Health Facilities In Bangladesh Research Articles

Shock, response, and resilience of COVID-19 on Kangaroo Mother Care service utilisation in public health facilities in Bangladesh: An interrupted time series analysis

Shock, response, and resilience of COVID-19 on Kangaroo Mother Care service utilisation in public health facilities in Bangladesh: An interrupted time series analysis

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.

Vaccination and Pandemic Control in Bangladesh: Post Vaccination COVID-19 Positive Cases among Health Care Providers

Vaccination was started on a trial basis in Bangladesh from 27th January, 2021 and started mass vaccination from 7th February, 2021. Since starting of mass vaccination it was noticed that, the health care providers (HCPs) who received two doses of Astra-Zeneca were then reported of being infected. This cross-sectional study was conducted during the period of July to December 2021 and data were collected from July to August 2021. The main objective was to measure the proportion of post vaccinated Corona Virus Disease-19 (COVID-19) positive cases among healthcare providers working in different healthcare facilities in Bangladesh and aimed to collect available evidence to characterize these infections and correlations with different co-morbidities. This study was carried out among 450 vaccinated HCPs who received 2 doses of vaccine at various health care facilities (HCFs) from 32 districts of Bangladesh. Data were collected from HCPs (Doctors, Nurses, Lab technician) who willing to participate irrespective of age and sex. Among the HCPs nearly three-fourth (71.6%) was doctors, 21.3% nurses and 7.1% were lab technologists. Here, most of the (88.0%) respondents were in age group 21 to 40 years and other 22.0% was in age group 41 to 59 years. The number of Male-female respondents was equal and 77.8% of the respondents was Muslim followed by Hinduism (20.2%), Buddhist and Christian 2.0%. Study finds that 27.6% of the respondents was post vaccination COVID-19 positive (PVC-19+) (according to their rt-PCR test result). Less than one-fifth (18.7%) of the respondents had pre-existing co-morbidities among them 8.2% was suffering from hypertension (HTN), 6.0% asthma, 4% Diabetes Mellitus (DM), 2.0% Obesity, 1.1% ischemic heart disease (IHD) and 1.1% was others co-morbidities. Among the PVC-19+ cases most of them (84.6%) were in age group 21-40 years, male-female ratio was 1:0.9 and 81.5% was Muslim. More than three-fourth (77.4%) of positive cases were doctors, 17.7% nurses and 4.8% was lab technicians; among the PVC-19+ cases 87.9% was symptomatic. Three-fourth (75%) of the positive cases had fever, 51.6% had lost of smell and taste, 49.2% showed fatigue/ or malaise, 48.4% dry cough, 43.5% headache, 26.6% runny nose, 25.8% felt muscle pain, 19.4% sore throat, 18.5% shortness of breathing, 14.5% experienced joint pain, 9.7% had productive cough and 32.3% complained for other symptoms and signs. Majority of the PVC+19+ cases (57.26%) developed complications; among them 71.8% had tiredness/ fatigue, 31% difficulty in thinking/ concentrating, 21.1% headache, 19.7% cough, 15.5% dizziness, 14.1% loss of smell or taste, 12.7% joint or muscle pain, 12.7% fast-beating or pounding heart, 11.3% shortness of breathing, 8.5% chest pain and 29.9% developed other complications. Pre-existing co-morbidity was found in 66.94% of positive cases, among those 41.5% HTN, 36.6% asthma, 14.6% DM, 14.6% obesity, 4.9% IHD and 9.8% had others co-morbidity. Chi-square test for independence with α = 0.05 was done to assess association, hypertension (P = 0.009) and asthma (P = 0.001) with PVC-19+ cases was statistically significant. Hypertensive and asthmatic HCPs are more likely to be COVID-19 positive even after complete vaccination. Healthcare providers are at high risk for contracting COVID-19 and might become infected at home or nosocomially while caring for patients or interacting with other staff members. COVID-19 vaccination together with incessant use of personal protective equipment (PPE) might be recommended for HCPs to combat its pandemicity. Bangladesh Med J. 2022 Sept; 51(3): 1-9

Tobacco use in people with severe mental illness: Findings from a multi-country survey of mental health institutions in South Asia.

