Md. Mahbubur Rahman

• MBBS, DPS ,MPH, MPS
• Project Manager at International Centre for Diarrhoeal Disease Research

Shorter telomere length (TL) is associated with an increased risk for developing chronic or age-related diseases in adults. The process of telomere shortening is accelerated in response to stress and is well characterized in adult populations from high-income countries. Prior studies suggest the relationship between stress, shorter TL, and disease...

Introduction Early life soil-transmitted helminth (STH) infection and diarrhoea are associated with growth faltering, anaemia, impaired child development and mortality. Exposure to faecally contaminated soil inside the home may be a key contributor to enteric infections, and a large fraction of rural homes in low-income countries have soil floors....

Background A previous cluster-randomized controlled trial in Bangladesh found that individual or combined water, handwashing, sanitation, and nutrition interventions during pregnancy and after birth improved developmental outcomes of children at 1 and 2 years of age. We aimed to determine if these intervention effects were sustained at school-age....

Soil can harbor enteropathogens and antimicrobial-resistant organisms in settings with domestic animals. We enrolled 49 households with young children (28 soil floors, 21 concrete floors) in Bangladesh and recorded animal ownership/management. Staff swabbed the floor of children’s sleeping area with a sterile sponge and collected floor dust and a c...

Background In low- and middle-income countries like Bangladesh, inadequate water, sanitation, and hygiene (WASH) practices lead to a higher disease burden among children and hinder their academic performance. However, there have been efforts to improve WASH between 2014 and 2018. Objectives The study aimed to investigate changes in WASH facilities...

Children in low-resource settings often consume microbially contaminated food, risking their health. We evaluated the impact of a food hygiene intervention on complementary food contamination in Bangladesh. A 3-year homestead food production intervention was complemented by an 8-month behavior change module to improve household food hygiene practic...

Background Water, sanitation, hygiene (WSH), nutrition (N), and combined (N+WSH) interventions are often implemented by global health organizations, but WSH interventions may insufficiently reduce pathogen exposure, and nutrition interventions may be modified by environmental enteric dysfunction (EED), a condition of increased intestinal permeabili...

Introduction In Bangladesh, the reported prevalence of mental disorders among adults varies from 6.5% to 31.0%. This study aims to identify the socio-demographic factors associated with mental health disorders among rural women in Bangladesh. Method We enrolled 401 adult women from four sub-districts of Mymensingh district, Bangladesh. To determin...

Background: Poor sanitation and fecal sludge management contribute to fecal contamination in Dhaka's urban environment. An exposure assessment through nine-environmental pathways was conducted using the SaniPath tool to understand the risk of exposure to fecal contamination. Methods: Data collection took place from April 2017-January 2018 in ten ne...

Background Weather extremes are predicted to influence pathogen exposure but their effects on specific faecal–oral transmission pathways are not well investigated. We evaluated associations between extreme rain and temperature during different antecedent periods (0–14 days) and Escherichia coli along eight faecal–oral pathways in rural Bangladeshi...

Antibiotics can trigger antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and undernutrition can reduce infections and antibiotic use. We assess effects of water, sanitation, handwashing (WSH) and nutrition interventions on caregiver-reported antibiotic use in Bangladesh and Kenya, longitudinally measured at three time...

Unsafe hospital wastewater (HWW) is a significant concern, especially in low-and middle-income countries (LMICs) where the health impact is often underreported. Socio-technical systems (STS) theory, which examines the interplay between social and technical elements within complex systems, is widely used in developed countries but rarely applied in...

Background: While water, sanitation, and hygiene (WASH) interventions can reduce diarrheal disease, many large-scale trials have not found the expected health gains for young children in low-resource settings. Evidence-based guidance is needed to improve interventions and remove barriers to diarrheal disease reduction. Objectives: We aimed to es...

Sanitation approaches in low-income urban areas are predominately on-site sanitation, with septic tanks promoted as an improved sanitation solution. While a septic tank system is designed to contain sludge in the tank and discharge effluent to a soil infiltration system, in many urban contexts effluent from tanks discharge directly to open drains o...

In low- and middle-income countries, living in homes with soil floors and animal cohabitation may expose children to fecal organisms, increasing risk of enteric and antimicrobial-resistant infections. Our objective was to understand whether cow cohabitation in homes with soil floors in rural Bangladesh contributed to the presence and diversity of p...

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Background Prenatal depression can have lasting adverse impacts on child health. Little is known about the impact of floods on prenatal depression in low- and middle-income countries. Methods We conducted a cross-sectional survey of 881 pregnant women from September 24, 2023 to July 19, 2024 in riverine communities in rural Bangladesh. We recorded...

