Lessons learned from an under-reported mumps epidemic among Rohingya refugees in Cox's Bazar District, Bangladesh.
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SUBMITTER: Mair L
PROVIDER: S-EPMC7456598 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
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Lessons learned from an under-reported mumps epidemic among Rohingya refugees in Cox's Bazar District, Bangladesh.
Mair Luke L Relan Pryanka P Hamilton David Oliver DO Al-Noman Abdullah A O'Dempsey Timothy T
Transactions of the Royal Society of Tropical Medicine and Hygiene 20200901 9
<h4>Background</h4>In 2018, a large mumps epidemic coincided with an outbreak of diphtheria in refugee camps established in Bangladesh for the Rohingya people. These refugees did not receive a mumps-containing vaccine.<h4>Methods</h4>Cases of mumps were reported to the WHO's Early Warning, Alert and Response System (EWARS) during the Rohingya refugee crisis. The authors present amalgamated epidemiological data of a major, previously under-reported, mumps epidemic.<h4>Results</h4>In total, 19 215 ...[more]
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Project description:Bangladesh is currently hosting more than one million stateless Rohingya refugees, who fled from the Rakhine State to avoid genocide and serious crimes against humanity persecuted by the Myanmar Army. The newly arrived Rohingyas were accommodated in overcrowded refugee camps in Cox's Bazar District (CBD). The camps are highly vulnerable to landslides, tropical cyclones, flash-flooding, and communicable disease outbreak. Although a number of improvement measures are ongoing, however, no study to date has addressed Rohingyas' self-adopted strategies to mitigate disaster risks. Consequently, this paper aims to explore how refugees cope with risks associated with environmental hazards in the Kutupalong Rohingya Camp in CBD. A mixed-methods research strategy incorporating both quantitative household questionnaire survey and qualitative focus group discussions (FGDs) techniques were applied. In total 250 Rohingya refugees were selected for the questionnaire survey using a stratified random sampling method from camps 17 and 19, and two FGDs (male and female-only) were carried out in camp 13 involving 21 Rohingya participants. Results derived from the study show that responding to early warning systems, storing dried food and medicine, utilising available resources, relocating to safer shelters, and keeping hopes high were some of the coping strategies practised by the respondents. Literacy level imposed a significant impact over respondents' perception to accept various measures. For instance, the probability of storing dried food in preparation for disasters was 4 times higher among literate Rohingya compared to their illiterate counterparts. Similarly, for literate respondents, the probability was 20 times higher to store medicine than for illiterate. Guaranteed distribution of shelter strengthening kits among all refugee households, the inclusion of disaster risk awareness and preparedness training, ensuring safe and dignified return in Myanmar, and global and regional cooperation to address the refugee crisis are some of the propositions recommended in this study for improving Rohingyas' future adaptation strategies in a humanitarian context.
| S-EPMC7263258 | biostudies-literature
Project description:Oral health is a critical component of human health but is sometimes forgotten, particularly during humanitarian crises. This research aimed to ascertain the state of oral health among Rohingya refugees living in one of the largest refugee camps and evaluate their knowledge and practice of oral health. A multicenter cross-sectional survey was conducted among 477 participants from July to September 2021 using a structured questionnaire. There were 34 Rohingya camps and out of those 14 camps were accessible for data collection. The study participants were between 18-82 years residing in the refugee camps under Cox's Bazar. The majority of participants (53.88%) were female and between the ages of 25 and 45. Around 46.12% of respondents did not have basic oral health knowledge, while 53.67% were in need of dental care. Nearly half of the participants demonstrated poor oral health practices. Participants' age and educational level were positively associated with oral health knowledge (p = 0.02 and p<0.001). Furthermore, the knowledge level was positively associated with oral health practice (p = .025). Participants with a history of teeth pain and discomfort in the last 12 months were ten times more likely to seek treatment (OR = 9.93, CI: 5.591-17.64). The study indicated a growing demand for dental care among Rohingya refugees staying in Bangladesh. To reduce the severity of oral health issues, use of minimally invasive restorative procedures can be suggested in camps. New oral health promotion campaigns should be emphasized and proper education, ideally in their original language, can be beneficial.
