Frontline health workers (FHW) are working relentlessly to combat the COVID-19 pandemic globally. This is particularly challenging for low-and middle-income countries such as Bangladesh because of resource scarcity. Therefore, it is critical to understand the challenges of healthcare providers to help shaping a contextual pandemic response plan address current and future similar crises. Aim: This study aimed to describe the challenges faced by FHWs in Bangladesh in terms of information on COVID-19, managing patients with COVID-19, and what motivated them to continue providing service during the pandemic. Methods: This qualitative study explored the experiences of 18 FHWs who were purposely recruited from different health interventions of a development organization in Bangladesh. In-depth interviews and focus group discussions were conducted during July-August 2020 using a semi-structured interview guide. The interviews were transcribed verbatim and content analysis was used to analyze the data which led to four categories. Results: Four main categories and ten sub-categories emerged from the analysis. Categories derived from the analysis were as follows: i) experiences of the FHWs regarding information on COVID-19: "Working in the dark", ii) experience of providing care: "Patients are grateful", iii) impact on personal/family life: "Life is still in lockdown" and iv) motivation to carry on providing care. Conclusion: FHWs desire a stable information source to prepare themselves for future health care crises. Organizational support is essential for them to overcome physical and mental struggles and keep themselves motivated to continue service provision during pandemics.

IntroductionThe long-term impact of COVID-19 on mental health, particularly in relation to socio-economic vulnerabilities, has received little attention. This study reports the prevalence of mental health-related symptoms among previously hospitalized patients after recovery from COVID-19, and its association with socio-economic status (SES).MethodsData collection of this cross-sectional study was conducted during February–April 2021, among previously hospitalized patients with COVID-19 like symptoms, on average six months after their discharge from the hospital. Using DASS-21, a validated scale to document symptoms of depression, anxiety, and stress, information on mental health-related symptoms were recorded from 481 respondents along with sociodemographic and economic information through telephone interviews. Chi-square tests were performed to identify significant group differences. Multinomial logistic regression analyzed the association between the changes in socioeconomic characteristics and mental health-related symptoms. Relative index of inequality (RII), slope index of inequality (SII), and concentration index (CIX) were applied to capture relevant inequalities in relation to mental health-related symptoms.ResultsEleven percent of the respondents reported changes in employment status, nearly half changes in income and expenditure. Forty-five percent reported symptoms of depression, anxiety and/or stress, and 12% reported coexistence of all three symptoms. Women [Adjusted Odds Ratio, AOR: 2.95; 95% Confidence Interval, CI: 1.39–5.68], and those who reported changes in occupation [AOR: 3.04; 95% CI: 1.01–9.08] and expenditure [AOR: 2.46; 95% CI: 1.12–5.37] were more likely to report all three mental health-related symptoms compared to men and those without changes in occupation and expenditure. The older age group was less likely [AOR: 0.96; 95%CI: 0.93–0.99] to report coexistence of all three symptoms compared to their younger counterparts. Negative values of concentration index (CIX) indicate that any one mental health-related symptom was significantly concentrated among those with lower expenditure and poor SES.ConclusionThis study will help in addressing mental health-related challenges after recovery from COVID-19 among the identified vulnerable groups through relevant community-based and clinical response, including counseling services, in Bangladesh and similar LMIC contexts.

BackgroundThere is increasing evidence of long-term consequences of COVID-19. The world has seen multidimensional impact of the pandemic and Bangladesh is no exception to that. Policymakers in Bangladesh laid out strategies to curb the initial spread of COVID-19. However, long-term consequences of COVID-19 received little or no attention in the country. Evidence suggests that people presumed to be recovered face multidimensional post-covid consequences. This study aimed to describe the aftermath of COVID-19 in relation to social, financial and health related aspects among previously hospitalized patients.MethodsThis descriptive qualitative study includes participants (n = 14) who were previously hospitalized for COVID-19 and returned home after recovery. The participants were part of a mixed method study from which they were purposively selected. Semi-structured in-depth interviews were conducted over telephone. Inductive content analysis was used to analyze the data.ResultsTwelve sub-categories emerged from the data analysis which converged into five main categories. The main categories included perspective on physical health, financial struggle, life adjustment, interplay between different domains, and spontaneous support.ConclusionThe lived experiences of COVID-19 recovered patients highlighted multidimensional impact on their daily lives. Physical and psychological wellbeing found to be related to the effort of restoring financial status. People’s perception about life altered due to pandemic, for few the pandemic was an opportunity to grow while others found it difficult to accept the hardship. Such multidimensional post COVID-19 impact on people’s lives and wellbeing holds considerable implication for response and mitigation plan for future related pandemics.

IntroductionNot much is known about the long-term consequences of COVID-19, popularly known as long COVID. This is particularly so in terms of patterns and clusters of symptoms over time, sociodemographic and economic characteristics of patients, and related clinical history. This is crucial for resource-constrained health systems such as Bangladesh to address long COVID as a forthcoming challenge. This protocol aims to investigate the consequences of COVID-19 over time for physical and mental health and how these are associated with demographic and socio-economic factors.Methods and analysisThis mixed-method study collected information on all patients with symptoms of COVID-19 admitted to and discharged after recovery from a COVID-19-dedicated hospital in Bangladesh (N = 942), from April to December 2020. The sources of data were admission records and discharge certificates from the hospital for clinical history, cross-sectional survey on physical and mental health (assessed by DASS21 scale)-related symptoms and socioeconomic changes after recovery, and qualitative in-depth interviews on experiences of COVID-19. Interviews were conducted over the phone. Quantitative analysis was done to estimate the prevalence of physical and mental health consequences of COVID-19 after recovery and the association with socio-economic and demographic information. The qualitative analysis was performed using a thematic analysis approach.DiscussionIt is imperative to understand the post-COVID consequences and related health and non-health aspects to inform evidence-based policymaking, especially for resource-poor contexts such as Bangladesh. Given the dearth of evidence in this regard, the proposed study will contribute to bridging this knowledge gap. It is important to note that this study is one of the few which presents information on post-COVID-19 consequences in the context of low- and middle-income countries and the first in Bangladesh.

Background The COVID-19 epidemic has especially impacted the urban population in Bangladesh. Despite the illness impacts not only the patient but also other members in the family, studies on COVID-19 have primarily focused on the patient’s perspective. It is important to understand the experience of family members who adopt caregiving roles. This study aimed to explore the challenges, preventative practices, health-seeking behaviour, and navigating the health care system from the perspective of family members of persons who had recovered from COVID-19 during its initial outbreak in Bangladesh. Methods Participants of this qualitative study were family members (n = 7) of persons who had recovered from COVID-19 (either suspected or confirmed) and received treatment either at home, in a hospital or isolation centre. Data for the study was collected through in-depth interviews over telephone using a semi-structured interview guide. Thematic analysis was used to analyse the data. Results Analysis revealed three key themes: changes in everyday practices and choice of health care, challenges and constraints, and unexpected positive outcomes. All the themes had temporal dimension to them with four distinct phases: early stage of COVID-19, strict lockdown phase, COVID-19 diagnosis and illness period, and post COVID-19 recovery. Conclusion The importance of maintaining social contact for psychological wellbeing during critical times was evident in the study. Online communication and social media enabled participants to remain ‘socially connected’ rather than ‘socially distanced’, which further supported their mental health during the healing process. Increased attention to hygiene practices both before, during and subsequent to COVID-19 infections within families was reported. The recommendation of physical distancing in case of suspected or confirmed case of COVID-19 was found logistically and socially impractical in a densely populated city.