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Rahman QM, Sikder MT, Talha MTUS, Banik R, Pranta MUR. Perception regarding health and barriers to seeking healthcare services among rural rickshaw pullers in Bangladesh: A qualitative exploration. Heliyon 2022; 8:e11152. [PMID: 36281402 PMCID: PMC9586896 DOI: 10.1016/j.heliyon.2022.e11152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/30/2021] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
Background Understanding health in daily life can vary from person to person. The concept of health arises from the perspective of an individual's experience. People face several kinds of barriers while seeking healthcare services, where rickshaw pullers are one of the most vulnerable groups to meet their basic health needs. This study aimed to investigate Bangladeshi rural rickshaw pullers' perception regarding health and what obstacles they face while seeking healthcare services. Methods This study followed a qualitative approach conducted in-depth interviews involving 20 rickshaw pullers in rural Bangladesh from 4th to 15th December 2020. Participants were selected through purposive and snowball sampling techniques. The verbatim transcription was performed, and the thematic analysis was done through manual coding and NVivo version 12. Results According to the study's findings, participants' perception regarding health were mainly based on physical, nutritional, and social points of view. The financial hardship to convey medical costs, long waiting time in receiving healthcare services, social class inequality, low trustworthiness on diagnostic services, and mastery of broker in the hospital setting were acknowledged as prevailing barriers to seeking healthcare services. Conclusion Several health perceptions existed among the rural rickshaw pullers. They faced different kinds of barriers while seeking healthcare services, and those obstacles made them hopeless and worried about getting quality healthcare services. Concerned authorities, including government and private organizations, should take effective strategies to ensure that healthcare services are available, reliable, and affordable.
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Affiliation(s)
- Quazi Maksudur Rahman
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh,Corresponding author.
| | - Md. Tajuddin Sikder
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | | | - Rajon Banik
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Mamun Ur Rashid Pranta
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
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Chowdhury KIA, Jabeen I, Rahman M, Faruque ASG, Alam NH, Ali S, Ahmed T, Fuchs GJ, Duke T, Gyr N, Sarma H. Barriers to seeking timely treatment for severe childhood pneumonia in rural Bangladesh. Arch Dis Child 2022; 107:436-440. [PMID: 34526294 DOI: 10.1136/archdischild-2021-321993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Delays in seeking medical attention for childhood pneumonia may lead to increased morbidity and mortality. This study aimed at identifying the drivers of delayed seeking of treatment for severe childhood pneumonia in rural Bangladesh. METHODS We conducted a formative study from June to September 2015 in one northern district of Bangladesh. In-depth interviews were conducted with 20 rural mothers of children under 5 years with moderate or severe pneumonia. We analysed the data thematically. RESULTS We found that mothers often failed to assess severity of pneumonia accurately due to lack of knowledge or misperception about symptoms of pneumonia. Several factors delayed timely steps that could lead to initiation of appropriate treatment. They included time lost in consultation with non-formal practitioners, social norms that required mothers to seek permission from male household heads (eg, husbands) before they could seek healthcare for their children, avoiding community-based public health centres due to their irregular schedules, lack of medical supplies, shortage of hospital beds and long distance of secondary or tertiary hospitals from households. Financial hardships and inability to identify a substitute caregiver for other children at home while the mother accompanied the sick child in hospital were other factors. CONCLUSIONS This study identified key social, economic and infrastructural factors that lead to delayed treatment for childhood pneumonia in the study district in rural Bangladesh. Interventions that inform mothers and empower women in the decision to seek healthcare, as well as improvement of infrastructure at the facility level could lead to improved behaviour in seeking and getting treatment of childhood pneumonia in rural Bangladesh.