| S-EPMC9200329 | biostudies-literature
Project description:BackgroundThe health status of Rohingya refugees or Forcibly Displaced Myanmar Nationals (FDMNs), especially women and children, is a significant challenge for humanitarian workers in Bangladesh. Though the Government of Bangladesh, in partnership with other organizations, is offering health care services to FDMNs, a comprehensive understanding of the program implementation is required for continuation in the future. This study explores the challenges and potential solutions for effective implementation of maternal, newborn, and child health (MNCH) programs for FDMNs residing in camps of Cox's Bazar, Bangladesh.MethodsWe conducted a qualitative study conducted in Cox's Bazar district, Bangladesh, which involved 34 interviews (15 key informant interviews and 19 in-depth interviews) with relevant persons working in organizations responsible for MNCH services to FDMNs. We relied on both inductive and deductive coding and applied the Consolidated Framework for Implementation Research (CFIR) as a guide to our thematic analysis and presentation of qualitative data.ResultsOur study identified some key challenges hindering the effective implementation of MNCH service delivery for the FDMNs. High turnover and poor retention of staff, overlapping of service, weak referral mechanism, complex health information system, and lack of security of the front line health providers were some of the key challenges identified. Motivating the health workers, task shifting, capacity building on emergency obstetric care, training CHW & TBA on danger signs, and ensuring the security of the workers are the potential solutions suggested by the respondents. Selecting a few indicators and the introduction of E-tracker can harmonize the health information system.ConclusionProviding healthcare in an emergency setting has several associated challenges. Considering the CFIR as the base for identifying different challenges and their potential solutions at a different level of the program can prove to be an excellent asset for the program implementers in designing their plans. Two additional domains, context, and security should be included in the CFIR framework for any humanitarian settings.
| S-EPMC7098630 | biostudies-literature
Project description:AimTo determine the prevalence and causes of blindness, vision impairment and cataract surgery coverage among Rohingya refugees aged ≥ 50 years residing in camps in Cox's Bazar, Bangladesh.MethodsWe used the Rapid Assessment of Avoidable Blindness (RAAB) methodology to select 76 clusters of 50 participants aged ≥ 50 years with probability proportionate to size. Demographic and cataract surgery data were collected using questionnaires, visual acuity was assessed per World Health Organization criteria and examinations were conducted by torch, and with direct ophthalmoscopy in eyes with pinhole-corrected vision <6/12. RAAB software was used for data entry and analysis.ResultsWe examined 3,629 of 3800 selected persons (95.5%). Age and sex adjusted prevalence of blindness (<3/60), severe visual impairment (SVI; >3/60 to ≤6/60), moderate visual impairment (MVI; >6/60 to ≤6/18), and early visual impairment (EVI; >6/18 to ≤6/12) were 2.14%, 2.35%, 9.68% and 14.7% respectively. Cataract was responsible for 75.0% of blindness and 75.8% of SVI, while refractive error caused 47.9% and 90.9% of MVI and EVI respectively. Most vision loss (95.9%) was avoidable. Cataract surgical coverage among the blind was 81.2%. Refractive error was detected in 17.1% (n = 622) of participants and 95.2% (n = 592) of these did not have spectacles. In the full Rohingya cohort of 76,692, approximately 10,000 surgeries are needed to correct all eyes impaired (<6/18) by cataract, 12,000 need distance glasses and 73,000 require presbyopic correction.ConclusionThe prevalence of blindness was lower than expected for a displaced population, in part due to few Rohingya being ≥60 years and the camp's good access to cataract surgery. We suggest the United Nations High Commissioner for Refugees include eye care among recommended health services for all refugees with long-term displacement.
| S-EPMC7707460 | biostudies-literature
Project description:The Rohingya have endured generations of trauma through displacement and targeted violence in Myanmar. Hundreds of thousands have been forced out of the country, with a large proportion settling in refugee camps in Cox's Bazar, Bangladesh. This study examines the impacts of exposure to trauma on mental health outcomes among Rohingya adolescents living in Bangladesh. Post-traumatic stress disorder (PTSD) and depression are examined as outcomes. The main explanatory variable is a measure of exposure to trauma at two levels of proximity (experiencing and witnessing). Resilience is investigated as a potential effect modifier. Experiencing and witnessing traumatic events are positively and significantly associated with PTSD and depression. However, this effect is only seen for PTSD as a continuous measure, reflecting high rates of low-level PTSD in this population. Resilience is found to reduce the effects of trauma on depression, indicating an effect modification of this relationship.
