Upazila Health Complex Research Articles

Effectiveness of the 10-valent pneumococcal conjugate vaccine against radiographic pneumonia among children in rural Bangladesh: A case-control study

BackgroundPneumococcal conjugate vaccine (PCV) effectiveness against radiographic pneumonia in South Asia is unknown. Bangladesh introduced PCV10 in 2015 using a three dose primary series (3 + 0). We sought to measure PCV10 effectiveness for two or more vaccine doses on radiographic pneumonia among vaccine-eligible children in rural Bangladesh. MethodsWe conducted a matched case-control study over two years from 2015 to 2017 using clinic and community controls in three subdistricts of Sylhet, Bangladesh. Cases were vaccine eligible 3–35 month olds at Upazila Health Complex outpatient clinics with World Health Organization-defined radiographic primary endpoint pneumonia (radiographic pneumonia). Clinic controls were matched to cases within a one week time window by age, sex, and clinic and had an illness unlikely to be Streptococcus pneumoniae; community controls were healthy and similarly matched within a one week time window by age and sex, and distance from the clinic. We estimated adjusted vaccine effectiveness (aVE) using conditional logistic regression. ResultsWe matched 1262 cases with 2707 clinic and 2461 community controls. Overall, aVE using clinic controls was 21.4% (95% confidence interval, −0.2%, 38.4%) for ≥2 PCV10 doses and among 3–11 month olds was 47.3% (10.5%, 69.0%) for three doses. aVE increased with higher numbers of doses in clinic control sets (p = 0.007). In contrast, aVE using community controls was 7.6% (95% confidence interval, −22.2%, 30.0%) for ≥2 doses. We found vaccine introduction in the study area faster and less variable than expected with 75% coverage on average, which reduced power. Information bias may also have affected community controls. ConclusionsClinic control analyses show PCV10 prevented radiographic pneumonia in Bangladesh, especially among younger children receiving three doses. While both analyses were underpowered, community control enrollment – compared to clinic controls – was more difficult in a complex, pluralistic healthcare system. Future studies in comparable settings may consider alternative study designs.

Socio-Economic Condition and Livelihood Status of the Fisherman Community at Muradnagar Upazila in Cumilla

The present study become carried out to assess the socio-economic condition and livelihood structure of fishermen community at Muradnagar Upazila under Cumilla district during the period from February 2019 to July 2019. This Upazila is very close to Gumti River. Data were collected from randomly selected 40 respondents of local fishermen community through questionnaire interview. The study was performed on the basis of personal interview and Focus Group Discussion. From the survey, it was estimated that most of them are directly or indirectly involved in fishing. They are engaged in different fishing-related activities during banning season. The study shows that the majority (66%) of fishermen were Hindu, where 34% were Muslim. The literacy rate was only 18% here. The research indicates that 70% of fishers directly involved in fishing. They were provided license card from Upazila Fisheries Office. Their jointed family was 70%. Most of them live in a tin shed house which is 90%. The survey also informed that most of the fisher, like 80% use tube-well for drinking water. Treatment facilities were developed, but it depends upon their economic condition. Poor fishermen go to village doctor and kabiraj for treatment. Comparatively wealthy fishermen go to Upazila Health Complex and Sadar hospital in serious condition. In the study area, there were no training facilities for local fishermen. Sometime they could not get enough loans for lack of proper management program. As a result, fishers became helpless while flooding occurs. Electricity facilities in the study area were better than before. Annual incomes of the fishermen were varied from BDT 50000-100000. Except fishing, fishermen were involved in net making, boat construction, agricultural activities etc. The government should come forward to take necessary steps to manage their problems and to motivate them for creating significant opportunities for their better livelihood structures.

