Care In Bangladesh Research Articles

A novel digital health approach to improving global pediatric sepsis care in Bangladesh using wearable technology and machine learning.

Sepsis is the leading cause of child death globally with low- and middle-income countries (LMICs) bearing a disproportionate burden of pediatric sepsis deaths. Limited diagnostic and critical care capacity and health worker shortages contribute to delayed recognition of advanced sepsis (severe sepsis, septic shock, and/or multiple organ dysfunction) in LMICs. The aims of this study were to 1) assess the feasibility of a wearable device for physiologic monitoring of septic children in a LMIC setting and 2) develop machine learning models that utilize readily available wearable and clinical data to predict advanced sepsis in children. This was a prospective observational study of children with sepsis admitted to an intensive care unit in Dhaka, Bangladesh. A wireless, wearable device linked to a smartphone was used to collect continuous recordings of physiologic data for the duration of each patient's admission. The correlation between wearable device-collected vital signs (heart rate [HR], respiratory rate [RR], temperature [T]) and manually collected vital signs was assessed using Pearson's correlation coefficients and agreement was assessed using Bland-Altman plots. Clinical and laboratory data were used to calculate twice daily pediatric Sequential Organ Failure Assessment (pSOFA) scores. Ridge regression was used to develop three candidate models for advanced sepsis (pSOFA > 8) using combinations of clinical and wearable device data. In addition, the lead time between the models' detection of advanced sepsis and physicians' documentation was compared. 100 children were enrolled of whom 41% were female with a mean age of 15.4 (SD 29.6) months. In-hospital mortality rate was 24%. Patients were monitored for an average of 2.2 days, with > 99% data capture from the wearable device during this period. Pearson's r was 0.93 and 0.94 for HR and RR, respectively) with r = 0.72 for core T). Mean difference (limits of agreement) was 0.04 (-14.26, 14.34) for HR, 0.29 (-5.91, 6.48) for RR, and -0.0004 (-1.48, 1.47) for core T. Model B, which included two manually measured variables (mean arterial pressure and SpO2:FiO2) and wearable device data had excellent discrimination, with an area under the Receiver-Operating Curve (AUC) of 0.86. Model C, which consisted of only wearable device features, also performed well, with an AUC of 0.78. Model B was able to predict the development of advanced sepsis more than 2.5 hours earlier compared to clinical documentation. A wireless, wearable device was feasible for continuous, remote physiologic monitoring among children with sepsis in a LMIC setting. Additionally, machine-learning models using wearable device data could discriminate cases of advanced sepsis without any laboratory tests and minimal or no clinician inputs. Future research will develop this technology into a smartphone-based system which can serve as both a low-cost telemetry monitor and an early warning clinical alert system, providing the potential for high-quality critical care capacity for pediatric sepsis in resource-limited settings.

O27 DEVELOPMENT OF A CONCEPTUAL EVALUATION MODEL AND TESTING ITS PERFORMANCE IN HYPOTHETICAL PAY-FOR-PERFORMANCE INTERVENTIONS TO IMPROVE HYPERTENSION CONTROL

Background and Objective: Hypertension is a growing concern, particularly in low- and middle-income countries. Financial incentives, such as pay-for-performance, have shown promise in improving non-hypertension outcomes. However, their efficacy and cost-effectiveness in hypertension management, especially in low-resource contexts, remain uncertain. Our objectives were to 1) document studies exploring health financial interventions for hypertension management 2) develop a conceptual model which can facilitate future research on health financing approaches for hypertension management, and 3) assess the model's performance in hypothetical pay-for-performance interventions. Methods: Our literature review identified few studies evaluating finance interventions on hypertension management with somewhat more evidence for pay-for-performance strategies. Thus, we developed a conceptual model and assessed its performance in hypothetical scenarios of pay-for-performance schemes to enhance public hypertension care in Bangladesh. Using a state-transition modeling framework, we estimated the incentive costs and impact on cardiovascular disease burden in 18 scenarios with varying intervention coverage, blood pressure effects, and incentive rates (Figure 1). Key model inputs were derived from the 2019 Global Burden of Disease Study, the 2018 WHO STEPS survey, and WHO-CHOICE. Our primary outcome was incentive costs per health-adjusted life year (HALY) gained. Results: Based on our model, the incentive costs per HALY gained depended on the intervention coverage, intervention effect and incentive rate (Figure). If only currently treated patients were included, the most optimistic scenario (i.e., the largest blood pressure reduction with the lowest incentive rate) was estimated to cost 11,043 USD in incentives per HALY gained (Figure). If the intervention also included new, previously untreated patients while maintaining the same total incentives, the estimated incentive costs per HALY gained was 5,515 USD. Conclusions: Our model suggests that pay-for-performance interventions for hypertension care may demand substantial financial resources, but that the intervention could become more favorable with increased treatment coverage. While more studies on the impact of financial interventions in hypertension care are necessary, our model can guide planning and designing such a study.

