Extreme, high indoor temperatures in urban slums of tropical regions pose significant health risks, particularly for vulnerable populations. This study investigates the influence of housing construction materials on indoor temperatures in Dhaka, Bangladesh, in the context of rising global temperatures. A longitudinal prospective survey was conducted between January and December 2022 in five urban slums of Dhaka, covering 44 dwellings purposively selected to ensure good spatial coverage and to reflect predominant construction materials. Temperature data loggers were placed unobtrusively to record hourly indoor temperatures. Housing construction materials, including cement, tin, or a combination of both, were examined. Negative binomial models were employed to analyze the impact of construction materials on hours per day exceeding 32 °C and 35 °C. Descriptive statistics showed wide temperature variations based on construction materials, with tin-tin dwellings exhibiting the widest temperature range (19.1 °C to 47.2 °C). Negative binomial models showed that houses with tin elements, especially those with both tin roofs and walls, experienced significantly more hours above 35 °C compared to cement-cement houses. Tin-tin dwellings had the greatest risk of extreme, high indoor temperatures. The study underscores the substantial influence of housing construction materials on indoor temperatures, with tin sheeting contributing to rapid temperature increases. This has critical implications, particularly for vulnerable populations, as mean temperatures continue to rise. Policies addressing building materials and climate resilience are essential to mitigate heat-related health risks in urban slums.

Background: Community-based palliative care (CBPC) shows promise for supporting patients with advanced noncommunicable diseases, yet implementation remains inconsistent. Most research focuses on organizational and provider perspectives, with limited understanding of patient and caregiver views on service acceptability and implementation. Objectives: To understand barriers and facilitators to implementing CBPC services from the perspectives of patients with advanced congestive heart failure, chronic obstructive pulmonary disease and end-stage renal failure, and their primary caregivers. Design: Qualitative study using focused open-ended interviews conducted over four-monthly intervals. Data were analysed using reflexive thematic analysis within a critical realist paradigm. Methods: Twenty-five patients (11 male, 14 female; 13 CHF, 8 ESRF, 4 COPD) and 9 caregivers (1 male, 9 female) were recruited from the Segamat district in Malaysia. Participants met inclusion criteria using the Supportive and Palliative Care Indicators Tool. One-on-one open-ended qualitative interviews using the reflexive thematic analysis approach explored experiences of living with advanced illness, perceived needs and perspectives on establishing CBPC services. Results: Four key themes emerged: “What they offer is not what we need” revealed skepticism towards new healthcare services based on negative past experiences; “Supportive relationships over support services” demonstrated preference for care from trusted community members rather than outsiders; “The myriad cares of family” highlighted the valued role of family caregivers in providing companionship and maintaining patient identity; and “How to care for us” identified unmet needs including transportation, financial support and social connection. Participants emphasized that trust-building through community engagement must precede service implementation. Conclusion: Successful CBPC implementation requires fundamental shifts from expert-driven service delivery towards relationship-centred, community-engaged approaches. Services must be co-developed with communities, prioritize trust-building and address social determinants of health alongside clinical needs. Traditional “build it and they will come” approaches are insufficient for achieving community acceptance and sustainable implementation.

I critique of the use of “epistemic injustice” and “decolonisation” in global health. Fricker’s ethico-epistemic notion of epistemic injustice, which focuses on harms to knowers rather than the truth of claims, struggles to apply in empirical fields where error can have material health consequences. In global health, the usage tends to conflate moral recognition with epistemic warrant. It encourages the levelling of credibility across competing claims irrespective of evidence. I trace how decolonial and pluriversal rhetoric—drawing on Quijano, Grosfoguel, Mignolo, and Lugones—extends this conflation into ontological pluralism, dissolving truth into perspective while retaining universalist health ambitions. Through cases of spirit children, umbilical cord care, and snakebite treatment, I show how these frameworks can licence harmful practices and obscure structural analyses of power independent of coloniality. I conclude by sketching a modest alternative: epistemic humility, realist standards of evidence, and procedural justice in access to the means of inquiry.

[This corrects the article DOI: 10.1371/journal.pone.0284005.].

