{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T04:45:22Z","timestamp":1750308322907,"version":"3.41.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>In 2017, hundreds of thousands of Rohingya fled Myanmar to refugee camps in Cox\u2019s Bazar in southeastern Bangladesh. Peace Winds Japan and Dhaka Community Hospital Trust have jointly operated a primary health center (PHC) at Camp 14 in this region since 2018. Our objective was to determine the effect of Ramadan on clinical visits at this PHC during 2020. We conducted a retrospective analysis of patient data, including diagnoses and use of medications, by review of medical records from January to December 2020. We compared the percentage of visits for five health events (acute respiratory infection [ARI], non-communicable disease [NCD], gastritis, female related issues, and injury) for three consecutive 31-day periods: before Ramadan period (BR-period), Ramadan period, and after Ramadan period (AR-period). There were 11,286 PHC visits during 2020. The rate of new patient visits was significantly lower during Ramadan than during the BR-period (aOR: 0.447; 95%CI: 0.356, 0.561; P\u2009&lt;\u20090.001). The three periods had no significant differences in mean patient age, patient sex, or surgical procedures. The most noteworthy differences were fewer visits for NCD during Ramadan than during the BR-period (OR: 0.461; 95%CI: 0.307, 0.693; P\u2009&lt;\u20090.0004); more visits for gastritis during Ramadan than during the BR-period (OR: 1.246; 95%CI: 1.106,1.404; P\u2009=\u20090.0019); and more visits for ARI during Ramadan than during the AR-period (aOR: 1.842; 95%CI: 1.567, 2.164, P\u2009&lt;\u20090.0001). The overall decrease in PHC visits during Ramadan relative to the BR-period may be because these refugees devoted more time to prayer and associated religious practices during Ramadan, and therefore had less time available for visiting the PHC. The sharp decline in PHC visits for NCD and several other health events during Ramadan relative to the BR-period highlights the need to provide improved care for refugees during this period.<\/jats:p>","DOI":"10.1371\/journal.pgph.0004764","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:38:43Z","timestamp":1750268323000},"page":"e0004764","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Ramadan on clinical visits at a primary health center in a Rohingya refugee camp in Bangladesh"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0331-6225","authenticated-orcid":true,"given":"Taizo","family":"Sakata","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Odgerel","family":"Chimed-Ochir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md Omar Sharif","family":"Ibne Hasan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mototaka","family":"Inaba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-1082","authenticated-orcid":true,"given":"Yasuhiko","family":"Kamiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yui","family":"Yumiya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuhiko","family":"Kubo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"pgph.0004764.ref001","article-title":"Joint Government of Bangladesh - UNHCR Population Factsheet - as of 31 January 2024","author":"United Nations High Commissioner for Refugees UNHCR, Joint Government of Bangladesh","year":"2024"},{"key":"pgph.0004764.ref002","article-title":"Joint Response Plan: Rohingya Humanitarian Crisis","author":"United Nations High Commissioner for Refugees UNHCR","year":"2022"},{"key":"pgph.0004764.ref003","first-page":"187","article-title":"The Qur\u2019an","author":"YA Abdullah","year":"2003"},{"issue":"624","key":"pgph.0004764.ref004","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3399\/bjgp14X680605","article-title":"Ramadan: what it means for general practice","volume":"64","author":"F Mughal","year":"2014","journal-title":"Br J Gen Pract"},{"issue":"10","key":"pgph.0004764.ref005","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.2337\/diacare.27.10.2306","article-title":"A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422\/2001 (EPIDIAR) study","volume":"27","author":"I Salti","year":"2004","journal-title":"Diabetes Care"},{"issue":"6","key":"pgph.0004764.ref006","first-page":"491","article-title":"Association between Spirituality and Adherence to Management in Outpatients with Heart Failure","volume":"106","author":"JS Alvarez","year":"2016","journal-title":"Arq Bras Cardiol"},{"issue":"1","key":"pgph.0004764.ref007","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/1751-0759-7-15","article-title":"Spiritual and religious beliefs: do they matter in the medication adherence behaviour of hypertensive patients?","volume":"7","author":"I Kretchy","year":"2013","journal-title":"Biopsychosoc Med"},{"key":"pgph.0004764.ref008","article-title":"Rohingya Population by Location - UNHCR Population Map as of 31 March 2022","author":"United Nations High Commissioner for Refugees UNHCR, Joint Government of Bangladesh","year":"2022"},{"key":"pgph.0004764.ref009","article-title":"Joint Government of Bangladesh - UNHCR Population Factsheet - Block Level as of 30 April 2022","author":"United Nations High Commissioner for Refugees UNHCR, Joint Government of Bangladesh","year":"2022"},{"key":"pgph.0004764.ref010","unstructured":"Bangladesh local government, Cox\u2019s Bazar. Host community data provided to the humanitarian health partners in the camp. 2022."