Thesis/ Project Report, Master of Public Health (James P. Grant School of Public Health)

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A qualitative exploration of motivations and barriers in the decision-making regarding the uptake of HPV vaccine among caregivers of adolescent girls in Dhaka Korail slums
(BRAC University, 2025) Yudhianto, Kristian; Anwar, Humayra Binte; Barua, Mrittika
Introduction: Cervical cancer, primarily caused by the human papillomavirus (HPV), remains a health concern globally, particularly in low- and middle-income countries like Bangladesh. HPV vaccination is a proven preventive measure, yet the implementation of HPV vaccination in urban slums such as Dhaka’s Korail slum is challenging. This study aims to explore the motivations and barriers influencing caregivers’ decision-making regarding HPV vaccination for their adolescent daughters aged 10–14 years. Method: The study population is caregivers of adolescent girls aged 10-14 years living in Korail slum Dhaka, Bangladesh. A qualitative study was conducted by using the Behavioral and Social Drivers (BeSD) framework developed by WHO to guide data collection and analysis. In-depth interviews were carried out with eight caregivers, selected through purposive and snowball sampling methods. Data were analyzed thematically to identify interactional factors shaping vaccination decisions. Findings: Caregivers demonstrated low awareness of cervical cancer and HPV vaccination. Motivators for vaccination included trust in school authorities, influence from family and peers, and perceived health benefits for their daughters. Barriers included misinformation, concerns about vaccine side effects, inadequate communication from implementers, and cultural perceptions. Mothers were often the primary decision-makers, with HPV vaccination viewed as a “feminine matter”. Conclusion: The research highlights the urgency for targeted communication strategies to improve caregivers’ understanding of HPV vaccination. Engaging trusted figures such as schoolteachers and community health workers is important to address misconceptions and build trust with caregivers. Specific interventions should focus on enhancing the understanding of HPV vaccination and cervical cancer in urban slum communities, to increase HPV vaccination uptake and prevent cervical cancer in future generations.
A qualitative research on knowledge, attitude, and practice of hand washing among BRAC volunteers and their experience on message dissemination in Cox’s Bazar, Bangladesh
(Brac University, 2023) Rajan, N Ganesh; Sarker, Malabika; Barua, Mrittika
Introduction: Covid-19 Volunteers played a vital role in absorbing the shock on the healthcare system to some extent during the pandemic by task shifting. They played a multifaceted role where healthcare students assisted in medical activities, and non-medical volunteers helped with surveillance, quarantine, providing psychological support, and preventive measure campaigns. On contrary, disseminating healthcare knowledge by a non-medical person to the community in this infodemic scenario is challenging. The practice of handwashing is considered to be one of the best ways to prevent covid-19 infection. The current study focused on knowledge, attitude, and practice of handwashing among BRAC volunteer and their experience in message dissemination and implementation of handwashing stations. Method: This study was conducted in the Sadar and Ramu Upazila of cox’s Bazar of Bangladesh. We used an exploratory qualitative study to conduct this research and purposive sampling was done to select the volunteer. 8 in-depth interview was conducted using semi-structured in-depth interview guidelines. Findings: we found that volunteers were from different educational backgrounds and ages but they have good knowledge about covid-19 and handwashing. Induction training post-recruitment helped to attain this uniform knowledge among them. All-volunteer believed that covid-19 can be controlled by embracing proper covid-19 preventive measures, and handwashing. Various factors like financial allowance, security, power play, misconceptions, power play, inadequate logistical supply, and the design of the handwashing station acted as barriers and the BRAC brand, support from the local government and religious leader, and response from the community were the facilitator’s factors for message dissemination. Conclusion: From this study, we can say that volunteers have the proper knowledge to disseminate correct information to the community. During emergency periods volunteers can be trained to perform appropriate tasks. So as to absorb the shocks in the health system. In addition, involving key community stockholders in planning can make the message context-specific and easy to implement. Lately providing a human-centric designed handwashing station can promote hand washing in the community.
A qualitative study on implementer’s perspective of success and challenges: Interactive Popular Theatre (IPT) component of BRAC CST
(Brac University, 2023) Nawaz, Shahpara; Barua, Mrittika
Interactive popular theater (IPT) has been used as a public health education tool for decades in different countries of the world. Bangladesh Rural Advancement Committee (BRAC) conducted IPTs in the Cox’s bazar districts of Bangladesh to build awareness about COVID-19 and cervical cancer prevention. This study aimed to explore the experience of the IPT implementers and understand their perspective on the success and challenges of BRAC IPT implementation at Cox’s Bazar. A qualitative approach with exploratory research design was employed and in-depth interviews were done to with the managerial level and field level implementers of IPT to conduct the study. The study finding indicated that the IPT implementers had overall positive experience about the implementation and they considered the IPTs successful due to the positive feedback they received from beneficiaries and positive behavior change they observed in the community after conducting IPTs. However, this study also discovered that the implementers faced certain challenges during the IPT implementation. The challenges found were lack of acceptance of IPT among Muslim conservative people and Muslim religious leaders, difficulty of conducting IPTs in hard-to-reach areas, no sitting arrangement done for the audience in the IPT conducting site, difficulty in crowd management and short duration of training for the actors. These challenges can be overcome by involving the Muslim religious leaders in the consultation meetings prior to conducting IPTs, developing specific plan focusing on timing and transportation process to conduct IPTs in hard-to-reach areas, provide logistic support for the sitting arrangement of audience and trainers assessing the need of extending the training period through close supervision and discussion with the actors.
