Snakebite Epidemiology in Bangladesh—A National Community Based Health and Injury Survey

Insert Snakebite is a global public health issue, and in majority of cases it is undermined. Tropical and subtropical countries are most effected, Bangladesh being one of them. There is scarcity of countries’ epidemiological situation in relation to snakebite poisoning. This study has looked at the epidemiological status of snakebite poisoning from national representative survey findings. Methods: A nationwide cross-sectional survey was conducted in 12 randomly selected districts of Bangladesh in 2003. A total of 171,366 households were surveyed and information was collected from 819,429 populations by face to face interview. Multi-stage cluster sampling methods were used in this survey and covered urban, rural and slum populations. Results: Annually an estimated 15,372 (10.98/100,000) individuals were bitten by snakes and of them 1709 (1.22/100,000) died every year. Males were found to be most vulnerable with a risk of 1.51 times higher than female. Rural populations were also 10.54 times higher at risk than the populations living in the urban areas. Among the victims 94% were from the poor socio economic conditions. Around 43.9% of the incidences occurred during evening to midnight. Home was found the most common area for snake bite (33.6%), and the Leg was found to be the most common site for biting (63.1%). A total of 96.6% victims sought treatment, of them 61% sought immediate treatment from traditional healing methods. Conclusions: Present incidence of snakebite in Bangladesh has clearly shown that there is emerging public health needs for intervention that can reduce the mortality and burden of the disease in the country.

Shrinking greenery： Land use and land cover changes in Kurram Agency, Kohi Safid Mountains of north-western Pakistan

Deforestation and other Land Use and Land Cover(LULC) changes, driven by variety of physical and anthropogenic factors, have altered the mountainous environment. Mountains around the world including northern and north western belts of Pakistan are highly sensitive to deforestation and other LULC changes, which have profound impacts on various sectors of bio-physical and socio-economic systems. Assessment of LULC changes has high significance for protection, conservation and monitoring mountainous environment. The present study is an attempt to assess the landscape changes with particular reference to forest cover depletion in Kurram Agency located in the north western mountain belt of Pakistan. For detailed comparative analysis the study area has been divided into three sections, which coincide with the present administrative divisions of the Agency, i.e., Upper,Lower and Central Kurram. Temporal span of this study covers four decades. In this study, land use map of 1970 and land sat satellite imageries of 1987, 2000 and 2014 were used as spatial data sets. The images were processed and classified into six LULC classes through geospatial packages and change detection maps were prepared for each division and time period.Findings of the study reveal two trends in the four major LULC categories. Forest and rangeland have shrunk, on average, by 15% and 7.5% respectively while, bare soil and rocks outcrops have expanded by 89% and agriculture land by 7.2% in Kurram agency.The water bodies and snow cover have minor fluctuation in its land area. Major causes of shrinking greenery is attributed to high influx of Afghan refugees and high energy demand of growing population. However, with outflow of the refugees from Kurram agency the general trend in forest cover has reverted and deforestation rate has slowed down.

Socio-Economic Drivers of Deforestation in Roghani Valley,Hindu-Raj Mountains,Northern Pakistan

Deforestation and associated ecological disturbances are the issues of global concern.Researchers have investigated a number of driving forces which accelerate the rate of deforestation at local and regional levels.These include poverty,population growth,market demand and prices,political instability,agricultural expansion and changes in property right and ownership regimes.This paper seeks to explore the impacts of population growth,changing tenure system and other socioeconomic factors on the forest cover of Roghani Valley,located in Hindu Raj Mountains,Northern Pakistan.The present study is mainly based on information collected through participatory observation,selfadministered interviews and questionnaire survey.Geographical Information System(GIS) database is also used for mapping and quantification.The results reveal that in the past three to four decades the study area has been subjected to severe deforestation and about half of the forest area has been converted into barren land.Thus,the area under natural forests decreased from 2099 to 1444 hectares in four decades.This large-scale deforestation is attributed to both proximate and under lying causes particularly traditional land tenure system and demographic development.Consequently,forest resources have been degraded and a number of plant species have disappeared from the forests of the study area while several others are in the process of disappearance.

