Predictors of Psychological Impact Among the Healthcare Workers Exposed to Covid-19 Cases in a Tertiary Hospital of Bangladesh

Background: The unprecedented global pandemic caused by SARS-CoV-2 creates considerable psychological problems among the health care workers (HCW). The present study aimed to determine the predictors of psychological impact (in terms of depression, anxiety and stress) among the HCWs exposed Covid-19 cases in Combined Military Hospital (CMH) Dhaka. Methods: This cross-sectional study was conducted at CMH Dhaka among purposively selected 390 HCWs. Data were collected through face-to-face interview using a pre-tested semi-structured questionnaire with validated and reliable tools. The study was conducted in the Combined Military Hospital Dhaka from 15 July 2020 to 30 September 2020. Results: Among the 390 respondents, 21.6%, 43.1% and 24.1% had depression, anxiety and stress symptoms, respectively. Being married (OR=0.391, 95% CI=0.160-0.953), graduate (OR=2.977; 95% CI=1.181-7.509) and attending 41-80 patients per day (OR=1.996; 95% CI=0.965-4.125) was significantly associated with depressive symptoms. In respect of anxiety, being graduate (OR=2.788, 95% CI=1.228 -6.333) and HSC qualified (OR=2.714, 95% CI=1.073-6.869), staying in family accommodation (OR=2.720, 95% CI=1.136 - 6.516), with nuclear family (OR=0.459, 95% CI=0.281-0.750), smoker (OR=1.827, 95% CI=0.987 - 3.384), doctor (OR=0.362, 95% CI=0.173- 0.758), having service length <20 years (OR=2.229, 95% CI=1.158 - 4.289), service in current place of posting for <20 months (OR=0.460, 95% CI=0.241-0.880), attended 41-80 patient daily (OR=1.720, 95% CI=0.933 - 3.169) and performing overtime duty (OR=2.568, 95% CI=1.609-4.099) were significantly associated with anxiety symptoms. Being graduate (OR=2.249, 95% CI=0.866-5.844), with nuclear family type (OR=0.423, 95% CI=0.249-0.721), having duty place at emergency (OR=2.135, 95% CI=0.902-5.053), being a nurse (OR=0.364, 95% CI=0.162-0.819), having service length <10 years (OR=2.570, 95% CI=1.207-5.472) and performing overtime duty (OR=2.214, 95% CI=1.3101-3.742) were significantly associated with stress symptoms. Conclusion: Psychological problems among the HCW found very common in our study which needs psychological crisis interventions to protect the mental health of HCWs. JOPSOM 2021; 40(1): 1-13

Comparison of Body Mass Index with Modified Subjective Global Assessment for Detection of Malnutrition Among Patients Under Maintenance Hemodialysis: A Multi-Center Cross-Sectional Study

Background: Patients under maintenance hemodialysis are at increased risk of malnutrition, causing from multitude of factors. Present study aims to assess the prevalence of malnutrition among maintenance hemodialysis patients using both modified subjective global assessment score and body mass index, compare them and assess the sensitivity and specificity of body mass index for detecting malnutrition, along with determining a new cutoff value for BMI that better represent the maintenance hemodialysis patient’s nutritional status. Methods: This was a cross-sectional study conducted in the hemodialysis unit of Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College Mitford Hospital, BIRDEM General Hospital and National Institute of Kidney Diseases & Urology; among 80 adult CKD patients who were on regular (≥2 sessions per week) maintenance hemodialysis for more than 3 months without any acute infection, during the period of July 2016 to June 2017. Nutritional assessment was done for each patient using modified SGA score along with BMI. Sensitivity analysis of WHO recommended cutoff value for BMI was done among the study population using modified SGA score as gold standard test for detection of malnutrition among the respondents. ROC curve was used to estimate the best fitting cutoff value of BMI that showed highest sensitivity, specificity and accuracy for detracting malnutrition among maintenance hemodialysis patients. Results: The study participants were predominantly male (66.3%) and from age group 45 to 59 years (36.3%). Modified SGA score detected 90.0% of the study population as malnourished. WHO recommended 18.5 kg/m2 cutoff value was also used to detect malnutrition among study population and 13.8% were found to be malnourished, with a sensitivity and specificity of 12.5% and 75.0% respectively. Accuracy was found to be 18.8%. Using ROC curve, 23.1 kg/m2 was found to be the best fitting cutoff value of BMI for the study population to detect malnutrition. With a sensitivity of 47.2%, specificity of 37.5% and accuracy of 46.3%. Conclusion: BMI showed low sensitivity for detecting malnutrition among patients under maintenance hemodialysis, compared to modified SGA score and should be avoided as a screening tool, but 23.1 kg/m2 cutoff value for BMI showed potential to be used as an easy to use and quick tool for detecting malnutrition among such patients. Further study with larger sample size could shed more light on this. JOPSOM 2021; 40(1): 14-21

