Sojib Zaman | International Centre for Diarrhoeal Disease Research, Bangladesh (original) (raw)

Papers by Sojib Zaman

Rotavirus is the leading cause of diarroheal disease for the under five children in the developin... more Rotavirus is the leading cause of diarroheal disease for the under five children in the developing countries. Although many countries have implemented Rotavirus vaccine (RV) in their immunizationProgramme due to its proven efficacy, Bangladesh has not yet implemented it in Expanded Programme on Immunization (EPI) Schedule. There is substantial evidence that oral RV vaccine can be taken with pentavalent and oral polio vaccine in Bangladesh. If Bangladesh can introduce RV vaccine in routine EPI, it will improve the child survival in Bangladesh by averting the infant mortality due to diarrhoeal diseases.However, there are few challenges in administrative, logistical and financial issues regarding integration of rotavirus vaccines. Bangladesh has the potential to introduce RV vaccine into the EPI schedule.

Background: Bangladesh continues to be one of the top ten countries with the highest burden of ne... more Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal mortality. While, most of the neonatal deaths are preventable; health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges.

Objective: 1) to determine the level of knowledge among the recently delivered women (RDW) about newborn danger signs and 2) to distinguish the factors associated with ability of identifying the danger signs.

Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015. Seven key danger signs were identified, and responses were categorized accordingly. Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification.

Results: About 51% of RDW could identify one key danger sign. Knowledge on “fever’’ was the most commonly known danger sign (65%). Middle age (OR 1.67, 95% CI: 1.09 - 2.18), high education (OR 2.37, 95% CI: 1.46 - 2.77), increased parity (OR 1.91, 95% CI: 1.17 - 2.89), and previous hospital delivery (OR 1.79, 95% CI: 1.14 - 2.68) were found associated with the knowledge of the danger signs.

Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge. Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.

Fluorescence in situ hybridization (FISH) is a macromolecule recognition technique, which is cons... more Fluorescence in situ hybridization (FISH) is a macromolecule recognition technique, which is considered as a new advent in the field of cytology. Initially, it was developed as a physical mapping tool to delineate genes within chromosomes. The accuracy and versatility of FISH were subsequently capitalized upon in biological and medical research. This visually appealing technique provides an intermediate degree of resolution between DNA analysis and chromosomal investigations. FISH consists of a hybridizing DNA probe, which can be labeled directly or indirectly. In the case of direct labeling, fluorescent nucleotides are used, while indirect labeling is incorporated with reporter molecules that are subsequently detected by fluorescent antibodies or other affinity molecules. FISH is applied to detect genetic abnormalities that include different characteristic gene fusions or the presence of an abnormal number of chromosomes in a cell or loss of a chromosomal region or a whole chromosome. It is also applied in different research applications, such as gene mapping or the identification of novel oncogenes. This article reviews the concept of FISH, its application, and its advantages in medical science.

PLOS ONE, 2017

Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ fail... more Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled &amp;amp;amp;amp;amp;amp;amp;#39;Interrupting Pathways to Sepsis Initiative&amp;amp;amp;amp;amp;amp;amp;#39; (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite &amp;amp;amp;amp;amp;amp;amp;#39;Program Coaches&amp;amp;amp;amp;amp;amp;amp;#39;, facilitating triage and rapid transfer of patients through &amp;amp;amp;amp;amp;amp;amp;#39;Welcoming Persons&amp;amp;amp;amp;amp;amp;amp;#39; and enabling rapid treatment through &amp;amp;amp;amp;amp;amp;amp;#39;Task Shifting&amp;amp;amp;amp;amp;amp;amp;#39; from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30%) were referred to higher level facilities than post-neonates (6%) (p&amp;amp;amp;amp;amp;amp;amp;lt;0.05). Immediately after admission, around 99% were assessed for hypoxemia, hypoglycaemia and hypothermia. Around 21% were hypoxemic (neonate-37%, post-neonate-18%, p&amp;amp;amp;amp;amp;amp;amp;lt;0.05), among which 94% received immediate oxygenation. Vascular access was established in 78% cases and 85% received recommended broad spectrum antibiotics parenterally within 1 hour of admission. There was significant improvement in the rate of establishing vascular access and choice of recommended first line parenteral antibiotic over time. After arrival in the emergency department, the median time taken for identification of syndromic sepsis and completion of admission procedure was 6 minutes. The median time taken for completion of assessment for complications was 15 minutes and administration of first dose of broad spectrum antibiotics was 35 minutes. There were only 3 inpatient deaths during the reporting period. Needs based health systems strengthening, supportive-supervision and task shifting can improve the quality and timeliness of in-patient management of syndromic sepsis in resource limited settings.