People with severe mental illness (SMI) tend to die early due to cardiovascular and respiratory diseases, which may be linked to tobacco use. There is limited information on tobacco use in people with SMI in low- and middle-income countries where most tobacco users reside. We present novel data on tobacco use in people with SMI and their access to tobacco cessation advice in South Asia. We conducted a multi-country survey of adults with SMI attending mental health facilities in Bangladesh, India, and Pakistan. Using data collected with a standardized WHO STEPS survey tool, we estimated the prevalence and distribution of tobacco use and assessed receipt of tobacco cessation advice. We recruited 3874 participants with SMI; 46.8% and 15.0% of men and women consumed tobacco, respectively. Smoking prevalence in men varied by country (Bangladesh 42.8%, India 20.1% and Pakistan 31.7%); <4% of women reported smoking in each country. Smokeless tobacco use in men also varied by country (Bangladesh 16.2%, India 18.2% and Pakistan 40.8%); for women, it was higher in Bangladesh (19.1%), but similar in India (9.9%) and Pakistan (9.1%). Just over a third of tobacco users (38.4%) had received advice to quit tobacco. Among smokers, 29.1% (n=244) made at least one quit attempt in the past year. There was strong evidence for the association between tobacco use and the severity of depression (OR=1.29; 95% CI: 1.12-1.48) and anxiety (OR=1.29; 95% CI: 1.12-1.49). As observed in high-income countries, we found higher tobacco use in people with SMI, particularly in men compared with rates reported for the general population in South Asia. Tobacco cessation support within mental health services offers an opportunity to close the gap in life expectancy between SMI and the general population. ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933 39.

1857. Why do antibiotic become resistant in hospitalized patients? Evidence from tertiary healthcare facilities in Bangladesh

Abstract Background Antibiotic resistance among hospitalized patients is a growing concern due to irrational antibiotic consumption. Exploring the dynamics of antibiotic consumption including healthcare-seeking behavior is indispensable to minimizing the antibiotic resistance burden. This study explored the pattern of antibiotic consumption and healthcare-seeking behavior of patients before being admitted to tertiary hospitals in Bangladesh. Methods Between August and September 2022, we conducted this cross-sectional study in four tertiary care ( 2 public and 2 private) hospitals. A total of 943 admitted patients were randomly enrolled and face-to-face interviews were conducted to obtain data on antibiotic usage history, healthcare-seeking patterns, and duration of medical consultation. Descriptive statistics were used for the analysis and interpretation. Results Prior to hospitalization, 32.8% (95%CI: 30.5, 35.1) of patients had antibiotic consumption history within the previous two months without lab confirmation. About one-quarter (25.6%) of the participants sought antibiotic treatment from unregistered physicians. Patients admitted to private hospitals were found to be higher to seek treatment from unregistered sources compared to public hospitals (37.8% vs. 13.4%, p-value: 0.001). Less than two-thirds (63.8%) of patients completed their entire course of antibiotics before admission to the hospitals. The average duration between symptom onset and medical consultation was 5.6 (SD 1.3) days before hospitalization. In terms of place for healthcare seeking, the majority of participants (52.0%) visited government hospitals, followed by private hospitals (22.6%), and pharmacies (20.1%). Self-medication was found in 5.3% of participants before being admitted to the hospital. However, 72.2% of patients were prescribed antibiotics after admission and only 5.3% had a laboratory diagnosis before receiving antibiotics. Conclusion Hospitalized patients were found to consume antibiotics more frequently before and after admission. Furthermore, healthcare seeking from unregistered sources, including delayed and incomplete treatment could hindrance to combating against antibiotic resistance among admitted patients. Disclosures All Authors: No reported disclosures

Working conditions of the clinical health workforce in the public health facilities in Bangladesh.

