Discontinuation of mental health care is a persistent global challenge, with up to one-third of patients dropping out before treatment completion. Evidence on discontinuation from facility-based tele-mental health services in low- and middle-income countries remains limited. This study explores why patients disengage from facility-based tele-mental health services delivered through Wellbeing Centres in Bangladesh. A qualitative study was conducted between October 2024 and February 2025 using mobile phone interviews. Participants were service recipients who had discontinued follow-up services provided by the Wellbeing Centres. A total of 26 interviews were conducted, and the data were analyzed thematically. Discontinuation was shaped by dynamic and sometimes contradictory patient experiences. First, perceptions of treatment outcomes influenced disengagement in complex ways: both perceived improvement and perceived lack of benefit led to discontinuation, reflecting shifting expectations of care. Second, everyday constraints—including fluctuations in mental wellbeing, competing life demands, distance from facilities, and communication gaps with providers—disrupted continuity of care. Third, family dynamics played a critical role, with limited support and motivation reducing sustained engagement with services. Discontinuation from facility-based tele-mental health services is not solely driven by access barriers but emerges from the interaction between perceived recovery, unmet expectations, and socio-cultural influences, particularly family involvement. Interventions should move beyond access-focused models to incorporate continuous patient engagement, clearer communication of treatment pathways, and active involvement of family members. These findings have implications for the design and scale-up of facility-based tele-mental health services in low- and middle- income countries (LMICs).

BACKGROUND:Snakebite is a neglected tropical disease with significant public health implications, especially in rural Bangladesh. Studies to identify an effective community-based intervention to address this underappreciated problem are scarce. This study evaluates the effectiveness of community engagement and enhanced health literacy for snakebite prevention and increased appropriate first aid practices utilizing existing health care system in rural communities of Bangladesh. METHODOLOGY AND PRINCIPAL FINDING:This quasi experimental study was conducted in two rural sub-districts of Bangladesh. Educational sessions, visual aids, and culturally tailored community engagement activities were implemented in intervention area. Baseline and endline surveys were conducted to evaluate the effectiveness of the intervention in terms of outcome on preventive measures, first aid knowledge, and practices by the community people. In the intervention area, preventive knowledge improved modestly from 9.2% to 12% (OR: 1.38, 95% CI: 1.09-1.74), and first aid knowledge rose from 50% to 73% (OR: 2.62, 95% CI: 2.25-3.06). Positive practices increased significantly from 18% to 22% (OR: 1.24, 95% CI: 1.04-1.49). The incidence rate of snakebite increased by 10.6% in the control area while it dropped by 43.4% in the intervention area (from 294.4 to 166.5 per 100,000). CONCLUSION:The incidence of snakebite was significantly decreased by community-based initiatives that improved the knowledge and practice of community people. Tailored education, community engagement, and culturally sensitive strategies were key to success. However, gaps in sustaining positive practices highlight the need for ongoing support. These findings provide a replicable model for addressing snakebite challenges in resource-limited settings.

Burkholderia pseudomallei (BP), the causative agent of melioidosis, is a major cause of sepsis in Southeast Asia, especially in people with diabetes mellitus (DM). The role of Mucosal-associated invariant T (MAIT) cells; innate-like T cells important for antibacterial immunity; in melioidosis is unknown. We measured MAIT cell activation by BP in vitro using co-culture assays with THP-1 cells, and evaluated MAIT cell frequency, activation, and function ex vivo in an observational cohort (n = 120) of melioidosis patients and endemic controls with and without DM in Thailand. We show that BP induces IFN-γ secretion by MAIT cells in a cytokine dependent manner. In acute melioidosis, circulating MAIT cells, particularly the double-negative (DN) subset, were significantly reduced, and highly activated but dysfunctional, with reduced IFN-γ responses to BP and E. coli which were restored upon recovery. Among acute patients, non-survivors showed lower granzyme B and IFN-γ expression. Acute melioidosis patients with DM co-morbidity exhibited reduced DN MAIT cell frequency and responses to E. coli compared to non-DM patients. Overall, the frequency and function of MAIT cells is impaired during acute melioidosis, especially in patients with DM, indicating a key role for these cells in antibacterial defence and disease susceptibility.

