Muhammad Asaduzzaman

• Ghosh, Prakash; Reck, Nicola; Schneider, Gisela; Asin, Judith; Okuni, Julius Boniface & Muvunyi, Claude Mambo [Show all 14 contributors for this article] (2026). Rapid consensus building to strengthen AMR surveillance in LMICs using One Health approach: a modified table-top exercise coupled with a Delphi study protocol. BMJ Open. 16(8), p. 1–9. doi: 10.1136/bmjopen-2025-112822. Full text in Research Archive
• Vongpradith, Avina; Dominguez, Regina Mae Villanueva; Car, Lorainne Tudor; Movo, Amanda; Ostroff, Samuel M. & He, Jiawei [Show all 1,883 contributors for this article] (2026). Global burden of enteric infectious diseases, diarrhoeal diseases, and corresponding aetiologies, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet Infectious Diseases. ISSN 1473-3099. doi: 10.1016/S1473-3099(26)00194-5.
• Ledesma, Jorge R.; Zhang, Meixin; Liew, Mei Fong; Dominguez, Regina Mae Villanueva; Whikehart, Sophie Mei Lin & Verma, Megan [Show all 1,701 contributors for this article] (2026). Global, regional, and national burden of tuberculosis and multidrug-resistant tuberculosis by HIV status, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet Infectious Diseases. ISSN 1473-3099. doi: 10.1016/S1473-3099(26)00295-1. Full text in Research Archive
• Santomauro, Damian F.; Miller, Paul Anthony; Shadid, Jamileh; Hanson, Sarah Wulf; Vo, Anh & Roy, Darius Jake [Show all 1,199 contributors for this article] (2026). Updated trends in the global prevalence and burden of mental disorders, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 407(10543), p. 2040–2064. doi: 10.1016/S0140-6736(26)00519-2. Full text in Research Archive Show summary

  Background: The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Methods: Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. Findings: We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. Interpretation: A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice.

• Guido, Giacomo; Abbara, Aula; Asaduzzaman, Muhammad; Farkas, Ferenc Balazs; Diabate, Kader & Duvignaud, Alexandre [Show all 31 contributors for this article] (2026). AdMiRE Study: Development and Validation of a WHO-aligned Tool to Assess Healthcare Access and Antibiotic Use Among Migrant Populations in Europe — A Multicountry Delphi and Psychometric Study on behalf of the ESGITM group. CMI Communications (CMI Comms). p. 105184–105184. doi: 10.1016/j.cmicom.2026.105184. Full text in Research Archive
• Nkwasa, Albert; Menke, Inga; Murken, Lisa; Zaharia, Liliana; Ioana-Toroimac, Gabriela & Müller, Laura [Show all 21 contributors for this article] (2025). Stakeholder engagement for inclusive climate impact attribution studies. Environmental Research: Climate. 4(1). doi: 10.1088/2752-5295/ada8cc. Full text in Research Archive
• Jamalludin, Farah Humaira Binti; Ahmed, Minhaz Farid; Halder, Bijay; Khai, Tual Sawn & Asaduzzaman, Muhammad (2025). Waterborne diseases in flood compromised WASH conditions in Malaysia: a planetary health perspective. Frontiers in Climate. 7. doi: 10.3389/fclim.2025.1646753. Full text in Research Archive
• Totaro, Valentina; Guido, Giacomo; Cotugno, Sergio; Vita, Elda De; Asaduzzaman, Muhammad & Patti, Giulia [Show all 15 contributors for this article] (2025). Antimicrobial Resistance in Sub-Saharan Africa: A Comprehensive Landscape Review. American Journal of Tropical Medicine and Hygiene. ISSN 0002-9637. 113(2), p. 253–263. doi: 10.4269/ajtmh.25-0035. Full text in Research Archive
• Sajish, V. Pooja; Uzzaman, Nazim; Aramvalarthan, Niroshini & Asaduzzaman, Muhammad (2025). Prevalence, distribution and antimicrobial resistance profiles in poultry meat samples from India: a systematic review. Frontiers in Veterinary Science. 12. doi: 10.3389/fvets.2025.1672628. Full text in Research Archive
• Asaduzzaman, Muhammad; Rahaman, Md Zamiur; Afrin, Sadia; Ara, Rifat; Mehmood, Seemab & Boriani, Elena [Show all 7 contributors for this article] (2025). Antibiotic prescribing patterns in the community and primary care settings through a gender lens: A systematic review. Public Health. ISSN 0033-3506. 242, p. 311–318. doi: 10.1016/j.puhe.2025.03.020. Full text in Research Archive
• Sperling, Daniel; Schou-Juul, Frederik; Lauridsen, Sigurd; Asaduzzaman, Muhammad; Guney, Seda & Kohanová, Dominika [Show all 10 contributors for this article] (2025). Ethical Principles Pertaining to the Care of People With Dementia: Protocol for a Qualitative Thematic Synthesis of Legal Documents. JMIR Research Protocols. 14. doi: 10.2196/71490. Full text in Research Archive
• Salwén, Håkan; Holm, Cyril; Achermann, Gerald; Asaduzzaman, Muhammad; Blom, Fenneke & Dwojak-Matras, Agnieszka [Show all 12 contributors for this article] (2025). Teaching research integrity: a manual of good practices: an outline. International Journal for Educational Integrity. doi: 10.1007/s40979-025-00186-7. Full text in Research Archive Show summary

  This article addresses the critical need for effective teaching strategies in research integrity (RI), acknowledging widespread uncertainty among educators on the best approach. Building on existing literature, the authors advocate for an ethics-inclusive perspective in RI courses, emphasizing the importance of understanding the ethical dimensions of research practice beyond mere regulatory compliance. In the main article, this dimension of RI training is discussed in detail with regard to ethics. In an abstract we provide a ready-to-use manual of how to implement this in research integrity training. The structure of the article includes a discussion of the ethical foundation of RI. The Appendix introduces a practical, tested course package designed to assist educators, particularly those without specialized ethics training, in developing meaningful RI courses. This includes a detailed overview of the course content, and practical guidance for implementation, aiming to equip educators with the tools necessary to navigate the complexities of teaching research integrity. The focus is on PhD students (but nothing is suggesting that the contents of the article and the Appendix, cannot be used for teaching research integrity on other levels), with the hope that the NERQ community’s shared experiences will contribute significantly to advancing RI education.

• Haeuser, Emily; Byrne, Sam; Nguyen, Jason; Raggi, Catalina; McLaughlin, Susan A & Bisignano, Catherine [Show all 1,331 contributors for this article] (2025). Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 406(10500), p. 260–260. doi: 10.1016/s0140-6736(25)01037-2. Full text in Research Archive
• Naghavi, Mohsen; Kyu, Hmwe Hmwe; A, Bhoomadevi; Aalipour, Mohammad Amin; Aalruz, Hasan & Ababneh, Hazim S [Show all 2,463 contributors for this article] (2025). Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 406(10513), p. 1811–1872. doi: 10.1016/s0140-6736(25)01917-8. Full text in Research Archive Show summary

  Background Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. Methods GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. Findings The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6–47·0) in 1990 to 63·4 years (63·1–63·7) in 2023. For males, mean age increased from 45·4 years (45·1–45·7) to 61·2 years (60·7–61·6), and for females it increased from 48·5 years (48·1–48·8) to 65·9 years (65·5–66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9–81·0) and for males 74·8 years (74·8–74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5–38·4) for females and 35·6 years (35·2–35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. Interpretation We examined global mortality patterns over the past three decades, highlighting—with enhanced estimation methods—the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales.

• Hay, Simon I.; Ong, Kanyin Liane; Santomauro, Damian F.; Bhoomadevi, A.; Aalipour, Mohammad Amin & Aalruz, Hasan [Show all 2,781 contributors for this article] (2025). Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 406(10513), p. 1873–1922. doi: 10.1016/s0140-6736(25)01637-x. Full text in Research Archive Show summary

  Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.

• Stark, Benjamin A; DeCleene, Nicole K; Desai, Emily C; Hsu, Johnathan M; Johnson, Catherine O & Lara-Castor, Laura [Show all 51 contributors for this article] (2025). Global, Regional, and National Burden of Cardiovascular Diseases and Risk Factors in 204 Countries and Territories, 1990-2023. Journal of the American College of Cardiology. ISSN 0735-1097. 86(22), p. 2167–2243. doi: https:/www.jacc.org/doi/10.1016/j.jacc.2025.08.015. Full text in Research Archive Show summary

  Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. Objectives: We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. Methods: The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. Results: CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. Conclusions: CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.

• Cotugno, Sergio; VITA, Elda DE; Frallonardo, Luisa; Novara, Roberta; Papagni, Roberta & Asaduzzaman, Muhammad [Show all 16 contributors for this article] (2025). Antimicrobial Resistance and Migration: Interrelation Between Two Hot Topics in Global Health. Annals of Global Health. 91(1). doi: 10.5334/aogh.4628. Full text in Research Archive
• Masud, Abdullah Al; Walpola, Ramesh Lahiru; Sarker, Malabika; Kabir, Alamgir; Asaduzzaman, Muhammad & Islam, Md Saiful [Show all 9 contributors for this article] (2025). Assessing community antibiotic usage and adherence as per standard treatment guidelines: A potential area to enhance awareness at community pharmacy settings. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 17. doi: 10.1016/j.rcsop.2024.100552. Full text in Research Archive
• Khai, Tual Sawn & Asaduzzaman, Muhammad (2025). Daily challenges and coping strategies of Chin irregular migrant workers in Malaysia: A qualitative study on health and well-being. International Journal of Social Welfare. ISSN 1369-6866. 34(3). doi: 10.1111/ijsw.70016. Full text in Research Archive
• Nkansah, Jacob Oppong; Khai, Tual Sawn; Rose, Elizabeth S. & Asaduzzaman, Muhammad (2025). Overcoming the Odds: First-Generation College Students' Journey to Higher Education in the Global South—A Phenomenological Study From Ghana. European Journal of Education. ISSN 0141-8211. 60(2). doi: 10.1111/ejed.70064. Full text in Research Archive
• Steel, Nicholas; Bauer-Staeb, Clarissa Maria Mercedes; Mercedes, Bauer-Staeb Clarissa Maria; Ford, John A.; Ford, John A & Abbafati, Cristiana [Show all 631 contributors for this article] (2025). Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021. The Lancet Public Health. ISSN 2468-2667. 10(3), p. e172–e188. doi: 10.1016/S2468-2667(25)00009-X. Full text in Research Archive Show summary

  Background: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021. Interpretation: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Funding: Gates Foundation.

