International journal of critical care and emergency medicine, Mar 31, 2022
Background: Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (... more Background: Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh. The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions. Methods: The study was conducted in July/August 2017, after analyzing medical and relevant records, a one week observational study was conducted in 4 purposively selected hospitals in Dhaka city. The Mode of transport to the emergency centre and delay times were determined by observing and assessing medical records of the incoming patients. Information on the management of incoming emergency calls and trips of the ambulances were also documented. Satisfaction and perceived experience with the services was investigated by in-depth interviews of 56 patients relatives. 23 EMRS providers and managers were interviewed for their perceptions and recommendations. Results: Our document analysis of 2 study hospitals in Dhaka showed that 45.9% of total deaths (N = 13707) in 2014 were due to cardiovascular diseases, road traffic incidents, other accidents, and suicides. During the observation in 4 study hospitals, only 11.3% of the 734 emergency patients used ambulances to get to hospital, while 63% used rickshaws/motor-rickshaws and 25.8% bus/ car. 55.6% of emergency patients got to hospital after 60 minutes/later after start of symptoms (median delay 120 minutes; range: 40-2880 minutes). The median delay of ambulances (call to hospitalization) was 85 minutes (day-time 102 minutes; night 45 minutes). On emergency request only 23.6% of the 127 callers, a hospital ambulance was sent to the patient, while the other cases were not supported due to unavailability, long distance, and high fare issues of ambulance. Ambulances were used in only 10.7% of their available time for transporting patients. Ambulances were poorly equipped (unskilled driver, oxygen and rarely with first aid box). Satisfaction level about current services among patients relatives was low (only 1.8 on a scale of 4; N = 56). Major reasons of their not calling for an ambulance at emergencies were unavailability (67.3%) and unknowing phone number (51.9%). EMRS providers and managers complained about the poor structure of EMRS. Major concerns were: Policy deficit, corruption, no coordination centre with unique phone number, poor ambulance services, and traffic-jams. Conclusion: To reduce the number of deaths and disabilities, Dhaka needs to upgrade and improve its EMRS through a step-by-step process of telephone assisted emergency first responders led pre-clinical care.
International Journal of Infectious Diseases, Apr 1, 2016
Conclusion: The new treatment regimens showed excellent outcome and safety profile to be used wit... more Conclusion: The new treatment regimens showed excellent outcome and safety profile to be used within the programme settings. On the basis of these results, Indian national program have revised the treatment policy in Sep 2014 where SDA has been recommended as the 1st option and M+P as the 2nd option. Extension of FU beyond the standard 6 months yielded additional relapses and PKDL cases.
Transactions of The Royal Society of Tropical Medicine and Hygiene, May 1, 2016
Background: The majority of individuals infected with Leishmania donovani complex remain asymptom... more Background: The majority of individuals infected with Leishmania donovani complex remain asymptomatic. They may act as transmission reservoirs for visceral leishmaniasis (VL). We investigated sero-prevalence of L. donovani complex among those closely associated with patients with VL and whether these sero-reactive individuals had Leishmania parasites in their peripheral blood. Other risk factors were also investigated. Methods: A total of 257 individuals in contact with patients with VL were tested for anti-Leishmania antibodies by rK39 immunochromatographic test (rK39 ICT), ELISA using promastigote antigen (p-ELISA) and indirect fluorescent antibody test (IFAT). Buffy coats of rK39 ICT positive individuals were cultured; sero-reactive buffy coats were tested for Leishmania DNA by ITS1 PCR. DNA obtained from culture was sequenced to confirm Leishmania species. Risk factors were evaluated for each sero-positive sample. Results: The results showed 29.2% (75/257) prevalence by serological tests: 14.4% (37/257) were positive by rK39 ICT, 25.3% (65/257) by p-ELISA, 18.3% (47/257) by IFAT and 10.9% (28/257) by all three serological methods. Ten percent (3/30) of cultures were positive for Leishmania promastigotes. Only 3% (2/74) sero-reactive buffy coats were positive for DNA; sequence analysis revealed L. donovani species. Significant risk factors were age, working as farmers, domestic animals in household and proximity to animal shelters. Conclusions: Asymptomatic family members of patients with VL can carry live L. donovani in peripheral blood and may act as potential reservoirs. GenBank accession number: BankIt1863680 Leishmania KT921417 (DNA sequences of the ribosomal ITS1 region of L. donovani).
