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Baseline sociodemographic and sexual and reproductive health characteristics of the AdSEARCH adolescent cohort study participants in rural Bangladesh: a cohort profile

Por: Alam · A. · Shiblee · S. I. · Rana · M. S. · Sheikh · S. P. · Rahman · F. N. · Sathi · S. S. · Alam · M. M. · Sharmin · I. · Arifeen · S. E. · Rahman · A. E. · Ahmed · A. · Nahar · Q.
Purpose

In Bangladesh, evidence on the long-term trajectory of adolescents' sexual and reproductive health (SRH) remains limited, largely due to the lack of longitudinal data to assess the changes over time. To address this gap, the Advancing Sexual and Reproductive Health and Rights (AdSEARCH) project of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) set up an adolescent cohort study aimed at documenting changes in SRH knowledge, attitudes and practices, and identifying the factors affecting these changes. This article presents the baseline sociodemographic and SRH characteristics of this cohort as a pathway for future analyses.

Participants

This cohort study included 2713 adolescents from the Baliakandi Health and Demographic Surveillance System run by icddr,b. The cohort covered three age groups from girls and boys, giving a total of five cohorts: girls aged 12, 14 and 16 years; and boys aged 14 and 16 years. A total of seven rounds of data had been collected at 4-month intervals over 2-years follow-up period.

Findings from the baseline

The majority of adolescents were attending school (90%), and school dropouts were higher among boys. Around 17% of the respondents were involved in income-generating activities, which were mostly boys. Among girls, the mean age of menarche was 12.2 years. Overall, 6% of adolescents had major depressive disorder, with prevalence increasing with age. Gender differences were evident regarding knowledge about conception and contraception. Egalitarian attitudes towards social norms and gender roles were found higher among girls (52%) compared to boys (11%). The majority of adolescents reported experiencing social/verbal bullying (43%), followed by physical violence (38%) and cyberbullying (4%).

Future plans

This article presents the baseline findings only. A series of papers is in the pipeline for submission to different peer-reviewed journals. The findings from this study will be used to support data-driven policy formulation for future adolescent health programmes.

Observational study on the clinical epidemiology of infectious acute encephalitis syndrome including Nipah virus disease, Bangladesh: BASE cohort study protocol

Por: Hassan · M. Z. · Rojek · A. · Rahman · D. I. · Sultana · S. · Rahman · M. · Khaja Mafij Uddin · M. · Hossain · M. E. · Rahman · M. W. · Merson · L. · Garcia · E. · Dunning · J. · Bourner · J. · Choudhury · S. S. · Chowdhury · K. I. A. · Zaman · K. · Khan · S. I. · Tarik · M. H. · Yeasmin
Introduction

Nipah virus (NiV) is a bat-transmitted paramyxovirus causing recurrent, high-mortality outbreaks in South and South-East Asia. As a WHO priority pathogen, efforts are underway to develop therapies like monoclonal antibodies and small-molecule antivirals, which require evaluation in clinical trials. However, trial design is challenging due to limited understanding of NiV’s clinical characteristics. Given the rarity of NiV infections, strategies targeting improved outcomes for the broader acute encephalitis syndrome (AES) patient population, including those with NiV, are essential for advancing therapeutic research. To address these gaps, we designed the Bangladesh AES cohort study to characterise the patient population, clinical features, treatment practices, common aetiologies and outcomes in patients presenting with AES, including NiV infection, as a clinical characterisation study to inform the design of clinical trials for NiV and AES more broadly.

Methods and analysis

This prospective cohort study will be conducted in Bangladesh, a NiV endemic country with annual outbreaks. In collaboration with the ongoing NiV surveillance programme in Bangladesh, we aim to enrol up to 2000 patients of all ages presenting with AES at three tertiary care hospitals within the Nipah belt. Patients who provide informed consent to participate will be monitored throughout their hospital stay until 90 days post enrolment. Data will be systematically collected through interviews and medical record reviews at several time points: on the day of enrolment, day 3, day 7, the day of critical care admission (if applicable), discharge day and 90 days post enrollment. Additionally, a portion of the cerebrospinal fluid collected under the concurrent NiV surveillance protocol will be tested for an array of viral and bacterial pathogens responsible for encephalitis at the International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) laboratory.

