DOI: http://dx.doi.org/10.3329/bjmm.v4i1.8470BJMM 2011; 4(1): 46-50

Background The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh. Methods We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n = 4); key informant interviews with central level health policymakers/ managers (n = 15) and focus group discussions with CHWs (4 FGDs; total n = 29). Participants in a stakeholder consultative meeting included members from the government (n = 4), non-government organisations (n = 2), private sector (n = 1) and universities (n = 2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses. Results The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation. Conclusion Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.

BackgroundIn November 2011, a government hospital physician in Shibganj sub-district of Bangladesh reported a cluster of patients with fever and joint pain or rash. A multi-disciplinary team investigated to characterize the outbreak; confirm the cause; and recommend control and prevention measures.MethodsShibganj's residents with new onset of fever and joint pain or rash between 1 September and 15 December 2011 were defined as chikungunya fever (CHIKF) suspect cases. To estimate the attack rate, we identified 16 outpatient clinics in 16 selected wards across 16 unions in Shibganj and searched for suspect cases in the 80 households nearest to each outpatient clinic. One suspect case from the first 30 households in each ward was invited to visit the nearest outpatient clinic for clinical assessment and to provide a blood sample for laboratory testing and analyses.ResultsWe identified 1,769 CHIKF suspect cases from among 5,902 residents surveyed (30%). Their median age was 28 (IQR:15−42) years. The average attack rate in the sub-district was 30% (95% CI: 27%−33%). The lowest attack rate was found in children <5 years (15%). Anti-CHIKV IgM antibodies were detected by ELISA in 78% (264) of the 338 case samples tested. In addition to fever, predominant symptoms of serologically-confirmed cases included joint pain (97%), weakness (54%), myalgia (47%), rash (42%), itching (37%) and malaise (31%). Among the sero-positive patients, 79% (209/264) sought healthcare from outpatient clinics. CHIKV was isolated from two cases and phylogenetic analyses of full genome sequences placed these viruses within the Indian Ocean Lineage (IOL). Molecular analysis identified mutations in E2 and E1 glycoproteins and contained the E1 A226V point mutation.ConclusionThe consistently high attack rate by age groups suggested recent introduction of chikungunya in this community. Mosquito control efforts should be enhanced to reduce the risk of continued transmission and to improve global health security.

A multi-staged cr oss sectional study was conducted among childr en aged 2 -17 year s to assess the level of soil tr ansmitted helminthes (ST H ) infections and its r elation to socio-demogr aphic char acter istics among them. T wo thousand childr en wer e r andomly selected fr om two r ur al and four differ ent communities of ur ban ar eas of Dhaka distr ict since November 2009 to J une 2010. F our differ ent communities classified as higher , medium, poor er and slum/ low socio-economic gr oups fr om ur ban ar eas wer e selected on the basis of their place of r esidence with differ ent socio-economic status. Ur ban study subjects wer e again sub gr ouped into upper (higher and medium socio-economic) and lower (poor er and slum/low socio-economic) classes. Stool specimens of the r espondents wer e collected and tested at the Par asitology depar tment of I E DC R , using the K ato-katz faecal technique for identification of helminthes eggs following their mor phology (A . lumbr icoides, T tr ichiur a, and A . duodenale), and lar val stage (S. ster cor alis). A bout 32.15% study population har bor ed at least one of the four helminthes species. B aseline pr evalence of infections and mean par asite loads for A scar is lumbr icoides wer e 40.61% and 600.80 e/g, for T r ichur is tr ichiur a 30.42% and 206.11e/g, and for A . duodenale 6.80% and 78.75 e/g. T hr ee childr en (0.49% ) wer e positive for Str ongyloides ster cor alis. Single infection of 78.32 % and double infection of 21.68 % wer e r ecor ded. Single infection of A . lumbr icoides (40.61% ) and T tr ichiur a (30.42% ) and double infection of A . lumbr icoides -T tr ichiur a (18.61 % ) wer e mor e pr evalent. T he pr evalence of ST H infection was 25.47 % and 38.68 % for r ur al and ur ban ar eas r espectively (P <.001). A mong ur ban study subjects, the distr ibution of ST H infection was 0.0 % in the higher (living in higher socioeconomic ar eas) (only 3 samples could be collected), 26.75 % in medium (living in medium socio-economic ar eas), 45.95 % in poor er and 50.54 % in slum/low socio-economic gr oups. Significantly higher number of ST H infection was obser ved among lower than that in upper socio-economic classes (P <.001). T hese r esults suggest that ST H infections r emain a ser ious health pr oblem among childr en in B angladesh and need appr opr iate pr evention and contr ol measur es.K ey wor ds: Pr evalence, ST H , childr en, par asite load, ur ban and r ur al ar eas, K ato-katz technique.