Transactions of The Royal Society of Tropical Medicine and Hygiene, Dec 1, 2012
Residents of a slum community of Dhaka city, Bangladesh were tested by serological and faecal exa... more Residents of a slum community of Dhaka city, Bangladesh were tested by serological and faecal examination for evidence of Strongyloides stercoralis infection. In stool specimens from a total of 147 participants Strongyloides larvae were found in 34 (23.1%) by Harada-Mori culture, 15 (10.2%) by agar plate culture (APC) and one (0.7%) by microscopy. Strongyloides IgG, IgG1 and IgG4 antibodies were found in 90 (61.2%), 46 (31.3%) and 53 (36.1%) of participants, respectively. A positive correlation was observed between total IgG levels and the presence of isotypes IgG1 and IgG4 (p<0.001). Six sera (4.0%) reacted to the recombinant filaria antigen Bm 14, three of which were Strongyloides IgG positive. This indicates either there is cross reactivity or some participants are co-infected with lymphatic filariasis. No correlations were found between positive serology and Strongyloides infection in stool, sociodemographic factors or domestic hygienic practices. However, positive stool cultures showed significant associations with irregular nail trimming, walking barefoot and irregular hand washing after defecation (p<0.05). Other enteric parasites were detected in stools of some participants but their presence showed no correlation with S. stercoralis infection or socio demographic factors. This study confirms that squatters in this slum community in Dhaka have a high prevalence of S. stercoralis infection identified both by serological and coprological methods.
Background. A safe and effective short-course treatment regimen for post-kala-azar dermal leishma... more Background. A safe and effective short-course treatment regimen for post-kala-azar dermal leishmaniasis (PKDL) is considered essential for achieving and sustaining elimination of visceral leishmaniasis (VL) in the Indian subcontinent [1, 2]. Here, single-dose liposomal amphotericin B (AmBisome) has been adopted as a first-line regimen for VL; however the effectiveness and safety of AmBisome for PKDL has not been formally evaluated. Methods. The safety and effectiveness of AmBisome 15 mg/kg, given over 15 days in 5 biweekly infusions of 3 mg/kg on an outpatient basis, was evaluated between April and November 2014 in patients with clinically diagnosed PKDL, aged ≥12 years and residing in a highly VL-endemic area in Bangladesh. This was a prospective cohort observational study, with the objective to assess final cure 12 months after treatment. Clinical response was monitored at 1, 3, 6, and 12 months, and safety during treatment and up to 1 month after treatment. Results. Of the 280 patients meeting the inclusion criteria, 273 were assessed at 12 months. A complete or major improvement of lesions was seen in 245 patients (89.7%); 213 (78.0%) were considered completely cured. Lesions did not improve in 28 (10.3%) and new lesions appeared in 13 (4.8%). All patients completed treatment without severe or serious adverse events. Conclusions. A short-course 15-mg/kg AmBisome regimen proved safe and effective in the treatment of clinically diagnosed PKDL in Bangladesh, and should be considered a treatment option for routine programmatic use in the VL elimination effort in the Indian subcontinent.
Background: Definitive diagnosis of visceral leishmaniasis (VL) by demonstrating parasites in tis... more Background: Definitive diagnosis of visceral leishmaniasis (VL) by demonstrating parasites in tissue smears or by culture involves invasive procedures, technical expertise and adequate laboratory facilities. Endemic countries rely mainly on serological tests to diagnose VL. Currently, the immunochromatographic test incorporating the recombinant K39 antigen (rK39 ICT) is the reference test for rapid diagnosis of VL in the Indian subcontinent. The performance of serological tests using rK39 and other promastigote antigens can vary due to differences in antigen expression, the various hosts and environmental factors. To achieve elimination of VL, diagnostic accuracy will be necessary for active case detection especially in those who carry asymptomatic infections. We evaluated the performance of rK39 ICT, enzyme linked immunosorbent assay using mixed Leishmania promastigotes from different Leishmania species (p-ELISA) and indirect fluorescent antibody test (IFAT) utilizing whole promastigotes from the Leishmania donovani complex for sero-diagnosis of VL in Bangladesh. Methods: The sensitivity of each serological test was evaluated on 155 patients who were diagnosed to have VL by microscopy and/or by culture methods. Test specificities were calculated on 706 healthy blood donors, 91 diagnostic sera from patients with a febrile illness and sera from patients positive for malaria (n = 91) and Chagas disease (n = 91). All statistical calculations were at 95% confidence intervals. Results: The sensitivities of rK39 ICT, p-ELISA and IFAT were 100%, 86.5% and 92.3%, respectively. All three serological methods had a pooled sensitivity of 82.6%. The specificities of rK39 ICT, p-ELISA and IFAT from combined control groups were 100%, 93.1% and 99.9%, respectively. The respective positive and negative predictive values of the tests were both 100% for rK39 ICT, 66.3% and 97.8% for p-ELISA and 99.3% and 98.8% for IFAT. The p-ELISA showed cross reactivity with 36.3% of sera positive for malaria and 28.6% of sera positive for Chagas disease while rK39 ICT and IFAT showed no cross reactivity. Conclusion: This study confirms the efficiency of rK39 ICT for rapid diagnosis of VL. The p-ELISA using mixed promastigote antigens did not perform well as a serological test for VL in Bangladesh. Due to high sensitivity and specificity of whole promastigote antigen of L. donovani complex utilized in IFAT, this test can be considered in combination with rK39 ICT to confirm VL diagnosis when clinical diagnosis cannot distinguish between other diseases.
Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327... more Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006-2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = −0.88) of human rabies cases (Correlation coefficient: −0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths. Rabies is a zoonotic viral disease responsible for the death of approximately 59,000 people worldwide with more than 3.7 million disability-adjusted life years lost annually 1. Due to acute progressive encephalitis, rabies is almost always fatal once clinical signs appear. The disease occurs predominantly in impoverished communities, in both rural and urban areas, and has been recognized for over 4000 years 2,3. Rabies is present across all continents, except Antarctica with more than 95% of human fatalities happening in the areas of Asia and Africa, and approximately 40% of cases in the population are aged below 15 years. Although all warm-blooded animals are susceptible to rabies, domestic dogs are the main cause of rabies virus transmission to humans in up to 99% of cases in rabies-endemic regions 4. Most cases of rabies are caused by the bite of an infected dog. The effect of rabies virus (RABV) exposure depends on a number of factors, including the gravity of the wound, the anatomical site of the bite on the body, the viral quantity and variant (genotype) inoculated into the wound(s) and the timeliness of post-exposure prophylaxis (PEP) 3. The clinical manifestation of human rabies can appear in any of two forms: the widely perceived furious (classical or encephalitic) form or the paralytic (or dumb) form 5,6. Each case of rabies has
Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. O... more Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. Objective: To determine 1) the numbers of patients diagnosed with visceral leishmaniasis (VL) and post-kala azar dermal leishmaniasis (PKDL) using an active case detection (ACD) strategy in Fulbaria and a passive case detection (PCD) strategy in Trishal, and 2) the time taken from symptoms to diagnosis in the ACD subdistrict. Design: A cross-sectional descriptive study of patients diagnosed from May 2010 to December 2011. The ACD strategy involved community education and outreach workers targeting households of index patients using symptom-based screening and rK-39 tests for suspected cases. Results: In the ACD subdistrict (Fulbaria) and PCD subdistrict (Trishal), respectively 1088 and 756 residents were diagnosed with VL and 1145 and 37 with PKDL. In the ACD subdistrict, the median time to diagnosis for patients directly referred by outreach workers or self-referred was similar, at 60 days for VL and respectively 345 and 360 days for PKDL. Conclusion: An ACD strategy at the subdistrict level resulted in an increased yield of VL and a much higher yield of PKDL. As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent.
Background: Bangladesh is making progress toward achieving zero human dog-mediated rabies deaths ... more Background: Bangladesh is making progress toward achieving zero human dog-mediated rabies deaths by 2030, a global goal set in 2015. Methods: Drawing from multiple datasets, including patient immunization record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between the years 2011 to 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences in Bangladesh and other South Asian countries from GenBank. Findings: The human-to-dog ratio in Bangladesh was 85.83 (95% CI 74.63, 97.03), with an average dog population density of 11.51 dogs/km2 (95% CI 10.09, 12.92). The mass dog vaccination (MDV) campaign has resulted in the vaccination of 81.46% (95% CI: 80.54-82.37) of the estimated 3,030,662 dogs in the country. A decreasing trend from predicted and observed human rabies cases was identified, and it is projected th...
