Directorate General Of Health Services Research Articles

Clinical manifestations and seasonal occurrence of patients with dengue hospitalized at Dhaka city of Bangladesh in 2021

For the past few years, the intensity of dengue in Bangladesh has been rising. The current study was done among 533 dengue patients hospitalized in 2021 in Dhaka to observe the different aspects of clinical manifestations and seasonal occurrence of dengue. Due to COVID-19 restriction, hospital entry and face-to-face interview of the patients was not possible. Hence, contact numbers of the hospitalized dengue patients were collected from Directorate General of Health Services (DGHS) and patients were interviewed over the phone. Out of 533 patients, majority were from Dhaka south city corporation (DSCC) (53.7%), had a monthly household income of 30001≥ BDT (67.4%), and lived in small sized families (76.9%). High fever (p=0.013), headache (p<0.001), body pain (p<0.001), vomiting/nausea (p=0.0085), skin rash (p=0.033), eye lesion/red eyes (p=0.0011), pleural effusion (p=0.0404), weakness (p=0.017) and gum bleeding (p=0.014)- were significantly associated with age groups whereas vomiting/nausea (p=0.048), skin rash (p=0.002) and eye lesion/red eyes (p=0.032) were significantly associated with gender. 86.7% suffered from thrombocytopenia (<150000 per microliter blood), while 27% were in serious condition with lowest platelet count ≤ 20000 per microliter blood. 3.6% patients were admitted to ICU and 1.7% died of dengue. Death due to dengue was significantly associated with age groups (p <0.05) and majority among them were children (≤ 10 years). Family members of 44.6% patients were also affected with dengue and majority of the patients belonged to small sized families. Dengue occurrence had significant association with season where majority of the patients were from monsoon season (65.29%) followed by post-monsoon (33.21%) season. Dengue manifests a wide spectrum of symptoms as shown by the study, so now it is necessary to identify the changes in pattern of the clinical manifestations, and effective disease management to lessen the severity of the outbreak. Dhaka Univ. J. Biol. Sci. 33(1): 33-46, 2024 (January)

Profile of Blood Donors and Reasons for Deferral at a District Hospital in North Goa

Introduction: A blood transfusion is a life-sustaining procedure in several medical and surgical conditions. It isvital that an adequate inventory of safe blood is established by implementing stringent donor selection criteria andscreening for transfusion transmitted infections by ultrasensitive methods of detection. Despite a huge population,scarcity of blood lingers nationwide and it is important to analyse the varied reasons of deferrals in order to lessenthe deferrals in the future.The aim of this paper is to scrutinise the demographic profile of blood donors and evaluate the patterns andreasons for donor deferral at North Goa District hospital, India.Materials and Methods: This is a retrospective study carried out at the Blood Centre , North Goa Districthospital,India,. All those who registered for donation between June 2022 till May 2023 were included in the study.The donors were screened by a questionnaire followed by medical examination and were selected or deferredbased on the guidelines laid down by Drugs and Cosmetics Act,1940 and Directorate General of Health Services,MoHFW,Govt of India1.2 .Data was collected using a proforma and analysed by SPSS software wherever indicated.Results: During this time period, 2611 donors registered for blood donation, out of which 425 donors were deferreddue to diverse reasons. Most of the donors were voluntary donors(98.3%) of which majority were males(86.4%).The commonest cause of deferral in males was high BP(24%) and high Hb(11.3%) whereas the commonest cause ofdeferrals in females was low Hb (46.9%). Most of the donors were rejected due to temporary reasons(97.1%). Thecommonest reason of permanent deferrals was a medical history of uncontrolled DM.

Institutional capacity assessment in the lens of implementation research: Capacity of the local institutions in delivering WASH services at Cox's Bazar district, Bangladesh.

The influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal district of Cox's Bazar with one of the greatest contemporary humanitarian crises, stressing the existing water, sanitation, and hygiene (WASH) resources and services. This study aimed to assess the existing capacity of local institutions involved in delivering WASH services and identify relevant recommendations for intervention strategies. We used a qualitative approach, including interviews and capacity assessment workshops with institutions engaged in WASH service delivery. We conducted five key informant interviews (KII) with sub-district level officials of the Department of Public Health Engineering (DPHE), Directorate General of Health Services (DGHS), Directorate of Primary Education (DPE) and Bangladesh Rural Advancement Committee (BRAC) to have a general idea of WASH service mechanisms. Seven capacity assessment workshops were organized with the relevant district and sub-district level stakeholders from August 2019 to September 2019. These workshops followed three key areas: i) knowledge of policy, organizational strategy, guidelines, and framework; ii) institutional arrangements for service delivery such as planning, implementation, coordination, monitoring, and reporting; and iii) availability and management of human, financial and infrastructural resources. Data were categorized using thematic content analysis. The majority of stakeholders lacked awareness of national WASH policies. Furthermore, the top-down planning approaches resulted in activities that were not context-specific, and lack of coordination between multiple institutions compromised the optimal WASH service delivery at the local level. Shortage of human resources in delivering sustainable WASH services, inadequate supervision, and inadequate evaluation of activities also required further improvement, as identified by WASH stakeholders. Research evidence suggests that decision-makers, donors, and development partners should consider learning from the WASH implementers and stakeholders about their existing capacity, gaps, and opportunities before planning for any WASH intervention in any particular area.