• Sarker, Tanwne; Roy, Rana; Yeasmin, Sabina; Rabbany, Md. Ghulam & Asaduzzaman, Muhammad (2025). Technology Adoption Intention and Sustainable Entrepreneurship Ability of Rural Women in Bangladesh. Business Strategy and Development. 8(1). doi: 10.1002/bsd2.70067. Full text in Research Archive
• Armocida, Benedetta; Monasta, Lorenzo; Sawyer, Susan M.; Bustreo, Flavia; Onder, Graziano & Castelpietra, Giulio [Show all 50 contributors for this article] (2024). The Burden of Type 1 and Type 2 Diabetes Among Adolescents and Young Adults in 24 Western European Countries, 1990–2019: Results From the Global Burden of Disease Study 2019. International Journal of Public Health. ISSN 1661-8556. 68. doi: 10.3389/ijph.2023.1606491. Full text in Research Archive
• Sarker, Tanwne; Roy, Rana; Yeasmin, Sabina & Asaduzzaman, Muhammad (2024). Enhancing women's empowerment as an effective strategy to improve food security in rural Bangladesh: a pathway to achieving SDG-2. Frontiers in Sustainable Food Systems. 8. doi: 10.3389/fsufs.2024.1436949. Full text in Research Archive
• Masud, Abdullah Al; Walpola, Ramesh Lahiru; Sarker, Malabika; Kabir, Alamgir; Asaduzzaman, Muhammad & Islam, Md Saiful [Show all 10 contributors for this article] (2024). Understanding antibiotic purchasing practices in community pharmacies: A potential driver of emerging antimicrobial resistance. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 15. doi: 10.1016/j.rcsop.2024.100485. Full text in Research Archive
• Velde, Lode Van der; Shabaan, Ahmed Nabil; Månsson, Anastasia; Wennberg, Peter; Allebeck, Peter & Karlsson, Thomas G [Show all 32 contributors for this article] (2024). Alcohol-attributed disease burden and formal alcohol policies in the Nordic countries (1990-2019): an analysis using the Global Burden of Disease Study 2019. European Journal of Public Health. ISSN 1101-1262. 35(1), p. 52–59. doi: 10.1093/eurpub/ckae195. Full text in Research Archive Show summary

  It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.

• Khai, Tual Sawn; Ahmed, Minhaz Farid & Asaduzzaman, Muhammad (2024). Examining the vulnerability of persons with disabilities in Myanmar pre and post-COVID-19 and military coup. Disability & Society. ISSN 0968-7599. doi: 10.1080/09687599.2024.2360433. Full text in Research Archive
• Zaheer, Muhammad Saqlain; Aijaz, Nazish; Hameed, Akhtar; Buttar, Noman Ali; Rehman, Shamsur & Riaz, Muhammad Waheed [Show all 9 contributors for this article] (2024). Cultivating resilience in wheat: mitigating arsenic toxicity with seaweed extract and Azospirillum brasilense. Frontiers in Microbiology. 15. doi: 10.3389/fmicb.2024.1441719. Full text in Research Archive
• Habiba, Um E; Khan, Amjad; Mmbaga, Elia; Green, Ivan Robert & Asaduzzaman, Muhammad (2023). Use of antibiotics in poultry and poultry farmers- a cross-sectional survey in Pakistan. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1154668. Full text in Research Archive Show summary

  Background Antimicrobial resistance (AMR) which has been ascribed to be due to community carriage of antibiotic-resistant bacteria is highly prevalent in the WHO South-East Asia region. One of the major reasons for this is the misuse of antibiotics in animal farming practices and at the community level, which threatens both human and animal health. However, this problem of antibiotic misuse in poultry farms and in respective farmers is not well studied in countries like Pakistan. Methods We conducted a cross-sectional study in rural Punjab to explore the current practices of antibiotic use in poultry and poultry farmers, associated factors, their healthcare-seeking behavior and biosecurity practices. Results In the context of antibiotic use for poultry, 60% comprised of Colistin sulfate and Amoxicillin trihydrate whereas Colistin is considered as the last resort antibiotic. In addition, the significant consumption of antibiotics in poultry farms (60%) and poultry farmers (50%) was without prescription by either human health physicians or veterinarians. Most of the farms (85%) had no wastewater drainage system, which resulted in the direct shedding of poultry waste and antibiotic residue into the surrounding environment. The lack of farmers’ education, professional farm training and farming experience were the most significant factors associated with antibiotic use and knowledge of AMR. Conclusion Our study findings show that it is necessary for an integrated AMR policy with the inclusion of all poultry farmers to be educated, a mass awareness program to be undertaken and that strict antibiotic usage guidelines be available to them. Such initiatives are also important to ensure food safety and farm biosecurity practices.

• Ziveri, Davide & Asaduzzaman, Muhammad (2023). International Non-Governmental Organizations (INGOs) in Humanitarian Field: why and how to engage with Planetary Health? Qeios. doi: 10.32388/1BHA16. Full text in Research Archive Show summary

  Planetary Health is an emerging field reshaping Global Health understanding of health concerns and interventions living into the Anthropocene. Many challenges faced by humanitarian actors are exacerbated by the climate crisis that could be considered itself another humanitarian crisis. However, often the humanitarian response focuses mainly on disaster risk reduction and on efforts to decarbonize operations. Arguing that Planetary Health offer the missing piece to assess and respond to the complexity of the climate crisis, authors identify the added-value of this approach for humanitarian programs. They pinpoint the main barriers among humanitarian actors in adopting or exploring further the Planetary Health approach. Finally, they share few suggestions toward integrated Planetary Health programs in Low and Middle Income Countries (LMICs). Ultimately, this personal viewpoint calls for an inclusive debate to bring Planetary Health insights, critics, and innovations into Non-Governmental Organization (NGOs) hard daily-work in order to strengthen co-benefits for health and environment.

• Khai, Tual Sawn & Asaduzzaman, Muhammad (2023). Preventive knowledge, attitude, and vaccination challenges for COVID-19 among Myanmar refugees and irregular migrants in Malaysia. Vaccine: X. 15. doi: 10.1016/j.jvacx.2023.100360. Full text in Research Archive Show summary

  Access to vaccinations is crucial for everyone in the fight against the COVID-19 pandemic, regardless of migration or refugee status. This study explored COVID-19 prevention knowledge, attitudes, and vaccination challenges among refugees and irregular migrants from Myanmar in Malaysia. This study employed a descriptive mixed-method approach. Convenience sampling was used to conduct an online survey of 174 participants and two focus groups (N = 14). The majority (51.7 %) were refugees, and 48% were irregular migrant workers. In this study, 90.9% of the participants used social networks and social media chats to obtain information about COVID-19, 84.1% understood and found the vaccination campaign helpful, and 44.2% were aware of it. Although 70% of the participants considered vaccination crucial, 95% said that they would not take it because of fear of arrest and deportation, even though they considered vaccination necessary. Approximately 21.2% of the workers reported that their employers did not provide masks or hand sanitisers. Most of the participants (39.7 %) lived in dormitories provided by their employers. This puts them at a higher risk of infection because of the difficulty in practising social distancing. As part of COVID-19 prevention, the government should grant an amnesty period and work with migrant civil society organisations to administer vaccinations and effective measures for all immigrant populations in Malaysia.

• Oladosu, Ayomide Oluwaseyi; Khai, Tual Sawn & Asaduzzaman, Muhammad (2023). Factors affecting access to healthcare for young people in the informal sector in developing countries: a systematic review. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1168577. Full text in Research Archive
• Asaduzzaman, Muhammad; Mekonnen, Zeleke; Rødland, Ernst Kristian; Sahay, Sundeep; Winkler, Andrea Sylvia & Gradmann, Christoph (2023). District health information system (DHIS2) as integrated antimicrobial resistance surveillance platform: An exploratory qualitative investigation of the one health stakeholders’ viewpoints in Ethiopia. International Journal of Medical Informatics. ISSN 1386-5056. 181. doi: 10.1016/j.ijmedinf.2023.105268. Full text in Research Archive Show summary

  Introduction There is an unmet need for One Health (OH) surveillance and reporting systems for antimicrobial resistance (AMR) in resource poor settings. District health information system, version 2 (DHIS2), is a globally recognized digital surveillance platform which has not been widely utilized for AMR data yet. Our study aimed to understand the local stakeholders’ viewpoints on DHIS2 as OH-AMR surveillance platform in Jimma, Ethiopia which will aid its further context specific establishment. Methods We performed an exploratory qualitative study using semi-structured key informant interviews (KIIs) in Jimma Zone at Southwest Ethiopia. We interviewed 42 OH professionals between November 2020 and February 2021. Following verbatim transcription of the audio recordings of KIIs, we conducted thematic analysis. Results We identified five major themes which are important for understanding the trajectory of OH-AMR surveillance in DHIS2 platform. The themes were: (1) Stakeholders' current knowledge on digital surveillance platforms including DHIS2. (2) Stakeholders' perception on digital surveillance platform including DHIS2. (3) Features suggested by stakeholders to be included in the surveillance platform. (4) Comments from stakeholders on system implementation challenges. (5) Stakeholders' perceived role in the process of implementation. Despite several barriers and challenges, most of the participants perceived and suggested DHIS2 as a suitable OH-AMR surveillance platform and were willing to contribute at their current professional roles. Conclusions Our study demonstrates the potential of the DHIS2 as a user friendly and acceptable interoperable platform for OH-AMR surveillance if the technology designers accommodate the stakeholders’ concerns. Piloting at local level and using performance appraisal tool in all OH disciplines should be the next step before proceeding to workable format.

