ࡱ> /   MOQSUd] bjbjzz #1\1\E$$v2v2BBBCCCpFElS!C_~uXq6,$!>$d BL98qLLv2v2GL5ڌڌڌLf^v2 BڌLڌڌRЩ\>DȮkT01Ī_b<DDBF>,ڌ_#C FFFFFF_LLLLFFFFFFFFF$> <1:   RRC APPLICATION FORM RESEARCH PROTOCOL NUMBER: 2009-0 FORMTEXT 04 FOR OFFICE USE ONLYRRC Approval: FORMCHECKBOX  Yes / FORMCHECKBOX  NoDate: 2 Feb 2009ERC Approval: FORMCHECKBOX  Yes / FORMCHECKBOX  NoDate: 31 Mar 2009AEEC Approval: FORMCHECKBOX  Yes / FORMCHECKBOX  NoDate: FORMTEXT      Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Short title (in 50 characters including space): Bangladesh secondary transmission handwashing protocol Theme: (Check all that apply)  FORMCHECKBOX  Nutrition  FORMCHECKBOX  Emerging and Re-emerging Infectious Diseases  FORMCHECKBOX  Population Dynamics  FORMCHECKBOX  Reproductive Health  FORMCHECKBOX  Vaccine Evaluation  FORMCHECKBOX  HIV/AIDS  FORMCHECKBOX  Environmental Health  FORMCHECKBOX  Health Services  FORMCHECKBOX  Child Health  FORMCHECKBOX  Clinical Case Management  FORMCHECKBOX  Social and Behavioural SciencesKey words: Influenza, secondary transmission, handwashing, BangladeshRelevance of the Protocol: Influenza is an important cause of respiratory illnesses among children and adults in Bangladesh. The next influenza pandemic is expected to spread rapidly in resource-poor settings. Influenza viruses spread from human-to-human via large respiratory droplets. The greatest risk of transmission from personal contact comes from the household contact of an index case. However, there is no published data available on the secondary attack ratio or the risk factors for secondary transmission of influenza among household contacts from the index case-patients of low-income countries. Moreover, we do not have any evidence whether promoting handwashing with soap can reduce the risk of secondary transmission of influenza among household contacts. The proposed study will determine the secondary attack ratio and the risk factors for secondary transmission of influenza and assess the impact of handwashing intervention on influenza transmission among household contacts in Bangladesh. Centres Priority (as per Strategic Plan, to be imported from the attached Separate Word Sheet): 4.1 Define the epidemiology and burden of selected infectious diseases and identify effective strategies for prevention and control. 4.4 Enhance the capacity to investigate, study, and manage outbreaks of communicable diseases in the region.Programmes:  FORMCHECKBOX  Child Health Programme  FORMCHECKBOX  Nutrition Programme  FORMCHECKBOX  Programme on Infectious Diseases & Vaccine Science  FORMCHECKBOX  Poverty and Health Programme   FORMCHECKBOX  Health and Family Planning Systems Programme  FORMCHECKBOX  Population Programme  FORMCHECKBOX  Reproductive Health Programme  FORMCHECKBOX  HIV/AIDS ProgrammePrincipal Investigator (Should be a Centres staff) Dr. Stephen P. Luby Address (including e-mail address): Head, PIDVS, HSID, ICDDR,B. Mohakhali, Dhaka 1212 Email: sluby@icddrb.org  DIVISION:  FORMCHECKBOX  CSD  FORMCHECKBOX  LSD  FORMCHECKBOX  HSID  FORMCHECKBOX  PHSDCo-Principal Investigator(s): Internal  FORMTEXT       Co-Principal Investigator(s): External: (Please provide full official address including e-mail address and Gender) Pavani K. Ram, MD Assistant Professor Department of Social and Preventive Medicine School of Public Health and Health Professions University at Buffalo 3435 Main Street, Rm. 273 Farber Hall Buffalo, NY 14214 E-mail:  HYPERLINK "mailto:pkram@buffalo.edu" pkram@buffalo.edu Gender: Female Co-Investigator(s): Internal: Tasnim Azim, Eduardo Azizz-Baumgartner, W. Abdullah Brooks, Stephen Luby, Mustafizur Rahman and Rashid Uz ZamanCo-Investigator(s): External (Please provide full official address including e-mail address and Gender) Joe Bresee, Influenza Division, CDC, 1600 Clifton road, Atlanta, GA 30333, USA.  HYPERLINK "mailto:jsb6@cdc.gov" jsb6@cdc.gov. Male Alicia Fry, Influenza Division, CDC, 1600 Clifton road, Atlanta, GA 30333, USA.  HYPERLINK "mailto:agf1@cdc.gov" agf1@cdc.gov. FemaleStudent Investigator(s): Internal (Centre s staff):  FORMTEXT      Student Investigator(s): External: (Please provide full address of educational institution and Gender) Margaret DiVita, PhD Candidate, Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, Rm. 273 Farber Hall, Buffalo, NY 14214,  HYPERLINK "mailto:mdivita@udsmr.org" mdivita@udsmr.org. Female Country USA Contact person Pavani K. Ram, MD Department (including Division, Centre, Unit) Department of Social and Preventive Medicine Institution (with official address) School of Public Health and Health Professions University at Buffalo 3435 Main Street, Rm. 273 Farber Hall Buffalo, NY 14214 Directorate (in case of GoB i.e. DGHS)  FORMTEXT       Ministry (in case of GoB)  FORMTEXT       Collaborating Institute(s): Please Provide full address Institution # 1  Institution # 2 Country USA Contact person Alicia Fry, MD MPH Department (including Division, Centre, Unit) Influenza Division, National Centre for Immunization and Respiratory Diseases Institution (with official address) Centers for Disease Control and Prevention Directorate (in case of GoB i.e. DGHS)  FORMTEXT       Ministry (in case of GoB)  FORMTEXT        Institution # 3 Country  FORMTEXT       Contact person  FORMTEXT       Department (including Division, Centre, Unit)  FORMTEXT       Institution (with official address)  FORMTEXT       Directorate (in case of GoB i.e. DGHS)  FORMTEXT       Ministry (in case of GoB)  FORMTEXT       Note: If more than 3 collaborating institutions are involved in the research protocol, additional block(s) can be inserted to mention its/there particular(s). Population: Inclusion of special groups (Check all that apply): Sex  FORMCHECKBOX  Male  FORMCHECKBOX  Female Age  FORMCHECKBOX  0 4 years  FORMCHECKBOX  5 9 years  FORMCHECKBOX  10 19 years  FORMCHECKBOX  20 64 years  FORMCHECKBOX  65 +  FORMCHECKBOX  Pregnant Women  FORMCHECKBOX  Fetuses  FORMCHECKBOX  Prisoners  FORMCHECKBOX  Destitutes  FORMCHECKBOX  Service Providers  FORMCHECKBOX  Cognitively Impaired  FORMCHECKBOX  CSW  FORMCHECKBOX  Others (specify  FORMTEXT      )  FORMCHECKBOX  Animal NOTE It is the policy of the Centre to include men, women, and children in all research projects involving human subjects unless a clear and compelling rationale and justification (e.g. gender specific or inappropriate with respect to the purpose of the research) is there. Justification should be provided in the `Sample Size section of the protocol in case inclusiveness of study participants is not proposed in the study.Project/study Site (Check all the apply):  FORMCHECKBOX  Dhaka Hospital  FORMCHECKBOX  Matlab Hospital  FORMCHECKBOX  Matlab DSS Area  FORMCHECKBOX  Matlab non-DSS Area  FORMCHECKBOX  Mirzapur  FORMCHECKBOX  Dhaka Community  FORMCHECKBOX  Chakaria  FORMCHECKBOX  Abhoynagar  FORMCHECKBOX  Mirsarai  FORMCHECKBOX  Patyia  FORMCHECKBOX  Other areas in Bangladesh: Jahurul Islam Medical College Hospital, Kishorgonj  FORMCHECKBOX  Outside Bangladesh Name of Country:  FORMTEXT        FORMCHECKBOX  Multi Centre Trial (Name other countries involved):  FORMTEXT       Type of Study (Check all that apply):  FORMCHECKBOX  Case Control Study  FORMCHECKBOX  Community-based Trial/Intervention  FORMCHECKBOX  Program Project (Umbrella)  FORMCHECKBOX  Secondary Data Analysis  FORMCHECKBOX  Clinical Trial (Hospital/Clinic)  FORMCHECKBOX  Family Follow-up Study  FORMCHECKBOX  Cross Sectional Survey  FORMCHECKBOX  Longitudinal Study (cohort or follow-up)  FORMCHECKBOX  Record Review  FORMCHECKBOX  Prophylactic Trial  FORMCHECKBOX  Surveillance/Monitoring  FORMCHECKBOX  Others: NOTE: Does the study meet the definition of clinical studies/trials given by the International Committee of Medical Journal Editors (ICMJE)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Please note that the ICMJE defined clinical trial as Any research project that prospectively assigns human subjects to intervention and comparison groups to study the cause-and-effect relationship between a medical intervention and a health outcome. If YES, after approval of the ERC, the PI should complete and send the relevant form to provide required information about the research protocol to the Committee Coordination Secretariat for registration of the study into websites, preferably at the  HYPERLINK "http://www.clinicaltrials.gov" www.clinicaltrials.gov. It may please be noted that the PI would require to provide subsequent updates of the research protocol for updating protocol information in the website. Targeted Population (Check all that apply):  FORMCHECKBOX  No ethnic selection (Bangladeshi)  FORMCHECKBOX  Bangalee  FORMCHECKBOX  Tribal group   FORMCHECKBOX  Expatriates  FORMCHECKBOX  Immigrants  FORMCHECKBOX  Refugee Consent Process (Check all that apply):  FORMCHECKBOX  Written  FORMCHECKBOX  Oral  FORMCHECKBOX  None   FORMCHECKBOX  Bengali Language  FORMCHECKBOX  English Language Proposed Sample Size: Sub-group (Name of subgroup (e.g. Men, Women) and Number Name Number Name Number (1) Index case patients (2009) 200 (3)Index case patients (2010) 400 (2) Household contacts (2009) 2000 (4) Household Contacts (2010) 4000 Total sample size: 6600 a) Will the specimen be stored for future use? Yes  FORMCHECKBOX  No  FORMCHECKBOX  b) If yes, how long the specimens be preserved? _20 years. c) Will consent be obtained from study participants Yes  FORMCHECKBOX  No  FORMCHECKBOX  NA  FORMCHECKBOX  for the specimen be stored for future, for unrelated use without further taking consent? d) What types of tests will be carried out with the preserved samples? Tests will be for identification of respiratory illness other than influenza e) Will the samples be shipped to other country(ies)? Yes  FORMCHECKBOX  No  FORMCHECKBOX  NA  FORMCHECKBOX  f) If yes, name of institution(s) and country(ies): ______ surplus aliquots may be shipped to the CDC in Atlanta, GA, USA for confirmation of unsubtypable samples and for random quality control.___ g) Will the surplus/unused specimen be returned to the Centre? Yes  FORMCHECKBOX  No  FORMCHECKBOX  NA  FORMCHECKBOX  h) Who will be the custodian of the specimen at the Centre and when shipped outside of the country(ies)?: __Mustafizur Rahman , PhD, ICDD,B Influenza Laboratory__ i) Who will be the owner(s) of the samples? : _______________ICDDR,B j) Has a MoU been made for the protocol covering the specimen collection, storage, use and ownership? Yes  FORMCHECKBOX  No  FORMCHECKBOX  NA  FORMCHECKBOX  k) If yes, please attach a copy. Determination of Risk: Does the Research Involve (Check all that apply):  FORMCHECKBOX  Human exposure to radioactive agents?  FORMCHECKBOX  Fetal tissue or abortus?  FORMCHECKBOX  Investigational new device? (specify:)  FORMCHECKBOX  Existing data available from Co-investigator  FORMCHECKBOX  Human exposure to infectious agents?  FORMCHECKBOX  Investigational new drug  FORMCHECKBOX  Existing data available via public archives/sources  FORMCHECKBOX  Pathological or diagnostic clinical specimen only  FORMCHECKBOX  Observation of public behaviour  FORMCHECKBOX  New treatment regime  Yes  FORMCHECKBOX  No  FORMCHECKBOX  Is the information recorded in such a manner that study participants can be identified from information provided directly or through identifiers linked to the study participants? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Does the research deal with sensitive aspects of the study participants behaviour; sexual behaviour, alcohol use or illegal conduct such as drug use? Could the information recorded about the individual if it became known outside of the research: Yes  FORMCHECKBOX  No  FORMCHECKBOX  Place the study participants at risk of criminal or civil liability? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Damage the study participants financial standing, reputation or employability, social rejection, lead to stigma, divorce etc.?  Do you consider this research (Check one):  FORMCHECKBOX  Greater than minimal risk  FORMCHECKBOX  No more than minimal risk  FORMCHECKBOX  Only part of the diagnostic test Minimal Risk is "a risk where the probability and magnitude of harm or discomfort anticipated in the proposed research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical, psychological examinations or tests. For example, risk of drawing a small amount of blood from a healthy individual for research purposes is no greater than the risk of doing so as a part of routine physical examination".  Yes/ No  FORMCHECKBOX   FORMCHECKBOX  Is the proposal funded? If yes, sponsor Name: (1) Centers for Disease Control and Prevention (CDC) (2)  FORMTEXT        Yes/No  FORMCHECKBOX   FORMCHECKBOX  Is the proposal being submitted for funding? If yes, name of funding agency: (1)  FORMTEXT       (2)  FORMTEXT       Do any of the participating investigators and/or member(s) of their immediate families have an equity relationship (e.g. stockholder) with the sponsor of the project or manufacturer and/or owner of the test product or device to be studied or serve as a consultant to any of the above? IF YES, a written statement of disclosure to be submitted to the Centres Executive Director. Dates of Proposed Period of Support Cost Required for the Budget Period ($) Years Direct Cost Indirect Cost Total Cost Year-1 127,040 40,125 166,573 Year-2  FORMTEXT        FORMTEXT        FORMTEXT  =SUM(TEXT292,TEXT293) 00 Year-3  FORMTEXT        FORMTEXT        FORMTEXT  =SUM(TEXT295,TEXT296) 00 Year-4  FORMTEXT        FORMTEXT        FORMTEXT  =Sum(text298, text299) 00 Year-5  FORMTEXT        FORMTEXT        FORMTEXT  =sum(text301, text302) 00 Total 127,040 40,125 167,165 (Day, Month, Year - DD/MM/YY) Beginning Date : 01 May 2009 End Date : 31 Decmeber 2010  Certification by the Principal Investigator I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. I agree to accept the responsibility for the scientific conduct of the project and to provide the required progress reports including updating protocol information in the SUCHONA (Form # 2) if a grant is awarded as a result of this application. ___________ ____________ Signature of PI Date  Approval of the Project by the Division Director of the Applicant The above-mentioned project has been discussed and reviewed at the Division level as well by the external reviewers. The protocol has been revised according to the reviewers comments and is approved.  FORMTEXT        FORMTEXT       Name of the Division Director Signature Date of Approval  TOC \o "1-3" \h \z \u  HYPERLINK \l "_Toc268031174" RRC APPLICATION FORM  PAGEREF _Toc268031174 \h 1  HYPERLINK \l "_Toc268031175" Project Summary  PAGEREF _Toc268031175 \h 9  HYPERLINK \l "_Toc268031176" Description of the Research Project  PAGEREF _Toc268031176 \h 11  HYPERLINK \l "_Toc268031177" Hypothesis to be Tested:  PAGEREF _Toc268031177 \h 11  HYPERLINK \l "_Toc268031178" Specific Aims:  PAGEREF _Toc268031178 \h 12  HYPERLINK \l "_Toc268031179" Background of the Project including Preliminary Observations  PAGEREF _Toc268031179 \h 12  HYPERLINK \l "_Toc268031180" Research Design and Methods  PAGEREF _Toc268031180 \h 15  HYPERLINK \l "_Toc268031181" Measures of interest  PAGEREF _Toc268031181 \h 25  HYPERLINK \l "_Toc268031182" Laboratory methods  PAGEREF _Toc268031182 \h 28  HYPERLINK \l "_Toc268031184" Sample Size Calculation and Outcome Variable(s)  PAGEREF _Toc268031184 \h 31  HYPERLINK \l "_Toc268031185" Data Safety Monitoring Plan (DSMP)  PAGEREF _Toc268031185 \h 34  HYPERLINK \l "_Toc268031186" Data Analysis  PAGEREF _Toc268031186 \h 35  HYPERLINK \l "_Toc268031187" Ethical Assurance for Protection of Human Rights  PAGEREF _Toc268031187 \h 38  HYPERLINK \l "_Toc268031188" Use of Animals  PAGEREF _Toc268031188 \h 39  HYPERLINK \l "_Toc268031189" Literature Cited  PAGEREF _Toc268031189 \h 40  HYPERLINK \l "_Toc268031190" Dissemination and Use of Findings  PAGEREF _Toc268031190 \h 42  HYPERLINK \l "_Toc268031191" Collaborative Arrangements  PAGEREF _Toc268031191 \h 42  HYPERLINK \l "_Toc268031192" Biography of the Investigators  PAGEREF _Toc268031192 \h 42  HYPERLINK \l "_Toc268031195" Budget Justifications  PAGEREF _Toc268031195 \h 66  HYPERLINK \l "_Toc268031196" Personnel  PAGEREF _Toc268031196 \h 66  HYPERLINK \l "_Toc268031197" Other Support  PAGEREF _Toc268031197 \h 67  HYPERLINK \l "_Toc268031198" Appendix 1: Figure and Details about Bari  PAGEREF _Toc268031198 \h 68  HYPERLINK \l "_Toc268031203" Appendix 2: Adult Consent Form: Specimen Collection  PAGEREF _Toc268031203 \h 69  HYPERLINK \l "_Toc268031204" Appendix 3: Parent or Guardian Consent Form: Specimen Collection  PAGEREF _Toc268031204 \h 72  HYPERLINK \l "_Toc268031205" Appendix 4: Child Assent Form: Specimen Collection  PAGEREF _Toc268031205 \h 75  HYPERLINK \l "_Toc268031206" Appendix 5: Consent Form: Study Enrollment, Household/Bari  PAGEREF _Toc268031206 \h 77  HYPERLINK \l "_Toc268031214" Appendix 6: Bari Eligibility Form  PAGEREF _Toc268031214 \h 91  HYPERLINK \l "_Toc268031215" Appendix 7: Bari Drawing Form  PAGEREF _Toc268031215 \h 93  HYPERLINK \l "_Toc268031218" Appendix 8: Household Contact Enumeration Form  PAGEREF _Toc268031218 \h 95  HYPERLINK \l "_Toc268031219" Appendix 8b: Enrollment Day Sick List for all Bari members  PAGEREF _Toc268031219 \h 96  HYPERLINK \l "_Toc268031254" Appendix 9: Household Level Questionnaire/Observation Form  PAGEREF _Toc268031254 \h 97  HYPERLINK \l "_Toc268031255" Appendix 10: Illness Tracking Form (for all ages) Version 18.5.10  PAGEREF _Toc268031255 \h 135  HYPERLINK \l "_Toc268031266" Appendix 18: BISTIS Follow Up Survey Form  PAGEREF _Toc268031266 \h 158  HYPERLINK \l "_Toc268031267" Appendix 19: Follow Up Soap Tracking Form  PAGEREF _Toc268031267 \h 177  HYPERLINK \l "_Toc268031294" Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages e" 5 Years Old, Page 1  PAGEREF _Toc268031294 \h 180  HYPERLINK \l "_Toc268031295" Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages e" 5 Years Old, Page 2  PAGEREF _Toc268031295 \h 181  HYPERLINK \l "_Toc268031296" Appendix 22: Responses to the comments from the external reviewers  PAGEREF _Toc268031296 \h 202   FORMCHECKBOX  Check here if appendix is included Project Summary Describe in concise terms, the hypothesis, objectives, and the relevant background of the project. Also describe concisely the experimental design and research methods for achieving the objectives. This description will serve as a succinct and precise and accurate description of the proposed research is required. This summary must be understandable and interpretable when removed from the main application. Principal Investigator(s): Dr. Eduardo Azizz-Baumgartner Research Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Total Budget US$: 166,573 Beginning Date : 1 May 2009 Ending Date: 31 December 2010The next influenza pandemic is expected to spread rapidly in resource-poor settings. Influenza viruses spread from human-to-human via large respiratory droplets. Transmission via large-particle respiratory droplets is believed to be mediated by close contact between infected and susceptible persons or contact with droplet-contaminated fomites. Close contact between infected and susceptible persons may consist of skin-to-skin contact (e.g., via hands) or inhalation of respiratory droplets (e.g., due to talking, coughing, or sneezing by the infected person). Airborne transmission, which is expected to result in transmission over long distances (>1 meter) and which would be mediated by ventilation, is believed to be uncommon. Therefore, the greatest risk of transmission from personal contact comes from those people who are closest to an index case, such as contacts living in the same household. There are, to date, no published estimates of the secondary attack ratio of influenza among household contacts of index case-patients in low-income countries. Moreover, we do not have data on the risk factors for secondary transmission of influenza from index case-patients to their household contacts. There is some data for the benefits of promoting handwashing with soap on the risk of all-cause acute respiratory illness among children < 15 years old in a resource-poor setting in Pakistan. But, we do not have evidence that promoting handwashing with soap will acutely reduce the risk of secondary transmission. Therefore, we propose to conduct a study in rural Bangladesh to assess the following: The secondary attack ratio of influenza among household contacts of an index case-patient with influenza The risk factors for secondary transmission of influenza from an index case-patient to household contacts The impact of promoting handwashing with soap on the risk of secondary transmission of influenza from an index case-patient to household contacts The impact of a handwashing promotion intervention on handwashing behavior at 5-6 months following the intervention. To complete our study objectives, we will conduct a randomized controlled trial in the Kishoregonj area of Bangladesh, building on ongoing influenza surveillance at the Jahurul Islam Medical College Hospital (JIMCH). We will identify eligible index case-patients with influenza at the JIMCH, two local Upazilla Health Complex (UHC) clinics, pharmacies and other local health care providers. Index case-patients will be identified as having influenza using a rapid diagnostic test for influenza (QuickVue). Our study workers will visit the bari, obtain informed consent, and collect baseline information about the bari, including information on crowding, ventilation of the cooking space, and smoking status of bari residents. We will then assign baris to the intervention or control arm at random using a block randomization strategy. The intervention will consist of promotion of handwashing with soap and the provision of soap and a water vessel to facilitate handwashing; the intervention will be based on the Social Cognitive Theory. We will then follow up intervention and control baris for a total of 10 days following the resolution of the index case-patients illness, in order to track illness in each bari resident. At the conclusion of the illness tracking, control baris will be provided bars of soap. At a future time, the control baris will be provided a water vessel, and the same handwashing promotion session provided to intervention baris. We will follow-up with all enrolled baris 5-6 months after illness tracking was completed to assess handwashing behavior. We will use objective measures of handwashing behavior, and will also assess knowledge about influenza.  KEY PERSONNEL (List names of all investigators including PI and their respective specialties) Name Professional Discipline / Specialty Role in the Project Eduardo Azizz-Baumgartner ICDDR,B Co-Principal Investigator Pavani K. Ram University at Buffalo Co-Principal Investigator Tasnim Azim ICDDR,B Co-Investigator Joseph Bresee CDC Co-Investigator W. Abdullah Brooks ICDDR,B Co-Investigator Margaret DiVita University at Buffalo Student Investigator Alicia Fry CDC Co-Investigator Stephen Luby ICDDR,B Co-Investigator Mustafizur Rahman ICDDR,B Co-Investigator Rashid Uz Zaman ICDDR,B Co-Investigator Description of the Research Project Hypothesis to be Tested:  Concisely list in order, the hypothesis to be tested and the Specific Aims of the proposed study. Provide the scientific basis of the hypothesis, critically examining the observations leading to the formulation of the hypothesis. There is secondary transmission of influenza from index case-patients to household contacts in a rural setting. Promotion of handwashing with soap will reduce secondary transmission of influenza from index cases to household contacts. Risk factors for intrahousehold transmission of influenza in a rural setting include young age of index case or of household contact, active or passive smoking, crowding, and poor ventilation. Exposure to an intensive handwashing education intervention will result in sustained improvement in handwashing behavior change. Exposure to an intensive handwashing education intervention will result in a reduced risk of respiratory infections, diarrhea, and influenza. Specific Aims: Describe the specific aims of the proposed study. State the specific parameters, biological functions/ rates/ processes that will be assessed by specific methods.  To measure the secondary attack ratio of influenza among household contacts of index cases with influenza, in a rural setting in Bangladesh To test the efficacy of an intervention promoting handwashing with soap for prevention of intrahousehold transmission of influenza virus To identify risk factors for intrahousehold transmission of influenza in a rural setting in Bangladesh To compare handwashing behavior among households who were exposed to the intervention promoting hanwashing with soap to handwashing behavior among households who were not exposed to the intervention 5-6 months after enrollment To measure the longitudinal prevalence of respiratory infections, diarrhea, and influenza among intervention and control households 5-6 months after enrollment. Background of the Project including Preliminary Observations  Describe the relevant background of the proposed study. Discuss the previous related works on the subject by citing specific references. Describe logically how the present hypothesis is supported by the relevant background observations including any preliminary results that may be available. Critically analyze available knowledge in the field of the proposed study and discuss the questions and gaps in the knowledge that need to be fulfilled to achieve the proposed goals. Provide scientific validity of the hypothesis on the basis of background information. If there is no sufficient information on the subject, indicate the need to develop new knowledge. Also include the significance and rationale of the proposed work by specifically discussing how these accomplishments will bring benefit to human health in relation to biomedical, social, and environmental perspectives.  The emergence of the highly pathogenic avian influenza A (H5N1) among humans throughout South and Southeast Asia and Eastern Europe ADDIN EN.CITE 200866612Cumulative Number of Confirmed Human Cases of Avian Influenza A / (H5N1) Reported to WHO2008October 28, 20082008September 10, 2008GenevaWorld Health Organizationhttp://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_09_10/en/index.html[1] , and the potential for a new global pandemic of H5N1 or another influenza subtype, highlight the immediate need to identify risk factors for influenza transmission in low-income settings and to assess the efficacy of interventions to reduce the transmission of influenza viruses in these settings. Influenza viruses spread from human-to-human via large respiratory droplets. ADDIN EN.CITE Fiore200822217Fiore, A.E.Shay, D.K.Broder, K.Iskander, J.K.Uyeki, T. M.Mootrey, G.Bresee, J.S.Cox, N. J.Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008MMWR Recomm Rep1-6457RR-72008/08/08AdolescentAdultAgedAntiviral Agents/administration & dosage/adverseeffects/pharmacokinetics/therapeutic useChildChild, PreschoolCost of IllnessCost-Benefit AnalysisDrug InteractionsDrug Resistance, ViralFemaleHumansInfantInfection ControlInfluenza Vaccines/*administration & dosage/adverseeffects/contraindications/economicsInfluenza, Human/drugtherapy/economics/epidemiology/physiopathology/*prevention & controlMaleMiddle AgedPregnancyRisk FactorsVaccination/adverse effects/contraindications/economics/*standardsVaccines, Inactivated2008eng[2] Transmission via large-particle respiratory droplets is believed to be mediated by close contact between infected and susceptible persons or contact with droplet-contaminated fomites. ADDIN EN.CITE  ADDIN EN.CITE.DATA [2-3] Close contact between infected and susceptible persons may consist of skin-to-skin contact (e.g., via hands) or inhalation of respiratory droplets (e.g., due to talking, coughing, or sneezing by the infected person). ADDIN EN.CITE Brankston200777717Brankston, G.Gitterman, L.Hirji, Z.Lemieux, C.Gardam, M.Infection Prevention and Control Unit, University Health Network, Toronto, Ontario, Canada.Transmission of influenza A in human beingsLancet Infect Dis257-65742007/03/23AnimalsCross Infection/prevention & controlDisease Models, AnimalDisease Outbreaks/prevention & control*Disease Transmission, HorizontalFomites/microbiologyHumansInfluenza A Virus, H5N1 SubtypeInfluenza, Human/prevention & control/*transmissionRespiratory Protective Devices2007Apr1473-3099 (Print)17376383http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17376383S1473-3099(07)70029-4 [pii] 10.1016/S1473-3099(07)70029-4eng[4] Airborne transmission, which is expected to result in transmission over long distances (>1 meter) and which would be mediated by ventilation, is believed to be uncommon. ADDIN EN.CITE Brankston200777717Brankston, G.Gitterman, L.Hirji, Z.Lemieux, C.Gardam, M.Infection Prevention and Control Unit, University Health Network, Toronto, Ontario, Canada.Transmission of influenza A in human beingsLancet Infect Dis257-65742007/03/23AnimalsCross Infection/prevention & controlDisease Models, AnimalDisease Outbreaks/prevention & control*Disease Transmission, HorizontalFomites/microbiologyHumansInfluenza A Virus, H5N1 SubtypeInfluenza, Human/prevention & control/*transmissionRespiratory Protective Devices2007Apr1473-3099 (Print)17376383http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17376383S1473-3099(07)70029-4 [pii] 10.1016/S1473-3099(07)70029-4eng[4] Therefore, the greatest risk of transmission from personal contact comes from those people who are closest to an index case, such as contacts living in the same household. The incubation period of the influenza virus is short, lasting typically 1 to 3 days. The infectious period for adults may begin 1 day prior to the onset of symptoms, and last until 5 days after symptoms begin. Children can be infectious for up to 7 days after symptom onset. The epidemiology of influenza has been well documented and understood in industrialized countries, but the data on influenza in developing countries is minimal. Globally, influenza epidemics occur annually, with clinical attack rates ranging from 10 to 20 percent in the general population, and more than 50 percent in closed populations, such as schools. Hospitalizations and deaths typically occur in high risk groups such as the elderly, very young, and the immuno-compromised. The death toll associated with annual epidemics of influenza is estimated to reach nearly 1 million people per year ADDIN EN.CITE Heymann200444444428Heymann, David L.Control of Communicable Diseases Manual182004Washington, DCAmerican Public Health Association[5]. In a low-income setting such as Bangladesh, 16% of children aged less than 13 years with fever and cough (and who tested negative for dengue infection) were found to have influenza type A or B infection. ADDIN EN.CITE Abdullah Brooks200788817Abdullah Brooks, W.Terebuh, P.Bridges, C.Klimov, A.Goswami, D.Sharmeen, A. T.Azim, T.Erdman, D.Hall, H.Luby, S.Breiman, R. F.Influenza A and B infection in children in urban slum, BangladeshEmerg Infect Dis1507-813102008/02/09Bangladesh/epidemiologyChildHumans*Influenza A virus*Influenza B virusInfluenza, Human/*epidemiology*Population Surveillance*Poverty AreasRainSeasonsSeroepidemiologic StudiesUrban Health2007Oct1080-6059 (Electronic)18257997http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18257997eng[6] The first recognized human case of A(H5N1) influenza in Bangladesh occurred in 2008 in a child in Kamalapur, a densely populated urban slum in Dhaka, the capital city. ADDIN EN.CITE 200813131317First confirmed human infection with avian influenza A (H5N1) virus in BangladeshHealth and Science Bulletin6206/200820081729-343X[7] In order to develop rational prevention strategies, it is essential that we identify the relationship between demographic, behavioral, and environmental factors and influenza transmission among contacts of infected persons in low-income settings. Poor hand hygiene ADDIN EN.CITE Jefferson200815151517Jefferson, T.Foxlee, R.Del Mar, C.Dooley, L.Ferroni, E.Hewak, B.Prabhala, A.Nair, S.Rivetti, A.Cochrane Vaccines Field, Alessandria, Italy.Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic reviewBMJ77-8033676352007/11/29Gloves, Protective*HandwashingHumansMasksProtective Clothing*QuarantineRespiratory Tract Infections/*prevention & controlVirus Diseases/*prevention & control2008Jan 121468-5833 (Electronic)18042961http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18042961bmj.39393.510347.BE [pii] 10.1136/bmj.39393.510347.BEeng[8], crowding ADDIN EN.CITE Hasan200699917Hasan, K.Jolly, P.Marquis, G.Roy, E.Podder, G.Alam, K.Huq, F.Sack, R.ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh. Zahid@icddrb.orgViral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, BangladeshScand J Infect Dis690-53882006/07/22Bangladesh/epidemiologyChild, PreschoolCohort StudiesHumansInfantInfant, NewbornInfant, Newborn, Diseases/epidemiology/*virologyInfluenza B virus/isolation & purificationLogistic ModelsParainfluenza Virus 2, Human/isolation & purificationParainfluenza Virus 3, Human/isolation & purificationPneumonia, Viral/epidemiology/microbiology/*virologyRespiratory Syncytial Viruses/isolation & purification20060036-5548 (Print)16857616http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16857616N04747837306445P [pii] 10.1080/00365540600606473eng[9], and tobacco use ADDIN EN.CITE Arcavi200432323217Arcavi, L.Benowitz, N. L.Clinical Pharmacology Unit, Kaplan Medical Center, Rehovot, Israel.Cigarette smoking and infectionArch Intern MedArch Intern Med2206-16164202004/11/10AdultAge DistributionAgedBacterial Infections/*epidemiology/immunologyCausalityDisease Susceptibility/*immunologyFemaleHumansMaleMiddle AgedPrognosisRisk FactorsSex DistributionSmoking/adverse effects/immunology*Smoking CessationTobacco Use Disorder/*epidemiology/*immunologyVirus Diseases/*epidemiology/immunology2004Nov 80003-9926 (Print)15534156http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15534156164/20/2206 [pii] 10.1001/archinte.164.20.2206eng[10] are commonplace in Bangladesh and thought to contribute to respiratory illness and outbreaks of respiratory illness (refs). ADDIN EN.CITE Stephen200329292917Stephen, G. A.McRill, C.Mack, M. D.O'Rourke, M. K.Flood, T. J.Lebowitz, M. D.Southern Arizona VA Health Care System, University of Arizona, Tucson, Arizona 85723, USA. stephen@med.va.govAssessment of respiratory symptoms and asthma prevalence in a U.S.-Mexico border regionArch Environ Health156-625832003/10/11Air Pollutants/*adverse effectsArizona/epidemiologyAsthma/*epidemiology/*etiologyChildCough/epidemiology/etiology*Environmental ExposureFemaleHumansMaleMexico/epidemiologyParticle SizePrevalenceRespiratory Function TestsRespiratory Sounds/etiologyUrban Population2003Mar0003-9896 (Print)14535575http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14535575eng[11] Only 14% of primary caregivers of young children in rural Bangladesh were observed to wash hands with soap before preparing or serving food and none washed hands before eating. ADDIN EN.CITE Ram200815815815810PK RamAK HalderSP GrangerP HallT JonesD HitchcockB NygrenMS IslamJ MolyneauxSP LubyUse of a novel method to detect reactivity to structured observation for measurement of handwashing behaviorAmerican Society of Tropical Medicine and Hygiene2008New Orleans, LA[12] In another study with a substantially larger sample size, the proportion of primary caregivers observed to wash hands with soap was less than 1 percent. ADDIN EN.CITE 200823232317Handwashing behavior in rural BangladeshHealth and Science Bulletin632008September 2008[13] In rural Mirzapur, crowding was shown to be a risk factor for viral pneumonia among children < 24 months of age. ADDIN EN.CITE Hasan200699917Hasan, K.Jolly, P.Marquis, G.Roy, E.Podder, G.Alam, K.Huq, F.Sack, R.ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh. Zahid@icddrb.orgViral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, BangladeshScand J Infect Dis690-53882006/07/22Bangladesh/epidemiologyChild, PreschoolCohort StudiesHumansInfantInfant, NewbornInfant, Newborn, Diseases/epidemiology/*virologyInfluenza B virus/isolation & purificationLogistic ModelsParainfluenza Virus 2, Human/isolation & purificationParainfluenza Virus 3, Human/isolation & purificationPneumonia, Viral/epidemiology/microbiology/*virologyRespiratory Syncytial Viruses/isolation & purification20060036-5548 (Print)16857616http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16857616N04747837306445P [pii] 10.1080/00365540600606473eng[9] Nationwide, in Bangladesh, 40% of adult males and 21% of adult females were estimated to be tobacco users in 2001. ADDIN EN.CITE 22222212Regional Tobacco Surveillance System, Country Profile, Bangladesh2008October 29, 2008World Health Organization[14] Passive exposure to tobacco smoke has been implicated as a risk factor for respiratory illness among children. ADDIN EN.CITE  ADDIN EN.CITE.DATA [10-11, 15] We do not fully understand the relevance of these factors for transmission of Influenza virus from ill persons to their household contacts. In high-income countries, annual vaccination of high risk groups is the principal measure of prevention and control of influenza illness. ADDIN EN.CITE Fiore200822217Fiore, A.E.Shay, D.K.Broder, K.Iskander, J.K.Uyeki, T. M.Mootrey, G.Bresee, J.S.Cox, N. J.Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008MMWR Recomm Rep1-6457RR-72008/08/08AdolescentAdultAgedAntiviral Agents/administration & dosage/adverseeffects/pharmacokinetics/therapeutic useChildChild, PreschoolCost of IllnessCost-Benefit AnalysisDrug InteractionsDrug Resistance, ViralFemaleHumansInfantInfection ControlInfluenza Vaccines/*administration & dosage/adverseeffects/contraindications/economicsInfluenza, Human/drugtherapy/economics/epidemiology/physiopathology/*prevention & controlMaleMiddle AgedPregnancyRisk FactorsVaccination/adverse effects/contraindications/economics/*standardsVaccines, Inactivated2008eng[2] These measures are not available at scale in resource-poor settings, where the next influenza pandemic is expected to have devastating consequences. In such settings, therefore, it is imperative to assess the efficacy of non-pharmaceutical interventions to prevent the spread of influenza. Indeed, non-pharmaceutical interventions such as handwashing with soap are already recommended for prevention of influenza transmission (http://www.cdc.gov/flu/protect/preventing.htm). However, there is no published empirical evidence for the efficacy or effectiveness of handwashing with soap for prevention of influenza transmission in resource-poor settings. A recent meta-analysis done by Aiello et al found that most studies assessing the effectiveness of hand washing interventions upon infectious disease treated any respiratory illness as the outcome, not specifically influenza virus, and that the majority of the studies found took place in high-income settings (67%). ADDIN EN.CITE Aiello200815615615617Aiello, A. E.Coulborn, R. M.Perez, V.Larson, E. L.University of Michigan-School of Public Health.Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-AnalysisAm J Public HealthAm J Public Health2008/06/172008Jun 121541-0048 (Electronic)18556606http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18556606AJPH.2007.124610 [pii] 10.2105/AJPH.2007.124610Eng[16] Moreover, a systematic review of the literature done by Jefferson et al shows that the majority of trials assessing the impact of hand washing on respiratory illness were done in day care or hospital settings. ADDIN EN.CITE Jefferson200815151517Jefferson, T.Foxlee, R.Del Mar, C.Dooley, L.Ferroni, E.Hewak, B.Prabhala, A.Nair, S.Rivetti, A.Cochrane Vaccines Field, Alessandria, Italy.Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic reviewBMJ77-8033676352007/11/29Gloves, Protective*HandwashingHumansMasksProtective Clothing*QuarantineRespiratory Tract Infections/*prevention & controlVirus Diseases/*prevention & control2008Jan 121468-5833 (Electronic)18042961http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18042961bmj.39393.510347.BE [pii] 10.1136/bmj.39393.510347.BEeng[8] Since the risk of transmission is likely high among household contacts of ill persons in low-income settings, it is crucial that such interventions are tested within households. Given that much influenza transmission occurs among close contacts, the critical role that non-vaccine interventions will play in prevention of pandemic influenza transmission in resource-poor settings, and the high likelihood that the next influenza pandemic will greatly impact such a setting, we propose to conduct a multi-pronged study in Bangladesh. Our objectives are: To measure the secondary attack ratio of influenza among household contacts of influenza-infected persons in a rural setting in Bangladesh To test the efficacy of a handwashing promotion intervention for prevention of intrahousehold transmission of influenza virus in a rural setting in Bangladesh To investigate risk factors for secondary transmission of influenza from index case-patients to household contacts Since Bangladesh has high rates of influenza illness and vaccination of this population is virtually non-existent, it represents an ideal setting for the proposed study. While several studies regarding handwashing and respiratory illness, including influenza, have been and will be carried out in urban slum areas of Dhaka, there is little information on the role of handwashing and other risk factors for influenza transmission within households in rural areas. About of the Bangladeshi population lives in rural areas ADDIN EN.CITE National Institute of Population Research and Training200520202046<style face="normal" font="default" size="10">Bangladesh Demographic and Health Survey 2004</style>[17] and contact with poultry, a risk factor for avian influenza, is substantially more common in rural communities. For this reason, and because the Jahurul Islam Medical College Hospital is a high-functioning participant in an ongoing human influenza surveillance project, we have chosen this site. We also propose to complete a follow-up study of all households enrolled in the original study. The intervention given is particularly intensive in nature because we seek to establish whether maximal improvement in handwashing behavior will prevent secondary transmission of influenza. Luby and colleague have undertaken intensive handwashing promotion in their studies in Karachi, Pakistan on the efficacy of handwashing for the presevention of diarrhea and pneumonia. Despite weekly visits to intervention households to promote handwashing and to provide soap over an entire year, Luby et al. found little sustained behavior change among these households  ADDIN EN.CITE Luby200891919117Luby, S. P.Mendoza, C.Keswick, B. H.Chiller, T. M.Hoekstra, R. M.Enteric Diseases Epidemiology Branch, Division of Foodborne Bacterial and Mycotic Diseases, National Center for Zoonotic, Vectorborne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. sluby@cdc.govDifficulties in bringing point-of-use water treatment to scale in rural GuatemalaAm J Trop Med HygAm J Trop Med Hyg382-77832008/03/14*Chlorine CompoundsDeveloping CountriesDiarrhea/prevention & controlDisinfectants/pharmacology/*supply & distributionFlocculationGuatemalaHumansRural HealthWater MicrobiologyWater Purification/*economics/methods*Water Supply2008Mar0002-9637 (Print)18337330http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1833733078/3/382 [pii]eng[18]. Moreover, there was no difference in the disease risk among children in intervention households, compared to those in control households who had not received the intervention. The intervention proposed for this study is even more intensive than that used in the Karachi studies because it seeks to reinforce benefits, overcome barriers, and motivate group-level behavior change. This proof of concept study not only hopes to find a difference in the rate of secondary transmission of influenza during the intervention, but also hopes to yield sustainable improvements in handwashing behavior change. Therefore, we propose to complete a follow-up study to answer the following questions: Does exposure to the intervention in the primary intervention study result in sustained handwashing behavior change? Does exposure to the intervention in the primary intervention study result in a reduced risk of respiratory infections, diarrhea, and influenza in intervention households compared to control households.? The proposed study will hereafter be referred to as the Bangladesh Interruption of Secondary Transmission of Influenza study (BISTIS). Research Design and Methods  Describe in detail the methods and procedures that will be used to accomplish the objectives and specific aims of the project. Discuss the alternative methods that are available and justify the use of the method proposed in the study. Justify the scientific validity of the methodological approach (biomedical, social, or environmental) as an investigation tool to achieve the specific aims. Discuss the limitations and difficulties of the proposed procedures and sufficiently justify the use of them. Discuss the ethical issues related to biomedical and social research for employing special procedures, such as invasive procedures in sick children, use of isotopes or any other hazardous materials, or social questionnaires relating to individual privacy. Point out safety procedures to be observed for protection of individuals during any situations or materials that may be injurious to human health. The methodology section should be sufficiently descriptive to allow the reviewers to make valid and unambiguous assessment of the project.  