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Kabir A, Karim MN, Karim J, Billah B. Challenges and Strategies in Conducting Population Health Research during the COVID-19 Pandemic: Experience from a Nationwide Mixed-Methods Study in Bangladesh. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095629. [PMID: 37174149 PMCID: PMC10178606 DOI: 10.3390/ijerph20095629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 05/15/2023]
Abstract
Introduction: Globally, the coronavirus (COVID-19) pandemic poses fundamental challenges in everyday life. Various controlling measures, including nationwide lockdowns, movement restrictions, travel bans, social distancing, and improved hygiene practices, have been widely introduced to curtail transmission of the disease. Notably, these measures have affected the execution of population health research that typically involves face-to-face data collection. This paper details a subjective reflective account of the challenges and mitigating strategies in conducting a nationwide study during the COVID-19 pandemic in 2021. Challenges and strategies: The research team faced a wide range of challenges in conducting this study. The major categories of challenges were defined as follows: (i) challenges relating to the COVID-19 pandemic, such as insufficient access to field sites; (ii) challenges related to contextual factors, such as cultural and gender sensitivity and extreme weather events; and (iii) challenges related to data quality and validity. The key mitigating strategies to overcoming these challenges included engaging a local-level field supervisor, hiring data collectors from respective study sites, incorporating team members' reviews of literature and experts' views to develop research instruments, modifying original research instruments, organizing regular meetings and debriefing, adjusting field operation plans, building gender-sensitive teams, understanding local norms and adopting culturally appropriate dress codes, and conducting interviews in local languages. Conclusions: This paper concludes that despite several COVID-19-related challenges coupled with contextual factors, data were successfully collected through timely and successful adaptations of several mitigating strategies. The strategies adopted in this study may be useful for overcoming unforeseeable challenges in planning and conducting future population-based health research in similar circumstances elsewhere.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Jahirul Karim
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka 1212, Bangladesh
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Kabir A, Karim MN, Billah B. The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases. BMC PRIMARY CARE 2023; 24:60. [PMID: 36864391 PMCID: PMC9979470 DOI: 10.1186/s12875-023-02016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). METHODS A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. RESULTS The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. CONCLUSION All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kabir A, Roy S, Begum K, Kabir AH, Miah MS. Factors influencing sanitation and hygiene practices among students in a public university in Bangladesh. PLoS One 2021; 16:e0257663. [PMID: 34551017 PMCID: PMC8457467 DOI: 10.1371/journal.pone.0257663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 09/07/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction Improved hygiene and sanitation practices in educational settings are effective for the prevention of infections, controlling the transmission of pathogens, and promoting good health. Bangladesh has made remarkable advances in improving higher education in recent decades. Over a hundred universities were established to expand higher education facilities across the country. Hundreds of thousands of graduate students spend time in university settings during their studies. However, little is known about the sanitation and hygiene practice of the university-going population. This study aims to understand and uncover which factors influence students’ sanitation and hygiene behavior in university settings. Methods This study was conducted in a public university named Shahjalal University of Science and Technology located in a divisional city of Bangladesh. Based on the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH), we adopted an exploratory qualitative study design. We developed semi-structured interview guides entailing sanitation and hygiene behavior, access, and practice-related questions and tested their efficacy and clarity before use. We conducted seventeen in-depth interviews (IDIs), and four focus group discussions (FGDs, [6–8 participants per FGD]) with students, and seven key informant interviews (KIIs) with university staff. Thematic analysis was used to analyze the data. Triangulation of methods and participants was performed to achieve data validity. Results Despite having reasonable awareness and knowledge, the sanitation and hygiene practices of the students were remarkably low. A broad array of interconnected factors influenced sanitation and hygiene behavior, as well as each other. Individual factors (gender, awareness, perception, and sense of health benefits), contextual factors (lack of cleanliness and maintenance, and the supply of sanitary products), socio-behavioural factors (norms, peer influence), and factors related to university infrastructure (shortage of female toilets, lack of monitoring and supervision of cleaning activities) emerged as the underpinning factors that determined the sanitation and hygiene behavior of the university going-population. Conclusion The results of this study suggest that despite the rapid expansion of on-campus university education, hygiene practices in public universities are remarkably poor due to a variety of dynamic and interconnected factors situated in different (individual, contextual, socio-phycological) levels. Therefore, multi-level interventions including regular supply of WASH-related materials and agents, promoting low-cost WASH interventions, improving quality cleaning services, close monitoring of cleaning activities, promoting good hygiene behavior at the individual level, and introducing gender-sensitive WASH infrastructure and construction may be beneficial to advance improved sanitation and hygiene practices among university students.