},{"key":"pgph.0004764.ref011","article-title":"Surveillance in post extreme emergencies and disasters operations manual for managers","author":"Department of Health R of the P"},{"issue":"4","key":"pgph.0004764.ref012","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4274\/eajem.galenos.2019.89410","article-title":"Effect of Ramadan on emergency department attendances: a retrospective study","volume":"20","author":"P \u015eim\u015fek","year":"2021","journal-title":"Eurasian J Emerg Med"},{"key":"pgph.0004764.ref013","volume-title":"Experimental and Quasi-experimental designs for generalized causal inference","author":"WR Shadish","year":"2002"},{"key":"pgph.0004764.ref014","volume-title":"Designing clinical research","author":"SB Hulley","year":"2013"},{"issue":"6","key":"pgph.0004764.ref015","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"18","author":"JP Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"pgph.0004764.ref016","article-title":"Gastrointestinal health in Ramadan with special reference to diabetes","volume":"65","author":"Z Abbas","year":"2015","journal-title":"J Pak Med Assoc"},{"key":"pgph.0004764.ref017","unstructured":"Karabon P, Beaumont W. Rare events or non-convergence with a binary outcome? The power of Firth regression in PROC LOGISTIC. In: Presented at: SAS Global Forum 2020. 2020."},{"issue":"12","key":"pgph.0004764.ref018","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.4103\/indianjpsychiatry.indianjpsychiatry_827_23","article-title":"Firth\u2019s penalized logistic regression: a superior approach for analysis of data from India\u2019s National Mental Health Survey, 2016","volume":"65","author":"S Suhas","year":"2023","journal-title":"Indian J Psychiatry"},{"issue":"6","key":"pgph.0004764.ref019","article-title":"Demographics and clinical presentations of patients visiting the emergency department during the holy month of ramadan: a three-year retrospective study in a Muslim-Majority Country","volume":"15","author":"IM Khojah","year":"2023","journal-title":"Cureus"},{"key":"pgph.0004764.ref020","first-page":"23333928241266041","article-title":"Patient care during ramadan: a narrative review","volume":"11","author":"MN Bhuiyan","year":"2024","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"pgph.0004764.ref021","year":"2023"},{"key":"pgph.0004764.ref022","author":"S Balsari","year":"2023"},{"issue":"2","key":"pgph.0004764.ref023","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/2230-8229.181006","article-title":"Ramadan fasting is not usually associated with the risk of cardiovascular events: A systematic review and meta-analysis","volume":"23","author":"TC Turin","year":"2016","journal-title":"J Family Community Med"},{"issue":"2","key":"pgph.0004764.ref024","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/2231-0770.179547","article-title":"The cardiac patient in Ramadan","volume":"6","author":"M Chamsi-Pasha","year":"2016","journal-title":"Avicenna J Med"},{"key":"pgph.0004764.ref025","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.diabres.2017.03.003","article-title":"Diabetes and Ramadan: Practical guidelines","volume":"126","author":"M Hassanein","year":"2017","journal-title":"Diabetes Res Clin Pract"},{"issue":"5","key":"pgph.0004764.ref026","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1007\/s10943-015-0160-0","article-title":"Evaluation of self-perceived changes in gastrointestinal symptoms during Ramadan fasting","volume":"56","author":"AH Keshteli","year":"2017","journal-title":"J Relig Health"},{"key":"pgph.0004764.ref027","author":"Inter Sector Coordination Group","year":"2020"},{"key":"pgph.0004764.ref028","author":"United Nations Population Fund (UNFPA)","year":"2022"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004764","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T17:39:09Z","timestamp":1750268349000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0004764"}},"subtitle":[],"editor":[{"given":"Julia","family":"Robinson","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":28,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0004764","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}