hospital Anxiety and Depression Scale (HADS).Results: Data from 803 HCWs (50.7% male; mean age: 27.3 [SD=6.9]; age range: 18-58 years) were included in analyses. Prevalence estimates of anxiety and depression were, respectively, 69.5% and 39.5% for at least borderline abnormal, 41.2% and 15.7% for at least abnormal symptoms. Regression analyses with HADS-score as dependent variable revealed significant (p&lt;0.05) associations with female sex, moderate and poor health status, irregular physical exercising, smoking, having had regrets about their profession because of the pandemic and many unexpected experiences, not updating on the latest COVID-19-related research, experiencing discrimination in the workplace, and facing social problems due to working in a lab or hospital.Conclusions: Symptoms of mental ill-health are prevalent among HCWs during the COVID-19 pandemic in Bangladesh. The findings suggest a need for monitoring and early interventions to help these individuals.

The prevalence of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) among hotel-based sex workers (HBSWs) in Dhaka, Bangladesh, was studied. A total of 400 HBSWs were enrolled in the study during April to July 2002. Endocervical swabs, high vaginal swabs, and blood samples from 400 HBSWs were examined for Neisseria gonorrhoeae (by culture), Chlamydia trachomatis (by PCR), Trichomonas vaginalis (by microscopy), antibody to Treponema pallidum (by both rapid plasma reagin and Treponema pallidum hemagglutination tests), and antibody to herpes simplex virus type 2 (HSV-2) (by enzyme-linked immunosorbent assay). Sociodemographic information as well as gynecological and obstetric information was collected. Among the HBSWs, 228 women (57%) were symptomatic and 172 (43%) were asymptomatic, 35.8% were positive for N. gonorrhoeae, 43.5% were positive for C. trachomatis, and 4.3% were positive for T. vaginalis. A total of 8.5% had syphilis, 34.5% were positive for HSV-2, and 86.8% were positive for at least one RTI or STI. There was no significant difference between the prevalences of STIs among the symptomatic and asymptomatic HBSWs. These data suggested a high prevalence of STIs, particularly gonorrhea and chlamydia, among HBSWs in Dhaka.As in other developing countries, sexually transmitted infections (STIs) and reproductive tract infections (RTIs) represent a major public health problem in Bangladesh (1). Control of ulcerative (syphilis, chancroid, and herpes simplex virus type 2 [HSV-2] infection) and nonulcerative (gonorrhea, chlamydia, and trichomoniasis) STIs and of RTIs (bacterial vaginosis and candidiasis) is important not only for preventing complications related to infection but also for preventing heterosexual transmission of human immunodeficiency virus (HIV). In a number of recent studies, it has been shown that bacterial and parasitic agents of STIs and RTIs, increase the release of virion particles in the semen and ulcers in the genital region and thus increase the risk of both acquisition and transmission of HIV in patients with STIs (15, 2, 4). Consistent with this observation, Grosskurth et al. have demonstrated that control of STIs through syndromic management in the general population in a rural area of Tanzania was able to reduce the serological incidence of HIV by 42% (8).Female sex workers (FSWs) are particularly at risk for STIs and HIV (5). They often are infected by their clients and subsequently transmit the infection to other partners. It has earlier been demonstrated that in most parts of Asia and Africa, 60 to 70% of the STIs relate to clients of FSWs and sexual networks (14).The number of FSWs in Bangladesh is unknown, but estimates range from 50,000 to 100,000. FSWs work in brothels, streets, hotels, and residences (7). However, in recent years there has been remarkable change in the nature of the sex industry, possibly due to (i) eviction of brothels from major cities, (ii) increased demand for sex workers in nonstigmatized locations, (iii) demand for flexible...