Text messaging to improve retention in hypertension care in Bangladesh.

Visit non-attendance is a common barrier to hypertension control in low and middle-income countries (LMICs). We aimed to evaluate the effectiveness of mobile text messaging in improving visit attendance among patients with hypertension in primary healthcare facilities in Bangladesh. A randomized A/B testing study was conducted with two patient groups: (1) patients regularly attending visits (regular patients) and (2) patients overdue for their follow-up clinic visit (overdue patients). Regular patients were randomized into three groups: a cascade of three text reminders, a single text reminder, or no text reminder. Overdue patients were randomized into two groups: a single text reminder or no text reminder. 20,072 regular patients and 12,708 overdue patients were enrolled. Among regular patients, visit attendance was significantly higher in the cascade reminder group and the single reminder group compared to the no reminder group (78.2% and 76.6% vs. 74.8%, p < 0.001 and 0.027, respectively). Among overdue patients, the single reminder group had a 5.8% higher visit attendance compared to the no reminder group (26.5% vs. 20.7%, p < 0.001). The results remained consistent in multivariable analysis; adjusted prevalence ratio (PR) was 1.04 (95% CI 1.02-1.06) for the cascade reminder group and 1.02 (95% CI 1.00-1.05) for the single reminder group among regular patients. The adjusted PR for the single reminder group vs. the no reminder group among overdue patients was 1.23 (95% CI 1.15-1.33). Text message reminders are an effective strategy for improving retention of patients in hypertension treatment in LMICs, especially for patients overdue to care.

Inequalities in adolescent girls’ nutrition, education, and health care in Bangladesh, Ethiopia, India, and Nigeria

ABSTRACT Poor nutrition during adolescence can undermine current and future health, well-being, schooling, and productivity, particularly among socioeconomically disadvantaged girls. We analysed wealth and schooling-related inequalities among adolescent girls in Bangladesh, Ethiopia, India, and Nigeria. Using data from Demographic and Health Surveys (DHS), we calculated the Erreygers Index (EI) for low body mass index (BMI), anaemia, completed primary education, and health care. The patterns of socioeconomic inequalities differed among countries. Adolescent girls from relatively higher economic groups and with better education had better nutrition, education, and health care outcomes across countries. EI by wealth for a low BMI ranged from −0.059 to −0.095; anaemia ranged from −0.043 to −0.088. Nutritional status inequalities by wealth varied less than inequalities in schooling. EI by wealth for primary school completion ranged from 0.166 to 0.646 and EI for 4 or more ANC visits from 0.211 to 0.315. Substantial differences were found in inequalities within countries. The underlying reasons for inequalities need to be studied and investments should be made to implement targeted interventions for improving the current and future development and well-being of adolescent girls.

Patterns of Socioeconomic Inequalities Experienced by Adolescent Girls in Nutrition, Education and Health Care in Bangladesh, Ethiopia, India and Nigeria

Patterns of Socioeconomic Inequalities Experienced by Adolescent Girls in Nutrition, Education and Health Care in Bangladesh, Ethiopia, India and Nigeria

Understanding patient and family experiences of critical care in Bangladesh and India: What are the priority actions to promote person-centred care?

Patients' experiences in the intensive care unit (ICU) can enhance or impair their subsequent recovery. Improving patient and family experiences on the ICU is an important part of providing high quality care. There is little evidence to guide how to do this in a South Asian critical care context. This study addresses this gap by exploring the experiences of critically ill patients and their families in ICUs in Bangladesh and India. We elicit suggestions for improvements from patients, families and staff and highlight examples of practices that support person-centred care. This multi-site hospital ethnography was carried out in five ICUs in government hospitals in Bangladesh and India, selected using purposive sampling. Qualitative data were collected using non-participant observation and semi-structured interviews and analysed using reflexive thematic analysis. A total of 108 interviews were conducted with patients, families, and ICU staff. Over 1000 hours of observation were carried out across the five study sites. We identified important mediators of patient and family experience that span many different aspects of care. Factors that promote person-centred care include access to ICU for families, support for family involvement in care delivery, clear communication with patients and families, good symptom management for patients, support for rehabilitation, and measures to address the physical, environmental and financial needs of the family. This study has generated a list of recommendations that can be used by policy makers and practitioners who wish to implement person-centred principles in the ICU.