Assessment of risk factors associated with vitamin D status among children of an urban and a rural areas of Bangladesh

Background: Vitamin D deficiency is one of the most common micronutrient deficiency in children worldwide, even in Bangladesh. However, to date, the prevalence of vitamin D deficiency among children of different region of Bangladesh is less reported.
 Objective: This study was conducted to assess vitamin D status of urban and rural Bangladeshi children including the risk factors associated with vitamin D deficiency are also evaluated.
 Methods: A multi-centre (urban and rural based), cross sectional study was done from July 2016 to June 2017, using serum 25(OH) vitamin D3 as a marker of nutritional vitamin D status. Urban and rural children were taken from Paediatric Outpatient Department, United Hospital Limited. Dhaka and Medical Outpatient Department, Upazila Health Complex, Ghatail, Tangail respectively. Children of 1-10 years age attending OPD with mild undernutrition (<–1 SD z score) and/or clinical features suggestive of vitamin D deficiency were included in the study.
 Results: A total 150 children were studied with 102 (68.0%) urban and 48 (32.0%) rural children. Hypovitaminosis D (25-OHD <30ng/ml) was found in 75.0% of children. Hypovitaminosis D was found significantly more in urban children (81.0%) compared to rural (62.0%) children (OR=0.382, 95% CI: 0.177-0.822, p value <0.05). Inadequate exposure to sunlight was significantly associated with hypovitaminosis D compared to adequate sun exposure and it was about 2.5 times higher (OR=2.475, 95% CI: 1.139-5.380, p value <0.05). No significant associations of vitamin D deficiency were detected with skin color of children, covering clothes of mother, exclusive breast feeding, limb pain and anthropometric status. Children of higher educated mother (above Secondary School Certificate) (OR=0.412, 95% CI: 0.189-0.900) were more associated with vitamin D deficiency.
 Conclusion: Vitamin D deficiency (VDD) is prevalent among Bangladeshi children, urban children being more vulnerable to VDD. Adoption of a screening programme for children of all age group and implementation of preventive strategies for VDD through public health policies are strongly recommended.
 Bangladesh Med Res Counc Bull 2020; 46(2): 134-141

Accessibility to Health Care Services of Upazila Health Complex: Experience of Rural People

Background: Upazila health complex (UHC) is the first referral health facility at primary level of health care delivery system in the country. Rural people attend the UHCs to meet their health care needs and demands. But accessibility of the rural people to the UHCs is still not up to the mark.
 Objective: This study was conducted to assess accessibility of rural people to health care services of UHC.
 Methods: The study was a cross-sectional study, which was conducted at the Kaliakair UHC of Gazipur district in Bangladesh during the period from January to December 2016. The study included 300 rural adults, who were selected systemically. Data were collected by face-to-face interview with the help of a semi-structured questionnaire. Prior to data collection, informed written consent was taken from each participant.
 Results: The study revealed that males (51.3%) and females (48.7%) were very close in proportion with mean age of 35.73(±11.74) years. More than three fourth (77.3%) were married and 31.3% had primary education while 28.7% were illiterate. One third was housewives; average family size was 5.43 (±2.54) and average monthly family income was Tk.13920 (±10290.75). Around half of the participants choose the UHC for effective treatment and due to close distance from their residence while one third for low cost treatment and free of cost treatment. Around half of them didn‟t find any display board at the UHC. More than three fourth (82.0%) regarded doctor‟s behavior as „Good‟ while behavior of supporting staff was regarded „Good‟ by 66.0% participants. About half of the participants went to the UHC by rickshaw and 32.0% on foot. Average waiting time was 23.99 (±15.07) minutes to get access to treatment. Off all, 62.0% got full course of prescribed drugs but majority (71.3%) didn‟t get access to advised laboratory facility. Most (82.7%) could not be admitted in the hospital due to insufficient bed (24.2%) and inadequate treatment facility (22.6%), manpower (62.8%) and drug supply. Overall accessibility to UHC was „good‟ (21.3%) followed by „average‟ (31.3%) and „poor‟ (47.3%). It was found that females (53.3%) had significantly (p<0.05) poor accessibility to the UHC services than their counterpart males (41.1%). On the contrary, young adults, elderly, illiterate and primary education groups had significantly (p<0.05) „poor‟ accessibility to UHC services. Higher education (42.9% Masters and 36.4% Graduates) group had significantly „good‟ accessibility. More than half (53.1%) of the service holders and majority (60.0%) of higher income (Tk.30001-50000) group had had „average‟ and „good‟ accessibility respectively, which is statistically significant (p<0.05). Barriers to accessibility included long waiting time (67.0%), inadequate drug supply (62.0%), limited laboratory facility (40.0%), inadequate manpower (37.9%) and poor cooperation of the staff (32.0%) and communication (18.4%).
 Conclusion: To improve accessibility of the rural people to the health care services of the UHC, associated problems must be overcome by effective measures and program interventions.
 JOPSOM 2019; 38(2): 30-37