Journal of Advanced Veterinary and Animal Research, 2020
Objectives: Knowledge, attitude, and practice (KAP) of rabies in the community are essential for ... more Objectives: Knowledge, attitude, and practice (KAP) of rabies in the community are essential for developing post-exposure behavioral treatment and for understanding current prevention and control policy on rabies. This was a cross-sectional study in Gaibandha Sadar, a northern district of Bangladesh, investigating the level of KAP about rabies. Materials and methods: A total of 368 interviewed respondents, of whom 280 (76.09%) were male, and 88 (23.91%) were female. A structured questionnaire was used for the data collection from respondents on socio-demographic information and KAP regarding rabies. The data analyzed with STATA-IC-11.0 and the association of independent variables with rabies KAP scores were calculated using Pearson’s Chi-square. Results: Most respondents had adequate KAP levels and positive thoughts on rabies prevention. The KAP scores were strongly associated with education and employment status (p < 0.05). Most respondents said that stray dogs are a headache in the area and believed that control of the dog population in Gaibandha is essential. Conclusion: These outcomes also revealed that there is an information gap about rabies that might improve by developing an education program for awareness.
International Journal of Infectious Diseases, 2014
noticeable decrease in the number of shigellosis cases was observed and subsequent water testing ... more noticeable decrease in the number of shigellosis cases was observed and subsequent water testing on 10 December 2012 showed no E. coli. Conclusion: The sudden unprecedented increase in Shigella cases was likely due to contaminated potable water exposure and additional secondary cases. The investigation highlighted the necessity for continual monitoring of potable water quality and prompt corrective action to maintain a safe water supply in the district. The efficient, timely outbreak response resulted in appropriate public health interventions and underscores the value of a wellfunctioning DORT and NOU-DORT collaboration within the South African public health context.
SUMMARYIn February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of n... more SUMMARYIn February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7–14 days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9·5%, OR undefined, P<0·001) and to have touched him (83% vs. 0%, OR undefined, P<0·001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions.
Background The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) ... more Background The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR's engagement and contribution to this initiative. Methodology/principal findings Multiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid-recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with incountry researchers, national programme managers, and partners to generate evidencebased interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and
Background: The concept of eco-toilets in Bangladesh was promoted by an NGO (Practical Action, Ba... more Background: The concept of eco-toilets in Bangladesh was promoted by an NGO (Practical Action, Bangladesh). The ecotoilets are especially built to collect human excreta for using them as manure on the fields after appropriate treatment for 12 months. Objectives: This study was designed to see the physical properties appropriate for fields and pathogenic potential to ensure the treated human excreta are safe for cultivator’s handling. Methodology: The study was carried out in three phases during 2010 to 2014. A total of 210 composted faecal excreta were examined for physical properties like colour, odour, odour intensity, moisture, bacteriological examination for faecally transmitted potential bacteria and parasitological examination for ova / cysts of faecally - transmitted parasites to recommend whether these composted excreta were suitable for use as manure by the cultivators. Results: Majority of the specimens in all three phases contained remarkable moisture: 22.3-80.0% in all s...
International journal of critical care and emergency medicine, Mar 31, 2022
Background: Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (... more Background: Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh. The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions. Methods: The study was conducted in July/August 2017, after analyzing medical and relevant records, a one week observational study was conducted in 4 purposively selected hospitals in Dhaka city. The Mode of transport to the emergency centre and delay times were determined by observing and assessing medical records of the incoming patients. Information on the management of incoming emergency calls and trips of the ambulances were also documented. Satisfaction and perceived experience with the services was investigated by in-depth interviews of 56 patients relatives. 23 EMRS providers and managers were interviewed for their perceptions and recommendations. Results: Our document analysis of 2 study hospitals in Dhaka showed that 45.9% of total deaths (N = 13707) in 2014 were due to cardiovascular diseases, road traffic incidents, other accidents, and suicides. During the observation in 4 study hospitals, only 11.3% of the 734 emergency patients used ambulances to get to hospital, while 63% used rickshaws/motor-rickshaws and 25.8% bus/ car. 55.6% of emergency patients got to hospital after 60 minutes/later after start of symptoms (median delay 120 minutes; range: 40-2880 minutes). The median delay of ambulances (call to hospitalization) was 85 minutes (day-time 102 minutes; night 45 minutes). On emergency request only 23.6% of the 127 callers, a hospital ambulance was sent to the patient, while the other cases were not supported due to unavailability, long distance, and high fare issues of ambulance. Ambulances were used in only 10.7% of their available time for transporting patients. Ambulances were poorly equipped (unskilled driver, oxygen and rarely with first aid box). Satisfaction level about current services among patients relatives was low (only 1.8 on a scale of 4; N = 56). Major reasons of their not calling for an ambulance at emergencies were unavailability (67.3%) and unknowing phone number (51.9%). EMRS providers and managers complained about the poor structure of EMRS. Major concerns were: Policy deficit, corruption, no coordination centre with unique phone number, poor ambulance services, and traffic-jams. Conclusion: To reduce the number of deaths and disabilities, Dhaka needs to upgrade and improve its EMRS through a step-by-step process of telephone assisted emergency first responders led pre-clinical care.
