In Bangladesh, the National Drug Policy (NDP) 1982 was instrumental in improving the supply of essential drugs of quality at an affordable price, especially in the early years. However, over time, evidence showed that the situation deteriorated in terms of both availability of essential drugs and their rational use. The study examined the current status of the outcome of the NDP objectives in terms of the availability and rational use of drugs in the primary healthcare (PHC) facilities in Bangladesh, including affordability by consumers. The study covered a random sample (n=30) of rural Upazila Health Complexes (UHCs) and a convenient sample (n=20) of urban clinics (UCs) in the Dhaka metropolitan area. Observations on prescribing and dispensing practices were made, and exit-interviews with patients and their attendants, and a mini-market survey were conducted to collect data on the core drug-use indicators of the World Health Organization from the health facilities. The findings revealed that the availability of essential drugs for common illnesses was poor, varying from 6% in the UHCs to 15% in the UCs. The number of drugs dispensed out of the total number of drugs prescribed was higher in the UHCs (76%) than in the UCs (44%). The dispensed drugs were not labelled properly, although >70% of patients/care-givers (n=1,496) reported to have understood the dosage schedule. The copy of the list of essential drugs was available in 55% and 47% of the UCs and UHCs respectively, with around two-thirds of the drugs being prescribed from the list. Polypharmacy was higher in the UCs (46%) than in the UHCs (33%). An antibiotic was prescribed in 44% of encounters (n=1,496), more frequently for fever (36-40%) and common cold (26-34%) than for lower respiratory tract infection, including pneumonia (10-20%). The prices of key essential drugs differed widely by brands (500% or more), seriously compromising the affordability of the poor people. Thus, the availability and rational use of drugs and the affordability of the poor people have remained to be achieved in Bangladesh even 27 years after approving the much-acclaimed NDP 1982.

Background: A link between the provision of iron and infectious morbidity has been suggested, particularly in children with malnutrition. Two meta-analyses concluded that iron is not harmful, but malnourished children were underrepresented in most available studies.Objective: This study evaluated the effect of iron-containing micronutrient powder (iron MNP) on infectious morbidities when provided to children with moderate-to-severe malnutrition and anemia. Design: A randomized, double-blind, placebo-controlled, noninferiority safety trial using a 2-mo course of daily iron MNP or placebo powder (PP) was conducted in 268 Bangladeshi children aged 12-24 mo with moderate-to-severe malnutrition (weight-for-age z score 22) and a hemoglobin concentration between 70 and 110 g/L. The primary endpoint was a composite of diarrhea, dysentery, and lower respiratory tract infection episodes (DDL) recorded through home visits every 2 d during the intervention and then weekly for 4 mo. The noninferiority margin was 1.2. Secondary endpoints included hemoglobin and anthropometric changes at 2 and 6 mo. All deaths and hospitalizations were documented. To capture seasonal variation, the study was repeated in the winter and summer with 2 distinct groups. An intention-to-treat analysis of recurrent events was performed by using the univariate Anderson-Gill model. Results: The baseline characteristics of the subjects were similar. Analysis of phase-aggregated DDL data showed that iron MNP was not inferior to PP (relative risk: 0.81; 95% CI: 0.62, 1.04) and improved hemoglobin concentrations (P , 0.0001). We recorded no deaths, and hospitalizations were rare. Conclusion: Iron MNP is safe and efficacious when provided to children aged 12-24 mo with moderate-to-severe malnutrition and anemia. This trial is registered at clinicaltrials.gov as NCT00530374.Am J Clin Nutr 2011;94:585-93.

Misperception, lack of knowledge and irrational use of antibiotics are challenges that need to be addressed for controlling and preventing TB efficiently.