A qualitative study on the knowledge, perceptions, and practices regarding heatwaves among mothers of young children in a slum of Dhaka, Bangladesh
(BRAC University, 2025) Urmi, Sohana Reza; Misha, Farzana; Ivy, Nishita
Heat waves are a global concern that affects millions of people's health and well-being worldwide. Bangladesh is no exception, and the resource-constrained slum community suffers from its impact on a massive scale due to poor housing, a lack of essential services, and the unavailability of affordable health facilities. Mothers and children are the most vulnerable groups. This study aims to explore the knowledge, perception, and practice regarding heat waves and their associated impacts on mothers of young children in a slum in Dhaka City, Bangladesh. Employing a qualitative approach involving 12 in-depth interviews with mothers of young children and 4 key-informant interviews with valuable community stakeholders, the knowledge, perception, and practices among mothers were captured. Participants were selected through purposive sampling to capture the diverse experiences of the mothers. The interview guidelines were focused on how much they know about heatwaves, and their relation to climate change, their perception of how heatwave affects their life, and their coping mechanism and health-seeking behavior for the heatwaves. Thematic data analysis highlighted patterns and unique insights from their lived experience. The findings reveal that while mothers are aware of the increasing heat, their understanding of its causes and health implications is limited. Many reported heat-related illnesses in children along with themselves, such as dehydration, fever, and heat rash, but financial and logistical constraints often hindered healthcare access. Coping mechanisms included using cooling solutions and increasing water intake, but these measures were insufficient to mitigate the severe impacts of extreme heat. This study underscores the urgent need for targeted interventions, including awareness campaigns, affordable healthcare access, and community-level support systems to address the challenges of heatwaves in urban slums. The insights gained can inform policies to improve resilience and reduce health vulnerabilities among marginalized populations in rapidly urbanizing areas.
Air quality and respiratory health: prevalence, knowledge, and practices in Dhaka’s informal settlements - a cross-sectional study
(BRAC University, 2025) Akter, Rabeya; Quayyum, Zahidul; Saha, Priom
Background: Several studies suggest that air pollution causes morbidity and mortality, this problem is particularly severe in developing countries. However, little is known about the prevalence of respiratory symptoms among adults in informal settlements with varying air pollution and their practice and knowledge status regarding air pollution and its impact on health. The objective of this study is to explore the prevalence of respiratory symptoms in two informal settlements in Dhaka and the knowledge and practice status of the adult residents. Methods: The study design was cross-sectional and was conducted in Shyampur and Dakshinkhan areas. These study sites were selected based on air quality data collected from a study conducted in BRAC JPGSPH in 2023. Shyampur was selected for having comparatively high air pollution, whereas Dakshinkhan was chosen for having comparatively low air pollution. A total of 316 adult residents were interviewed. This study used multiple sequential logistic regression models to examine the relationship between respiratory symptoms, sociodemographic, and environmental factors, and knowledge and practice status. Results: The proportion of people having respiratory symptoms in Shyampur and Dashinkhan areas were 60.26% and 55.41% respectively. Knowledge status varied in the two areas, while the practice status was almost equal in Shyampur and Dakshinkhan. Results of the sequential multiple logistic regression revealed that the participants in Dakshinkhan had lower odds of having respiratory symptoms (OR= 0.61; 95% CI: 0.36-1.01) compared to Shyampur area. The odds of suffering from respiratory symptoms were significantly associated with individuals who are aged 50 years and above ( OR= 2.31; 95% CI: 1.07-4.98); those who were aged 30-39 years old (OR= 2.05; 95% CI: 1.11-3.82); exposure to indoor smoking (OR= 1.53; 95% CI:0.93-2.50), higher income level ( OR=1.91; 95% CI:1.04-3.49), knowledge status (Good level) ( OR= 2.07; 95% CI: 1.06-4.05), knowledge status (moderate level) ( OR = 2.07, 95% CI: 1.06-4.05). In stratified logistic regression analysis age, income, and exposure to smoking indoors showed a significant association, while in Dakshinkhan resident’s knowledge status was significantly associated with respiratory symptoms. Conclusion: The impact on respiratory symptoms is higher in areas with comparatively high pollution than in areas with comparatively low pollution. Along with socio-demographic and environmental factors, housing conditions, and participant’s knowledge status emerged as significant variables in predicting respiratory symptoms in informal settlements.