BISTIS builds on hospital-based surveillance for Influenza virus infection, which is ongoing in hospitals around Bangladesh, as part of the Hospital-based Influenza Surveillance (HBIS) and Surveillance for the Epidemiology of Influenza in Bangladesh (SEIB) projects. We intend to recruit patients identified at the Jahurul Islam Medical College Hospital in Kishoregonj, Bangladesh, where both HBIS and SEIB are in place. In this hospital 80% of all the patients who present with influenza-like illness (ILI) to the outpatient departments of Medicine and Pediatrics are from three upazillas of Kishorgonj district: Bajitpur, Kuliar char and Kotiadi. The distances of these three upazillas are within 30 minutes travel time from Jahurul Islam Medical College Hospital (one way) and hence these upazillas will serve as the primary catchment areas for BISTIS. The table below illustrates the number of ILI cases identified through HBIS and SEIB study at Jahurul Islam Medical College Hospital in 2008 and also the number and proportion among them who were tested PCR positive for influenza virus.  N.B. most influenza-positive specimens were collected between May and September in 2007 and 2008 We will also enroll patients who present to two local upazilla health complexes (UHCs), one in Bajitpur and one it Kuliar Char. These local health complexes see numerous patients a day from the rural areas surrounding the clinic. Patients who present to these clinics are more likely to have symptom onset within 24 hours of presentation then those patients who seek care at JIMCH, since patients may only want to go to the hospital if their illness has been severe and prolonged over several days. There has been published evidence that interventions on handwashing practices will only prevent influenza transmission in a household setting if the intervention is delivered within 36 hours of symptom onset  ADDIN EN.CITE  ADDIN EN.CITE.DATA [19]; therefore, the UHC sites are appropriate for enrollment of patients for BISTIS in addition to enrollment at JIMCH. We will also enroll patients who present to pharmacies and other local health care providers in Bajitpur and Kuliarchar. During the enrollment in the early 2010 season, we have found that many individuals seeking care at the UHCs are waiting longer than 24 hours after symptom onset to visit the UHC. We hypothesize that individuals with symptom onset within 24 hours may seek early treatment at local pharmacies and other local health care providers, and only then visit the UHCs or JIMCH should their symptoms persist. By the time many individuals seek further treatment, there may be secondary cases within the bari. With secondary transmission occurring at the bari level prior to the individual seeking care at our enrollment sites, this greatly weakens our ability to determine whether our intervention does in fact prevent influenza transmission within the bari. Therefore, we propose to enroll index case-patients at local pharmacies and other local health care providers, in addition to the UHCs and JIMCH. The medical officers will identify pharmacies and other local health care providers willing to allow placement of one of our FRAs for several hours on each working day. We will place one FRA at each participating site. The pharmacist or health care provider will identify individuals with fever, and will refer that person to our FRA. The FRA will then complete the Hospital Check List Form (Appedix 13) to determine the eligibitlity of the individual. When the FRA finds a person who meets the eligibility criteria, he/she will contact an MO by phone to confirm that the person does in fact meet eligibility. Once the MO confirms the eligibility, the FRA will obtain informed consent for a sample collection. If the person consents, the FRA should then contact the MT or MO to let them know that the participant requires specimen collection. The MT or MO can either meet the FRA and participant at the pharmacy for the specimen collection, or the FRA can travel to the bari with the participant and the MT or MO can meet them there, which ever is more convenient. The sample collection for the participant enrolled at the pharmacy or other local health care provider should take place no later than 24 hours after enrollment, although a concerted effort should be made to collect the sample the same day as enrollment. Specific Aim 1: To measure the secondary attack ratio (SAR) of influenza viruses among household contacts of index cases with influenza, in a rural setting in Bangladesh Methods for Specific Aim 1 In the ongoing SEIB and HBIS projects, patients at Jahurul Islam Medical College Hospital with influenza-like illness (ILI) or severe acute respiratory illness (SARI) and who are seen as outpatients are requested to provide nasal and oropharyngeal swab specimens for testing for influenza virus. The sample collections occur on 6 days per month in the outpatient population. ILI and SARI are currently defined as follows: Influenza-like illness (ILI): any patient presenting with history of fever and either cough or sore throat within the previous 7 days Severe acute respiratory illness (SARI): Patients > 5 years of age: hospitalized patient with acute lower respiratory tract illness consisting of fever And cough or sore throat And shortness of breath or difficulty breathing Patients < 5 years of age: definition of pneumonia or severe pneumonia as per the Integrated Management of childhood Illness guidelines ADDIN EN.CITE WHO200114114114113WHOUNICEFIntegrated Management of Childhood Illness: Model Chapter for Textbooks2001World Health Organization[20] For BISTIS, we plan to daily identify patients meeting the following age-specific case definitions, and to request them to provide specimens (with the exception of Tuesdays when the hospital is closed) for the duration of the study. The case definition for index case-patients is: Persons, any age, with acute fever onset within 7 days preceding presentation to either JIMCH, the UHCs, the pharmacies, or other local health care providers. Additional inclusion criteria for the proposed study are: Return to home within 24 hours of presentation to Jahurul Islam Medical College Hospital, the UHCs, the pharmacies, or other local health care providers; i.e., the index case cannot be admitted at Jahurul Islam Medical College Hospital. If admitted, the patient would not be eligible for inclusion in this study. At least two persons (in addition to the index case-patient) who intend to reside in the bari during the subsequent 20 days. Residence within 2 hours travel time (one-way) from the Jahurul Islam Medical College Hospital or the UHCs Patients who meet the case definition and additional inclusion criteria will hereafter be referred to as index case-patients. In rural Bangladesh, homes are typically clustered into baris, with several homes in each bari (appendix 1 figure and details about baris). Typically, related individuals, with extended or joint family kinships, live in these homes and there is one head of the bari (usually the most elderly man). There is substantial contact between residents of different homes within a bari, with shared cooking spaces, play areas for children, toilets, and courtyards. Thus, most or all bari members are at risk for secondary transmission of influenza, irrespective of which specific home is occupied by an index case. For the purposes of this study, therefore, the household refers to the entire bari in which the index case-patients home sits. Hereafter, household contact refers to any member residing in the bari, apart from the index case-patient. Within 4 hours of presentation to the Jahurul Islam Medical College Hospital, the UHCs, the pharmacies, or other local health care providers, the medical officer will approach patients who meet inclusion criteria in order to describe the study. The index case-patient or his/her guardian in the case of a child < 18 years old will be requested to provide informed consent for specimen collection for rapid testing for influenza (appendix 2 and 3 consent for specimen collection and parental consent for specimen collection). Children between 7 and 17 years old will be requested to provide informed assent for specimen collection (appendix 4 assent for specimen collection). Specimen collection and processing A trained study physician will procure a nasal swabfrom consenting index case-patients meeting the inclusion criteria above using a standardized method. This specimen will be used for a rapid antigen detection test (QuickVue Influenza A + B). After the results of the QuickVue test are known, for patients ages 5 years and older a second nasal swab and an oropharyngeal swab will be take and both will be placed into a single tube containing viral transport media (VTM). The VTM will be kept at 4C. All VTM will be transported to the ICDDR,B virology laboratory in Dhaka on a weekly basis. At the ICDDR,B virology laboratory, RT-PCR testing for Influenza A (H1N1), Influenza A ( H3N2), Novel Influenza A (H1N1) and Influenza B will be carried out. If Influenza A H1N1 and , novel H1N1, and A H3N2 are both all negative, RT-PCR testing for Influenza A H5N1 will be performed. The QuickVue test materialswill be discarded using appropriate infection control procedures. Enumeration of bari contacts and questionnaire administration For all index case patients who meet the age-specific case defintions we will request that a field research assistant (FRA) accompany the index case-patient to the household. Once at the bari, the FRA will verify whether the bari meets the following inclusion criteria using the Bari Eligibility Form (Appendix 6): Inclusion criteria for baris of index case-patients are: At least two persons (in addition to the index case-patient) who intend to reside in the bari during the subsequent 20 days. Residence in the bari refers to sleeping in the bari at night, even if the individual works outside the bari during the day. Written informed consent for the following study components from the head of bari on behalf of all bari residents (Appendix 5 household consent) for each bari enrolled in the study Questionnaire administration Rapid observations of the household Illness tracking Random assignment to intervention or control group The FRA will draw the bari (appendix 7: Drawing of Bari Form), recording the following items in the bari: housing structures, water source, toilet facilities, cooking areas, handwashing station (present before intervention), intervention handwashing station (to be filled in for intervention households only), the entrance to the bari, the entrance of the housing structures, and households. The FRA will enumerate all eligible bari contacts (appendix 8 enumeration sheet) and carry out assessments of ventilation, crowding, indoor air pollution, smoking, and socioeconomic status (appendix 9 household questionnaire/ observations . These measures are described in more detail below. The questionnaire will be administered to each household within the index case-patients bari. For the purposes of our study, we will define a household as individuals who share the same cooking pot. Some questions will be specific to each household or housing structure within the bari, in which case we will pose those questions to the male or female head of that particular household and structure. Housing structure is defined as where individuals sleep. Illness tracking among bari contacts Illness tracking will be carried out on each day for 10 days until after resolution of the index case-patients symptoms. Resolution will be defined as the lack of fever, cough, and sore throat for two consectutive days during the FRAs daily illness tracking visit. Thus, if the index case-patients illness resolves on day 4 after enrollment, illness tracking will continue until day 14 after enrollment. The FRA will visit the patients home and record information regarding the presence or absence of ILI and SARI symptoms in each household contact using an individual illness tracking form (appendix 10 illness tracking form). The case definitions for household contacts are: Any bari resident with fever during the follow up visits of the index cases by the FRAs. If any household contact meets the case definition, that person will be eligible for testing for influenza by the medical officer or technologist. If any household contact reports the following danger signs, the FRA will refer him/her immediately to the Jahurul Islam Medical College Hospital: Persons > 5 years old: Cyanosis, severe respiratory distress, convulsions, altered mental status Persons < 5 years old: Chest in-drawing, lethargy, cyanosis, inability to drink, convulsions The FRA will pay for transport of the ill household contact and one or two accompanying family members to Jahurul Islam Medical College Hospital. S/he will provide a card indicating the ill household contacts participation in BISTIS, so that when s/he arrives at the hospital, the BISTIS study physician will be contacted. Once the patient is deemed clinically stable by physicians at JIMCH, the BISTIS study physician will verify that the ill household contact meets the age-specific case definition and will request him/her to provide written informed consent for specimen collection (appendix 2 specimen collection from household contact for adult > 18 years old). If the ill household contact is a child < 18 years old, informed consent will be obtained from the parent or guardian (appendix 3 specimen collection from household contact for child < 18 years old). Children between 7 and 17 years old will be requested to provide informed assent for specimen collection (appendix 4 assent for specimen collection). The medical technologists will collect information on the type of visit (secondary or follow up) and the date and time of the specimen collection on the specimen collection form (Appendix 11: Secondary/Follow Up Specimen Collection Form). We will store samples for 20 year for future testing of respiratory illnesses other than influenza; consent for specimen storage will be included in the specimen collection consent/assent form. If informed consent for specimen collection is provided, the study physician will collect nasal and oropharyngeal swabs from the ill household contact and place them in a single VTM vial. As with other specimens collected under BISTIS at the Jahurul Islam Hospital, the VTM vial will be kept at 4C. Of course, it is the choice of the patient or guardian (in the case of an ill household contact < 18 years old) to decide whether or not to comply with the FRAs recommendation to go to Jahurul Islam Medical College Hospital. In the event that the ill individual does not comply with the recommendation, the FRA will notify the BISTIS study physician. The physician will visit the bari within 24 hours to assess the ill household contact and provide further recommendations regarding treatment. If a household contact meets the case definition and does NOT have any danger signs, the FRA will contact the MO to travel to the bari to obtain written informed consent for specimen collection (appendix 2 Adult Consent Form: Specimen Collection, Appendix 3Parental Guardian Consent Form: Specimen Collection, Appendix 4Child Assent Form: Specimen Collection). The medical officer, who will visit the home no later than the following day in order to collect nasal and oropharyngeal swabs from the ill household contact. She will immediately place both swabs into VTM, which will then be placed into a cool box, containing ice and a thermometer to ensure temperatures < 40C. All specimens collected in the field will be placed in a liquid nitrogen dewer and will be transported to the ICDDR,B laboratory within two weeks of sample collection. At the ICDDR,B virology laboratory, all specimens for household contacts in baris where the index case patient tested QuickVue positive will be tested using RT-PCR for Influenza A (H1N1), A (H3N2), novel Influenza A (H1N1) and Influenza B (and A (H5N1) if appropriate). For household contacts of index case patients who tested QuickVue negative, the specimens will only be rt-PCR tested for influenza if the index cases rt-PCR test is positive for influenza. Illness tracking among household contacts will continue in each household until the 10th full day following the resolution of the index case-patients symptoms, irrespective of whether any household contact develops illness or not. Specific Aim 2: To test the efficacy of a handwashing promotion intervention for prevention of intrahousehold transmission of influenza virus Methods for Specific Aim 2 To address this specific aim, we will conduct a randomized controlled trial. Households of index case-patients with influenza-like illness who are not admitted at Jahurul Islam Medical College Hospital or the UHCs will be randomized to the intervention group or the routine practices group. The two groups will be defined as: Intervention Households: intensive promotion of handwashing with soap, and provision of facilitating tools, to the index-case-patient and all available household contacts Routine practices Households: continuation of the households usual handwashing and respiratory hygiene practices Randomization We will carry out block randomization of households of index case-patients to ensure random and even assignment to the intervention group or the routine practices group. Using a block size of four, the US-based co-Principal Investigator (PKR) will generate a list of random assignments to the routine practice or intervention groups. There will be two randomization sheets, one for the index case patients who test QuickVue positive and one for the index case patients who test QuickVue negative, to ensure equal assignment of the intervention among households with known positive influenza cases. The lists will be shared with the ICDDR,B PI and the FROs based at JIMCH. The FRO will consult the assignment list in order to determine whether the next enrolled household should be allocated to the intervention group or the routine practices group. Delivery of the intervention After the head of the bari has signed the informed consent for bari enrollment in the study, the FRA will telephone the FRO and tell the FRO that the bari has been enrolled. The FRO will consult the appropriate randomization sheet, and, if the bari is assigned to the intervention group, the FRO will assign an FIS to visit the household later in the day, after the FRA has finished with data collection. For promotion of handwashing with soap to intervention households, the FIS will be trained to carry out a structured intervention that will follow constructs of Social Cognitive Theory (SCT) ADDIN EN.CITE Glanz20023030306Glanz, KarenRimer, Barbara K.Viswanath, K.Health behavior and health education : theory, research, and practice558 p.3rdHealth behavior.Health education.Health promotion.2002San Francisco, CAJossey-Bass[21]. SCT addresses the reciprocal interaction between individuals, their environment, and health behaviors. Given that intervention will occur at the bari level, group-mediated constructs such as observational learning and reinforcements are highly relevant. We have included below a table of the major constructs of SCT, their definitions, and application of the constructs within this intervention. In addition, the FIS will work with the household to identify the most convenient place to wash hands with soap and water. If no water container, or sink is present, the FIS will provide a water container that has a spout for running water FISs will visit the intervention households on a daily basis for 10 days after the resolution of the index case-patients illness in order to encourage handwashing with soap at the recommended times. The FIS and FRA will coordinate their visits to the household so that they do not arrive at the same time. This will decrease the possibility of observer bias by the FRA should s/he see the intervention being implemented in the household while s/he is tracking illness symptoms. S/he will also note daily whether soap and water are available at the convenient handwashing station and, if not, s/he will again take necessary steps to assist the family with complying with a fully stocked handwashing station. The FIS will track both compliance with maintenance of a fully stocked handwashing station and the provision of additional soap or a tippy tap to the home. (Appendix 12 facilitating tools tracking). Routine practices households will also be exposed to the intervention, but only upon completion of the study. An FIS will visit the routine practices household around 6 months after the completion of the study in order to encourage handwashing with soap at the recommended times, andto provide a water container as needed. Blinding Due to the physical nature of the intervention and no feasible placebo control, we will not be able to blind participants or FRAs during illness tracking. However, FRAs will be blinded to the intervention assignment until after the first days data collection. We accept this limitation in order to achieve the most intensive handwashing intervention possible. Detection of outcome of interest As noted above, under Specific Aim 1, an FRA will visit the home of the index case-patient daily for 10 days after the resolution of the index case-patients symptoms in order to record age-specific case defining symptoms. When a household contact meets the age-specific case definition, nasal and oropharyngeal swabs will be collected for RT-PCR testing for Influenza A and Influenza B viruses at ICDDR,B. Specific aim 3: To identify risk factors, other than handwashing with soap, for intrahousehold transmission of influenza in a rural setting in Bangladesh Methods for Specific Aim 3 To address Specific Aim 3, we will conduct a nested cohort study to assess risk factors for intrahousehold transmission of influenza viruses. Here, the cohort under investigation is the routine practices group, as defined under Specific Aim 2. All data required to address this Specific Aim 3 will have been collected as part of the data collection described above under Specific Aim 1. A case will be defined as: RT-PCR confirmed Influenza virus infection (A or B) in a household contact of an RT-PCR confirmed Influenza virus infection (A or B) index case-patient during 10 days of follow-up after resolution of the index case-patients symptoms Specific aim 4: To assess whether exposure to the BISTIS intervention results in sustained improvements in handwashing behavior. Methods for Specific Aim 4 To address Specific Aim 4, we will visit each bari that was enrolled in the intervention study 4 - 7 months after illness tracking is complete. Baris were told at the time of enrollment into the primary BISTIS study that field workers would be visiting again in several months for further data collection. An FRA will visit the bari and explain the objectives and methods of the follow-up study and request written voluntary informed consent (Appendix 16: BISTIS Follow Up Study Enrollment Consent Form, Household/Bari). After consent is taken, at the first visit, the FRA will measure handwashing behavior at the bari. We will complete a structured observation of the baris common handwashing behaviors. This observation will last for one and a half hours. We will record information on handwashing opportunities, such as after defecation or before preparing meals, and hand washing behaviors. Handwashing behavior will be also measured by the following methods (Appendix 18: BISTIS Follow Up Survey Form) : The presence of a handwashing station that has both soap AND water The presence of any soap available in the bari, available within one minute of fieldworkers request to see the soap Demonstration of use of soap to wash hands after hypothetical respiratory secretions contact event For baris who were randomized to the intervention group, the fieldworker will assess whether cue cards provided as part of the intervention are visible in the bari and, if not visible, available within one minute of the fieldworkers request to see them The FRA will return to the bari 4-6 weeks later and collect the same information. This repeated collection will help us to determine if there is any reactivity to our follow-up visit in changing handwashing behavior. Two to three months after the initial follow-up visit, the FRA will return to the bari and once again collect the same information on the handwashing behavior but will also provide SmartSoap to the bari. A SmartSoap is a bar of soap with a motion sensor embedded in the soap that will allow us to measure the number of times the soap is used per day per capita. The FRA will collect the SmartSoap three days later. Data from the SmartSoap will be used to calculate the number of soap use events in the bari. In total an FRA will visit the household a total of four times, three visits for data collection and one visit to collect the SmartSoap. The FRA will use Appendix 19: Follow Up Soap Tracking Form to record information on the soap that is given to the bari, such as the date the soap was given, and the location the soap was placed within the bari. Specific aim 5: To assess if exposure to the BISTIS intervention results in a reduced risk of respiratory infections, diarrhea, and influenza. Methods for Specific Aim 5 The measurements of the health outcomes will be done in two different ways. At the first visit, after the handwashing behavior information is collected, the FRA will record whether each member of the bari has had symptoms of fever, cough, sore throat, difficulty breathing, or diarrhea in the previous 48 hours (Appendix 20: BISTIS Follow Up Visit Illness Tracking Form). At this time the FRA will ask about known danger signs of respiratory illness or diarrhoea, and if any member has these signs, the FRA will refer him/her to JIMCH for care. Symptoms of respiratory illness and diarrheoa will be collected at each subsequent visit. At the third visit, in April 2010, the FRA will record mobile phone numbers of two or three bari members. The FRA will identify a key informant, who will be able to provide information regarding fever in any bari member. The FRA will phone the bari once each week during the influenza season and speak with the key informant once per week to assess whether any bari member has had fever during the previous 3 days (Appendix 21a: BISTIS Follow Up Study Phone Call Illness Tracking Form: Ages e" 5 Years Old). If any member is reported to have a fever, we will dispatch an MO or lab/medical technician to the bari to obtain nasopharyngeal swab from that member for flu testing by PCR. A case will be defined as: RT-PCR confirmed Influenza virus infection (A or B) (Appendix 11: Secondary/Follow Up Case Specimen Collection Form). The medical technologist will obtain informed consent/assent for specimen collection for all follow up contacts (appendix 2 Adult Consent Form: Specimen Collection, Appendix 3Parental Guardian Consent Form: Specimen Collection, Appendix 4Child Assent Form: Specimen Collection). The FRA will use Appendix 17: Follow Up Bari Eligibility Form to track the eligibility of the bari for the follow up study, as well as to track any drop outs from the follow up phase. Measures of interest The following factors are potential risk factors for intrahousehold transmission of influenza. We have excluded here routine demographic factors, such as age and number of years of education since those will be collected directly using a structured questionnaires and the household contact enumeration sheet (appendix 8 enumeration of household contacts, appendix 9 household questionnaire/ observations). Socioeconomic status: We will construct an SES index using principal components analysis based on previously described methods. ADDIN EN.CITE Vyas200612812812817Vyas, S.Kumaranayake, L.HIVTools Research Group, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. seema.vyas@lshtm.ac.ukConstructing socio-economic status indices: how to use principal components analysisHealth Policy PlanHealth Policy Plan459-682162006/10/13Data CollectionGreat BritainHumansPrincipal Component Analysis/*methods*Social Class2006Nov0268-1080 (Print)17030551http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17030551czl029 [pii] 10.1093/heapol/czl029eng[22] Asset scores from principal components analysis will allow us to assign households to SES quartiles. Crowding: We will calculate a crowding index based on the number of persons residing in a structured divided by the number of rooms (excluding the kitchen and bathroom) available in that structure. Since, in baris, there are multiple structures and a given individual typically sleeps and lives within only one of those structures, the crowding index for each household contact will take into account the total number of persons living in his/her structure and the number of rooms within that structure. Ventilation: Ventilation of the home will be assessed by a tool used elsewhere in Bangladesh. In each structure in the bari, we will identify the kitchen space and the main sleeping space of the index case. In each of those, we will count the number of walls, the availability of doors and windows, and the presence of spaces between walls and ceilings, and spaces between walls and floors. We will develop a scale using this information to assign kitchen spaces and sleeping spaces to strata of ventilation. Indoor air pollution: We will use the UCB Particle Monitor, which has been validated and used in research studies in India, Nepal, and elsewhere in sub-Saharan Africa and Latin America. ADDIN EN.CITE  ADDIN EN.CITE.DATA [23-24] The UCB Particle Monitor measures concentrations of particulate matter < 50 microns (PM50). The monitor will be placed for 24 hours in the sleeping space of the index case-patient . Placement of the monitor will occur within 72 hours of enrollment into the study to ensure that we measure particulate matter concentrations when influenza transmission is most likely to occur. (Appendix 13: Air Monitor Form). For baris that contain a fully enclosed cooking area (four full walls with an entrance) we will also collect AQM data within the cooking area. Respiratory hygiene: We will inquire about whether the respondent sneezes or coughs directly into her hands, or into a kerchief or other cloth. In addition, we will inquire about whether the respondent washes hands after they come into contact with nasal secretions. This information is self-reported. Active smoking: Smoking related behaviors will be elicited using questions from the Global Adult Tobacco Survey (GATS) and the Global Youth Tobacco Survey (GYTS), which are validated tools being utilized internationally in 15 countries, as part of the Bloomberg Global Initiative to Reduce Tobacco Use. We will inquire about whether the individual used any smoked tobacco products within the previous 30 days and determine where the individual ever used those products inside the home. Passive exposure to smoking: Since we will collect information about direct smoking by all household contacts, we will be able to determine whether passive exposure to smoking occurs within each structure in the bari. Availability of soap and water at a handwashing station: We will identify the location, if any, that the household primarily uses to wash hands. We will inspect whether any cleansing agent (e.g., soap, detergent, mud) and water are available at that location. Application of Social Cognitive Theory constructs to handwashing promotion for prevention of secondary transmission of influenza ADDIN EN.CITE Glanz20023030306Glanz, KarenRimer, Barbara K.Viswanath, K.Health behavior and health education : theory, research, and practice558 p.3rdHealth behavior.Health education.Health promotion.2002San Francisco, CAJossey-Bass[21] ConstructDefinitionExample of application in proposed interventionEnvironmentFactors physically external to the personThe FIS will ensure that the environment facilitates handwashing behavior by ensuring, on a daily basis, that the tools of soap and water are present at a convenient handwashing station in the bari.SituationPersons perception of the environmentThe FIS will strive to understand perceived barriers to handwashing with soap and influenza prevention among bari members, and help the bari members to overcome these barriers. Expected barriers include perceptions of soap affordability, inability to keep soap at an outdoor handwashing station for fear of theft by humans or crows, lack of time to wash hands during busy household or child-rearing tasks, and perception that influenza / respiratory illness transmission within household members is inevitable. Behavioral capabilityKnowledge and skill to perform a given behaviorThe FIS will demonstrate, on a daily basis, the proper way to wash hands with soap. She will remind all bari members daily about the critical times to wash hands, as outlined below.ExpectationsAnticipatory outcomes of a behaviorThe FIS will reinforce to bari members the need to prevent influenza transmission, and the role that handwashing is expected to play in preventing influenza transmission.ExpectanciesThe values that the person places on a given outcome; incentivesThe FIS will assess the positive and negative expectancies, as perceived by bari members. She will emphasize the positive potential health, educational, and economic consequences of preventing influenza transmission to bari members, especially the young, the elderly, and those working outside the homeObservational learningBehavioral acquisition that occurs by watching the actions and outcomes of others behaviorThe FIS will demonstrate on a daily basis, if needed, the appropriate way to wash hands with soap following critical times. More importantly, she will engage key bari members, such as the head of the bari, mothers, and school-aged children to act as models of good handwashing behavior in order to provide vicarious reinforcement to those under their sphere of influence. ReinforcementsResponses to a persons behavior that increase or decrease the likelihood of reoccurrenceThe FIS will provide direct reinforcement by complimenting, on a daily basis, the maintenance of a designated handwashing station fully stocked with water and soap, and the demonstration of appropriate handwashing with soap by bari members. She will engage children and mothers to provide direct reinforcements to fellow bari members in her absence.Self-efficacyThe persons confidence in performing a particular behavior and in overcoming barriers to that behaviorBy engaging bari members in active learning of handwashing with soap during her daily visits, the FIS will encourage self-efficacy. In addition, ensuring the availability of a fully stocked convenient handwashing station will promote self-efficacy.Reciprocal determinismThe dynamic interaction of the person, behavior, and the environment in which the behavior is performedThe FIS will highlight, on a daily basis, the positive steps being taken by individuals and the bari as a whole to move all bari members towards better handwashing behavior. She will provide positive reinforcement directly and encourage bari members themselves to provide mutual reinforcement in order to achieve the common good of improved handwashing behavior. The FIS will ensure that, on a daily basis, the facilitating tools necessary to wash hands will be in place.  These constructs and definitions are verbatim from Glanz et al, Health Behavior and Health Education: Theory, Research, and Practice, 3rd edition. ADDIN EN.CITE Glanz20023030306Glanz, KarenRimer, Barbara K.Viswanath, K.Health behavior and health education : theory, research, and practice558 p.3rdHealth behavior.Health education.Health promotion.2002San Francisco, CAJossey-Bass[21] Critical times to wash hands with soap are: After coughing or sneezing After cleaning ones nose or the nose of a child After defecation After cleaning a child who has defecated Before preparing food Before eating Facilitating tools for handwashing are: A designated handwashing station at a convenient location for most or all bari members Soap available daily at the handwashing station Water available daily at the handwashing station Laboratory methods Nasal swab and oropharyngeal swab specimens will be collected using methods already in place at the Jahurul Islam Hospital for HBIS. Compared to nasopharyngeal washes, nasal swabs have been shown to have sensitivity and specificity of 91% and 100% in detecting influenza among children 2 weeks to 15 years old in a small study from Finland. ADDIN EN.CITE Heikkinen200121212117Heikkinen, T.Salmi, A. A.Ruuskanen, O.Department of Paediatrics, Turku University Hospital, FIN-20520 Turku, Finland. terho.heikkinen@utu.fiComparative study of nasopharyngeal aspirate and nasal swab specimens for detection of influenzaBMJ13832272792001/02/13AdolescentAntigens, Viral/*analysisChildChild, PreschoolFemaleHumansInfantInfant, NewbornInfluenza A virus/*immunologyInfluenza B virus/*immunologyInfluenza, Human/*diagnosisMaleNasal Mucosa/*virologyNasopharynx/*virologyPoint-of-Care SystemsProspective StudiesSpecimen Handling/methods2001Jan 200959-8138 (Print)11159569http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11159569eng[25] Also, among children < 18 years (median age 1.1 year) nasal and throat swab pairs performed similarly (92% sensitivity) to nasopharyngeal washes in identifying influenza A virus. ADDIN EN.CITE  ADDIN EN.CITE.DATA [26] Among adults, throat swabs were less sensitive in identifying influenza than nasopharyngeal aspirates, when viral culture was the gold standard (47% sensitivity). ADDIN EN.CITE Schmid199825252517Schmid, M. L.Kudesia, G.Wake, S.Read, R. C.North Trent Department of Infection and Tropical Medicine, Royal Hallamshire, Hospital, Sheffield.Prospective comparative study of culture specimens and methods in diagnosing influenza in adultsBMJ27531671271998/02/24AdultHumansInfluenza, Human/*diagnosisMicrobiological Techniques/*standardsNasopharynx/virologyPharynx/virologySensitivity and Specificity1998Jan 240959-8138 (Print)9472512http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9472512eng[27] Among children < 18 years, throat swabs were less sensitive (83%) than nasopharyngeal swab for detecting respiratory viruses with nucleic acid amplification. ADDIN EN.CITE Robinson200826262617Robinson, J. L.Lee, B. E.Kothapalli, S.Craig, W. R.Fox, J. D.Public Health and Provincial Laboratory (Microbiology), University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada. jr3@ualberta.caUse of throat swab or saliva specimens for detection of respiratory viruses in childrenClin Infect DisClin Infect Dise61-44672008/05/01ChildChild, PreschoolFluorescent Antibody Technique, DirectHumansInfantInfant, NewbornNucleic Acid Amplification TechniquesPharynx/*virologyRespiratory Tract Infections/*virologySaliva/*virologySensitivity and SpecificityVirology/*methodsViruses/*isolation & purification2008Apr 11537-6591 (Electronic)18444806http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1844480610.1086/529386eng[28] There is no published data on the yield of nasal swabs or nasal and throat swab pairs compared to naspharyngeal wash or swab for seasonal influenza detection in persons older than 15 years old. Oropharyngeal swabs are preferred over nasal or nasophayngeal swab for detection of human H5N1 infection. ADDIN EN.CITE Abdel-Ghafar200827272717Abdel-Ghafar, A. N.Chotpitayasunondh, T.Gao, Z.Hayden, F. G.Nguyen, D. H.de Jong, M. D.Naghdaliyev, A.Peiris, J. S.Shindo, N.Soeroso, S.Uyeki, T. M.Ministry of Health and Population, Cairo.Update on avian influenza A (H5N1) virus infection in humansN Engl J Med261-7335832008/01/18AdultAge FactorsAnimalsAntiviral Agents/therapeutic useHemagglutinins/geneticsHumansIncidence*Influenza A Virus, H5N1 Subtype/genetics/pathogenicity/physiologyInfluenza in Birds/epidemiology/transmission*Influenza, Human/diagnosis/epidemiology/therapy/virologyMiddle AgedOseltamivir/therapeutic usePneumonia, Viral/virologyPoultryVirus Replication2008Jan 171533-4406 (Electronic)18199865http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18199865358/3/261 [pii] 10.1056/NEJMra0707279eng[29] Nasal and throat swabs are used in HBIS due to increased acceptability by patients and less technical expertise to perform compared to nasopharyngeal washes or swabs, and increased likelihood of detecting all influenza viruses (including A(H5N1). From index case-patients, a nasal swab for testing using the QuickVue (Quidel Corporation). The QuickVue uses monoclonal antibodies for direct detection of Influenza A and B and can be used with nasal swabs, nasopharyngeal swabs, nasal washes, or nasal aspirates. The QuickVue test has been shown to have a sensitivity of 78% when using specimens collects with nasal swabs; the specificity has been shown to be 97 to 98% ADDIN EN.CITE  ADDIN EN.CITE.DATA [30]. During the influenza season, QuickVue has a positive predictive value of 94%, when compared with RT-PCR, for detection of influenza for residents of the Kamalapur slum in Dhaka, Bangladesh (WA Brooks, personal communication). Since the PPV of QuickVue is estimated to be so high, we are not adjusting the required sample size of index case-patients in order to allow for false positive QuickVue tests. After the QuickVue test, another nasal swab and an oropharyngeal swab will be collected from index case-patients and immediately placed into VTM. The VTM will be placed in a cool box (4p C) and transferred to a liquid nitrogen dewer at the end of the day for eventual transport to ICDDR,B for RT-PCR testing. From ill household contacts meeting the case definition, a nasal swab and an oropharyngeal swab will be collected and placed into VTM. This will occur for ill contacts during follow up as well. The VTM will be placed immediately in a cool box with ice (4p C). The VTM will then be placed in a liquid nitrogen dewer at the end of the day for eventual transport to the ICDDR,B virology laboratory in Dhaka for RT-PCR testing. Samples will also be stored for future testing of non-influenza respiratory illnesses. At ICDDR,B, RT-PCR will be done to detect Influenza A (H1N1), novel Influenza A (H1N1) Influenza A (H3N2), Influenza B, and Influenza A (H5N1), with appropriate using standardized laboratory methods already in place. ADDIN EN.CITE Chung200728282817Chung, J. Y.Han, T. H.Kim, S. W.Kim, C. K.Hwang, E. S.Department of Pediatrics, Sanggyepaik Hospital, Inje University College of Medicine, Seoul, Korea. pedchung@sanggyepaik.ac.krDetection of viruses identified recently in children with acute wheezingJ Med Virol1238-437982007/06/29Acute DiseaseBocavirus/*isolation & purificationBronchial Spasm/*complications/*virologyChild, PreschoolCoronaviridae/isolation & purificationHumansInfantMetapneumovirus/isolation & purificationRespiratory Syncytial Viruses/*isolation & purificationRespirovirus/isolation & purificationRhinovirus/*isolation & purificationVirus Diseases/*complications/*diagnosis/virology2007Aug0146-6615 (Print)17597481http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1759748110.1002/jmv.20926eng[31] Timeline:  Updated Timeline: Activities2009201020111011121234567891011121234567Update protocol to include follow-up phaseDevelopment of follow-up phaseforms, budgetRRC/ERC SubmissionRRC/ERC ApprovalData Collection Intervention Study First SeasonTraining Staff: Follow Up PhaseData Collection Follow Up PhaseTraining Staff Intervention Study: Second SeasonData Collection Intervention Study: Second SeasonData AnalysisReport DisseminationManuscript Preparation Figure: Study flow diagram  Sample Size Calculation and Outcome Variable(s) Sample size calculation for Specific Aim 1 This sample size calculation is based an estimated 10 potential contacts per bari. This is a gross estimate and is likely an underestimate of the number of persons residing in a bari in most cases, based on our experience. Literature from high-income countries, including Hong Kong, suggests that the secondary attack ratio of influenza or respiratory illness among household contacts of patients with influenza ranges between 8% and 17%. ADDIN EN.CITE  ADDIN EN.CITE.DATA [32-33] For this sample size calculation, we allowed the largest population size allowable in Epi6 software, and assumed secondary attack ratios of 20% and 10% with varying acceptable error rates. The assumptions that we have made here with respect to the number of contacts per bari and the secondary attack ratios are underestimations; we have done so deliberately in order to yield the most conservative sample size requirements. These figures reflect the 95% confidence level. Population sizeExpected secondary attack ratioAcceptable error# household contacts# households if 10 contacts / hh999,99920%3%68268999,99920%7%12513999,99920%10%616999,99910%3%38438999,99910%5%13814999,99910%7%717 As detailed below, Specific Aim 2 entails promotion of handwashing with soap and improved respiratory hygiene in an intervention group of index case-patients and their households. Therefore, Specific Aim 1 will be answered based on the natural history of intrahousehold transmission, which will be evident in the routine practices group. If, as proposed for Specific Aim 2, we enroll 100 households in the routine practices group, we will be able to describe all of the scenarios in the table above. Sample size calculation for Specific Aim 2 Sample size calculations for this controlled intervention study were based on the proportion of household contacts of index cases in each group that will become secondary cases. We assumed that standard deviations in the proportion of household contacts that become secondary cases will be the same in the intervention and routine practices groups. Sample sizes below were estimated at the 95% confidence level to achieve 80% power. We assume 10 contacts per household (excluding the index case-patient), as described under Sample size calculation for Specific Aim 1. In previous studies, the secondary attack ratio of respiratory illness or influenza has ranged from 8% to 17% among household contacts, with the 8% SAR for influenza detected in a pilot study in Hong Kong of non-pharmaceutical interventions. ADDIN EN.CITE  ADDIN EN.CITE.DATA [32-34] Since we do not already have SAR data from Bangladesh, we performed sample size calculations based on estimates of 30%, 20%, and 10% SAR in the routine practices group, and relative risk reductions of 50% and 33%. We propose a design effect of 2.0 to account for clustering of secondary cases within households. ADDIN EN.CITE  ADDIN EN.CITE.DATA [17, 35] Routine practices group* (%)Intervention group* (%)Relative risk reduction (%)# household contacts in each arm# households in each arm# households in both arms# households in both arms after applying design effect of 2.030155011912244830203329229581172010501952039782013.4334975099199105504244285170106.7331093109219437*This is the secondary attack ratio among household contacts of index case-patients. After taking into account a design effect of 2.0, we propose a minimum sample size of 39 households per study arm or a total of 78 households. We expect that, in one influenza season at Jahurul Islam hospital, we will identify about 80 Influenza A and B cases per month. Assuming that there are three months during the 2009 influenza season (this appears to vary a bit from year to year), we anticipate a total of 240 Influenza cases detected during 2009 at Jahurul Islam Hospital. A number of these patients may not be the index case-patients in the home and, thus, would not be eligible for the study. Weighing sample size calculations with eligibility criteria and logistical realities, we estimate that we will be able to enroll a maximum sample size of 100 households per study arm or 200 households. This would allow us to detect all of the differences in the SAR shown above except for the last scenario. Sample size calculations for Specific Aim 3 The sample size calculation for this cohort investigation is based on the proportion of index cases that are less than 5 years old (Tsolia, Vaccine, 2006). In that study set in Greece, 31% of siblings of children with influenza who were less than 5 years old developed respiratory illness, compared to 19% of siblings of children with influenza who were 5 years or older. We do not have published data on the relative burden of influenza on persons > 5 years old, compared to persons < 5 years old from Bangladesh. Thus, we assume that 33% of our index case-patients are < 5 years old. We expect 10 susceptible contacts per household, as outlined under Sample size calculation for Specific Aim 1, and assume that the secondary attack ratios of influenza among siblings and other household contacts are similar. We performed sample size calculations based on several estimated SARs, and relative risks of 2.0, 1.5, and 1.2 for each estimated SAR. These findings are expected to be significant at p=.05 with 80% power. To account for clustering of secondary transmission within households, we propose a design effect of 2.0. Here, exposure is defined as the index case-patients age being < 5 years. Non-exposure is defined as the index case-patients age being > 5 years. As appropriate for cohort studies, we indicate the attack rate among exposed and the attack rate among non-exposed, and the resultant relative risk. The SAR indicates the secondary attack ratio of RT-PCR confirmed Influenza virus infection among all household contacts of the index case-patient. SAR among non-exposed (%)SAR among exposed (%)Relative risk# household contacts of index case-patients > 5 years old# household contacts of index case-patients < 5 years oldTotal # household contactsTotal # householdsTotal # households after applying design effect of 2.02040213266198204020301.54602306906913820241.2257612883864386773306027236108112230451.5260130390397830361.2148474222262234454080240206061240601.516080240244840481.29404701410141282Therefore, if, as proposed for Specific Aim 2, we enroll 100 households in the routine practices arm, we will have sufficient sample size to detect the following at the 95% confidence level, with 80% power. SAR among non-exposed (%)SAR among exposed (%)Relative risk# household contacts of index case-patients > 5 years old# household contacts of index case-patients < 5 years oldTotal # household contactsTotal # householdsTotal # households after applying design effect of 2.02040213266198204020301.546023069069138306027236108112230451.526013039039784080240206061240601.5160802402448 Facilities Available Describe the availability of physical facilities at the place where the study will be carried out. For clinical and laboratory-based studies, indicate the provision of hospital and other types of patients care facilities and adequate laboratory support. Point out the laboratory facilities and major equipment that will be required for the study. For field studies, describe the field area including its size, population, and means of communications.  