• Devnath, Popy; Karah, Nabil; Graham, Jay P.; Rose, Elizabeth S. & Asaduzzaman, Muhammad (2023). Evidence of Antimicrobial Resistance in Bats and Its Planetary Health Impact for Surveillance of Zoonotic Spillover Events: A Scoping Review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 20(1). doi: 10.3390/ijerph20010243. Full text in Research Archive Show summary

  As a result of the COVID-19 pandemic, as well as other outbreaks, such as SARS and Ebola, bats are recognized as a critical species for mediating zoonotic infectious disease spillover events. While there is a growing concern of increased antimicrobial resistance (AMR) globally during this pandemic, knowledge of AMR circulating between bats and humans is limited. In this paper, we have reviewed the evidence of AMR in bats and discussed the planetary health aspect of AMR to elucidate how this is associated with the emergence, spread, and persistence of AMR at the human–animal interface. The presence of clinically significant resistant bacteria in bats and wildlife has important implications for zoonotic pandemic surveillance, disease transmission, and treatment modalities. We searched MEDLINE through PubMed and Google Scholar to retrieve relevant studies (n = 38) that provided data on resistant bacteria in bats prior to 30 September 2022. There is substantial variability in the results from studies measuring the prevalence of AMR based on geographic location, bat types, and time. We found all major groups of Gram-positive and Gram-negative bacteria in bats, which are resistant to commonly used antibiotics. The most alarming issue is that recent studies have increasingly identified Methicillin Resistant Staphylococcus aureus (MRSA), ESBL producing, and Colistin resistant Enterobacterales in samples from bats. This evidence of superbugs abundant in both humans and wild mammals, such as bats, could facilitate a greater understanding of which specific pathways of exposure should be targeted. We believe that these data will also facilitate future pandemic preparedness as well as global AMR containment during pandemic events and beyond.

• Rose, Elizabeth S.; Bello-Manga, Halima; Boafor, Theodore & Asaduzzaman, Muhammad (2023). International collaborative research, systems leadership and education: reflections from academic biomedical researchers in Africa. Frontiers in Education. 8. doi: 10.3389/feduc.2023.1217066. Full text in Research Archive
• Wunrow, Han Yong; Bender, Rose G; Vongpradith, Avina ; Sirota, Sarah Brooke ; Swetschinski, Lucien R  & Novotney, Amanda  [Show all 51 contributors for this article] (2023). Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurology. ISSN 1474-4422. 22(8), p. 685–711. doi: 10.1016/S1474-4422(23)00195-3. Full text in Research Archive Show summary

  Background Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. Methods We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. Findings In 2019, there were an estimated 236000 deaths (95% uncertainty interval [UI] 204000–277000) and 2·51 million (2·11–2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400–145 000) and 1·28 million incident cases (0·947–1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6–8·4) per 100 000 population in 1990 to 3·3 (2·8–3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1–19·2]), followed by N meningitidis (13·6% [12·7–14·4]) and K pneumoniae (12·2% [10·2–14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5–81·8]), followed by N meningitidis (72·3% [64·4–78·5]) and viruses (58·2% [47·1–67·3]). Interpretation Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment.

• Asaduzzaman, Muhammad; Rousham, Emily Kate; Unicomb, Leanne; Islam, Md. Rayhanul; Amin, Mohammed Badrul & Rahman, Mahdia [Show all 10 contributors for this article] (2022). Spatiotemporal distribution of antimicrobial resistant organisms in different water environments in urban and rural settings of Bangladesh. Science of the Total Environment. ISSN 0048-9697. doi: 10.1016/j.scitotenv.2022.154890. Full text in Research Archive Show summary

  The spatial distribution of clinically important antibiotic resistant bacteria (ARB) and associated genes is important to identify environmental distribution of contamination and ‘hotspots’ of antimicrobial resistance (AMR). We conducted an integrated survey of AMR in drinking water, wastewater and surface water (rivers and ponds) in three settings in Bangladesh: rural households, rural poultry farms, and urban food markets. Spatial mapping was conducted via geographic information system (GIS) using ArcGIS software. Samples (n = 397) were analyzed for the presence of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec), carbapenem-resistant E. coli (CR-Ec) and resistance genes (blaCTX-M-1, blaNDM-1). In rural households, 5% of drinking water supply samples tested positive for ESBL-Ec, and a high proportion of wastewater, pond and river water samples were positive for ESBL-Ec (90%, 76%, and 85%, respectively). In poultry farms, 10% of drinking water samples tested positive for ESBL-Ec compared to a high prevalence in wastewater, pond and river water (90%, 68%, and 85%, respectively). CR-Ec prevalence in household wastewater and pond water was relatively low (8% and 5%, respectively) compared to river water (33%). In urban areas, 38% of drinking water samples and 98% of wastewater samples from markets tested positive for ESBL-Ec while 30% of wastewater samples tested positive for CR-Ec. Wastewaters had the highest concentrations of ESBL-Ec, CR-Ec, blaCTXM-1 and blaNDM-1 and these were significantly higher in urban compared to rural samples (p < 0.05). ESBL-Ec is ubiquitous in drinking water, wastewater and surface water bodies in both rural and urban areas of Bangladesh. CR-Ec is less widespread but found at a high prevalence in wastewater discharged from urban food markets and in rural river samples. Surveillance and monitoring of antibiotic resistant organisms and genes in waterbodies is an important first step in addressing environmental dimensions of AMR.

• Naghavi, Mohsen; Ikuta, Kevin S.; Swetschinski, Lucien R.; Augilar, Gisela Robles; Sharara, Fablina & Mestrovic, Tomislav [Show all 9 contributors for this article] (2022). Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. ISSN 0140-6736. 400(10369), p. 2221–2248. doi: 10.1016/S0140-6736(22)02185-7. Full text in Research Archive Show summary

  Background Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development.

• Asaduzzaman, Muhammad; Ara, Rifat; Afrin, Sadia; Meiring, James E. & Saif-Ur-Rahman, K. M. (2022). Planetary Health Education and Capacity Building for Healthcare Professionals in a Global Context: Current Opportunities, Gaps and Future Directions. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(18). doi: 10.3390/ijerph191811786. Full text in Research Archive Show summary

  The emerging concept of planetary health needs to be discussed in a more organized and sustainable way within the global public health and healthcare disciplines. Therefore, planetary health should be considered a cardinal component of the global academic framework for healthcare professionals. The availability of related curricula and courses is crucial to equip health professionals in this relatively new discipline of planetary health. In this review article, we aimed to explore published articles and online databases of courses to summarize the available planetary health education opportunities and discussions for health professionals, to identify the gaps in resource allocation and to suggest future recommendations. We observed a visible resource inequity in the global south with the lack of a universal planetary health module for healthcare professionals. Additionally, there is minimal inclusion of allied health disciplines in this learning process. We therefore recommend a dedicated network of motivated healthcare professionals and regional hubs with an agenda to ensure a comprehensive, uniform, and inclusive planetary health education curriculum and practice.

• Islam, Mohammad Aminul; Islam, Md Rayhanul; Khan, Rizwana; Amin, Mohammed Badrul; Rahman, Mahdia & Hossain, Muhammed Iqbal [Show all 9 contributors for this article] (2022). Prevalence, etiology and antibiotic resistance patterns of community-Acquired urinary tract infections in Dhaka, Bangladesh. PLOS ONE. 17(9). doi: 10.1371/journal.pone.0274423. Full text in Research Archive Show summary

  Urinary tract infection (UTI) accounts for a significant morbidity and mortality across the world and is a leading cause for antibiotic prescriptions in the community especially in developing countries. Empirical choice of antibiotics for treatment of UTI is often discordant with the drug susceptibility of the etiologic agent. This study aimed to estimate the prevalence of community-acquired UTI caused by antibiotic resistant organisms. This was a cross-sectional study where urine samples were prospectively collected from 4,500 patients at the icddr,b diagnostic clinic in Dhaka, Bangladesh during 2016–2018. Urine samples were analyzed by standard culture method and the isolated bacteria were tested for antibiotic susceptibility by using disc diffusion method and VITEK-2. Descriptive statistics were used to estimate the prevalence of community acquired UTI (CA-UTI) by different age groups, sex, and etiology of infection. Relationship between the etiology of CA-UTI and age and sex of patients was analyzed using binary logistic regression analysis. Seasonal trends in the prevalence of CA-UTI, multi-drug resistant (MDR) pathogens and MDR Escherichia coli were also analyzed. Around 81% of patients were adults (≥18y). Of 3,200 (71%) urine samples with bacterial growth, 920 (29%) had a bacterial count of ≥1.0x10 5 CFU/ml indicating UTI. Women were more likely to have UTI compared to males (OR: 1.48, CI: 1.24–1.76). E . coli (51.6%) was the predominant causative pathogen followed by Streptococcus spp. (15.7%), Klebsiella spp. (12.1%), Enterococcus spp. (6.4%), Pseudomonas spp. (4.4%), coagulase-negative Staphylococcus spp. (2.0%), and other pathogens (7.8%). Both E . coli and Klebsiella spp. were predominantly resistant to penicillin (85%, 95%, respectively) followed by macrolide (70%, 76%), third-generation cephalosporins (69%, 58%), fluoroquinolones (69%, 53%) and carbapenem (5%, 9%). Around 65% of patients tested positive for multi-drug resistant (MDR) uropathogens. A higher number of male patients tested positive for MDR pathogens compared to the female patients ( p = 0.015). Overall, 71% of Gram-negative and 46% of Gram-positive bacteria were MDR. The burden of community-acquired UTI caused by MDR organisms was high among the study population. The findings of the study will guide clinicians to be more selective about their antibiotic choice for empirical treatment of UTI and alleviate misuse/overuse of antibiotics in the community.