Engaging National Professional Society to Combat Postpartum Hemorrhage Using Bundle Approach - A FIGO-SAFOG-OGSB-MGH Project: Experience of Implementation in Bangladesh

Objective: To reduce the incidence and death due to post-partum Hemorrhage (PPH) and capacity building of health service providers by using PPH Emergency response using Bundle Approach. Method: Planning and implementation of WHO formulated PPH Bundles [Active Management of Third Stage of Labour (AMTSL), First response Bundle and Refractory PPH Bundle] by Obstetrical and Gynaecological Society of Bangladesh (OGSB) in 14 different levels of public and private hospitals in Bangladesh. After discussion with International Federation of Gynaecology and Obstetrics (FIGO) and South Asian Federation of Obstetrics and Gynaecology (SAFOG) team, a Memorandum of understanding (MOU) was signed; permission from Ministry of Health and Family welfare (MOHFW) was obtained through Directorate General of Health Services (DGHS) and also from all the institutions. The project period was from November 2019 to September 2022 in a spoke-and-hub fashion. A group of master trainers and a technical advisory group were developed comprising of senior obstetricians and gynecologist of Bangladesh. Data were obtained through record keeping of the respective hospitals and Management Information System (MIS) of DGHS, monitoring was done by OGSB and Massachusetts General Hospital (MGH)-FIGO team. Results: Consultative and planning meetings were organized among OGSB, FIGO, SAFOG and MGH: 16 master trainers, 74 trainers were produced and 740 health service providers (Doctor, Nurses, midwives) and 450 non clinical staffs were trained. All clinical and nonclinical bundles were implemented in 14 facilities in spoke-and-hub fashion. Occurrence of PPH, detection rate of PPH, filling up PPH checklist and debrief forms were improved. Data collection system, understanding about data improved a lot. Facility readiness, team work, data monitoring & supervision, network integration and leadership skills were instituted and shown excellent positive changes. Regular simulations were continued which helped old & new service providers to learn and continue proper use of the clinical and non-clinical interventions. Scale up was planned and continued. Conclusion: PPH emergency response using bundle approach was found to be an important practical way to reduce occurrence, death and disability related to PPH. Needs for surgery has reduced also. Quality of services improved in terms of providing standard care, record keeping and reporting. Regular supervision and monitoring; data management and personal motivation are the challenges. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 98-108

Development of Pharmacovigilance System in India and Paradigm of Pharmacovigilance Research: An Overview.

The drugs are projected to cure, prevent and treat diseases; however, there are also chances of mild or severe adverse drug reactions (ADRs) in the patients. Pharmacovigilance (PV) enhances the approach to safe medicines and healthcare, but integration into public healthcare remains a challenge in many countries. The Pharmacovigilance Programme of India (PvPI) is a nationwide programme launched by the Ministry of Health and Family Welfare (MoHFW), Government of India, on 14 July 2010. It is currently run by the Indian Pharmacopoeia Commission (IPC). Presently, 567 ADR Monitoring Centres (AMC) are functioning under PvPI across India. The Central Drugs Standard Control Organization (CDSCO), under the Directorate General of Health Services (DGHS), and the Ministry of Health, Family & Welfare (MoHFW) Government of India is the National Regulatory Authority (NRA) of India. This review aims to trace the development of PV in India and its status among the top ADR reporting countries, with a focus on the current status of the studied ADR in different regions in India. Among the top 20 countries enthusiastic about sending ICSR per million population between 2015 and 2020, India shares 2% of the total ICSRs in VigiBase. India is now being recognized as a hub of global clinical trials and clinical research studies. Hence, it is the need of the hour in India to have a dynamic PV network system with an efficient and prudent operation method. Nevertheless, in India, PV programs are at an early stage on par with other countries, and only because of underreporting of ADRs. However, in the future, PvPI may appear as a big dashboard for ADR reporting culture in India as it continuously works hard to improve patients and drug safety.

