Magnitude and Predictors of Health Care Workers Depression During the COVID-19 Pandemic: Health Facility-Based Study in Eastern Ethiopia

Background: Depression of health care workers was related to work absences, resignations, and poor work performance, affecting the quality of patient care and the health care system. The Coronavirus disease pandemic has had an effect on the mental health of health care workers. Health care workers are facing challenges that can be stressful, overwhelming, and cause strong emotions, may put them at higher risk to develop depression. There is limited evidence that assesses health care workers' depression and its associated factors in the study area during the Coronavirus disease pandemic. Therefore this study aimed to assess depression and associated factors among health care workers in eastern Ethiopia.Method: The cross-sectional study design was conducted from October 26th to November 15, 2020. A total of 265 health care workers from 10 health facilities participated. Patient Health Questionnaire was used for the collection of depressive symptoms. The data were analyzed by using STATA version 14 software. To assess the association between depression and the predictors Adjusted Odds Ratio along with a 95% confidence interval was estimated by using logistic regression analysis. A statistical significance was declared at p-value ≤ 0.05.Results: Of the total 265 study participant, 176 (66.4%) and 95% CI: 60.4%, 71.8% of them reported depressive symptoms. Of 176 reported symptoms of depression 27.9, 24.1, 9.4, 3.7, and 1.1% were had minimal, mild, moderate, moderate-severe, and severe depressive symptoms respectively. The multivariable logistic regression analysis revealed the odds of depression were 2.34 times higher among female participants compared to male participants (AOR: 2.34, 95%CI: 1.09-5.02). In addition, the odds of depression for participants who perceived susceptibility to COVID-19 was 4.05 times higher among their counterpart (AOR: 4.05, 95%CI: 1.12-14.53).Conclusions: Health care workers who experienced depression in the study was high. Health care workers' mental health needs to be protected during the COVID-19 pandemic. Female health care workers and health care workers perceived susceptibility of COVID-19 need attention.

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Depressive Symptoms among Haramaya University Students in Ethiopia: A Cross-Sectional Study

Depression Research and Treatment ◽

10.1155/2020/5027918 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Mitiku Teshome Hambisa ◽

