Jahangir Hossain

Lightning Injury is a disaster in Bangladesh? - Exploring its magnitude and public health needs

Background: Lightning injury is a global public health issue. Low and middle-income countries in the tropical and subtropical regions of the world are most affected by lightning. Bangladesh is one of the countries at particular risk, with a high number of devastating lightning injuries in the past years, causing high mortality and morbidity. The exact magnitude of the problem is still unknown and therefore this study investigates the epidemiology of lightning injuries in Bangladesh, using a national representative sample. Methods: A mixed method was used. The study is based on results from a nationwide cross-sectional survey performed in 2003 in twelve randomly selected districts. In the survey, a total of 819,429 respondents from 171,336 households were interviewed using face-to-face interviews. In addition, qualitative information was obtained by reviewing national and international newspaper reports of lightning injuries sustained in Bangladesh between 13 and 15 May 2016. Results: The annual mortality rate was 3.661 (95% CI 0.9313–9.964) per 1,000,000 people. The overall incidence of lightning injury was 19.89/100,000 people. Among the victims, 60.12% (n=98) were males and 39.87% (n=65) were females. Males were particularly vulnerable, with a 1.46 times increased risk compared with females (RR 1.46, 95% CI 1.06–1.99). Rural populations were more vulnerable, with a 8.73 times higher risk, than urban populations (RR 8.73, 95% CI 5.13–14.86). About 43% of injuries occurred between 12 noon and 6 pm. The newspapers reported 81 deaths during 2 days of electric storms in 2016. Lightning has been declared a natural disaster in Bangladesh. Conclusions: The current study indicates that lightning injuries are a public health problem in Bangladesh. The study recommends further investigations to develop interventions to reduce lightning injuries, mortality and related burden in Bangladesh.

An evaluation of Emergency Management of Severe Burn (EMSB) course in Bangladesh: a strategic direction

BackgroundBurn is one of the major public health problems in Bangladesh. Specialized personnel and technologies are required, however, in many cases they are not readily available. Taking the situation into account, Interplast Australia and New Zealand, Australia & New Zealand Burn Association (ANZBA), and Centre for Injury Prevention and Research, Bangladesh (CIPRB) initiated Emergency Management of Severe Burn (EMSB) training programme for Bangladeshi physicians in 2008 to help improving their burn management skill. The study was designed to evaluate the effect of EMSB programme in Bangladesh.MethodsBoth qualitative and quantitative methods were adopted. A cross-sectional survey was conducted to obtain quantitative information from 38 randomly selected EMSB-trained doctors among 380 trained physicians based on a five year database of EMSB (2008-2012). In-depth interviews (IDIs) and focus group discussion (FGD) were used as data collection techniques to get information.ResultsA total of 32 participants completed the interview. It was found that 87.5% (n=28) doctors were using their skill in burn management that they learnt from the EMSB course. About 43.8% (n=14) doctors felt that the course largely helped improve their confidence. Majority (56.2%, n=18) of doctors stated EMSB is essential for the Bangladeshi doctors to learn better management of burns. Qualitative findings show that the courses were organized successfully with an excellent coordination, maintaining same quality and standard as running anywhere in the world. For its effectiveness, the course has been recommended to train graduate nurses and junior doctors from the periphery of the country.ConclusionsEMSB has already created a large doctor community who are able to effectively manage burn patients. It also has proven its indispensability for learning burn management skill. The EMSB established a platform to serve the burn victims and reduce the burden of injuries in Bangladesh.