The COVID-19 pandemic has highlighted the importance of a well-equipped and supported healthcare workforce, and Bangladesh still faces challenges in providing adequate and well-equipped healthcare services. Therefore, the study aims to assess the level of working conditions of the clinical health workers in Bangladesh and their relative importance in delivering quality healthcare services. The study followed a cross-sectional study design and collected primary data adopting a quantitative method. A total of 319 clinical workforces from four districts and eight sub-districts were randomly selected using a multi-stage sampling technique. A 26-component questionnaire used to assess various components of working conditions. Descriptive statistics, and bivariate analysis were used to analyze the data. The study found that the working conditions of clinical health workers in primary and secondary healthcare facilities in Bangladesh were quite poor (3.40), with almost two-thirds of respondents showing negative views in 23 out of 26 indicators. The results also showed that working conditions were significantly (p ≤ 0.05) higher in primary compared to secondary level facilities. Moreover, men, younger workforce, and workforce with shorter length of service were more likely to report poor working conditions than their counterparts. Lastly, receiving monthly salary in due time was top-ranked (99.15) in terms of importance for delivering quality healthcare, followed by availability of medicines (98.04), and medical and surgical requisites (97.57), and adequate mentoring and support to perform duties (97.50). The study highlights the poor working conditions of clinical health workers in public health facilities in Bangladesh. It recommends that policymakers should prioritize improving working conditions by addressing the factors that are crucial for delivering quality healthcare. Improving working conditions will have a positive impact on the retention and motivation of workers, which will ultimately lead to better health outcomes for the population.

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...

Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis.

The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.

Post-COVID-19 Illness Trend in a Local Community in Bangladesh.

An infection with coronavirus disease 2019 (COVID-19) might show a wide range of symptoms. Many individuals still experience symptoms after a prolonged period of initial COVID-19. The objective is to find out the prolonged consequences of COVID-19 with their associations. Two hundred and eighty-six COVID-19 cases were the subject of this cross-sectional investigation, which was carried out in basic and secondary healthcare facilities in Bangladesh. COVID-19-positive participants with consent wereinterviewed in person about their sociodemographic traits, the nature of their COVID-19 infection, risk factors, present manifestations, etc. We carried out our statistical exploration by use ofIBMSPSSStatistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). To evaluate differences, we utilized the chi-square (χ2) test as well as the unpaired t-test. Our significance threshold level was 0.05. In this study, 18.5% of participants reported having post-COVID-19 symptoms. The four main symptom categories were anorexia (26.4%), myalgia (34.8%), fatigue (41.5%), and palpitations (25.5%). The majority of post-COVID-19 syndrome patients (e.g., 40.0%) were over 50 years old. Severe disease (81.8%) was more likely to develop post-COVID-19 illness. Fifty-three out of 286 participants (or 18.5%) reported having post-COVID-19 symptoms. The main symptom categories included fatigue, myalgia, anorexia, and palpitations. In order to determine the risk variables our data supports, additional investigation is required.

Equity assessment of maternal and child healthcare benefits utilization and distribution in public healthcare facilities in Bangladesh: a benefit incidence analysis

BackgroundThe distribution of healthcare services should be based on the needs of the population, regardless of their ability to pay. Achieving universal health coverage implies first ensuring that people of all income levels have access to quality healthcare, and then allocating resources reasonably considering individual need. Hence, this study aims to understand how public benefits in Bangladesh are currently distributed among wealth quintiles considering different layers of healthcare facilities and to assess the distributional impact of public benefits.MethodsTo conduct this study, data were extracted from the recent Bangladesh Demographic and Health Survey 2017–18. We performed benefit incidence analysis to determine the distribution of maternal and child healthcare utilization in relation to wealth quintiles. Disaggregated and national-level public benefit incidence analysis was conducted by the types of healthcare services, levels of healthcare facilities, and overall utilization. Concentration curves and concentration indices were estimated to measure the equity in benefits distribution.ResultsAn unequal utilization of public benefits observed among the wealth quintiles for maternal and child healthcare services across the different levels of healthcare facilities in Bangladesh. Overall, upper two quintiles (richest 19.8% and richer 21.7%) utilized more benefits from public facilities compared to the lower two quintiles (poorest 18.9% and poorer 20.1%). Benefits utilization from secondary level of health facilities was highly pro-rich, while benefit utilization found pro-poor at primary levels. The public benefits in Bangladesh were also not distributed according to the needs of the population; nevertheless, poorest 20% household cannot access 20% share of public benefits in most of the maternal and child healthcare services even if we ignore their needs.ConclusionsBenefit incidence analysis in public health spending demonstrates the efficacy with which the government allocates constrained health resources to satisfy the needs of the poor. Public health spending in Bangladesh on maternal and child healthcare services were not equally distributed among wealth quintiles. Overall health benefits were more utilized by the rich relative to the poor. Hence, policymakers should prioritize redistribution of resources by targeting the socioeconomically vulnerable segments of the population to increase their access to health services to meet their health needs.