Andualem Derese ◽

Tilahun Abdeta

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Regression Analysis ◽

Depressive Symptoms ◽

University Students ◽

Logistic Regression Analysis ◽

Associated Factors ◽

Mental Health Problems ◽

Cross Sectional Study ◽

Cross Sectional

Background. The prevalence of mental health problems including depression is increasing in severity and number among higher institution students, and it has a lot of negative consequences like poor academic performance and committing suicide. Identifying the prevalence and associated factors of mental illness among higher institution students is important in order to administer appropriate preventions and interventions. In Ethiopia, only a few studies tried to report associated factors of depression among university students. Objective. The objective of this study was to determine the prevalence and factors associated with depressive symptoms among Haramaya University students, Ethiopia. Methods. Institution-based, cross-sectional study design was conducted among 1040 students. A standard, self-administered questionnaire was used to get data from a sample of randomly selected 1040 undergraduate university students using a multistage systematic random sampling technique. The questionnaire used was the Beck Depression Inventory (BDI) scale which is a self-report 21-item scale that is used to assess the presence of depressive symptoms. All 21 items are rated on a three-point scale (0 to 3). Each question is scored on a 0 to 3 scale, and total scores range from 0 to 63, with higher scores reflecting greater levels of depressive symptoms. The questionnaire has been well validated as a measure of depressive symptomatology with scores 1-13 indicating minimal depressive symptoms, 14-19 showing mild depressive symptoms, 20-28 showing moderate depressive symptoms, and 29-63 indicating severe depressive symptoms. Logistic regression analysis was used to identify variables independently associated with depressive symptoms after we dichotomized the depressive symptoms screening tool to “yes/no” depressive symptoms. This means students who did not report any depressive symptoms were given “no” depressive symptoms and who reported at least one (≥1) depressive symptoms were given “yes” (depressive symptoms). Results. A total of 1022 (98.3%) out of 1040 students participated in this study. The mean age of participants was 20.9 years (SD±2.17), and the majority of them (76.0%) were male students. Prevalence of depressive symptoms among undergraduate students was 26.8% (95% CI: 24.84, 28.76). Among those who had reported depressive symptoms: 10%, 12%, 4%, and 1% of students reported minimal, mild, moderate, and severe depressive symptoms, respectively. Multivariable logistic regression analysis in the final model revealed that being a first-year student (AOR 6.99, 95% CI: 2.31, 21.15, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), and being a third-year student (AOR 3.85, 95% CI: 1.26, 11.78, p value < 0.018) and being divorced/widowed (AOR 5.91, 95% CI: 1.31, 26.72, p value < 0.021), current drinking alcohol (AOR 2.53, 95% CI: 1.72,3.72, p value < 0.001), current smoking cigarettes (AOR 1.71, 95% CI: 1.02, 2.86, p value < 0.042), and current use of illicit substances (AOR 2.20, 95% CI: 1.26, 3.85, p value < 0.006) were independently associated with depressive symptoms. Having no religion and currently chewing Khat were statistically significantly associated with depressive symptoms in the binary logistic regression analysis but not in the final model. Conclusions. The prevalence of depressive symptoms among university students in this study is high relative to the general population. Sociodemographic factors year of study and current substance use were identified as associated factors of depressive symptoms. Recommendations. This finding suggests the need for the provision of mental health services at the university, including screening, counseling, and effective treatment. Families need to closely follow their students’ health status by having good communication with the universities, and they have to play their great role in preventing depression and providing appropriate treatment as needed. The governments and policy-makers should stand with universities by supporting and establishing matured policies which helps universities to have mental health service centers. Generally, the university and other stakeholders should consider these identified associated factors for prevention and control of mental health problems of university students.

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COVID-19 vaccine confidence and hesitancy among health care workers: A cross-sectional survey from a MERS-CoV experienced nation

PLoS ONE ◽

10.1371/journal.pone.0244415 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0244415

Author(s):

Mazin Barry ◽

Mohamad-Hani Temsah ◽

Abdullah Alhuzaimi ◽

Nurah Alamro ◽

Ayman Al-Eyadhy ◽

...

Keyword(s):

Health Care ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Health Care Workers ◽

Outcome Variable ◽

Cross Sectional ◽

Validated Questionnaire ◽

Care Workers ◽

To Receive

Objectives This study aimed to identify coronavirus disease 2019 (COVID-19) vaccine perception, acceptance, confidence, hesitancy, and barriers among health care workers (HCWs). Methods An online national cross-sectional pilot-validated questionnaire was self-administered by HCWs in Saudi Arabia, which is a nation with MERS-CoV experience. The main outcome variable was HCWs’ acceptance of COVID-19 vaccine candidates. The factors associated with vaccination acceptance were identified through a logistic regression analysis, and the level of anxiety was measured using a validated instrument to measure general anxiety levels. Results Out of the 1512 HCWs who completed the study questionnaire—of which 62.4% were women—70% were willing to receive COVID-19 vaccines. A logistic regression analysis revealed that male HCWs (ORa = 1.551, 95% CI: 1.122–2.144), HCWs who believe in vaccine safety (ORa = 2.151; 95% CI: 1.708–2.708), HCWs who believe that COVID vaccines are the most likely way to stop the pandemic (ORa = 1.539; 95% CI: 1.259–1.881), and HCWs who rely on the Centers for Disease Control and Prevention website for COVID 19 updates (ORa = 1.505, 95% CI: 1.125–2.013) were significantly associated with reporting a willingness to be vaccinated. However, HCWs who believed that the vaccines were rushed without evidence-informed testing were found to be 60% less inclined to accept COVID-19 vaccines (ORa = 0.394, 95% CI: 0.298–0.522). Conclusion Most HCWs are willing to receive COVID-19 vaccines once they are available; the satisfactoriness of COVID-19 vaccination among HCWs is crucial because health professionals’ knowledge and confidence toward vaccines are important determining factors for not only their own vaccine acceptance but also recommendation for such vaccines to their patients.

