Mohammad Habibur Rahman Sarker

Background and objectives The global burden of prediabetes and diabetes is rising rapidly, particularly in low- and middle-income countries like Bangladesh, where lifestyle and nutritional transitions are accelerating. Economically disadvantaged rural populations often lack awareness and access to care, making them highly vulnerable. Measuring the prevalence and identifying associated factors is essential for guiding public health strategies and resource allocation. This study aimed to assess the prevalence and associated factors of prediabetes and diabetes in a rural and peri-urban Bangladeshi community to inform targeted prevention and control strategies. Methodology We recruited 891 adults for this cross-sectional study in January-June 2020 through random sampling from the Mirzapur Demographic Surveillance System in Bangladesh, ensuring at least five years of residency. Trained Community Health Workers collected sociodemographic data using a semi-structured questionnaire and performed physical examination and anthropometric measurements. We used fasting blood sugar to screen patients for prediabetes and diabetes, and measured serum creatinine and urine albumin to creatinine ratio to diagnose chronic kidney disease (CKD). We also collected blood samples to measure serum albumin, hemoglobin, total cholesterol, and triglycerides. Blood and urine samples were tested in an accredited laboratory. Results Prevalence of prediabetes was 38% (n=343), and diabetes was 17% (n=151). Age-specific prevalences of prediabetes were 5%, 12% and 22%, and of diabetes were 1%, 3% and 13%, for the age groups of 18-30, 31-45, and ≥46 years, respectively. Sex-specific prevalences of prediabetes were 22% and 17%, and diabetes were 9% and 8%, for female and male participants, respectively. In multiple multinomial logistic regression, for prediabetes, significant risk factor was age ≥31 years (adjusted odds ratio (aOR) 2.84, 95%CI 1.64-4.92), and protective factors were smokeless tobacco use (aOR 0.58, 95%CI 0.36-0.94) and hypoalbuminemia (aOR 0.48, 95%CI 0.24-0.99), and for diabetes, significant risk factors were age ≥31 years (aOR 4.04, 95%CI 1.37-11.95), abdominal obesity (aOR 2.80, 95%CI 1.49-5.30), CKD (aOR 2.80, 95% CI 1.70-4.62), hypercholesterolemia (aOR 1.97, 95%CI 1.17-3.30) and hypertriglyceridemia (aOR 2.33, 95%CI 1.44-3.79), and protective factors were being female (aOR 0.21, 95%CI 0.066-0.68), and smokeless tobacco user (aOR 0.32, 95%CI 0.17-0.63). Conclusion This study reveals a high burden of prediabetes and diabetes in a rural and peri-urban Bangladeshi population. The findings underscore the urgent need to strengthen community-based screening and targeted prevention strategies to address the growing diabetes burden in underserved areas.

Background: Sea level rise, heavy rainfall, flooding, and temperature changes due to climate change contribute to the spread of enteric infections, disrupting normal intestinal functions and leading to gastrointestinal (GI) symptoms such as nausea, vomiting, and diarrhea etc. Coastal regions of Bangladesh are projected to be highly vulnerable to diarrheal diseases and cholera outbreaks by 2050. However, there is limited research on how coastal proximity affects GI health. Thus, we aimed to examine the association between GI symptoms and geographic distance from the sea in a coastal area of Bangladesh. Materials and methods: This study was conducted in the Chakaria Health and Demographic Surveillance System area of icddr,b which is running since 1999. A total of 61,295 household members were interviewed between 2012 and 2016. GI symptoms were chosen as the primary outcome measure of this study. We employed chi-square tests and logistic regression analysis model. Result: Overall, 7% reported experiencing one or more GI symptoms in the previous two weeks. Diarrhea was the most prevalent symptom (35%), followed by heartburn (22%) and abdominal pain (18%). Prevalence was significantly higher among females (8%, p<0.05), older adults (13%, p<0.05), and individuals from lower socioeconomic backgrounds (8%, p<0.05). Seasonal variation was observed, with the highest prevalence in summer (9%, p<0.05) and the lowest in winter (5%, p<0.05). Additionally, participants living within 15 kilometers (aOR: 1.35, 95% CI: 1.24-1.46) and 15-20 kilometers (aOR: 1.23, 95% CI: 1.10-1.38) of the sea had a higher risk of GI symptoms compared to those residing more than 20 kilometers away, after adjusting for other covariates. Conclusion: Our finding demonstrates that individuals residing near the coast have a higher prevalence of GI symptoms. This evidence suggests the need for targeted public health strategies to improve GI health in climate vulnerable coastal populations. Also, further research is needed to determine the causal effect as well as the underlying biological mechanisms of GI symptoms in these population.