Introduction: Gradual total health expenditure (THE) has become a major concern. It is not only t... more Introduction: Gradual total health expenditure (THE) has become a major concern. It is not only the increased THE, but also its unequal growth in overall economy, found among the developing countries. If increased life expectancy is considered as a leverage for an individual’s investment in health services, it can be expected that as the life expectancy increases, tendency of health care investment will also experience a boost
up.
Objective: The aim of the present study was to explore and identify the association of healthcare expenditure with the life expectancy and Gross Domestic Product (GDP) in developing countries, especially that of Bangladesh.
Methodology: Data were retrospectively collected from “Health Bulletin 2011” and “Sample Vital Registration System 2010” of Bangladesh considering the fiscal year 1996 to fiscal year 2006. Using STATA, multivariable logistic regression was performed to find out the association of total health expenditure with GDP and life expectancy.
Results: A direct relationship between GDP and total health expenditure was found through analysing the data. At the individual level, income had a direct influence on health spending. However, there was no significant relationship between total health expenditure with increased life expectancy.
Conclusion: The present study did not find any association between life expectancy and total health expenditure. However, our analysis found out that total health expenditure is more sensitive to gross domestic product rather than life expectancy.

Keeping up with a sound health is a fundamental right for the human beings. It also acts as an in... more Keeping up with a sound health is a fundamental right for the human beings. It also acts as an indicator of the socioeconomic development of a country. However, nowadays keeping sound health is challenging because of rapidly increasing non-communicable diseases. Concurrently, we are on the edge of very fast technological advancement which includes usage of cellular technology, high-speed internet and wireless communications. These technologies and their unique applications are creating lots of new dimensions in health care system which is known as e-Health. The medical call centers, emergency toll-free telephone services are being used in all over the world. The newly developed electronic health system can play a vital role in the remote regions of emerging and developing countries although sometimes it seems difficult due to the lack of communication infrastructure. E-Health can be a promising aspect for providing public health benefits if it integrates with the conventional medical system. More strategic approaches are necessary for the planning, development, and evaluation of e-Health. This article is written to depict the existing and future opportunities of e-Health in health support system.

Background: The term of universal health coverage (UHC) are getting popularity among the countrie... more Background: The term of universal health coverage (UHC) are getting popularity among the countries who have not yet attained it. Majority of the developing countries are planning to implement the UHC to protect the vulnerable citizen who cannot afford to buy the health services. Poor people living in developing countries, where there is no UHC, are bereft of getting equal health care. They have to bear a significant amount of health cost in buying different services which often causes catastrophic expenditures for an individual and a family. If a country can provide UHC, it will be possible to bring all the citizens under provision of equal and quality care. However, implementation of a UHC is not an easy phenomenon, rather it needs proper design of a good health insurance system by integrating both the public and private health care providers. The influence of good governance and a sustainable health financing system is fundamental to establish UHC in the developing countries

Working in a resource-poor setting is always considered as a challenge for the public health prof... more Working in a resource-poor setting is always considered as a challenge for the public health professionals. Most of the models suggest that group work can increase the productivity of the workers, and it also plays a role to increment both the client and employee satisfaction. Among the many, the model described by Bruce W. Tuckman about the stages of small group development has gained popularity over the years. The developmental process of the small group consists of four phases: forming, norming, storming and performing. Team members develop expertise by exchanging their ideas and sharing their diverse experiences. Therefore, organisation prefers teamwork or small group activity to implement projects by sharing the responsibilities. A leader accumulates idea by integrating several insights, cultures, skills and experiences of the team members, and try to adopt the best strategy. In this study, we attempted to review some relevant studies using the Tuckman’s model and sought to locate the role/place of a leader. This study tries to identify the process how every member of a group gets engaged into their part of responsibilities to accomplish their teamwork. The theoretical contribution of the analysis lies in the fact that it allowed revisiting into the theory to explore the leader’s role at the time of conflict resolution. At the practical level, the implication of the review lies on the use of the understanding of effective leadership within Tuckman model in different context.