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Affiliation(s)
- Ashraful Kabir
- Children Without Worms, The Task Force for Global Health, Dhaka, Bangladesh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
| | - Shuvo Roy
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Korima Begum
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Ariful Haq Kabir
- Institute of Education and Research, Dhaka University, Dhaka, Bangladesh
| | - Md Shahgahan Miah
- Department of Anthropology, Shahjalal University of Science and Technology, Sylhet, Bangladesh
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Dwivedi R, Pradhan J. Does affordability matter? Examining the trends and patterns in health care expenditure in India. Health Serv Manage Res 2020; 33:207-218. [PMID: 32447992 DOI: 10.1177/0951484820923921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Absence of better financing mechanism results in higher out of pocket expenditure and catastrophe, which leads to impoverishment and poverty especially among low- and middle-income countries like India. This paper examines the major characteristics associated with the higher out of pocket expenditure and provides an insight from Andersen's behavioural model that how predisposing, enabling and need factors influence the level and pattern of out of pocket expenditure in India. METHODS Data has been extracted from three rounds of nationally representative consumer expenditure surveys, i.e. 1993-1994, 2004-2005 and 2011-2012 conducted by the Government of India. States were categorized based on regional classification, and adult equivalent scale was used to adjust the household size. Multiple Generalized-Linear-Regression-Model was employed to explore the relative effect of various socio-economic covariates on the level of out of pocket expenditure. RESULTS The gap has widened between advantaged and disadvantaged segment of the population along with noticeable regional disparities among Indian states. Generalized-Linear-Regression-Model indicates that the most influential predisposing and enabling factor determining the level of out of pocket expenditure were age composition, religion, social-group, household type, residence, economic status, sources of cooking and lighting arrangements among the households. CONCLUSIONS Present study suggests the need for strengthening the affordability mechanism of the households to cope with the excessive burden of health care payments. Furthermore, special consideration is required to accommodate the needs of the elderly, rural, backward states and impoverishment segment of population to reduce the unjust burden of out of pocket expenditure in India.
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Affiliation(s)
- Rinshu Dwivedi
- Department of Humanities and Social Sciences, Indian Institute of Information Technology, Tiruchirappalli, Tamil Nadu, India
| | - Jalandhar Pradhan
- Department of Humanities and Social Sciences, National Institute of Technology Rourkela, Rourkela, India
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Choudhury N, Raihan MJ, Ahmed SMT, Islam KE, Self V, Rahman S, Schofield L, Hall A, Ahmed T. The evaluation of Suchana, a large-scale development program to prevent chronic undernutrition in north-eastern Bangladesh. BMC Public Health 2020; 20:744. [PMID: 32443977 PMCID: PMC7245033 DOI: 10.1186/s12889-020-08769-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 04/23/2020] [Indexed: 11/27/2022] Open
Abstract
Evidence of the impact of community-based nutrition programs is uncommon for two main reasons: the lack of untreated controls, and implementation does not account for the evaluation design. Suchana is a large-scale program to prevent malnutrition in children in Sylhet division, Bangladesh by improving the livelihoods and nutrition knowledge of poor and very poor households. Suchana is being implemented in 157 unions, the smallest administrative unit of government, in two districts of Sylhet. Suchana will deliver a package of interventions to poor people in about 40 randomly selected new unions annually over 4 years, until all are covered. All beneficiaries will receive the normal government nutrition services. For evaluation purposes the last 40 unions will act as a control for the first 40 intervention unions. The remaining unions will receive the program but will not take part in the evaluation. A baseline survey was conducted in both intervention and control unions; it will be repeated after 3 years to estimate the impact on the prevalence of stunted children and other indicators. This stepped wedge design has several advantages for both the implementation and evaluation of services, as well as some disadvantages. The units of delivery are randomized, which controls for other influences on outcomes; the program supports government service delivery systems, so it is replicable and scalable; and the program can be improved over time as lessons are learned. The main disadvantages are the difficulty of estimating the impact of each component of the program, and the geographical distribution of unions, which increases program delivery costs. Stepped implementation allows a cluster randomized trial to be achieved within a large-scale poverty alleviation program and phased-in and scaled-up over a period of time. This paper may encourage evaluators to consider how to estimate attributable impact by using stepped implementation, which allows the counterfactual group eventually to be treated.
