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Perry HB, Chowdhury AMR. Bangladesh: 50 Years of Advances in Health and Challenges Ahead. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300419. [PMID: 38233096 PMCID: PMC10906562 DOI: 10.9745/ghsp-d-23-00419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/06/2023] [Indexed: 01/19/2024]
Abstract
Bangladesh has inspired the rest of the world with its remarkable health achievements over the past half-century. A considerably stronger government investment in health care is now needed to achieve universal health coverage and “Health for All” in Bangladesh.
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Affiliation(s)
- Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ahmed Mushtaque Raza Chowdhury
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Keough School of Global Affairs and Eck Institute of Global Health, University of Notre Dame, South Bend, IN, USA
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Maroju RG, Choudhari SG, Shaikh MK, Borkar SK, Mendhe H. Application of Artificial Intelligence in the Management of Drinking Water: A Narrative Review. Cureus 2023; 15:e49344. [PMID: 38146561 PMCID: PMC10749683 DOI: 10.7759/cureus.49344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Waterborne illnesses are a significant concern worldwide. The management of water resources can be facilitated by artificial intelligence (AI) with the help of data analytics, regression models, and algorithms. Achieving the Sustainable Development Goals (SDGs) of the 2030 Agenda for Sustainable Development of the United Nations depends on understanding, communicating, and measuring the value of water and incorporating it into decision-making. Various barriers are used from the source to the consumer to prevent microbiological contamination of drinking water sources or reduce contamination to levels safe for human health. Infrastructure development and capacity-building policies should be integrated with guidelines on applying AI to problems relating to water to ensure good development outcomes. Communities can live healthily with such technology if they can provide clean, economical, and sustainable water to the ecosystem as a whole. Quick and accurate identification of waterborne pathogens in drinking and recreational water sources is essential for treating and controlling the spread of water-related diseases, especially in resource-constrained situations. To ensure successful development outcomes, policies on infrastructure development and capacity building should be combined with those on applying AI to water-related problems. The primary focus of this study is the use of AI in managing drinking water and preventing waterborne illness.
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Affiliation(s)
- Revathi G Maroju
- Department of Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Sonali G Choudhari
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (DU), Wardha, IND
| | - Mohammed Kamran Shaikh
- Department of Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Sonali K Borkar
- Department of Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
| | - Harshal Mendhe
- Department of Community Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (DU), Nagpur, IND
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Nassikas NJ, Gold DR. Climate change is a health crisis with opportunities for health care action: A focus on health care providers, patients with asthma and allergic immune diseases, and their families and neighbors. J Allergy Clin Immunol 2023; 152:1047-1052. [PMID: 37742937 PMCID: PMC10841871 DOI: 10.1016/j.jaci.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
Climate change has increased the frequency of extreme weather events and compounded natural disasters. Heat, wildfires, flooding, and pollen are already threatening public health and disproportionately affecting individuals in susceptible situations and vulnerable locations. In this theme issue of the Journal of Allergy and Clinical Immunology, we address what is known and not known about the biologic as well as clinical upstream and downstream effects of climate change on asthma and allergy development and exacerbation. We present potential actions that individuals can take at the family, neighborhood, community, health care system, and national and international levels to build climate resilience and protect their own health and the health and welfare of others. We emphasize the importance of actions and policies that are context specific and just. We emphasize the need for the health care system, which contributes between 3% and 5% of global greenhouse gas emissions, to reduce its carbon footprint and build resiliency. Health care providers play a pivotal role in helping policymakers understand the effects of climate on the health of our patients. There is still a window to avoid the most serious effects of climate change on human health and our planet.