Women in urban slums are particularly susceptible due to a lack of knowledge about sexual and reproductive health (SRH), and abortion is frequently performed. Our study investigates the level and predictors of SRH knowledge among the reproductive-aged women who have had abortions and lived in urban slums in Dhaka, Bangladesh. We adopted a cross-sectional survey among the reproductive-aged women who experienced any kind of abortion from July 2020 to January 2022 living in the UHDSS sites, applying a predefined interviewer-assisted survey questionnaire. Data were analyzed using descriptive statistics (i.e., mean, standard error, and 95

The United Nations announced a historic milestone in global child mortality in March 2024, with deaths among children less than 5 years falling below 5 million in 2022. While this news is welcome, the headline news is too definitive and masks uncertainties in the results. The UN’s projections rely heavily on modeled estimates based on historical data, with only 5

Abstract Background We aimed to identify specific multimorbidity latent classes among multi-ethnic community-dwelling adults aged ≥ 18 years in Malaysia. We further explored the risk factors associated with these patterns and examined the relationships between the multimorbidity patterns and 11-year all-cause mortality risk, as well as health-related quality of life (HRQoL). Methods Using data from 18,101 individuals (aged 18–97 years) from the baseline Census 2012, Health Round 2013, and Verbal Autopsies 2012–2023 of the South East Asia Community Observatory (SEACO) health and demographic surveillance system, latent class analysis was performed on 13 chronic health conditions to identify statistically and clinically meaningful groups. Multinomial logistic regression and Cox proportional hazards regression models were conducted to investigate the adjusted association of multimorbidity patterns with the risk factors and mortality, respectively. HRQoL was analyzed by linear contrasts in conjunction with ANCOVA adjusted for baseline confounders. Results Four distinct multimorbidity latent classes were identified: (1) relatively healthy (n = 10,640); (2) cardiometabolic diseases (n = 2428); (3) musculoskeletal, mobility and sensory disorders (n = 2391); and (4) complex multimorbidity (a group with more severe multimorbidity with combined profiles of classes 2 and 3) (n = 699). Significant variations in associations between socio-demographic characteristics and multimorbidity patterns were discovered, including age, sex, ethnicity, education level, marital status, household monthly income and employment status. The complex multimorbidity group had the lowest HRQoL across all domains compared to other groups (p < 0.001), including physical health, psychological, social relationships and environment. This group also exhibited the highest mortality risk over 11 years even after adjustment of confounders (age, sex, ethnicity, education and employment status), with a hazard of death of 1.83 (95% CI 1.44–2.33), followed by the cardiometabolic group (HR 1.42, 95% CI 1.18–1.70) and the musculoskeletal, mobility and sensory disorders group (HR 1.29, 95% CI 1.04–1.59). Conclusions Our study advances the understanding of the complexity of multimorbidity and its implications for health outcomes and healthcare delivery. The findings suggest the need for integrated healthcare approaches that account for the clusters of multiple conditions and prioritize the complex multimorbidity cohort. Further longitudinal studies are warranted to explore the underlying mechanisms and evolution of multimorbidity patterns.

Abstract Background This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City (NYC). Methods A retrospective ecological study was conducted assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and NYC Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in NYC. Population data were obtained from Census Bureau and NYC Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Results Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45–64 years in the wealthiest quintile). Conclusion A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower. Disclosures All Authors: No reported disclosures

This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.

Bangladesh is rapidly urbanizing and approximately half of its urban population resides in deprived slums with limited access to basic needs. However, there is a dearth of information on vulnerability levels among slum dwellers. We aimed to assess the level of vulnerability within and between slums via various socioeconomic and health indicators. A cross-sectional survey of 810 randomly selected households was conducted in two purposively selected slums, Korail and Shyampur, in Dhaka from November to December 2021. Data was collected on various indicators, including demographics, education, employment, access to utility, and healthcare services. Principal component factor analysis was employed to identify the key indicators to construct the socioeconomic and health vulnerability index for the urban slums of Bangladesh (SEHVI-BD). Kaiser-Meyer-Olkin, Bartlett’s test, and Cronbach’s alpha coefficient test were used to assess indicators’ suitability. The selected indicators were used to generate an index on a scale of 100, with a higher index value indicating a higher level of vulnerability. The estimated scores were used to categorize the vulnerability status into three levels: mild, moderate, and severe vulnerability. The Mann-Whitney-U test and Kruskal-Wallis test were applied between the generated index and other socioeconomic variables to validate the relationship. A total of 27 socioeconomic and health indicators were identified that explained 60

