A. M. Rumayan Hasan

Background: Kangaroo Mother Care (KMC) is a cornerstone of neonatal thermal care for preterm and low birthweight neonates, yet sustained implementation is often constrained in low-resource settings. Limited evidence exists on how biomedical warming technologies are used in everyday practice alongside KMC. This study aims to explore how caregivers and healthcare providers experienced and adapted neonatal thermal care between KMC and the Thermal Jacket under health system constraints.Methods: We conducted an exploratory qualitative study in three district hospitals in Bangladesh between August 2024 and June 2025. Data were collected through 30 In-Depth Interviews with caregivers, three Focus Group Discussions with nurses, and 12 Key Informant Interviews with clinicians, managers, and policymakers. Data were analysed inductively using thematic network analysis.Findings: Caregivers and healthcare providers adapted the Thermal Jacket alongside KMC to maintain neonatal thermal care despite practical constraints, including maternal physical limitations and health system challenges. Mothers felt maintaining warmth was a moral responsibility central to good parenthood and simultaneously exercised agency by making situational decisions about when and how to use KMC or the Thermal Jacket in family and institutional settings. At the system level, effective adaptation of the Thermal Jacket depended on its integration into existing KMC guidelines, training, infrastructure, and supply systems. While the Thermal Jacket maintained warmth, some caregivers and providers expressed unease, highlighting concern about an emotional detachment and a reduced ability to recognise early signs of neonatal distress.Interpretation: This study demonstrates that biomedical supplementation to KMC is adapted through everyday practice rather than implemented as a fixed protocol. Clinical priorities, caregiving expectations, and contextual conditions interplayed in navigating the use of the Thermal Jacket and KMC to support continuity of neonatal thermal care. However, successful scale-up requires governance solutions to strengthen neonatal care in resource-constrained settings.

Background: Adolescents in Bangladesh, approximately one-fifth of the total population, face significant challenges accessing relevant sexual and reproductive health (SRH) information, with the added burdens of cultural taboo, limited accessibility, and poor communication channels. Traditional adolescent-friendly approaches have shown limited effectiveness in addressing these challenges. In response, Mukhorito was developed as a peer-led, mobile-based digital platform to facilitate SRH, education, and communication among ninth-grade students. Objective: This study explored the feasibility and constraints of piloting the Mukhorito app to enhance adolescent SRH education in Bangladesh. It also sought to determine the self-reported usage, usability, and effect on knowledge and peer communication of the app, as well as to identify implementation and adoption challenges. Methods: A qualitative design was applied in the context of a broader mixed-methods study. Data were collected through 6 in-depth interviews, 3 key informant interviews, and 1 focus group discussion from 19 participants, including students, peer leaders, teachers, and government representatives, across 3 secondary schools (a boys’ school, girls’ school, and coeducational school) in the Feni district. Thematic analysis was conducted using NVivo software (QSR International) under Braun and Clarke’s guidelines. Results: The Mukhorito app was perceived as a valuable tool to meet the SRH needs of adolescents in Bangladesh owing to its well-structured, easily navigable content with relatable stories. Participants described increased awareness of critical SRH issues, including reproductive health, nutrition, early marriage, violence against adolescents, and drug addiction, and reported sharing this knowledge with their families and communities. The app was seen as creating a safe space to discuss previously taboo SRH topics, reducing cultural reluctance to communicate, and promoting peer-to-peer communication. Interactive sessions were noted to strengthen decision-making skills and leadership qualities. Many users reported feeling more comfortable discussing SRH issues without shyness. However, challenges such as limited smartphone access, unreliable internet connection, and economic factors hindered adoption, especially in rural settings. Participants suggested the integration of the Mukhorito app in school curricula, aligning it with the government adolescent health program, adding visually rich and interactive content (eg, short dramas, videos, and animations), and enabling offline access to address connectivity challenges and maximize the effectiveness of the app. Conclusions: Mukhorito possesses strong potential as a culturally relevant, digital SRH education tool for Bangladeshi adolescents. The app enabled knowledge and openness in SRH discourse. Alignment with national health programs and enhanced app functionality may promote greater and more sustainable adolescent health.