Understanding variations in diarrhea management across healthcare facilities in Bangladesh: a formative qualitative study.

Acute diarrhea remains a leading cause of morbidity and mortality with over 6.3 billion cases and 1.3 million deaths annually. Despite the existence of standardized guidelines for diarrhea management, wide variability in clinical practice exists, particularly in resource-limited settings. The goal of this study was to qualitatively explore how diarrhea management in Bangladesh varies according to resource availability, clinical setting, and provider roles. This was a secondary analysis of a cross-sectional qualitative study conducted in three diverse hospital settings (district hospital, subdistrict hospital, and specialty diarrhea research hospital) in Bangladesh. A total of eight focus group discussions with nurses and physicians were conducted. Applied thematic analysis was used to identify themes regarding variations in diarrhea management. Of the 27 focus group participants, 14 were nurses and 13 doctors; 15 worked in a private diarrhea specialty hospital and 12 worked in government district or subdistrict hospitals. Several key themes emerged from the qualitative data analysis: 1) priorities in the clinical assessment of diarrhea 2) use of guidelines versus clinical judgment; 3) variability in clinician roles and between clinical settings influences care delivery; 4) impact of resource availability on diarrhea management; and 5) perceptions of community health workers' role in diarrhea management. Findings from this study may aid in informing interventions to improve and standardize diarrhea management in resource-constrained settings. Resource availability, practices regarding diarrhea assessment and treatment, provider experience, and variability in provider roles are essential considerations when developing clinical tools in low- and middle- income countries.

Service availability and readiness assessment of COVID-19 disease management at different tiers of health service delivery in Bangladesh

Background: The world is passing through a hard time due to the highly infectious COVID-19 pandemic. Like other countries in the world, the Bangladesh government has taken various preventive measures. As part of this, the availability and readiness of different health facilities is crucial. Objective: The study aimed to assess availability and readiness based on logistics, workforce, clinical management, and IPC. Methods: A cross-sectional quantitative study was conducted from August 20 to September 30, 2021, which comprised a health facility survey with a sample of 210. The health facilities included all three tiers of hospitals, covering 24 districts of eight divisions. All COVID-19 dedicated hospitals were included in this survey. The questionnaire consisted of a standard checklist developed by WHO, DGHS, and CDC. Results: The overall scores for ICU, HDU, and ventilation service were 76.8%, 87.5%, and 85.7%, respectively, but they were almost missing in Upazila health complex and below the average in non-dedicated hospitals. All (100%) secondary and tertiary level hospitals had a 24-hour staffed emergency unit, with dedicated hospitals outperforming non-dedicated hospitals (99.2% vs 98.7%). Above 90% of hospitals in different tiers had hand hygiene supplies and respiratory hygiene supplies for staff and patients, 98% of the primary level hospitals displayed instructions on hand and respiratory hygiene practices. On the other hand, 94.9% of secondary level hospitals had clearly identified and separated COVID-19 isolation areas from non-COVID-19 areas; 82.1% of secondary level hospitals had service providers (MOs) who used PPE; 97.4% had routine cleaning and disinfection of ambulances done according to IPC guidelines; and 64.1% had staff of laboratory, laundry, food services, and waste management teams who used appropriate PPE. Secondary level hospitals had a better availability of PPE compared to primary and tertiary level hospitals, which consisted of protective gowns (87.8%), disposable latex gloves (examination) (92.5%), goggles, protective (82.9%), face shields (72.5%), respirator masks (N95 or FFP2) (75.0%), and masks, medical/surgical (97.6%) available for all health service providers. Almost 26.2% facility have PCR testing lab and almost all (96.7%) the facilities have specimen collection system in their facility. Conclusion: The service availability and readiness regarding COVID-19 among different tiers of health facilities in Bangladesh are not adequate. We need more support for disease detection capacities through provision of technical expertise, laboratory equipment and increase capacity of the secondary and primary health care tier along with national capacity for covid-19 testing. Bangladesh Medical Res Counc Bull 2022; 48: 160-171

Post-traumatic stress disorders and coping strategies of health professionals during COVID-19 pandemic in Bangladesh: Findings of a countrywide cross-sectional study.

