Subhasish Das

Introduction: The emergence of COVID-19 pandemic compelled to undertake a ‘lockdown or shutdown’ approach to control the spread of the virus. People from resource-limited settings experienced food insecurity due to lack of supply and access to adequate food during lockdown. Therefore, we developed a low-cost food package and assessed its effectiveness to improve household food insecurity during the COVID-19 pandemic. Method: A food package was developed with low-cost, culturally acceptable foods. Each food basket, designed to support a family of four adults and/or one child for 15 days costs 23 USD. A community-based quasi-experimental intervention study was conducted to evaluate the effectiveness of the food package. A total of 245 participants were enrolled in the intervention group, and 244 participants in the control group. A community-based census was carried out to identify vulnerable households and were randomly assigned to the intervention or control groups. Data was collected to assess changes in food insecurity status using the Household Food Insecurity Access Scale, as well as dietary diversity, food frequency, morbidity, and nutritional outcomes. Results: Statistically significant changes (p < 0.05) in food insecurity status were observed in the intervention group before, during, and after the intervention. The proportion of food-insecure households decreased from 45.31% to 7.80%, while the proportion of food-secure households increased from 8.60% to 31.02% after one month of intervention. The Difference-in-Differences (DID) models estimated a 13.10 percentage point improvement in proportions of food-secure households and a 16.20 percentage point reduction in food-insecure households, both of which were statistically significant (p < 0.05). Conclusion: A low-cost food intervention improved the food security status of vulnerable families during COVID-19 lockdown. This finding suggests that government and other aid agencies can adopt the developed food package to ameliorate household food insecurity in adverse situations.

Introduction: Shigellosis is the second leading cause of diarrhoeal deaths among children worldwide. Oral azithromycin and intravenous ceftriaxone are the recommended first-line and second-line therapies for shigellosis in Bangladesh, respectively, but growing antibiotic resistance will require new antibiotic options. Tebipenem pivoxil, an orally administered carbapenem antibiotic with activity against many strains of antibiotic-resistant bacteria, may be a viable option. Methods: A phase IIb randomised controlled trial was planned to determine the efficacy and safety of oral tebipenem pivoxil, compared with intravenous ceftriaxone, for children with Shigella diarrhoea unresponsive to the first-line antibiotic therapy. We will enrol 132 children in the trial (66 in each arm). Children from Bangladesh aged 24–59 months suspected of having Shigella diarrhoea, with no clinical improvement within 48 hours of starting first-line therapy, will be randomised to a 3-day course of intravenous ceftriaxone (50 mg/kg, once a day) or a 3-day course of oral tebipenem pivoxil (4 mg/kg, three times a day). The children will be evaluated for key clinical, microbiological and safety outcomes during the subsequent 30-day period. Clinically, failure at day 3 will be defined as the presence of fever (axillary temperature ≥38°C), diarrhoea (three or more abnormally loose or watery stools in the last 24 hours), blood in stool, or abdominal pain/tenderness at day 3 of follow-up or death or hospitalisation prior to day 3. It is hypothesised that children treated with tebipenem pivoxil will have no worse clinical and microbiological failure rates compared with ceftriaxone. Ethics and dissemination: This study protocol was approved by the institutional review board of the International Centre for Diarrhoeal Disease Research, Bangladesh, which comprises a research review committee and an ethics review committee. In addition, the use of tebipenem pivoxil in shigellosis was approved by the Directorate General of Drug Administration of Bangladesh. Trial registration number: NCT05121974 .

Introduction: Treatment in the intensive care unit (ICU) generates complex data where machine learning (ML) modelling could be beneficial. Using routine hospital data, we evaluated the ability of multiple ML models to predict inpatient mortality in a paediatric population in a low/middle-income country.Method: We retrospectively analysed hospital record data from 0-59 months old children admitted to the ICU of Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh. Five commonly used ML models- logistic regression, least absolute shrinkage and selection operator, elastic net, gradient boosting trees (GBT) and random forest (RF), were evaluated using the area under the receiver operating characteristic curve (AUROC). Top predictors were selected using RF mean decrease Gini scores as the feature importance values.Results: Data from 5669 children was used and was reduced to 3505 patients (10% death, 90% survived) following missing data removal. The mean patient age was 10.8 months (SD=10.5). The top performing models based on the validation performance measured by mean 10-fold cross-validation AUROC on the training data set were RF and GBT. Hyperparameters were selected using cross-validation and then tested in an unseen test set. The models developed used demographic, anthropometric, clinical, biochemistry and haematological data for mortality prediction. We found RF consistently outperformed GBT and predicted the mortality with AUROC of ≥0.87 in the test set when three or more laboratory measurements were included. However, after the inclusion of a fourth laboratory measurement, very minor predictive gains (AUROC 0.87 vs 0.88) resulted. The best predictors were the biochemistry and haematological measurements, with the top predictors being total CO₂, potassium, creatinine and total calcium.Conclusions: Mortality in children admitted to ICU can be predicted with high accuracy using RF ML models in a real-life data set using multiple laboratory measurements with the most important features primarily coming from patient biochemistry and haematology.

