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Islam SMS, Uddin R, Das S, Ahmed SI, Zaman SB, Alif SM, Hossen MT, Sarker M, Siopis G, Livingstone KM, Mehlman ML, Rahman MM, Chowdhury RI, Alim MA, Choudhury SR, Ahmed SM, Adhikary RK, Anjum A, Banik PC, Chowdhury FR, Faruk MO, Gupta RD, Hannan MA, Haque MN, Haque SE, Hasan MT, Hossain MB, Hossain MM, Hossain M, Hossain S, Hossain SJ, Khan MN, Khan MJ, Mamun MA, Mokdad AH, Moni MA, Murray CJL, Rahman M, Rahman MM, Rahman M, Ratan ZA, Ripon RK, Saif-Ur-Rahman KM, Sayeed A, Siraj MS, Sultana S, Maddison R, Hay SI, Naghavi M. The burden of diseases and risk factors in Bangladesh, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Glob Health 2023; 11:e1931-e1942. [PMID: 37973341 PMCID: PMC10664824 DOI: 10.1016/s2214-109x(23)00432-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/07/2023] [Accepted: 09/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Bangladesh has made substantial progress in improving socioeconomic and health indicators over the past 50 years, but data on national disease burden are scarce. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to estimate the burden of diseases and risk factors in Bangladesh from 1990 to 2019. METHODS For this systematic analysis, we analysed data from vital registration systems, surveys, and censuses using multistage modelling processes to estimate life expectancy at birth, mortality rate, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). Additionally, we compared the health status of Bangladesh with that of the other countries in the GBD south Asia region-Bhutan, India, Nepal, and Pakistan. FINDINGS Life expectancy at birth in Bangladesh increased from 58·2 years (95% uncertainty interval 57·1-59·2) in 1990 to 74·6 years (72·4-76·7) in 2019. Between 1990 and 2019, the age-standardised mortality rate decreased from 1509·3 (1428·6-1592·1) to 714·4 (604·9-838·2) deaths per 100 000 population. In 2019, non-communicable diseases represented 14 of the top 20 causes of death; the leading three causes were stroke, ischaemic heart disease, and chronic obstructive pulmonary disease. High blood pressure, high fasting plasma glucose, and smoking were the top three risk factors. From 1990 to 2019, the rate of all-cause DALYs decreased by 54·9% (48·8-60·4). In 2019, the leading causes of DALYs and YLLs were neonatal disorders, stroke, and ischaemic heart disease, whereas musculoskeletal disorders, depressive disorders, and low back pain were the leading causes of YLDs. Bangladesh has the lowest age-standardised rates of mortality, YLDs, and YLLs and the highest life expectancy at birth in south Asia. INTERPRETATION Over the past 30 years, mortality rates have reduced by more than half in Bangladesh. Bangladesh must now address the double burden of communicable and non-communicable diseases. Cost-effective, multisectoral efforts are needed to prevent and control non-communicable diseases, promote healthy lifestyles, and prevent premature mortality and disabilities. FUNDING Bill & Melinda Gates Foundation. TRANSLATION For the Bangla translation of the abstract see Supplementary Materials section.
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Magnus D, Bhatta S, Mytton J, Joshi E, Bhatta S, Manandhar S, Joshi S. Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance. Arch Dis Child 2021; 106:1050-1055. [PMID: 34462264 PMCID: PMC8543225 DOI: 10.1136/archdischild-2020-321198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 07/01/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.
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Affiliation(s)
- Dan Magnus
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Santosh Bhatta
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Julie Mytton
- Centre for Academic Child Health, University of the West of England, Bristol, UK
| | - Elisha Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | - Sumiksha Bhatta
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
| | | | - Sunil Joshi
- Nepal Injury Research Centre, Kathmandu Medical College, Kathmandu, Nepal
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Alfonso YN, Hyder AA, Alonge O, Salam SS, Baset K, Rahman A, Hoque DME, Islam MI, Rahman F, El-Arifeen S, Bishai D. Cost-effectiveness analysis of a large-scale crèche intervention to prevent child drowning in rural Bangladesh. Inj Epidemiol 2021; 8:61. [PMID: 34715946 PMCID: PMC8555188 DOI: 10.1186/s40621-021-00351-9] [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: 04/01/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Drowning is the leading cause of death among children 12–59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche (daycare) intervention in preventing child drowning. Methods The cost of the crèches intervention was evaluated using an ingredients-based approach and monthly expenditure data collected prospectively throughout the study period from two agencies implementing the intervention in different study areas. The estimate of the effectiveness of the crèches intervention was based on a previous study. The study evaluated the cost-effectiveness from both a program and societal perspective. Results From the program perspective the annual operating cost of a crèche was $416.35 (95% CI: $221 to $576), the annual cost per child was $16 (95% CI: $8 to $23), and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,008 (95% CI: $8817 to $24,619). From the societal perspective (including parents time valued) the ICER per life saved was − $166,833 (95% CI: − $197,421 to − $141,341)—meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $1978, the crèche intervention was cost-effective even when the societal economic benefits were ignored. Conclusions Based on the evidence, the crèche intervention has great potential for generating net societal economic gains by reducing child drowning at a program cost that is reasonable. Supplementary Information The online version contains supplementary material available at 10.1186/s40621-021-00351-9.