BackgroundThe National Tuberculosis (TB) Control Programme (NTP) of Bangladesh succeeded in achieving the dual targets of 70 % case detection and 85 % treatment completion as set by the World Health Organization. However, TB prevention and control in work places remained largely an uncharted area for NTP. There is dearth of information regarding manufacturing workers’ current knowledge, attitudes and practices (KAP) on pulmonary TB which is essential for designing a TB prevention and control programme in the workplaces. This study aimed to fill-in this knowledge gap.MethodsThis cross-sectional survey was done in multiple workplaces like garment factories, jute mills, bidi/tobacco factories, flour mills, and steel mills using a multi-stage sampling procedure. Data on workers’ KAP related to pulmonary TB were collected from 4800 workers in face-to-face interview.ResultsThe workers were quite knowledgeable about symptoms of pulmonary TB (72 %) and free- of-cost sputum test (86 %) and drug treatment (88 %), but possessed superficial knowledge regarding causation (4 %) and mode of transmission (48 %). Only 11 % knew about preventive measures e.g., taking BCG vaccine and/or refraining from spitting here and there. Knowledge about treatment duration (43 %) and consequences of incomplete treatment (11 %) was poor. Thirty-one percent were afraid of the disease, 21 % would feel embarrassed (and less dignified) if they would have TB, and 50 % were afraid of isolation if neighbours would come to know about it. Workers with formal education (AOR 1.92; 95 % CI 1.61, 2.29) and exposure to community health workers (CHW) (AOR 31.60; 95 % CI 18.75, 53.35) were more likely to have TB knowledge score ≥ mean. Workers with knowledge score ≥ mean (AOR = 1.91; 95 % CI:1.44, 2.53) and exposure to CHWs either alone (AOR = 42.4; 95 % CI: 9.94, 180.5) or in combination with print media (AOR = 37.35; 95 % CI: 9.1, 180.5) were more likely to go to DOTS centre for treatment . Only around 43 % had sputum examination despite having chronic cough of ≥ 3 weeks duration.ConclusionThe workers had inadequate knowledge regarding its causation, transmission and prevention which may interfere with appropriate treatment-seeking for chronic cough including sputum test. NTP needs to be cognizant of these factors while designing a workplace TB prevention and control programme for Bangladesh.

high TB burden. 2,6,12 The effective management of TB therefore requires a detailed evaluation of nutritional status, as this can help to prevent or modify many complications of the disease.Signifi cant improvement has been achieved in TB control in Bangladesh in the last few years. 13 The government of Bangladesh, in partnership with different non-government organisations, including BRAC, has been implementing a community-based National Tuberculosis Control Programme (NTP) based on the DOTS strategy since 1993. 14 As data on the nutritional status of TB patients are scarce and unreliable in Bangladesh, the BRAC Research and Evaluation Division (RED) initiated a study to explore the nutritional status of TB patients attending peri-urban BRAC sputum microscopy laboratories during the various stages of convalescence before, at 2 months and immediately after completion of DOTS-based treatment.The present study will help fi ll in this gap in knowledge and help design programme interventions for better management of nutrition for TB patients in the country. METHODS Study settingsThe study was conducted among TB patients from peri-urban populations registered for treatment at BRAC TB sputum microscopy laboratories in Dhaka City. Patients with cough of >3 weeks' duration attend the microscopy laboratories for sputum testing free of charge under the NTP. Smear-positive pulmonary TB cases are registered immediately for treatment. Patients with negative microscopy results undergo further investigations and, if found positive, are admitted for treatment at the BRAC laboratory. Study population and sample sizeWe included 1110 new TB patients aged >15 years registered at 10 BRAC sputum microscopy laboratories from May 2010 to December 2011. Of these, 42 were excluded (3.9%) as they were not available for interview, had a previous history of TB, were receiving anti-t uberculosis treatment, were pregnant or currently lactating, had diabetes mellitus or had any form of mental disease, as confi rmed by physicians. Healthy controls (comparison group) were selected from nonfamily neighbours of the patients (same socio-economic status), and were matched by age and sex with TB patients (one for each TB case). Around 12% of the controls did not agree to provide information or participate. A fi nal sample of 1068 TB patients (624 males Results: Two thirds of the patients (67%) had a low BMI (<18.5 kg/m 2 ) before treatment, compared to only 23% among the healthy controls. At the end of treatment, 50% of the patients still had a low BMI, including 12% who had severe malnourishment (BMI ⩽ 16 kg/m 2 ). MUAC < 22.0 cm was higher among patients before (42%), at 2 months (39%) and immediately after completion of treatment (34%) compared to the control group (9%). Conclusions:Malnutrition is a serious problem among TB patients in peri-urban areas of Dhaka City. Under the circumstances, additional nutritional supplements, combined with education on nutrition, are expected to contribute to rapid and sustained recovery during DOTSbased treatmen...