An assessment of knowledge and uptake of COVID-19 vaccine among the school going students at Cox Bazar in Bangladesh
(Brac University, 2023) Das, Nikkon Ranjan; Chowdhury, Mohiuddin Ahsanul Kabir; Sarker, Malabika
Adequate knowledge about COVID-19 vaccination among school students is necessary after the re-opening of schools to ensure that the students stay protected from COVID-19. BRAC has implemented interventions in the selected schools of Cox’s Bazar to increase knowledge and awareness about COVID-19. The purpose of this research was to evaluate the knowledge of school students about COVID-19 vaccination and the uptake rate of the vaccines among students who have received BRAC intervention at Cox’s Bazar. The sample size calculated for this study was 1546. The study used the descriptive statistics and logistic regression to assess the knowledge and uptake rate of vaccines and the associated factors with vaccine uptake among the students. The study found that 94% of the surveyed students knew about the COVID-19 vaccine, and 92% of them knew accurately about the vaccine doses. Moreover, 91% of the surveyed students have knowledge about the vaccine registration process. In the case of vaccine uptake, 97% of the surveyed students have taken a minimum of one dose of COVID-19 vaccine, and both male and female students have nearly equal uptake percentages. The logistic regression showed that the student’s age, the education of mother, the upazila (sub-district), the student's knowledge about vaccination, and the student’s knowledge about the vaccination process are significant factors associated with vaccine uptake. The knowledge about vaccines among students and the vaccine uptake rate were satisfactory. The results of this study demonstrated that the BRAC intervention to create awareness among students in schools has been successful in terms of COVID-19 vaccination.
An exploratory qualitative study on the enabling factors of volunteerism: the perspective of BRAC volunteers and their family members in Cox’s Bazar District, Bangladesh
(Brac University, 2023) Lastima, Jorina; Barua, Mrittika
Introduction: Volunteers have a vital role in the community. Their motivation to volunteer can influence other people to change their behavior. Especially in the time of the COVID-19 pandemic, volunteers assisted institutions to help deliver service. Similarly, the BRAC CST project is dealing with COVID-19 in 6 project sites in Cox’s Bazar, Bangladesh with the aid of volunteers. BRAC volunteers are disseminating COVID-19 messages and distributing masks in the community. The volunteers and their families have the relevant information to determine their perception, motivation, and experiences on volunteerism. This study aimed to understand enabling factors of volunteerism from BRAC volunteers and their family members' perspectives in Cox’s Bazar, Bangladesh. Method: The study design used is a qualitative study. An in-depth interview was conducted with 10 BRAC volunteers and 4 family members in 3 BRAC CST project sites located in Cox’s Bazar, Bangladesh. The purposive sampling method was used to select the samples. A semi-structured IDI guideline was developed along with a consent form. IDIs were recorded, transcribed, translated, coded, and analyzed thematically. Clustering and comparing were done by using a data matrix and the results were summarized. Data triangulation was done to verify the responses from the volunteers and family members. Ethical approval from BRAC University James P Grant School of Public Health Institutional Review Board was obtained. The study purpose, risks, benefits, and right to refuse and withdraw from the study were explained to the participants. Anonymity and confidentiality were maintained during the entire time of the study. o Findings: The study discovered that enabling factors on volunteerism contribute to volunteers’ positive experience in volunteer work. The volunteers' and family members’ perception of volunteerism was that it is noble work to do. Volunteers serve the people willing to improve their health which people find respectable. Representing a respectable institution such as BRAC gave the volunteers a sense of pride. Volunteers along with their family members enjoy volunteering activities as they experienced good interactions with the people. Gaining knowledge on COVID-19 prevention benefited the volunteers as well as their families as it enhanced their health practices. Volunteers also developed their communication skills in dealing with many people. The family supported and encouraged volunteers in joining and doing volunteer work. They are proud of their family member as the volunteer is doing a good deed for others. The supervisors were also supportive of the volunteer’s time in taking leaves for their schoolwork. Recognition in the community is also experienced by the volunteers. People’s participation facilitated the discussion that helped the volunteer convey COVID-19 messages in the community. Conclusion: This study concluded that there were different factors of volunteerism. Each one was interconnected with the other that making volunteers motivated to do volunteering. Factors discovered where volunteer work is perceived as an honorable act, being proud to be part of a respectable institution, enjoying volunteering, experiencing benefits, acceptability, and support from the family, institution, and the community. These enabling factors identified made volunteer work on COVID-19 awareness feasible in Cox’s Bazar, Bangladesh.
