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Shafique S, Bhattacharyya DS, Hossain MT, Hasan SM, Ahmed S, Islam R, Adams AM. Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh. PLoS One 2024; 19:e0266581. [PMID: 38271358 PMCID: PMC10810507 DOI: 10.1371/journal.pone.0266581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/01/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. METHODS This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. RESULTS Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. CONCLUSION While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.
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Affiliation(s)
- Sohana Shafique
- Urban Health Research Group, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Md. Tarek Hossain
- Urban Health Research Group, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shaikh Mehdi Hasan
- Urban Health Research Group, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shakil Ahmed
- Urban Health Research Group, Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rubana Islam
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alayne M. Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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Rahaman MA, Kalam A, Al-Mamun M. Unplanned urbanization and health risks of Dhaka City in Bangladesh: uncovering the associations between urban environment and public health. Front Public Health 2023; 11:1269362. [PMID: 37927876 PMCID: PMC10620720 DOI: 10.3389/fpubh.2023.1269362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Background Dhaka City, the capital of Bangladesh, has experienced rapid and unplanned urbanization over the past few decades. This process has brought significant challenges to public health as the urban environment has become a breeding ground for various health risks. Understanding the associations between unplanned urbanization, the urban environment, and public health in Dhaka City is crucial for developing effective interventions and policies. Objectives This review paper aims to uncover the associations between unplanned urbanization and health risks in Dhaka City, with a specific focus on the urban environment and its impact on public health. The objectives of this study are to examine the health challenges faced by the city's population, explore the specific urban environmental factors contributing to health risks, analyze the socioeconomic determinants of health in unplanned urban areas, evaluate existing policies and governance structures, identify research and data gaps, and provide recommendations for future interventions. Methods A comprehensive literature review was conducted to gather relevant studies, articles, reports, and policy documents related to unplanned urbanization, the urban environment, and public health in Dhaka City. Various databases and online resources were searched, and the selected literature was critically analyzed to extract key findings and insights. Results The findings reveal that unplanned urbanization in Dhaka City has led to a range of public health risks, including air pollution, inadequate water and sanitation, poor waste management, overcrowding, slums, and substandard housing conditions. These environmental factors are strongly associated with respiratory diseases, waterborne illnesses, and other adverse health outcomes. Socioeconomic determinants such as poverty, income inequality, and limited access to healthcare further exacerbate the health risks faced by the urban population. Conclusion Unplanned urbanization in Dhaka City has significant implications for public health. Addressing the associations between unplanned urbanization, the urban environment, and public health requires comprehensive policies and interventions. Improved urban planning, enhanced infrastructure, and better policy governance are essential for mitigating health risks. Furthermore, addressing socioeconomic disparities and ensuring equitable access to healthcare services are crucial components of effective interventions.
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Affiliation(s)
- Mohammad Anisur Rahaman
- College of Public Administration, Zhejiang University, Hangzhou, China
- Department of Sociology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Abul Kalam
- Department of Sociology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
| | - Md. Al-Mamun
- Department of Sociology, Bangabandhu Sheikh Mujibur Rahman Science and Technology University, Gopalganj, Bangladesh
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Mansoor M, de Glanville WA, Alam R, Aslam K, Ahmed M, Isaakidis P, Pasha A. Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002076. [PMID: 37729129 PMCID: PMC10511086 DOI: 10.1371/journal.pgph.0002076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
The burden of hepatitis C virus (HCV) infection in Pakistan is amongst the highest in the world. People living in slums are likely to be at high risk of infection. Here, we describe the results of a cross-sectional survey conducted in March 2022 that aimed to quantify the prevalence of HCV infection in Machar Colony, one of the largest and oldest slum settlements in Karachi. Risk factors for HCV seropositivity were identified using multi-level logistic regression. We recruited 1,303 individuals in a random selection of 441 households from Machar Colony. The survey-adjusted HCV-seroprevalence was 13.5% (95% Confidence Interval (CI) 11.1-15.8) and survey-adjusted viraemic prevalence was 4.1% (95% CI 3.1-5.4) with a viraemic ratio of 32% (95% CI 24.3-40.5). Of 162 seropositive people, 71 (44%) reported receiving previous treatment for chronic hepatitis C. The odds of HCV seropositivity were found to increase with each additional reported therapeutic injection in the past 12 months (OR = 1.07 (95% Credible Interval (CrI) 1.00-1.13)). We found weaker evidence for a positive association between HCV seropositivity and a reported history of receiving a blood transfusion (OR = 1.72 (95% CrI 0.90-3.21)). The seroprevalence was more than double the previously reported seroprevalence in Sindh Province. The overall proportion of seropositive people that were viraemic was lower than expected. This may reflect the long-term impacts of a non-governmental clinic providing free of cost and easily accessible hepatitis C diagnosis and treatment to the population since 2015. Reuse of needles and syringes is likely to be an important driver of HCV transmission in this setting. Future public health interventions should address the expected risks associated with iatrogenic HCV transmission in this community.
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Affiliation(s)
- Munazza Mansoor
- Interactive Research and Development (IRD), Karachi, Pakistan
| | | | - Ridwa Alam
- Interactive Research and Development (IRD), Karachi, Pakistan
| | - Khawar Aslam
- Médecins Sans Frontières (MSF), Brussels, Belgium
| | | | - Petros Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Aneeta Pasha
- Interactive Research and Development (IRD), Karachi, Pakistan
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Bhattacharyya DS, Sarker T, Akter N, Shafique S, Nabi MH, Hawlader MDH, Mitra DK. Factors associated with fathers' involvement in infant and young child feeding and nurturing care in the urban slums of Bangladesh: A cross-sectional study. Food Sci Nutr 2023; 11:4020-4029. [PMID: 37457166 PMCID: PMC10345689 DOI: 10.1002/fsn3.3390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 03/20/2023] [Accepted: 04/06/2023] [Indexed: 07/18/2023] Open
Abstract
Optimal infant and young child feeding (IYCF) and nurturing care during the first years of children's lives are crucial for ensuring their growth and development. The IYCF and nurturing practices are associated with a multifaceted interplay of context-specific factors where fathers' involvement is necessary. The aim of this study is to explore the current scenario of fathers' involvement in IYCF practices in the urban slums of Bangladesh. A cross-sectional survey among the residents of the Sat Tola slum in Dhaka, the capital of Bangladesh was conducted. To avoid social desirability bias, 361 mothers of children aged <24 months were interviewed regarding fathers' involvement. An operational definition of father's involvement was developed based on 11 criteria and then scoring was applied to classify 'Good Involvement' and associated factors were identified using multivariable logistic regression. Fathers' mean age was around 31 (SD ± 6.09) years and the majority of them (44.32%) completed primary education. Fathers had diversified occupations such as day laborer (32.41%), garment worker (22.71%), and business (14.96%). Factors that were significantly associated with the father's involvement in IYCF practices include educational status (aOR = 3.98, 95% CI = 1.91, 8.26, p < .00) and theiroccupational status (aOR = 0.34, 95% CI = 0.16, 0.70, p = .00). Fathers were more active for their first child (aOR: 1.99, 95% CI = 1.04, 3.79, p = .03). Having child in the age group of 14-20 months (aOR = 2.73, 95% CI = 1.32, 5.64, p = <.01) and wife in the age group of 21-30 years (aOR = 2.34, 95% CI = 1.20, 4.58, p = .01) were significantly associated. The study finding explored that fathers' education and occupation as well as mothers' age and education were significantly associated factors for fathers' involvement in the IYCF practices. Further longitudinal studies are recommended to establish the causal relationship between fathers' involvement with IYCF and their impact on child growth and development.
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Affiliation(s)
- Dipika Shankar Bhattacharyya
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
- Department of Public HealthNorth South UniversityDhakaBangladesh
| | - Tonmoy Sarker
- Department of Public HealthNorth South UniversityDhakaBangladesh
- Infectious Disease Divisionicddr,bDhakaBangladesh
| | - Nargis Akter
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
| | - Sohana Shafique
- Health System and Population Studies Divisionicddr,bDhakaBangladesh
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Gajanan Prabhune A, Manjunath U, Satheesh SS. A Literature Review on Perceptions and Practices Related to Healthcare and Nutrition Amongst the Residents of Urban Slums Across India. Cureus 2023; 15:e36654. [PMID: 37113376 PMCID: PMC10129044 DOI: 10.7759/cureus.36654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 03/28/2023] Open
Abstract
Urban regions are home to more than a billion people worldwide; by 2030, more than half of the world's population is projected to reside there. Many rural residents relocate to urban regions in pursuit of employment, better living conditions, and access to healthcare facilities. The study's primary objective is to collate the findings related to perceptions, knowledge, attitude, and practices from studies across the urban slums in India related to healthcare and nutrition. A systematic search of articles was conducted on the National Library of Medicine PubMed Portal Google Scholar, and J-Stor databases for published studies across the indexed journals. Academic social media sites like Academia.edu and Researchgate.org were also searched for grey literature. The inclusion criteria include studies conducted in Urban slums from 2010 to 2022, conducted amongst the Indian population within the Indian Geography, and focusing on documenting perceptions, knowledge, attitude, and practices. Exclusion criteria were cross-sectional surveys with quantitative questionnaires focusing on the prevalence of diseases and the burden of risk factors, literature reviews, systematic reviews, frameworks for implementation of specific interventions, and experimental study designs. A total of 18 qualitative observational studies were included in the review and the findings related to knowledge, attitudes, and practices identified from the literature were summarized. The literature indicated adequate knowledge about nutrition and healthcare, and the barriers towards transitioning knowledge to practice were related to lack of resources, priorities around employment and income, and the attitudes towards change-making were usually based on convenience to access cost of service and availability of the services. The review recommends further investment in research to understand the perceptions, patterns of nutrition, and health-seeking behaviours. Also, there is a pressing need to use the evidence for developing policies in line with the expectations of poor urban communities.
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Osuh ME, Oyaniran OH, Tunde‐Alao TS, Lawal FB, Oke GA, Osuh JI, Harris B, Chen Y, Lilford RJ. Tooth adornment among siblings living in an urban slum in Nigeria: Health implications for a vulnerable population. Clin Case Rep 2023; 11:e6563. [PMID: 36619480 PMCID: PMC9810584 DOI: 10.1002/ccr3.6563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 01/05/2023] Open
Abstract
Tooth jewelry boosts the appearance and confidence of wearers. However, its use may carry adverse health consequences. This paper creates awareness about a practice not previously reported in Nigeria, to prevent negative health consequences while appropriate measures are taken to quantify and describe the determinants and plan appropriate interventions.
