The poverty impact of OOP outlays for health care, in general, is quite high. However, it is especially high for NCDs, particularly for chronic NCDs and those requiring immediate surgical procedures. Hence, these illnesses should be given more priority for policy framing. In addition to suggesting some ex-ante measures (e.g. raising awareness regarding the risk factors causing NCDs), the paper argues for reforms to enhance efficiency in the public health care facilities and increasing the quality of public health care.

Objective To investigate the impact of zinc supplementation in children with cholera.

This case-control study was conducted in the Dhaka Hospital of ICDDR,B to identify the risk factors of mortality in severely-malnourished children hospitalized with diarrhoea. One hundred and three severely-malnourished children (weight-for-age <60% of median of the National Center for Health Statistics standard) who died during hospitalization were compared with another 103 severely-malnourished children who survived. These children were aged less than three years and admitted to the hospital during 1997. On admission, characteristics of the fatal cases and non-fatal controls were comparable, except for age. The median age of the cases and controls were six and eight months respectively (p=0.05). Patients with low pulse rate or imperceptible pulse had three times the odds of death compared to the control group (p<0.01). The presence of clinical septicaemia and clinical severe anaemia had 11.7 and 4.2 times the odds of death respectively (p<0.01). Patients with leukocytosis (>15,000/cm3) had 2.5 times the odds of death (p<0.01). Using logistic regression, clinical septicaemia [adjusted odds ratio (AOR)=8.8, confidence interval (CI) 3.7-21.1, p=0.01], hypothermia (AOR=3.5, CI 1.3-9.4, p<0.01), and bronchopneumonia (AOR=3.0, CI 1.2-7.3, p<0.01) were identified as the significant risk factors of mortality. Severely-malnourished children (n=129) with leukocytosis, imperceptible pulse, pneumonia, septicaemia, and hypothermia had a high risk of mortality. The identified risk factors can be used as a prognostic guide for patients with diarrhoea and severe malnutrition.

This study examines factors associated with low birthweight (LBW) in rural Bangladesh. Enrolled in early first trimester, 350 women were followed for duration of pregnancy and data gathered on maternal factors such as social, demographic, anthropometric, biochemical measures and newborn's birth weight within 48 hours of birth. Almost a quarter of babies (24%) were born with LBW and mean birth weight was 2961 g. Bivariate analysis found associations between LBW and mother's age, parity, weight and hemoglobin level at booking, weight gain and health problems during pregnancy, tobacco consumption, and gestational age. But no such association was seen for birth spacing, mother's height, economic status, educational level, body mass index, mid upper arm circumference and number of ANC visits. Multivariable analysis revealed gestational age, hemoglobin levels at first visit and weight gain during pregnancy as significant predictors of LBW in this rural setting. Although antenatal care provision is absolutely necessary, intervention approaches that go beyond clinical or primary care settings are also warranted for better nutrition of women. Concerted efforts in health and non-health sectors are necessary for improvement in health and social status of women in order to reduce low birthweight in Bangladesh.

This study analyses the responsiveness of outpatient care to assess the quality of urban primary health care among all 5 types of health care providers in Bangladesh, namely, the Urban Primary Health Care Services Delivery Project, the NGO Health Services Delivery Project (NHSDP), NGOs, private hospitals, and the Ministry of Health and Family Welfare (MOHFW). Other than some public-private comparisons, there is an absolute knowledge gap regarding responsiveness in urban health systems, particularly in the context of Bangladesh, and this gap motivates this study. The study used primary data collected from 810 randomly selected outpatients. The survey used a structured questionnaire on all 7 domains of responsiveness of outpatient care suggested by the World Health Organization. The estimated mean responsiveness score reveals that overall, approximately 33% of the patients rated the responsiveness of the system as poor. In reported responsiveness, the NHSDP was ranked at the top and the MOHFW at the bottom. The latter is quite expected. Overall, prompt attention and autonomy were the worst-performing domains, and choice of provider, dignity, and clear communication were the better-performing ones. The results suggest the need to improve the degree of responsiveness of all domains, especially those that are more concerned with access to health care, namely, prompt attention, dignity, clear communication, and confidentiality. The Ministry of Health and Family Welfare facilities should give additional consideration to promote prompt attention, autonomy, and quality of basic amenities. Private facilities should also provide additional stress on improving prompt attention and autonomy. The nontherapeutic quality of health care needs to be emphasized in the medical education system. Further research based on household surveys could be worthwhile to measure responsiveness more comprehensively.

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This study was undertaken to understand the health status of elderly people and to gather some information about their perceived health needs. This study was conducted in the north-western part of Dhaka district in the year 1999-2000. People aged over 60 years constituted about 3.5% of the total population with more than half (55.6%) belonging to the middle class and another one third to the lower class. Elderly people made up 5.7% of all out-patient consultations and 6.9% of all in-patient admissions. Hypertension, peptic ulcer, chronic obstructive pulmonary diseases, pneumonia, skin diseases and anaemia were common among these people. Only 14% of the elderly people in this rural area were insured, but these insured people constituted about half (48%) of the in-patient and 90% of the out-patient elderly patients. Thus insurance has significantly increased their health care access (p<0.05). Provision of free health care, drugs at a cheaper price, services at their doorsteps, free ambulance service and allocation of old age allowance were some of their notable demands. A cheaper, accessible and effective geriatric health care service with an emphasis on health promotion, income generating activities and rehabilitation programme should be developed to protect the health and well being of the elderly people.