Assessing facility readiness for timely diagnosis, management, and prevention of Dengue transmission within Savar Upazila Health Complex in Dhaka, Bangladesh: a mixed-methods study
(BRAC University, 2024) Arinda, Yosi Duwita; Hasan, Tanvir; Ashrafi, Shah Ali Akbar
Introduction: Dengue, a viral infection, is rapidly increasing globally. It constitutes a serious public and economic threat, especially in resource-constraint countries like Bangladesh. The weaknesses in healthcare systems in these countries result in poor preparedness for diagnosis, management, and prevention of dengue. Method This mixed-methods study assessed the readiness of Savar Upazila Health Complex, Dhaka, Bangladesh, to manage dengue cases effectively. Quantitative data were obtained through an observational checklist, while qualitative information was derived from 11 Key Informant interviews with healthcare professionals. The study evaluated the essential components of prevention and management: infrastructure, logistics, operational processes, and community engagement in the fight against dengue fever. Findings: The facility showed some promise to readiness, as basics like mosquito nets and institutional treatment were available. However, critical gaps were identified in the availability of diagnostic tools, trained personnel, and infection control measures. Notably, challenges in waste management were significant, including inadequate biomedical waste disposal within the facility and the accumulation of general garbage around the hospital premises. These issues and insufficient ventilation increase the risk of mosquito breeding and dengue transmission. Despite some community awareness efforts, the lack of educational materials and poor coordination limited the effectiveness of preventive initiatives. Conclusion: Savar Upazila Health Complex's readiness for dengue management illustrates some major strengths and critical weaknesses. It is vital to ensure that different structural factors such as inadequate health workforce, limited availability of diagnostic tools, and beds are addressed to efficiently increase the facility’s readiness to manage dengue cases. Strengthening the community education program is also required to reduce the disease burden and prevent future outbreaks.
Assessing knowledge and practices for covid-19prevention among students from class 8th & 9th standard in selected schools and equivalent grades level of madrasas in cox bazar districts, Bangladesh
(Brac University, 2023) Chand, Deepika Joyec; Sarker, Malabika; Chowdharyz, Mohiuddin Ahsanul Kabir
Background: Knowledge and practices are crucial cognitive components in public health, especially in health promotion and prevention (Ferdous et al., 2020).this paper examines knowledge and practice among students of 8th and 9th grade in schools and madrasas of Cox’s bazar district as this will help in developing effective intervention to increase knowledge and practice among students. Method: quantitative approach and cross-sectional design used to collect data among all student in grade 8 & 9 in schools and madrasas. Results: it was found that students have inadequate knowledge score about covid prevention whereas adequate practice score is observed to prevent covid-19. The level of knowledge varied by sociodemographic characteristics. Females [AOR .605,95% CI: (0.484 -0.755) < 0.01] and individuals studying in 9th grade [1.307(1.024 - 1.668) p<0.05 demonstrated inadequate levels of knowledge. Whereas the students living in Pekua were having odds .630 times performing more practice about COVID-19 prevention [OR .630, 95% CI: (0.396 - 1.004)] than students living in Sadar. the study predicts that the odds of a female student being carrying out practice about COVID-19 prevention are 1.014 times [OR 1.014 95% CI: (0.687 - 1.498) than those of a male student. Conclusion: Our findings suggest the need for effective and tailored health education programs aimed at improving COVID-19knowledge among students and to implementation and maintenance of safe practices.
Assessing the feasibility and acceptability of a wearable device for early detection and monitoring of pediatric sepsis among healthcare workers and health facility managers in a peri-urban hospital in Dhaka, Bangladesh: a scenario-based exploration
(BRAC University, 1/5/2025) Levi, Fiona Pauru; Barua, Mrittika; Anwar, Humayra Binte
Background: Sepsis remains a leading cause of morbidity and mortality in under-five children globally, particularly in low-resource settings, with early detection playing a critical role in improving outcomes. This study explores the feasibility and acceptability of a wearable device designed for early sepsis detection and monitoring in a peri-urban hospital setting in Bangladesh, where such technology is not yet widely used. Methods: A qualitative approach was used involving key informant interviews (KII) with nurses and doctors working in the pediatric department and the health facility managers at Sajida Foundation Hospital. Participants were asked about their perceptions of the wearable device, its usability, and potential barriers to its acceptance. The study applied the Theoretical Framework of Acceptability (TFA) and the data was analyzed thematically to identify key themes. Results: Participants highlighted the device's ease of use, remote monitoring capabilities, ability to provide real-time updates, and potential to improve workflow efficiency and neonatal sepsis management. Concerns include infection control, cost, and the need for comprehensive training. The device was perceived as a valuable tool, particularly in resource-limited settings, provided that these challenges were addressed. Suggestions for integration with existing hospital systems and pilot testing were emphasized. Conclusion: The findings demonstrate that wearable device technology for under five children sepsis monitoring is feasible and acceptable. Recommendations include pilot testing, healthcare provider training, and public awareness efforts. With careful implementation and ongoing evaluation, this technology has the potential to significantly improve early sepsis detection and outcomes in pediatric care settings in low-resource environments.