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Affiliation(s)
- Mary E. Osuh
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK,Department of Periodontology and Community DentistryFaculty of DentistryCollege of MedicineUniversity of IbadanOyoNigeria,Department of Periodontology and Community DentistryFaculty of Dental SurgeryUniversity College HospitalIbadanOyoNigeria
| | - Olaide H. Oyaniran
- Department of Periodontology and Community DentistryFaculty of Dental SurgeryUniversity College HospitalIbadanOyoNigeria
| | - Tobi S. Tunde‐Alao
- Department of Periodontology and Community DentistryFaculty of Dental SurgeryUniversity College HospitalIbadanOyoNigeria
| | - Folake B. Lawal
- Department of Periodontology and Community DentistryFaculty of DentistryCollege of MedicineUniversity of IbadanOyoNigeria,Department of Periodontology and Community DentistryFaculty of Dental SurgeryUniversity College HospitalIbadanOyoNigeria
| | - Gbemisola A. Oke
- Department of Periodontology and Community DentistryFaculty of DentistryCollege of MedicineUniversity of IbadanOyoNigeria,Department of Periodontology and Community DentistryFaculty of Dental SurgeryUniversity College HospitalIbadanOyoNigeria
| | - Jackson I. Osuh
- Department of PsychologyFaculty of Social SciencesFederal UniversityOye‐EkitiNigeria
| | - Bronwyn Harris
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK
| | - Yen‐Fu Chen
- Division of Health SciencesWarwick Medical SchoolUniversity of WarwickCoventryUK
| | - Richard J. Lilford
- Institute of Applied Health ResearchCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
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Mahmud I, Siddiqua S, Akhter I, Sarker M, Theobald S, Rashid SF. Factors affecting motivation of close-to-community sexual and reproductive health workers in low-income urban settlements in Bangladesh: A qualitative study. PLoS One 2023; 18:e0279110. [PMID: 36638097 PMCID: PMC9838845 DOI: 10.1371/journal.pone.0279110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/29/2022] [Indexed: 01/14/2023] Open
Abstract
Close-to-community (CTC) health workers play a vital role in providing sexual and reproductive health services in low-income urban settlements in Bangladesh. Retention of CTC health workers is a challenge, and work motivation plays a vital role in this regard. Here, we explored the factors which affect their work motivation. We conducted 22 in-depth interviews in two phases with purposively selected CTC health workers operating in low-income urban settlements in Dhaka, Bangladesh. We analyzed our data using the framework technique which involved identifying, abstracting, charting, and matching themes across the interviews following the two-factor theory on work motivation suggested by Herzberg and colleagues. Our results suggest that factors affecting CTC sexual and reproductive health workers' work motivation include both extrinsic and intrinsic factors. Extrinsic or hygiene factors include financial incentives, job security, community attitude, relationship with the stakeholders, supportive and regular supervision, monitoring, and physical safety and security. While, the intrinsic factors or motivators are the perceived quality of the services provided, witnessing the positive impact of the work in the community, the opportunity to serve vulnerable clients, professional development opportunities, recognition, and clients' compliance. In the context of a high unemployment rate, people might take a CTC health worker's job temporarily to earn a living or to use it as a pathway move to more secure employment. To maintain and improve the work motivation of the CTC sexual and reproductive health workers serving in low-income urban settlements, organizations should provide adequate financial incentives, job security, and professional development opportunities in addition to supportive and regular supervision.
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Affiliation(s)
- Ilias Mahmud
- Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- * E-mail:
| | - Sumona Siddiqua
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Irin Akhter
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
- Heidleberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka, Bangladesh
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Barua P, Kibuchi E, Aktar B, Chowdhury SF, Mithu IH, Quayyum Z, Filha NTDS, Leyland AH, Rashid SF, Gray L. The effects of social determinants on children's health outcomes in Bangladesh slums through an intersectionality lens: An application of multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001588. [PMID: 36963045 PMCID: PMC10022045 DOI: 10.1371/journal.pgph.0001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023]
Abstract
Empirical evidence suggests that the health outcomes of children living in slums are poorer than those living in non-slums and other urban areas. Improving health especially among children under five years old (U5y) living in slums, requires a better understanding of the social determinants of health (SDoH) that drive their health outcomes. Therefore, we aim to investigate how SDoH collectively affects health outcomes of U5y living in Bangladesh slums through an intersectionality lens. We used data from the most recent national Urban Health Survey (UHS) 2013 covering urban populations in Dhaka, Chittagong, Khulna, Rajshahi, Barisal, Sylhet, and Rangpur divisions. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to estimate the Discriminatory Accuracy (DA) of the intersectional effects estimates using Variance Partition Coefficient (VPC) and the Area Under the Receiver Operating Characteristic Curve (AUC-ROC). We also assessed the Proportional Change in Variance (PCV) to calculate intersectional effects. We considered three health outcomes: cough, fever, and acute respiratory infections (ARI) in U5y.We found a low DA for cough (VPC = 0.77%, AUC-ROC = 61.90%), fever (VPC = 0.87%, AUC-ROC = 61.89%) and ARI (VPC = 1.32%, AUC-ROC = 66.36%) of intersectional strata suggesting that SDoH considered do not collectively differentiate U5y with a health outcome from those with and without a health outcome. The PCV for cough (85.90%), fever (78.42%) and ARI (69.77%) indicates the existence of moderate intersectional effects. We also found that SDoH factors such as slum location, mother's employment, age of household head, and household's garbage disposal system are associated with U5y health outcomes. The variables used in this analysis have low ability to distinguish between those with and without health outcomes. However, the existence of moderate intersectional effect estimates indicates that U5y in some social groups have worse health outcomes compared to others. Therefore, policymakers need to consider different social groups when designing intervention policies aimed to improve U5y health outcomes in Bangladesh slums.
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Affiliation(s)
- Proloy Barua
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Bachera Aktar
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Imran Hossain Mithu
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Zahidul Quayyum
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Sabina Faiz Rashid
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Linsay Gray
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
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Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
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Quality of nutrition services in primary health care facilities of Dhaka city: State of nutrition mainstreaming in urban Bangladesh. PLoS One 2022; 17:e0278621. [PMID: 36516160 PMCID: PMC9749975 DOI: 10.1371/journal.pone.0278621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite high prevalence of malnutrition little is known about the quality of nutrition services provided through urban health systems. This study aimed to fill in knowledge gaps on quality of nutrition service provision at public primary health care facilities in urban Dhaka. METHOD This cross-sectional study was conducted from April-July 2019 in Dhaka City. Fifty-three health facilities were sampled following NetCode protocol. Quality of nutrition services was assessed in terms of structural readiness, process, and client satisfaction. Structural readiness included equipment, guidelines, and registers, and knowledge of health professionals (n = 130). For process, client provider interaction was observed (ANC: n = 159, Pediatric: n = 150). For outcome assessment, client's satisfaction with nutrition service provision was measured through interviews with pregnant women (n = 165) and caregivers of 0-24 month-old children (n = 162). Bivariate and multivariate analyses were conducted using SPSS. RESULTS There were gaps in availability of equipment and guidelines in health facilities. Only 30% of healthcare providers received basic nutrition training. The mean knowledge score was 5.8 (range 0-10) among ANC providers and 7.8 for pediatric service providers. Process: Only 17.6% health facilities had dedicated space for counselling, 48.4% of pregnant women received four key nutrition services; 22.6% of children had adequate growth monitoring; and 38.7% of caregivers received counselling on exclusive breastfeeding. Outcome: The mean satisfaction with services was 4.3 for ANC and 4.0 for paediatric visits (range 1-5). Participants attending public facilities had significantly lower satisfaction compared to those attending private and NGO health facilities. CONCLUSION There were gaps in facility readiness, and implementation of nutrition services. The clients were more satisfied with services at private facilities compared to public. The gaps in nutrition service delivery need to be adequately addressed to ensure promotion of good nutrition and early detection and management of malnutrition among pregnant women and children in urban Bangladesh.
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Sarker AR, Khan AI, Islam MT, Chowdhury F, Khanam F, Kang S, Ahmmed F, Im J, Kim DR, Tadesse BT, Ahmed T, Aziz AB, Hoque M, Park J, Liu X, Pak G, Zaman K, Marks F, Kim JH, Clemens JD, Qadri F. Cost of oral cholera vaccine delivery in a mass immunization program for children in urban Bangladesh. Vaccine X 2022; 12:100247. [PMID: 36545347 PMCID: PMC9761845 DOI: 10.1016/j.jvacx.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Cholera poses a substantial health burden in the developing world due to both epidemic and endemic diseases. The World Health Organization recommends oral cholera vaccines for mass vaccination campaigns in addition to traditional prevention practices and treatments in resource-poor settings. In many developing countries like Bangladesh, the major challenge behind implementing mass vaccination campaigns concerns the affordability of the oral cholera vaccine (OCV). Vaccination of children with OCV is not only an impactful approach for controlling cholera at the population level and reducing childhood morbidity but is also considered more cost-effective than vaccinating all ages. The aim of the study was to estimate the cost of an OCV campaign for children from a societal perspective using empirical study. A total of 66,311 children aged 1 to 14 years old were fully vaccinated with two doses of the OCV Shanchol while 9,035 individuals received one dose of this vaccine. The estimated societal cost per individual for full vaccination was US$ 6.11, which includes the cost of vaccine delivery estimated at US$ 1.95. The cost per single dose was estimated at US$ 2.86. The total provider cost for full vaccination was estimated at US$ 6.01 and the recipient cost at US$ 0.10. Our estimation of OCV delivery costs for children was relatively higher than what was found in a similar mass OCV campaign for all age groups, indicating that there may be additional cost factors to consider in targeted vaccine campaigns. This analysis provides useful benchmarks for the possible costs related to delivery of OCV to children and future OCV cost-effectiveness models should factor in these possible cost disparities. Attempts to reduce the cost per dose are likely to have a greater impact on the cost of similar vaccination campaigns in many resource-poor settings.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies (BIDS), Bangladesh,Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Ashraful Islam Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh,Corresponding author at: International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Md. Taufiqul Islam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahima Chowdhury
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farhana Khanam
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sophie Kang
- International Vaccine Institute, Seoul, Republic of Korea
| | - Faisal Ahmmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Justin Im
- International Vaccine Institute, Seoul, Republic of Korea
| | - Deok Ryun Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - Birkneh Tilahun Tadesse
- International Vaccine Institute, Seoul, Republic of Korea,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden,Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa P.O. Box 9086, Ethiopia
| | - Tasnuva Ahmed
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Masuma Hoque
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Juyeon Park
- International Vaccine Institute, Seoul, Republic of Korea,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0AW, United Kingdom
| | - Xinxue Liu
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Gideok Pak
- International Vaccine Institute, Seoul, Republic of Korea
| | - Khalequ Zaman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea,Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge CB2 0AW, United Kingdom,University of Antananarivo, Antananarivo, Madagascar,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Jerome H. Kim
- International Vaccine Institute, Seoul, Republic of Korea
| | - John D. Clemens
- International Vaccine Institute, Seoul, Republic of Korea,UCLA Fielding School of Public Health, Los Angeles, CA 90095-1772, USA
| | - Firdausi Qadri
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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12
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Kabir A, Karim N, Billah B. Preference and willingness to receive non-communicable disease services from primary healthcare facilities in Bangladesh: A qualitative study. BMC Health Serv Res 2022; 22:1473. [PMID: 36463166 PMCID: PMC9719224 DOI: 10.1186/s12913-022-08886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden. NCD services have been significantly mobilized to primary healthcare (PHC) facilities to better manage the rising burden of NCDs. However, little is known about community members' preference and willingness to receive NCD services from PHC facilities; therefore, this particular subject is the focus of this study. METHODS A qualitative study was conducted from May 2021 to October 2021. Data were collected via 16 focus group discussions involving community members and 14 key informant interviews with healthcare professionals, facility managers, and public health practitioners. Based on a social-ecological model (SEM), data were analyzed thematically. The triangulation of methods and participants was conducted to validate the information provided. RESULTS Preference and willingness to receive NCD services from PHC facilities were influenced by a range of individual, interpersonal, societal, and organizational factors that were interconnected and influenced each other. Knowledge and the perceived need for NCD care, misperception, self-management, interpersonal, and family-level factors played important roles in using PHC facilities. Community and societal factors (i.e., the availability of alternative and complementary services, traditional practices, social norms) and organizational and health system factors (i.e., a shortage of medicines, diagnostic capacity, untrained human resources, and poor quality of care) also emerged as key aspects that influenced preference and willingness to receive NCD services from PHC facilities. CONCLUSION Despite their substantial potential, PHC facilities may not take full advantage of managing NCDs. All four factors need to be considered when developing NCD service interventions in the primary healthcare system to better address the rising burden of NCDs.
