ABSTRACT
Background: Growing up without parental care can significantly affect a child's psychological well-being. Challenges within family relationships may further contribute to emotional difficulties among orphaned children. Objective: To assess the mental health status of orphaned children and examine its association with selected socio-demographic and orphanage-related characteristics in Bangladesh. Methods: A descriptive cross-sectional study was conducted among 102 orphaned children aged 10–18 years. The participants were residing at Sir Salimullah Muslim Orphanage, Azimpur, Dhaka, Bangladesh. Convenience sampling was used to select the participants. Data were collected through face-to-face interviews. A socio-demographic questionnaire was used to collect background information. Status of Mental health was assessed using the 38-item Mental Health Inventory (MHI-38). Frequencies, percentages, means, and standard deviations were used to summarize the data. Independent-samples t-tests, one-way analysis of variance (ANOVA), and Pearson’s correlation were used for data analysis. A p-value of less than .05 was set as statistically significant. Results: The mean mental health score was 85.67 ± 32.97. Mental health status was significantly associated with age (r = .297, p = .002), sex (p = .009), educational level (p = .035), academic performance (p = .003), frequency of relatives’ visits (p = .004), relationship with caregivers (p = .004), and living arrangements (p < .001). Older children, girls, and those with higher education and better academic performance had higher mental health scores. Children receiving relatives’ visits, having better caregiver relationships, and living in well-organized arrangements also had higher scores. Ages at parental loss, duration of stay, age at placement, and reason for admission were not significantly associated with mental health status. Conclusion: The mental health status of orphaned children was associated with several factors. These

ABSTRACT
Background: A referral system is an essential component in healthcare. The unpredictable nature of any pregnancy and the potential for life-threatening complications necessitate timely and effective referral mechanisms to ensure access to appropriate emergency obstetric care. An optimal obstetric referral system reduces delays and ensures timely access to appropriate care, leading to a reduction in pregnancy and childbirth complications. However, weaknesses in transport and communication systems, including health infrastructure often compromise the provision of quality obstetric care. The study aimed to assess the referral process for emergency obstetric care in primary level facilities as well as the availability of essential supplies for EmOC. Methods: The study used a cross-sectional design. The study was conducted between August and December 2022, targeting all healthcare workers working in obstetric units in Level 3 and 4 hospitals. Cochran’s formula was used to estimate the sample size (n =151). Stratified random sampling was used to select study participants. An interviewer-administered structured questionnaire and an observation checklist were used to collect data. The data was entered into SPSS v25 for analysis and analysed using descriptive and inferential statistics as applicable. Findings: Most of the respondents were aged between 30-39 years (54.0%), held a diploma education (88.2%), were nurses/midwives (81.4%) and were from Level 3 facilities (55.7%). Over 98% of the respondents agreed that EMoC referral is a common occurrence in their facilities and 96.3% were aware of obstetric signal functions. Effective communication and transport (linear regression coefficient, T=3.24, p=0.001), healthcare workers' perceived competence on the use of signal functions (linear regression coefficient, T=7.15, p=0.003), and the availability of supplies and equipment were strongly associated with the provision of quality EmOC services during the referral process (Chi-s