Health Care In Bangladesh Research Articles

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

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.

Financial and Geographic Barriers in Seeking and Utilizing Eye Healthcare in Bangladesh

Measures that may increase accessing and utilizing eye health care may include introduction of health insurance covering fully or partially eye healthcare, spectacles and common eye surgeries and medicines and subsidize medical travel expenses; setting up of small satellite eye clinics, offering eye care services at Upazilla level clinics, offering tele-ophthalmology in underserved areas, providing incentives for eye doctors to practice in remote areas

Zafrullah Chowdhury: surgeon, freedom fighter, and innovator in rural healthcare in Bangladesh

Zafrullah Chowdhury: surgeon, freedom fighter, and innovator in rural healthcare in Bangladesh

Health Literacy: Intervention and Outcome in Child Healthcare in Bangladesh

Bangladesh made significant improvements in child healthcare and achieved its Millennium Development Goal (MDG) 4 (to reduce child mortality). In 2010, the United Nations recognized Bangladesh for its exceptional progress towards MDG 4 to reduce child and maternal mortality in the face of many socioeconomic challenges. We are also committed to achieve our Sustainable Development Goal (SDG) by 2030. Health education department of Government of Bangladesh prioritized several essential health interventions over the past decades. There were focuses on expanding immunization, tackling diarrhoea and pneumonia, vitamin A campaign, prevention of blindness, iodine deficiency, and improving adolescent health. These programmes and strategies were scaled-up nationwide. The government along with its stakeholders promoted widespread availability and affordability of those health literacy interventions with an emphasis on community-based approaches. As a result, inequities in coverage of specific interventions declined; this may explain the improvements seen amongst even the most disadvantaged populations of the country. Media campaigns played a great role, which were undertaken in Bangladesh for decades and involved a nationally broadcast television supported by radio, television, newspaper, and billboard advertisements and local promotion activities. We expect that ongoing public private partnerships (PPPs) in which the government contracts NGOs and the private sector will enable us greater success and coverage of health information and literacy services throughout the country.
 CBMJ 2023 January: Vol. 12 No. 01 P: 124-128

‘Bending’ against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh

BackgroundDespite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative ‘straightening devices’ – mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage – to identify ‘invisible’ structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives.MethodsThis article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author’s doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24.ResultsRespondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity.ConclusionOur study highlighted young people’s everyday experiences of having to ‘bend’ to – and against – heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more ‘barriers’ confronted by sexual and gender diverse young people.

Rural-Urban Determinants of Receiving Skilled Birth Attendants among Women in Bangladesh: Evidence from National Survey 2017-18.

SBAs (skilled birth attendants) play a crucial role in reducing maternal mortality. The proportion of maternal healthcare in Bangladesh that receives quality care at birth has increased; the reasons for this are unknown. The purpose of this study is to see if there has been a change in the use of specific maternal healthcare indicators in urban and rural areas, as well as significant risk factors. The data set was extracted from a nationally representative survey based on a cross-sectional study, the Bangladesh Health and Demographic Survey (BDHS) 2017-18. The frequency distribution reveals the general state of SBAs. To identify the association, we performed the chi-square test. Finally, multiple logistic regression was used to analyse the factors associated with SBAs and determine the degree of SBAs disparity between urban and rural areas. In Bangladesh, 53% of women received SBAs during childbirth, with urban and rural areas receiving 68.1 and 52.2 percent, respectively. Women with secondary (AOR: 1.79, CI: 1.05-3.08) and higher (AOR: 4.18, CI: 2.09-8.50) education were more likely to receive SBAs than women in urban areas who were illiterate. Husband's education, women's working status, wealth index, children's birth order, and number of ANC visit are significant factors in receiving SBSs in both urban and rural areas. Higher educated husbands are 1.83 times (AOR = 1.83, CI: 1.04-3.25, p = 0.037) and 1.82 times (AOR = 1.82, CI: 1.29-2.59, p = 0.001) more likely to attend skilled births than uneducated husbands in both urban and rural areas. Respondents from the richest families are more likely to attend skilled births than those from the poorest families in both urban and rural areas. During delivery, significant risk factors are substantially related to SBAs. More attention must be given to rural and illiterate populations, who are less likely to obtain these services, to minimize maternal and neonatal mortality. Special programs could be developed to raise awareness and facilitate the poor in receiving the basic necessities of maternal care.