• Amin, Mohammed Badrul; Talukdar, Prabhat Kumar; Asaduzzaman, Muhammad; Roy, Subarna; Flatgard, Brandon M. & Islam, Md Rayhanul [Show all 13 contributors for this article] (2022). Effects of chronic exposure to arsenic on the fecal carriage of antibiotic-resistant Escherichia coli among people in rural Bangladesh. PLoS Pathogens. ISSN 1553-7366. 18(12), p. e1010952–e1010952. doi: 10.1371/journal.ppat.1010952. Full text in Research Archive Show summary

  Antibiotic resistance is a leading cause of hospitalization and death worldwide. Heavy met als such as arsenic have been shown to drive co-selection of antibiotic resistance, suggest ing arsenic-contaminated drinking water is a risk factor for antibiotic resistance carriage.This study aimed to determine the prevalence and abundance of antibiotic-resistant Escher ichia coli (AR-Ec) among people and drinking water in high (Hajiganj, >100 μg/L) and low arsenic-contaminated (Matlab, <20 μg/L) areas in Bangladesh. Drinking water and stool from mothers and their children (<1 year) were collected from 50 households per area. AR Ec was detected via selective culture plating and isolates were tested for antibiotic resis tance, arsenic resistance, and diarrheagenic genes by PCR. Whole-genome sequencing (WGS) analysis was done for 30 E. coli isolates from 10 households. Prevalence of AR-Ec was significantly higher in water in Hajiganj (48%) compared to water in Matlab (22%, p<0.05) and among children in Hajiganj (94%) compared to children in Matlab (76%, p<0.05), but not among mothers. A significantly higher proportion of E. coli isolates from Haji ganj were multidrug-resistant (83%) compared to isolates from Matlab (71%, p <0.05). Co resistance to arsenic and multiple antibiotics (MAR index >0.2) was observed in a higher proportion of water (78%) and child stool (100%) isolates in Hajiganj than in water (57%) and children (89%) in Matlab (p <0.05). The odds of arsenic-resistant bacteria being resis tant to third-generation cephalosporin antibiotics were higher compared to arsenic-sensitive bacteria (odds ratios, OR 1.2–7.0, p <0.01). WGS-based phylogenetic analysis of E. coli iso lates did not reveal any clustering based on arsenic exposure and no significant difference in resistome was found among the isolates between the two areas. The positive association detected between arsenic exposure and antibiotic resistance carriage among children in arsenic-affected areas in Bangladesh is an important public health concern that warrants redoubling efforts to reduce arsenic exposure.

• Clarsen, Benjamin Matthew; Nylenna, Magne; Klitkou, Søren Toksvig; Vollset, Stein Emil; Baravelli, Carl Michael & Bølling, Anette Kocbach [Show all 31 contributors for this article] (2022). Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019. The Lancet Public Health. ISSN 2468-2667. 7(7), p. e593–e605. doi: 10.1016/S2468-2667(22)00092-5. Full text in Research Archive Show summary

  Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties. Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient. Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors. Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.

• Khai, Tual Sawn & Asaduzzaman, Muhammad (2022). ‘I Doubt Myself and Am Losing Everything I Have since COVID Came’—A Case Study of Mental Health and Coping Strategies among Undocumented Myanmar Migrant Workers in Thailand. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(22). doi: 10.3390/ijerph192215022. Full text in Research Archive Show summary

  Migrant populations have always been vulnerable to a high burden of social exclusion, mental disorders, physical illnesses, and economic crises. The current COVID-19 pandemic has further created a frantic plight among them, particularly for undocumented migrant workers in the global south. We have conducted a mixed method study among the undocumented Myanmar migrant workers (UMMWs) in Thailand to explore how the COVID-19 disruption has impacted their mental health and what coping strategies they have adopted. Following the onset of COVID-19 and the recent coup d’état in Myanmar, our current study is the first attempt to understand the mental health status and predicament of this neglected migrant group. A total of 398 UMMWs were included in the online survey, of which 23 participated in qualitative interviews. The major mental health issues reported by the study participants were depression, generalized anxiety disorder, frustration, stress, and panic disorders, while loss of employment, worries about the pandemic, social stigma, lack of access to healthcare, lockdown, and fear of detention were the predominant contributing factors. In response, we identified two key coping mechanisms: coping at a personal level (listening to music, playing online game, praying, and self-motivation) and coping at a social level (chatting with family and friends and visiting religious institutions). These findings point to the importance of policy and intervention programs aimed at upholding mental health at such humanitarian conditions. Sustainable institutional mental health care support and social integration for the migrant workers, irrespective of their legal status, should be ensured.

• Boriani, Elena; Aragrande, Maurizio; Canali, Massimo; Balzan, Mario V. & Asaduzzaman, Muhammad (2021). Pragmatic use of Planetary Health and nature based solutions for future pandemics using COVID-19 case scenario. Frontiers in Public Health. doi: 10.3389/fpubh.2021.620120. Full text in Research Archive
• Sarker, Tanwne; Sarkar, Apurbo; Rabbany, Md. Ghulam; Barmon, Milon; Roy, Rana & Rahman, Md. Ashfikur [Show all 9 contributors for this article] (2021). Evaluation of preventive, supportive and awareness building measures among international students in China in response to COVID-19: a structural equation modeling approach. Global Health Research and Policy. 6. doi: 10.1186/s41256-021-00192-5. Full text in Research Archive Show summary

  Background Education institutions promptly implemented a set of steps to prevent the spread of COVID-19 among international Chinese students, such as restrictive physical exercise, mask wear, daily health reporting, etc. Success of such behavioral change campaigns largely depends on awareness building, satisfaction and trust on the authorities. The purpose of this current study is to assess the preventive, supportive and awareness-building steps taken during the COVID-19 pandemic for international students in China, that will be useful for planning such a behavioral change campaign in the potential pandemic situation in other parts of the world. Methods We conducted an online-based e-questionnaire survey among 467 international students in China through WeChat. The data collection duration was from February 20, 2020 to March 10, 2020 and we focused on their level of awareness, satisfaction, and trust in authorities regarding pandemic measures. Simple bivariate statistics was used to describe the background characteristics of the respondents along with adoption of the partial least squares-structural equation modeling (PLS-SEM) as the final model to demonstrate the relationship between the variables. Results In our study, the leading group of the respondents were within 31 to 35 years’ age group (39.82%), male (61.88%), living single (58.24%) and doctoral level students (39.8%). The preventive and supportive measures taken by students and/or provided by the respective institution or authorities were positively related to students’ satisfaction and had an acceptable strength (β = 0.611, t = 9.679, p < 0.001). The trust gained in authorities also showed an acceptable strength (β = 0.381, t = 5.653, p < 0.001) with a positive direction. Again, the personnel awareness building related to both students’ satisfaction (β = 0.295, t = 2.719, p < 0.001) and trust gain (β = 0.131, t = 1.986, p < 0.05) in authorities had a positive and acceptable intensity. Therefore, our study clearly demonstrates the great impact of preventive and supportive measures in the development of students’ satisfaction (R2 = 0.507 indicating moderate relationship). The satisfied students possessed a strong influence which eventually helped in building sufficient trust on their institutions (R2 = 0.797 indicating above substantial relationship). Conclusions The worldwide student group is one of the most affected and vulnerable communities in this situation. So, there is a profound ground of research on how different states or authorities handle such situation. In this study, we have depicted the types and magnitude of care taken by Chinese government and educational institutions towards international students to relieve the panic of pandemic situation. Further research and such initiatives should be taken in to consideration for future emerging conditions.

• Rousham, Emily K; Asaduzzaman, Muhammad; Mozmader, T.I.M. Amin Uddin; Amin, Mohammed Badrul; Rahman, Mahdia & Hossain, Muhammed Iqbal [Show all 10 contributors for this article] (2021). Human Colonization with Extended-Spectrum Beta-Lactamase-Producing E. coli in Relation to Animal and Environmental Exposures in Bangladesh: An Observational One Health Study. Environmental Health Perspectives. ISSN 0091-6765. 129(3). doi: 10.1289/EHP7670. Full text in Research Archive Show summary

  Background: Human exposure to intensively farmed livestock is a potential risk for transmission of antibiotic-resistant bacteria (ARB) but few studies have assessed the relative role of animal vs. environmental sources of ARB in low-resource community settings. Objectives: We conducted an observational study to compare ARB colonization and antibiotic-resistant gene prevalence and abundance in humans with high or low exposure to poultry in rural households, commercial poultry farms, and urban markets in Bangladesh. Methods: Extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant E. coli were quantified in feces from adults with high or low poultry exposure (n=100, respectively), poultry (n=200), drinking water (n=120), and wastewater (n=120) from 40 rural households, 40 poultry farms, and 40 urban markets. Results: ESBL-producing E. coli (ESBL-EC) prevalence was 67.5% (95% CI: 61.0, 74.0) in samples from adults, 68.0% (95% CI: 61.5, 74.5) in samples from poultry, and 92.5% (95% CI: 87.7, 97.3) in wastewater samples. Carbapenem-resistant E. coli prevalence was high in market wastewaters [30% (95% CI: 15.0, 45.0)] but low in humans (1%) and poultry (1%). Human, poultry, and wastewater isolates shared common resistance genes: blaCTX-M-1, qnr, and blaTEM. Human colonization was not significantly associated with exposure to poultry or setting (rural, farm, or market). Ninety-five percent of commercial poultry farms routinely administered antibiotics. Susceptibility tests were significantly different in household vs. farm and market poultry isolates for four of seven antibiotic classes. In human isolates, there were no differences except aminoglycoside resistance (16.4% high vs. 4.4% low exposure, p=0.02). Urban market wastewaters and poultry samples had significantly higher concentrations of ESBL-EC (p<0.001) and blaCTX-M-1 (p<0.001) compared with samples from farms and rural households. Discussion: ESBL-EC colonization was high in humans but not significantly associated with exposure to poultry. Bidirectional transmission of antibiotic resistance is likely between humans, poultry, and the environment in these community settings, underlining the importance of One Health mitigation strategies.

