Fosiul Nizame

• Researcher at International Centre for Diarrhoeal Disease Research

According to UNICEF, pneumonia is the leading cause of death in children under 5. 70% of worldwide pneumonia deaths occur in only 15 countries, including Bangladesh. Previous research has indicated a potential association between the incidence of pneumonia and the presence of cross-ventilation in slum housing in Dhaka, Bangladesh. The objective of...

Schoolchildren frequently transmit respiratory and gastrointestinal infections because of dense person-to-person contact in schools. We piloted a low-cost handwashing intervention among elementary schoolchildren in Bangladesh. We trained teachers to lead behavior change communication sessions using flipcharts to encourage students’ handwashing befo...

Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug s...

In low- and middle-income countries, most latrines are not accessible to young children. We explored how to modify existing pit latrines to make them child friendly. We conducted four focus group discussions with mothers to explore barriers to child latrine use. We then enrolled 20 households with a child aged 3–7 years old to test six enabling tec...

The rising salinity of land and water is an important, but understudied, climate change-sensitive trend that can exert devastating impacts on food security. This mixed methods investigation combines salinity testing with qualitative research methods to explore these impacts in one of the most salinity-affected regions in the world—the Ganges River...

Background South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural cha...

Community health workers (CHWs) are key to implementing community-based health interventions and quality can be enhanced by better understanding their lived experiences. The WASH Benefits, Bangladesh trial engaged 540 female CHWs to promote varying health intervention packages. We report on factors influencing their lived experiences during the tri...

In low- and middle-income countries (LMICs), hand sanitizer may be a convenient alternative to soap and water to increase hand hygiene practices. We explored perceptions, acceptability, and use of hand sanitizer in rural Bangladesh. We enrolled 120 households from three rural villages. Promoters distributed free alcohol-based hand sanitizer, instal...

Background: South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals, a lack of compliance with policy among healthcare providers, high population density and high infectious disease burden. This paper describes development of social and behavioural change communication (SBCC) to i...

1) Background: Residents of Dhaka slums frequently lack clean and functional shared latrines. We explored the role of landlords and compound managers in promoting latrine cleanliness in the intervention arm of a randomized trial; (2) Methods: We conducted focus group discussions, key informant interviews, and in-depth interviews with community heal...

Background: Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore under...

Background In the south-western coastal region of Bangladesh ground water, normally used for drinking, is excessively saline. Increased salinity in drinking water can have a range of adverse health impacts. Managed aquifer recharge (MAR) systems, which infiltrate rainwater and fresh pond water into aquifers, are adaptive strategies to deliver low-s...

Background To understand how to reduce antibiotic use, greater knowledge is needed about the complexities of access in countries with loose regulation or enforcement. This study aimed to explore how households in Bangladesh were accessing antimicrobials for themselves and their domestic animals.Methods In-depth interviews were conducted with 48 hou...

Schoolchildren are commonly linked to influenza transmission. Handwashing with soap has been shown to decrease infections; however, improving handwashing practices using soap and water is difficult in low-resource settings. In these settings, alternative hygiene options, such as hand sanitizer, could improve handwashing promotion to reduce influenz...

Hundreds of thousands of children continue to die each year from diarrhea. We piloted a low-cost liquid chlorine point-of-use (POU) water treatment among elementary school children in Bangladesh. We began the 1-month intervention in four schools (two urban and two rural) by introducing POU drinking water hardware and behavior change communication....

Poor hand hygiene and food handling put consumers of restaurant and street food at risk of enteric disease, especially in low-income countries. This study aimed to collect hygiene indicators from a nationally representative sample of restaurants and street food vendors. The field team collected data from 50 rural villages and 50 urban administrativ...

Handwashing instructions vary in complexity, with some recommending multiple steps. To assess whether complex handwashing instructions changed handwashing procedure replication, we conducted a randomized non-inferiority trial in a low-income area, Dhaka. We randomly assigned mothers and children aged 5-10 years to one of three handwashing instructi...

Objective The behavioural effect of large‐scale handwashing promotion programmes has been infrequently evaluated, and variation in the effect over time has not been described. We assess the effect of a large‐scale handwashing promotion programme on handwashing outcomes in a community setting in Dhaka, Bangladesh. Methods We analysed data from a cl...

Introduction Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited r...

We assessed the impact of handwashing promotion on reported respiratory illness as a secondary outcome from among > 60,000 low-income households enrolled in a cluster-randomized trial conducted in Bangladesh. Ninety geographic clusters were randomly allocated into three groups: cholera-vaccine-only; vaccine-plus-behavior-change (handwashing promoti...

Hundreds of thousands of children continue to die each year from diarrhea. We piloted a low-cost liquid chlorine point-of-use (POU) water treatment among elementary school children in Bangladesh. We began the 1-month intervention in four schools (two urban and two rural) by introducing POU drinking water hardware and behavior change communication....

Background: Water, sanitation, and hygiene (WASH) efficacy trials deliver interventions to the target population under optimal conditions to estimate their effects on outcomes of interest, to inform subsequent selection for inclusion in routine programs. A systematic and intensive approach to intervention delivery is required to achieve the high-l...

Handwashing with soap at key times is an effective means of reducing pathogen transmission. In a low-income community in urban Dhaka, we piloted and evaluated the acceptability and feasibility of a shared handwashing intervention. This included promotion by community health promoters of a homemade solution of detergent powder mixed with water and s...

