Mohammad Sharif Hossain

BackgroundOral poliovirus vaccine has been reported to cause vaccine-derived poliovirus and vaccine-associated paralytic poliomyelitis, and the limited global supply of conventional IPV has led many countries to rely on fractional-dose IPV regimens alongside OPV. The current study aims to assess the sIPV safety and immunogenicity when given concurrently with or in a staggered manner with routine immunization.MethodsA multi-country, multi-center, open-label, randomized controlled, extended phase III non-inferiority clinical trial was conducted with 1442 healthy infants aged 6-8 weeks from Bangladesh and Pakistan enrolled and randomized into four groups, i.e., co-administration group 1 (group C1), co-administration group 2 (group C2), staggered administration group 1 (group S1) and staggered administration group 2 (group S2). Antibody levels were determined using the collected sera for immunogenicity evaluation. The difference in seroconversion rates between the coadministration group and the staggered administration group is compared using the Cochran-Mantel-Haenszel χ2 (CMH-χ2) test, stratified by study site.FindingsThe post-vaccination seroconversion rates for PV I were 90.3% (306/339) in group C1 and 87.0% (261/300) in group S1, for PV II, 91.7% (311/339) in group C1 and 91.3% (274/300) in group S1 and for PV III, 86.4% (293/339) in group C1 and 92.3% (277/300) in group S1. Among adverse reactions (ARs) reported within 7 days of vaccination, the incidence was similarly high in both the co-administration and staggered vaccination groups (92.8% vs. 95.5%).InterpretationOur results demonstrated favorable safety and immunogenicity of co-administration of sIPV with other routine infant vaccines according to a 3-dose primary immunization schedule

Background: In Bangladesh, as well as throughout the world, children’s screen time has significantly increased. Children spend a lot of time on the internet and digital screens for entertainment, education, and communication, which has increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children’s mental, physical, and social health have drawn attention. Objective: This study aimed to explore the effect of high exposure to screens on the health and mental well-being of school-going children and adolescents in Dhaka, Bangladesh. Methods: This cross-sectional descriptive study was conducted from July 2022 to June 2024. A total of 420 school-going children and adolescents aged 6 to 14 years were enrolled from 3 English-language and 3 Bangla-language schools in Dhaka using a stratified random sampling technique. Anthropometric measurements, a semistructured questionnaire, and the Pittsburgh Sleep Quality Index, the Development and Well-Being Assessment scale, and the Strengths and Difficulties Questionnaire, all of which were validated in Bangla, were used to gather data. We considered students who were exposed to screens for less than 2 hours a day as the low-exposure group and those who were exposed for more than 2 hours a day as the high-exposure group. Results: A total of 83.3% (350/420) of the students were in the high-exposure group, and their average screen time per day was 4.6 (SD 2.3) hours. Eye problems were reported by 35.7% (150/420) of the students, and a significant difference was found between the low- and high-exposure groups. In total, 96% (144/150) of the students with eye problems were from the high-exposure group, whereas 4% (6/150) were from the low-exposure group. Headaches were reported by 80% (336/420) of the students, and they were common in the high-exposure group (279/336, 83%). Moreover, students from the high-exposure group had a short duration and poor quality of sleep (mean 7.3, SD 1.4 hours), which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group ( P <.001). Our study revealed that, overall, 31% (130/420) of the students had at least one mental health problem and 9.8% (41/420) had more than one mental health problem using the Development and Well-Being Assessment scale, and mental health problems were greater in the high-exposure group than the low-exposure group. Although behavioral problems such as conduct issues (119/420, 28.3%) and peer difficulties (121/420, 28.8%) were observed among the participants, no statistically significant difference was found between the 2 groups. Conclusions: A collaborative and coordinated multistage approach is essential to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on a larger scale can be conducted to determine the impacts of screen time on aspects of health.