Conference Presentations by Sojib Zaman

Background Every year 2.9 million babies are devoid of savoring their thirty-days celebration glo... more Background Every year 2.9 million babies are devoid of savoring their thirty-days celebration globally. Approximately, 99% of newborn death happens in the low-and middle-income countries. Bangladesh' has made significant strides to reduce child mortality (under five years) in the last two decades. However, progress to reduce newborn mortality has been dismal. Research suggests newborn infection/sepsis as one of the leading cause of neonatal mortality in Bangladesh contributing disproportionately to the under-five mortality as a whole. While several studies have addressed causes of neonatal mortality from an epidemiological perspective, there is a dearth of research to analyze the existing gaps from the service provider's point of view. Inadequate knowledge, resource constraints, lack of motivation to understand or maintain standard protocols and misperceptions with regards to hygiene were found as the main deterrents to provide essential newborn care to manage neonatal infections in the rural areas. Emphasis on capacity building, periodic training, and behavior change communication among the rural healthcare providers appeared to be required to improve the quality of newborn care. Further research will be to explore best practices in rural settings that would reduce neonatal mortality as a result of infections. The policymakers should play a key role to support in-service education, arrange regular training and conduct workshops to enhance knowledge, attitude and practices of rural healthcare providers to provide good quality neonatal care.

Executive summary Two-thirds of all households (HHs) in the developing countries rely on unproces... more Executive summary Two-thirds of all households (HHs) in the developing countries rely on unprocessed biomass fuel (solid plant, wood, animal dung and crop residue) for cooking by mean of exposing themselves to harmful pollutants (Particulates Matter: PM 2.5). In Bangladesh, around 90 percent rural women use biomass fuel for cooking and spends an average of 2 to 5 hours/day in kitchen. Switching to improved cook stove (ICS), a well-designed earthen stove, could be beneficial for the maternal health. The objective of this study was to assess the efficacy of ICS on maternal health in rural Bangladesh. This study adopted a quasi-experimental design to compare the effect of ICS in compared to traditional stoves. We used Spirometry to assess the lung performance of the mothers (who have at least one child), and Air Quality Meter was used to measure 24-hours air sample.
The study found, the reduction of the PM2.5 among the mothers in using ICS group was less in compared to the control group. Moreover, ICS reduced the incidence of respiratory illness, however, did not demonstrate significant changes in LFT during the six months of follow up period. We found ICS has the potential to be used to improve the maternal health in rural Bangladesh. However, more longitudinal investigations are expected to demonstrate the efficacy and
impact of ICS on maternal health to support our statement.

The prevalence of diabetes-related complications is quite high among the Thai Population. Poor gl... more The prevalence of diabetes-related complications is quite high among the Thai Population. Poor
glycemic control initiates the process of complications. Thailand has already integrated diabetes
management as part of primary health care to provide Universal Health Care (UHC) for all. But the
equitable provision of high-quality care under the schemes of UHC could pose a challenge. The findings showed, among the three schemes of Universal Health Care Coverage, patients covered
by CSW scheme or SSS were less likely to develop poor glycemic control compared to patients covered
by the UCS scheme. Scheme-based differences in management of diabetes could perhaps explain the
different quality of care provided for glycemic control. Further, the prevalence of sub-optimal glycemic
control among the diabetic population covered by the Universal health care coverage, as a whole is quite
high. Since optimal glycemic control is fundamental to preventing diabetes-related complications,
further research to refine diabetes management protocols under the different schemes is required to
ensure equitable access to high-quality care essential for a healthy diabetic population in rural Thailand

Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pamp... more Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele can progressively deteriorate the sperm production resulting in abnormal quality and quantity of sperm. Moreover, varicocele is also known as the surgically correctable cause of male infertility. To the best of our knowledge, no study is yet done to see the efficacy of varicocelectomy among the patients with abnormal semen parameter in Bangladesh. This study tried to compare the microscopic changes in sperm concentration, sperm motility, and sperm morphology before and after varicocelectomy. This study was a quasi-experimental study which was done in Urology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from November 2014 to April 2016. Forty-five male patients were included according to eligibility criteria: age between 18 years to 45 years; clinically palpable varicocele; any abnormal semen parameter of sperm concentration, motility or morphology. After undergoing sub-inguinal varicocelectomy, follow-up was done three months and six months after surgery. For each follow-up, physical examination and semen analysis were performed. Data extraction was done from medical records and laboratory investigation of patients. The data were analyzed with statistical software SPSS 20 and level of significance was assessed by Student t-test. Almost 60% of patients were 25 to 35 years old, 87% patients were presented with left sided varicocele, and 80% grade III. All the patients should oligospermia on semen analysis, whereas the number of abnormal sperm motility and abnormal morphology was 39, and 09, respectively. After surgical correction of varicocele, mean improvement of sperm concentration, motility and morphology found in 35 patients (77.78%), 31 patients (79.48%) and six patients (66.67%), respectively. The differences between pre-operative and post-operative semen analysis in the improvement of semen parameter were found statistically significant (P<0.05). For each case, improvement in semen parameter i.e. number, morphology, and mortality was improved in 2nd follow-up period in comparison to the first (P<0.05). Surgical treatment can lead to the betterment of semen parameters in patients with clinically palpable varicocele and impaired semen parameters. This study will be helpful for taking the decision in treating patients presented with clinically palpable varicocele with abnormal semen parameter.

The necessity of identifying the challenges to interrupt the pathways of newborn infection from t... more The necessity of identifying the challenges to interrupt the pathways of
newborn infection from the lens of health care providers’ is paramount. Collected information will be applied to understand the root problems within the health system and they will act as a springboard for developing new ideas, considerations, and decisions regarding newborn care. Bringing back or restoring the clinical confidence to deal with sick newborn among the service providers is found to be essential. However, management of neonatal infection can be feasible in resource-poor settings by means of providing proper training, ensuring strong political commitment, promoting the health seeking behavior and securing
a quality service

Thesis Chapters by Sojib Zaman

The prevalence of chronic kidney disease (CKD) amidst Thai adult T2DM patients is quite high. Unc... more The prevalence of chronic kidney disease (CKD) amidst Thai adult T2DM patients is quite high. Uncontrolled DM and long-term hyperglycemia can play a role to initiate this renal vascular complication. Glycated hemoglobin (HbA1c) is a well-known valid biomarker to estimate glycemic control. High concentration of HbA1c indicates poor or sub-optimal control of DM. However, it is not clear whether HbA1c with other conventional indicators can act as a reliable determinant to predict CKD. The intention of this study was examining the association of HbA1c and other associated risk factors for developing CKD. This study also attempted to evaluate different methods to report CKD. A diabetic registry was used to collect 4042 participants from a district hospital in the Northeast of Thailand. CKD was reported by using estimated glomerular filtration rate (eGFR<60 ml/min/1.73m 2). Using STATA, multiple logistic regression analysis was performed to report adjusted odds ratio and 95% confidence intervals. This investigation used different formulas to verify the eGFR values to report CKD prevalence. More than one-fifth of T2DM patients (887, 21.9%), were at risk to develop kidney disease. The majority of the participants were remained in the poor glycemic state (82%), and 43% of them were reported as overweight. HbA1c was found not to be a reliable indicator for CKD. Age, hypertension, micro albuminuria, and triglyceride were considered to be the implied risk factors besides HbA1c. Also, Body Mass Index (BMI) was found to decrease in the course of developing CKD. The lower values of HbA1c and BMI for high-risk CKD patients might be explained by the fact that CKD patients usually develop anemia and their nutritional status also can declines. More investigations are necessary to infer the actual clinical stage of CKD at which HbA1c values get unpredictable. Therefore, both the contemporary guidelines of HbA1c and BMI need to be modified in consideration of CKD patients. It appears to be a presence of lack of generally accepted indicators for detecting CKD in T2DM patients.

PLOS ONE, 2017