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Health care workers depression and associated factors during COVID-19. Health facility-based study in Eastern Ethiopia

10.21203/rs.3.rs-135135/v1 ◽

2020 ◽

Author(s):

Tesfaye Assebe Yadeta ◽

Yadeta Desie Baca ◽

Bikila Balis

Keyword(s):

Health Care ◽

Depressive Symptoms ◽

Health Care Workers ◽

Work Experience ◽

Associated Factors ◽

Depression Symptoms ◽

Eastern Ethiopia ◽

Perceived Susceptibility ◽

Perceived Severity ◽

Care Workers

Abstract Background Depression of health care workers was related to work absences, resignations, and poor work performance, affecting the quality of patient care and the health care system. It may be at higher risk during the Coronavirus disease (COVID-19) pandemic. There is limited evidence that assesses depression and its associated factors in the study area. Therefore this study aimed to assess depression and associated factors among health care workers (HCW) in eastern Ethiopia. Method: The cross-sectional study design was conducted from October 26th to November 10, 2020. To assess depression among health care workers. Patient Health Questionnaire (PHQ-19) questionnaire was used for the collection of depressive symptoms. The data were analyzed by using STATA version 14 software. Adjusted Odds Ratio (AOR) along with 95% CI was estimated to examine factors associated with depression symptoms using logistic regression analysis. Results Of the total 265 study participant, 176 (66.4%) and 95% CI: 60.4%, 71.8% of them reported depressive symptom. Of 176 reported symptoms of depression 27.9%, 24.1%, 9.4%, 3.7%, and 1.1% were had minimal, mild, moderate, moderate-severe, and severe depressive symptoms respectively. Being female [AOR: 3.40, (95%CI: (1.79, 6.45)], participants who perceived susceptibility to COVID-19 [AOR: 2.30, (95%CI: (1.12, 4.71)], and perceived severity to COVID-19 [AOR: 3.06, (95%CI: (1.35, 6.91)] were higher risks of experiencing depression symptoms. Participants who had work experience 3–5 years [AOR: 0.21, (95%CI: (0.08, 0.56)], and the participant who had 6–10 years’ work experience [AOR: 0.30, (95%CI: (0.11, 0. 84)] were had less likely to experience depression symptoms when compared with a participant who had two and fewer years of work experience. Conclusions A high proportion of health care workers experienced depression symptoms. Health care workers' mental health needs to be protected during the COVID-19 pandemic. Female health care workers, junior health care workers, and HCWs perceived susceptibility, and perceived severity of COVID-19 need attention.

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Prevalence and Associated Factors of Posttraumatic Stress Symptoms and Stigma among Health Care Workers in Contact with COVID-19 Patients

Iranian Journal of Psychiatry ◽

10.18502/ijps.v15i4.4303 ◽

2020 ◽

Author(s):

Atefeh Zandifar ◽

Rahim Badrfam ◽

Nami Mohammadian Khonsari ◽

Mohammad Reza Mohammadi ◽

Hamid Asayesh ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Logistic Regression ◽

