Background : Suicide is a public health problem too often neglected by researchers, health policy makers and the medical profession. In the year 2000, approximately one million people died of suicide which represents a global mortality rate of 16 per 100,000. According to WHO estimates for the year 2020 and based on current trends approximately 1.53 million people will die from suicide and 10-20 times more people will attempt suicide worldwide. The aim of this study was to describe the community prevalence of suicidal attempts and deaths in rural area of Bangladesh and to find out the relationship between suicide and socio-demographic variables. Study Design and Setting : A Community based survey was carried out by members of the Department of Medicine, Shaheed Suhrawardi Medical College and Hospital at Mominpur union under Sadar Upazilla of district Chuadanga. Statistical analyses were performed using SPSS 16. Results : A total of 3551 households were surveyed covering 12422 individuals. A total of 35 individuals attempted suicide in last one year and of them 16 died and rest of he 19 survived. One year incidence of suicidal attempt in the study area was 281.8 per thousand population and the incidence of suicidal deaths was 128.8 per 100000 population. Median age of the people attempted or committed suicide was 30.36(range12 to 70 years). Most (42.9%) suicide was attempted by people at their twenties (20–29 years). Male to female ratio was around 1:4. Around 33.3% of the people who attempted or committed suicide studied up to secondary level, 28.6% studied up to primary level. Most (55.2%) of the people who committed or attempted suicide were housewives,10.3% were daily basis worker, 6.9% were students, another 6.9% engaged in agricultural work and 3.4% were disabled. Majority (45.7%) of the people who committed or attempted suicide was of lower class, 37.1% were of lower middle class, 14.3% were of middle class and 2.9% were of upper class. Majority (82.9%) of the person attempted suicide or died of suicide were married. Around 57% had discord in the family, around 23% had at least one relative died of suicide, around 17% of them were suffering from chronic diseases. Two of them were substance abuser. One of them had preexisting mental disorder, two (5.8%) were orphan and around seven (20%) made an attempt before the current one. Conclusion: Community survey in a rural area of South-West Bangladesh revealed that suicide is a major cause of mortality, especially in young females. Although this study results were from a small population of a community, the high rate of deaths from suicide are alarming and warrants further studies in regional and national level to find out the risk factors. DOI: http://dx.doi.org/10.3329/jom.v13i1.10042 JOM 2012; 13(1): 3-9

Aims: To study the demographic, clinical features, treatment as well as outcomes of tetanus patients in the Bangladeshi population from 1994 to 2003. Design: A retrospective descriptive study. Setting: A large public Medical college hospital with a regional as well as referral service. Materials and Methods: All cases of tetanus in adult patients from January 1994 to December 2003 were identified from the medical record at the hospital and these were then retrospectively reviewed. Results: A total of 80 cases of tetanus were seen at the Faridpur Medical college hospital in the 10 years period with a mean of 8 cases per year. There were 55 male (68.75%) and 25 female (31.25%) patients. The mean age of the study population was 51.7±10.08 years. Most cases occurred in the age group of 60-69 years. Risk factor analysis revealed identifiable acute injury (puncture, prick/laceration) in 85%, CSOM (2.5%), surgery (2.5%), abortion (2.5%), skin ulcer (1.25%), burn (1.25%), child birth (1.25%), boil (1.25%). Thirty-two (40%) patients had medical wound care before hospital admission but none received tetanus immunoglobulin despite the absence of tetanus immunity. All the patients had the generalized type of disease. Body stiffness, trismus and dysphagia were the three commonest presenting complaints. All the patients with injury and wound (74/80) had their wound debrided. All the tetanus patients (80/80) received intravenous diazepam infusion as part of their management. Seventy two (90%) patients received intravenous crystalline penicillin. Sixty-five (81.25%) patients received intramuscular human antitetanus immunoglobulin and fourteen (17.5%) had tracheostomy performed. Inhospital complications were observed as respiratory (80%), cardiovascular (65%), gastrointestinal (57-5%), renal (33.37%), neurological (17.%) and others (22.5%). There were eighteen deaths in hospital, accounting for overall mortality of 22.5% (18/80). Higher mortality were observed in age group above 50 years than the age group below 50 years (29.16% vs 12.5%, P<0.05), in female than the male (40% vs 14.54%, P<0.05), in farmer than nonfarmer (30.95% vs 13.15%, P<0.05), in patients who had short incubation period than those who had incubation period more than one week (53.33% vs 23.25%, P<0.05). Conclusion: In general, tetanus remains in Bangladesh an important disease with substantial mortality that primarily affects unvaccinated or inadequately vaccinated individuals. Prevention during wound management of tetanus prone wounds was inappropriate in many patients. The elderly population may have the highest risk for tetanus since they may not have had tetanus toxoid immunization or regular booster injections. It is, however, highly preventable through both routine vaccination and appropriate wound management. Our case series show comparable pattern and outcome with other case series in the developing countries reported in the literatures. (J Bangladesh Coll Phys Surg 2007; 25 : 62-69)