Forest cover dynamics in Palas Valley Kohistan, Hindu Kush-Himalayan Mountains, Pakistan

Forest cover change in the mountainous region is driven by a variety of anthropogenic and natural factors.The Hindu Kush-Himalayan Mountains has experienced a considerable vegetation cover change due to intensive human activities,such as population growth,proximate causes,accessibility,unstable political situations,government policy failure and poverty.The present study seeks to find out the impact of population growth and road network expansion on forest cover of Palas valley based on remotely sensed data and employing geospatial techniques.Changes in forest cover were determined by classifying time-series satellite images of Landsat and Sentinel 2 A.The images of October 1980,2000,2010 and 2017 were classified into six land cover classes and then the impact of population growth and accessibility on forest cover was analyzed.Furthermore,forest cover and land-use change detection map was prepared using classified images of 1980 and 2017.The data were collected mainly from field visits(ground verification),census reports,Communication and Works Department,Kohistan.Satellite imageries were obtained from the United States Geological Survey’s websites and classified in ERDAS imagine 2014 and ESRI ArcGIS 10.2.1 using supervised classification-maximum likelihood algorithm.Result of this study revealed that a substantial reduction in forest cover has taken place mainly in the proximity of human settlements.On the average,during the study period,annually more than 460 hectares of forest area has been converted into other uses.

Maternal and Neonatal Death Review (MNDR): A Useful Approach to Identifying Appropriate and Effective Maternal and Neonatal Health Initiatives in Bangladesh

Objectives: To identify the effects of Maternal and Neonatal Death Review (MNDR) in terms of improving maternal and neonatal health at the community level in Bangladesh. Methods: Both quantitative and qualitative methods were undertaken for collecting data in Kashipur Union, Bangladesh. Death notifications from households, subsequent data collections from a focus-group discussion (FGD), a group discussion (GD) and in-depth interviews (IDIs) were obtained using structured tools and guidelines. Results: A total of four maternal deaths, 21 neonatal deaths and 15 still births were reported in the MNDR death notification system at Kashipur Union in 2010. Data were presented to local programme managers, who took various initiatives including awareness programmes, pregnancy registration, antenatal care, birth planning, and also the revitalization of a community clinic. The coverage of antenatal care, delivery in clinics, postnatal care and referral of complications increased through the active participation of the community. Community healthcare providers, care recipients and members of the community expressed satisfaction with the quality of maternal and neonatal services. In the preceding two years, maternal and neonatal deaths substantially reduced in Kashipur (in 2011 maternal death = 1, neonatal death = 20, still birth = 8;in 2012 maternal death = 1, neonatal death = 8, still birth = 13). Conclusions: The MNDR system successfully delivered notification of all maternal and neonatal deaths in the defined area and collected information for the formulation and implementation of specific interventions, which resulted in visible and tangible changes in care-seeking and client satisfaction.

Community Notification of Maternal, Neonatal Deaths and Still Births in Maternal and Neonatal Death Review (MNDR) System: Experiences in Bangladesh

Objectives: The aim of the study was to examine the process of community maternal, neonatal deaths and still births notification within the Bangladesh government health structure using the Maternal and Neonatal Death Review (MNDR) system. The study also explored the feasibility and acceptance of community death notification in the MNDR system. Methods: The study was under-taken in the Thakurgaon district of Bangladesh during 2010. During the study a mix of both qualitative and quantitative information was collected. A review of the documentation process of community death notification was undertaken and focus group discussions (FGDs) with community members, health care providers and managers in a sub-district were conducted, with in-depth interviews (IDIs) with district heath and family planning managers. Quantitative data were collected from community death notifications in the district during January to December 2010. Results: The death notification process was implemented by the government health care system within the Thakurgaon district. Field level health and family planning staff collected maternal and neonatal death information, recorded the death on the notification form and reported back to the Upazila (sub-district of the district) focal point at the Upazila health complex (primary health care centre). Community people were encouraged to share their death information to field level health staff. The health and family planning managers in the district periodically discussed the maternal and neonatal deaths and prepared remedial action plans in high death notified areas. In 2010, 59 maternal deaths, 739 neonatal deaths and 633 still births were reported in Thakurgaon district. District health and family planning departments performed community death notification as part of their routine daily work and integrated these procedures with other field level activities. Conclusion: Community death notification under the MNDR system was found to be achievable and acceptable at the district level using the existing government health system. The simple death notification process used to capture community level maternal, neonatal deaths and still births provides a guide for planning corrective actions for better health outcomes for the community.