Socioeconomic correlates of Adequate Maternal Care in Bangladesh: Analysis of the Bangladesh Demographic and Health Survey 2017-18.

In recent times, Bangladesh has made significant improvements in various health outcomes, but not so much in maternal death. The current flat trend in reducing maternal mortality in Bangladesh has been mainly due to the lower coverage of maternal health care. To improve the coverage, it is essential to find biosocial factors related to adequate maternal health care. Therefore, this study is aimed at finding out the socioeconomic correlates of adequate maternal health care in Bangladesh. The study used data from the Bangladeshi demographic and health survey 2017-18. The total unweighted sample of 4012 women who reported pregnancy before three years of the survey was analyzed. A composite binary indicator of adequate maternal care has been constructed using the variables-access to maternal care service, four antenatal care visits, at least one visit with qualified providers, and institutional delivery. A binary logistic regression model was employed to find out the socioeconomic correlate of adequate maternal care. Only 24.4% percent of sample women received adequate maternal care. The result of the logistic regression model shows that urban, Khulna, Rajshahi, and Rangpur were associated with an increase in the odds of having adequate maternal care. High education and health care decisions taken by the partner or husband were also associated with an increased odd of adequate maternal care. Islam and lower wealth status were associated with a lower probability of adequate maternal care. Policymakers and health administration should pay attention to the variation in the utilization of maternal health care across residence, region, religion, education, and wealth status to ensure safe motherhood.

Financial risk protection in health care in Bangladesh in the era of Universal Health Coverage

BackgroundEnsuring financial risk protection in health care and achieving universal health coverage (UHC) by 2030 is one of the crucial Sustainable Development Goals (SDGs) targets for many low- and middle-income countries (LMICs), including Bangladesh. We examined the critical trajectory of financial risk protection against out-of-pocket (OOP) health expenditure in Bangladesh.MethodsUsing Bangladesh Household Income and Expenditure Survey data from 2005, 2010, and 2016, we examined the levels and distributions of catastrophic health expenditure (CHE) and impoverishment incidences. We used the normative food, housing, and utilities method, refining it by categorizing households with zero OOP expenses by reasons.ResultsOOP expenditure doubled between 2005 and 2016 (USD 115.6 in 2005, USD 162.1 in 2010, USD 242.9 in 2016), accompanied by rising CHE (11.5% in 2005, 11.9% in 2010, 16.6% in 2016) and impoverishment incidence (1.5% in 2005, 1.6% in 2010, 2.3% in 2016). While further impoverishment of the poor households due to OOP expenditure (3.6% in 2005, 4.1% in 2010, 3.9% in 2016) was a more severe problem than impoverishment of the non-poor, around 5.5% of non-poor households were always at risk of impoverishment. The poorest households were the least financially protected throughout the study period (lowest vs. highest quintile CHE: 29.5% vs. 7.6%, 33.2% vs. 7.2%, and 37.6% vs. 13.0% in 2005, 2010, and 2016, respectively). The disparity in CHE among households with and without chronic illness was also remarkable in 2016 (25.0% vs. 9.1%).ConclusionFinancial risk protection in Bangladesh exhibits a deteriorated trajectory from 2005 to 2016, posing a significant challenge to achieving UHC and, thus, the SDGs by 2030. The poorest and chronically ill households disproportionately lacked financial protection. Reversing the worsening trends of CHE and impoverishment and addressing the inequities in their distributions calls for implementing UHC and thus providing financial protection against illness.

Identifying the Key Big Data Analytics Capabilities in Bangladesh’s Healthcare Sector

The study explores the crucial big data analytics capabilities (BDAC) for healthcare in Bangladesh. After a rigorous and extensive literature review, we list a wide range of BDAC and empirically examine their applicability in Bangladesh’s healthcare sector by consulting 51 experts with ample domain knowledge. The study adopted the DEcision MAking Trial and Evaluation Laboratory (DEMATEL) method. Findings highlighted 11 key BDAC, such as using advanced analytical techniques that could be critical in managing big data in the healthcare sector. The paper ends with a summary and puts forward suggestions for future studies.

