Improving compliance with environmental regulations is critical for promoting clean environments and healthy populations. In South Asia, brick manufacturing is a major source of pollution but is dominated by small-scale, informal producers who are difficult to monitor and regulate—a common challenge in low-income settings. We demonstrate a low-cost, scalable approach for locating brick kilns in high-resolution satellite imagery from Bangladesh. Our approach identifies kilns with 94.2% accuracy and 88.7% precision and extracts the precise GPS coordinates of every brick kiln across Bangladesh. Using these estimates, we show that at least 12% of the population of Bangladesh (>18 million people) live within 1 km of a kiln and that 77% and 9% of kilns are (illegally) within 1 km of schools and health facilities, respectively. Finally, we show how kilns contribute up to 20.4 μg/${\mathrm{m}}^3$ of ${\mathrm{P}\mathrm{M}}_{2.5}$ (particulate matter of a diameter less than 2.5 μm) in Dhaka when the wind blows from an unfavorable direction. We document inaccuracies and potential bias with respect to local regulations in the government data. Our approach demonstrates how machine learning and Earth observation can be combined to better understand the extent and implications of regulatory compliance in informal industry. Significance Monitoring compliance with environmental regulations is a global challenge. It is particularly difficult for governments in low-income countries, where informal industry is responsible for a large amount of pollution, because the governments lack the ability to locate and monitor large numbers of dispersed polluters. This study demonstrates an accurate, scalable machine-learning approach for identifying brick kilns, a highly polluting informal industry in Bangladesh, in satellite imagery. Our data reveal widespread violations of the national regulations governing brick manufacturing, which has implications for the health and well-being of the country. Our approach offers a low-cost, replicable method for regulatory agencies to generate information on key pollution sources.

Acute diarrhoeal disease management often requires rehydration alone without antibiotics. However, non-indicated antibiotics are frequently ordered and this is an important driver of antimicrobial resistance. The mHealth Diarrhoea Management (mHDM) trial aimed to establish whether electronic decision support improves rehydration and antibiotic guideline adherence in resource-limited settings. A cluster randomised controlled trial was done at ten district hospitals in Bangladesh. Inclusion criteria were patients aged 2 months or older with uncomplicated acute diarrhoea. Admission orders were observed without intervention in the pre-intervention period, followed by randomisation to electronic (rehydration calculator) or paper formatted WHO guidelines for the intervention period. The primary outcome was rate of intravenous fluid ordered as a binary variable. Generalised linear mixed-effect models, accounting for hospital clustering, served as the analytical framework; the analysis was intention to treat. The trial is registered with ClinicalTrials.gov (NCT03154229) and is completed. From March 11 to Sept 10, 2018, 4975 patients (75·6%) of 6577 screened patients were enrolled. The intervention effect for the primary outcome showed no significant differences in rates of intravenous fluids ordered as a function of decision-support type. Intravenous fluid orders decreased by 0·9 percentage points for paper electronic decision support and 4·2 percentage points for electronic decision support, with a 4·2-point difference between decision-support types in the intervention period (paper 98·7% [95% CI 91·8-99·8] vs electronic 94·5% [72·2-99·1]; pinteraction=0·31). Adverse events such as complications and mortality events were uncommon and could not be statistically estimated. Although intravenous fluid orders did not change, electronic decision support was associated with increases in the volume of intravenous fluid ordered and decreases in antibiotics ordered, which are consistent with WHO guidelines. US National Institutes of Health.

Schoolchildren are commonly linked to influenza transmission. Handwashing with soap has been shown to decrease infections; however, improving handwashing practices using soap and water is difficult in low-resource settings. In these settings, alternative hygiene options, such as hand sanitizer, could improve handwashing promotion to reduce influenza virus infections. We conducted a cluster randomized control trial in 24 primary schools in Dhaka to assess the effectiveness of hand sanitizer and a respiratory hygiene education intervention in reducing influenza-like illness (ILI) and laboratory-confirmed influenza during June–September 2015. Twelve schools were randomly selected to receive hand sanitizer and respiratory hygiene education, and 12 schools received no intervention. Field staff actively followed children daily to monitor for new ILI episodes (cough with fever) through school visits and by phone if a child was absent. When an illness episode was identified, medical technologists collected nasal swabs to test for influenza viruses. During the 10-week follow-up period, the incidence of ILI per 1,000 student-weeks was 22 in the intervention group versus 27 in the control group (P-value = 0.4). The incidence of laboratory-confirmed influenza was 53% lower in the intervention schools (3/1,000 person-weeks) than in the control schools (6/1,000 person-weeks) (P-value = 0.01). Hand sanitizer and respiratory hygiene education can help to reduce the risk of influenza virus transmission in schools.

Soil degradation is an important threat to sustainable agriculture. In Bangladesh, brick production contributes to soil loss as the country relies on clay-rich soil for brick making. An in-depth understanding of why farmers sell soil and the corresponding impacts on agricultural productivity is critical for developing and implementing new policies for utilizing alternate materials and methods in Bangladesh and other areas that continue to rely on fired clay bricks as their primary building material. A team of anthropologists conducted 120 structured interviews and 20 in-depth interviews in two different geographical areas in Bangladesh to understand the incentives for and impacts of selling soil. The primary reason farmers sold soil was pressure from neighboring farmers who had previously sold soil. Once neighboring property owners had sold soil, then farmers felt they needed to sell their soil to level their land with the neighboring plot to avoid future production loss. Short-term monetary gain from selling soil was also a strong motivator helping farmers manage acute financial crises. In addition, farmers are frequently compelled to sell soil for brick making because of coercive practices by brick-owners and their soil brokers. In this study, farmers reported 40–80% reduction in crop production and 40–70% reduction in income due to soil removal. The loss of the soil reduces agricultural yields leading to both short- and longer-term impacts on crop production that influence the country’s food security.