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Affiliation(s)
| | - Ishrat Jabeen
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Mahfuzur Rahman
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | | | - Nur H Alam
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Shahjahan Ali
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh
| | - George J Fuchs
- Department of Paediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Trevor Duke
- Department of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, NCD, Papua New Guinea.,Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Basel, Switzerland
| | - Haribondhu Sarma
- Nutrition and Clinical Services Division (NCSD), icddr,b, Dhaka, Bangladesh.,Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Pulok MH, Sabah MNU, Uddin J, Enemark U. Progress in the utilization of antenatal and delivery care services in Bangladesh: where does the equity gap lie? BMC Pregnancy Childbirth 2016; 16:200. [PMID: 27473150 PMCID: PMC4967314 DOI: 10.1186/s12884-016-0970-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/14/2016] [Indexed: 11/26/2022] Open
Abstract
Background Universal access to health care services does not automatically guarantee equity in the health system. In the post Millennium Development Goals (MDGs) era, the progress towards universal access to maternal health care services in a developing country, like Bangladesh requires an evaluation in terms of equity lens. This study, therefore, analysed the trend in inequity and identified the equity gap in the utilization of antenatal care (ANC) and delivery care services in Bangladesh between 2004 and 2011. Methods The data of this study came from the Bangladesh Demographic and Health Survey. We employed rate ratio, concentration curve and concentration index to examine the trend in inequity of ANC and delivery care services. We also used logistic regression models to analyse the relationship between socioeconomic factors and maternal health care services. Results The concentration index for 4+ ANC visits dropped from 0.42 in 2004 to 0.31 in 2011 with a greater decline in urban area. There was almost no change in the concentration index for ANC services from medically trained providers during this period. We also found a decreasing trend in inequity in the utilization of both health facility delivery and skilled birth assistance but this trend was again more pronounced in urban area compared to rural area. The concentration index for C-section delivery decreased by about 33 % over 2004–2011 with a similar rate in both urban and rural areas. Women from the richest households were about 3 times more likely to have 4+ ANC visits, delivery at a health facility and skilled birth assistance compared to women from the poorest households. Women’s and their husbands’ education were significantly associated with greater use of maternal health care services. In addition, women’s exposure to mass media, their involvement in microcredit programs and autonomy in healthcare decision-making appeared as significant predictors of using some of these health care services. Conclusions Bangladesh faces not only a persistent pro-rich inequity but also a significant rural-urban equity gap in the uptake of maternal health care services. An equity perspective in policy interventions is much needed to ensure safe motherhood and childbirth in Bangladesh.
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Affiliation(s)
- Mohammad Habibullah Pulok
- Department of Economics, Southeast University, Dhaka, Bangladesh. .,Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney (UTS), Sydney, Australia.
| | - Md Nasim-Us Sabah
- Department of Finance, Rawls College of Business, Texas Tech University, Lubbock, USA
| | - Jalal Uddin
- Department of Sociology, University of Alabama at Birmingham, Birmingham, USA
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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4
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The social and political construction of health-care systems – historical observations from selected countries in Asia. Health Syst (Basingstoke) 2015. [DOI: 10.1057/hs.2014.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
ABSTRACT Nipah virus is a zoonotic paramyxovirus that has caused outbreaks of human disease with high fatality rates. Important differences in epidemiological features of human disease are associated with Nipah viruses isolated from Malaysia and Bangladesh, with person-to-person transmission a major pathway for infection in Bangladesh. Comparisons of Nipah virus isolates in vitro have demonstrated differences in regulation of innate immunity and replicative ability. In contrast, similarities in infection outcomes and tissue tropism in the ferret model indicate that differences between viral isolates may not be the pivotal determinants of Nipah virus transmission. Consideration and understanding of the social and cultural context within which Nipah virus outbreaks occur may be critical in the development of practical, achievable disease management strategies.
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Affiliation(s)
- Bronwyn A Clayton
- CSIRO Biosecurity Flagship, Australian Animal Health Laboratory, East Geelong, Australia
| | - Glenn A Marsh
- CSIRO Biosecurity Flagship, Australian Animal Health Laboratory, East Geelong, Australia
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Arora NK, Lal AA, Hombach JM, Santos JI, Bhutta ZA, Sow SO, Greenwood B. The need for targeted implementation research to improve coverage of basic vaccines and introduction of new vaccines. Vaccine 2014; 31 Suppl 2:B129-36. [PMID: 23598474 DOI: 10.1016/j.vaccine.2013.01.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/22/2013] [Accepted: 01/25/2013] [Indexed: 01/01/2023]
Abstract
The Decade of Vaccines Collaboration (DoVC) Research and Development (R&D) Working Group identified implementation research as an important step toward achieving high vaccine coverage and the uptake of desirable new vaccines. The R&D Working Group noted that implementation research is highly complex and requires participation of stakeholders from diverse backgrounds to ensure effective planning, execution, interpretation, and adoption of research outcomes. Unlike other scientific disciplines, implementation research is highly contextual and depends on social, cultural, geographic, and economic factors to make the findings useful for local, national, and regional applications. This paper presents the broad framework for implementation research in support of immunization and sets out a series of research questions developed through a Delphi process (during a DoVC-supported workshop in Sitges, Spain) and a literature review.
