Farah Naz Rahman

Background: Sustained implementation of human papillomavirus (HPV) vaccination is essential for population-level impact. Although Gavi, the Vaccine Alliance, provides catalytic support, long-term success depends on national ownership and integration into routine systems. We examined how sustainability emerged within policymakers’ and implementers’ accounts of HPV vaccine adoption, introduction, and implementation in five low-income and lower middle-income countries. Methods: This qualitative multi-country policy study was embedded within the Global Burden Estimation of Human Papillomavirus (GLOBE-HPV) project. We conducted 79 key-informant interviews with national stakeholders, programme implementers, and partners involved in HPV vaccine introduction in Bangladesh, the Democratic Republic of the Congo, Nepal, Pakistan, and Sierra Leone. Data were analysed using inductive thematic analysis. Findings: Five interrelated factors shaped programme sustainability. Sustained political commitment depended on maintaining cervical cancer elimination as a national priority, generating national evidence of disease burden and vaccine impact, and ensuring reliable vaccine availability. Confidence in HPV vaccination required continued investment in community-engaged communication, credible monitoring and management of adverse events following immunisation, and healthcare worker training. Equitable access depended on adapting delivery strategies to reach underserved populations. Sustainability was further constrained by limited health and education system capacity and reliance on external financing. Coordinated leadership, national ownership, and adaptive governance were needed to translate policy commitments into resilient routine delivery. Interpretation: Sustainability concerns were evident across all five countries, irrespective of implementation stage. HPV vaccine introduction support should extend beyond rollout, adapt to country context, and strengthen national ownership, institutional capacity, public confidence, and responsive delivery. Without sustained domestic commitment and appropriately phased external support, early gains might not translate into equitable coverage or continued progress towards cervical cancer elimination. Funding: The GLOBE-HPV study was supported by the Gates Foundation [Investment ID INV-046024] and the International Vaccine Institute through investment from the Sweden Ministry for Foreign Affairs grant UD2022/000123. The conclusions and opinions expressed in this work are those of the author(s) alone and shall not be attributed to the Gates Foundation or the Government of Sweden. Under the grant conditions of the Gates Foundation, a Creative Commons Attribution 4.0 License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Please note works submitted as a preprint have not undergone a peer review process.

Background: Hypertension poses a significant public health challenge in Bangladesh, particularly among rural populations with limited access to healthcare. Thus, this study aimed to identify the influential factors associated with hypertension and prehypertension in rural Bangladesh using sophisticated machine learning (ML) methods. Methods: A total of 1603 respondents were selected in this study using a multistage random sampling from a cross-sectional survey. Five commonly used sophisticated ML algorithms were used. The predictive performance of these models was evaluated using standard validation metrics. Influential variables were identified and ranked using SHapley Additive exPlanations (SHAP) technique. Results: The prevalence of hypertension and prehypertension was 30.9% and 40.8%, respectively. The XGB model outperformed other ML models in predicting hypertension (accuracy: 74.3%, ROC: 75.8%), while the LR model was better at predicting prehypertension (accuracy: 59.2%, ROC: 54.1%). Top factors in predicting hypertension were older age, being overweight or obese, having a past or no smoking history, reporting no chronic disease, and having a family history of hypertension, whereas top factors for pre-hypertension were current smoking status, absence of cardiovascular disease, being in a younger or middle-aged group, having no family history of hypertension, and current employment. Conclusion: Three out of ten people in rural areas were hypertensive, while two out of five were prehypertensive. The ML models had the potential to predict hypertension. The current findings highlight an urgent need for strengthened national and regional public health initiatives to improve hypertension detection, awareness, and management in rural Bangladesh.

Background: As more countries plan and launch human papillomavirus (HPV) vaccination campaigns, a variety of self-sampling methods and assays have been used for detecting high-risk HPV (HR-HPV) types. This study compared HR-HPV detection in self-collected vaginal swabs (SCVS) and first-void urine (FVU) among sexually active girls and women aged 15–25 years in diverse settings (Bangladesh, Nepal, and Pakistan) using harmonized methods for each step. Methods: Within the Global Burden Estimation of HPV (GLOBE-HPV) project, which aims to estimate HPV prevalence and incidence across eight low- and middle-income countries in South Asia and Sub-Saharan Africa, we analyzed paired SCVS and FVU samples from 753 participants in Bangladesh, Pakistan, and Nepal using standardized protocols. DNA was extracted using the QIAamp DNA Mini Kit, and HPV testing was performed with the Allplex HPV28 Detection PCR assay. We evaluated HPV detection and type-specific concordance using Cohen’s Kappa, McNemar’s test, and a 3 × 3 agreement table, along with accuracy and positive/negative agreement metrics. Results: The overall prevalence of 14 HR-HPV types was 8.6% in SCVS and 7.2% in FVU samples. Detection rates for 7 HR-HPV vaccine types were similar (5.3% in SCVS versus 5.0% in FVU), with nearly identical HPV 16/18 rates (2.3% in SCVS and 2.4% in FVU). Bi-directional type-specific discordance was noted, with each sample type detecting unique types. SCVS demonstrated higher sensitivity for detecting HPV types beyond the 9 vaccine types with McNemar p-values of 0.013 and 0.7). Samples with lower viral load (indicated by higher real-time PCR cycle threshold values) were more likely to yield discordant results. Conclusion: SCVS and FVU yielded similar HR-HPV results, including those targeted by the 9-valent HPV vaccine, in sexually active young women. Both non-invasive self-sampling methods have potential for use in large-scale HPV surveillance programs in resource-limited settings.

