ObjectiveWe aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Ba... more ObjectiveWe aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh.DesignSetting and participantsA cross-sectional survey among 476 households was conducted during October–December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted.Outcome measuresPercentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19.ResultsAbout 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare ...
Bangladesh typifies many developing countries experiencing an increasing trend in tobacco consump... more Bangladesh typifies many developing countries experiencing an increasing trend in tobacco consumption. However, little is known about the general pattern of tobacco consumption and about population groups who are more prone to tobacco consumption. This paper aimed at generating knowledge on tobacco con-sumption, especially emphasizing the identification of sociodemographic groups who are more prone to tobacco consumption vis-à-vis tobacco-related health consequences in a remote rural area in Bangladesh. Information on the tobacco consumption status of 6,618 individuals (52.1 % males, 47.9 % females), aged over 15 years, was collected in 1994. Both univariate and multivariate analyses were done. Individuals were categorized as consumers if they consumed tobacco in any form at all, i.e. smoke or chew. The in-dependent variables included various characteristics of individuals and households. Overall, 43.4 % of the study subjects consumed tobacco. Males were 9.38 times more likely to co...
Background: Bangladesh is facing serious shortage of trained health professionals. In the plurali... more Background: Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. Methods: The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April–May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analy...
2Demographic Events, Safe Motherhood and Infant Feeding Practices, and Care-seeking behaviour for... more 2Demographic Events, Safe Motherhood and Infant Feeding Practices, and Care-seeking behaviour for Malaria and Tuberculosis 2010 ICDDR,B The annual reports of Chakaria Health and Demographic Surveillance System (Chakaria HDSS) are not copyrighted and may be freely quoted as long as the source is properly indicated. All staff members of the Chakaria HDSS, Dhaka and Chakaria, have contributed to the preparation of this report. ISBN: 978-984-551-327-2 Scientific report No. 116
Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are ... more Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how ...
This study aimed to assess completeness of antenatal care coverage following implementation of a ... more This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15–49 with children aged 0–23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A ‘completeness index’ for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher ‘completeness index’ scores, with a mean score of 185.2±101....
Community clinics, a flagship programme of the Government of Bangladesh, are health facilities se... more Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. This set up is a unique example of public-private partnership as community clinics run through community participation. A community clinic is managed by a Community Group (CG), representing healthcare providers and a Community Support Group (CSG) that is representative of the community. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources
Background: Although mental health is an important part of health and wellbeing, very little is k... more Background: Although mental health is an important part of health and wellbeing, very little is known about the impact of the COVID-19 pandemic on the mental health of marginalized communities like urban slum dwellers. Our study estimated the prevalence of generalized anxiety disorder and insomnia among the residents of the informal settlements of Dhaka, Bangladesh, during the COVID-19 pandemic.Methods: A cross-sectional phone-based survey was conducted from October to November 2020 among adult residents of five informal settlements of Dhaka city randomly chosen from an existing Urban Health and Demographic Surveillance Systems (UHDSS) run by icddr,b. Data on Generalized Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI) were collected. A multinomial logistic regression was performed to assess the associated factors of anxiety and insomnia.Results: Of the total 586 participants, the prevalence of mild to severe anxiety and insomnia were 53% and 43%, respectively. As per th...
Journal of Health, Population, and Nutrition, 2007
Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-cons... more Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status def...
Background The government of Bangladesh initiated community clinics (CC) to extend the reach of p... more Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group di...
Background Engaging communities in health facility management and monitoring is an effective stra... more Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare p...
A simple, rapid, and reliable method to detect Vibrio cholerae in fecal specimens would assist in... more A simple, rapid, and reliable method to detect Vibrio cholerae in fecal specimens would assist in the management of cases of severe diarrhea, especially since most such cases occur in areas with minimal laboratory facilities. A coagglutination test was used to detect V. cholerae antigen in bile-peptone broth incubated with feces. In the technique, Staphylococcus aureus Cowan 1 coated with anti-V. cholerae O1 antiserum was tested with cultures incubated for 4 h. When 165 specimens were tested, the sensitivity, specificity, and accuracy of the test, compared with standard culture methods, were 97, 99, and 98%, respectively. These promising results were better than those of dark-field microscopy using the same specimens, and the test was logistically easy to perform. The coagglutination test using enrichment broth culture of feces is a simple and rapid method which may be used to confirm a diagnosis of cholera.