Integrating pharmacogenetic studies into clinical trials enhances personalized medicine by identifying genetic variations that influence drug efficacy and safety. Eltrombopag, a thrombopoietin receptor agonist, has shown efficacy in treating thrombocytopenia associated with various conditions, including dengue fever, though variability in patient response remains poorly understood. This study investigates the impact of genetic variants in the thrombopoietin receptor (TPOR) and GATA1 transcription factor on eltrombopag response in dengue-induced thrombocytopenia. Exonic and flanking region variants of TPOR and GATA1 were analyzed by Sanger sequencing in patients enrolled in a phase-II trial of eltrombopag. Univariate and multivariate logistic regression analyses were performed to assess associations between genetic variants and drug response. The TPOR variant Ch1:43804387T > G (S129R) was linked to slower natural recovery in the control group, with significantly lower platelet counts from day 3 onwards (p < 0.05) in heterozygous carriers, while eltrombopag treatment restored recovery to wild-type levels. Additionally, double mutants of Ch1:43804387T > G and Ch1:43804421 C > A (intronic) showed a compounded disadvantage in natural recovery, which was mitigated by eltrombopag. Patients heterozygous for Ch1:43803796G > A (E36K) exhibited significantly reduced treatment efficacy, with lower platelet counts from day 2 onwards (p < 0.05). In contrast to TPOR variants, the GATA1 variants ChX:48792009G > A (S129N) was associated with significantly faster natural platelet recovery in the control group (p < 0.05). However, logistic regression analysis did not identify any specific variant as a statistically significant independent predictor of binary treatment response (Responder vs. Non-responder at Day 7). The study suggests TPOR variants as potential biomarkers for predicting eltrombopag response, while GATA1 variants may influence natural recovery dynamics in dengue-induced thrombocytopenia. These findings contribute to patient stratification and optimized therapeutic strategies. Further research combining pharmacogenetic and pharmacokinetic factors is essential for fully understanding eltrombopag response variability and advancing personalized treatment approaches.

Background:Identifying core mental health symptoms is crucial for precision-targeted interventions, especially in resource-limited settings. However, symptom structures among individuals actively seeking telemental healthcare remain underexplored in Bangladesh and similar contexts. This study aimed to map symptom severity, factor structures, and interrelationships between depressive and anxiety symptoms to inform precision-driven mental healthcare approaches. Methods:We conducted an observational study among 4,900 patients who attended a health facility-based telemental healthcare in Bangladesh from January 2023 to July 2024. We assessed depression using PHQ-9 and anxiety using GAD-7 and applied exploratory factor analysis and network analysis. Results:Overall, 84% (95% CI: 83-86) screened positive for depressive symptoms, 85% (95% CI: 83-86) screened positive for anxiety symptoms, and 77% (95% CI: 76-78) presented co-occurring symptoms. Commonly reported symptoms included fatigue (57%), anhedonia (42%), sleep disturbance (42%), nervousness (70%), and uncontrollable worrying (66%). Factor analysis revealed "depressed mood" (λ = 0.58) and "anhedonia" (λ = 0.51) as core depressive features, and "uncontrollable worry" (λ = 0.68) and "nervousness" (λ = 0.61) as core anxiety features. Network analysis revealed strong associations between "anhedonia" and "depressed mood" in depression and "trouble relaxing" and "restlessness" in anxiety. "Uncontrollable worrying" showed the highest centrality, and "sleep disturbance" and "trouble relaxing" served as important bridge symptoms linking depression and anxiety domains. Conclusions:Depressive and anxiety symptoms in people seeking telemental healthcare cluster around a small number of key and connecting symptoms, rather than contributing equally to overall distress. Precision mental healthcare in resource-limited settings can use this structure to direct limited time and resources toward the symptoms that matter most. Protocol Registration: Institutional Review Board (IRB) of https://www.icddrb.org/. Protocol number: PR-22103.

Abstract not available J Bangladesh Coll Phys Surg 2025; 43: 239-242

Background: Brain death is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of brain oxygenation. In medical practice, common causes of death include stroke, acute myocardial infraction, heart failure, septicemia, COPD with respiratory failure, poisoning etc. Vital statistics outlining the major causes of death in a population are an important measure of public health. Objective: The aim of this study was to identify the causes of death from acute emergency and in chronic medical diseases with their demographic profiles. Methodology: It was a hospital based observational study, and the study period was 3 months (July, 2010 to September, 2010). The patients who died after admission in medicine ward of Dhaka Medical College Hospital were enrolled. The death certificate was collected from the office copy and the ICD code-based certificate writing was noted. The underlying cause of death, immediate cause of death and contributory cause of death was observed to understand the exact etiology of death in Medicine department. Results: The study group consisted of 100 subjects of whom 56 were male and 44 were female. Male: female ratio was 1.27:1. The age range was 18-90 years. Mean age was 49.34 for male and 42.94 for female. Death occurred in 45% cases within 24 hours, 49% cases from 1 to 7 days, 6% after 7 days. The major cause of death was stroke (26%) followed by poisoning (14%). Conclusion: The death audit revealed that the majority cases of death in medicine happen due to cerebrovascular accident and poisoning. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):28-33

