Fatema Khatun

Background: COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. Objective: The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. Methods: A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service—Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Results: Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18‐39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (β=.946), service interaction (β=.974), and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=.327; P<.001) and intention to use teleconsultation services (β=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (β=.311; P<.001). Conclusions: The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery.

Lead, a potent neurotoxin, causes irreversible damage to the nervous system, and low- and middle-income countries face huge health and economic productivity losses due to childhood lead exposure. In Bangladesh, informal Used Lead Acid Battery (ULAB) recycling sites are an important source of lead pollution. Little is known about lead awareness among communities exposed to ULAB recycling. Therefore, this study aims to assess knowledge, attitudes, and practices related to lead pollution among caregivers of young children and adolescents living adjacent to informal ULAB sites. A cross-sectional study was conducted among 732 mothers of young children and adolescents in 4 districts of Bangladesh (survey and observation). Simple and multiple linear regression was conducted to describe patterns and predictors of lead-related knowledge and practices. 60% of respondents had heard the name ‘lead’ (“shisha”). The mean knowledge score was low (19 out of 44). Residents of high-risk districts, male respondents, and those with more than 5 years of schooling were significantly more likely to have higher knowledge scores than others. In terms of attitude, 52% of respondents perceived lead to be risky for human health but 43% thought lead pollution was controllable. Observation of households for lead exposure revealed that 63% of children and adolescents play or pass by ULAB sites, 29% ate non-food items, 41% of households had visible paint chips on the walls, 59% households used polished turmeric and 15% used lead-soldered cans to store foods. Among protective practices, 70% reported cleaning floors, 84% consumed iron-rich foods, and 48% consumed calcium-rich foods. The population had a high potential for lead exposure. Their knowledge about lead was limited, and risk perception was moderate. To reduce lead exposure and increase knowledge and awareness among the at-risk population, it is crucial to take measures such as mass awareness campaigns through media and schools. It is important to strengthen the implementation of existing policies, such as policies on leaded gasoline, paints, and lead-acid batteries, that can address the sources of lead exposure for the community.

Objective Our study explored the impact of the COVID-19 pandemic on the food environment from the perspective of the urban poor and food vendors. Design This was a qualitative study conducted during September 2020 and February 2021. Setting The study was carried out in two purposively selected informal settlements of Dhaka City, Bangladesh. Participants We conducted 21 in-depth interviews with residents of informal settlements and 10 key informant interviews with food vendors and food aid workers. Result The availability of staple foods was not disrupted during the pandemic but some perishables foods became more expensive due to supply chain disruptions and increased transportation costs. Limited market hours affected market access and mobility restrictions adversely affected local vendors. Cart vendors selling perishables incurred business losses they could ill afford. Demand for food reduced as employment disruption lead to reduced purchasing power and, therefore, reduction of quantity, quality and desirability of foods purchased. Respondents reported skipping meals and going hungry. The aid received was considered inadequate to meet needs. Conclusion The food environment of the urban poor was disrupted from both supply and demand sides and the organisational response (both government and non-government) was severely inadequate. The social safety net needs to be extended and redesigned to ensure food security and health for the urban working poor in the future.

Background:In 2016, the Government of Bangladesh (GoB) established a teleconsultation service called Shastho Batayon to increase access to physicians. During COVID-19 pandemic, health care access became limited due to movement restrictions. In response, GoB made Shastho Batayon toll free, publicized the number through media, increased the number of call center doctors, introduced automated messages on COVID-19 preventive measures, and developed a scoring system to classify risk groups for COVID-19. Objectives and Methods:In this case report, we describe how an existing national teleconsultation service can be utilized in a low- and middle-income country to address primary health care needs during a public health emergency. We conducted secondary analysis of Shastho Batayon service data from January to April 2020. Results:The total calls for doctor's consultation increased during the pandemic. Prepandemic, Shastho Batayon received less than 20,000 calls per month. In March 2020, when the first cases of COVID-19 were confirmed, Shastho Batayon services received 60,811 calls for doctor's consultation, which increased to 125,660 calls in April, 2020. The doctor's consultation for primary care has increased for all conditions. Shastho Batayon services screened 28,944 patients with the influenza-like illness or COVID-19-like symptoms in March and April, 2020, provided preventive measures, advice, and referral to designated hospitals based on a national guideline. Conclusions:In public health emergencies such as COVID-19 pandemic, teleconsultation services can help provide prevention guidelines, debunk misinformation, identify risk categories, and refer people to appropriate service and facilities in a timely manner.

BACKGROUND The COVID-19 pandemic was a burden for our health system, and created opportunities for using teleconsultation as an alternative way of accessing expert medical advice. In Bangladesh, the use of tele consultation increased about 20-fold during the pandemic. OBJECTIVE This study aimed to assess the influence of service quality and user satisfaction on the intention to continue to use teleconsultation services among users of national teleconsultation services during the pandemic in Bangladesh. METHODS A cross-sectional survey was conducted in 2020 among users of national teleconsultation service - Shastho Batayon who availed the service for acute respiratory infection. A validated mHealth Service Quality model based on structural equation modelling (SEM) and Confirmatory Factor Analysis was used to analyse the data with SmartPLS 3.0. RESULTS Among the 2097 study participants, the majority were male (78%), aged 18-39 years (68%), residents of urban areas (76%), had more than 10 years of schooling (64%), and were from middle income households (79%). From consumer perspective the quality of service platform (β=.946), service interaction (β=.974) and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=0.327, P<.001) and intention to use teleconsultation services (β= 0.102, P<.001). User satisfaction was positively associated with intention to use teleconsultation services (β= 0.311, P<.001). CONCLUSIONS Our study findings showed that maintenance of the service quality is crucial for the user satisfaction and continuance of use of teleconsultation services; and that user satisfaction increased the continuance of use of teleconsultation services. Our findings are relevant for low income context where teleconsultation services are trying to address the gap in service delivery. CLINICALTRIAL

Unique identifiers are not universal in low- and middle-income countries. Biometric solutions have the potential to augment existing name-based searches used for identification in these settings. T...

Background: Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization’s guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. Objective: The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. Methods: The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. Results: The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. Conclusions: This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. Trial Registration: ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836 International Registered Report Identifier (IRRID): DERR1-10.2196/26918

BACKGROUND Digital health interventions (DHIs) can alleviate several barriers to achieving better maternal and child health. The World Health Organization’s guideline recommendations for DHIs emphasize the need to integrate multiple DHIs for maximizing impact. The complex health system of Bangladesh provides a unique setting for evaluating and understanding the role of an electronic registry (eRegistry) for antenatal care, with multiple integrated DHIs for strengthening the health system as well as improving the quality and utilization of the public health care system. OBJECTIVE The aim of this study is to assess the effect of an eRegistry with DHIs compared with a simple digital data entry tool without DHIs in the community and frontline health facilities. METHODS The eRegMat is a cluster-randomized controlled trial conducted in the Matlab North and Matlab South subdistricts in the Chandpur district, Bangladesh, where health facilities are currently using the eRegistry for digital tracking of the health status of pregnant women longitudinally. The intervention arm received 3 superimposed data-driven DHIs: health worker clinical decision support, health worker feedback dashboards with action items, and targeted client communication to pregnant women. The primary outcomes are appropriate screening as well as management of hypertension during pregnancy and timely antenatal care attendance. The secondary outcomes include morbidity and mortality in the perinatal period as well as timely first antenatal care visit; successful referrals for anemia, diabetes, or hypertension during pregnancy; and facility delivery. RESULTS The eRegistry and DHIs were co-designed with end users between 2016 and 2018. The eRegistry was implemented in the study area in July 2018. Recruitment for the trial started in October 2018 and ended in June 2020, followed by an 8-month follow-up period to capture outcome data until February 2021. Trial results will be available for publication in June 2021. CONCLUSIONS This trial allows the simultaneous assessment of multiple integrated DHIs for strengthening the health system and aims to provide evidence for its implementation. The study design and outcomes are geared toward informing the living review process of the guidelines for implementing DHIs. CLINICALTRIAL ISRCTN Registry ISRCTN69491836; https://www.isrctn.com/ISRCTN69491836 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/26918

The objective of this study was to assess the level of knowledge of cervical cancer among Bangladeshi women and to assess their willingness to receive the human papillomavirus (HPV) vaccine. A population-based, cross-sectional survey was conducted from July to December 2011 in one urban and one rural area of Bangladesh. A total of 2037 ever-married women, aged 14 to 64 years, were interviewed using a structured questionnaire. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Willingness to receive the HPV vaccine was assessed. Univariate analyses were completed using quantitative data collected. Multivariable logistic regression models were developed to identify factors associated with having heard of cervical cancer and the HPV vaccine. The majority of study participants reported to have heard of cervical cancer (urban: 89.7%, rural 93.4%; P = 0.003). The odds of having heard of cervical cancer were significantly higher in urban women aged 35–44 years (aOR: 2.92 (1.34–6.33) and rural women aged 25–34 years (aOR: 2.90 (1.24–6.73) compared to those aged less than 24 years. Very few women reported to have detailed knowledge on risk factors (urban:9.1%, rural: 8.8%) and prevention (urban: 6.4%, rural: 4.4%) of cervical cancer. In our sample, one in five urban women and one in twenty rural women heard about a vaccine that can prevent cervical cancer. Among urban women, secondary education or higher (aOR: 3.48, 95% CI: 1.67–7.25), age of 20 years and above at marriage (aOR: 2.83, 95% CI: 1.61–5.00), and high socioeconomic status (aOR: 2.25, 95% CI: 1.28–3.95) were factors associated with having heard of the HPV vaccine. Willingness to receive the HPV vaccine among study participants either for themselves (urban: 93.9%, rural: 99.4%) or for their daughters (urban: 91.8%, rural: 99.2%) was high. Detailed knowledge of cervical cancer among Bangladeshi women was found to be poor. Education on cervical cancer must include information on symptoms, risk factors, and preventive methods. Despite poor knowledge, the study population was willing to receive the HPV vaccine.

Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh. We interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates. Of the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18–29 years (n = 663, 76.3%), and for women among those aged 30–39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status. Compared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.