Sub-districts Of Bangladesh Research Articles

Active and passive case detection strategies for the control of leishmaniasis in Bangladesh.

Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis. To determine 1) the numbers of patients diagnosed with visceral leishmaniasis (VL) and post-kala azar dermal leishmaniasis (PKDL) using an active case detection (ACD) strategy in Fulbaria and a passive case detection (PCD) strategy in Trishal, and 2) the time taken from symptoms to diagnosis in the ACD subdistrict. A cross-sectional descriptive study of patients diagnosed from May 2010 to December 2011. The ACD strategy involved community education and outreach workers targeting households of index patients using symptom-based screening and rK-39 tests for suspected cases. In the ACD subdistrict (Fulbaria) and PCD sub-district (Trishal), respectively 1088 and 756 residents were diagnosed with VL and 1145 and 37 with PKDL. In the ACD subdistrict, the median time to diagnosis for patients directly referred by outreach workers or self-referred was similar, at 60 days for VL and respectively 345 and 360 days for PKDL. An ACD strategy at the subdistrict level resulted in an increased yield of VL and a much higher yield of PKDL. As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent.

Feasibility, acceptability, and programme effectiveness of misoprostol for prevention of postpartum haemorrhage in rural bangladesh: a quasiexperimental study.

We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH) among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum's delivery mat), a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh.

Effect of a maternal health voucher scheme on out-of-pocket expenditure and use of delivery care services in rural Bangladesh: a prospective controlled study

BackgroundMost births in rural Bangladesh are done at home because of barriers to access to facility-based services. To address this issue, the Bangladeshi Government piloted a demand-side financing scheme (the maternal health voucher programme) at subdistrict public health facilities in rural areas. We assessed the effect of this intervention on use of delivery care services and out-of-pocket expenses.MethodsWe did a non-randomised, controlled study. We selected 22 subdistricts in Bangladesh with a probability proportional to their size: 11 intervention subdistricts took part in the demand-side financing programme and 11 control subdistricts did not. We selected 150 women from each subdistrict. From each subdistrict, three of nine unions and three villages from each union were selected through probability proportional to size and from each selected village we drew the required numbers of respondents through simple random sampling. We included women aged 18–49 years who had given birth in the previous 12 months. A baseline survey was done in 2010, and a follow-up survey was done in 2012, recording socioeconomic and demographic characteristics as well as service use and cost of services, collected with a structured questionnaire.Findings3300 women were surveyed (1650 in each group). Use of delivery services was 8% (126/1650) in 2010 versus 16% (263/1663) in 2012 in the intervention subdistricts and 8% (129/1650) versus 11% (178/1671) in control areas. Delivery at a public health facility in the intervention areas increased significantly compared with the control areas (p<0·0001) and the intervention contributed to some of the change (difference in differences 5·1%). Average out-of-pocket cost in intervention areas fell for both normal births (from US$40 to $22) and caesarean births (from $115 to $80). In control areas, average out-of-pocket cost decreased slightly for normal births (from $33 to $29), but increased for caesarean births (from $118 to $125).InterpretationTo sustain the trend of use, the maternal health voucher programme needs to continue to provide financial assistance to women who cannot afford to seek delivery care in health facilities.FundingBill & Melinda Gates Foundation.

Distance travelled and cost of transport for use of facility-based maternity services in rural Bangladesh: a cross-sectional survey

<h2>Abstract</h2><h3>Background</h3> Although maternal mortality in Bangladesh has decreased significantly, underutilisation of facilities for maternal health care continues to be a persistent challenge. Women often have to travel long distances and face transportation costs to deliver at a health facility. To reduce financial barriers, the Ministry of Health and Family Welfare introduced a demand-side financing programme that gives incentives to expectant mothers. We assessed the role of distance and transportation cost in the use of antenatal care, delivery, complication management, and postnatal care from a health facility. <h3>Methods</h3> We did this cross-sectional survey in 22 subdistricts in Bangladesh. From each subdistrict, three of nine unions and three villages from each union were selected through probability proportional to size in 2010. Mothers who had given birth in the preceding year were interviewed about distance from residence to a health facility, transportation cost, and mode of transport. <h3>Findings</h3> 3300 women were interviewed. 1742 (53%) women received antenatal care, 647 (20%) received delivery care, and 343 (10%) received postnatal care at a health-care facility. On average, women travelled 6 km for antenatal check-ups (range 0–70 km) and postnatal check-ups (range 0–45 km) and 8 km for management of complications (range 0–50 km) or delivery (0–70 km). Most women used a non-motorised rickshaw or van to reach a health facility. On average, women spent Taka 100 (US$1·4, range 0–32·14) on transportation for antenatal care, Taka 432 ($6·17, range 0–100) for delivery, and Taka 132 ($1·89, range 0–35·71) for a postnatal check-up. For each additional kilometre, the cost increased by Taka 9 ($0·13) for antenatal care, Taka 31 ($0·44) for delivery, and Taka 8 ($0·11) for postnatal care. <h3>Interpretation</h3> Use of maternal health-care services at a health-care facility was low in rural Bangladesh. At present, the demand-side financing programme gives a flat payment of Taka 100 ($1·4) for transportation cost for each visit. This payment is insufficient. Programme managers should review the transportation allowance. <h3>Funding</h3> Bill & Melinda Gates Foundation.