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Naghdi S, Ghiasvand H, Shaarbafchi Zadeh N, Azami S, Moradi T. Association of health and food expenditures inequality with health outcomes: a case study on Iranian rural households. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14335. [PMID: 24829771 PMCID: PMC4005433 DOI: 10.5812/ircmj.14335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 12/17/2013] [Accepted: 12/25/2013] [Indexed: 11/16/2022]
Abstract
Background: Inequality in households’ and individuals' consumption expenditures is one of the most important aspects of health status difference among households and individuals. Objectives: We investigated the impact of some macro-economic factors specially inequality factors on the Iranian rural health status since 1986 through 2012. Patients and Methods: We conducted a longitudinal ecological and analytical study. The average sample size was 14602 households whom Iranian Statistics Center selected by a multi-stages clustering sampling approach. All required data has been collected from Iranian Statistics Centre and Deputy for Curial Affaires of Iranian Ministry of Health. We calculated the Gini coefficients for the rural food and health expenditures, then conducted a transloge autoregressive order one (AR1) to investigate the association between the Iranian rural households' key mortality rates and the food and health expenditure Gini coefficients, time trend, GDP per capita (PPP), and GDP per capita Gini coefficients. Results: The mean of Gini coefficients were 0.137 and 0.21 for the rural food expenditures inequality based on current and constant price, respectively. In addition, the mean of Gini coefficients were 0.26 and 0.31 for the rural health expenditures inequality based on current and constant price, respectively. The time trend, transloged form of Gini coefficients for health expenditures and GDP per capita Gini coefficients presented a significant negative correlation with transloged form of neonatal mortality rate. With regard to the transloged form of under five mortality we observed a significant negative correlation with time trend and transloged form of Gini coefficients for health expenditure and GDP per capita. Finally, there was a significant negative correlation between transloged forms of maternal mortality rate. Conclusions: Iranian policy makers should consider the rural health and food expenditures inequality and try to adopt more effective policies and plans to decrease it. In addition, they should improve the macro-economic factors to improve the rural households' health status.
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Affiliation(s)
- Seyran Naghdi
- Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran
| | - Hesam Ghiasvand
- Hospital Management Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Nasrin Shaarbafchi Zadeh
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
| | - Saeidreza Azami
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Saeidreza Azami, Health Management and Economics Center, School of Health Management and Information Sciences, Yasemi St., Vali-Asr Ave, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125486014, E-mail:
| | - Tayebeh Moradi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
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Grundy J, Annear P, Chomat AM, Ahmed S, Biggs BA. Improving average health and persisting health inequities--towards a justice and fairness platform for health policy making in Asia. Health Policy Plan 2013; 29:873-82. [PMID: 24122092 DOI: 10.1093/heapol/czt068] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Following a period of rapid economic and social change across Asia in the 1980s and 1990s, there have been persisting reports of public sector health systems decline and worsening health inequities within countries. Many studies and analyses in the region have indicated that these inequities are socially determined, leading to questions regarding the adequacy of current health policy approaches towards addressing the challenge of persisting health inequities. METHODS Utilizing published data from Demographic Health Surveys (DHS) and case studies and reviews on health inequity in the Asian region, this article aims to describe the existing patterns of inequity of health access both within and between countries, focusing on immunization, maternal health access, nutritional outcomes and child mortality, with a view to recommending health policy options for addressing these health inequities. We compare the gap in access and outcomes between the highest and the lowest wealth quintiles, as well as cross-reference these findings with case studies and surveys on health inequities in the region. RESULTS In Asia, while in terms of aggregate health more of the poor are being reached, the reduction in the gap between social groups in some cases is stagnating, particularly for maternal health access and childhood stunting. Inequity gaps for immunization are persisting, and remain very wide in large population countries. For child mortality, more of the poor are surviving, although the rate of mortality decline is more rapid in higher than lower socio-economic groupings. CONCLUSIONS Both a strategic shift towards public health critique of social and political policy and operational shifts in health management and practice will be required to attain improvements in distributive health in Asia.
