Background The Cholera-Hospital-Based-Intervention-for-7-days (CHoBI7) mobile health (mHealth) program was a cluster-randomized controlled trial of diarrhea patient households conducted in Dhaka, Bangladesh. Methods Patients were block-randomized to three arms: standard recommendation on oral rehydration solution use; health facility delivery of CHoBI7 plus mHealth (no home visits); and health facility delivery of CHoBI7 plus two home visits and mHealth. The primary outcome was reported diarrhea in the past two weeks collected monthly for 12 months. The secondary outcomes were stunting, underweight, and wasting at a 12 month follow-up. Analysis was intention-to-treat. The trial is registered at ClinicalTrials.gov (NCT04008134). Results Between December 4, 2016 and April 26, 2018, 2626 participants in 769 households were randomly allocated to three arms: 849 participants to standard message, 886 to mHealth with no home visits, and 891 to mHealth with two home visits. Children under five years had significantly lower 12-month diarrhea prevalence in both the mHealth with two home visits arm (Prevalence Ratio(PR): 0.73 (95% Confidence Interval(CI): 0.61, 0.87)) and the mHealth with no home visits arm (PR: 0.82 (95% CI: 0.69, 0.97)). Children under 2 years were significantly less likely to be stunted in both the mHealth with two home visits arm (33% vs. 45%, Odds Ratio(OR): 0.55, 95% CI: 0.31, 0.97) and the mHealth with no home visits arm (32% vs. 45%, OR: 0.54, 95% CI: 0.31, 0.96) compared to children in the standard message arm. Conclusion The CHoBI7 mHealth program lowered pediatric diarrhea and stunting among diarrhea patient households.

Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Out of the total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations. The data suggesting the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city.

Objective The objective of the study was to investigate potential risk factors for growth faltering among children under 5 years of age. Method We conducted a prospective cohort study of 553 children under 5 years from diarrhoea patient households in urban Dhaka, Bangladesh. Height and weight measurements were obtained at baseline and at a 12‐month follow‐up. Caregivers of young children were administered a monthly questionnaire on household sociodemographic characteristics and hygiene practices. Results Children with caregiver reports of mouthing soil at the majority of household visits had a significant reduction in their height‐for‐age z‐scores (HAZ) from baseline to the 12‐month follow‐up (ΔHAZ: −0.28 (95% confidence interval (CI): −0.51, −0.05)). A significant reduction in HAZ was also observed for children in households with animals in their sleeping space (ΔHAZ: −0.37 (95% CI: −0.71, −0.04)). Conclusion These findings provide further evidence to support the hypothesis that child mouthing of soil and the presence of animals in the child’s sleeping space are potential risk factors for growth faltering among young children. Interventions are urgently needed to provide clean play and sleeping spaces for young children to reduce exposure to faecal pathogens through child mouthing.

Background: This study is to investigate the acceptance of a public-private joint venture, which is formed in-between public-sector community health centers (PCHC) and private-sector m-health service providers and can be a potential solution for two practical problems. The first problem is about PCHCs, which are operating about forty-one percent underutilization rates. The second problem is the lack of a revenue-generating business model for m-health service providers' while having a surprising number of registered users with daily health-care consultation queries. This joint venture will help to bridge the strengths of the public-sector health-care system (e.g., highly qualified doctors, offline health-care facilities) with the strengths of private-sector m-health service providers (e.g., a dramatic number of registered users, daily health-care consultation queries) resulting in a win-win situation for both parties. Methods: The data collected from doctors associated with a territory hospital in Hefei, China, and analyzed using partial least squares, a structural equation modeling technique. Results: This study extended the unified theory of acceptance and use of technology with the channel expansion theory. We explored that perceived media richness, government support, effort, and performance expectancies positively influence behavioral intention to deliver health-care consultation using m-health services that are equipped with PCHCs. Surprisingly, social influence and facilitating conditions found insignificant in the Chinese context. Conclusion: It can help the government healthcare authorities, and policymakers to build confidence in PCHCs, and to improve PCHC resource utilization. It can help m-health service providers to build confidence in m-health services resulting in a revenue-generating business model.