BACKGROUND Street food comprises prepared and readily available food and drinks sold by vendors, frequently situated along streets. It is popular among people of all classes as it is low-cost and readily available. However, unsafe food hygiene practices contribute to a substantial burden of foodborne illness particularly in insufficient hygiene dur...

Background: Low-cost, household-level water, sanitation, and hygiene (WASH) and nutrition interventions can reduce pediatric antibiotic use, but the mechanism through which interventions reduce antibiotic use has not been investigated. Methods: We conducted a causal mediation analysis using data from the WASH Benefits Bangladesh cluster-randomized...

Weather events associated with climate change can influence the environmental spread and survival of fecal pathogens, potentially impacting the efficacy of water, sanitation, and hygiene (WASH) interventions. We used longitudinal data from a randomized controlled trial in Bangladesh to assess whether rainfall and temperature modified the effect of...

Unsafe hospital wastewater is a significant concern, especially in low- and middle-income countries (LMICs) where the health impact is often underreported. Socio-technical systems (STS) theory, which examines the interplay between social and technical elements within complex systems, is widely used in developed countries but rarely applied in LMIC...

Background Lead, a potent neurotoxin, causes irreversible damage to the nervous system, and low- and middle-income countries face huge health and economic productivity losses due to childhood lead exposure. In Bangladesh, informal Used Lead Acid Battery (ULAB) recycling sites are an important source of lead pollution. Little is known about lead awa...

We present results from a randomized controlled trial in Bangladesh that introduced operational practices to improve energy efficiency and reduce emissions in 276 "zigzag" brick kilns. 65% of intervention kilns adopted the improved practices. Treatment assignment reduced energy use by 10.3% (p-value<0.001) and decreased CO2 and PM2.5 emissions by 1...

Due to global climate change and anthropogenic activities, many low-lying coastal communities experience high sodium in drinking water as a result of saltwater intrusion, an emerging environmental health problem in many coastal regions. Drinking saline water is associated with higher sodium intake and hypertension. Exposure to higher ambient temper...

Introduction Early life soil-transmitted helminth infection and diarrhea are associated with growth faltering, anemia, impaired child development, and mortality. Exposure to fecally contaminated soil inside the home may be a key contributor to enteric infections, and a large fraction of rural homes in low-income countries have soil floors. The obje...

Children in low-resource settings often consume microbially contaminated food, posing a risk to their health. We evaluated the impact of a food hygiene intervention on complementary food contamination in Bangladesh. A three-year homestead food production intervention was complemented by an eight-month behavior change module to improve household foo...

Antimicrobial resistance (AMR) is a rising health concern worldwide. As an indicator organism, E. coli, specifically extended-spectrum β-lactamase (ESBL) producing E. coli, can be used to detect AMR in the environment and estimate the risk of transmitting resistance among humans, animals and the environment. This study focused on detecting cefotaxi...

Background Lack of access to functional and hygienic toilets in healthcare facilities (HCFs) is a significant public health issue in low- and middle-income countries (LMICs), leading to the transmission of infectious diseases. Globally, there is a lack of studies characterising toilet conditions and estimating user-to-toilet ratios in large urban h...

Background: Water contamination, particularly in humanitarian contexts, poses a significant health risk due to waterborne diseases exacerbated by fecal matter. Point-of-use water treatment with chlorine may reduce diarrheal disease around the globe including in humanitarian settings. However, applying chlorination to underground water is challengin...

Background A number of studies have detected relationships between weather and diarrhea. Few have investigated associations with specific enteric pathogens. Understanding pathogen-specific relationships with weather is crucial to inform public health in low-resource settings that are especially vulnerable to climate change. Objectives Our objectiv...

Frequent antibiotic use in areas with high infection burdens can lead to antimicrobial resistance and microbiome alterations. Reducing pathogen exposure and child undernutrition can reduce infections and subsequent antibiotic use. We assessed effects of water, sanitation, handwashing (WSH) and nutrition interventions on pediatric antibiotic use in...

BACKGROUND Plastic pollution has reached alarming magnitude, defining the contemporary era as the ‘Plastic Age.’ Uncontrolled plastic production and inadequate recycling processes have led to widespread contamination of the environment with micro and nanoplastics. OBJECTIVE Understanding the extent of environmental exposure to plastic additives an...

Background Plastic pollution has reached an alarming magnitude, defining the contemporary era as the “Plastic Age.” Uncontrolled plastic production and inadequate recycling processes have led to widespread contamination of the environment with micro and nanoplastics. Objective The study aims to assess the environmental and human health consequence...