The objective of this study was to explore the stigma among attendants (close relatives or other caregivers) who brought patients with mental illness to the selected mental health facilities in Bangladesh. This mixed-method study was part of a nationwide survey where respondents were conveniently selected. Cross-sectional data were collected from 176 attendants of patients with mental illness, and qualitative data were collected from 40 respondents. Quantitative data were collected in hand-held tablets using the Day’s Mental Illness Stigma Scale questionnaire. Qualitative data was collected in recorders, using a semi-structured guideline. The attendants had more stigma around the patients’ ability to maintain relationships, hygiene and discretion regarding their illness, with the highest level of stigma towards hygiene issues (score: 5.4). There was more positive attitude towards the treatability, curability, and recovery of the patients due to faith in the professional expertise of the service providers at mental health facilities, with the least level of stigma towards professional expertise (score: 6.4). Older people, females, and educated attendants were generally less stigmatized towards patients with mental illness than their counterparts. This study found that more stigma was present around the domains’ relationships, hygiene, anxiety, and visibility, while less stigma was present around the domains’ treatability, curability, and recovery of the patients. Further studies can be conducted to understand the effect of various factors on stigma, to aid in the development of interventions and counselling frameworks.

This study investigated the socio-demographic predictors of gendered political participation by 64 adults selected using a multistage sampling technique. Eight focus group discussions (FGDs) of eight discussants each were used to collect data, while thematic analysis was utilized. Findings revealed that political participation is gendered and women are not equally represented. There are some socio-demographic and political predictors of women’s participation in politics and the low political participation by women has some resultant consequences on governance in Nigeria. Social workers are therefore encouraged to utilize various measures to address the consequences linked to the low participation of women in politics.

Introduction: Diabetes Mellitus (DM) is one of the most prevalent non-communicable diseases (NCDs)as well as a major cause of morbidity and mortality worldwide. Around 80% diabetic patients live in low- and middle-income countries. In Bangladesh, there is a scarcity of data on the quality of DM management within health facilities. This study aims to describe service availability and readiness for DM at all tiers of health facilities using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) standard tool. Methods: This cross-sectional survey was conducted in 266 health facilities all across Bangladesh using the WHO SARA standard tool. Descriptive analyses for the availability of DM services was carried out. Composite scores for facility readiness index (RI) were calculated in four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. Indices were stratified by facility level and a cut off value of 70% was considered as ‘ready’ to manage diabetes at each facility level. Results: The mean RI score of tertiary and specialized hospitals was above the cutoff value of 70% (RI: 79%), whereas for District Hospitals (DHs), Upazila Health Complexes (UHCs) and NGO and Private hospitals the RI scores were other levels of 65%, 51% and 62% respectively. This indicating that only the tertiary level of health facilities was ready to manage DM. However, it has been observed that the RI scores of the essential medicine domain was low at all levels of health facilities including tertiary-level. Conclusions: The study revealed only tertiary level facilities were ready to manage DM. However, like other facilities, they require an adequate supply of essential medicines. Alongside the inadequate supply of medicines, shortage of trained staff and unavailability of guidelines on the diagnosis and treatment of DM also contributed to the low RI score for rest of the facilities.

Introduction The COVID-19 pandemic has exacerbated health inequalities across the globe, disproportionately affecting those with poor social determinants of health (SDOHs). It is imperative to understand how SDOH influences the transmission and outcomes (positive case, hospitalisation and mortality) of COVID-19. This systematic review will investigate the impact of a wide range of SDOHs across the globe on the transmission and outcomes of COVID-19. Methods and analysis This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. We will search three electronic bibliographical databases (MEDLINE via PubMed, Embase and Scopus), as well as the WHO COVID-19 Global Research on Coronavirus Disease database. We will consider observational studies that report statistical relationships between the SDOHs (as listed in PROGRESS-Plus and Healthy People 2020) and COVID-19 transmission and outcomes. There will be no limitation on the geographical location of publications. The quality of included observational studies will be assessed using a modified version of the Newcastle-Ottawa Scale. A narrative synthesis without meta-analysis reporting standards will be used to report the review findings. Ethics and dissemination This review will be based on published studies obtained from publicly available sources, and therefore, ethical approval is not required. We will publish the results of this review in a peer-reviewed journal, as well as present the study findings at a national conference. PROSPERO registration number CRD42021228818.