Complementary Feeding Practices Among Mothers of Rural Bangladesh; A Knowledge, Attitude, and Practice Study

Background. In developing countries, inadequate knowledge and cultural practice on complementary feeding (CF) is one of the main reasons for malnutrition.
 Objective: This study aimed to document the knowledge, attitude, and practices pertaining to CF among the mothers of rural area in Bangladesh.
 Materials and Methods: A communitybased cross-sectional study was conducted in upazila health complex, kachua, Chandpur from July to December, 2017. A total 408 mothers of the babies aged 6-24 months and children under six months were included. Data were collected from the mothers/caregivers of the children in a pretested semi-structured data collection sheet and analyzed by SPSS version 20. Appropriate statistical tests were done. Statistical significance was considered if p value was <0.05.
 Results: Knowledge regarding recommended CF practice only 50.8% but feeding should be started at 6 months of age (52.9),thick consistency (40.2%), adequate quantity( 61.8%), and appropriate quality (62.3%) cases. Knowledge in recommended appropriate timing and consistency varied significantly with maternal education. Frequency of CF was not appropriate in many cases. Most common first complimentary food was thick dal with rice/roti, khichuri rice 166(40.7%). One hundred twenty four (30.4%) mothers did not properly clean their hands before feeding and 138(33.8%) of mother used bottle for feeding, force full feeding (56.9%) and environment during feeding playing 72.5% and roaming around 25.5%.
 Conclusion: CF knowledge and practices are far gap from ideal in our country. Awareness building in the community may change improper feeding practices need health education.
 KYAMC Journal Vol. 11, No.-1, April 2020, Page 26-31

Utilization of Essential Service Package by rural community

Background: Government has implemented Essential Service Package (ESP) under Health, Nutrition and Population Sector Program (HNPSP) to reach and maintain the highest attainable level of health care to the people of Bangladesh.
 Objective: To assess the utilization of Essential Service Package by rural community.
 Methodology: A descriptive, cross-sectional study was carried out during January 2011 to June 2011 on 160 respondents of age 18 years and above.Sample was selected purposively from Nababganj Upazila under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire. Data analysis was done by SPSS version 16.
 Results: The study revealed that highest number (71.9%) of respondents attended Upazila health Complex (UHC) to utilize ESP services. Among the respondents female (85.6%) were more than male. The lower class (19.4%) and middle class population (46.9%) utilized significantly more than upper class (8.7%).The most of the respondents had primary level of education (31.9%). Utilization of Expanded Programme on Immunization (EPI) (82.9%), Antenatal care (ANC) (16.2%), Family planning (FP) (11.2%), treatment of communicable diseases (40%) and limited curative care (12.5%) were found. Regarding Behavioural change communication (BCC) (41.3%) said that they got health education from the UHC and 58.9% response was negative.
 Conclusion: The overall utilization of ESP services is good. To utilize the ESP from the existing UHC facilities for the rural community population is needed to be strengthening for achieving the health goals.
 Northern International Medical College Journal Vol.10 (2) Jan 2019: 377-380

Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method

ObjectiveThis study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.DesignMixed-methods, combining qualitative...