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Affiliation(s)
- John Grundy
- Cambodia Office, Nossal Institute for Global Health, University of Melbourne, 8c, 183, Tec Tlar, Phnom Penh, 12102, Cambodia, Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Victoria 3010, Australia, Institute of Parasitology and School of Environment, McGill University, Montreal, Quebec, Canada and Adjunct Faculty at the Department of Public Health and Community Medicine, Tufts Medical Center, Boston, MA H3A 2T5, USA and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Peter Annear
- Cambodia Office, Nossal Institute for Global Health, University of Melbourne, 8c, 183, Tec Tlar, Phnom Penh, 12102, Cambodia, Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Victoria 3010, Australia, Institute of Parasitology and School of Environment, McGill University, Montreal, Quebec, Canada and Adjunct Faculty at the Department of Public Health and Community Medicine, Tufts Medical Center, Boston, MA H3A 2T5, USA and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Anne Marie Chomat
- Cambodia Office, Nossal Institute for Global Health, University of Melbourne, 8c, 183, Tec Tlar, Phnom Penh, 12102, Cambodia, Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Victoria 3010, Australia, Institute of Parasitology and School of Environment, McGill University, Montreal, Quebec, Canada and Adjunct Faculty at the Department of Public Health and Community Medicine, Tufts Medical Center, Boston, MA H3A 2T5, USA and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Shakil Ahmed
- Cambodia Office, Nossal Institute for Global Health, University of Melbourne, 8c, 183, Tec Tlar, Phnom Penh, 12102, Cambodia, Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Victoria 3010, Australia, Institute of Parasitology and School of Environment, McGill University, Montreal, Quebec, Canada and Adjunct Faculty at the Department of Public Health and Community Medicine, Tufts Medical Center, Boston, MA H3A 2T5, USA and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
| | - Beverley-Ann Biggs
- Cambodia Office, Nossal Institute for Global Health, University of Melbourne, 8c, 183, Tec Tlar, Phnom Penh, 12102, Cambodia, Nossal Institute for Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Victoria 3010, Australia, Institute of Parasitology and School of Environment, McGill University, Montreal, Quebec, Canada and Adjunct Faculty at the Department of Public Health and Community Medicine, Tufts Medical Center, Boston, MA H3A 2T5, USA and Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria 3050, Australia
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Khan MMH, Zanuzdana A, Kraemer A. Levels, trends and disparities in public-health-related indicators among reproductive-age women in Bangladesh by urban-rural and richest-poorest groups, 1993-2011. PLoS One 2013; 8:e75261. [PMID: 24086485 PMCID: PMC3783385 DOI: 10.1371/journal.pone.0075261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/13/2013] [Indexed: 11/18/2022] Open
Abstract
Background And Objectives Although Bangladesh has already achieved noticeable progress in the field of development and health, disparities in public health indicators for several markers are still reported. To assess public health development in Bangladesh during the last two decades, firstly, we analysed levels, trends and disparities in public-health-related indicators by rural versus urban as well as by the richest versus poorest group of women who have ever been married. Secondly, using the most recent data set we performed multiple analyses to check whether urban-rural and richest-poorest disparities were still significant. Methods The analysis was based on six nationally representative data sets from the Bangladesh Demographic and Health Surveys (BDHS) conducted in 1993-94 (n=9,640), 1996-1997 (n=9,127), 1999-2000 (n=10,544), 2004 (n=11,440), 2007 (n=10,996) and 2011 (n=17,749). The outcome variables were six selected public-health-related indicators. We performed various types of analyses, including multiple logistic regressions. Results The trend of all indicators except being overweight (1993-2011) displayed gradual improvements for both markers. However, the urban and richest groups revealed a better situation than their counterparts in both simple and multiple analyses. Disparities between richest-poorest groups were more pronounced than urban-rural disparities. For instance, the prevalence of delivery at any healthcare facility in 2011 was 20.4% in rural areas and 46.5% in urban areas, whereas it was 9.1% in the poorest group and 57.6% in the richest group. Conclusion The public health sector in Bangladesh has achieved some successes over the last two decades. However, urban-rural and richest-poorest disparities are still considerable and therefore more public health strategies and efforts are clearly needed for the rural and poorest groups of women in order to reduce these gaps further.