• masud, Abdullah Al; Rousham, Emily Kate; Islam, Mohammad Aminul; Alam, Mahbub-Ul; Rahman, Mahbubur & Mamun, Abdullah Al [Show all 9 contributors for this article] (2020). Drivers of Antibiotic Use in Poultry Production in Bangladesh: Dependencies and Dynamics of a Patron-Client Relationship. Frontiers in Veterinary Science. doi: 10.3389/fvets.2020.00078. Full text in Research Archive Show summary

  Background: There is increasing concern around the use of antibiotics in animal food production and the risk of transmission of antimicrobial resistance within the food chain. In many low and middle-income countries, including Bangladesh, the commercial poultry sector comprises small-scale producers who are dependent on credit from poultry dealers to buy day-old chicks and poultry feed. The same dealers also supply and promote antibiotics. The credit system is reliant upon informal relationships among multiple actors as part of social capital. This paper aims to describe dependencies and relationships between different actors within unregulated broiler poultry production systems to understand the social and contextual determinants of antibiotic use in low-resource settings. Methods: We used a cross-sectional qualitative design including in-depth interviews among purposefully selected commercial poultry farmers (n = 10), poultry dealers (n = 5), sales representatives of livestock pharmaceutical companies (n = 3) and the local government livestock officer as a key-informant (n = 1). We describe the food production cycle and practices relating to credit purchases and sales using social capital theory. Findings: Poultry dealers provide credit and information for small-scale poultry farmers to initiate and operate their business. In return for credit, farmers are obliged to buy poultry feed and medicine from their dealer and sell their market-ready poultry to that same dealer. All farms applied multiple antibiotics to poultry throughout the production cycle, including banned antibiotics such as colistin sulfate. The relationship between dealers and poultry farmers is reciprocal but mostly regulated by the dealers. Dealers were the main influencers of decision-making by farmers, particularly around antibiotic use as an integral part of the production cycle risk management. Our findings suggest that strategies to improve antibiotic stewardship and responsible use should exploit the patron-client relationship which provides the social and information network for small-scale farmers. Conclusion: Social capital theory can be applied to the patron-client relationship observed among poultry farmers and dealers in Bangladesh to identify influences on decision making and antibiotic use. Within unregulated food production systems, strategies to promote the prudent use of antibiotics should target commercial feed producers and livestock pharmaceutical manufacturers as a first step in developing a sustainable poultry value chain.

• Islam, Mohammad Aminul; Amin, Mohammed Badrul; Roy, Subarna; Asaduzzaman, Muhammad; Islam, Md.Rayhanul & Navab-Daneshmand, Tala [Show all 10 contributors for this article] (2019). Fecal Colonization With Multidrug-Resistant E. coli Among Healthy Infants in Rural Bangladesh. Frontiers in Microbiology. doi: 10.3389/fmicb.2019.00640. Full text in Research Archive Show summary

  Third generation cephalosporins (3GC) are one of the main choices for treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria. Due to their overuse, an increasing trend of resistance to 3GC has been observed in developing countries. Here, we describe fecal colonization of 3GC-resistant (3GCr) Escherichia coli in healthy infants (1-12 months old) living in rural areas of Bangladesh. We found that stool samples of 82% of infants (n = 100) were positive for 3GCr E. coli with a mean ± standard deviation of 6.21 ± 1.32 log10 CFU/g wet weight of stool. 3GCr E. coli encompasses an average one third (33%) of the total E. coli of stool. Almost 77% (n = 63) of these 3GCr E. coli were MDR (or resistant to ≥3 classes of antibiotics). Around 90% (n = 74) of 3GCr E. coli were extended spectrum beta-lactamase (ESBL)-producing in which bla CTX-M-group-1 was the predominant (96%, n = 71) ESBL-gene followed by bla TEM (41%, n = 30) and bla OXA-1 (11%, n = 8). A significant proportion (26.5%, n = 22) of 3GCr E. coli was pathogenic, comprising two types, enteroaggregative (EAEC, n = 19) and enteropathogenic (EPEC, n = 3). Colonization of 3GCr E. coli in infant guts was not associated with demographic characteristics such as age, sex, mode of delivery, maternal and infant antibiotic use, disease morbidity, and feeding practices. The high rate of colonization of 3GCr E. coli in infants' guts is a serious public health concern which needs immediate attention and warrants further studies to explore the cause. KEYWORDS: E. coli; ESBL; colonization; multidrug-resistant; third generation cephalosporins

• Alam, Mahbub-Ul; Rahman, Mahbubur; Masud, Abdullah-Al-; Islam, Mohammad Aminul; Asaduzzaman, Muhammad & Sarker, Supta [Show all 8 contributors for this article] (2019). Human exposure to antimicrobial resistance from poultry production: Assessing hygiene and waste-disposal practices in Bangladesh. International Journal of Hygiene and Environmental Health. ISSN 1438-4639. 222(8), p. 1068–1076. doi: 10.1016/j.ijheh.2019.07.007. Full text in Research Archive Show summary

  The unregulated use of antibiotics is linked with intensive poultry farming in developing economies. In low-and middle-income countries, the dissemination of antimicrobial resistance (AMR) has also been attributed to contamination, poor public health infrastructure and inadequate waste disposal practices. There are limited data on hygiene and waste disposal practices in small-scale commercial and household poultry farming and market sales in Bangladesh. Our objective was to explore human exposures, hygiene and waste disposal practices in poultry raising and processing to identify probable pathways for transmission of AMR bacteria.

• Asaduzzaman, Muhammad; Muhammed, Iqbal Hossain; Saha, Sumita Rani; Islam, Rayhanu; Ahmed, Niyaz & Islam, Mohammad Aminul (2019). Quantification of Airborne Resistant Organisms With Temporal and Spatial Diversity in Bangladesh: Protocol for a Cross-Sectional Study. JMIR Research Protocols. 8(12). doi: 10.2196/14574. Full text in Research Archive Show summary

  Background Antimicrobial resistance is a widespread, alarming issue in global health and a significant contributor to human death and illness, especially in low and middle-income countries like Bangladesh. Despite extensive work conducted in environmental settings, there is a scarcity of knowledge about the presence of resistant organisms in the air. Objective The objective of this protocol is to quantify and characterize the airborne resistomes in Bangladesh, which will be a guide to identify high-risk environments for multidrug-resistant pathogens with their spatiotemporal diversity. Methods This is a cross-sectional study with an environmental, systematic, and grid sampling strategy focused on collecting air samples from different outdoor environments during the dry and wet seasons. The four environmental compartments are the frequent human exposure sites in both urban and rural settings: urban residential areas (n=20), live bird markets (n=20), rural households (n=20), and poultry farms (n=20). We obtained air samples from 80 locations in two seasons by using an active microbial air sampler. From each location, five air samples were collected in different media to yield the total bacterial count of 3rd generation cephalosporin (3GC) resistant Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus. Results The study started in January 2018, and the collection of air samples was completed in November 2018. We have received 800 air samples from 80 study locations in both dry and wet seasons. Currently, the laboratory analysis is ongoing, and we expect to receive the preliminary results by October 2019. We will publish the complete result as soon as we clean and analyze the data and draft the manuscript. Conclusions The existence of resistant bacteria in the air like those producing extended-spectrum beta-lactamases, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci, and methicillin-resistant Staphylococcus aureus will justify our hypothesis that the outdoor environment (air) in Bangladesh acts as a reservoir for bacteria that carry genes conferring resistance to antibiotics. To our knowledge, this is the first study to explore the presence of superbugs in the air in commonly exposed areas in Bangladesh. International Registered Report Identifier (IRRID) DERR1-10.2196/14574 Keywords: antimicrobial resistance, airborne resistomes, air quality, global health, planetary health, environmental risk assessment

• Sheikh, Nurnabi; Sultana, Marufa; Ali, Nausad; Akram, Raisul; Mahumud, Rashidul Alam & Asaduzzaman, Muhammad [Show all 7 contributors for this article] (2018). Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh. Tropical Medicine and Infectious Disease. 3(72). doi: 10.3390/tropicalmed3030072. Full text in Research Archive Show summary

  BACKGROUND The objective of this study was to estimate the extent of timely immunization coverage and to investigate the determinants of incomplete and untimely vaccination. METHODS: The study used data from the latest Bangladesh Demographic Health Survey (BDHS) 2014. A total sample of 1631 children aged 12⁻23 months who had an Expanded Program on Immunization (EPI) card and immunization history were analyzed. RESULTS: The proportions of children who received timely vaccinations were 24% for BCG, 46% for pentavalent 3, and 53% for measles, whereas 76%, 51%, and 36% children failed to receive the BCG, pentavalent 3, and measles vaccines, respectively, in a timely manner. CONCLUSIONS: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.

• Ali, Nausad; Sultana, Marufa; Sheikh, Nurnabi; Akram, Raisul; Mahumud, Rashidul Alam & Asaduzzaman, Muhammad [Show all 7 contributors for this article] (2018). Predictors of Optimal Antenatal Care Service Utilization Among Adolescents and Adult Women in Bangladesh. Health Services Research and Managerial Epidemiology. 5(1). doi: 10.1177/2333392818781729. Full text in Research Archive Show summary

  Introduction: Utilization of recommended antenatal care (ANC) throughout the pregnancy period is a proven healthy behavior in reducing maternal mortalities and morbidities. The objective of this study is to identify the demand side factors that are associated with the recommended utilization of ANC services among adolescents and adult women in Bangladesh. Method: This study utilized cross-sectional data from latest Bangladesh Demographic and Health Survey 2014. Data of a total of 4626 adolescents and adult women were analyzed. Bivariate and multivariate analyses were performed for identifying the significant determining factors associated with the ANC services utilization. Results: Approximately, 32% adult and 30% adolescent women utilized the recommended ANC care. The higher educated adolescents and adult women were 8.08 times (P

• Islam, Mohammad Zahirul; Rutherford, Shannon; Phung, Dung; Uzzaman, Md. Nazim; Baum, Scott & Huda, M. Mamun [Show all 9 contributors for this article] (2018). Correlates of Climate Variability and Dengue Fever in Two Metropolitan Cities in Bangladesh. Cureus - Journal of Medical Science. 10(10). doi: 10.7759/cureus.3398. Full text in Research Archive Show summary

  Dengue fever is a major public health concern in Bangladesh with increased incidence during monsoon. We aimed to assess the correlation of temperature, humidity, and rainfall on dengue fever in two dengue endemic cities in Bangladesh. It was a time series analysis of climate factors and dengue occurrence data in Dhaka and Chittagong cities from 1 January 2000 to 31 December 2009. Daily mean temperature, rainfall, and humidity data were obtained from the Bangladesh meteorological department and daily dengue cases data were obtained from the directorate general of health services (DGHS) of Bangladesh. The mean dengue incidence was 31.62 (SD 28.7) per 100,000 in Dhaka whereas it was 5.76 (SD 11.7) per 100,000 population in Chittagong. The incidence of dengue cases was found significantly associated with the monthly mean temperature, total rainfall, and mean humidity in Dhaka, though in Chittagong, the significantly associated factors​ ​​​​​​were monthly total rainfall and mean humidity. The autoregressive integrated moving average (ARIMA) model identified monthly mean humidity and total rainfall as the most significant contributing factors for dengue cases in Dhaka and Chittagong, respectively. Our study reinforces the relationship of climate parameters with dengue fever, which will support policy-makers in developing a climate-based early warning system for dengue in Bangladesh.