Opportunities and Challenges At Upazila Health Complexes

Abstract not available
 JCMCTA 2019 ; 30 (2) : 1-3

Developing accountability mechanisms in NGOs in providing health services

ABSTRACT Purpose: The aim of this study is to evaluate NGOs’ accountability in delivering sub-district (upazila) health services in Bangladesh Methodology: The approach of this study is qualitative and 85 respondents, including two focus group participants (each focus group consists of 8 respondents) from rural and urban areas, have been selected for the interview to collect data for understanding accountability mechanisms and NGOs in health care delivery. Findings: The study found that the staff members of NGOs ensure their accountability to their higher officials and the conditions of fund-receiving agencies. Field data demonstrate that NGOs have poor accountability to the government and the local elected representatives because of their poor coordination, lack of policy, and an inadequate legal framework. In addition, NGOs work with limited clients in a particular area, but they have no direct accountability to service users as the policy of the organization does not allow being accountable. The mechanism of supervision is cooperative and supportive which closely guides the staff to contribute to the effective and efficient health care. NGOs have limited capacity and resources for promoting health care although they use their available resources efficiently, with strong monitoring and supervision to provide satisfactory health service delivery. In addition, the positive behavior of NGO health care providers, the minimal amount of time needed in getting services, friendly insurance schemes, freedom from politics and greater fairness all contribute to the effective and efficient health care delivery. Practical Implications: The evidence of this research will promote health care management and ensure good governance in health service delivery as NGOs in supervision mechanism and resource management are highly appreciated and could be a good example for health service managers. Also, this research can be a policy guideline for health care managers for future improvement for many developing countries. Originality/value: This paper demonstrates that managerial efficiency, intensive supervision, need-based motivation, commitment and positive ethos contribute to promoting NGOs’ health service accountability and the quality health care. The ideas on accountability mechanisms promote good governance in the health service organizations and can be a valuable understanding for international health care managers around the world. Abbreviations: BRAC: Bangladesh Rural Advancement Committee; CC: community clinics; GK: Gonoshasthaya Kendra; NGOs: Non-governmental Organizations; PNC: Post natal care; TB: tuberculosis; UHC: Upazila health complex; UPHCP: urban primary health care project (UPHCP)

Pattern of Non-Communicable Diseases among the Admitted Patients in a District Level Hospital of Bangladesh

Background: Non-communicable Diseases (NCD), particularly cardiovascular diseases, cancer, diabetes and chronic respiratory disease, have emerged as the leading threat to mankind worldwide. Likewise in Bangladesh, an increasing trend of incidence of NCDs has been observed and already they have become major public health concern. Hence, we aimed to study the pattern of NCDs among the admitted patients at an Upazila Health Complex (UHC) in Bangladesh.
 Methods: In this retrospective study, data of in-hospital patients admitted from January 2018 to June 2018 in UHC, Chhagalnaiya, Feni was analyzed. Data on age, gender, occupation, hospital admission/discharge and diagnosis of disease was obtained from the hospital register. Diseases were categorized into NCD or communicable disease using the World Health Organization’s International Classification of Diseases (ICD) coding system.
 Results: 1,367 adult patients with different diseases were admitted into the medical ward over the study period of six months (mean age 57.4 ± 17.9 years; 61.3% male and 38.7% female). There were 904 cases of various NCDs constituting 66.1% of total admissions. The number of cases of NCDs was two times more compared to CDs (ratio 2:1). In all six months, admissions due to NCDs were significantly higher compared to communicable diseases CDs (p = 0.0001). Among the admissions due to NCDs, more than half (51.3%) were aged between 50 to 69 years. In terms of pattern of disease, cardiovascular diseases were the number one cause for hospital admission followed by endocrine disorders.
 Conclusion: This study found that the burden of NCDs has increased among the admitted patients in an UHC. These findings could be useful to draw the attention of health authorities to adopt preventive strategies against NCDs even at Upazila level.
 Bangladesh Heart Journal 2019; 34(2) : 118-121

Respiratory Morbidities among Children in a Grass Root Level Hospital in Bangladesh

