Upazilla Health Complex Research Articles

Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Disease Surveillance System of Bangladesh: Combating Public Health Emergencies

Pattern of Injuries Suffered by Patients Treated for Alleged Assault at Sherpur Upazilla Health Complex, Bogra, Bangladesh

Background: In Bangladesh, violence plays a detrimental role in our daily lives directly or indirectly. The country experiences high levels of violence, with incidents of violence being reported in mass media daily.
 Objective: The objectives of this study were to assess the demographic and social factors associated with assault incidents as well as to establish the type of injuries suffered by the victims of assault.
 Materials and methods: This study was a retrospective, cross-sectional survey, undertaken at the casualty department of the Sherpur Upazilla Health Complex, Bogura, Bangladesh from 12th November 2016 to 11th December 2016. All patients who attended for injuries due to alleged assault (interpersonal violence) and met the inclusion criteria were included in the study. A total of 72 patients were assaulted which are selected as subjects of the study out of 131 casualties.
 Results: The majority of the victims were males (51.38%), 27.76% were single and 90.27% were of Muslims. The age group of the majority (31.94%) ranged between 21 and 30 years. Most the respondents (68.05%) had injuries to more than one part of the body. Among the assaulted patients, 65.27% had more than one type of injury. The majority of the victims of assault (58.33%2) were admitted for in-hospital treatment.
 Conclusion: The study revealed that majority of typical victims of assault treated at Health Complex was males between the ages of 21 and 30 years suffering from minor injuries, mainly to the abdomen and chest.
 KYAMC Journal Vol. 10, No.-1, April 2019, Page 13-16

Understanding Spatial and Contextual Factors Influencing Intraregional Differences in Child Vaccination Coverage in Bangladesh.

In Bangladesh, policy discourse has mostly focused on regional inequities in health, including child immunization coverage. Knowledge of local geographical and contextual factors within regions, however, becomes pertinent in efforts to address these inequities. We used the Bangladesh Demographic and Health Survey 2011 to examine factors that influence intraregional differences in vaccination coverage using a multilevel analysis. We found that in spite of the provision of health facilities at each level of administrative governance, only distance to the Upazilla Health Complex was a consistent predictor for each dose of vaccine, highlighting the remote locations of the communities that remain underserved. Our analysis demonstrates the value of subregional analyses that identify the characteristics of communities that are vulnerable to incomplete immunization coverage. Unless specific policy actions are taken to increase coverage in these remote areas, geographic inequities are likely to persist within regions, and desired targets will not be achieved.

Study of Primary Amenorrhea with etiology in out door patient of Rupganj Upazilla Health Complex

Background : Amenorrhea means without menstruation. Primary Amenorrhea is the absence of menstruation by 16 years of age in the presence of normal secondary sexual characteristics or by 14 years of age if secondary sexual characteristics have not developed.Objectives : To explore the prevalence of Primary Amenorrhea with etiology in outdoor patient with limited investigation sourcesMethods : This was a cross sectional study conducted at Rupganj Upazila Health Complex (UHC) from January 2014 to June 2016. During this period total 2500 patients attended at Gynae out patient department (OPD). Among them 45 patients was sorted out with Primary amenorrhea. History and physical examination was done for presence or absence of secondary sexual characteristics, external genital abnormalities. Investigations were ultrasonogram (USG), Hormonal test were Follicle stimulating Hormone (FSH), Lutilizing hormones (LH), Serum Prolactin, Thyroid Stimulating Hormone. Karyotyping done. Data were analysed by using SPSS version 20.Result : In our study prevalence of Primary Amenorrhea was 1.8%. Among them infantile uterus was 17.78%, imperforated hymen was 13.33%. Turner mosaic 11.4%, mullarian agenesis 6.66%, gonadal agenesis-4.45%. hypothyroid 8.89%, hyperprolactenemia-8.89%, and 11.11% patients were with positive progesterone challenge test without anatomical and hormonal abnormalities.Conclusion : Considering the study result, Infantile uterus was the most prevalent etiological factor of amenorrhoea followed by imperforated hymen and Turner mosaic.Northern International Medical College Journal Vol.9(2) Jan 2018: 300-303