Prevalence of COVID-19 Reinfection and Associated Factors: Findings of a Countrywide Cross-Sectional Study in Bangladesh

Background: Information on the extent of COVID-19 reinfection and associated risk factors is scarce in Bangladesh. The present study aimed to determine the prevalence, severity, and associated risk factors of COVID- 19 reinfection. Methods: This countrywide cross-sectional study targeted all COVID-19 patients reported in May 2021 at the Health Information Unit (HIU), Directorate General of Health Services (DGHS), Bangladesh. The study identified 242 re-infected cases among 41408 confirmed COVID-19 patients by reviewing the medical records at HIU, and DGHS. Considering the selection criteria and informed consent, we enrolled 202 re-infected patients. Data were collected through telephone interviews and reviewing medical records using a semi-structured questionnaire and a checklist. Results: The prevalence of COVID-19 reinfection was 0.58%, and most (98.0%) of them were urban residents. Of all, 37.1% had an interval of 3-6 months between two attacks of infections. The severity of reinfection included asymptomatic (6.4%), mild (67.8%), moderate (22.3%), and severe (3.5%) infections. The moderate and severe (25.9% and 7.4%) illness were significantly (p<0.001) higher in the patients having an interval of <3 months between two attacks. The moderate and severe illnesses (73.7% and 5.3%) were significantly (p<0.001) higher among the patients who didn’t maintain social distance. The patients aged 30-39 years had more chance of having mild (AOR=9.26, p=0.009) and moderate (AOR=16.58, p=0.008) infection. Conclusion: To avert COVID-19 reinfection and its severity, patients should be vigilant about preventive practices even after recovery. The study suggests effective interventions aligned with exposure, physical distancing, vaccination, and comorbidities to mitigate COVID-19 reinfection. JOPSOM 2021; 41(1):8-18

Assessment of the Performance of selected Special Care Newborn Units (SCANUs) in Bangladesh: A cross Sectional Study

Background: Government of Bangladesh initiated the Special Care Newborn Units (SCANU) in 2011 at selected district hospitals followed by its scale up in other districts with support from UNICEF and other partners. The objective of the study was to assess the performance of those SCANUs in Bangladesh. Methods: A cross-sectional study approach was applied for assessment of the performance of SCANU facilities compared to facilities without SCANU. Fifteen facilities with SCANUs and five facilities without SCANUs were selected from eight divisions of the country for the study. The selected SCANU and Non-SCANU facilities were of secondary level hospital with similar patient flow and workload. Quantitative data were collected from direct observation of the 20 facilities and interviews with 678 caregivers using a field-tested questionnaire. Caregivers were mothers of the infants (<59 days old) who were admitted and stayed for at least one day in those hospitals. Analysis was done using Stata version 15.1 and presented in tabular, graphical and numerical measures of central tendency and dispersion. Result: The results of the assessment found that 60% of SCANU facilities had KMC care services and 27% of SCANU facilities had rooming in services and special sick baby ward services but no such services was available in non-SCANU facilities. Equipment in the SCANUs such as resuscitation bag and mask, radiant warmers, phototherapy machines and to a large extent CPAP machines and Oxygen blenders were mostly available and functioning optimally. More than half of the SCANUs still need to have oxygen blenders, CPAP machines and transcutaneous bilirubinometers since they were not found/functional during the assessment. Majority of SCANU facilities 60%-80% reported no stock-outs of critical medications like dexamethasone, ceftriaxone and gentamicin which are critical for management of preterm and sick babies. A web-based online ‘Individual Case Tracking’ system has been developed for online reporting from all SCANUs by the Health Management Information System (HMIS) of the Directorate General of Health Services (DGHS). UNICEF was supporting its linkage to the district health information system (DHIS-2). There was a statistically significant difference between SCANUs and non-SCANUs with respect to the proportions of admissions. SCANUs are acting as referral destination for sick and small newborns as 41%-45% of the admitted newborns were either were born at home or in other facilities. Conclusion: The assessment findings will be helpful for country strategy for improving newborn care through expansion of SCANU expansion throughout the country

Vaccine efficacy of COVID-19 in Bangladesh: Does vaccination prevent the pandemic?

We adopted a commonly used epidemiologic model known as Susceptible-Infectious-Recovered (SIR) by adding a compartment vaccination to locate the COVID-19 hotspot in Bangladesh. Using data from the Directorate General of Health Services (DGHS), we utilized the Susceptible-Vaccinated-Infectious-Recovered (SVIR) model to assess vaccine efficacy. Vaccination against COVID-19 has begun in industrialized nations and will be completed by early December 2020. Before 2023, mass vaccination for impoverished or low-income nations would be extremely difficult. Bangladesh, a lower-middle-income country, started a statewide COVID- 19 immunization effort in early February 2021. This study aimed to recognize the effectiveness of vaccination on the infected population in Bangladesh. Additionally, the study aimed to create public awareness of the importance of vaccination during a pandemic.
 GANIT J. Bangladesh Math. Soc. 43.1 (2023) 045- 062