| S-EPMC8156348 | biostudies-literature
Project description:BackgroundForcibly Displaced Myanmar Nationals (FDMNs) fled into Cox's Bazar, Bangladesh due to internal conflict. Considering the public health situation, a surveillance network was established to identify the enteric pathogens and early detection of cholera epidemics. The purpose of this manuscript is to report the clinical, epidemiological determinants of cholera and other enteric pathogens among hospitalized diarrheal patients from FDMNs and host community.MethodsA total of 11 sentinel surveillance sites were established around the camps in Ukhia and Teknaf Upazila, Cox's Bazar. Rapid diagnostic testing was conducted for immediate detection of cholera cases. Stool samples were transferred to the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b) laboratory for culture.ResultsA total of 8134 participants with diarrhea were enrolled from 2017 to 2019: 4881 were FDMNs and 3253 were from the Bangladeshi host community. Among the FDMNs, the proportion of Vibrio cholerae was 0.7%, the proportion of enterotoxigenic Escherichia coli (ETEC) was 4.9%, and the proportion of Shigella was 1.5%. The distributions from host community were 1.2% V cholerae, 1.8% ETEC, and 1.1% Shigella. Similar risk factors have been identified for the diarrheal pathogens for both communities.ConclusionsThis surveillance helped to monitor the situation of diarrheal diseases including cholera in refugee camps as well as in the neighboring host community. These findings lead policymakers to take immediate preventive measures.
| S-EPMC8687071 | biostudies-literature
Project description:IntroductionImmunization campaigns and Expanded Program on Immunization (EPI) were launched by Government of Bangladesh (GoB) in collaboration with WHO and other Non-governmental Organizations (NGOs) to tackle the increased risk of vaccine preventable disease outbreak in the Rohingya refugee camps. Immunization coverage was found to be lower than expected. However, a few studies explored the factors behind low vaccine uptake among Refugee children. Therefore, this study was aimed.MethodsA cross sectional study was carried out among Rohingya parents living in registered camps and makeshift settlements located in Teknaf and Ukhiya upazilla of Cox's Bazar, Bangladesh. A total of 224 Rohingya parents were conveniently selected (122 parents from each type of camps). Data was collected using a pretested interviewer-administered semi-structured questionnaire with the help of bilingual volunteers who understand Rohingya dialect. All statistical analyses were carried out in IBM SPSS Version 26 (New York, USA).ResultsTotal 63.1% of Rohingya parents had good practice regarding childhood immunization (completed EPI vaccination) as per schedule. Of all, 74.6% had good knowledge and 94.7% had positive attitude towards EPI vaccination. Good practice regarding vaccination was significantly more common among parents living in registered camps (77%) than those living in makeshift settlements (49.2%, p<0.001). Multivariable logistic regression analysis revealed that living in registered camps (Adjusted Odds Ratio [aOR]: 2.99; 95% Confidence Interval [CI]: 1.41-6.32) and good knowledge level (aOR: 2.88; 95%CI: 1.32-15.82) were independent determinants of good practice. A separate analysis in both type of camps revealed that in registered camps, good knowledge level (aOR: 3.62; 95%CI: 1.45-9.04) and having >2 children (aOR: 3.71; 95%CI: 1.34-10.27), and in makeshift settlements, father's employment (aOR: 2.33; 95%CI: 1.34-6.72), father's education (aOR: 3.00; 95%CI: 1.34-6.72) and presence of any electronic device (e.g., radio, television, mobile phone) (aOR: 4.01; 95%CI: 0.96-16.84) were significant determinants of good childhood immunization practice.ConclusionHealth education and promotion strategies should be implemented to increase knowledge and awareness about EPI immunization benefits among Rohingya parents to ensure greater coverage.