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Affiliation(s)
- Ashraful Kabir
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nazmul Karim
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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13
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Antibiotic Resistance: An Increasingly Threatening but Neglected Public Health Challenge in Bangladesh. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Bashar F, Islam R, Khan SM, Hossain S, Sikder AAS, Yusuf SS, Adams AM. Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh. PLoS One 2022; 17:e0262358. [PMID: 34986200 PMCID: PMC8730431 DOI: 10.1371/journal.pone.0262358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/21/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND "Contracting Out" is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor's retention both in managerial as well as service provision level in the contracted-out setting. METHODOLOGY In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. RESULTS The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. CONCLUSIONS An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.
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Affiliation(s)
- Farzana Bashar
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Rubana Islam
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Shaan Muberra Khan
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shahed Hossain
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Adel A. S. Sikder
- Infectious Disease Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sifat Shahana Yusuf
- Health Systems and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Alayne M. Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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15
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Win H, Wallenborn J, Probst-Hensch N, Fink G. Understanding urban inequalities in children's linear growth outcomes: a trend and decomposition analysis of 39,049 children in Bangladesh (2000-2018). BMC Public Health 2021; 21:2192. [PMID: 34847918 PMCID: PMC8631262 DOI: 10.1186/s12889-021-12181-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite significant progress in reducing child undernutrition, Bangladesh remains among the top six countries globally with the largest burden of child stunting and has disproportionately high stunting prevalence among the urban poor. We use population representative data to identify key predictors of child stunting in Bangladesh and assess their contributions to linear growth differences observed between urban poor and non-poor children. METHODS We combined six rounds of Demographic and Health Survey data spanning 2000-2018 and used official poverty rates to classify the urban population into poor and non-poor households. We identified key stunting determinants using stepwise selection method. Regression-decomposition was used to quantify contributions of these key determinants to poverty-based intra-urban differences in child linear growth status. RESULTS Key stunting determinants identified in our study predicted 84% of the linear growth difference between urban poor and non-poor children. Child's place of birth (27%), household wealth (22%), maternal education (18%), and maternal body mass index (11%) were the largest contributors to the intra-urban child linear growth gap. Difference in average height-for-age z score between urban poor and non-poor children declined by 0.31 standard deviations between 2000 and 2018. About one quarter of this observed decrease was explained by reduced differentials between urban poor and non-poor in levels of maternal education and maternal underweight status. CONCLUSIONS Although the intra-urban disparity in child linear growth status declined over the 2000-2018 period, socioeconomic gaps remain significant. Increased nutrition-sensitive programs and investments targeting the urban poor to improve girls' education, household food security, and maternal and child health services could aid in further narrowing the remaining linear growth gap.
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Affiliation(s)
- Hayman Win
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Jordyn Wallenborn
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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16
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Khan FA, Khalequzzaman M, Hasan M, Choudhury SR, Chiang C, Aoyama A, Islam SS. Dietary salt intake and its correlates among adults in a slum area in Dhaka, Bangladesh: a cross-sectional study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 83:589-599. [PMID: 34552291 PMCID: PMC8438000 DOI: 10.18999/nagjms.83.3.589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/19/2021] [Indexed: 11/30/2022]
Abstract
High dietary salt intake increases the risk of noncommunicable diseases (NCDs). NCDs are increasing among the urban poor in Bangladesh, but the data of their dietary salt intake are yet scarce. This study aimed to explore the amount of dietary salt intake among adults in an urban slum area in Dhaka, Bangladesh. A cross-sectional community-based study was conducted. We randomly selected 100 residents (39 men and 61 women) aged 20–59 years without history of NCDs. A modified World Health Organization standard instrument was used for behavioral risk factor assessment and physical measurements. Dietary salt intake was estimated from the measurement of sodium (Na) excretion in spot urine samples.The estimated mean dietary salt intake was 7.8 ± 2.5 g/day, and the mean Na/potassium (K) ratio in urine was 4.9 ± 3.4. More than half (54%) of them always took additional salt in their meals, but only 6% of them consumed 5 or more servings of fruits and vegetables per day. A quarter of them perceived salt reduction not at all important. Increased mean salt intakes were marginally associated with lower waist circumference and lower waist-hip ratio. Dietary salt intake among urban slum residents was higher than the recommended level of 5 g/day; however, its association with NCD risk factors was not significant. Further studies are required to identify the urban poor specific factors.
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Affiliation(s)
- Fahmida Afroz Khan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Md Hasan
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan.,Nagoya University of Arts and Sciences, Nissin, Japan
| | - Syed Shariful Islam
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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17
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Ganle JK, Baatiema L, Ayamah P, Ofori CAE, Ameyaw EK, Seidu AA, Ankomah A. Family planning for urban slums in low- and middle-income countries: a scoping review of interventions/service delivery models and their impact. Int J Equity Health 2021; 20:186. [PMID: 34412647 PMCID: PMC8375135 DOI: 10.1186/s12939-021-01518-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
Background Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings. Methods We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings. Results The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls’ club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services. Conclusions This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01518-y.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13 Legon, Accra, Ghana.
| | - Leonard Baatiema
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, NSW, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Shaarbafchizadeh N, Fouladi Z, Aqdak P, Raeisi AR. Health-care reform implementation challenges at suburban areas in Isfahan province: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:268. [PMID: 34485565 PMCID: PMC8395986 DOI: 10.4103/jehp.jehp_703_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 11/24/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Health system reform plan in public health sector in Iran in the first phase focused on improving primary health care in suburban areas in and around big cities. The present study was conducted to assess the implementation process challenges of the reform plan in comprehensive health service centers at suburban areas of Isfahan in 2019. MATERIALS AND METHODS This qualitative study with conventional content analysis approach was conducted in 2019. Participants were purposefully selected and interviewed at provincial levels from Isfahan University of Medical Sciences health department and health-care providers of comprehensive health services centers. The saturation point was reached after 21 face-to-face semi-structured interviews. Thematic analysis was employed to analyze transcribed documents assisted by MAXQDA version 10. RESULTS The results revealed four main themes; the human resource management, the executive management, the electronic infrastructure, and the resource management. The major challenges in the implementation planning process included: the referral system, monitoring and supervision, electronic services infrastructure in the design and development of the EHR called the SIB system, lack of instructions guide, salaries and benefits, inconsistent financial and human resources and inappropriate allocation of theses resources. CONCLUSION Despite the achievements in the development of the Iran health system reform plan, there were many challenges in the implementation planning process. It is recommended that theses challenges be reviewed and amended by health system managers and policymakers.
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Affiliation(s)
- Nasrin Shaarbafchizadeh
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Fouladi
- Department of Health Services Management, School of Management and Medical Information, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pejman Aqdak
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Reza Raeisi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Unicomb LE, Nizame FA, Uddin MR, Nahar P, Lucas PJ, Khisa N, Akter SMS, Islam MA, Rahman M, Rousham EK. Motivating antibiotic stewardship in Bangladesh: identifying audiences and target behaviours using the behaviour change wheel. BMC Public Health 2021; 21:968. [PMID: 34022819 PMCID: PMC8140425 DOI: 10.1186/s12889-021-10973-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Asia is a hotspot for antimicrobial resistance due largely to over-the-counter antibiotic sales for humans and animals and from a lack of policy compliance among healthcare providers. Additionally, there is high population density and high infectious disease burden. This paper describes the development of social and behavioural change communication (SBCC) to increase the appropriate use of antibiotics. METHODS We used formative research to explore contextual drivers of antibiotic sales, purchase, consumption/use and promotion among four groups: 1) households, 2) drug shop staff, 3) registered physicians and 4) pharmaceutical companies/medical sales representatives. We used formative research findings and an intervention design workshop with stakeholders to select target behaviours, prioritise audiences and develop SBCC messages, in consultation with a creative agency, and through pilots and feedback. The behaviour change wheel was used to summarise findings. RESULTS Workshop participants identified behaviours considered amenable to change for all four groups. Household members and drug shop staff were prioritised as target audiences, both of which could be reached at drug shops. Among household members, there were two behaviours to change: suboptimal health seeking and ceasing antibiotic courses early. Thus, SBCC target behaviours included: seek registered physician consultations; ask whether the medicine provided is an antibiotic; ask for instructions on use and timing. Among drug shop staff, important antibiotic dispensing practices needed to change. SBCC target behaviours included: asking customers for prescriptions, referring them to registered physicians and increasing customer awareness by instructing that they were receiving antibiotics to take as a full course. CONCLUSIONS We prioritised drug shops for intervention delivery to all drug shop staff and their customers to improve antibiotic stewardship. Knowledge deficits among these groups were notable and considered amenable to change using a SBCC intervention addressing improved health seeking behaviours, improved health literacy on antibiotic use, and provision of information on policy governing shops. Further intervention refinement should consider using participatory methods and address the impact on profit and livelihoods for drug shop staff for optimal compliance.
