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.

Background: This paper provides the first national analysis of antimicrobial use (AMU) of oral and parenteral dosages in Bangladesh, as well as biannual trends for the years from 2019 to 2023. It also analyzes the effect of the COVID-19 pandemic on AMU. Methods: AMU was analyzed in accordance with the WHO Anatomical Therapeutic Chemical classification and defined daily doses per 1000 inhabitants per day methodology. Data on antimicrobial medicine dispatched from manufacturers’ central warehouse was collected and categorized based on the WHO’s Access, Watch, and Reserve (AWaRe) classification. Findings: This AMU surveillance demonstrates an increase in the use of antimicrobial medicines from 2021 to 2022, and in 2023, it decreased, with our national AMU surveillance data indicating that cefixime and azithromycin were the most consumed antibiotics during this period. Most antibiotics used in Bangladesh are broad-spectrum ‘Watch’-category antibiotics. Among oral antibiotics, 50 to 67% are from the ‘Watch’-category. When considering only parenteral antibiotics, 70 to 91 % fall under the ‘Watch’-category. Third-generation cephalosporin consumption has been found to be higher than second- and first-generation cephalosporins. The oral antimicrobials are more commonly used than parenteral ones. AMU notably increased during the COVID-19 pandemic, especially in the case of systemic antibacterial use. Conclusions: To achieve the global target of 70% use of Access category antibiotics by 2030, the use of Watch-group antibiotics, like cefixime, azithromycin, ciprofloxacin, levofloxacin, and ceftibuten, needs to be reduced through investing in and strengthening stewardship programs and eliminating self-medication in Bangladesh. The findings of this study provide useful information to policymakers to tackle AMR in Bangladesh.

Background: Blood transfusion services (BTS) are essential for timely and safe care in critical conditions. This study assessed the availability and functionality of BTS in Bangladesh to describe the operational landscape, identify gaps and inform recommendations. Methods: A cross-sectional quantitative survey was conducted in 17 districts across eight administrative divisions of Bangladesh, selected on the highest concentration of blood transfusion (BT) centers. Of 402 centers nationwide, 201 were assessed: public tertiary, district and sub-district health facilities, private hospitals, standalone blood banks and Red Crescent centers. Specifically trained field investigators collected data on site using a standardized facility assessment instrument. Descriptive analysis used Stata 17. Results: Dedicated BTS infrastructure was limited at sub-district health facilities: air-conditioned transfusion-transmissible infection (TTI) laboratories (27%), blood storage rooms (13%), and no professor or consultant, available in only 2 of 13 district hospitals (DHs). Median family replacement donations exceeded voluntary non-remunerated donations (774 vs. 404 units, April–June 2024). All centers used rapid diagnostic tests for TTIs. About 70% of public and 34% of private hospitals followed no standard operating procedures (SOPs). A valid license was reported by 84% of private for-profit facilities. Red cell concentrate, fresh frozen plasma and platelet concentrate were prepared most often by Red Crescent centers (6/7) and public tertiary hospitals (20/27). Maximum discards due to TTIs and expiry were 147 and 1,500 units. Functional BT committees were absent in 13 of 40 public tertiary hospitals and DHs, and hemovigilance in 37 of 126 applicable centers. Conclusion: BTS in Bangladesh require strengthened regulatory oversight by the Directorate General of Health Services (DGHS) and its Safe Blood Transfusion Programme, particularly for licensing and SOP adherence. The services should be expanded to sub-district levels. Stock management, functional BT committees and a national hemovigilance system need strengthening to reduce wastage and monitor adverse events.