Background The mosquito-borne arboviral disease dengue has become a global public health concern. However, very few studies have reported atypical clinical features of dengue among children. Because an understanding of various spectrums of presentation of dengue is necessary for timely diagnosis and management, we aimed to document the typical and atypical clinical features along with predictors of severity among children with dengue during the largest outbreak in Bangladesh in 2019. Methods We conducted a cross-sectional study between August 15 and September 30, 2019. in eight tertiary level hospitals in Dhaka city. Children (aged < 15 years) with serologically confirmed dengue were conveniently selected for data collection through a structured questionnaire. Descriptive, inferential statistics, and multivariable logistic regression were used to analyze data. Results Among the 190 children (mean age 8.8 years, and male-female ratio 1.22:1) included in the analysis, respectively 71.1 and 28.9% children had non-severe and severe dengue. All children had fever with an average temperature of 103.3 ± 1.2 F (SD). Gastrointestinal symptoms were the most common associated feature, including mostly vomiting (80.4%), decreased appetite (79.5%), constipation (72.7%), and abdominal pain (64.9%). Mouth sore, a less reported feature besides constipation, was present in 28.3% of children. Atypical clinical features were mostly neurological, with confusion (21.3%) being the predominant symptom. Frequent laboratory abnormalities were thrombocytopenia (87.2%), leucopenia (40.4%), and increased hematocrit (13.4%). Age (AOR 0.86, 95%CI 0.75–0.98, p = 0.023), mouth sore (AOR 2.69, 95%CI 1.06–6.96, p = 0.038) and a decreased platelet count (< 50,000/mm3) with increased hematocrit (> 20%) (AOR 4.94, 95%CI 1.48–17.31, p = 0.01) were significant predictors of severity. Conclusions Dengue in children was characterized by a high severity, predominance of gastrointestinal symptoms, and atypical neurological presentations. Younger age, mouth sores, and a decreased platelet with increased hematocrit were significant predictors of severity. Our findings would contribute to the clinical management of dengue in children.

It is unclear whether there is any association between psychological distress and unhealthy dietary habits among adolescents in low- and middle-income countries. We aimed to estimate the prevalence of these factors in South-East Asia region and investigate their associations. We used data from the Global School-based Health Survey for nine South-East Asian countries. Psychological distress was defined by presence of ≥2 factors from loneliness, anxiety, suicide ideation, suicide planning, and suicide attempt. We assessed inadequate fruit intake, inadequate vegetable intake, daily soft drink, and weekly fast-food consumption. We used random-effects meta-analysis to estimate pooled prevalence. Logistic regressions were used to estimate odds ratios (ORs) of unhealthy dietary behaviours for psychological distress. Among 30,013 adolescents (56% girls) aged 12-15 years, the prevalence of psychological distress was 11.0%, with girls reporting slightly higher than boys (11.8% vs. 10.1%). The prevalence of inadequate fruit intake, inadequate vegetable intake, daily soft drink consumption, and weekly fast-food consumption was 42%, 26%, 40%, and 57%, respectively. Psychological distress was associated with inadequate fruit intake (pooled OR=1.20, 95% CI 1.03-1.40), inadequate vegetable intake (pooled OR=1.17, 1.05-1.31), and daily soft drink consumption (pooled OR=1.14, 1.03-1.26); but not with weekly fast-food consumption (pooled OR=1.13, 0.96-1.31). We observed substantial cross-country variations in prevalence and OR estimates. In conclusion, South-East Asian adolescents have significant burden of psychological distress and unhealthy dietary behaviours, with those having psychological distress are more likely to have unhealthy dietary behaviours. Our findings will guide preventative interventions and inform relevant policies around adolescent nutrition in the region.

Background: During an outbreak, the health-seeking behaviour (HSB) of patients plays a vital role to mitigate the disease spread. Poor HSB may significantly increase mortality and complicate contact tracing. In our study, we aimed to assess the status of HSB among the educated young adults of Bangladesh.Methods: A cross-sectional study was conducted online in June-July 2020 when the country was under strict social distancing measures. A snowball sampling method was employed to capture the suspected COVID-19 patients who did not undergo the COVID-19 test. Descriptive and inferential analyses were performed with statistical significance defined as p < 0.05. Results: Among the 390 participants, more male (79.5%) and urban-dwelling residents (80.3%) participated in the study. About 45% of the participants had a bachelor’s degree followed by 25.9% of post-graduation degrees such as master’s and Ph.D. Common symptoms included fever (77.7%), cough (50.5%), headache (46.2%), body pain (36.4%), sore throat (35.6%), anosmia (31.3%), anorexia (13.8%), diarrhea (11.4%) and dyspnea (11.3%). Compared to females, males were more likely to self-medicate. The odds of male participants considering COVID-19 infection as harmless was 3.2 times higher (AOR: 3.2, CI: 1.28-7.98) than the female participants. Smokers were more likely to use government hotlines for support and take drugs at home. Participants from rural areas were 2.5 times more likely to purchase drugs from nearby stores. The most common reasons for not taking the COVID-19 test were limited testing facilities (48%), risk of infection from the test centre (46%), fear of social stigma (19%), belief that COVID-19 will not cause any harm (18%) and fear of forced quarantine (5%). Respondents having higher monthly income were less likely to fear forced quarantine (AOR: 0.27, CI: 0.4-2.02) but more likely to consider the risk of being infected from the test centre (AOR: 1.75, CI: 0.88-3.49). Conclusion: Non-compliance with public health guidelines by educated people in the epidemic reflects the absence of health literacy and distrust in the healthcare system. Along with enhanced infrastructure, improved public health risk communication and health literacy efforts are needed to rebuild public trust in the healthcare system.

Background High levels of vitamin D deficiency are commonly reported even in regions with abundant sunshine. This necessitates a comprehensive understanding of the determinants that influence sun exposure practices. As the primary source of health-related knowledge for the general public, the attitude of the healthcare professionals towards sunlight and their awareness related to vitamin D deficiency can be critical in this regard. Methods A cross-sectional survey was conducted among 2,242 physicians, intern doctors, and senior medical students in Bangladesh from October 2019 to February 2020. A pre-tested structured questionnaire (containing twelve close-ended questions) was used. The perceptions of health risks due to sun exposure, and basic knowledge of the physiological and epidemiological aspects of vitamin D deficiency were tested. Results An overall negative attitude towards sunlight in the context of Bangladesh was highlighted – 68% participants thought regular sun exposure would be harmful or very harmful; 26% thought the level of UV radiation was very high; 44% recommended using sunscreen always; skin burns, heat stroke, and cancer were selected as potential consequences of regular sun exposure by 45%, 21%, and 30% respondents respectively. Overall knowledge regarding vitamin D deficiency appeared to be biased towards bone health; other symptoms and associated illnesses not having obvious link to Calcium-metabolism were identified much lesser frequently. Furthermore, ‘sunrise to 10 am’ was identified as the best time to get vitamin D by 69% participants; 60% believed < 30 min of weekly sun exposure would be sufficient for the Bangladeshi population; an only 33% identified that prevalence of vitamin D insufficiency in Bangladesh would be 50% or more. Taking vitamin D-rich food was suggested by more respondents over regular sun exposure (43% vs. 33%) as more effective remedial strategy to curb vitamin D deficiency in Bangladesh. Conclusion In addition to highlighting some crucial knowledge gaps, results from this study provides a comprehensive baseline dataset for knowledge and attitude regarding the public health aspects of vitamin D deficiency among the healthcare providers in Bangladesh, which would be generalizable to other countries with similar socio-demographic context, and will facilitate taking more effective policies worldwide.