Factors Influencing Perception of Social Support among Patients with Advanced Cancer Receiving Palliative Care in Bangladesh

The perception of social support among patients with advanced diseases is influenced by various factors. The socio-cultural context of Bangladesh significantly shapes the experience of patients with advanced cancer and their perception of social support. This study’s aim was to assess the perceived social support by these patients and investigate the factors that shape their perception. This cross-sectional study was conducted among 115 advanced cancer patients admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). Perceived social support was moderate to high for most (74.7%) of the participants. The majority (97.4%) perceived moderate to high level of support from their families. The lowest level of support was perceived from friends (53%). Factors such as economic status, family size, companionship of children, and emotional support from spouses influenced the level of perceived social support. Social support is one of the important aspects of palliative care. Identifying the factors influencing the perception of social support among cancer patients is essential for palliative care professionals to effectively address their care needs.

National chlorhexidine coverage and factors associated with newborn umbilical cord care in Bangladesh and Nepal: a cross-sectional analysis using household data

BackgroundPreventable newborn deaths are a global tragedy with many of these deaths concentrated in the first week and day of life. A simple low-cost intervention, chlorhexidine cleansing of the umbilical cord, can prevent deaths from omphalitis, an infection of the umbilical cord. Bangladesh and Nepal have national policies promoting chlorhexidine use, as well as routinely collected household survey data, which allows for an assessment of coverage and predictors of the intervention.MethodsWe used data from the 2017–2018 Bangladesh Demographic and Health Survey and the 2016 Nepal Demographic and Health Survey, two large-scale nationally representative household surveys. We studied coverage of single application of chlorhexidine to the umbilical cord of newborns born in the past year using descriptive, bivariate and multivariable analyses. Key predictors of newborns receiving chlorhexidine cleansing, including socio-economic factors, healthcare related factors and the application of harmful and nonharmful substances, were explored in this study.ResultsCoverage of chlorhexidine cleansing was 15.0% in Bangladesh and 50.7% in Nepal, while the application of a harmful substance was 16.9% in Bangladesh and 22.6% in Nepal. Results from the multivariable analyses indicated that delivery in a health facility was strongly associated with a newborn’s receipt of chlorhexidine in both countries (Bangladesh: OR = 2.23, p = 0.002; Nepal: OR = 5.01, p = 0.000). In Bangladesh, delivery by Cesarean section and application of another non-harmful substance were significantly and positively associated with the receipt of chlorhexidine. In Nepal antenatal care was significantly and positively associated with chlorhexidine, while application of a harmful substance was significantly and negatively associated with receipt of chlorhexidine. Maternal education, urban/rural residence, religion and sex were not significant in the multivariable analysis. Wealth was not a significant factor in Bangladesh, but in Nepal newborns in the two highest wealth quintiles were significantly less likely to receive chlorhexidine than newborns in the lowest wealth quintile.ConclusionAs Bangladesh and Nepal continue to scale-up chlorhexidine for newborn umbilical cord care, additional focus on newborns born in non-facility environments may be warranted. Chlorhexidine cleansing may have the potential to be an equitable intervention, as newborns from the poorest wealth quintiles and whose mothers had less education were not disadvantaged in receiving the intervention in these two settings.

Introducing a digital emergency obstetric and newborn care register for indoor obstetric patient management: An implementation research in selected public health care facilities of Bangladesh.