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Affiliation(s)
- Nicholas J Nassikas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
| | - Diane R Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Mass
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Durga P, Caffery LA, Muurlink OT, Taylor‐Robinson AW. Under the regulatory radar: Unregulated rural healthcare in Bangladesh and Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3184-e3192. [PMID: 35194864 PMCID: PMC9542652 DOI: 10.1111/hsc.13763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Pratima Durga
- School of Business & LawCentral Queensland UniversityBrisbaneAustralia
| | - Lisa A. Caffery
- School of Business & LawCentral Queensland UniversityEmeraldAustralia
| | - Olav T. Muurlink
- School of Business & LawCentral Queensland UniversityBrisbaneAustralia
| | - Andrew W. Taylor‐Robinson
- College of Health SciencesVin UniversityHanoiVietnam
- Center for Global HealthUniversity of PennsylvaniaPhiladelphiaUSA
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Faruque ASG, Alam B, Nahar B, Parvin I, Barman AK, Khan SH, Hossain MN, Widiati Y, Hasan ASMM, Kim M, Worth M, Vandenent M, Ahmed T. Water, Sanitation, and Hygiene (WASH) Practices and Outreach Services in Settlements for Rohingya Population in Cox's Bazar, Bangladesh, 2018-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159635. [PMID: 35954994 PMCID: PMC9368108 DOI: 10.3390/ijerph19159635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 05/14/2023]
Abstract
(1) Background: This study aimed to investigate the existing water, sanitation, and hygiene (WASH) policy and practice of the study population and strengthen the evidence base by documenting changes in the WASH policy and practice over 3 years of the Rohingya refugee humanitarian crisis, Cox's Bazar, Bangladesh. (2) Methods: A cross-sectional surveillance design was followed; the sampling of the study population included the Rohingya refugee population and neighborhood host nationals who required hospitalization soon after seeking care and enrolled into the diarrheal disease surveillance in diarrhea-treatment centers. Throughout the study period of 3 years, a total of 4550 hospitalized individuals constituted the study participants. (3) Results: Among the hospitalized Rohingya refugee population; the use of public tap water increased significantly from 38.5% in year 1 to 91% in year 3. The use of deep tube well water significantly changed from 31.3% to 8.2%, and the use of shallow tube well water reduced significantly from 25.8% to 0.4%. Households using water seal latrine were 13.3% in year 1 and increased significantly to 31.7% in year 3. ORS consumption at home changed significantly from 61.5% in the first year to 82.1% in third year. Multivariable analysis demonstrated patients' age groups at 5 to 14 years, and 15 years and more, drinking non-tube well water, soap use after using toilet, use of non-sanitary toilet facility, father's and mother's lack of schooling, and some and severe dehydration were significantly associated with the Rohingya refugee population enrolled into the diarrheal disease surveillance. (4) Conclusion: The findings indicate significant advances in WASH service delivery as well as outreach activities by aid agencies for the Rohingya refugee population living in settlements.
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Affiliation(s)
- ASG Faruque
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Correspondence:
| | - Baharul Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Baitun Nahar
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Irin Parvin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Ashok Kumar Barman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Soroar Hossain Khan
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - M Nasif Hossain
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
| | - Yulia Widiati
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - ASM Mainul Hasan
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - Minjoon Kim
- UNICEF Bangladesh Country Office, Dhaka 1207, Bangladesh
| | - Martin Worth
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar 4700, Bangladesh
| | - Maya Vandenent
- UNICEF Bangladesh Country Office, Dhaka 1207, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
- Office of Executive Director, International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), Dhaka 1212, Bangladesh
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A High-Resolution Earth Observations and Machine Learning-Based Approach to Forecast Waterborne Disease Risk in Post-Disaster Settings. CLIMATE 2022. [DOI: 10.3390/cli10040048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Responding to infrastructural damage in the aftermath of natural disasters at a national, regional, and local level poses a significant challenge. Damage to road networks, clean water supply, and sanitation infrastructures, as well as social amenities like schools and hospitals, exacerbates the circumstances. As safe water sources are destroyed or mixed with contaminated water during a disaster, the risk of a waterborne disease outbreak is elevated in those disaster-affected locations. A country such as Haiti, where a large quantity of the population is deprived of safe water and basic sanitation facilities, would suffer more in post-disaster scenarios. Early warning of waterborne diseases like cholera would be of great help for humanitarian aid, and the management of disease outbreak perspectives. The challenging task in disease forecasting is to identify the suitable variables that would better predict a potential outbreak. In this study, we developed five (5) models including a machine learning approach, to identify and determine the impact of the environmental and social variables that play a significant role in post-disaster cholera outbreaks. We implemented the model setup with cholera outbreak data in Haiti after the landfall of Hurricane Matthew in October 2016. Our results demonstrate that adding high-resolution data in combination with appropriate social and environmental variables is helpful for better cholera forecasting in a post-disaster scenario. In addition, using a machine learning approach in combination with existing statistical or mechanistic models provides important insights into the selection of variables and identification of cholera risk hotspots, which can address the shortcomings of existing approaches.
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Shifting seasonality of cyclones and western boundary current interactions in Bay of Bengal as observed during Amphan and Fani. Sci Rep 2021; 11:22052. [PMID: 34764378 PMCID: PMC8586239 DOI: 10.1038/s41598-021-01607-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
In recent years, the seasonal patterns of Tropical Cyclones (TC) in the Bay of Bengal have been shifting. While tropical depressions have been common in March-May (spring), they typically have been relatively weaker than the TCs during October-December. Here we show that the spatial pattern of recent warming trends during the last two decades in the southwestern Bay has allowed for stronger springtime pre-monsoon cyclones such as Amphan (May 2020, Super Cyclone) and Fani (April-May 2019, Extremely Severe Cyclone). The tracks of the pre-monsoon cyclones shifted westward, concurrent with an increasing rate of warming. This shift allowed both Fani and Amphan tracks to cross the northeastward warm Western Boundary Current (WBC) and associated warm anti-cyclonic eddies, while the weaker Viyaru (April 2013, Cyclonic Storm) did not interact with the WBC. A quantitative model linking the available along-track heat potential to cyclone's intensity is developed to understand the impact of the WBC on cyclone intensification. The influence of the warming WBC and associated anti-cyclonic eddies will likely result in much stronger springtime TCs becoming relatively common in the future.