Integrative medicine: The future of Indian health care

Integrative medicine is a patient-focused healing-oriented medicine selectively incorporating elements of complementary (chiropractic therapy, yoga, and meditation) medicine and alternative medicine (drugs, surgery, and lifestyle changes) evidence-based and experience-based therapy into comprehensive treatment methods. It is a form of health care that seeks to understand the individual as a whole (body, mind, and spirit) including all aspects of lifestyle, and use all appropriate therapeutic approaches within a framework that focuses on health, the therapeutic relationship, and the whole person. In recent years, integrative medicine has developed into a distinct medical specialty as more and more health-care professionals have embraced it as an approach to patient care and the public has also become more educated and conscious enough about its foundational concepts. As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine combines mainstream medical therapies and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness. The term integration is used to express the formalization and official incorporation of traditional medicine into the National Health Services.[1] India is a reservoir of the antiquity of health practices supported by a strong foundation of indigenous traditional knowledge. The health needs of modern society are enormous and no single established and approved health-care system can address all the needs. Hence, became evident the need for a new collaborative regimen to guide health interventions and programs. India is backed with a rich heritage of indigenous knowledge coupled with a robust infrastructure and skilled workforce in modern medicine serving as a fertile land for medical pluralism to bloom. The integrative approach has thus proved effective in formulating strategies for healthy senescence, promoting self-management, and managing health-care expenditures. The Government of India has also promoted the integrative approach by mainstreaming Ayurveda and Yoga (AYUSH) with the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke in 2015 by the Ministry of AYUSH and Central Council of Research in Ayurvedic Sciences in collaboration with the Directorate General of Health Services with the objective to reduce drug dependency in chronic cases through yoga practices and Ayurveda and lifestyle changes. The application of Ayurveda as an adjuvant therapy has been used to reduce morbidities and associated ailments, to incorporate yoga sessions among admitted patients during their stay at the hospital for enhancing metabolism and positive physical and mental health. The National Health Policy 2017 advocates the improvement of health status through coordinated policy implementation in all sectors. The WHO Global Report on Traditional and Complementary Medicine 2019 reiterates the need for integrating the best of traditional and complementary medicine and that of conventional medicine to tackle the unique health challenges posed in the 21st century.[23] Scope of Integrative Medicine and Ways Forward Integrative health recognizes that modern systems and AYUSH systems have their own strengths and limitations in a way that they complement each other. The strengths of modern medicine include emergency management, anesthesia, surgical management, antimicrobial therapy, and management of communicable and noncommunicable diseases. In contrast, the conventional systems of traditional Indian health practices have strengths in preventive and promotive health, dietetics, advocacy of moral conduct, yoga, etc., An integrative approach incorporating the strengths of different systems of medicine provides scope for holistic and comprehensive care. Integrative Medicine is Not… Unfortunately, integrative medicine has often been mislabeled as mixopathy necessitating the need for the professions and consumers to distinguish between the two. Understanding the reason for integration is a pivotal step in preserving, protecting, and rejuvenating health along with effective, ethical, and safe management of different ailments. Integration aims to bring together the best practices of each system without losing their identity. In contrast, mixopathy is the unethical practice of self-perpetuated and self-convenient methods by unqualified people, which is not supported by any evidence. A system of integrative medicine can thus avoid the ballooning of health-care expenditure and provide a continuum of care and help us realize the Sustainable Development Goal 3 of universal health care.[3]

Endemic, emerging and re-emerging zoonotic diseases: The way forward!

Endemic, emerging and re-emerging zoonotic diseases: The way forward!

An Analysis of Risk Assessment of Health Care Workers Exposed to COVID -19 Cases

Introduction: People most at risk of acquiring the disease are those who are in contact with or care for patients with COVID-19. This inevitably places health care workers (HCWs) at high risk of infection, especially when there is a breach in the personal protection while managing patients for categorization of risk in exposure to COVID-19 in health care workers, a risk assessment tool in the form of questionnaire has been devised by The Ministry of Health & Family Welfare (MoHFW), Directorate General of Health Services after the risk assessment of HCWs as high or low risk, management is done according to the recommendations. Materials & Methods: We analyzed the data collected by the Risk Assessment Committee members of Health care workers exposed to COVID 19 for a period of 1year from June 2020 to June 2021. After the interview of HCWs, they were categorized as high or low risk. Results: Risk assessment committee(RAC) members interviewed a total of 1660 HCW contacts of 144 index cases in one year period from June 2020 to June 2021. Our contacts include doctors, nurses, technicians, sanitation worker and other staffs. Index cases were mostly HCWs except few, who were patients. On an average, we used to receive a list of 8-12 contacts for each index case from the Contact Tracing Committee. Out of 1660 contacts, we found 241(14.5%) were high risk and 1419 (85.4%) low risk. Conclusion: Risk assessment of HCWs not only reduces the burden of disease in HCWs, but also prevents unnecessary quarantine of low risk category and shortage of man power as more scientific evidence on COVID- 19 becomes available, more accurate validated risk prediction scores will facilitate more precise estimates of individual risk.