Jahurul Islam Medical College Hospital, Kishorgonj has been selected for identifying the index cases for the study. This is a 400 bed non-government hospital located in the rural village of Bajitpur upazilla in district Kishorgonj. This is one of the high performing hospitals participating in the ongoing National Hospital Based Influenza Surveillance and Surveillance for Epidemiology of Influenza in Bangladesh. Data Safety Monitoring Plan (DSMP)  This protocol will be approved by the Research and Ethics Review Committees of the ICDDR,B and the Institutional Review Board (IRB) of the Centers for Disease Control and Prevention before its initiation. This study is expected to pose no more than minimal risk to participants. However, we appreciate the importance of ensuring the rights and safety of participants and thus will implement the following data safety monitoring plan. Responsibility for data safety monitoring will rest with Dr. Eduardo Azziz-Baumgartner, a physician serving as the Principal Investigator responsible for overseeing data collection in the field. Serious adverse events (SAEs) directly related to the implementation of this study are not anticipated given the nature of the intervention (handwashing promotion) and the nature of study measures (questionnaire, rapid observation of the household environment, and tracking of illness symptoms among household contacts of index case-patients). However, since influenza can result in hospitalization and death, we will track and report all cases of hospitalization and death among contacts of participating households. The expected adverse event (AE) is dermatologic reaction to soap, which will be provided to intervention households. All study staff involved in data collection and behavioral intervention in the field will be trained on this data safety monitoring plan. Data for all AEs and SAEs will be collected on standard case report forms. All SAEs, irrespective of whether they are related to the project, will be reported to Dr. Sohel within 24 hours of becoming aware of the event. Dr. Azziz-Baumgartner will report all SAEs to the Ethics Review Committee of the ICDDR,B, and Dr. Fry will report all SAEs to the CDC HRPO using established mechanisms for reporting of SAEs to the respective review committees. Reporting of SAEs to the respective review committees will occur within one week, or sooner, as required by the review committee at the time that the protocol is approved. Non-serious AE information will be captured and summarized during data analysis. All data will be collected by trained research assistants using paper-based questionnaires, which will be maintained in a locked cabinet accessible only by research personnel. Data will be entered into password-protected databases. Entered data will be stripped of identifying information and will, instead, be coded using unique identification codes to ensure confidentiality. All data collection is expected to be completed within one year and we do not expect sufficient power to demonstrate significant differences between intervention and control groups in interim analyses. Although we intend to conduct data analysis to establish equivalence between intervention and control groups, we do not plan to conduct interim analysis of secondary attack ratios. The Principal Investigators assume primary responsibility for monitoring data and safety aspects of this study, and will report on these issues in the annual applications to the respective review committees. Per the Research Review Committee of the ICDDR,B, a data safety monitoring board is not indicated, given the nature of this study. Data Analysis  Describe plans for data analysis. Indicate whether data will be analyzed by the investigators themselves or by other professionals. Specify what statistical software packages will be used and if the study is blinded, when the code will be opened. For clinical trials, indicate if interim data analysis will be required to monitor further progress of the study.  Data analysis for Specific Aim 1 We will describe clinical features of index case-patients and household contacts with RT-PCR confirmed Influenza virus infection. Information from index case-patients with Quickvue-positive but RT-PCR negative nasal swabs will be excluded from further data analysis. The household demographics, socioeconomic status, self-reported respiratory hygiene, active and passive smoking status, ventilation, and availability of soap and water at handwashing stations will be described. We will report means and standard deviations of continuous variables and frequencies of categorical variables. For Specific Aim 1, the following secondary attack ratios (SAR) will be the outcome of interest. The SAR for RT-PCR confirmed influenza will be defined as follows: # household contacts with RT-PCR confirmed Influenza virus infection detected during follow-up visit Total # household contacts of index cases of RT-PCR confirmed Influenza virus infection Data analysis for Specific Aim 2 Baseline characteristics of the intervention and routine practices groups will be compared using chi-squares for categorical variables, t-tests for normally distributed continuous variables, and the Wilcoxon rank sums test for non-normally distributed continuous variables. Outcome of interest For Specific Aim 2, the outcome of interest is the secondary attack ratio (SAR) of RT-PCR confirmed Influenza virus infection among household contacts of index case-patients in the intervention and the routine practices groups. As defined for Specific Aim 1, the SAR will be defined as # household contacts with RT-PCR confirmed Influenza virus infection detected during follow-up visit Total # household contacts of index cases of RT-PCR confirmed Influenza virus infection The comparison of intervention and routine practices groups with respect to the SAR of RT-PCR confirmed Influenza virus infection among household contacts of index case-patients will be performed using multivariable linear regression, with adjustment for within-household correlation of illness. Intra-cluster correlation of illness will be estimated based on the between-cluster variance and the total variance of the SAR. We will use generalized estimating equations (GEE) to evaluate the difference in the SAR between intervention and control groups, given the possibility of household-level clustering of secondary illness. Primarily, analysis will be based on the intent to treat (i.e., irrespective of the handwashing practices following the administration of the intervention). Secondarily, we will also conduct per-protocol analysis based on the adherence of the intervention household to maintaining a fully stocked handwashing station with soap and water present during the majority of illness tracking days (i.e. until 10 days after the resolution of the index case-patients symptoms). Data analysis for Specific Aim 3 Explanatory variables of interest Since we will examine whether handwashing with soap is associated with reduced risk of intrahousehold transmission of influenza, we will focus on other potential explanatory factors in our analysis for Specific Aim 3. Specifically, we will examine whether cases differ from controls with respect to the following explanatory variables (described under Measures of interest below): Age of the index child Age of the secondary case-patient Self-reported respiratory hygiene Passive or active smoking among household contacts Crowding Ventilation Socioeconomic status To account for clustering of secondary illness within households, we will perform generalized estimating equations in order to test relationships between explanatory variables and case status. All variables associated with case status on univariate analysis, at a p-value < 0.10, will be tested in multivariate analysis. We will add variables to the multivariate model one-by-one, retaining only those variables that are significantly associated with case status after adjusting for potential confounders. Tests for interaction will also be conducted for possible effect modifiers. Data analysis for Specific Aim 4 For specific aim 4, there will be two main outcomes of interest: Rate of compliance with intervention Baris that are found to have both soap and water present at the handwashing station will be considered compliant Number of times soap is used per day per capita We will replace all bars of soap actively being used in the bari with bars of soap containing motion sensors. The motion sensors will be set to begin data analysis at 11:59 pm on the day of placement. The data collector will retrieve the bars of soap with the motion sensor on the third day, after two full days (24-hour periods) of data collection have been completed. The motion sensors use accelerometer technology and measure movement in three dimensions: if the soap with motion sensor is still or moving slowly, its orientation with respect to gravity can be inferred. Algorithms for analysis of motion sensor data decode whether the bar of soap changes orientation in any of the three dimensions. Movements are classified as non-use when the soap is still, when motion does not involve two or more dimensions, or when motion takes place for <1 second. Movements are classified as genuine soap use when movement in two or three dimensions occurs for > 1 second. Soap movement data will be analyzed accordingly to estimate number of soap use events in each 24-hour period. Differences in the rate of compliance at the first follow up visit in baris by intervention groups compared to control groups at follow up will be tested using chi-squared analysis. Differences in the mean number of times soap is used per day per capita between the intervention and control groups at follow up will be tested using t-tests.. Data analysis for Specific Aim 5 For specific aim 2, there will be three main outcomes of interest: Longitudinal prevalence of respiratory illness (presence of fever, cough, sore throat, or difficulty breathing within last 48 hours) Longitudinal prevalence of diarrhea (presence of diarrhea within the last 48 hours) Cumulative incidence of influenza, as deteremined by RT-PCR Longitudinal prevalence will be defined as: Number of person-days with symptoms Total number of person-days observed The comparison of intervention and routine practices baris with respect to the longitudinal prevalence among household contacts will be performed using multivariable linear regression, with adjustment for within-household correlation of illness. Intra-cluster correlation of illness will be estimated based on the between-cluster variance and the total variance of the prevalence. We will use generalized estimating equations (GEE) to evaluate the difference in the prevalence between intervention and control groups at follow up, given the possibility of household-level clustering of illness. Incidence of influenza, as determined by RT-PCR will be defined as: # of participants with RT-PCR confirmed Influenza A or B during the follow up study Total number of participants in the follow up study We will use the same analysis plan as above, for the longitudinal prevalence data, here for incidence. Ethical Assurance for Protection of Human Rights  Describe in the space provided the justifications for conducting this research in human subjects. If the study needs observations on sick individuals, provide sufficient reasons for using them. Indicate how subjects rights are protected and if there is any benefit or risk to each subject of the study.  Risks: The level of risk encountered by subjects in this study is no greater than minimal. Our research procedures include promotion of handwashing with soap, questionnaire administration, rapid observations of the household environment, and query regarding symptoms of influenza-like illness and severe acute respiratory illness. The research procedures that will be used represent routine data sources for conducting syndromic surveillance and measuring hygiene behaviors in both research studies and in program evaluations. Collection of nasal and oropharyngeal swab specimens is a routine clinical procedure used in medical practices worldwide and is associated with minor irritation or discomfort. Benefits: Households in the intervention group will receive soap and will be exposed to the promotion of handwashing with soap. While the proposed study intends to assess the impact of this intervention on influenza transmission, previously published data supports the beneficial effects of promotion of handwashing with soap on diarrhea and respiratory illness risk, particularly among young children. ADDIN EN.CITE Luby200510110110117Luby, S. P.Agboatwalla, M.Feikin, D. R.Painter, J.Billhimer, W.Altaf, A.Hoekstra, R. M.Division of Bacterial and Mycotic Diseases, National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sluby@icddrb.orgEffect of handwashing on child health: a randomised controlled trialLancetLancet225-333669481Acute DiseaseCarbanilides/administration & dosageChildChild, Preschool*Developing CountriesDiarrhea/epidemiology/*prevention & control*HandwashingHealth EducationHumansImpetigo/epidemiology/*prevention & controlIncidenceInfantPakistanPovertyResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.Respiratory Tract Infections/epidemiology/*prevention & controlSoaps2005Jul 16-2216023513http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16023513 [36] Although there is good evidence that handwashing with soap can prevent diarrhea and respiratory disease among children, the benefit of handwashing with soap for prevention of secondary transmission of influenza within households has not been previously studied in Bangladesh or similar low-income countries.  ADDIN EN.CITE  ADDIN EN.CITE.DATA [36-37] Because we recognize the benefit of handwashing with soap for childhood diarrhea and respiratory disease prevention, we propose to provide the standard practices group with handwashing promotion and two bars of soap upon conclusion of illness tracking (which will occur for 10 days following the resolution of the index case-patients symptoms). Since antiviral medications are not routinely available for the treatment of Influenza in Bangladesh, identification of rapid test positive influenza will not change the physicians clinical management of the illness. Therefore, rapid test results do NOT represent a benefit to the index case-patient and will not be reported to the treating physician. Adverse events: The study involves interview and observation of index case-patients and their households. The observational and interview techniques are non-invasive and we do not anticipate serious adverse events; however all serious events will be monitored and the principal investigator will report on these issues in the annual applications to the respective review committees. Consent: Participation in the study will be voluntary. This study involves the collection of information related to illness and hygiene practices in the household. These questions are generally not perceived to be of a sensitive nature in Bangladeshi culture. All household contacts of potential case-patients will be informed about the purposes and intent of the study, and the voluntary nature of their participation. Written informed consent will be obtained from each potential index case-patient for specimen collection; from each head of the bari, for household contact enumeration, questionnaire administration, rapid observations, and assignment to the intervention and control group; and from each ill household contact for specimen collection (Appendix x, y, and z). The consent forms will be translated into Bangla by a bilingual study staff person who holds a graduate degree. The interviewer will read the consent form aloud since the literacy rate among Bangladeshis remains very low. The potential participants questions and concerns will be addressed. If a potential participant agrees to take part, s/he will sign the consent form or provide a thumbprint in lieu of signature. Scientific and Ethical Review: The protocol will require approval by the Research Review Committee and the Ethical Review Committee of ICDDR,B, the Human Research Protection Office at the Centers for Disease Control and Prevention, and the Institutional Review Board (IRB) of the University at Buffalo before its initiation. The committees will be notified of all protocol deviations. Confidentiality: The consent form will contain the full names of the index case-patient, his/her Unique ID number, and a household Unique ID number. The questionnaire and rapid observation form will have the index case-patients first name, his/her Unique ID number, and the household Unique ID number. Each illness tracking form will contain the household Unique ID number, and the full name and respective Unique ID numbers of the household contact. All paper documents, once entered into a computer database, will be kept in a locked cabinet at Jahurul Islam Medical College Hospital, the partner institution located in Kishoregonj. The research investigator from ICDDR,B will have sole access to the locked cabinet. Use of Animals  Describe in the space provided the type and species of animals that will be used in the study. Justify with reasons the use of particular animal species in the experiment and the compliance of the animal ethical guidelines for conducting the proposed procedures.  Not applicable Literature Cited Identify all cited references to published literature in the text by number in parentheses. List all cited references sequentially as they appear in the text. For unpublished references, provide complete information in the text and do not include them in the list of Literature Cited. There is no page limit for this section, however exercise judgment in assessing the standard length.  ADDIN EN.REFLIST 1. Cumulative Number of Confirmed Human Cases of Avian Influenza A / (H5N1) Reported to WHO. 2008 September 10, 2008 [cited 2008 October 28, 2008]; Available from:  HYPERLINK "http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_09_10/en/index.html" http://www.who.int/csr/disease/avian_influenza/country/cases_table_2008_09_10/en/index.html. 2. Fiore, A.E., et al., Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008. MMWR Recomm Rep, 2008. 57(RR-7): p. 1-64. 3. Bridges, C.B., M.J. Kuehnert, and C.B. Hall, Transmission of influenza: implications for control in health care settings. Clin Infect Dis, 2003. 37(8): p. 1094-101. 4. Brankston, G., et al., Transmission of influenza A in human beings. Lancet Infect Dis, 2007. 7(4): p. 257-65. 5. Heymann, D.L., ed. Control of Communicable Diseases Manual. 18 ed. 2004, American Public Health Association: Washington, DC. 6. Abdullah Brooks, W., et al., Influenza A and B infection in children in urban slum, Bangladesh. Emerg Infect Dis, 2007. 13(10): p. 1507-8. 7. First confirmed human infection with avian influenza A (H5N1) virus in Bangladesh. Health and Science Bulletin, 2008. 6(2). 8. Jefferson, T., et al., Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ, 2008. 336(7635): p. 77-80. 9. Hasan, K., et al., Viral etiology of pneumonia in a cohort of newborns till 24 months of age in Rural Mirzapur, Bangladesh. Scand J Infect Dis, 2006. 38(8): p. 690-5. 10. Arcavi, L. and N.L. Benowitz, Cigarette smoking and infection. Arch Intern Med, 2004. 164(20): p. 2206-16. 11. Stephen, G.A., et al., Assessment of respiratory symptoms and asthma prevalence in a U.S.-Mexico border region. Arch Environ Health, 2003. 58(3): p. 156-62. 12. Ram, P., et al. Use of a novel method to detect reactivity to structured observation for measurement of handwashing behavior. in American Society of Tropical Medicine and Hygiene. 2008. New Orleans, LA. 13. Handwashing behavior in rural Bangladesh. Health and Science Bulletin, 2008. 6(3). 14. Regional Tobacco Surveillance System, Country Profile, Bangladesh. [cited 2008 October 29, 2008]. 15. Komoroski, E.M., et al., Risk factors for febrile, presumed viral illness in the first ten weeks of life. J Perinatol, 1997. 17(4): p. 288-91. 16. Aiello, A.E., et al., Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. Am J Public Health, 2008. 17. National Institute of Population Research and Training, M.a.A., and ORC Macro, Bangladesh Demographic and Health Survey 2004. 2005, National Institute of Population Research and Training, Mitra and Associates, and ORC Macro: Dhaka, Bangladesh and Calverton, Maryland [USA]. 18. Luby, S.P., et al., Difficulties in bringing point-of-use water treatment to scale in rural Guatemala. Am J Trop Med Hyg, 2008. 78(3): p. 382-7. 19. Cowling, B.J., et al., Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Ann Intern Med, 2009. 151(7): p. 437-46. 20. WHO and UNICEF, Integrated Management of Childhood Illness: Model Chapter for Textbooks. 2001, World Health Organization. 21. Glanz, K., B.K. Rimer, and K. Viswanath, Health behavior and health education : theory, research, and practice. 3rd ed. 2002, San Francisco, CA: Jossey-Bass. 558 p. 22. Vyas, S. and L. Kumaranayake, Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan, 2006. 21(6): p. 459-68. 23. Bonner, M.R., et al., Mitochondrial DNA content and lung cancer risk in Xuan Wei, China. Lung Cancer, 2008. 24. Wilson, J.H., Jr., et al., Emission projections for the U.S. Environmental Protection Agency Section 812 second prospective Clean Air Act cost/benefit analysis. J Air Waste Manag Assoc, 2008. 58(5): p. 657-72. 25. Heikkinen, T., A.A. Salmi, and O. Ruuskanen, Comparative study of nasopharyngeal aspirate and nasal swab specimens for detection of influenza. BMJ, 2001. 322(7279): p. 138. 26. Lambert, S.B., et al., Comparing nose-throat swabs and nasopharyngeal aspirates collected from children with symptoms for respiratory virus identification using real-time polymerase chain reaction. Pediatrics, 2008. 122(3): p. e615-20. 27. Schmid, M.L., et al., Prospective comparative study of culture specimens and methods in diagnosing influenza in adults. BMJ, 1998. 316(7127): p. 275. 28. Robinson, J.L., et al., Use of throat swab or saliva specimens for detection of respiratory viruses in children. Clin Infect Dis, 2008. 46(7): p. e61-4. 29. Abdel-Ghafar, A.N., et al., Update on avian influenza A (H5N1) virus infection in humans. N Engl J Med, 2008. 358(3): p. 261-73. 30. Agoritsas, K., et al., Evaluation of the Quidel QuickVue test for detection of influenza A and B viruses in the pediatric emergency medicine setting by use of three specimen collection methods. J Clin Microbiol, 2006. 44(7): p. 2638-41. 31. Chung, J.Y., et al., Detection of viruses identified recently in children with acute wheezing. J Med Virol, 2007. 79(8): p. 1238-43. 32. Principi, N., et al., Burden of influenza in healthy children and their households. Arch Dis Child, 2004. 89(11): p. 1002-7. 33. Cowling, B.J., et al., Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS ONE, 2008. 3(5): p. e2101. 34. Tsolia, M.N., et al., Impact of influenza infection in healthy children examined as outpatients and their families. Vaccine, 2006. 24(33-34): p. 5970-6. 35. Kerry, S.M. and J.M. Bland, Sample size in cluster randomisation. BMJ, 1998. 316(7130): p. 549. 36. Luby, S.P., et al., Effect of handwashing on child health: a randomised controlled trial. Lancet, 2005. 366(9481): p. 225-33. 37. Curtis, V. and S. Cairncross, Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infectious Disease, 2003. 3: p. 275-281.  Dissemination and Use of Findings  Describe explicitly the plans for disseminating the accomplished results. Describe what type of publication is anticipated: working papers, internal (institutional) publication, international publications, international conferences and agencies, workshops etc. Mention if the project is linked to the Government of the Peoples Republic of Bangladesh through a training programme.  The findings of the study will be shared with the government and the participating hospital. The summary results will be published in the Health and Science Bulletin. The findings will be disseminated through presenting in the appropriate scientific conference. A manuscript will be prepared summarizing the principle measures of interest for publishing in an international peer reviewed scientific journal. As per ICDDR,B data access policy the data will be made available to other researchers within 3 years of completion of the study. Collaborative Arrangements Describe briefly if this study involves any scientific, administrative, fiscal, or programmatic arrangements with other national or international organizations or individuals. Indicate the nature and extent of collaboration and include a letter of agreement between the applicant or his/her organization and the collaborating organization. This study will build upon the collaboration between ICDDR,B, University at Buffalo, and CDC, Atlanta. Biography of the Investigators Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator. (Note: Biography of the external Investigators may, however, be submitted in the format as convenient to them) Biography of the Investigators NAME Ram, Pavani KalluriPOSITION TITLE Assistant ProfessoreRA COMMONS USER NAME n/aEDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)INSTITUTION AND LOCATIONDEGREE (if applicable)YEAR(s)FIELD OF STUDYColumbia College, Columbia University, New York, NYAB1989-1993Middle East Languages and Cultures Mount Sinai School of Medicine, New York, NYMD1994-1998MedicineWashington University School of Medicine, St. Louis, MO--1998-2001Internal medicineCenters for Disease Control and Prevention, Atlanta, GAn/a2001-2003Epidemiology  A. Positions & Honors Positions and Employment 7/01 7/03 Epidemic Intelligence Service, US Centers for Disease Control and Prevention, Atlanta, GA 7/03 7/05 Medical Epidemiologist, Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 9/05 1/08 Research Assistant Professor, Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, NY 1/08 present Assistant Professor, Department of Social and Preventive Medicine, University at Buffalo, State University of New York, Buffalo, NY Honors and Awards 7/88 Governors Scholar, Public Issues, New Jersey 5/92 Dean Hawkes Memorial Prize for Excellence in Humanities, Columbia College 5/93 Magna Cum Laude, Columbia College, Columbia University 6/01 Teaching award, Washington University School of Medicine, in recognition of outstanding teaching of medical students on the Internal Medicine Clerkship 10/01 Crisis Response Award, US Public Health Service, for participation in post-9/11 activities 11/01 Crisis Response Award, US Public Health Service, for participation in response to anthrax bioterrorism 2/04 Achievement Medal, US Public Health Service, for exemplary performance of duty in implementation of the Safe Water System in Afghanistan 6/04 Unit Commendation, US Public Health Service, for rapid response to an outbreak of foodborne botulism 5/05 10th Anniversary Hero, National Foundation for the Centers for Disease Control and Prevention B. Selected peer-reviewed publications 2004 Naheed A, Kalluri P, Talukder KA, et al. Fluoroquinolone resistant Shigella dysenteriae Type 1 in northeastern Bangladesh. Lancet Infectious Diseases 2004; 4: 607-608. 2006 Kalluri P, Naheed A, Rahman S, et al. An evaluation of three rapid diagnostic test kits for cholera: does the skill level of the technician matter? Tropical Medicine & International Health 2006; 11: 49-55. 2006 Ram PK, Naheed A, Brooks WA et al. Risk factors for typhoid fever in a densely populated slum in Dhaka, Bangladesh. Epidemiology and Infection; epub Aug 8, 2006:1-8. 2007 Gupta S, Sheikh M, Islam M, Rahman K, Jahan N, Rahman M, Hoekstra R, Johnston R, Ram P, Luby S. Usefulness of the hydrogen sulfide test for assessment of water quality in Bangladesh. Journal of Applied Microbiology. 2007; epub ahead of print. 2008 Ram PK, Choi M, Blum LS, Wamae AW, Mintz ED, Bartlett AV. Declines in case management of diarrhoea among children < 5 years old. Bulletin of the World Health Organization. 2008; epub ahead of print 2008 Ram PK, Crump, JA, Gupta SK, Miller MA, Mintz ED. Analysis of Data Gaps Pertaining to Shigella Infections in Low- and Medium Human Development Index Countries, 1984-2005. Epidemiology and Infection. 2008; 136:577-603. In Press Naheed A, Ram PK, Brooks WA, Mintz ED, Hossain A, Bird M, Luby SP, Breiman RF. Clinical Value of TubexTM and Typhidot Rapid Diagnostic Tests for Typhoid Fever in an Urban Community Clinic in Bangladesh. Diagnostic Microbiology and Infectious Diseases. C. Research Support ACTIVE Validation and improvement of measures of handwashing behavior 2/08 6/08 Water and Sanitation Program, The World Bank Role: Principal Investigator Objective: Validation and improvement measures of handwashing behavior and technical advice on measuring handwashing as part of monitoring and evaluation of four-country scale-up of handwashing promotion. Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  1 Name : Tasnim Azim 2 Present position : Scientist, Head HIV/AIDS Programme and Virology Laboratory 3 Educational background : Ph.D., 1989, Immunology/Virology, University of London, UK (last degree and diploma & training relevant to the present research proposal) 4. List of ongoing research protocols (Start and end dates; and percentage of time) As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time2007-05501-12-0730-11-0810%Activity no. 00021 Bhutan Surveillance 29/05/200628/11/200917%Activity No. 00236 GFATM-IDU02/02/200831/05/20085%Activity No. 00237-GFATM-Care & Support02/02/200830/04/20093%Activity No. 00248, GFATM OR Round 607/02/200830/04/20098.5%Activity No. 00225 UNODC-ROSA H1301-12-0730-11-0810% As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of timeActivity No.00231, PPTCT01/01/200831/12/20085% As Co-Investigator Protocol NumberStarting dateEnding datePercentage of time2003-03031/10/200329/09/20085%2007-00201/01/200729/09/20085%2006-04401-01-200731/12/0815%2008-00730/09/200730/03/20095% 5. Publications Types of publicationsNumbersa) Original scientific papers in peer-review journals 58b) Peer reviewed articles and book chapters 2c) Papers in conference proceedings>25c) Letters, editorials, annotations, and abstracts in peer-reviewed journals 6Working papersMonographs/reports8 6 Five recent publications including publications relevant to the present research protocol Rahman M, Hassan ZM. Zafrul H, Saiada F, Banik A, Faruque ASG, Delbeck T, Matthijnssens J, van Ranst M, Azim T. Sequence analysis and evolution of group B rotaviruses. Virus Research 2007 125:219-225. Brooks WA, Terebuch P, Bridges C, Klimov A, Goswami D, Sharmeen AT, Azim T, Erdman D, Hall H, Luby S, Breiman RF. Influenza A and B in children inurban slum, Bangladesh. Emerg Inf Dis 2007 (Oct). Brooks WA, Erdman D, Terebuch P, Klimov A, Goswami D, Sharmeen AT, Azim T, Hall H, Luby S, Bridges C, Breiman RF. Human metapneumovirus infection among children, Bangladesh. Emerg Inf Dis 2007 13:1611-1613. Azim T, Rahman M, Alam MS, Chowdhury IA, Khan R, Reza M, Rahman M, Chowdhury EI, Hanifuddin M, , Rahman ASMM., Bangladesh moves from being a low prevalence nation for HIV to one with a concentrated epidemic in injecting drug users. Int J STD AIDS 2008 (in press). Sarker MS, Rahman M, Yirrell D, Khan R, Campbell E, Islam LN, Azim T. Molecular evidence for polyphyletic origin of human immunodeficiency virus type 1 subtype C in Bangladesh. Virus Research 2008 (in press). Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  1 Name: Eduardo Azziz-Baumgartner 2 Present Position: Scientist, Programme on Infectious Diseases and Vaccine Sciences, ICDDR,B 3 Educational background: (last degree and diploma & training relevant to the present research proposal) Bachelors in Science, Molecular Biology (1993) University of Michigan, Ann Arbor, Michigan Medical School, (1997) University of Alabama Medical School, Birmingham, Alabama Residency, Family Medicine (2000) University of Texas at San Antonio, San Antonio, Texas Fellowship in Minority Health Policy, Commonwealth Fund (2003) Harvard Medical School, Boston, Massachusetts Masters in Public Health, Family and Community Medicine Health (2003) Harvard School of Public, Boston, Massachusetts Epidemic Intelligence Service, National Center for Environmental Health Division of Environmental Hazards and Health Effects, Health Studies Branch (2003-2005) 4.0 List of ongoing research protocols (start and end dates; and percentage of time) As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       5 Publications Types of publicationsNumbersOriginal scientific papers in peer-review journals13 Peer reviewed articles and book chapters  FORMTEXT      Papers in conference proceedings1Letters, editorials, annotations, and abstracts in peer-reviewed journals FORMTEXT      Working papers0Monographs FORMTEXT       6 Five recent publications including publications relevant to the present research protocol Eduardo Azziz-Baumgartner, George Luber, Helen Schurz Rogers, L. Backer, M. Belson, Stephanie Kieszak, K. Caldwell, B Lee, R Jones, R Todd, and Carol Rubin. Exposure assessment of a mercury spill in a Nevada school2004Clinical Toxicology. 2007. Volume 45. 15. Heather Strosnider, Eduardo Azziz-Baumgartner, Marianne Banziger, Ramesh V. Bhat, Robert Breiman, Marie-Noel Brune, Kevin DeCock, Abby Dilley, John Groopman, Kerstin Hell, Sara H. Henry, Daniel Jeffers, Curtis Jolly, Pauline Jolly, Gilbert N. Kibata, Lauren Lewis, Xiumei Liu, George Luber, Leslie McCoy, Patience Mensah, Marina Miraglia, Ambrose Misore, Henry Njapau, Choon-Nam Ong, Mary T.K. Onsongo, Samuel W. Page, Douglas Park, Manish Patel, Timothy Phillips, Maya Pineiro, Jenny Pronczuk, Helen Schurz Rogers, Carol Rubin, Myrna Sabino, Arthur Schaafsma, Gordon Shephard, Joerg Stroka, Christopher Wild, Jonathan T. Williams, and David Wilson. Workgroup Report: Public Health Strategies for Reducing Aflatoxin Exposure in Developing Countries. Environmental Health Perspectives. 2006. Volume 114. 18981903 Alberto B. Broce; Ludek Zurek; James A. Kalisch; Robert Brown; David L. Keith; David Gordon; Janis Goedeke; Cal Welbourn; John Moser; Ronald Ochoa; Eduardo Azziz-Baumgartner; Fuyuen Yip; Jacob Weber. Pyemotes herfsi (Acari: Pyemotidae), a Mite New to North America as the Cause of Bite Outbreaks. Journal of Medical Entomology. 2006. Volume 43. (3) 610 613. Eduardo Azziz-Baumgartner;Wolkin, Amy;Sanchez, Carlos;Bayleyegn, Tesfaye;Young, Stacy;Kieszak, Stephanie;Oberst, Kathleen;Batts, Dahna;Thomas, Charles C.;Rubin, Carol. Impact of Hurricane Ivan on Pharmacies in Baldwin County, Alabama. HYPERLINK "http://www.ingentaconnect.com/content/apa/japha;jsessionid=34b8nm6n649vt.victoria" \o "Journal of the American Pharmacists Association"Journal of the American Pharmacists Association. 2005. Volume 45. (6) 670-675. Eduardo Azziz-Baumgartner, Kimberly Lindblade, Karen Gieseker, Helen Schurz Rogers, Stephanie Kieszak, Henry Njapau, Rosemary Schleicher, Leslie F. McCoy, Ambrose Misore, Kevin DeCock, Carol Rubin, Lawrence Slutsker, and the Aflatoxin Investigative Group. Case-Control Study of an Acute Aflatoxicosis Outbreak - Kenya--2004 Environmental Health Perspectives 2005. Vol. 113 (12) 1779-1783. Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  1 Name: Joseph S. Bresee 2 Present Position: Chief, Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA USA 1986-1990 M.D., Baylor College of Medicine, Houston, TX 1990-1993 Internship/Residency in Pediatrics, University of Washington School of Medicine/Children's Hospital and Medical Center, Seattle, WA 1993-1995 Epidemic Intelligence Service (EIS) Influenza Branch Division of Viral and Rickettsial Diseases National Center for Infectious Diseases Centers for Disease Control and Prevention 3 Educational background: (last degree and diploma & training relevant to the present research proposal) 4.0 List of ongoing research protocols (start and end dates; and percentage of time) Dr. Bresee is Chief, Epidemiology and Prevention Branch, Influenza Division at the Centers for Disease Control and Prevention in Atlanta. The EPB is responsible for conducting influenza surveillance, working to understand influenza disease burden, helping to derive appropriate vaccine and antiviral use policies to prevent seasonal influenza, detecting and preventing avian influenza and pandemic influenza, and providing technical expertise to global public health partners. As such, Dr. Bresee is a collaborator on several influenza research studies, but only those related to Bangladesh are listed below. As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Investigator Protocol NumberStarting dateEnd datePercentage of timeCDC IRB #40302003Sept 20085%CDC IRB#43142003Dec 20072% FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       Both of these protocols are ICDDR,B studies. CDC IRB#4030 is a surveillance study in Kamalpur, (PI Dr. Brooks). CDC IRB# 4314 is a study of effects of air pollution on respiratory disease (PI  Dr. Brooks) 5 Publications Types of publicationsNumbersOriginal scientific papers in peer-review journals85 Peer reviewed articles and book chapters 135Papers in conference proceedings5Letters, editorials, annotations, and abstracts in peer-reviewed journals3Working papers10Monographs0 Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  NAME W. Abdullah Brooks, MD, MPH POSITION TITLE Head, Infectious Diseases Unit, Division of Health Systems and Vaccine Sciences, ICDDR,B Centre for Health and Population Research Asst. Scientist , Department of International Health, Johns Hopkins University School of Hygiene and Public Health EDUCATION Institution/LocationDegreeYear ConferredField of StudyStanford UniversityMD1991MedicineThe New York Hospital / Cornell Medical CenterDiploma1994PediatricsJohns Hopkins UniversityMPH1995International HealthJohns Hopkins UniversityDiploma1996Preventive Medicine EXPERIENCE AND APPOINTMENTS YearActivity2007 PresentCo-Investigator: National influenza hospital surveillance, Bangladesh2006 2007 Co-PI: Efficacy Zinc in outpatient bronchiolitis in children < 2 y/o2006 PresentCo-Inv: Role of prolactin in diagnosis of pneumonia in children2003 Present Principal Investigator: Efficacy Zinc in Outpatient Pneumonia in Children < 2 y/o 2003 Present Principal Investigator: Pneumococcal disease burden urban study2003 Present Principal Investigator: Influenza, other respiratory virus burden of diesase2002 2004 Typhoid burden of disease and risk factor study2002 2003Principal Investigator: Safety, Immunogenicity, Tolerability CAIV-T (Influenza) vaccine and MMR2002 2003 Prevalence & risk factors for asthma among urban children, Dhaka2002 PresentUnit Head, Infectious Diseases; Division of Health Systems & Infectious Disease2001 2002Co-PI: Safety, Immunogenicity, Tolerability CAIV-T (Influenza) vaccine and OPV2001 PresentCo-PI: Shigella burden of disease study2001 2002 Principal Investigator: Typhoid burden of disease in urban Dhaka2000 PresentPrincipal Investigator: Community-based Emergency Epidemiological Study Dengue 1999 2001Principal Investigator: Hospital-based study of efficacy zinc as adjuvant therapy in management severe pneumonia, hospitalised children < 2 y/o1998 PresentPrincipal Investigator: Demographic Surveillance System, Kamalapur, Dhaka1998 2001Principal Investigator: Community-based study to prevent pneumonia/diarrhoea with zinc in children less than 2 years old1997 PresentRegional Medical Consultant: International SOS, Singapore1997 2001Principal Investigator: Hospital-based study to test efficacy zinc in acute watery diarrhoea in children less than 6 months old1997 PresentPaediatric Consultant, UNOCAL1997 PresentRegional Medical Consultant: International SOS, Singapore1997 2001Paediatric Consultant, US Embassy, Dhaka 1996 1997Chief Resident Preventive Medicine Program, Johns Hopkins University1996EPI Technical Advisor: National measles vaccination campaign children 12 - 59 months, PAHO, EPI/SVI, Georgetown, Guyana1996Epidemiologist: Consultants in Epidemiology and Occupational Health, Washington, DC1995 1997Paediatric Emergency Room Attending, St. Josephs Hospital, Baltimore1995 1997Paediatric consultant: Urban school-based clinics for Baltimore County 1994 1997Paediatric On-Call Physician, Kennedy-Krieger Institute, Johns Hopkins1995Multicentre Study on Lower Osmolar ORS, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)1992Investigator: Community-based dysentery intervention urban slum children, Salvador, Bahia, Brazil1990Epidemiology Intelligence Service Medical Student Clerkship, Enteric Branch, Centers for Disease Control and Prevention1986Investigator: Isolation of L. major attachment proteins, National Institutes of Health1985-1986Principal Investigator: Identification of heat-shock proteins in F.hepatica, Stanford University  Honours and Awards (Selected) Time Magazine 2005, The year in medicine recognition of Brooks et al. Lancet, 2005. 366(9490): p. 999-1004 contribution to child mortality reduction Awardee Office of Dietary Supplements, National Institutes of Health, 100 most significant advances in Annual Bibilography of Significant Advances in Dietary Supplement Research 2004 for Brooks et al. Lancet, 2004. 363(9422): p. 1683-8. Chief Residency, Preventive Medicine, Johns Hopkins University School of Public Health 1996 7 Awardee Health & Child Survival Scholarship to Johns Hopkins University 1994 5 Selectee Ciba-Geigy Medical Student (competitive) Scholarship for internship NIH 1985 while at Stanford Medical School PUBLICATIONS (Selected) Brooks, W.A., Breiman, R. F., Goswami, D., Hossain, A., Alam, K., Saha, S. K., Nahar, K., Nasrin, D., Ahmed, M. D., Arifeen, S. E., Naheed, A., Sack, D. A., Luby, S. , Invasive pneumococcal disease burden, seasonality, and antimicrobial resistance patterns, and implications for vaccine policy in urban Bangladesh. In Press, 2007. Ram, P.K., Naheed, A., Brooks, W.A., Hossain, M.A., Mintz, E.D., Breiman, R.F., and Luby, S.P., Risk factors for typhoid fever in a slum in Dhaka, Bangladesh. Epidemiol Infect, 2007. 