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Hoq MS, Raha SK, Hossain MI. Livelihood Vulnerability to Flood Hazard: Understanding from the Flood-prone Haor Ecosystem of Bangladesh. ENVIRONMENTAL MANAGEMENT 2021; 67:532-552. [PMID: 33609148 DOI: 10.1007/s00267-021-01441-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/29/2021] [Indexed: 06/12/2023]
Abstract
Bangladesh is a country of natural disasters and climatic hazards, which frequently affect its inhabitants' lives and livelihoods. Among the various risks and disasters, floods are the most frequent hazard that makes haor households vulnerable. Therefore, this study was undertaken to estimate livelihood vulnerability to flooding within the flood-prone haor ecosystem in Bangladesh. Primary data were collected from 100 haor households each from Kishoreganj, Netrokona, and Sunamganj districts (N = 300) by applying a multistage random sampling technique. Data were collected through face-to-face interviews using a pretested structured questionnaire. The Livelihood Vulnerability Index (LVI) and the Intergovernmental Panel on Climate Change (IPCC) framework of vulnerability were applied to compare vulnerabilities among the selected haor-based communities. The empirical results revealed that haor households in Sunamganj district were more vulnerable to flood hazard and natural disaster in terms of food, water, and health than households in the other two districts. Taking into account the major components of the LVI, the IPCC framework of vulnerability indicated that households in Sunamganj district were the most vulnerable due to their lowest adaptive capacity and highest sensitivity and exposure. These findings enable policymakers to formulate and implement effective strategies and programs to minimize vulnerability and enhance resilience by improving the livelihoods of the vulnerable haor households of Bangladesh, especially those in Sunamganj district.
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Affiliation(s)
- Mohammad Shamsul Hoq
- Agricultural Economics Division, Bangladesh Agricultural Research Institute, Joydebpur, Gazipur, 1701, Bangladesh.
| | - Shankar Kumar Raha
- Department of Agribusiness and Marketing, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Mohammad Ismail Hossain
- Department of Agribusiness and Marketing, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
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Khayyam U, Noureen S. Assessing the adverse effects of flooding for the livelihood of the poor and the level of external response: a case study of Hazara Division, Pakistan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:19638-19649. [PMID: 32221827 DOI: 10.1007/s11356-020-08303-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 03/02/2020] [Indexed: 05/21/2023]
Abstract
Flood is found to be a frequent phenomenon. Over the past few decades, Pakistan has been the home of climate-related disasters like floods. This paper attempts to examine the effect of floods on the rural communities; those are vulnerable to floods, and their livelihood patterns were damaged due to flooding events in Hazara Division. This research study assessed the causes, the impact, and the aftermath of flooding and their link with climate change in Hazara Division (Torghar, Kohistan, Mansehra, Abbottabad, and Haripur). The significance of environmental changes and flood's threats were discovered and examined through the logistic regressions and then pathway analysis. The findings showed that floods, directly and indirectly, affected the livelihood, social standing, and physical and economic status of rural communities. Rise in poverty level is also reported in already vulnerable communities that further increase their exposure to risks and hazards. This study calls for local government strengthening, early warning systems, and (non)financial assistance in times of needs to minimize the floods risk and disastrous impacts on localities and resources.