According to the Non-communicable disease Risk Factors Survey of 2018, more than one-fifth (21.0%) of adults aged 25 years or older have hypertension and one-third of the adults did not have their blood pressure (BP) measured in their lifetime in Bangladesh. The National Heart Foundation of Bangladesh participated in May Measurement Month (MMM) 2017 and 2018 as well as this 2019 as a part of a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programmes worldwide. This opportunistic screening of voluntary participants aged ≥18 years was carried out from May to July 2019. Data were collected from 100 screening sites in 16 districts in Bangladesh. BP measurement, the definition of hypertension, and statistical analysis followed the MMM protocol. Data on 24 941 individuals were analysed. Among the participants, 12 658 (50.8%) were female. After multiple imputation, 6990 (28.0%) had hypertension. Among the 6990 participants with hypertension, 5007 (71.6%) were on antihypertensive medication and 5331 (76.3%) were aware of having hypertension. Among 6990 participants with hypertension, 3217 (46.0%) had controlled BP (&lt;140/90 mmHg) and among the participants with hypertension and on antihypertensive medication, 64.2% had controlled BP. Opportunistic BP screening can identify significant numbers of people with raised BP and thus assist in the prevention of cardiovascular diseases.

ObjectiveTo estimate the costs of scaling up the HEARTS pilot project for hypertension management and risk-based cardiovascular disease (CVD) prevention at the full population level in the four subdistricts (upazilas) in Bangladesh.SettingsTwo intervention scenarios in subdistrict health complexes: hypertension management only, and risk-based integrated hypertension, diabetes, and cholesterol management.DesignData obtained during July–August 2020 from subdistrict health complexes on the cost of medications, diagnostic materials, staff salaries and other programme components.MethodsProgramme costs were assessed using the HEARTS costing tool, an Excel-based instrument to collect, track and evaluate the incremental annual costs of implementing the HEARTS programme from the health system perspective.Primary and secondary outcome measuresProgramme cost, provider time.ResultsThe total annual cost for the hypertension control programme was estimated at US$3.2 million, equivalent to US$2.8 per capita or US$8.9 per eligible patient. The largest cost share (US$1.35 million; 43%) was attributed to the cost of medications, followed by the cost of provider time to administer treatment (38%). The total annual cost of the risk-based integrated management programme was projected at US$14.4 million, entailing US$12.9 per capita or US$40.2 per eligible patient. The estimated annual costs per patient treated with medications for hypertension, diabetes and cholesterol were US$18, US$29 and US$37, respectively.ConclusionExpanding the HEARTS hypertension management and CVD prevention programme to provide services to the entire eligible population in the catchment area may face constraints in physician capacity. A task-sharing model involving shifting of select tasks from doctors to nurses and local community health workers would be essential for the eventual scale-up of primary care services to prevent CVD in Bangladesh.

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Background: The increasing burden of Non-Communicable Diseases (NCDs) in Bangladesh underscores the importance of strengthening primary health care systems. In this study, we examined the barriers and facilitators to engaging Community Health Workers (CHWs) for NCDs prevention and control in Bangladesh.Methods: We used multipronged approaches, including a. Situation analyses using a literature review, key personnel and stakeholders’ consultative meetings, and exploratory studies. A grounded theory approach was used for qualitative data collection from health facilities across three districts in Bangladesh. We conducted in-depth interviews with CHWs (Health Inspector; Community Health Care Provider; Health Assistant and Health Supervisor) (n=4); key informant interviews with central level health policymakers/ managers (n=15) and focus group discussions with CHWs (4 FGDs; total n=29). Participants in a stakeholder consultative meeting included members from the government (n=4), non-government organisations (n=2), private sector (n=1) and universities (n=2). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.Results: The CHWs in Bangladesh deliver a wide range of public health programs. They also provide several NCDs specific services, including screening, provisional diagnosis, and health education and counselling for common NCDs, dispensing basic medications, and referral to relevant health facilities. These services are being delivered from the sub-district health facility, community clinics and urban health clinics. The participants identified key challenges and barriers, which include lack of NCD specific guidelines, inadequate training, excessive workload, inadequate systems-level support, and lack of logistics supplies and drugs. Yet, the facilitating factors to engaging CHWs included government commitment and program priority, development of NCD related policies and strategies, establishment of NCD corners, community support systems, social recognition of health care staff and their motivation.Conclusion: Engaging CHWs has been a key driver to NCDs services delivery in Bangladesh. However, there is a need for building capacity of CHWs, maximizing CHWs engagement to NCD services delivery, facilitating systems-level support and strengthening partnerships with non-state sectors would be effective in prevention and control efforts of NCDs in Bangladesh.