Wastewater-based epidemiological surveillance to monitor the prevalence of SARS-CoV-2 in developing countries with onsite sanitation facilities

Wastewater-based epidemiology (WBE) has emerged as a valuable approach for forecasting disease outbreaks in developed countries with a centralized sewage infrastructure. On the other hand, due to the absence of well-defined and systematic sewage networks, WBE is challenging to implement in developing countries like Bangladesh where most people live in rural areas. Identification of appropriate locations for rural Hotspot Based Sampling (HBS) and urban Drain Based Sampling (DBS) are critical to enable WBE based monitoring system. We investigated the best sampling locations from both urban and rural areas in Bangladesh after evaluating the sanitation infrastructure for forecasting COVID-19 prevalence. A total of 168 wastewater samples were collected from 14 districts of Bangladesh during each of the two peak pandemic seasons. RT-qPCR commercial kits were used to target ORF1ab and N genes. The presence of SARS-CoV-2 genetic materials was found in 98% (165/168) and 95% (160/168) wastewater samples in the first and second round sampling, respectively. Although wastewater effluents from both the marketplace and isolation center drains were found with the highest amount of genetic materials according to the mixed model, quantifiable SARS-CoV-2 RNAs were also identified in the other four sampling sites. Hence, wastewater samples of the marketplace in rural areas and isolation centers in urban areas can be considered the appropriate sampling sites to detect contagion hotspots. This is the first complete study to detect SARS-CoV-2 genetic components in wastewater samples collected from rural and urban areas for monitoring the COVID-19 pandemic. The results based on the study revealed a correlation between viral copy numbers in wastewater samples and SARS-CoV-2 positive cases reported by the Directorate General of Health Services (DGHS) as part of the national surveillance program for COVID-19 prevention. The findings of this study will help in setting strategies and guidelines for the selection of appropriate sampling sites, which will facilitate in development of comprehensive wastewater-based epidemiological systems for surveillance of rural and urban areas of low-income countries with inadequate sewage infrastructure.

Role of Fellows of Bangladesh College of Physicians and Surgeons in the Management of COVID-19 Crisis

The first case of COVID-19 in Bangladesh was declared in March 08, 2020 and since then we are fighting against this deadly pandemic under the prudent and dynamic leadership of Hon’ble Prime Minister Sheikh Hasina as Chief Advisor. The active, sincere and dedicated efforts of Prime Minister’s Office, Cabinet Division, Ministry of Health and Family Welfare and other different ministries have proved this COVID battle to be a winning game for our country. All the doctors, nurses and health workers played the pivotal role along with administration, police and all others. Among the frontline doctors, the fellows and members of all specialties of Bangladesh College of Physicians and Surgeons (BCPS) had a significant participation. They remain to be appraised. This review article probes to reveal the enormous contributions of all fellows and members of BCPS in various sectors of the COVID-19 battle in Bangladesh. This paper analyzed all activities of BCPS fellows and members by collecting data from the COVID-19 dedicated hospitals, Directorate General of Health Services, Bangladesh and directly from fellows of BCPS. A systematic search in the net was also performed using specific search words to extract relevant data and articles published on COVID-19 from Bangladesh. A non-probability sampling technique was used without any structured questionnaire. Data were directly included in MS excel spread sheet. Simple description analysis was performed and results were expressed in tables and charts. We found that fellows and members of BCPS took a significant leadership and provided supreme dedicated services in almost all fields of COVID-19 crisis; e.g. frontline patientcare, education and training, national policy making, research and publication and nationwide guidance and awareness build-up. Among the doctors of government COVID-19 dedicated hospitals in Dhaka, about 650 fellows participated in treating about 1.5 lacs admitted patients. First interim guideline on COVID-19 management in Bangladesh was published by fellows in executive committee of Bangladesh Society of Medicine. It was later transformed into national guideline by DGHS. Fellows were the leaders at national level. The National Technical Advisor Committee and Directorate General of Health Services of Bangladesh are the two main bodies who lead the war in the frontline and both are headed by fellows of BCPS. Journal of BCPS was the first in Bangladesh to publish COVID-19 supplement issue on July 31, 2020 with 12 original articles. So far 128 COVID related articles from BCPS fellows have been published in national and international journals. Fellows fought in the frontline in every sector, shoulder to shoulder with all doctors and health workers of Bangladesh. They have triumphed their beloved college, Bangladesh College of Physicians and Surgeons, to be one of the greatest centers of excellence for the medical education and patient care in Bangladesh. J Bangladesh Coll Phys Surg 2022; 40: 19-27