Awareness, Treatment, and Control of Diabetes in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey 2017/18.

Background The prevalence of diabetes is increasing in Bangladesh from ∼5% in 2001 to ∼13% in 2017/18 (∼8.4 million cases). The prevalence of undiagnosed diabetes was also found to be higher at 6% in 2017/18. However, very little is known about the management of diabetes assessed by diabetes awareness, treatment, and control. We aimed to estimate the age-standardised prevalence of awareness, treatment, and control of diabetes and its associated factors. Methods Cross-sectional data from 1,174 Bangladeshi adults aged 18 years and older available from the most recent nationally representative Bangladesh Demographic and Health Survey (BDHS) 2017–18 were analysed. Outcomes were age-standardised prevalence of awareness, treatment, and control of diabetes, estimated using the direct standardisation. Multilevel mixed-effects Poisson regression models were used to identify factors associated with awareness, treatment, and control of diabetes. Results Of the respondents we analysed, 30.9% (95% CI, 28.2–33.6) were aware that they had the condition, and 28.2% (95% CI, 25.6–30.7) were receiving treatment. Among those treated for diabetes, 26.5% (95% CI, 19.5–33.5) had controlled diabetes. The prevalence of diabetes awareness, treatment, and control was lower in men than women. Factors positively associated with awareness and treatment were increasing age and hypertension, while factors negatively associated with awareness and treatment were being men and lower education. Factors associated with poor control were secondary education and residing in Rajshahi and Rangpur divisions. Conclusions This study provides evidence of poor management of diabetes in Bangladesh, especially in men. Less than one-third of the people with diabetes were aware of their condition. Just over one-fourth of the people with diabetes were on treatment, and among those who were treated only one-fourth had controlled diabetes. Interventions targeting younger people, in particular men and those with lower education, are urgently needed. Government policies that address structural factors including the cost of diabetes care and that strengthen diabetes management programmes within primary healthcare in Bangladesh are urgently needed.

Can programmatic inputs improve adolescent mothers\u2019 access to maternal care in rural Bangladesh? Nine years of evidence from a cohort study

BackgroundAdolescent mothers (Girls aged 15–19) constitute 8% of annual global births, but account for 10% of annual maternal deaths. WHO recommended 4–8 Antenatal Care (ANC) visits, in addition to quality care and facility-based deliveries, are well-documented interventions to reduce maternal and child morbidity and mortality. Determinants of maternal and child health care in Bangladesh have received considerable attention, but less attention has been focused on adolescent mothers. This study explores the factors associated with 4 or more (4 +) ANC visits and facility-based delivery among adolescent mothers in one rural area of Bangladesh.MethodsThis study uses Health and Demographic Surveillance System (HDSS) data. We conducted a comparative study on trends in 4 + ANC visits and facility-based deliveries among adolescent mothers (10–19 years) residing in an intervention area (icddr,b service area, ISA) against a comparison area (government service areas, GSA) of HDSS between 2007 and 2015. Totally, 4,996 adolescent mothers were included in the final analysis. Binary logistic regression was used to document the statistical difference on outcome indicators in the two study areas.ResultsTrends in 4 + ANC visits and facility-based deliveries were higher in the ISA relative to the GSA. The adjusted odds of an adolescent mother accessing 4 + ANC visits in the GSA, relative to ISA, were 0.57 (95% CI 0.49–0.66, p value < 0.05); the adjusted odds of an adolescent mother accessing facility-based delivery in the ISA, relative to GSA, were 6.63 (95% CI: 5.85–7.52, p value < 0.05). Increasing numbers of ANC visits were associated with increases in facility-based births in both the ISA and GSA.ConclusionThis study documented that both 4 + ANC visits and facility delivery rates among adolescent mothers are much higher in the ISA than GSA. Increasing 4 + ANC visits and facility deliveries over the years, particularly in the ISA, coincide with programmatic efforts to improve the quality and availability of maternal and newborn health services. Learning from existing interventions in ISA and applying them to other areas will strengthen Bangladesh’s efforts to improve maternal and newborn health outcomes and achieve the Sustainable Development Goal 3 (SDG 3).

Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia.