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Affiliation(s)
- Umer Khayyam
- Department of Development Studies, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Shabana Noureen
- Department of Economics, School of Social Sciences and Humanities (S3H), National University of Sciences and Technology (NUST), Islamabad, Pakistan
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Wu J, Huang C, Pang M, Wang Z, Yang L, FitzGerald G, Zhong S. Planned sheltering as an adaptation strategy to climate change: Lessons learned from the severe flooding in Anhui Province of China in 2016. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 694:133586. [PMID: 31386954 DOI: 10.1016/j.scitotenv.2019.133586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/12/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Evacuation and sheltering is both a disaster response measure and a strategy to adapt to climate change, and consequently address the Sustainable Development Goals. Research has found that displacement does cause negative health impacts to evacuees, but few studies have observed how planned sheltering might reduce adverse health impacts. This article identifies the good practice and lessons learned from China's response to severe flooding in Anhui province in 2016. METHODS First, we identified the key phases for disaster sheltering by analyzing related government reports. We then interviewed 21 relevant professionals in order to identify good practice and lessons learned which could lead to better health outcomes (e.g., reduce fatalities, infectious diseases, and mental health problems). Interviewees were selected through a purposive sampling strategy, which identified emergency management professionals and those who had been assigned evacuation, sheltering, or medical tasks. Finally, thematic analysis and the constant comparative method were used to code, identify, and describe the good practice and challenges during key phases. RESULTS Good practice included: using early warning systems to advise communities of risks and enforce evacuation in the flood zone; preparing and using schools as shelters with open-ended periods of operation; and, providing stable shelter accommodations which offered medical and public health services, clean drinking water and food, sanitation, and toilet hygiene through multiagency cooperation. Challenges included: providing mental health services, evaluating intervention effectiveness, managing volunteers, monitoring long-term health effects, and providing economic support. CONCLUSIONS The unintended negative effects caused by sheltering during extreme weather can be reduced. This requires close cooperation among government entities to establish planned mass shelters with appropriate levels of personal, environmental and healthcare support and to ensure long-term physical and mental health support. Additionally, if disaster mitigation strategies are integrated with climate adaptation plans, we can design more health-oriented and sustainable cities.
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Affiliation(s)
- Jiabing Wu
- Public Health Emergency Office, Anhui Province Center for Disease Control and Prevention, Hefei, China
| | - Cunrui Huang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Minghui Pang
- Center for Chinese Public Administration Research, School of Government, Sun Yat-Sen University, Guangzhou, China
| | - Zhe Wang
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lianping Yang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Gerard FitzGerald
- School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Shuang Zhong
- Center for Chinese Public Administration Research, School of Government, Sun Yat-Sen University, Guangzhou, China.
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Jagnoor J, Rahman A, Cullen P, Chowdhury FK, Lukaszyk C, Baset KU, Ivers R. Exploring the impact, response and preparedness to water-related natural disasters in the Barisal division of Bangladesh: a mixed methods study. BMJ Open 2019; 9:e026459. [PMID: 30948605 PMCID: PMC6500363 DOI: 10.1136/bmjopen-2018-026459] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the impact of natural disasters on communities in the Barisal division of Bangladesh, exploring community approaches to disaster preparedness and mitigation. SETTING Communities in all districts of the Barisal division of Bangladesh. PARTICIPANTS Quantitative data were collected through a cross-sectional household survey (n=9263 households; n=38 981 individuals). Qualitative data were collected through in-depth interviews (n=7) and focus group discussions (n=23) with key informants. OUTCOME MEASURES Quantitative research recorded features of natural disaster events from the previous 5 years, documenting risk factors that increase vulnerability to disaster, use of disaster warning systems and evacuation processes. Qualitative research investigated disaster risk perceptions, experiences during and following disaster, and disaster preparedness practices. RESULTS The survey response rate was 94.7%. Exposure to disaster in the last 5 years was high (82%) with flooding and cyclones considered the greatest threats. Awareness of evacuation processes was low; and only 19% of respondents evacuated their homes at the time of disaster. Drowning during disaster was the primary concern (87%), followed by debt, livestock and crop loss (78%). The qualitative findings indicated prevailing fatalistic perceptions towards natural disasters among community. The consequences of disasters included significant loss of livelihoods and exposure to infections due to poor sanitation. There was also insufficient support for the most vulnerable, particularly women, children and the elderly. Although several community preparedness and practices existed, there was a lack of response to early warning systems. Barriers to disaster response and resilience included financial insecurities, loss of livelihoods and cultural concerns regarding women's privacy. CONCLUSIONS Critical to achieving disaster resilience is increased government investment in infrastructure and systems-level responses that empower communities. Further research can support this by addressing community challenges to promoting disaster resilience and how to leverage existing community strengths to implement locally owned solutions.
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Affiliation(s)
- Jagnoor Jagnoor
- Injury Division, The George Institute for Global Health, Sydney, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, New Delhi, New Delhi, India
| | - Aminur Rahman
- International Drowning Research Centre, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Patricia Cullen
- Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Fazlul Kader Chowdhury
- International Drowning Research Centre, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Caroline Lukaszyk
- Injury Division, The George Institute for Global Health, Sydney, Australia
| | - Kamran ul Baset
- International Drowning Research Centre, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Rebecca Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Flinders University, Adelaide, South Australia, Australia
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El Saghir NS, Soto Pérez de Celis E, Fares JE, Sullivan R. Cancer Care for Refugees and Displaced Populations: Middle East Conflicts and Global Natural Disasters. Am Soc Clin Oncol Educ Book 2018; 38:433-440. [PMID: 30231320 DOI: 10.1200/edbk_201365] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Conflicts and natural disasters can cause major disruptions to people's lives. Media and news agencies usually focus on immediate consequences of these events, including loss of life and injuries, environmental and property destruction, and relief efforts. In this article, we will examine the effects of conflicts (focusing on in the Middle East) and global natural disasters on patients already diagnosed with cancer and on those who are diagnosed with cancer during and in the immediate aftermath of these events. We will review the limited literature, provide situational analysis, and discuss medical relief efforts, governmental readiness, and the role of United Nations agencies and international nongovernmental organizations. We will also discuss treatment of patients with cancer in the context of prolonged displacements and limited resources.
