National Institute of Preventive and Social Medicine NIPSOM

Dhaka, Bangladesh

National Institute of Preventive and Social Medicine NIPSOM

Dhaka, Bangladesh
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Chowdhury R.,National Institute of Preventive and Social Medicine NIPSOM | Mondal D.,ICDDR | Chowdhury V.,Dhaka College | Faria S.,National Institute of Preventive and Social Medicine NIPSOM | And 4 more authors.
PLoS Neglected Tropical Diseases | Year: 2014

Introduction: In 2005, Bangladesh, India, and Nepal joined forces to eliminate Visceral Leishmaniasis (or kala-azar) from the region by 2015. In Bangladesh the elimination target is set at less than one new case per 10,000 population per year at upazila (sub-district) level. As the deadline approaches, we review the status of the elimination initiative in this country. Methods: We collected all available disease surveillance data at the Disease Control Unit of the Directorate General of Health Services, Government of Bangladesh from 1994 to 2013. Additionally, we retrieved data from the Civil Surgeon Office from the Mymensingh district, one of the most heavily affected areas in Bangladesh. Results: Between 1994 and 2013, 109,266 kala-azar cases causing 329 deaths were reported from 37 endemic districts in Bangladesh. Only 16 districts reported cases every year. The Mymensingh district was the most affected with 53,582 (49.04%) cases. Between 2008 and 2013 only 16 upazilas showed incidence rates above the elimination target in which they ranged from 1.06 to 18.25 per 10,000 people per year. Discussion: While clear progress has been made towards eliminating VL, 16 upazilas in Bangladesh had not yet reached the target in 2013, based on official notification data that probably suffered from under-reporting bias. The elimination initiative urgently needs to establish methods to ascertain and monitor the elimination target. © 2014 Chowdhury et al.

Karim M.R.,National Institute of Preventive and Social Medicine NIPSOM
One Century of the Discovery of Arsenicosis in Latin America (1914-2014): As 2014 - Proceedings of the 5th International Congress on Arsenic in the Environment | Year: 2014

A study was conducted on 600 children of arsenic exposed ([As] >50 μg L-1 of tube well water) and non-exposed (<50 μg L-1 of tube well water) areas to find out any difference in the nutritional status. Nutritional status was assessed by z-scores of weight for age, height for age and weight for height and also using 5th and 85th percentiles of the Body Mass Index for age. BMI of the children was found to be strongly associated with the arsenic level of the well water used by the families (p < 0.01). Thinness was found more among the children of exposed area (49%) than that of non-exposed one (38%). Comparatively children with normal BMI was found to be more in non-exposed area than in exposed area and the difference was found to be significant. The study suggests that arsenic exposure had negative impact on the nutritional status of children. © 2014 Taylor & Francis Group.

PubMed | National Institute of Preventive and Social Medicine NIPSOM and Institute of Public Health
Type: Journal Article | Journal: The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease | Year: 2016

Questions have been raised as to the accuracy of smear-positive tuberculosis (TB) diagnoses at DOTS centres in Bangladesh.To assess the validity of diagnoses by smear microscopy at 62 DOTS centres in various health facilities.Using a cross-sectional study design, smear-positive TB cases were included from high, medium and low-performing DOTS centres from July to December 2010. The centres were categorised according to their case detection rate: centres with case detection rates of >70%, 50-70% and <50% were classed as high, medium and low-performing, respectively. Microscopy was performed on spot and early morning sputum samples for all cases.A convenience sample of 333 recently diagnosed smear-positive TB cases was included. The average number of patients enrolled per centre was 5.4; the highest number of cases was diagnosed from low-performing DOTS centres. Of the 333 cases, 302 (90.7%) were confirmed, while 31 (9.3%) were smear-negative.Differences in microscopy results could be due to the poor quality of the sputum sample, of smearing, staining or reading, or erroneous reporting by the DOTS centres. Preset programme targets and the nationwide drug stockout may have led to overreporting by the DOTS centres.

