The adolescence period is considered a life stage worthy of strategic health investments since it is a critical period of physical and neuro-maturational development. Adolescent girls face different health difficulties in that phase of life. Children born to adolescent mothers are at a higher risk of undernutrition. This paper aims to estimate the prevalence of stunting among adolescent mothers and their children in Bangladesh by time period and determine the associated factors of adolescent maternal stunting status. We also sought to establish the relationship between maternal and childhood stunting by comparing the geographical regions in Bangladesh. We derived data from the nationally representative Bangladesh Demographic and Health Survey, which was conducted between 2007 and 2017/18. The outcome variables of this study were ever-married adolescent girls’ stunting status and their children’s stunting status. Interaction analysis between administrative division and maternal stunting status was conducted with childhood stunting as the outcome variable to investigate the impact of maternal stunting status on their children’s stunting compared to geographical location. Our results indicated that in comparison to other divisions, the frequency of stunting among children and adolescent mothers was higher in the Sylhet region. It also revealed that children whose mothers were stunted had a 2.36 times increased chance of being stunted. Our study suggests that education for women could help them attain self-sufficiency and, as a result, reduce the prevalence of poor childhood nutrition, especially stunting.

(1) Shigella spp. (Shigella) is known for causing dysentery with blood in stool, but most children infected with Shigella have non-dysentery Shigella-associated diarrhea (NDSD). The World Health Organization recommends the use of antibiotics when diarrhea is bloody, leaving most NDSD cases untreated. The absence of dysentery may not indicate a low risk of death and severe morbidity. Rapid diagnosis and treatment of shigellosis in vulnerable, young children may be lifesaving. INSIGHT aims to determine the potential benefit of identifying NDSD cases (n = 296) and their outcomes compared to cases of Shigella dysentery [DS (n = 148)] and non-Shigella watery diarrhea [WD (n = 148)]. (2) Children seeking care at hospitals in Bangladesh will be enrolled and followed for 1 year (NDSD and DS) or 90 days (WD). We will determine the impact of NDSD on morbidity, mortality, gut health, nutritional status, and cognitive development compared to DS and WD in children and whether the simple “Rapid LAMP-based Diagnostic Test (RLDT)” can accelerate the detection and treatment of shigellosis in the clinical settings of rural Bangladesh. (3) INSIGHT will determine the impact of NDSD in children and determine if the treatment guidelines of shigellosis need to be revisited to improve clinical outcomes and the development of these children.

Improvement in hand hygiene has been strongly associated with positive outcomes in maternal and child health. Although Bangladesh has a high level of awareness of key hygiene messages, the practice of handwashing, the most effective hygiene behavior, is low. Suchana, a multisectoral nutrition program, aims to increase knowledge and practices around various water, sanitation, and hygiene settings in Sylhet region, the northeast of rural Bangladesh. This study aimed to investigate the changes in indicators related to handwashing knowledge and practices among Suchana beneficiaries in final compared with baseline evaluations. Data were derived from the baseline and final cross-sectional evaluation survey. The following handwashing knowledge and practices were considered: handwashing before preparing food, before eating food and feeding children, before serving food, after defecation, and after touching animals. The descriptive findings indicate that Suchana intervention improved handwashing knowledge and practices in the intervention area compared with the control. The odds of having knowledge of hand washing before preparing food (adjusted odds ratio [aOR]: 1.60; 95% CI: 1.30–1.98), before eating food and feeding children (aOR: 1.68; 95% CI: 1.25–2.25), before serving food (aOR: 1.35; 95% CI: 1.04–1.76), after defecation (aOR: 1.74; 95% CI: 1.25–2.41), and after touching animals (aOR: 1.67; 95% CI: 1.29–2.16) were higher in intervention area than the control area. Similarly, the impact on maternal handwashing practices at final evaluation indicated successful effects of the intervention. These results suggest scaling-up of similar interventions for larger populations living in vulnerable areas of rural Bangladesh.

: Enterotoxigenic Escherichia (E.) coli (ETEC) and enteropathogenic E. coli (EPEC) are major bacterial causes of childhood diarrhea. We explored the clinico-epidemiological characteristics of children aged <5 years associated with moderate-to-severe diarrhea (MSD), asymptomatic ETEC or EPEC infections, and subsequent impact on growth reflected by z-score. Data from 9,439 MSD and 13,128 asymptomatic children were extracted from Global Enteric Multicenter Study, conducted between 2007 and 2011. Epidemiological risk factors and clinical characteristics of ETEC and EPEC infection were explored using multivariable logistic regression, and a paired t-test was used to investigate the impact of infection on nutritional status. Children aged 12–23 months were more affected by ETEC-positive MSD compared with 0–11 months, whereas children aged 0–11 months were more vulnerable to EPEC-positive MSD. ETEC- and EPEC-positive MSD children showed more characteristics of clinical dehydration like sunken eyes and loss of skin turgor preservation, and needed more intravenous rehydration than ETEC- and EPEC-negative MSD children. Among the other identified co-pathogen, presence of Campylobacter in the analyzed stool sample had higher likelihood to be associated with symptomatic MSD (adjusted odds ratio [aOR] 1.42, 95% CI 1.17–1.71) and asymptomatic children with ETEC infection (aOR 1.42, 95% CI 1.16–1.73) and asymptomatic EPEC infection (aOR 1.22, 95% CI 1.04–1.43). Significant growth faltering was noted in MSD children with ETEC (mean difference 0.22, 95% CI 0.10–0.34) and EPEC (mean difference 0.15, 95% CI 0.03–0.27) from baseline to ∼60 days (50–90 days). Our findings highlight the need to implement preventative strategies to reduce the risk of diarrheal illnesses.