ObjectiveWe aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Ba... more ObjectiveWe aimed to rapidly assess the health system impact of COVID-19 in the urban slums of Bangladesh.DesignSetting and participantsA cross-sectional survey among 476 households was conducted during October–December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted.Outcome measuresPercentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19.ResultsAbout 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare ...
Bangladesh typifies many developing countries experiencing an increasing trend in tobacco consump... more Bangladesh typifies many developing countries experiencing an increasing trend in tobacco consumption. However, little is known about the general pattern of tobacco consumption and about population groups who are more prone to tobacco consumption. This paper aimed at generating knowledge on tobacco con-sumption, especially emphasizing the identification of sociodemographic groups who are more prone to tobacco consumption vis-à-vis tobacco-related health consequences in a remote rural area in Bangladesh. Information on the tobacco consumption status of 6,618 individuals (52.1 % males, 47.9 % females), aged over 15 years, was collected in 1994. Both univariate and multivariate analyses were done. Individuals were categorized as consumers if they consumed tobacco in any form at all, i.e. smoke or chew. The in-dependent variables included various characteristics of individuals and households. Overall, 43.4 % of the study subjects consumed tobacco. Males were 9.38 times more likely to co...
Background: Bangladesh is facing serious shortage of trained health professionals. In the plurali... more Background: Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. Methods: The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April–May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analy...
2Demographic Events, Safe Motherhood and Infant Feeding Practices, and Care-seeking behaviour for... more 2Demographic Events, Safe Motherhood and Infant Feeding Practices, and Care-seeking behaviour for Malaria and Tuberculosis 2010 ICDDR,B The annual reports of Chakaria Health and Demographic Surveillance System (Chakaria HDSS) are not copyrighted and may be freely quoted as long as the source is properly indicated. All staff members of the Chakaria HDSS, Dhaka and Chakaria, have contributed to the preparation of this report. ISBN: 978-984-551-327-2 Scientific report No. 116
Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are ... more Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how ...
This study aimed to assess completeness of antenatal care coverage following implementation of a ... more This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15–49 with children aged 0–23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A ‘completeness index’ for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher ‘completeness index’ scores, with a mean score of 185.2±101....
Community clinics, a flagship programme of the Government of Bangladesh, are health facilities se... more Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. This set up is a unique example of public-private partnership as community clinics run through community participation. A community clinic is managed by a Community Group (CG), representing healthcare providers and a Community Support Group (CSG) that is representative of the community. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources
Background: Although mental health is an important part of health and wellbeing, very little is k... more Background: Although mental health is an important part of health and wellbeing, very little is known about the impact of the COVID-19 pandemic on the mental health of marginalized communities like urban slum dwellers. Our study estimated the prevalence of generalized anxiety disorder and insomnia among the residents of the informal settlements of Dhaka, Bangladesh, during the COVID-19 pandemic.Methods: A cross-sectional phone-based survey was conducted from October to November 2020 among adult residents of five informal settlements of Dhaka city randomly chosen from an existing Urban Health and Demographic Surveillance Systems (UHDSS) run by icddr,b. Data on Generalized Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI) were collected. A multinomial logistic regression was performed to assess the associated factors of anxiety and insomnia.Results: Of the total 586 participants, the prevalence of mild to severe anxiety and insomnia were 53% and 43%, respectively. As per th...
Journal of Health, Population, and Nutrition, 2007
Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-cons... more Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status def...
Background The government of Bangladesh initiated community clinics (CC) to extend the reach of p... more Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group di...
Background Engaging communities in health facility management and monitoring is an effective stra... more Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare p...
A simple, rapid, and reliable method to detect Vibrio cholerae in fecal specimens would assist in... more A simple, rapid, and reliable method to detect Vibrio cholerae in fecal specimens would assist in the management of cases of severe diarrhea, especially since most such cases occur in areas with minimal laboratory facilities. A coagglutination test was used to detect V. cholerae antigen in bile-peptone broth incubated with feces. In the technique, Staphylococcus aureus Cowan 1 coated with anti-V. cholerae O1 antiserum was tested with cultures incubated for 4 h. When 165 specimens were tested, the sensitivity, specificity, and accuracy of the test, compared with standard culture methods, were 97, 99, and 98%, respectively. These promising results were better than those of dark-field microscopy using the same specimens, and the test was logistically easy to perform. The coagglutination test using enrichment broth culture of feces is a simple and rapid method which may be used to confirm a diagnosis of cholera.
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