Background: Informal and unregulated rural medical practitioners (RMPs) provide healthcare services to about two-thirds of people in Bangladesh, although their service is assumed to be substandard by qualified providers. As the RMPs are embedded in the local community and provide low-cost services, their practice pattern demands investigation to identify the shortfalls and design effective strategies to ameliorate the service. Methods: We conducted a cross-sectional study in 2015–16 using a convenient sample from all 64 districts of Bangladesh. Personnel practising modern medicine, without any recognized training, or with recognized training but practising outside their defined roles, and without any regulatory oversight were invited to take part in the study. Appropriateness of the diagnosis and the rationality of antibiotic and other drug use were measured as per the Integrated Management of Childhood Illness guideline. Results: We invited 1004 RMPs, of whom 877 consented. Among them, 656 (74.8%) RMPs owned a drugstore, 706 (78.2%) had formal education below higher secondary level, and 844 (96.2%) had informal training outside regulatory oversight during or after induction into the profession. The most common diseases encountered by them were common cold, pneumonia, and diarrhoea. 583 (66.5%) RMPs did not dispense any antibiotic for common cold symptoms. 59 (6.7%) and 64 (7.3%) of them could identify all main symptoms of pneumonia and diarrhoea, respectively. In pneumonia, 28 (3.2%) RMPs dispensed amoxicillin as first-line treatment, 819 (93.4%) dispensed different antibiotics including ceftriaxone, 721 (82.2%) dispensed salbutamol, and 278 (31.7%) dispensed steroid. In diarrhoea, 824 (94.0%) RMPs dispensed antibiotic, 937 (95.4%) dispensed ORS, 709 (80.8%) dispensed antiprotozoal, and 15 (1.7%) refrained from dispensing antibiotic and antiprotozoal together. Conclusions: Inappropriate diagnoses, irrational use of antibiotics and other drugs, and polypharmacy were observed in the practising pattern of RMPs. The government and other stakeholders should acknowledge them as crucial partners in the healthcare sector and consider ways to incorporate them into curative and preventive care.

Introduction: Compared to smoking, which has major consequences in chronic kidney disease (CKD) initiation and progression, smokeless tobacco (SLT) consumption is considered to have fewer health consequences. We investigated the prevalence of SLT consumption and its association with risk...

Cholera is a leading global public health threat, especially in developing countries. This study aimed to determine the changing determinants of cholera related to water-sanitation practices between 1994–1998 and 2014–2018 in Dhaka, Bangladesh. Data of all cause diarrhea cases were extracted from the Diarrheal Disease Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, and analysis was performed among three groups: Vibrio cholerae detected as sole pathogen, V. cholerae detected as mixed infection, and detection of no common enteropathogen in stool specimens (reference). Using sanitary toilet, drinking tap water, drinking boiled water, family size greater than five, and slum dwelling were the main exposures. Overall, 3,380 (20.30%) and 1,290 (9.69%) patients were positive for V. cholerae during 1994–1998 and 2014–2018, respectively. In 1994–1998, use of sanitary toilet (adjusted odds ratio [aOR]: 0.86, 95% CI: 0.76–0.97) and drinking tap water (aOR: 0.81, 95% CI: 0.72–0.92) were found to be negatively associated and in 2014–2018, drinking tap water (aOR: 1.47, 95% CI: 1.21–1.78) and slum dwelling (aOR: 1.43, 95% CI: 1.10–1.86) were found to be positively associated with V. cholerae infection after adjusting for age, sex, monthly income, and seasonality. Because the determinants of cholera such as drinking tap water can change over time in developing cities, ameliorating the water, sanitation, and hygiene (WASH) situation is of paramount importance. In addition, in settings such as urban slums, where long-term WASH monitoring might be difficult to achieve, mass vaccination with oral cholera vaccine should be introduced to control cholera.

