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Kinetic analysis was used to study the destabilization of mayonnaise by focusing on the fat crystals. Mayonnaise prepared from rapeseed oil and soybean oil was stored at temperatures ranging from −20 to −40 °C. The destabilization kinetic parameters were measured by observing oil separation over time. The destabilization rate constant, kd, increased with decreasing temperature. The highest value of kd was 1.28 × 10−3 min−1 at −40 °C for rapeseed oil mayonnaise (RoM) and the lowest was 1.95 × 10−6 min−1 at −20 °C for soybean oil mayonnaise (SoM). At each temperature, the kd value in RoM was higher than that in SoM. However, the order of destabilization, n, followed no specific pattern. The crystallization rate constant, Kc, and Avrami constant, n, were calculated using microscopic images of the fat crystals. The increase in crystallization kinetic parameters with decreasing temperature revealed changes in crystal behavior. Both the destabilization rate constant, kd, and the crystallization rate constant, Kc, depended on the temperature. This temperature dependency behavior showed a correlation between kd and Kc, suggesting that the destabilization rate depended on the rate of growth of fat crystals during the freeze-thawing of mayonnaise.

The Sundarbans Reserved Forest, and its surrounding buffer zone, is one of the most diverse and richest areas of natural resource in Bangladesh. It is a part of the largest mangrove forest in the world, with an area of about 10,000 km², of which 6,000 km² are in Bangladesh and about 4,000 km² are part of India: it has been recognized as an internationally important World Heritage and Ramsarsite. The mangroves provide substantial ecosystem services supporting the livelihood of local communities. This paper describes the diverse uses of these natural resources and aims to evaluate the contribution of ecosystem services to the livelihood of residents. The results indicate that residents depend on ecosystem services in two ways. First, local households earn cash income by selling ecosystem products, such as fish, honey, and nipa palm, at local markets. Second, the use of natural resources provides substantial subsistence such as food, fresh water, and timber. However, residents’ income may be significantly increased by improved resource management, including reducing local authority corruption and improvements in law enforcement. Our paper concludes with a range of recommendations for enhancing residents’ standard of living while conserving natural resources.

Background Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately higher in low- and middle-income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. In LMICs, an estimated half of all newborns are born at home and few receive screening or treatment for hyperbilirubinemia, leading to 6 million newborns per year who need phototherapy treatment for hyperbilirubinemia but are untreated. Household screening and treatment for neonatal hyperbilirubinemia with phototherapy administered by a trained community health worker (CHW) may increase indicated treatment for neonatal hyperbilirubinemia in comparison to the existing care system in Bangladesh. Methods 530 Bangladeshi women in their second or third trimester of pregnancy from the rural community of Sakhipur, Bangladesh will be recruited for a cluster randomized trial and randomized to the intervention arm — home screening and treatment for neonatal hyperbilirubinemia — or the comparison arm to receive usual care. In the intervention arm, CHWs will provide mothers with two prenatal visits, visit newborns by 2 days of age and then daily for 3 days to measure transcutaneous bilirubin (TcB) and monitor for clinical danger signs. Newborns without danger signs but with a TcB above the treatment threshold, but >15 mg/dL will be treated with light-emitting diode (LED) phototherapy at home. Newborns with danger signs or TcB ≥15 mg/dL will be referred to a hospital for treatment. Treatment rates for neonatal hyperbilirubinemia in each arm will be compared. Conclusion This study will evaluate the effectiveness of CHW-led home phototherapy to increase neonatal hyperbilirubinemia treatment rates in rural Bangladesh. LMICs are expanding access to postnatal care by using CHWs, and our work will give CHWs a curative treatment option for neonatal hyperbilirubinemia. Similar projects in other LMICs can be pursued to dramatically extend healthcare access to vulnerable newborns with hyperbilirubinemia.

Most vaccinations in the immunization schedule need two or more doses to elicit a protective immune response. Therefore, completion of all doses is crucial for achieving the best possible immunity. The objective of this study was to investigate the factors influencing missed opportunities of polio vaccination in children between the ages of 1–3 years in urban Dhaka. In 2018, according to the immunization card records or histories from parents/guardians, we sorted1–3-year-old children from areas of Dhaka South City Corporation who were not fully immunized. Immunization records were obtained from the Expanded Program on Immunization (EPI) card or maternal recall. Reasons for non-vaccination were documented. A total of 501 children were tracked down to determine the causes of their incomplete polio doses. Determinants of incomplete immunization and factors for missed opportunities were assessed by using bivariate and multivariable logistic regression model. The households with a child who had not received all the recommended vaccines had a considerably lower monthly income (18,000 BDT; p < 0.001). In both the complete and partial vaccination groups, the average family size was five people, and the average child age was 28 months. Education level of the household head after adjustment (AOR), the odds of the event occurring decrease by 25% with primary education (95% CI: 0.66, 0.85), p-value: < 0.001). Occupation of the household head for rickshaw/van/cart puller, AOR, the odds increase even more, with the event being 3.15 times more likely for this occupation (95% CI: 1.95, 5.08) and statistical significance (p-value < 0.05). Again, for daily wager AOR, 2.16 times higher for daily wagers (95% CI: 1.35, 3.45) and statistical significance (p-value: 0.001). This study identifies sociodemographic factors that influence incomplete childhood immunization in this urban area of Dhaka. In order to improve the coverage, the identified factors need to be mitigated and policymakers should focus on enhancing community engagement, combating misinformation and increasing the accessibility of vaccination services.