Assessing the knowledge, attitude and practice of anti-microbial resistance (AMR) among the adult drug sensitive tuberculosis patients in BRAC DOTS center in Dhaka city
(BRAC University, 2025) Salman, Abdullah; Rahman, Ataur; Islam, Shayla
Introduction: Tuberculosis (TB) remains a significant public health challenge globally. Moreover it is burdened by the growing threat of antimicrobial resistance (AMR). In Bangladesh, Anti microbial Resistance contributes to treatment failures, particularly among drug-sensitive TB (DS-TB) patients. Additionally, lack of knowledge regarding AMR among the adult TB patients often result in treatment non-adherence. This non- adherence often creates implementation challenges in the Directly observed treatment shortcourse (DOTS) program. To mitigate the implementation challenges, targeted educational interventions are needed that can be integrated into the DOTS program. Understanding the knowledge, attitude, and practice (KAP) levels regarding AMR among the adult Drug Sensitive-TB patients is crucial for designing targeted interventions to mitigate resistance. Objective: This study aimed to assess the knowledge, attitude and practice (KAP) of AMR among adult DS-TB patients in BRAC DOTS center in Dhaka city. Also it tried to see the socio-demographic factors influencing this KAP level. Methods: A quantitative cross-sectional study was conducted among 128 adult DS-TB patients from Dhaka city enrolled in the BRAC DOTS program. It was done using a structured KAP questionnaire validated by Institute of Health Economics, Dhaka University . Participants were selected through simple random sampling based on their registration number. Data were analyzed using descriptive statistics and ordered logistic regression to determine associations between KAP levels and socio-demographic factors. Results: The majority of participants demonstrated moderate knowledge (46.9%) and attitudes (44.5%) toward AMR, while 58.6% reported good practices. Higher education, internet access, and urban residency were significantly associated with better KAP levels. Ordered logistic regression analysis showed that reading AMR-related articles in the Newspaper or in the internet significantly improved knowledge , attitudes and practice of AMR. Moreover individuals having higher education were more likely to have positive attitude towards AMR. Respondents living in the urban area were more likely to have better practices towards AMR than the respondents from peri-urban area . Despite this, critical gaps were identified, such as unawareness about Antibiotics treating bacterial infection infections and the importance of completing antibiotic course. Conclusion: The study highlights the need for targeted educational interventions to address misconceptions and improve AMR-related KAP among DS-TB patients. Integrating AMR education into DOTS programs, focusing on peri-urban areas, and leveraging digital platforms can enhance patient behavior and support Bangladesh's efforts to achieve the End TB Strategy goals.
Assessment of self-management behavior and psychological adjustment practices among drug-sensitive tuberculosis patients at BRAC DOTS TB Center in Dhaka city: a cross-sectional study
(BRAC University, 1/5/2025) Musavi, Zainab; Rahman, Ataur; Islam, Shayla
Introduction: the study used a cross-sectional study design to assess the self-management behaviors and self-efficacy practices of drug-sensitive TB (DS-TB) patients at the BRAC TB DOTS center Kamrangirchar located in Dhaka South City Corporation (DSCC). The primary goal of this study was to assess and evaluate DS-TB patient's self-management behaviors and psychological adjustment practices with a focus on socio-demographic factors. Method: The study was conducted among the 121 DS-TB patients with validated tools self-management scale for tuberculosis patients (SMSTP) & tuberculosis self-efficacy scale (TBSES). The study tool consisted of 24 questions within 4 domains including adherence to treatment, support behavior, disease transmission prevention behavior, and psychological adjustment. Data analysis was conducted using descriptive and inferential statistics including chi-square and t-tests to examine the associations between self-management behaviors, self-efficacy, and socio-demographic characteristics. Findings: The study found variability across each domain of self-management behaviors and self-efficacy practices. The findings indicate the majority of the participants (51.1%) have moderate self-management behaviors followed by 25.7% with low self-management behaviors and 23.1% with high self-management behaviors. Gender-based findings were particularly significant, with females exhibiting moderate and higher self-management 80.6% compared to male patients 66.7%. In addition, education level and occupation of the patients have also been found to be influencing factors, 83.54% of patients with secondary or higher education have moderate and high self-management compared to 57.14% uneducated or primary education completed. Students 94.12% and homemakers 82.05%, have higher self-management behaviors. Additionally, larger household sizes impact the psychological adjustment negatively as 76.92% of patients with 7 or more family members have lower psychological adjustment score. Conclusion: The study found gender as one influencing factor that is important to be considered for gender-specific interventions addressing health education, mental health support, and community-based awareness to improve the effectiveness of the DOTS intervention through self-management behaviors and self-efficacy practices in urban Bangladesh. The findings emphasize the need for community-based interventions and policy development to address the gap in self-management and psychological adjustment to achieve the targeted goal of the End TB strategy and National Tuberculosis Program (NTP).