COVID-19 pandemic imposed a devastating effect on the psychological health of health professionals as they worked nonstop to withstand the hardship of the pandemic. The present study intended to determine the post-traumatic stress disorders (PTSD) and coping strategies among health professionals during the COVID-19 pandemic in Bangladesh. This country-wide cross-sectional study was conducted from July to December 2021 among 1394 health professionals (596 physicians, 713 nurses, 85 medical technologists) who served COVID-19 patients at the secondary, tertiary, and specialized government healthcare facilities in Bangladesh and completed at least one month after exposure to COVID-19 patient-care. Data were collected through face-to-face interviews using a semi-structured questionnaire and analyzed by SPSS software. All the ethical issues were maintained strictly. Most of the participants, 877(62∙9%) [95% CI: 60∙3-65∙5], were female, and 327(23∙5%) [95% CI: 21∙3-25∙8] developed PTSD. Females (AOR:1∙42 [95% CI: 1∙083-1∙868] p=0∙011), having an elderly family member (AOR:1∙515 [95% CI: 1∙173-1∙956] p=0∙0014), working in specialized hospitals (AOR:2∙685 [95% CI: 1∙928-3∙739] p<0∙001), and working ≥8 hours/day (AOR:1∙897 [95% CI: 1∙350-2∙666] p=0∙0002) had higher odds of developing PTSD. Most of the participants adopted spiritual approaches 96(29∙4%) [24∙5-34∙6] and distraction by watching TV/YouTube 59(18∙0%) [14∙0-22∙6] as coping strategies. The study findings would be helpful for health policymakers and managers to develop comprehensive measures for restoring the mental well-being of health professionals by alleviating PTSD induced by a pandemic like COVID-19. The study got funding from the Directorate General of Medical Education under the Ministry of Health and Family Welfare, Bangladesh.

The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases

BackgroundThe rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs).MethodsA cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities’ readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered ‘ready’ to manage NCDs.ResultsThe general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs.ConclusionAll levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.

"They were quick, insipid, and stuck to the typical medical checkups": A Narrative Study on Women's Expectations and Experiences of Maternity Care in Bangladesh.

The quality of healthcare service delivery is generally determined by how patients' expectations were met successfully. This narrative study explores how women perceive and experience healthcare during childbirth in the context of Bangladesh. This study is inspired by Clandinin and Connelly's three-dimensional paradigm of narrativity that combines temporality, social interaction, and place. To unearth patient-driven narratives, the researcher purposely picked 12 women who gave birth in different private and public health facilities in Bangladesh. Four themes standout from the women's narratives. Excerpts of women's stories have been included in discussing the themes as well as author's conviction on this phenomenon. Most of the participants experienced a shared level of difficulty in choosing the health facilities (private vs public), motivated primarily by delivery costs and social background. Women with a higher level of education and financial means often opted to give birth in private facilities due to their negative perception and experience of the public facility. There was evident discontent when doctors decided for cesarean deliveries. Women were dissatisfied by providers' general lack of empathy and vicarious emotion. However, those women who gave birth in public hospitals expressed some degree of satisfaction which might be attributed to their low expectations and moderate social standing. Women's stories also delved into how societal norms, taboos, and elderly relatives put them in uncomfortable situations. To improve patient-provider interactions, healthcare practitioners should prioritize patient-centered care and collaborative decision-making. Reducing healthcare disparity and resolving superannuated pregnancy norms are also critical challenges.