135(3): p. 458-65. Islam, M.S., Brooks, A., Kabir, M. S., Jahid, I. K., Islam, M. S., Goswami, D., Nair, G. B., Larson, C., Yukiko, W., Luby, S., Faecal contamination of drinking water sources of Dhaka during the 2004 flood in Bangladesh and use of disinfectants for water treatment. J Appl Microbio, 2006. Brooks, W.A., Santosham, M., and Black, R.E., Zinc, infectious diseases, and low birth weight. Am J Clin Nutr, 2006. 84(3): p. 667. Harris, J.B., Baresch-Bernal, A., Rollins, S.M., Alam, A., LaRocque, R.C., Bikowski, M., Peppercorn, A.F., Handfield, M., Hillman, J.D., Qadri, F., Calderwood, S.B., Hohmann, E., Breiman, R.F., Brooks, W.A., and Ryan, E.T., Identification of in vivo-induced bacterial protein antigens during human infection with Salmonella enterica serovar Typhi. Infect Immun, 2006. 74(9): p. 5161-8. Brooks, W.A., Santosham, M., Naheed, A., Goswami, D., Wahed, M.A., Diener-West, M., Faruque, A.S., and Black, R.E., Effect of weekly zinc supplements on incidence of pneumonia and diarrhoea in children younger than 2 years in an urban, low-income population in Bangladesh: randomised controlled trial. Lancet, 2005. 366(9490): p. 999-1004. Brooks, W.A., Hossain, A., Goswami, D., Nahar, K., Alam, K., Ahmed, N., Naheed, A., Nair, G.B., Luby, S., and Breiman, R.F., Bacteremic typhoid fever in children in an urban slum, Bangladesh. Emerg Infect Dis, 2005. 11(2): p. 326-9. Brooks, W.A., Santosham, M., Roy, S.K., Faruque, A.S., Wahed, M.A., Nahar, K., Khan, A.I., Khan, A.F., Fuchs, G.J., and Black, R.E., Efficacy of zinc in young infants with acute watery diarrhea. Am J Clin Nutr, 2005. 82(3): p. 605-10. LaRocque, R.C., Breiman, R.F., Ari, M.D., Morey, R.E., Janan, F.A., Hayes, J.M., Hossain, M.A., Brooks, W.A., and Levett, P.N., Leptospirosis during dengue outbreak, Bangladesh. Emerg Infect Dis, 2005. 11(5): p. 766-9. Brooks, W.A., Yunus, M., Santosham, M., Wahed, M.A., Nahar, K., Yeasmin, S., and Black, R.E., Zinc for severe pneumonia in very young children: double-blind placebo-controlled trial. Lancet, 2004. 363(9422): p. 1683-8. RELEVANT MANUSCRIPTS UNDER REVIEW Brooks, W.A., Terebuh, P., Bridges, C., Klimov, A., Goswami, D., Sharmeen., Azim, T., Erdman, D., Hall, H., Luby, S., Breiman, R.F., Influenza A and B infection among children in an urban slum of Dhaka, Bangladesh: A pilot study. Manuscript submitted and under review, 2007. Brooks, W.A., Erdman, D., Terebuh, P., Klimov, A., Goswami, D., Sharmeen., Azim, T., Luby, S., Bridges, C., Breiman, R.F., Human metapneumovirus infection among children in an urban slum of Dhaka, Bangladesh: A pilot study. Manuscript submitted and under review, 2007. BOOKS/GUIDELINES Guidelines for the control of shigellosis, including Shigella dysenteriae type 1. WHO 2005 GRANTS Health and Human Services: Population-based influenza surveillance among children < 5 years old in Kamalapur in Dhaka, Bangladesh. US $250,000 2006 - 2007 Thrasher Research Foundation: Efficacy of Zinc in the Treatment of Outpatient Pneumonia Among Urban Slum Children Less than Two Years Old. US $250,000; 2004 2007 Centers for Disease Control and Prevention: Surveillance for influenza and the viral aetiologies of influenza-like febrile illnesses in an urban slum in Dhaka, Bangladesh US $392,133; 2004-2008 Accelerated Development and Introduction Plan (ADIP): Burden of Pneumococcal Disease in children in Bangladesh: A Project to Enhance Laboratory Capacity and Create Awareness, and to Prepare for Introduction of a Pneumococcal Vaccine. US $599,816; 2004 2008 Bill & Melinda Gates Foundation: Efficacy of Zinc in the Treatment of Outpatient Pneumonia Among Urban Slum Children Less than Two Years Old. US $250,591; 2004 2007 Wyeth: A Prospective, Randomized, Double Blind, Placebo-Controlled, Trial to Assess Safety, Efficacy, Tolerability and Immunogenicity of Influenza Virus Vaccine, Trivalent, Types A & B, Live Cold-Adapted, Liquid Formulation (CAIV-T), Administered Concomitantly with a Combination Live, Attenuated, Mumps, Measles, and Rubella Vaccine in Healthy Children Aged 11 24 Months Protocol No. D153 P522. US $116,419; 2002 2003 National Institutes of Health (ICIDR): Emergency epidemiological study of dengue and dengue haemorrhagic fever in Dhaka, Bangladesh. US $100,097; 2002 2003 Wyeth: A prospective, randomised, partially-blinded, placebo-controlled, Phase III, multicentre trial to assess safety, tolerability and imunogenicity of liquid influenza virus vaccine, trivalent, types A & B, live cold-adapted (liquid CAIV-T) administered concomitantly with live, attenuated, poliovirus vaccine in healthy children. US $185,845; 2001 2002 International Vaccine Institute: Population based evaluation of Shigella infections in an urban area of Dhaka, Bangladesh US $459,672; 2001 2004 United States Agency for International Development/Johns Hopkins University: Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $115,102; 1998 2001 Swiss Development Corporation: Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $50,000; 1998 - 2001 United States Agency for International Development (USAID): Efficacy of Zinc in the Prevention of Pneumonia in Urban Slum Children in Dhaka, Bangladesh. US $65,000; 1998 2001 United States Agency for International Development (USAID): Efficacy of Zinc in the Treatment of Severe Pneumonia Among Hospitalised Children less than Two Years Old. US $62,365; 1999 2001 United States Agency for International Development (USAID)/Johns Hopkins University: Efficacy of zinc in treatment of acute watery diarrhoea in infants less than six months old. US $13,355; 1998 2000 Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  NAME DiVita, Margaret AnnePOSITION TITLE PhD CandidateeRA COMMONS USER NAME n/aEDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)INSTITUTION AND LOCATIONDEGREE (if applicable)YEAR(s)FIELD OF STUDYSUNY GeneseoBA1999-2002Anthropology and Spanish SUNY BinghamtonMS2002-2004BioMedical AnthropologySUNY Buffalo--2004- currentEpidemiology and Community Health A. Honors Honors and Awards 5/2002 Magna Cum Laude, SUNY Geneseo Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  Alicia M. Fry Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop A-34 Atlanta, GA 30333 Phone: (404) 639-2680 Email:  HYPERLINK "mailto:afry@cdc.gov" afry@cdc.gov December 2006 EDUCATION AND TRAINING (Relevant to proposal) Postgraduate 7/93- 6/95 Infectious Diseases Fellowship (overlapping with Molecular Medicine Fellowship) University of California, San Francisco 7/90 6/93 Internal Medicine Internship and Residency The Johns Hopkins Hospital, Baltimore, Maryland Graduate/Undergraduate 6/98-5/99 Masters of Public Health (Epidemiology) University of California, Berkeley, School of Public Health 9/84-5/90 Doctorate of Medicine University of Cincinnati College of Medicine, Cincinnati, Ohio CURRENT POSITION Centers for Disease Control and Prevention Medical Epidemiologist Division of Viral Diseases, Epidemiology Branch, National Center for Immunization and Respiratory Diseases 5 PEER-REVIEWED PUBLICATIONS (Relevant to proposal) Fry AM, Lu X, Peret TDT, Chittaganpitch M, Fischer J, Erdman DD, Olsen SJ. Human bocavirus: a novel parvovirus epidemiologically associated with hospitalized pneumonia in Thailand. J Infect Dis (in press) Fry AM, Curns A, Harbour K, Anderson LJ. Seasonal Trends of Human Parainfluenza Viruses in the United States; National Respiratory Virus Surveillance Data, 1990-2002, Clin Inf Dis 2006 43(8):1016-22. Fry, AM, Shay DK, Holman R, Curns A, Anderson LJ. Trends in hospitalizations for pneumonia among persons 65 years of age and older in the United States, 19882002. JAMA 2005; 294(21):2712-2719. Fry AM, Udeagu CC, Soriano-Gabarro M, Fridkin S, Musinski D, LaClaire L, Elliott J, Cook DJ, Kornblum J, Layton M, Whitney CG.. Persistence of a fluoroquinolone-resistant multidrug-resistant Streptococcus pneumoniae in a long-term care facility: Efforts to decrease transmission, Infection Control and Hospital Epidemiology 2005;23: 239-47. Fry AM, Facklam R, Whitney CG, Plikaytis BD, and Schuchat A. Multi-state evaluation of invasive pneumococcal diseases in adults with HIV infection: serotype and antimicrobial resistance patterns in the United States, J Infect Dis 2003: 181; 643. Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  1 Name: Stephen P Luby 2 Present Position: Head, Programme on Infectious Diseases and Vaccine Sciences. University of Texas Southwestern Medical School at Dallas MD, 1986 University of Rochester Strong Memorial Hospital Internship and residency in Internal Medicine. Centers for Disease Control -- Epidemic Intelligence Service 1990 Completed Preventive Medicine Residency 1993. 3 Educational background: (last degree and diploma & training relevant to the present research proposal) 4.0 List of ongoing research protocols (start and end dates; and percentage of time) As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time2003-0241 Sep 200331 Dec 200652005-0261 Oct 200531 Dec 200652005-0231 Feb 200631 Dec 200752006-0431 Nov 200631 July 200752007-0031 May 200731 Apr 200832007-0021 May 200730 Sep 200852007-0101 July 200730 Sep 200852007-0041 May 200730 Sep 200812007-0301 Sep 200731 Dec 20085 As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of time2003-024Jun 2004June 200652003-002June2003Dec 20065 4.3 As Co-Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       5 Publications Types of publicationsNumbersOriginal scientific papers in peer-review journals 118 Peer reviewed articles and book chapters 9Papers in conference proceedings1Letters, editorials, annotations, and abstracts in peer-reviewed journals 4Working papers0Monographs0 Five recent publications including publications relevant to the present research protocol Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial. Lancet. July 15, 2005; 366:225-33. Ram PK, Naheed A, Brooks WA, Hossain MA, Mintz ED, Breiman RF, Luby SP. Risk factors for typhoid fever in a densely populated slum in Dhaka, Bangladesh. Epidemiology and Infection. 2007 135:458-65. Bowen A, Huilai M, Ou J, Billhimer W, Long T, Mintz E, Hoekstra RM, Luby S. A Cluster-Randomized Controlled Trial Evaluating the Effect of a Handwashing Promotion Program in Chinese Primary Schools, American Journal of Tropical Medicine and Hygiene. June 2007 76(6):1166-1173. Brooks WA, Breiman RF, Goswami D, Hossain A, Alam K, Saha S, Narar K, Nasrin D, Ahmed N, El Arifeen S, Naheed A, Sack D, Luby S. Invasive pneumococcal disease burden and implications for vaccine policy in urban Bangladesh. American Journal of Tropical Medicine and Hygiene. 2007 Nov 77(5): 795801. Luby SP, Halder AK. Associations among handwashing indicators, wealth, and symptoms of childhood respiratory illness in urban Bangladesh. Tropical Medicine and International Health. 2008 Jun 13(6):835-844. Biography of the Investigators  Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator.  1 Name: Mustafizur Rahman 2 Present Position: Senior Research Officer, Virology Laboratory, LSD, ICDDR,B. 1995 M.Sc. in Microbiology, University of Dhaka. Bangladesh. 2001-2002 Training in Virology, University of Leuven, Belgium. 2002 Training in Bio-informatics in Charles University, Prague, Czech Republic. 2007 IEIP/GDD Laboratory Workshop for Respiratory Disease, Centers for Disease Control, Atlanta, USA. 3 Educational background: (last degree and diploma & training relevant to the present research proposal) 4.0 List of ongoing research protocols (start and end dates; and percentage of time) As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       5 Publications Types of publicationsNumbersOriginal scientific papers in peer-review journals 25 Peer reviewed articles and book chapters 1Papers in conference proceedings0Letters, editorials, annotations, and abstracts in peer-reviewed journals 0Working papers5Monographs0 6 Five recent publications including publications relevant to the present research protocol Rahman, M., J. Matthijnssens, X. Yang, T. Delbeke, I. Arijs, K. Taniguchi, M. Iturriza-Gomara, N. Iftekharuddin, T. Azim, and M. Van Ranst. 2007. Evolutionary history and global spread of the emerging G12 human rotaviruses. J Virol 81:2382-90. Rahman, M., R. Sultana, G. Ahmed, S. Nahar, Z. M. Hassan, F. Saiada, G. Podder, A. S. G. Faruque, A. K. Siddique, D. A. Sack, J. Matthijnssens, M. Van Ranst, and T. Azim. 2007. Prevalence of G2P[4] and G12P[6] rotavirus, Bangladesh. Emerg Infect Dis 13:18-24. Rahman, M., Z. M. Hassan, H. Zafrul, F. Saiada, S. Banik, A. S. G. Faruque, T. Delbeke, J. Matthijnssens, M. Van Ranst, and T. Azim. 2007. Sequence analysis and evolution of group B rotaviruses. Virus Res 125:219-25. Rahman, M., J. Matthijnssens, T. Goegebuer, K. De Leener, L. Vanderwegen, I. Van der Donck, L. Van Hoovels, S. De Vos, T. Azim, and M. Van Ranst. 2005. Predominance of rotavirus G9 genotype in children hospitalised for rotavirus gastroenteritis. J Clin Virology 33:1-6. Rahman, M., J. Matthijnssens, S. Nahar, G. Podder, D. A. Sack, T. Azim, and M. Van Ranst. 2005. Characterization of a novel P[24],G11 human group A rotavirus. J Clin Microbiol 43:3208-12. Biography of the Investigators Give biographical data in the following table for key personnel including the Principal Investigator. Use a photocopy of this page for each investigator. (Note: Biography of the external Investigators may, however, be submitted in the format as convenient to them) 1 Name: Rashid Uz Zaman 2 Present Position: Research Investigator, PIDVS, ICDDR,B Post Graduate Diploma in Health Economics (PGDHE), University of Dhaka Bachelor of Medicine and Surgery (MBBS), University of Dhaka 3 Educational background: (last degree and diploma & training relevant to the present research proposal) 4.0 List of ongoing research protocols (start and end dates; and percentage of time) As Principal Investigator Protocol NumberStarting dateEnd datePercentage of time FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Principal Investigator Protocol NumberStarting dateEnd datePercentage of time2007-002Apr 2007Apr 200970% FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       As Co-Investigator Protocol NumberStarting dateEnd datePercentage of time2006-054Mar 2007Jan 200910%2007-010Jul 2007Jul 20085%2007-031Oct 2007Oct 20085%2008-001May 2008Apr 200810% 5 Publications Types of publicationsNumbersOriginal scientific papers in peer-review journals 2 Peer reviewed articles and book chapters  FORMTEXT      Papers in conference proceedings2Letters, editorials, annotations, and abstracts in peer-reviewed journals  FORMTEXT      Working papers1Monographs FORMTEXT       6 Five recent publications including publications relevant to the present research protocol 1) ICDDR,B, 2008, Hospital based surveillance revealed high prevalence of influenza in Bangladesh. Health Sci Bull 2008; 6(1):1-5 2) Begum B, Zaman R, Ahmed SMU, Ali S. Burst abdomen a preventable morbidity. Mymensingh Med J. 2008 Jan; 17(1): 63-6 3) Hossain N, Zaman RU, Banks N, Gierbo HC. The incentives and constrains of Government Doctors in Primary Healthcare Facilities in Bangladesh. BRAC/RED Research Report: November 2007 4) Ahmed SMU, Kakehi Y, Zaman RU, Hasan AU. Role of Brachytherapy in curbing prostatic cancer. Bang Med J (Khulna) 2007; 40(1 & 2); 16-19 5) Begum B, Uddin KU, Rahman MA, Habib A, Yeasmin S, Zaman RU. Better management expectation for Pelvic Inflammatory Disease. Bangladesh Medical Journal 2004; 33(4): 132-135 Detailed Budget  Budget Justifications  Please provide one page statement justifying the budgeted amount for each major item. Justify use of human resources, major equipment, and laboratory services. Personnel PD/PI: A Research Investigator from ICDDR,B will allot 50% of his/her time to oversee all the activities of the study. Medical Officer: Two full time (100%) Medical Officers will be hired for 8 months on CSA basis who will be stationed in the field site. They will be responsible for identifying index case patients from the selected hospital and collect their samples from the departments of medicine and pediatrics. They will also provide other technical supports to the study including field management. Lab Research Officer: A full time Research Officer will be hired to support the lab activities during the overall project time period. Health assistant: Two full time health assistants will be employed to assist in daily logistical and sample collection activities including transport of specimens. Field research officer: Two FROs are budgeted 100% time to ensure implementation and coordinate the research activities at the community level and also support and oversee the overall activities of the FRAs. Field research assistants: 12 full time FRAs have been budgeted who will be responsible for field implementation of the planned activities and to collect data from the community. They will work by dividing into two groups (FIS and FRA). Travel Local travel: We have budgeted $4,620 to cover the local travel costs associated with the movement by the FROs and FRAs across villages in 3-4 upazillas. This cost will also cover the cost of specimen transport by the FAs from field to ICDDR,B lab. Per diem for staff: The MOs, FROs, FRAs and the FAs will be stationed in the field site. However their trainings and meetings will be conducted in Dhaka. Moreover, the PI and the other investigators will often pay monitoring visits to the field. For this we have allocated $5,380 to cover all their per diem during the life of the project. The average per diem for all level staff was considered about $20 per night. Supplies and lab supplies We have allocated a total of $41,310 for general stock and non-stock items, rapid tests, for handwashing and promotion supplies and for UCB particle monitors and cool boxes. We have also allocated money to buy an EDGE modem for the field staff for communication via internet. Communications and others We have budgeted $1200 for internet and mobile phone bill for our field staff and $200 for fax, postage, DHL etc. Equipment We will provide a laptop computer with software to the field staff for internet communication and for tracking the field activities. We have kept $1200 for this purpose. Interdepartmental cost A total amount of $3,500 is budgeted to cover some of interdepartmental cost like data entry, photocopy and hospitalization/treatment cost of the patients. Other Support Describe sources, amount, duration, and grant number of all other research funding currently granted to PI or under consideration.  FORMTEXT       Appendix 1: Figure and Details about Bari The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Jahurul Islam Medical College Hospital, Kishorgonj EMBED Unknown Instructions: Draw the overall layout of the bari, including the location of the following: Entry / entries to bari Each household within bari Latrine(s) Cooking space(s) Below is an example of a drawing of two baris. You should label your drawing, as shown in the bari on the bottom left.  Appendix 2: Adult Consent Form: Specimen Collection Protocol Number: 2009-004 Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Investigators name: Dr. Stephen P. Luby Organization: ICDDR,B Name of Index Case Patient: _____________________________________ Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Introduction You are invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA, are doing a research study to understand factors associated with the spread of influenza virus in a rural population. Purpose of the research We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors. Why selected We are asking you to participate in this study because, in the past 7 days, you have had symptoms of cough and/or sore throat and a fever. These symptoms may be related to an illness called influenza. We are interested in studying this illness. What is expected from the patient/respondent? For probable index case-patients ONLY We ask you to allow one of our trained research personnel to take a swab from your nose. This swab will then be tested for influenza. We will then take a second swab from your nose and also a swab from your throat. We will use these swabs to test for the type of influenza you may have. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502. For probable secondary/follow-up case-patients ONLY We ask you to allow one of our trained research personnel to take a swab from your nose and throat. These swabs will then be tested for influenza at a later time. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502. Risk and benefits One of our trained research personnel will have to place a swab into your nose and a different swab into your throat. This may be uncomfortable. There are no other known risks for this procedure. There is no specific benefit to you having this test done. Because the results of the swab will not affect your medical care in any way, we will not be providing you with the results of your swab. But, information from the swab that we take from you will help us to understand how the influenza virus is spread within a bari. Privacy, anonymity and confidentiality All of the information we collect about you will be kept private and confidential. We will keep all paper documents in a locked cabinet. We will not give any information about you to anyone not involved in the study. Your name will never be used in reports of this study. Future use of information If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy. Right not to participate You may choose to allow us to take swabs from your nose and throat or not to allow us to take these swabs. You may choose to ask us to stop taking the specimen or to discard the specimen before testing it. Refusal to participate will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to take this specimen, you will still receive the usual care at the hospital. You will not be denied any treatments or benefits for which you would otherwise be eligible. If you choose to allow us to take these swabs, you may choose to allow us to store the specimens or not allow us to store the specimens. You may still participate in the study even if you refuse to allow us to store your specimens. Refusal to allow us to store your specimens will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to store your specimens, you will still receive the usual care at the hospital. You will not be denied any treatments or benefits for which you would otherwise be eligible. Principle of compensation There is no cost to you for allowing us to take a nose and/or throat specimen. There will also be no compensation to you. Persons to Contact: If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact: Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502, If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact: Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989 If you agree to our proposal of obtaining a nose and/or throat specimen, please indicate that by putting your signature or your left thumb impression at the specified space below. Thank you for your cooperation _______________________________________ ____________________ Signature or left thumb impression of subject Date _______________________________________ ____________________ Signature or left thumb impression of the witness Date _______________________________________ ___________________ Signature of the PI or his/her representative Date Appendix 3: Parent or Guardian Consent Form: Specimen Collection Protocol Number: 2009-004 Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Investigators name: Dr. Stephen P. Luby Organization: ICDDR,B Name of Index Case Patient: _____________________________________ Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Introduction Your child is invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University of Buffalo, a university in the USA, are doing a research study understand factors associated to the spread of influenza virus in a rural population. Purpose of the research We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors. Why selected We are asking your child to participate in this study because he/she has had in the past 7 days a cough and/or sore throat and a fever. These symptoms are related to an illness called influenza. We are interested in studying this illness. What is expected from the patient/respondent? For probable index case-patients ONLY We ask you to allow one of our trained research personnel to take a swab from your childs nose. This swab will then be tested for influenza. We will then take a second swab from your childs nose and also a swab from your childs throat. We will use these swabs to test for the type of influenza your child may have. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your childs swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502. For probable secondary/follow-up case-patients ONLY We ask you to allow one of our trained research personnel to take a swab from your childs nose and throat. These swabs will then be tested for influenza at a later time. If you agree, we will store the material from the swabs for future testing for twenty years, after which the samples will be destroyed. Such testing may include tests for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your childs swabs removed from storage at any time by calling Dr. Stephen P. Luby at 8860523-32 # 2502. Risk and benefits One of our trained research personnel will have to place a swab into your childs nose and a different swab into your childs throat. This may be uncomfortable. There are no other know risks for this procedure. There is no specific benefit to you having this test done. Because the results of the swab will not affect your childs medical care in any way, we will not be providing you with the results of your childs swab. But, information from the swab that we take from your child will help us to understand how the influenza virus is spread within a bari. Privacy, anonymity and confidentiality All of the information we collect about your child will be kept private and confidential. We will keep all paper documents in a locked cabinet. We will not give any information about your child to anyone not involved in the study. Your childs name will never be used in reports of this study. Future use of information If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy. Right not to participate You may choose to allow us to take swabs from your childs nose and throat or not allow us to take these swabs. You may choose to ask us to stop taking the specimen or to discard the specimen before testing it. Refusal to participate will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to take this specimen, your child will still receive the usual care at the hospital. Your child will not be denied any treatments or benefits for which he/she would otherwise be eligible. If you choose to allow us to take these swabs from your child, you may choose to allow us to store the specimens or not allow us to store the specimens. You may still participate in the study even if you refuse to allow us to store your childs specimens. Refusal to allow us to store your childs specimens will involve no penalty or loss of benefits at the hospital. Even if you do not allow us to store your childs specimens, your child will still receive the usual care at the hospital. Your child will not be denied any treatments or benefits for which you would otherwise be eligible. Principle of compensation There is no cost to you or your child for allowing us to take a nose or throat specimen. There will also be no compensation to you or your child. Persons to Contact: If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact: Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502, If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact: Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989 If you agree to our proposal of obtaining a nose and/or throat specimen from your child, please indicate that by putting your signature or your left thumb impression at the specified space below. Thank you for your cooperation. _______________________________________ ____________________ Signature or left thumb impression Date of attendant/Guardian _______________________________________ ____________________ Signature or left thumb impression of the witness Date _______________________________________ ___________________ Signature of the PI or his/her representative Date Appendix 4: Child Assent Form: Specimen Collection Protocol Number: 2009-004 Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Investigators name: Dr. Stephen P. Luby Organization: ICDDR,B Name of Index Case Patient: _____________________________________ Who are we? My name is ________ and I work for ____________. Why are we meeting with you? We want to tell you about a study that we are doing that involves people with certain symptoms: cough and/or sore throat and fever. These symptoms are associated with an illness called influenza. We are interested in studying this illness. Why are we doing this study? We are trying to understand factors that are connected to the spread of influenza within a bari. We want to know if the spread of this illness is connected to any specific behaviors. What will happen to you if you are in the study? For possible index case-patients ONLY We ask you to allow one of our trained research personnel to put a swab into your nose. We will test this swab to test for the influenza virus. A second nose swab and also a throat swab will then be taken. We will use these swabs to test for the type of influenza you may have. If you agree, we will store the material from the swabs for twenty years. We may test the swabs later for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time. You can do this by calling Dr. Stephen P. Luby at 8860523-32 # 2502. For probable secondary/follow-up case-patients ONLY We ask you to allow one of our trained research personnel to put a swab into your nose and throat. We will test these swabs to test for the influenza virus at a later time. If you agree, we will store the material from the swabs for twenty years. We may test the swabs later for respiratory illnesses other than influenza. The results of the future testing will not affect medical care, and, thus, these results will not be reported. You can ask to have the material from your swabs removed from storage at any time. You can do this by calling Dr. Stephen P. Luby at 8860523-32 # 2502. What are the good things and bad things that may happen to you? One of our trained research personnel will have to place a swab into your nose and throat; this may be uncomfortable, but this should not hurt you. Do you have to allow us to take this specimen? No, you do not. No one will get upset or angry with you if you do not want to do this. Just tell us if you do not want to take part. Remember, you can change your mind later if you decide you dont want to take part in the study anymore. You also do not have to let us store your specimens. No one will get upset or angry with you if you do not want this. Just tell us if you do not want us to store your specimens. You can still take part in the study even if you do not want us to store your specimens. Remember, you can change your mind later if you decide you no longer want us to store your specimens. Do you have any questions? You can ask them at any time. You can ask now, or you can ask later. You can talk to me or you can talk to someone else at any time during the study. You can also call the person below. Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502 If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact: Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989 If you want to take part in the study and allow us to take these specimens, please indicate that by putting your signature or your left thumb impression at the specified space below Thank you for your cooperation _______________________________________ ____________________ Signature or left thumb impression of subject Date _______________________________________ ____________________ Signature or left thumb impression Date of attendant/Guardian _______________________________________ ____________________ Signature or left thumb impression of the witness Date _______________________________________ ___________________ Signature of the PI or his/her representative Date Appendix 5: Consent Form: Study Enrollment, Household/Bari Protocol Number: 2009-004 Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Investigators name: Dr. Stephen P. Luby Organization: ICDDR,B Introduction Your Bari is invited to take part in a research trial. Scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA, are doing a research study understand factors associated to the spread of influenza virus in a rural population. Purpose of the research We are trying to understand factors that are connected to the spread of influenza virus within a bari. We would also like to understand whether washing hands with soap prevents the spread of this illness. Around 400 baris will be part of the study. We will aim to find out whether the spread of influenza is linked to specific behaviors. Why selected One of the members of your Bari has been identified as having symptoms that are associated with influenza. This is why we are inviting your Bari to help us. What is expected from the members of your Bari? If you agree to enrolling your Bari in the study: I will identify all the members within each bari. We will also observe aspects of your Bari that may be related to the spread of influenza-like illness. We will ask questions about each household within the bari and observe the physical characteristics of the households. We will visit your Bari every day until ten days after the symptoms of the person with influenza-like illness resolve. During those daily visits, we will ask about whether each member of your Bari has influenza-like symptoms. During our visits, if a member of your bari shows symptoms of influenza-like illness, we will ask that person to allow us to take swabs from the nose and throat. These swabs will be used to test for influenza at a later time. This study is an intervention trial. This means half the Baris will be taught some new behaviors and given soap during the time period we will be visiting the bari. The remaining Baris will be given soap after we complete the daily visits. The remaining Baris will also be taught the behaviors at a future time. Baris will be assigned to the group that will receive the teaching and soap randomly, so it is beyond our control when each bari receives the teaching and soap. Risk and benefits In people who have skin reactions to the soap available at the market, the soap we give you may cause similar reactions. These people should not use the soap we give you. The process of having someone visit your home may be uncomfortable to you. However, we do not expect any harm to come to you or your family because of being visited. All Baris that take place in the study will receive the benefit of teaching and bars of soap; however there will be no other immediate benefits. However, this study will help us better understand what factors are associated with the spread of influenza within a bari. This study will also help us test prevention methods that may stop the spread of influenza. This study may help us understand how to stop the spread of influenza-like illness within baris in rural Bangladesh. For those people who have symptoms and who allow us to take a nose and throat swab, one of our trained research personnel will have to place a swab into their nose and a different swab into their throat. This may be uncomfortable. There are no other known risks for this procedure. The results of the influenza testing will not be available for one or more months after the specimen is collected. The results of the test will not alter in any way the treatment of the person who has influenza related symptoms. Privacy, anonymity and confidentiality All of the information we collect about the members of your community will be kept private and confidential. We will keep all data in a locked cabinet. We will not give any information about your community to anyone not involved in the study. Future use of information If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy. Right not to participate and withdraw You may choose to allow your Bari to take part or not to take part in this study. You may refuse to take part at any time. You may also withdraw your Bari from the study at any time. Refusal to participate or withdrawal from the study will involve no penalty or loss of benefits for the members of your community at the clinic or hospital. Even if you do not enroll your Bari in the study, everyone in your Bari will still receive the usual care at the clinic. Each individual in your Bari may choose to participate or not participate, and may choose to withdraw from the study at any time. Principle of compensation There is no cost to you or your bari for participation in this study. Other than receiving free soap, you will not receive any compensation for being in the study. Persons to Contact: If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact: Dr. Stephen P. Luby, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 2502 If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact: Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989 If you agree to enrolling your Bari in our study, please indicate that by putting your signature or your left thumb impression at the specified space below. Thank you for your cooperation. _______________________________________ ____________________ Signature or left thumb impression of subject Date _______________________________________ ____________________ Signature or left thumb impression Date of attendant/Guardian _______________________________________ ____________________ Signature or left thumb impression of the witness Date _______________________________________ ___________________ Signature of the PI or his/her representative Date cwiwk-2t cveq`i mwZct bgybv msMn MelYv b^i: 2009-004 Melbvi bvgt mvevb w`q nvZ avqvi gvag ivM ciewZ gvbyli ga mswgZ Bbdzqv msgb cwZiva| ivM cieZx gvbyli ga mswgZ/gvbe Bbdzqv msgb cwZiva msv Melbv evsjv`k (wemwUm)| avbMelK:Wvt wdb wc. jzw| cwZvbt AvRvwZK D`ivgq MelYv K`, evsjv`k (AvBwmwWwWAvi,we)| cv_wgK ivMxi bvg t BDwbK AvB wWt MelYvi f~wgKvt Avgiv Avgv`i Melbvq Ask MnY Kivi Rb AvcbvK Avgb RvbvwQ| evsjv`ki Mvgv‡ji gvbyli ga Bbdzqv fvBivm Qovbvi Rb Kvb Kvb welq `vqx m mK Rvbvi Rb evsjv`ki AvRvwZK D`ivgq MelYv K` (AvBwmwWwWAvi,we), hyivi ivM wbqb I cwZiva K` Ges AvgwiKvZ AewZ GwU evdjv BDwbfvwmwU mwwjZfve GKwU Melbv KiQ| Melbvi Dkt GKUv evwoi ga Bbdzqv fvBivm Qovbvi Rb wK wK welq RwoZ Avgiv Zv eySZ Pv KiwQ| Avgiv Aviv eySZ Pv KiwQ h, mvevb w`q nvZ ayq Bbdzqv fvBivmRwbZ ivMi wevi iva Kiv me wKbv| cvq 400 evwoK Avgiv Avgv`i Melbvq Af~ Kie| Avgv`i j _vKe mywbw` wKQz AvPib Bbdzqv msvgbi mv_ RwoZ wKbv Zv LyRu ei Kiv| AvcbvK Kb GB MelYvq AskMnYi Rb Abyiva KiwQ? GB MelYvq AskMnYi Rb AvcbvK Avgiv Abyiva KiwQ KviY MZ 7 w`bi ga Rii mv_ mv_ Avcbvi Kvuwk/Mjve_v DcmM j Kiv MQ| GB jb jv Bbdzqv bvgK AmyZvi mv_ RwoZ _vKZ cvi | Avgiv GB AmyZvwU wbq Melbv KiZ AvMnx| ivMx / Di`vZvi KvQ _K Avgiv wK f~wgKv Avkv Kie? Kejgv mve cv_wgK ivMxi cևhvRt Avgv`i GKRb cwkwZ MelbvKgx Avcbvi bvK _K bgybv msMn Kie Ges Zv Bbdzqv fvBivmi Rb cixv Kie| Avgiv Gevcvi Avcbvi AbygwZ Kvgbv KiwQ| wZxqevi Avevi Avgiv Avcbvi bvK _K Ges Mjv _KI bgybv msMn Kie|AvgivGB bgybvjv _K Bbdzqvi aib cixv Ki ei Kiev, hv Avcbvi _vKZ cvi| Avcwb ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| mB cixv jv nZ cvi Bbdzqv Qvov kvmZi AmyZvi Abvb Kvib Rvbvi Rb| fwelZ GB cixvi djvdj Kvb fve Avcbvi wPwKrmvK cfvweZ Kee bv ZvB Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Avcwb msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvib t Wvt wdb wc. jzw, 8860523-32 #2502| Kejgv cieZx~Z Avv ivMx`i cևhvRt Avgv`i GKRb cwkwZ MelbvKgx Avcbvi Mjv Ges bvK _K bgybv msMn Kie,Avwg G evcvI Avcbvi AbygwZ cv_bv KiwQ| GB bgybv mg~yn Bbdyqv AvQ wKbv Zv cixv Ki `Lv ne cieZx mgq| Avcwb ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| mB cixv jv nZ cvi Bbdzqv Qvov kvmZi AmyZvi Abvb Kvib Rvbvi Rb| fwelZ GB cixvi djvdj Kvb fve Avcbvi wPwKrmvK cfvweZ Kee bv ZvB Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Avcwb msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvib t Wvt wdb wc. jzw, 8860523-32 #2502| SzwKu Ges myweav: Avgiv Avcbvi Mjv I bvvK _K gv_vq Zzjv cuvPvbv GKwU KvwVi mvnvh wKQy bgybv msMn Kie| GZ Avcbvi wKQyUv A^w nZ cvi; wK cwZUv wbivc` Ges GZ Avcbvi Kvb wZi mvebv bB| GB cixvwU Kivi Rb Avcbvi Kvb mywbw` myweav bB| hnZz GB cixvi djvdj Kvb fve Avcbvi wPwKrmvK cfvweZ Kee bv Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Ze Avcbvi KvQ _K msMwnZ bgybv Avgv`i eySZ mvnvh Kie wKfve GKwU evoxi ga Bbdzqv Qovq| MvcbxqZv: Avcbvi `qv mKj Z_ Mvcb ivLv ne| Avcbvi mg Z_ I cixv- wbixvi djvdj dvBjex Ki ivLv ne| MelYvi KvR mswk bq Ggb KvDK Avgiv Avcbvi Z_ `e bv| Avcbvi bvg KLbB Melbvi djvdj cKvwkZ ne bv| fwelZ Z_i eenvi t Avgiv h Z_ msMn Kiev Zv fwelZ Ab MelK eenvi KiZ Pvq Ze Kvb ewMZ Z_ Zv`i `e bv G&es KVvi fve MvcbxqZv iv Kie| MelYvq AskMnb bv Kiv Ges cZvnvii AwaKvi: Avcwb Avcbvi Mjv I bvvK _K bgybv msMn Kivi AbygwZ w`Z cvib Avevi bvI w`Z cvib| Avcwb Avcbvi KvQ _K bgybv msMn Kiv e Ki w`Z cvib A_ev msMnKZ bgybv cixv Kivi c~e dj w`ZI ejZ cvib| Avcwb GB MelYvq AskMnb AmZ njI Gi Rb AvcbvK Kvb kvw ev Rwigvbv w`Z ne bv Ges nvmcvZvj cvc myweav _KI Avcwb ewZ neb bv| GgbwK Avcwb Avgv`iK bgybv msMn Kivi AbygwZ bv w`jI nvmcvZvj _K h_vh_ mev cveb| Avcwb wPwKrmv mev A_ev Abvb myhvM-myweav _K ewZ neb bv| wZc~iY ev cև`q: bvK I Mjv _K bgybv msMn KiZ `Iqvi Rb Avcbvi Kvb LiP bB| GKBfve AvcbvK Kvb wZc~ibI `qv ne bv| hvMvhvMi evwt GB cwqv PjvKvjxb Avcbvi Kvb ck _vKj h Kvb mgq KiZ cvib| hw` Avcbvi Melbv mK Kvb AwZwi ck _vK Avcwb hvMvhvM KiZ cvib t Wvt wdb wc. jzw, cvMvg Ab BbdKkvm wWwRR Gv fKwmb mvBm (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 8860523-32 # 2502| GB Melbv Ask wnmve Avcbvi AwaKvi mK hw` Avcbvi Kvb ck _vK A_ev hw` Melbvi Rb Avcbvi Kvb wZ nqQ ej gb nq Zvnj hvMvhvM Kib t wgt Gg.G.mvjvg, wimvP G cևR mvcvU wWcvUgU (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 9886489, # 01711428989| hw` Avcwb/Avcbvi ivMx hw` Avgv`i bvK I Mjv _K bgybv msMևni c֯ve ivwR _vKvb Zvnj AbyMn Ki i Avcbvi ^vi w`q A_ev Avcbvi evg nvZi eyov Avyji Qvc w`q Zv wb`k Kib| Avcbvi mnhvMxZvi Rb abev`| ___________________________________________ ^vi/ AskMnbKvixi evg nvZi evyjxi Qvc ZvwiL ___________________________________________ ^vxi ^vvi / A_ev evg nvZi evyjxi Qvc ZvwiL ___________________________________________ cavb MelK ev Zvi cwZwbwai ^vi ZvwiL cwiwk-3t wcZv gvZv A_ev AwffveK`i mwZct bgybv msMn MelYv b^i: 2009-004 Melbvi bvgt mvevb w`q nvZ avqvi gvag ivM ciewZ Bbdzqv msgb cwZiva| ivM cieZx Bbdzqv msgb cwZiva msv Melbv evsjv`k (wemwUm)| avbMelK:Wvt wdb wc. jzw| cwZvbt AvRvwZK D`ivgq MelYv K`, evsjv`k (AvBwmwWwWAvi,we)| cv_wgK ivMxi bvg t BDwbK AvB wWt MelYvi f~wgKvt Avgiv Avgv`i Melbvq Ask MnY Kivi Rb Avcbvi wkK Avgb RvbvwQ| evsjv`ki Mvgv‡ji gvbyli ga Bbdzqv fvBivm Qovbvi Rb Kvb Kvb welq `vqx m mK Rvbvi Rb evsjv`ki AvRvwZK D`ivgq MelYv K` (AvBwmwWwWAvi,we), hyivi ivM wbqb I cwZiva K` Ges evdjv BDwbfvwmwUi MelKiv wgj mwwjZfve GKwU Melbv KiQ| Melbvi Dkt GKUv evwoi ga Bbdzqv fvBivm Qovbvi Rb wK wK welq RwoZ Avgiv Zv eySZ Pv KiwQ| Avgiv Aviv eySZ Pv KiwQ h, mvevb w`q nvZ ayq Bbdzqv fvBivmRwbZ ivMi wevi iva Kiv me wKbv| cvq 200 evwoK Avgiv Avgv`i Melbvq Af~ Kie| Bbdzqv wevii mv_ wbw` Kvb AvPib RwoZ wKbv Zv LyuR ei Kivi j Avgiv KvR Kie| Kb gbvwbZ Kiv nqQ ? GB MelYvq AskMnYi Rb Avcbvi wkK Avgiv Abyiva KiwQ Kvib MZ 7 w`bi ga Rii mv_ mv_ Zvi Kvwk/Mjve_v DcmM j Kiv MQ| Zvi G mKj DcmM Bbdzqv bvgK AmyZvi mv_ mwKZ Avgiv GB AmyZvwU wbq Melbv KiZ AvMnx| ivMx / Di`vZvi KvQ _K Avgiv wK f~wgKv Avkv Kie ? Kejgv mve cv_wgK ivMxi cևhvRt Avgv`i GKRb cwkwZ MelbvKgx Avcbvi wki bvK _K bgybv msMn Kie Ges Zv Bbdzqv fvBivmi Rb cixv Kie| Avgiv G evcvi Avcbvi AbygwZ Kvgbv KiwQ| Avgiv wZxqevi Avevi I Zvi bvK I Mjv _K bgybv msMn Kie| Avcbvi wk wK aibi Bbdyqv viv Avv nq _vKZ cvi Zv GB bgybv w`q cixv Kiv ne| Avcwb ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| mB cixv jv nZ cvi Bbdzqv Qvov kvmZi AmyZvi Abvb Kvib Rvbvi Rb| fwelZ GB cixvi djvdj Kvb fve Avcbvi wki wPwKrmvK cfvweZ Kee bv ZvB Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Avcwb msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvib t Wvt wdb wc. jzw, 860523-32 #2502| Kejgv cieZxZ Avv ivMx`i cևhvRt Avgv`i GKRb cwkwZ MelbvKgx Avcbvi wki bvK I Mjv _K bgybv msMn Kie,Avwg G evcviI Avcbvi AbygwZ cv_bv KiwQ| GB bgybv mg~yn Bbdyqv AvQ wKbv Zv cixv Ki `Lv ne| Avcwb ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| mB cixv jv nZ cvi Bbdzqv Qvov kvmZi AmyZvi Abvb Kvib Rvbvi Rb| fwelZ GB cixvi djvdj Kvb fve Avcbvi wki wPwKrmvK cfvweZ Kee bv ZvB Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Avcwb msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvib t Wvt GWyqvWy AvwRR evgMvUbvi | 8860523-32 #2500| SzwKu Ges myweav: Avgiv Avcbvi Mjv I bvvK _K gv_vq Zzjv cuvPvbv GKwU KvwVi mvnvh wKQy bgybv msMn Kie| GZ Avcbvi wKQyUv A^w nZ cvi; wK cwZUv wbivc` Ges GZ Avcbvi Kvb wZi mvebv bB| GB cixvwU Kivi Rb Avcbvi Kvb mywbw` myweav bB| hnZz GB cixvi djvdj Kvb fve Avcbvi wPwKrmvK cfvweZ Kee bv Avgiv AvcbvK Kvb djvdjI c`vb Kie bv| Ze Avcbvi KvQ _K msMwnZ bgybv Avgv`i eySZ mvnvh Kie wKfve GKwU evoxi ga Bbdzqv Qovq| MvcbxqZv: Avcbvi wki/Avcbvi mKj Z_ hv Avgiv msMn KiwQ Zv Mvcb ivLv ne| mg Z_ I cixv- wbixvi djvdj dvBjex Ki ivLv ne| MelYvi mv_ RwoZ bq Ggb KvDK Avcbvi wki Kvb Z_ `Iqv ne bv| MelYv welqK Kvb AvjvPbvq wKsev Melbvi dj cKvki mgq Avcbvi wki bvg KLbv eeZ ne bv| Z_mg~ni fwelZ eenvi: hw` Avgv`i msMwnZ Z_ fwelZ Ab MelK`i cqvRb nq Zvnj Avgiv Avcbv`i Kvb evwMZ Z_ Zv`iK `e bv Ges KwVb MvcbxqZv iv Kie| MelYvq AskMnb bv Kiv Ges cZvnvii AwaKvi: Avcwb Avcbvi wki Mjv I bvK _K bgybv msMn Kivi AbygwZ w`Z cvib Avevi bvI w`Z cvib| Avcwb Avcbvi wki KvQ _K bgybv msMn Kiv e Ki w`Z cvib A_ev msMnKZ bgybv cixv Kivi c~e dj w`ZI ejZ cvib| Avcwb Avcbvi wkK GB MelYvq AskMnb KiZ w`Z AmZ njI Gi Rb AvcbvK Kvb kvw ev Rwigvbv w`Z ne bv Ges nvmcvZvj cvc myweav _KI Avcbvi wk ewZ ne bv| GgbwK Avcwb Avgv`iK bgybv msMn Kivi AbygwZ bv w`jI Avcbvi wk nvmcvZvj _K h_vh_ mev cve| m wPwKrmv mev A_ev Abvb myhvM-myweav _K ewZ ne bv| wZc~iY ev cև`q: bvK I Mjv _K bgybv msMn KiZ `Iqvi Rb AvcbvK/ Avcbvi wki Kvb LiP bB| GKBfve AvcbvK ev Avcbvi wkK I Kvb wZc~ib `qv ne bv| hvMvhvMi evwt GB cwqv PjvKvjxb Avcbvi Kvb ck _vKj h Kvb mgq KiZ cvib| hw` Avcbvi Melbv mK Kvb AwZwi ck _vK Avcwb hvMvhvM KiZ cvib t Wvt wdb wc. jzw, cvMvg Ab BbdKkvm wWwRR Gv fKwmb mvBm (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 8860523-32 # 2502| GB Melbv Ask wnmve Avcbvi AwaKvi mK hw` Avcbvi Kvb ck _vK A_ev hw` Melbvi Rb Avcbvi Kvb wZ nqQ ej gb nq Zvnj hvMvhvM Kib t wgt Gg.G.mvjvg, wimvP G cևR mvcvU wWcvUgU (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 9886489, # 01711428989| hw` Avcwb/Avcbvi ivMx hw` Avgv`i bvK I Mjv _K bgybv msMևni c֯ve ivwR _vKvb Zvnj AbyMn Ki i Avcbvi ^vi w`q A_ev Avcbvi evg nvZi eyov Avyji Qvc w`q Zv wb`k Kib| Avcbvi mnhvMxZvi Rb abev`| _______________________________________ klvKvix / AwffveK Gi evg nvZi evyjxi Qvc ZvwiL ___________________________________________ ^vxi ^vvi / A_ev evg nvZi evyjxi Qvc ZvwiL ___________________________________________ cavb MelK ev Zvi cwZwbwai ^vi ZvwiL cwiwk-4t wk`i mwZct bgybv msMn MelYv b^i: 2009-004 Melbvi bvgt mvevb w`q nvZ avqvi gvag ivM ciewZ Bbdzqv msgb cwZiva| ivM cieZx Bbdzqv msgb cwZiva msv Melbv evsjv`k (wemwUm)| avbMelK:Wvt wdb wc. jzw| cwZvbt AvRvwZK D`ivgq MelYv K`, evsjv`k (AvBwmwWwWAvi,we)| Avgiv Kviv? Avgvi bvg_______________ Ges Avwg KvR Kwi_______________ Avgiv Kb Zvgvi mv_ mvvr KiwQ? hme jvKi wbw` wKQy DcmM t Kvwk I/ A_ev Mjve_v Ges Ri `Lv hvq Avgiv Zv`i wbq GKwU MelYv cwiPvjbv KiwQ| GmKj DcmM Bbdzqv bvgK AmyZvi mv_ mwKZ Avgiv GB AmyZvwU wbq Melbv KiZ AvMnx| Avgiv Kb GB MelYv KgwU cwiPvjbv KiwQ? GKUv evwoi ga Bbdzqv fvBivm Qovbvi Rb wK wK welq RwoZ Avgiv Zv eySZ Pv KiwQ| Bbdzqv wevii mv_ wbw` Kvb AvPib RwoZ wKbv Avgiv Zv RvbZ PvB| GB MelYvq _vKj Zvgvi wK ne? aygv mve cv_wgK ivMxi - GKRb cwkwZ MelbvKgx Zvgvi bvK _K bgybv msMn Kie|Avwg m evcvi Zvgvi AbygwZ PvwQ| GB bgybvwU Bbdzqv fvBivm Gi Rb cixv Kie| wZxqevi AveviI Zvgvi bvK Ges Mjv _KI bgybv msMn Kie|Avgiv GB bgybv jv _K Zvgvi wK aibi Bbdzqv nq _vKZ cvi Zv cixv Ki `Lev| Zzwg ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| Avgiv cieZxZ GB bgybvjv Bbdzqv Qvov kvmZi Abvb AmyZv Rvbvi Rb cixv Kie | fwelZ GB cixvi djvdj Kvb fve Zvgvi wPwKrmvK cfvweZ Kee bv ZvB Avgiv ZvgvK Kvb djvdjI c`vb Kie bv| Zywg msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvi t Wvt wdb wc. jzw, 8860523-32 #2502| Kejgv cieZxZ AvvZ ivMxi cևhvh: Avgv`i GKRb cwkwZ MelbvKgx Zvgvi Mjv Ges bvK _K bgybv msMn Kie| Avwg m evcvi Zvgvi AbygwZ PvwQ| GB bgybv mgyn Bbdzqv fvBivm AvQ wKbv Zv cixv Ki `Le| Zzwg ivwR _vKj Avgiv bgybvwU fwelZ cixv Ki `Lvi Rb wek eQi msib Kie Zvici Zv b Ki djv ne| mB cixv jv nZ cvi Bbdzqv Qvov kvmZi AmyZvi Abvb Kvib Rvbvi Rb| fwelZ GB cixvi djvdj Kvb fve Zvgvi wPwKrmvK cfvweZ Kee bv ZvB Avgiv ZvgvK Kvb djvdjI c`vb Kie bv| Zywg msMwnZ bgybvwU h Kvb mgq msiwZ Aev _K mwiq djZ ejvi Rb dvb KiZ cvi t Wvt wdb wc. jzw, 8860523-32 #2502| fvj ev Lvivc wRwbmjv wK hv Zvgvi nZ cvi? Avgv`i GKRb cwkwZ MelbvKgx Zvgvi Mjv Ges bvK _K gv_vq Zzjv cuvPvbv GKwU KvwVi mvnvh wKQy bgybv msMn Kie| GZ Zvgvi wKQyUv A^w nZ cvi; wK Zzwg ev_v cve bv| Zzwg wK Avgv`iK bgybv msMn KiZ w`Z ivRx? bv , Zzwg bgybv msMn KiZ w`Z ivRx bv| Zzwg bgybv msMn KiZ w`Z bv PvBj KD Zvgvi cwZ gb Lvivc Kie bv ev ivMvw^Z ne bv| AskMnY KiZ bv PvBj Avgv`iK ejZ cviv| gb iLv, Zzwg PvBj ciI gZ e`jvZ cviv hw` Zzwg wmav wbq _vK h Avi MelYvq AskMnY Kie bv| Zvgvi wK Kvb ck AvQt Zzwg Zv wbwשavqhKvb mgq ck KiZcvib| Zzwg Zv GLb A_ev ciI wRm KiZ cviv| MelYv PjvKvj Zzwg Avgvi mv_ A_ev Ab Kviv mv_ K_v ejZ cviv| Zvgvi Aviv wKQy Rvbvi _vKj Zzwg wbwjwLZ ewi mv_ hvMvhvM KiZ cvivt Wvt wdb wc. jzw, cvMvg Ab BbdKkvm wWwRR Gv fKwmb mvBm (wc,AvvB.wW.wf.Gm) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 8860523-32 # 2502| GB Melbv Ask wnmve Avcbvi AwaKvi mK hw` Avcbvi Kvb ck _vK A_ev hw` Melbvi Rb Avcbvi Kvb wZ nqQ ej gb nq Zvnj hvMvhvM Kib t wgt Gg.G.mvjvg, wimvP G cևR mvcvU wWcvUgU (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 9886489, # 01711428989| Zzwg hw` MelYvq Ask wbZ Ges bgybv msMn KiZ w`Z ivRx _vKv, Zvnj AbyMn Ki bxP Zvgvi ^vi A_ev evg nvZi evywji Qvc `vI: Zvgvi mnhvwMZvi Rb abev`| __________________________________ ____________________ AskMnYKvixi ^vi/evg nvZi evyjxi Qvc ZvwiL __________________________________ ____________________ AwffveKi ^vi/evg nvZi evyjxi Qvc ZvwiL __________________________________ ____________________ mvxi ^vi/evg nvZi evyjxi Qvc ZvwiL __________________________________ ___________________ MelK/cwZwbwai ^vi ZvwiL cwiwk-5t mwZct Melbv ZvwjKvf~wKib, Lvbv/ evwo MelYv b^i: 2009-004 Melbvi bvgt mvevb w`q nvZ avqvi gvag ivM ciewZ Bbdzqv msgb cwZiva| ivM cieZx Bbdzqv msgb cwZiva msv Melbv evsjv`k (wemwUm)| avbMelK:Wvt wdb wc. jzw| cwZvbt AvRvwZK D`ivgq MelYv K`, evsjv`k (AvBwmwWwWAvi,we)| MelYvi f~wgKvt Avgiv Avgv`i Melbvq Ask MnY Kivi Rb Avcbvi evwoK Avgb RvbvwQ| evsjv`ki Mvgv‡ji gvbyli ga Bbdzqv fvBivm Qovbvi Rb Kvb Kvb welq `vqx m mK Rvbvi Rb evsjv`ki AvRvwZK D`ivgq MelYv K` (AvBwmwWwWAvi,we), hyivi ivM wbqb I cwZiva K` Ges evdjv BDwbfvwmwUi MelKiv wgj mwwjZfve GKwU Melbv KiQ| Melbvi Dkt GKUv evwoi ga Bbdzqv fvBivm Qovbvi Rb wK wK welq RwoZ Avgiv Zv eySZ Pv KiwQ| Avgiv Aviv eySZ Pv KiwQ h, mvevb w`q nvZ ayq Bbdzqv fvBivmRwbZ ivMi wevi iva Kiv me wKbv| cvq 400 evwoK Avgiv Avgv`i Melbvq Af~ Kie| Avgv`i j _vKe mywbw` wKQz AvPib Bbdzqv msvgbi mv_ RwoZ wKbv Zv LyRu ei Kiv| Avcbvi evwoK Kb GB MelYvq Aͩf~ Kiv nqQ? Avcbvi evwoi GKRb m`mi ga Bbdzqv ivMi jY/DcmM cvIqv MQ| ZvB Avcbvi evwoK Avgv`iK mnhvwMZv Kivi Rb Abyiva KiwQ| Avcbvi evwoi m`mi KvQ Avgiv wK cZvkv Kie? 