A regulated stress response is essential for healthy child growth and development trajectories. We conducted a cluster-randomized trial in rural Bangladesh (funded by the Bill & Melinda Gates Foundation, ClinicalTrials.gov NCT01590095) to assess the effects of an integrated nutritional, water, sanitation, and handwashing intervention on child healt...

Background: Diarrheal disease is a leading cause of childhood morbidity and mortality globally. Household water, sanitation, and handwashing (WASH) interventions can reduce exposure to diarrhea-causing pathogens, but meteorological factors may impact their effectiveness. Information about effect heterogeneity under different weather conditions is...

Background: Water, sanitation, hygiene (WSH), nutrition (N), and combined (N+WSH) interventions are often implemented by global health organizations, but WSH interventions may insufficiently reduce pathogen exposure, and nutrition interventions may be modified by environmental enteric dysfunction (EED), a condition of increased intestinal permeabil...

Background The WASH benefits Bangladesh trial multi-component sanitation intervention reduced diarrheal disease among children < 5 years. Intervention components included latrine upgrades, child feces management tools, and behavioral promotion. It remains unclear which components most impacted diarrhea. Methods We conducted mediation analysis with...

Background Quantifying contributions of environmental faecal contamination to child diarrhoea and growth faltering can illuminate causal mechanisms behind modest health benefits in recent water, sanitation, and hygiene (WASH) trials. We aimed to assess associations between environmental detection of enteropathogens and human or animal microbial sou...

Introduction Men are vulnerable to ambient heat-related kidney disease burden; however, limited evidence exists on how vulnerable women are when exposed to high ambient heat. We evaluated the sex-specific association between ambient temperature and urine electrolytes, and 24-hour urine total protein, and volume. Methods We pooled a longitudinal 56...

Many diarrhea-causing pathogens are climate-sensitive, and populations with the lowest socioeconomic position (SEP) are often most vulnerable to climate-related transmission. Household Water, Sanitation, and Handwashing (WASH) interventions constitute one potential effective strategy to reduce child diarrhea, especially among low-income households....

There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead...

Background The influx of Forcibly Displaced Myanmar Nationals (FDMNs) has left the Southwest coastal district of Cox’s Bazar with one of the greatest contemporary humanitarian crises, stressing the existing water, sanitation, and hygiene (WASH) resources and services. This study aimed to assess the existing capacity of local institutions involved i...

Cluster randomized trials are often used to study large-scale public health interventions. In large trials, even small improvements in statistical efficiency can have profound impacts on the required sample size and cost. Location integrates many socio-demographic and environmental characteristics into a single, readily available feature. Here we s...

Introduction Air pollution is a global issue that poses a significant threat to public health. Children, due to their developing physiology, are particularly susceptible to the inhalation of environmental pollutants. Exposure can trigger immune modulation and organ damage, increasing susceptibility to respiratory diseases. Therefore, we aim to exam...

Background: The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. Objectives: This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in r...

Background Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately higher in low- and middle-income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. In LMICs, an estimated half of all newborns are born at home and few receive screening or treatment for hyperbilirubinemia,...

Waste and sanitation workers in South-Asian countries are vulnerable to injuries and diseases, including COVID- 19. In Bangladesh, an intervention was implemented during COVID-19 to lower these workers’ occupational health risks through training and PPE distribution. We assessed how the intervention affected their occupational health behaviors usin...

Background Weather extremes are predicted to influence pathogen exposure but their effects on specific fecal-oral transmission pathways are not well investigated. We evaluated effects of extreme rain and temperature during different antecedent periods (0-14 days) on E. coli along eight fecal-oral transmission pathways in rural Bangladeshi household...

Introduction: Behavioural interventions could improve caregivers’ food hygiene practices in low-resource set- tings. So far, evidence is limited to small-scale and short-term studies, and few have evaluated the long-term maintenance of promoted behaviours. We evaluated the effect of a relatively large-scale behaviour change intervention on medium a...

Poor sanitation and hygiene practices and inadequate diets can contribute to environmental enteric dysfunction (EED). We evaluated the impact of a combined homestead food production and food hygiene intervention on EED biomarkers in young children in rural Bangladesh. The analysis was conducted within the Food and Agricultural Approaches to Reducin...

School-based water, sanitation, and hygiene (WASH) promotion often lacks strategies to sustain behaviors beyond the promotion period. This paper describes school community engagement, in the form of a hygiene committee to institutionalize a school-based hygiene intervention and its role in implementation and sustainability. With formative data on e...

Background Hundreds of millions of children in low-and middle-income countries are exposed to chronic stressors, such as poverty, poor sanitation and hygiene, and sub-optimal nutrition. These stressors can have physiological consequences for children and may ultimately have detrimental effects on child development. This study explores associations...