Salinity, exacerbated by global environmental change and other phenomena, is a major challenge affecting densely populated river deltas around the world. One critical consequence of salinity is its effect on access to freshwater, crucial for drinking, hygiene, and other livelihood activities. To gain insight on the impacts and adaptation responses...

Background: Diarrhoea and growth faltering in early childhood are associated with subsequent adverse outcomes. We aimed to assess whether water quality, sanitation, and handwashing interventions alone or combined with nutrition interventions reduced diarrhoea or growth faltering. Methods: The WASH Benefits Bangladesh cluster-randomised trial enr...

School children are important vectors for transmitting influenza. High infection rates among children and overcrowding at schools in many low-income countries make children more susceptible to exposure and spread of influenza viruses at school. Common measures to prevent transmission include non-pharmaceutical interventions such as handwashing and...

Schools convene many people together for a prolonged time, facilitating spread of respiratory pathogens and amplifying epidemics. Crowded Bangladeshi schools lack the infrastructure to support optimal cough etiquette behaviors. We collected formative data on current practices from four elementary schools, and developed and piloted a low-cost cough...

Background: Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalizat...

Background Bangladesh faces daunting challenges in addressing the sanitation needs of its urban poor. Maintaining the cleanliness and functionality of communal toilets is dependent upon periodic emptying of fecal sludge, and cooperation between users of communal toilets. Trash disposal into latrines can block the outflow pipes, rendering the toilet...

Objectives: Shared toilets in urban slums are often unclean and poorly maintained, discouraging consistent use and thereby limiting impacts on health and quality of life. We developed behaviour change interventions to support shared toilet maintenance and improve user satisfaction. We report the intervention effectiveness on improving shared toile...

Background Health programs commonly promote handwashing by drawing attention to potential fecal contamination in the environment. The underlying assumption is that the thought of fecal contamination will result in disgust, and motivate people to wash their hands with soap. However, this has not proven sufficient to achieve high rates of handwashing...

Background Diarrhea prevalence increases from around the time that complementary foods are introduced. Improving caregiver’s hand hygiene during food preparation could reduce complementary food contamination and enteric pathogen transmission. Washing hands with soap is more common when water and soap are together at a convenient location. We conduc...

We conducted a nonrandomized trial of strategies to promote soapy water for handwashing in rural Bangladesh and measured uptake. We enrolled households with children < 3 years for three progressively intensive study arms: promotion of soapy water (N = 120), soapy water promotion plus handwashing stations (N = 103), and soapy water promotion, statio...

Background Shared toilets in urban slums are often unclean and poorly maintained which results in underutilized or abandoned sanitation facilities, encouraging open defecation. Improving water, sanitation and hygiene (WASH) facilities and WASH-related behaviors of urban slum residents is difficult because of limited space, weak social support, and...

This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process....

Background: Contaminated complementary foods are associated with diarrhea and malnutrition among children aged 6 to 24 months. However, existing complementary food safety intervention models are likely not scalable and sustainable. Objective: To understand current behaviors, motivations for these behaviors, and the potential barriers to behavior...

Background: Shared toilets in urban slums are often unclean and poorly maintained. Dirty, poorly maintained sanitation facilities may be underutilized or abandoned encouraging open defecation. Previous studies have measured cleanliness based on user's perceptions. This study describes multiple objective indicators of cleanliness of shared toilets a...

Background: Bangladeshi public hospitals often lack handwashing stations and have intermittent water supplies. We deployed a hand sanitizer intervention in a public hospital to improve hand-hygiene behavior among family caregivers (FCG), who provide the majority of nursing care to patients, and healthcare workers (HCW). Method: We conducted this...

Bangladeshi communities have historically used ash and soil as handwashing agents. A structured observation study and qualitative interviews on the use of ash/soil and soap as handwashing agents were conducted in rural Bangladesh to help develop a handwashing promotion intervention. The observations were conducted among 1,000 randomly selected hous...

Introduction: Diarrhea, an important cause of child death, increases from around the time that complementary foods are introduced. Consumption of contaminated food may contribute to diarrhea and growth faltering. Caregiver's hand hygiene during food preparation can prevent food contamination and reduce diarrhea transmission. Washing hands with soap...

Enteric diseases are often caused by poor hygiene and can contribute to stunting. From 50 randomly selected villages in Bangladesh, we collected quantitative and qualitative data on handwashing linked to child feeding to integrate handwashing promotion into a young child complementary feeding program. Most participants stated that the community kne...

In Bangladesh diarrhoeal disease and respiratory infections contribute significantly to morbidity and mortality. Handwashing with soap reduces the risk of infection; however, handwashing rates in infrastructure-restricted settings remain low. Handwashing stations -- a dedicated, convenient location where both soap and water are available for handwa...

Introduction Cost, theft, wastage and difficulty sharing are barriers to keeping soap at a hand washing station that hinder regular hand washing in low income communities. Soapy water, a water solution of locally available detergent, contained in plastic soda bottles is a low cost alternative to bar soap. We piloted soapy water in rural communities...

Respiratory infections are the leading cause of childhood deaths in Bangladesh. Promoting respiratory hygiene may reduce infection transmission. This formative research explored community perceptions about respiratory infections. We conducted 34 in-depth interviews and 16 focus group discussions with community members and school children to explore...