Distance travelled and cost of transport for use of facility-based maternity services in rural Bangladesh: a cross-sectional survey

BackgroundAlthough maternal mortality in Bangladesh has decreased significantly, underutilisation of facilities for maternal health care continues to be a persistent challenge. Women often have to travel long distances and face transportation costs to deliver at a health facility. To reduce financial barriers, the Ministry of Health and Family Welfare introduced a demand-side financing programme that gives incentives to expectant mothers. We assessed the role of distance and transportation cost in the use of antenatal care, delivery, complication management, and postnatal care from a health facility. MethodsWe did this cross-sectional survey in 22 subdistricts in Bangladesh. From each subdistrict, three of nine unions and three villages from each union were selected through probability proportional to size in 2010. Mothers who had given birth in the preceding year were interviewed about distance from residence to a health facility, transportation cost, and mode of transport. Findings3300 women were interviewed. 1742 (53%) women received antenatal care, 647 (20%) received delivery care, and 343 (10%) received postnatal care at a health-care facility. On average, women travelled 6 km for antenatal check-ups (range 0–70 km) and postnatal check-ups (range 0–45 km) and 8 km for management of complications (range 0–50 km) or delivery (0–70 km). Most women used a non-motorised rickshaw or van to reach a health facility. On average, women spent Taka 100 (US$1·4, range 0–32·14) on transportation for antenatal care, Taka 432 ($6·17, range 0–100) for delivery, and Taka 132 ($1·89, range 0–35·71) for a postnatal check-up. For each additional kilometre, the cost increased by Taka 9 ($0·13) for antenatal care, Taka 31 ($0·44) for delivery, and Taka 8 ($0·11) for postnatal care. InterpretationUse of maternal health-care services at a health-care facility was low in rural Bangladesh. At present, the demand-side financing programme gives a flat payment of Taka 100 ($1·4) for transportation cost for each visit. This payment is insufficient. Programme managers should review the transportation allowance. FundingBill & Melinda Gates Foundation.

Effect of a maternal health voucher scheme on out-of-pocket expenditure and use of delivery care services in rural Bangladesh: a prospective controlled study

BackgroundMost births in rural Bangladesh are done at home because of barriers to access to facility-based services. To address this issue, the Bangladeshi Government piloted a demand-side financing scheme (the maternal health voucher programme) at subdistrict public health facilities in rural areas. We assessed the effect of this intervention on use of delivery care services and out-of-pocket expenses. MethodsWe did a non-randomised, controlled study. We selected 22 subdistricts in Bangladesh with a probability proportional to their size: 11 intervention subdistricts took part in the demand-side financing programme and 11 control subdistricts did not. We selected 150 women from each subdistrict. From each subdistrict, three of nine unions and three villages from each union were selected through probability proportional to size and from each selected village we drew the required numbers of respondents through simple random sampling. We included women aged 18–49 years who had given birth in the previous 12 months. A baseline survey was done in 2010, and a follow-up survey was done in 2012, recording socioeconomic and demographic characteristics as well as service use and cost of services, collected with a structured questionnaire. Findings3300 women were surveyed (1650 in each group). Use of delivery services was 8% (126/1650) in 2010 versus 16% (263/1663) in 2012 in the intervention subdistricts and 8% (129/1650) versus 11% (178/1671) in control areas. Delivery at a public health facility in the intervention areas increased significantly compared with the control areas (p<0·0001) and the intervention contributed to some of the change (difference in differences 5·1%). Average out-of-pocket cost in intervention areas fell for both normal births (from US$40 to $22) and caesarean births (from $115 to $80). In control areas, average out-of-pocket cost decreased slightly for normal births (from $33 to $29), but increased for caesarean births (from $118 to $125). InterpretationTo sustain the trend of use, the maternal health voucher programme needs to continue to provide financial assistance to women who cannot afford to seek delivery care in health facilities. FundingBill & Melinda Gates Foundation.