PubMed | Health Economics Unit, Bangabandhu Sheikh Mujib Medical University, Telenor Health, Institute of Public Health Nutrition and 4 more.
Type: Journal Article | Journal: Nagoya journal of medical science | Year: 2016

Unsafe food is linked to the deaths of an estimated two million people annually. Food containing harmful agents is responsible for more than 200 diseases ranging from diarrhoea to cancers. A one-sample pilot intervention study was conducted to evaluate the role of courtyard counselling meetings as the means of intervention for improving food safety knowledge and practices among household food handlers in a district of Bangladesh. The study was conducted in three phases: a baseline survey, the intervention and an end-line survey between April and November 2015 where 194 food handlers took part. Data were collected through observations and face-to-face interviews. The mean age of the respondents was 38.8 (12.4) years, all of whom were females. Hand washing before eating, and washing utensils with soap were significantly improved at the end-line in comparison to the baseline (57% vs. 40% and 83% vs. 69%, respectively). Hand washing with soap was increased by 4%. The mean score of food handling practices was significantly increased after the intervention (20.5 vs. 22.1; P<0.001). However, hand washing after use of toilet was unchanged after the intervention (75% vs.76%). Knowledge about safe food and the necessity of thorough cooking were significantly increased after the intervention (88% from 64% and 34% from 21%, respectively). Mean scores of knowledge and practice on food safety were significantly increased by 1.9 and 1.6, respectively after the one month intervention. Thus this food safety education in rural communities should be scaled up and, indeed, strengthened using the courtyard counselling meetings in Bangladesh.

Chapman L.A.C.,University of Warwick | Dyson L.,University of Warwick | Courtenay O.,University of Warwick | Chowdhury R.,Country Programme Manager Bangladesh | And 4 more authors.
Parasites and Vectors | Year: 2015

Background: Visceral leishmaniasis has been targeted for elimination as a public health problem (less than 1 case per 10,000 people per year) in the Indian sub-continent by 2017. However, there is still a high degree of uncertainty about the natural history of the disease, in particular about the duration of asymptomatic infection and the proportion of asymptomatically infected individuals that develop clinical visceral leishmaniasis. Quantifying these aspects of the disease is key for guiding efforts to eliminate visceral leishmaniasis and maintaining elimination once it is reached. Methods: Data from a detailed epidemiological study in Bangladesh in 2002-2004 was analysed to estimate key epidemiological parameters. The role of diagnostics in determining the probability and rate of progression to clinical disease was estimated by fitting Cox proportional hazards models. A multi-state Markov model of the natural history of visceral leishmaniasis was fitted to the data to estimate the asymptomatic infection period and the proportion of asymptomatic individuals going on to develop clinical symptoms. Results: At the time of the study, individuals were taking several months to be diagnosed with visceral leishmaniasis, leading to many opportunities for ongoing transmission. The probability of progression to clinical disease was strongly associated with initial seropositivity and even more strongly with seroconversion, with most clinical symptoms developing within a year. The estimated average durations of asymptomatic infection and symptomatic infection for our model of the natural history are 147 days (95 % CI 130-166) and 140 days (95 % CI 123-160), respectively, and are significantly longer than previously reported estimates. We estimate from the data that 14.7 % (95 % CI 12.6-20.0 %) of asymptomatic individuals develop clinical symptoms - a greater proportion than previously estimated. Conclusions: Extended periods of asymptomatic infection could be important for visceral leishmaniasis transmission, but this depends critically on the relative infectivity of asymptomatic and symptomatic individuals to sandflies. These estimates could be informed by similar analysis of other datasets. Our results highlight the importance of reducing times from onset of symptoms to diagnosis and treatment to reduce opportunities for transmission. © 2015 Chapman et al.

