Tuberculosis (TB) is the tenth leading cause of death worldwide. About 1.3 million people die from TB each year, and most of them are in developing countries. The stigma associated with TB is a barrier to seeking treatment and adequate care. It causes a delay in treatment-seeking and diagnosis and thus decreases the likelihood of being cured and ultimately leads to death. The objective of this study was to explore the perceptions, attitudes, experiences, and opinions about stigma related to TB among adults infected with TB and adults who were not infected with TB. Our study was qualitative in nature. The study was conducted in the community of Bolgatanga municipality of the upper-east region of Ghana. Three focus group discussions (FGDs) were conducted; one with six TB-infected females, one with seven TB-infected males, and one with six non-TB-infected participants. Data were analyzed using qualitative content analysis and presented in pre-defined and/or emerging themes: perception about signs and symptoms observed by TB infected person, attitudes towards TB patients before and after diagnosis, reasons for stigmatization, perception about diagnostic testing, and taking the drugs. Transcripts of the discussions were read, and a list of meanings for units, codes, and themes was generated on the research question. We identified the existence of stigma associated with TB. TB-infected male patients had more autonomy in decision-making about receiving treatment and other family matters compared to female TB patients. TB-infected women suffered more economic vulnerability due to the loss of their work, and the stigma was worsened due to delayed diagnosis and treatment, and they were regarded as liabilities rather than assets. TB-infected patients became stigmatized because non-TB-infected community participants did not want to come into close contact with them. Our findings suggest heightening of advocacy, communication, social mobilization, and health education on TB in the community of Bolgatanga municipality is needed to allay TB-related stigma, especially for women.

Background: Breastfeeding practice is still not optimum in Bangladesh. Understanding barriers to breastfeeding is needed to prevent harmful practices. This study aimed to understand barriers to breastfeeding among infants and young children in Bangladesh.Methods: This qualitative study was conducted in five rural sub-districts and one urban slum in Bangladesh. We conceptualized that barriers to breastfeeding can be broadly grouped into individual, society, and system level barriers. We conducted in-depth interviews with 33 breastfeeding mothers and 13 grandmothers of breastfed children (totaln = 46 interviews). We observed 23 of these infants and young children being breastfed. These data were supplemented by 3 focus group discussions held with the children’s fathers. We managed the data using Atlas.ti software and analyzed the data thematically using an inductive approach.Results: Important individual-level barriers perceived to influence breastfeeding included misconceptions about the adverse effects of breastfeeding on maternal health, nutrition and physical appearance, and lack of awareness of the value of breastfeeding among family members. Perceived society-level barriers included sociocultural norms, beliefs, and practices such as mother obliged to give more attention on household chores than breastfeeding to become a good housewife and feeding formula milk perceived as a symbol of parents’ financial solvency in the society. System-level barriers included attractive advertisements of breastmilk substitutes, and inadequate facilities and support processes in mothers’ work environments.Conclusion: A range of barriers at individual, society and system level have important implications for infant and young children’s breastfeeding practices in Bangladesh. Development of interventions that address the range of barriers that many mothers face is essential to support breastfeeding practices. Potential interventions include strengthening information-giving during interaction between mothers and health workers on breastfeeding techniques, and engaging fathers and other “significant others” in counseling on breastfeeding.

Objective: To determine the prevalence and associated risk factors of sepsis among neonates admitted into neonatal intensive care units (NICU) of public hospitals in Dhaka. Methods: This was a cross-sectional study conducted among 173 neonates admitted into the NICUs of Dhaka Medical College Hospital (DMCH) and Dhaka Shishu (Children) Hospital from March 1, 2016 to September 30, 2016 at Dhaka, Bangladesh. On the basis of the presence of clinical signs and symptoms of sepsis, neonates were admitted into the NICUs. The weight of the baby was measured and blood culture, complete blood count (CBC), C-reactive protein (CRP) and urine R/M/E were done at the time of admission. The neonates, who had positive blood culture reports, were confirmed as having sepsis. After receiving informed written consent, maternal data were collected from the mother of the neonate and neonatal data were collected from NICUs. Results: The prevalence of sepsis among the neonates admitted into NICU of the concerned public hospitals in Dhaka was 69.35%. In the multiple logistic regression model, perinatal asphyxia (adjusted odds ratio (aOR) = 3.37, 95% confidence interval (CI) = 1.27-8.90), presence of infection at umbilical cord (aOR = 3.32, 95% CI = 1.40-7.85), history of bottle feeding of the neonates (aOR = 3.02, 95% CI = 1.11-8.25) and pre-existing maternal infection (aOR = 4.44, 95% CI = 1.92-10.26) were significantly (p-value < 0.05) associated with neonatal sepsis. The odds of developing sepsis among the neonates with ≤ 2.5 kg weight at admission was more than three times higher (aOR 3.82, 95% CI = 1.59-9.19) than neonates with admission weight > 2.5 kg. Conclusion: Like other South Asian countries, the prevalence of neonatal sepsis is alarming in Bangladesh. Further research should be conducted to measure the burden of infections in the entire neonatal period and observe the effects of biological risk factors on the early and late-onset neonatal sepsis.