Background: Suicide is a public health problem too often neglected by researchers, health policy makers and the medical profession. In the year 2000, approximately one million people died of suicide which represents a global mortality rate of 16 per 100,000. According to WHO estimates for the year 2020 and based on current trends approximately 1.53 million people will die from suicide and 10-20 times more people will attempt suicide worldwide. This represents on average 1 death per 20 seconds and 1 attempt every 1-2 seconds. No nationwide survey on suicidal risk factors has yet been conducted in Bangladesh. Reports from police records, Media, court, hospitals and the focused study on selected population indicate that suicide is a public health problem in Bangladesh. The aim of this study was to unearth the potential risk factors of suicide or suicidal attempts and to assess psychiatric illness, non psychiatric co-morbidity, individual’s behavioral and physical factor, familial risk factors and socio-demographic risk factors of suicide and its attempts. Study Design and Setting: A case control study was carried out by members of the Department of Medicine, Shaheed Suhrawardi Medical College and Hospital at Mominpur,Haowlee and Jibonnagar unions under three Upazilla of district Chuadanga,. Statistical analyses were performed using SPSS 16. Results: A total 230 subjects (113 cases and 117 controls) were interviewed. Mean age among cases was 29.6±12.8 years and controls were 29.7±12.9 years.Majority of the participants, 65.5% of cases and 63.2% of controls were aged between 20-39 years. Among cases 38.9% were male and among the controls 42.7% were male.Among cases 30.1% and among controls 27.4% had less than 4 family members. More than half of the participants, among cases (58.4%) and among controls (55.6%) had between 4- 6 members in the family. Economic status was also similar in two groups.Problem of love affair (OR 5.2), Personal problem (OR 11.9), Feeling of economic hardship (OR 2.4) appeared to have statistically significant association with suicidal attempt. Problem with relatives (OR 3.8), death of near relative (OR 0.9) and poor academic performance (OR 1.6) didn’t appear to have any association with risk of suicidal attempt. History of chronic disease (OR 2.9) showed statistically significant association but long term physical disability (OR 4.4) and physical problems didn’t appear to have any significant association with suicidal attempt. History of suicidal attempt by any relative (OR 4.2) and previous attempt to suicide (OR 7.4) appeared as highly significant factor for suicide. Not being reared by biological parents (OR 3.2), marital disharmony (OR 4.0), Conflict within the family (OR 6.9) appeared to be strongly associated with suicidal attempts. Suicidal attempts of participants were significantly associated with sleeping disturbance (OR 2.3), uncertainty about future (7.2), impulsivity (OR 13.8), and history of criminal behavior (OR 2.1). Conclusion: Case control study on the risk factors of suicide in rural area of South-West Bangladesh revealed that the married female especially the younger age from unitary family of low income group are more vulnerable to commit suicide or parasuicide. Several emotional factors, presence of chronic diseases, familial suicidal predisposition, individual factor and mental state, premorbid persionality and psychiatric syndrome appeared to have significant association with suicidal attempts. DOI: http://dx.doi.org/10.3329/jom.v14i2.19653 J Medicine 2013, 14(2): 123-129

Bangladesh Journal of Medicine, Vol 24 No 1, 2013, Page 14-19 DOI: http://dx.doi.org/10.3329/bjmed.v24i1.15030

not availableJ Shaheed Suhrawardy Med Coll, June 2018, Vol.10(1); 1-2