This study examines health regulation under conditions of geographical constraint in two strikingly different settings, one on a remote island in Bangladesh and the other in an impoverished rural region in Australia. Both suffer from an absence of medically qualified professionals, which means that in the resultant vacuum, patients access alternative healthcare. The concept of regulation (or lack of regulation) is explored in terms of unconventional new responses to rural health deficits. The two cases show unexpected commonality, with policymakers facing shared challenges beyond physical remoteness. The difference in the degree of enforcement of regulation offers the greatest point of difference. This comparative study revealed a weak health regulatory system in the remote Bangladesh area of Bhola Island where ‘alternatives’ to formal clinical approaches have become the default choice. Brazen stop‐gap servicing is commonplace on Bhola Island, but in The Gemfields such practices only occur in the shadows or as a last resort. Each isolated location, one in a developing country and the other in a developed setting, exemplifies how geographical remoteness can present an opportunity for innovations in supply to emerge. Surprisingly, it is the developing world case that better leverages a regulatory void to respond to local healthcare needs.

Out-of-pocket payment for healthcare among urban citizens in Dhaka, Bangladesh

ObjectivesOut-of-pocket (OOP) payment is the major payment strategy for healthcare in Bangladesh, and the share of OOP expenditure has increased alarmingly. Dhaka is recognised as one of the fastest-growing megacities in the world. The objective of this study is to capture the self-reported illnesses among urban citizens and to identify whether and to what extent socioeconomic, demographic and behavioural factors of the population influence OOP healthcare expenditures.Subject and methodsThis study utilises cross-sectional survey data collected from May to August 2019 in urban Dhaka, Bangladesh. A total of 3,100 households were randomly selected. Simple descriptive statistics including frequencies, percentage, mean (95% CI), median and inter-quartile range were presented. Bivariate analysis and multivariate regression models were employed.ResultsWe observed that acute illnesses (e.g., fever, flu/cough) were dominant among participants. Among the chronic illnesses, approximately 9.6% of people had diabetes, while 5.3% had high/low blood pressure. The richest quintile only spent 5.2% of their household income on healthcare, while the poorest households spent approximately six times more than the richest households. We noted that various factors such as marital status, religion, source of care, access to safe water, income quintile and even the location of households had a significant relationship with OOP expenditure.ConclusionsOur findings can serve as important source of data in terms of disease- specific symptoms and out-of-pocket cost among urban citizens in Dhaka. The people belonging to wealthier households tended to choose better healthcare facilities and spend more. A pro-poor policy initiative and even an urban health protection scheme may be necessary to ensure that healthcare services are accessible and affordable, in line with the Bangladesh National Urban Health Strategy.

Forgone healthcare and financial burden due to out-of-pocket payments in Bangladesh: a multilevel analysis

BackgroundEnsuring access to health services for all is the main goal of universal health coverage (UHC) plan. Out-of-pocket (OOP) payment still remains the main source of funding for healthcare in Bangladesh. The association between barriers to accessing healthcare and over-reliance on OOP payments has not been explored in Bangladesh using nationally representative household survey data. This study is a novel attempt to examine the burden of OOP payment and forgone healthcare in Bangladesh, and further explores the inequalities in catastrophic health expenditures (CHE) and forgone healthcare at the national and sub-national levels.MethodsThis study used data from the most recent nationally representative cross-sectional survey, Bangladesh Household Income and Expenditure Survey, conducted in 2016–17 (N = 39,124). In order to identify potential determinants of CHE and forgone healthcare, multilevel Poisson regression was used. Inequalities in CHE and forgone healthcare were measured using the slope index of inequality.ResultsAround 25% of individuals incurred CHE and 14% of the population had forgone healthcare for any reasons. The most common reasons for forgone healthcare were treatment cost (17%), followed by none to accompany or need for permission (5%), and distance to health facility (3%). Multilevel analysis indicated that financial burden and forgone care was higher among households with older populations or chronic illness, and those who utilize either public or private health facilities. Household consumption quintile had a linear negative association with forgone care and positive association with CHE.ConclusionThis study calls for incorporation of social safety net in health financing system, increase health facility, and gives priority to the disadvantaged population to ensure access to health services for all.