Child Day Care Center Use and Mental Stress of Working Mothers

Background: Some of the working mothers use child day care center (CDCC) for their children to reduce their mental stress. This study was designed to assess the association between mental stress of working mothers and child day care center use. Methods: This comparative cross sectional study was conducted among 106 working mothers of whom 53 were CDCC users and 53 were non-users from January to December, 2019. Data were collected by face to face interview by a semi-structured questionnaire. Mental stress was estimated by Perceived Stress Scale (PSS). Data were analyzed by the Statistical Package for Social Sciences. Quality control checks for data were done. All ethical issues were maintained strictly in different stages of the study and informed written consent was taken from each individual. Results: Mean (±SD) age was 32.92(± 2.901) and 33.55(± 3.160) years in CDCC users and non-users respectively. Average monthly family income was Tk.191698.11 in CDCC users and Tk. 209433.96 in non-users. Majority (67.9%) of the CDCC users lived in nuclear family while 67.9% of the CDCC non-users lived in joint family. Mothers had significantly higher (85.5%) stress who had maid servant in comparison to mothers who had not and mothers had higher (75.0%) stress who suffered from illness compared to mothers who did not suffer and it was significant (p<0.05). Both low (61.5%) and moderate (59.4%) stress were significantly higher among CDCC users while high stress (83.3%) was significantly higher among CDCC non-users. Chance of having low stress was high (OR=8.0) in mothers who were CDCC users than mothers who were CDCC non-users. Conclusion: CDCC non-users had high level of mental stress than the CDCC users. CDCC should be established with every organization to reduce the mental stress of working mothers. JOPSOM 2021; 40(1): 59-65

Late-Stage Presentation of Testicular Cancer Patients Attended a Specialized Hospital: Findings of a Crosssectional Study

Background: Testicular Cancer (TC) is of interest and importance because its incidence has been increasing in most countries over the past four decades. The purpose of this study is to determine the frequency of patients with common histopathology, most common stage during presentation, biochemical and radiological findings, common levels of tumour markers. Methods: This cross-sectional study was carried out in the Department of Medical Oncology of National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka, Bangladesh from July 2015 to June 2016. A total number of 52 patients were taken as study participants who are admitted as newly diagnosed at the NICRH. Data collection: tumour markers, USG of whole abdomen and chest X-ray were performed to all the patients for determination of the staging of the tumour. Results: The present study found the majority of the patients were found in stage III disease. Patients with Cryptorchidism needed to be educated regarding its early management to reduce the incidence of testicular tumour among them. It was observed that young people could be adequately knowledgeable and optimal awareness could be developed regarding early symptoms of the disease, then they may be found in earlier stage of their disease, which is curable with modern management method. Targeting to alter the cancer patients’ presentation by rising consciousness about TC, prognosis can be largely improved in future. Conclusion: This study was conducted to find out the features which were unknown in perspective of Bangladesh, so that burden of TC can be reduced, and prognosis can be further improved of this potentially curable disease. JOPSOM 2021; 40(1): 26-33

Maintenance of Consent Paper in Daily Dental Practices

Background: To assess maintenance of consent paper in daily dental practices. Methods: It was a cross-sectional study. To assess maintenance of consent paper in daily dental practice at the chambers of the dentist. Data were collected through face to face interview. Dental chambers were selected by simple random sampling technique and respondents were selected purposively in Mymensingh sadar. 50 chambers and 70 dental surgeons were interviewed. Study period was January to March, 2019. Results: In respect of distribution of the chamber owners by sex, female owners comprised 16% and 84% was male owners. By educational background of chamber owners, 40% owners had no B.D.S degree. It was found that 16% dental chambers had two dental surgeons and 84% dental chambers had one dental surgeon. Of all, 92.90% dental surgeons had knowledge about consent paper. The study showed that 80% dental surgeon sometimes, 7.1% dental surgeon always maintained consent paper in daily practice. Among the dental surgeons, 44.3% sometimes faced problem for taking consent paper in daily practice. Among all, 71.4% maintained verbal consent, 7.1% written and 21.4% maintained implied consent. Of all, 94. 3% dental surgeons maintained written consent paper only for costly treatment and specialized cases while 18.6% thought that it was not important and 40% thought that time consuming and 34.3% thought that patients were not interested. It was also found that 42% ancillary of the dental chambers had diploma degree and 58% had no degree. Conclusion: It is a general legal and ethical principle that one must get valid consent because it is the patients' rights before starting treatment or physical investigation. JOPSOM 2021; 40(1): 22-25