Study of early flood warning dissemination system in Bangladesh

AbstractA study has been conducted with the objective to assess the existing early flood warning dissemination system (EFWDS) in Bangladesh and to suggest the suitable improvements in the same system based on review of literature, interaction with stakeholders of various organisations involved in flood forecasting and dissemination, and analysis of feedback from the flood‐affected people of Dhobaura and Shibalaya subdistricts in Bangladesh. The existing set‐up has been studied to assess the present activities and future expectations. The recommendation for active participation by all related organisations has been made in this study. Two studies have been conducted by surveying the opinion of flood vulnerable communities so that all elements of the EFWDS would provide useful flood warnings to all potential users.

English

Toll free mobile phone intervention was tested in one sub district of Bangladesh. Prior to implementation, we conducted a formative research to explore perceived advantages and disadvantages of mobile phone communication for maternal and neonatal complication management. We conducted in-depth interviews among twelve community skilled birth attendants and fourteen mothers along with their husbands. All husbands were supportive in their wives’ accessibility to their phone, but wives revealed disparity in access to husbands’ phone. The advantages identified were reduced cost of consultation and transportation to appointments with skilled providers, time saving during emergencies and controlling barriers to pregnant women’s mobility. Other direct benefit was consultation with health professionals to increase confidence of community based skilled birth attendants (CSBAs) in handling emergencies. Respondents sensed that determining the management without examining patient might affect the appropriateness in providing treatment, when the communication mode is only phone. Mothers and their husbands who communicated through mobile phone with providers for their health issue noted some other barriers: irritability from the provider’s side and switched off phones. Mobile phone access pathway should be explained to pregnant women, their husbands and service providers from the beginning of an intervention. The well designed e-health solutions based on evidence of formative research may have larger impact on quality of care in Bangladesh. Key words: Maternal and neonatal emergencies, mobile phone, barriers, rural Bangladesh.

Risk factors of childhood tuberculosis: a case control study from rural Bangladesh.

Childhood tuberculosis (TB) is one of the major causes of childhood morbidity and mortality; however, it is relatively a neglected disease. Hence, we explored the risk factors for childhood TB. Ninty-five cases and 94 controls were selected during January to May 2011 from DOTS centres located in four sub-districts of Bangladesh. The exposure status of recently diagnosed childhood TB patients (<18-year-olds), who were sputum-positive, were compared with children who were sent to the laboratory with suspected tuberculosis but were found to be sputum-negative. Data were collected by a structured questionnaire. Crude odds ratios (OR), adjusted odds ratio (AOR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression model was used to identify independent predictors. Children under 14 years of age (AOR: 0.25; 95% CI: 0.10-0.66), having completed primary education (AOR: 0.28; 95% CI: 0.10-0.74), whose fathers' were in business or service (AOR: 0.24; 95% CI: 0.08-0.72), and who slept in a less crowded room (AOR: 0.32; 95% CI: 0.14-0.76), lived in a house with a separate kitchen (AOR: 0.39; 95% CI: 0.16-0.96) had less chance of having TB. Those who had contact with cases of TB among relatives or neighbours were less likely to have TB (AOR: 0.28; 95% CI: 0.16-0.70) compared to those who had contact with a TB case in the family. Age, education, father's occupation, crowding, kitchen location and intimate contact with a TB case were significantly associated with smear-positive childhood TB.

Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh

To determine the effectiveness of green banana in the home management of acute (<7 days) or prolonged (≥ 7 days) diarrhoea at the community level. A cluster randomized field trial was conducted among 2968 Bangladeshi rural children 6-36 months old. Wards (villages) were randomly assigned to either a standard care group or a standard care plus green banana group where mothers were instructed to add cooked green banana to the diets of diarrhoeal children. Through a village-based surveillance system, diarrhoeal morbidity data (severity, duration, compliance) were collected for 14 days. Treatment effects were determined by analysing cumulative probability of cure by testing Cox proportional hazards models and relative risk (RR). The cumulative probability of cure was significantly (P < 0.001) different in children receiving GB for both acute [hazard ratio (HR) = 0.63 (95% CI: 0.56-0.67)] and prolonged diarrhoea [HR = 0.38 (95% CI: 0.26-0.59)]. The recovery rates of children with acute diarrhoea receiving GB (vs. control) were significantly more by day 3: 79.9%vs. 53.3% [(RR) = 0.47, 95% CI: 0.41-0.55], (P < 0.001) and day 7: 96.6%vs. 89.1% (RR = 0.32; 0.22-0.46), (P < 0.001). Children with prolonged diarrhoea receiving green banana had significantly higher recovery rates by day 10: 79.8%vs. 51.9% (RR = 0.42; 0.23-0.73), (P < 0.001) and day 14: 93.6%vs. 67.2% (RR = 0.22; 0.08-0.54), (P < 0.001). A green banana-supplemented diet hastened recovery of acute and prolonged childhood diarrhoea managed at home in rural Bangladesh.