Assessment of the status and its associated factors among lactating mothers taking services in an urban healthcare facility in Dhaka city: a cross-sectional study
(BRAC University, 1/5/2025) Delwar, Umama Binte; Ireen, Santhia; Akter, Fahmida
Our study aims to determine the nutritional status of lactating mothers attending an urban MNCH facility in Dhaka, Bangladesh, and identify the associated factors. A cross-sectional study was conducted which analyzed socio-demographic data, dietary diversity, and body mass index (BMI). Among the participants, 39.7% were aged 21–25 years, and 40% held a bachelor’s degree or higher. The majority (79.2%) were homemakers, with a median monthly income of 50,000 BDT. Nutritional assessment revealed a dual burden, with overweight and obesity prevalent in 64% of the lactating mothers and undernutrition observed in 10%. When regression analysis was done it highlighted that mothers aged more than 30 years had significantly higher the odds of being overweight or obese (AOR=9.98; p=0.001), emphasizing the impact of age on BMI. Attainment of education also influenced BMI significantly; mothers completing higher secondary education were more likely to have increased BMI (AOR=3.02; p=0.026), likely due to calorie-dense food choices, while those who had completed their education up to bachelors and above education appeared to mitigate this risk. Mothers coming from middle-income households were less likely to be overweight or obese (AOR=0.37; p=0.023), this indicated the impact of income on nutritional outcomes. Dietary factors also played a significant role; frequent consumption of sugary foods increased the likelihood of higher BMI (AOR=2.73; p=0.001), whereas sweets consumption showed an inverse association with overweight and obesity (AOR=0.40; p=0.003) which could be due to differential reporting or cultural practices. Thus interventions should focus on the enhancement of nutritional literacy particularly women of lactational phase and additionally, introduce policies that ensure access to affordable, nutrient-rich foods which could mitigate the rising burden of overweight and obesity. Future longitudinal studies are necessary to explore the long-term effects of these factors on maternal and child health in urban Bangladesh.
Association of childhood feeding practices and occurrence of early childhood caries: A cross sectional study among children under 5 years of age across two urban slum areas of
(Brac University, 2023) Association of childhood feeding practices and occurrence of Early Childhood Caries: A Cross Sectional Study among children under 5 years of age across two urban slum areas of; Ahmed, Syed Masud; Naher, Nahitun
Introduction Early Childhood Caries (ECC) is the occurrence of a carious lesion in a primary tooth in children less than 71 months. It is a significant dental problem that has negative effects on the growth and development of children affected. The objective of this study was to explore the association between early childhood feeding practices and the occurrence of dental caries in children under the age of 5 living in the selected slums of Dhaka city. Method ECC and risk factors were examined using data from 402 children (between ages of 6 months and less than 5 years old) recruited via systematic random sampling and cross-sectional explorative study design in Dhaka's Dholpur and Korail slums. The age, sex, socioeconomic position, oral hygiene practices, childhood-feeding practices, mother’s knowledge of oral health, and oral health seeking practices of children were collected from their mothers through a guided questionnaire tool. In addition, the oral hygiene and caries status of children were evaluated using the Decayed, missing, and filled teeth (DMFT) index. Using chi-square and logistic regression analysis, risk variables related with ECC were identified. Findings Fifty-five children (14 %) children had ECC. There was association between ECC and the child's age and consumption of sugary foods. Compared to 0-11-month-olds, 48-59-month-olds had 25 times more dental caries. Children who don't eat sugary foods are less likely to have dental caries, while those who do are three times as likely. Conclusion ECC is low in the population under study, but increasing mothers' oral health knowledge may lead to better oral hygiene behaviors and reduced sugary snack intake. It would be helpful to undertake more study to evaluate ECC risk factors to recommend appropriate strategies based on risk factors and dissemination of information / build awareness to reduce the occurrence.
Barriers and facilitators in implementing human papillomavirus vaccination for adolescent girls: qualitative insights from healthcare implementers in the Korail slum, Dhaka, Bangladesh
(BRAC University, 2025) Powjithan, Natkunarajah; Anwar, Humayra Binte; Barua, Mrittika
Introduction: Cervical cancer remains as a significant global health issue, ranking fourth among cancers among women. Low- and middle-income countries (LMICs) account for over 90% of related deaths due to limited access to prevention and treatment. The Human Papilloma (Virus) vaccine offers up to 97% protection against cervical cancer when given to women during adolescence, yet the uptake remains alarmingly low in disadvantaged communities. This study explores the qualitative insights from the implementors to identify the barriers and facilitators to HPV vaccination in the urban Korail slum in Dhaka, Bangladesh. Method: A qualitative exploratory design was employed, involving Key Informant Interviews (KIIs) with nine healthcare implementers, including vaccinators, school principals, and field-level supervisors. Data were analyzed using thematic analysis framed by the Consolidated Framework for Implementation Research (CFIR), highlighting contextual and systemic challenges in the Korail slum setting. Findings: The study identified significant facilitators, including high awareness among healthcare workers involved in HPV vaccination, parents and school teachers about cervical cancer prevention, free vaccine provision, and trust in schools as vaccination sites. Training programs boosted implementers' confidence, while stakeholder engagement involving local leaders, parents, and school teachers enhanced vaccine uptake. However, barriers such as misinformation among community members, the sociocultural stigma among adolescent girls and their parents, logistical constraints, and financial challenges faced by the healthcare workers impeded widespread coverage. Logistical hurdles, including the lack of male assistants and transportation support for healthcare workers, added operational inefficiencies. Conclusion: The study highlights the need to address sociocultural barriers through tailored, community-driven strategies. Enhancing implementers' capacity, combating misinformation with culturally sensitive campaigns, and ensuring sustained logistical support are pivotal to improving vaccine uptake. These insights contribute to refining HPV vaccination programs in resource-constrained settings, aligning with global goals to reduce cervical cancer-related morbidity and mortality. Future interventions should focus on sustainable models and scaling successful practices to similar LMIC contexts.