Fetal Outcome in Unhooked Postdated Pregnancy

Background: People always complain that previously almost all women used to have vaginal delivery, but they do not mention the fetal outcome, eg, the number of affected fetus and also intrauterine death or stillborn. The objective of our study was to see the fetal outcome among antenatally unbooked women with gestational age beyond EDD who came to hospital with labor pain and also to see the mode of delivery in these pregnancies.
 Method: It was an observational prospective study conducted in Daudkandi Upazilla Health Complex, Kumilla, from March , 2012 to May, 2012. Sampling procedure was consecutive sampling. A total number of 52 postdated pregnant women were enrolled in our study who came to hospital with labor pain.
 Result: The percentage of vaginal delivery in postdated pregnancy was 80.77% and the percentage of cesarean delivery was 19.23% . Fetal outcome was good in 76.92%, baby was asphyxiated in 19.23% , baby was stillborn in 3.85% women.
 Conclusion: Though vaginal delivery rate is high in women with antenatally unbooked postdated pregnancy with spontaneous onset of labour pain , but the fetal outcome is not good. The women who are crossing EDD must undergo careful fetal monitoring to have more vaginal delivery with good fetal outcome.
 J Dhaka Medical College, Vol. 27, No.1, April, 2018, Page 47-50

Attitude of Health Care Providers on Snake Bite in Rural Community of Bangladesh

Background: Health care providers have different attitude and practice about the snake bite in rural community of Bangladesh.Objective: The purpose of the present study was to know the attitude and practice about the snake bite in rural community of Bangladesh.Methodolgoy: The findings from survey study on snake bite have been elicited from face to face interview with 243 number of medical professionals/health service providers consisting of 113 number of MBBS doctors, 86 number of nurses and 46 number of other health practitioners. The study area consisted of 5 zillasadar hospitals and 15 upazilla health complexes. This study aims to assess the Attitude and Practice of snakebite in rural community and effective management of snake bite through community engagement and using health care system of Bangladesh approach for prevention of snakebite in rural community and effective management of snake bite for the rural Bangladeshi people. It uses the methodological triangulation qualitative and quantitative approach as well as a case study design in analyzing data, whereby the exploratory-descriptive design is followed.Result: We purposively select the 243 sample (Doctors, Nurses, Paramedics ,Others) from the selected districts and its consisting random upazillas from the govt. sector hospitals keeping in mind gender balance (Male-Female) as a primary total target population. So in total, 5 division and its consisting random upazilas hospital including union health complex hospital personnel (From District, Upazilla& Community Hospitals)will be interviewed throughout mention areas of Bangladesh. The findings show that 60.1% of doctors, 50.0% of nurses and 56.8% of practitioners have a notion that the snake bite victims would go to Ozha followed by 11.5% of doctors, 4.7% of nurses and 11.4% of practitioners have a notion that they would go to the local healers and that of 26.5% of doctors, 41.9% of nurses and 32.9% of practitioners mentioned that the snake bite victims would go to doctors. The findings show that 69.0% of doctors, 64.0% of nurses and 56.8% of practitioners will recommend not to apply ‘ tight bandage’ to victim’s snake bite spot and 67.3% of doctors, 65.1% of nurses and 13.6% of practitioners will recommend not to apply ‘Suction by mouth or chick’ to victim’s snake bite spot. The findings show that 82.3% of doctors, 90.7% of nurses and 70.5% of practitioners applied first aid to the snake bite victim as their common practice.Conclusion: Majority of health professionals are well informed regarding harmful traditions and measuresJournal of National Institute of Neurosciences Bangladesh, 2018;4(1): 28-32

Assessment of facility readiness for implementing the WHO/UNICEF standards for improving quality of maternal and newborn care in health facilities \u2013 experiences from UNICEF\u2019s implementation in three countries of South Asia and sub-Saharan Africa