| S-EPMC10081790 | biostudies-literature
Project description:BackgroundFollowing an influx of an estimated 742,000 Rohingya refugees in Bangladesh, Médecins sans Frontières (MSF) established an active indicator-based Community Based Surveillance (CBS) in 13 sub-camps in Cox's Bazar in August 2017. Its objective was to detect epidemic prone diseases early for rapid response. We describe the surveillance, alert and response in place from epidemiological week 20 (12 May 2019) until 44 (2 November 2019).MethodsSuspected cases were identified through passive health facility surveillance and active indicator-based CBS. CBS-teams conducted active case finding for suspected cases of acute watery diarrhea (AWD), acute jaundice syndrome (AJS), acute flaccid paralysis (AFP), dengue, diphtheria, measles and meningitis. We evaluate the following surveillance system attributes: usefulness, Positive Predictive Value (PPV), timeliness, simplicity, flexibility, acceptability, representativeness and stability.ResultsBetween epidemiological weeks 20 and 44, an average of 97,340 households were included in the CBS per surveillance cycle. Household coverage reached over 85%. Twenty-one RDT positive cholera cases and two clusters of AWD were identified by the CBS and health facility surveillance that triggered the response mechanism within 12 hours. The PPV of the CBS varied per disease between 41.7%-100%. The CBS required 354 full-time staff in 10 different roles. The CBS was sufficiently flexible to integrate dengue surveillance. The CBS was representative of the population in the catchment area due to its exhaustive character and high household coverage. All households consented to CBS participation, showing acceptability.DiscussionThe CBS allowed for timely response but was resource intensive. Disease trends identified by the health facility surveillance and suspected diseases trends identified by CBS were similar, which might indicate limited additional value of the CBS in a dense and stable setting such as Cox's Bazar. Instead, a passive community-event-based surveillance mechanism combined with health facility-based surveillance could be more appropriate.
| S-EPMC7757896 | biostudies-literature
Project description:This study aims to understand the level of residential satisfaction of the host communities' aftermath of the influx of Rohingya in Bangladesh. A total of 151 household heads were randomly interviewed from Ukhiya and Ramu Upazila of Cox's Bazar district, Bangladesh. A residential satisfaction index is developed with a total of twenty-two variables comprised of four components- social environment (SE), neighbourhood environment (NE), public services and facilities (PS&F), and dwelling units (DU). The coefficients of the components indicate that the PS&F, SE, and NE impact much on the overall residential satisfaction compare to the DU. The analysis demonstrates that the people who have tertiary level education, who is Muslim and whose work opportunities remain the same as before, are more satisfied, but older people are less satisfied than younger. Besides, the degradation of social harmony, livestock and agricultural land losses, and decreased wages were the significant causes of dissatisfaction. These findings may contribute to taking appropriate policies and programs for the host communities taken by the government and non-government organizations.
| S-EPMC8084219 | biostudies-literature
Project description:BackgroundWe performed a cross-sectional survey in April-May 2018 among Rohingya in Cox's Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies.Methods and findingsRohingya children aged 1-6 years (younger group) and 7-14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and simple random sampling in Nayapara registered camp. Surveyors asked parents/caregivers if the child received any oral poliovirus vaccine (OPV) in Myanmar and, for younger children, if the child received vaccine in any of the 5 campaigns delivering bivalent OPV (serotypes 1 and 3) conducted during September 2017-April 2018 in Cox's Bazar. Dried blood spot (DBS) specimens were tested for neutralizing antibodies to poliovirus types 1, 2, and 3 in 580 younger and 297 older children. Titers ≥ 1:8 were considered protective. Among 632 children (335 aged 1-6 years, 297 aged 7-14 years) enrolled in the study in makeshift settlements, 51% were male and 89% had arrived after August 9, 2017. Among 245 children (all aged 1-6 years) enrolled in the study in Nayapara, 54% were male and 10% had arrived after August 9, 2017. Among younger children, 74% in makeshift settlements and 92% in Nayapara received >3 bivalent OPV doses in campaigns. Type 1 seroprevalence was 85% (95% CI 80%-89%) among younger children and 91% (95% CI 86%-95%) among older children in makeshift settlements, and 92% (88%-95%) among younger children in Nayapara. Type 2 seroprevalence was lower among younger children than older children in makeshift settlements (74% [95% CI 68%-79%] versus 97% [95% CI 94%-99%], p < 0.001), and was 69% (95% CI 63%-74%) among younger children in Nayapara. Type 3 seroprevalence was below 75% for both age groups and areas. The limitations of this study are unknown routine immunization history and poor retention of vaccination cards.ConclusionsYounger Rohingya children had immunity gaps to all 3 polio serotypes and should be targeted by future campaigns and catch-up routine immunization. DBS collection can enhance the reliability of assessments of outbreak risk and vaccination strategy impact in emergency settings.
| S-EPMC7108688 | biostudies-literature