Health Care Facilities for Senior Citizens in Selected Tertiary Hospitals During Covid-19 Pandemic

Background: To assess the health care facilities provided for senior citizens in selected tertiary hospitals. Methods: This descriptive type of cross-sectional study was carried out among service providers (doctors and nurses) and hospital administrators within the period of January to December 2020. A total of 305 respondents was selected purposively. Semi structured questionnaire and observational checklist was used to collect data. Data was collected by face to face interview and observation. Data was analyzed by using SPSS (Statistical Package for Social Science) software version 25. Results: Among participants, Administrator 2.6%, Doctor 25.2% and Nurse 72.1%. Mean age of the respondents was 32.72±7.67 years. Most of the respondents 90.8% working experience less than 10 years and their average monthly income was Tk. 35398.90±16509.12. In DMCH separate geriatric ward present but in BSMMU geriatric ward absent. Rehabilitation center & long-term care facilities for elderly patients, telemedicine service, separation facility for non COVID geriatric patients from COVID positive patients, free care facility for poor elderly patients, social welfare support facilities present in both hospitals. Separate bed facility in general wards, geriatric ICU and COVID ward absent, training facility on geriatric health absent in both hospitals. Majority of the respondents 97.0% take consent before any procedure, 89.6% service provider involve geriatric patients in decision making about their care and treatment, 56.6% respondents follow polypharmacy guideline. Opinion regarding utility service was average. Opinion regarding diagnostic facilities, essential drugs, sterilization facilities, of this hospital for senior citizens was moderately sufficient 50.5%, 60.6% and 59.3% respectively and ambulance service insufficient 53.4%. Among respondents 89.8% face barriers in providing geriatric health care. Opinion regarding the existing health care facilities for senior citizens of this hospitals insufficient 52.8%. Regarding improvement of health care services 26.0% mentioned that training of doctor/ nurses followed by separate geriatric ward facilities for geriatric patients 20.8%, increase the number of supporting staff 16.2%, free health care facilities for poor elderly patients 11.8%, training of supporting staffs 10.6%, training for informal/family caregiver 7.4%, separate bed for geriatric patient in general wards 6.4% and the rest others mentioned 0.7%. Analysis found statistically significant association between national guideline follow for the treatment and care of older patients and their educational qualification (0.001), designation (p=0.001), polypharmacy guideline follows for the treatment and care of older patients and their designation, referral guideline follows for geriatric patients and their designation (p=0.001). Conclusion: To provide quality healthcare service to the senior citizens of Bangladesh, geriatric health care should be given highest priority. JOPSOM 2021; 40(1): 51-58

Assessment of Biochemical Changes Among Covid-19 Cases in a Tertiary Hospital of Bangladesh During Early Pandemic

Background: Corona virus disease 2019 (COVID-19) involves various organs of the body causing several biochemical changes which plays an essential role in estimating the patients’ condition and prognosis, directing treatment, and even evaluating the curative effects. The present study aimed to assess the biochemical changes among the COVID-19 patients during early pandemic. Methods: This cross sectional study was conducted at Combined Military Hospital (CMH) Dhaka among purposively selected 237 confirm COVID-19 cases. Data were collected through face to face interview and review of medical records using a pre-tested semi-structured questionnaire. The study was conducted in the Combined Military Hospital Dhaka from 15 April 2020 to 31 May 2020 Results: Highest number of the respondents were in the age group of 31-40 years (37.1%) with male predominance (83.1%). About 95.6% were Muslim and 58.6% were educated up to secondary level. About 87.8% had contact with a confirmed case and having 47.7%, 37.2%, 15.1% cardiovascular, endocrine and respiratory comorbidities respectively. Fever (34.6%) was the most common presenting symptoms followed by cough (22.9%), sore throat (10.6%). Neutrophilia observed in 26.16%, lymphopenia in 20.7%, thrombocytopenia in 14.3% cases, 30.0% with positive D-dimer test, 22.4% either sepsis or systemic infection in procalcitonin estimation, 28.3% with increased ferritin, 28.7% with positive C reactive protein, 21.1% with increased LDH. Chi-square analysis revealed a statistically significant association between cardiovascular and endocrine diseases with several biochemical changes (p<0.05). Conclusion: Early identification of various biochemical changes would help the physician for appropriate assessment and management. JOPSOM 2021; 40(1): 34-42

Advancement, Collaboration and Effective Combat in Low Resource Setting: Public Health Overview After One year of the Corona Virus Pandemic in Bangladesh