BackgroundThere is a global drive to promote facility deliveries but unless coupled with concurrent improvement in care quality, it might not translate into mortality reduction for mothers and babies. The World Health Organization published the new “Standards for improving quality of care for mothers and newborns in health facilities” but these have not been tested in low- and middle-income settings. UNICEF and its partners are taking the advantage provided by the Mother and Baby Friendly Hospital Initiative in Bangladesh, Ghana and Tanzania to test these standards to inform country adaptation. This manuscript presents a framework used for assessment of facility quality of care to inform the effect of quality improvement interventions.MethodsThis assessment employed a quasi-experimental design with pre-post assessments in “implementation” and “comparison” facilities-the latter will have no quality improvement interventions implemented. UNICEF and assessment partners developed an assessment framework, developed uniform data collection tools and manuals for harmonised training and implementation across countries. The framework involves six modules assessing: facility structures, equipment, drugs and supplies; policies and guidelines supporting care-giving, staff recruitment and training; care-providers competencies; previous medical records; provider-client interactions (direct observation); and client perspectives on care quality; using semi-structured questionnaires and data collectors with requisite training. In Bangladesh, the assessment was conducted in 3 districts. In one "intervention" district, the district hospital and five upazilla health complexes were assessed. similar number of facilities were assessed each two adjoining comparison districts. In Ghana it was in three hospitals and five health centres and in Tanzania, two hospitals and four health centres. In the latter countries, same number of facilities were selected in the same number of districts to serve for comparison. Outcomes were structured to examine whether facilities currently provide services commensurate with their designation (basic or comprehensive emergency obstetric and newborn care). These outcomes were stratified so that they inform intervention implementation in the short-, medium- and long-term.ConclusionThis strategy and framework provides a very useful model for supporting country implementation of the new WHO standards. It will serve as a template around which countries can build quality of care assessment strategies and metrics to inform their health systems on the effect of QI interventions on care processes and outcomes.

Knowledge of Snake Bite Management among Health Service Providers at a Rural Community of Bangladesh

Background: Snake bile is a very common incidence among the rural people.Objective: This study was aimed to assess the pattern of snakebite in rural community through community engagement.Methodology: It uses the methodological triangulation qualitative and quantitative approach as well as a case study design in analyzing data, whereby the exploratory-descriptive design is followed. The findings from survey study on snake bite have been elicited from face to face interview with 243 number of medical professionals/health service providers consisting of 113 number of MBBS doctors, 86 number of nurses and 46 number of other health practitioners. The study area consisted of 5 zilla sadar hospitals and 15 upazilla health complexes. We purposively select the 243 sample(Doctors, Nurses, Paramedics ,Others) from the selected districts and its consisting random upazillas from the govt. sector hospitals keeping in mind gender balance (Male -Female) as a primary total target population. So in total, 5division and itsconsisting random upazilas hospital including union health complex hospital personnel will be interviewed throughout mention areas of Bangladesh. Result: Most of the health professionals (93.8%) stated that the existence of facilities in their respective hospitals is not adequate to manage the treatment of snake bite victims. Of the total number of medical personnel - around 30.0% of the health professionals had the opportunity to manage snake bite in their respective span of service (50.4% of MBBS docs + 11.6% of nurses + 11.4% of other practitioners).The findings show that majority of 87.6% of doctors, 85.0% of nurses and 95.5% of other practitioners mentioned rainy season as the most prevalent time for occurrence of snake bite in rural areas of Bangladesh. As for whether all snake bites are poisonous- around 17.0% of doctors followed by 18.6% of nurses and 16.0% of other practitioners are found to have wrong notion about mentioning that all snake bites are poisonous but in reality this is not true.Conclusion: There is insufficient knowledge, skill and experience of how to treat snake bite victims. Journal of Current and Advance Medical Research 2017;4(1):17-22

Relationship between feeding practices and morbidity pattern of children under two years of age in a community setting at Mymensingh

This descriptive cross-sectional study was performed in the department of Pediatrics, Mymensingh Medical College Hospital to assess the feeding practices and their relationship with the morbidity pattern of children under two years of age. For this study four hundred (400) children from eight different Upazilla Health Complexes (UHC) of Mymensingh district were enrolled and UHCs were selected randomly. Mothers with their children under two years of age who gave voluntary, informed, written consent were included and very sick children, motherless children, handicapped children were excluded from the study. Immediately after registration, detailed history was taken from child's mother using a preset questionnaire and clinical examination (anthropometry and bipedal edema) was done. Among them, 214 children (53.5%) were male and 186 children (47.5%) were female and M: F=1.2:1. Regarding morbidity pattern, 17.3% had acute respiratory tract infection (ARI), 12.7% had acute watery diarrhea (AWD), 2.2% had dysentery, and 9.5% children had more than one disease. In exclusive breast feeding (EBF), acute respiratory tract infection was 10.24% where as in partial breast feeding it was 23.24% and acute watery diarrhea in exclusive breast-fed baby was 6.6% but in partial breast-fed baby it was 17.29%. Morbidity were more in children who started complementary feeding with luta, barley, suji and cow's milk with suji than with khichuri and mixed family diet.
 CBMJ 2018 January: Vol. 07 No. 01 P: 10-15