International Journal of Infectious Diseases, Apr 1, 2016
Conclusion: The new treatment regimens showed excellent outcome and safety profile to be used wit... more Conclusion: The new treatment regimens showed excellent outcome and safety profile to be used within the programme settings. On the basis of these results, Indian national program have revised the treatment policy in Sep 2014 where SDA has been recommended as the 1st option and M+P as the 2nd option. Extension of FU beyond the standard 6 months yielded additional relapses and PKDL cases.
Transactions of The Royal Society of Tropical Medicine and Hygiene, May 1, 2016
Background: The majority of individuals infected with Leishmania donovani complex remain asymptom... more Background: The majority of individuals infected with Leishmania donovani complex remain asymptomatic. They may act as transmission reservoirs for visceral leishmaniasis (VL). We investigated sero-prevalence of L. donovani complex among those closely associated with patients with VL and whether these sero-reactive individuals had Leishmania parasites in their peripheral blood. Other risk factors were also investigated. Methods: A total of 257 individuals in contact with patients with VL were tested for anti-Leishmania antibodies by rK39 immunochromatographic test (rK39 ICT), ELISA using promastigote antigen (p-ELISA) and indirect fluorescent antibody test (IFAT). Buffy coats of rK39 ICT positive individuals were cultured; sero-reactive buffy coats were tested for Leishmania DNA by ITS1 PCR. DNA obtained from culture was sequenced to confirm Leishmania species. Risk factors were evaluated for each sero-positive sample. Results: The results showed 29.2% (75/257) prevalence by serological tests: 14.4% (37/257) were positive by rK39 ICT, 25.3% (65/257) by p-ELISA, 18.3% (47/257) by IFAT and 10.9% (28/257) by all three serological methods. Ten percent (3/30) of cultures were positive for Leishmania promastigotes. Only 3% (2/74) sero-reactive buffy coats were positive for DNA; sequence analysis revealed L. donovani species. Significant risk factors were age, working as farmers, domestic animals in household and proximity to animal shelters. Conclusions: Asymptomatic family members of patients with VL can carry live L. donovani in peripheral blood and may act as potential reservoirs. GenBank accession number: BankIt1863680 Leishmania KT921417 (DNA sequences of the ribosomal ITS1 region of L. donovani).
Transactions of The Royal Society of Tropical Medicine and Hygiene, Dec 1, 2012
Residents of a slum community of Dhaka city, Bangladesh were tested by serological and faecal exa... more Residents of a slum community of Dhaka city, Bangladesh were tested by serological and faecal examination for evidence of Strongyloides stercoralis infection. In stool specimens from a total of 147 participants Strongyloides larvae were found in 34 (23.1%) by Harada-Mori culture, 15 (10.2%) by agar plate culture (APC) and one (0.7%) by microscopy. Strongyloides IgG, IgG1 and IgG4 antibodies were found in 90 (61.2%), 46 (31.3%) and 53 (36.1%) of participants, respectively. A positive correlation was observed between total IgG levels and the presence of isotypes IgG1 and IgG4 (p<0.001). Six sera (4.0%) reacted to the recombinant filaria antigen Bm 14, three of which were Strongyloides IgG positive. This indicates either there is cross reactivity or some participants are co-infected with lymphatic filariasis. No correlations were found between positive serology and Strongyloides infection in stool, sociodemographic factors or domestic hygienic practices. However, positive stool cultures showed significant associations with irregular nail trimming, walking barefoot and irregular hand washing after defecation (p<0.05). Other enteric parasites were detected in stools of some participants but their presence showed no correlation with S. stercoralis infection or socio demographic factors. This study confirms that squatters in this slum community in Dhaka have a high prevalence of S. stercoralis infection identified both by serological and coprological methods.