Preference and willingness to receive non-communicable disease services from primary healthcare facilities in Bangladesh: A qualitative study

BackgroundIn Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden. NCD services have been significantly mobilized to primary healthcare (PHC) facilities to better manage the rising burden of NCDs. However, little is known about community members’ preference and willingness to receive NCD services from PHC facilities; therefore, this particular subject is the focus of this study.MethodsA qualitative study was conducted from May 2021 to October 2021. Data were collected via 16 focus group discussions involving community members and 14 key informant interviews with healthcare professionals, facility managers, and public health practitioners. Based on a social-ecological model (SEM), data were analyzed thematically. The triangulation of methods and participants was conducted to validate the information provided.ResultsPreference and willingness to receive NCD services from PHC facilities were influenced by a range of individual, interpersonal, societal, and organizational factors that were interconnected and influenced each other. Knowledge and the perceived need for NCD care, misperception, self-management, interpersonal, and family-level factors played important roles in using PHC facilities. Community and societal factors (i.e., the availability of alternative and complementary services, traditional practices, social norms) and organizational and health system factors (i.e., a shortage of medicines, diagnostic capacity, untrained human resources, and poor quality of care) also emerged as key aspects that influenced preference and willingness to receive NCD services from PHC facilities.ConclusionDespite their substantial potential, PHC facilities may not take full advantage of managing NCDs. All four factors need to be considered when developing NCD service interventions in the primary healthcare system to better address the rising burden of NCDs.

Midwifery centers as enabled environments for midwifery: A quasi experimental design assessing women's birth experiences in three models of care in Bangladesh, before and during covid.

The midwifery model of care is a human rights-based approach (HRBA) that is unique and appropriate for the majority of healthy pregnant women, yet full expression may be limited within the medical model. Midwifery centers are facilities designed specifically to enable the practice of midwifery. In high resource countries, they have been shown to be cost effective, evidence-based, avoid over medicalization, and provide safe, efficient and satisfying care. A quasi-experimental design was used to assess the impact of three models of care on women's experiences of respect, and trust in maternity care provision, both before and during the pandemic in Bangladesh, as well as their fear and knowledge around COVID-19, during the pandemic. The models were: "fully enabled midwifery" ("FEM") in freestanding midwifery centers; "midwifery and medicine" ("MAM") in medical facilities with midwives working alongside nurses and doctors; and "no midwifery" ("NoM") in medical facilities without midwives. Phone survey data were collected and analyzed from all women (n = 1,191) who delivered from Jan 2020-June 2020 at seven health care facilities in Bangladesh. Comparison of means, ANOVA, post hoc Tukey, and effect size were used to explore the differences in outcomes across time periods. Pre-pandemic, women served by the FEM model reported significantly higher rates of trust and respect (p<0·001) compared to the NoM model, and significantly higher rates of trust (p<0·001) compared to MAM. During the pandemic, in the FEM model, the experiences of respect and trust did not change significantly from the pre-pandemic rates, and were significantly higher than both the MAM and NoM models (p < 0·001). Additionally, during the pandemic, women served by the FEM model had the lowest experience of COVID fear (p<0·001). Fully enabled midwifery in midwifery centers had a significantly positive effect on woman's experience of respect and trust in care compared to the other models, even in the context of a pandemic.

Disability-friendly healthcare at public health facilities in Bangladesh: a mixed-method study to explore the existing situation

BackgroundSeveral strategies and policies are being implemented in Bangladesh to address the healthcare needs of people with disabilities, who comprise about 10% of the country’s total population. However, these measures are not adequate to provide accessible or friendly healthcare to the people with disabilities. This study aimed to explore the disability-friendliness of healthcare facilities, and the challenges of people with disabilities in terms of access to 1) information and communication, 2) access to infrastructure, and 3) providers’ capacity in Bangladesh.MethodsAn explanatory sequential mixed-method study was conducted, including a cross-sectional survey of healthcare facilities, followed by structured-interview with people with disabilities and healthcare managers, and qualitative interviews among people with disabilities or their caregivers, healthcare providers (HCPs), policymakers, and community leaders. Data were collected from 150 public healthcare (primary-to-tertiary) facilities and from 300 people with disabilities in 16 districts across Bangladesh between January-December 2019. An observational checklist and structured questionnaires were used to assess the situation of healthcare facilities, and literature-guided guidelines were used for qualitative interviews. During analysis, the disability-friendliness of healthcare facilities were quantified through a scoring system, and thematic analysis of qualitative data was performed to identify the challenges of implementing disability-friendly healthcare (DFHC).ResultsThe score for providing DFHC was low across all the four objectives in the healthcare facilities. The highest score (mean percentage) was observed in the infrastructure domain: 29.3 ± 20.5, followed by communication: 18.2 ± 4.8, and information: 14.6 ± 6.22, and the lowest (0.93 ± 7.1) score was for capacity of the HCPs to provide DFHC. Mean percentage scores for access to 13 infrastructure points were low, and extremely low scores were found in areas such as access to elevators (5.6 ± 5.0), ticket counters (7.3 ± 17.7) and toilets (10.6 ± 9.3). Furthermore, about 59.1% of people with disabilities expressed dissatisfaction regarding access to information and communication. The majority (98.2%) recommended that training of HCPs can improve the situation.ConclusionThis study revealed that most of the public health facilities in Bangladesh were not disability-friendly. Findings can inform development of a national disability-friendly policy with implementation guidelines.