Cholera remains a substantial health burden in Asia and Africa particularly in resource poor settings. The standard procedures to identify the etiological organism V. cholerae are isolation from microbiological culture from stool as well as Polymerase Chain Reaction (PCR). Both the processes are highly lab oriented, labor extensive, time consuming, and expensive. In an effort to control for outbreaks and epidemics; an effective, convenient, quick and relatively less expensive detection method is imperative, without compromising the sensitivity and specificity that exists at present. The objective of this component of the study was to evaluate the effectiveness of a locally produced rapid diagnostic test (RDT) for cholera diagnosis. In Bangladesh, nationwide cholera surveillance is ongoing in 22 hospitals covering all 8 divisions of the country since June, 2016. In the surveillance, stool samples have been collected from patients presenting to hospitals with acute watery diarrhea. Crystal VCTM (Span diagnostics, India) and Cholkit (locally produced RDT) have been used to detect V. cholerae from stool samples. Samples have also been sent to the main laboratory at icddr,b where the culture based isolation is routinely performed. All the tests were carried out for both direct and enriched stool samples. RDT sensitivity and specificity were calculated using stool culture as the gold standard. A total of 7720 samples were tested. Among these, 5865 samples were solely tested with Crystal VC and 1355 samples with Cholkit whereas 381 samples were tested with both the RDTs. In comparison with culture, direct testing with Crystal VC showed a sensitivity of 72% (95% CI: 50.6% to 87.9%) and specificity of 86.8% (95% CI: 82.8% to 90.1%). After enrichment the sensitivity and specificity was 68% (95% CI: 46.5% to 85.1%) and 97.5% (95% CI: 95.3% to 98.8%) respectively. The direct Cholkit test showed sensitivity of 76% (95% CI: 54.9% to 90.6%) and specificity of 90.2% (95% CI: 86.6% to 93.1%). This evaluation has demonstrated that the sensitivity and specificity of Cholkit is similar to the commercially available test, Crystal VC when used in field settings for detecting V. cholerae from stool specimens. The findings from this study suggest that the Cholkit could be a possible alternative for cholera endemic regions where V. cholerae O1 is the major causative organism causing cholera.

Mangrove forests are paramount for sustaining and enhancing ecosystem services benefitting both local and regional communities, and the global environment. Scholars have long studied the values of ecosystem services of mangrove forests. However, the number of recent primary studies monetizing ecosystem services is rather limited. This paper ascertains the values of ecosystem services of 66 primary valuation studies with a total of 250 observations. The results indicate that the range of values is substantially wide. This range cannot be explained sufficiently by the various differences of the studies, as the explanatory power of the econometric estimations is low. Main influential factors on the values of ecosystem services are the elicitation methods, the types of ecosystem services considered, and the conservation status of the respective mangrove forest as Ramsar site. The results stress the significant economic values of ecosystem services of mangrove forests and the importance for conservation management. However, the results also caution against a direct transfer of benefits between sites. The substantial variety of site and country specifics warrants the implementation of separate, original valuation studies.

Cholera remains an important public health problem in major cities in Bangladesh, especially in slum areas. In response to growing interest among local policymakers to control this disease, this study estimated the impact and cost-effectiveness of preventive cholera vaccination over a ten-year period in a high-risk slum population in Dhaka to inform decisions about the use of oral cholera vaccines as a key tool in reducing cholera risk in such populations. Assuming use of a two-dose killed whole-cell oral cholera vaccine to be produced locally, the number of cholera cases and deaths averted was estimated for three target group options (1-4 year olds, 1-14 year olds, and all persons 1+), using cholera incidence data from Dhaka, estimates of vaccination coverage rates from the literature, and a dynamic model of cholera transmission based on data from Matlab, which incorporates herd effects. Local estimates of vaccination costs minus savings in treatment costs, were used to obtain incremental cost-effectiveness ratios for one- and ten-dose vial sizes. Vaccinating 1-14 year olds every three years, combined with annual routine vaccination of children, would be the most cost-effective strategy, reducing incidence in this population by 45% (assuming 10% annual migration), and costing was $823 (2015 USD) for single dose vials and $591 (2015 USD) for ten-dose vials per disability-adjusted life year (DALY) averted. Vaccinating all ages one year and above would reduce incidence by >90%, but would be 50% less cost-effective ($894-1,234/DALY averted). Limiting vaccination to 1-4 year olds would be the least cost-effective strategy (preventing only 7% of cases and costing $1,276-$1,731/DALY averted), due to the limited herd effects of vaccinating this small population and the lower vaccine efficacy in this age group. Providing cholera vaccine to slum populations in Dhaka through periodic vaccination campaigns would significantly reduce cholera incidence and inequities, and be especially cost-effective if all 1-14 year olds are targeted.