This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8

This cross-sectional study evaluated the validity of three alternative methods compared to the gold standard 24-h urine collection for estimating dietary sodium intake, a modifiable risk factor for hypertension, among middle-aged and older adults with elevated blood pressure. These included spot urine collection (using Kawasaki, Tanaka, and INTERSALT equations), 24-h dietary recall, and food frequency questionnaire responses, compared to 24-h urine collection in a subset of 65 participants (aged 50–75 years, 58.5% women, 61.6% hypertensive) from the DePEC-Nutrition trial. The validity of the methods was assessed using bias, the Spearman correlation coefficient (SCC), the intraclass correlation coefficient (ICC), and Bland–Altman analysis. Among the alternative methods, spot urine collection using the Kawasaki equation showed the strongest correlation (SCC 0.238; ICC 0.119, 95% CI −0.079 to 0.323), but it exhibited a significant bias (1414 mg/day, p-value < 0.001) relative to 24-h urine collection. Conversely, dietary surveys had a smaller bias but wider limits of agreement. These findings underscore the complexities of accurately estimating dietary sodium intake using spot urine collection or dietary surveys in this specific population, suggesting that a combination or the refinement of existing methodologies might improve accuracy. Further research with larger samples is necessary to develop more reliable methods for assessing sodium intake in this high-risk group.

BACKGROUND:Although under-five mortality has declined appreciably in Bangladesh over the last few decades, neonatal mortality still remains high. The objective of the study is to assess the level and determinants of preterm birth and the contribution of preterm birth to neonatal mortality. METHODS:Data for this study came from selected slums in and around Dhaka city, where; since 2015, icddr,b has been maintaining the Health and Demographic Surveillance System (HDSS). The HDSS data were collected by female Field Workers by visiting each household every three months; however, during the visit, data on the Last Menstrual Period (LMP) were also collected by asking each eligible woman to ascertain the date of conception. Gestational age was estimated in complete weeks by subtracting LMP from the date of the pregnancy outcome. In this study, 6,989 livebirths were recorded by HDSS during 2016-2018, and these births were followed for neonatal survival; both bivariate and multivariate analyses were performed. RESULTS:Out of total births, 21.7% were born preterm (before 37 weeks of gestation), and sub-categories were: 2.19% for very preterm (28 to 31 weeks), 3.81% for moderate preterm (32 to 33 weeks), and 15.71% for late preterm (34 to 36 weeks). The study revealed that preterm babies contributed to 39.6% of neonatal deaths; however, the probability of death was very high on the 1st day of birth (0.124 for very preterm, 0.048 for moderate preterm, 0.024 for late preterm, and 0.013 for term birth), and continued until the 3rd day. In the regression analysis, compared to the term neonates, the odds of neonatal mortality were 8.66 (CI: 5.63, 13.32, p<0.01), 4.13 (CI: 2.69, 6.34, p<0.01) and 1.48 (CI: 1.05, 2.08, p<0.05) respectively for very, moderate, and late preterm birth categories. The population attributable fraction for neonatal mortality was 23%, and sub-categories were 14% for very preterm, 10% for moderate preterm, and 6% for late preterm. CONCLUSIONS:Although urban slums are in proximity to many health facilities, a substantial proportion of preterm births contribute to neonatal deaths. So, pregnant women should be targeted, to ensure timely care during pregnancy, delivery, and post-partum periods to improve the survival of new-borns in general and preterm birth in particular.