Posttraumatic Stress ◽

Health Care Workers ◽

Associated Factors ◽

Posttraumatic Stress Symptoms ◽

Multivariate Logistic Regression ◽

Stress Symptoms ◽

Care Workers

Objective: The global spread of COVID-19 has caused great psychological stress in health care workers (HCWs). This study aims to assess the prevalence and associated factors of posttraumatic stress symptoms (PTSS) and stigma among health care workers (HCWs) who are involved in treating COVID-19 patients. This study was conducted as part of studies related to assessing the mental health status of HCWs in Iran during the COVID-19 pandemic. Method: Overall, in this cross sectional study, 894 HCWs working in 9 general hospitals in Alborz province, Iran, in the field of diagnostic and treatment care of patients with COVID-19 were selected using multistage sampling method. PTSS and its subscales, including intrusion, avoidance, and hyper vigilance were obtained based on the Posttraumatic Stress Disorder-8 Item validated questionnaire. Information on Stigma's perception among HCWs was also obtained based on a questionnaire adopted from the HIV Stigma Scale. Predictors of PTSS and Stigma's perception among HCWs were assessed using multivariate logistic regression analysis. Results: Overall, 71.4% of the participants were women and 46.9% were front line staff. The prevalence of intrusion, avoidance, and hyper vigilance symptoms was 44.2% (95% CI: 40.8-47.6), 31. 8% (95% CI: 28.8-35.0), and 37.7% (95% CI: 34.5-41.0), respectively. A strong and positive significant correlation was found between stigma score with PTSD total score (coefficient: 0.83) and its components. In multivariate logistic regression model, female gender was associated with intrusion (OR: 1.46, 95% CI: 1.03-2.06) and avoidance (OR: 1.66, 95% CI: 1.147-2.417) and working in frontline increased the odds of intrusion (OR: 1.45, 95% CI: 1.06-1.97) and hyper vigilance (OR: 1.41, 95% CI: 1.03-1.91). Conclusion: The prevalence of PTSS is high among HCWs during COVID-19 pandemic and it is associated with some demographic characteristics of HCWs. This situation should be considered by health policymakers so that while trying to control the disease, the mental health status of this group of personnel should be given much attention.

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Secondary Traumatization Outcomes and Associated Factors Among the Health Care Workers Exposed to the COVID-19

International Journal of Social Psychiatry ◽

10.1177/0020764020940742 ◽

2020 ◽

pp. 002076402094074 ◽

Cited By ~ 4

Author(s):

Selim Arpacioglu ◽

Meltem Gurler ◽

Suleyman Cakiroglu

Keyword(s):

Mental Health ◽

Health Care ◽

Health Care Workers ◽

Associated Factors ◽

Health Workers ◽

Health Conditions ◽

Secondary Traumatization ◽

Mental Health Conditions ◽

Care Workers ◽

Epidemic Period

Background: Secondary traumatization exposure and mental health conditions of health care workers gained importance during the coronavirus disease 2019 (COVID-19) epidemic period. Aims: In our study, we aim to research the secondary traumatization and associated factors among health care workers. Method: This cross-sectional study was applied through an online questionnaire using the snowball sampling method. Two hundred fifty-one health care workers from different units/services and 312 non-medical worker adults attended to the research. Health care workers were divided into two groups based on working with COVID-19 patients at the frontline or not. The data were collected via Introductory Information Form, Secondary Traumatic Stress Scale (STSS) and Patient Health Questionnaire-4 (PHQ-4) between 22 May and 30 May 2020. Results: Among the 563 participants, 251 (44.6%) were health care workers and 312 (55.4%) were non-medical workers. The anxiety, depression and secondary traumatization scores of the frontline health care workers for the COVID-19 were found to be significantly higher than those of the other health workers or non-medical workers ( p < .001). Also, we found that being a woman, being in the first years of the work, living with a parent, having a chronic disease, having a trauma history and increased social media use are related to having higher scores from the secondary traumatization scale. Conclusion: The secondary traumatization exposure and the mental health conditions of the health care workers directly working with the COVID-19 patients should be taken into consideration. It is important to provide social support, examine and control riskier groups for mental health regularly during the pandemic.

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Preparedness toward COVID-19 pandemics and associated factors among health care workers in Dire Dawa Hospitals, Eastern Ethiopia: A facility-based cross-sectional study

SAGE Open Medicine ◽

10.1177/20503121211054970 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110549

Author(s):

Tameru Menberu ◽

Robel Mekonnen ◽

Yibekal Manaye ◽

Mesfin Kebede ◽

Yonatan Solomon ◽

...

Keyword(s):

Health Care ◽

Health Care Workers ◽

Associated Factors ◽

Control Policy ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Eastern Ethiopia ◽