PW 2017 Beach safety knowledge, attitudes and practices among beach users in cox’s bazar, and the challenges to implementing a lifeguard service in bangladesh

Introduction With increasing tourism in Cox’s Bazar beach, drowning become a common occurrence. To increase beach and water safety, the Centre for Injury Prevention and Research, Bangladesh (CIPRB), with support from the Royal National Lifeboat Institution (RNLI) has implemented a lifeguard service on 3 popular tourist beaches in Cox’s Bazar. Objectives The objective of this study was to assess the knowledge level of beach users regarding the lifeguard service and to identify barriers to lifeguarding in Cox’s Bazar. Methods A qualitative study, a combination of in-depth interviews and focus group discussions with 42 participants consisted of beach visitors, beach vendors, hotel staff, and beach police, was carried out. Results Results from the data analysis highlighted that the majority people could identify the lifeguards and their activities. All participants knew that the indication of the lifeguards’ presence at the beach is their red and yellow uniform and the safety devices they are carrying. However, many newcomers to the beach were unaware of the lifeguard service and its purpose in detail. Also, women are less likely to know about the lifeguard service. The results showed that the main barriers to implementing a lifeguard service in Bangladesh are the lack of personnel and coverage, lack of beach vendors’ and hawkers’ cooperation, and lack of government support and/or funding. Discussion and conclusions Newcomers are often unaware of the lifeguard service. Beach users who do know about lifeguards indicate that they do not necessarily understand the purpose of the service. Those beach users and other stakeholders who are aware of the lifeguard service tend to perceive that the number of lifeguards is not enough to raise awareness among the beach users, especially on busy days. Greater prioritisation on education and provision of consistent messages by various stakeholders, may be necessary to improve the delivery of the lifeguard service.

PW 2050 Estimating the burden of injuries among urban children in bangladesh from a nationwide survey: evidence for policy implication

Introduction Injuries among urban children has become an emerging public health problem in Bangladesh like other low- and middle-income countries due to epidemiological transition. Despite of huge burden, child injuries could not draw the attention of the policy makers over the last few decades to be a national priority agenda in health sector due to lack of reliable data. Objective Objective of the study was to investigate the epidemiological burden of injuries among urban children in Bangladesh. Methodology A nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. It uses a complex sampling strategy based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. After cleaning and validation, data from 2 99 216 household residents including 1 06 233 urban residents was available for analysis of which 33 578 were children aged 0–17 years. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program developed for the survey. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis. Results Injury was responsible for 27% of all causes of deaths among urban children (157.4/100,000 children per year). Drowning was the leading cause of mortality (46.7%) followed by electrocution (13.3%), road traffic injuries (6.7%) and suicide (6.7%). Injury mortality was significantly higher among boys (218.5/100,000 boys per year) than girls (92.7/100,000 girls per year). Falls (39.5%, cuts (19.7%) and road traffic injuries (13.6%) were the three leading causes of injury morbidity while cuts, burns and road traffic injuries are the main cause of injury related permanent disability. Conclusion It is the time to act now for developing injury prevention, control and rehabilitation interventions as integral part of developmental efforts in achieving the SDGs targets.

PW 1368 Disaster preparedness in local community: a quantitative baseline study in coastal regions of bangladesh

Bangladesh experiences frequent natural disasters, which cause loss of life damage to infrastructure and economic assets and adversely impacts on lives and livelihoods, especially of poor people. To investigate the impact of aquatic disasters on the community and explore current disaster preparedness practices and resilience in Barisal division. A sub sample survey conducted to identify the risk factors for drowning during disaster at household and community level and understand the situation. We had conducted interview on 10% of the survey population through using systematic random sampling in 24 sub districts in Barisal Division. The 82% respondents gathered experience one or more natural disaster in the last five year, 63% respondents believed that flooding/flash flood to be the biggest threat followed by cyclones/big storms (24%). As a weather forecast information, television was the most common source of weather signals (46%) about the natural disaster that respondents had received. A high proportion of respondents (70%) reported having received warning messages such as television (45%) followed by warnings from local authorities and volunteers, at 21% each, were the most common source for receiving warning signals. The 81% respondent reported not going to any shelter, 44% believed that seeking shelter was not required and that the shelter was not easily accessible, and 38% did not seek shelter for the security of their property and for protecting their cattle (13%). The vulnerability of Bangladesh to climate change with particular reference to tropical cyclone frequency and intensity, flooding against current coping and adaptation-mitigation mechanism through local communities under coastal belt of Bangladesh. Disaster preparedness had predominately managed by individual community members. Warning signals indicates event severity, directing community members towards cyclone shelters and other protected areas of the community. Government initiatives primarily focus on protection at time of disaster and relief post-disaster.