Abstract Background To target public health obesity prevention, we need to predict who might become obese i.e. predictors of increasing Body Mass Index (BMI) or obesity incidence. Predictors of incidence may be distinct from more well-studied predictors of prevalence, therefore we explored parent, child and sociodemographic predictors of child/adolescent BMI z-score and obesity incidence over 5 years in Malaysia. Methods The South East Asia Community Observatory in Segamat, Malaysia, provided longitudinal data on children and their parents (n = 1767). Children were aged 6–14 years at baseline (2013-14) and followed up 5 years later. Linear multilevel models estimated associations with child BMI z-score at follow-up, adjusting for baseline BMI z-score and potential confounders. Predictors included parent cardiometabolic health (overweight/obesity, central obesity, hypertension, hyperglycaemia), and socio-demographics (ethnicity, employment, education). Logistic multilevel models explored predictors of obesity incidence. Results Higher baseline BMI z-score predicted higher follow-up BMI z-score both in childhood to late adolescence (0.60; 95% CI: 0.55, 0.65) and early to late adolescence (0.76; 95% CI: 0.70, 0.82). There was inconsistent evidence of association between child BMI z-score at follow-up with parent cardiometabolic risk factors independent of baseline child BMI z-score. For example, maternal obesity, but not overweight, predicted a higher BMI z-score in childhood to early adolescence (overweight: 0.16; 95% CI: -0.03, 0.36, obesity: 0.41; 95% CI: 0.20, 0.61), and paternal overweight, but not obesity, predicted a higher BMI z-score in early to late adolescence (overweight: 0.22; 95% CI: 0.01, 0.43, obesity: 0.16; 95% CI: -0.10, 0.41). Parental obesity consistently predicted five-year obesity incidence in early to late adolescence, but not childhood to early adolescence. An adolescent without obesity at baseline with parents with obesity, had 3–4 times greater odds of developing obesity during follow-up (incidence OR = 3.38 (95% CI: 1.14–9.98, mother) and OR = 4.37 (95% CI 1.34–14.27, father) respectively). Conclusions Having a higher BMI z-score at baseline was a stronger predictor of a higher BMI z-score at follow-up than any parental or sociodemographic factor. Targeting prevention efforts based on parent or sociodemographic factors is unwarranted but early childhood remains a key period for universal obesity prevention.

Objective The COVID-19 pandemic imposed unprecedented challenges to health systems globally. This study explored slum dwellers’ experience of receiving essential health services during the pandemic and the challenges faced by healthcare providers in urban areas of Bangladesh.Design The study followed a cross-sectional study design using qualitative methods.Setting The study was conducted in Dhaka and Gazipur City Corporations during November 2020–February 2021.Participants 17 key informant interviews were carried out with healthcare providers and policy-makers and 22 in-depth interviews were carried out with slum dwellers. Thematic analysis was performed.Results The study identified challenges to the provision of essential healthcare in selected areas of Dhaka and Gazipur City Corporations during the COVID-19 pandemic. The lack of information on the availability of functional healthcare facilities, fear of contracting COVID-19 and restrictions on movement and transportation, resulted in delays in seeking essential healthcare during a pandemic. Access to healthcare facilities was further hindered by various hospitals’ decision to refuse care to general patients without valid, negative COVID-19 test results. Healthcare providers identified patients’ tendency to hide COVID-19 symptoms as a barrier to providing healthcare services to general patients. Conversely, patients concealed their symptoms to avoid COVID-19 tests and gain access to required treatment. In addition, the reallocation of human resources for COVID-19 treatment disrupted the delivery of essential health services.Conclusion The pandemic affected the accessibility of the slum population to essential healthcare and disrupted health service delivery. The findings of the study have highlighted gaps in the health system during an emergency response period like COVID-19. The study will assist the government and other stakeholders in designing tailored interventions and allocating resources in a more efficient manner to ensure universal health coverage in the face of health emergencies.