• Rousham, Emily K; Unicomb, Leanne; Wood, Paul; Smith, Michael; Asaduzzaman, Muhammad & Islam, Mohammad Aminul (2018). Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol. BMJ Open. 8. doi: 10.1136/bmjopen-2018-023158. Full text in Research Archive Show summary

  Introduction Increasing antibiotic resistance (ABR) in low-income and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic-resistant bacteria and concentrations of antibiotic-resistant genes from a ‘One Health’ perspective. The holistic assessment of ABR in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: (1) rural poultry-owning households, (2) commercial poultry farms and (3) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and food-producing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract.

• Qadri, Firdausi; Ali, Mohammad; Lynch, Julia; Chowdhury, Fahima; Khan, Ashraful Islam & Wierzba, Thomas F [Show all 25 contributors for this article] (2018). Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: results from 2 years of follow-up of a randomised trial. The Lancet Infectious Diseases. ISSN 1473-3099. doi: 10.1016/S1473-3099(18)30108-7. Full text in Research Archive Show summary

  Background A single-dose regimen of inactivated whole-cell oral cholera vaccine (OCV) is attractive because it reduces logistical challenges for vaccination and could enable more people to be vaccinated. Previously, we reported the efficacy of a single dose of an OCV vaccine during the 6 months following dosing. Herein, we report the results of 2 years of follow-up. Methods In this placebo-controlled, double-blind trial done in Dhaka, Bangladesh, individuals aged 1 year or older with no history of receipt of OCV were randomly assigned to receive a single dose of inactivated OCV or oral placebo. The primary endpoint was a confirmed episode of non-bloody diarrhoea for which the onset was at least 7 days after dosing and a faecal culture was positive for Vibrio cholerae O1 or O139. Passive surveillance for diarrhoea was done in 13 hospitals or major clinics located in or near the study area for 2 years after the last administered dose. We assessed the protective efficacy of the OCV against culture-confirmed cholera occurring 7–730 days after dosing with both crude and multivariable per-protocol analyses. This trial is registered at ClinicalTrials.gov, number NCT02027207. Findings Between Jan 10, 2014, and Feb 4, 2014, 205 513 people were randomly assigned to receive either vaccine or placebo, of whom 204 700 (102 552 vaccine recipients and 102 148 placebo recipients) were included in the per-protocol analysis. 287 first episodes of cholera (109 among vaccine recipients and 178 among placebo recipients) were detected during the 2-year follow-up; 138 of these episodes (46 in vaccine recipients and 92 in placebo recipients) were associated with severe dehydration. The overall incidence rates of initial cholera episodes were 0·22 (95% CI 0·18 to 0·27) per 100 000 person-days in vaccine recipients versus 0·36 (0·31 to 0·42) per 100 000 person-days in placebo recipients (adjusted protective efficacy 39%, 95% CI 23 to 52). The overall incidence of severe cholera was 0·09 (0·07 to 0·12) per 100 000 person-days versus 0·19 (0·15 to 0·23; adjusted protective efficacy 50%, 29 to 65). Vaccine protective efficacy was 52% (8 to 75) against all cholera episodes and 71% (27 to 88) against severe cholera episodes in participants aged 5 years to younger than 15 years. For participants aged 15 years or older, vaccine protective efficacy was 59% (42 to 71) against all cholera episodes and 59% (35 to 74) against severe cholera. The protection in the older age groups was sustained throughout the 2-year follow-up. In participants younger than 5 years, the vaccine did not show protection against either all cholera episodes (protective efficacy −13%, −68 to 25) or severe cholera episodes (−44%, −220 to 35). Interpretation A single dose of the inactivated whole-cell OCV offered protection to older children and adults that was sustained for at least 2 years. The absence of protection of young children might reflect a lesser degree of pre-existing natural immunity in this age group. Funding Bill & Melinda Gates Foundation to the International Vaccine Institute.

• Asaduzzaman, Muhammad (2018). Antimicrobial resistance: an urgent need for a planetary and ecosystem approach. The Lancet Planetary Health. 2(3), p. e99–e100. doi: 10.1016/S2542-5196(18)30019-6. Full text in Research Archive Show summary

  Our planet is rushing towards a post-antibiotic era and the global burden of antimicrobial resistance is estimated to rise to 10 million annual deaths by 2050, a figure that can substantially increase if adequate measures are not taken. Antimicrobial resistance is an ancient but complex phenomenon that emerges in response to antimicrobial exposure. The abundance of existing scientific publications on antimicrobial resistance in an environmental context supports its inclusion in the planetary health agenda. Unfortunately, antimicrobial resistance is still a public health concern and it has not been considered a priority area to work on from an ecological perspective. Ecologists and Earth scientists have not been made aware of this situation and have not been included in discussions of control strategies between public health experts and social scientists.

• Flowra, Mahfuza Talukder & Asaduzzaman, Muhammad (2018). Resurgence of infectious diseases due to forced migration: is planetary health and One Health action synergistic? The Lancet Planetary Health. 2(10), p. e419–e420. doi: 10.1016/S2542-5196(18)30203-1. Full text in Research Archive Show summary

  Forced migration is an ancient phenomenon and will continue as long as politics exists. Although it mainly evolves from persecution, development, or exploitation, its public health consequences and effects go far beyond assumption. The ongoing epidemic of a rare and controlled disease like diphtheria in Rohingya camps, in Bangladesh, is a unique example of a public health disaster due to forced migration. Planetary health and One Health have approached the issue by working together as an interdisciplinary collaboration; which might be the best strategy in such conditions.

• Asaduzzaman, Muhammad; Chowdhury, Shahanaz; Shahed, Jahid Hossen; Kafi, Mohammad Abdullah Heel; Uzzaman, Md. Nazim & Flowra, Mahfuza Talukder [Show all 7 contributors for this article] (2018). Prevalence of Type 2 Diabetes Mellitus Among Urban Bihari Communities in Dhaka, Bangladesh: A Cross-sectional Study in a Minor Ethnic Group. Cureus - Journal of Medical Science. doi: 10.7759/cureus.2116. Full text in Research Archive Show summary

  Introduction The prevalence, disease progression, and treatment outcomes for patients with type 2 diabetes vary significantly between ethnic groups. The Bihari community constitutes one of the most vulnerable populations in Bangladesh on the basis of access to health services and other fundamental rights. Our study aimed at finding out the prevalence and risk factors of type 2 diabetes among the Bihari adults in Dhaka city. Methods This cross-sectional community-based study was carried out among stranded Pakistanis (known as Bihari) living in camps in the Mirpur area from July 2014 to June 2015. Laboratory-based oral glucose tolerance test (OGTT) was the basis for the diagnosis of type 2 diabetes mellitus (DM). Anthropometric measurements, blood pressure, biochemical tests, family history, and socioeconomic information were obtained to determine the risk factors. Results The prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were estimated at 10.11%, 8.74%, and 4.55%, respectively. Increased diastolic blood pressure, serum triglyceride, and cholesterol level were observed to be significantly (p

• Khan, Ashraful Islam; Ali, Mohammad; Chowdhury, Fahima; Saha, Amit; Khan, Iqbal Ansary & Khan, Arifuzzaman [Show all 15 contributors for this article] (2017). Safety of the oral cholera vaccine in pregnancy: Retrospective findings from a subgroup following mass vaccination campaign in Dhaka, Bangladesh. Vaccine. ISSN 0264-410X. doi: 10.1016/j.vaccine.2017.01.080. Full text in Research Archive Show summary

  BACKGROUND: Pregnant women are vulnerable to complications of cholera. Killed oral cholera vaccines (OCV) are not recommended for pregnant women though there is no evidence of harmful effects during pregnancy. We evaluated the effect of a killed OCV, Shanchol™, on pregnancy outcomes during an effectiveness trial of the vaccine in urban Bangladesh. METHODOLOGY: Individuals ⩾1year were invited to participate in the trial, conducted in 2011 in Dhaka, Bangladesh. Pregnancy by history was an exclusion criterion and all women of reproductive age (15-49years) were verbally questioned about pregnancy at enrollment and prior to vaccination. Out of 48,414 women of reproductive age 286 women received the OCV unknowingly while pregnant. Out of these, we could recruit 69 women defined as exposed to OCV. Accordingly, we selected 69 pregnant women randomly from those who did not take the OCV (non-exposed to OCV). We evaluated adverse pregnancy outcome (spontaneous miscarriages, still births, or congenital malformations) between those who were exposed to OCV and those who were not exposed to OCV. RESULTS: About 16% of pregnant women exposed to OCV had pregnancy loss, as compared to 12% of unvaccinated pregnant women (P=0.38). One congenital anomaly was observed and occurred in women non-exposed to OCV group. Models that adjusted for baseline characteristics that were unbalanced between the exposed and non-exposed groups, revealed a no elevation of risk of adverse pregnancy outcomes in vaccinees versus non-vaccinees (Adj. OR (95% CI): 0.45 (0.11-1.88). CONCLUSIONS: No excess of adverse fetal outcomes associated with receipt of OCV was observed in this study. TRIAL REGISTRATION: Clinical Trials.gov number NCT01339845.

• Al‐Mamun, Md Mahfuz; Sarker, Suprovath Kumar; Qadri, Syeda Kashfi; Shirin, Tahmina; Mohammad, Quazi Deen & LaRocque, Regina [Show all 11 contributors for this article] (2016). Examination of Huntington's disease with atypical clinical features in a Bangladeshi family tree. Clinical Case Reports. 4(12), p. 1191–1194. doi: 10.1002/ccr3.743. Full text in Research Archive Show summary

  Atypical manifestation of Huntington's disease (HD) could inform ongoing research into HD genetic modifiers not present in the primarily European populations studied to date. This work demonstrates that expanding HD genetic testing into under-resourced healthcare settings can benefit both local communities and ongoing research into HD etiology and new therapies. Here, we describe an extended family in northern Bangladesh with eight members affected with Huntington's disease (HD) exhibiting atypical clinical features. All eight have the CAG repeat expansion in exon 1 of HTT gene and do not carry mutations associated with other HD‐like disorders, Wilson's disease, or other neurodegenerative diseases. The affected family, in northern Bangladesh, has eight living members with Huntington's disease (HD), all with atypical clinical features. The disorder appeared almost 130 years ago in one of the two siblings. All affected individuals are progeny of the affected sibling, and no progeny of the healthy sibling are affected. No consanguineous marriages are reported for the study participants.