Background: India has a high burden of P. vivax malaria. Current guidelines recommend a total primaquine dose of 3·5 mg/kg administered over 14 days, however, adherence is poor, impacting effectiveness. The efficacy and safety of the same total dose administered over 7 days in India is unknown. Methods: We conducted a multicentre, open-label randomised controlled non-inferiority trial at two sites in India. Febrile patients aged 16 years or older with microscopically confirmed P. vivax monoinfection and ≥30% G6PD activity were eligible for enrolment. Patients were randomly assigned (1:1) using block randomisation stratified by site to either 3·5 mg/kg primaquine over 7 days or 3·5 mg/kg primaquine over 14 days, the current standard of care. Primaquine was administered in combination with chloroquine as per national treatment guideline. The primary endpoint was the cumulative incidence of symptomatic recurrent microscopy-confirmed P. vivax parasitaemia within six months. The study was registered with the Clinical Trials Registry of India (CTRI/2022/12/048283).Findings: Between September 2023 and October 2024, a total of 400 patients were enrolled (201 randomised to the 7-day group and 199 to the 14-day group). The cumulative incidence of symptomatic parasitaemia by day 180 was 1·1% (95% CI 0·0-4·1) following 7-day primaquine and 1·1% (95% CI 0·0-4·4) following 14-day primaquine. Sixteen patients treated with 7-day primaquine missed a primaquine dose (8%) compared with 40 patients treated with 14-day primaquine (20%). There were 35 adverse events in each group, 11 of which were reported to be drug-related in the 7-day group compared with 13 in the 14-day group. Gastrointestinal side effects at day 7 were rare in both the 7-day (0·5% [1/183]) and in the 14-day group (1·1% [2/180]). No patients had a haemoglobin fall from day 0 to days 1-14 by >5 g/dL or required a blood transfusion. One patient in the 14-day group had a haemoglobin fall to <8 g/dL.Interpretation: Compared with a 14-day primaquine regimen, a 7-day regimen of 3·5 mg/kg total dose was well-tolerated and non-inferior. Adherence was greater in patients with the 7-day regimen. These findings support the use of 7-day primaquine regimens in India.Funding: Bill & Melinda Gates Foundation

Introduction Malaria remains a major public health challenge, particularly in endemic regions like Bangladesh. To combat this, the National Malaria Elimination Programme (NMEP) has been working to ensure long-lasting insecticidal nets (LLINs) reach vulnerable populations. This study assessed LLIN coverage, access, and utilization among the Bangladeshi population and Forcibly Displaced Myanmar Nationals (FDMN). Methods A cross-sectional survey was conducted from May to October 2023 across five malaria-endemic districts in Bangladesh and ten FDMN camps in Cox’s Bazar. Data were collected from 1,575 households using structured interviews. Statistical analyses were performed to evaluate LLIN distribution and utilization patterns among different demographic groups, particularly households with pregnant women and under-five children. Results Among Bangladeshi households, 97.6% owned at least one LLIN, with sufficient coverage for 93.2%. Utilization was high, with 96.4% sleeping under LLINs the previous night. Among pregnant women and under-five children, 95.0% and 98.3%, respectively, used LLINs. However, in FDMN households, while 98.2% owned at least one LLIN, only 44.3% had sufficient coverage, and utilization rates were significantly lower, with 65.7% sleeping under LLINs. Key barriers included inadequate LLIN supply. Conclusion Bangladesh has made significant progress in LLIN coverage and utilization among its population, surpassing WHO’s 80% threshold. However, gaps remain in the FDMN population, necessitating targeted interventions to achieve universal coverage and further reduce malaria morbidity and mortality.

BACKGROUND In Bangladesh as well as throughout the world, children's screen time has significantly increased. Children spent a lot of time on the internet and digital screens for entertainment, education, and communication which have increased their daily screen time. However, the potential detrimental impacts of excessive screen time on children's mental, physical, and social health have drawn attention. OBJECTIVE This study aimed to explore the effect of high exposure to screen on health and mental well-being of school-going children in Dhaka, Bangladesh. METHODS From July 2022 to June 2024, this cross-sectional descriptive study was carried out. 420 kids between the ages of 6 and 14 were enrolled in three English-medium and three Bangla-medium schools in Dhaka city using a stratified random sample technique. Anthropometric measurements, a semi-structured questionnaire, the Pittsburgh Sleep Quality Index Scale (PSQI), the Development and Wellbeing Assessment Scale (DAWBA), and the Strength and Difficulties Questionnaire (SDQ), which was validated in Bangla, were used to gather data. We considered the students who were exposed to screen for less than 2 hours as the low-exposed group and those who were exposed for more than 2 hours as high-exposed group. RESULTS We found 83% of the students were high exposed group and their average screen time was 4.6 ± 2.3 hours. Compared to the low exposed group, the high exposed group had a significantly higher rate of eye problems (96% vs 4%, P< 0.001). Headache was also common in high exposed group (83%). Moreover, students of high exposed group had a short duration and poor quality of sleep which was statistically significant. Furthermore, obesity was more predominant in the high-exposure group (p < 0.001). Our study revealed overall 40% of children suffered from mental health problems by using DAWBA scale which was increased in high exposed group compared to low exposed group. Behavioral problems, such as conduct issues (28.3%) and peer difficulties (28.8%), were observed among the participants. However, there was no statistically significant difference was found between two groups. CONCLUSIONS A collaborative and coordinated multistage approach will be required to create effective and acceptable guidelines and policies for the optimum and positive use of digital screens for the children of Bangladesh. Further prospective studies on larger scales can be conducted to determine the impacts on health aspects meticulously.

