Background: In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. Method: The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of

BackgroundIn spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh.MethodsWe used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs).ResultsEight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care.ConclusionOur study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.

Non-communicable Diseases (NCDs) account for 67% of total deaths in Bangladesh. However, the Bangladeshi health system is inadequately prepared to tackle NCDs. Evidence on NCD-specific health-seeking behavior can help appropriately address the needs of people affected by NCDs in Bangladesh. Our study aims to explore health-seeking behavior for people affected by NCDs in northern Bangladesh. We conducted a qualitative study in Mithapukur, Rangpur, during 2015–2016. We purposely selected respondents and carried out 25 in-depth interviews with individuals affected by non-communicable diseases and 21 healthcare providers. Additionally, we held six focus group discussions in the wider community. We verbatim transcribed all interviews and analyzed the content using thematic analysis, according to the following thematic areas: individual, household, and contextual factors that influence health-seeking behavior for NCDs within the context of the broader socio-economic environment. Study findings indicate that people seek care only when symptoms disrupt their daily lifestyle. Henceforth, people’s health beliefs, religious beliefs, and relations with local providers direct their actions, keeping provider accessibility, cost anticipation, and satisfying provider-encounters in mind. Health-seeking is predominantly delayed and fragmented. Semi-qualified providers represent a popular first choice. Gender roles dominate health-seeking behavior as women need their guardian’s permission to avail care. Our findings indicate the need to sensitize people about the importance of early health-seeking for NCDs, and continuing life-long NCD treatment. Our findings also highlight the need for people-centered care, making preventive and curative NCD services accessible at grassroots level, along with relevant provider training. Furthermore, special provisions, such as financial support and outreach programs are needed to enable access to NCD care for women and the poor.

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Maternal education is significantly related to early childhood morbidity and mortality. In Bangladesh, most mothers do not have a correct knowledge on exclusive breastfeeding and the appropriate time for introduction of weaning foods; and only 3% of them know how to prepare proper weaning foods 1 . Another study conducted in the rural population reported that according to Gomez classification, 96% of children had varying degrees of protein energy malnutrition (PEM) (28.4% mild, 58.2% moderate and 9.2% severe) 2 . Timely weaning, education and promotion of essential vaccination may reduce childhood malnutrition, especially severe PEM. It has also been reported that the prevalence of breastfeeding in Bangladesh is one of the highest in the world where diarrheal diseases are hyper-endemic and issues of breastfeeding in several diarrheal diseases have been well documented 3 . We undertook this study to determine knowledge, attitude and feeding behavior of the mothers in a rural community. This cross sectional study was conducted in Sreepur Thana. Four villages were purposively selected. All women having children below 5 years were interviewed face to face. Structured questionnaire was used. Each participant was informed about the objectives of the interviewing. After taking her consent the interview session was started. The interviewing included socio-demographic information like housing, sanitation, education, water-supply and family-income. As regards feeding practices, each mother was interviewed for information related to nutrition during pregnancy and lactation. The questionnaire also included information about breast feeding like colostrum, exclusive breastfeeding, weaning and feeding during diarrhea and fever. The collected information were entered into computer using SPSS 11.5 version. The prevalence rates of feeding and weaning practices were expressed in percentages. Chi-sq was used to determine association of feeding practices with education and social class.A total of 500 families were visited in four villages. Of these families, 409 (81.1%) women were selected. Of the 91 non-participants, 85 women had no children below 5 years and only 6 women refused to participate. The mean age of the participants was 25 years (16-45y). The average family size was 4 (4-11) and the average monthly expenditure was 3751 (500-15000) taka. About 25% were illiterate and 95% were housewives. Most of the families had access to tube well water for drinking and domestic purposes. Of them, 94% had living rooms with corrugated tin sheet.The study revealed that 68% of mothers took extra food during pregnancy, 80% took extra food during lactation, 54% mothers gave exclusive breast feeding for 6 months. More than one third (36%) mothers started weaning at 6 th month and only 62% mothers chose khichuri made of rice and pulse as supplementary food. About twothirds used to provide balanced diet to their children; 70% used to serve normal diet during fever, 71% during diarrhea and 88% during recovery from illness. The prevalence of taki...