Factors Associated ◽

Care Workers

Introduction: Health care workers are at the frontline of the response against the COVID-19 outbreak. Poor preparedness and infection prevention practices among health care workers compound the hazard and occurrence of COVID-19 hospital transmission. Thus, the study aimed to assess preparedness toward COVID-19 pandemics and associated factors among health care workers in Hospitals of Eastern Ethiopia. Methods: Facility-based cross-sectional study was conducted from 20 June to July 10 2020. A simple random sampling technique was used to select 423 health care workers. Data were collected using a structured self-administered questionnaire and analyzed using SPSS Version 23. Bivariate and multivariable logistic regression was conducted to identify factors associated with the outcome variable, and statistical significance was declared at a p-value less than 0.05. Results: This study revealed that the proportion of health care workers’ preparedness toward the COVID-19 pandemic was 40.9% (95% CI: 36.2–45.9). Working in a public hospital (AOR = 2.7, 95% CI: 1.6–4.3), being unafraid of transmitting COVID-19 to patients (Adjusted odds ratio/AOR = 4.6, 95% CI: 2.2–10.0), feeling safe at the workplace (AOR = 3.3, 95% CI: 1.7–6.4)), satisfied with the infection control policy (AOR = 6.0, 95% CI: 2.3–15.0), and not feeling anxious about the likelihood of COVID-19 spread (AOR = 2.1, 95% CI: 1.3–3.4) were significantly associated with COVID-19 preparedness. Conclusion: The majority of the health care workers were not prepared for COVID-19 pandemics. Feeling safe at the workplace scared of transmitting COVID-19 to patients, satisfied with the infection control policy, and feeling anxious concerning the likelihood of COVID-19 were factors associated with health care workers’ preparedness to COVID-19. The current awareness creation training, including motivational and psychological preparation for all health care workers, is mandatory, regardless of their profession or working place.

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Mental health outcomes among health-care workers during the COVID-19 outbreak in Iran

Mental Health Review Journal ◽

10.1108/mhrj-10-2020-0075 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Mohammad Ali Zakeri ◽

Mahlagha Dehghan ◽

Fatemeh Ghaedi Heidari ◽

Hassan Pakdaman ◽

Mehdi Mehdizadeh ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Logistic Regression ◽

Anxiety Disorder ◽

Health Care Workers ◽

Stress Disorder ◽

Generalized Anxiety ◽

Multivariate Logistic Regression ◽

Content Type ◽

Care Workers

Purpose The increasing prevalence of coronavirus disease (COVID-19) is a global crisis that leads to physical and psychological outcomes for health-care workers, so this study aims to investigate the mental health outcomes (including general health, generalized anxiety disorder and posttraumatic stress disorder) in health-care workers in Rafsanjan, Iran. Design/methodology/approach By using convenience sampling, this cross-sectional study was conducted on 332 health-care workers working in public hospitals in southern Iran. Data collection lasted from March to April 2020. General Health Questionnaire (GHQ-28), Generalized Anxiety Disorder 7-item (GAD-7) and Impact of Event Scale were used to collect data. The data were then analyzed by using SPSS 25 and descriptive and inferential statistics (chi-square and multivariate logistic regression). Findings In total 45.5% of the participants had psychological disorder according to GHQ. In addition, 25.3% of the participants had GAD and 31.6% had posttraumatic stress disorder (PTSD). The results using multivariate logistic regression showed that only income was significantly associated with psychological disorders (95% confidence interval for odds ratio: 1.32–6.45, P = 0.008). Practical implications According to the results, the incidence of GAD and PTSD was high among health-care workers. Therefore, it is recommended that the psychological skills of health-care workers be strengthened through counseling and training programs. Originality/value This paper provides a novel analysis of mental health in health-care workers in Iran.

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Estimation of incidence of tuberculosis infection in health-care workers using repeated interferon-γ assays

Epidemiology and Infection ◽

10.1017/s0950268809002751 ◽

2009 ◽

Vol 137 (12) ◽

pp. 1691-1698 ◽

Cited By ~ 21

Author(s):

T. YOSHIYAMA ◽

N. HARADA ◽

K. HIGUCHI ◽

Y. NAKAJIMA ◽

H. OGATA

Keyword(s):