Practice and Knowledge of Health Personnel on Impact of Medical Wastes in Upazilla Health Complexes under Dhaka Division in Bangladesh

A cross-sectional study was conducted among 42 health personnel and people without a medical background but concerned with the waste management. They were interviewed through pretested semistructured questionnaires at their working places of the upazilla health complexes at Sreepur, Kapasia, Kaligonj, Shivaloya, Saturia, Savar and Dhamrai under Dhaka division of Bangladesh. A total of 6 respondents (2 doctors, 2 nurses and 2 support staff) from each of the upazillas were recruited. Upazilla health complexes were running with average bed occupancy of ?10/day and where ?10 health personnel were working. The objective of this study was to assess the practice and knowledge on impact of the medical wastes of the health personnel working in the health complexes. The distribution of the respondents by their responses regarding environmental impact of medical wastes were recorded, analyzed and tabulated. Hundred percent (100.0%) respondents said about pollution of air, 89.7% said about pollution of surface water, 69.0% said about pollution of ground water, 58.6% said about open dump with infectious agents, soil pollution, 48.3% said about enhance spread of infectious diseases by rodent, 34.5% said about litter and leachate, 20.7% said about production of methane and greenhouse gases and 10.3% said about raised environmental temperature due to the increase of greenhouse gases. Regarding the knowledge of environmental impact of medical wastes, doctors and nurses were found to be more knowledgeable than the support staff. The difference was found to be statistically significant. DOI: http://dx.doi.org/10.3329/cdcj.v10i1.13830 City Dent. Coll. J Volume-10, Number-1, January-2013

Ear Foreign Body: A Study of 148 Cases

Ear foreign body is a common ENT emergency and a challenge also to otolaryngologist worldwide. Prompt and appropriate management of it can reduce the morbidity. An observational retrospective study of 148 cases of foreign body in the ear done in Comilla Medical College Hospital and two upazilla health complexes (Nangalkot and Chowddagram) of Bangladesh within the period of January 2014 to December 2014 to evaluate the nature, mode of presentation, technique of removal and outcome of it. Data were collected from hospital records including age, sex of patient and mode and time of presentation, nature of foreign body, management outcome and complication, and the result showed that children o funder 15 year age group were mostly affected (60%), among them highest incidence were in 5-10 year age group (25%) with male to female ratio 1:1.28. The most common foreign body was the seeds of various vegetables (25.67%) followed by plastic beads (18.24%) and cotton bud (15.54%), the right ear affected more (54%). Almost half of them (47.97%) presented with history of insertion of a foreign body and most of them (91.98%) were removed in OPD or emergency department under direct vision and remaining required general anesthesia. Despite a high proportion of cases managed in the office setting, complication rates were within acceptable level. It is inversely proportional to the skill of the personnel, number of attempts &availability of equipment. Key to successful outcome are prompt help by well-trained doctor and otolaryngological equipment set up.Medicine Today 2017 Vol.29(2): 5-8

Prevalence and Common Risk Factors of Rickets among the Children below 15 Years

This cross sectional study was done in different upazillas of Sylhet district during July 2009 to June 2011 to find out the prevalence & common risk factors of rickets below 15 years in Sylhet district. The children under 15 years of age were selected from villages/slums by multistage random sampling. After recognition of at least one feature of rickets, the cases were sent to SOMCH or Upazilla Health Complex. They were examined by investigator and suspected cases were selected for further investigation. After radiological and biochemical examination the final cases were analyzed. In this study the prevalence of rickets in Sylhet district is 0.097%. Male children were more affected than female. In this study regarding feeding habit rice was the stable food which was eaten more than one time by all the rachitic children. Only twenty five percent of children drank milk once a day. The prevalence of rickets in Sylhet district was 0.097% which was almost similar to other parts of Bangladesh. Common risk factors for developing rickets are low socio-economic condition and carbohydrate rich dietary habit.Medicine Today 2017 Vol.29(2): 13-16