Objective: We assessed the role of home visits by Shasthya Shebika (SS) – female volunteer community health workers (CHWs) – in improving the distribution of micronutrient powder (MNP), and explored the independent effects of caregiver–provider interaction on coverage variables.Design: We used data from three cross-sectional surveys undertaken at baseline (n 1927), midline (n 1924) and endline (n 1540) as part of an evaluation of a home fortification programme. We defined an exposure group as one that had at least one SS visit to the caregiver’s household in the 12 months preceding the survey considering three outcome variables – message (ever heard), contact (ever used) and effective coverage (regular used) of MNP. We performed multiple logistic regressions to explore the determinants of coverage, employed an ‘interaction term’ and calculated an odds ratio (OR) to assess the modifying effect of SS’s home visits on coverage.Settings: Sixty-eight sub-districts from ten districts of Bangladesh.Participants: Children aged 6–59 months and their caregivers.Results: A home visit from an SS positively impacts message coverage at both midline (ratio of OR 1·70; 95 % CI 1·25, 2·32; P < 0·01) and endline (ratio of OR 3·58; 95 % CI 2·22, 5·78; P < 0·001), and contact coverage both at midline (ratio of OR 1·48; 95 % CI 1·06, 2·07; P = 0·021) and endline (ratio of OR 1·74; 95 % CI 1·23, 2·47; P = 0·002). There was no significant effect of a SS’s home visit on effective coverage.Conclusions: The households visited by BRAC’s volunteer CHWs have better message and contact coverage among the children aged 6–59 months.

Anaemia is a major public health problem among children < 5 years of age in Bangladesh due to recurrent intestinal parasite infections. The aim of this study was to understand the association between combining deworming and MNP home fortification (MNP + Deworming) and the prevalence of anaemia among children < 5 years of age in Bangladesh. We used pooled data from five cross-sectional surveys and performed multivariable logistic regression and calculated crude and adjusted odds ratios (AORs) to quantify the association of anaemia with the exposure variables. A total of 9948 households were considered for this paper. In the unadjusted logistic regression, no significant association was detected between the effective MNP coverage and anaemia prevalence, but the associations were significant (p < 0.001) between the deworming and anaemia prevalence and between the MNP + Deworming condition and anaemia prevalence. In the adjusted model, children who were exposed to both deworming and effective MNP coverage were 30% (AOR 0.70; 95% CI 0.52, 0.94; p = 0.018) less likely to be anaemic compared with children who were unexposed to combined MNP + Deworming. The combined effects of deworming and MNP supplementation on the reduction in anaemia prevalence highlighted the importance of using integrated and multidisciplinary intervention strategies.

Suboptimal healthcare quality may be a barrier to achieving child health improvements, yet little is known about the relationship between provider compliance with evidence-based practices and client behavior change. We assess provider compliance in the context of infant and young child feeding (IYCF) counseling, its relationship with client IYCF behaviors in Bangladesh, and explore its potential determinants. We use data from a 2017 evaluation of an IYCF program that includes a health worker survey (n = 74), caregiver survey (n = 232), and direct service observation checklists of counseling sessions (n = 232 observations of 74 health workers). We assess the relationship between provider compliance with recommended IYCF counseling topics and behaviors (standardized to a 100-point scale) and three reported IYCF behaviors among clients using multi-level models with random effects at the health worker and sub-district (sampling) levels. We also evaluate whether health worker self-efficacy, satisfaction, and technical knowledge are associated with provider compliance. Health worker compliance was significantly associated with reported exclusive breastfeeding for children under 6 months of age (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.06, 95% CI 1.01, 1.12) and marginally associated with minimum dietary diversity (adjusted odds ratio per 1 percentage point increase in counseling compliance score = 1.05, 95% CI 1.00, 1.11). Counseling compliance was significantly and positively associated with both health worker self-efficacy and technical knowledge. We find evidence for an association between health worker compliance and client health behaviors; however, small effect sizes suggest that behavior change is multifactorial and affected by factors beyond care quality. Improvements to technical quality of care may contribute to desired health outcomes; but policies and programs seeking to change health behaviors through counseling may also wish to target upstream factors such as self-efficacy, alongside technical skill-building and knowledge, for maximum impact.