In spite of various effective intervention programs, the under-5 child mortality rate (U5MR) is still high in Bangladesh. The present paper focused on the levels, trends and determinants of U5MR in Bangladesh utilizing data from Bangladesh Demographic and Health Survey (BDHS), 2007. Differential pattern in U5MR in Bangladesh was examined using life table technique as a bi-variate analysis and Cox proportional hazard model was used to analyze the determinants of U5MR mortality. Data from BDHS (2007) showed that U5MR during the five years preceding the survey was 65 per 1,000 live births, i.e. one in fifteen children born in Bangladesh died before reaching the fifth birthday. The risk of dying in the first month of life (37 per 1,000) was nearly two and a half times greater than in the subsequent 11 months (15 per 1,000). Deaths in the neonatal period accounted for 57 percent of all under-five deaths. In the Cox proportional hazard model analysis, factors such as the place of residence, parents education, fathers working status, sources of drinking water, type of toilet facility, wealth status, watching of television, mothers age, months of breastfeeding, birth interval had significant influence on infant and child mortality. The most significant predictors of neonatal, post-neonatal, infant and child mortality were residence, parents education, type of toilet facility, wealth status, watching TV, months of breastfeeding, and birth interval. Despite the improvement of medical technology, child mortality remained alarmingly high, indicating that demographic, socioeconomic, household and environmental conditions must be improved to substantially reduce child mortality in this population. DOI: http://dx.doi.org/10.3329/bjms.v13i4.20590 Bangladesh Journal of Medical Science Vol.13(4) 2014 p.431-437
Background: The present cross sectional study was undertaken to assess the food habits and nutritional status among elderly people in rural Bangladesh and to compare the same between male and female. A simple random sampling and geographical re-conciliation method was used to select the study population. All the patients in a pre-publicized medical camp were approached and a total of 186 male and 237 female participated in the study. Data were collected through face to face interview with a semi-structured questionnaire and anthropometric measures were collected using instruments. Associations between dietary intake and World Health Organization (WHO) referred Body Mass Index (BMI) range was done using cross tabulation. Results: The mean age of male was 67.69 years and that of female was 65.46 years. The female subjects were higher than males in number in this study. The rate of male literacy was found to be 39.8% where literacy among the female was 13.9%. Among all, 79.6% males were found to be living with their spouse where the rate of living with spouse among the female amounted 53.2%. About half of elderly people were found to be living under poor and 32% in low middle class socio-economic condition. Study revealed that 80.6% male and 78.9% female got no opportunity to take protein-rich food more than three days per week. Again 95.7% male and 97.5% female had no opportunity take more than two servings of protein rich food per week. The similar case occurred in case of taking fatty food, vegetable and fruits per week. Similarly 100 % male and 99.6% female reported that they were taking more than two servings of fatty food per week. No significant association was found between BMI and food intake. The significance was tested by Pearson chi-square. In this test the p value for protein rich food was 0.234 (p?0.05), while fatty food (0.712), vegetable (0.502) and fruits (0.274) which was more than referred significance p-value ?0.05. Hence, the study confirmed that malnutrition remains a common problem among older people living in rural Bangladesh though there is no significant association was found between food intake and nutrition. Conclusion: Management of malnutrition in case of elderly population requires a multidisciplinary approach that treats pathology and uses both social and dietary forms of intervention. Bangladesh Journal of Medical Science Vol. 12 No. 02 April13 Page 150-157 DOI: http://dx.doi.org/10.3329/bjms.v12i2.14943
BackgroundIn regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA.AimTo describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC) in regional New South Wales, Australia.Materials and methodsThe PAST protocol was evaluated using a prospective and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention), patient data were collected prospectively at the PSC. Control patients included two groups (i) patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, (ii) patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs) averted in the intervention period compared to the control period.ResultsThe intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42–31.2, p < 0.05) and the majority of the associated costs were incurred during acute care and rehabilitation. Overall, the intervention was associated with an estimated net avoidance of 93.3 DALYs. The estimated average cost per DALY averted per patient in the intervention group compared to the control group was $10,921.ConclusionBased on our simulation modeling, the pre-hospital triage intervention was a potentially cost-effective strategy for improving access to tPA therapy for patients with ischemic stroke in regional Australia.
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