Nasal Foreign Body: A Retrospective Study

Background: Nasal foreign bodies are a frequent accident to otolaryngologist especially in young children. They are generally harmless and can be managed easily in outpatient department but may become life threatening if it is overlooked or attempt at removal by unskilled hand. Objective: To evaluate the nature, location, mode of presentation, technique of removal and outcome of foreign body in the nose.Setting: A retrospective study of 110 cases of nasal foreign body was done in Comilla medical college and two upazilla health complexes (Nangalkot and Chowddagram) of Bangladeesh within the period of July 2015 to December 2015.Result: The most frequent foreign body were seeds of various vegetables (27.27%), mostly found in right nasal cavity (57.27%) and unilateral foul smelling nasal discharge (36.36%) was the common presenting complaint. We found high incidence in 2-5 year age group (79%) with male predominance. Most of the foreign bodies (94.55%) were removed under direct vision with various instruments with or without local anesthesia. Conclusion: Nasal foreign body is a one of the most common ENT emergencies in our country. Prompt and appropriate management can reduce morbidity.Keywords: Nasal foreign body, otolaryngologist, seed, anesthesia, ENT emergency.

Traumatic Perforation of Tympanic Membrane: A Rural Profile of Bangladesh

To determine the various etiological factors, clinical presentation and outcome of traumatic perforation of tympanic membrane (TM) in a rural area of Bangladesh. A retrospective study of 210 cases of traumatic perforation of TM in upazilla health complex, Nangalkot and Muradnagar, Comilla, Bangladesh within the period of March 2013 to February 2014. The study showed middle age people of 20-39 years age group were mostly affected (61.89%), where males are more than females at the ratio of 1.18:1. Domestic violence was a major factor (50%) and husbands are only culprit for 35.13% of housewives and slap was the major mode of injury (52.86%) affecting the left ear mostly (70.95%). Spontaneous healing rate was very satisfactory and it was 88% within 03 months in our study. Traumatic perforation of TM is a common type of injury in rural areas. Unnecessary surgical intervention or unskilled handling should be discouraged. Early appearance and watchful treatment reduces the morbidity.Medicine Today 2016 Vol.28(2): 79-82

Utilization of Postnatal Care Services among the Rural Women in Bangladesh

Background : Low utilization of routine postnatal care (PNC) is an important determinant of high maternal and neonatal mortality in Bangladesh.Objective : To determine the utilization of post-natal care services among the rural women in a selected area in Bangladesh.Methodology : During October 2015 to March 2016 a descriptive, cross-sectional study was carried out among 200 married women of reproductive age who had a live baby below 5years of age. Sample was selected purposively from village Islampur in Dhamrai Upzilla under Dhaka district. After taking informed consent data were collected by face to face interview using structured questionnaire.Results : The study revealed that 73.50% of the respondents utilized PNC services among them 55.10% took PNC for less than 3 times and 28.57% took PNC for more than 3 times during postnatal period. Most of them 86% were house wife; age between 25-30 years. About 35% respondents were educated up to secondary level and 31.5% were from middle economic group. In this study 79.50% respondents received Antenatal care and advice for Post-Natal Care (PNC) Source of information for PNC was 32.5% from health workers. Fifty nine percent respondents took PNC on combined decision of husband and wife. A significant number of respondents 61.91% received postnatal care at Upazilla Health Complex. Most of the respondents 73.47% found health care provider available on duty and good behavior were found by 72.11% respondents. Among respondents 62.59% attended Health Centre by walking. Only 59.86% respondents got free PNC service. Regarding importance of PNC 67.5% believed for healthy mother and 12.5% for healthy baby.Conclusions : Post Natal Care service utilization was satisfactory (73.50%) in the study area which is higher than the national figure (36%). The findings of the study clearly showed that female education, monthly household income, antenatal care utilization, distance of health center turned out important factors in determining the postpartum care utilization among the mothers. Availability and interaction with health care providers also affected the postpartum care utilization in the study population.Northern International Medical College Journal Vol.8(2) January 2017: 208-212