Digital health records have emerged as vital tools for improving health care delivery and patient data management. Acknowledging the gaps in data recording by a paper-based register, the emergency obstetric and newborn care (EmONC) register used in the labour ward was digitised. In this study, we aimed to assess the implementation outcome of the digital register in selected public health care facilities in Bangladesh. Extensive collaboration with stakeholders facilitated the development of an android-based electronic register from the paper-based register in the labour rooms of the selected district and sub-district level public health facilities of Bangladesh. We conducted a study to assess the implementation outcome of introducing the digital EmONC register in the labour ward. The digital register demonstrated high usability with a score of 83.7 according to the system usability scale, and health care providers found it highly acceptable, with an average score exceeding 95% using the technology acceptance model. The adoption rate reached an impressive 98% (95% confidence interval (CI) = 98-99), and fidelity stood at 90% (95% CI = 88-91) in the digital register, encompassing more than 80% of data elements. Notably, fidelity increased significantly over the implementation period of six months. The digital system proved a high utility rate of 89% (95% CI = 88-91), and all outcome variables exceeded the predefined benchmark. The implementation outcome assessment underscores the potential of the digital register to enhance maternal and newborn health care in Bangladesh. Its user-friendliness, improved data completeness, and high adoption rates indicate its capacity to streamline health care data management and improve the quality of care.

Assessing the Quality and Coverage of Maternal Postnatal Care in Bangladesh: A Comparative Analysis of Quality Postnatal Care among Home and Facility Births.

Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. From 2010 to 2016, postnatal care coverage within 48 h of delivery by a qualified provider rose from 23% to 47%. Of the births, 94% were facility births that received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, type of birth attendant, delivery method, and financial readiness. Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. This study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC.

Blood Pressure, Urine, and Blood Test Barriers During Antenatal Care in Bangladesh: An Analysis of MICS 6

Antenatal care is important during the pregnancy. During that, pregnant women will be tested for blood pressure, urine, and blood test as the essential information for mother and baby. This study purposed to examine the factors impact to inaccessibility of blood pressure, urine, and blood test. This study used the secondary data using “Multiple Indicators Clusters Survey” round 6 in 2019. Total sample of this study are 7,607 women who experienced antenatal care services. The data analysis was done for univariate, bivariate, and multivariate using binary logistic regression. The results in this study revealed that educational level and wealth index as the main predictors of inaccessible tests during antenatal care. Increasing level of education and wealth index will decrease the barriers to access testes. Government and stakeholders can focus on education and economics sectors to increase the accessibility to antenatal care especially for blood pressure, urine, and blood test services.

Relationship between perceived social support and mental health status of the advanced cancer patients receiving palliative care in Bangladesh.

Cancer patients experience significant changes in their social roles along with various physical and psychological challenges. Despite the growing recognition of the importance of palliative care in Bangladesh, there is a notable gap in research focusing on the psychosocial issues faced by patients with advanced cancer. This study aims to explore the level of social support perceived by Bangladeshi cancer patients and determine how this support relates to their mental health status. This cross-sectional study was conducted among 115 advanced cancer (stages III and IV) patients admitted to the palliative medicine department of a tertiary care hospital in Bangladesh. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support, and the mental health status of the patients was assessed by Depression, Anxiety, and Stress Scale-21. Data collection was done from June to November 2023. Relationships between perceived social support, depression, anxiety, and stress were assessed by the Spearman correlation test. The moderating effect of perceived social support on patients' mental health variables was determined by multiple linear regression and simple slope analysis. p Value <0.05 was considered to be statistically significant. The study included an almost equal number of male (49.6%) and female (50.4%) patients, with a mean age of 50.7 ± 14.4 years. Overall, perceived social support was moderate to high for most (74.7%) of the participants. Among the participants, 78.3% experienced anxiety, 77.4% suffered from depression, and 70.5% experienced stress. Depression, anxiety, and stress were all negatively and significantly (p < 0.05) correlated with perceived social support. Younger patients reported higher levels of anxiety, stress, and depression. Perceived social support had a significant buffering effect on depression and anxiety among the younger patients. Perceived social support has a profound and significant effect on the mental health of advanced cancer patients. Integrating psychosocial support early in palliative care can be highly beneficial to the mental health of these patients.

Enforcing right to emergency medical care in Bangladesh: overcoming the constitutional hurdles and filling the legislative gap

Enforcing right to emergency medical care in Bangladesh: overcoming the constitutional hurdles and filling the legislative gap

Quality midwifery care during the COVID-19 pandemic in Bangladesh: A focus group study with midwives, nurses, and midwifery educators.