Prevalence and determinants of using complementary and alternative medicine for the treatment of chronic illnesses: A multicenter study in Bangladesh.

While conventional medicine (CM) is commonly used to treat non-communicable diseases (NCDs), complementary and alternative medicine (CAM) is gaining popularity as a healthcare option in Bangladesh. We aimed to investigate the prevalence and factors associated with using CAM solely and using CAM in conjunction with CM for chronic illness treatment among NCD patients in Bangladesh. A multicenter cross-sectional study was conducted, including 549 adults with a confirmed chronic illness diagnosis from three tertiary care hospitals in Dhaka city. Interviews were used to gather socio-demographic data, while medical records were used to get information on chronic illnesses. A multinomial logistic regression model was used to determine the associated factors of utilizing CAM primarily and CAM use in conjunction with CM to manage the chronic disease. Out of 549 NCD patients (282 women [51.4%], mean [standard deviation] age 45.4 [12.8] years), 180 (32.8%) ever used CAM for the treatment of chronic illness. Also, 15.3% of patients exclusively used CAM among the NCD patients, while 17.5% used CAM in conjunction with CM. Homeopathy medicine was the most prevalent type of treatment among CAM users (52.2%). Furthermore, 55.5% of CAM users said they used it due to its less adverse effects, and 41.6% trusted its effectiveness for chronic illness. Elderly patients (≥60 years) preferred CAM in complementary with CM, but they did not rely only on CAM. According to the multinomial regression analysis, unmarried patients, predominantly in the younger age group, adopted CAM significantly for chronic illness treatment (Relative risk ratio, RRR = 0.29, 95% CI = 0.12-0.71, reference = Unmarried). Patients in the high-income group used CAM in conjunction with CM (RRR = 6.26, 95% CI = 1.35-18.90, reference: low-income), whereas patients in the high-income group did not rely on CAM alone (RRR = 0.99, 95% CI = 0.34-2.85). Although CM remains the mainstream of health care in Bangladesh, CAM services play an essential role in people's health care, particularly in treating chronic illnesses. Physicians of Bangladesh should be aware that their patients may be using other services and be prepared to ask and answer questions regarding the risks and benefits of using CAM in addition to regular medical care. Thus, clinicians required to follow best-practice guidelines, which are currently not practiced in Bangladesh, when disseminating information regarding integrative techniques that combine CM and CAM approaches.

Applied Artificial Intelligence and user satisfaction: Smartwatch usage for healthcare in Bangladesh during COVID-19

The evolution of Artificial Intelligence (AI) has revolutionized many aspects of human life, including healthcare. Amidst the Covid-19 pandemic, AI-enabled smartwatches are being used to help users to self-monitor and self-manage their health. Using a framework based on Stimulus-Organism-Response (S–O-R) theory, this present study aimed to explore the use of AI-enabled smartwatches for health purposes, in particular the effects of product quality, service quality, perceived convenience, and perceived ease of use on user experience, trust and user satisfaction. Based on a purposive survey sample of 486 smartphone users in Bangladesh, data collected was analyzed using SPSS software for elementary analyses and PLS-SEM for hypotheses testing. The findings showed that the predictors, namely product quality, service quality, perceived convenience, and perceived ease of use, significantly affected user experience and trust. Similarly, user experience and trust were influential on user satisfaction and played partial mediating roles between predictors and user satisfaction. Besides, gender and age moderate the relationships of experience and trust with customer satisfaction. These findings support the S–O-R theoretical framework and have practical implications for brand and marketing managers of smartwatches in developing product features and understanding users' attitudes and behaviours.

Protecting Autonomy of Rohingya Women in Sexual and Reproductive Health Interventions

Protecting Autonomy of Rohingya Women in Sexual and Reproductive Health Interventions

The current state of mental healthcare in Bangladesh: part 2 - setting priorities.

This is the second of a two-part profile on mental healthcare in Bangladesh. It describes the state of mental health research in the country and presents a set of priorities for addressing improvements to the fundamental gaps in mental healthcare highlighted in part 1. Focus on building infrastructure for public mental health facilities, training skilled mental health professionals, adequate distribution of financial resources and addressing stigma are all priorities that will contribute to significantly improving mental healthcare in Bangladesh.