Anxiety and depression are significant concerns among antenatal women in Bangladesh. Despite the critical need for tailored mental health care in health facilities, studies on these symptoms in this demographic remain lacking. Therefore, our study aimed to assess the levels, distribution, and associated factors of depressive and anxiety symptoms and their co-occurrence among women seeking antenatal care at a public healthcare facility in Bangladesh. We conducted a cross-sectional study between May 2024, and June 2024, among women seeking antenatal care (ANC) care in Durgapur Upazila Health Complex, a primary-level public health facility in Bangladesh. Among 640 women who received ANC care, 638 participated in the study. Depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9), and anxiety symptoms were assessed by the Generalized Anxiety Disorder-7 (GAD-7). Bivariate and multivariable logistic regression were conducted to determine factors contributing to depressive and anxiety symptoms. About 39% of participants had depressive symptoms and 50% had anxiety symptoms, with 26% experiencing both simultaneously. No participants had severe overall depressive or anxiety symptoms. PHQ-9 data indicated half experienced daily fatigue, while GAD-7 data showed over half experienced daily nervousness and two-fifths had daily fears. Women in the second and third trimesters had 43% (aOR: 0.57, 95% CI: 0.36-0.89) and 58% (aOR: 0.42, 95% CI: 0.24-0.71) lower odds of depressive symptoms compared to those in the first trimester respectively. Women with 11 years or more education had 40% (aOR: 0.60, 95% CI: 0.38-0.94) lower odds of anxiety. Additionally, women in the second and third trimesters had 40% (aOR: 0.60, 95% CI: 0.37-0.97) and 49% (aOR: 0.59, 95% CI: 0.29-0.91) lower likelihood of co-occurrence compared to those in the first trimester and women with 6-10 years of education had 48% (aOR: 0.52, 95% CI: 0.34-0.79) and those with 11 or more years had 52% (aOR: 0.48, 95% CI: 0.29-0.81) lower likelihood of co-occurring depressive and anxiety symptoms compared to women with 5 years or less education. Our study found a high prevalence of depressive and anxiety symptoms among antenatal care seekers, with notable co-occurrence of these conditions. Given these findings, there is an urgent need for targeted mental health support for these women, especially those in their first trimester and those with limited education.

Background Snakebite poses a significant public health concern in Bangladesh, also globally. Annually, approximately 450,000 individuals in Bangladesh fall victim to snakebites, resulting in around 7,500 fatalities due to envenomation. Recognizing its widespread impact, WHO identifies snakebite as a highly neglected tropical disease, urging member states to urgently address this issue. They call for decisive actions to alleviate the suffering of millions, aiming to cut snakebite fatalities by 50% before 2030. WHO has stressed the necessity of utilizing antivenoms tailored to the venoms of the specific snake species responsible for the envenomation. Bangladesh employs antivenoms produced against Indian snake species, which is scientifically suboptimal for neutralizing the venoms of local snakes. Description In response to this issue, the 'Venom Research Centre, Bangladesh' was established in 2018 as a project of Non-Communicable Disease Control program under the Directorate General of Health Services of the Ministry of Health and Family Welfare, Government of Bangladesh. Objectives The immediate objective was to collect specimens of and venom from medically important snakes across the country. Long-term goals involve obtaining standard, representative venom samples, standardizing them, conducting venomic and proteomic studies, and developing effective and affordable antivenoms. Outcomes and Learnings The centre has collected and reared up snakes from diverse geo-locations of Bangladesh, representing Cobras, Kraits, and Vipers. To rear these snakes, a self-sufficient mice-breeding facility was developed. Milking from these snakes has been accomplished, paving the way for venomic and anti-venomic studies. The centre is poised to evaluate the efficacy of existing antivenoms and embark on the scientific development of antibodies in goats and chickens for testing against local venoms. This marks the initial steps towards producing a representative batch of a locally tailored antivenom. Implications Beyond addressing immediate health concerns, it also offers a unique platform for veterinary physicians to systematically research snakes and their diseases. It serves as a central hub for academic research and educational excursions, catering to students studying life sciences at various educational levels. Conclusions The centre act as an unparalleled and flagship initiative for the country to tackle a critical public health issue like snakebite through a scientific research.