Pattern of Skin Diseases at Upazilla Level

Skin the largest organ in the human body plays a vital role in one's health care. This anatomical barrier regulates the body temperature and interface with the environment for protecting the body against pathogens. The type of skin problems varies in different geographical areas, climate, economic and other factors including personal characteristics such as age and sex. The pattern of skin diseases varies from one area to another and across different parts within the same country. A retrospective study was done among patient attending Upazilla health complex, South Matlab OPD during the period January 2014 to 31 Dec 2014. To determine the pattern of skin diseases seen in a rural upazilla community. All patients attending the Skin & VD outpatient department were included in this study. All those with dermatological complaints were examined in detail, brief relevant history was elicited and clinical diagnosis was made by a consultant dermatologist. Patient of Skin diseases comprised 8984 (12 % of total 74870 patients at OPD). The most common age group was 11-20 years (36.06%). Infective disorders were found in 62% and non-infective disorders in 32%, of all the dermatological cases. Fungal infections (48.20%) were the most common among infective dermatoses, whereas bacterial infections were 2nd in position. Among the non-infective dermatoses, eczemas were the most common (33.54%) followed by urticaria (23.78%). In our study, higher prevalence of infective dermatoses especially fungal infections was more common at rural upazilla level. Since the placement of dermatologists at Upazilla Health Complexes, non-infective dermatoses were also identified in great numbers e.g. Urticaria, Psoriasis, Lichen planus, Pityriasisalba Polymorphic Light Eruption, and vitiligo. These patients were diagnosed, treated and followed up regularly at primary health care settings.
 CBMJ 2017 January: Vol. 06 No. 01 P: 08-11

Substitution Reduced Health Work Force Syndrome: A Way Forward for Developing Countries

World Health Organization (WHO) state Worlds 57 countries suffered from shortage of doctors in term of health worker imbalance, maldistribution. The objective of this study is to assess does substitution can be carried out in the mainstream of health systems to reduce health workforce syndrome for developing countries. Six facilities (two union health family welfare center, two Upazilla health complex and two clinics from Non-Government Organizations) were taken purposively. A structured questioner addressing one hundred and eleven (111) variables for Essential service package was used for in-depth interviews and observation. A hypothetical framework was used to focus on substitution, crisis and policy implication. Study report reveals that in seven components of Essential Service Package most of the services provided by doctors in public health facilities were same services served by non-doctor health care providers in health care facilities operated by non-government organizations. Non-doctor health care providers are not allow to serve even for non-communicable disease screening. Research result reveal that non-doctor health care service providers skill and expertise regards maternal health care, child health care, adolescent care, nutritional care and care for other diseases are gold standard. Regard maternal health care services non-doctor health care service providers not able to serve and referred the cases of identify obstetric emergencies (ANC7), labour induction (ND4), episiotomy (ND7) and identify and manage obstetric emergencies (isolation or B/CEmonC), obstructed labour, pre/eclampsia, haemorrhage, pre-term labour, including administration of antenatal Corticosteroids (ND8) and complicated cases (ND9), identification and management of obstetric complications:, Hemorrhage, Puerperal infection/sepsis (PNC4). In respect to neonatal care non-doctor providers not cannot manage preterm or low birth weight (LBW) neonate (INC4), identification and management of sepsis (NCD5), identification and management of omphalitis (NCD6), identification and management of LBW babies (refer <1, 800 (NCD7), identification and management of neonatal jaundice (NCD8) and obs and neonatal emergencies. Among family planning services non-doctor provider at NGO clinic do not serve the services are advocacy and awareness development on PPFP and post-MR/PAC–FP (FP2), menstrual regulation(FP11), post abortion FP(FP12), post-partum FP (FP13), post MR–FP (FP14), management of contraceptive complications (FP15). IMCI and EPI were well covered by non-doctor health care service providers following book chart let. Non-doctor health care service providers well capable to serve the services of essential service package (ESP). If top-up training given to them and allow to served more services that presently not covered would able to covered and doctors were get to engage themselves to manage more complicated cases. A special cadre will create in the mainstream of health service systems that increase service range in public health sector and able to ensure universal health coverage.