Bangladesh has made remarkable strides in the development of the midwifery profession. However, the COVID-19 pandemic has had profound effects on healthcare systems worldwide, including those related to reproductive, perinatal, and maternal health. Given the recent advancements in the midwifery field in Bangladesh, it is crucial to examine the pandemic's impact on existing barriers and the capacity of midwifery professionals to deliver high-quality care. The aim of this study is to describe the possibility of midwives being able to provide quality midwifery care in Bangladesh during the COVID-19 pandemic. To gather insights, data were collected from July to October 2020 via four qualitative focus group discussions online; 23 actively practicing midwives, nurses specializing in midwifery care, and midwifery educators, participated. The data analysis employed reflexive thematic analysis. The COVID-19 crisis posed significant threats to women's safety and health, with lockdowns exacerbating gender inequalities in society. Midwives faced added challenges due to their relatively low professional status and increased workloads. Insufficient policy implementation further compromised midwives' safety. Fear of contracting the virus and working during their free time also raised concerns about the quality of care provided. Nevertheless, the pandemic provided opportunities for midwives to demonstrate their ability to deliver independent midwifery care in Bangladesh. The pandemic underscored the importance of creating respectful and dignified working conditions for midwives. It revealed that professional midwives can work independently when provided with the necessary space and a supportive work environment. This opens the door for the implementation of a midwifery-led care model. Further research is recommended to investigate the medical safety and efficacy of independent midwifery care in the context of Bangladesh.

Implementing maternal and newborn health quality of care standards in healthcare facilities to improve the adoption of respectful maternity care in Bangladesh, Ghana and Tanzania: a controlled before and after study

IntroductionMany women worldwide cannot access respectful maternity care (RMC). We assessed the effect of implementing maternal and newborn health (MNH) quality of care standards on RMC measures.MethodsWe used a facility-based...

Out-of-pocket expenditure among patients with diabetes in Bangladesh: A nation-wide population-based study

Background and objectivesDiabetes has become one of the fastest growing public health emergencies worldwide. The objective of this study was to estimate the average annual out-of-pocket cost of diabetes treatment as well as to find out the catastrophic health expenditure (CHE) and their determinants in Bangladeshi context. Data and methodsThe study utilised data from the most recent nationally representative Household Income and Expenditure Survey 2016–2017. The incidence of CHE was estimated by applying 10% and 25% of the annual total household expenditure threshold levels. The factors associated with CHE was presented as adjusted odds ratio with 95% confidence intervals. ResultsThe annual average out-of-pocket cost per diabetes patient was US$ 323 (BDT 25,473). The cost of medication was the main cost driver contributed for 75.43% of the total out-of-pocket cost. The incidence of CHE was 14.34%, and 5.86% of the study households for 10% and 25% of the threshold levels, respectively. The patient aged more than 60 (AOR: 4.89; CI 0.82 to 28.95), uneducated (AOR: 1.83; CI 0.25 to 2.12), comorbid condition (AOR: 1.62; CI 0.94 to 2.79), small household size (AOR: 3.20; CI 0.58 to 17.51), rural resident (AOR: 1.85; CI 0.46 to 1.57), poorest asset quintile (AOR: 4.06; CI 1.43 to 13.87) and private facility type (AOR: 8.16; CI 3.46 to 19.;25) were significantly associated with the incidence of CHE due to diabetes treatment. ConclusionsThere are considerable out-of-pocket costs needed for diabetes care in Bangladesh. The evidence of catastrophic expenditure suggests the urgent need to improve financial risk protection to ensure access to care.

The Evolution of Alternative Care in Bangladesh over the Last Decade and the Way Forward

Article 20 of the Child Rights Convention (CRC) confers responsibility upon states for ensuring such care in situations where children are ‘temporarily or permanently deprived of his or her family environment’. Bangladesh, being among the first two countries in Asia to ratify CRC, enacted Children Act 2013 to implement the CRC standards. The Act has dedicated a chapter on alternative care covering type of disadvantaged children, alternative care options, child protection mechanism including gatekeeping measures, referral mechanism and the periodic review of alternative care arrangement. Though there is no defined alternative care system yet but several alternative cares such as kinship care, family-based care, family like care, residential/institutional care, etc. have been facilitated by Government, NGOs and private sectors. Challenges remain in assuring quality alternative care for all children including lack of resources and capacity, inadequate number of social welfare workforce; caregivers, limited access to mental health and disability services. Based on the literature and observation, this article explores ideas on the alternative care of children, particularly relating to its modalities and challenges in the context of Bangladesh. The authors opine that the children’s best interest cannot be achieved when a group grows without quality care.