• Qadri, Dr Firdausi; Wierzba, Thomas F.; Ali, Mohammad; Chowdhury, Fahima; Khan, Ashraful Islam & Saha, Amit [Show all 27 contributors for this article] (2016). Efficacy of a Single-Dose, Inactivated Oral Cholera Vaccine in Bangladesh. New England Journal of Medicine. ISSN 0028-4793. 374, p. 1723–1732. doi: 10.1056/NEJMoa1510330. Full text in Research Archive Show summary

  Background A single-dose regimen of the current killed oral cholera vaccines that have been prequalified by the World Health Organization would make them more attractive for use against endemic and epidemic cholera. We conducted an efficacy trial of a single dose of the killed oral cholera vaccine Shanchol, which is currently given in a two-dose schedule, in an urban area in which cholera is highly endemic. Methods Nonpregnant residents of Dhaka, Bangladesh, who were 1 year of age or older were randomly assigned to receive a single dose of oral cholera vaccine or oral placebo. The primary outcome was vaccine protective efficacy against culture-confirmed cholera occurring 7 to 180 days after dosing. Prespecified secondary outcomes included protective efficacy against severely dehydrating culture-confirmed cholera during the same interval, against cholera and severe cholera occurring 7 to 90 versus 91 to 180 days after dosing, and against cholera and severe cholera according to age at baseline. Results A total of 101 episodes of cholera, 37 associated with severe dehydration, were detected among the 204,700 persons who received one dose of vaccine or placebo. The vaccine protective efficacy was 40% (95% confidence interval [CI], 11 to 60%; 0.37 cases per 1000 vaccine recipients vs. 0.62 cases per 1000 placebo recipients) against all cholera episodes, 63% (95% CI, 24 to 82%; 0.10 vs. 0.26 cases per 1000 recipients) against severely dehydrating cholera episodes, and 63% (95% CI, −39 to 90%), 56% (95% CI, 16 to 77%), and 16% (95% CI, −49% to 53%) against all cholera episodes among persons vaccinated at the age of 5 to 14 years, 15 or more years, and 1 to 4 years, respectively, although the differences according to age were not significant (P=0.25). Adverse events occurred at similar frequencies in the two groups. Conclusions A single dose of the oral cholera vaccine was efficacious in older children (≥5 years of age) and in adults in a setting with a high level of cholera endemicity. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT02027207. opens in new tab.)

• Chowdhury, Fahima; Mather, Alison E.; Begum, Yasmin Ara; Asaduzzaman, Muhammad; Baby, Nabilah & Sharmin, Salma [Show all 15 contributors for this article] (2015). Vibrio cholerae Serogroup O139: Isolation from Cholera Patients and Asymptomatic Household Family Members in Bangladesh between 2013 and 2014. PLoS Neglected Tropical Diseases. ISSN 1935-2727. 9(11). doi: 10.1371/journal.pntd.0004183. Full text in Research Archive Show summary

  Background Cholera is endemic in Bangladesh, with outbreaks reported annually. Currently, the majorityof epidemic cholera reported globally is El Tor biotypeVibrio choleraeisolates of the ser-ogroup O1. However, in Bangladesh, outbreaks attributed toV.choleraeserogroup O139isolates, which fall within the same phylogenetic lineage as the O1 serogroup isolates, wereseen between 1992 and 1993 and in 2002 to 2005. Since then,V.choleraeserogroup O139has only been sporadically isolated in Bangladesh and is now rarely isolated elsewhere. Methods Here, we present case histories of four cholera patients infected withV.choleraeserogroupO139 in 2013 and 2014 in Bangladesh. We comprehensively typed these isolates usingconventional approaches, as well as by whole genome sequencing. Phenotypic typing andPCR confirmed all four isolates belonging to the O139 serogroup. Findings Whole genome sequencing revealed that three of the isolates were phylogenetically closely related to previously sequenced El Tor biotype, pandemic 7, toxigenicV.choleraeO139 iso-lates originating from Bangladesh and elsewhere. The fourth isolate was a non-toxigenic V.cholerae that, by conventional approaches, typed as O139 serogroup but was genetically divergent from previously sequenced pandemic 7V.cholerae lineages belonging to the O139 or O1 serogroups. Conclusion These results suggest that previously observed lineages of V.choleraeO139 persist in Bangladesh and can cause clinical disease and that a novel disease-causing non-toxigenicO139 isolate also occurs.

• Qadri, Dr Firdausi; Ali, Mohammad; Chowdhury, Fahima; Khan, Ashraful Islam; Saha, Amit & Khan, Iqbal Ansary [Show all 28 contributors for this article] (2015). Feasibility and effectiveness of oral cholera vaccine in an urban endemic setting in Bangladesh: a cluster randomised open-label trial. The Lancet. ISSN 0140-6736. 386(10001), p. 1362–1371. doi: 10.1016/S0140-6736(15)61140-0. Full text in Research Archive Show summary

  Background Cholera is endemic in Bangladesh with epidemics occurring each year. The decision to use a cheap oral killed whole-cell cholera vaccine to control the disease depends on the feasibility and effectiveness of vaccination when delivered in a public health setting. We therefore assessed the feasibility and protective effect of delivering such a vaccine through routine government services in urban Bangladesh and evaluated the benefit of adding behavioural interventions to encourage safe drinking water and hand washing to vaccination in this setting. Methods We did this cluster-randomised open-label trial in Dhaka, Bangladesh. We randomly assigned 90 clusters (1:1:1) to vaccination only, vaccination and behavioural change, or no intervention. The primary outcome was overall protective effectiveness, assessed as the risk of severely dehydrating cholera during 2 years after vaccination for all individuals present at time of the second dose. This study is registered with ClinicalTrials.gov, number NCT01339845. Findings Of 268 896 people present at baseline, we analysed 267 270: 94 675 assigned to vaccination only, 92 539 assigned to vaccination and behavioural change, and 80 056 assigned to non-intervention. Vaccine coverage was 65% in the vaccination only group and 66% in the vaccination and behavioural change group. Overall protective effectiveness was 37% (95% CI lower bound 18%; p=0·002) in the vaccination group and 45% (95% CI lower bound 24%; p=0·001) in the vaccination and behavioural change group. We recorded no vaccine-related serious adverse events. Interpretation Our findings provide the first indication of the effect of delivering an oral killed whole-cell cholera vaccine to poor urban populations with endemic cholera using routine government services and will help policy makers to formulate vaccination strategies to reduce the burden of severely dehydrating cholera in such populations. Funding Bill & Melinda Gates Foundation .

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• Asaduzzaman, Muhammad; Khai, Tual Sawn; Claro, Vergil de & Zaman, Farzana (2023). Global Disparities in COVID-19 Vaccine Distribution: A Call for More Integrated Approaches to Address Inequities in Emerging Health Challenges. Challenges. 14(4). doi: 10.3390/challe14040045. Full text in Research Archive Show summary

  The advent of the COVID-19 vaccine signified a historic milestone in the field of vaccinology, showcasing remarkable scientific collaboration and global solidarity. However, the most prominent hurdle in maximizing the global public health impact of vaccines remains the absence of comprehensive and inclusive health systems in both high- and low-resource settings. Our discussion centers around the major contributing factors that played a key role in formulating the rapid and efficacious COVID-19 vaccines. Simultaneously, we illuminate the disparities that have marred the vaccine delivery process throughout the pandemic. In particular, we highlight the case scenarios of two minority and vulnerable communities from the Global South and North—the undocumented migrants in Thailand and the Roma community in Europe—who continue to experience inequitable vaccine access regardless of their location. We note that a crucial programmatic solution that is rooted in inclusive and equitable global public health policy, characterized by empathy and trust and bolstered by digital innovation, is lacking. These examples underscore the significance of establishing a comprehensive and integrated health system at multiple levels across countries and the entire world. Furthermore, we highlight the need for both local and global actors to collaboratively engage in vaccine distribution efforts. By gaining a concise grasp of these intricacies, the global community will be better poised to effectively combat future pandemics and emerging health challenges.

• Moura, Pedro; Collineau, Lucie; Sandberg, Marianne; Tomassone, Laura; Meneghi, Daniele De & Norström, Madelaine [Show all 16 contributors for this article] (2023). Users’ perception of the OH-EpiCap evaluation tool based on its application to nine national antimicrobial resistance surveillance systems. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1138645. Full text in Research Archive
• Asaduzzaman, Muhammad; Rødland, Ernst Kristian; Mekonnen, Zeleke; Gradmann, Christoph & Winkler, Andrea Sylvia (2022). Understanding transmission pathways and integrated digital surveillance potential of antimicrobial resistance in Ethiopia in a One Health approach: a mixed-method study protocol. BMJ Open. 12(6). doi: 10.1136/bmjopen-2021-051022. Full text in Research Archive Show summary

  Introduction Antimicrobial resistance (AMR) has a critical global impact, mostly affecting low- and middle-income countries. A major knowledge gap exists in understanding the transmission pathway of the gut colonisation with AMR bacteria between healthy humans and their animals in addition to the presence of those AMR bacteria in the surrounding environment. A One Health (OH) approach is necessary to address this multisectoral problem. Methods and analysis This cross-sectional, mixed-method OH study design will use both quantitative and qualitative methods of data collection. Quantitative methods will be carried out to assess the prevalence and risk factors associated with multidrug resistant Gram-negative bacteria and vancomycin-resistant enterococci in humans, animals (cattle) and the environment. The focus will be on cattle rearing as an exposure risk for AMR among humans. The assessment of AMR in the population of Jimma, Ethiopia with or without exposure to cattle will reinforce the importance of OH research to identify the impending exchange of resistance profile between humans and animals as well as its ultimate dissemination in the surrounding environment. The targeted semistructured key stakeholder interviews will aid to strengthen the OH-AMR surveillance in Ethiopia by understanding the acceptability of an integrated AMR surveillance platform based on the District Health Information Software-2 and the feasibility of its context-specific establishment. Ethics and dissemination The study has been approved by the Regional Ethics Committee, Norway, and the Institutional Review Board of Jimma University, Ethiopia. The study’s data will be stored on a secure server known as Services for Sensitive Data hosted by the University of Oslo. In addition, the new European Union Global Data Protection Guidelines for data sharing, storage and protection will be followed. We will publish the results in peer-reviewed journals and present the findings at national and international conferences.