Rescue and Emergency Management of a Water-Related Disaster: A Bangladeshi Experience

Background: The Padma, one of the largest rivers in the world, is crossed by thousands of people every day by boat or launch (a local made ferry). However, the number of launches is insufficient, and launches are frequently overloaded with passengers. The authorities do not strictly enforce waterway rules. On 22 February 2015, a cargo vessel hit a launch carrying over 200 passengers in the Padma near Paturia launch terminal, Manikganj, Bangladesh. At least 79 people including 14 children and 28 women died and over 50 went missing. Here we examine the rescue process and emergency management services during this event. Methods: Qualitative methods, including in-depth interviews and reviews of the daily national newspaper reports on the disaster event and related documents were performed. Results: At 11:40 am, the launch sank in middle of the river 15 minutes after it had left the terminal Short Research Article Biswas et al.; AJMAH, 4(1): 1-9, 2017; Article no.AJMAH.32163 2 after collision with a cargo vessel. The launch was carrying 200 passengers even though its capacity was 140. Around 100 passengers were either rescued or swam about half a kilometer to reach the shore. Locals started rescuing passengers immediately after the accident with the help of boats and trawlers from both sides. Around 150 members of different government rescue agencies participated in the rescue operation from 12:00 noon to midnight. A rescue vessel reached the accident site at around 11.00 pm to salvage the sunken vessel. After 24 hours of rescue operations, 70 bodies were handed over to family members. Conclusion: Emergency management was inadequate, and the launch authorities did not take appropriate measures to rescue passengers from drowning. Mass public awareness is essential to enforce the rules for safe river crossing. A national level policy is required for mass rescue during water-related disasters.

270 Survival swimming – effectiveness of swimsafe in preventing drowning in mid and late childhood

Introduction Conclusive evidence of the protective effect of swimming has been lacking in high income countries. Nested case control studies in surveys done across Asia have shown significant associations between swimming ability and protection against drowning in children four years and older. In order to confirm that the relationship between swimming ability and protection from drowning was a causal relationship, a four year cohort study of a structured survival swimming program known as SwimSafe was undertaken in Bangladesh. Methods A cohort study was conducted to compare the protection from drowning conferred by participation in the SwimSafe survival swimming. The survival swimming cohort was made up of children primarily aged 4–12 years old who were graduates of the SwimSafe program in rural Bangladesh. The non-survival swimming cohort was made up of age- and sex-matched children from neighbouring villages who were not participants in the SwimSafe program. Death from drowning was compared in both groups using survival analysis techniques. Results A total of 81,659 children had been taught survival swimming in the study area who had been followed through September 30, 2010 and whose survival status was known. A cohort of 140,479 non-SwimSafe participants had been followed in the same system and whose survival status was known. Children from this non-SwimSafe cohort were matched on age and sex with SwimSafe graduates and a total of 66,066 children from each cohort were fully matched. The matching cohorts were subjected to Kaplan Meier and Cox Proportional Hazard survival analyses with fatal drowning as the primary outcome. These showed a substantial and statistically significant reduction in relative risk of drowning in SwimSafe children as compared to the matched non-SwimSafe children. Conclusions Survival swimming, as taught in the SwimSafe survival swimming program with its highly structured and skills based methodology confers protection from drowning in children who graduate from the SwimSafe program.