Behavioral risk factors profile of people living with hypertension and diabetes comorbidity: a cross-sectional study in Chirirbandar sub-district, Bangladesh
(BRAC University, 2025) Kumari, Sita; Mridha, Malay Kanti; Latif, Mahbub A.H.M
Introduction: Non-Communicable Disease (NCDs) and their behavioral risk factors are rising worldwide. Moreover, co-occurrence of hypertension and diabetes is also rising among adults in low- and middle-income countries (LMICs) like Bangladesh. The study aims to assess the behavioral risk factors and to identify the factors associated with the clustering of behavioral risk factors (≥3 risk factors) among people living with hypertension and diabetes comorbidity in Chirirbandar sub-district of Bangladesh. Methods: A cross-sectional study was conducted to assess behavioral risk factors among 387 participants from rural households of Chirirbandar sub-district. The data was conducted using WHO STEPs approach to chronic disease risk factor surveillance (STEPs) tools. Presence of three or more risk factors of NCDs was defined as the presence of clustering of NCDs risk factors. Multivariable logistic regression was conducted to identify the factors associated with clustering of behavioral risk factors. Findings: This community-based study covered twelve community clinics of Chirirbandar sub-district of Bangladesh. In total, 387 (148 men and 239 women) were included in the study. The mean age of the respondent was 56.99 years, more than half of them were unemployed, currently married, and less than one third of them had secondary and higher level of education. The prevalence of tobacco use, insufficient fruits and vegetable intake and inadequate physical activity was higher among men, however exposure to indoor air pollution was higher among women. The prevalence of clustering of NCDs risk factors for zero risk factors, one risk factor, two risk factors, three risk factors, and four risk factors were 0.78%, 9.04%, 51.94%, 32.3%, and 5.94% respectively. Majority (61.76%) of the study participants had at most two risk factors and 38.24% of them had three or four risk factors of NCDs. Risk of three or more risk factors was higher among the respondents aged 60 and above (48.47%), and male participants (43.92%). Moreover, the clustering of risk factors was found significantly associated with increased age, and self-care management for hypertension, particularly those who frequently forget to take their medications. Conclusion: The high prevalence of clustering of risk factors demands an integrated NCDs preventive strategies to reduce the burden of risk factors and relevant complications in the rural setting of the country.
Burden and risk factors of sexually transmitted diseases and infections in women of reproductive age (15–49 years) in Sub-Saharan Africa (SSA): a scoping review
(Brac University, 2023) Sheriff, Hannah; Hossain, Shaikh A. Shahed
Introduction Sexually transmitted diseases and infections have a significant negative impact on both individual and community productivity across all countries, particularly in developing ones. Depending on the STI and the population, the risk of HIV acquisition and transmission may increase by two to eight times in low-income nations. Due to the consequences of co-infection with HPV and HIV, the prevalence of cervical diseases, including cervical cancer, has grown in Sub-Saharan Africa (SSA). Method This is a scoping evaluation of primary studies released between 2012 and 2022. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses expanded for scoping reviews in order to publish the findings of this inquiry (PRISMA.ScR). The original, peer-reviewed research publications that satisfied the inclusion requirements and were published from 2012 onward were given priority. These articles were collected from the databases of PubMed, EMBASE, and African Journals Online. Two impartial reviewers used preset criteria to conduct the screening. Objective This review was done to provide evidence on the burden and factors of sexually transmitted diseases and infections in women of reproductive age (15–49 years) in SSA. Findings Eleven (11) studies met the inclusion criteria. Ten (10) out of the eleven (11) included studies reported the prevalence of sexually transmitted diseases and infections in women of reproductive age in SSA. The risk factors were persistent with socio-cultural, behavioral, and socio-economic factors. The sociocultural factors identified include the age of the woman, marital status, employment, education of the woman, and, being in a female-headed home. The behavioral factors identified include having more than one sexual partner, and not using condoms with regular partners, and the socioeconomic factors identified include the environment of the woman respectively. Conclusion We come to the conclusion that age, being unmarried, living in urban areas, having sex with multiple sexual partners, low/primary education, and, self-employment/employment were factors associated with sexually transmitted diseases and infections in women of reproductive age in SSA. This review noted some gaps like ( the mortality rate of STDS and STIs in SSA, the impact STDs, and STIs create on the reproductive health of the women, facilities available to test and treat women for STDs and , STIs etc.) which are required to be further researched in these areas.