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Affiliation(s)
- Md. Mobarak Hossain Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
- * E-mail:
| | - Arina Zanuzdana
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Alexander Kraemer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany
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Dingle A, Powell-Jackson T, Goodman C. A decade of improvements in equity of access to reproductive and maternal health services in Cambodia, 2000-2010. Int J Equity Health 2013; 12:51. [PMID: 23837577 PMCID: PMC3723953 DOI: 10.1186/1475-9276-12-51] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Despite encouraging reductions in global maternal mortality rates, Millennium Development Goal (MDG) 5 on reducing maternal mortality and achieving universal access to reproductive health remains the most off-track of all MDGs. Furthermore a preoccupation with aggregate coverage statistics masks extensive disparities in health improvements between societal groups. Recent national health indicators for Cambodia highlight impressive improvements, for example, in maternal, infant and child mortality, whilst substantial government commitments have been made since 2000 to address health inequities. It is therefore timely to explore the extent of equity in access to key reproductive and maternal health services in Cambodia and how this has changed over time. METHODS Analysis was conducted on three rounds of Demographic and Health Survey data from 2000, 2005 and 2010. Outcome variables comprised utilisation of six reproductive and maternal health services--antenatal care, skilled birth attendance, facility-based delivery, postnatal care, met need for family planning and abortion by skilled provider. Four equity measures were calculated--equity gaps, equity ratios, concentration curves and concentration indices. Household assets were used to create the social-stratification variable, using principal components analysis. RESULTS Coverage levels of all six services improved over the decade. Coverage improvements were greatest amongst wealthier quintiles of the population, although poorer quintiles also increased use of services. Critically, inequity in service use of all services dramatically reduced over time, except for postnatal care where inequity increased slightly. However, in 2010 inequity in service use remained favouring wealthier quintiles, greatest in use of skilled birth attendance and facility-based delivery, though the magnitude of inequity was substantially reduced compared to 2000. Met need for family planning was almost perfectly equitable in 2010. CONCLUSIONS Cambodia has made impressive improvements in overall coverage of reproductive and maternal health services over the last decade, and also in the distribution of their use across wealth quintiles. A range of pro-poor health financing and supply-side policies as well as non-health factors may have contributed to these achievements. Further research will explore specific schemes qualitatively and quantitatively to assess their impact on equity and service use.
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Affiliation(s)
- Antonia Dingle
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Katulanda P, Ranasinghe P, Jayawardena R, Constantine GR, Sheriff MHR, Matthews DR. The prevalence, patterns and predictors of diabetic peripheral neuropathy in a developing country. Diabetol Metab Syndr 2012; 4:21. [PMID: 22642973 PMCID: PMC3408375 DOI: 10.1186/1758-5996-4-21] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 05/29/2012] [Indexed: 11/16/2022] Open
Abstract
Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. Presently there are studies on the community prevalence of distal peripheral neuropathy (DPN) in Sri Lanka. We describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with 'presence of DPN' as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0 ± 12.4 years and 37.3% were males, while 18% were from urban areas. Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1 ± 10.8 and 55.1 ± 10.8 years respectively (p < 0.001). The majority of those with DPN were from rural-areas (75.3%) and earned a monthly income < Sri Lankan Rupees 12,000 (87.6%). In the binary logistic-regression presence of foot ulcers (OR:10.4; 95%CI 1.8-16.7), female gender (OR:6.7; 95%CI 2.0-9.8) and smoking (OR:5.9; 95%CI 1.4-9.7) were the strongest predictors followed by insulin treatment (OR:4.3; 95%CI 1.3-6.9), diabetic retinopathy (OR:2.7; 95%CI 1.3-5.4), treatment with sulphonylureas (OR:1.8; 95%CI 1.1-3.2), increasing height (OR:1.8; 95%CI 1.2-2.4), rural residence (OR:1.8; 95%CI 1.1-2.5), higher levels of triglycerides (OR:1.6; 95%CI 1.2-2.0) and longer duration of DM (OR:1.2; 95%CI 1.1-1.3). There is a high prevalence of DPN among Sri Lankan adults with diabetes. The study defines the impact of previously known risk factors for development of DPN and identifies several new potential risk factors in an ethnically different large subpopulation with DM.