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Affiliation(s)
- Nagi S El Saghir
- From the Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon; Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Institute of Cancer Policy and Centre for Study of Conflict & Health, King's College, London, United Kingdom
| | - Enrique Soto Pérez de Celis
- From the Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon; Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Institute of Cancer Policy and Centre for Study of Conflict & Health, King's College, London, United Kingdom
| | - Johny E Fares
- From the Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon; Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Institute of Cancer Policy and Centre for Study of Conflict & Health, King's College, London, United Kingdom
| | - Richard Sullivan
- From the Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon; Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Institute of Cancer Policy and Centre for Study of Conflict & Health, King's College, London, United Kingdom
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Pacheco Barzallo D, Pacheco Barzallo A, Narvaez E. The 2016 Earthquake in Ecuador: Zika Outbreak After a Natural Disaster. Health Secur 2018; 16:127-134. [PMID: 29596013 DOI: 10.1089/hs.2017.0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this work was to examine the spread of the Zika virus after the destructive impact of the earthquake of April 2016 along the coast of Ecuador. Using a difference-in-difference estimation method and a unique dataset to track Zika cases at the national level, we estimated the impact of the earthquake on the reported cases of Zika in the affected region. Our results suggest that the earthquake increased the reported cases of Zika by 0.509 per epidemiologic week (data per 10,000 population), and we argue that the destroyed built environment along with other factors created a disease focus, where the virus spread easily. Because of its potential complications and devastating long-term effects, Zika represents a national threat. After a natural disaster, the health authorities, together with a multidisciplinary team and the wider community, all have an urgent responsibility to collaborate to minimize the health risks to the population.
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Urban Surface Water Quality, Flood Water Quality and Human Health Impacts in Chinese Cities. What Do We Know? WATER 2018. [DOI: 10.3390/w10030240] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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15
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Jutla A, Khan R, Colwell R. Natural Disasters and Cholera Outbreaks: Current Understanding and Future Outlook. Curr Environ Health Rep 2018; 4:99-107. [PMID: 28130661 DOI: 10.1007/s40572-017-0132-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Diarrheal diseases remain a serious global public health threat, especially for those populations lacking access to safe water and sanitation infrastructure. Although association of several diarrheal diseases, e.g., cholera, shigellosis, etc., with climatic processes has been documented, the global human population remains at heightened risk of outbreak of diseases after natural disasters, such as earthquakes, floods, or droughts. In this review, cholera was selected as a signature diarrheal disease and the role of natural disasters in triggering and transmitting cholera was analyzed. RECENT FINDINGS Key observations include identification of an inherent feedback loop that includes societal structure, prevailing climatic processes, and spatio-temporal seasonal variability of natural disasters. Data obtained from satellite-based remote sensing are concluded to have application, although limited, in predicting risks of a cholera outbreak(s). We argue that with the advent of new high spectral and spatial resolution data, earth observation systems should be seamlessly integrated in a decision support mechanism to be mobilize resources when a region suffers a natural disaster. A framework is proposed that can be used to assess the impact of natural disasters with response to outbreak of cholera, providing assessment of short- and long-term influence of climatic processes on disease outbreaks.
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Affiliation(s)
- Antarpreet Jutla
- Human Health and Hydro-environmental Sustainability Simulation Laboratory, Department of Civil and Environmental Engineering, West Virginia University, Morgantown, WV, 26505, USA.