Patients’ Satisfaction with Services Obtained from a Health Care Centre in Rural Bangladesh

Background: Patients’ satisfaction is one of the established yard sticks to measure success of the services being provided in the hospitals. Human satisfaction is a complex concept. A satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical providers, leading to improved compliance, continuity of care, and ultimately better outcomes.Objective: To assess patient satisfaction with services provided in a primary health care centre in rural Bangladesh.Materials and method: This descriptive cross sectional study was carried out among the patients who attended the outpatient department at Upazilla Health Complex, Dhamrai from November 2015 to January 2016. Study subjects were selected by convenient type of non-probability sampling. Semi-structured pre-tested questionnaire was used and face to face interview was conducted. A Total of 328 respondents, age more than 18 years,irrespective of sex, were included in this study.Results: Majority of the patients stated that the general basic facilities, in terms of lighting facilities, signboards, canteen services and toilet facilities at the hospital were adequate. Majority respondents reported that the hospital was clean, ventilation facilities were found adequate, sitting arrangements and drinking water was available in waiting rooms. Most of the patients were satisfied with the behaviour of health personnel and quality of professional services provided by doctors. Regarding overall satisfaction, 44.2% patients were satisfied with health services and only 3.0% patients were dissatisfied. A high statistically significant relation was found between educational level and occupation with satisfaction level of the respondents.Conclusion: The health care delivered at this centre can be improved further by monitoring the delivery ofquality care by ongoing basis and continually making small changes as per need so as to improve the individual processes.Delta Med Col J. Jul 2016 4(2): 77-82

Salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension in coastal Bangladesh: a case-control study.

BackgroundHypertensive disorders in pregnancy are among the leading causes of maternal and perinatal death in low-income countries, but the aetiology remains unclear. We investigated the relationship between salinity in drinking water and the risk of (pre)eclampsia and gestational hypertension in a coastal community.MethodsA population-based case-control study was conducted in Dacope, Bangladesh among 202 pregnant women with (pre)eclampsia or gestational hypertension, enrolled from the community served by the Upazilla Health Complex, Dacope and 1,006 matched controls from the same area. Epidemiological and clinical data were obtained from all participants. Urinary sodium and sodium levels in drinking water were measured. Logistic regression was used to calculate odds ratios, and 95% confidence intervals.FindingsDrinking water sources had exceptionally high sodium levels (mean 516.6 mg/L, S.D 524.2). Women consuming tube-well (groundwater) were at a higher disease risk than rainwater users (p<0.001). Adjusted risks for (pre)eclampsia and gestational hypertension considered together increased in a dose-response manner for increasing sodium concentrations (300.01–600 mg/L, 600.1–900 mg/L, >900.01 mg/L, compared to <300 mg/L) in drinking water (ORs 3.30 [95% CI 2.00–5.51], 4.40 [2.70–7.25] and 5.48 [3.30–9.11] (p-trend<0.001). Significant associations were seen for both (pre)eclampsia and gestational hypertension separately.InterpretationSalinity in drinking water is associated with increased risk of (pre)eclampsia and gestational hypertension in this population. Given that coastal populations in countries such as Bangladesh are confronted with high salinity exposure, which is predicted to further increase as a result of sea level rise and other environmental influences, it is imperative to develop and evaluate affordable approaches to providing water with low salt content.

Socio Demographic Factors Related to Smoking among Rural Adolescent

Background: Smoking is one of the leading preventable causes of premature death, disease, and disability. Adolescence is the period of physical, psychological and social maturation from childhood to adulthood and adolescent smoking is a continuous process which is related to many disease factors. Objective: To find out the factors related to smoking among rural adolescents. Materials and method: One hundred and fifty one male adolescent aged 13 to 19 years from rural areas were interviewed with a semi-structured questionnaire during January to June 2013, at Dhamrai Upazilla Health Complex, Savar, Dhaka, Bangladesh. The socio demographic details, smoking and depression history were recorded. The Center for Epidemiologic Studies Depression (CES-D) Scale was used to measure the presence of depression. Smoking behavior was measured by a number of questions. Results: Mean(±SD) age of the study subjects was 16.8(±1.9) years. Most of the respondents started smoking around the average age of 14.3 years. The study shows that 64% respondents were smokers. Among smokers 80% were influenced by their friends about smoking. Seventy eight percent of the smokers were suffering from depression while 22% of nonsmokers were depressed (p&lt;0.001). Majority (72%) of the issues of the smoker parents were smoker (p&lt;0.5). Domestic violence (p&lt;0.001) and stressful events in life (p&lt;0.05) also played significant roles for smoking. Conclusion: Depression, parent smoking and peer smoking, domestic violence, and stressful life events are important factors to start smoking in rural adolescents. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20525 Delta Med Col J. Jul 2014; 2(2): 58-63