Approach of Ayurveda in post COVID management

COVID-19 is a respiratory illness global epidemic caused by “Severe Acute Respiratory Syndrome Coronavirus 2”. Acute post COVID syndrome lasts longer than 3 weeks after the main infection, whereas chronic post COVID syndrome lasts longer than 3 weeks after the main infection. Fatigue, dyspnea, low-grade fever, cough, tastelessness, anosmia, chest pain, myalgia, and sleep and mental disturbances are common post-COVID manifestations. The cause of post-COVID syndrome is not well understood. According to Ayurveda concepts, the symptoms of Covid-19 are similar to Vatakapha pradhan Sannipataj Jwara and there will be Dhatu-Kshaya & Agnimandya Avastha in Post-COVID 19 infection. Hence in this condition agnideepana, amapachana, brimhana and rasayana chikitsa is indicated. A Post-COVID management strategy has been issued by the MHFW's Directorate General of Health Services (EMR Division) that include Ayush Kwath, Samshamani vati or Giloy powder, Ashwagandha vati or Ashwagandha powder, Amla fruit or Amla powder, Mulethi powder, Warm Milk with Haldi, Gargling with turmeric and salt, Chyawanprash and daily practice of Yogasana, Pranayama and Meditation. Many research evidences proved that all these drugs possess anti-inflammatory, antistress, antioxidant and immunomodulatory properties which help in management of post COVID syndrome.

Impact of TeleHealth Services through “Shastho Batayon 16263” for Tackling the COVID-19 pandemic in Bangladesh

Background: The National Telehealth Service,“Shastho Batayon 16263” was launched on April 2016. The aim was to provide cost effective and less time-consuming health care delivery service over one call, by certified health professionals and efficient counsellors 24/7. It has been financed by MoHFW through Directorate General of Health Services (DGHS) and implemented by Synesis IT. To use the service of Shastho Batayon, dialing 16263 from any phone to reach healthcare professionals and health information officers who can give evaluations, treatment and counseling, referral services, emergency ambulance services, and complaint management based on the needs of the customer. Since the outbreak began, Shastho Batayon played significant role regarding delivering health services more than 10 million citizens of Bangladesh by managing of patients with COVID-19 or other diseases in 2020. Methodology: Shastho Batayon 16263 operates on three 8 hourly shifts everyday where 15 doctors and 8 HIOs are engaged per shift initially. During the pandemic situation, calls jumped up to 85,000 per day. Therefore, overall, 150 doctors and 30 HIOs served to tackle the pandemic crisis. Implementation of the telehealth consultation has been conducted according to Standard Operating Procedure (SOP) developed and approved for Shastho Batayon by DGHS through a 24/7 service package. Data was collected by integrated Customer Relationship Management (CRM). While serving the customer, Doctors and HIOs input the required data in the CRM which is analyzed by the integrated software developed by Synesis IT. The CRM also consists patients’ earlier information and his history, previous medication and it can generate prescription through mobile phone.Result: In the first 6 months of 2021, Shastho Batayon successfully managed to serve 1.58 million callers. However, the majority of calls (average 80%) from March to June 2021 were related to COVID-19. Among all the calls from January 2021 to June 2021, 952,646 calls made for doctor’s consultancy (highest in April), 70,413 calls for health information, 104,341 calls for ambulance information, 73,119 complaints were registered and 383,517 people called to know about the service. Shastho Batayon received most of the calls from Dhaka (38%), followed by Chittagong (15%), Barisal (13%) and Khulna (10%) division. Least number of callers were from Mymensing (5%) and Sylhet (3%) division. The proportion of calls received from males were 69% while the rest of the calls were done for females and age distribution was mostly from 21 to 30 years old. Most of the patients called with symptoms of flu like symptoms such as, fever, cough, runny nose, sore throat, weakness and so on. The source of knowing about Shastho Batayonwas mostly from Friends & Family. These repeat callers increased drastically up to 41%. Conclusions: During pandemic where face-to-face health assistance is not possible there Shastho Batayon call center platform could serve as a model for underdeveloped countries. TelemHealth is able to provide low-cost, trustworthy health services while maintaining privacy, earning individuals’ appreciation and contributing to the government’s current health system.