Background Universal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medically significant condition by caregivers and community members. We aimed to evaluate the acceptability and operational feasibility of community health worker (CHW)-led, home-based, non-invasive neonatal hyperbilirubinemia screening using a transcutaneous bilimeter in Shakhipur, a rural subdistrict in Bangladesh. Methods We employed a two-step process. In the formative phase, we conducted eight focus group discussions with parents and grandparents of infants and eight key informant interviews with public and private healthcare providers and managers to explore their current knowledge, perceptions, practices, and challenges regarding identification and management of neonatal hyperbilirubinemia. Next, we piloted a prenatal sensitization intervention and home-based screening by CHWs using transcutaneous bilimeters and evaluated the acceptability and operational feasibility of this approach through focus group discussions and key informant interviews with parents, grandparents and CHWs. Results Formative findings identified misconceptions regarding neonatal hyperbilirubinemia causes and health risks among caregivers in rural Bangladesh. CHWs were comfortable with adoption, maintenance and use of the device in routine home visits. Transcutaneous bilimeter-based screening was also widely accepted by caregivers and family members due to its noninvasive technique and immediate display of findings at home. Prenatal sensitization of caregivers and family members helped to create a supportive environment in the family and empowered mothers as primary caregivers. Conclusion Adopting household neonatal hyperbilirubinemia screening in the postnatal period by CHWs using a transcutaneous bilimeter is an acceptable approach by both CHWs and families and may increase rates of screening to prevent morbidity and mortality.

Background In low to middle-income countries where home births are common and neonatal postnatal care is limited, community health worker (CHW) home visits can extend the capability of health systems to reach vulnerable newborns in the postnatal period. CHW assessment of newborn danger signs supported by mHealth have the potential to improve the quality of danger sign assessments and reduce CHW training requirements. We aim to estimate the validity (sensitivity, specificity, positive and negative predictive value) of CHW assessment of newborn infants aided by mHealth compared to physician assessment. Methods In this prospective study, ten CHWs received five days of theoretical and hands-on training on the physical assessment of newborns including ten danger signs. CHWs assessed 273 newborn infants for danger signs within 48 h of birth and then consecutively for three days. A physician repeated 20% ( n  = 148) of the assessments conducted by CHWs. Both CHWs and the physician evaluated newborns for ten danger signs and decided on referral. We used the physician’s danger sign identification and referral decision as the gold standard to validate CHWs’ identification of danger signs and referral decisions. Results The referrals made by the CHWs had high sensitivity (93.3%), specificity (96.2%), and almost perfect agreement (K = 0.80) with the referrals made by the physician. CHW identification of all the danger signs except hypothermia showed moderate to high sensitivity (66.7–100%) compared to physician assessments. All the danger signs assessments except hypothermia showed moderate to high positive predictive value (PPV) (50–100%) and excellent negative predictive value (NPV) (99–100%). Specificity was high (99–100%) for all ten danger signs. Conclusion CHW's identification of neonatal danger signs aided by mHealth showed moderate to high validity in comparison to physician assessments. mHealth platforms may reduce CHW training requirements and while maintaining quality CHW physical assessment performance extending the ability of health systems to provide neonatal postnatal care in low-resource communities. Trial registration clinicaltrials.gov NCT03933423 , January 05, 2019.

There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead to an increase in indicated treatment rates for newborns with hyperbilirubinemia. We aimed to investigate the operational feasibility and acceptability of a CHW-led home phototherapy intervention in a rural sub-district of Bangladesh for families and CHWs where home delivery was common and a treatment facility for neonatal hyperbilirubinemia was often more than two hours from households. We enrolled 23 newborns who were ≥  2 kg in weight and ≥  35 weeks gestational age, without clinical danger signs, and met the American Academy of Pediatric treatment criteria for phototherapy for hyperbilirubinemia. We employed a mixed-method investigation to evaluate the feasibility and acceptability of home phototherapy through surveys, in-depth interviews and focus group discussions with CHWs, mothers, and grandparents. Mothers and family members found home phototherapy worked well, saved them money, and was convenient and easy to operate. CHWs found it feasible to deploy home phototherapy and identified hands-on training, mHealth job aids, a manageable workload, and prenatal education as facilitating factors for implementation. Feasibility and acceptability concerns were limited amongst parents and included: a lack of confidence in CHWs’ skills, fear of putting newborn infants in a phototherapy device, and unreliable home power supply. CHW-led home phototherapy was acceptable to families and CHWs in rural Bangladesh. Further investigation should be done to determine the impact of home phototherapy on treatment rates and on preventing morbidity associated with neonatal hyperbilirubinemia. Clinical Trial (CT) registration ID : NCT03933423, full protocol can be accessed at https://doi.org/10.1186/s13102-024-00824-6 . Name of the trial registry: clinicaltrials.gov. Clinical Trial (CT) registration Date: 01/05/2019.