Observational studies and randomised controlled studies suggest that vitamin D plays a role in the prevention of acute respiratory tract infection (ARTI); however, findings are inconsistent and the optimal serum 25-hydroxyvitamin D (25(OH)D) concentration remains unclear. To review the link between 25(OH)D concentration and ARTI, we searched PubMed and EMBASE databases to identify observational studies reporting the association between 25(OH)D concentration and risk or severity of ARTI. We used random-effects meta-analysis to pool findings across studies. Twenty-four studies were included in the review, 14 were included in the meta-analysis of ARTI risk and five in the meta-analysis of severity. Serum 25(OH)D concentration was inversely associated with risk and severity of ARTI; pooled odds ratios (95% confidence interval) were 1.83 (1.42–2.37) and 2.46 (1.65–3.66), respectively, comparing the lowest with the highest 25(OH)D category. For each 10 nmol/L decrease in 25(OH)D concentration, the odds of ARTI increased by 1.02 (0.97–1.07). This was a non-linear trend, with the sharpest increase in risk of ARTI occurring at 25(OH)D concentration < 37.5 nmol/L. In conclusion, there is an inverse non-linear association between 25(OH)D concentration and ARTI.

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use.

Background: Healthcare workers (HCWs) play a pivotal role in preventing healthcare-associated infections by adhering to infection prevention and control (IPC) practices. This study assessed IPC knowledge, attitudes, and practices (KAP) among HCWs at tertiary care hospitals in Bangladesh during the coronavirus disease 2019 pandemic. Methods: From September 2020 to January 2021, semistructured questionnaires were administered to physicians, nurses, and cleaning staff at 11 tertiary care hospitals in Bangladesh. KAP components were classified into “good,” “fair,” and “poor” based on the frequency of favorable responses (>75%, 50%–75%, <50%). Multivariate logistic regression was used to assess the relationship between knowledge, attitudes, and self-reported practices. Results: We enrolled 1728 HCWs, including 526 physicians (30.4%), 934 nurses (54.1%), and 268 cleaning staff (15.5%). Physicians and nurses demonstrated “good” IPC knowledge (median 94.8% and 96.6% favorable responses, respectively) and self-reported IPC practices (median 76.2% and 80.4% favorable responses). However, most cleaning staff exhibited “poor” IPC knowledge (median 47.3% favorable responses) and practices (21.3% favorable responses). Across all categories of HCWs, the median attitude score was “fair” (range 60.0%–71.2% favorable responses). Having a positive attitude toward IPC was associated with increased IPC knowledge (adjusted odds ratio 3.0, P < .001) and good IPC practices (adjusted odds ratio 16.3, P < .001). Conclusions: HCW's KAP toward IPC was found to be suboptimal, especially among cleaning staff. However, the strong association noted between favorable attitudes toward IPC and adherence to safe IPC practices demonstrates the need for hospital leadership to promote a positive IPC culture, in addition to training and resources, to improve IPC practices and enhance healthcare resiliency beyond the coronavirus disease 2019 pandemic.

Unsafe hospital wastewater (HWW) is a significant concern, especially in low-and middle-income countries (LMICs) where the health impact is often underreported. Socio-technical systems (STS) theory, which examines the interplay between social and technical elements within complex systems, is widely used in developed countries but rarely applied in LMIC hospitals. STS theory was employed to evaluate the social and technical aspects of HWW treatment and management in Dhaka City, alongside a comprehensive assessment of WWT processes. A mixed-methods approach was used, combining quantitative (structured observations) and qualitative interviews. Structured observations assessed the availability and functionality of WWT systems in selected hospitals. The fieldworkers conducted 30 key-informant interviews across 13 hospitals, including 21 respondents from government and nine from private hospitals. The respondents were cleaners, key health professionals, and public works department (PWD) engineers. We also analyzed relevant government reports and policies. Among the hospitals surveyed, 10 had some form of WWT system, while the remaining three lacked any treatment infrastructure. Of those with WWT, seven utilized anaerobic baffled reactors and three had septic tanks. Interviews revealed that hospital authorities prioritize patient care and medical equipment maintenance over WWT, with limited understanding among hospital staff regarding WWT. PWD-engineers reported frequent staff shortages and bureaucratic delays, affecting the efficiency of WWT system repairs and desludging. Our study identified significant gaps in WWT in Dhaka hospitals, including the limited use of adequate treatment technologies, poor wastewater management knowledge, and many systems in disrepair, leading to hazardous liquid being discharged directly into the environment. The STS approach highlighted the need for policy formulation for HWW regulation, government leadership, adequate financing, technical assistance, and staff capacity building. Addressing these issues comprehensively can lead to safer and more sustainable wastewater management practices in HCFs, ultimately benefiting public health and the environment.

Background: Over 700,000 Myanmar nationals known as the ‘Rohingyas’ fled into Cox’s Bazar, Bangladesh, in late 2017. Due to this huge displacement into unhygienic areas, these people became vulnerable to communicable diseases including cholera. Assessing the risk, the Government of Bangladesh (GoB), with the help of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and other international partners, decided to take preventive measures, one of which is the execution of oral cholera vaccination (OCV) campaigns. This paper describes the implementation and delivery of OCV campaigns during humanitarian crises in Bangladesh. Methods: Seven rounds of OCV campaigns were conducted between October 2017 and December 2021. The OCV campaigns were conducted by applying different strategies. Results: Approximately 900,000 Rohingya Myanmar nationals (RMNs) and the host population (amounting to 528,297) received OCV across seven campaigns. In total, 4,661,187 doses of OCVs were administered, which included 765,499 doses for RMNs, and 895,688 doses for the host community. The vaccine was well accepted, and as a result, a high level of coverage was achieved, ranging from 87% to 108% in different campaigns. Conclusions: After successful pre-emptive campaigns in Cox’s Bazar humanitarian camps, no cholera outbreaks were detected either in the RMN or host communities.

Background: Baseline assessment of standard precaution relating to infection prevention and control (IPC) preparedness to fight health crisis within healthcare facilities at different levels and its associated factors in Bangladesh remains unknown. Methods: We analyzed the nationally representative Bangladesh health facility survey (BHFS) data conducted by the Ministry of Health and Family Welfare (MoHFW) during July–October 2017. We used the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) manual to determine the standard precautions related to the IPC readiness index. Using a conceptual framework and multivariable linear regression, we identified the factors associated with the readiness index. Results: We analyzed data for 1,524 surveyed healthcare facilities. On average, only 44% of the standard precaution elements were available in all facilities. Essential elements, such as guidelines for standard precautions (30%), hand-washing soap (29%), and pedal bins (38%), were not readily available in all facilities. The tuberculosis service area was least prepared, with 85% of elements required for standard precaution deficient in all facilities. Significantly lower readiness indexes were observed in the rural healthcare facilities (mean difference, −13.2), healthcare facilities administered by the MoHFW (mean difference, −7.8), and private facilities (mean difference, −10.1) compared to corresponding reference categories. Conclusions: Our study revealed a severe lack of standard precaution elements in most healthcare facilities, particularly in rural health centers. These data can provide a baseline from which to measure improvement in infection prevention and control (IPC) in these facilities and to identify areas of gaps for targeted interventions to improve IPC strategies that can improve the Bangladesh health system.