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Affiliation(s)
- Leanne E Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Fosiul Alam Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rofi Uddin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, Sussex University, Brighton, UK
| | | | - Nirnita Khisa
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - S M Salim Akter
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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20
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Yusuf SS, Acharya K, Ahmed R, Ahmed A. Understanding general health service readiness and its correlates in the health facilities of Bangladesh: evidence from the Bangladesh Health Facility Survey 2017. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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21
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Adams AM, Ahmed R, Ahmed S, Yusuf SS, Islam R, Zakaria Salam RM, Panciera R. Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh. BMC Public Health 2020; 20:1476. [PMID: 32993610 PMCID: PMC7526238 DOI: 10.1186/s12889-020-09594-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.
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Affiliation(s)
- Alayne M Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Cote des Neiges, Room 332, Montréal, H3S 1Z1, Québec, Canada. .,Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
| | - Rushdia Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shakil Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Rubana Islam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Rocco Panciera
- Implementation Research and Delivery Science Unit, Health Section, UNICEF, New York, NY, USA
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Hasan SM, Borces KG, Bhattacharyya DS, Ahmed S, Ali A, Adams A. Healthcare Systems Strengthening in Smaller Cities in Bangladesh: Geospatial Insights From the Municipality of Dinajpur. Health Serv Insights 2020; 13:1178632920951586. [PMID: 32952402 PMCID: PMC7485152 DOI: 10.1177/1178632920951586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022] Open
Abstract
Throughout South Asia a proliferation of cities and middle-sized towns is
occurring. While larger cities tend to receive greater attention in terms
national level investments, opportunities for healthy urban development abound
in smaller cities, and at a moment where positive trajectories can be
established. In Bangladesh, municipalities are growing in size and tripled in
number especially district capitals. However, little is known about the
configuration of health services to hold these systems accountable to public
health goals of equity, quality, and affordability. This descriptive
quantitative study uses data from a GIS-based census and survey of health
facilities to identify gaps and inequities in services that need to be
addressed. Findings reveal a massive private sector and a worrisome lack of
primary and some critical care services. The study also reveals the value of
engaging municipal-level decision makers in mapping activities and analyses to
enable responsive and efficient healthcare planning.
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Affiliation(s)
- Shaikh Mehdi Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | | | - Shakil Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.,Centre of Excellence for Urban Equity and Health, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Azam Ali
- Country Office, Bangladesh, Options Consultancy Services UK Ltd., Dhaka, Bangladesh
| | - Alayne Adams
- Centre of Excellence for Urban Equity and Health, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
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Nahar P, Unicomb L, Lucas PJ, Uddin MR, Islam MA, Nizame FA, Khisa N, Akter SMS, Rousham EK. What contributes to inappropriate antibiotic dispensing among qualified and unqualified healthcare providers in Bangladesh? A qualitative study. BMC Health Serv Res 2020; 20:656. [PMID: 32669092 PMCID: PMC7362537 DOI: 10.1186/s12913-020-05512-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Over-prescribing and inappropriate use of antibiotics contributes to the emergence of antimicrobial resistance (AMR). Few studies in low and middle-income settings have employed qualitative approaches to examine the drivers of antibiotic sale and dispensing across the full range of healthcare providers (HCPs). We aimed to explore understandings of the use and functions of antibiotics; awareness of AMR and perceived patient or customer demand and adherence among HCPs for human and animal medicine in Bangladesh. Methods We used an ethnographic approach to conduct face-to-face, in-depth interviews with 46 community HCPs in one urban and one rural area (Gazipur and Mirzapur districts respectively). We purposefully selected participants from four categories of provider in human and veterinary medicine: qualified; semi-qualified; auxiliary and unqualified. Using a grounded theory approach, thematic analysis was conducted using a framework method. Results Antibiotics were considered a medicine of power that gives quick results and works against almost all diseases, including viruses. The price of antibiotics was equated with power such that expensive antibiotics were considered the most powerful medicines. Antibiotics were also seen as preventative medicines. While some providers were well informed about antibiotic resistance and its causes, others were completely unaware. Many providers mistook antibiotic resistance as the side effects of antibiotics, both in human and animal medicine. Despite varied knowledge, providers showed concern about antibiotic resistance but responsibility for inappropriate antibiotic use was shifted to the patients and clients including owners of livestock and animals. Conclusions Misconceptions and misinformation led to a wide range of inappropriate uses of antibiotics across the different categories of human and animal healthcare providers. Low awareness of antibiotic action and antibiotic resistance were apparent among healthcare providers, particularly those with little or no training and those in rural areas. Specific and targeted interventions to address AMR in Bangladesh should include educational messages on the rational use of antibiotics and how they work, targeting all types of healthcare providers. While tailored training for providers may increase understanding of antibiotic action and improve practices, more far-reaching structural changes are required to influence and increase responsibility for optimising antibiotic dispensing among all HCPs.
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Affiliation(s)
- Papreen Nahar
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | | | - Mohammad Rofi Uddin
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Mohammad Aminul Islam
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, USA
| | - Fosiul Alam Nizame
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Nirnita Khisa
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - S M Salim Akter
- International Centre for Diarrhoeal Disease Research, (icddr, b), Dhaka, Bangladesh
| | - Emily K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University
- , Loughborough, UK.
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Jolly SP, Chowdhury TR, Rahman M, Alam A, Afsana K. Prevention of social exclusion and role of antenatal care by BRAC community health workers in improving safe motherhood and neonatal care in urban slums of Bangladesh. PLoS One 2020; 15:e0235340. [PMID: 32639998 PMCID: PMC7343159 DOI: 10.1371/journal.pone.0235340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/12/2020] [Indexed: 12/05/2022] Open
Abstract
The transformation of the BRAC MANOSHI programme from humanitarian to a social enterprise model, has made it increasingly urgent to enumerate the minimum number of door-to-door antenatal care (ANC) visits by community health workers (CHWs), for the purpose of effectively improving facility delivery. Thus prevent social exclusion of poor slum communities in Bangladesh with regard to safe motherhood and essential newborn care (ENC). This cross-sectional study was conducted, during March–July, 2015 in slums of Chittagong, Dhaka and Sylhet city corporations of Bangladesh. A census was conducted among 25,700 households covering 10 branch offices of MANOSHI to identify women with a delivery outcome in the preceding three years of the survey. A total of 1100 respondents were interviewed randomly through a structured questionnaire. These women were stratified into three categories-1, 2 & 3, consisting of 497, 205 and 398 women respectively. Women in category-1 did not receive any ANC checkup from the BRAC CHWs, while women in category-2 and category-3 received one to three and ≥four ANC checkups from BRAC CHWs respectively. Data was analysed using STATA Version 13 (Chicago Inc.). Findings revealed that women, who received ≥four ANC checkups from BRAC CHWs, are 25% more likely to avail facility delivery [adjusted Prevalence Ratio (aPR) 1.25; 95% confidence interval (CI) (1.01–1.54)] compared to the women who did not receive any ANC from BRAC CHWs. Women in category-2 [aPR3.64; 95% CI (1.76–7.54)] and in category-3 [aPR5.92; 95% CI (3.04–11.53)] respectively had four and six folds higher tendency to receive postnatal care (PNC) within 48 hours after delivery. Furthermore, facility delivery improved PNC assisted by medically trained providers (MTPs) within 48 hours after delivery and ENC in both categories 2 & 3. The evidence shows that at least four ANC visits of BRAC CHWs can increase institutional delivery, and which can further facilitate PNC and ENC visits. At present, the BRAC MANOSHI programme needs to implement feasible strategies to include pregnant women in the slums in receiving at least four ANC checkups by BRAC CHWs for ensuring safe motherhood and newborn care.
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Affiliation(s)
| | | | | | - Ariful Alam
- Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh
| | - Kaosar Afsana
- Health, Nutrition and Population Programme, BRAC, Dhaka, Bangladesh
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Adams AM, Islam R, Yusuf SS, Panasci A, Crowell N. Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings. PLoS One 2020; 15:e0233635. [PMID: 32542043 PMCID: PMC7295220 DOI: 10.1371/journal.pone.0233635] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/08/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country’s goal of Universal Health Coverage by 2030. Methods This descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed. Results Significant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet. Conclusions Study results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.
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Affiliation(s)
- Alayne M. Adams
- Department of Family Medicine, McGill University, Montreal, Canada
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Rubana Islam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Anthony Panasci
- Department of Global Health, School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Crowell
- School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia, United States of America
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Corburn J, Vlahov D, Mberu B, Riley L, Caiaffa WT, Rashid SF, Ko A, Patel S, Jukur S, Martínez-Herrera E, Jayasinghe S, Agarwal S, Nguendo-Yongsi B, Weru J, Ouma S, Edmundo K, Oni T, Ayad H. Slum Health: Arresting COVID-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health 2020; 97:348-357. [PMID: 32333243 PMCID: PMC7182092 DOI: 10.1007/s11524-020-00438-6] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The informal settlements of the Global South are the least prepared for the pandemic of COVID-19 since basic needs such as water, toilets, sewers, drainage, waste collection, and secure and adequate housing are already in short supply or non-existent. Further, space constraints, violence, and overcrowding in slums make physical distancing and self-quarantine impractical, and the rapid spread of an infection highly likely. Residents of informal settlements are also economically vulnerable during any COVID-19 responses. Any responses to COVID-19 that do not recognize these realities will further jeopardize the survival of large segments of the urban population globally. Most top-down strategies to arrest an infectious disease will likely ignore the often-robust social groups and knowledge that already exist in many slums. Here, we offer a set of practice and policy suggestions that aim to (1) dampen the spread of COVID-19 based on the latest available science, (2) improve the likelihood of medical care for the urban poor whether or not they get infected, and (3) provide economic, social, and physical improvements and protections to the urban poor, including migrants, slum communities, and their residents, that can improve their long-term well-being. Immediate measures to protect residents of urban informal settlements, the homeless, those living in precarious settlements, and the entire population from COVID-19 include the following: (1) institute informal settlements/slum emergency planning committees in every urban informal settlement; (2) apply an immediate moratorium on evictions; (3) provide an immediate guarantee of payments to the poor; (4) immediately train and deploy community health workers; (5) immediately meet Sphere Humanitarian standards for water, sanitation, and hygiene; (6) provide immediate food assistance; (7) develop and implement a solid waste collection strategy; and (8) implement immediately a plan for mobility and health care. Lessons have been learned from earlier pandemics such as HIV and epidemics such as Ebola. They can be applied here. At the same time, the opportunity exists for public health, public administration, international aid, NGOs, and community groups to innovate beyond disaster response and move toward long-term plans.
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Affiliation(s)
- Jason Corburn
- School of Public Health & Department of City & Regional Planning, University of California, Berkeley, CA USA
| | | | - Blessing Mberu
- Urbanization and Wellbeing Unit, African Population and Health Research Centre (APHRC), Nairobi, Kenya
| | - Lee Riley
- Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Waleska Teixeira Caiaffa
- Epidemiology and Public Health, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | | | - Albert Ko
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
| | - Sheela Patel
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | - Smurti Jukur
- Society for the Promotion of Area Resource Centre (SPARC), Mumbai, India
| | | | | | | | | | - Jane Weru
- Akiba Mashinani Trust (AMT), Nairobi, Kenya
| | - Smith Ouma
- Cardiff Law and Global Justice, Cardiff, UK
| | | | - Tolu Oni
- MRC Epidemiology unit, University of Cambridge, UK & School of Public Health and Family Medicine, Cambridge, UK
- University of Cape Town, Cape Town, South Africa
| | - Hany Ayad
- Alexandria University, Alexandria, Egypt
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Lee TW, Lee SJ, Kim MS, Choi Y. Establishing a nurse-managed health center for the urban poor in Dhaka, Bangladesh. Public Health Nurs 2020; 37:560-568. [PMID: 32342569 DOI: 10.1111/phn.12731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite the rise in community health problems in populations living in urban slums, activities of community health nurses are limited in Bangladesh. This study aimed to describe how a nurse-managed health center (NMHC) was developed in Dhaka, Bangladesh. DESIGN An exploratory-descriptive research design was used. SAMPLE AND MEASUREMENTS The commitment phase was conducted to establish partnerships in the community. Involvement of community leaders and members and partnerships with various organizations were established successfully in the commitment phase. The assessment phase was completed by implementing personal interviews, community site visits, and household surveys of 172 households in the community. Action plans were developed and strategies were followed to change the community during the planning phase. RESULTS Household survey results showed that community people suffered from non-communicable diseases, risk behaviors, and inadequate housing conditions. The high-priority community needs included nutrition and chronic management services, behavior change programs, and a clean environment. Action plans for health programs based on community needs and strategies such as securing manpower and equipment were developed. CONCLUSIONS The systematic process of creating a NMHC, and the necessity of the community health nurse's role in responding to health needs of the urban poor in Dhaka, Bangladesh was confirmed.
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Affiliation(s)
- Tae Wha Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Su Jeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | | | - Yoona Choi
- Department of Nursing, Ulsan College, Ulsan, Korea
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Association of Time since Migration from Rural to Urban Slums and Maternal and Child Outcomes: Dhaka (North and South) and Gazipur City Corporations. J Urban Health 2020; 97:158-170. [PMID: 31745692 PMCID: PMC7010893 DOI: 10.1007/s11524-019-00395-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study analyzes data from a new Urban Health and Demographic Surveillance (UHDSS) in five slums in Dhaka (North and South) and Gazipur City Corporations to examine the relationship between migration status and maternal and child health service utilization. Migration status was determined by duration in urban slums (<= 9.99 years, 10-19.99 years, 20+ years, and urban-born). Compared to those born in the city, migrants were characterized by significant disadvantages in every maternal, neonatal, and child health (MNCH) indicator under study, including antenatal care, facility-based delivery, doctor-assisted delivery, child immunization, caesarean-section delivery, and use of modern contraceptives. We found that the level of service coverage among migrants gradually converged-but did not fully converge-to that of the urban-born with increasing duration in the city. We observed a strong positive association between wealth and total MNCH coverage, with a more modest association with higher levels of schooling attainment. Women who were engaged in market employment were less likely to receive adequate coverage, suggesting a tradeoff between livelihood attainment and mother-and-child health. After controlling for these socioeconomic and neighborhood variations in coverage, the duration gradient was diminished but still significant. In line with existing studies of healthcare access, this study highlights the persistent and widespread burden of unequal access to maternal and child health care facing migrants to slum areas, even relative to the overall disadvantages experienced in informal settlements.
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Pathways to antibiotics in Bangladesh: A qualitative study investigating how and when households access medicine including antibiotics for humans or animals when they are ill. PLoS One 2019; 14:e0225270. [PMID: 31756224 PMCID: PMC6874326 DOI: 10.1371/journal.pone.0225270] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/31/2019] [Indexed: 01/21/2023] Open
Abstract
Background To understand how to reduce antibiotic use, greater knowledge is needed about the complexities of access in countries with loose regulation or enforcement. This study aimed to explore how households in Bangladesh were accessing antimicrobials for themselves and their domestic animals. Methods In-depth interviews were conducted with 48 households in one urban and one rural area. Households were purposively sampled from two lower income strata, prioritising those with under 5-year olds, older adults, household animals and minority groups. Households where someone was currently ill with a suspected infection (13 households) were invited for a follow-up interview. Framework analysis was used to explore access to healthcare and medicines. Findings People accessed medicines for themselves through five pathways: drugs shops, private clinics, government/charitable hospitals, community/family planning clinics, and specialised/private hospitals. Drug shops provided direct access to medicines for common, less serious and acute illnesses. For persistent or serious illnesses, the healthcare pathway may include contacts with several of these settings, but often relied on medicines provided by drug shops. In the 13 households with an unwell family member, most received at least one course of antibiotics for this illness. Multiple and incomplete dosing were common even when prescribed by a qualified doctor. Antibiotics were identified by their high cost compared to other medicines. Cost was a reported barrier to purchasing full courses of antibiotics. Few households in the urban area kept household animals. In this rural area, government animal health workers provided most care for large household animals (cows), but drug shops were also important. Conclusions In Bangladesh, unregulated drug shops provide an essential route to medicines including those prescribed in the formal sector. Wherever licensed suppliers are scarce and expensive, regulations which prohibit this supply risk removing access entirely for many people.
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Albis MLF, Bhadra SK, Chin B. Impact evaluation of contracting primary health care services in urban Bangladesh. BMC Health Serv Res 2019; 19:854. [PMID: 31752843 PMCID: PMC6956513 DOI: 10.1186/s12913-019-4406-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Urban Primary Health Care Project (UPHCP) was implemented by the Government of Bangladesh in response to rapid urbanization and growing inequalities in access to and quality of primary health care. The goal of the project was to improve health status of the urban poor living in city corporations and municipalities through the provision of health care services by NGOs that are contracted through public-private partnership. The first phase of the project started in 1998 and the project is currently in its fourth phase covering more urban areas than the first three phases. This study evaluates the impact of the second phase project (UPHCP-II) on health outcomes, mainly child diarrhea, acute respiratory infection, antenatal and postnatal care, skilled birth attendance, breastfeeding prevalence, contraceptive prevalence, sexually transmitted infections, and HIV/AIDS awareness. METHODS The effect of the project was estimated through propensity score matching between project and non-project areas comparing baseline and endline surveys over a six-year period from 2006 to 2012. An innovation of this study is the recalibration of the sampling weights that allows the use of these two independent surveys in impact evaluation. RESULTS Over the six-year period, UPHCP-II improved the health status of the population in project areas compared to non-project areas. The study found significant improvement in health outcomes in terms of reduced diarrhea and acute respiratory infection in children, which explains the downward trend in child mortality rate. Moreover, the project also improved antenatal care and skilled birth attendance. Contraceptive prevalence and HIV/AIDS awareness and avoidance increased, and sexually transmitted infections decreased. CONCLUSIONS UPHCP-II was effective in achieving its health outcome targets, while previous studies show that it was efficient in the delivery of health care and clients were highly satisfied because health facilities were in close proximity, and doctors and staff were perceived as responsive in delivering high quality of care. The results of this study could help inform future design and implementation of urban health interventions that involve contracting primary health care service delivery in Bangladesh and other similar settings.
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Affiliation(s)
| | - Subrata K Bhadra
- National Institute of Population Research and Training, Dhaka, Bangladesh
| | - Brian Chin
- Asian Development Bank, Manila, Philippines
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Ahmed S, Adams AM, Islam R, Hasan SM, Panciera R. Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh. PLoS One 2019; 14:e0222488. [PMID: 31525226 PMCID: PMC6746363 DOI: 10.1371/journal.pone.0222488] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city's slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh's policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas.
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Affiliation(s)
- Shakil Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne M. Adams
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rubana Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shaikh Mehdi Hasan
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rocco Panciera
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis. Confl Health 2019; 13:40. [PMID: 31485263 PMCID: PMC6714409 DOI: 10.1186/s13031-019-0224-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022] Open
Abstract
Background Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees’ views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations. Electronic supplementary material The online version of this article (10.1186/s13031-019-0224-y) contains supplementary material, which is available to authorized users.
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Adams AM, Ahmed R, Shuvo TA, Yusuf SS, Akhter S, Anwar I. Exploratory qualitative study to understand the underlying motivations and strategies of the private for-profit healthcare sector in urban Bangladesh. BMJ Open 2019; 9:e026586. [PMID: 31272974 PMCID: PMC6615794 DOI: 10.1136/bmjopen-2018-026586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/17/2019] [Accepted: 05/31/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access. METHODS This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients. RESULTS Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised such as aspirations to serve the disadvantaged, personal ambition, desire for greater social status, obligations to continue family business and adverse family events.The discussion of private sector motivations and strategies is framed using the Business Policy Model. This model is comprised of three components: products and services, and efforts to make these attractive including patient-friendly discounts and service-packages, and building 'good' doctor-patient relationships; the market environment, cultivated using medical brokers and referral fees to bring in fresh clientele, and receipt of pharmaceutical incentives; and finally, organisational capabilities, in this case overcoming human resource shortages by relying on medical staff from the public sector, consultant specialists, on-call and less experienced doctors in training, unqualified nursing staff and referring complicated cases to public facilities. CONCLUSIONS In the context of low public sector capacity and growing healthcare demands in urban Bangladesh, private for-profit engagement is critical to achieving universal health coverage (UHC). Given the informality of the sector, the nascent state of healthcare financing, and a weak regulatory framework, the process of engagement must be gradual. Further research is needed to explore how engagement in UHC can be enabled while maintaining profitability. Incentives that support private sector efforts to improve quality, affordability and accountability are a first step in building this relationship.
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Affiliation(s)
- Alayne Mary Adams
- Department of International Health, Georgetown University, Washington, District of Columbia, USA
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Tanzir Ahmed Shuvo
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA
| | | | - Sadika Akhter
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
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Sizear MMI, Nababan HY, Siddique MKB, Islam S, Paul S, Paul AK, Ahmed SM. Perceptions of appropriate treatment among the informal allopathic providers: insights from a qualitative study in two peri-urban areas in Bangladesh. BMC Health Serv Res 2019; 19:424. [PMID: 31242900 PMCID: PMC6595608 DOI: 10.1186/s12913-019-4254-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 06/12/2019] [Indexed: 12/01/2022] Open
Abstract
Background How the informal providers deliver health services are not well understood in Bangladesh. However, their practices are often considered inappropriate and unsafe. This study attempted to fill-in this knowledge gap by exploring their perceptions about diagnosis and appropriate treatment, as well as identifying existing barriers to provide appropriate treatment. Methods This exploratory study was conducted in two peri-urban areas of metropolitan Dhaka. Study participants were selected purposively, and an interview guideline was used to collect in-depth data from thirteen providers. Content analysis was applied through data immersion and themes identification, including coding and sub-coding, as well as data display matrix creation to draw conclusion. Results The providers relied mainly on the history and presenting symptoms for diagnosis. Information and guidelines provided by the pharmaceutical representatives were important aids in their diagnosis and treatment decision making. Lack of training, diagnostic tools and medicine, along with consumer demands for certain medicine i.e. antibiotics, were cited as barriers to deliver appropriate care. Effective and supportive supervision, training, patient education, and availability of diagnostics and guidelines in Bangla were considered necessary in overcoming these barriers. Conclusion Informal providers lack the knowledge and skills for delivering appropriate treatment and care. As they provide health services for substantial proportion of the population, it’s crucial that policy makers become cognizant of the fact and take measures to remedy them. This is even more urgent if government’s goal to reach universal health coverage by 2030 is to be achieved. Electronic supplementary material The online version of this article (10.1186/s12913-019-4254-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Herfina Y Nababan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Md Kaoser Bin Siddique
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | | | | | - Syed Masud Ahmed
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Elsey H, Agyepong I, Huque R, Quayyem Z, Baral S, Ebenso B, Kharel C, Shawon RA, Onwujekwe O, Uzochukwu B, Nonvignon J, Aryeetey GC, Kane S, Ensor T, Mirzoev T. Rethinking health systems in the context of urbanisation: challenges from four rapidly urbanising low-income and middle-income countries. BMJ Glob Health 2019; 4:e001501. [PMID: 31297245 PMCID: PMC6577312 DOI: 10.1136/bmjgh-2019-001501] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/26/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022] Open
Abstract
The world is now predominantly urban; rapid and uncontrolled urbanisation continues across low-income and middle-income countries (LMICs). Health systems are struggling to respond to the challenges that urbanisation brings. While better-off urbanites can reap the benefits from the 'urban advantage', the poorest, particularly slum dwellers and the homeless, frequently experience worse health outcomes than their rural counterparts. In this position paper, we analyse the challenges urbanisation presents to health systems by drawing on examples from four LMICs: Nigeria, Ghana, Nepal and Bangladesh. Key challenges include: responding to the rising tide of non-communicable diseases and to the wider determinants of health, strengthening urban health governance to enable multisectoral responses, provision of accessible, quality primary healthcare and prevention from a plurality of providers. We consider how these challenges necessitate a rethink of our conceptualisation of health systems. We propose an urban health systems model that focuses on: multisectoral approaches that look beyond the health sector to act on the determinants of health; accountability to, and engagement with, urban residents through participatory decision making; and responses that recognise the plurality of health service providers. Within this model, we explicitly recognise the role of data and evidence to act as glue holding together this complex system and allowing incremental progress in equitable improvement in the health of urban populations.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Irene Agyepong
- Research and Development Division, Ghana Health Service, Accra, Greater Accra Region, Ghana
- Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | - Zahidul Quayyem
- Centre of Excellence for Urban Equity and Health, BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - Riffat Ara Shawon
- Public Health Research, Centre for Injury Prevention and Research Bangladesh, Dhaka, Bangladesh
| | - Obinna Onwujekwe
- Department of Pharmacology and Therapeutics, University of Nigeria Faculty of Medical Sciences, Nsukka, Enugu, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, Universiy of Nigeria, Enugu, Nigeria
| | - Justice Nonvignon
- School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | | | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tim Ensor
- Nuffield Centre for Health, University of Leeds, Leeds, UK
| | - Tolib Mirzoev
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Causes of Urban Migration in Bangladesh: Evidence from the Urban Health Survey. POPULATION RESEARCH AND POLICY REVIEW 2019. [DOI: 10.1007/s11113-019-09532-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh? J Urban Health 2019; 96:193-207. [PMID: 30159634 PMCID: PMC6458191 DOI: 10.1007/s11524-018-0307-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Bangladesh is undergoing a rapid urbanization process. About one-third of the population of major cities in the country live in slums, which are areas that exhibit pronounced concentrations of factors that negatively affect health and nutrition. People living in slums face greater challenge to improve their health than other parts of the country, which fuels the growing intra-urban health inequities. Two rounds of the Bangladesh Urban Health Survey (UHS), conducted in 2013 and 2006, were designed to examine the reproductive health status and service utilization between slum and non-slum residents. We applied an adaptation of the difference-in-differences (DID) model to pooled data from the 2006 and 2013 UHS rounds to examine changes over time in intra-urban differences between slums and non-slums in key health outcomes and service utilization and to identify the factors associated with the reduction in intra-urban gaps. In terms of change in intra-urban differentials during 2006-2013, DID regression analysis estimated that the gap between slums and non-slums for skilled birth attendant (SBA) during delivery significantly decreased. DID regression analysis also estimated that the gap between slums and non-slums for use of modern contraceptives among currently married women also narrowed significantly, and the gap reversed in favor of slums. However, the DID estimates indicate a small but not statistically significant reduction in the gap between slums and non-slums for child nutritional status. Results from extended DID regression model indicate that availability of community health workers in urban areas appears to have played a significant role in reducing the gap in SBA. The urban population in Bangladesh is expected to grow rapidly in the coming decades. Wide disparities between urban slums and non-slums can potentially push country performance off track during the post-2015 era, unless the specific health needs of the expanding slum communities are addressed. To our knowledge, this is the first systematic explanation and quantification of the role of various factors for improving intra-urban health equity in Bangladesh using nationally representative data. The findings provide a strong rationale for continuing and expanding community-based reproductive health services in urban areas by the NGOs with a focus on slum populations.
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Saif-Ur-Rahman KM, Mamun R, Anwar I. Identifying gaps in primary healthcare policy and governance in low-income and middle-income countries: protocol for an evidence gap map. BMJ Open 2019; 9:e024316. [PMID: 30819705 PMCID: PMC6398635 DOI: 10.1136/bmjopen-2018-024316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION There are gaps in the primary healthcare (PHC) delivery in majority of low-income and middle-income countries (LMICs) due to epidemiological transition, emergence of outbreaks or war, and often lack of governance. In LMICs, governance is always a less focused aspect, and often limited to the role of the authority despite potential contribution of other actors. It is evident that community engagement and social mobilisation of health service delivery result in better health outcomes. Even in case of systems failure, the need for PHC services is satisfied by individuals and communities in LMICs. Available evidence including systematic reviews on PHC governance is mostly from high-income countries and there is limited work in LMICs. This evidence gap map (EGM) is a systematic exploration to identify evidence gaps in PHC policy and governance in this region. METHODS AND ANALYSIS Different bibliographic databases were explored to retrieve available studies considering the time period between 1980 and 2017, and these were independently screened by two reviewers. Screened articles will be considered for full-text extraction based on prespecified criteria for inclusion and exclusion. A modified SURE (Supporting the Use of Research Evidence) checklist will be used to assess the quality of included systematic reviews. Overview of the findings will be provided in synthesised form. Identified interventions and outcomes will be plotted in a dynamic platform to develop a gap map. ETHICS AND DISSEMINATION Findings of the EGM will be published in a peer-reviewed journal in a separate manuscript. This EGM aims to explore the evidence gaps in PHC policy and governance in LMICs. Findings from the EGM will highlight the gaps in PHC to guide policy makers and researchers for future research planning and development of national strategies. PROSPERO REGISTRATION NUMBER CRD42018096883.
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Affiliation(s)
- K M Saif-Ur-Rahman
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Razib Mamun
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division (HSPSD), International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Adams AM, Nambiar D, Siddiqi S, Alam BB, Reddy S. Advancing universal health coverage in South Asian cities: a framework. BMJ 2018; 363:k4905. [PMID: 30498010 PMCID: PMC7115914 DOI: 10.1136/bmj.k4905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Alayne M Adams
- Georgetown University, Washington, DC, USA
- BRAC James P Grant School of Public Health, Dhaka, Bangladesh
| | - Devaki Nambiar
- The George Institute for Global Health, Delhi, India
- University of New South Wales, Sydney, Australia
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Al-Shoaibi AAA, Matsuyama A, Khalequzzaman M, Haseen F, Choudhury SR, Hoque BA, Chiang C, Hirakawa Y, Yatsuya H, Aoyama A. Perceptions and behavior related to noncommunicable diseases among slum dwellers in a rapidly urbanizing city, Dhaka, Bangladesh: a qualitative study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:559-569. [PMID: 30587870 PMCID: PMC6295424 DOI: 10.18999/nagjms.80.4.559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/23/2018] [Indexed: 02/03/2023]
Abstract
The increasing burden of noncommunicable diseases (NCDs) in Bangladesh can be attributable to rapid urbanization and coinciding changes in lifestyle accompanied by nutrition transition. The objective of this study is to explore respondents' lived experiences and perceptions relating to NCDs and nutrition change in an urban slum community in Dhaka. Qualitative methods were employed to explore a general understanding of behavior related to NCDs among residents of the slum community. We conducted key informant interviews of six men and seven women of various backgrounds and five focus group discussions to focus salient topics emerged from the interviews. The transcriptions of the audio-recordings were thematically analyzed, using the constant comparison method. Four major themes emerged: (1) financial hardship influencing health; (2) urbanized lifestyle affecting diet; (3) tobacco and sweetened tea as cornerstones of social life; and (4) health-seeking behavior utilizing local resources. One notable finding was that even with general economic improvement, respondents perceived poverty to be one of the major causes of NCDs. A promising finding for potentially curbing NCDs was the current trend for women to walk for exercise contrary to the commonly held notion that urban dwellers generally lead sedentary lifestyles. This study described how urban slum dwellers in Dhaka, experiencing a transition from a traditional to urbanized lifestyle, perceived their daily practices in relation to NCDs and nutrition. Our research revealed both adverse and encouraging elements of perceptions and behavior related to NCDs, which may contribute to the optimal design of NCD prevention and health promotion programs.
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Affiliation(s)
| | - Akiko Matsuyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Md Khalequzzaman
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Fariha Haseen
- Department of Public Health and Informatics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Chifa Chiang
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Japan
| | - Atsuko Aoyama
- Department of Public Health and Health Systems, Nagoya University School of Medicine, Nagoya, Japan
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Billah SM, Hoque DE, Rahman M, Christou A, Mugo NS, Begum K, Tahsina T, Rahman QSU, Chowdhury EK, Haque TM, Khan R, Siddik A, Bryce J, Black RE, El Arifeen S. Feasibility of engaging "Village Doctors" in the Community-based Integrated Management of Childhood Illness (C-IMCI): experience from rural Bangladesh. J Glob Health 2018; 8:020413. [PMID: 30202517 PMCID: PMC6125986 DOI: 10.7189/jogh.08.020413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Informal health care providers particularly "village doctors" are the first point of care for under-five childhood illnesses in rural Bangladesh. We engaged village doctors as part of the Multi-Country Evaluation (MCE) of Integrated Management of Childhood Illness (IMCI) and assessed their management of sick under-five children before and after a modified IMCI training, supplemented with ongoing monitoring and supportive supervision. Methods In 2003-2004, 144 village doctors across 131 IMCI intervention villages in Matlab Bangladesh participated in a two-day IMCI training; 135 of which completed pre- and post-training evaluation tests. In 2007, 38 IMCI-trained village doctors completed an end-of-project knowledge retention test. Village doctor prescription practices for sick under-five children were examined through household surveys, and routine monitoring visits. In-depth interviews were done with mothers seeking care from village doctors. Results Village doctors' knowledge on the assessment and management of childhood illnesses improved significantly after training; knowledge of danger signs of pneumonia and severe pneumonia increased from 39% to 78% (P < 0.0001) and from 17% to 47% (P < 0.0001) respectively. Knowledge on the correct management of severe pneumonia increased from 62% to 84% (P < 0.0001), and diarrhoea management improved from 65% to 82% (P = 0.0005). Village doctors retained this knowledge over three years except for home management of pneumonia. No significant differences were observed in prescribing practices for diarrhoea and pneumonia management between trained and untrained village doctors. Village doctors were accessible to communities; 76% had cell phones; almost all attended home calls, and did not charge consultation fees. Nearly all (91%) received incentives from pharmaceutical representatives. Conclusions Village doctors have the capacity to learn and retain knowledge on the appropriate management of under-five illnesses. Training alone did not improve inappropriate antibiotic prescription practices. Intensive monitoring and efforts to target key actors including pharmaceutical companies, which influence village doctors dispensing practices, and implementation of mechanisms to track and regulate these providers are necessary for future engagement in management of under-five childhood illnesses.
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Affiliation(s)
- Sk Masum Billah
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Muntasirur Rahman
- School of Public Health, University of Queensland, Herston, Australia
| | - Aliki Christou
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Ngatho Samuel Mugo
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Khadija Begum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Tazeen Tahsina
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | | | - Enayet K Chowdhury
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Rasheda Khan
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Ashraf Siddik
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Jennifer Bryce
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Chowdhury F, Sturm-Ramirez K, Mamun AA, Iuliano AD, Chisti MJ, Ahmed M, Bhuiyan MU, Hossain K, Haider MS, Aziz SA, Rahman M, Azziz-Baumgartner E. Effectiveness of an educational intervention to improve antibiotic dispensing practices for acute respiratory illness among drug sellers in pharmacies, a pilot study in Bangladesh. BMC Health Serv Res 2018; 18:676. [PMID: 30170573 PMCID: PMC6119333 DOI: 10.1186/s12913-018-3486-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate dispensing of antibiotics for acute respiratory illness (ARI) is common among drug sellers in Bangladesh. In this study, we evaluated the impact of an educational intervention to promote guidelines for better ARI management among drug sellers. METHODS From June 2012 to December 2013, we conducted baseline and post-intervention surveys on dispensing practices in 100 pharmacies within Dhaka city. In these surveys, drug sellers participated in 6 standardized role-playing scenarios led by study staffs acting as caregivers of ARI patients and drug sellers were blinded to these surveys. After the baseline survey, we developed ARI guidelines and facilitated a one-day educational intervention about ARI management for drug sellers. Our guidelines only recommended antibiotics for children with complicated ARI. Finally, we conducted the six month post-intervention survey using the same scenarios to record changes in drug dispensing practices. RESULTS Only 2/3 of participating pharmacies were licensed and few (11%) of drug sellers had pharmacy training. All the drug sellers were male, had a median age of 34 years (IQR 28-41). For children, dispensing of antibiotics for uncomplicated ARI decreased (30% baseline vs. 21% post-intervention; p = 0.04), but drug sellers were equally likely to dispense antibiotics for complicated ARI (15% baseline vs. 17% post-intervention; p = 0.6) and referrals to physicians for complicated ARIs decreased (70% baseline vs. 58% post-intervention; p = 0.03). For adults, antibiotic dispensing remained similar for uncomplicated ARI (48% baseline vs. 40% post-intervention; p = 0.1) but increased among those with complicated ARI (44% baseline vs. 78% post-intervention; p < 0.001). Although our evidence-based guidelines recommended against prescribing antihistamines for children, drug sellers continued to sell similar amounts for uncomplicated ARI (33% baseline vs. 32% post-intervention; p = 0.9). CONCLUSIONS Despite the intervention, drug sellers continued to frequently dispense antibiotics for ARI, except for children with uncomplicated ARI. Pairing educational interventions among drug sellers with raising awareness about proper antibiotic use among general population should be further explored. In addition, annual licensing and an reaccreditation system with comprehensive monitoring should be enforced, using penalties for non-compliant pharmacies as possible incentives for appropriate dispensing practices.
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Affiliation(s)
- Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Katharine Sturm-Ramirez
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
- Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - Abdullah Al Mamun
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | | | - Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Makhdum Ahmed
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Mejbah Uddin Bhuiyan
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Kamal Hossain
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | | | - Shaikh Abdul Aziz
- International Centre for Diarrhoeal Disease Research, (icddr,b), Bangladesh, Dhaka, Bangladesh
| | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research, (IEDCR), Dhaka, Bangladesh
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Naydenova E, Raghu A, Ernst J, Sahariah SA, Gandhi M, Murphy G. Healthcare choices in Mumbai slums: A cross-sectional study. Wellcome Open Res 2018. [PMID: 30027122 DOI: 10.12688/wellcomeopenres.13127.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Informal urban settlements, known as slums, are the home for a large proportion of the world population. Healthcare in these environments is extremely complex, driven by poverty, environmental challenges, and poor access to formal health infrastructures. This study investigated healthcare challenges faced and choices made by slum dwellers in Mumbai, India. Methods: Structured interviews with 549 slum dwellers from 13 slum areas in Mumbai, India, were conducted in order to obtain a population profile of health-related socio-economic and lifestyle factors, disease history and healthcare access. Statistical tools such as multinomial logistic regression were used to examine the association between such factors and health choices. Results: Private providers (or a mixture of public and private) were seen to be preferred by the study population for most health conditions (62% - 90% health consultations), apart from pregnancy (43% health consultations). Community-based services were also preferred to more remote options. Stark differences in healthcare access were observed between well-known conditions, such as minor injuries, pulmonary conditions, and pregnancy and emerging challenges, such as hypertension and diabetes. A number of socio-economic and lifestyle factors were found to be associated with health-related decisions, including choice of provider and expenditure. Conclusions: Better planning and coordination of health services, across public and private providers, is required to address mortality and morbidity in slum communities in India. This study provides insights into the complex landscape of diseases and health providers that slum dwellers navigate when accessing healthcare. Findings suggest that integrated services and public-private partnerships could help address demand for affordable community-based care and progress towards the target of universal health coverage.
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Affiliation(s)
- Elina Naydenova
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Arvind Raghu
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Johanna Ernst
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Sirazul A Sahariah
- Centre for the Study of Social Change, Mumbai, Maharashtra, 400051, India
| | - Meera Gandhi
- Centre for the Study of Social Change, Mumbai, Maharashtra, 400051, India
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Shafique S, Bhattacharyya DS, Anwar I, Adams A. Right to health and social justice in Bangladesh: ethical dilemmas and obligations of state and non-state actors to ensure health for urban poor. BMC Med Ethics 2018; 19:46. [PMID: 29945594 PMCID: PMC6019983 DOI: 10.1186/s12910-018-0285-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The world is urbanizing rapidly; more than half the world’s population now lives in urban areas, leading to significant transition in lifestyles and social behaviours globally. While offering many advantages, urban environments also concentrate health risks and introduce health hazards for the poor. In Bangladesh, although many public policies are directed towards equity and protecting people’s rights, these are not comprehensively and inclusively applied in ways that prioritize the health rights of citizens. The country is thus facing many issues that raise moral and ethical concerns. Methods A narrative literature review was conducted between October 2016 and November 2017 on issues related to social justice, health, and human rights in urban Bangladesh. The key questions discussed here are: i) ethical dilemmas and inclusion of the urban poor to pursue social justice; and ii) the ethical obligations and moral responsibilities of the state and non-state sectors in serving Bangladesh’s urban poor. Using a Rawlsian theory of equality of opportunity to ensure social justice, we identified key health-related ethical issues in the country’s rapidly changing urban landscape, especially among the poor. Results We examined ethical dilemmas in Bangladesh’s health system through the rural–urban divide and the lack of coordination among implementing agencies. The unregulated profusion of the private sector and immoral practices of service providers result in high out-of-pocket expenditures for urban poor, leading to debt and further impoverishment. We also highlight policy and programmatic gaps, as well as entry points for safeguarding the right to health for Bangladeshi citizens. Conclusions The urban health system in Bangladesh needs a reform in which state and non-state actors should work together, understanding and acknowledging their moral responsibilities for improving the health of the urban poor by engaging multiple sectors. The social determinants of health should be taken into account when formulating policies and programs to achieve universal health coverage and ensure social justice for the urban poor in Bangladesh.
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Affiliation(s)
- Sohana Shafique
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
| | | | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Department of International Health, Georgetown University, Washington, DC, USA
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Dutta A, Pattanaik S, Choudhury R, Nanda P, Sahu S, Panigrahi R, Padhi BK, Sahoo KC, Mishra PR, Panigrahi P, Lekharu D, Stevens RH. Impact of involvement of non-formal health providers on TB case notification among migrant slum-dwelling populations in Odisha, India. PLoS One 2018; 13:e0196067. [PMID: 29791449 PMCID: PMC5965830 DOI: 10.1371/journal.pone.0196067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 04/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Migrant labourers living in the slums of urban and industrial patches across India make up a key sub-population so far controlling Tuberculosis (TB) in the country is concerned. This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India. This marginalized community usually seeks early-stage healthcare from "friendly neighbourhood" non-formal health providers (NFHPs). Because, RNTCP has limited capacity to involve the NFHPs, an implementation research project was conceived, whereby an external partner would engage with the NFHPs to enable them to identify early TB symptomatics from this key sub-population who would be then tested using Xpert MTB/RIF technology. Diagnosed TB cases among them would be referred promptly to RNTCP for treatment. This paper aimed to describe the project and its impact. METHODS Adopting a quasi-experimental before-after design, four RNTCP units from two major urban-industrial areas of Odisha were selected for intervention, which spanned five quarters and covered 151,400 people, of which 30% were slum-dwelling migrants. Two similar units comprised the control population. The hypothesis was, reaching the under reached in the intervention area through NFHPs would increase TB notification from these traditionally under-notifying units. RNTCP notification data during intervention was compared with pre-intervention era, adjusted for contemporaneous changes in control population. RESULTS The project detected 488 Xpert+ TB cases, of whom 466 were administered RNTCP treatment. This translated into notification of additional 198 new bacteriologically positive cases to RNTCP, a 30% notification surge, after adjustment for 2% decline in control. This meant an average quarterly increase in notification of 41.20(20.08, 62.31; p<0.001) cases. The increase was immediate, evident from the rise in level in the time series analysis by 50.42(10.28, 90.55; p = 0.02) cases. CONCLUSION Engagement with NFHPs contributed to an increase in TB notification to RNTCP from key under reached, slum-dwelling migrant populations.
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Affiliation(s)
- Ambarish Dutta
- Asian Institute of Public Health, Bhubaneswar, India
- * E-mail:
| | | | | | - Pritish Nanda
- Asian Institute of Public Health, Bhubaneswar, India
| | | | | | | | | | - P. R. Mishra
- Asian Institute of Public Health, Bhubaneswar, India
| | - Pinaki Panigrahi
- University of Nebraska Medical Centre, Omaha, Nebraska, United States of America
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Naydenova E, Raghu A, Ernst J, Sahariah SA, Gandhi M, Murphy G. Healthcare choices in Mumbai slums: A cross-sectional study. Wellcome Open Res 2017; 2:115. [PMID: 30027122 PMCID: PMC6039940 DOI: 10.12688/wellcomeopenres.13127.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2017] [Indexed: 12/21/2022] Open
Abstract
Background: Informal urban settlements, known as slums, are the home for a large proportion of the world population. Healthcare in these environments is extremely complex, driven by poverty, environmental challenges, and poor access to formal health infrastructures. This study investigated healthcare challenges faced and choices made by slum dwellers in Mumbai, India. Methods: Structured interviews with 549 slum dwellers from 13 slum areas in Mumbai, India, were conducted in order to obtain a population profile of health-related socio-economic and lifestyle factors, disease history and healthcare access. Statistical tools such as multinomial logistic regression were used to examine the association between such factors and health choices. Results: Private providers (or a mixture of public and private) were seen to be preferred by the study population for most health conditions (62% - 90% health consultations), apart from pregnancy (43% health consultations). Community-based services were also preferred to more remote options. Stark differences in healthcare access were observed between well-known conditions, such as minor injuries, pulmonary conditions, and pregnancy and emerging challenges, such as hypertension and diabetes. A number of socio-economic and lifestyle factors were found to be associated with health-related decisions, including choice of provider and expenditure. Conclusions: Better planning and coordination of health services, across public and private providers, is required to address mortality and morbidity in slum communities in India. This study provides insights into the complex landscape of diseases and health providers that slum dwellers navigate when accessing healthcare. Findings suggest that integrated services and public-private partnerships could help address demand for affordable community-based care and progress towards the target of universal health coverage.
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Affiliation(s)
- Elina Naydenova
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Arvind Raghu
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Johanna Ernst
- Institute of Biomedical Engineering, University of Oxford, Oxford, OX3 7DQ, UK
| | - Sirazul A Sahariah
- Centre for the Study of Social Change, Mumbai, Maharashtra, 400051, India
| | - Meera Gandhi
- Centre for the Study of Social Change, Mumbai, Maharashtra, 400051, India
| | - Georgina Murphy
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN, UK
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Shawar YR, Crane LG. Generating global political priority for urban health: the role of the urban health epistemic community. Health Policy Plan 2017; 32:1161-1173. [PMID: 28582532 PMCID: PMC5886225 DOI: 10.1093/heapol/czx065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 11/15/2022] Open
Abstract
Over the past decade there has been much discussion of the challenges posed by rapid urbanization in the developing world; yet the health of the urban poor, and especially those residing in low- and middle-income countries, continues to receive little political priority in most developing countries and at the global level. This research applies social science scholarship and a public policy analytical framework to assess the factors that have challenged efforts to make health in urban poor settings a priority. We conducted 19 semi-structured phone interviews with key urban health proponents and experts representing agencies that shape opinions and manage resources in global health. We also conducted a literature review, which included published scholarly literature and reports from organizations involved in urban health provision and advocacy. Utilizing a process-tracing method, we triangulated among these sources of data to create a historical narrative and analyse the factors that shape the global level of attention to and resources for urban health. The urban health agenda continues to be challenged by six factors, three of which concern the political context or characteristics of the issue: long-standing competition with the dominant development agenda that is rural health oriented; limited data and measurement tools that can effectively gauge the extent of the problem; and lack of evidence on how to best to address the issue. The other three factors are directly under the control of the urban health community: the community's ineffective governance; little common understanding among its members of the problem and how to address it; and an unconvincing framing of the issue to the public. The study offers suggestions as to what advocates can do to secure greater attention and resources in order to help address the health needs of the urban poor.
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Affiliation(s)
- Yusra Ribhi Shawar
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA and
| | - Lani G Crane
- Department of Global Health, Save the Children, Washington, DC, USA
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Rasheed S, Roy SK, Das S, Chowdhury SN, Iqbal M, Akter SM, Jahan K, Uddin S, Thow AM. Policy content and stakeholder network analysis for infant and young child feeding in Bangladesh. BMC Public Health 2017; 17:402. [PMID: 28675137 PMCID: PMC5496023 DOI: 10.1186/s12889-017-4338-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate infant and young child feeding (IYCF) practices are essential for nutrition of infants and young children. Bangladesh has one of the highest levels of malnutrition globally along with sub-optimal IYCF practices. A supportive policy environment is essential to ensure that effective IYCF interventions are scaled up. The objectives of our study were to assess the support for IYCF in the national policy environment through policy analysis and stakeholder analysis and in so doing identify opportunities to strengthen the policy environment. METHODS We used a matrix developed by SAIFRN (the South Asian Infant Feeding Research Network) to systematically identify supportive national policies, plans and guidelines for IYCF. We adapted narrative synthesis and descriptive approaches to analyze policy content, based on four themes with a focus on support for mothers. We conducted three Net-Map interviews to identify stakeholders who influenced the policies and programs related to IYCF. RESULTS We identified 19 national policy documents relevant to IYCF. Overall, there was good level of support for IYCF practices at policy level - particularly regarding general support for IYCF and provision of information to mothers - but these were not consistently supported at implementation level, particularly regarding specificity and population coverage. We identified gaps regarding the training of health workers, capacity building, the monitoring and targeting of vulnerable mothers and providing an enabling environment to mothers, specifically with respect to maternity leave for working women. Urban populations and providers outside the public sector remained uncovered by policy. Our stakeholder analysis identified government entities such as the National Nutrition Service, as the most influential in terms of both technical and funding support as they had the mandate for formulation and implementation of policies and national programs. Stakeholders from different sectors played important roles, demonstrating the salience of IYCF. CONCLUSIONS Although there is strong supportive policy environment for IYCF, it is important that policies cover all populations. Our analysis indicated that opportunities to strengthen the policy environment include: expanding population coverage, increasing inter-sector coordination, improving translation of policy objectives to implementation-level documents, and the engagement of non-public sectors. In addition, we recommend explicit strategies to engage diverse stakeholders in the formulation and implementation of IYCF policies.
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Affiliation(s)
- Sabrina Rasheed
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh.
| | | | - Susmita Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - Syeda Nafisa Chowdhury
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Mohammad Iqbal
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | | | | | - Shahadat Uddin
- Complex Systems Research Group, The University of Sydney, Sydney, Australia
| | - Anne Marie Thow
- Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Siddiqi K, Elsey H. Supporting the urban poor to quit tobacco: adding years to lives. Thorax 2017; 72:105-106. [PMID: 27815521 DOI: 10.1136/thoraxjnl-2016-209435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Helen Elsey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Kruk ME, Kujawski S, Moyer CA, Adanu RM, Afsana K, Cohen J, Glassman A, Labrique A, Reddy KS, Yamey G. Next generation maternal health: external shocks and health-system innovations. Lancet 2016; 388:2296-2306. [PMID: 27642020 PMCID: PMC5167371 DOI: 10.1016/s0140-6736(16)31395-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/15/2016] [Accepted: 06/20/2016] [Indexed: 02/02/2023]
Abstract
In this Series we document the substantial progress in the reduction of maternal mortality and discuss the current state of science in reducing maternal mortality. However, maternal health is also powerfully influenced by the structures and resources of societies, communities, and health systems. We discuss the shocks from outside of the field of maternal health that will influence maternal survival including economic growth in low-income and middle-income countries, urbanisation, and health crises due to disease outbreaks, extreme weather, and conflict. Policy and technological innovations, such as universal health coverage, behavioural economics, mobile health, and the data revolution, are changing health systems and ushering in new approaches to affect the health of mothers. Research and policy will need to reflect the changing maternal health landscape.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, School of Public Health, Harvard T H Chan, Boston, Boston, MA, USA.
| | - Stephanie Kujawski
- Department of Epidemiology, Mailman School of Public Health, Columbia University, NY, USA
| | - Cheryl A Moyer
- Department of Learning Health Sciences and Department of Obstetrics and Gynaecology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | - Kaosar Afsana
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jessica Cohen
- Department of Global Health and Population, School of Public Health, Harvard T H Chan, Boston, Boston, MA, USA
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Gavin Yamey
- Duke Global Health Institute, Durham, NC, USA
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