Shamima Akhter

Household Characteristics Associated with Handwashing with Soap in Rural Bangladesh

Handwashing with soap prevents diarrhea and respiratory disease, but it is rarely practiced in high-need settings. Among 100 randomly selected villages in rural Bangladesh, field workers enrolled 10 households per village and observed and recorded household activities for 5 hours. Field workers observed 761 handwashing opportunities among household members in 527 households who had just defecated or who cleaned a childs anus who had defecated. In the final multivariate analysis, having water available at the place to wash hands after toileting (odds ratio = 2.2, 95% confidence interval 1.3, 4.0) and having soap available at the place to wash hands after toileting (odds ratio = 2.1, 95% confidence interval 1.3, 3.4) were associated with washing both hands with soap after fecal contact. Interventions that improve the presence of water and soap at the designated place to wash hands would be expected to improve handwashing behavior and health.

Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh

BackgroundWe analyzed data from the baseline assessment of a large intervention project to describe typical handwashing practices in rural Bangladesh, and compare measures of hand cleanliness with household characteristics.MethodsWe randomly selected 100 villages from 36 districts in rural Bangladesh. Field workers identified 17 eligible households per village using systematic sampling. Field workers conducted 5-hour structured observations in 1000 households, and a cross-sectional assessment in 1692 households that included spot checks, an evaluation of hand cleanliness and a request that residents demonstrate their usual handwashing practices after defecation.ResultsAlthough 47% of caregivers reported and 51% demonstrated washing both hands with soap after defecation, in structured observation, only 33% of caregivers and 14% of all persons observed washed both hands with soap after defecation. Less than 1% used soap and water for handwashing before eating and/or feeding a child. More commonly people washed their hands only with water, 23% after defecation and 5% before eating. Spot checks during the cross sectional survey classified 930 caregivers (55%) and 453 children (28%) as having clean appearing hands. In multivariate analysis economic status and water available at handwashing locations were significantly associated with hand cleanliness among both caregivers and children.ConclusionsA minority of rural Bangladeshi residents washed both hands with soap at key handwashing times, though rinsing hands with only water was more common. To realize the health benefits of handwashing, efforts to improve handwashing in these communities should target adding soap to current hand rinsing practices.

Health system costs of menstrual regulation and care for abortion complications in Bangladesh.

CONTEXT Treatment of complications of unsafe abortion can be a significant financial drain on health system resources, particularly in developing countries. In Bangladesh, menstrual regulation is provided by the government as a backup to contraception. The comparison of economic costs of providing menstrual regulation care with those of providing treatment of abortion complications has implications for policy in Bangladesh and internationally. METHODS Data on incremental costs of providing menstrual regulation and care for abortion complications were collected through surveys of providers at 21 public-sector facilities in Bangladesh. These data were entered into an abortion-oriented costing spreadsheet to estimate the health system costs of providing such services. RESULTS The incremental costs per case of providing menstrual regulation care in 2008 were 8-13% of those associated with treating severe abortion complications, depending on the level of care. An estimated 263,688 menstrual regulation procedures were provided at public-sector facilities in 2008, with incremental costs estimated at US

Quality and efficiency of care for complications of unsafe abortion: a case study from Bangladesh.

2.2 million, and 70,098 women were treated for abortion-related complications in such facilities, with incremental costs estimated at US

Risk Factors for Death in Bangladeshi Children Under 5 Years of Age Hospitalized for Diarrhea and Severe Respiratory Distress in an Urban Critical Care Ward

1.6 million. CONCLUSION The provision of menstrual regulation averts unsafe abortion and associated maternal morbidity and mortality, and on a per case basis, saves scarce health system resources. Increasing access to menstrual regulation would enable more women to obtain much-needed care and health system resources to be utilized more efficiently.

Incidences and Costs of Illness for Diarrhea and Acute Respiratory Infections for Children < 5 Years of Age in Rural Bangladesh

Treating complications of unsafe abortion can be financially draining for health systems. This analysis assessed incremental health system costs of service delivery for abortion‐related complications in the Bangladesh public health system and confirmed that providing postabortion care with vacuum aspiration is less expensive than using dilation and curettage (D&C). Implementing several evidence‐based best practices, such as replacing D&C with vacuum aspiration, reducing use of high‐level sedation, authorizing midlevel providers to offer postabortion care, and providing postabortion contraceptive counseling and services to women while still at the health facility, could increase the quality and cost efficiency of postabortion care in Bangladesh.

Factors Associated with Klebsiella Bacteremia and Its Outcome in Under-Five Children Admitted with Diarrhea.

Children with diarrhea hospitalized for respiratory distress often have fatal outcome in resource-limited settings, although data are lacking on risk factors for death in such children. We sought to evaluate clinical predictors for death in such children. In this prospective cohort study, we enrolled under-5 children with diarrhea admitted with severe respiratory distress to the intensive care unit of Dhaka Hospital of International Centre for Diarhoeal Disease Research, Bangladesh, from September 2014 through September 2015. We compared clinical and laboratory characteristics between study children those who died (n = 29) and those who survived (n = 62). In logistic regression analysis, after adjusting for potential confounders, the independent predictors for death in children hospitalized for diarrhea and severe respiratory distress were severe sepsis and hypoglycemia (P < .05 for all). Thus, recognition of these simple parameters may help clinicians identify children with diarrhea at risk of deaths in order to initiate prompt management for the better outcome, especially in resource-poor settings.

A low-cost approach to measure the burden of vaccine preventable diseases in urban areas

AbstractUnderstanding illness costs associated with diarrhea and acute respiratory infections (ARI) could guide prevention and treatment strategies. This study aimed to determine incidence of childhood diarrhea and ARI and costs of homecare, hospitalization, and outpatient treatment by practitioner type in rural Bangladesh. From each of 100 randomly selected population clusters we sampled 17 households with at least one child < 5 years of age. Childhood diarrhea incidence was 3,451 and ARI incidence was 5,849/1,000 child-years. For diarrhea and ARI outpatient care per 1,000 child-years, parents spent more on unqualified (

Chlorination of Household Drinking Water Among Cholera Patients' Households to Prevent Transmission of Toxigenic Vibrio cholerae in Dhaka, Bangladesh: CHoBI7 Trial

2,361 and

Handwashing Behaviors in Rural Bangladesh

4,822) than qualified health-care practitioners (