Background: Dyspnea is the most common symptom associated with the COVID-19 caused by novel coronavirus SARS-CoV-2. The aim of this study was to assess the prevalence of dyspnea, observe co-variables, and find predictors of dyspnea after two months of recovery from COVID-19. Methods: This study was conducted in 327 patients and they were asked if they had experienced dyspnea with the COVID-19. Patients’ responses about dyspnea were categorized as being improved, remained the same, or (worsened) two months post-COVID-19. Software “R” was used in this study for statistical computing. The p-value was set <0.05 for all statistical tests. A repeated k-fold cross-validation was used for measuring the accuracy of logistic regression. Results: Of the total 327 participants in the study, 34% had stated that they were suffering from respiratory symptoms even after two months of COVID-19. The study demonstrated that SpO2 (p value <0.03), D-dimer (p value <0.001), serum ferritin (p value <0.006) and the presence of dyspnea are significantly correlated. The repeated k-fold cross-validation method revealed that the prediction performance was around 65%. Conclusion: These findings can be useful for the physicians treating COVID-19 patients after discharge from hospital.

Background: Considering the health literacy status of service seekers is crucial while developing programs and policies to improve service delivery in primary health care settings. Objective: Our aim was to assess health literacy among adults seeking non-communicable disease (NCD)-related services in primary health care centers (PHC) of Bangladesh and identify its contributing factors and its preventive effect on risky behaviors. Methods: In this cross-sectional study, 2,793 NCD service seekers were interviewed face-to-face from eight rural and three urban PHCs selected by a multi-stage random sampling method. We used the European Health Literacy Survey Questionnaire to collect data on health literacy. We applied logistic regression analysis to identify the contributing factors related to adequate health literacy. Odds ratios were used to calculate the preventive fraction of health literacy for NCD risk behaviors. Key Results: Limited health literacy was found among 43% of the respondents. Adequate health literacy was associated with younger age, male sex, having a formal education, living in an extended family, hailing from a high socioeconomic group, and attending urban PHC. After adjusting the sociodemographic factors, the prevalence of smoking, smokeless tobacco usage, and inadequate fruits and vegetables consumption among participants were found to be 25%, 51%, and 18% lower for people with sufficient health literacy. Conclusions: NCD service seekers have a high rate of inadequate health literacy. Adequate health literacy has the potential to lower the behavioral risk factors of NCDs. [HLRP: Health Literacy Research and Practice. 2024;8(1):e12–e20.]

Background: A limited number of studies have exclusively assessed fatigue among post-COVID patients. Our study aimed to assess the persistence and associations of fatigue among COVID-19 survivors after two months of recovery from their primary illness. Method: During hospital admission from August to September, 2020, a total of 373 patients were diagnosed to be suffering from fatigue using Chalder fatigue scale. After obtaining informed written consent, patients were followed up two months later over telephone. A total of 332 participants participated in the interview (36 patients could not be traced and another 5 patient died within two months). Patients were asked to categorize their present fatigue condition based on a simplified questionnaire developed for telephone interview. Result: Among study participants, 62.9% (n=207) were found to be still suffering from fatigue two months after their hospital discharge. A significant association of fatigue was found with age (p=0.000), hypertension (RR: 1.51; CI: 1.15-1.99; p=0.002), diabetes mellitus (RR: 1.45; CI: 1.08-1.95; p=0.010), ischemic heart disease (RR: 2.04; CI: 1.15-3.64; p=0.011), on admission SpO2 (p=0.000), on admission serum ferritin (p=0.000), d-dimer (p=0.000), CRP (p=0.000), and Hb% (p=0.019). Binary logistic regression model revealed significant association of age and on-admission SpO2 with persistence of fatigue. Conclusion: Fatigue is a highly prevalent symptom among the COVID-19 survivors with significant association between fatigue and patients clinical and laboratory markers.