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Affiliation(s)
- Y Natalia Alfonso
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kamran Baset
- Center for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Aminur Rahman
- Center for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Dewan Md Emdadul Hoque
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Md Irteja Islam
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - Fazlur Rahman
- Center for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Shams El-Arifeen
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh
| | - David Bishai
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Challenges in Documenting Non-Fatal Drowning Disability in Bangladesh: A Community-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189738. [PMID: 34574663 PMCID: PMC8467877 DOI: 10.3390/ijerph18189738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022]
Abstract
Limited access to health care and the lack of robust data systems means non-fatal drownings are largely missed in low-and middle-income countries. We report morbidity among individuals who experienced non-fatal drowning in the Barishal Division, Bangladesh. A representative household survey was conducted in the Barishal Division in southern Bangladesh between September 2016 and February 2017, covering a population of 386,016. The burden of non-fatal drowning was assessed using the WHODAS 2.0 disability assessment tool, a generic assessment instrument for health and disability. A total of 5164 non-fatal drowning events occurred in the one year preceding the survey. Among these 18% were multiple events. From these, 4235 people were administered the WHODAS 2.0 questionnaire. Non-fatal drowning incidence rates were highest in children aged 1–4 years at 5810 per 100,000 population, and among males. Non-fatal drowning was associated with lower socio-economic status and larger family sizes. Few respondents (6.5%; 95% CI: 4.5–8.4%) reported some level of disability (WHODAS-12 score > 8). Incidence of non-fatal drowning is high in the population, however limited impact on morbidity was found. There is a need to develop tools and methodologies for reliable and comparable data for non-fatal drowning, especially to capture post-event disability in children.
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Jagnoor J, Kobusingye O, Scarr JP. Drowning prevention: priorities to accelerate multisectoral action. Lancet 2021; 398:564-566. [PMID: 34303411 DOI: 10.1016/s0140-6736(21)01601-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/22/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Jagnoor Jagnoor
- The George Institute for Global Health, New Delhi 110025, India; The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
| | - Olive Kobusingye
- School of Public Health, Makerere University, Mulago, Kampala, Uganda
| | - Justin-Paul Scarr
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Royal Life Saving Society Australia, Broadway, NSW, Australia
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Dodd M, Zwi A, Rahman A, Chowdhury FK, Ivers RQ, Jagnoor J. Keeping afloat: a case study tracing the emergence of drowning prevention as a health issue in Bangladesh 1999-2017. Inj Prev 2020; 27:300-307. [PMID: 32718974 DOI: 10.1136/injuryprev-2020-043720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drowning is a leading cause of child death in Bangladesh. The present study investigated the emergence of drowning reduction as a priority within Bangladesh and the position it currently holds on the national policy agenda. METHODS This case study documents the evolution of policy responses to drowning, reporting on data from semistructured interviews and a document analysis. To identify key factors that have facilitated the prioritisation of drowning prevention, data were synthesised using Shiffman and Smith's 2007 Policy Prioritisation Framework. Furthermore, an inductive approach was used to identify key themes unique to drowning prevention that were not embedded in the framework. RESULTS Four key phases of policy development for drowning prevention were distinguishable: (1) identification of issue and the emergence of actor support; (2) enhanced leadership and the accumulation of issue characteristics; (3) the formation of an internal frame and its impact on global support; and (4) enhanced national recognition and supportive global normative factors. Four additional themes unique to the case of drowning were also identified: competing health priorities, limited issue awareness, shift of disease burden to non-communicable diseases and the multisectoral nature of drowning. CONCLUSION This study demonstrates that the level of political prioritisation given to drowning prevention has evolved over the last decade and a half. A comprehensive understanding of factors that have elevated the issue onto the policy agenda will ensure future stakeholder engagement activities can be designed to foster deeper and more sustained commitment by key actors and organisations.
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Affiliation(s)
- Madeleine Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anthony Zwi
- Health, Rights and Development, School of Social Sciences, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Aminur Rahman
- International Drowning Research Centre-Bangladesh (IDRC-B), Dhaka, Bangladesh
| | | | - Rebecca Q Ivers
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Injury Division, The George Institute for Global Health, Sydney, NSW, Australia
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia .,Injury Division, The George Institute for Global Health, New Delhi, India
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Gupta M, Rahman A, Dutta NC, Nambiar D, Ivers R, Jagnoor J. Opportunities for gender transformative approaches in a community-based drowning reduction program in Bangladesh. Int J Equity Health 2020; 19:108. [PMID: 32611417 PMCID: PMC7329458 DOI: 10.1186/s12939-020-01226-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background Community-based programs in rural low-and middle-income country settings are well-placed to conduct gender transformative activities that aid program sustainability and catalyse wider social change, such as reducing gender inequities that in turn improve health outcomes. The Anchal program is a drowning prevention intervention for children aged 1–5 years old in rural Bangladesh. It provides community crèche-based supervision delivered by local trained paid-female volunteers. We aimed to identify the influence of the Anchal program on gender norms and behaviours in the community context, and the effects these had on program delivery and men and women’s outcomes. Methods Qualitative in-depth interviews, focus group discussions and observations were conducted with program beneficiaries and providers. Gender outcomes were analysed using FHI 360’s Gender Integration Framework. Results The Anchal program was found to be a gender accommodating program as it catered for communities’ gender-based roles and constraints but did not actively seek to change underlying beliefs, perceptions and norms that led to these. The program in some cases enhanced the independence and status of female community staff. This changed perceptions of communities towards acceptable levels of physical mobility and community involvement for women. Conversely, gender affected program delivery by reducing the ability of female supervisory staff to engage with male community leaders. The double burden of wage and household labour carried by local female staff also limited performance and progression. Gender-based constraints on staff performance, attrition and community engagement affected efficiency of program delivery and sustainability. Conclusions The Anchal program both adapted to and shaped community gender norms and roles. The program has well-established relationships in the community and can be leveraged to implement gender transformative activities to improve gender-based equity. Health programs can broaden their impacts and target social determinants of health like gender equity to increase program sustainability and promote equitable health outcomes.
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Affiliation(s)
- M Gupta
- The George Institute for Global Health Australia, University of New South Wales, Sydney, Australia
| | - A Rahman
- Centre for Injury Prevention and Research, House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - N C Dutta
- Centre for Injury Prevention and Research, House B 162, Road 23, New DOHS, Mohakhali, Dhaka, 1206, Bangladesh
| | - D Nambiar
- The George Institute for Global Health India, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India
| | - R Ivers
- School of Public Health and Medicine, Faculty of Medicine, UNSW Australia, Samuels Building, Botany Street, Kensington, 2052, Australia
| | - J Jagnoor
- The George Institute for Global Health India, 311-312, Third Floor, Elegance Tower, Plot No. 8, Jasola District Centre, New Delhi, 110025, India.
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Alonge O, Bishai D, Wadhwaniya S, Agrawal P, Rahman A, Dewan Hoque EM, Baset KU, Salam SS, Bhuiyan AA, Islam MI, Talab A, Rahman QSU, Rahman F, El-Arifeen S, Hyder AA. Large-scale evaluation of interventions designed to reduce childhood Drownings in rural Bangladesh: a before and after cohort study. Inj Epidemiol 2020; 7:17. [PMID: 32389128 PMCID: PMC7212604 DOI: 10.1186/s40621-020-00245-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background This paper estimates the impact on childhood drowning rates of community-based introduction of crèches or playpens or both in rural Bangladesh for children aged 0–47 months. Methods A baseline census of the whole population of 270,387 households in 51 unions, 451 villages from 7 rural sub-districts in Bangladesh was conducted in 2013. The baseline census determined retrospective, age-specific, and cumulative drowning incidence rates (IR) experienced in the target households in the 12 months prior to the intervention. Beginning in late 2013, creches for drowning prevention were established across the study area. Acceptance into creches was provided and written assent to attend a creche was obtained for all children aged 9–47 months in all participating unions. Playpens were provided to 45,460 of these children, of which 5981 children received only the playpens. All children were followed-up until their 48-month birthday or administrative censoring (fixed timepoint to stop observing the drowning deaths), after a two-year implementation period (2014–2016). Drowning IR were estimated for children and compared to corresponding baseline rates from 2012. Age-specific drowning IR under different “as treated” categories (playpen-only, creche-only, and playpen-plus-creche) were compared to the baseline rates experienced by the categorized households prior to intervention. Results A total of 3205 creches (average of 7 creches per village) were established, and 116,054 children aged 9–47 months were exposed to the intervention packages. Aggregated drowning IRs between age 0 and 47 were estimated per 100,000 population per year at 86.73 (95% CI: 69.67–107.97) and 43.03 (95% CI: 35.55–52.10) in the baseline and post implementation period, respectively. Risk ratios were 0.40 (95% CI: 0.28–0.57) overall, and 0.34 (95% CI: 0.13–0.90), 0.09 (95% CI: 0.02–0.36), and 0.04 (95% CI: 0.002–0.60) in children under the creche-only, aged, 1, 2, and 3 years old respectively. Inexplicably, drowning rates were statistically significantly higher post-intervention in children 0-11 months. There was no mortality reduction with playpen use (alone or in combination), and this group may actually have had a higher risk of drowning. Conclusions Creches are effective for preventing childhood drowning in rural Bangladesh for children above age 1-year, and should be considered for further scale-up.
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Affiliation(s)
- Olakunle Alonge
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - David Bishai
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.,Department of Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shirin Wadhwaniya
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Priyanka Agrawal
- Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Aminur Rahman
- Center for Injury Prevention Research, Dhaka, Bangladesh
| | - Emdad Md Dewan Hoque
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Shumona Sharmin Salam
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Md Irteja Islam
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Abu Talab
- Center for Injury Prevention Research, Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Fazlur Rahman
- Center for Injury Prevention Research, Dhaka, Bangladesh
| | - Shams El-Arifeen
- Maternal and Child Health Division, International Center for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington DC, USA
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