Mohammad Muhit

Best practice eye care models.

Since the launching of Global Initiative, VISION 2020 “the Right to Sight” many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

Interventions to prevent respiratory diseases - Nutrition and the developing world

Malnutrition is a major cause of morbidity and mortality in developing countries and nutrition plays a critical role in both acute and chronic respiratory conditions. Inadequacies in the nutritional requirements of a developing lung in utero and in early life can compromise the respiratory system integrity and result in poor lung function, reduced protection against infections, greater likelihood of acute illnesses in childhood and chronic illness in adulthood. Nutritional interventions harness great potential in reducing respiratory illness related morbidity and mortality in the developing world. In this review we have summarized the findings from published systematic reviews/meta-analysis, experimental and observational studies that looked into different nutritional interventions for preventing respiratory diseases in developing countries.

Generating Evidence for Program Planning: Rapid Assessment of Avoidable Blindness in Bangladesh

ABSTRACT Purpose: There is a lack of data on the prevalence and causes of blindness in Bangladesh, which is important to plan effective eye health programs and advocate support services to achieve the goals of Vision 2020. Methods: We conducted a rapid assessment of avoidable blindness (RAAB) in 8 districts of Bangladesh (January 2010 – December 2012) to establish the prevalence and causes of blindness. People aged ≥50 years were selected, and eligible participants had visual acuity (VA) measured. Ocular examinations were performed in those with VA<6/18. Additional information was collected for those who had or had not undergone cataract surgery to understand service barriers and quality of service. Results: In total, 21,596 people were examined, of which 471 (2.2%, 95% confidence interval, CI, 2.0–2.4%) were blind. The primary cause of blindness was cataract (75.8%). The majority of blindness (86.2%) was avoidable. Cataract and refractive error were the primary causes of severe visual impairment (73.6%) and moderate visual impairment (63.6%), respectively. Cataract surgical coverage for blind persons was 69.3% (males 76.6%, females 64.3%, P<0.001). The magnitude of blindness among people aged ≥50 years was estimated to be 563,200 people (95% CI 512,000–614,400), of whom 426,342 had un-operated cataract. Conclusions: In Bangladesh, the majority of blindness (86.2%) among people aged ≥50 years was avoidable, and cataract was the most important cause of avoidable blindness. Improving cataract surgical services and refraction services would be the most important step towards the elimination of avoidable blindness in Bangladesh.

Risk factors for dental caries among children with cerebral palsy in a low-resource setting.

To describe the oral health status and investigate factors affecting dental caries experience among children with cerebral palsy (CP) in rural Bangladesh.

Infectious causes of childhood disability: results from a pilot study in rural Bangladesh.

PURPOSE To identify the contribution of infectious aetiologies to major childhood disabilities in Bangladesh. METHODS Active community-based survey was conducted for severe childhood disability using the Key Informants Method between September 2011 and March 2012 in a rural sub-district of Bangladesh. RESULTS We screened 1069 children and identified 859 with severe disabilities. The mean age of the disabled children was 8.5 year and 42.9% were girls. The major forms of impairments/conditions were cerebral palsy (n = 324, 37.7%), hearing impairment (n = 201, 23.4%), physical impairment (n = 147, 17.1%), visual impairment (n = 49, 5.7%), cerebral palsy with epilepsy (n = 39, 4.5%) and epilepsy (n = 41, 4.7%). Congenital rubella syndrome was identified in 1.1% (n = 9). 7.1% disabilities resulted from clinically confirmed infections, and another 10.8% originated from probable infections; thus a total of 17.9% disabilities were related to an infectious origin. CONCLUSIONS Infectious diseases appear to be one of the major causes of severe childhood disability in rural Bangladesh.

Prevalence of refractive error, presbyopia, and unmet need of spectacle coverage in a northern district of Bangladesh: Rapid Assessment of Refractive Error study

ABSTRACT Purpose: To determine the prevalence of refractive error (RE), presbyopia, spectacle coverage, and barriers to uptake optical services in Bangladesh. Method: Rapid assessment of refractive error (RARE) study following the RARE protocol was conducted in a northern district (i.e., Sirajganj) of Bangladesh (January 2010–December 2012). People aged 15–49 years were selected, and eligible participants had habitual distance and near visual acuity (VA) measured and ocular examinations were performed in those with VA<6/18. Those with phakic eyes with VA <6/18, but improving to ≥6/18 with pinhole or optical correction, were considered as RE and people aged ≥35 years with binocular unaided near vision of <N8 were considered presbyopic. Result : A total of 3,043 people were examined, of which 143 had RE (4.7%, 95% CI: 3.9–5.5). Among people aged ≥35 years (n = 1402), 869 had presbyopia (62.0, 95% CI: 59.4–64.5). Spectacle coverage for RE and presbyopia were 13.3% (95% CI 7.7–18.9) and 3.2% (95% CI 2.2–4.6), respectively. “Unaware of the problem” was the main reason for not utilizing any optical services among the people with RE (92.8%) and presbyopia (89.5%). Extrapolating the survey findings to the 2011 national census data, the magnitude of RE among people aged 15–49 years in Bangladesh is estimated to be 3,493,980 people (95% CI 2,899,260–4,088,700), of whom 3,029,280 people do not use any spectacles. Conclusion : The burden of RE and presbyopia is substantial in Bangladesh. Improving awareness and availability of refraction services is required to correct REs and presbyopia in Bangladesh.