The first two cases of Russell’s viper bite (RV)presented in contemporary period from Chapainwabgonj and Patuakhali districts of Bangladesh in 2013. The unfortunate death of both the cases indicates the severity it can produce and difficulties in its management in resource limited settings. Treatment seeking from traditional healer, sub-district hospital could not provide first dose of AV before referral and delayed arrival to hospital are concerned to be addressed to prevent death from bite by RV in future. Basic preventive measures such as careful while working and walking in the field and unnecessary handling of snake could avoid bite in both the cases. Bangladesh. Bangladesh J Medicine 2024; 35: 204-210

Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. The management recommendations for patients with rheumatoid arthritis (RA) is the first initiative in Bangladesh by the Bangladesh Rheumatology Society (BRS) and an updated contribution following a paradigm shift in the management of RA. These recommendations encompass the most crucial elements in treating rheumatoid arthritis, particularly in a country where infection, including tuberculosis, is prevalent, but the resources are limited. BRS established a task force (TF) consisting of four rheumatologists. The task group conducted a comprehensive search for all relevant literature, including the latest ACR, EULAR, APLAR, and other guidelines and systematic literature reviews up until October 2023. A steering committee was established, comprising rheumatologists and internists. We adhered to the EULAR standard operating procedures for classifying levels of evidence and assigning grades to recommendations. This recommendation consists of two components: a general section that includes the diagnosis of rheumatoid arthritis, the nomenclature of disease-modifying antirheumatic drugs (DMARDs), and disease activity indexes; and a therapy section. The task team reached a consensus on four fundamental principles and twelve recommendations. Overarching themes encompass the identification of diseases at an early stage and the ongoing monitoring of disease activity. Recommendations 1-5 propose the utilization of glucocorticoids, NSAIDs, and conventional synthetic DMARDs (csDMARD) as treatment options. Recommendations 6-9 expand the utilization of targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) and biological diseasemodifying antirheumatic drugs (bDMARDs). The recommended treatment for rheumatoid arthritis involves starting with methotrexate (MTX) or another conventional synthetic disease-modifying antirheumatic drug (csDMARD) if MTX is not suitable. This is done in the initial phase. A targeted synthetic DMARD (tsDMARD) is added in the second phase. In later phases, moving to a different tsDMARD or a biologic DMARD (bDMARD) may be necessary. Recommendations 10-12 pertain to the screening of infections, administration of vaccines, and the gradual reduction of disease-modifying antirheumatic drugs (DMARDs). Due to the cost-benefit analysis, BRS has suggested using targeted synthetic disease-modifying antirheumatic medicines (tsDMARDs) in the second phase and biologics in the third phase. The use of the Padua Prediction Score is advised to evaluate the likelihood of vascular thromboembolism in persons who are taking or undergoing dose escalation of tsDMARDs. Bangladesh has a higher prevalence of RA. This recommendation will serve as a tool to treat this high burden of patients with RA scientifically and more effectively. Bangladesh J Medicine 2024; Vol. 35, No. 2, Supplementation: 153

Background Although caregiving is considered a normal phenomenon for parents, delivering care to a child with neurodevelopmental disabilities can be taxing and disastrously impact parents' quality of life (QoL). This study explored the relationship between QoL, coping strategies, and psychosocial support status of caregivers of children with neurodevelopmental disabilities. Methodology This cross-sectional study included 906 caregivers of children having neurodevelopmental disabilities utilizing the World Health Organization Quality of Life Brief and Perceived Stress Scale. A tailored questionnaire gauged coping strategies and psychosocial support. Linear regression was used to identify significant contributors. Results Most caregivers (78.8%) experienced a moderate level of stress, and their QoL scores were 14.4 (SD = 2.5) for physical health, 12.0 (SD = 2.4) for psychological health, 14.6 (SD = 1.9) for social relationships, and 12.1 (SD = 2.1) for the environment. Mothers had the lowest QoL of all caregivers. Negative influences on QoL encompassed caregiver and child age, perceived stress, and lower socioeconomic status. A higher coping score positively predicted a high health-related QoL score. Gender differences were observed in psychosocial support sources. Conclusions The study underscores the need for policymaking considering findings to develop psychosocial intervention programs for enhancing the QoL of caregivers of children with neurodevelopmental disabilities.