212 Oil spillage effects on health and safety among the local communities – experience from Bangladesh

Background on 9th December 2014 an oil tanker collided with a cargo vessel at Sundarban, the largest mangrove forest in the world. About 350, 000 litres of furnace oil spilled into the Shela river. No major oil clean-up was in placed due to lack of equipments and experiences. However, most of the local people including children came to the place without any safety measures to collect oil so that they could sell it later. Methods Qualitative method was used to explore the situation. IDI, FGD, observation technique and relevant daily national and international newspapers were reviewed to collect the information. Results The disaster affected both on health and safety of the community. Primarily local people, who do not have any previous experience, were involved to collect the oil from the river and government showed interest to procure the furnace oil at a fix rate. This lead local community to start collecting oil and later on faced various health problems like diarrhoea, skin diseases, abdominal pain and headache etc. A child drowning case was found due to collecting oil. Though 7-year old kid was rescued he suffered from diarrhoea for four days. To get the better quality of oil community people boiled the oil so that water evaporated and quality of it became better. Females were involved in boiling oil and they faced severe headache, irritation on eyes and nose and vomiting tendency. Conclusion Disaster preparedness is essential for any country like Bangladesh. Government should take necessary initiative on awareness and safety before involving local community in any disaster management especially dealing with chemicals2.Community people’s safety should be the priority to avoid or reduce health effects.

1018 Women’s participation in ensuring children safety-experences from Bangladesh

Background Drowning is the leading killer of children 1–4 year in Bangladesh, accounting for 43% of total child mortality in this age group. Lack of supervision, high exposure to water hazards, lack of education and poverty are some of the major risk factors for childhood drowning in Bangladesh. To ensure child safety from drowning in the rural areas 1600 Anchals (community crèches) were implemented during 2013–14 in three sub-districts of Bangladesh where children stay safely under supervision of two local caregivers (Anchal caregiver and her Assistant). In each Anchal 20–25 children aged 9 to 36 months, are kept between 9:00 am and 1:00 pm, six days a week. The objective of the study was to assess the women’s participation in ensuring child safety through Anchal in rural areas of Bangladesh. Methods A qualitative method was applied in this study. Last 17 months salaries of 3200 women were analysed and Focus Group Discussions (FGDs) were conducted with 100 Anchal caregivers in 10 groups in the three different locations to understand their position in the family and the society. Results 3200 Women worked voluntarily to ensure injury safety of 35,000 children. From June 2014 to October 2015 (17 months) these women earned a total of BDT 5,40,96,890/- which made social, financial and economic changes in their lives. Community people respected them as teacher of the children. These women were more aware on injury prevention. The FGDs also found that independent earnings gave them a higher status in the family and as a result of that, the husband-wife interaction on decision-making increased. Five days basic training, monthly meetings and compliance training increased their mobility outside home and the social status of them. These women’s communication skills had also increased. Conclusions From the study it was found that women had been empowered and children’s safety was ensured through the Anchal programme.

1039 Challenges in injury data entry management in low resource settings – experiences from Bangladesh

Background Centre for Injury Prevention and Research, Bangladesh (CIPRB) is a leading research organisation in Bangladesh which works with different health related data since 2005. Since its inception, CIPRB developed over 25 different data bases mostly on injury prevention. CIPRB also managed surveillance databases with sample around 1,000,000. There are lots of challenges during data entry using hard copy data collection forms. Objective The objective of the study was to describe the challenges those were faced during management of data entry in a low resource setting, Bangladesh. Methodology Since 2005 Centre for Injury Prevention and Research, Bangladesh (CIPRB) has been implementing several research programs. CIPRB established a data entry centre in Dhaka with around 30 data enterers. Before starting data entry all hard copy questionnaires were collected and stored in a store room then the data enterers entered injury data manually in a software . The data entry process was closely monitored under the supervision of a statistician. On completion of entry each data-sets was cleaned for analysis. Results Computers used for data entry were old versioned and unupgraded. Unstable power supply interrupted data entry process. Maintaining network and server system is expensive and time consuming. Frequent damage of the computer sometimes caused loss of entered data. Poor storage system also caused data loss. Missing and confusing unclear data delays entry process. Data entry became slower in the evening than in the morning time. Due to unavailability of spear computers sometimes data enterers needed to wait until fixation of the broken computer. Conclusion A lot of challenges were identified, which were mostly due to financial constraints. These challenges are common in the low- and middle-income countries. During research funding donors should support to improve the data entry process which will eventually help to conduct better research. Acknowledgement Centre for Injury Prevention and Research, Bangladesh (CIPRB)