In the summer of 2017, an estimated 745,000 Rohingya fled to Bangladesh in what has been described as one of the largest and fastest growing refugee crises in the world. Among numerous health concerns, an outbreak of acute jaundice syndrome (AJS) was detected by the disease surveillance system in early 2018 among the refugee population. This paper describes the investigation into the increase in AJS cases, the process and results of the investigation, which were strongly suggestive of a large outbreak due to hepatitis A virus (HAV). An enhanced serological investigation was conducted between 28 February to 26 March 2018 to determine the etiologies and risk factors associated with the outbreak. A total of 275 samples were collected from 18 health facilities reporting AJS cases. Blood samples were collected from all patients fulfilling the study specific case definition and inclusion criteria, and tested for antibody responses using enzyme-linked immunosorbent assay (ELISA). Out of the 275 samples, 206 were positive for one of the agents tested. The laboratory results confirmed multiple etiologies including 154 (56%) samples tested positive for hepatitis A, 1 (0.4%) positive for hepatitis E, 36 (13%) positive for hepatitis B, 25 (9%) positive for hepatitis C, and 14 (5%) positive for leptospirosis. Among all specimens tested 24 (9%) showed evidence of co-infections with multiple etiologies. Hepatitis A and E are commonly found in refugee camps and have similar clinical presentations. In the absence of robust testing capacity when the epidemic was identified through syndromic reporting, a particular concern was that of a hepatitis E outbreak, for which immunity tends to be limited, and which may be particularly severe among pregnant women. This report highlights the challenges of identifying causative agents in such settings and the resources required to do so. Results from the month-long enhanced investigation did not point out widespread hepatitis E virus (HEV) transmission, but instead strongly suggested a large-scale hepatitis A outbreak of milder consequences, and highlighted a number of other concomitant causes of AJS (acute hepatitis B, hepatitis C, Leptospirosis), albeit most likely at sporadic level. Results strengthen the need for further water and sanitation interventions and are a stark reminder of the risk of other epidemics transmitted through similar routes in such settings, particularly dysentery and cholera. It also highlights the need to ensure clinical management capacity for potentially chronic conditions in this vulnerable population.

Water, sanitation, and healthcare waste management are essential services in healthcare facilities to ensure the quality of care and minimize infection risk. World Health Organization (WHO) Cox Bazar's sub-office supported the implementation of the Water and Sanitation for Health Facility Improvement Tool in 21 purposively selected HCFs in Rohingya refugee settlements. A total of 16 WASH FIT indicators from three of the seven WASH FIT domains (five on water, five on sanitation, and six on healthcare waste management) were monitored for 1 year employing a mixed method approach. After 1 year 67% of indicators in all three domains met minimum WASH FIT standards, indicating a significant (p ≤ 0.01) contribution to improved quality of care compared to 29% at the start in August 2018. By domain, 81% of water indicators (vs. 67% at the start), 76 vs. 24% for sanitation, and 48 vs. 33% for healthcare waste management met standards. Key informant interviews and focus group discussions affirm improvement in all three domains, including quality of care, staff satisfaction, and awareness of occupational risks and mitigation measures. Challenges remain, including limited budget, lack of leadership and absence of formal programs for improving water supply infrastructure, sanitation and healthcare waste management.

The study characterises the straw-colour in groundwater of coastal areas of Bangladesh. The study design was exploratory to have a better understanding of straw colouration. Findings indicate that the straw-colour is an entirely true colour in Alpha-Hazen Scale due to dissolved organic components tannin/lignin with different functional groups. The concentration of different parameters of water influences the intensity of the colour. The intensity of straw-colour has a significant positive correlation with depth and has spatial variation within the study sites. Borehole sediment sample analysis confirms the presence of organic particles. People who drink straw-coloured water in Barguna Upazila for a relatively more extended period show signs and symptoms of kidney-related disorders. A further detailed study with chemical analysis of straw-coloured water by NMR and GCMS should help identify the exact structure of the organic elements and public health vulnerabilities that a cohort study should firm.

The National Adaptation Plan of Bangladesh identifies eleven climate-stressed zones, placing nearly 100 million people at high risk of climate-related hazards. Vulnerable groups such as the poor, floating populations, daily laborers, and slum dwellers are particularly affected. However, there is a lack of data on climate-sensitive diseases and related hospital visits in these areas. This study explored the prevalence of such diseases using the Delphi method through focus group discussions with 493 healthcare professionals from 153 hospitals in 156 upazilas across 21 districts and ten zones. Participants were selected by district Civil Surgeons. Key climate-sensitive diseases identified included malnutrition, diarrhea, pneumonia, respiratory infections, typhoid, skin diseases, hypertension, cholera, mental health disorders, hepatitis, heat stroke, and dengue. Seasonal surges in hospital visits were noted, influenced by factors like extreme heat, air pollution, floods, water contamination, poor sanitation, salinity, and disease vectors. Some diseases were zone-specific, while others were widespread. Regions with fewer hospital visits often had higher disease burdens, indicating under-reporting or lack of access. The findings highlight the need for area-specific adaptation strategies and updates to the Health National Adaptation Plan. Strengthening resilience through targeted investment and preventive measures is crucial to reducing health risks from climate change.