| | - Rakibul Khan
- Human Health and Hydro-environmental Sustainability Simulation Laboratory, Department of Civil and Environmental Engineering, West Virginia University, Morgantown, WV, 26505, USA
| | - Rita Colwell
- Center for Bioinformatics and Computational Biology, University of Maryland, College Park, MD, 20742, USA.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 20742, USA
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Yunus FM, Khan S, Mitra DK, Mistry SK, Afsana K, Rahman M. Relationship of sleep pattern and snoring with chronic disease: findings from a nationwide population-based survey. Sleep Health 2018; 4:40-48. [PMID: 29332678 DOI: 10.1016/j.sleh.2017.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the association of total sleep time and presence or absence of snoring with chronic disease among the Bangladeshi adult population. DESIGN Cross-sectional survey. SETTING Urban and rural Bangladesh. PARTICIPANTS A total of 12,338 men and women aged ≥35 years. MEASUREMENTS Total sleep time was considered as the total hours of sleep in 24 hours. Furthermore, sleep time was categorized into <7, 7-9, and >9 hours according to National Sleep Foundation (2015) guidelines. Self-reported snoring history was captured and corroborated with their respective sleep partner/spouse in more than 80% cases. Registered physician-diagnosed current and/or previous cases of hypertension, diabetes, coronary heart disease, cancer, stroke, chronic obstructive pulmonary disease, and any other chronic conditions were counted. RESULTS Overall prevalence of at least 1 chronic disease in our study population was around 18%: men (15.4%) and women (20.0%). Hypertension has the highest prevalence (overall: 12.7%, men: 12.2%, women: 15%) followed by diabetes (4.9%), coronary heart diseases (3.2%), stroke (1.8%), chronic obstructive pulmonary disease (0.9%), and cancer (any type: 0.1%). Sleep pattern and snoring are significantly associated with all individual chronic disease except cancer. Sociodemographic, behavioral, and lifestyle variables were adjusted, and inadequate total sleep time (<7 hours) and snoring (yes/no) showed significant association with chronic disease status (risk ratio = 1.11, 95% confidence interval 1.00-1.22 and risk ratio = 1.20, 95% confidence interval 1.11-1.29, respectively). CONCLUSION Inadequate sleep and snoring are independently associated with chronic disease in Bangladeshi adult population and perhaps elsewhere.
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Affiliation(s)
- Fakir Md Yunus
- BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh; College of Pharmacy and Nutrition, The University of Saskatchewan, 104 Clinic Place, Saskatoon SK S7N 2Z4, Saskatchewan, Canada
| | - Safayet Khan
- BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh
| | - Dipak K Mitra
- School of Public Health, Independent University, Bangladesh, Plot 16 Block B, Aftabuddin Ahmed Road, Bashundhara /A, Dhaka, Bangladesh
| | - Sabuj Kanti Mistry
- BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh
| | - Kaosar Afsana
- BRAC Health, Nutrition and Population Program, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh; James P Grant School of Public Health, BRAC University, 68 ShahidTajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh
| | - Mahfuzar Rahman
- BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh.
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Gruebner O, Khan M, Burkart K, Lautenbach S, Lakes T, Krämer A, Subramanian SV, Galea S. Spatial variations and determinants of infant and under-five mortality in Bangladesh. Health Place 2017; 47:156-164. [PMID: 28888890 DOI: 10.1016/j.healthplace.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/19/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations.
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Affiliation(s)
- Oliver Gruebner
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany; University of Zurich, Epidemiology, Biostatistics, and Prevention Institute, Zurich, Switzerland.
| | - Mmh Khan
- King Faisal University, College of Applied Medical Sciences, Department of Public Health, Saudi Arabia; University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - Katrin Burkart
- Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, New York City, NY, USA
| | - Sven Lautenbach
- University of Bonn, Institute of Geodesy and Geoinformation (IGG), Bonn, Germany
| | - Tobia Lakes
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany
| | - Alexander Krämer
- University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - S V Subramanian
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Sandro Galea
- Boston University, School of Public Health, Boston, MA, USA
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18
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Flood in a Changing Climate: The Impact on Livelihood and How the Rural Poor Cope in Bangladesh. CLIMATE 2016. [DOI: 10.3390/cli4040060] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Huda TM, Tahsina T, El Arifeen S, Dibley MJ. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh. Glob Health Action 2016; 9:29741. [PMID: 26880153 PMCID: PMC4754013 DOI: 10.3402/gha.v9.29741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/13/2015] [Accepted: 12/15/2015] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. OBJECTIVES This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). DESIGN We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. RESULTS The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. CONCLUSION The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.