Disparities, distribution, and determinants in appropriate timely initiation, number, and quality of antenatal care in Bangladesh: Evidence from Demographic and Health Survey 2017-18.

Like many other low- and middle-income countries, Bangladesh experiences a disproportionately higher number of maternal and neonatal deaths compared to high-income countries. Despite this, a majority of pregnant women in Bangladesh do not receive appropriate antenatal care (ANC). We investigated the disparities, distribution, and determinants of the timing, number, and quality of ANC in this country. This cross-sectional study analyzed Bangladesh Demographic and Health Survey (BDHS) 2017-18 data on ever-married reproductive-age (i.e., 15-49-year-olds) women. After describing the study sample and proportions, multilevel logistic regression was applied to study determinants. The prevalence and odds of the studied outcomes were higher among women with higher parity, a higher education level, more highly educated husbands, urban residence, and residence in some administrative divisions (p<0.05). For instance, among women in the poorest, poorer, middle, richer, and richest wealth quintiles, the proportions of those who initiated ANC during the first trimester were 22.2% (95% confidence interval (CI): 19.6-25.0), 30.1% (95% CI: 27.1-33.2), 35.1% (95% CI: 31.7-38.6), 38.5% (95% CI: 35.2-42.0), and 61.0% (95% CI: 57.5-64.3). Then, compared to women in the poorest wealth quintile, the adjusted odds ratio (AOR) for ANC initiation was higher among those in the poorer (AOR: 1.3, 95% CI: 1.1-1.7), middle (AOR: 1.5, 95% CI: 1.2-1.9), richer (AOR: 1.4, 95% CI: 1.1-1.8), and richest (AOR: 2.7, 95% CI: 2.1-3.5) household wealth quintiles. Given the importance of appropriate ANC, it is crucial to increase awareness and coverage among women with low socioeconomic status and rural residence, among other factors studied.

Effects of Job Demands, Job Resources and Psychological Capital on Work Engagement among Nurses in Bangladesh

The level of work engagement of nurses has indisputable contributions to patient service in the health care sectors. The Job Demands-Resources (JD-R) model predicts job demands and resources related to work engagement but has not previously been tested in the specific context of registered nurses of Bangladesh using psychological capital as a mediator. The main objective of this study is to investigate the impacts of job demands, and job resources on the work engagement of nursesof public hospitals in Bangladesh where psychological capital plays the role of mediator. A comprehensive review will be presented based on the most recently selected literature from an academic journal and relevant online platforms. However, as mentioned in the conceptual analysis, it will contribute to the literature by providing expanded knowledge of the job aspects associated with the work engagement of nurses and will confirm the importance of monitoring nurses' work engagement and psychological capital to improve patient satisfaction with nursing care in Bangladesh. Besides, the conceptual configuration of this study will help healthcare managers and policymakers of healthcare services that could serve as input for planning purposes. Furthermore, the conceptual model may possibly be able to assist nurses in practicing their ability with the responsibility to handle certain situations with the nursing staff coordinator's supervision.

Cascade of diabetes care in Bangladesh, Bhutan and Nepal: identifying gaps in the screening, diagnosis, treatment and control continuum

Diabetes has become a major cause of morbidity and mortality in South Asia. Using the data from the three STEPwise approach to Surveillance (STEPS) surveys conducted in Bangladesh, Bhutan, and Nepal during 2018–2019, this study tried to quantify the gaps in diabetes screening, awareness, treatment, and control in these three South Asian countries. Diabetes care cascade was constructed by decomposing the population with diabetes (diabetes prevalence) in each country into five mutually exclusive and exhaustive categories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled, (5) treated and controlled. In Bangladesh, Bhutan, and Nepal, among the participants with diabetes, 14.7%, 35.7%, and 4.9% of the participants were treated and controlled, suggesting that 85.3%, 64.3%, and 95.1% of the diabetic population had unmet need for care, respectively. Multivariable logistic regression models were used to explore factors associated with awareness of the diabetes diagnosis. Common influencing factors for awareness of the diabetes diagnosis for Bangladesh and Nepal were living in urban areas [Bangladesh-adjusted odd ratio (AOR):2.1; confidence interval (CI):1.2, 3.6, Nepal-AOR:6.2; CI:1.9, 19.9].