Ethics and dissemination

The study received ethical approval from the Oxford Tropical Research Ethics Committee, University of Oxford, UK (OxTREC Ref: 576–23) and the institutional review board of icddr,b, Bangladesh (icddr,b protocol number: 24016). By characterising the AES patient population, this study will generate essential evidence on key clinical parameters, which will be pivotal in optimising the design of clinical trials for potential interventions aimed at improving outcomes in patients with AES, including those with NiV disease. Findings will be shared with participating hospitals, patients and relevant government stakeholders. Results will also be disseminated through conference presentations and peer-reviewed publications.

Clinical trial number

Not applicable (this is an observational study).

Postnatal care utilisation and health beliefs among mothers in the Jazan region of Saudi Arabia: a cross-sectional study

Por: Altraifi · A. A. · Albasheer · O. · Abdelwahab · S. I. · Chourasia · U. · Abdelmageed · M. M. · Hakami · A. M. · Khormi · A. H. · Medani · I. E. · Ali · S. A. · Habeeb · S. A. · Shebaly · G. A. · Somaily · M. M. · Harshan · S. M. · Ali · S. M. · Hukma · S. H.
Background

The postnatal period is critical for preventing maternal and neonatal morbidity and mortality. Globally, a significant proportion of maternal and neonatal deaths occur within the first 6 weeks after delivery. Timely and adequate postnatal care (PNC) can detect and manage life-threatening complications; however, service utilisation remains alarmingly low in many low- and middle-income countries, including Saudi Arabia. Addressing the behavioural and perceptual factors that influence service use is essential for improving health outcomes.

Objectives

This study aimed to assess mothers’ utilisation of PNC services and examine how their health beliefs and sociodemographic characteristics influence this behaviour.

Design

A cross-sectional study guided by the Health Belief Model (HBM) was conducted to explore predictors of PNC utilisation.

Setting

Eight primary healthcare (PHC) centres were randomly selected from 179 PHC centres distributed in the different governorates of the Jazan region of Saudi Arabia.

Participants

A total of 464 mothers were surveyed between October and December 2023 using an interviewer-administered questionnaire.

Primary and secondary outcome measures

The primary outcome was PNC utilisation, defined by the number of postnatal visits. The independent variables included sociodemographic characteristics and HBM constructs (perceived susceptibility, benefits, barriers and cues to action).

Results

In terms of PNC utilisation, 80.0% of participants had two or fewer postnatal visits, whereas 20.0% had three or more postnatal visits. Perceived barriers had the strongest influence (mean score 2.51±0.87), followed by cues to action (2.43±0.89), susceptibility (1.92±0.72) and benefits (1.86±0.64). In the multivariate analysis, perceived barriers, cues to action and perceived susceptibility were significantly associated with PNC utilisation, with adjusted ORs of 1.679 (95% CI: 1.007 to 2.799), 0.470 (95% CI: 0.256 to 0.863) and 0.405 (95% CI: 0.197 to 0.832), respectively.

Conclusions

PNC utilisation in the Jazan region remains suboptimal. Perceptual factors, particularly barriers and cues to action, play a central role in service use. Health interventions targeting these beliefs and improving follow-up mechanisms may help increase PNC engagement and improve maternal and infant health outcomes in Saudi Arabia.

Evaluating pharmacist prescribing education programmes: a realist synthesis protocol

Por: Xenos · K. · Rees · C. E. · Heslop · I. M. · Benrimoj · S. I. · Dineen-Griffin · S.
Introduction

Pharmacist prescribing has evolved to meet healthcare system needs, but the effectiveness, mechanisms and contextual factors influencing education programmes remain poorly understood. Realist approaches are fairly novel in pharmacy practice research. This realist synthesis aims to answer the question: to what extent do pharmacy prescribing education programs work (or not), for whom and under what circumstances, and why?