Programmatic Aspects of Dropouts in Child Vaccination in Bangladesh: Findings From a Prospective Study

The present study investigated prospectively programmatic factors relating to dropouts in child vaccination in 6 subdistricts of Bangladesh. A cross-sectional survey (n = 2700) was conducted estimating overall coverage of immunization using cluster sampling. The eligible subsample of children (n = 1064) was followed up prospectively to understand reasons for dropouts. In-depth interviews (n = 73) with mothers/caregivers and service providers were done and EPI (Expanded Programme on Immunization) sessions were observed (n = 131). Irregular EPI sessions were the prime cause of dropouts particularly in low-performing subdistricts. The other programmatic factors linked with dropouts were (a) no reminder about subsequent session/doses, (b) unfriendly behavior or absence of vaccinator, ( c) refusal due to lost card or vaccine exhausted, and (d) short duration of sessions. Providers highlighted constraints such as financial problems for transportation, particularly in the hard-to-reach areas and vacancies of the posts of health assistants. The barriers to completing full schedules of vaccination can be removed to a large extent through programmatic adjustments.

Risk factors and clusters of Highly Pathogenic Avian Influenza H5N1 outbreaks in Bangladesh

Between March 2007 and July 2009, 325 Highly Pathogenic Avian Influenza (HPAI, subtype H5N1) outbreaks in poultry were reported in 154 out of a total of 486 sub-districts in Bangladesh. This study analyzed the temporal and spatial patterns of HPAI H5N1 outbreaks and quantified the relationship between several spatial risk factors and HPAI outbreaks in sub-districts in Bangladesh. We assessed spatial autocorrelation and spatial dependence, and identified clustering sub-districts with disease statistically similar to or dissimilar from their neighbors. Three significant risk factors associated to HPAI H5N1 virus outbreaks were identified; the quadratic log-transformation of human population density [humans per square kilometer, P = 0.01, OR 1.15 (95% CI: 1.03–1.28)], the log-transformation of the total commercial poultry population [number of commercial poultry per sub-district, P < 0.002, OR 1.40 (95% CI: 1.12–1.74)], and the number of roads per sub-district [ P = 0.02, OR 1.07 (95% CI: 1.01–1.14)]. The distinct clusters of HPAI outbreaks and risk factors identified could assist the Government of Bangladesh to target surveillance and to concentrate response efforts in areas where disease is likely to occur. Concentrating response efforts may help to combat HPAI more effectively, reducing the environmental viral load and so reducing the number of disease incidents.

Violent deaths among women of reproductive age in rural Bangladesh

The objectives of this paper are to investigate levels and trends in mortality due to violence in women of reproductive age and the social and demographic factors associated with such mortality. The study took place in Matlab, a rural sub-district in Bangladesh between 1982 and 1998. The data were furnished by a longitudinal population-based demographic surveillance system located in that area. A case–control design study was used out to identify factors associated with death due to violence, and data from death registration forms were analyzed. The death rate due to violence, defined in terms of suicides and homicides, was higher among women than men. Death rates from violence remained at the same level during the study period while death rates from other causes decreased. Young, not yet married women were a high risk group with respect to death from violence. Oppression, physical and mental abuse by husbands and relatives often preceded suicides and homicides. The disadvantaged position of women in Bangladesh society is the key underlying social cause of the violence that occurred. In order for violence against women to decrease, improvement in the social position of women is essential.

Demand-based water options for arsenic mitigation: an experience from rural Bangladesh

A supply of safe drinking water is a recognized global concern. The arsenic contamination of groundwater in Bangladesh and other countries has furthered this concern. Lack of appropriate water options is one of the main barriers to the supply of safe drinking water for 30–60 million people who are exposed to the risk of drinking arsenic-contaminated water in Bangladesh. This paper describes the experience from a water supply programme for arsenic mitigation based on demand and participation of 30,000 rural people in Srinagar, a subdistrict of Bangladesh. About 85% of the 912 tubewell water samples tested had an arsenic content higher than 0.05 mg/l. The project promoted 11 options including groundwater, surface-water and rainwater-harvesting household-based options as well as community managed technologies. Most people, particularly women, wanted piped water, and hand-operated deep tubewells were also requested. Four cluster-based motorized piped water systems, 20 home-based arsenic-removal options (two types) and an arsenic-removal filter plant were installed. The public contributed about 49, 25 and 20% of the installation costs of piped water, home-based options and filter options, respectively, and 100% of all operation and maintenance costs. The household options and filter plant were abandoned within a few weeks. Reportedly, those options required too much attention, discharged small volumes of water at low rates, were difficult to maintain, and discharged poor-quality water. The proportion of families (54%) that drank arsenic-contaminated water during the final survey was significantly lower than in the baseline survey (87%). For arsenic-affected areas, it is recommended that a cluster-based piped water system be given proper consideration when selecting appropriate water options rather than household-based options or the development of new low-cost options.