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Affiliation(s)
- Tanvir M Huda
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; ;
| | - Tazeen Tahsina
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Michael J Dibley
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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20
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Kelman I. Catastrophe and Conflict: Disaster Diplomacy and Its Foreign Policy Implications. ACTA ACUST UNITED AC 2016. [DOI: 10.1163/24056006-12340001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Beier D, Brzoska P, Khan MMH. Indirect consequences of extreme weather and climate events and their associations with physical health in coastal Bangladesh: a cross-sectional study. Glob Health Action 2015; 8:29016. [PMID: 26477878 PMCID: PMC4609650 DOI: 10.3402/gha.v8.29016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022] Open
Abstract
Background Bangladesh is one of the countries in the world which is most prone to natural disasters. The overall situation is expected to worsen, since extreme weather and climate events (EWCE) are likely to increase in both frequency and intensity. Indirect consequences caused in the events’ aftermath widen the range of possible adverse health outcomes. Objective To assess the association of indirect consequences of EWCE and physical health. Design We used recent cross-sectional self-reported data from 16 coastal villages in Bangladesh. A total of 980 households were surveyed using a structured questionnaire. The outcome of physical health was categorized into three groups, reflecting the severity of reported diseases by the respective source of treatment as a proxy variable (hospital/clinic for severe disease, other source/no treatment for moderate disease, and no disease). The final statistical analysis was conducted using multinomial logistic regression. Results Severe diseases were significantly associated with drinking water from open sources [odds ratio (OR): 4.26, 95% confidence interval (CI): 2.25–8.09] and tube wells (OR: 2.39, 95% CI: 1.43–4.01), moderate harm by river erosion (OR: 6.24, 95% CI: 2.76–14.11), food scarcity (OR: 1.98, 95% CI: 1.16–3.40), and the perception of increased employment problems (OR: 2.19, 95% CI: 1.18–4.07). Moderate diseases were significantly associated with moderate harm by river erosion (OR: 2.65, 95% CI: 1.28–5.48) and fully experienced food scarcity (OR: 1.75, 95% CI: 1.16–2.63). For both categories, women and the elderly had higher chances for diseases. Conclusions Indirect consequences of EWCE were found to be associated with adverse health outcomes. Basic needs such as drinking water, food production, and employment opportunities are particularly likely to become threatened by EWCE and, thus, may lead to a higher likelihood of ill-health. Intervention strategies should concentrate on protection and provision of basic needs such as safe drinking water and food in the aftermath of an event.
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Affiliation(s)
- Dominik Beier
- Department of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Patrick Brzoska
- Unit of Epidemiology, Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, Chemnitz, Germany
| | - Md Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany;
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Hanifi SMA, Mahmood SS, Bhuiya A. Cause-specific mortality and socioeconomic status in Chakaria, Bangladesh. Glob Health Action 2014; 7:25473. [PMID: 25377331 PMCID: PMC4220129 DOI: 10.3402/gha.v7.25473] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/12/2014] [Accepted: 09/12/2014] [Indexed: 11/20/2022] Open
Abstract
Background Bangladesh has achieved remarkable gains in health indicators during the last four decades despite low levels of economic development. However, the persistence of inequities remains disturbing. This success was also accompanied by health and demographic transitions, which in turn brings new challenges for a nation that has yet to come to terms with pre-transition health challenges. It is therefore important to understand the causes of death and their relationship with socioeconomic status (SES). Objective The paper aims to assess the causes of death by SES based on surveillance data from a rural area of Bangladesh, in order to understand the situation and inform policy makers and programme leaders. Design We analysed population-based mortality data collected from the Chakaria Health and Demographic Surveillance System in Bangladesh. The causes of death were determined by using a Bayesian-based programme for interpreting verbal autopsy findings (InterVA-4). The data included 1,391 deaths in 217,167 person-years of observation between 2010 and 2012. The wealth index constructed using household assets was used to assess the SES, and disease burdens were compared among the wealth quintiles. Results Analysing cause of death (CoD) revealed that non-communicable diseases (NCDs) were the leading causes of deaths (37%), followed by communicable diseases (CDs) (22%), perinatal and neonatal conditions (11%), and injury and accidents (6%); the cause of remaining 24% of deaths could not be determined. Age-specific mortality showed premature birth, respiratory infections, and drowning were the dominant causes of death for childhood mortality (0–14 years), which was inversely associated with SES (p<0.04). For adult and the elderly (15 years and older), NCDs were the leading cause of death (51%), followed by CDs (23%). For adult and the elderly, NCDs concentrated among the population from higher SES groups (p<0.005), and CDs among the lower SES groups (p<0.001). Conclusions Epidemiologic transition is taking place with a shift from the dominance of CDs to NCDs. SES inequity in mortality still persists – the poor suffer from CDs in all age groups, whereas those better off suffer more from NCDs than CDs. Policy makers thus need to consider the social distribution of diseases before developing any public health action targeted towards reducing mortality and the extent of disease burden in an equitable manner.
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Affiliation(s)
- Syed M A Hanifi
- INDEPTH Network, Accra, Ghana; Centre for Equity and Health Systems, ICDDR,B, Dhaka, Bangladesh;
| | - Shehrin S Mahmood
- INDEPTH Network, Accra, Ghana; Centre for Equity and Health Systems, ICDDR,B, Dhaka, Bangladesh
| | - Abbas Bhuiya
- INDEPTH Network, Accra, Ghana; Centre for Equity and Health Systems, ICDDR,B, Dhaka, Bangladesh
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Abstract
The extreme weather events that the world is experiencing are consistent with the effects of anthropogenic climate change. The western North Pacific is the area of the world with the most intense tropical cyclones. Increased sea surface temperatures directly contribute to the wind speed of storms. The 2013 Typhoon Yolanda/Haiyan was the strongest tropical cyclone in recorded history to make landfall-causing more than 6000 deaths in the Philippines, mostly from storm surge. This event represents a climate injustice. On one hand, disaster prevention and preparedness were inadequate for impoverished populations in the Philippines who lived in poorly constructed housing. While the international community assisted with the response, recovery was hampered by inadequate and inequitable investment. On the other hand, climate change has been driven by the carbon emissions of industrialized states. Those who call for climate justice argue for more robust measures to control carbon emissions responsible for climate change and worsening global health security. As global citizens and as health professionals, we examine the implications for all of us as moral actors.
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Uddin J, Mazur RE. Socioeconomic factors differentiating healthcare utilization of cyclone survivors in rural Bangladesh: a case study of cyclone Sidr. Health Policy Plan 2014; 30:782-90. [PMID: 24992935 DOI: 10.1093/heapol/czu057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although many studies have been carried out to examine healthcare utilizations in rural Bangladesh, yet little is known about the healthcare utilization among survivors of a natural disaster. This study addresses this gap by examining the socioeconomic factors associated with healthcare utilization among Cyclone Sidr survivors. METHODS A systematic random sample of 384 heads of household was interviewed using a semi-structured questionnaire. This study used multivariate logistic analyses to examine post-cyclone healthcare utilizations. Healthcare utilization is defined as the process of seeking professional healthcare and submitting oneself to the application of available health services, with the purpose to prevent or treat health problems. RESULTS Over half (58%) of Cyclone Sidr survivors suffered from some type of illness occurring during the 15 days preceding the survey. The most common healthcare choices among survivors to address illnesses were seeking assistance from para-professionals (37%), qualified allopaths (26%) and drug store salespersons (17%). A principal finding was that a household's socioeconomic status, as reflected by wealth quintiles, was a major determinant in healthcare utilization. The household heads in the higher wealth quintile were significantly more likely to seek modern allopathic providers for healthcare than those in the poorest quintile (Odds ratio (OR) = 2.89, Confidence interval (CI): 1.92-5.87). The household heads who listened to health risk communications were 2.55 times more likely to seek any healthcare (CI: 1.35-5.11) and 1.77 times to seek modern allopathic care (CI: 1.62-5.09) than those who did not. Other significant predictors of healthcare utilization were education, listening to radio, distance to healthcare facility and perceived susceptibility to water-borne diseases. CONCLUSIONS Para-professionals, qualified allopath and drugstore salespeople are the primary vehicles for providing healthcare services to population at risk of cyclone. Therefore, there is a need for more medical training for these primary healthcare providers in rural Bangladesh.
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Affiliation(s)
- Jalal Uddin
- Department of Sociology, Iowa State University, Ames, IA 50011, USA
| | - Robert E Mazur
- Department of Sociology, Iowa State University, Ames, IA 50011, USA
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Adams AM, Ahmed T, El Arifeen S, Evans TG, Huda T, Reichenbach L. Innovation for universal health coverage in Bangladesh: a call to action. Lancet 2013; 382:2104-11. [PMID: 24268605 DOI: 10.1016/s0140-6736(13)62150-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges. Central to the reform process will be the development of a multipronged strategic approach that: responds to existing demands in a way that assures affordable, equitable, high-quality health care from a pluralistic health system; anticipates health-care needs in a period of rapid health and social transition; and addresses underlying structural issues that otherwise might hamper progress. A pragmatic reform agenda for achieving universal health coverage in Bangladesh should include development of a long-term national human resources policy and action plan, establishment of a national insurance system, building of an interoperable electronic health information system, investment to strengthen the capacity of the Ministry of Health and Family Welfare, and creation of a supraministerial council on health. Greater political, financial, and technical investment to implement this reform agenda offers the prospect of a stronger, more resilient, sustainable, and equitable health system.
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Affiliation(s)
- Alayne M Adams
- Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Tanvir Ahmed
- Centre for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams El Arifeen
- Centre for Child Health and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Tanvir Huda
- Centre for Child Health and Adolescent Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Laura Reichenbach
- Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Affiliation(s)
- Amartya Sen
- Department of Economics, Harvard University, Littauer Center, Cambridge, MA 02138, USA.
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Abstract
How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from official sources, research studies, case studies of specific innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive effects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defines the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world.
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Affiliation(s)
- Syed Masud Ahmed
- Centre for Equity and Health Systems, icddr,b, Dhaka, Bangladesh; Centre of Excellence for Universal Health Coverage, James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
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Chowdhury AMR, Bhuiya A, Chowdhury ME, Rasheed S, Hussain Z, Chen LC. The Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet 2013; 382:1734-45. [PMID: 24268002 DOI: 10.1016/s0140-6736(13)62148-0] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.
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