Methods and analysis

A realist methodology (realist synthesis) will be used to review the outcomes of programmes. Pawson’s key stages will be followed: (1) clarifying the scope; (2) determining the search strategy; (3) study selection; (4) extracting and analysing data; and (5) synthesising findings and drawing conclusions. The synthesis will follow Realist And Meta-narrative Evidence Syntheses–Evolving Standards publication guidelines. Data extracted will include the study characteristics, alongside the contexts, mechanisms and outcomes of varied pharmacy prescribing education programmes. The search strategy will include searching PubMed, Scopus, Web of Science and CINAHL Complete. An initial programme theory will use selected grey literature. Context-mechanism-outcome configurations will be identified, and recurring patterns will be synthesised to refine the initial programme theory.

Ethics and dissemination

Ethics approval is not required. Dissemination will be sought via peer-reviewed academic conferences and journals.

PROSPERO registration number

CRD420251056576.

Development of an algorithm for ethnicity recording in cohorts from the UK Clinical Practice Research Datalink primary care and linked Hospital Episode Statistics databases

Por: Shiekh · S. I. · Williams · R. · Axson · E. L.
Objective

To evaluate various prioritisation strategies within an algorithm designed to ascertain the most likely ethnicity and create a standardised methodology to benefit future research.

Design

Retrospective cohort study.

Setting

The Clinical Practice Research Datalink (CPRD) primary care and linked Hospital Episode Statistics (HES) data sets.

Participants

The population of 54 029 174 patients included all acceptable patients registered at English practices in CPRD GOLD or CPRD Aurum from the May 2023 to May 2022 builds, respectively.

Primary outcome measure

Ethnicity data within CPRD and HES data sets were identified by employing established code lists and subsequently categorised into broader ethnic groups. Changes were made to a previously used algorithm to assess their effect on ethnic categorisations. Modifications included prioritising primary over secondary care data, recent over frequent records and ‘non-other’ ethnicity categories. Different data sources were examined: CPRD with all HES data sets, CPRD with HES Admitted Patient Care (APC) only, CPRD only and HES APC only. Ethnic distributions from these variations were compared using counts and percentages, evaluating inter-rater reliability using Cohen’s kappa. Sensitivity analyses included repetition using only currently registered patients and after removing cases with unknown ethnicity. Ethnic distributions were compared with English Census 2021.

Results

There was almost perfect agreement in ethnicity distributions whether prioritising primary over secondary care data (kappa=1.0000, SE=0.0001), whether prioritising most frequently or most recently recorded data (kappa=0.9824, SE=0.0001) and whether prioritising ‘non-Other’ categories (kappa=0.9705, SE=0.0001). There was moderate agreement in ethnicity distributions when sourcing data from single data sources (CPRD only (kappa=0.5554, SE=0.0001) or HES APC only (kappa=0.5526, SE=0.0001)) compared with combined data sources (CPRD and HES datasets).

Conclusions

All variations of the algorithm produced similar population-level ethnicity distributions. Versions using data from multiple sources had higher inter-rater reliability than those using a subset of sources; however, there was little difference in categorisations produced by varying the hierarchical decision-making of the ethnicity algorithm. The CPRD population was representative of the English population in terms of ethnicity. While researchers should remain vigilant of the limitations of using these data, the CPRD Ethnicity Records provide a standardised and pragmatic approach to ascertaining ethnicity for future research.