The COVID-19 pandemic was a burden for our health system, and created opportunities for using teleconsultation as an alternative way of accessing expert medical advice. In Bangladesh, the use of tele consultation increased about 20-fold during the pandemic. This study aimed to assess the influence of service quality and user satisfaction on the intention to continue to use teleconsultation services among users of national teleconsultation services during the pandemic in Bangladesh. A cross-sectional survey was conducted in 2020 among users of national teleconsultation service - Shastho Batayon who availed the service for acute respiratory infection. A validated mHealth Service Quality model based on structural equation modelling (SEM) and Confirmatory Factor Analysis was used to analyse the data with SmartPLS 3.0. Among the 2097 study participants, the majority were male (78%), aged 18-39 years (68%), residents of urban areas (76%), had more than 10 years of schooling (64%), and were from middle income households (79%). From consumer perspective the quality of service platform (β=.946), service interaction (β=.974) and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=0.327, P<.001) and intention to use teleconsultation services (β= 0.102, P<.001). User satisfaction was positively associated with intention to use teleconsultation services (β= 0.311, P<.001). Our study findings showed that maintenance of the service quality is crucial for the user satisfaction and continuance of use of teleconsultation services; and that user satisfaction increased the continuance of use of teleconsultation services. Our findings are relevant for low income context where teleconsultation services are trying to address the gap in service delivery.

BACKGROUND:Globally, non-communicable diseases (NCDs) are increasingly the primary cause of mortality and morbidity among women. Like many developing countries, Bangladesh also faces a growing burden of NCDs. The "Multisectoral Action Plan for Prevention and Control of Non-communicable Diseases, 2018-2025" signifies Bangladesh's commitment to comprehensively combating the rising burden of NCDs. This study investigates the perceptions of those involved in developing the action plan and if/how a gender lens was incorporated into its implementation. METHODS:In-depth interviews were conducted with 25 key individuals involved in a high-level committee to develop and implement Bangladesh's multisectoral action plan to address the burden of NCDs. Data were collected between July and November 2021, and thematic analysis was conducted. RESULTS:The findings revealed that interviewees believed the multisectoral action plan adopted a population-wide approach without considering gender-specific needs. This study presents the explanations for this inattention under five themes: (1) A population-level approach to NCD prevention; (2) Understanding women's health beyond reproductive health; (3) Absence of gender-specific programs; (4) Lack of consideration of gender constraints on physical activity; and (5) Lack of collaborative efforts to address NCDs beyond the health ministry. CONCLUSION:In conclusion, governments in countries like Bangladesh can develop more effective strategies to reduce the disease burden of NCDs among women by recognizing and addressing the gendered nature of preventive health. This can be achieved by promoting gender-responsive research, programs, and policy initiatives that consider women's specific health concerns, ultimately leading to better health outcomes for all.

BackgroundThe global COVID-19 pandemic profoundly impacted nations worldwide, and Bangladesh was no exception. In response, the government of Bangladesh implemented community awareness initiatives aimed at containing the spread of the virus, aligned with international guidelines and recommendations. Despite these efforts, a lack of comprehensive community awareness programs played an essential role during the pandemic, not the preventive measures. A qualitative study employing framing theory was conducted to gain a deeper insight into how the social context influenced risk communication and community response throughout the COVID-19 pandemic in Bangladesh.MethodsThe study was conducted in four selected districts of Bangladesh from February to May 2022 using complementary data collection methods, including key informant interviews, in-depth interviews, and focus group discussions with purposely selected participants. Data were analyzed thematically by following six steps of the thematic analysis process. Codes were developed based on the data and summarized into themes and sub-themes grounded on the codes.ResultsThe findings indicate that the government of Bangladesh, along with development partners and non-government organizations, made a significant effort to raise awareness about COVID-19 in the community. However, there were certain limitations to this effort. These include a lack of social science and public health approaches to understanding the pandemic; inadequate coordination among the authorities for COVID-19 prevention and control; technological and geographical barriers for disseminating messages; the living conditions and lack of facilities; socio-cultural norms in understanding the COVID-19 health messages, and the gendered understanding of the messages. The findings also revealed that the awareness activities remained a one-way approach to inform the people and faced challenges to actively engage and create ownership of the community in the pandemic response.ConclusionThe study identified gaps in implementing risk communication and community engagement strategies in Bangladesh during the COVID-19 pandemic. Increasing focus on public health and prioritizing community ownership is essential to designing a more effective community awareness campaign. This approach will help ensure that health messages are communicated effectively and tailored to different communities’ needs.