PurposeOverall health status indicators have improved significantly over the past three decades in Indonesia. However, the country’s maternal mortality ratio remains high with a stark inequality by region. Fewer studies have explored access inequity in maternal health care service over time using multiple inequality markers. In this study, we analyzed Indonesian Demographic and Health Survey (DHS) data to explore trends and inequities in use of any antenatal care (ANC), four or more ANC (ANC4+), institutional birth, and cesarean section (c-section) birth in Indonesia during 1986–2012 to inform policy for future strategies ending preventable maternal deaths.MethodsIndonesian DHS data from 1991, 1994, 1997, 2002/3, 2007, and 2012 surveys were downloaded, merged, and analyzed. Inequity was measured in terms of variation in use by asset quintile, parental education, urban–rural location, religion, and region. Trends in use inequities were assessed plotting changes in rich:poor ratio, rich:poor difference, and concentration indices over period based on asset quintiles. Sociodemographic determinants for service use were explored using multivariable logistic regression analysis.FindingsBetween 1986 and 2012, institutional birth rate increased from 22% to 73% and c-section rate from 2% to 16%. Private sector was increasingly contributing in maternal health. There were significant access inequities by asset quintile, parental education, area of residence, and geographical region. The richest women were 5.45 times (95% CI: 4.75–6.25) more likely to give birth in a health facility and 2.83 times (95% CI: 2.23–3.60) more likely to give birth by c-section than their poorest counterparts. Urban women were 3 times more likely to use institutional birth and 1.45 times more likely to give birth by c-section than rural women. Use of all services was higher in Java and Bali than in other regions. Access inequity was narrowing over time for use of ANC and institutional birth but not for c-section birth.ConclusionOngoing pro-poor health-financing strategies should be strengthened with introduction of innovative ways to monitor access, equity, and quality of care in maternal health.

Background In recent years, developing countries like Bangladesh are facing a higher burden of non-communicable diseases such as hypertension as a result of demographic transition. Prevalence of hypertension is often studied in this setting. However, evidence on undiagnosed hypertension is not widely available in the existing literature. Therefore, the current study focuses on inequalities in the prevalence of undiagnosed hypertension in Bangladesh. Methods A total of 8835 participants aged 35+ years were included in this study using nationally representative Bangladesh Demographic and Health Survey 2011 (BDHS). In the survey, systolic blood pressure (SBP) and diastolic blood pressure (DBP) of these participants were measured three times with approximately 10 minutes of an interval between each measurement. Any respondent with either SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was considered as patient with hypertension as per the guidelines from American Heart Association. Among the participants, undiagnosed hypertension was defined as having SBP > =140 mmHg or DBP > =90 mmHg and never taking prescribed medicine or being told by health professionals to lower/control blood pressure. Multiple logistic regression analysis was applied for identifying factors associated with undiagnosed hypertension. Further, socioeconomic inequalities in the prevalence of undiagnosed hypertension were estimated using Concentration Index (C). Results We found 978 (59.9% of the total) were undiagnosed among 1685 hypertensive patients studied. Regression analysis showed individuals with being underweight, having poor socioeconomic conditions, and lower educational qualifications were more likely to have undiagnosed hypertension. A similar association between undiagnosed hypertension and socioeconomic quintiles was observed using concentration index (C = − 0.07). On the other hand, individuals from higher age group (50–64 or above), female sex, and Sylhet region were at lower risk of undiagnosed hypertension. Conclusions This study showed that a large proportion of the cases with hypertension are remained undiagnosed in Bangladesh, especially among the poor and low educated population. Screening and awareness building initiatives on hypertension should be taken for this group of population to reduce the burden of undiagnosed hypertension.

Although internet addiction (IA) has been the subject of research in many countries, it is poorly studied in Bangladesh, and previous studies in the country have not examined potential mental health risk factors in relation to the development of IA. The present pilot study attempted to assess the prevalence and associated risk factors of IA among a convenience sample of recently graduated university students actively looking for a job (N = 284) from July to October 2018 in Rajshahi (a city in Bangladesh). The measures included socio-demographic and behavioral variables, the Internet Addiction Test (IAT), and the Depression, Anxiety, and Stress Scale. Surprisingly, no cases of IA were identified in the sample (i.e., the prevalence rate of IA was 0%) which may have been a consequence of the specific population sampled. A total of 3.9% of the participants (n = 11) were classified as excessive users (≥ 60 in IAT). Using regression analysis, the risk factors for excessive internet use were spending more time online (> 5 h daily) and experiencing psychiatric conditions (i.e., depression, stress). It is hoped the present pilot study will facilitate further study in Bangladesh with a more in-depth focus on the socio-demographic and psychiatric morbidities in excessive and problematic internet use. It is also speculated that job-seeking may be a situational protective risk factor for developing IA.

Topological insulator (TI) materials such as Bi 2 Te 3 and Bi 2 Se 3 have attracted strong recent interests. Large scale, high quality TI thin films are important for developing TI-based device applications. In this work, structural and electronic properties of Bi 2 Te 3 thin films deposited by metal organic chemical vapor deposition (MOCVD) on GaAs (001) substrates were characterized via X-ray diffraction (XRD), Raman spectroscopy, angle-resolved photoemission spectroscopy (ARPES), and electronic transport measurements. The characteristic topological surface states (SS) with a single Dirac cone have been clearly revealed in the electronic band structure measured by ARPES, confirming the TI nature of the MOCVD Bi 2 Te 3 films. Resistivityand Hall effect measurements have demonstrated relatively high bulk carrier mobility of ~350 cm 2 /Vs at 300K and ~7,400 cm 2 /Vs at 15 K. We have also measured the Seebeck coefficient of the films. Our demonstration of high quality topological insulator films grown by a simple and scalable method is of interests for both fundamental research and practical applications of thermoelectric and TI materials.

