Bangladesh Institute of Child Health

Background: Reducing perinatal deaths is a priority, but data on maternal infectious causes are sparse in low- and middle-income countries where the burden is highest. We aimed to describe maternal infections at delivery and their association with perinatal death in Kilifi County Hospital (KCH), Kenya and Hiwot Fana Comprehensive Specialised Hospital (HFCSH), Ethiopia. Methods: We investigated 642 mothers delivering stillbirths/newborns dying in the first 24h after birth (cases) and 855 mothers with newborns surviving >24h (controls), from well-characterised pregnancy cohorts in a nested case-control design in KCH (2011-17) retrospectively and HFCSH (2019-20) prospectively. We tested maternal blood for infection at delivery using molecular methods with 60 PCR targets (TaqMan Array Cards, TAC). In HFCSH, vagino-rectal swabs (VRS) and oropharyngeal swabs (OPS) were also tested, with 28 and 42 PCR targets respectively, along with conventional microbiological testing. We tested associations between maternal infection and perinatal death for each site, separately, and combined, and adjusted for potential confounders. We did a sensitivity analysis using only controls with good pregnancy outcomes in KCH. Where appropriate, we calculated the population attributable fraction (PAF). Results: In HFCSH, maternal bacteraemia was associated with perinatal death (adjusted odds ratio aOR3.7 [1.5-9.2]). In KCH, bacterial detection in maternal blood was associated with perinatal death (aOR2.7 [1.2-6.0]), but only in sensitivity analysis. Escherichia coli/Shigella was associated with perinatal death when cultured/detected in blood (aOR2.6 [1.1-6.3]) across sites. Though infrequent, Bordetella sp. was associated with perinatal death (OR4.9[1.1- 23.0]) on OPS in HFCSH. No other individual infections were associated with perinatal death. The PAF for perinatal deaths among hospital deliveries was 6.1% (4.0%-8.2%) for maternal bacteraemia in HFCSH and 4.9% (2.6%-7.2%) for bacterial detection in KCH. Conclusions: Maternal bacterial infection is associated with perinatal death in high-burden settings, and in our study accounted for around 5% of perinatal deaths in hospital deliveries. The study was underpowered to detect species-specific infections associated with perinatal death. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Wellcome (205184) through a fellowship to ACS. JAGS was funded by Wellcome (214320). The funder had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the London School of Hygiene & Tropical Medicine, London, UK (14381); Kenya Medical Research Institute (KEMRI/SERU/CGMR-C/089/3479); Institutional Health Research Ethics Review Committee (IHRERC) College of Health and Medical Sciences, Harar Campus, Haramaya University (IHRERC/143/2017); Armauer Hansen Research Institute (AHRI/ALERT Ethics Review Committee (AAERC Protocol No. PO33/17)) and the Ethiopian Ministry of Science and Technology (310/298/2017). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data available on reasonable request and with institutional and ethical approvals.

Osteoarthritis (OA) is a common degenerative condition primarily affecting the knee joint. OA is defined as the gradual degradation of the cartilage in the joints, accompanied by changes in the bone underlying the cartilage, the synovial fluid, the ligaments and the muscles around the affected area. Common manifestations of OA include sensations of pain, stiffness and decreased physical movement. The estimated worldwide incidence of OA is 16.0%. The treatment known as mobilisation with movement (MWM) reduces pain and restores a full range of motion in the affected joint. This study will be a randomised, single-blind controlled trial. 50 adult patients diagnosed with knee OA will be recruited. Participants will be randomly assigned to receive either MWM or conventional physiotherapy treatment. Outcome measures will include the Numerical Pain Rating Scale for assessing pain intensity, a goniometer for measuring joint range of motion, and the Western Ontario and McMaster Universities Osteoarthritis Index for evaluating functional status. Assessments will be conducted at baseline (pretest) and after the intervention (post-test). The Institutional Review Board of the Bangladesh Health Professions Institute has approved the study. Every participant will give their informed consent, and only authorised people will have access to the anonymised data. The study results will be presented at conferences and in peer-reviewed journals. Trial registration number: CTRI/2025/05/086343.