Context:The COVID-19 epidemic has had a substantial influence on the mental health of chronic disease patients. However, there is a scarcity of research on them in Bangladesh. Aims:This study aims to explore the prevalence of and identify the risk factors for depression, anxiety, and stress symptoms during the COVID-19 pandemic among people with chronic diseases in Bangladesh. Materials and Methods:This cross-sectional study involving face-to-face and telephone interviews was carried out among Bangladeshi people diagnosed with chronic diseases between September and November 2020. The total sample size was 878, and a convenient sampling technique was used. Logistic regression analysis was performed to investigate potential influencing factors for depression, anxiety, and stress. Results:The mean age of respondents was 50.10 years. Among them, 35.0%, 36.0%, and 29.0% suffered from depression, anxiety, and stress symptoms, respectively. In multivariable logistic regression, depression had a significant positive association with higher age (≥60 years), lower income, rural residency, and loss of close family members due to COVID-19. Anxiety had a significant positive association with higher age (≥40 years), lower education, lower income, rural residency, and loss of close family members due to COVID-19. Stress had a significant positive association with higher age (≥40 years), no income, rural residency, and loss of close family members due to COVID-19. Conclusion:It is urgent to consider the risk of developing mental health distress among chronic disease patients, especially aged people, by health service providers and generate effective programs for emergency situations.

Objective To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.Design A secondary analysis of a prospective multicountry study.Setting Three COVID-19-designated hospitals in Bangladesh.Participants Adult patients aged ≥18 years with PCR-positive COVID-19 admitted between 10 October 2020 and 31 July 2021 at participating hospitals.Outcome measures In-hospital cardiovascular events and mortality.Main exposures Pre-existing comorbidities and cardiovascular risk factors.Results In 897 COVID-19 patients, 18.7% developed cardiovascular events and 12.6% died. After adjusting for clinical information and treatment, patients with two comorbidities (excluding CVD risk factors) were significantly associated with cardiovascular events (adjusted (adj.) OR 2.47, 95% CI 1.24 to 4.90). Patients with a higher heart rate at admission (adj. OR 1.03, 95% CI 1.01 to 1.04) and those who were receiving intravenous fluids (adj. OR 2.13, 95% CI 1.23 to 3.70) or antibiotics (adj. OR 4.54, 95% CI 1.47 to 14.01) had significantly higher odds of cardiovascular events. The odds of cardiovascular events were lower in those receiving antiviral medications (adj. OR 0.31, 95% CI 0.18 to 0.53). There were no interactions between comorbidities and other covariates in the models. Comorbidities and cardiovascular risk factors were not significantly associated with 30-day mortality in the Cox regression models after adjusting with clinical information and treatment. The mortality within 30 days of admission was significantly higher in patients receiving corticosteroids (adj. HR 2.82, 95% CI 1.48 to 5.38) and lower in those receiving antiviral treatment (adj. HR 0.53, 95% CI 0.34 to 0.81). Those having cardiovascular events significantly increased mortality hazard.Conclusions Clinical factors and treatment affected in-hospital cardiovascular events, which subsequently increased the risk of mortality within 30 days for COVID-19 patients. COVID-19 patients regardless of CVD risk factors and comorbidities require close monitoring for cardiovascular events.

Abstract not available Bangladesh J Medicine 2024; 35: 129-132

Rheumatoid arthritis (RA) is the most common inflammatory polyarthritis in Bangladesh. Bangladesh Rheumatology Society (BRS) proposes these management recommendations to treat the considerable burden of RA in the resource -constrained situation based on the best current evidence combined with societal challenges and opportunities. BRS formed a task force (TF) comprising four rheumatologists. The TF searched for all available literature, including updated American College of Rheumatology (ACR), European Alliance of Associations for Rheumatology (EULAR), and Asia -Pacific League of Associations for Rheumatology (APLAR) and several other guidelines, and systematic literature reviews until October 2023, and then a steering committee was formed, which included rheumatologists and internists. We followed the EULAR standard operating procedures to categorize levels of evidence and grading of recommendations. This recommendation has two parts -- general (diagnosis of RA, nomenclature of disease -modifying antirheumatic drugs [DMARDs], disease activity indices) and management portion. The TF agreed on four overarching principles and 12 recommendations. Overarching principles deal with early diagnosis and disease activity monitoring. Recommendations 1-5 discuss using glucocorticoids, NSAIDs, and conventional synthetic DMARDs (csDMARD). Recommendations 6-9 stretch the use of targeted synthetic DMARDs (tsDMARDs) and biological DMARDs (bDMARDs). The suggested DMARD therapy includes initiation with methotrexate (MTX) or another csDMARD (in case of contraindication to MTX) in the first phase and the addition of a tsDMARD in the second phase, switching to an alternative tsDMARDs or bDMARDs in the subsequent phases. The TF included the Padua prediction score for the thromboembolism risk estimation. Recommendations 10-12 cover infection screening, vaccination, and DMARD tapering. Bangladesh has a higher prevalence of RA. This recommendation will serve as a tool to treat this high burden of patients with RA scientifically and more effectively.