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Affiliation(s)
- Prasad Katulanda
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Ranil Jayawardena
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Godwin R Constantine
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - M H Rezvi Sheriff
- Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - David R Matthews
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
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Lhamsuren K, Choijiljav T, Budbazar E, Vanchinkhuu S, Blanc DC, Grundy J. Taking action on the social determinants of health: improving health access for the urban poor in Mongolia. Int J Equity Health 2012; 11:15. [PMID: 22429615 PMCID: PMC3349495 DOI: 10.1186/1475-9276-11-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/20/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. METHODS Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. FINDINGS The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. CONCLUSIONS Lessons from Mongolia mirror other international studies which point to the need to measure and take action on the social determinants of health at the local area level in order to adequately reduce persistent inequities in health care access for the urban poor.
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Affiliation(s)
- Khandsuren Lhamsuren
- Chief Pediatrician, Bayanzurkh District Health Department, Ulaanbaatar City, Mongolia
| | | | - Enkhtuya Budbazar
- Officer EPI team, National Centre for Communicable Diseases, Ministry of Health, Ulaanbaatar City, Mongolia
| | | | - Diana Chang Blanc
- Regional Immunization Specialist, UNICEF East Asia Pacific Regional Office, Bangkok, Thailand
| | - John Grundy
- Public Health Consultant, Nossal Institute for Global Health, The University of Melbourne, Cambodia Office, Phnom Penh, Cambodia
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Khan MMH, Grübner O, Krämer A. Frequently used healthcare services in urban slums of Dhaka and adjacent rural areas and their determinants. J Public Health (Oxf) 2012; 34:261-71. [PMID: 22241915 DOI: 10.1093/pubmed/fdr108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To compare patterns of healthcare service user preference between urban slums in Dhaka and adjacent rural areas and to identify key determinants of those preferences. METHODS The data were collected through baseline surveys conducted in 2008 and 2009. A total of 3207 subjects aged 10-90 years were systematically selected from 12 big slums in Dhaka and 3 rural villages outside Dhaka. RESULTS Two frequently used healthcare sources utilized in 1 month preceding the baseline survey were pharmacies (slum, 42.6%; rural, 30.1%) and government hospitals/clinics (GVHC; slum, 13.5%; rural, 8.9%). According to the multilevel logistic regression analysis adjusted for age, sex and marital status, the likelihood of using pharmacies and GVHC were higher for those subjects who used non-hygienic toilets, who reported food deficiency at a family level, who expressed dissatisfaction about family income and who stated poor health status. Some more factors namely overweight, living in permanently structured house, smoking bidis and less frequency of watching TV were associated with higher likelihood of using GVHC. CONCLUSIONS Pharmacy was the most dominant healthcare service in both areas. As persons running pharmacies often provide poor quality of healthcare services, they need continuous training and back-up supports to improve their quality of services and to strengthen the overall healthcare system in Bangladesh.
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Affiliation(s)
- M M H Khan
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany.