• Asaduzzaman, Muhammad (2022). Water and food in One Health perspective. Full text in Research Archive
• Asaduzzaman, Muhammad (2022). Neo-colonialism in Global Health:Perspectives from VIRDE Alumni and Evidence from the Field. Full text in Research Archive
• Asaduzzaman, Muhammad; Rose, Elizabeth S. & Boafor, Theodore Kobla (2022). Understanding Implications of Research Colonialism to Make Change for the Future. Full text in Research Archive
• Asaduzzaman, Muhammad (2021). One Health - Interdisciplinary Research Approach in Global Health. Full text in Research Archive
• Asaduzzaman, Muhammad (2021). Water and Food in One Health perspective. Full text in Research Archive
• Asaduzzaman, Muhammad; Rahman, K M Saif-Ur- & Ahmed, Sabrina (2021). Prevention of future pandemics needs attention to planetary health: the example of bat ecology and COVID-19. Medium. Full text in Research Archive
• Asaduzzaman, Muhammad & Murshid, Munzur-E- (2020). Climate Change and Vulnerability to Emerging Infections: Nature’s Revenge or Our Fate! Medium. Full text in Research Archive Show summary

  The whole world is at standstill due to the COVID-19 pandemic. Vehicles are not running, planes are not flying, factories are closed and even social gatherings are halted. The world has not been faced with such great danger since World War II. The COVID-19 crisis has demonstrated how helpless we truly are. After the COVID-19 pandemic, the question arose as to whether climate change has anything to do with the emergence of such pandemics. The question has not yet been fully answered. However, scientists have identified various factors that have been linked to the emergence of viral diseases

• Asaduzzaman, Muhammad; Rousham, Emily K & Zaman, Farzana (2020). Antibiotic consumption may be linked to exaggeration of COVID-19. Medical Hypotheses. ISSN 0306-9877. 143. doi: 10.1016/j.mehy.2020.109913. Full text in Research Archive Show summary

  When we observe the history of the deadliest pandemics on earth from Antonine Plague to current COVID-19, no bacterial pandemic has occurred since the discovery of Penicillin. The misuse of antibiotics in respiratory viral infections is well established. We hypothesize that use of antibiotics is linked with the exacerbation of viral infections like COVID-19 on the basis of epidemiological and immunological evidence.

• Asaduzzaman, Muhammad (2020). Think About Climate Change and Pandemics While Washing Your Hands. Medium. Full text in Research Archive Show summary

  The need for access to safe water, sanitation and hygiene has proven to be of the utmost importance in order to safeguard human health, especially amidst the ongoing COVID-19 pandemic. These three symbiotic terms are collectively known as WASH. Among them, hand-washing is the most commonly recommended measure to prevent the spread of disease. My concern is about the link between WASH and climate change as well as how understanding this planetary issue is essential in order to prepare for future pandemics. I believe that WASH is important to the planetary health agenda, particularly for urban populations.

• Asaduzzaman, Muhammad (2019). Antimicrobial Resistance – The value of Global One Health Studies. Full text in Research Archive
• Storeng, Katerini Tagmatarchi; Roalkvam, Sidsel & Asaduzzaman, Muhammad (2019). Action to protect the independence and integrity of global health research. BMJ Global Health. 4. doi: 10.1136/bmjgh-2019-001746. Full text in Research Archive Show summary

  The tensions between research ethics and the wider politics of the global health field are increasingly recognised. However, the repercussions of these tensions for individuals and research institutions need careful consideration. While ‘rocking the boat’ is uncomfortable and may threaten individual career progression and research institutions’ external income, biased evidence can harm health programme beneficiaries and public trust in research. There are certainly no simple, fail-safe, technocratic quick fixes to resolving issues of power and politics, but the ideas proposed here should at least create better relationships between the institutions involved in commissioning, undertaking and publishing research, and feed into more sophisticated and thoughtful mechanisms of accountability, which do not simply re-enforce existing frameworks that favour accountability towards donors. The ideas we propose should be considered within broader discussions on how to address north–south power imbalances within the research community, and will hopefully catalyse wider action on protecting the independence of public universities and other research institutions globally. We believe this is necessary to enable researchers to hold power to account and advance informed and healthy debate on issues of public interest.

• Asaduzzaman, Muhammad & Ahmed, Niyaz (2018). F1000 Prime Recommendation of "A poor-quality generic drug for the treatment of visceral leishmaniasis: a case report and appeal". F1000Prime. doi: 10.3410/f.720295206.793549590. Full text in Research Archive
• Asaduzzaman, Muhammad & Ahmed, Niyaz (2017). F1000 Prime Recommendation of "Interconnected microbiomes and resistomes in low-income human habitats". F1000Prime. doi: 10.3410/f.726354064.793532883. Full text in Research Archive Show summary

  This important research article highlights a very significant pathway of the spread of antibiotic resistance among humans, animals and the environment by horizontal gene transfer between bacterial genomes including benign gut microbiota and environmental pathogens. This article reports the identification of interconnected resistomes from human faecal samples and the surrounding environment (including feaces of domesticated animals, soil, water as well as samples from composting latrines and sewage systems) which are exclusively influenced by bacterial phylogeny along ecological gradients. Due to the selection of low income rural and peri-urban communities as study areas, these findings are relevant for two-thirds of the global population. The authors also focused on safe water, improved sanitation and waste management as an effective intervention to reduce the burden of antibiotic resistance.

• Asaduzzaman, Muhammad & Ahmed, Niyaz (2017). F1000 Prime recommendation of "Evolution of antibiotic resistance is linked to any genetic mechanism affecting bacterial duration of carriage". F1000Prime. doi: 10.3410/f.727215364.793535058. Full text in Research Archive
• Asaduzzaman, Muhammad & Mahmood, Sultan (2016). Epidemiology, impact, prevention and control of nipah encephalitis in Bangladesh: a systematic review of one health issue. Full text in Research Archive
• Asaduzzaman, Muhammad & Mahmood, Sultan (2016). Epidemiology, impact, prevention and control of nipah encephalitis in Bangladesh: a systematic review of one health issue. European Journal of Epidemiology (EJE). ISSN 0393-2990. 31. doi: 10.1007/s10654-016-0183-1. Full text in Research Archive Show summary

  Background Nipah virus poses an eminent threat in Bangladesh as it encounters almost yearly outbreak since 2001. Comprehensive and coherent understanding of the disease is of paramount importance due to high case fatality. The objective of this review is to summarize the epidemiology and control of Nipah encephalitis in Bangladesh. Methods We searched three different databases- PubMed, Web of Science and Google Scholar using different search term as appropriate for those databases mixing the Boolean operators that yielded 144, 113 and 1530 articles respectively. We screened the titles first for relevance and later abstracts. 47 articles met our criteria and were finally reviewed. A literature matrix was formed in Excel for compilation and analysis. Results Nipah outbreaks in Bangladesh were different compared to initial outbreak in Malaysia in 1999. Unlike Malaysian outbreak, person to person transmission occurred in Bangladesh leaving humans most vulnerable. Infections were reported in domesticated pigs, dogs, cats in South Asia and serological study in Bangladesh showed 6.5, 4.3 and 44.2 %seroprevalence in cattle, goat and pig respectively. Pteropus bat plays a key role in Nipah transmission and risk factors include drinking raw date palm sap contaminated with bat urine or faeces, eating halfeaten bat saliva laden fruit and close contact or involvement in burial of cases. As date palm sap is harvested during winter, Nipah outbreaks mostly occurred during this season. Nipah occurred within the ‘‘Nipah belt’’ and had a high case fatality of more than 70 %. Avoiding raw date palm sap and drinking sap from trees protected with bamboo skirt or ‘‘bana’’ remain the principle preventive measures along with strict infection control in hospitals for prevention of secondary cases. Conclusion Extensive knowledge of this emerging zoonosis is the key for prevention and saving lives. Community sensitization and multisectoral intervention through One Health approach can prevent this deadly disease especially in outbreak areas.

• Flowra, Mahfuza Talukder & Asaduzzaman, Muhammad (2016). PREVALENCE AND ASSOCIATED RISK FACTORS FOR HYPERTENSION IN A MINOR ETHNIC GROUP (BIHARI COMMUNITY) IN BANGLADESH. Full text in Research Archive Show summary

  Objective: This study is the first one to determine the prevalence and associated risk factors for Hypertension among the Bihari community of Bangladesh, a neglected minor ethnic group of population living in different camps with poor facilities for more than four decades. Being poor and illiterate, they are also unaware of the dangers of major NCDs. So, it is important to know the current situation of Hypertension and other NCDs of this community. Design and Method: This cross-sectional study was conducted among subjects, aged ≥ 30 years in Bihari camp at Mirpur of Dhaka city. Along with Blood pressure measurement, OGTT, anthropometric measurements and biochemical tests were obtained. Stata 13 was used for data entry and analysis. Statistical comparisons were carried out using t-test and χ2 test. Logistic regression was applied to calculate crude and adjusted odds ratio to identify risk factors. Results: The prevalence of Hypertension was 7.03% in this study group. Prevalence of Hypertension was greater in females than males. Increased blood pressure was significantly (p < 0.05) associated with type 2 DM, increased Triglyceride and Cholesterol level. It has been also observed that positive family history of DM and high BP along with obesity significantly affected the probability of Hypertension. The higher waist circumference had significant (p < 0.05) association with high BP in both sex. Conclusions: The prevalence of Hypertension in the study population was found to be almost equal to that of the general population of Bangladesh. Therefore, the policy makers should initiate cardiovascular care with health education in the minor ethnic groups and whatever the causes, they must be included in the country's health policy regarding development of prevention and control model of noncommunicable diseases.

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