Background: Antimicrobial resistance, driven by inappropriate use and overuse of antibiotics, is a major public health threat. Diarrhea and respiratory illness are the leading causes of pediatric healthcare visits in low- and middle-income countries like Bangladesh. Despite clear WHO guidelines recommending limited use of antibiotics for these conditions, potentially inappropriate or non-prescription antibiotic use remains a concern. Methods: We interviewed caregivers of 3025 under-5 children via cellphones to assess common illnesses, associated care-seeking practices, and antibiotic use for diarrhea and respiratory illnesses experienced by their children in the prior 14 days. Caregivers were identified through hospital outpatient screening and were contacted over the phone for the interview at least two months after that hospital visit. Results: Among the participants, 116 (3.8%) reported diarrheal disease and 570 (18.8%) experienced respiratory illness during the preceding 2-week recall period. Among the children with diarrhea, 52.6% received antibiotics, and 73.8% obtained them over the counter from pharmacies. Among those with respiratory illness, 26.3% received antibiotics, and 58% procured them from local drugstores without a prescription from a registered physician. For diarrhea, azithromycin and metronidazole were the commonly used antibiotics, while for respiratory illness, cefixime and azithromycin were frequently used. Notably, 68% of the diarrheal children either sought care from local drugstores, were self-medicated, or did not receive any formal treatment. Conventional practice, long wait times at healthcare facilities, distance, and poverty were the main reasons for not seeking care from a registered healthcare provider. Conclusions: Understanding community-level antibiotic use and care-seeking behavior is essential to strengthening antibiotic stewardship and child health programs. Our findings suggest the need for context-sensitive community education, improved access to appropriate care, and enforcement of regulations restricting the over-the-counter sale of antibiotics to curb irrational and excessive antibiotic use.

Background: Misuse and overuse of antibiotics in childhood diarrhea pose a high risk of antimicrobial resistance (AMR), which is a public health threat globally, and Bangladesh is no exception. This study aims to describe urban-rural differences and determine the factors associated with antibiotic use at home in children before seeking care for diar-rhea at the health care facilities. Methods: This cross-sectional study, over an 18-month period, included 5,894 children aged 1-59 months from two large health facilities: a rural secondary-level district hospital, located in Tangail, and an urban diarrhea specialized facility, icddr,b Dhaka hospital. Following clinical care, trained staff used a pre-validated structured questionnaire to collect data on child demographics, clinical symptoms, feeding practices, and treatment received prior to hospital visit. The primary outcome was antibiotic use at home before hospital presentation. Multivariable logistic regression models analyzed factors linked to home antibiotic use. Results: The preva-lence of antibiotic use at home before seeking care among diarrheal children was sig-nificantly higher in children visiting a rural facility as compared to that of the urban facility (90.0% vs. 68.4%). Pharmacies were the primary source of antibiotics for children in both rural and urban areas (64.1% vs. 61.2%). Multivariable analysis showed that in urban settings, children with diarrhea for 1-3 days were more than twice as likely (aOR:2.39, 95% CI:1.66.4), and those sick for 4 or more days were three times as likely (aOR:3.09, 95% CI: 2.21–4.43) to receive antibiotics at home compared to children who had less than one day of diarrhea. Children with no history of a prior hospital visit for diarrhea were also 1.86 times at higher risk of using antibiotics (aOR: 1.86, 95% CI:1.28–2.72). In a rural setting, children with diarrhea for 1–3 days had five times (aOR:5.11, 95% CI: 3.6–7.1), and those who had diarrhea for 4 days or more had two times higher odds (aOR: 1.97, 95% CI: 1.43–2.73) for antibiotic use. Moreover, children whose caregivers used ORS were 2.8 times more likely to use antibiotics at home (aOR:2.80, 95% CI: 1.06-7.35). Conclusions: This study demonstrates that antibiotic use at home before seeking care is alarmingly high among children with diarrhea in Bangladesh, particu-larly in rural settings, driven by informal pharmacy access and symp-tom-duration-driven decision-making in urban areas. This emphasizes the need to en-hance awareness in both sectors of the public and healthcare providers. Moreover, im-plementing and monitoring strict regulations for antibiotic sales over-the-counter in pharmacies is essential to impede escalating trends of AMR in Bangladesh.