An adapted behavioural activation intervention (DiaDeM) for people with diabetes and depression in South Asia: A feasibility study protocol

Background: The burden of depression is a rapidly growing problem worldwide. Its prevalence is particularly high among individuals with chronic physical conditions such as Type 2 Diabetes (T2DM), precipitating poorer health outcomes. There is a lack of evidence around treatments that can work among such groups, particularly in Low and Middle-Income Countries (LMICs). This study aims to test the feasibility and acceptability of a culturally adapted Behavioural Activation (BA) intervention (DiaDeM) for people with T2DM and depression in two LMICs in South Asia. Methods: A multicentre, randomised-controlled feasibility trial will be conducted from March 2022 to February 2023. We will recruit 128 adults from health facilities in Bangladesh and Pakistan with a diagnosis of T2DM and depression. Using a 1:1 allocation ratio, consenting individuals will be randomised to either optimised usual care or the DiaDeM intervention. The latter will involve six face-to-face or remotely delivered BA sessions conducted by non-mental health facilitators over six to twelve weeks. Participants will be followed up at three and six months post-randomisation. Feasibility outcomes include the feasibility and acceptability of recruitment and retention, the feasibility of intervention delivery and the feasibility of data collection at baseline and follow-up (including economic data). An embedded mixed-methods process evaluation will also be carried out to inform the main trial. Conclusions: BA is a low resource intervention for depression treatment that can be optimised for delivery in LMIC settings such as South Asia. The planned feasibility trial will directly inform a larger trial to assess the effectiveness and cost-effectiveness of such an intervention in people with T2DM and depression. It will also contribute to the wider evidence base around BA in patients with chronic physical illnesses, with particular relevance to South Asian, as well as wider LMIC regions and populations. Trial registration: ISRCTN 75501608

The Use of Mobile Phones by Women Accessing Health Care Services in Bangladesh: A Cross-Sectional Study

Background: Maternal and neonatal mortality rates still pose a global challenge. Objectives: The present study aimed to identify the socio-demographic characteristics of mobile users trying to access antenatal care services, transportation to facilities, and postnatal care for mothers and newborns. Methods: This was a cross-sectional study that used data collected from the Bangladesh Demographic and Health Survey (BDHS) 2014. Data were gathered using a questionnaire. Participants comprised 4,494 mothers aged between 14 and 49. Models of logistic regression were used to determine associations. Results: The overall sample size was 4494, with only 22.23% of women using mobile phones. Among these, 29.9% used their mobile phones to obtain health services or advice and 70.1% did not. Women with mobile phones who had a higher level of education used them to receive more health care (secondary and higher: OR = 1.922, 95%CI = 1.225−3.014; primary: OR = 1.982, 95% CI = 1.738−2.654); they were of higher socio-economic status (rich: OR = 1.228, 95% CI = 1.009&amp;−1.494; middle income: OR = 1.691, 95% CI = 1.256−2.333); they accessed more prenatal care (yes: OR = 1.993, 95% CI = 1.425−1.987) and antenatal care (yes: OR = 1.951, 95% CI = 1.765−1.998); they checked their health status after delivery (yes: OR = 1.966, 95% CI = 1.639−2.357). Conclusion: The results of the present study showed that young women who had a higher level of education and income and resided in urban areas were more likely to use a mobile phone to receive health care facilities in Bangladesh. Intervention studies are essential in recognising that mobile phone-based facilities improve maternal health care.