Dynamics of Communal Land Degradation and Its Implications in the Arid Mountains of Pakistan:A Study of District Karak, Khyber Pakhtunkuwa

Similar to other areas of Pakistan, land resources in Khyber Pakhtunkhwa(KP) is kept under various ownership regimes for socio-economic and ecological benefits. For the last three to four decades, communal lands and resources are subjected to high rate of degradation and deterioration, which is leading to multifarious socio-economical and ecological implications. This paper intends to look into factors that are responsible for the degradation of communal land and the adaptability of the management mechanisms developed by the local inhabitants to conserve these resources. Moreover, this study also explores the sustainability of these adopted strategies in present circumstances. Data regarding socio-economic parameters of the inhabitants and their interactions with communal lands were collected through questionnaire cum interview method. As long-term climatic data for the area do not exist therefore focus group discussions were conducted to document the changing trend in rainfall regimes and temperature variations for the last about four decades. Results indicate that communal lands are highly vulnerable to degradation due to biophysical and anthropogenic factors. Local inhabitants have developed suitable measures to control the situation, however, accelerated socioeconomic transformations in the area have weakened the role of local institutions and that led to further degradation of these resources. Nevertheless, a number of locally formulated rules have been revived and implemented and it is hoped that these threatened resources would be conserved.

Identification of potential inhibitors for Sterol C-24 reductase of Leishmania donovani through virtual screening of natural compounds

Leishmaniasis is a vector-borne parasitic neglected tropical disease caused by a group of about 30 different species of the genus Leishmania.It is transmitted by the bite of female phlebotomies sand fly.Three main clinical manifestations of leishmaniasis include cutaneous,visceral,and mucocutaneous leishmaniasis.Visceral leishmaniasis(VL)caused by Leishmania donovani,is an infection of reticuloendothelial system and fatal if untreated.Cholesterol,a sterol that is prominent in the mammalian cell membranes whereas stigmasterol and ergosterol are more prevalent in plants,yeast,and protozoa,respectively.Ergosterols which is absent in human being,is an important constituent of parasite membrane.Sterol C-24 reductase(LdSR)enzyme catalyzes the final step in the ergosterol biosynthesis pathway.The inhibition of biosynthesis of ergosterol may lead to decreased cell viability and growth.Here,we performed the molecular docking-based virtual screening of a library of natural ligands against LdSR to identify a potential inhibitor to fight leishmaniasis.Capsaicin,prenyletin,flavan-3-ol,resveratrol,and gingerol showed the top binding affinity towards LdSR.Based upon ADME properties and bioactivity score,gingerol showed the best lead-likeness and drug-likeness properties.Hence,we further annotated its leishmanicidal properties.We found that gingerol inhibited the growth and proliferation of promastigotes as well as intra-macrophagic amastigotes.Gingerol exerted its antileishmanial action through the induction of reactive oxygen species(ROS)in concentration-dependent manner.Gingerol induced ROS led to apoptosis.Overall,this study described that gingerol would act as possible inhibitor to LdSR.

An evaluation of Emergency Management of Severe Burn (EMSB) course in Bangladesh: a strategic direction

Background: Burn is one of the major public health problems in Bangladesh. Specialized personnel and technologies are required, however, in many cases they are not readily available. Taking the situation into account,Interplast Australia and New Zealand, Australia & New Zealand Burn Association (ANZBA), and Centre for Injury Prevention and Research, Bangladesh (CIPRB) initiated Emergency Management of Severe Burn (EMSB) training programme for Bangladeshi physicians in 2008 to help improving their burn management skill. The study was designed to evaluate the effect of EMSB programme in Bangladesh.Methods: Both qualitative and quantitative methods were adopted. A cross-sectional survey was conducted to obtain quantitative information from 38 randomly selected EMSB-trained doctors among 380 trained physicians based on a five year database of EMSB (2008-2012). In-depth interviews (IDIs) and focus group discussion (FGD) were used as data collection techniques to get information.Results: A total of 32 participants completed the interview. It was found that 87.5% (n=28) doctors were using their skill in burn management that they learnt from the EMSB course. About 43.8% (n=14) doctors felt that the course largely helped improve their confidence. Majority (56.2%, n=18) of doctors stated EMSB is essential for the Bangladeshi doctors to learn better management of burns. Qualitative findings show that the courses were organized successfully with an excellent coordination, maintaining same quality and standard as running anywhere in the world. For its effectiveness, the course has been recommended to train graduate nurses and junior doctors from the periphery of the country.Conclusions: EMSB has already created a large doctor community who are able to effectively manage burn patients. It also has proven its indispensability for learning burn management skill. The EMSB established a platform to serve the burn victims and reduce the burden of injuries in Bangladesh.