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Mørkrid K, Ali L, Hussain A. Risk factors and prevalence of diabetic peripheral neuropathy: A study of type 2 diabetic outpatients in Bangladesh. Int J Diabetes Dev Ctries 2011; 30:11-7. [PMID: 20431800 PMCID: PMC2859278 DOI: 10.4103/0973-3930.60004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 12/23/2009] [Indexed: 12/30/2022] Open
Abstract
Aims/Hypothesis: The purpose of the study is to estimate the prevalence and risk factors for diabetic peripheral neuropathy (DPN) in type 2 diabetic outpatients at the BIRDEM hospital, Bangladesh. Materials and Methods: Type 2 diabetic outpatients, diagnosed 5-11 years prior to the investigation were randomly selected for the study. DPN was assessed using the Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS). Data about demographics, blood pressure, height, weight, waist and hip circumference, and random blood and urine samples were collected. Results: Two hundred and ninety four (139 men, 155 women) type 2 diabetic outpatients were studied. The overall DPN prevalence was 19.7 %; male (20.9%), female (18.7 %). The prevalence increased with age (from 11.1% in the 23-40 year-old group to 32.3% in the 60-80 year-old group) and duration of diabetes (from 14.1% in patients with five years to 29.2% in patients with 9-11 years duration). Age > 60 years (OR 4.2, 95% CI 1.4-12.3), low/normal WHR (OR 3.8, 95% CI 1.6-9.3), income < 800 TK (OR 3.1, 95% CI 1.1-9.3) and insulin treatment (OR 2.0, 95% CI 1.0-4.0) were independent, significant risk factors. Longer duration of diabetes (OR1.2 95% CI 1.0-1.4), and higher HbA1c (OR1.1, 95% CI 1.0-1.3) were marginally independent, significant risk factors for DPN. Conclusions/Interpretations: We observed a DPN prevalence of 19.7%. Higher age, low socioeconomic status, treatment with insulin, longer duration of diabetes and poor glycemic control were risk factors for DPN.
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Affiliation(s)
- Kjersti Mørkrid
- Institute of General Practice and Community Medicine, Department of International Health, University of Oslo. Postbox 1130 Blindern, 0318 Oslo, Norway
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Khan MMH, Krämer A, Khandoker A, Prüfer-Krämer L, Islam A. Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist? Bull World Health Organ 2011; 89:583-93. [PMID: 21836757 DOI: 10.2471/blt.11.087429] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/06/2011] [Accepted: 05/11/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess levels, trends and gaps between the poorest and the richest in selected health and human development indicators in Bangladesh. METHODS Data for selected indicators associated with sociodemographic characteristics among ever-married women, contraception use, child vaccination, antenatal care practices and health conditions were extracted from the Bangladesh Demographic and Health Surveys conducted in 1993-94, 1996-1997, 1999-2000, 2004 and 2007. Results for the whole sample and for the poorest and the richest wealth quintiles are presented. FINDINGS Positive trends were noted in urbanization, availability of electricity, age at first marriage, use of modern contraception, access to skilled antenatal care, child vaccination, knowledge of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome and overweight and obesity. In contrast, negative trends were seen in factors such as literacy, infant and child mortality, fertility rate, home delivery and malnutrition and underweight. However, changes in these indicators differed between the poorest and richest quintiles. For instance, only the richest quintile experienced rapid urbanization, whereas illiteracy declined more among the poorest. Noteworthy gaps were found in almost all factors. Rich-poor gaps in urbanization, age at marriage, fertility, condom use, home delivery and overweight increased; in contrast, gaps in education, water and sanitation, use of contraception (except condoms) and child vaccination declined. CONCLUSION Persistent inequities in Bangladesh endanger equitable and sustainable human development in the country. Pro-poor development strategies based on the principles of equity and quality should be implemented to narrow existing gaps and further promote holistic and equitable human development.
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Affiliation(s)
- Md Mobarak Hossain Khan
- School of Public Health, University of Bielefeld, PO Box 100131, D-33501, Bielefeld, Germany.
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Baqui AH, Rosecrans AM, Williams EK, Agrawal PK, Ahmed S, Darmstadt GL, Kumar V, Kiran U, Panwar D, Ahuja RC, Srivastava VK, Black RE, Santosham M. NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity. Health Policy Plan 2008; 23:234-43. [DOI: 10.1093/heapol/czn012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Costa LS, Almeida RMVR, Pinheiro RS. Access by elderly patients with hip fractures to public hospitals in the city of Rio de Janeiro, Brazil. Public Health 2007; 121:525-8. [PMID: 17336351 DOI: 10.1016/j.puhe.2007.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/17/2006] [Accepted: 01/04/2007] [Indexed: 11/17/2022]
Affiliation(s)
- L S Costa
- Biomedical Engineering Programme, COPPE, Federal University in Rio de Janeiro, Caixa Postal 68510 Cidade Universitária, Rio de Janeiro, RJ 21941-972, Brazil
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