Many diarrhea-causing pathogens are climate-sensitive, and the poorest populations are often most vulnerable to climate-related transmission. Household Water, Sanitation, and Handwashing (WASH) interventions constitute one potential effective strategy to reduce diarrhea among children, especially among low-income households. Here, capitalizing on a...

There is an unmet need for phototherapy treatment in low- and middle-income countries (LMICs) to prevent disability and death of newborns with neonatal hyperbilirubinemia. Home phototherapy deployed by community health workers (CHWs) in LMICs may help increase access to essential newborn postnatal care in a more acceptable way for families and lead...

In addition to diet, drinking water can be an important contributor to the total body burden of salts. Water salinity (defined as the amount of dissolved salts in a body of water) has been associated with adverse health effects. We mapped the current research on drinking water salinity and its effects on blood pressure (BP). We aimed to identify kn...

Background Wastewater-based epidemiological surveillance has been considered a powerful tool for early detection and monitoring of the dynamics of SARS-CoV-2 and its lineages circulating in a community. This study is aimed to investigate the complexity of SARS-CoV-2 infection dynamics in Dhaka city by examining its genetic variants in wastewater. A...

Background: Poor immune function increases children's risk of infection and mortality. Several maternal factors during pregnancy may affect infant immune function during the postnatal period. Objectives: We aimed to evaluate whether maternal micronutrients, stress, estriol, and immune status during the first or second trimester of pregnancy were...

Our objective was to quantify the effects of yogurt supplementation and nutrition education over three months on the linear growth of infants at risk of stunting. We conducted a three-arm pilot randomized controlled trial: (1) nutrition education for mothers; (2) nutrition education plus a daily yogurt supplement (50 g) for the index child; and (3)...

Background In South Asia, roughly half of women attend at least four antenatal care visits with skilled health personnel, the minimum number recommended by the World Health Organization for optimal birth outcomes. A much greater proportion of women attend at least one antenatal care visit, suggesting that a key challenge is ensuring that women init...

Educating boys about puberty and menstruation has been hypothesized to aid in reducing menstrual stigma and negative attitudes about menstruation. We developed and piloted a school-based intervention for girls and boys to increase knowledge about puberty and foster a more supportive environment for menstruating schoolgirls. In this sub-study, we co...

Turmeric adulterated with lead chromate pigment has been previously identified as a primary source of lead exposure in Bangladesh. This study assesses the impact of a multi-faceted intervention between 2017 and 2021 to reduce lead-tainted turmeric in Bangladesh. The intervention involved: i) disseminating findings from scientific studies via news m...

Children in low- and middle-income countries face an increased risk of impaired cognitive development due to contaminated environments, poor nutrition, and inadequate responsive stimulation from caregivers. Implementing multi-component, community-level interventions may reduce these risks; however, there is little evidence supporting implementation...

Background: Sanitation interventions typically result in modest increases in latrine access, and any gains in latrine access and use are often not sustained over time. Sanitation programs also rarely include child-focused interventions such as potties. We aimed to assess the sustained effect of a multi-component sanitation intervention on access t...

Custer randomized trials are often used to study large-scale public health interventions. In large trials, even small improvements in statistical efficiency can have profound impacts on the required sample size and cost. Pair matched randomization is one strategy with potential to increase trial efficiency, but to our knowledge there have been no e...

Background: Portal hypertension is an important cause of morbidity and mortality in Bangladeshi children. Development of esophageal varices and bleeding is one of the major complications of CLD. The mortality from each episode of variceal bleeding is 30-50% depending on the clinical status of the patient. All conditions that interfere with blood fl...

Background: Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately high in low to middle income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. Of the estimated 50% of newborns born in LMICs born at home, few receive screening or treatment for hyperbilirubinemia, leading...

Background Universal screening for neonatal hyperbilirubinemia risk assessment is recommended by the American Academy of Pediatrics to reduce related morbidity. In Bangladesh and in many low- and middle-income countries, there is no screening for neonatal hyperbilirubinemia. Furthermore, neonatal hyperbilirubinemia may not be recognized as a medica...

Wastewater-based epidemiological surveillance has been considered a powerful tool for early detection and monitoring of the dynamics of SARS-CoV-2 and its lineages circulating in a community. This study collected 504 wastewater samples across different treated and untreated sanitation points in the capital city, Dhaka, Bangladesh, from September 20...

Introduction We evaluated the effects of yogurt supplementation and nutrition education to low educated mothers on infant-gut health at an early age. Methods We designed a three-arm pilot randomized controlled trial with 162 infants aged 5-6 months and at risk of stunting (LAZ ≤-1 SD and >-2 SD at enrollment) living in slum areas in Dhaka, Banglad...