Background: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low.Objective: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD.Methods: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio.Results: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01).Conclusions: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings.Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831.International Registered Report Identifier (IRRID): RR2-10.2196/30191

Chronic diseases, including non-communicable diseases (NCDs), have arisen as a severe threat to health and socio-economic growth. Telemedicine can provide both the highest level of patient satisfaction and the lowest risk of infection during a pandemic. The factors associated with its usage and patient adherence are not visible in Bangladesh’s resource-constrained settings. Therefore, this study aimed to identify perceptions about telemedicine among populations with chronic diseases amid the COVID-19 pandemic. A closed-ended self-reported questionnaire was created, and the questionnaire was written, reviewed, and finalized by a public health investigator, a psychiatrist, and an epidemiologist. The data for this study were collected from individuals using simple random sampling and snowball sampling techniques. Ethics approval was granted, and written/verbal consent was taken before interviews. Most of the participants showed a positive attitude towards telemedicine. People aged 35–54 years old and a higher level of education were less frequently associated with willingness to receive telemedicine services for current chronic disease (WRTCCD) than their counterparts. People living in urban areas and lower-income participants were more strongly associated with WRTCCD. Additionally, people who did not lose their earnings due to the pandemic were less strongly associated with WRTCCD. However, the main strength of this research is that it is a broad exploration of patient interest in several general forms of telehealth. In Bangladesh, there are many opportunities for telemedicine to be integrated into the existing healthcare system, if appropriate training and education are provided for healthcare professionals.

Gestational Toxoplasma gondii (T. gondii) infection may cause substantial adverse effects on developing fetuses, newborns and also mothers. This study aims to estimate the seroprevalence of T. gondii among rural Bangladeshi pregnant women and determine the risk of a low birth weight (LBW). We followed a longitudinal design where 208 pregnant women were followed until the birth of their infants. Levels of IgG and IgM of T. gondii were assessed using chemiluminescent immunoassay. Modified Poisson regression was used to estimate crude and adjusted associations and multiple regression analysis was performed to understand the confounding and modifying effects of the variables. Thirty-nine (19%) children were born with LBW, among whom 15 (39%) mothers were positive for T. gondii IgG during pregnancy. After adjusting for several confounders and modifiers, pregnant women with T. gondii IgG or IgM seropositivity were significantly associated with LBW of infants (aRR: 2.00, 95% CI: 1.17–3.42). The strength of this association increased after adjusting for maternal education (aRR: 4.88, 95% CI: 1.74–13.69). The final model had an AROC of 0.84 with a sensitivity of 36% and specificity of 97%. Although causality is yet to be established, the study observed an association between T. gondii infection during pregnancy among rural Bangladeshi women and LBW of newborns.

BACKGROUND Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. OBJECTIVE The present study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults suffering from CKD. METHODS This study was a parallel-group (1:1) randomized controlled trial in the Mirzapur sub-district of Bangladesh that compared two groups of CKD patients. Adults individual with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned to one of two groups: intervention or control. The intervention group received health education through a CKD awareness campaign and mHealth technologies, whereas the control group received standard treatment, and was observed for 6 months. Primary Outcome was evaluation of improved scores on the chronic kidney disease knowledge questionnaire and secondary outcomes were improved QOL and changes in the level of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, HDL-c, triglyceride, serum uric acid, blood urea nitrogen, and ACR. RESULTS We enrolled 126 patients (control group, n=63, intervention group, n=63) in the study and performed intention to treat analysis. The analyses included repeated measures ANOVA and results were observed to be significantly different in case of within-group (P<.001), between groups (P<.001) and interaction of group × time factor (P<.001) in terms of knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001, P=.01 respectively) and in interaction of group × time factor (P=.001, P=.02 respectively); food salinity and hip circumferences showed significant difference arising from within groups (P=.001, P=.03 respectively) and between groups (P=.001, P=.02 respectively). Moreover, systolic BP and waist circumference showed significant differences within groups (P<.001, P=.003 respectively). However, no significant differences were found arising from within groups, between groups and interactions of group × time in terms of QOL, urine salinity and MUAC. Regarding laboratory findings, from baseline to six months, the mean (±SD) fasting plasma glucose decreased by 0.51 ± 3.77mg/dl in the intervention group and by 0.10 ± 1.44 g/dl in the control group (P=.03); however, blood urea nitrogen increased by 3.64 ± 7.17 in the intervention group and by 1.68 ± 10.10 g/dl in the control group (P=.01). CONCLUSIONS The health education strategy, which included a campaign and mHealth, showed promise for enhancing CKD knowledge among CKD patients. This strategy may also aid CKD patients in controlling their fasting blood sugar and blood pressure. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. CLINICALTRIAL ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831.