Nahar S.,National Institute of Preventive and Social Medicine NIPSOM | Banu M.,Research and Evaluation Division | Nasreen H.E.,Research and Evaluation Division
BMC Pregnancy and Childbirth | Year: 2011

Background: Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC.Methods: This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed.Results: The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours, p < 0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p = 0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p = 0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities.Conclusions: Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC. © 2011 Nahar et al; licensee BioMed Central Ltd.

Hossain K.J.,National Institute of Preventive and Social Medicine NIPSOM
Mymensingh medical journal : MMJ | Year: 2012

The aim of this study was to investigate mental illnesses among the substance abuse dependent populations. A total of 1076 substance abusers were recruited from the Outpatient Department of the Central Drug Addiction Treatment Center, Tejgaon, Dhaka from July 2008 to June 2009. They sought detoxification therapy voluntarily at this centre. The research participants were selected consecutively following the defined selection criteria. Research instruments were interviewer-administered questionnaire and standard mental state examination scales. Of the 1076 substance abusers, 82.6% had been using heroin currently and rest of them used phensedyl followed by injection drugs and cannabis with a period ranged 2-30 years. Results showed that 91.3% of the substance abusers had been suffering from insomnia and 75.0% had altered food habit. About 49.0% showed disturbed behaviors and 45.2% had been suffering from sexual dysfunctions. Around 32.0% of the substance abusers had been suffering from nonspecific generalized anxieties and 72.7% were found in abnormal mood/affects. A striking finding was that 7.3% of the substance abusers had been suffering from perceptual and/or thought disturbances. In conclusion, 7.3%-92.5% of the substance abusers had been suffering from mental illnesses. Insomnias, decreased intake of food and taste preference, irritable mood/affects, loss of interest in sex and non-specific anxieties were highly prevalent among them. Medical management and altering lifestyle are still the only applicable way to control this human catastrophe.

Hossain K.J.,National Institute of Preventive and Social Medicine NIPSOM | Nandi A.K.,National Institute of Preventive and Social Medicine NIPSOM
Mymensingh medical journal : MMJ | Year: 2015

The objective of the study was to determine the incidence of Hepatitis-B (HBV) infection among the injection drugs abusers (IDUs). The research work was a cross-sectional study. A total of 400 IDUs were selected from July 2012 to June 2013 at the Outpatient Department of the Central Drug Addiction Treatment Center, Tejgaon, Dhaka, Bangladesh. They were selected consecutively following the purposive sampling method on the basis of defined selection criteria. Research instruments were a pre-tested interviewer questionnaire and blood specimen. Results showed that 79.70%(315) of the IDUs were found literate and 20.3%(85) illiterate. In present occupation, majority of them 60.5%(242) had no work and 39.5%(158) specific occupation. The mean age of them was 27.9±6.4 years. In marital status, 46.5%(186) were unmarried, 20.7%(83) married after addiction and 30.3%(121) married before addiction. Majority of the IDUs 75.2%(289) started their addiction with cannabis. In addition to injection drugs use, all of them were multiple drug abusers. In response to the sharing of needle, 35.7%(143) of the IDUs shared needle uncommonly and 64.3%(257) did not shared it at all. Ninety-three percent (372) of them were heterosexual and polygamous having extramarital sex with multiple partners. The quality of sex-partners was wife, friends, brothel & hotel based sex sellers and street sex sellers. Majority of IDUs {82.0%(328)} did not use condom at all and 15.5(62) sold blood several times in their lifetime. Seven percent {7.0%(28)} injection drug abusers had been suffering from hepatitis-B virus (HBV) infection. HBV infection was found to be significantly (p≥0.05) associated with the quality of sex partners and number of sex partners, and age and marital status. There is no significant association with sharing of needle particularly occasional sharing of needle. Altering the behaviors of IDUs, especially their sexual lifestyles, drug habit, using of disposable syringe without sharing of needle, and also alternative preventive measures against injection drugs are still the applicable way to control spread of the HBV among the IDUs in Bangladesh.