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. A cross-sectional survey was conducted between December 2020 and January 2021 involving 1382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate handwashing and sanitation facilities (17.6%), and negative influences on family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01, 1.7), rural residents (OR = 1.5, 95% CI = 1.2, 2), respondents with a low level of education: no schooling vs. ≥higher secondary (OR = 3.5, 95% CI = 2.3, 5.2), primary vs. ≥higher secondary (OR = 2.5, 95% CI = 1.7, 3.8), respondents engaged in agricultural (OR = 1.7, 95% CI = 1.2, 2.4), laboring (OR = 3.2, 95% CI = 2, 5), and domestic works (OR = 1.6, 95% CI = 1.07, 2.5), and people with disabilities (OR = 1.7, 95% CI = 1.1, 2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents’ education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. A substantial percentage of Bangladeshi adults have difficulty practising COVID-19 protective behaviours and have poor comprehension of risk communications, particularly in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

BACKGROUND Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. METHODS A cross-sectional survey was conducted between December 2020 and January 2021 involving 1,382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. RESULTS Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate hand washing and sanitation facilities (17.6%), and negative influences of family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01,1.7), rural residents (OR = 1.5, 95% CI = 1.2,2), respondents with a low level of education: No schooling vs ≥ higher secondary (OR = 3.5, 95% CI = 2.3,5.2), Primary vs ≥ higher secondary (OR = 2.5, 95%CI = 1.7,3.8), respondents engaged in agricultural (OR = 1.7, 95%CI = 1.2,2.4), laboring (OR = 3.2, 95% CI = 2,5), and domestic (OR = 1.6, 95% CI = 1.07,2.5) works, and people with disabilities (OR = 1.7, 95% CI = 1.1,2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents’ education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. CONCLUSION A substantial percentage of Bangladeshi adults have difficulty practicing COVID-19 protective behaviors and have poor comprehension of risk communications, that is particularly prevalent in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

Objective This study assessed the risk perception and preventive behavioral practice towards COVID-19 just prior to the second wave of corona, as well as the impact of perceived risk on preventive practices. Design, setting, participants, and outcome measures A cross-sectional study was conducted between December 2020 and January 2021, involving 1382 respondents aged 18 years and above from all eight divisions in Bangladesh. We used multiple linear regression to identify sociodemographic predictors of risk perception and multiple logistic regression to determine the relationship between risk perception and preventive practice. Results Low risk perception regarding COVID-19 was present among one-fifth of the respondents (19.8%). Younger age, being male, low education, single marital status, and rural residence were significantly associated with a low perceived risk of COVID-19. Hand washing and wearing mask were practiced by 80% and 67% of respondents, respectively. A low prevalence was noticed for social distancing (31%), avoiding social gathering (31%), and covering face while coughing/sneezing (18%). Furthermore, respondents with a high risk perception were found to be more likely than those with a low risk perception to practice all recommended COVID-19 preventive behaviors-hand washing (OR=2.4, 95% CI=1.5, 3.7), mask use (OR=3.4, 95% CI=2.3, 5), social distancing (OR=3.7, 95% CI=2.4, 5.6), sanitizer use (OR=2.7, 95% CI=1.8, 4.1), avoiding gathering (OR=2.3, 95% CI=1.6, 3.5), avoid touching face and mouth (OR=2.8, 95% CI=1.5, 5.3), and covering mouth while coughing/sneezing (OR=7, 95% CI=3.6, 13.4). Conclusion Considerable number of Bangladeshi adults had low risk perception and low practice of some vital COVID-19 preventive behaviors before the onset of second wave of corona. All preventive practices were also influenced by respondent’s risk perception. This highlights the importance of strengthening and optimizing risk communication strategy even when the number of corona cases are low. STRENGTHS AND LIMITATIONS OF THIS STUDY The study explored the perceived risk and preventive practices for COVID-19 in Bangladesh right before the recent onset COVID-19 second wave in the South Asian region, and included a larger sample size than previous studies. Unlike most other studies on COVID-19 risk perception that used online surveys, this study administered a face-to-face data collection from both urban and rural settings across all the eight divisions of Bangladesh. This is the first study in Bangladesh that investigated the effect of perceived risk of COVID-19 on the practice of a range of preventive behaviors, and used an analytical approach to quantify risk perception. Respondents’ self-reported information on COVID-19 preventive behavior practice is subject to be influenced by recall and desirability bias. The study was unable to explore the respondents’ frequency and adherence to preventive practices, as well as the influence of psychological factors on preventive behaviors.