Health Care ◽

Logistic Regression ◽

Mycobacterium Tuberculosis ◽

Regression Analysis ◽

Health Care Workers ◽

Interferon Γ ◽

Multivariable Logistic Regression Analysis ◽

Cross Sectional ◽

Care Workers ◽

Ifn Γ

SUMMARYThe aim was to estimate the incidence of Mycobacterium tuberculosis (Mtb) infection in health-care workers (HCWs) in Japan. We repeated cross-sectional surveys of HCWs with QuantiFERON®-TB Gold (QFT-G) in 2003, 2005 and 2007 at a hospital with tuberculosis (TB) wards, and 311 HCWs who underwent QFT-G testing two or three times were included in the study. Five HCWs (1·8%) converted from negative to positive. Incidence of new TB infection was estimated to be 0·6/100 person-years by the CDC's definition. Thirteen positive persons (41%) reverted from positive to negative. Multivariable logistic regression analysis identified a significant association between QFT-G conversion and working in TB wards. The IFN-γ levels of all but two subjects with reverting or converting QFT-G results were close to the test's cut-off. The incidence of Mtb infection in HCWs at our hospital was higher than that estimated for the general population in Japan. Criteria for defining QFT-G conversion and reversion need further investigation considering the high proportion of reversion, as the incidence of infection would have changed if we had applied other definitions.

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Psychological impact of COVID-19 pandemic on frontline health care workers in Bangladesh: A cross-sectional study

BJPsych Open ◽

10.1192/bjo.2021.621 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S232-S233

Author(s):

Suman Ahmed ◽

Mohammad Shamsul Ahsan ◽

Rubaiya Khan ◽

Mahbubul Hasan ◽

Fahmida Ferdous ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Regression Analysis ◽

Health Care Workers ◽

Health Care Professionals ◽

Health Workers ◽

P Value ◽

Cross Sectional ◽

Frontline Health Workers ◽

Care Workers

AimsFrontline health care workers exposed to COVID-19 patients could be at increased risk of developing psychological issues. The study aimed to estimate the prevalence of mental health-related problems, specifically depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia among health care professionals during the COVID-19 pandemic in Bangladesh and to compare these between medical and allied health care professionals.MethodThis cross-sectional survey was conducted using Google Form then subsequent telephone interview between June and August 2020. Using random sampling, a total of 479 health care professionals participated in the study. We collected data on demographics. Anxiety and depression were measured using 4 items Patient Health Questionnaire-4 (PHQ-4), PTSD was measured using 4 items Primary Care (PC)-PTSD-Screen, and insomnia was measured by using a 7-item Insomnia Severity Index (ISI). A multivariable logistic regression analysis was performed to assess risk factors associated with mental health symptoms.ResultOverall, 17.6% of frontline health workers had symptoms of anxiety, 15.5% had depression symptoms, 7.6% had PTSD symptoms and 5.9% had symptoms of insomnia. Compared to allied health professionals (n = 113, 24%), doctors (n = 366, 76%) had significantly higher prevalence of anxiety: 21.1% vs 06%, (OR = 4.19; 95% CI = 1.88–9.35; p-value <0.001); depression: 18% vs 6.8%, (OR = 2.99; 95% CI = 1.40–6.42; p-value 0.005); PTSD: 9.4% vs 1.7%, (OR = 5.96; 95% CI = 1.41–25.11; p-value 0.015) and insomnia: 7.4% vs 0.9%, (OR = 9.22; 95% CI = 1.24–68.4; p-value 0.03). Logistic regression analysis showed that pre-existing medical illness has significantly more risks of developing symptoms of anxiety (adjusted OR = 2.85; 95% CI = 1.71–4.76; p-value <0.001) and depression (OR = 2.29; 95% CI = 1.39–3.77; p-value 0.001). Having a postgraduate degree (adjusted OR = 6.13; 95% CI = 1.28–29.28; p-value 0.023) and working in secondary care setting (adjusted OR = 3.08; 95% CI = 1.18–8.02; p value 0.021) have significant predictors of developing anxiety symptoms among health workers. Those who had worked more than 6 weeks in COVID-19 dedicated hospitals had risk of developing symptoms of PSTD (OR = 2.83; 95% CI = 1.35–5.93; p value 0.006) and insomnia (OR = 2.63; 95% CI = 1.15–6.02; p value 0.022).ConclusionOur study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers (particularly among doctors) during the COVID-19 pandemic. There is an urgent need to address the mental health needs of frontline health workers.Funding: Medical Research Council, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

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