Background: Current Coronavirus pandemic causing millions of deaths and unfathomable damage of nations worldwide, especially in health sector. Bangladesh is dealing with the biggest catastrophic public health event of the history in a courageous and effective way. An evidence based narrative review has been undergone to scientifically describe Bangladesh government’s measures to encounter the Corona pandemic, so far. The aim of this study is to document the collaborative action of different ministries of Bangladesh government during this pandemic to understand the in-depth steps of the healthcare provision and disaster preparedness of the public-private-international association in a low-resource setting. Methods: A literature review over five months has been conducted to write down the evidential narration of the activities against the pandemic damage in Bangladesh. Keyword and result based literatures and current media reports searched has been done. Selection criteria: Both online and offline reports, descriptive articles, governmental portal and ministerial websites were reviewed. The description is reported specifically based on the documents directed by government to fight against COVID-19 from the beginning of the pandemic till the writing period. Findings and discussion: In spite of the resource constraints, government of Bangladesh has been able to limit the damage in an optimal level. The inter- and- inter ministerial functional proposition and collaboration in national and international stakeholders initiated and sustained by the government strengthen the shield against the Coronavirus invasion. Conclusion: The sufferings brought by the pandemic knows no bound. The pandemic damage and ruin are unspeakable and undeniable at the same time. It is time to observe the positivity and critically appreciate the efforts taken by the current governmental authority to make a constructive remark for present situation, and be prepare for future building of the nation. JOPSOM 2021; 40(1): 66-71

Knowledge of Health Care Providers of a Tertiary Hospital Regarding Post-Operative Infection

Background: Infection is a very common post-operative complication. Now a day the knowledge about infection among healthcare provider is very essential. The study was aimed to determine the knowledge health care provider regarding the management of infection in postoperative ward. Methods: The cross-sectional study was conducted among 90 respondents (60 doctors, 50 nurses & 40 supporting staff) from January 2015 to December 2015 in Dhaka Medical College and Hospital. A semi structured questionnaire was used to obtain socio-demographic data and infection management related information from the respondents through face to face interview. In-depth interviews were taken from director of DMCH, head of the department of surgery and nurse in-charge in post-operative ward for qualitative data. After collection data were complied, summarized and analyzed. The study was approved by ethical committee of National institute of Preventive and Social Medicine. Before collection of data, written permission was taken from the director of the selected hospital & take consent from the respondents. Results: Among 150 respondents, 58% were female with 26-30 years age group. Most doctors were post-graduate & nurses were diploma in nursing. Most of doctors had knowledge about infections- 83.3% told bacterial as a type, 80% told devices as a source and 94% told diabetes as a risk factor. Both doctors and nurses had knowledge about the causes and mode of transmission of infection (90% doctors & 93.2% nurses told unsterile instrument), complication due to infection (100% doctors told sepsis & 86.7% nurses told wound become red & swelling), prevention (100% doctors &92% nurses told proper sterilization of instrument). Doctors (95% and nurse (74%) known about infection control guideline and. Doctors (47.5%) and nurses (68%) received training about infection management Among 40 staff 80% were known about infection and they knew from their colleague. 82.5% staffs known about sterilization. Conclusion: This finding had great impact for management of infection and it will be beneficial for all HCW to receive formal and periodic refresher trainings. JOPSOM 2021; 40(1): 43-50

Association between weather factors and dengue in Dhaka: a time-series analysis

Background: There was an epidemic of dengue fever that happened in Bangladesh in the year of 2019. Temperature of this country has been raising which leads to changing in rainfall pattern. This study was aimed to investigate the relationship of weather factors and dengue incidence in Dhaka. Methods: A time series analysis was carried out by using 10 years weather data as average , maximum and minimum monthly temperature, average monthly humidity and average and cumulative monthly rainfall. Reported number of dengue cases was extracted from January 2009 to July 2019. Firstly, dengue incidence rate was calculated. Correlation analysis and negative binomial regression model was developed. Results: Dengue incidence rate had sharp upward trend. Dengue incidence and mean, maximum and minimum average temperature showed statistically significant negative correlation at 3 months' lag. Highest incidence Rate Ratio (IRR) of dengue was found at minimum average temperature at 0 and I-month lag. Average humidity showed positive and significant correlation with dengue incidence at 0-month lag. Average and cumulative rainfall also showed negative and significant correlation only at 3-months lag period. Conclusion: Weather variability influences dengue incidence and the association between the weather factors are non­ linear and not consistent. So the study findings should be evaluated area basis with other local factors to develop early warning for dengue epidemic prediction. JOPSOM 2020; 39(1): 43-49