With COVID-19 vaccination underway, this study aimed to understand belief, attitude and intention of the people in the South Asia region towards the vaccine. We conducted a cross-sectional study using semi-structured questionnaires among 18201 individuals in four South Asian countries; Bangladesh, India, Pakistan, and Nepal between January 17 and February 2, 2021. We used the Health Belief Model (HBM) to identify the predictors related to vaccine acceptance. STATA (v16.1) was used for all analyses. The percentage of respondents willing to be vaccinated against COVID-19 was 65%, 66%, 72% and 74% for Bangladesh, India, Pakistan and Nepal, respectively. Perceived destructive impact of COVID-19, positive perception of vaccines and concern about possible side effects were significant in modifying respondents’ intentions.. In multivariable logistic regression, age, sex, marital status, education, comorbidities, worry about getting infected, perceived COVID-19 impact, belief regarding vaccine efficacy, positive attitude towards mandatory measures, and vaccine availability were found to be associated with vaccine acceptance across countries. Nearabout two-third of the respondants were willing to take COVID-19 vaccine in the four South Asia countries.

Background: Bangladesh, a developing country with a lower-middle-income and one of the world’s most densely populated areas, has been severely affected by COVID-19. This global epidemic is not only affecting the physical health of the patients but also causing severe psychological effects among those who have not yet been infected. Sleep disturbance is one of the key symptoms of major depression and one of the proven risk factors for suicide. The objective of this study is to identify the risk factors associated with sleep disturbance which has developed as a general impact of COVID-19 and new normal life during the lockdown (a measure to control the spread of COVID-19) in Bangladesh. Methods: Demographic characteristics, COVID-19, and lockdown related information have been collected from 1,128 individuals by conducting a web-based survey. Respondent’s perspective regarding sleep disturbance during COVID-19 lockdown is considered as the outcome of interest which is dichotomous. Descriptive statistics methods have been applied to explore the distribution of respondent’s demographic characteristics. Pearson’s chi-square tests have been performed to relate the sleep disturbance status of the respondents to their demographic, personal, and COVID-19 related information. Furthermore, a multivariable logistic regression model has been adopted to identify the significant association of sleep disturbance with the demographic, COVID-19, and lockdown related information of respondents during the COVID-19 lockdown in Bangladesh. Findings: The prevalence of sleep disturbance during the COVID-19 lockdown is found to be higher among participants aged 31–40 years. Gender disparity has also been observed in favor of male participants, whereas no significant regional heterogeneity has been found. Working from home or doing online classes during the lockdown has been found as a potential predictive factor of sleep disturbance. Losing a job has been considered as an adverse economic effect of COVID-19, which also induces sleep disturbance. Perception regarding the risk of getting infected and anxiety triggered the chance of developing sleep disturbance. The sleeping schedule is also found as a risk factor for sleep disturbance. Conclusion: Evidence-based policies are required to combat psychological challenges that have arisen due to COVID-19, primarily targeting the groups who are largely suffering from sleep disturbance.

The sound mental health of reproductive-aged women is crucial for overall maternal and child well-being. However, mental health aspects are historically overlooked in low- and lower-middle-income countries, including Bangladesh. National-level evidence on common mental disorders like anxiety and depression among reproductive-aged women is limited in Bangladesh. Therefore, this study aims to estimate the prevalence of anxiety and depression among ever-married reproductive-aged women in Bangladesh and examine their individual, marital, household, and contextual correlates. We used data from the Bangladesh Demographic and Health Survey 2022 that collected anxiety and depression data using GAD-7 and PHQ-9 modules, respectively. This study included a total of 19,987 ever-married women aged 15 to 49 years. We used a cluster-adjusted multivariable logistic regression model to examine the factors associated with anxiety and depression. The national level prevalence of anxiety and depression among ever-married reproductive-aged women was 19.5% and 4.9%, respectively. The odds of having anxiety monotonically increased from the age of 25. Menopause, educational attainment, autonomy, household wealth, and type of residence were not associated with anxiety or depression. Non-Muslim women were respectively 34% (AOR: 0.66, 95% CI: 0.55, 0.80) and 33% (AOR: 0.67, 95% CI: 0.97, 2.77) less likely to confront anxiety and depression than Muslims. Having a husband who completed secondary level education, having weekly marital coitus, and residing under the headship of a father or mother-in-law was associated with lower odds of anxiety and depression. Women from the Rangpur and Khulna divisions had higher odds of anxiety and depression than those from Dhaka. This study reveals a high prevalence of anxiety among ever-married reproductive-aged women and highlights that anxiety and depression are not clustered among disadvantageous groups like less educated, less autonomous, rural, and poor women. Anxiety and depression are rather associated with late reproductive age, religious affiliation, marital factors, and region.