Paediatric dosage ‘need of hours among family physicians/other speciality physicians’

Dear editor, We read the article with bated breath by Sil et al.[1] ‘A study of knowledge, attitude and practice regarding administration of paediatric dosage forms and allied health literacy of caregivers for children’. It is an essential topic because it serves as a reminder to prescribers to emphasise the dose pattern to caregivers. They have very nicely concluded that Physicians must be mindful of the limitations of their knowledge as well as the likelihood of incorrect administration practices among childcarers. Medication errors can be reduced by taking corrective action in this area. Paediatricians, for example, are notorious for emphasising and stressing dosage, approach and patterns. Other speciality physicians are forced to manage paediatric cases in low-developed countries such as India, where paediatricians are few in rural settings. In the current pandemic crisis, dextromethorphan is often used to treat dry cough in in-patients or as a prescription for out-patients. Because its dosage is based on age rather than body weight, there is a lot of variation in the amount of medicine given.[2] The clinical effectiveness of syrup or any other formulation of dextromethorphan for treating acute cough is unknown, and the American Academy of Paediatrics does not recommend it. With this as a backdrop, we tried to focus on current issues that have been highlighted in the media and by India’s drug regulatory authorities. It is with reference to the recent news and official order given by Directorate General of Health Services (DGHS) of India regarding the report of dextromethorphan poisoning admitted at Kalawati Saran Children Hospital in New Delhi.[3] There is another crucial factor to consider with respect to the advisory as per the National Formulary of India (NFI) and Current Index of Medical Specialities (CMIS). In NFI, the age for which drug dextromethorphan advised is 2–12 years with dosage mentioned in Table 1. In CIMS India the dosage for 2–12 years is mentioned and provided information that individualized dose for children up to 2 years has to be followed.Table 1: Information regarding dextromethorphan for childrenIn all the drug resources, there is an indication with a clear distinction between giving doses to children and prescribing doses to adults. Even though, depending on the amount or the components of the exact formulation taken, the medicine dextromethorphan might cause a variety of side effects, the majority of cases with dextromethorphan abuse improve just with supportive care. However, seriously affected patients may need more attention. Because dextromethorphan is typically misused in younger age groups, early detection and treatment of dextromethorphan abuse may be critical in preventing broader substance dependence in these kids.[4] In light of the foregoing, we were intrigued to investigate the labelling of a few pharmaceutical items available at a nearby pharmacy. Again, it is surprising to our knowledge that just a small percentage of the preparations still contain children aged 2 and up. This banning of dextromethorphan for children less than 4 years of age is also an alert for all the family Physicians and Paediatricians and provides us a signal to be vigilant before prescribing any paediatric drug and by sticking to the guidelines or drug dosage information in existence from time to time. As a result, it is now required to follow the DGHS’s new instructions on the use of children above the age of four, regardless of the label. It is also an earnest request for all the prescribers to update knowledge over the over the counter drugs. Ethical approval Not required Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. I would like to submit the letter entitled ‘PAEDIATRIC DOSAGE ‘NEED OF HOURS AMONG FAMILY PHYSICIANS/OTHER SPECIALITY’ to letter to editor, in your esteemed journal. I declare there is no conflict of interest and no completing financial support is required for this work. And also, I confirmed that the manuscript has been read and approved for submission by all the named authors.

Forecasting COVID-19 situation in Bangladesh

Forecasting the COVID-19 confirmed cases, deaths, and recoveries demands time to know the severity of the novel coronavirus. This research aims to predict all types of COVID-19 cases (verified people, deaths, and recoveries) from the deadliest 3rd wave data of the COVID-19 pandemic in Bangladesh. We used the official website of the Directorate General of Health Services as our data source. To identify and predict the upcoming trends of the COVID-19 situation of Bangladesh, we fit the Auto-Regressive Integrated Moving Average (ARIMA) model on the data from Mar. 01, 2021 to Jul. 31, 2021. The finding of the ARIMA model (forecast model) reveals that infected, deaths, and recoveries number will have experienced exponential growth in Bangladesh to October 2021. Our model reports that confirmed cases and deaths will escalate by four times, and the recoveries will improve by five times at a later point in October 2021 if the trend of the three scenarios of COVID-19 from March to July lasts. The prediction of the COVID-19 scenario for the next three months is very frightening in Bangladesh, so the strategic planner and field-level personnel need to search for suitable policies and strategies and adopt these for controlling the mass transmission of the virus.