Objectives There remain hesitations and miscommunication regarding appropriate public health behaviours and conceptions related to COVID-19. We tested the effectiveness of the community-based health cell approach in improving knowledge, attitude and practice (KAP) related to COVID-19. Setting Households of the Bauniabadh slum area in Mirpur, Dhaka, Bangladesh. Participants Household heads (HHs) and homemakers (HMs) of intervention (n=211) and comparison households (n=209). Interventions Behaviour change communication delivered at the community level in a quasi-experimental manner through small-scale community meetings and home visits. Outcome variables and methods The outcomes of interest were before–after mean and per cent changes in KAP scores. Data were collected from HHs and HMs before and after the intervention and difference-in-differences (DID) analysis technique was applied. Results We found statistically significant (pConclusion Scientifically valid information disseminated at the community level using the health cell approach could bring positive changes in KAP related to COVID-19.

Objective To generate baseline evidence regarding the nutritional and dietary diversity status of under-5 children and adolescent girls among forcibly displaced Myanmar nationals (FDMN) relocated to Bhasan Char relocation camp of Bangladesh. Design Cross-sectional survey. Setting Bhasan Char relocation camp, Bangladesh, 7 November 2021–12 November 2021. Participants 299 under-5 children (both male and female) and 248 adolescent girls (11-17 years) were surveyed. Outcome measures Anthropometric indices and nutritional status of the study participants. Results Nearly 17% of the adolescent girls were suffering from severe thinness/thinness, while 5% were overweight/obese. Severe thinness was more prevalent (2% vs 3.9%) in older adolescents (15–17 years) than their younger counterparts (11–14 years). The prevalence of severe stunting and stunting in adolescents were 14% (95% CI 11.21 to 16.87%) and 29% (95% CI 25.93 to 31.59%), respectively. One-third of the surveyed under-5 children were severely (8.50% (95% CI 5.60 to 11.33%)) or moderately (23.08% (95% CI 20.24 to 25.90%)) stunted, 27% were either severely (4.43% (95% CI 1.60 to 7.27%)) or moderately (22.98% (95% CI 20.15 to 25.81%)) underweight and 12% were severely (1.21% (95% CI 0.00 to 4.04%)) or moderately (10.88% (95% CI 8.05 to 13.72%)) wasted. The prevalence of moderate and severe acute malnutrition in children was low. Surveyed adolescents took a mean of 3.10 (SD 1.03) of nine food groups and 25% (95% CI 22.97 to 28.64%) of under-5 children took minimum diversified diet. The survey respondents mostly consumed carbohydrate-based poorly diversified diets. Nutritional status of the participants did not show any statistically significant association to the dietary diversity status. Conclusion A significant number of surveyed under-5 children and adolescent girls of relocated FDMN living in Bhasan Char of Bangladesh were suffering from thinness, stunting, underweight and wasting. Dietary diversity was poor among the surveyed population.

Introduction Maternal undernutrition is highly prevalent in most of the developing countries. Prevalence of both extremes of maternal malnutrition (undernutrition and overweight/obesity) are common in those countries. For Bangladesh, the scenario is not different. The Government of Bangladesh recognises maternal nutrition as a public health priority and addresses the issue in its policies and programmes. We identified and analysed the existing maternal nutrition programmes and determined the bottlenecks in implementing the programmes in Bangladesh using qualitative approach. Methods We followed a qualitative research approach and conducted 25 key informant interviews with the programme managers and policymakers, 10 in-depth interviews with the service providers and six focus group discussions with the pregnant women to identify the constraints of programme implementation. We analysed data using thematic and inductive approaches of qualitative research methods. Results We have found that successful implementation of maternal nutrition intervention was being hampered by both the demand and supply side issues. On the demand side, major constraints were financial inability of the families to avail maternal nutrition-related services, ignorance of the family members and cultural barriers of using maternal nutrition-related services. Lack of priority and heavy workload of the service providers, lack of human resources, poor monitoring system, lack of medicine to supply and incoordination have been identified as major supply-side constraints in providing maternal nutrition-related interventions in Bangladesh. Conclusion Both supply side and demand side issues are responsible for the existing bottlenecks in implementing maternal nutrition-related programmes in Bangladesh. Findings of this study will help the policymakers to learn about the programmatic constraints regarding maternal nutrition services in Bangladesh.