Health‐related quality of life of children and adolescents with cerebral palsy in low‐ and middle‐income countries: a systematic review

To systematically review literature on health‐related quality of life (HRQoL) of children and adolescents (≤18yo) with cerebral palsy (CP) from low‐ and middle‐income countries (LMICs) to identify trends in HRQoL and areas for future research.

Burden of Congenital Rubella Syndrome (CRS) in Bangladesh: Systematic review of existing literature and transmission modelling of sero–prevalence studies

Background and objectives Congenital Rubella Syndrome (CRS) is the leading cause of vaccine preventable congenital anomalies. Comprehensive country-level data on the burden of CRS in low and middle-income countries, such as Bangladesh, are scarce. This information is essential for assessing the impact of rubella vaccination programs. We aim to systematically review literature on the epidemiology of CRS and estimate the burden of CRS in Bangladesh. Methods We conducted a systematic review of existing literature and transmission modelling of sero-prevalence studies to estimate the pre-vaccine period burden of CRS in Bangladesh. OVID Medline (1948 - 23 November 2016) and OVID EMBASE (1974 - 23 November 2016) were searched using a combination of database specific controlled vocabulary and free text terms. We used an age-stratified deterministic model to estimate the pre-vaccination burden of CRS in Bangladesh. Findings Ten articles were identified, published between 2000 and 2014, including seven cross-sectional studies, two case series and one analytical case-control study. Rubella sero-positivity ranged from 47.0% to 86.0% among all age population. Rubella sero-positivity rose with age. Rubella sero-positivity among women of childbearing age was 81.0% overall. The estimated incidence of CRS was 0•99 per 1,000 live births, which corresponds to approximately 3,292 CRS cases annually in Bangladesh. Conclusion The estimated burden of CRS in Bangladesh during the pre-vaccination period was high. This will provide important baseline information to assess the impact and cost-effectiveness of routine rubella immunisation, introduced in 2012 in Bangladesh.

Immunization status of mothers of children with cerebral palsy in rural Bangladesh

BACKGROUND Vaccination is one of the most effective public health tools for prevention of infectious diseases, morbidity and disability. Little is known about the rate of maternal immunization among mothers of children with cerebral palsy (CP), as well as any possible role of maternal immunization in development of CP in the newborns. OBJECTIVE To determine the socio-demographic characteristics and self-reported vaccination status of mothers of children with CP and compare vaccination coverage in this cohort with national data on immunization. The study also aims to assess vaccination status of children with CP. METHOD A subset of the Bangladesh CP Register (BCPR) cohort of women who had children with CP were recruited during April 2017 from a community based early intervention and rehabilitation program going on in Shahjadpur . Socio-demographic characteristics and maternal immunization status were assessed using a semi-structured questionnaire . The vaccination status of the children was also assessed by interviewing mother and observing the BCG marks. All data were compared with the corresponding information among general population using national vaccination coverage survey reports of the Ministry of Health and Family Welfare, Bangladesh. RESULT Sixty-eight mothers were interviewed of which 17.6% mothers reported not receiving any vaccine during pregnancy. Tetanus vaccine was most commonly (82.0%) received during pregnancy. Overall coverage for at least two doses of tetanus toxoid (TT) among mothers of children with CP was significantly lower than the national tetanus coverage (79.4% versus 96.4%, p<0.01). Forty two (61.7%) mothers with a child with CP reported to have not received tetanus vaccine during their pregnancy compared to only twenty (29.4%) mothers with healthy children reported missing tetanus vaccination during their pregnancy. This difference was statistically significant (p<0.01). Hepatitis B and influenza vaccine were received by mothers of children with CP during antenatal period (2 and 6 respectively). CONCLUSION Immunization among mothers of children with CP is significantly poorer than the national coverage. Also, the immunization of the children with CP is poorer than the national EPI coverage. Our findings reflect that necessity for specific strategies to improve the vaccination coverage among mothers of children with disabilities especially CP and the children with CP.

Immunisation status of children with cerebral palsy in rural Bangladesh: results from the Bangladesh Cerebral Palsy Register (BCPR).

BACKGROUND Cerebral palsy (CP) is the most common cause of physical disability in childhood, with an estimated 17 million cases worldwide. There is limited data concerning the general health of this population and the immunisation status of children with CP is largely unknown. OBJECTIVE We aimed to assess the immunisation status of children with CP in rural Bangladesh and determine the predictors of non-immunisation. METHODS This study is part of the Bangladesh CP Register (BCPR) study; a population based CP register commenced in January 2015 in the Shahjadpur sub-district of Bangladesh. As part of BCPR registration, all children with CP in the catchment area were assessed by a paediatrician and their clinical and immunisation history were collected. RESULTS Between January and December 2015, 615 children with CP were registered on the BCPR. The median age of the children was 7.5 years, and 38.5% were female. 91.7% of those children had a BCG vaccine scar (as an objective marker for immunisation at birth). However, only 43.2% reported to have received the rubella vaccine during the 2014 national rubella immunisation campaign. Timing of CP diagnosis was found to be an independent predictor for immunisation uptake; those diagnosed after the age of 3 were more likely to have received the rubella vaccine (95% confidence interval [CI] 1.6 - 4.3, odds ratio [OR] 2.6, p <0.0001). CONCLUSIONS To the best of our knowledge, this is the first paper to use a formal CP register to examine the relationship between CP and immunisation status in a low or middle income country like Bangladesh. Our data suggest that more than two thirds of children with CP in rural Bangladesh did not receive immunisation during a recent national campaign.