SECOND WAVE AND PANDEMIC SITUATION OF COVID-(2020-2021) IN BANGLADESH

Background: In Bangladesh, the Institute of Epidemiology, Disease Control and Research (IEDCR) reported the first COVID-19 positive patients in the country on March 8, 2020. The world health organization (WHO) declared a COVID-19 epidemic on March 11, 2020. The aim of this study was related to the situation and relation of tests, infested, recovered and death of people against COVID-19 of Bangladesh. The study was carried out from 8 March 2020 to 30 April 2021 (N=419 days) to observe the status of Bangladesh towards rampant COVID-19. Methods: The data of this research was collected from IEDCR, Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MoHFW), and cross-checked with different newspapers and online news portals. Correlations were made using Spearman's rank correlation coefficient. Results: The total tests, infection, recovered and died were 5357294, 747761, 669995 and 11250; respectively in Bangladesh. The tests of COVID-19 were 1482, 69252, 244064, 460528, 409503, 362113, 397452, 389452, 436862, 454892, 424034, 392403 and 722848 in March to December, 2020 to January to April 2021; respectively in Bangladesh. The infestation of COVID-19 was 49, 7616, 39486, 98330, 92125, 73070, 50457, 44205, 57248, 58948, 21629, 11077 and 128555 in March to December, 2020 to January to April 2021; respectively in Bangladesh. The recovered of COVID-19 was 25, 135, 7904, 34845, 76517, 69452, 71600, 48658, 56099, 70367, 22285, 17140 and 150816 in March to December, 2020 to January to April 2021; respectively in Bangladesh. The death of COVID-19 was 6, 163, 472, 1198, 1264, 1125, 970, 666, 718, 938, 568, 277 and 2237 in March to December, 2020 to January to April 2021; respectively in Bangladesh. The maximum number of people infested and death in April, 2021. The positive correlation found between infested with tests and recovered with tests of April, 2021 by people where (R2= 0.5289, p<0.012 and 0.0000006 p<0.05) and the negative correlation found between tests with date and death with tests (R2= 0.2567, p<0.01 and 0.3614, p<0.01). All the Spearman correlation positive with moderate to strong relation between the variables at the 0.01 level in two-tailed and the total number was n=419. The mean Spearman correlation for tests was 0.31 (range 0.553 to 0.634), for infested was 0.35 (range 0.611 to 0.880), for recovered was 0.796 (range 0.634 to 0.799), for death was 0.808 (range 0.553 to 0.880). March to December 2020 and January to February 2021, not much less than April 2021. Conclusions: More people infested and died in April, 2021 than previous year. This study also indicated that there is moderate to strong relation among tests, infested, recovered and death with COVID-(2020-2021).

Active Surveillance: Strategy to Reach The Unreported TB Patient In Hospitals

Background and Aims: The National Tuberculosis Program (NTP) conducted active surveillance to find unreported TB patients in hospitals. CTB supports by conducted active surveillance in 6 provinces. This study was conducted to see an overview of the implementation of active surveillance of TB cases in hospitals among districts supported by CTB and non CTB supported, including the challenges of active surveillance implementation to provide recommendations for National TB program. Methods: This study is a qualitative research with a case study design. Data collected by document reviews, observations, discussions, and in-depth interviews with key informants. Results: Only about 23% of TB cases from HIS are reported into SITT. This is partly due to the procedure or the flow of tuberculosis (TB) data from the Hospital to the National TB Program, which is a manuallly input by entry the data into the SITT.There are about 70% of cases that are not reportedly due to lack of human resources in the hospital to do data entry. Findings also show that districts supported by CTB have a percentage of cases gap less (4%-43%) than non CTB supported district (43%-74%). The data shows the importance of partnership or involvement of other partners in TB control programs. Conclusion: Active surveillance shows the need to strengthen hospital internal network. Standardized guideline and treatment monitoring mechanism should be established to support active surveillance nationwide. The NTP needs also to collaborate with the Directorate General of Health Services to establish a linkage between HIS and National TB surveillance system.

Adjusted dynamics of COVID-19 pandemic due to herd immunity in Bangladesh

Amid growing debate between scientists and policymakers on the trade-off between public safety and reviving economy during the COVID-19 pandemic, the government of Bangladesh decided to relax the countrywide lockdown restrictions from the beginning of June 2020. Instead, the Ministry of Public Affairs officials have declared some parts of the capital city and a few other districts as red zones or high-risk areas based on the number of people infected in the late June 2020. Nonetheless, the COVID-19 infection rate had been increasing in almost every other part of the country. Ironically, rather than ensuring rapid tests and isolation of COVID-19 patients, from the beginning of July 2020, the Directorate General of Health Services restrained the maximum number of tests per laboratory. Thus, the health experts have raised the question of whether the government is heading toward achieving herd immunity instead of containing the COVID-19 pandemic. In this paper, the dynamics of the pandemic due to SARS-CoV-2 in Bangladesh is analyzed with integrated the Unscented Kalman Filter (UKF) in the SIRD model. We demonstrate that the herd immunity threshold can be reduced to 31% than that of 60% by considering age group cluster analysis resulting in a total of 53.0 million susceptible populations. With the data of COVID-19 cases till January, 2021, the time-varying reproduction numbers are used to explain the nature of the pandemic. Based on the estimations of active, severe and critical cases, we discuss a set of policy recommendations to improve the current pandemic control methods in Bangladesh.