Challenges in dengue referral system at Savar Upazila Health Complex, Dhaka: a mixed method study
(BRAC University, 2025) Stanis, Conrad Russel; Hasan, Md Tanvir; Ashrafi, Shah Ali Akbar
Background: Dengue-endemic regions are home to up to 3.6 billion individuals, or 40% of the global population (CDC, 2024). In Bangladesh, 327 deaths were attributed to Dengue fever between January and August 2023, resulting in a case fatality rate of 0.47% (WHO, 2023). Bangladesh continues to face challenges in the Healthcare system, which has affected the referral process of patients seeking timely healthcare services in tertiary hospitals. This study aims to identify the barriers in the referral process for dengue management in primary healthcare settings in Bangladesh. Methods: Savar Upazila Health Complex (UHC) was used as the study site. The study employed a mixed method concurrent study design, the qualitative approach was used to identify the barriers affecting the referral system for dengue management by exploring experiences and perceptions shared by healthcare professionals. The quantitative approach was used to assess the level of satisfaction by dengue patients in selected domains including the referral process, communication, and quality of care throughout the referral. Results: The study identified health system barriers that disrupt the referral process for dengue patients in accessing higher medical care in tertiary hospitals. Some health system-related factors that negatively affect the timely referral include a shortage of ambulances, lack of feedback system, shortage of skilled healthcare professionals and inadequate infrastructure. Furthermore, the study found that, of the 36 referred patients (n=36), 13.89% are dissatisfied with the overall referral process, 25.00% are dissatisfied with the overall communication between UHC and the hospital and 16.67% are dissatisfied with the quality of care offered throughout the referral process. What’s more is that 16.67% of the 36 patients reported experiencing form of delay during their referral, solely the main delay is the shortage of ambulances which is a transport-related challenge clearly revealed by the healthcare professionals. Conclusion: It is recommended that the Ministry of Health and Family Welfare (MoHFW) must develop a referral management policy and a standard medical referral guideline for all healthcare facilities in Bangladesh. The MoHFW should also engage with international partners to initiate infrastructure development and increase annual budgetary allocation for address the current resources constraint faced at primary healthcare facilities. All in all, these policy changes and program implementation will strengthen the dengue referral system in Bangladesh.
Challenges to dengue treatment access and delivery at Savar Upazila Health Complex, Dhaka, Bangladesh: a concurrent mixed-methods study
(BRAC University, 2025) Ahmadzai, Mahaz Rahman; Hasan, Md Tanvir; Ashrafi, Shah Ali Akbar
Introduction: Dengue remains a critical public health challenge in Bangladesh, particularly during peak seasons when healthcare facilities encounter high demand. A concurrent mixedmethods research examines the challenges that patients face in accessing treatment and healthcare providers experience in delivering care at the Savar Upazila Health Complex in Dhaka, Bangladesh. Method: Quantitative data on satisfaction with services were gathered from 167 dengue patients, through semi-structured surveys, while qualitative data were obtained from 8 key informant interviews with healthcare providers. Findings: Quantitative findings indicated that 64.07% of dengue patients received adequate details about diagnostic tests, and 77.25% of dengue patients perceived the facility as wellequipped. However, only 34.73% of patients expressed satisfaction with the healthcare services they received. Additionally, 55.09% of patients reported long waiting times, 57.49% rushed consultations, and 61.08% difficulties making appointments as important service delivery challenges that need to be addressed. More than half (52.10%) of patients shared financial issue as an important barrier to accessing treatment on time. Qualitative findings revealed critical shortages of resources, including beds, medical supplies, and diagnostic tools, particularly during peak dengue seasons as important challenges for the efficient delivery of services. The healthcare providers highlighted operational inefficiencies, overcrowded wards, and limited post-hours diagnostic services as key challenges. Conclusion: The results of this study demonstrate significant gaps in service delivery that influence patient satisfaction and effective care. These challenges include inadequate infrastructure, insufficient medical supplies, long waiting times, and rushed. Recommended interventions include expanding facility capacity to serve more patients, increasing healthcare staff, and ensuring consistent availability of diagnostic tools and other medical supplies. Engaging the community through focused awareness campaigns is also crucial to enhancing treatment-seeking and disease-prevention practices.
Climate and health: insights from healthcare providers on vector-borne diseases
(BRAC University, 2025) Anand, Abhinandan; Misha, Farzana; Ivy, Nishita
Objective: To assess the knowledge, attitudes, and perceptions of healthcare providers in Dhaka, Bangladesh, about climate change-induced vector-borne diseases (VBDs) and evaluate their preparedness, training gaps, challenges, and adaptation strategies. Methodology: A qualitative study, including in-depth interviews with healthcare providers, explored their experiences and perspectives on climate change and VBDs. The study took place in urban and peri-urban health facilities, including Shaheed Suhrawardy Medical College Hospital and Keraniganj Upazila Health Center, Dhaka. The study involved Eighteen healthcare providers, comprising six doctors, ten nurses, and two ward boys actively engaged in managing and controlling VBDs. Findings: Healthcare providers had different levels of understanding about how climate change affects health, shaped by the nature of their work. Doctors emphasized biological factors such as viral mutations, while nurses focused on environmental conditions and public awareness. Key challenges included limited training on climate-sensitive health threats, resource constraints, and gaps in systemic preparedness. Despite these limitations, healthcare providers demonstrated resilience through practical disease management strategies and personal preventive measures. Conclusion: The study highlights the critical need for targeted training, resource allocations, and policy-driven capacity-building initiatives to address climate-sensitive health threats in public healthcare facilities. Insights from this research provide a foundation for developing climate-adaptive health systems in Bangladesh, emphasizing the importance of systemic preparedness and public health awareness in managing the impacts of climate-induced VBDs.