Children mostly suffer from respiratory illnesses around the world. Situation is not different in Bangladesh as suggested by many studies on childhood illness. But most of these studies have been done in tertiary level hospitals located in urban areas and very few were done in rural setting. This study was conducted to estimate the frequency and to determine the pattern of respiratory morbidity among children and also to assess the impact of passive smoking on the magnitude of acute respiratory tract infections (ARI) among children. This was an observational study. It was carried out on 1002 children over a period of about 180 days, who attended the Tungipara Upazila Health Complex (UHC), Gopalganj, Bangladesh between January 2018 and June 2018. Data were collected through face to face interview, physical examination, relevant investigations and collected data in the questionnaire for respiratory illness and others then respiratory data were not collected. Out of 1002 children, more then half (54%) were male and the age range was new born to 168 months. Among them upper respiratory tract infections (URTI) were 98.5% as against only 1.5% of lower respiratory tract infections (LRTI). In this study, 38% fathers were smoker and no mother found as smoker. Families of 63% patients used smoke producing substances for cooking. Respiratory illness was more prevalent among the children whose fathers used to smoke tobacco χ2 (1) 380 P 0.01. As well as babies more vulnerable for respiratory morbidity where smoke producing fuel used for cooking χ2 (1) 170 P 0.01. Children suffered more from diseases affecting the respiratory system than diseases of other systems. Simple cough related illness was the most common URTI. Under 05 children suffered most. Respiratory illness was more common among those whose fathers smoked tobacco. Children were more vulnerable to respiratory morbidity, where smoke producing fuel used for cooking. There need multicentric study to observe the real picture of respiratory morbidity.
 Bangladesh Med J. 2019 Jan; 48 (1): 1-4

Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level

ObjectiveTo explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services...

Evaluation of Endemic Status of Lymphatic Filariasis in Areas Adjoining to the Endemic District of Bangladesh

In Bangladesh, it was assumed that the endemicity of Lymphatic Filariasis (LF) in areas adjoining to the endemic districts may be related to the endemicity of this districts due to presence of sufficient vectors and extend of microfilaria for it’s chronicity. LF is caused by nematodes (round worms) and mainly transmitted to man by the infected- Culex mosquito. Among the 3 types of thread-like filarial worms; Wuchereria bancrofti is responsible for 90% of the cases. Filariasis is endemic in 34 districts and clinical cases are reported from 51 districts, with high endemicity in the northern part of Bangladesh. This cross-sectional survey study was conducted among 6,100 participants at areas adjoining to the endemic districts of LF to evaluate the endemic status during the period of 1st July 2014 to 30th June 2016. Total 10 sub-districts (upa-zilas) were selected from 5 districts of 4 divisions adjoining to the filaria endemic districts, and then 02 sub-districts (Sub-D) from each district. From each Sub-D, 02 unions (several unions constitute a sub-districts) and 10 ‘spot check site (SCS)’ from these unions were selected randomly. Villages and nearby areas of the ‘SCS’ were publicized previous day of data collection by personnel from Upa-zila Health Complexes (UHC) and audio announce. Average 60 samples were collected from each ‘SCS’ and interviewed participants in the same day. Data were collected by using On Site Filariasis Rapid test cassette for identifying the filarial cases and socioeconomic and demographic data had also been collected by interviewing using questionnaire. The mean age of the participants was 30.03+14.85; female - male ratio of were 1: 0.97 and almost equal numbers (20%-30%) respondents were in each age group (5-15, 16-25, 26-40 and >40 years). Most of the participants were Muslims and two third were married, where 56% were completed primary education or could not read and write and 44% secondary level or above. Nearly three fourth of participants were involved in household/ agricultural works or laborers; others were students, had service and small business and 01% had no work. Two third of participants had no income or could not state and other had monthly income ranges from 1000 to 10,000 taka. Prevalence rate of LF test positive cases was 0.2%; male-female ratio was 1:3, IgG was detected in 83% and rest IgM. Two third of cases were in age group 16-25 years and one fourth in >40 years; only 8.3% were in 5-15 years and no cases were found in age group 26-40 years. All positive cases were Muslim and two third were married, where majority were illiterate or primary and rest of them completed secondary or above. Two third of cases did household or agricultural works and rest were students. Two third had no income or could not state, one fourth had >2000 to 5000 taka and only 8.3% had income 5001–>10000 taka. The highest prevalence rate (2.50/1000 Pop) were found in Naogaon & Gaibandha districts and sub-districts were Niamotpur & Sadullapur (5.0/1000 Pop) and no cases were detected at Singra (Natore), Porsha (Naogaon), Palashbari (Gaibandha). Two third of cases suffered from itching; majority had fever and cough and one third stated breathlessness. Clinical signs edema was seen in feet 41.7% of cases. Few cases 08.3% had reached to health care facilities and 91.7% cases had never sought diagnostic facilities. Adjoining areas of endemic districts of LF are prone to spread this disease. Routine survey of LF cases would be continued in areas adjoining to the endemic district.
 Bangladesh Med J. 2019 May; 48 (2): 13-19