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Affiliation(s)
- Nuzhat Choudhury
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
- Department of Anthropology, Durham University, Durham, UK.
| | - Mohammad Jyoti Raihan
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - S M Tanvir Ahmed
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Kazi Eliza Islam
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Vanessa Self
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Shahed Rahman
- Save the Children Bangladesh, House CWN (A) 35, Road 43, Gulshan, Dhaka, Bangladesh
| | - Lilly Schofield
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Andrew Hall
- Save the Children U.K., 1 St John's Lane, London, EC1M 4AR, UK
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddrb, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Kabir A, Datta R, Raza SH, Maitrot MRL. Health shocks, care-seeking behaviour and coping strategies of extreme poor households in Bangladesh's Chittagong Hill tracts. BMC Public Health 2019; 19:1008. [PMID: 31357962 PMCID: PMC6664711 DOI: 10.1186/s12889-019-7335-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 07/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background How and whether health shocks, care-seeking behaviour and coping strategies are interlinked and influence households resilience to ill-health remains an under-researched subject in the context of Bangladesh. This study investigates whether and how health shocks, care-seeking processes and coping strategies interplay and impact the resilience of extremely poor adivasi (ethnic minority) households in the Chittagong Hill Tracts (CHT), Bangladesh. Methods Our analysis draws from qualitative data collected through a range of methods (see Additional file 1). We conducted 25 in-depth interviews (IDIs) of two adivasi communities targeted by an extreme-poverty alleviation programme, 11 key informant interviews (KIIs) with project personnel (community workers, field officers, project managers), community leaders, and healthcare providers, and 9 focus group discussions (FGDs) with community members. Data triangulation was performed to further validate the data, and a thematic analysis approach was used to analyze the data. Results Health shocks were a defining characteristic of households’ experiences of extreme poverty in the studied region. Care-seeking behaviours are influenced by an array of cultural and economic factors. Households adopt a range of coping strategies during the treatment or care-seeking process, which are often insufficient to allow households to maintain a stable economic status. This is largely due to the fact that healthcare costs are borne by the household, primarily through out-of-pocket payments. Households meet healthcare cost by selling their means of livelihoods, borrowing cash, and marketing livestock. This process erodes their wellbeing and hinders they attempt at achieving resilience, despite their involvement in an extreme poverty-alleviation programme. Conclusions Livelihood supports or asset-transfers alone are insufficient to improve household resilience in this context. Therefore, we argue that extreme poor households’ healthcare needs should be central to the design of poverty-alleviating intervention for them to contribute to foster resilience. Electronic supplementary material The online version of this article (10.1186/s12889-019-7335-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Rupa Datta
- United Nations High Commissioner for Refugees, Dhaka, Bangladesh
| | | | - Mathilde Rose Louise Maitrot
- Lecturer in International Development and Global Social Policy, Department of Social Policy and Social Work, The University of York, York, UK
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