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M! Q? 1. ASK: Apart from the ICP, have any of the residents of the ICP household had a fever in the past 7 days? Yes (1) No (2) (nv n! j evwo Dchy bq) (If  yes, this bari is ineligible) (1b. wRvmv Ki b: Lvbv Avcbvi evwoi Kv! bv m`mwK MZ 7 w`! bi g! a R! i f~! M! Q? 1b. ASK: Apart from the ICP household, have any of the residents of the bari had a fever in the past 7 days? Yes (1) No (2) (nv nj 1c Ges 1d Z hvb, bv nj 2 G hvb) (If yes, go to 1c and 1d. If no, go to 2.) (1c. hw` 1b nuv nq, wRvmv Kib: Zvi KZ w`b Ri wQj ? : bvg I KZ w`b Ri wQj (99 = Rvwb bv ) 1c. If 1b is  yes, ASK: How many days did s/he have fever? RECORD: Name and days of fever (99=don t know) bvg/ Name___________________________ w`b / Days _____ bvg/ Name________________ ___________w`b / Days _____ bvg/ Name___________________________ w`b / Days _____ (1d ) (Continue to 1d.)1d. evoxi Kv! iv wK MZ 7 w`! b 2 w`b ev Zvi ekx w`b a! i Ri wQj? 1d. Did anyone in the bari have fever for 2 or more days during the past 7 days? Yes (1) No (2) (nv nj evwo Dchy bq) (If yes, this bari is ineligible)(2. wRvmv Kib: BbW Km wK GB evwoZ AvMvgx 20 w`b Nygve? 2. ASK: Will the index case be sleeping in this bari for the next 20 days? Yes (1) No (2) (bv nj evwo Dchy bq) (If no, this bari is ineligible) (3. wRvmv Kib: BbW Km QvovI Aviv 2 ev Zvi ewk jvKRb wK GB evwoZ AvMvgx 20 w`b _vKe? 3. ASK: Will 2 or more other persons, other than the index case, be living in your bari during next 20 days? Yes (1) No (2) bv nj evwo Dchy bq| (If no, this bari is ineligible) (4. wRvmv Kib: Avcbvi evwowU wK Avgv`i MelYvq BwZc~e bqv nqwQjv? 4. ASK: Was your Bari enrolled before in our Study? Yes (1) No (2) nv nj evwo Dchy bq| (If yes, this bari is ineligible) (5. : evwo wK Dc! ii Aaf~w KiY wbq! gi g! a c! i! Q? 5. RECORD: Does the bari meet the above inclusion criteria? Yes (1) No (2) (nv n! j d   , d (If  yes , continue with Bari Consent. If  no , bari is ineligible ( please thank them for their time) (6. : evwoi cavb ev g! bvbxZ cwZwbwa wK Lvbv AbygwZ c ^vi KiQY? 6. RECORD: Did the head of the bari, or appropriate designee, and any necessary household leaders accept and sign the household consent form? Yes (1) No (2) (nv nj d   , d (If  yes , continue with Bari Drawing. If  no , this bari is ineligible( please thank them for their time) (7. : Lvbvi Kvb m`mi (AvBwmwc evwZZ) MZ 7 w`bi ga Ri wQj ej Rvbv MQ wK A_ev Kvb evox m`mi (AvBwmwc _vbvi evBi) MZ 7w`bi ga 2 ev Zvi ekx w`b Ri wQj ej Rvbv MQ wK ? 7. RECORD: At any point while completing the Enumeration Form, was a resident of the ICP household (other than the ICP) found to have fever during the last 7 days, or was a bari resident (outside the ICP household) found to have had a fever for two or more days during the last 7 days? Yes (1) No (2) (  d   , ) (If  no , continue with Household Questionnaires .If  yes , this bari is ineligible ( please thank them for their time)(c_g wfwRU RvbZ PvBZ ne: To be asked at the first visit to the household: AmyZv UvwKskl nIqvi ci Di `qvi Rb (A_ev Zvi c~e Wc AvDU ZvwiLi Dci wbfikxj) To be answered after completion of illness tracking (or before depending on drop out date): 8. AmyZv UvwKs Gi Kvbv chvq wK evwo AskMnY A^xKwZ RvwbqQ ( )? 8. RECORD: Did bari discontinue study participation (for any reason) during illness tracking? Yes (1) No (2) nv n! j wb! P KviY evLv Kib| (If yes, explain why below) ( 9. Wc AvDUi KviY 9. Explanation of household drop out: 10. Wc AvDUi ZvwiL _____/______/_______Date of drop out (dd/mm/yyyy):_____/______/_______ Appendix 7: Bari Drawing Form VERSION 18.5.10 Use the symbols below to draw a picture to represent the bari. Symbol Definitions:   = Housing Structure = Cooking Area (Stove) = Toilet Facilities = Entrance to Bari  (draw the most used entrance) = Handwashing station -- -- -- -- = Draw a dashed line between the front entrance of housing structure 01 and the nearest front entrance of each other numbered structure.. Label each line with the length in steps.  = Entrance(s) to Housing Structure = Water source = Intervention handwashing station (draw next day)   ICP ID: FRA Code: Appendix 8: Household Contact Enumeration Form (VERSION 07.07.2010) ICP Household (1) Secondary Household (2) Date (dd/mm/yy) :___ ___/ ___ ___/ ___ ___ Code of FRA: ((( Household Unique ID# : (((((((( Call to FRO: Yes=1, No=2 ( Name of Respondent: _________________________ Did household participate in bari consent (1) or consent as an individual household (2)? ( ASK Primary Respondent: Who are the members of your khana? List whoever the respondent lists. Include guests if the respondent lists them; otherwise DO NOT. Individual Number(a) Name (Write in ENGLISH and CAPITAL letters) (b) Sex Male (1) Female (2) (c) Age-years (YY)(d) Age-months (mm) Unique ID (10 digits) = -ICPs serial number (4 digits) -Housing structure number (2 digits) - Household number (2 digits) - Individual (enumeration) number (e) Unique ID (f) Interaction with ICP Avcwb BbW Kmi m w`bi ga KZvUv mgq KvUvb? How often does _______ spend time with the index-case patient?* READ CHOICES Multiple times per day 1 Around once per day 2 A few times each week 3 Around once per week 4 Rarely 5 Never 6 Self 7 No answer 99(g) Relationship of _____ to Index Case Self (1) Parent (2) Child (3) Sibling (4) Grandparent (5) Aunt/Uncle (6) Cousin (7) Spouse (8) Unrelated (9) Grandchild (10) Other (specify) (88) NOTE: Include in-laws within these categories. For example, code  sister-in-law as  sibling (h) What is the smoking status of _______? (Ask of respondents e" 15 years of age) Never (0) Former (1) Current(2) Refused to answer (77) Not applicable (due to age) (88) Don't Know (99) (j) On most days, how many minutes per day does this person spend in the cooking area of your household? NOTE: Ask this regardless of whether time spent involves cooking (k) On most nights, does ______ sleep in the same room as the index case? Yes(1) No (2) Self (3) (l) Has ____ had a fever in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset (dd/mm/yy) For ICP, put 1 and write onset date(m) Has _____ had a cough in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset dd/mm/yy(n) Has ____ had a sore throat in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset (dd/mm/yy)Check vaccination (EPI) card, or birth certificate when household member is <5 years old or if respondent is not certain of household members age For children less than 1 month/30 days old, write 00 for both columns ( If yes, please record more information on p.3, Sick List010203040506070809* mgq KvUvbv ejZ K_v ejv, Lvevi LvIqv, M Kiv BZvw` evSvbv nQ: A_ev wk ICP Gi : Ljv Kiv, LvIqvbv , Mvmj Kivbv BZvw` By spending time, we mean: talking with the person, sharing meals, gossiping, etc.; or in the case of a child ICP: playing with, feedbing , bathing, etc.  Appendix 8: Household Contact Enumeration Form (PAGE 2, if needed) Individual Number(a) Name (Write in ENGLISH and CAPITAL letters) (b) Sex Male (1) Female (2) (c) Age-years (YY)(d) Age-months (mm) Unique ID (10 digits) = -ICPs serial number (4 digits) -Housing structure number (2 digits) - Household number (2 digits) - Individual (enumeration) number (e) Unique ID (f) Interaction with ICP Avcwb BbW Kmi m w`bi ga KZvUv mgq KvUvb? How often does _______ spend time with the index-case patient?* READ CHOICES Multiple times per day 1 Around once per day 2 A few times each week 3 Around once per week 4 Rarely 5 Never 6 Self 7 No answer 99(g) Relationship of _____ to Index Case Self (1) Parent (2) Child (3) Sibling (4) Grandparent (5) Aunt/Uncle (6) Cousin (7) Spouse (8) Unrelated (9) Grandchild (10) Other (specify) (88) NOTE: Include in-laws within these categories. For example, code sister-in-law as sibling (h) What is the smoking status of _______? (Ask of respondents e" 15 years of age) Never (0) Former (1) Current(2) Refused to answer (77) Not applicable (due to age) (88) Don't Know (99) (j) On most days, how many minutes per day does this person spend in the cooking area of your household? NOTE: Ask this regardless of whether time spent involves cooking (k) On most nights, does ______ sleep in the same room as the index case? Yes(1) No (2) Self (3) (l) Has ____ had a fever in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset (dd/mm/yy) For ICP, put 1 and write onset date(m) Has _____ had a cough in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset dd/mm/yy(n) Has ____ had a sore throat in the last 7 days (including today)? Yes (1) No (2) Not Presently living in Bari (3) Dont Know (99) / Date of symptom onset (dd/mm/yy)Check vaccination (EPI) card, or birth certificate when household member is <5 years old or if respondent is not certain of household members age For children less than 1 month/30 days old, write 00 for both columns ( If yes, please record more information on p.3, Sick List10111213141516171819* mgq KvUvbv ejZ K_v ejv, Lvevi LvIqv, M Kiv BZvw` evSvbv nQ: A_ev wk ICP Gi : Ljv Kiv, LvIqvbv , Mvmj Kivbv BZvw` By spending time, we mean: talking with the person, sharing meals, gossiping, etc.; or in the case of a child ICP: playing with, feedbing , bathing, etc. Appendix 8b: Enrollment Day Sick List for all Bari membersIf any member of the ICP household had fever during the last 7 days, the bari is ineligible for study participation. Do not continue with Sick List ( Return to Bari Eligibility Form List any bari member (including the ICP) that had fever, cough or sore throat during the last 7 days (including today), and record the number of days s/he had each symptom.NameUnique IDNumber of days of fever during last 7 days Last day of symptoms (dd/mm/yy) or todays date 99= dont know If any bari member (outside the ICP household) had fever for 2 or more days during the last 7 days, the bari is ineligible for study participation ( Return to Bari Eligibility FormDate of Sample Collection (if fever is present on day of enrollment) (dd/mm/yy)Number of days of cough during last 7 days Last day of symptoms (dd/mm/yy) or todays date 99= dont knowNumber of days of sore throat during last 7 days Last day of symptoms (dd/mm/yy) or todays date 99= dont know123456789101112131415 Mnvjx msv ckgvjv/ cheY dg Appendix 9: Household Level Questionnaire/Observation Form Start Time (24-hour format): __ __:__ __ Section One: Respondent Information 1.1 AvBwmwc AvBwW ICP ID (((((((((( 1.2 Gd Avi G KvW FRA Code ((( 1.3 Di`vZv i bvg Name of Respondent: _______________________________________ 1.4 Di`vZv i BDwbK AvBwW (BwbDgikb dg _K bIqv) (((((((((( Respondent Unique ID# (Taken from enumeration form) 1.5 Di`vZv i nvDwRs vKPvi AvBwW # (BDwbK AvBwW-i 5g Ges 6 msLv) (( Respondent Housing Structure ID # (5th and 6th digit of Unique ID) 1.6 Di`vZv i Lvbv AvBwW# (BDwbK AvBwW-i 7g Ges 8g msLv) (( Respondent Household ID # (7th and 8th digit of Unique ID) 1.6b Di`vZv wK AvBwmwc Lvbvi jvK? (( Is the respondent from the ICP household? Yes (nuv) 01 No (bv) 02 ( Di 2 nj, mKkb `yB-G Pj hvb If (2), SKIP to SECTION TWO 1.7 BwbDgikY dg `L ei Kib AvBwmwc-i eqm 18 eQii ewk wK-bv (( Look on Enumeration Form to see if ICP is 18 or above Yes (nuv) 01 No (bv) 02 ( Di 1 nj, mKkb `yB-G Pj hvb If (1), SKIP to SECTION TWO 1.8 AvBwmwci eqm 18 eQii bxP nj wRm KiY, AvBwmwc Amy nj cavbZ K ZvK mev Ki? (mev`vbKvixi GKK AvB wW wjLyb) cևhvR bq =7700000000, Kvb Di bvB =9900000000 If ICP < 18 years old, ASK, Who is the primary caregiver of the index case patient when s/he is sick? (WRITE UNIQUE ID of caregiver) Not Applicable = 7700000000; No Answer= 9900000000 (((((((((( 1.9 AvBwmwc Amy nj Avi KD Zvi mev Ki? (Di nuv nj GKK AvBwW wjLyb) cևhvR bq bv=2000000000 =7700000000, Kvb Di bvB /ewwUBwbDgviUW nqwb =9900000000 ASK, Does anyone else take care of the index case patient when s/he is sick?(WRITE UNIQUE ID IF YES) No = 2000000000; Not Applicable = 7700000000; No Answer/person not enumerated write 9900000000 (((((((((( End of Section One mKkb 2: vb Section Two: Knowledge (mvqvBb dz) Swine Flu (Bbdzqv) Influenza Illness 2.1 Di`vZvK wRvmv Kib Avcwb wK KLbv _______________ kwU bQb? (ev KvW wjLyb ) ASK: Have you ever heard of the word_______? (Record code in box) - j Kib: KvbvfveB mvBb dz ev Bbdzqvwelq evLv Kieb bv | ay ckKib, Zviv GB kwUbQ wK bv? --NOTE: Do not explain the terms& swine flu or influenza illness in any way. Simply ask if they know the word/term. Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv) 99(( ( Di 02 ev 99 nj ciewZ Kjvg Pj hvb If the answer is 02 or 99, SKIP to next column ( Di 01 nj GB Kjvg Pvwjq hvq| If the answer is 01, continue down This column (( ( Di 02 ev 99 nj ck 2.28-G Pj hvb If the answer is 02 or 99, SKIP to question 2.28 ( Di 01 nj GB Kjvg Pvwjq hvq| If the answer is 01, continue down This column 2.2 Avcwb wK Rvbb,-------------G Kvb jY `Lv `q? ASK, Do you know what symptoms can occur with______? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv) 99(( ( Di 02 ev 99 nj ck 2.4-G Pj hvb If the answer is 02 or 99, SKIP to question 2.4(( ( Di 02 ev 99 nj ck 2.4-G Pj hvb If the answer is 02 or 99, SKIP to question 2.42.3 Di`vZvK wRvmv KiY ------- G Kvb Kvb jY `Lv `q ? ASK: What symptoms are associated with _____? (Ackbjv DP^i co kvbveb bv) (G ckwU Lvjv cևki gZ Ki wRm Kib, Di`vZv cvki ZvwjKvi DcmMjv DjL Kij nuv =1 , bv =2, KvW Kiyb)| Avcwb cևqvRbeva Avi wKQy K_vwU `yBevi wRm KiZ cvib| (DO NOT READ RESPONSE OPTIONS ALOUD Ask this as an open-ended question. If the respondent mentions the listed symptom, write 1 for yes in the space, write 2 for no. May ask anything else? twice if appropriate.) Yes(nuv) 1 No(bv) 2 Kvwk (Cough) ___ Mjve_v (Sore throat) ___ bvK Siv (Runny nose) ___ Ri (Fever) ___ gv_v e_v (Headache) ___ kixi e_v (Body Aches) ___ Wvqwiqv(Diarrhea) ___ nuvwP (Sneezing) ___ ewg (Vomiting) ___ PvLi mgmv (Eye Problems) ___ Abvb, wbP wbw` Kib (Other, specify below) ___ _______________________ Kvwk (Cough) ___ Mjve_v (Sore throat) ___ bvK Siv (Runny nose) ___ Ri (Fever) ___ gv_v e_v (Headache) ___ kixi e_v (Body Aches) ___ Wvqwiqv(Diarrhea) ___ nuvwP (Sneezing) ___ ewg (Vomiting) ___ PvLi mgmv (Eye Problems) ___ Abvb, wbP wbw` Kib (Other, specify below) ___ _______________________Swine Flu Influenza Illness 2.4 ______ gvbyli wKfve nq? ASK, How a person can get sick with __________? ((cQ`jv DP^i co kvbveb bv) G ckwU Lvjv cևki gZ Ki wRm Kib, Di`vZv cvki ZvwjKvi DcmMjv DjL Kij nuv =1 , bv =2, KvW Kiyb)| Avcwb cևqvRbeva Avi wKQy K_vwU `yBevi wRm KiZ cvib|) (DO NOT READ RESPONSE OPTIONS ALOUD Ask this as an open-ended question. If the respondent mentions the listed symptom, write 1 for yes in the space, write 2 for no in the space. May ask anything else? twice if appropriate.) Yes(nuv) 1 No(bv) 2a. _____ivMxi msk _vKj Close contact with ________ patienta. (a. (b. cvbxi msk Contact with animalsb. ( b. ( c. RxevbyM֯ e _K (wUDeIqji nvZj, dvb) Contact with contaminated surfaces (tube well handles, phones)c. ( c. ( d.bvsiv nvZ Lj ev LvIqv Zix Kij Eating or preparing food with dirty handsd. ( d. ( e. GKB _vjv-evmb, PvgP (ZRmc) fvMvfvwM Kij Sharing utensilse. ( e. ( f. Rxevbyhy cvwb ev Lvevi Lj Contaminated drinking water or food f. ( f. ( g. hb mK Sexual relationsg. ( g. ( h. bvsiv _vKj/A^vKi _vKj (^vfvweK fve, nvZ cwivi Kivi K_v ejv nq bvB) Being dirty/poor hygiene (general, no mention of hand cleanlinessh. ( h. ( i. bvsiv _vKj/A^vKi _vKj, (weklZ nvZ Acwivi _vKj ev evievi nvZ bv ayj) Being dirty/poor hygiene (hands specifically having dirty hands or not washing hands enough)i. ( i. ( j. ! cvKv-gvK! oi Kvgo _! K Insect bite (mosquito or other insect)j. ( j. ( k. fvBivm/evK! Uwiqv/Rxevby Virus/Bacteria/Germsk. ( k. ( l. Abvb/wbw` Ki b Other (specify)l. ( If  other , specify: ________________________________l. ( If other, specify: ________________________________m. Rvwb bv/ wbwZ bB| Dont know/not surem. (m. ((mvqvBb dz) Swine Flu (Bbdzqv) Influenza Illness 2.5 Di`vZvK wRvmv Kib ______ wK cwZiva/VKvbv hvq? (ev KvW wjLyb) ASK: Can _____________ be prevented? (Record code in box) Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv) 99(( If the answer is 02 or 99, skip to top of next column Di 02 ev 99 nj ciewZ Kjvg Pj hvb(( If the answer is 02 or 99, skip to 2.9 Di 02 ev 99 n! j ckS bs 2.9-G P! j hvb2.6 Avcbv Kv! Q wK g! b nq ________-- / VKv! bv ? ASK, Would you say that preventing the spread of __________ is easy or difficult? Easy 01 Difficult 02 / 99 Don t know/not sure(( If the answer is 99, skip to 2.8 Di 99 n! j ckS bs 2.8-G P! j hvb(( If the answer is 99, skip to 2.8 Di 99 n! j ckS bs 2.8-G P! j hvb2.7   ,  ? (If respondent answered  easy , ASK, Would you say that it is somewhat easy or very easy?   ,  ? (If respondent answered  difficult , ASK, Would you say that it is somewhat difficult or very difficult? Somewhat Easy 01 Very Easy 02 Somewhat Difficult 03 Very Difficult 04 Refused to answer 66(((( (! mvqvBb dz) Swine Flu(Bbdzqv) Influenza Illness2.8 wRvmv Kib ______ wKfve cwZiva/VKvbv hvq? ASK: How can ___________ be prevented? (cQ`jv DP^i co kvbveb bv) G ckwU Lvjv cևki gZ Ki wRm Kib, Di`vZv cvki ZvwjKvi DcmMjv DjL Kij nuv =1 , bv =2, KvW Kiyb)| (DO NOT READ RESPONSES ALOUD) (Ask this as an open-ended question. If the respondent mentions the listed prevention, write 1 for yesand 2 for no in the space.) Yes 1 No 2 Amy ew _! K `~! i _vKvi gva! g (Keep away from ill persons) ____ evievi nvZ avqvi gva! g (Wash hands frequently) ____ evievi mvevb w`! q nvZ avqvi gva! g (Wash hand with soap frequently) ____ wUKv bIqvi gva! g (Vaccination) ____ Vvv Lvevi bv Lj (Not taking cold foods) ____ Abvb, wbw` Ki wjLyb (Other, specify below) ____ ___________________________ Rvwb bv/ wbwZ bB (Dont know/not sure) ____ Bbdzqv Kjvg hvb Go to Influenza columnAmy ew _K `~i _vKvi gvag (Keep away from ill persons) ____ evievi nvZ avqvi gvag (Wash hands frequently) ____ evievi mvevb w`q nvZ avqvi gvag (Wash hand with soap frequently) ____ wUKv bIqvi gvag (Vaccination) ____ Vvv Lvevi bv Lj (Not taking cold foods) ____ Abvb, wbw` Ki wjLyb (Other, specify below) ____ ___________________________ Rvwb bv/ wbwZ bB (Dont know/not sure) ____ 2.9. Avcwb gnvgvix kwU bQb? (( ASK: Have you heard the word epidemic? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv) 99 2.10. Avcwb cvbWwgK ev wek-gnvgvix kwU bQb? (( ASK: Have you heard the word pandemic? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv) 99 ( Di (2) ev (9) n! j ckS bs 2.12 G P! j hvb (If (2) or (9), SKIP to question 2.12) 2.11. Kvb eQi kl Bbdz! qv wek-gnvgvix `Lv w`! qwQ! jv? (((( ASK: In which year did the last influenza pandemic occur? -- : , d NOTE: If answer is given in Bangla calendar years, convert to Roman calendar (Current Bangla year as of April 14th , 2010: 1417) / ,  9999 d Write 9999 if Dont Know/Not Sure2.12. kl 12 gvm Avcbvi Lvbvi KD wK h Kvbv KviY nvmcvZvj fwZ nqwQjv? (( ASK, Has anyone in your household been hospitalized for any reason in the last 12 months? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv/ wbwZ bB) 99 ( Di (2) ev (99) nj ck 2.15-G Pj hvb (If (2) or (99), SKIP to question 2.15 2.13 Avcbvi Lvbvi KqRb MZ nvmcvZv! j fwZ n! qwQ! jv? (( ASK, How many people in your household have been hospitalized for any reason in the last 12 months? 2.14 hviv fwZ n! qwQ! jv, Avcbvi g! Z Zv! `i KqRb Kv! bv iv! Mi (( , , , , ) Kvi! Y fwZ n! qwQ! jv? /  99 d ASK, Of those people who were admitted to the hospital, in the last 12 months, how many people were hospitalized for a disease related to respiration (for example - fever, cough, sore throat, runny nose, breathing difficulties)? Write  99 for don't know/no answer 2.15-2.21 Avwg ? d d SAY, I shall tell you name of some diseases and ask you which one causes more worry to you. You may or may not know the names of those diseases. Please let me know if you dont understand my question and also let me know if any of the diseases are not known to you. wRm Kib, wbPi Kvb ivM Avcbvi mePq ewk `ywvi/fqi KviY? ASK, Which illness is more concerning/causes more worry to you? -- :  ,  ? -- : , ,  99 . -- : , ,  99 --NOTE: If respondent says they  do not know which one is more concerning, please stress that this is an opinion and ask them to think about which one is more concerning for them. --NOTE: If someone is concerned about one, but does not know of the other, write 99. --NOTE: If someone does not know one of the diseases, you can automatically write 99 anytime that disease is listed. `yBUvi ga GKUv ( ) iv! Mi bvg ! kv! bb bvB (Don t know one (or both) of the diseases) Refused to Answer Respondent does not understand question and has no response2.15Bbdz! qv (Influenza) 01orWvqwiqv (Diarrhea) 02996633((2.16Wvqwiqv (Diarrhea) 01orGBPAvBwf/GBWm (HIV/AIDS) 02996633((2.17Bbdz! qv (Influenza) 01orGBPAvBwf/GBWm (HIV/AIDS) 02996633((2.18GBPAvBwf/GBWm (HIV/AIDS) 01or ev wUwe (Tuberculosis/TB) 02996633((2.19 ev wUwe (Tuberculosis/TB) 01orWvqwiqv (Diarrhea) 02996633((2.20 ev wUwe (Tuberculosis/TB) 01orBbdz! qv (Influenza) 02996633(( 2.21 Avcwb wK g! b K! ib Bbdz! qvq Avva n! q GKRb gvbyl gviv h! Z cv! i? (( Do you think a person can die from influenza? Yes (nuv) 01 No (bv) 02 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 ( Di (02) ev (99) n! j ckS 2.26-G P! j hvb (If 02 or 99, SKIP to question 2.26) 2.22-2.25 ? SAY, I shall tell you some age groups and ask you if you think that they may die from Influenza illness. Yes (nuv) 01 No (bv) 02 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 2.22 Avcwb wK g! b K! ib 5 eQ! ii Kg eq! mi wki ! ! Bbdz! qv iv! M f~! M g Zz NUvi mve ? Do you think it is likely that a child less than 5 years old with influenza would die ?((2.23 Avcwb wK g! b K! ib 5 _! K 1 eQ eqmx 9 z! j hvIqv wki ! Bbdz! qv iv! M f~! M g Zz NUvi mvebv ? Do you think it is likely that a child 5-17 years old with influenza would die ,? ((2.24 Avcwb wK g! b K! ib cveq9 gvby! li ! Bbdz! qv iv! M f~! M g Zz NUvi mvebv ? Do you think it is likely that a person with influenza would die if they are an adult? ((2.25 Avcwb wK g! b K! ib e ewi ! Bbdz! qv iv! M f~! M g Zz NUvi mvebv ? Do you think it is likely that a person with influenza would die if they are an elderly person? (( 2.26 Avcwb ev Avcbvi Lvbvi jvKRb Bbdz! qv wel! q LeivLei Kgb K! i ! c! q _v! Kb? ASK, How you or the people living in your household obtained information about influenza? (cQ: `! jv D P^! i c! o kvbv! eb bv) G ckSwU Lvjv c! kSi gZ K! i wR! m Ki b, Di`vZv ZvwjKvi ! jv D! jL Ki! j nuv =1 , bv =2, KvW Kiyb)| (DO NOT READ RESPONSE OPTIONS ALOUD) (Ask this as an open-ended question. If the respondent mentions the listed symptom, write  1 for  yes  2 for  no .) -- : , d --NOTE: Please only record responses that the primary respondent says. Yes 01 No 02a. ( iwWI) Radio((b.. ( Uwjwfkb Television((c.. (Le! ii KvMR) Newspaper ((d.. ( /Dc! Rjv ^v K: ` ev ^v Kgx Wvvi /bvm) Health professional - Hospital, Upazilla Health Center/Healthcare provider (doctor, nurse), Community health worker or pharmacist ((e. (ez-eve, mnKgx, evwoi m`m, ) Social Circle - Family and friends, Co(w)-workers, Bari members or neighbors ((f. (agxq bZv ev gmwR`/gw: `i) Religious leader or church/temple ((g. Contact with BISTIS team in field or in clinical setting (current or previous contact)((h. , ( ) Contact with ICDDR,B in field or clinical setting (other than BISTIS project)((i. / School((j. (Avwg Bbdz! qv wel! q Kv! bv Z_ cvB bvB) I have not received any information about influenza ((k. (Rvwb bv/wbwZ bB) Don t know/not sure ((l. ( ) Respondent does not understand question and has no response((m. (Abvb/wbw` Ki b) Other (specify) __________________________________________________________________________ (( 2.27 weMZ 6 gv m Lvbvi Kv! bv m`m Bbd! qv ev wUKv wb! qwQ! jv wK? (( ASK: Has anyone in your household received a vaccination for influenza or swine flu in the past six months? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv/ wbwZ bB) 99 Di hw` nuv nq, Ze h ev hviv wUKv wbqwQjv, Zviv Kv_vq wbqwQjv DjL Kib| j ---Kib: GwU njv wUKv c`vbi vb, hgb zj, KvRi vb BZvw` kixii Kvbv vb bq| If yes, please indicate where that person (those people) received the vaccine: --NOTE: This is the location, such as school, clinic, etc., where the vaccine was obtained (not the location on the body) ______________________________________________________________ ( Di (02) ev (99) nj ck bs 2.28 G Pj hvb (If 02 or 99, SKIP to question 2.28) 2.27b wRm Kib: Avcwb wK AvgvK wUKv KvW `LvZ cvib? (( imcۛU wK AvcbvK KvW `wLqQ? ASK: Can you show me the vaccination card? Does respondent show you? Yes (nuv) 01 No (bv) 02 Dont Know/Not Sure (Rvwb bv/ wbwZ bB) 992.28 hw` Di`vZv AvBwmwc nq, wR! m Ki b MZ GK gv! mi g! a Avcbvi Ri n! qwQ! jv wK? (( hw` Di`vZv AvBwmwc nq wR! m Ki b eZgvb Qvov MZ GK gv! mi g! a Avcbvi Ri n! qwQ! jv wK? If respondent is NOT the ICP (ASK: Have you had a fever within the last month? If respondent is the ICP (ASK: Apart from this current fever, have you had a fever within the last month? -- : , d --NOTE: You may indicate what the date was one month prior. Yes (nuv) 01 No (bv) 02 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 ( hw` Di 02 ev 99 nq, ckS 2.43-G hvb| (If 02 or 99, SKIP to question 2.43) 2.29-2.42 wR! m Ki b MZ GK gv! mi g! a hLb Avcbvi Ri n! qwQ! jv, wb! Pi KvR! jvi GKwUI K! iwQ! jb wK? d ASK,  When you had a fever within the last month, did you do any of the following? Then read choices one at a time and record the respondent s responses. ( c! qvRb n! j evSvi myveav! _ wR! m Ki b MZ GKgv! mi g! a hLb Avcbvi Ri n! qwQj Avcwb wK---------------? ( If necessary, for clarification at any time, ASK,  When you had a fever within the last month___________? Yes (nuv) 01 No (bv) 02 Respondent does not understand question and has no response 33 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 2.29 nvZ ? Did you wash your hands more frequently than usual? (( 2.30 nuvwP ev Kvwki mg! q Kvco ev KbyB w`! q gyL ? Did you cover your cough or sneeze with tissue or your elbow?(( 2.31 wKwbK ev nvmcvZvj ? Did you visit a clinic or hospital? (( 2.32 Ab jv! K! `i Lye KvQvKvwQ ? Did you avoid close contact with other people? (( 2.33 9 z! j/Kv! R/evRv! i/KwgDwbwU m: Uv! i bv wM! q evwo! Z ? Did you stay home from work/school/market/community centers? (( 2.34 Wvv! ii cmwckb QvovB Jla L! qwQ! jb? (Ila we! Zv _! K ev Kvb dvgvwm ! _! K ev wb! R wb! R) Did you take medicine without a doctor s prescription (from a medicine seller, a pharmacist or self-medicated)?(( 2.35 ( , , , , ) Dc! `k Abyhvqx Jla ? Did you seek help or take medicine prescribed by a MBBS doctor or other certified medical professionals paramedics, nurses, medical assistants, family welfare visitors, etc.)?(( 2.36b ! nvwgIcvw_K Wvv! ii / civgk Abyhvqx Jla ? Did you seek help or take medicine from a homeopathic doctor or a traditional healer? (( 2.38 Rjv nvmcvZvj _! K webvg~! j A! mvwgwfi Jla ? Did you receive free Oseltamivir from a district hospital? (( 2.39 evqy PjvPj ? Did you increase ventilation in your household? (( 2.40 Ab! `i _vjv-evm! b Lvevi bv Lv ? Did you avoid sharing drink or utensils with others? (( 2.41 Ab! `i ! _! K Avjv`v Ny ? Did you sleep separately from others? (( 2.42 Abvb (wbw` Ki b) Other (specify): ((  [2.43-2.58] BwbDwgikb dg `L ei Kib Lvbvq (nvDRnv) 5 eQii Kg eqmx Kvbv wk iqQ wK bv| hw` _vK, Ze wbPi ckwU Kib| hw` bv _vK, Ze ck bs 2.59 G Pj hvb| Check Enumeration Form to see if there is a child who is less than 5 years of age in the household. (If there is a child under 5, ask this question: (If there is no child less than 5 years old, SKIP to question 2.59 2.43 Avcwb wK cavbZ 5 eQ! ii Kg eqmx wki `Lv! kvbv ev cwiPhv ? (( Are you a primary caretaker for a child that is less than 5 years of age? Yes (nuv) 01 No (bv) 02 ( hw` 02 Di nq Z! e 2.59G P! j hvb| If 02, SKIP to question 2.59 2.44 hw` 5 eQ! ii Kg eqmx wk AvBwmwc nq, Z! e wR! m Ki Y Avcbvi cwiPhvq _vKv 5 eQ! ii Kg eqmx Kv! bv wki MZ GK gv! m Ri n! qwQ! jv wK? hw` 5 eQ! ii Kg eqmx wk AvBwmwc nq , wR! m Ki Y ( ) ) eZgvb Qvov Avcbvi cwiPhvq _vKv 5 eQ! ii Kg eqmx Kv! bv wki MZ GK gv! m Ri n! qwQ! jv wK? (( If child less than 5 years old is NOT the ICP, (ASK: Has a child under your care, who is less than 5 years old, had a fever in the past month? If child less than 5 years old is the ICP, (ASK: Apart from (name of ICP) s current fever, has (name of ICP) or another child under your care, who is less than 5 years old, had a fever in the past month? - : , d --NOTE: You may indicate what the date was one month prior. Yes (nuv) 01 No (bv) 02 Don t know/Refused to answer (Rvwb bv/ Di `! eb bv) 99 ( hw` Di 02 ev 99 nq, ckS 2.59-G hvb| If 02 or 99, SKIP to question 2.59 [2.45-2.58] wR! m Ki Y Avcbvi 5 eQ! ii Kg eqmx mav! bi MZ GK gv! mi g! a hLb Ri n! qwQ! jv, ZLb wb! Pi KvR! jvi K! iwQ! jb wK? ( d ASK,  When a child under your care, who is less than 5 years old, had a fever within the last month, did you do any of the following? Then read choices one at a time and record the respondents responses. ( cևqvRb nj evSvi myveav_ wRm Kib MZ GKgvmi ga hLb GB wkwUi Ri nqwQj Avcwb wK---------------? (If necessary, for clarification at any time, ASK, When this child had a fever within the last month,_______________? -j Kib: hw` Di`vZvi cwiPhvq GKi AwaK wk _vK hv`i MZ GK gvm Ri nqwQjv, m mePq Kg eqmx wki Di cևhvR ne| -NOTE: If respondent has more than one child under their care who had a fever within the last month, the answers will be applicable for the youngest child. Yes (nuv) 01 No (bv) 02 Respondent does not understand question and has no response 33 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 2.45 nvZ ? Did you wash your hands more frequently? (( 2.46 Avcbvi wkwU wKwbK ev nvmcvZv! j wM! qwQj? Did your child visit a clinic or hospital? (( 2.47 Avcbvi wk! K Ab jv! K! `i Lye KvQvKvwQ ? Did you have your child avoid close contact with other people? (( 2.48 Avcbvi wk! K 9 z! j/Kv! R/evRv! i/KwgDwbwU m: Uv! i bv wb! q evwo! Z ? Did you keep your child home from work/school/market/community centers? (( 2.49 Wvv! ii cmwckb QvovB dvgvmx _! K Jla wK! b wk! K Lv ev N! i ivLv Jla Lv ? Did you give your child medicine from home or bought at a pharmacy without a doctor s Prescription (self-medicate)? (( 2.50 Jlawe! Zvi (mvwUwd! KU cvIqv dv! gmx bb) m! civgk K! i Jla ? Did you seek help or medicine prescribed by a medicine seller (not a certified pharmacist)? (( 2.51 ( , , , , ) Dc! `k Abyhvqx Jla ? Did you seek help or take medicine prescribed by a MBBS doctor or other certified medical professionals (certified pharmacist, paramedics, nurses, medical assistants, family welfare visitors, etc.)? (( 2.52 ! nvwgIcvw_K Wvv! ii / civgk Abyhvqx Jla ? Did you seek help or medicine from a homeopathic doctor or a traditional healer? (( 2.53 Rjv nvmcvZvj _! K webvg~! j A! mvwgwfi Jla ? Did you receive free Oseltamivir from a district hospital? (( 2.54 evqy PjvPj ? Did you increase ventilation in your housing structure? (( 2.55 Ab! `i _vjv-evm! b wk! K Lvevi bv LvIqv ? Did you avoid sharing drink or utensils with your child? (( 2.56 Avcbvi wk! K Ab! `i ! _! K ! _! K Avjv`v Nygv! Z ? Did you have your child sleep separately from others? (( 2.57 Abvb (wbw` Ki b) Other (specify): ((  [2.59- 2.74] BwbDwg! ikb dg `! L ei Ki b Lvbvq 5-17 eQi eqmx (5 Ges 17 eQimn) Kvbv wk iqQ wK bv| hw` _vK, Ze wbPi ckwU Kib| hw` bv _vK, Ze ck bs 2.84 G Pj hvb| Check Enumeration Form to see if there is a child who 5-17 years of age (including those that are 5 and 17) in the household. (If there is no child 5-17 years old, SKIP to question 2.84 (If there is a child 5-17 years old, ask this question: 2.59 Avcwb wK cavbZ 5-17 eQi eqmx wki `Lv! kvbv ev cwiPhv ? (( Are you a primary caretaker for a child that is 5-17 years of age? Yes (nuv) 01 No (bv) 02 ( hw` 02 Di nq Z! e 2.75G P! j hvb| (If 02, SKIP to question 2.75) 2.60 hw` 5-17 eQi eqmx wk AvBwmwc nq wR! m Ki b Avcbvi cwiPhvq _vKv 5-17 eQi eqmx Kv! bv (( wki MZ GK gv! m Ri n! qwQ! jv wK? hw` 5-17 eQi eqmx wk AvBwmwc , , ( )- 5-17 , ? If child between 5 and 17 years old is NOT the ICP, (ASK: Has a child under your care, who is between 5 and 17 years old, had a fever in the past month? If child between 5 and 17 years old is the ICP, (ASK: Apart from (name of ICP) s current fever, has (name of ICP) or another child under your care, who is between 5 and 17 years old, had a fever in the past month? - : , d --NOTE: You may indicate what the date was one month prior. Yes (nuv) 01 No (bv) 02 Don t know/Refused to answer (Rvwb bv/ Di `! eb bv) 99 ( hw` Di 02 ev 99 nq, ckS 2.75-G hvb| If 02 or 99, SKIP to question 2.75 [2.61-2.74] wR! m Ki b Avcbvi 5-17 eQ! ii eqmx Kv! bv mav! bi hLb MZ Ri n! qwQ! jv ZLb wb! Pi KvR! jvi Kvb KvbwU K! iwQ! jb? ( d d ASK,  When a child under your care, who is 5-17 years old, had a fever within the last month, did you do any of the following? Then read choices one at a time and record the respondents responses. (If necessary, for clarification at any time, ASK, When this child had a fever within the last month,_______________? -j Kib: hw` Di`vZvi cwiPhvq 5-17 eQi eqmx GKi AwaK wk _vK hv`i MZ GK gvm Ri nqwQjv, m mePq Kg eqmx wki Di cևhvR ne| -NOTE: If respondent has more than one child, between 5-17 years old, under their care who had a fever within the last two weeks, please report on their actions regarding the YOUNGEST of those children. Yes (nuv) 01 No (bv) 02 Respondent does not understand question and has no response 33 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 99 2.61 nvZ ? Did you wash your hands more frequently? (( 2.62 Avcbvi wkwU wKwbK ev nvmcvZv! j wM! qwQj? Did your child visit a clinic or hospital? (( 2.63 Avcbvi wk! K Ab jv! K! `i Lye KvQvKvwQ ? Did you have your child avoid close contact with other people? (( 2.64 Avcbvi wk! K 9 z! j/Kv! R/evRv! i/KwgDwbwU m: Uv! i bv wb! q evwo! Z ? Did you keep your child home from work/school/market/community centers? (( 2.65 Wvv! ii cmwckb QvovB dvgvmx _! K Jla wK! b wk! K LvIqv! bv ev N! i ivLv Jla Lv ? Did you give your child medicine from home or bought at a pharmacy without a doctor s Prescription (self-medicate)? (( 2.66 Jlawe! Zvi (mvwUwd! KU cvIqv dv! gmx bb) m! civgk K! i Jla ? Did you seek help or medicine prescribed by a medicine seller (not a certified pharmacist)? (( 2.67 ( , , , , ) Dc! `k Abyhvqx Jla ? Did you seek help or medicine prescribed by a MBBS doctor or from other certified medical professionals (certified pharmacist, paramedics, nurses, medical assistants, family welfare visitors, etc.)? (( 2.68 ! nvwgIcvw_K Wvv! ii / civgk Abyhvqx Jla ? Did you seek help or medicine from a homeopathic doctor or a traditional healer? (( 2.70 Rjv nvmcvZvj _! K webvg~! j A! mvwgwfi Jla ? Did you receive free Oseltamivir from a district hospital?(( 2.71 evwoi evqy PjvPj ? Did you increase ventilation in your household? (( 2.72 Ab! `i _vjv-evm! b wk! K Lvevi ? Did you avoid sharing drink or utensils with your child? (( 2.73 Avcbvi wk! K Ab! `i ! _! K ! _! K Avjv`v Nygv! Z ? Did you have your child sleep separately from others? (( 2.74 Abvb (wbw` Ki b) Other (specify): ((  [2.75-2.83]Avwg Avcbv! K wKQy AvPiY m! K ej! ev `qv K! I, Avgv! K ejyb wb! Pi Kvb Kvb eenvi Avcbv! K - ivM ( , , , , ) Qov! bvi nvZ _! K euvP! Z ? SAY, I shall tell you about some behaviors. For the following, tell me if you think that the behavior would help you avoid the spread of repiratory diseases (including such as fever, cough, sore throat, runny nose, breathing difficulties). c! hvR ! wR! m Ki b: Avcwb wK g! b K! ib _______ Avcbv! K ivM Qov! bvi _! K euvP! Z ? ( If necessary, for clarification at any time, ASK Do you think __________ help you avoid the transmission of disease ? Yes (nuv) 01 No (bv) 02 Don t Know/Not Sure (Rvwb bv/ wbwZ bB) 992.75 Amy jv! Ki Lye KvQvKvwQ bv Avoiding close contact with persons that are sick?((2.76 cvwb w`! q nvZ avqv Washing your hands with water?((2.77 mvevb w`! q nvZ avqv Washing your hands with soap and water?((2.78 evRvi Ges Ab Rbej  vb Gwo! q Pjv Avoiding going to the market and other public meeting places?((2.79 KD Amy n! j N! ii evqy PjvPj evov! bvi ee v Kiv Increasing ventilation in the household when a member is sick?((2.80 nvZ bv gjv! bv/ Avoid shaking hands?((2.81 Amy ew! K Avjv`v ivLv Isolating a sick person from other individuals?((2.82 wUKv bqv Getting a vaccine?((2.83 gvm&K - ( ) Covering your face or nose with a mask or other cloth? (PUT HAND OVER MOUTH TO DEMONSTRATE)(( [2.84-2.93] d ! klevi hLb Avcwb ev Avcbvi Lvbvi Kv! bv wk Amy n! qwQ! jv, ZLb iv ! VKv! bvi R! b ev wPwKrmvi ! ! wb! Pi Kv evavi myLxb nqwQjb? (Ackbjv co kvbvb) SAY, I shall tell you some barriers which might become a problem for protecting yourself and your family from diseases. Think about the last time (apart from this current illness) you or a child from your household was sick. Please tell me if you encountered any of the following barriers to preventing or treating the disease. (READ RESPONSE OPTIONS ) cևqvRb nj evSvi myveav_ wRm Kib klevi hLb Avcwb ev Avcbvi Lvbi Kvb wk Amy nqwQj ZLb wK--------------?(If necessary, for clarification at any time, ASK,  The last time you or a child from your household was sick _________________________________? Yes (nuv) 01 No (bv) 02 Respondent does not understand question and has no response 33 (c! hvR bq) Not applicable (illness did not require this) 55 Don t know/ Don t remember (Rvwb bv/g! b bB) 992.84 wPwKrmvi LiP ewk ? Was healthcare too expensive? ((2.85 Jl! ai `vg Lye ewk ? Was medicine too expensive? ((2.86 wbR! K ev cwievi! K wKfv! e iv! Mi nvZ _! K euvPv! eb m m! K LeivLe! ii Afve ? Was there was a lack of information about what you could do to protect yourself or your family?((2.87 ! iv! Mi nvZ _! K euvPvi Dcvq! jv m! K cwi9 vi Lei cvb bvB? Was information received about how to prevent or treat disease unclear? ((2.88 nvZ avqvi cvwb wQ! jv bv? Was water to wash hands was not available?((2.89 nvZ avqvi mvev! bi `vg ewk A_ev cvIqv hv ? Was soap to clean hands was too expensive or not available?((2.90 KvRi Rb evwoZ _vKv me nq wb? Were you unable to stay in the house because you had to go to work? ((2.91 evmvq wk`i `Lvi KD wQjv bv weavq Zv`i evwoZ ivLv me nq wb? Were you unable keep the kids at home because there was nobody to watch them?((2.92 Avjv`v K bv _vKvq Amy ewK Avjv`v ivLv me nq wb ? Were you unable to isolate sick people because there is no separate room in your home? ((2.93 Abvb, wbw` Kib Other (Specify: _____________________)(( mKkb 3t ivbvNi I cavb Nygi Nii evqy mvjb eevi g~jvqb Section 3: Ventilation Assessment of Cooking area and Main Sleeping Place Di`vZvK ck Kib t `qv Ki Avcwb AvgvK Avcbvi Lvbvi ivbv Kivi vbwU `Lveb wK? Ask to respondent: Can you show me the cooking area that your household uses most often? j Kib: ivbvi vb ejZ ewk eeZ PzjvwU h vb AewZ ZvK eySvbv nqQ| --NOTE: Cooking area is defined by the location of the primary stove. 3.1 cheb: ivbvNii Aevb (ev KvW wjLyb ) (( Observation: Cooking area location (Record code in box): evmvbi Pvi `Iqvji wfZi (Within four walls of housing structure). 