Awareness about Antenatal Care Services among Rural Pregnant Women

Introduction: Antenatal care (ANC) is the care of a pregnant woman required to ensure a healthy pregnancy and safe childbirth. According to the World Health Organization to achieve the full life-saving potential for pregnant women and babies, minimum four ANC visits are essential. Quality and quantity of ANC visit depends on socio-demographic characteristics, knowledge, awareness and attitude of the individual. To get the benefits from ANC services awareness among pregnant women and their family members are very important.
 Objective: To evaluate the awareness about ANC service among the pregnant women attending Upazila Health Complex of a rural community.
 Materials and Methods: This descriptive cross-sectional study was conducted among the pregnant women attending the outpatient department of Kaligonj Upazila Health Complex, Gazipur, Bangladesh from January to March 2017. Data were collected by face-to-face interview of the respondents using a structured questionnaire. Chi-square (χ2) test was done to see the association among the respondents’ socio-demographic characteristics with awareness about ANC services.
 Result: Respondents’ age range was 16-40 years and 61.9% were below 25 years and 71.1% married before 20 years. More than half (66.5%) of the respondents’ found aware about pregnancy danger sign, safe delivery and benefits of ANC service. This study found a significant (p<0.05) association between socio-demographic characteristics and awareness about ANC services of respondents.
 Conclusion: Overall knowledge and awareness level on different component and benefits of ANC visit were below the national standard. To improve the community awareness and practice on ANC services community campaign is recommended.
 Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 11-14

Job satisfaction of doctors working at Upazila Health Complexes in Barisal District.

Doctor's profession has long been among one of the most attractive professions in our society, but doctors are increasingly getting dissatisfied with their jobs. Job satisfaction is very important but very less studied issue. The aim of this study to assess the level of job satisfaction among doctors at selected Upazila Health Complexes in Barisal District. A descriptive cross sectional study was conducted among 59 doctors posted in 9 Upazila Health Complexes of Barisal district. Data was collected by using structured questionnaire consisting of 54 questions and JSS (Job Satisfaction Survey) scale, where higher values indicated higher level of satisfaction. The average scores of items were computed to construct factor scores for each individual. The total number of doctors included in this study was 59.78% were male. Majority (66.1%) had age ranged 25-35 years. Majority (86.4%) of doctors was married and almost 80% were Muslim. Most of the respondents (64.4%) had clinical experience of 0 to 5 years. The result displayed that 57.6% of doctors were dissatisfied, 27.1% were satisfied and 15.3% were ambivalent. Majority of the respondents were dissatisfied with salary, promotional scope allowances, night duty, working hours, accommodation facility and transport facility. Job satisfaction among doctors in this study was low. Responsible authority should take necessary action to improve job satisfaction.

