BackgroundSupported by development partners, the Government of Bangladesh carried out a comprehensive reform of health services in Bangladesh between 1998 and 2003, intended to make services more responsive to public needs: the Health and Population Sector Programme (HPSP). They commissioned a series of surveys of the public, as part of evaluation of the HPSP. This article uses the survey findings to examine the changes in public opinions, use and experience of health services in the period of the HPSP.MethodsWe carried out three household surveys (1999, 2000 and 2003) of a stratified random sample of 217 rural sites and 30 urban sites. Each site comprised 100–120 contiguous households. Each survey included interviews with 25,000 household respondents and managers of health facilities serving the sites, and gender-stratified focus groups in each site. We measured: household ratings of government health services; reported use of services in the preceding month; unmet need for health care; user reports of waiting times, payments, explanations of condition, availability of prescribed medicines, and satisfaction with service providers.ResultsPublic rating of government health services as "good" fell from 37% to 10% and the proportion using government treatment services fell from 13% to 10%. Unmet need increased from 3% to 9% of households. The proportion of visits to government facilities fell from 17% to 13%, while the proportion to unqualified practitioners rose from 52% to 60%. Satisfaction with service providers' behaviour dropped from 66% to 56%. Users were more satisfied when waiting time was shorter, prescribed medicines were available, and they received explanations of their condition.ConclusionServices have retracted despite increased investment and the public now prefer unqualified practitioners over government services. Public opinion of government health services has deteriorated and the reforms have not specifically helped the poorest people. User satisfaction could be increased if government doctors improved their interaction with patients and if waiting times were reduced by better management of facilities.
There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO ‘Watch’ list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.
The relationship between birthweight, sociodemographic variables and maternal anthropometry was examined in a sample from an inner urban area of Dhaka, Bangladesh. About 21% of babies were of low birthweight (LBW) using the World Health Organization cut-off of < 2500 g. LBW was more common in younger (< 20 years) and older (> 30 years) mothers, the low-income group and those with little or no education. The mean birthweights of the higher-educated, higher-income group and male children were on average 290, 260 and 120 g, respectively, higher than uneducated, lower-income groups and female children. The best cut-offs for detecting LBW and normal-weight infants was maternal weight of 50 kg (odds ratio = 4.6), maternal arm circumference of 23 cm (odds ratio = 5.0) and body mass index of 20.5 (odds ratio = 6.5). The sensitivity and specificity were best for maternal weight (69% and 68%, respectively). Logistic regression analyses show that mothers' weight at term was the best single predictor of LBW (31%), while maternal weight along with age, educational level and income group correctly predicted just over 35% of LBW. Regression analyses also confirmed that mothers' weight at term was the best predictor of birthweight, with a correlation coefficient of 0.49.
The shift from acute infectious and deficiency diseases to chronic noncommunicable diseases is not a simple transition but a complex and dynamic epidemiological process, with some diseases disappearing and others appearing or reemerging. The unabated pandemic of childhood and adulthood obesity and concomitant comorbidities are affecting both rich and poor nations, while infectious diseases remain an important public health problem, particularly in developing countries. More attention should be given to the high burden of disease associated with soil-transmitted helminths and schistosomiasis, which until recently was not considered a priority even though regular drug treatment is obtainable at relatively little cost. In developing countries, the pressing requirement is to provide an accessible and good quality health-care system, whereas industrialized countries have a major need for greater public health education and the promotion of healthy life-styles.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.