Background: Children’s screen time has substantially increased worldwide, including in Bangladesh, especially since the pandemic, which is raising concern about its potential adverse effects on their physical, mental, and social health. Parental supervision may play a crucial role in mitigating these negative impacts. However, there is a lack of empirical evidence assessing the relationship between parental screen time supervision and health outcomes among school children in Dhaka, Bangladesh. Objective: We aimed to explore the association between supervised and unsupervised screen time on the physical, mental, and social health of school-going children in Dhaka, Bangladesh. Methods: We conducted a cross-sectional descriptive study between July 2022 and June 2024. A total of 420 children, aged 6‐14 years, were enrolled via the stratified random sampling method across three English medium and three Bangla medium schools in Dhaka. Data were collected through a semistructured questionnaire; anthropometry measurements; and the Bangla-validated Strength and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI) Scale, and Spencer Children Anxiety Scale (SCAS). Results: A total of 234 out of 420 students (56%) used digital screen devices without parental supervision. We did not find a substantial difference in the duration of the daily mean use of digital devices among the supervised students (4.5 hours, SD 2.2 hours) and the unsupervised students (4.6 hours, SD 2.4 hours). According to the type of school, English medium school children had a mean higher screen time (5.46 hours, SD 2.32 hours) compared to Bangla medium school children (3.67 hours, SD 2.00 hours). Headache was significantly higher among the unsupervised digital screen users compared to those who used digital screens with parental supervision (175/336 students, 52.1% versus 161/336 students, 47.9%; P<.003). Moreover, students who used digital screens without parental supervision had poor quality of sleep. Behavioral problems such as conduct issues (119/420 students, 28.3%) and peer difficulties (121/420 students, 28.8%) were observed among the participants. However, when comparing supervised and unsupervised students, we found no statistically significant differences in the prevalence of these issues. Conclusions: The findings of the study showed that the lack of screen time supervision is associated with negative health effects in children. The roles of various stakeholders, including schools, parents, policy makers, and students themselves, are crucial in developing effective guidelines for managing screen use among students. Further research is needed to demonstrate causal mechanisms; identify the best interventions; and determine the role of mediators and moderators in households, surroundings, and schools.

Ensuring adherence to antimalarial treatment is crucial for achieving a radical cure and elimination of malaria, especially in hard-to-reach areas. We conducted this study to assess the current scenario of drug adherence in four endemic sub-districts of Bangladesh. Among 110 enrolled participants, 70% were mono-infected with Plasmodium falciparum and the remaining 30% with P. vivax. The overall treatment adherence frequency was 92.7% (95% CI: 83.0–96.3%). A total of eight participants were found to be nonadherent to treatment and all of them were from Bandarban. Level of nonadherence was equally observed in two age groups: 11–17 and 18+ years. However, male participants (n = 6) were found to be more nonadherent than females (n = 2). Among 7.3% with nonadherence to treatment, a single participant with P. falciparum mono-infection refused to take medication and became nonadherent. Remaining participants stated that they were feeling well and going to work, thus leaving treatment course uncompleted. Although overall compliance with malaria medication seems good, a gradual increase in noncompliance to P. vivax malaria treatment suggests that the National Malaria Elimination Program must be enhanced and monitored to fulfil the projected malaria elimination goal before 2030 from Bangladesh.

Background: The COVID-19 pandemic and resulting restrictions, particularly travel restrictions, have had significant impact on the conduct of global clinical trials. Our clinical trials programme, which relied on in-person visits for training, monitoring and capacity building across nine low- and middle-income countries, had to adapt to those unprecedented operational challenges. We report the adaptation of our working model with a focus on the operational areas of training, monitoring and cross-site collaboration. The new working model: Adaptations include changing training strategies from in-person site visits with three or four team members to a multi-pronged virtual approach, with generic online training for good clinical practice, the development of a library of study-specific training videos, and interactive virtual training sessions, including practical laboratory-focused training sessions. We also report changes from in-person monitoring to remote monitoring as well as the development of a more localized network of clinical trial monitors to support hybrid models with in-person and remote monitoring depending on identified risks at each site. We established a virtual network across different trial and study sites with the objective to further build capacity for good clinical practice–compliant antimalarial trials and foster cross-country and cross-study site collaboration. Conclusion: The forced adaptation of these new strategies has come with advantages that we did not envisage initially. This includes improved, more frequent engagement through the established network with opportunities for increased south-to-south support and a substantially reduced carbon footprint and budget savings. Our new approach is challenging for study sites with limited prior experience but this can be overcome with hybrid models. Capacity building for laboratory-based work remains difficult using a virtual environment. The changes to our working model are likely to last, even after the end of the pandemic, providing a more sustainable and equitable approach to our research.