Antenatal care practice among Pregnant Women in a selected rural area of Bangladesh

Background : Antenatal care (ANC) is an important determinant of high maternal mortality rate and one of the basic components of maternal care on which the life of mothers and newborn babies depend.
 Objective : To study the Antenatal care practice among pregnant women in a selected rural area.
 Methodology : This descriptive cross-sectional study was conducted among pregnant women in a selected rural area from July 2016 to December 2016. Total sample was 121. Purposive sampling technique was followed. Data collection was done by face to face interview by using pretested structured questionnaire. Data was analyzed by SPSS version 17.0.
 Results : A total of 121 women were interviewed. Sixty nine (57.02%) pregnant women were registered for ANC. Among them 47(68.11%) of respondents completed more than 4ANC visits. For the current pregnancy 56(46.28%) preferred Upazila Health Complex (UHC) and home delivery was preferred by 34(28.09%) respondents. Among the respondent age group 25-30 yrs were 61(50.41%) and educated upto primary level were 59(48.76%). Monthly income between 5000-10000 taka was among 48(39.66%) respondents. Most of their husbands (52.06%) were educated up to primary level and 25.61 % of them were garments worker and 23.96 % were day laborers.
 Conclusion : ANC practice was not satisfactory. Only half of the pregnant women attended for ANC and completed minimum four visits. Nearly half of the pregnant women preferred UHC. Educated women from lower economic status were found to attend for ANC.
 Northern International Medical College Journal Vol.10(1) Jul 2018: 339-342

Study of Primary Amenorrhea with etiology in out door patient of Rupganj Upazilla Health Complex

Background : Amenorrhea means without menstruation. Primary Amenorrhea is the absence of menstruation by 16 years of age in the presence of normal secondary sexual characteristics or by 14 years of age if secondary sexual characteristics have not developed.Objectives : To explore the prevalence of Primary Amenorrhea with etiology in outdoor patient with limited investigation sourcesMethods : This was a cross sectional study conducted at Rupganj Upazila Health Complex (UHC) from January 2014 to June 2016. During this period total 2500 patients attended at Gynae out patient department (OPD). Among them 45 patients was sorted out with Primary amenorrhea. History and physical examination was done for presence or absence of secondary sexual characteristics, external genital abnormalities. Investigations were ultrasonogram (USG), Hormonal test were Follicle stimulating Hormone (FSH), Lutilizing hormones (LH), Serum Prolactin, Thyroid Stimulating Hormone. Karyotyping done. Data were analysed by using SPSS version 20.Result : In our study prevalence of Primary Amenorrhea was 1.8%. Among them infantile uterus was 17.78%, imperforated hymen was 13.33%. Turner mosaic 11.4%, mullarian agenesis 6.66%, gonadal agenesis-4.45%. hypothyroid 8.89%, hyperprolactenemia-8.89%, and 11.11% patients were with positive progesterone challenge test without anatomical and hormonal abnormalities.Conclusion : Considering the study result, Infantile uterus was the most prevalent etiological factor of amenorrhoea followed by imperforated hymen and Turner mosaic.Northern International Medical College Journal Vol.9(2) Jan 2018: 300-303

Using focused pharmacovigilance for ensuring patient safety against antileishmanial drugs in Bangladesh\u2019s National Kala-azar Elimination Programme

BackgroundAdverse effects of antileishmanial drugs can affect patients’ quality of life and adherence to therapy for visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). In Bangladesh, there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas (subdistricts) of 26 districts (these include VL, PKDL, treatment failure, and relapse VL and cutaneous leishmaniasis cases). This study aimed to investigate the feasibility of using focused pharmacovigilance for VL (VLPV) in Bangladesh’s National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions (ADRs).MethodsThis activity has been going on since December 2014. Activity area includes secondary public hospital or Upazila health complex (UHC) in hundred sub districts and Surya Kanta Kala-azar Research Center (SKKRC) in Mymensingh District, a specialized center for management of complicated VL and PKDL cases. Communicable Disease Control (CDC) of the Directorate General of Health Services (DGHS) assigned twenty five of hundred UHCs and SKKRC (total 26) as treatment centers depending on their suitable geographical location. This was implemented for better management of VL cases with Liposomal Amphotericin B (AmBisome®) to ensure patient convenience and proper utilization of this expensive donated drug. A VLPV expert committee and a UHC VLPV team were established, an operational manual and pharmacovigilance report forms were developed, training and refresher training of health personnel took place at UHCs and at the central level, collected information such as patient data including demographics, treatment history and response, adverse events were analyzed. This report includes information for the period from December 2014 to December 2016.ResultsFrom December 2014 to December 2016, 1327 leishmaniasis patients were treated and 1066 (80%) were available for VLPV. Out of these, 57, 33, 9, and 1% were new VL, PKDL, VL relapse, and other cases, respectively. Liposomal amphotericin B was mostly used (82%) for case management, followed by miltefosine (20%) and paromomycin (3%). Out of the 1066 patients, 26% experienced ADRs. The most frequent ADR was fever (17%, 176/1066), followed by vomiting (5%, 51/1066). Thirteen serious adverse events (SAEs) (eight deaths and five unexpected SAEs) were observed. The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment. Out of the five unexpected SAEs, four were miltefosine-induced ophthalmic complications and the other was an AmBisome®-induced avascular necrosis of the nasal alae. The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre (WHO-UMC) VigiFlow database.ConclusionsThis study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.