Ahmed S.M.,National Institute of Preventive and Social Medicine NIPSOM | Islam M.Z.,National Institute of Preventive and Social Medicine NIPSOM
Bangladesh Journal of Medical Science | Year: 2015

Background: Childhood cancer is an emerging health problem worldwide. It is the second common cause of child death. Epidemiological and clinical attributes of childhood cancer are not properly documented in Bangladesh. This study was designed to reveal the attributes of childhood cancer among the patients attended specialized hospitals in Dhaka city. Objective: To determine the epidemiological and clinical attributes of childhood cancer. Materials and Methods: The cross-sectional study was conducted among 99 under 18 years old children suffering from cancer, who were included considering specific selection criteria. Data were collected by face to face interview using a semi-structured questionnaire with the help of a semi-structured questionnaire and checklist. Data were analyzed by using SPSS software. Results: Of all the children, majority (40.4%) was in age group of 6-10 years and their mean (±SD) age was 7.48 (±3.70) years. Male to female ratio was 1.9:1.6 and majority (48.5%) was in middle income group. Major part (42.4%) of the children was from sub-urban followed by 30.3% rural and 27.2% from urban communities. Major types of childhood cancer comprised acute lymphoblastic leukaemia (37.4%), retinoblastoma (14.1%), neuroblastoma (10.1%), and Wilm’stumour (10.1%). Less common cancers included non-Hodgekin’s lymphoma (7.1%), Hodgekin’s lymphoma (5.1%), osteosercoma (5.1%), nasopharyngeal carcinoma (4.0%), germ cell tumour (3.0%), acute myeloid leukaemia (3.0%) and Ewing’s tumour (1.0%). Majority (35.1%) of acute lymphoblastic leukaemia patients were from urban while most (85.7%) of retinoblastoma patients from sub-urban, 50.0% of neuroblastoma cases from rural, and 40.0% of Wilm’s tumour from sub-urban communities, this geographical variation of childhood cancer was statistically significant [χ2(33)=56.46, p=0.01]. In poor and middle income group, most of the children (91.8%) were detected in stage II while among the higher income group, most (88.9%) of the cancer were detected in stage-I and this variation was statistically significant [χ2(9)=16.77, p=0.05]. Family history was strongly related with childhood cancer [χ2(20)=32.81, p=0.04]. Conclusion: Cancer was more prevalent among male children with poor socio-economic condition residing in sub-urban communities. The study recommends specific measures to detect childhood cancer and related risk factors at early stage to prevention and control. © 2015, Ibn Sina Trust. All rights reserved.

Halim K.S.,National Institute of Preventive and Social Medicine NIPSOM
Mymensingh medical journal : MMJ | Year: 2010

This descriptive type of study was carried out to determine the various factors of attempted suicide in a selected area at Patnitala and Dhamuirhat upazilla health complex of Naogaon district. All reported alive cases of attempted suicide (self poisoning, hanging, self burning or immolation, drowning etc) during the period from March to June 2003 were interviewed purposely. Data were collected by face to face interview and also from hospital records. Of the interviewed cases, the mean age was 21.4 years. Household workers, day labours, students and agricultural workers (42.6%, 23.9%, 15.5% and 11.3% respectively) were the major victims and nearly 60% had nuclear family. The highest number (77.5%) used organophosphorus compound. Highest number (25.4%) mentioned that husband mainly provoked for suicidal attempt, followed by mother and father. It was evident that 71.8% of suicidal attempt was due to their emotional stress, followed by family violence, disturbed family, social deprivation, stressful events and health problems (50.7%, 49.3%, 36.6%, 25.4%, and 8.5% respectively). It was evident that attempted suicide is proportionately higher among adolescents of unmarried, with early age at marriage, with higher income and with nuclear family compared with adult. Emotional stress, disturbed family, social deprivation, health related problems are appeared to be important reasons for attempted suicide among adolescents whereas family violence in adults.

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