Gender differences in mental health help-seeking behaviour in Bangladesh: findings from a cross-sectional online survey

Por: Al Azdi · Z. · Saif · S. I. · Ashraf Kushal · S. · Islam · M. T. · Maaz · L. · Reza · S. · Yasmeen · S. · Chaklader · M. A. · Amin · Y. M.
Background

Mental health disparities persist as a pressing public health concern globally. Gender disparities in mental health are evident, with women disproportionately affected by conditions such as depression and anxiety. Despite the apparent need, studies from Bangladesh indicate that women are less likely to seek mental healthcare compared with men.

Objective

This study aims to investigate gender differences in mental health help-seeking behaviour in Bangladesh.

Methods

A cross-sectional online survey was conducted from 15 to 30 October 2021, targeting individuals with perceived mental health problems through the Facebook page of LifeSpring, a mental health and well-being organisation based in Bangladesh. Data (n=3031; women: 2140; men: 891) were collected using the JotForm online survey tool and analysed using descriptive statistics, bivariate analyses and multinomial logistic regression.

Results

The majority of participants were female (70.6%), aged between 18 and 34 years (87.3%), and from urban areas (85.4%). Overall, 28.4% received non-professional help, with females at 30.9% and males at 22.3%. Additionally, 22.9% received help from professionals, with females at 20.8% and males at 28.1%. Notable disparities were observed in mental health help-seeking behaviour between genders. While females exhibit higher odds of seeking non-professional support (OR 1.49, 95% CI 1.21 to 1.84, p value

Conclusion

This study contributes to our understanding of gender disparities in mental healthcare utilisation in Bangladesh, highlighting the need for gender-sensitive approaches in mental healthcare service delivery.

How to age right and care(fully) at home? A protocol for a multistage comparative study of ageing in place and hospital at home care across three countries

Por: Sturge · J. · Nordin · S. · Pilosof · N. P. · Vogt · T. · Janus · S. I. M. · Ludden · G. · Helder · R. · Kylen · M. · Zimlichman · E. · Glazer · J.
Introduction

Ageing right care(fully) is a transnational research study which explores and maps an understanding of the care pathways between ageing in place and hospital at home policy and practices for older adults in Israel, the Netherlands and Sweden. The countries are suited to be compared where they have growing, ageing populations, a focus on healthcare reform and several policies to reduce the cost of care for older populations. Ageing in place is a government-led policy that is often associated with choice; however, there is a recent debate about whether ageing in place is a universal desire for all older adults. Research shows that the care pathway between the hospital and the home, associated with ageing in place, can impact well-being, especially if the built, social and technological environments do not meet the healthcare needs and preferences of older adults. This is significant as new programmes for digital hospital at home innovations are being developed as part of a global transformation in healthcare systems. The aim of the study is to compare different approaches to ageing in place and hospital at home care in different regions. The multiapproach study explores the demographics, policy structure, decision-making process and the crucial role of the built, social and technological environments along the hospital to home care pathways of older adults.

Methods and analysis

The mixed-method, comparative study includes a new multienvironment theoretical contribution explored across a three-phase research method to understand the care pathways of older adults ageing in place receiving hospital at home care. The first phase compares each country’s population and policy structures relating to ageing in place, hospital discharge, home hospitalisation and at-home care for older adults. The second phase maps patient journeys of older adults living in each country through the perspective of the older adult, caregivers and care professionals. The third phase explores the synergies between the knowledge gained through phases 1 and 2—from a policy and a personal level—and mobilises the knowledge into policy recommendations and implementation guidelines.

Ethics and dissemination

The comparative study has been approved by the Sheba Medical Centre in Israel (SMC-1330-24), the Ethics Committee of Tel Aviv University (0009216-2), the Humanities and Social Science Ethics Committee at the University of Twente in the Netherlands (240040) and the Swedish Ethical Review Authority (Dnr 2024-07569-01). The results will be shared with end-users, including citizens, carers, healthcare policymakers, planners, architects and designers, through social media, publications, workshops and international conferences. This future-focused research approach will allow stakeholders to rethink and imagine ways that health and care systems can be personalised and responsive to the future needs of older adult populations.

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