The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate antibiotic stewardship and optimal use. In Bangladesh, data on antibiotic dispensing in pharmacies according to the AWaRe classification are scarce. We aimed to explore antibiotic dispensing pattern in pharmacies according to the WHO AWaRe classification to aid pharmacy-targeted national antibiotic stewardship program (ASP). From January to July 2021, we interviewed drug-sellers from randomly selected pharmacies and randomly selected customers attending the pharmacies. We collected data on demographics and medicines purchased. We classified the purchased antibiotics into the Access, Watch, and Reserve groups among 128 pharmacies surveyed, 98 (76.6%) were licensed; 61 (47.7%) drug-sellers had pharmacy training. Of 2686 customers interviewed; 580 (21.6%) purchased antibiotics. Among the 580 customers, 523 purchased one, 52 purchased two, and 5 purchased three courses of antibiotics (total 642 courses). Of the antibiotic courses, the Watch group accounted for the majority (344, 53.6%), followed by the Access (234, 36.4%) and Reserve (64, 10.0%) groups. Approximately half of the antibiotics (327/642, 50.9%) were purchased without a registered physician’s prescription. Dispensing of non-prescribed antibiotics was higher in the Access group (139/234, 59.4%), followed by Watch (160/344, 46.5%) and Reserve (28/64, 43.8%) groups. These findings highlight the need to implement strict policies and enforce existing laws, and pharmacy-targeted ASP focusing on proper dispensing practices to mitigate antimicrobial resistance in Bangladesh.

Background: Frontline healthcare workers (HCWs) were particularly vulnerable to contracting SARS-CoV-2 infection as a result of occupational exposure. There is a scarcity of data characterizing the risk of SARS-CoV-2 infection among HCWs, particularly in low-income hospital settings. This study aimed to assess the prevalence of COVID-19 among HCWs and identify associated risk factors. Methods: From July 2021 to July 2023, we enrolled HCWs from 13 primary, 2 secondary, and five tertiary care hospitals in four selected districts of Bangladesh. We collected information on demography and risk exposure in a face-to-face interview. We calculated the odds ratio to measure the risk using multivariable logistic regression. Results: We enrolled 3436 HCWs: 22% (747) physicians, 47% (1632) nurses, and 31% (1057) support staff. Most of the HCWs were female 67% (2292), and the mean age was 38.1, IQR = 29–44 years. Overall, 26% (889) of HCWs had lab-confirmed SARS-CoV-2 infection. Among HCWs, nurses accounted for the highest proportion of COVID-19 infections at 53% (473/1632). Physicians had a significantly higher risk of infection with an aOR of 3.08 (95% CI 2.42–3.93; p < .001) compared to support staff. HCWs who had direct exposure to COVID-19 patients were also at a higher risk, with a 1.93 times higher likelihood of infection ([aOR] = 1.93, 95% CI 1.50–2.47; p < .001), compared to HCWs who were not exposed. Conclusions: This study highlights the heightened vulnerability of HCWs to SARS-CoV-2 infection due to occupational exposure and indicates the risk of nosocomial transmission to patients and emphasizes the importance of implementing targeted infection control measures, such as improved workplace safety protocols and comprehensive training to tackle future pandemics of similar traits.

Background: Influenza remains a significant public health challenge in low- and middle-income countries (LMICs) like Bangladesh, where vaccine uptake remains low despite the substantial disease burden. Physicians play a vital role in promoting vaccination, yet their intentions and influencing factors are not well understood. Methods: We conducted a cross-sectional study from June to October 2022 across four tertiary-level hospitals in Bangladesh using a questionnaire grounded in the Theory of Planned Behavior (TPB). Hierarchical logistic regression was employed to identify factors associated with vaccine recommendation intentions. Results: Among 972 physicians with an average age of 32.1 years, 40.1% intended to recommend and administer the influenza vaccine. Most (85.3%) agreed vaccination reduces risk, 65.5% desired vaccination for self-protection, 63.5% would vaccinate if available at work, and 85.3% anticipated Ministry of Health support. Male (OR = 1.9, 95% CI: 1.5–2.3) and married (OR = 1.5, 95% CI: 1.1–1.9) physicians were more likely to recommend vaccination. Each unit increase in attitude score doubled the likelihood of recommending the vaccine (OR = 2.0, 95% CI: 1.4–3.0). Conclusions: Physicians’ influenza vaccine recommendations in Bangladesh are suboptimal, influenced by gender, marital status, and attitudes. Targeted educational interventions addressing attitudinal barriers and leveraging institutional support could improve recommendation practices.

Respiratory syncytial virus (RSV) is the leading cause of respiratory morbidity and mortality in children under five years of age, especially in low- and middle-income countries (LMICs). In 2023, two RSV immunisation options, including a maternal RSV vaccine and a monoclonal antibody (mAb), became approved in several high-income countries. The World Health Organization has recently prequalified the maternal vaccine and the Gavi has committed funding for its introduction, raising the prospect of RSV vaccine availability in LMICs in the near future. This analysis thus underscores the need for country-specific data on the burden of disease and seasonality, as well as the acceptability of new immunisation options and evaluations of their cost-effectiveness. Achieving successful implementation will require health system strengthening, targeted strategies to address unwillingness to vaccinate, securing sustainable financing for immunisation, and ensuring sustained policy commitment. As in many other LMICs, the RSV infection continues to pose a substantial public health concern in Bangladesh. However, evidence gaps persist regarding RSV epidemiology, healthcare system readiness, and public perceptions and willingness regarding new immunisation options. We use Bangladesh as a model to identify gaps, review available evidence, and outline strategies for integrating maternal vaccine and infant mAb into the country’s maternal and child health programmes. Lessons drawn from this case study may be directly applicable to other LMICs, offering a pathway to equitable adoption of these life-saving interventions and reducing the substantial global burden of RSV.

The Bangladesh HCW Cohort is a prospective study established to assess the physical and psychological effects of COVID-19 on Bangladeshi HCWs. This paper outlines the study design and baseline characteristics of the cohort participants. The cohort was initiated in February 2021 and enrolled 3,697 HCWs. Baseline demographic, clinical, and occupational risk data were collected through face-to-face interviews. Participants were followed up biweekly to monitor changes in risk factors over time. Validated instruments were used to assess mental health outcomes and infection prevention and control practices. In January 2023, a second phase of the study was initiated to examine breakthrough COVID-19 infections, immune responses by vaccine type, long-term consequences of COVID-19, and booster vaccine uptake. The median age of the HCWs recruited to the cohort was 36 years (IQR: 30-44), and 53.5% were female. Nurses accounted for approximately half of the participants (47.8%), followed by support staff (31.8%) and physicians (20.4%). Nearly half of participants (47%) reported symptomatic COVID-19, most commonly fever (82%) and cough (56%). Additionally, 32% reported hospitalization due to COVID-19.The Bangladesh HCW Cohort provides a prospective platform to evaluate the occupational, physical, and psychological impacts of COVID-19 among HCWs, generating evidence to inform occupational health policy and workforce protection strategies in Bangladesh.