BACKGROUND Bangladeshi adolescents face significant challenges accessing relevant sexual and reproductive health (SRH) information, with the added burdens of cultural taboo, limited accessibility, and poor communication channels. Traditional adolescent-friendly approaches have shown limited effectiveness in addressing these challenges. In response, Mukhorito was developed as a peer-led, mobile-based digital platform to facilitate SRH, education, and communication among ninth-grade students. OBJECTIVE This study explored the feasibility and constraints of piloting the Mukhorito app to enhance adolescent SRH education in Bangladesh. It also sought to determine the self-reported usage, usability, and effect on knowledge and peer communication of the app, as well as to identify implementation and adoption challenges. METHODS Qualitative design was applied in the context of a broader mixed-methods study. Data were collected through six In-Depth Interviews (IDIs), three Key Informant Interviews (KIIs), and one Focus Group Discussion (FGD) from 19 participants, including students, peer leaders, teachers, and government representatives, across three secondary schools in the Feni district. Thematic analysis was conducted using NVivo software under Braun and Clarke's guidelines. RESULTS The Mukhorito app was received positively for its structured material, interactivity, and easy peer-to-peer communication. Almost all participants shared improved SRH awareness and leadership skills, as well as reduced stigma when discussing delicate topics. The main challenges were limited smartphone access, poor internet connectivity, and affordability. Potential ways to improve the app’s usability were integrating the application into the school curriculum, improving offline functionality, and adding visual material such as short dramas or videos. CONCLUSIONS Mukhorito possesses strong potential as a culturally relevant, digital SRH education tool for Bangladeshi adolescents. The app enabled knowledge and openness in SRH discourse. Alignment with national health programs and enhanced app functionality may promote greater and more sustainable adolescent health.

The global burden of maternal mortality ratio (MMR) (223 per 100 000 live births) remains a pressing issue, with the majority (94%) of deaths occurring in low- and middle-income countries (LMICs), particularly in South Asia [1,2]. The disparities in health care service access and quality among LMICs contribute to the high MMR [3,4]. This highlights the […]

Objective The COVID-19 pandemic imposed unprecedented challenges to health systems globally. This study explored slum dwellers’ experience of receiving essential health services during the pandemic and the challenges faced by healthcare providers in urban areas of Bangladesh. Design The study followed a cross-sectional study design using qualitative methods. Setting The study was conducted in Dhaka and Gazipur City Corporations during November 2020–February 2021. Participants 17 key informant interviews were carried out with healthcare providers and policy-makers and 22 in-depth interviews were carried out with slum dwellers. Thematic analysis was performed. Results The study identified challenges to the provision of essential healthcare in selected areas of Dhaka and Gazipur City Corporations during the COVID-19 pandemic. The lack of information on the availability of functional healthcare facilities, fear of contracting COVID-19 and restrictions on movement and transportation, resulted in delays in seeking essential healthcare during a pandemic. Access to healthcare facilities was further hindered by various hospitals’ decision to refuse care to general patients without valid, negative COVID-19 test results. Healthcare providers identified patients’ tendency to hide COVID-19 symptoms as a barrier to providing healthcare services to general patients. Conversely, patients concealed their symptoms to avoid COVID-19 tests and gain access to required treatment. In addition, the reallocation of human resources for COVID-19 treatment disrupted the delivery of essential health services. Conclusion The pandemic affected the accessibility of the slum population to essential healthcare and disrupted health service delivery. The findings of the study have highlighted gaps in the health system during an emergency response period like COVID-19. The study will assist the government and other stakeholders in designing tailored interventions and allocating resources in a more efficient manner to ensure universal health coverage in the face of health emergencies.

In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. KPs’ willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities.