Policy opportunities and limitations of evidence-based planning for immunization: lessons learnt from a field trial in Bangladesh

Under five children's acute respiratory infection dropped significantly in Bangladesh: an evidence from Bangladesh demographic and health survey (BDHS), 1996-2018

AIM

This study aims to systematically identify and review the most significant risk factors and the trends that follow Acute Respiratory Infection (ARI) among children under five in Bangladesh.

METHODS

A total of 6863 under-five children were eligible for our analysis, retrieved from Bangladesh Demographic and Health Survey, 2014. ARI cases were defined if a child experienced of coughing with short and rapid breathing at the chest that occurred during two weeks prior to the study. Logistic regression and systematic review methods were appraised to explore the various risk factors involving ARI in Bangladesh. Furthermore, a trend analysis was performed to overlook the historical trend of ARI prevalence and affiliated determinants from 1996/97 to 2017/18 in Bangladesh.

RESULTS

Over the past two decades, Bangladesh experienced a significant drop in ARI prevalence from 12.8% in 1996 to only 3.0% in 2018. The cross-sectional findings revealed that boys (OR=1.35, 95% CI: 1.03-1.78), stunted children (OR=1.35, 95% CI: 1.03-1.78) and mothers with primary or no education (OR=2.53, 95% CI: 1.43-4.90) and secondary education (OR=1.77, 95% CI: 1.00-3.44) has the higher odds of ARI than their counterparts.

CONCLUSION

ARI prevalence significantly declined in Bangladesh while boys, stunted children and uneducated or primary educated mothers were identified as potential risk factors.

Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda

Background: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system.

Methods: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study.

Results: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent.

Conclusion: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified.