Farhad Kabir

In coastal Bangladesh, climate-related hazards threaten health and primary healthcare (PHC) systems, already constrained by infrastructure, workforce, and energy gaps. Teknaf, a coastal sub-district of Cox’s Bazar, hosts part of the approximately 1.19 million Forcibly Displaced Myanmar Nationals (FDMNs) living in Cox’s Bazar District, adding pressure on PHC facilities. Terre des hommes (Tdh), Climate Action Accelerator (CAA), and icddr,b, with local stakeholders, developed Climate-Resilient and Environmentally Sustainable Healthcare (CRESH) solutions for thirteen PHC facilities in Teknaf. This protocol describes a RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance)-guided longitudinal, mixed-methods evaluation to assess implementation feasibility, acceptability, fidelity, adaptation, immediate outcomes, potential indicators of sustainment, and scale-up of CRESH solutions. The evaluation comprises pre–post facility surveys (13 facilities, approximately 35 staff per round), pre–post beneficiary surveys in three facility catchments (186 interviews per round), and initial and concurrent qualitative assessments (interviews, focus group discussions, and facility observations). Data collection runs from January to October 2026 within a 22-month project (March 2025–December 2026). Quantitative data will be analyzed with survey-design methods in Stata 17, and qualitative data by framework analysis. Without a comparison group and with a short implementation period, observed changes will be reported as changes following implementation rather than as effects caused by CRESH. Study findings will inform policy, effectiveness trials, and scale-up in Bangladesh and similar climate-vulnerable, displacement-affected settings.

Children carrying Staphylococcus aureus in their nasopharynx are at a higher risk of contracting systemic infection. Due to lack of sufficient information regarding such carriage, this study was conducted to explore the prevalence, antibiotic susceptibility, and genomic profiles of S. aureus isolated from nasopharyngeal samples of 163 randomly selected asymptomatic Bangladeshi children aged from 5–p = 0.002) and influenza (p = 0.004). Among the isolates, 84.1% were multidrug-resistant and 47.5% (n = 40) were methicillin-resistant S. aureus (MRSA). All the isolates (100%) were resistant to cefixime with higher resistance to ampicillin (95.5%) and penicillin (90.9%). Among the three investigated isolates, two were ST80 (ID-1 and ID-52) and one was a novel strain (ID-19) with the presence of aph-Stph, blaI, blaZ, dha1, fosB, lmrS, mepA, norA, and tet38 genes. The current research demonstrates a high incidence of multidrug-resistant S. aureus and reports the first instance of ST80 in asymptomatic children in Bangladesh.

: Children with malnutrition present with aberrant laboratory parameters. This study aimed to identify high-risk diarrheal children with varied nutritional status. The data were obtained from the electronic database of Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh from 2019 to 2021. Among 1,068 children under 5 years of age with diarrhea, 177 (14%) had severe acute malnutrition (SAM; weight-for-length/height Z score < −3), 239 children (17%) had severe stunting (SS; length/height-for-age Z score < −3), and 652 did not have malnutrition (weight-for-length/height and weight-for-age and length/height-for-age Z score > −2). We independently assessed the relationship of nutritional profiles with each clinical and laboratory parameter. After adjustment for age and sex in the multiple regression model, hyponatremia (adjusted odds ratio [aOR] = 2.37 [95% CI: 1.52–3.68]; P < 0.001) and dehydration (aOR = 2.42 [95% CI: 1.67–3.52]; P < 0.001) were independently associated with SAM compared with children without malnutrition. In comparison to non-malnutrition, SS was less likely to be associated with acute watery diarrhea (aOR = 0.66 [95% CI: 0.47–0.92]; P = 0.014) but was significantly associated with anemia (aOR = 2.18 [95% CI: 1.57–3.02]; P < 0.001) and thrombocytosis (aOR = 2.43 [95% CI: 1.78–3.32]; P < 0.001). The presence of hypernatremia was substantially lower in children with SAM (aOR = 0.38 [95% CI: 0.22–0.65]; P < 0.001) or SS (aOR = 0.56 [95% CI: 0.35–0.88]; P = 0.012) than in children without malnutrition. Severe stunting was less likely to be associated with dehydration (aOR = 0.44 [95% CI: 0.29–0.67]; P < 0.001) in contrast to SAM. Therefore, children hospitalized with diarrhea may have different clinical and laboratory manifestations depending on their nutritional status and may require differential treatment.