Objective The main objective of this study is to investigate how the direction and strength of the association between infant mortality and its predictors are changing over time in Bangladesh using a nationally representative sample for the period 2011–2014. Design, setting and participants Data from two repeatedly cross-sectional Bangladesh Demographic and Health Surveys (BDHSs) for the years 2011 and 2014 were used. A total of 7664 (with 312 infant death) and 7048 (with 264 infant death) complete cases, respectively, from BDHS 2011 and 2014 datasets were included in the study. Methods Cox’s proportional hazard model with robust standard error (SE) that adjusts for the complex survey design characteristics was implemented to assess how the risk factors associated with infant mortality change their paths. Results Results reflected that administrative division remained as a potential risk factor of infant death for both periods. Household’s socioeconomic status, father’s employment status, age difference between parents turned out to be potential risk factors in 2014, though they did not show any significant association with infant death in the year 2011. In contrast to 2011, mothers’ individual-level characteristics such as age at childbirth, education, media exposure, employment status did not remain as significant risk factors for infant death in 2014. Younger fathers increased the burden of death among infants of adolescent mothers. At higher order births, the burden of infant death significantly shifted from rural to urban areas. From the year 2011 to 2014, urban areas achieved socioeconomic equity in infant survival, while the extent of inequity was increased in rural areas. Conclusion Community-based programmes should be designed for urban mothers who are expecting higher order births. To eradicate the socioeconomic inequity in infant survival, the government should design strong and sustainable maternal and child healthcare facilities, especially for rural areas.

Background: Worldwide, microbes are becoming more challenging by acquiring virulent skills to adapt and develop antimicrobial resistance (AMR). This is a concern as AMR increases morbidity, mortality, and costs. Consequently, physicians need to be trained on appropriate antimicrobial prescribing, starting as medical students. Objective: To evaluate medical students’ confidence in antimicrobial prescribing and AMR. Methods: Cross-sectional study assessing medical students’ knowledge, perception, and confidence in prescribing antimicrobials and AMR in a Malaysian University. A universal sampling method was used. Results: Most responding students believed that educational input regarding overall prescribing was sufficient. Regarding the principle of appropriate and accurate prescriptions, female medical students had less knowledge (odds ratio (OR) = 0.51; 95% confidence interval (CI) 0.25–0.99; p = 0.050). Year-IV and Year-V medical students had more excellent knowledge than Year-III students regarding confidence in potential antibiotic prescribing once qualified. Year-V students also showed an appreciably higher confidence in the broad principles of prescribing, including antibiotics for infectious diseases, compared to those in other years. Conclusion: Overall, medical students gain more knowledge and confidence regarding the potential prescribing of antimicrobials as their academic careers progress. This is important given concerns with the current excessive use of antimicrobials in Malaysia.

Understanding disease clustering and transmission patterns improves the prevention and control of disease. Herein, we described the epizootic characteristics and spatiotemporal dynamics of High Pathogenicity Avian Influenza (HPAI) H5N1 outbreaks as well as clade diversity and phylodynamics of H5N1 over time and across host species in Bangladesh. We used Morans I, Gearys C, Getis-Ord Gi^∗, and a space-time permutation model to analyze the spatiotemporal patterns of H5N1 outbreaks. We used Bayesian phylogenetic analysis to generate a time-scaled maximum clade credibility (MCC) tree. Our study revealed nine HPAI H5N1 epizootic waves between 2007 and 2020 that invariably peaked in the wintertime. After vaccination of poultry against H5N1 was introduced in 2012, the incidence of HPAI H5N1 outbreaks and poultry mortality decreased significantly over time. Nonetheless, our research revealed that the virus continued circulating unabatedly in Bangladesh. The various spatiotemporal analyses were identified up to nine space-time clusters across Bangladesh, with the most significant clustering and hotspots of H5N1 outbreaks in and around the district of Dhaka. Since 2007, four H5N1 clades have been detected in Bangladesh, with only clade 2.3.2.1a continuing to circulate since 2011, which was followed up by the reassorted clade 2.3.2.1a in 2012. The HA gene of the H5N1 clade 2.3.2.1a has been reassorted into at least nine subgroups (R1R9). After 2016, the first eight groups disappeared, with only the R9 group remaining. Spatiotemporal patterns and phylodynamics of H5N1 outbreaks are crucial for developing targeted and appropriate HPAI control and prevention measures. We recommended intensive monitoring of biosecurity measures and disease records in high-priority areas, along with assessing vaccine efficacy to better control HPAI outbreaks in Bangladesh.