BackgroundRising antimicrobial resistance (AMR) in Salmonella Typhi restricts typhoid treatment options, heightening concerns for pan-oral drug-resistant outbreaks. However, lack of long-term temporal surveillance data on AMR in countries with high burden like Bangladesh is scarce. Our study explores the AMR trends of Salmonella Typhi isolates from Bangladesh, drawing comparisons with antibiotic consumption to optimize antibiotic stewardship strategies for the country.Methodology/principal findingsThe typhoid fever surveillance from 1999 to 2022 included two pediatric hospitals and three private clinics in Dhaka, Bangladesh. Blood cultures were performed at treating physicians' discretion; cases were confirmed by microbiological, serological, and biochemical tests. Antibiotic susceptibility was determined following CLSI guidelines. National antibiotic consumption data for cotrimoxazole, ciprofloxacin, and azithromycin was obtained from IQVIA-MIDAS database for comparison. Over the 24 years of surveillance, we recorded 12,435 culture-confirmed typhoid cases and observed declining resistance to first-line drugs (amoxicillin, chloramphenicol, and cotrimoxazole); multidrug resistance (MDR) decreased from 38% in 1999 to 17% in 2022. Cotrimoxazole consumption dropped from 0.8 to 0.1 Daily defined doses (DDD)/1000/day (1999-2020). Ciprofloxacin non-susceptibility persisted at >90% with unchanged consumption (1.1-1.3 DDD/1000/day, 2002-2020). Low ceftriaxone resistance (<1%) was observed, with slightly rising MIC (0.03 to 0.12 mg/L, 1999-2019). Azithromycin consumption increased (0.1 to 3.8 DDD/1000/day, 1999-2020), but resistance remained ≤4%.ConclusionOur study highlights declining MDR amongst Salmonella Typhi in Bangladesh; first-line antimicrobials could be reintroduced as empirical treatment options for typhoid fever if MDR rates further drops below 5%. The analysis also provides baseline data for monitoring the impact of future interventions like typhoid conjugate vaccines on typhoid burden and associated AMR.

DesignProspective, cross-sectional study.ObjectivesTo determine the functional outcome and home and social integration of people who had spinal cord injury and completed their inpatient rehabilitation.SettingCentre for the Rehabilitation of the Paralysed (CRP), Bangladesh.MethodsSpinal Cord Independence Measure (SCIM) and Community Integration Questionnaire (CIQ) were used to analyse the relationship between the functional outcome and home and social integration at the end of rehabilitation. Descriptive and inferential statistics were performed to analyse the data.ResultsA total of two hundred participants (181 men and 19 women) were recruited for the study. Among the participants, 92.5% of them reported a history of trauma or accident, including road traffic accidents, falls and other injuries. Approximately 60% of participants presented with paraplegia and 62.5% of participants were categorized on the ASIA Impairment Scale (AIS) as Grade A, complete spinal cord injury. Participants with paraplegia and participants with a Grade B, incomplete injury, on the AIS were functionally more independent (p = 0.011)) compared with participants with tetraplegia and other AIS grades. Participants with paraplegia reported having a more active lifestyle (p = 0.040) in their home and social activities compared to those with tetraplegia. There was no significant association found between functional independence at pre-discharged and community integration one-month post-discharge of the people with SCI.ConclusionA month after discharge, there is no statistically significant relationship between community reintegration and functional independence. A measure of functional independence may not be a suitable indicator of community integration. It is proposed that to monitor a person's community integration the CIQ could be used with a measure of quality of life as this would indicate a person's contentment with their level of community integration.

This scoping review aimed to map the breadth of available literature, and to understand the barriers and facilitators of return to study and education participation for students with SCI. The authors performed electronic searches of six databases for peer-reviewed articles published in English between January 1990 and March 2021. Key search terms included: spinal cord injury, students, education participation, academic reintegration, and school re-entry. Data charting was used to summarise the study characteristics. Eleven articles addressed the return to study and education participation of students with SCI. These studies used qualitative and quantitative methods and involved participants aged between 10 and 42 years. The findings addressed five main areas: importance of education, participation and performance in education, the physical environment, support network, and strategies for integration. This review shows that there is limited evidence available on this topic, mostly from small scale studies with variable quality. More research is needed to understand how best to support the educational participation and success of students with SCI. Policies targeted to mitigating barriers, including inaccessible environments and curricula, adequate information and supports, are also needed to better facilitate return to study and education participation of students with SCI.