Background. A safe and effective short-course treatment regimen for post-kala-azar dermal leishma... more Background. A safe and effective short-course treatment regimen for post-kala-azar dermal leishmaniasis (PKDL) is considered essential for achieving and sustaining elimination of visceral leishmaniasis (VL) in the Indian subcontinent [1, 2]. Here, single-dose liposomal amphotericin B (AmBisome) has been adopted as a first-line regimen for VL; however the effectiveness and safety of AmBisome for PKDL has not been formally evaluated. Methods. The safety and effectiveness of AmBisome 15 mg/kg, given over 15 days in 5 biweekly infusions of 3 mg/kg on an outpatient basis, was evaluated between April and November 2014 in patients with clinically diagnosed PKDL, aged ≥12 years and residing in a highly VL-endemic area in Bangladesh. This was a prospective cohort observational study, with the objective to assess final cure 12 months after treatment. Clinical response was monitored at 1, 3, 6, and 12 months, and safety during treatment and up to 1 month after treatment. Results. Of the 280 patients meeting the inclusion criteria, 273 were assessed at 12 months. A complete or major improvement of lesions was seen in 245 patients (89.7%); 213 (78.0%) were considered completely cured. Lesions did not improve in 28 (10.3%) and new lesions appeared in 13 (4.8%). All patients completed treatment without severe or serious adverse events. Conclusions. A short-course 15-mg/kg AmBisome regimen proved safe and effective in the treatment of clinically diagnosed PKDL in Bangladesh, and should be considered a treatment option for routine programmatic use in the VL elimination effort in the Indian subcontinent.
Background: Definitive diagnosis of visceral leishmaniasis (VL) by demonstrating parasites in tis... more Background: Definitive diagnosis of visceral leishmaniasis (VL) by demonstrating parasites in tissue smears or by culture involves invasive procedures, technical expertise and adequate laboratory facilities. Endemic countries rely mainly on serological tests to diagnose VL. Currently, the immunochromatographic test incorporating the recombinant K39 antigen (rK39 ICT) is the reference test for rapid diagnosis of VL in the Indian subcontinent. The performance of serological tests using rK39 and other promastigote antigens can vary due to differences in antigen expression, the various hosts and environmental factors. To achieve elimination of VL, diagnostic accuracy will be necessary for active case detection especially in those who carry asymptomatic infections. We evaluated the performance of rK39 ICT, enzyme linked immunosorbent assay using mixed Leishmania promastigotes from different Leishmania species (p-ELISA) and indirect fluorescent antibody test (IFAT) utilizing whole promastigotes from the Leishmania donovani complex for sero-diagnosis of VL in Bangladesh. Methods: The sensitivity of each serological test was evaluated on 155 patients who were diagnosed to have VL by microscopy and/or by culture methods. Test specificities were calculated on 706 healthy blood donors, 91 diagnostic sera from patients with a febrile illness and sera from patients positive for malaria (n = 91) and Chagas disease (n = 91). All statistical calculations were at 95% confidence intervals. Results: The sensitivities of rK39 ICT, p-ELISA and IFAT were 100%, 86.5% and 92.3%, respectively. All three serological methods had a pooled sensitivity of 82.6%. The specificities of rK39 ICT, p-ELISA and IFAT from combined control groups were 100%, 93.1% and 99.9%, respectively. The respective positive and negative predictive values of the tests were both 100% for rK39 ICT, 66.3% and 97.8% for p-ELISA and 99.3% and 98.8% for IFAT. The p-ELISA showed cross reactivity with 36.3% of sera positive for malaria and 28.6% of sera positive for Chagas disease while rK39 ICT and IFAT showed no cross reactivity. Conclusion: This study confirms the efficiency of rK39 ICT for rapid diagnosis of VL. The p-ELISA using mixed promastigote antigens did not perform well as a serological test for VL in Bangladesh. Due to high sensitivity and specificity of whole promastigote antigen of L. donovani complex utilized in IFAT, this test can be considered in combination with rK39 ICT to confirm VL diagnosis when clinical diagnosis cannot distinguish between other diseases.
Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327... more Vaccinating dogs against rabies is an effective means of reducing human rabies. We subjected 1327 clinically diagnosed human rabies death and mass dog vaccination (MDV) data during 2006-2018 to quantify the impacts of MDV on human rabies incidence in Bangladesh and a subset of rabies death data (422) for clinico-epidemiological analysis. A positive and increasing trend of MDV (p = 0.01 and tau = 0.71) and a negative and declining trend (p < 0.001 and tau = −0.88) of human rabies cases (Correlation coefficient: −0.82) have been observed. Among 422 deaths, the majority (78%) of the victims sought treatment from traditional healers, and 12% received post-exposure prophylaxis (PEP). The mean incubation period of rabies in cases with exposure sites on the head & neck (35 days) was shorter than the upper limb (mean = 64 days, p = 0.02) and lower limb (mean = 89 days, p < 0.01). MDV has been found to be effective for reducing human rabies cases in Bangladesh. Creating awareness among the animal bite victims to stop reliance on traditional healers rather seeking PEP, addressing the role of traditional healers through awareness education programme with respect to the treatment of dog bites, ensuring availability of PEP, and continuing to scale up MDV may help to prevent human rabies deaths. Rabies is a zoonotic viral disease responsible for the death of approximately 59,000 people worldwide with more than 3.7 million disability-adjusted life years lost annually 1. Due to acute progressive encephalitis, rabies is almost always fatal once clinical signs appear. The disease occurs predominantly in impoverished communities, in both rural and urban areas, and has been recognized for over 4000 years 2,3. Rabies is present across all continents, except Antarctica with more than 95% of human fatalities happening in the areas of Asia and Africa, and approximately 40% of cases in the population are aged below 15 years. Although all warm-blooded animals are susceptible to rabies, domestic dogs are the main cause of rabies virus transmission to humans in up to 99% of cases in rabies-endemic regions 4. Most cases of rabies are caused by the bite of an infected dog. The effect of rabies virus (RABV) exposure depends on a number of factors, including the gravity of the wound, the anatomical site of the bite on the body, the viral quantity and variant (genotype) inoculated into the wound(s) and the timeliness of post-exposure prophylaxis (PEP) 3. The clinical manifestation of human rabies can appear in any of two forms: the widely perceived furious (classical or encephalitic) form or the paralytic (or dumb) form 5,6. Each case of rabies has
Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. O... more Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. Objective: To determine 1) the numbers of patients diagnosed with visceral leishmaniasis (VL) and post-kala azar dermal leishmaniasis (PKDL) using an active case detection (ACD) strategy in Fulbaria and a passive case detection (PCD) strategy in Trishal, and 2) the time taken from symptoms to diagnosis in the ACD subdistrict. Design: A cross-sectional descriptive study of patients diagnosed from May 2010 to December 2011. The ACD strategy involved community education and outreach workers targeting households of index patients using symptom-based screening and rK-39 tests for suspected cases. Results: In the ACD subdistrict (Fulbaria) and PCD subdistrict (Trishal), respectively 1088 and 756 residents were diagnosed with VL and 1145 and 37 with PKDL. In the ACD subdistrict, the median time to diagnosis for patients directly referred by outreach workers or self-referred was similar, at 60 days for VL and respectively 345 and 360 days for PKDL. Conclusion: An ACD strategy at the subdistrict level resulted in an increased yield of VL and a much higher yield of PKDL. As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent.
Background: Bangladesh is making progress toward achieving zero human dog-mediated rabies deaths ... more Background: Bangladesh is making progress toward achieving zero human dog-mediated rabies deaths by 2030, a global goal set in 2015. Methods: Drawing from multiple datasets, including patient immunization record books and mass dog vaccination (MDV) databases, we conducted a comprehensive analysis between the years 2011 to 2023 to understand the effectiveness of rabies control programmes and predict human rabies cases in Bangladesh by 2030 using time-series forecasting models. We also compared rabies virus sequences in Bangladesh and other South Asian countries from GenBank. Findings: The human-to-dog ratio in Bangladesh was 85.83 (95% CI 74.63, 97.03), with an average dog population density of 11.51 dogs/km2 (95% CI 10.09, 12.92). The mass dog vaccination (MDV) campaign has resulted in the vaccination of 81.46% (95% CI: 80.54-82.37) of the estimated 3,030,662 dogs in the country. A decreasing trend from predicted and observed human rabies cases was identified, and it is projected th...