The effects of M atomic species mixing on the structural, elastic, electronic, thermodynamic and charge transport properties of newly synthesized MAX phase (Zr 1-x Ti x ) 2 AlC (0 ≤ x ≤ 1) solid solutions have been studied for the first time by means of density functional theory (DFT) based first principles calculations. The lattice constants in good accord with the experimental results, are found to decrease with Ti content. The elastic constants, C ij , and the other polycrystalline elastic moduli have been calculated. The elastic constants satisfy the mechanical stability conditions of these solid solutions. The constants C 11 , C 33 and C 44 are found to increase with Ti contents up to x = 0.67, thereafter these decrease slightly. A reverse trend is followed by C 12 and C 13 . The elastic moduli are also found to increase up to x = 0.67, beyond which these moduli go down slightly. Pugh"s ratio and Poisson"s ratio both confirm the brittleness of (Zr 1-x Ti x ) 2 AlC. Different anisotropy factors revealed the anisotropic character of these solid solutions. A non-vanishing value of the electronic energy density of states (EDOS) at the Fermi level suggests that (Zr 1-x Ti x ) 2 AlC are metallic in nature. A mixture of covalent, ionic and metallic bonding has been indicated from the electronic structure with dominant covalent bonding due to hybridization of Zr-4d states and C-2p states. The variation of elastic stiffness and elastic parameters with x is seen to be correlated with partial DOS (PDOS) and charge density distribution. The calculated Debye temperature and minimum thermal conductivity are found to increase with Ti contents, while melting temperature is the highest for x = 0.67. The solid solution with x = 0.67 shows improved mechanical and thermal properties compared to that of the two end members Zr 2 AlC and Ti 2 AlC. The study of charge transport properties of (Zr 1-x Ti x ) 2 AlC reveals the metallic nature with saturated resistivity. The maximum power factor (S 2 /=11.1×10 10 Wm -1 K -2 s -1 ) is obtained at 400 K for (Zr 1-x Ti x ) 2 AlC.

Background District hospitals (DHs) provide secondary level of healthcare to a wide range of population in Bangladesh. Efficient utilization of resources in these secondary hospitals is essential for delivering health services at a lower cost. Therefore, we aimed to estimate the technical efficiency of the DHs in Bangladesh. Methods We used input-oriented data envelopment analysis method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) technical efficiency of the DHs using data from Local Health Bulletin, 2015. In this model, we considered workforce as well as number of inpatient beds as input variables and number of inpatient, outpatient, and maternal services provided by the DHs as output variables. A Tobit regression model was applied for assessing the association of institutional and environmental characteristics with the technical efficiency scores. Results The average scale, VRS, and CRS technical efficiency of the DHs were estimated to 85%, 92%, and 79% respectively. Population size, poverty headcount, bed occupancy ratio, administrative divisions were significantly associated with the technical efficiency of the DHs. The mean VRS and CRS technical efficiency demonstrated that the DHs, on an average, could reduce their input mix by 8% and 21% respectively while maintaining the same level of output. Conclusion Since the average technical efficiency of the DHs was 79%, there is little scope for overall improvements in these facilities by adjusting inputs. Therefore, we recommend to invest further in the DHs for improvement of services. The Ministry of Health and Family Welfare (MoHFW) should improve the efficiency in resource allocation by setting an input-mix formula for DHs considering health and socio-economic indicators (e.g., population density, poverty, bed occupancy ratio). The formula can be designed by learning from the input mix in the more efficient DHs. The MoHFW should conduct this kind of benchmarking study regularly to assess the efficiency level of health facilities which may contribute to reduce the wastage of resources and consequently to provide more affordable and accessible public hospital care.

The world is grappling with Covid-19, a dire public health crisis. Preventive and control measures are adopted to reduce the spread of COVID-19. It is important to know the knowledge, attitude, and practice (KAP) of people towards this pandemic to suggest appropriate coping strategies. The aim of this study was to assess the KAP of Bangladeshi people towards Covid-19 and determinants of those KAPs. We conducted a cross-sectional survey of 492 Bangladeshi people aged above 18 years from May 7 to 29, 2020 throughout the country. Simple and multiple logistic regression analyses were conducted to identify the factors associated with KAP on COVID-19. About 45% of respondents had good knowledge, 49% of respondents expressed positive attitude towards controlling of COVID-19 and 24% of respondents had favorable practice towards COVID-19. Almost three fourths of the respondents went outside home during the lockdown period. Furthermore, the study found that good knowledge and attitude were associated with better practice of COVID-19 health measures. An evidence informed and context specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh, based on the findings of this study, targeting different socio-economic groups.

Background Out-of-pocket (OOP) payments for healthcare have been increasing steadily in Bangladesh, which deteriorates the financial risk protection of many households. Methods We aimed to investigate the incidence of catastrophic health expenditure (CHE) and impoverishment from OOP payments and their determinants. We employed nationally representative Household Income and Expenditure Survey 2016 data with a sample of 46 076 households. A household that made OOP payments of >10% of its total or 40% of its non-food expenditure was considered to be facing CHE. We estimated the impoverishment using both national and international poverty lines. Multiple logistic models were employed to identify the determinants of CHE and impoverishment. Results The incidence of CHE was estimated as 24.6% and 10.9% using 10% of the total and 40% of non-food expenditure as thresholds, respectively, and these were concentrated among the poor. About 4.5% of the population (8.61 million) fell into poverty during 2016. Utilization of private facilities, the presence of older people, chronic illness and geographical location were the main determinants of both CHE and impoverishment. Conclusion The financial hardship due to OOP payments was high and it should be reduced by regulating the private health sector and covering the care of older people and chronic illness by prepayment-financing mechanisms.