01 evmvbi cvk Ges mivmwi evmvbi mv_ mshy (Attached to and directly next to the housing structure) 02 evmvbi cvk wK mivmwi evmvbi mv_ mshy bq (Attached to but NOT directly next to the housing structure) 03 j Kib: GB KvWwU eeZ ne hLb ivbvi vbwU Nii KvVvgvi mv_ mivmwi mshy wK gaeZx Ab Kvb K iqQ (hgb vi ig A_ev Mi QvMji Ni) hv kvevi Ni I ivbvi vbK Avjv`v KiQ --NOTE: Use this code when the cooking area is attached to the housing structure, but there is some other room (such as a storage area or animal room) separating the cooking area from where people sleep evmvb _K Avjv`v (Separate from living space) 04 j Kib: ivbvi vb I kvevi Nii gaeZx hKvb cwigvb Lvwj RvqMv _vKj 04 KvW cևhvR ne --NOTE: Any separation between the cooking area and the housing structure should be coded as 04 Abvb, wbP wbw` Ki wjLyb (Other, specify below) 99 _____________________________________________________________________________ 3.2a cheb: ivbvNii QvDwb ev Pvjvi aib (ev KvW wjLyb ) (( Observe: Roof of cooking area (Record number in box): -- : h Kv! bv ai! bi `qvj GgbwK Kvc! oi Zix n! jI Zv `qvj i! c Mb n! e --NOTE: Any material, even a tarp, should be considered a  roof Pvjv bB No roof 01 AvswkK Pvjv Av! Q Partial roof present 02 cwic~Y Pvjv Av! Q Complete roof present 03 ( hw` Di 3.2a 01 nq, Ze 3.6bs cևk Pj hvb If answer to 3.2b is 01, then SKIP to 3.6 3.2b cheb:ivbvNii `qvji aiY (ev KvW wjLyb) (( Observe: Walls of cooking area (Record number in box): -j Kib: h Kvbv aibi `qvj GgbwK Kvcoi Zix njI Zv ҆`qvj ic Mb ne --NOTE: Any material, even a tarp, should be considered a wall -j Kib: hw` Kgc GKwU `qvj AvswkK nq (AaK DPZvi), 2 wjLyb| --NOTE: If at least one wall is a partial wall (1/2 height), select 02 Kvbv `qvj bB (No walls) 01 AvswkK `qvj (AvswkK e) [Partial walls (partially enclosed)] 02 c~Y `qvj (`ivRv Ges Rvbvjv ev` cyivcywi e) [Full walls (completely enclosed (besides doors and windows)] 03 Abvb (wbP wbw` Kib) [Other (specify below)] 99 ________________________________________________________________________ ( hw` Di 3.2b 1 nq, Ze 3.7bs cևk Pj hvb If answer to 3.2b is 1, then SKIP to 3.7 ( hw` Di 3.2b 2 ev 9 nq, Ze 3.6bs cևk Pj hvb If answer to 3.2b is 2 or 9, then SKIP to 3.6 3.3 cheb:ivbvNii evqy mvjb eev (ev KvW wjLyb ) (( Observe: Ventilation of the cooking area (Record code in box): -- j Kib:: Kvbv 4 bs KvW bB| --NOTE: There is no choice 4 j Kib:vqxfve e Rvbvjv ev `iRv Mb ne bv --NOTE: Do not count windows or doors that appear to be permanently closed or blocked. j Kib:Ab Nii mv_ mshvMKvix Rvbvjv ev `iRv Mb KiZ ne --NOTE: Doorways or windows leading to other rooms should be observed for this question. ivbvNii Pvi w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of the 4 directions (in each of four walls) 01 ivbvNii wZb w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of 3 directions (in three walls) 02 ivbvNii wecixZ `yB w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ (Di I `wY) At least one window or door in each of 2 opposing directions (in two opposing walls) 03 ivbvNii hKvb non-wecixZ w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of 2 non-opposing directions (in two non-opposing walls) 05 ivbvNii GKB w`K gyL Ki `yBwU Rvbvjv ev `iRv AvQ (GKB `qvj) At least two windows/doors in only 1 direction (in one wall) 06 ivbvNii GKB w`K gyL KiGKwU Rvbvjv ev `iRv AvQ (GKB `qvj) Only one door or window in only 1 direction (in one wall) 07 Abvb, wbP wbw` Ki wjLyb Other (specify below) 99 __________________________________________________________________________ 3.4 cheY: ivbvNii evq~ mvjb eev, `Iqvj I Qv`i gaeZx RvqMv (ev KvW wjLyb) (( Observe: Ventilation of cooking area, space between walls and roof (Record code in box): --gaeZx RvqMv ejZ `qvj I Qv`i ga eeavb evSvbv nqQ hv Avcbvi nvZi cvvi mePq PIov vbi mgvb ev ewk ( d ) --NOTE: A space is defined as any separation between the wall/partition and roof that is equal or greater to the widest part of your hand (measure the widest space) PviwU `Iqvj I Qv! `i gaeZx RvqMv Av! Q Space between all 4 walls and roof 01 wZbwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 3 walls and roof. 02 `yBwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 2 walls and roof. 03 GKwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 1 wall and roof . 04 Kvb `Iqvj I Qv`i gaeZx RvqMv bvB No space between any walls and roof 05 3.5 cheY: ivbvi vbi evqy PjvPj, `qvj Ges gSi gaeZx vb (( Observe: Ventilation of cooking area, space between walls and floor (Record code in box) -- j Kib: gaeZx RvqMv ejZ `qvj I gSi ga eeavb evSvbv nqQ hv Avcbvi nvZi cvvi mePq PIov vbi mgvb ev ewk --NOTE: A space is defined as any separation between the wall/partition and floor that is equal or greater to the widest part of your hand PviwU `Iqvj I gSi gaeZx RvqMv AvQ Space between all 4 walls and floor 01 wZbwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 3 walls and floor 02 `yBwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 2 walls and floor 03 GKwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 1 wall and floor 04 Kvb `Iqvj I gSi gaeZx RvqMv bvB No space between any walls and floor 05 3.6 cheY: ivbvi vb cwigvc, `N Ges c֯ (K`g/cv w`q) msLvq wjLyb Observe: Measurement of cooking space, length by width (in steps): Record Number Below -- j Kib: mePq j^v `N Ges mePq PIov c֯ Mb Kib| --NOTE: Measure longest length and widest width present j Kib:AvswkK K`gi Rb wbKU c~Y wjLyb ( hgb 5.5 Gi Rb 6 wjLyb) --NOTE: Round up to the nearest step (for example, record 5.5 steps as 06) (( (`N length) (( (c֯ width) 3.7 cheY: ivbvi vb _K evmvbi `iZ K`g/cv w`q(ivbvi vbi mePq KvQi Nii `iRv _K Pzjv chZ cwigvc Kib) Observation: Distance from cooking area to housing structure in steps (measure from the stove to the entrance of housing structure that most frequently entered when returning from the cooking area)Record number below: (( j Kib: ivbv Kivi vb hw` Lvbvi wfZi nq, Ze 00 KvW Kib| --NOTE: If the cooking area is inside the household, code 00. j Kib:AvswkK K`gi Rb wbKU c~Y wjLyb ( hgb 5.5 Gi Rb 6 wjLyb) --NOTE: Round up to the nearest step (for example, record 5.5 steps as 06) 3.8 Di`vZv wK AvBwmwc Lvbvi jvK? (( Is the respondent from the ICP household? Yes (nuv) 01 No (bv) 02 ( Di bv nj mKkb 4 G Pj hvb If the answer to question 3.8 is no, SKIP to section 4 3.9 `qv Ki (Index ivMx) h NiwU ewkifvM mgq Nygvq mwU AvgvK `Lveb wK? (( Ask the respondent: Can you show me the room where the index case most often sleeps? Yes (nuv) 01 No (bv) 02 ( Di bv nj mKkb 4 G Pj hvb If the answer to question 3.9 is no, SKIP to section 4 3.10 cheY: Nygvbvi vbi evqy mvjb eev (ev KvW wjLyb ) (( Observation: Ventilation of the sleeping space (Record code in box): -- j Kib: Kvbv 4 bs AckY bB| --NOTE: There is no choice 4 --Nygi vb ejZ mve cv_wgK/BbW ivMx h vb Nygvq mB vbK eySvbv nqQ --NOTE: The sleeping space is the room in which the index case patient sleeps in. Count rooms as separate when you cannot see over the partition separating the two rooms while standing in front of partition j Kib:vqxfve e Rvbvjv ev `iRv Mb ne bv --NOTE: Do not count windows or doors that appear to be permanently closed or blocked. j Kib:Ab Nii mv_ mshvMKvix Rvbvjv ev `iRv Mb KiZ ne --NOTE: Doorways or windows leading to other rooms should be included in this question. j Kib: AvBwmwc h Ni Nygvq Zv cheY Kib --NOTE: Observe the room in which the ICP sleeps. Nygvbvi Nii Pvi w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of the 4 directions (in each of four walls) 01 Nygvbvi Nii wZb w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of 3 directions (in three walls) 02 Nygvbvi Nii wecixZ `yB w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ (Di I `wY) At least one window or door in each of 2 opposing directions (in two opposing walls) 03 Nygvbvi Nii hKvb non-wecixZ w`K Kgc GKwU Ki Rvbvjv A_ev `iRv AvQ At least one window or door in each of 2 non-opposing directions (in two non-opposing walls) 05 Nygvbvi Nii GKB w`K gyL Ki `yBwU Rvbvjv ev `iRv AvQ (GKB `qvj) At least two windows/doors in 1 direction (in one wall) 06 Nygvbvi Nii GKB w`K gyL KiGKwU Rvbvjv ev `iRv AvQ (GKB `qvj) Only one door or window in 1 direction (in one wall) 07 Abvb, wbP wbw` Ki wjLyb Other (specify below) 99 ____________________________________________________________________ 3.11 cheY: Nygvbvi Nii evqy mvjb eev, `qvj Ges Qv`i gaeZx vb (ev KvW wjLyb ) (( Observation: Ventilation of sleeping space, space between walls and roof (Record code in box): -- j Kib: gaeZx RvqMv ejZ eov/`qvj I Qv`i ga eeavb evSvbv nqQ hv Avcbvi nvZi mePq PIov vbi mgvb ev ewk --NOTE: A space is defined as any separation between the wall/partition and roof that is equal or greater to the widest part of your hand --j Ki b: d --NOTE: Please observe the largest spaces and use these to determine whether a space is present or not. PviwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between all 4 walls and roof 01 wZbwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 3 walls and roof. 02 `yBwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 2 walls and roof. 03 GKwU `Iqvj I Qv`i gaeZx RvqMv AvQ Space between 1 wall and roof . 04 Kvb `Iqvj I Qv`i gaeZx RvqMv bvB No space between any walls and roof 05 3.12 cheY: g~j evmvbi evqy mvjb eev, eov/`qvj I gSi gaKvi RvqMv (ev KvW wjLyb|)(( Observation: Ventilation of main living room, space between walls and floor (Record code in box): --( j Kib: gaeZx RvqMv ejZ eov/`qvj I gSi ga eeavb evSvbv nqQ hv Avcbvi nvZi mePq PIov vbi mgvb ev ewk) --NOTE: A space is defined as any separation between the wall/partition and floor that is equal or greater to the widest part of your hand PviwU `Iqvj I gSi gaeZx RvqMv AvQ Space between all 4 walls and floor 01 wZbwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 3 walls and floor 02 `yBwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 2 walls and floor 03 GKwU `Iqvj I gSi gaeZx RvqMv AvQ Space between 1 wall and floor 04 Kvb `Iqvj I gSi gaeZx RvqMv bvB No space between any walls and floor 05 3.13 cheY: Nygvbvi Nii cwigvc, `N-c֯ cwigvc (K`g/ cv w`q ) msLvq wjLyb t Observation: Measurement of sleeping space, length by width (in steps) Record numbers below: -- j Kib: mePq j^v `N Ges mePq PIov c֯ Mb Kib| --NOTE: Measure longest length and widest width present j Kib:AvswkK K`gi Rb wbKU c~Y wjLyb ( hgb 5.5 Gi Rb 6 wjLyb) --NOTE: Round up to the nearest step (for example, record 5.5 steps as 06) (( (`N length) (( (c֯ width) 3.14 BbW Km ivMx hLb GLvb Nygvb, ZLb Zvi mv_ mvavibZ Avi KZvRb jvK GLvb GKBmgq Nygvb? ASK: When the index case patient sleeps in this space, how many other people typically sleep in this space at the same time? Record numbers below: --j Ki b: d d --NOTE: Look at the room where the index case sleeps, not the entire housing structure. (( End of Section Three mKkb 4t nvZavqvi vb mvevbi mnRcvcZv (chebKZ) Section 4: Availability of Soap at Handwashing Stations (observed) Di`vZvK wRvmv Kib -Avcwb ekxi fvM mgq h vb Avcbvi nvZ avb `qv Ki AvgvK mB vbwU `Lveb wK? Ask the respondent: Can you please show me where you most often wash your hands? 4.1 cheY: nvZavqvi vbwU g~jZt Kv_vq AewZ? (ev KvW wjLyb ) (( Observation: Record the location of the primary handwashing station: (Record code in box) j Kib-hw` AvcbvK nvZ avqvi vbwU eenvii Rb Nii KvVvgvi evBi nU hZ nq Zvnj nvZ avqvi vbwU Nii evBi ej ai wbb|nvZ avqvi vbwU GKwU Qv`i wbP njI Zv Mb bq| Nii evBi ejZ g~j KvVvgvi evBi evSvbv nQ| --NOTE: If you have to walk outside the housing structure to use the handwashing station, consider the handwashing station to be outdoors. --NOTE: It does not matter whether the handwashing station is under a roof or not, outdoors means outside the main housing structure. Nii wfZi (cavb KvVvgvi wfZi) /Indoors (within main housing structure) 01 Nii evBi-cavb KvVvgvi evBi Ze evoxi wfZi/ Outdoors (outside main housing structure, within bari) 02 Nii evBi -evoxi evBi, cwZewki DVvb A_ev cyKzi/ Outdoors (outside bari, in neighbors yard or in pond) 03 Kvbv wbw` vb bq/ No specific place 04 `Lvi AbygwZ bB/ No permission to see 05 Abvb (wbw` Kib)/ Other (specify below) 88 _____________________________________________________________ (4.1 bs cևki Di 3, 4 ev 5 nj 4.8 bs cևk Pj hvb| (If the answer to question 4.1a is 3, 4 or 5, SKIP to question 4.8) 4.2 cheY: nvZ avqvi Rb wbw` vb cvwb AvQ wK? Observation: Is water present at the specific place for handwashing? ev KvW wjLyb (Record code in box) (( wbRi PvL cvwb `L ev nuv KvW wjLyb --NOTE: You must actually see water to record yes j Kib cwigvb A_ev gvb Kvb mgmv bq| hw` Kvb cvwb _vK Zvnj nv KvW Kib| --NOTE: The quantity and quality does NOT matter. If any water is present, code yes Yes (nuv) 01 No (bv) 02 4.3a cheY: nvZ avqvi vb wbPi KvbwU AvQ? ( hw` Avcwb KvbwU cheb Ki _vKb, Zvnj nuv =1, bv =2 ev KvW Kib)| Observation: Which of the following are present at the handwashing station? (If you observe the listed item, write 1 for yes in the box below. If you do not observe the listed item, write 2 for no in the box below.) j Kib nvZ avqvi vbi Pvi cvki gvwU / evjyi Rb gvwU / evjy KvW Kieb bv| hw` GKwU wbw` cv ivLv _vK Ges nvZ avqvi vb eeZ nq Zvnj KvW Kib --NOTE: Do not record mud/sand if there is mud on the ground around the handwashing station. Record it if it is kept in a specific place or container and if there is evidence that it is kept intentionally to be used at the handwashing station for any purpose. Yes (nuv) 01 No (bv) 02 mvevb (Bar soap) (( cvDWvi/wWUviRU (Detergent powder) (( Zij mvevb (Liquid soap) (( QvB (Ash) (( gvwU/evjy (Mud/Sand) (( wKQzB bB (None) (( Abvb, wbw` Kib (Other, specify below) (( ____________________________________________ 4.3b cheY: g~j nvZ avqvi vb _K ivbv Kivi vbi `yiZ (K`g w`q cwigvc Kib Ges wjLyb) MEASURE: Distance from primary handwashing station to cooking area (in steps, measure to stove in cooking area) ev KvW wjLyb (Record code in box) (( 4.3c cheY: g~j nvZ avqvi vb _K jvwUbi vbi `yiZ (K`g w`q cwigvc Kib Ges wjLyb) Kvbv jvwUb bv _vKj wUK w`b| MEASURE: Distance from primary handwashing station to latrine (in steps, measure to entrance of latrine) (Record number below) If there is NO LATRINE, code 99 ev KvW wjLyb (Record code in box) (( 4.4 Di`vZvK: wRvmv Kibt GQvov Avi Kv_vqI Avcwb nvZ avb wK? Ask the respondent: Is there anywhere else you wash your hands? ev KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 hw` 4.4 Gi Di 2 nqZ e ck 4.8 G hvb (If answer to 4.4 is 2, skip to question 4.8) 4.5 cheY: nvZ avqvi wZxq vbwU Kv_vq AewZ? (ev KvW wjLyb ) Observation: Record the location of the secondary handwashing station: ev KvW wjLyb (Record code in box) (( Nii wfZi /Indoors (within main housing structure) 01 Nii evBi-cavb KvVvgvi evBi Ze evoxi wfZi/ Outdoors (outside main housing structure, within bari) 02 Nii evBi -evoxi evBi, cwZewki DVvb A_ev cyKzi/ Outdoors (outside bari, in neighbors yard or in pond) 03 Kvbv wbw` vb bq/ No specific place 04 `Lvi AbygwZ bB/ No permission to see 05 Abvb (wbw` Kib)/ Other (specify below) 88 _____________________________________________________________ ( hw` 4.5 bs cևki Di 3, 4 ev 9 nq, ck 4.8 G hvb (If the answer to question 4.5a is 3, 4 or 9, SKIP to question 4.8 ) 4.6 cheY: nvZ avqvi Rb wbw` vb cvwb AvQ wK? (wbRi PvL cvwb `L ev nuv KvW wjLyb ) Observation: Record if water is present at the specific place for handwashing? (You must actually see water to record yes): ev KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 4.7a cheY: nvZ avqvi vb wbPi KvbwU AvQ? (hw` Avcwb KvbwU cheb Ki _vKb, Zvnj nuv =1 , bv =2 ev KvW Kib)| Observation: Which of the following are present at the handwashing station? (If you observe the listed item, write 1 for yes in the box below. If you do not observe the listed item, write 2 for no in the box below.) j Kib nvZ avqvi vbi Pvi cvki gvwU / evjyi Rb gvwU / evjy KvW Kieb bv| hw` GKwU wbw` cv ivLv _vK Ges nvZ avqvi vb eeZ nq Zvnj KvW Kib --NOTE: Do not record mud/sand if there is mud on the ground around the handwashing station. Record it if it is kept in a specific place or container and if there is evidence that it is kept intentionally to be used at the handwashing station for any purpose. Yes (nuv) 01 No (bv) 02 mvevb (Bar soap) (( cvDWvi/wWUviRU (Detergent powder) (( Zij mvevb (Liquid soap) (( QvB (Ash) (( gvwU/evjy (Mud/Sand) (( wKQzB bB (None) (( Abvb, wbw` Kib (Other, specify below) (( ___________________ 4.7b cheY: mKvix nvZ avqvi vb _K ivbv Kivi vbi `yiZ (K`g w`q cwigvc Kib Ges wjLyb) Observation: Distance from secondary handwashing station to cooking area (in steps, measure to stove in cooking area) Record number below: (( 4.7c cheY: mKvix nvZ avqvi vb _K jvwUbi vbi `yiZ (K`g w`q cwigvc Kib Ges wjLyb) Kvbv jvwUb bv _vKj wUK w`b| Observation: Distance from secondary handwashing station to latrine (in steps, measure to entrance of latrine) Record number below: jvwUb bv _vKj 99 KvW Kib If there is NO LATRINE, code 99 (( 4.8 Di`vZvK wRvmv Kib - Hvb Qvov Nii wfZi wbPi Kvb Dcv`vbwU iqQ? (Di`vZvK mUv AvcbvK `LvZ ejyb) ? (hw` Avcwb KvbwU cheb Ki _vKb, Zvnj nuv =1 , bv =2 ev KvW Kib)| Ask the respondent: Which of the following are present in the household regardless of place? (If you observe the listed item, write 1 for yes in the box below. If you do not observe the listed item, write 2 for no in the box below.) Di`vZvK `Lvbvi Rb ejZ ne| You should ask the respondent to show you. Yes (nuv) 01 No (bv) 02 mvevb (Bar soap) (( cvDWvi/wWUviRU (Detergent powder) (( Zij mvevb (Liquid soap) (( QvB (Ash) (( gvwU/evjy (Mud/Sand) (( wKQzB bB (None) (( Abvb, wbw` Kib (Other, specify below) (( __________________________________________ End of Section Four mKkb 5t MnvjxZ aygcvb msv ckmg~n Section 5: Housing structure Smoking Status Questions 5.1 Di`vZvK wRvmv Kib - Avcbvi Nii KvVvgvZ aygcvbi wbPi Kvb wbqgwU ekx cևhvR? ASK, Which of the following best describes the rules about smoking inside your housing structure? ev KvW wjLyb (Record number in box): (( mejv Ackb DP^i co kvbvb (Read all options out loud) Avcbvi Nii KvVvgvi ga aygcvb Kivi AbygwZ AvQ Smoking is allowed in your housing structure 01 Avcbvi Nii KvVvgvi ga mvavibZ aygcvb Kivi AbygwZ bB, Ze gvS gvS ewZg NU Smoking is generally not allowed inside of your housing structure but there are exceptions 02 Avcbvi Nii KvVvgvi ga KLbvB a~gcvbi AbygwZ bB Smoking is never allowed inside your housing structure 03 aygcvbi Rb Avcbvi Ni aivevav Kvb wbqg bB There are no rules about smoking in your housing structure 04 Rvwb bv Don't know 99 hw` 5.1 Gi Di 3 nqZ ! e 6 bs mKk! b P! j hvb If answer to 5.1 is 3 then skip to section 6 5.2 Di`vZv! K wRvmv Ki b - Avcbvi N! ii KvVv! gvi wfZ! i mKj i ! gB wK aygcvb MnY! hvM? ASK, Inside your housing structur is smoking allowed in every room? --j Ki b: hw` aygv GKwU wbw` ig GKRb gv jvKiI a~gcvbi AbygwZ _vK (hgb wcZv), wK Ab KD (hgb mvbiv) mLvb a~gcvb bv Ki, ZviciI mB ig a~gcvbi AbygwZ iqQ ej Mb KiZ ne| --NOTE: If any person is allowed to smoke inside a particular room for one person (for example, a father), even if other people (for example, the kids) are not allowed to smoke inside that same room, then smoking is allowed in that room. ev KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 Dont know/Refused to answer (Rvwb bv/ Di `eb bv) 99 5.3 Di`vZvK wRvmv Kib KZ mgq ci ci Avcbvi Nii KvVvgvi ga KD aygcvb Ki? ASK, How often does anyone smoke inside your housing structure? ev KvW wjLyb (Record code in box) (( `wbK Daily 01 mvvwnK Weekly 02 gvwmK Monthly 03 gvwmKi Pq Kg mgq Less than monthly 04 KLbvB bv Never 05 bv Rvwb bv Dont Know 99 End of Section Five mKkb 6: Av_-mvgvwRK Aev Section 6: Socioeconomic Status 6.1 Di`vZvK wRvmv Ki b - Avcbvi (A_ev Kvb m`! mi) Av! Q wK? (c! ZKwU ! hw` Lvbvi wb! Pi h Kv! bv AvB! Ug _v! K, Z! e nuv =1 , bv =2 ev! wjLyb| hw` Di`vZvi bv Rvbv _v! K Z! e ev! 9 KvW Ki b)| ASK, Does your household (or any member of your household from the Enumeration Form) have: (If the household has the listed item, write 1 for yes in the box below. If the household does not have the listed item, write 2 for no in the box below, if the respondent does not know, write 9 for Dont know in the box below.) j Kib-aygv mB Dcv`vbwj Afy Kib hv evoxZ DcwZ AvQ, XvKv wKsev we`k bq --NOTE: Include items that are present in bari, not items owned in Dhaka or abroad. Yes (nuv) 01 No (bv) 02 Dont know/Refused to answer (Rvwb bv/ Di `eb bv) 99 we`yr (Electricity)? (( Avjgvix (Almirah or wardrobe)? (( Uwej (A table)? (( Pqvi ev e (A chair or bench)? (( Nwo (A watch or clock)? (( LvU (Khat)? (( PwK (Chouki)? (( mPj iwWI (A radio that is working)? (( mPj UwjwflY (mv`v-Kvjv) (A television (B/W) that is working)? (( mPj UwjwflY (iwOb) (A television (Color) that is working)? (( wdR (A refrigerator)? (( ev&BmvBKj (A bicycle)? (( gUi mvBKj (A motorcycle)? (( mjvBgwkb (A sewing machine)? (( jvۇdvb (A land phone)? (( gvevBj dvb (A mobile phone)? (( 6.2 ch! eY: Di`vZvi nvDwRs vKPv! ii Qv` Zix! Z wK Dcv`vb eenvi Kiv n! q! Q ? Observation: Material of the Roof of respondent s housing structure: --j Ki b: d --NOTE: Please record the COSTLIEST material present ev KvW wjLyb (Record code in box) (( mvavib Qv`Natural roof KvuPv (evuk/Lo) Katcha (bamboo / thatch) 11 gwjK Qv` Rudimentary roof wUb Tin 21 mcb Qv` (cvKv) Finished roof (pukka) wmgU/ KswU/ Uvwj Cement / concrete / tiled 31 (Abvbt wbP wbw` Ki wjLyb) Other: Specify below 41 _____________________________________ 6.3 cheY: Di`vZv nvDwRs vKPvii `qvj ZixZ c wK Dcv`vb eenvi Kiv nqQ? (ch! ebK& Z Z_ wjwce Ki b) Observation: Material of the walls of the respondent s housing structure --j Ki b: d --NOTE: Please record the COSTLIEST material present ev! KvW wjLyb (Record code in box) (( mvavib ! `qvj Natural walls cvU/ evuk/ (KvuPv) Jute / bamboo / mud (katcha) 11 ! g`wjK ! `qvj Rudimentary walls KvV Wood 21 mbS ! `qvj (cvKv) Finished walls BU/wm! g: U Brick / cement 31 wUb Tin 32 (Abvbt wb! P wbw` K! i wjLyb) Other: Specify below 41 __________________________________________________ 6.4 cheY: Di`vZv nvDwRs vKPvii gS ZixZ wK Dcv`vb eenvi Kiv nqQ ? Observation: Main material of the floor of the respondents housing structure --j Kib: d --NOTE: Please record the COSTLIEST material present ev! KvW wjLyb (Record code in box) (( mvavib ! g! S Natural floor gvwU/evuk(KvuPv)Earth / bamboo (katcha) 11 ! g`wjK ! g! S Rudimentary floor KvV Wood 21 mcb gS (cvKv)Finished floor (pukka) wmgU/ KswK&U Cement / concrete 31 (Abvbt wbP wbw` Ki wjLyb)Other: Specify below 41 _________________________________________________ 6.5 Di`vZvK wRvmv Kib - MvmjLvbv I ivbvi vb ev` Avcbvi Ggb KZwU ig AvQ hv Nii KvVvgvi Af~? ASK, Excluding the bathroom and cooking area, how many rooms are there in your housing structure? -- : , d , d d --NOTE: Do not ask what the rooms are used for. Record the number that they give you. Ask them to give you a number. - : , d , d --NOTE: Only count rooms that are within the housing structures where household members live. Animal houses are not included. Store rooms or other rooms, that are within the housing structure, are included. - : , d d --NOTE: Count two rooms as separate if the partition that divides them covers >50% of the length of the wall. Otherwise consider as one room. ev! KvW wjLyb (Record code in box) (( 6.6 Di`vZv! K wRvmv Ki b - Avcbvi N! i ( )Nygv! bvi Rb KZwU ig Av! Q? ASK, How many rooms does your housing structure have for sleeping? - : % ,   d --NOTE: Count a room as  for sleeping if it is slept in >50% of days - : j Kib: hLb Avcwb `qv! ji mvg! b `uvwo! qI `yB i! gi gaeZx cvwUk! bi Dci w`! q ! `L! Z cvi! eb bv, ZLbB `ywU ig wn! m! e Mb Ki! eb| --NOTE: Count rooms as separate when you cannot see over the partition separating the two rooms while standing in front of partition ev KvW wjLyb (Record code in box) (( 6.7 Di`vZvK wRvmv Kib - Avcwb Kvb Kvk ch jLv-cov KiQb? (msLvq wjLyb) (hw` Di`vZvi bv Rvbv _vK Ze ev 99KvW Kib)| Ask the respondent: How many years of education have you completed? (record number of years completed below. If dont know, record 99.) - : , d , d - , - d -NOTE: If a respondent is in school, record the number corresponding to their current class number. (For example, for someone in class six, reply 06. For HSS graduates, record 12; for Bachelors graduates record 14; for Masters level record 16. ev KvW wjLyb (Record code in box) (( 6.8 Di`vZvK wRvmv Kib - Avcwb wK Lvbvi cavb? Ask the respondent: Are you the head of household? ev KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 Dont know/Refused to answer (Rvwb bv/ Di `eb bv) 99 (6.8 Gi Di hw` 1 nq, Ze ck bs 6.10 Z Pj hvb (If answer to 6.8 is 1, skip to question 6.10) 6.9 Di`vZvK wRvmv Kib - Lvbv cavb Kvb Kvk ch jLv-cov mb KiQb? (wbP msLvq wjLyb) hw` Di`vZvi bv Rvbv _vK Ze ev 99KvW Kib)| Ask the respondent: How many years of education has the head of household completed? (record number below. If dont know, record 99.) ev KvW wjLyb (Record code in box) (( 6.10 Di`vZvK wRvmv Kib - Avcbvi Lvbvi wbR^ emZwfUv AvQ wK? Ask the respondent: Does your household own homestead land? ev KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 Dont know/Refused to answer (Rvwb bv/ Di `eb bv) 99 (6.10 Gi Di hw` 2 ev 99 nq, Ze ck bs 6.12 Z Pj hvb (If answer to 6.10 is 2 or 99, skip to question 6.12) 6.11 Di`vZvK wRvmv Kib - Avcbvi Lvbv gvU KZUzKz emZ ( Wwm! gj) Av! Q? (Rvwb bv n! j  9999 KvW Ki b) Ask the respondent: How much homestead land does your household own? If  don t know code  9999 . Rwgi gvU  vbxq GKK Total local land unitt AMOUNT cwigvb: __________________ SPECIFY UNIT GKK wbw` K! i wjLyb: _______________ ( ) Conversion from Local Land Unit to Decimals (complete in BISTIS office) : Conversion Rate: Total Land in Decimalst AMOUNT cwigvb: __________________ decimals 6.12 Di`vZv! K wRvmv Ki b - emZ Qvov Avcbvi Lvbv Avi Kvb Rwg Av! Q wK? Ask the respondent: Does your household own any land, other than homestead land? ev! KvW wjLyb (Record code in box) (( Yes (nuv) 01 No (bv) 02 Dont know/Refused to answer (Rvwb bv/ Di `eb bv) 99 ( 6.12 Gi Di hw` 2 ev 9 nq, Ze ck bs 6.14 Z Pj hvb (If answer to 6.12 is 2 or 9, skip to question 6.14) 6.13 Di`vZvK wRvmv Kib - emZwfUv Qvov Avcbvi Lvbv wK cwigvb Abvb Rwg ( Wwm! gj) Av! Q? (Rvwb bv n! j  9999 KvW Ki b) Ask the respondent: How much land, other than homestead land, does your household own? If  don t know code  9999 . Rwgi gvU  vbxq GKK Total local land unitt AMOUNT cwigvb: __________________ SPECIFY UNIT GKK wbw` K! i wjLyb: _______________ ( ) Conversion from Local Land Unit to Decimals (complete in BISTIS office) : Conversion Rate: Total Land in Decimalst AMOUNT cwigvb: __________________ decimals 6.14 Di`vZv! K wRvmv Ki b - Avcbvi Lvbvq ivbSvi Rb cavbZ wK ai! bi Rvjvbx eenvi Kiv nq? Ask the respondent: What type of fuel does your household mainly use for cooking? ev! KvW wjLyb (Record code in box) (( KvV Wood 01 k! mi Aewkvsk/Nvm/ / Crop residue / grass/dried leaves/jute leaves 02 Kbv Mvei Dung cakes 03 Kqjv/KK/wjMbvBU Coal / coke / lignite 04 KvV Kqjv Charcoal 05 Kivwmb Kerosene 06 we`yr Electricity 07 Zij Mvm/cvKwZK Mvm Liquid gas / gas 08 evqv-Mvm Bio-gas 09 Abvb, wbP wbw` Ki wjLyb Other, specify below 88 ________________________________________________________ Rvwb bv Dont know 99 6.15 Di`vZvK wRvmv Kib - Avcbvi Lvbv Lvevi Rb cvwbi cavb Drm Kx? Ask the respondent: What is the main source of water your household uses for drinking? ev! KvW wjLyb (Record code in box) (( AMfxi wUDeI! qj Shallow tube well. 01 Mfxi wUDeI! qj Deep tube well. 02 myiwZ cvZK~qv Protected ring/dug well 03 AmyiwZ cvZK~qv Unprotected dug well . 04 Zviv cv Tara pump 05 AvmwbK kvabvMvi Arsenic free treatment plant 06 myiwZ Sbvi cvwb Water from protected spring 07 AmyiwZ Sbvi cvwb Water from unprotected spring 08 f~ci cvwbt Surface water ewi cvwb Rainwater .. 09 UvsKvi UvK Tanker truck .. 10 QvU UvsKhy KvU Cart with small tank 11 RxevbygyKib cvwbt Pathogen treatment plant (Pond Sand Filter) 12 mivmwi msMnxZ cvwbt Directly from: b`x/eva/jK/cyKzi/mP bvjv _K River/dam/lake/ponds/stream/canal/irrigation channel 13 evZjRvZ cvwb Bottled water .... 14 Nii wfZi Uvc ev cvBci cvwb Piped water into housing structure 15 DVvb Uvc ev cvBci cvwb Piped water into yard/plot 16 cvewjK Uvc Public tap/stand pipe . 17 Abvb, wbP wbw` Ki wjLyb Other: specify below 88 _______________________________________________________________________________________ 6.16 AbyMnKi AvgvK `Lvib wK Avcbviv Kv_vq cvqLvbv Kib ? cheY: cvqLvbvi aib iKW Kib| Say: Please show me the place where you go to defecate. Observation: Record type of toilet facility ev KvW wjLyb (Record code in box) (( DbZgvbi UqjU/ cvqLvbv Improved sanitation facilities: dvk UqjU A_ev cvwb Xj dvk Kiv UqjU hv cqwbvkb cvBci mv_ mshvM Ki `qv Flush / pour flush to piped sewer system 01 dvk UqjU A_ev cvwb Xj mcwUK UvsK hvevi eev AvQ Flush / pour flush to septic tank 02 dvk UqjU A_ev cvwb Xj cvqLvbv wcUi ga mwiq `qv hvq Flush / pour flush to pit latrine 03 ve mn wcU UqjU /jvwUb Pit latrine with slab 04 AbDbZgvbi UqjU/ cvqLvbv Unimproved sanitation facilities: dvk UqjU A_ev cvwb Xj dvk Kiv UqjU hv cqwbvkb cvBc, mcwUK UvsK ev jvwUbi mv_ mshvRb bB| ( UqjU hv Kvb Lvj,Wb,b`x BZvw`imv_ mshy) Flush or pour flush toilet not to sewer system, septic tank, or pit latrine (e.g., to canal, ditch, river, etc.).. 05 wcU jvwUb /UqjU hvi ve bB(Lvjv wcU) Pit latrine without slab (i.e., open pit).. 06 Szwo /cv ivLv Bucket 07 Szj UqjU / cvqLvbv Hanging toilet/latrine 08 Lvjv RvqMvq cvqLvbv Open defecation: Kvb cvqLvbv bB/Rj/SvcSvo/gvV No facility/bush/field 09 Abvb:( DjL Kib) others (Specify below) 88 __________________________________________________________________________________ 6.17 Di`vZvK wRvmv Kib - Avcbvi Lvbv evZxZ Avi KZjv Lvbv wgj GB cvqLvbvwU eenvi Kib ? Ask the respondent: How many households, other than your own, use this toilet facility? ev KvW wjLyb (Record code in box) (( 6.18 wRvmv Kib Avcbvi Lvbvi Lv`vfvm / Lv` Mnbi aiY Abyhvqx wKfve Avcwb Avcbvi Lvbvi kYx weYvm Kieb? mviv eQiB wK Lv` Afve _vK? KLbv KLbv Lv` Afve _vK, Lv` AfveI _vK bv D؄ _vK bv,Lv` D؄ _vK? ASK, In terms of household food consumption, how do you classify your household: deficit the whole year, sometimes deficit, neither deficit nor surplus, surplus? ev KvW wjLyb (Record code in box) (( mviv eQiB Lv` Afve _vK (Deficit the whole year) 01 KLbv KLbv Lv` Afve _vK (Sometimes deficit) 02 Lv` AfveI _vK bv D؄ _vK bv (Neither deficit nor surplus) 03 Lv` D؄ _vK (Surplus) 04 Di`vZv ck eySZ cvI bv Ges Kvb di `q bv (Respondent does not understand question and has no response) 33 Rvwb bv/ wbwZ bB (Don t know/not sure) 99 d d Thank you. This part is finished. Code and signature of FRA: Ending Time (24-hour format): __ __:__ __ Checked by: FRA/FRO/MO CodeSignatureDate (dd/mm)FRAFROMO Appendix 10: Illness Tracking Form (for all ages) Version 18.5.10 Name of Contact: ___________________________________ Is this the Index-Case? (Yes (1) or No (2)): ____ Contact Unique ID___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Age(years)at enrollment: __________________ Date of Call to FRO for Specimen Collection (dd/mm/yy) ___ ___/ ___ ___/ ___ ___ Time (24-hour format) ___ ___: ___ ___ First Day of Illness Tracking (dd/mm/yy): ___ ___/ ___ ___/ ___ ___ Last Day of Illness Tracking (dd/mm/yy): ___ ___/___ ___/___ ___ (ICP ONLY): Date of Second Fever-Free Day (dd/mm/yy): ___ ___/___ ___/___ ___  Mark 1 for yes, 2 for no, 99 for dont know, for SKIP, 55 for No household member present, and for Danger Signs Sections only: 0for observed danger sign and 3 for reported danger sign Day of Observation112131415161718191102112121131141151617181920Present in Bari during past 24 hours? (If 2, 55 or 99 SKIP column to FRA code and DATE)Contact present at time of illness tracking (If 2, collect symptom information from head mother/household head)Eligibility Symptoms & Specimen Collection ASK contact, In the past 24 hours have you had fever?Fever (If no, SKIP to Other Symptoms)If yes specimen collection neededcall to FRO* Record date and time of call above.Other Symptoms ASK contact,  In the past 24 hours, have you had _________? CoughSore ThroatWatery Diarrhea (e" 3 loose stools within 24 hours)Bloody Diarrhea (watery diarrhea (e" 3) with blood in it)InjuryDanger Signs* for AGES e" 5  SKIP if Contact is < 5. Enter  0 if danger signs (DSs) are directly observed, 3 if DSs are only reported, 2, 99 or when applicable Refer to JIMCH (unless patient already sought care and Danger Sign is no longer present) & Call FRO*CyanosisSevere respiratory distressConvulsionsAltered mental statusDanger Signs* for AGES < 5 SKIP if Contact is e" 5. Enter  0 if danger signs (DSs) are directly observed,  3 if DSs are only reported,  2 ,  99 or when applicable Refer to JIMCH (unless patient already sought care and Danger Sign is no longer present) & Call FRO*Chest In-drawingLethargyCyanosisInability to drinkConvulsionsFever for ages < 2 monthsDanger Sign Actions SKIP If no danger signs observed or reported on this day of illness tracking. Danger Sign Present ( Called to FROPatient referred & went to hospital w/ FRAPatient referred & will go to hospital w/o FRAPatient referred & refused to go to hospitalPatient visited hospital before FRA visit (referred if symptoms remain) Outcomes SKIP if none of the above symptoms (FEVER or Other Symptoms) are reported on this day of illness tracking. ASK, Did you miss school/work, take medication or seek medical care as a result of the above symptoms you identified? Missed work/schoolTook medicationSought medical care independently (from any source)Adverse Events SKIP only if 2, 55 or 99 entered in first row. Otherwise, always RECORD either yes (1) or no (2)Hospitalized**Death**Daily FRA CodeDate (dd/mm)*If (1) sample collection is necessary, (2) danger signs are present, or (3) a patient refused to go to the hospital, the FRA will notify the FRO. The FRO will then notify the MT and MO when necessary. The MT will call the FRA to obtain the bari address. **CALL FRO IMMEDIATELY. THESE ARE SERIOUS ADVERSE EVENTS AND THE FRO MUST FOLLOW UP. ADVERSE EVENT FORM IS NECESSARY. Appendix 11: Secondary/Follow Up Case Specimen Collection Form Contact Name: Contact Unique ID#: Medical Officer/ Medical Technologist IDDate of call (dd/mm/yy)Time of call (24 hour format) Household ID# UpazilaBajitpur / Kuliar Char Village / Para / MahallaDistrictKishorgonj Union / Ward Phone numberWhat type of case is this? ( Secondary Case = 1, Follow Up Case = 2, Sick Bari member = 3 Did the possible case or his/her guardian give consent/assent? ( (Yes = 1, No = 2) Case age e"18 years, self consent ( (Yes = 1, No = 2) Case age < 18 years, guardian consent ( (Yes = 1, No = 2) Case age 7 to < 18 years, self assent ( (Yes = 1, No = 2) Date of collection (dd/mm/yy)Time of collection (24 hour format)Age (YY-MM)Sex (Male=1; Female=2)If the possible case/guardian did NOT give consent/assent, or specimen wasnt collected, record why below: ______________________________________________________________________________ ______________________________________________________________________________ Code of Medical Officer/Technologist: _____________ Signature: _____________________________________ Date: _________________________________________ BISTIS: Facilitating Tools Tracking Form Unique ID: __________ Name of Bari Leader: _____________________________________________ evwoi cavbi bvg Code of FIS: _____ Name of FIS: _________________________________________________ Bari location evwoi Aevb: ______________________________________________________________________________________________________ Record Date and Time of FIS visit to bari on DAY ONE: (dd/mm/yyyy) ______________ GdAvBGm-Gi wfwRUi ZvwiL Ges mgq Complete this section on Day One of intervention. GB AskwU BUvifbkbi c_g w`b mgv Kib Write the number of the location in the boxes below: Aevbi msLv wbPi ev wjLyb 1 next to cooking area (ivbvNii cvk) 4 Uthaan (DVvb) 2 next to toilet area (cvqLvbvi cvk) 5 next to tubewell (wUDeIqji cvk) 3 next to household structure (Nii KvVvgvi cvk) 6 other (write in other location on line below) (Abvb, wbP wjLyb) 7 not found ( `Lv hvqwb ) 1. Site of baris handwashing station - must include water and soap % (evwoi nvZ avqvi RvqMvi Ae vb -AekB Zvi g! a cvwb I mvevb _vK! Z n! e ): Other: (Abvb: wb! Pi jvB! b wbw` K! i wjLyb) ________________________________________________________________________ 2. Site of primary intervention handwashing station (cvBgvix B: Uvi! fbkY nvZ avqvi RvqMvi Ae vb): % Other: (Abvb: wb! Pi jvB! b wbw` K! i wjLyb) ________________________ 3. Site of secondary intervention handwashing station ( m! Kvix B: Uvi! fbkY nvZ avqvi RvqMvi Ae vb): % c! hvR bq (Not Applicable):........................8 (Other: (Abvb: wbPi jvBb wbw` Ki wjLyb) ________________________________________________________________________ Number of Bari Members present for intervention on Day 1: _______ children (2-17 years of age) from Bari _______ adults (>18 years of age) from Bari Complete this section on day one, and all additional days as benefits and barriers are identified. (GB AskUzKz c_g w`b Ges Abvb AwZwi w`b c~iY Kib hLb myweav Ges Amyweav wPwZ ne) Benefits of handwashing with soap identified by bari members evwoi m`miv mvevb w`q nvZ avqvi h h myweav wPwZ KiQ (If bari members mention the listed benefit, write 1 for yes in the space. At the END of the Intervention Period, if bari members did not mention the listed benefit, write 2 for no in the space. hw` evwoi m`m wbgv myweav mg~n wPwZ Ki Zvnj nv Dˇii Rb 1 KvW wjLyb BUvifkb kl h h myweav wPwZ nqwb Zvi Rb 2 KvW Kib ): % 4a. Nurture child or family (cwievi ev wki hZS bqv) % 4b. Be accepted member of society (mgv! Ri m`m wn! m! e Mnb! hvMZv) % 4c. Reduced diarrhoeal disease (Wvqwiqv Kg nq) % 4d. Remove disgusting substances ( bvsiv _! K cwi9 vi _vKv hvq) % 4e. Improved health (DbSZ ^v ) % 4f. Reduced respiratory illness (kv! mi/Kvwki AmyL Kg nq) % 4g. Look, feel, smell clean (cwi9 vi-cwi QbS `Lvq Ges fv! jv eva nq) % 4h. Enhanced social status (mvgvwRK ghv`v ev! o) % 4i. Soap repels germs ( mvevb Rxevby `~i K! i) % 4j . Write any additional benefits identified below: (Abvb Kv! bv myweavi K_v e! j _vK! j wb! P wjLyb) Identify barriers and solutions of handwashing with soap. Identify those barriers stated by bari members as reasons they find it difficult to wash hands with soap. (If a barrier is mentioned, write 1 for yes in the space. At the END of the Intervention Period, if bari members did not mention a barrier, write 2 for no in the space.) Identify solution/s that bari members indicate are most appropriate for the stated barrier. (Focus solutions on the most appropriate solution/s, not all solutions.) (If a solution is mentioned, write 1 for yes in the space. At the END of the Intervention Period, if bari members did not mention a solution, write 2 for no in the space.) mvevb w`q nvZ avqvi evav Ges Zvi mgvavb wPwZ Kib| evwoi m`miv h h KviY mvevb w`q nvZ ayZ mgmvi ga cib, mjvK evav wnmve wPwZ Kib (hw` evwoi m`m wbgv evav mg~n wPwZ Ki Zvnj nv Dˇii Rb 1 KvW wjLyb BUvifkb kl h h evav wPwZ nqwb Zvi Rb 2 KvW Kib ) evox m`miv wbw` evavi Rb h h mgvavb DjL Ki Zv wPwZ Kib|( me mgvavb bq eis h mgvavbwU ewk cևhvR mUvK ewk iZ w`b) hw` evwoi m`m wbgv mgvavb mg~n wPwZ K! i Zvn! j nv D! ii Rb 1 KvW wjLyb B: Uvi! fkb k! l h h mgvavb wPwZ nqwb Zvi R! b 2 KvW Ki b ) % 5. Not part of routine or habit Solution/s: % 5a. BISTIS cue cards as reminders wemwUm wKD KvW Afvm bB mgvavb % 5b. BISTIS FIS frequent reminders wemwUm GdAvBGm evievi g! b Kwi! q `qv % 5c. Bari leader / elder daily or frequent reminders evwo cavb ev e! qv! R KD cwZw`b g! b Kwi! q `qv % 5d. Teach children now so it becomes habit wk! `i GLb _! KB wkv `qv hv! Z Afv! m cwiYZ nq % 5e. Place handwashing station in common area in central location mevB eenvi Ki! Z cv! i Ggb  v! b nvZ avqvi RvqMv ivLv % 5f. Other: Abvb: wb Pi jvB! b wjLyb| ______________________________________________________ % 6. Unaware of benefits/lack of knowledge Solution/s: % 6a. Benefits fact sheet review wemwUm dv wkU cov v! bi Afve/myweav Rv! bb bv mgvavb % 6b. Influenza education flash cards, influenza fact sheet review Bbdz! qv mwKZ Z! _i wdc KvW, Bbd! qv dv wkU cov % 6c. BISTIS cue cards for important times review iZc~Y mg! qi R! b wemwUm wKD KvW wiwfD % 6d. Other: Abvb: wb Pi jvB! b wjLyb| ______________________________________________________ % 7. Too much energy / laziness Solution/s: % 7a. Place handwashing station in common area in central location AZwaK PjZv ev AjmZv mgvavb mevB eenvi Ki! Z cv! i Ggb  v! b nvZ avqvi RvqMv ivLv % 7b. Benefits fact sheet review: handwashing can improve health, save more time and energy dv wkU wiwfD: nvZ ay! j ^v fv! jv _v! K, mgq Ges kw euv! P| % 7c. Benefits fact sheet review: handwashing steps take only a few seconds dv wkU wiwfD: nvZ ay! Z gv K! qK m! K mgq jv! M % 7d. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 8. Soap costs too much Solution/s: % 8a. Benefits fact sheet review: soap costs little, can improve health, mvev! bi LiP AZwaK ewk mgvavb people can work more to earn more when they re healthier dv wkU wiwfD: mvev! bi `vg Kg, GwU ^v fv! jv iv! L, my gvbyl ! ewk KvR K! i d! j ewk DcvRY K! i| % 8b. FIS will give soap when needed for handwashing for 2 weeks hLb c! qvRb, ZLb GdAvBGm `yB mv! ni R! b nvZ avqvi mvevb w`! Z cv! i| % 8c. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 9. Won t prevent illness Solution/s: % 9a. Influenza education flash cards, benefits fact sheet review mvevb iv! Mi nvZ _! K euvPvq bv mgvavb Bbdz! qv welqK wkvi wdc KvW, dv wkU wiwfD % 9b. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 10. Ash or mud cleans Solution/s: % 10a. Barriers and solutions fact sheet review: ash & mud may not QvB ev Kuv`v A` k Rxevby `~i K! i mgvavb clean invisible germs cwZeKZv Ges mgvavb dv wkU wiwfD: QvB Ges Kuv`v cwi9 vi K! i bv| % 10b. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 11. Water by itself cleans Solution/s: % 11a. Barriers and solutions fact sheet review: water alone may not cvwb wb! R _! KB A` k Rxevby `~i K! i mgvavb clean invisible germs cwZeKZv Ges mgvavb dv wkU wiwfD: ay cvwb Rxevby cwi9 vi K! i bv| %11b. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 12. Too busy / no time Solution/s: % 12a. Place handwashing station in common area in central location AZwaK eZv/mg! qi Afve mgvavb mevB eenvi Ki! Z cv! i Ggb  v! b nvZ avqvi RvqMv ivLv % 12b. Benefits fact sheet review: handwashing can improve health, more time and energy for daily tasks dv wkU wiwfD: nvZ ay! j ^v i DbSwZ nq, `bw: `b Kv! Ri R! b mgq Ges kw euv! P % 12c. Benefits fact sheet review: handwashing steps take only a few seconds dv wkU wiwfD: nvZ ay! Z gv K! qK m! K mgq jv! M % 12d. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 13. Soap will be stolen Solution/s: % 13a. BISTIS soap box can protect soap from animals and crows mvevb Pzwi n! q hvq mgvavb wemwUm mvev! bi ev! i Kvi! Y KvK ev Ab cvbx mvevb wb! Z cvi! e bv| % 13b. Take soap in at night to prevent theft iv! Z Pzwii nvZ _! K evP! Z mvevb N! i ivLv %13c. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 14. No handwashing station/too far away Solution/s: % 14a. BISTIS handwashing station will be given to keep in bari nvZ avqvi Kv! bv RvqMv bB ev A! bK `~! i mgvavb wemwUm nvZ avqvi  vb evwo! Z `! e % 14b. Place handwashing station in common area in central location mevB eenvi Ki! Z cv! i Ggb  v! b nvZ avqvi RvqMv ivLv %14c. Other: Abvb, wb! Pi jvB! b wjLyb _____________________________________________________ % 15. Don t care about handwashing Solution/s: % 15a. Barriers and solutions fact sheet review: handwashing with soap with soap mgvavb can improve health, save cost of medicine / clinic visits mvevb w`! q nvZ avqv `iKvix g! b Kwi bv cwZeKZv Ges mgvavb dv wkU wiwfD: mvevb w`! q nvZ a~! j ^v fv! jv _v! K, Jla ev wPwKrmvi LiP euv! P % 15b. Barriers and solutions fact sheet review: handwashing with soap may prevent illness, more time to work or spend in fields cwZeKZv Ges mgvavb dv wkU wiwfD: mvevb w`! q nvZ a~! j ivM cwZ! iva nq, ! Z ev KvR Kivi Rb ewk mgq cvIqv hvq| % 15c. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 16. Forget to wash hands with soap Solution/s: % 16a. Place handwashing station in common area in central location mvevb w`! q nvZ a~! Z fz! j hvb mgvavb mevB eenvi Ki! Z cv! i Ggb  v! b nvZ avqvi RvqMv ivLv % 16b. BISTIS cue cards as reminders wemwUm wKD KvW % 16c. Benefits fact sheet review: handwashing can improve health, more time and energy for daily tasks dv wkU wiwfD: nvZ ay! j ^v i DbSwZ nq, `bw: `b Kv! Ri R! b mgq Ges kw euv! P % 16d. Benefits fact sheet review: handwashing steps take only a few seconds dv wkU wiwfD: nvZ ay! Z gv K! qK m! K mgq jv! M % 16e. Other: Abvb, wb! Pi jvB! b wjLyb ______________________________________________________ % 17. Write any additional barriers and solutions identified below: GQvovI Kv! bv AwZwi cwZeKZv ev mgvavb _vKj wbP wjLyb| COMPLETE NEXT SECTION DAILY DURING INTERVENTION. Yes = 1 No = 2 wbPi AskwU cwZw`b BUvifbkbi mgq c~iY Kib| nuv = 1, bv = 2 Day of field visitDate (dd/mm)Time (24 hour format)Group Level Education deliveredSoap present at main HW stationSoap weighed at main HW stationWeight of soap at main HW station (in grams)Soap replaced at main HW stationWater present at main HW stationWeight of soap at secondary HW station (in grams)Number of soap bars givenGroup Skill Training deliveredRole Modeling deliveredIndividual Demonstration delivered** RASH or other skin problem due to our soapTime spent in bariFIS CodeFRO CodeDeliver on days:Day 1 & 2 and 7 (Use Influenza fact sheet only)All daysAs neededAs neededAs neededAll daysAs needed MUST FILL IN DAILYDays 1, 2, 3 or 4 and 9Days 1, 2, 3 or 4 and 9Days1,2, 3 or 4, & 6, 8, 10, 12,14 and 16MUST FILL IN DAILY In minutes MUST FILL IN DAILYMUST FILL IN DAILY12345678910111213141516 ** If any bari member develops a skin rash or other problem as a result of the intervention soap, FIS MUST CALL THE M.O. IMMEDIATELY. * Write 999 if soap is stolen, taken away by crow or lost *Replace soap at 20 grams or less. Last date of intervention _______________________________ FIS Signature on last date of intervention ________________________________________________________ FRO Signature on last date of intervention _______________________________________________________ Appendix 13: AQM Tracking Form  Device ID: __________ FRA Name:______________________ FRA Code: Placement instructions: 1) When possible, place the monitor on the wall of the room of interest (instead of hanging the monitor). 2) Locate the monitor 100 centimeters from the edge of the combustion zone of the stove. Measure distance as the shortest, horizontal line possible (i.e., parallel to the floor, from the closest edge of the combustion zone to the wall underneath where the monitor is to be placed). 3) Locate the monitor at a height of 145 centimeters above the floor. Correctly positioning the height of the monitor is important. 4) Locate the monitor at least 150 centimeters away (horizontally) from openable doors and windows, where possible. Since it may be difficult to simultaneously satisfy all recommendations, simply choose the best possible location. For additional instructions, see UC Berkeley manual of standard operating procedures for Installing Indoor Air Pollution Instruments in a Home |------------------FRO Responsibilities----------------------| |-----------------------------------FRA Responsibilities---------------------------------------------| |------FRO Responsibilities---| Battery change (Yes / No)Device Initialization DateDevice Launch Date & TimeZeroing (Before the monitor leaves the office)HHIDSleeping Room or KitchenMonitor Placement Distances (centimeters)MonitoringZeroing (Zeroing after retrieval / post placement)Data Download (Yes/No)Start Date & Time (hh:mm)End Date & Time (hh:mm)To edge of stoveFrom floorTo nearest door or windowPlacement Date & Time (hh:mm)Retrieval Date & Time (hh:mm)Start Date & Time (hh:mm)End Date & Time (hh:mm)   Maintenance and storage: The photoelectric (PE) chamber should be cleaned at least every 10 uses to ensure that the particle measurements are accurate. See UC Berkeley User Manual. All monitors should be stored in sealed Ziplock bags to prevent dust from accumulating inside the monitor. Also prevent the instruments from being bumped or dropped. Comments: ________________________________________________________________________________________________________________________________________________ Appendix 14: Hospital Check List Form Version 23.07.10 Eligibility Section 1. MO Code: 2. Name: 3. Date: 4. Which recruitment site? Bajitpur = 1 Kuliachar = 2 JIMCH = 3 Pharmacy = 4 5.Time (24 hour format) : 6. Age (YY-mm): 7. Sex (Male =1, female =2) Age-specific case definitions for index case-patients: (Yes=1, No=2, Dont Know = 9) Patient > 5 years Yes / NoPatient < 5 years Yes / NoDate of onset (dd-mm-yy) Approximate time of onset (00:00 24-hour format)8. Fever?  9. Date: __ __/__ __/__ __ 10. Time: __ __ : __ __ 11. MO: Did onset occur within the last 48 hours? Yes (1)/ No(2) 12. Cough?  13. Date: __ __/__ __/__ __ 14.Time: __ __ : __ __ 15. MO: Did onset occur within the last 48 hours? Yes (1)/ No(2) 16. Sore throat?  17. Date: __ __/__ __/__ __ 18. Time: __ __ : __ __ 19. MO: Did onset occur within the last 48 hours? Yes (1)/ No(2)  20. Does the patient meet age-specific case definition? 21. Comment (if any):  Instruction: If the patient meets the case definition, then consider him/her a suspected index case-patient and ask questions below under Additional inclusion criteria; otherwise thank the patient and stop the interview at this point. The age-specific case definitions for index case-patients are: Personse" 5 years old: Influenza-like illness (ILI), defined as history of fever, and either cough or sore throat with onset within the last 48 hours. Persons < 5 years old: any child with acute fever with onset within the last 48 hours  Additional inclusion criteria 22. Has any other resident in your household had fever during the past 7 days? (yes=1, no = 2, dont know = 9) (If yes, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If no, then continue. 22a. Has any other resident in your bari had fever during the past 7 days? (yes=1, no = 2, dont know = 9) (If no or dont know, SKIP to Question 23. If yes, proceed to Question 22b. 22b. Who had fever and for how many days did s/he have fever? 1. Name/Relation: _______________________ Days of fever (1-7, dont know=99) ________ 2. Name/Relation: _______________________ Days of fever (1-7, dont know=99) ________ 3. Name/Relation: _______________________ Days of fever (1-7, dont know=99) ________ (If any bari member had fever for 2 or more days out of the last 7 days, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If bari members(s) had fever for only 1 day or the patient does not know the duration of fever, then continue. 23. Does the patient live within 30 minutes of either UHC or JIMCH? (Yes = 1, No = 2) (If no, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If yes, then continue. 24. Which upazilla do you live in? Bajitpur = 1/Kuliachar = 2/Others = 8 If other then please specify ___________________________________________ 25. Will you be living in your bari during the next 20 days? (yes=1, no = 2) (If no, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If yes, then continue. 26. Will 2 or more other persons be living in your bari during next 20 days? (yes=1, no = 2) (If no, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If yes, then continue. 27. Was the patient previously enrolled in our study? (yes = 1, no = 2) (If yes, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If no, then continue.  28. Patient order for hospitalization and was hospitalized? (yes = 1, no = 2) (If yes, patient is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If no, then continue. 29. Patient ordered for admission but refused admission (yes=1, no=2) (If yes (patient refused admission), then eligible and continue is ineligible, SKIP the remaining questions and record No for the question Does the patient meet the additional inclusion criteria below. If yes, then continue. 30. Does the patient meet the additional inclusion criteria? (yes=1, no = 2)  31. Have you received a vaccination for influenza or Swine Flu/H1N1 in the past six months? (Yes=1, No=2) Possible Treatments: 32. Is the patient being treated with medications for the symptoms indicated above? (Yes=1, No=2) If no, skip following sectionWhat medications is the patient being treated with? List below 33. Name of the Drug34. Was the patient prescribed the drug? (Yes = 1, No = 2)35. Code of the Drug (Couldnt mention Drug name = 999)36. Has the patient begun treatment with the drug? (Yes = 1, No = 2)PCR Specimen Collection Section 37. Unique ID #  38. Time Sample collected (24 hour format): Time: __ __ : __ __ Signature of Medical Officer:___________________________ Date: ___________________ Appendix 15a: VENTILATION ASSESSMENT FORM: SLEEPING ROOM Note: Complete one ventilation assessment form for each room where a particle monitor is placed. Household ID: (((((((( Date: ___ /___/___ FRA code: ((( 1. Measure the dimensions of the room in centimeters. Width (centimeters): __________________ Length (centimeters): __________________ 2. How many people of any age sleep there: (( 3. How many children < 5 years old sleep there: (( 4. How many hours during the 24 hours the AQM was present in the room was the ceiling fan turned on (record 99 for NA): (( 5. How many hours during the 24 hours the AQM was present in the room was the table fan turned on (record 99 for NA): (( 6. Drawing Instructions: Using the symbols below, indicate the locations of stoves or burners, existing windows, doors, ventilators, indoor walls, index case-patients bed, and the particle monitoring device. The wall on which the particle monitor is placed should be drawn as the top wall on the diagram.  Stove/Burner Window Door Ventilators Indoor Wall Study Childs Bed AQM  CF TF Ceiling Fan Table Fan  Appendix 15b: VENTILATION ASSESSMENT FORM: COOKING AREA ONLY TO BE ASSESSED IN BARIS WITH FULLY ENCLOSED KITCHENS Note: Complete one ventilation assessment form for each room where a particle monitor is placed. Household ID: (((((((( Date: ___ /___/___ FRA code: ((( 1. Measure the dimensions of the room in centimeters. Width (centimeters): __________________ Length (centimeters): __________________ 2. How many people use this cooking area: (( 3. How many hours during the 24 hours the AQM was present in the room was the ceiling fan turned on (record 99 for NA): (( 4. How many hours during the 24 hours the AQM was present in the room was the table fan turned on (record 99 for NA): (( 5. Drawing Instructions: Using the symbols below, indicate the locations of stoves or burners, existing windows, doors, ventilators, indoor walls, and the particle monitoring device. The wall on which the particle monitor is placed should be drawn as the top wall on the diagram.  Stove/Burner Window Door Ventilators Indoor Wall Particle Monitor Ceiling Fan  Table Fan  Appendix 16: Consent Form: Follow Up Study Enrollment for Bari Protocol Number: 2009-004 Protocol Title: Prevention of secondary transmission of human influenza by promoting handwashing with soap: The Bangladesh Interruption of Secondary Transmission of Influenza Study (BISTIS) Follow Up Study Investigators name: Dr. Eduardo Azizz-Baumgartner Organization: ICDDR,B Introduction In 2009, your Bari took part in a research study about influenza. The research study was conducted by scientists from the International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B), Centers for Disease Control and Prevention (CDC), and University at Buffalo, a university in the USA. We are now here to talk with you about a second part of that study. We would like to understand household practices and illness experiences of members of your bari. Purpose of the research We are trying to how household practices can change over time and how these practices may affect certain illnesses, like diarrhea and respiratory illness. Why selected Your Bari took part in the first part of our study last year. This second part is being completed only in baris that were enrolled in the first part of the study. What is expected from the members of your Bari? If you agree to enrolling your Bari in the study: I will visit your bari to observe your baris household practices three times over the next three or four months. At two of the visits, I will speak to the person who came to the Jahurul Islam Medical College Hospital with influenza or another respiratory illness in (month) 2009. If that person was a child under 15 years old, I will speak to his/her parent or guardian. I will ask some questions about household practices. I will also make some quick observations of your bari at each of the visits. At one of the visits, I will also sit in the uthaan for about 90 minutes to observe your baris household practices. During these visits I will also ask each member of your bari if they have had symptoms of fever, respiratory illness, or gastrointestinal illness, in the previous 48 hours. (Following paragraph to be read aloud if SmartSoap will be used in the bari.) During one of the visits, I will give your bari a bar of special Lifebuoy soap to use for three days, after which I will return to collect the bar of soap two days later. The special Lifebuoy soap is almost the same as Lifebuoy soap available in the market and provides the same benefits. You will likely not be able to tell the difference between the special and regular soap. The special Lifebuoy soap should be used as soap is usually used in your bari. The special Lifebuoy soap that we are giving you has an electronic device that collects information on soap use. People who are sensitive to Lifebuoy soap or who experience skin reactions to Lifebuoy soap will experience similar reactions to the Lifebuoy soap that we are giving you and should not use it. Also at the third visit, I will ask two members of your bari to give me their mobile numbers. I will thereafter call that person twice per week for six months to determine if any of the members of your bari have a fever. After the third visit, for those people who have a fever, we will ask them to allow us to take a nose and throat swab; one of our trained research personnel will have to place a swab into their nose and a different swab into their throat. Risk and benefits The process of having someone visit your home may be uncomfortable to you. However, we do not expect any harm to come to you or your family because of being visited. (Following paragraph to be read aloud if SmartSoap will be used in the bari.) In people who have skin reactions to Lifebuoy soap available in the market, the special Lifebuoy soap may cause similar skin reactions. These people should not use the Lifebuoy soap that we give you. The Lifebuoy soap that we are giving you has a battery in it. The battery is like batteries that are used in watches and cameras. The battery is protected inside a case within the soap. It is very unlikely that you will see the battery. If you do see the battery case within the soap, you may continue to use the soap normally. Please try to remember on which day you saw the case sticking out through the soap. As with any soap, please do not allow children to put it into their mouths. All Baris that take part in the study will receive the benefit of bars of soap; however, there will be no other immediate benefits. However, this study will help us better understand if handwashing behavior can change over time. It will also help us understand if handwashing behavior is related to respiratory illness and diarrhea. For those people who have symptoms and who allow us to take a nose and throat swab, one of our trained research personnel will have to place a swab into their nose and a different swab into their throat. This may be uncomfortable. There are no other known risks for this procedure. The results of the test will not alter in any way the treatment of the person who has symptoms and, thus, the results will not be given to the person who has symptoms. Privacy, anonymity and confidentiality All of the information we collect about the members of your community will be kept private and confidential. We will keep all data in a locked cabinet. We will not give any information about your community to anyone not involved in the study. Future use of information If the information we collect needs to be used for future use by other researchers, we will not supply any personal information and will maintain strict privacy. Right not to participate and withdraw You may choose to allow your Bari to take part or not to take part in this study. You may refuse to take part at any time. You may also withdraw your Bari from the study at any time. Refusal to participate or withdrawal from the study will involve no penalty or loss of benefits for the members of your community at the clinic or hospital. Even if you do not enroll your Bari in the study, everyone in your Bari will still receive the usual care at the clinic. Each individual in your Bari may choose to participate or not participate, and may choose to withdraw from the study at any time. Principle of compensation There is no cost to you or your bari for participation in this study. Other than receiving free soap, you will not receive any compensation for being in the study. Persons to Contact: If you have questions during the procedure, ask at any time. If you have any additional questions about the surveillance you may contact: Dr. Eduardo Azizz-Baumgartner, Programme on Infectious Diseases and Vaccine Sciences (PIDVS), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 8860523-32 # 250025, 01711697962 If you have questions about your rights in regards to being part of this research surveillance or if you think some harm has been done to you because of the surveillance you may contact: Mr. M. A. Salam, Research and Project Support Department (RPSD), ICDDR,B, Mohakhali, Dhaka 1212. Phone: 9886489, 01711428989 If you agree to enrolling your Bari in our study, please indicate that by putting your signature or your left thumb impression at the specified space below. Thank you for your cooperation. _______________________________________ ____________________ Signature or left thumb impression of subject Date _______________________________________ ____________________ Signature or left thumb impression Date of attendant/Guardian _______________________________________ ____________________ Signature or left thumb impression of the witness Date _______________________________________ ___________________ Signature of the PI or his/her representative Date Appendix 17: Follow Up Bari Eligibility Form 1. Index case ID: __ __ __ __ 2. FRA code: __ __ __ First Visit 3. Date of first visit (dd/mm/yy) ___/ ___/ ___ 4. Did bari enrollment occur? Yes (1) No (2) (If yes, skip remaining questions 5. Why did bari enrollment not occur? No adults present to sign consent form.1 Head of bari would not sign consent form2 Unable to find bari members.3 Other, specify below.8 __________________________________________________________  Second Visit 6. Date of second visit (dd/mm/yy) ___/ ___/ ___ 7. Did bari enrollment occur? Yes (1) No (2) (If yes, skip remaining questions 8. Why did bari enrollment not occur? No adults present to sign consent form.1 Head of bari would not sign consent form2 Unable to find bari members.3 Other, specify below.8 __________________________________________________________  To be answered after completion of follow up study (or before depending on drop out date): 9. Did the household decide not to participate at some point during the follow up study? Yes (1) No (2) (If yes, explain why below) 10. Explanation of household drop out: 11. Date of drop out (dd/mm/yyyy):_____/______/_______ Appendix 18: BISTIS Follow Up Survey Form 1. Ask the respondent: Name of Respondent: _______________________ 2. How is the respondent related to the index case? Record code in box. Self.... 1 Parent/Guardian... 2 Fellow bari member. 3 3. Respondent (Index case/ Guardian/ Bari member) Unique ID# (Taken from enumeration form) ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 4. Index Case Patient Unique ID# ___ ___ ___ ___ 5. Follow Up Visit Number (1, 2, or 3 ): ______ 6. Follow Up Visit Date (dd/mm/yy): ___/___/______ 7. FRA code ___ ___ ___ Section One: HAND WASHING STATION QUESTIONS Ask: Can you please show me where you most often wash your hands? 8. Observation: Is there a designated place for hand washing?  (Record number in box): Yes.1 No.....2 ( If the answer to question 8 is no, skip to question 12 9. Observation: Is the BISTIS intervention handwashing container present at the bari handwashing place?  (Record number in box): Yes. 1 No... 2  10. Observation: Is water present at the bari handwashing place? (Record code in box) (You must actually see water to record yes): Yes. 1 No... 2 11. Observation of items present at the handwashing place (Look for each items individually and please do not prompt) (If you observe the listed item, write 1 for yes in the box below. If you do not observe the listed item, write 2 for no in the box below.) Bar soap ( Detergent (powder) ( Liquid soap ( Ash ( Mud/Sand ( Other cleansing agent, specify ( _____________________________________________ 12. Ask: Can you show me any items used in your household for washing hands? (If the respondent can show you the item within one minute after s/he goes to get it write 1 for yes in the box below. If you do not observe the listed item within one minute after the respondent goes to get the item, write 2 for no in the box below. Do NOT prompt) Bar soap ( Detergent (powder) ( Liquid soap ( Ash ( Mud/Sand ( Other, specify below ( ______________________ 13. Observe: Are intervention cue cards visible in the bari? (Record number in box)): Yes 1 No 2 ( If the answer to question 13 is yes, skip to section 2 Show the respondent an example of the BISITS Intervention Cue Cards. 14. Ask the respondent: Last year, did anyone give your bari cards that looked like this? (Record number in box)): Yes 1 No 2 ( If the answer to question 14 is no, skip to section 2 15. Ask the respondent: Can you please show me the cards? Record whether or not the respondent can show you the BISTIS Intervention Cue Cards. (Record number in box)): Yes 1 No 2 Section Two: STRUCTURED OBSERVATION 16. Record: Is this the first follow up visit at the bari? (Record number in box): Yes 1 No 2( If the answer to question 16 is no, skip to section three  16. Record which household is to be observed. Record number in box Index case household 1 Head of bari household 2 Secondary household 3 17. Record: Total no. of members of household to be observed (if this is ICP household, include ICP): ______ 18. Record Number of members of household to be observed present at the time of observation (if this is ICP household, include ICP if present): ______________ 19. Record the number of individuals in the household to be observed Record number in boxes Children < 5 (( 2.0 Children e" 5 to < 18 (( 2.1 Persons e" 18 (( Say to the respondent:  I would like to stay with you until about current time plus 2.5 hours. I would only like to observe and will not interrupt. If that would be okay now, you may please continue with your normal daily routine. After about 1.5 hours I will ask some people in the bari some questions. 20. Time of beginning observation (24 hrs): hh:mm ((:(( 21. Time of ending observation (24 hrs): hh:mm ((:(( Comments: ______________________________________________________________ __________________________________________________________________________ Section 2. Observation of Hand Wash Opportunities and Behaviors Line # Exposure: Before preparing /serving food 1 Before eating 2 After cleaning childs bottom/nappy 3 After using the toilet 4 After coughing / sneezing 5 After blowing or wiping own nose 6 After blowing or wiping child's nose 7 If the hands get visibly soiled... 9 Others: Specify 8 Time of observation 24-hours time (hh:mm)  Bari member: Child < 5 yrs 1 Child e" 5 yrs to < 18 2 Person e" 18& & & & & & 3  Gender of bari member: Male 1 Female. 2  Did bari member clean his/her hand(s)? Yes 1 No 2 DK 9 If 2 or 9 then skip to next episode. Location of hand cleaning At a handwashing station belonging to the household (located in or immediately outside household) 1 At a handwashing station belonging to the uthaan/bari 2 In the kitchen area, but not at a handwashing station 3 In the toilet area, but not at a handwashing station 4 In the yard, but not at a handwashing station. 5 Other: Specify 8  Were both hands cleaned? Yes 1 No 2 DK 9  Hand cleaning materials: Bar soap 1 Liquid/Powder soap 2 Ash 3 Mud/Sand 4 Only water 5 Wipe with cloth without water 6 Other: Specify below 8 Do not know 9  Comments:01020304050607080910Name of FRA: _______________________________ Signature of FRA: __________________________________ Date: ______/______/____________ Line # Exposure: Before preparing /serving food 1 Before eating 2 After cleaning childs bottom/nappy 3 After using the toilet 4 After coughing / sneezing 5 After blowing or wiping own nose 6 After blowing or wiping child's nose 7 If the hands get visibly soiled... 9 Others: Specify 8 Time of observation 24-hours time (hh:mm)  Bari member: Child < 5 yrs 1 Child e" 5 yrs to < 18 2 Person e" 183  Gender of bari member: Male 1 Female. 2  Did bari member clean his/her hand(s)? Yes 1 No 2 DK 9 If 2 or 9 then skip to next episode. Location of hand cleaning At a handwashing station belonging to the household (located in or immediately outside household) 1 At a handwashing station belonging to the uthaan/bari 2 In the kitchen area, but not at a handwashing station 3 In the toilet area, but not at a handwashing station 4 In the yard, but not at a handwashing station. 5 Other: Specify 8  Were both hands cleaned? Yes 1 No 2 DK 9  Hand cleaning materials: Bar soap 1 Liquid/Powder soap 2 Ash 3 Mud/Sand 4 Only water 5 Wipe with cloth without water 6 Other: Specify below 8 Do not know 9  Comments:11121314151617181920 Name of FRA: _______________________________ Signature of FRA: ___________________ Date: ______/______/____________ Line # Exposure: Before preparing /serving food 1 Before eating 2 After cleaning childs bottom/nappy 3 After using the toilet 4 After coughing / sneezing 5 After blowing or wiping own nose 6 After blowing or wiping child's nose 7 If the hands get visibly soiled... 9 Others: Specify 8 Time of observation 24-hours time (hh:mm)  Bari member: Child < 5 yrs 1 Child e" 5 yrs to < 18 2 Person e" 18& & & & & & 3  Gender of bari member: Male 1 Female. 2  Did bari member clean his/her hand(s)? Yes 1 No 2 DK 9 If 2 or 9 then skip to next episode. Location of hand cleaning At a handwashing station belonging to the household (located in or immediately outside household) 1 At a handwashing station belonging to the uthaan/bari 2 In the kitchen area, but not at a handwashing station 3 In the toilet area, but not at a handwashing station 4 In the yard, but not at a handwashing station. 5 Other: Specify 8  Were both hands cleaned? Yes 1 No 2 DK 9  Hand cleaning materials: Bar soap 1 Liquid/Powder soap 2 Ash 3 Mud/Sand 4 Only water 5 Wipe with cloth without water 6 Other: Specify below 8 Do not know 9  Comments:21222324252627282930 Name of FRA: ____________________ Signature of FRA: ___________________ Date: ______/______/___________ Line # Exposure: Before preparing /serving food 1 Before eating 2 After cleaning childs bottom/nappy 3 After using the toilet 4 After coughing / sneezing 5 After blowing or wiping own nose 6 After blowing or wiping child's nose 7 If the hands get visibly soiled... 9 Others: Specify 8 Time of observation 24-hours time (hh:mm)  Bari member: Child < 5 yrs 1 Child e" 5 yrs to < 18 2 Person e" 18& & & & & & 3  Gender of bari member: Male 1 Female. 2  Did bari member clean his/her hand(s)? Yes 1 No 2 DK 9 If 2 or 9 then skip to next episode. Location of hand cleaning At a handwashing station belonging to the household (located in or immediately outside household) 1 At a handwashing station belonging to the uthaan/bari 2 In the kitchen area, but not at a handwashing station 3 In the toilet area, but not at a handwashing station 4 In the yard, but not at a handwashing station. 5 Other: Specify 8  Were both hands cleaned? Yes 1 No 2 DK 9  Hand cleaning materials: Bar soap 1 Liquid/Powder soap 2 Ash 3 Mud/Sand 4 Only water 5 Wipe with cloth without water 6 Other: Specify below 8 Do not know 9  Comments:31323334353637383940 Thank you, that is the end of my observations. Section Three: HAND WASHING DEMONSTRATION Say to the respondent: Can you please show me exactly what you do when you cough? Please think about your typical routine, and show me whatever actions arecommon for you in this situation. There is no wrong response. Please do not describe what you would do, but rather, actually show me."  22. Record which bari member will demonstrate coughing/sneezing? Record number in box Index Case Patient 1 Guardian of Index Case Patient 2 Other, specify below 8 ______________________________________________ 23. Member who demonstrates coughing/sneezing unique ID: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ 24. Record age of member who demonstrates coughing/sneezing (YY/MM): ___ ___/ ___ ___ 25. Record Time of Observation of coughing/sneezing behavior (24 hour format): ___ ___:___ ___ 26. Observe: Did the index case patient/guardian/respondent do or say any of the following? If the index case patient/guardian/respondent completes the physical action below, write 1 for yes in the column labeled Observation below. If the index case patient/guardian/respondent does NOT complete the physical action below, write 2 for no in the column labeled Observation below. If the index case patient/guardian/respondent says the following, write 1 in the column labeled Verbal below. If the index case patient/guardian/respondent does NOT say following, write 2 in the column labeled Verbal below. If the index case patient/guardian/respondent BOTH does and says the following, put a 1 in both columns. ActionObservationVerbalSneeze or cough into shoulder/elbow Sneeze or cough into sleeve/sari Sneeze or cough into handsSneeze or cough the airWash his/her hands with soap and water (type of soap need not be specified) Time action is done or said (24-hour format): ___:___Wash hands with ash/mud/sand and water(use or mention of ash/mud/sand and water, but not soap) Time of washing hands with water but not soap (24 hour format) ___:___Wash hands with water only (use or mention of water but not soap) Time action is done or said (24-hour format): ___:___Wash hands with ash/mud/sand/cloth but no water (no use or mention of water or soap) Time action is done or said (24-hour format): ___:___ 27. Observe: Did the index case patient/guardian/respondent actually wash hands with at least water within the 5 minutes after coughing? (Record number in box): Yes 1 No 2 ( If the answer to question 20 is no, skip to section 3 28. Observe: Did the index case patient/guardian/respondent use any of the following when s/he washed his/her hands within the 5 minutes after coughing? (If the index case patient/guardian/respondent used the item, write 1 for yes in the box below. If the index case patient/guardian/respondent did NOT use the item, write 2 for no in the box below.) Bar soap ( Detergent (powder) ( Liquid soap ( Ash ( Mud/Sand ( Other, specify below ( ______________________ Section Four: HAND WASHING DEMONSTRATION Cleaning child after defecation If ICP is < 5years then demonstration should be done with him/her. If ICP is > 5years then look for any < 5 years child in ICPs household. If no < 5 years child present in ICPs household then ask the respondent: Can you bring me to the mother or other primary caregiver of the youngest child who lives in your bari? If the primary caregiver of the youngest child is not present, ask about the primary caregiver of the next youngest child, until you are able to identify a primary caregiver who is present during the interview time  29. Is there any <5years child in the bari? (Record the number in box) Yes 1 No 2 ( If answer to the question 22 is no, skip to question 31  30. Is the child the index case patient? Yes 1 No 2 31. Ask the primary caregiver: How old is your child? (YY/MM) ____ ____/____ ____ 32. Ask the primary caregiver: How old are you? (YY/MM) ____ ____ ____ ____  33. Record the sex of the primary caregiver: (Record number in box) Male 1 Female 2 34. Record the unique ID of the primary caregiver: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Say to the primary caregiver: "Can you please show me exactly what you do after your child defecates? Please think about your typical routine, and show mewhatever actions arecommon for you in this situation. There is no wrong response. Please do not describe what you would do, but rather, actually take me through the steps of what you do." Observe whether s/he washes her hands during the 5 minutes after the demonstration. The caregiver should clean the baby just as she would if the baby had actually defecated, including removing the childs clothes. 35. Record time of observation of cleaning the babys bottom (24 hour format): ____ ____:____ ____ If the person demonstrating completes the physical action below, write 1 for yes in the column labeled Observation below. If the person demonstrating does NOT complete the physical action below, write 2 for no in the column labeled Observation below. If the person demonstrating says the following, write 1 in the column labeled Verbal below. If the person demonstrating does NOT say following, write 2 in the column labeled Verbal below. If the primary caregiver BOTH does and says the following, put a 1 in both columns. ActionObservationVerbalTouch babys bottom for cleaning Use water to clean the babys bottom Use soap to clean the babys bottomWash his/her hands with soap and water (type of soap need not be specified) Time action is done or said (24-hour format): ___:___Wash hands with ash/mud/sand and water(use or mention of ash/mud/sand and water, but not soap) Time of washing hands with water but not soap (24 hour format) ___:___Wash hands with water only (use or mention of water but not soap) Time action is done or said (24-hour format): ___:___Wash hands with ash/mud/sand/cloth but no water (no use or mention of water or soap) Time action is done or said (24-hour format): ___:___ 36. Observe: Did the primary caregiver wash hands with water within the 5 minutes after cleaning the childs bottom? (Record number in box): Yes 1 No 2 ( If the answer to question 28 is no, skip to question 31 37. Observe: Did the primary caregiver use any of the following when s/he washed hands after cleaning the childs bottom? (If the index case patient/guardian used the item, write 1 for yes in the box below. If the index case patient/guardian did NOT use the item, write 2 for no in the box below.) Bar soap ( Detergent (powder) ( Liquid soap ( Ash ( Mud/Sand ( Other, specify below ( ______________________ Thank the primary caregiver for his/her time. The rest of the interview will be with the original respondent. 38. Record: Is this the final follow up visit at the bari? (Record number in box): Yes 1 No 2( If the answer to question 38 is no, skip remaining questions Section Four: KNOWLEDGE OF HANDWASHING SECTION 39. Ask: When should you wash your hands? (Ask this only of the respondent.) If the respondent says the listed item, write 1 for yes in the box below. If the respondent does NOT say the listed item, write 2 for no in the box below. Do NOT prompt. Before cooking food ( Before eating food ( After sneezing or coughing into hands ( After cleaning my or my childs nose ( After my hands get visibly soiled ( After defecation ( After cleaning a child who has defecated ( During prayer ( During bath ( After waking up from bed ( Other, specify below ( _________________________ 40. Ask: What are the steps you take when you wash your hands? (If the respondent says the listed item, write 1 for yes in the box below. If the respondent does NOT say the listed item, write 2 for no in the box below. Do NOT prompt.) Get hands wet ( Lather hands with soap ( Scrub for 10 seconds ( Rinse hands with water ( Dry Hands ( Other, specify below ( _________________________ Benefits and Barriers Section 41. Ask: What are the benefits of washing your hands with soap? (If the respondent says the listed item, write 1 for yes in the box below. If the respondent does NOT say the listed item, write 2 for no in the box below.) Nurture child or family ( Be accepted member of society ( Look, feel, smell clean ( Remove disgusting substances ( Improved Health ( Enhanced social status ( Reduced diarrheal disease ( Reduce respiratory illness ( Other, specify below ( ______________________ 42. Ask: What are the barriers to you washing your hands with soap? (If the respondent says the listed item, write 1 for yes in the box below. If the respondent does NOT say the listed item, write 2 for no in the box below.) Not part of routine or habit ( Unaware of benefits/lack of knowledge ( Too much energy/laziness ( Soap costs too much ( Wont prevent illness ( No handwashing station or too far away ( Dont care about handwashing with soap ( Ash or mud cleans ( Water by itself cleans ( Too busy/no time ( Forgets to wash hands with soap ( Soap will be stolen ( Other, specify ( ____________________ No barriers ( Section Five: KNOWLEDGE OF INFLUENZA SECTION 43. Ask: Have you ever heard of influenza illness? (Record code in box) Yes 1 No 2 ( If the answer to 43 is 2, skip to section six Dont Know/Not Sure 9 ( If the answer to 43 is 9, skip to section six 44. Ask: What symptoms are associated with influenza illness? (Ask this as an open ended question. If the respondent mentions the listed symptom, write 1 for yes in the box below. If the respondent does not mention the listed symptom, write 2 for no in the box below.) Cough ( Sore throat ( Runny nose ( Fever ( Headache ( Body aches ( Other, specify below ( _______________________________________________________________________ 45. Ask: Can influenza illness be prevented? (Record code in box) Yes 1 No 2 ( If the answer to 45 is 2, skip to section six Dont Know/Not Sure 9 ( If the answer to 45 is 9, skip to section six 46. Ask: How can influenza illness be prevented? (Ask this as an open ended question. If the respondent mentions the listed prevention, write 1 for yes in the box below. If the does not mention the listed prevention, write 2 for no in the box below.) Yes 1 No 2 Keep away from ill persons ( Wash hands frequently ( Wash hands frequently with soap ( Vaccination ( Avoid cold foods ( By taking doctors advice ( By maintaining cleanliness. ( Other, specify below ( ________________________________ Section Five: PHONE NUMBER RECORDING Contact Information for Follow Up Influenza Season Calls (Use during final visit to bari) Objectives: -Choose respondents and phone owners within the Index Cases household when possible -Choose respondents and phone owners who are likely to be at the bari during the day -Collect mobile numbers from two/three bari members who are willing to take BISTIS calls on their phone -Ensure that the bari members who provide mobile numbers are willing to allow other bari members to speak with the BISTIS team member -When possible, find a primary respondent that will be available to provide information for all the follow up calls Relationship to to index case-patient Self 1 Parent/Guardian 2 Other household member 3 Fellow bari member 4Primary Contact 1 Phone Number: Phone Owners Name: Relationship to index case-patient: Phone number confirmed as working? YES NORespondent 1 Name: Relationship to index case-patient:___________________ Respondent 2 Name: Relationship to index case-patient:___________________ Respondent 3 Name: Relationship to index case-patient:___________________ Respondent 4 Name: Relationship to index case-patient:___________________Backup Contact 2 Phone Number: Phone Owners Name: Relationship to index case-patient: Phone number confirmed as working? YES NOBackup Contact 3 Phone Number: Phone Owners Name: Relationship to index case-patient: Phone number confirmed as working? YES NOFor office use Name of FRA: ___________________________________________ Signature of FRA: ___________________ Date: ______/______/__________ Checked by: ______________________ Date: ______/______/_________ Appendix 19: Follow Up Soap Tracking FormIndex Case Patient Unique ID: Distribution FRA (Name): ____________Collection FRA (Name): _____________ASK Can you please show me where you most often wash your hands. Was a specific place shown? Yes ( No ( If YES, proceed to ROW 1, Column B. If NO, ASK I am going to provide your bari with a bar of soap. Where is the best place to put this bar of soap so that it is accessible to all bari members? Place ONE bar of soap in designated location, record notes on where soap was placed, and proceed to ROW 1, completing Columns E-G. Record where soap was placed so the location can be remembered for second visit: _________________________________________________________________Information collected during Soap Distribution (Second FU Visit) DATE OF SOAP DISTRIBUTION (dd/mm/yyyy): _______________________Soap Collection (2 days after soap distribution) DATE OF SOAP COLLECTION (dd/mm/yyyy): ____________ABCDEFGHJKLMN OBSERVE Record the location of the handwashing station: Indoors 1 Outdoors 2 No permission to see 3 Other (specify below) 9 (Add notes so that location can be easily identified at next visit.) OBSERVE Is water present at this specific place for hand washing? (You must actually see water to record yes) Yes 1 No 2OBSERVE Which of the following are present at the handwashing station (If observed, write 1 for yes; if not observed, write 2 for no): Yes 1 No 2 (If bars of soap are observed, record how many ( At this point, replace each bar of soap identified with a new BISTIS barOBSERVE Distance (in steps) between handwashing station (or location of new BISTIS bar) and: 1. stove in cooking area of ICP household 2. entrance of latrine of ICP household Record numbers below.RECORD Weight of BISTIS study soap given to bari. OBSERVE Where was the BISTIS soap placed? Near shallow tube well 1 Near deep tube well 2 Near piped water source 3 Other location (specify) 9 If handwashing place was shown in initial question, ASK Is there anywhere else you wash your hands? Yes 1 No 2 (If YES, complete row for additional handwashing stations)RECORD Weight of BISTIS study bars still present at handwashing location (If a BISTIS bar is not present that was weighed in column F, enter NA for not available)ASK How many households used this soap? ASK How many people in your bari used this soap? ASK Was the bar soap at this location used to READ ALL CHOICES Yes 1 No 2ASK Did anyone develop a rash or other skin problem due to using this soap? 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IMMEDIATELY. Note: Describe any disturbances to the soap placement in the household:  Appendix 20: Follow Up Visit Illness Tracking Form Name of Index case-patient: _______________________ Date of Follow Up Visit (dd/mm/yy): ____/_____/______ Respondent Unique ID # ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Number of Follow Up Visit (1, 2, o r 3): ______ FRA Code: _____________ Index Case Household Household Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ In the past 48 hours, has ____________ had any of the following symptoms? Yes = 1 No = 2 Not Present = 3 Dont Know = 9, record the number NameHas bari member been present for last 48 hours?If bari member not present, why? No longer lives there = 1 Died = 2 Other = 8, specifyIs this a new bari mem-ber?Unique IDAge (yy/mm)FeverCoughSore ThroatDifficulty BreathingWatery Diarrhea*Bloody Diarrhea** *Watery diarrhea is defined as 3 or more loose or watery stools in one day ** Bloody diarrhea is defined as watery diarrhea with blood in it Second Household Household Unique ID: ___ ___ ___ ___ ___ ___ ___ ___ In the past 48 hours, has ____________ had any of the following symptoms? Yes = 1 No = 2 Not Present = 3Dont Know = 9, record the number NameHas bari member been present for last 48 hours?If bari member not present, why? No longer lives there = 1 Died = 2 Other = 8, specifyIs this a new bari mem-ber?Unique IDAge (yy/mm)FeverCoughSore ThroatDifficulty BreathingWatery Diarrhea*Bloody Diarrhea***Watery diarrhea is defined as 3 or more loose or watery stools in one day ** Bloody diarrhea is defined as watery diarrhea with blood in it Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages e" 5 Years Old, Page 1 Name of Contact: ___________________________ Unique ID of Contact: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Age of Contact (mmyy): _________________ Record if the contact has the following symptoms Yes = 1 No = 2 Dont Know = 9, record the number Number of week123456789101112Number of Phone Call per Week121212121212121212121212Date of phone callEligibility SymptomFeverOther SymptomsCoughSore ThroatDifficulty BreathingWatery Diarrhea*Bloody Diarrhea**Danger Signs (Refer to JIMCH)CyanosisSevere respiratory distressConvulsionsAltered mental statusActionsRefer to MT for sampleDate of Sample CollectionMO/MT CodeHospitalizedFRA Code *Watery diarrhea is defined as 3 or more loose or watery stools in one day ** Bloody diarrhea is defined as watery diarrhea with blood in it Appendix 21a: Follow Up Phone Call Illness Tracking Form: Ages e" 5 Years Old, Page 2 Name of Contact: ___________________________ Unique ID of Contact: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Age of Contact (mmyy): _________________ Symptom information available for this contact? _________ Yes = 1 No = 2 Dont Know = 9, record the number Number of week131415161718192021222324Number of Phone Call per Week121212121212121212121212Date of phone callEligibility SymptomFeverOther SymptomsCoughSore ThroatDifficulty BreathingWatery Diarrhea*Bloody Diarrhea**Danger Signs (Refer to JIMCH)CyanosisSevere respiratory distressConvulsionsAltered mental statusActionsRefer to MT for sampleDate of Sample CollectionMO/MT CodeHospitalizedFRA Code*Watery diarrhea is defined as 3 or more loose or watery stools in one day ** Bloody diarrhea is defined as watery diarrhea with blood in it Gvcw۷ - 16 t mwZc t djvAvc UvwWZ evox AfyKib| cUKj b^i t 2009 -004 cUKj UvBUj (Melbvi bvg) t- wcևfbkb Ad mKvwi Uvwgkb Ae wnDgvb Bbdzqv evB cgwUs nv Iqvwks evD mvct w` evsjv`k BbUvivckb Ae mKvwi Uvwgkb Ae Bbdzqv vwW (BISTIS) djvv Avc vwW-2010| mvevb w`q nvZ avqvi gvag ivM cieZx Bbdzqv msgb cwZiva msv Melbv evsjv`k (wem&wUm&), djv Avc Melbv-2010| MelKi bvg t Wvt GWyqvWv AvwRR evgMvUvbvi | cwZvb t AvRvwZK D`ivgq MelYv K`, evsjv`k (AvB.wm.wW.wW.Avi,we) fywgKvt 2009 mvj Avcbvi evox Bbdzqv msv GKwU Melbvq Ask Mnb KiwQj| MelbvwU AvB.wm.wW.wW.Avi,we, wm.wW.wm I evdvjv wekwe`vjqi (AvgwiKvi GKvwU wekwe`vjq)i MelKiv cwiPvjbv Kib| eZgvb Avgiv GLvb GmwQ Melbvi wZxq Ask wbq Avcbvi mv_ K_v ejZ| Avgiv Lvbv m`m `i wewfb Afvm I evox m`m` AmyZvi AwfZv mK eySZ Pv eie| Melbvi Dk t Avgiv eySZ Pv KiwQ wKfve mgqi mv_ Lvbv m`m`i Afvm e`jvq Ges wKfve Zv wewfb AmyZvK cfvweZ Ki, hgb WvBwiqv Ges kvmZZ&i AmyZv| Kb gbvwbZ Kiv nqQ t Avcbvi evox MZ ermi Avgv`i Melbvi c_g Ask AskMnb KiwQj| wZxq Ask aygv mB evox jv DciB ne hviv c_g Ask Afy nqwQj| Avcbvi evox m`m`i KvQ _K wK Avkv Kiv ne? 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2500| GB Melbv Ask wnmve Avcbvi AwaKvi mK hw` Avcbvi Kvb ck _vK A_ev hw` Melbvi Rb Avcbvi Kvb wZ nqQ ej gb nq Zvnj hvMvhvM Kib t wgt Gg.G.mvjvg, wimvP G cևR mvcvU wWcvUgU (Avi.wc.Gm.wW) AvB.wm.wW.wW.Avi.we, gnvLvjx, XvKv 1212, dvb t 9886489, # 01711428989| hw` Avcwb Avcbvi evox Avgv`i MelYvq Afy KiZ Pvb, `qv Ki Avcbii ^vi w`q A_ev Avcbvi evgnvZi eyov Avyji Qvc w`q Zv wb`k Kib| Avcbvi mnhvMxZvi Rb abev`| ___________________________________________ ___________________ ^vi/ AskMnbKvixi evg nvZi evyjxi Qvc ZvwiL ___________________________________________ ___________________ klvKvix / AwffveK Gi evg nvZi evyjxi Qvc ZvwiL ___________________________________________ ___________________ ^vxi ^vvi / A_ev evg nvZi evyjxi Qvc ZvwiL ___________________________________________ ___________________ cavb MelK ev Zvi cwZwbwai ^vi ZvwiL wemwUm& t djv Avc mvf dig Di`vZvK wRvmv Kiyb t Di`vZvi bvgt ............................................................................. wKfve Di`vZv BbW Km Gi mv_ mwKZ?  (e KvW wjL~b) wbR .......................................... 1 AwffveK .................................. 2 evoxi m`m .............................. 3 Di`vZvi (BbW Km/ AwffveK / evoxi m`m) BDwbK AvB. wW (BwbDgvikY dig _K bIqv)t ............................................................................. BbW Km ivMxi BDwbK AvB.wWt ............................................................ djv Avc wfwRU b^i (1, 2 A_ev 3) t ...................................................... djv Avc wfwRUi ZvwiL t (w`b/gvm/eQi) ......../......../........ FRA KvW t ................................................... wefvM GK t nvZ avqvi vb mwKZ ckvejx Di`vZvK wRvmv Kib t Avcwb wK `qv Ki AvgvK `LvZ cvib mPivPi Avcwb Kv_vq nvZ ayq _vKb ? wjLyb: nvZ avqvi Rb mywbw` Kvb RvqMv AvQ wK? (e b^i wjLyb) nvu-------------------- 1 bv--------------------- 2 hw` 8 Gi Di bv nq Zv nj 12 b^i cևk hvb| wemwUm Gi BUvifbkb nvIqvwks KUBbviwU evoxi nvZ avqvi vbwUZ iqQ wK? (e KvW wjL~b) nvu-------------------- 1 bv--------------------- 2 cևhvR bq 8 cheY t evoxi nvZ avqvi vbwUZ cvwb AvQ wK? (e KvW wjLyb nvu wjLZ nj AvcbvK AekB cvwb AvQ wK bv Zv wbwZ nZ ne) nvu-------------------- 1 bv--------------------- 2 cheY t nvZ avqvi vb wbi Kvb Dcv`vb jv AvQ? cwZwU Dcv`vb Avjv`v fve j Kib `qv Ki gyL DPvib Kieb bv| (ZvwjKvf~ Dcv`vb jv chY Kij nvu Gi Rb bxP c` evK 1 wjLyb| ZvwjKv f~ Dcv`vb jv cheY bv Kij bv Gi Rb bxP c` evK 2 wjLyb )  evi mvevb / mvaviY mvevb ov mvevb Zij mvevb  QvB gvwU / evwj  Abvb cwiviK Dcv`vb (my wbw` Kib) 12. wRvmv Kib t nvZavqvi Rb Avcbvi LvbvZ eeZ nq &Ggb Kvb Dcv`vb AvgvK `LvZ cvib? (hw` Di`vZv GK wgwbUi fZi AvcbvK Kvb Dcv`vb `LvZ cvi Zvnj nvu Gi Rb bxP c` e 1 wjLyb| hw` Avcwb GK wgwbUi fZi wb ewbZ Kvb Dcv`vb cheb bv Kib Zvnj bv Gi Rb 2 bxPi c` e 2 wjLyb| Avcwb Di`vZvK a~gv `LvZ ejeb , `qv Ki gyL DPvib Kieb bv)  evi mvevb / mvaviY mvevb ov mvevb Zij mvevb  QvB gvwU / evwj  Abvb (wbw` Kib) 13. cheY t BbUvifbkb wKD KvW jv evoxZ `Lv hvQ wK? (e KvW wjL~b)  nvu-------------------- 1 bv--------------------- 2 Di `vZvK wemwUm BUvifbkb Gi GKwU wKD KvW D`vinib wnmve `Lvb| 14| Di `vZvK wRvm Kib MZ ermi GB iKg wKD KvW AvcbvK KD w`qQ wK?  nvu-------------------- 1 bv--------------------- 2 hw` 14 Gi Di bv nq Zv nj wefvM - `yB G hvb| 15| Di `vZvK wRvm Kib Avcwb wK wKD KvW wj `LvZ cvib? nvu-------------------- 1 bv--------------------- 2 wefvM - `yB t vKPviW Aemvifkb 16.GBwU wK evoxZ 1g djv Avc ? (e KvW wjL~b)  nvu-------------------- 1 bv--------------------- 2 hw` 16 Gi Di bv nq Zvnj wefvM -3 G hvb| 17. Kvb Lvbv cheb Kiv ne : ( ICP Gi Lvbv...................1 evox cavbi Lvbv...............2 2q Lvbv...........................3 17. Di `vZvi AvB.wW # (((( 18. cv_wgK cwiPhvKvixi/AwffvKi bvg (hw` ICP < 18 ermi nq) : ______________________ 19. chebKyZ LvbvZ gvU m`m msLv: (( 20. mvvrKvi Mnbi mgq chebKZ LvbvZ DcwZ m`mi msLv (ICP Gi LvbvZ ICP mn hw` DcwZ _vK) t < 5 ermi wk (( > 5 ermi < 18 ermii wk (( > 18 ermi evw : (( AvwgGLb _K Aviv AvovB NUv Avcbv`i mv_ _vKZ PvBe| Avwg ay cheb Kie Ges Kvb evav c`vb Kie bv| hw` ZvZ Kvb Amyweav bv nq Zvnj Avcwb Avcbvi mvavib `bw`b KvR Pvwjq hZ cvib | cvq `o NUv ci Avwg Avcbvi evoxi wKQz gvbylK wKQz ck Kie| 21. cheb ib mgq (24 NUv digU)t NUv / wgwbU : ((:(( 22. cheb kli mgq (24 NUv digU)t NUv / wgwbU : ((:(( ge t ______________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ _________________________________________________________________________ wefvM `yB t nvZ avqvi myhvM I AvPib cheK t jvBb b^iNUbv 1.Lvevi Zix / cwiekbi AvM ............................. 1 2.LvIqvi AvM ..... 2 3.cvqLvbvi ci wkK / bvwc cwiKvi Kivi ci ........ 3 4.cvqLvbv eenvii ci ...........4 5.Kvwk/nvwPi ci ......5 6.bvK Svivi ci ..... 6 7.evPvi bvK Svivi ci .......7 8. nvZ gqjv jvMj .....10 9.Abvb wbw` Kib ............8 chebi mgq 24 NUv digU NUv : wg:  evoxi m`m < 5 ermi wk - 1 > 5 ermi < 18 ermi wk - 2 > 18 ermi evw - 3  evoxi m`mi Rvi: cyil - 1 gwnjv - 2  evox m`m wK nvZ ayqQ? nvu -- 1 bv -- 2 Rvwb bv -- 9 hw` 2 A_ev 9 nq Zvnj cieZx NUbvq hvb| nvZ avqvi vb ivbvNi -- 1 cvqLvbvq -- 2 cv_wgK nvZ avqvi vb -- 3 cieZx nvZ avqvi vb -- 4 DVvb Ab Kv_vI nvZ avqvi vb bq, -- 6 ivbvNI Ab Kv_vI nvZ avqvi vb bq -- 7 Abvb, wbw`w Kib -- 8  `yB nvZ wK ayqQ? nvu -- 1 bv -- 2 Rvwb bv -- 3  nvZ avqvi Dcv`vb t evi mvevb ----- 1 QvB --------- 2 gvwU ------- 3 ay cvwb ----- 4 Abvb wbwϩ Kib ------ 8 chR bq ------ 9  ge 01020304050607080910 jvBb b^iNUbv 1.Lvevi Zix / cwiekbi AvM ............................. 1 2.LvIqvi AvM ..... 2 3.cvqLvbvi ci wkK / bvwc cwiKvi Kivi ci ........ 3 4.cvqLvbv eenvii ci ...........4 5.Kvwk/nvwPi ci ......5 6.bvK Svivi ci ..... 6 7.evPvi bvK Svivi ci .......7 8.Abvb wbw` Kib ............99 chebi mgq 24 NUv digU NUv : wg: evoxi m`m < 5 ermi wk - 1 > 5 ermi < 18 ermi wk - 2 > 18 ermi evw - 3  evoxi m`mi Rvi: gwnjv - 0 cyil - 1  evox m`m wK nvZ ayqQ? nvu -- 1 bv -- 0 Rvwb bv -- 9 hw` 0 A_ev 9 nq Zvnj cieZx NUbvq hvb| nvZ avqvi vb ivbvNi -- 1 cvqLvbvq -- 2 cv_wgK nvZ avqvi vb -- 4 evjwZ / Ab wKQz -- 5 DVvb Ab Kv_vI nvZ avqvi vb bq, -- 6 ivbvNI Ab Kv_vI nvZ avqvi vb bq -- 7 Abvb, wbw`w Kib -- 8  `yB nvZ wK ayqQ? nvu -- 1 bv -- 2 Rvwb bv -- 3 chR bq -- 0  nvZ avqvi Dcv`vb t evi mvevb ----- 1 QvB --------- 2 gvwU ------- 3 ay cvwb ----- 4 Abvb wbwϩ Kib ------ 8 chR bq ------ 9  ge 11121314151617181920 jvBb b^iNUbv 1.Lvevi Zix / cwiekbi AvM ............................. 1 2.LvIqvi AvM ..... 2 3.cvqLvbvi ci wkK / bvwc cwiKvi Kivi ci ........ 3 4.cvqLvbv eenvii ci ...........4 5.Kvwk/nvwPi ci ......5 6.bvK Svivi ci ..... 6 7.evPvi bvK Svivi ci .......7 8.Abvb wbw` Kib ............99  chebi mgq 24 NUv digU NUv : wg: evoxi m`m < 5 ermi wk - 1 > 5 ermi < 18 ermi wk - 2 > 18 ermi evw - 3  evoxi m`mi Rvi: gwnjv - 0 cyil - 1  evox m`m wK nvZ ayqQ? nvu -- 1 bv -- 0 Rvwb bv -- 9 hw` 0 A_ev 9 nq Zvnj cieZx NUbvq hvb| nvZ avqvi vb ivbvNi -- 1 cvqLvbvq -- 2 cv_wgK nvZ avqvi vb -- 4 evjwZ / Ab wKQz -- 5 DVvb Ab Kv_vI nvZ avqvi vb bq, -- 6 ivbvNI Ab Kv_vI nvZ avqvi vb bq -- 7 Abvb, wbw`w Kib -- 8  `yB nvZ wK ayqQ? nvu -- 1 bv -- 2 Rvwb bv -- 3 chR bq -- 0  nvZ avqvi Dcv`vb t evi mvevb ----- 1 QvB --------- 2 gvwU ------- 3 ay cvwb ----- 4 Abvb wbwϩ Kib ------ 8 chR bq ------ 9  ge 21222324252627282930 jvBb b^iNUbv 1.Lvevi Zix / cwiekbi AvM ............................. 1 2.LvIqvi AvM ..... 2 3.cvqLvbvi ci wkK / bvwc cwiKvi Kivi ci ........ 3 4.cvqLvbv eenvii ci ...........4 5.Kvwk/nvwPi ci ......5 6.bvK Svivi ci ..... 6 7.evPvi bvK Svivi ci .......7 8.Abvb wbw` Kib ............99  chebi mgq 24 NUv digU NUv : wg: evoxi m`m < 5 ermi wk - 1 > 5 ermi < 18 ermi wk - 2 > 18 ermi evw - 3  evoxi m`mi Rvi: gwnjv - 0 cyil - 1  evox m`m wK nvZ ayqQ? nvu -- 1 bv -- 0 Rvwb bv -- 9 hw` 0 A_ev 9 nq Zvnj cieZx NUbvq hvb| nvZ avqvi vb ivbvNi -- 1 cvqLvbvq -- 2 cv_wgK nvZ avqvi vb -- 4 evjwZ / Ab wKQz -- 5 DVvb Ab Kv_vI nvZ avqvi vb bq, -- 6 ivbvNI Ab Kv_vI nvZ avqvi vb bq -- 7 Abvb, wbw`w Kib -- 8  `yB nvZ wK ayqQ? nvu -- 1 bv -- 2 Rvwb bv -- 3 chR bq -- 0  nvZ avqvi Dcv`vb t evi mvevb ----- 1 QvB --------- 2 gvwU ------- 3 ay cvwb ----- 4 Abvb wbwϩ Kib ------ 8 chR bq ------ 9  ge 31323334353637383940 abev`, Avgvi cheb GLvbB kl| wefvM - wZb t nvZ avqv c`kb Di `vZvK ejyb: Avcwb wK AvgvK AbyMn Ki `LvZ cvib h Kvwk `Iqvi mgq Avcwb wVK wK Kib? AbyMn Ki Avcbvi cwZw`bi Afvm mK fe `Lyb Ges hv Avcbvi KvQ mvavib ZvB Ki `Lvb| GLvb Kvb fzj Di bB| AbyMn Ki Avcwb hv hv Kib Zv eYbv bv Ki AvgvK Ki `Lvb| 23. evoxi Kvb m`m Kvwk ev nvwP c`kb Kieb? (e KvW wjL~b) BbW Km ivMx .......................................... 1 AwffveK .................................. 2 evoxi m`m .............................. 3 24. h m`m Kvwk ev nvwP c`kb KiQb Zvi BDwbK AvB. wW. t 25. h m`m Kvwk ev nvwP c`kb KiQb Zvi eqm wjLyb t /(ermi/ gvm) 26. Kvwk ev nvwP welqK AvPiY c`kbi mgq wjLyb t (24 NUv digU) / 27. cheYt BbW Km / AwffveK / Di`vZv bxPi KvbwU KiQ wK ? (BbW Km / AwffveK / Di`vZv bxPi KvbwU Ki _vK Zvnj bxPi e Gi Rb 1 wjLyb| hw` BbW Km / AwffveK / Di`vZv bxPi KvbwU bv Ki _vK Zvnj bxPi e bv Gi Rb 2 wjLyb) hw` BbW Kvb iMx / AwffveK bxQi KvbwU Ki bv `Lvq Zvnj bv Gi Rb 2 wjLyb) cheYKjvg hw` BbW Km iMx/ AwffveK g~L ej Ki bv `Lvq Zvnj gwLK Kjvg nvuGi Rb 1 wjLyb| hw` AwffveK g~L bv ej Ges KI bv `Lvq Zvnj cheb Kjvg bv Gi Rb 2 wjL~b| NUbv cheb gwLK Kva / evZ nvuwP/ Kvwk w`qQRvgvi nvZv / kvoxZ nvuwP/ Kvwk w`qQnvZ nvwPu / Kvwk w`qQevZvm nvwPu / Kvwk w`qQ DjL KiQ h m Zvici nvZ aveAbvb (wbw`w Kib)  28. cheY t Kvwk ev nvuwP `Iqvi 5 wg: Gi ga wK Di`vZv nvZ ayqQ? (e b^i wjLyb)  nvu-------------------- 1 bv--------------------- 2 hw` 28 Gi Di bv nq Zv nj wefvM-wZb G hvb| 29. cheY t Kvwk ev nvuwP `Iqvi 5 wg: Gi ga nvZ avqvi mgq Di `vZv bxPi KvbwU eenvi KiQ wK ? (hw` BbW Km / AwffveK / Di`vZv hw` eenvi Ki _vK Zvnj bxPi e nvu Gi Rb 1 wjLyb| hw` BbW Km / AwffveK / Di`vZv eenvi bv Ki _vK Zvnj bxPi e bv Gi Rb 2 wjLyb|)  evi mvevb / mvaviY mvevb ov mvevb Zij mvevb  QvB gvwU / evwj  Abvb (wbw` Kib) wefvM Pvi t nvZ avqv c`kb - cvqLvbvi ci wkK cwi^^vi Kiv | hw` ICP <5 ermi nq Zvnj ZvK wbq c`kbwU KiZ ne| hw` ICP > 5ermi nq Zvnj Zvi LvbvZ < 5 ermi Kvb wk AvQ wK bv Zv `LZ ne| hw` ICP LvbvZ < 5 ermi Kvb wk bv _vK Zvnj Di`vZvK wRvmv Kiyb t Avcwb wK Avcbvi evoxi mePq QvU wkwUi gv A_ev Zvi cv_wgK cwiPhvKvixi KvQ AvgvK wbq hZ cvib? hw` mePq QvU wkwUi cv_wgK cwiPhvKvix DcwZ bv _vKb , Zvnj cieZx mePq A eqmx wkwUi cv_wgK cwiPhvKvix mK wRvmv Kib, hZb bv Avcwb GKRb cv_wgK cwiPhvKvixK mbv KiZ cviQb h mvvZKvi Mnbi mgq DcwZ iqQ| 30. evoxZ <5 eQii Kvb wk AvQ wK? (e b^i wjLyb)  nvu-------------------- 1 bv--------------------- 2 hw` 30 Gi Di bv nq Zv nj 39 b^i cևk hvb| 31. wkwU wK ICP? (e b^i wjLyb)  nvu-------------------- 1 bv--------------------- 2 hw` BbW Kvb iMx /AwfeveK bxPi KvbwU Ki bv `Lvq Zvnj bv Gi Rb 2 wjLyb cheY Kjvg hw` BbW Kvb iMx/ AwfeveK gyL ej Ki bv `Lvq Zvnj gwLK Kjvg nvucևqvRb 1 wjLyb|hw` AwffveK g~K bv ej Ges KvR bv `Lvq Zvnj cheb Kjvg bv Gi Rb 2 wj_~b| NUbv cheb gwLK cwiii mgq wkK k KiQcwivi Kivi mgq cvwb evenvi KiQmvevb I cvwb w`q (mvevbi cKvi DjLi cևqvRb bB ) mvevb w`q nvZ avqvi mgq 24 NUv digU nvZ ayqQ (cwb evenvi KiQ ev DjL KiQ wK mvevb bq)|cvwb w`q nvZ avqvi mgq 24 NUv digU 32. cv_wgK cwiPhvKvixK wRvmv Kib t Avcbvi wki eqm KZ? (ermi / gvm) / 33. cv_wgK cwiPhvKvixK wRvmv Kib t Avcbvi eqm KZ? (ermi / gvm) / 34. cv_wgK cwiPhv Kvixi Rvi wjL~b : (e KvW wjL~b) cyil ................................................... 1 gwnjv .................................................. 2 35. cv_wgK cwiPhv Kvixi BDwbK AvB. wW. wjL~b t cv_wgK cwiPhvKvixK wRvmv Kib AbyMn Ki wkK cvqLvbvi ci wKfve ZvK cwiKvi Kib Zv `LvZ cvib wK? | cheb Kib chebi 5 wg: ga wZwb mn nvZ ayqQb wK bv| cwiPhvKvix Ggb fve wkK cwi^vi Kive hv wVK ev͇e wkwU cvqLvbv Kij wZwb KiZb hgb c_g wki Kvco Lyj `Iqv| 36. wkK cwi^vi Kiv c`kbi mgq wjL~b ( 24 NUv digU) / 37. cheYt wk cwiPhvKvix wK wkK cwivi Kivi 5 wg: Gi ga nvZ ayqQ? (e KvW wjL~b)  nvu-------------------- 1 bv--------------------- 2 hw` 37 Gi Di bv nq Zv nj 39 b^i cևk hvb 38. cheYt wk cwiPhvKvix 5 wg: Gi ga nvZ avqvi mgq bxPi KvbwU eenvi KiQ? (hw` wk cwiPhvKvix Kvb Dcv`vb eenvi Ki _vK Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` wk cwiPhvKvix Kvb Dcv`vb eenvi bv Ki _vK Zvnj bxPi e bv Gi Rb 2 wjLyb)  evi mvevb / mvaviY mvevb ov mvevb Zij mvevb  QvB gvwU / evwj  Abvb (wbw` Kib) cv_wgK cwePhvKvixK mgq `qvi Rb abev` Rvbvb | mvvZKvii evKx Ask ne g~j Di`vZvi mv_| 39.GBwU wK evoxZ Pov djv Avc ? (e KvW wjL~b)  nvu-------------------- 1 bv--------------------- 2 hw` 39 Gi Di bv nq Zvnj mvvZKvi Mnb GLvbB kl Kib | wefvM cvuP t nvZ avqv mwKZ vb 40.wRvmv Kib: KLb Avcbvi nvZ a~qv DwPZ? a Di `vZvK wRvmv Kib (hw` BbW Km/ AwffveK / Di `vZv wbgewbZ mgq jv DjL Ki Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` BbW Km/ AwffveK / Di `vZv wbgewbZ mgq jv DjL bv Ki _vK Zvnj bxPi e bv Gi Rb 2 wjLyb)  ivbv Kivi AvM  LvIqvi AvM  nvZ nvuwP ev Kvwk `Iqvi ci  wbRi A_ev wki bvK cwivi Kivi ci  nvZ gqjv jvMj  cvqLvbvi ci  cvqLvbi ci wkK cwivi Kivi ci bvgvhi mgq Mvmji mgq  mKvj Nyg _K DV  Abvb (wbw KiyY) 41. wRvmv Kib : nvZ avqvi mgq wK wK avc Avcwb Kib? (hw` BbW Km/ AwffveK / Di `vZv wbewbZ avc jv DjL Ki Zv nj bxPi e nvu &Gi Rb 1 wjLyb| hw` BbW Km/ AwffveK / Di `vZv wbgewbZ avc jv DjL bv Ki _vK Zvnj bxPi e bv Gi Rb 2 wjLyb)  nvZ fRvbv  nvZ mvevbi dbv Zvjv  10 mK nvZ Nmv cvwb w`q nvZ ayq djv nvZ Kvbv Abvb (wbwϩ Kib) myweav I evav mg~n t 42. wRvmv Kib mvevb w`q Avcbvi nvZ avqvi myweavwj wK wK ? (hw` Di`vZv bxPi KvbwU ej Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` Di `vZv bxPi KvbwU bv ej Zvnj bxPi e bv Gi Rb 2 wjLyb)  wk I cwievii jvjb cvjb mgvRi GKRb MnbhvM ew nIqv wbRK cwivi `Lvbv I Abyfe Kiv  gqjv `~i Ki ^vi DbwZ Ki  mvgvwRK ghv`v evovq  Wvqwiqv RwbZ AmyZv Kgvq  kvmZi AmyZv Kgvq Abvb (wbw` Kib) 43. wRvmv Kib mvevb w`q nvZ avqvi Rb Avcbvi evav mg~n wK wK? (hw` Di`vZv bxPi KvbwU ej Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` Di `vZv bxPi KvbwU bv ej Zvnj bxPi e bv Gi Rb 2 wjLyb)  `bw`b KvRi AMZ bq ev Afvm bq  m~weavw` mK AewnZ bq / vbi Afve AwZwi kw LiP nq/ AjmZv  mvevb wKbZ AwZwi LiP nq  AmyZv cwZiva Ki bv  nvZ avqvi wbw Kvb vb bB ev Zv AbK `~i  mvevb w`q nvZ avqv mK Kvb weKvi bvB  QvB A_ev gvwU w`qB cwivi nh cvwb wbRB cwivi Ki  Lye e / mgq bvB  mvevb w`q nvZ ayZ f~j hvq  mvevb Pzwi nq hve  Abvb (wbw Ki wjLyb)  Kvb evav bvB wefvM cvuP t Bbdzqv mwKZ vb 44. Avcwb wK Bbdzqv bvgK AmyZvi K_v KLbI bQb? (e KvW wjLyb)  nvu -------------------------- 1 bv -------------------------- 2 Rvwb bv / wbwZ bv ------------- 9 hw` 44 Gi Di 2 A_ev 9 nq Zvnj mvvZKvi Mnb GLvbB kl Kib 45. wRvmv Kib Bdzqv RwbZ AmyvZvi mv_ wK wK jY RwoZ ? (ckwU GKwU Lvjv ck wnmve wRvmv Kib hw` BbW Km / Di`vZv bxPi Kvb jY DjL Kib Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` Di `vZv bxPi KvbwU bv ej Zvnj bxPi e bv Gi Rb 2 wjLyb) Kvwk .............................................................................  Mjv ev_v......................................................................  bvK w`q cvwb cov ......................................................... Ri.............................................................................. gv_v ev_v ..................................................................... kixi ev_v .................................................................... Abvb (wbwϮU Ki wjLyb) .............................................. 46. wRvmv Kib t Bdzqv RwbZ AmyZv wK cwZiva Kiv hvq ? (e KvW wjLyb)  nvu -------------------------- 1 bv -------------------------- 2 Rvwb bv / wbwZ bv ------------- 9 hw` 46 Gi Di 2 A_ev 9 nq Zvnj mvvZKvi Mnb GLvbB kl Kib 47. Bbdzqv RwbZ AmyZv wKfve cwZiva Kiv hvq? (ckwU GKwU Lvjv ck wnmve wRvmv Kib hw` BbW Km / Di`vZv bxPi Kvb cwZiva DjL Kib Zvnj bxPi e nvu &Gi Rb 1 wjLyb| hw` Di `vZv bxPi KvbwU bv ej Zvnj bxPi e bv Gi Rb 2 wjLyb)  Amy ewi KvQ _K `~i hvevi gvag evi evi nvZ avqvi gvag  evi evi mvevb w`q nvZ avqvi gvag  wUKv Mnbi gvag  Vvv Lvevi Mnb Gwoq Pjvi gvag  cwivi cwiQbZv eRvq ivLvi gvag  Abvb (wbw Ki wjLyb) Awdm eenvii Rb Gd.Avi.G bvg : ___________________________________________ Gd.Avi.G ^vi: ___________________ ZvwiL t ______/______/____________ cixwZ : ______________________ ZvwiL t ______/______/____________ Appendix 22: Responses to the comments from the external reviewers A. Responses to the comments from Dr. BJ Cowling This protocol describes a study to evaluate whether improved hand hygiene can prevent transmission of influenza within households in Bangladesh. The study is ambitious in the intensity and duration of follow-up of a moderate number of households, and may be logistically challenging although it has the potential to generate invaluable data on influenza transmission and prevention in a subtropical low-income setting. We thank the reviewer sincerely for his thoughtful comments. We have attempted to respond to specific comments below. Overall, we believe that our proposed study design is logistically feasible. Moreover, the proposed study design will allow us to collect detailed information on secondary transmission at the household / bari level. Major comments A strength of the proposed study is the timeliness of applying interventions following recruitment, where it is proposed that two team members will accompany a recruited case home immediately. The schedule also includes repeat home visits on a daily basis by the FRA to evaluate outcomes and in the intervention group by the FRO to maintain adherence to the intervention; my immediate concern is firstly whether this is feasible, and secondly whether it is necessary. I would be particularly concerned about the resources required to continue FRO daily visits for as long as 10 days after illness resolution in the index case to maintain the intervention; this design seems like overkill. To date, there is really only one study (ongoing) to examine the efficacy of hand hygiene promotion for prevention of secondary transmission of influenza. That study is being conducted in Bangkok, Thailand. There, only one intervention session is being held with households in the treatment arm. Handwashing is a difficult behavior to change. We have seen that, even after intensive interpersonal education over a yearlong period, improved handwashing behavior is not necessarily sustained (Luby, ASTMH, 2008). However, based on data regarding the impact of handwashing on all-cause respiratory illness, we hypothesize that improving hand hygiene will reduce influenza transmission at the household level. Our intent with daily visits by an FRO to reinforce the intervention is that we will demonstrate proof of the concept that improved handwashing behavior will, indeed, reduce secondary transmission. With a less than intensive, aggressive hand hygiene intervention, if we find no or little reduction of secondary transmission in the treatment arm, we will be left to wonder whether our findings were due a true lack of efficacy of hand hygiene or whether our intervention was inadequate. We have conducted the logistical exercises to determine whether we have the person-power and budget to afford daily intervention and illness tracking visits. We do have both person-power and budget. The inclusion criteria specify that an index case is eligible provided they have experienced symptom onset within 7 days. Unpublished data from the Hong Kong NPI study suggests that interventions are most effective if implemented within at most 36-48 hours of symptom onset in an index case. Narrowing the inclusion criteria to say symptom onset within 2 days would lead to a greater likelihood of detecting intervention effects, but would adversely impact recruitment rates. If a primary motivation for this study is pandemic preparedness, then one of the most interesting outputs must be the potential (theoretical) impact of immediate use of interventions following symptom onset. This is useful input. In the ongoing surveillance, we encounter many patients who come days after symptom onset. As Dr. Cowling notes, it would be interesting and important to understand whether intervening early would prevent secondary transmission. For this reason, we propose to retain the currently specified eligibility criteria but also propose to conduct subgroup analyses based on the duration of symptoms preceding enrollment. In the Hong Kong NPI study, children under the age of 15 were found to shed influenza virus for on average 7 days after symptom onset (unpublished data). Symptoms typically did not resolve until after cessation of viral shedding, and there are data in the literature suggesting children can have symptoms for 14 days or longer. In the current design, this would lead to daily visits for 24 days or more, which seems an excessive use of resources to study transmission in just one household. If we were to stop assessing illness in contacts before their symptoms were resolved, we could miss secondary cases. Since the unit of observation is the bari, each index case could potentially transmit to 10 or more susceptible persons. This large pool of susceptibles makes daily visits to the bari extremely worthwhile. Again, as noted above, we have the person-power and budget to pursue this strategy. The evaluation of primary outcome may be suboptimal particularly to answer Specific Aim 2 and bearing in mind the limited sample size. Influenza infection is associated with a wide variety and combination of symptoms. In the Hong Kong NPI study, only 8 out of 21 laboratory-confirmed secondary cases met the strict clinical definition of fever plus cough or sore throat in the pilot study (published in PLoS ONE), and 34 out of 75 in the main study (unpublished data). Approximately 20% of laboratory-confirmed secondary cases did not report any symptoms. In the proposed study, only household contacts who meet the strict clinical definition will provide specimens, and therefore more than half of all secondary cases will probably be missed (and any intervention effect will be less clear / the study will have less power). Clearly there would be logistical and budgetary implications if all household contacts were swabbed whether symptomatic or not; but perhaps a looser definition could be used for the purpose of collecting swabs We have updated the protocol to include in the case definition cough/sore throat OR fever in the last 7 days. We hope this will allow us to identify more symptomatic secondary cases. While identifying asymptomatic secondary cases would be interesting and allow for a more complete estimation of secondary transmission, it would not modify the identification of clinically relevant (i.e. symptomatic) illnesses among household contacts. The targeted maximum sample size of up to 100 households per arm (200 in total) appears adequate while the minimum sample size is unlikely to be sufficient. It is likely that secondary attack ratios will be under 10% rather than as high as 30% particularly if ascertainment is limited to contacts meeting the fever+cough/sore throat definition (see #4 above) and given the likely lower contact rates in the bahi compared to single households. It would seem optimistic to obtain the maximum sample size if the pool of potential recruits is at most 240. The sample size calculation does not allow for dropouts post-recruitment. We have read Dr. Cowlings paper published in PLoS ONE with interest. More recently, we have heard oral presentation of data from the HITS study from Bangkok, Thailand, in which handwashing and face mask use are being assessed for efficacy against secondary transmission of influenza. The rates of secondary transmission in Bangkok are about 30%, much higher than the 8% seen in the Hong Kong NPI study. Baris represent familial units and there is substantial daily ongoing interaction between most bari members. We believe that the Bangladeshi population will more closely resemble the Bangkok population, based on socioeconomic status indicators. Thus, we anticipate that our power calculations will hold true. We have modeled our sample size calculations on a range of secondary transmission rates and find that our estimated sample size will be adequate to demonstrate 33% risk reduction, in case the SAR in the routine practices group is only 20% (between the SAR found in Hong Kong and that found in Bangkok). The lack of serology is a limitation; baseline serology can help to clarify immunity/susceptibility and comparison with post-study serology could allow optimal detection of influenza virus infections during the study. Would it be possible to collect baseline and post-study serology even only in a subset of households? We agree that this may be a limitation. However, at present, the budget available to us will not allow for serological testing of household contacts. Is there a strong reason for using bar soap rather than liquid hand soap? We are using bar soap because that is the kind of soap commonly used in Bangladesh. Liquid soap is unusual in this setting and does not represent the intervention that would be implemented in the case of a pandemic,. Minor comments The investigative team does not seem to have a designated statistician. Margaret DiVita is a PhD student at the University at Buffalo. Margaret will be analyzing data from this study for her doctoral dissertation. Dr. Jihnhee Yu, a biostatistician in the Department of Biostatistics at the University at Buffalo, will advise Margaret on the statistical analysis of these data. The assessment of ventilation is fairly simplistic although pragmatic; the protocol is missing an interesting opportunity to really make a comprehensive study of environmental factors affecting transmission. New technologies are not particularly expensive and might allow tracking of carbon dioxide levels, or a tracer substance can be steadily released in one room and detected in other rooms. Timelines may not allow this to be set up this year, but the investigators can consider contacting a specialist engineer for future studies. This is useful input. We are planning on measuring PM50 using the Berkeley Particle Monitor, as detailed in the Measures of Interest section. It could be interesting to make a more detailed study of contact patterns within households and between households within a bari, perhaps in a subset. For example ask each member to report the number of skin-to-skin or conversational contacts with each other member, each day. This is an interesting suggestion. However we feel that it would require hours spent in direct observation of each household to accurately collect this data, which would not be feasible given the remainder of our proposed study methods. In terms of logistics, is there a strong rationale for sending the FRO to all households, and then asking them to call the physician and depart if the household is not in the intervention group. This may protect against certain biases, but on the other hand will the FRO be required to carry bottles of soap etc. to all households? The randomization is occurring at the bari level after the eligibility of the bari has been confirmed and baseline data has been collected. This will minimize interviewer bias during the baseline data collection Will specimens from symptomatic household contacts be tested for all influenza subtypes or only for the subtype corresponding to the strain detected in the index case? E.g. if the index case has influenza B, will the symptomatic household contacts only be tested for influenza B or perhaps a pragmatic approach could be to test only for influenza B in the first instance, and test for A H1N1 or A H3N2 if the flu B test is negative? All swabs obtained from potential secondary cases will be tested for all influenza subtypes, except Influenza A H5N1. The latter will be tested for in the event that PCR is negative for Influenza A H1N1 and A H3N2, and Influenza B.. Is influenza vaccination history so uncommon as not to warrant mention in Specific Aim 3? Perhaps it should be clarified in the protocol that vaccination rates are so low that the potential effects are unlikely to be observable. Influenza vaccination in this population is virtually nonexistent. The data collected in this study could be very amenable to mathematical modeling, although this does not necessarily need to be part of the study protocol and could be a separate supplementary project, if the investigators can find a modeler to collaborate with. Wed be interested in discussing this further with Dr. Cowling to learn his insights about the purpose and methods of such modeling. We will initiate this conversation separately. It seems strange to discard specimens corresponding to negative QuickVue tests, rather than freezing them. Funds might be available later to confirm test performance, and certainly the authors should keep and test the initial set of negative swabs to confirm that test performance is acceptable there are recent reports from NPI studies in the US that QuickVue sensitivity was just 20%-30% in large sample sizes, although in most previous studies sensitivity has been 60%-70%. Members of our study team have assessed the sensitivity of QuickVue among residents of a slum community in Dhaka, Bangladeshs capital and found it to be around 90%. We appreciate the caution that QuickVues sensitivity may be lower in other populations. We will measure and report the sensitivity and positive predictive value of QuickVue, as compared with PCR, upon conclusion of our study. We also will make an effort to freeze around 20 negative QuickVue specimens per month; should funds become available in the future, we will use these specimens to test for specificity and NPV. The Secondary Attack Rate is more of a ratio than a rate since time is not included in the denominator, and so it may be more appropriate to use Secondary Attack Ratio throughout (but rate has been a common usage historically). We have updated the protocol to reflect secondary attack ratio. Sample size calculation for Specific Aims 2 and 3, We assume 10 susceptible contacts per household should not refer to susceptibility/immunity as this is not evaluated in the study and is not involved in calculation of primary outcome measures. We have updated to protocol to say We assume 10 contacts per household B. Responses to the comments from Dr. Elaine Larson Good idea to obtain both nasal and OP swab, although it might be very difficult to obtain the OP. Consider a deep nasal swab. Provide rationale for both. These specimen collection procedures are already in place for national hospital-based influenza surveillance, which includes Jahurul Islam Medical College hospital where this study will be based. We have not had difficulty in obtaining OP swabs there. The sensitivity and specificity of this combination of specimens and, therefore, we do not see a need for a deep nasal swab. Our rationale for obtaining these samples is detailed in the laboratory methods section. In our recent CDC studies, QuickVue had a sensitivity of <50%--if possible with the funds you have, do lab tests on everybody who meets ILI definition. At the very least, test the sens and specificity of QuickVue in a small sample of your population before deciding not to culture or do PCR. Members of our study team have assessed the sensitivity of QuickVue among residents of a slum community in Dhaka, Bangladeshs capital and found it to be around 90%. We appreciate the caution that QuickVues sensitivity may be lower in other populations. Given the nature of the intervention (immediately upon identification of an index case-patient), the rapidity of secondary transmission (days after illness onset in the index case-patient), and the time frame needed to get PCR results (several weeks), we will need to rely on QuickVue results in order to make a decision on enrollment of a given index case-patient and his/her household contacts. Therefore, we propose to retain use of the QuickVue for identification of index case-patients. A lower than anticipated sensitivity of QuickVue would mean that a number of index case-patients who might otherwise be eligible for inclusion in the study would not be identified as influenza positive. This will not adversely affect our ability to answer the study questions, since we aim to assess the rate and prevention of secondary transmission, and not primary illness. To address this concern, we will measure and report the sensitivity and positive predictive value of QuickVue, as compared with PCR, upon conclusion of our study. Unfortunately, given the brevity of the influenza season (3-4 months), we will be unable to test the sensitivity of QuickVue in this particular population before initiating the proposed study. I don't think that your sample size calculation is convincing that you will have sufficient power. In addition to the data provided, what is the anticipated incidence of flu in the community? Will you have sufficient index cases during your time line? In the sample size calculation for specific aim two, we estimated that we will detect around 80 index cases of influenza per month, or a total of 240 cases during a three month influenza season. This data was extrapolated from a current study that is being conducted in the same population, from last years flu season (2008). Unfortunately, the study of influenza in Bangladesh is relatively young and we do not have population-based estimates of influenza incidence in all age groups in the community. Am I reading this correctly that the control group will not sign consents, only the intervention group? That doesn't seem acceptable by US standards, but perhaps different in Bangladesh? We will be obtaining written consent from baris enrolled in both intervention and control arms. We have updated the protocol to make this clearer. Is the same person doing the interviews, assessing the outcome, and taking swabs who is also doing the intervention? It would be stronger if that were not the case, particularly since you cannot blind. The study workers that are implementing the intervention will be separate from the workers that are assessing illness in the household members. We have updated the protocol with new titles for our study workers to make this clearer. The study worker who will carry out the intervention will now be called the field intervention specialist or FIS. This person is distinct from the field research assistant or FRA, who will collect all study measures, including questionnaire administration and illness tracking.. It would be great if you could comment briefly on sustainability of the intervention after the study is completed. This study is intended to demonstrate a proof of concept: does intensive handwashing promotion reduce the transmission of influenza from an index case-patient to household contacts? We do not make assumptions about the scalability or sustainability of such an intervention. If we can demonstrate that an intensive, well-designed, and well-executed handwashing promotion intervention does indeed reduce secondary transmission of influenza, we would then propose to examine the impact of a more scalable, and hopefully sustainable, handwashing promotion intervention. We believe that it is premature to discuss issues of sustainability and scalability at this time. CHECK-LIST FOR SUBMISSION OF RESEARCH PROTOCOL FOR CONSIDERATION OF RESEARCH REVIEW COMMITTEE (RRC) [Please check (X) appropriate box] Has the proposal been reviewed, discussed and cleared at the Division level? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If No, please clarify the reasons:  FORMTEXT       Has the proposal been peer-reviewed externally?  Yes  FORMCHECKBOX  No  FORMCHECKBOX  If the answer is  No , please explain the reasons:  FORMTEXT       If yes, have the external reviews comments and their responses been attached Yes   FORMCHECKBOX   No  FORMCHECKBOX Has the budget been cleared by Finance Department? Yes  FORMCHECKBOX  No  FORMCHECKBOX  If the answer is No, reasons thereof be indicated:  FORMTEXT       Does the study involve any procedure employing hazardous materials, or equipments? 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B.Kuehnert, M. J.Hall, C. B.Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. cbridges@cdc.govTransmission of influenza: implications for control in health care settingsClin Infect DisClin Infect Dis1094-1013782003/10/03AnimalsCross Infection/epidemiology/prevention & control/*transmissionDelivery of Health CareDisease Models, Animal*Health PersonnelHumansInfection ControlInfluenza Vaccines/administration & dosageInfluenza, Human/epidemiology/prevention & control/*transmission2003Oct 151537-6591 (Electronic)14523774http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14523774CID30919 [pii] 10.1086/378292engFiore200822217Fiore, A.E.Shay, D.K.Broder, K.Iskander, J.K.Uyeki, T. M.Mootrey, G.Bresee, J.S.Cox, N. J.Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2008MMWR Recomm Rep1-6457RR-72008/08/08AdolescentAdultAgedAntiviral Agents/administration & dosage/adverseeffects/pharmacokinetics/therapeutic useChildChild, PreschoolCost of IllnessCost-Benefit AnalysisDrug InteractionsDrug Resistance, ViralFemaleHumansInfantInfection ControlInfluenza Vaccines/*administration & dosage/adverseeffects/contraindications/economicsInfluenza, Human/drugtherapy/economics/epidemiology/physiopathology/*prevention & controlMaleMiddle AgedPregnancyRisk FactorsVaccination/adverse effects/contraindications/economics/*standardsVaccines, Inactivated2008engDKomoroski199710101017Komoroski, E. M.Kirby, R. S.Rickert, V. I.Yamauchi, T.Arkansas Children's Hospital and the University of Arkansas for Medical Sciences, Little Rock 72202, USA.Risk factors for febrile, presumed viral illness in the first ten weeks of lifeJ Perinatol288-911741997/07/01Family HealthFever/therapyHospitalizationHumansInfantInfant, Newborn*Infant, Newborn, DiseasesOffice VisitsProbabilityQuestionnairesRisk FactorsTobacco Smoke Pollution*Virus Diseases/transmission1997Jul-Aug0743-8346 (Print)9280093http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9280093engStephen200329292917Stephen, G. A.McRill, C.Mack, M. D.O'Rourke, M. K.Flood, T. J.Lebowitz, M. D.Southern Arizona VA Health Care System, University of Arizona, Tucson, Arizona 85723, USA. stephen@med.va.govAssessment of respiratory symptoms and asthma prevalence in a U.S.-Mexico border regionArch Environ Health156-625832003/10/11Air Pollutants/*adverse effectsArizona/epidemiologyAsthma/*epidemiology/*etiologyChildCough/epidemiology/etiology*Environmental ExposureFemaleHumansMaleMexico/epidemiologyParticle SizePrevalenceRespiratory Function TestsRespiratory Sounds/etiologyUrban Population2003Mar0003-9896 (Print)14535575http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14535575engArcavi200432323217Arcavi, L.Benowitz, N. L.Clinical Pharmacology Unit, Kaplan Medical Center, Rehovot, Israel.Cigarette smoking and infectionArch Intern MedArch Intern Med2206-16164202004/11/10AdultAge DistributionAgedBacterial Infections/*epidemiology/immunologyCausalityDisease Susceptibility/*immunologyFemaleHumansMaleMiddle AgedPrognosisRisk FactorsSex DistributionSmoking/adverse effects/immunology*Smoking CessationTobacco Use Disorder/*epidemiology/*immunologyVirus Diseases/*epidemiology/immunology2004Nov 80003-9926 (Print)15534156http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15534156164/20/2206 [pii] 10.1001/archinte.164.20.2206engEDd U0 550  # AbQE|z1@e-Eun%E|z1@ePNG  IHDR97,sRGB pHYs+DIDATx^=Rg^ S/{pp%8l`(8W%EWjI-f_tO6@@@@$p@|9R6   &{A@@@nX7j?|@@@MںA@@&_n@:unC{ W>@@@`૭@@@nX7j?|@@@MںA@@&_n@:unC{ W>@@@`૭=}ww{zZ*"g^,vUDCf?Tz̾NJJ;ŔsȦXSj >*-0ջ %A`zզ$w7ۓ-G7EVj٣˭Z\ʛM)JJH0 +^D;Q zK@`b&6!>5볼NU^v/L%rl6uk$Dֵ(>n]pR eAFj dqUyi(+=JG^՘^}Pf6mXm! -EȦUo٨CZ_tKD*HyjeiN&1wm{G mEE:6w1 tqw#fήoUm;1)u6k |u+v'%.qAT %]CϷ(0ZZI]_QOx{Mm'&:Ds7Ҟo[EzK޴O)аuUe Ti+u \V(9Mʿ(TXAcN,U7l O0X;lx{ B$'SccI fX ? 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K.Goodman, D.Salamon, D.Marcon, M. J.Department of Pathology, The Ohio State University College of Medicine and Public Health, and Department of Emergency Medicine, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.Evaluation of the Quidel QuickVue test for detection of influenza A and B viruses in the pediatric emergency medicine setting by use of three specimen collection methodsJ Clin MicrobiolJ Clin Microbiol2638-414472006/07/11AdolescentChildChild, PreschoolEmergency Medicine/*methodsFemaleHumansInfantInfant, NewbornInfluenza A virus/genetics/growth & development/*isolation & purificationInfluenza B virus/genetics/growth & development/*isolation & purificationInfluenza, Human/*diagnosisMaleNasopharynx/virologyNose/virologyReagent Kits, DiagnosticReverse Transcriptase Polymerase Chain ReactionSensitivity and SpecificityVirus Cultivation2006Jul0095-1137 (Print)16825402http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16825402148951744/7/2638 [pii] 10.1128/JCM.02644-05engDd * 0  # A29_3(”Ծ-(<u`! 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Nicola.Principi@unimi.itBurden of influenza in healthy children and their householdsArch Dis Child1002-789112004/10/23AdolescentAge DistributionChildChild, Preschool*Cost of IllnessFamily HealthFemaleHealth Care Costs/statistics & numerical dataHumansIncidenceInfantInfluenza A virus/isolation & purificationInfluenza B virus/isolation & purificationInfluenza, Human/economics/*epidemiology/therapyItaly/epidemiologyMaleProspective StudiesSocioeconomic Factors2004Nov1468-2044 (Electronic)15499051http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1549905189/11/1002 [pii] 10.1136/adc.2003.045401engCowling200817171717Cowling, B. J.Fung, R. O.Cheng, C. K.Fang, V. J.Chan, K. H.Seto, W. H.Yung, R.Chiu, B.Lee, P.Uyeki, T. M.Houck, P. M.Peiris, J. S.Leung, G. M.Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in householdsPLoS ONEPLoS Onee2101352008/05/08AdultAnimalsBody TemperatureCell LineChild, PreschoolDemographyDogs*Family Characteristics*HandwashingHong Kong/epidemiologyHumans*HygieneInfluenza, Human/epidemiology/*prevention & control/*transmissionKidneyMasks/*statistics & numerical dataNasal Mucosa/virologyOutpatientsSample Size20081932-6203 (Electronic)18461182http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1846118210.1371/journal.pone.0002101eng$$If_!vh#v#v#v#vg#v:V l t&65555g5/ /  / a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2$$If_!vh#v#v#v#vg#v:V lG t&6,5555g59/ / / /  a_p2lDCowling200817171717Cowling, B. J.Fung, R. O.Cheng, C. K.Fang, V. J.Chan, K. H.Seto, W. H.Yung, R.Chiu, B.Lee, P.Uyeki, T. M.Houck, P. M.Peiris, J. S.Leung, G. M.Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in householdsPLoS ONEPLoS Onee2101352008/05/08AdultAnimalsBody TemperatureCell LineChild, PreschoolDemographyDogs*Family Characteristics*HandwashingHong Kong/epidemiologyHumans*HygieneInfluenza, Human/epidemiology/*prevention & control/*transmissionKidneyMasks/*statistics & numerical dataNasal Mucosa/virologyOutpatientsSample Size20081932-6203 (Electronic)18461182http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1846118210.1371/journal.pone.0002101engPrincipi200416161617Principi, N.Esposito, S.Gasparini, R.Marchisio, P.Crovari, P.Institute of Paediatrics, University of Milan, Milan, Italy. Nicola.Principi@unimi.itBurden of influenza in healthy children and their householdsArch Dis Child1002-789112004/10/23AdolescentAge DistributionChildChild, Preschool*Cost of IllnessFamily HealthFemaleHealth Care Costs/statistics & numerical dataHumansIncidenceInfantInfluenza A virus/isolation & purificationInfluenza B virus/isolation & purificationInfluenza, Human/economics/*epidemiology/therapyItaly/epidemiologyMaleProspective StudiesSocioeconomic Factors2004Nov1468-2044 (Electronic)15499051http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1549905189/11/1002 [pii] 10.1136/adc.2003.045401engTsolia200618181817Tsolia, M. N.Logotheti, I.Papadopoulos, N. G.Mavrikou, M.Spyridis, N. P.Drossatou, P.Kafetzis, D.Konstantopoulos, A.Second Department of Pediatrics, University of Athens School of Medicine, P. and A. Kyriakou Children's Hospital, Athens 11527, Greece. matsolia@ath.forthnet.grImpact of influenza infection in healthy children examined as outpatients and their familiesVaccineVaccine5970-62433-342006/06/09AdolescentAnti-Bacterial Agents/therapeutic useChildChild, PreschoolFamily HealthFemaleHumansInfantInfluenza, Human/complications/*epidemiology/*transmissionMaleOtitis Media/drug therapy/etiologyOutpatientsProspective Studies2006Aug 140264-410X (Print)16759761http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16759761S0264-410X(06)00544-5 [pii] 10.1016/j.vaccine.2006.05.006engDNational Institute of Population Research and Training200517217217246<style face='normal' font='default' size='10'>Bangladesh Demographic and Health Survey 2004</style>Kerry199819191917Kerry, S. M.Bland, J. M.Division of General Practice and Primary Care, St George's Hospital Medical School, London.Sample size in cluster randomisationBMJ54931671301998/03/21*Cluster Analysis*Randomized Controlled Trials as Topic*Sample Size1998Feb 140959-8138 (Print)9501723http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=9501723eng$$If_!vh#v#v#v#v#v#v#v:V l t'65555555/ /  /  / a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF7$$If_!vh#v#v#v#v#v#v#v:V l; t'6,55555559/ /  / / /  a_pF$$If_!vh#v5#v6#v#vB#v#vd:V l t"65B5{5B55d/ /  / a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l t"65B5{5B55d/ /  / a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP$$If_!vh#v5#v6#v#vB#v#vd:V l; t"6,5B5{5B55d9/ / / /  a_pP DCurtis200322217Curtis, V Cairncross, SEffect of washing hands with soap on diarrhoea risk in the community: a systematic reviewLancet Infectious Disease275-28132003Luby200510110110117Luby, S. 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@qt "qt;ot at!Ut AtCt6t @t$ _Toc112127591 _Hlt112128169 _Toc246349020 _Toc254935006 _Toc255398831 _Toc268031174RESEARCH_PROTOCOL _Hlt111363759 _Hlt111363780Text74 _Hlt112146161Check3Check4 _Hlt110744894 _Hlt110744991Check5Check6Text3 OLE_LINK1 OLE_LINK2 _Hlt110069158 _Hlt110069189 _Hlt110069187 _Hlt110069135 _Hlt110069136 _Hlt110069153 _Hlt110069207 _Hlt110069202 _Hlt110069203 _Hlt110069143Check2Check10Check11Check12 _Hlt110069063 _Hlt110069064Check13Check14Check15Check16Check113Check114Check115Check116Text61Text15 _Hlt112128167Check17Check18Check19Check20Check21Check22Check23Check24Check25Check26Check27Check28Check29Check30Check31Text62Check32Check38Check39Check40Check41Check42Check43Check44Check45Check33Check34Check35Check36Text24Check37Text25Check46Check47Check48Check49Check50Check51Check52Check53Check54Check55Check56Check57Check117Check118Check58Check59Check60Check63Check62Check61Check64Check65Check66Check67Check68Check71Check72Check73Check74Check106Check77Check78Check79Check80Check81Check89Check91Check92Check93Check94Text318Check95Check96Text30 OLE_LINK5 OLE_LINK6 _Hlk218245158 OLE_LINK3 OLE_LINK4Text292Text293Text294Text295Text296Text297Text298Text299Text300Text301Text302Text303Text343Check112Project_Summary _Hlt110744591 _Hlt110744820 _Hlt110751487 _Hlt110825343 _Toc246349021 _Toc254935007 _Toc255398832 _Toc268031175DESCRIPTION_OF_THE_RESEARCH _Hlt110745989 _Hlt110825692 _Hlt111363819 _Toc112127592 _Toc246349022 _Toc254935008 _Toc255398833 _Toc268031176Hypothesis_to_be_tested _Hlt110745462 _Hlt110825727 _Hlt111363825 _Toc112127593 _Toc246349023 _Toc254935009 _Toc255398834 _Toc268031177 Specific_aims _Hlt110745465 _Toc112127594 _Toc246349024 _Toc254935010 _Toc255398835 _Toc268031178Background_of_the_project _Toc112127595 _Toc246349025 _Toc254935011 _Toc255398836 _Toc268031179Research_Design _Toc112127596 _Toc246349026 _Toc254935012 _Toc255398837 _Toc268031180 _Toc214231414 _Toc214231416 _Toc214231418 _Toc246349027 _Toc254935013 _Toc255398838 _Toc268031181 _Toc246349028 _Toc254935014 _Toc255398839 _Toc268031182 _Toc246349029 _Toc250624498 _Toc254935015 _Toc255398840 _Toc255399141 _Toc268031183 _Toc112127597 _Toc246349030 _Toc254935016 _Toc255398841 _Toc268031184 Facilities _Toc112127598 _Toc112127599 _Toc246349031 _Toc254935017 _Toc255398842 _Toc255399143 _Toc268031185 Data_Analysis _Toc112127600 _Toc246349032 _Toc254935018 _Toc255398843 _Toc268031186Ethical_Assurance _Toc112127601 _Toc246349033 _Toc254935019 _Toc255398844 _Toc268031187Use_of_Animals _Toc246349034 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_Toc254935032 _Toc255398857 _Toc255399158 _Toc268031200 _Toc246349047 _Toc250624516 _Toc254935033 _Toc255398858 _Toc255399159 _Toc268031201 _Toc246349048 _Toc250624517 _Toc254935034 _Toc255398859 _Toc255399160 _Toc268031202 _Toc246349049 _Toc254935035 _Toc255398860 _Toc268031203 _Toc246349050 _Toc254935036 _Toc255398861 _Toc268031204 _Toc246349051 _Toc254935037 _Toc255398862 _Toc268031205 _Toc246349053 _Toc254935038 _Toc255398863 _Toc268031206 OLE_LINK7 _Toc254935046 _Toc268031214 _Toc268031215 _Toc268031216 _Toc268031217 _Toc218412326 _Toc246349055 _Toc250624524 _Toc268031218 _Toc268031219 _Toc268031220 _Toc268031221 _Toc268031222 _Toc268031223 _Toc268031224 _Toc268031225 _Toc268031226 _Toc268031227 _Toc268031228 _Toc268031229 _Toc268031230 _Toc268031231 _Toc268031232 _Toc268031233 _Toc268031234 _Toc268031235 _Toc268031236 _Toc268031237 _Toc268031238 _Toc268031239 _Toc268031240 _Toc268031241 _Toc268031242 _Toc268031243 _Toc268031244 _Toc268031245 _Toc268031246 _Toc268031247 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