Journal of Advanced Veterinary and Animal Research, 2020
Objectives: Knowledge, attitude, and practice (KAP) of rabies in the community are essential for ... more Objectives: Knowledge, attitude, and practice (KAP) of rabies in the community are essential for developing post-exposure behavioral treatment and for understanding current prevention and control policy on rabies. This was a cross-sectional study in Gaibandha Sadar, a northern district of Bangladesh, investigating the level of KAP about rabies. Materials and methods: A total of 368 interviewed respondents, of whom 280 (76.09%) were male, and 88 (23.91%) were female. A structured questionnaire was used for the data collection from respondents on socio-demographic information and KAP regarding rabies. The data analyzed with STATA-IC-11.0 and the association of independent variables with rabies KAP scores were calculated using Pearson’s Chi-square. Results: Most respondents had adequate KAP levels and positive thoughts on rabies prevention. The KAP scores were strongly associated with education and employment status (p < 0.05). Most respondents said that stray dogs are a headache in the area and believed that control of the dog population in Gaibandha is essential. Conclusion: These outcomes also revealed that there is an information gap about rabies that might improve by developing an education program for awareness.
International Journal of Infectious Diseases, 2014
noticeable decrease in the number of shigellosis cases was observed and subsequent water testing ... more noticeable decrease in the number of shigellosis cases was observed and subsequent water testing on 10 December 2012 showed no E. coli. Conclusion: The sudden unprecedented increase in Shigella cases was likely due to contaminated potable water exposure and additional secondary cases. The investigation highlighted the necessity for continual monitoring of potable water quality and prompt corrective action to maintain a safe water supply in the district. The efficient, timely outbreak response resulted in appropriate public health interventions and underscores the value of a wellfunctioning DORT and NOU-DORT collaboration within the South African public health context.
SUMMARYIn February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of n... more SUMMARYIn February 2007 an outbreak of Nipah virus (NiV) encephalitis in Thakurgaon District of northwest Bangladesh affected seven people, three of whom died. All subsequent cases developed illness 7–14 days after close physical contact with the index case while he was ill. Cases were more likely than controls to have been in the same room (100% vs. 9·5%, OR undefined, P<0·001) and to have touched him (83% vs. 0%, OR undefined, P<0·001). Although the source of infection for the index case was not identified, 50% of Pteropus bats sampled from near the outbreak area 1 month after the outbreak had antibodies to NiV confirming the presence of the virus in the area. The outbreak was spread by person-to-person transmission. Risk of NiV infection in family caregivers highlights the need for infection control practices to limit transmission of potentially infectious body secretions.
Background The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) ... more Background The decade following the Regional Strategic Framework for Visceral Leishmaniasis (VL) elimination in 2005 has shown compelling progress in the reduction of VL burden in the Indian subcontinent. The Special Programme for Research and Training in Tropical Diseases (TDR), hosted by the World Health Organization (WHO) and other stakeholders, has coordinated and financed research for the development of new innovative tools and strategies to support the regional VL elimination initiative. This paper describes the process of the TDR's engagement and contribution to this initiative. Methodology/principal findings Multiple databases were searched to identify 152 scientific papers and reports with WHO funding or authorship affiliation around the following 3 framework strategies: detection of new cases, morbidity reduction, and prevention of infection. TDR has played a critical role in the evaluation and subsequent use of the 39-aminoacid-recombinant kinesin antigen (rK39) rapid diagnostic test (RDT) as a confirmatory test for VL in the national program. TDR has supported the clinical research and development of miltefosine and single-dose liposomal amphotericin B as a first-line treatment against VL. TDR has engaged with incountry researchers, national programme managers, and partners to generate evidencebased interventions for early detection and treatment of VL patients. TDR evaluated the quality, community acceptance, and cost effectiveness of indoor residual spraying, insecticide-treated bed nets, insecticide-impregnated durable wall linings, insecticidal paint, and
Background: The concept of eco-toilets in Bangladesh was promoted by an NGO (Practical Action, Ba... more Background: The concept of eco-toilets in Bangladesh was promoted by an NGO (Practical Action, Bangladesh). The ecotoilets are especially built to collect human excreta for using them as manure on the fields after appropriate treatment for 12 months. Objectives: This study was designed to see the physical properties appropriate for fields and pathogenic potential to ensure the treated human excreta are safe for cultivator’s handling. Methodology: The study was carried out in three phases during 2010 to 2014. A total of 210 composted faecal excreta were examined for physical properties like colour, odour, odour intensity, moisture, bacteriological examination for faecally transmitted potential bacteria and parasitological examination for ova / cysts of faecally - transmitted parasites to recommend whether these composted excreta were suitable for use as manure by the cultivators. Results: Majority of the specimens in all three phases contained remarkable moisture: 22.3-80.0% in all s...
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Papers by Be-Nazir Ahmed