Thyroid Surgery under Local Anaesthesia: Study of 30 Cases

Background: Thyroidectomy is usually done under general anaesthesia.Objective: The purpose of the present study was to present our experience and evaluate effectiveness of thyroid surgery under local anaesthesia.Methodology: This is a cross-sectional study carried out in upazila health complex, Boalkhali, Chittagong and 250 bed General Hospital, Chittagong since January 2013 to December 2015. 30 patient underwent thyroidectomy for benign and malignant diseases under local anaesthesia. All patients are adult from 20 to 60 years, examined thoroughly investigated accordingly, euthyroid or made euthyroid, normotensive or made normotensive. Each patient was given Tab. Bromazepam 3mg at night before the day of surgery and repeated in morning on the day of surgery. Half an hour before the surgery patient is given injection Pethidine 1mg/kg I.M, injection Ketorolac 30mg I.V, injection Ranitidine 50mg I.V, injection Ondansetron 8mg I.V, injection Ceftriaxone 1gm I.V.Result: Among 30 patients male 8, female 22. Male-Female ration 1:2.75. Mean age 33.8 years. Mean lesion size 5.95cm. Mean Operation time: 91min. Surgery included hemithyroidectomy 18, subtotal thyroidectomy 8, total thyroidectomy 6. Post operative complication included infection in 1 and haematoma in 1 case.Conclusion: In our study thyroidectomy under local anaesthesia found effective and safe in a setup of limited anaesthesia facilities and safe alternative where general anaesthesia is contraindicated.Journal of Current and Advance Medical Research 2016;3(2):56-59

Views of the students of the selected non-government medical colleges of Bangladesh regarding community based medical education (CBME) practice in their institutes

This was a descriptive cross-sectional study conducted in 2015, objective was to find out the views of the students of 3rd phase of non-government medical colleges regarding the community based medical education practice in their colleges. Data was collected from 507 students of 12 medical colleges by using self-administered structured questionnaires. Among the students 223 were from the Dhaka city and 284 from outside the Dhaka city. Almost 90 percent of the students mentioned that their institutes conducted RFST and Day Visit programe, and duration of Residential Field Site Training (RFST) programe ranges from 1-30 days with mean 9.45 and SD ± 6.34. Most of the students mentioned that they did not stay night in the community. About sixty percent of the students were satisfied with the RFST programe . During RFST programme most of the students 387 (77.7) visited upazila health complex, and 296 (59.4) participated in the conduction of survey. Most of the students visited institute of public health, EPI head quarter and MCH centre or clinic during Day visit programme. Most of them mentioned problems faced in RFST programme as: lack of transport support; lack own accommodation facilities; lack of security; and lack of cooperation from the authority of the different organizations. Suggestions given by the students for the further improvement of the practice of CBME programme in their institutes were mainly : realization of importance of CBME by college authority , teachers and students; College authority should be well motivated for conducting the CBME programme activities in their institute; College authority should build dormitories for the permanent solution of the residential problems and College authority should have the required amount of transport for this activities.Bangladesh Journal of Medical Education Vol.9(1) 2018: 21-25