Health in Bangladesh

Health levels remain relatively low in Bangladesh, although they have improved recently as poverty (31% at 2010[1]) levels have decreased.

Health infrastructure

To ensure equitable healthcare to every residing human in Bangladesh, an extensive network of health services has been established following the administrative web of Bangladesh. It is a circuitous form of healthcare network spread across the country ranging from policy-making bodies to healthcare facilities down to the community level.Infrastructure of healthcare facilities can be divided into three levels: Medical University, Medical College Hospitals, Specialized Hospitals exist at Tertiary Level. District Hospitals, Mother and Child Welfare Centers considered as Secondary Level. Upazilla (Sub District) Health Complex, Union Health & Family Welfare Centers, Community Clinics (Lowest-level healthcare facilities) are the Primary Level healthcare providers .Various NGOs(Non-Government Organization) and private institutions also contribute to this intricate network .[2][3]

The total expenditure on healthcare as a percentage of Bangladesh's GDP was 3.35% in 2009.[4]

In the parliamentary budget of 2017-18, only the budget has been set for the health sector is 16 thousand 203 crore 36 lakhs bangladeshi taka.[5]

The number of hospital beds per 10,000 population is 3.[6] The General government expenditure on healthcare as a percentage of total government expenditure was 7.9% as of 2009 and the citizens pay most of their health care bills as the out-of-pocket expenditure as a percentage of private expenditure on health is 96.5%.[4] Doctor to population ratio – 1:2,000[7] Nurse to population ratio – 1:5,000[7]

Hospitals

Health status

Demographics

  • Population – 157.9 million[8]
  • Rural population – 77%
  • Population density – (population/km2) 1,070/km2
  • People below poverty line – 60%
  • Population doubling rate – 25–30 years
  • GDP (current US$)(billions) – 221.42[9]

Health indicators

[10]

  • CDR – 5.35 /1000
  • Maternal mortality ratio – 176 /100000
  • IMR – 31 /1000 live births
  • Under 5 MR – 38 /1000 live births
  • Total Fertility Rate – 2.1
  • Life expectancy at birth – 71 (m) and 73 (f)
  • Fully immunized children – 52%

Health problems in Bangladesh

Due to huge number of population, Bangladesh faces double burden of diseases: Non-Communicable diseases: Diabetes, Cardiovascular diseases, Hypertension, Stroke, Chronic respiratory diseases, Cancer and Communicable diseases: Tuberculosis, HIV, Tetanus, Malaria, Measles, Rubella, leprosy and so on.[11]

The health problems of Bangladesh include communicable and non-communicable disease, malnutrition, environmental sanitation problems, and others.

Communicable disease

From historical aspect, it is known that Communicable diseases formed major bulk of total diseases in developing and tropical countries such as Bangladesh. By 2015 via Millennium development Goals, where communicable diseases were targeted, Bangladesh attained almost significant control on communicable diseases.[11] An expanded immunization programme against nine major diseases (TB, Tetanus, Diphtheria, Whooping cough, Polio, Hepatitis B, Haemophilus influenza type B, Measles, Rubella) was undertaken for implementation.

Non-Communicable disease

However, recent statistics shows that non-communicable disease burden has increased to 61% of the total disease burden due to epidemiological transition. According to National NCD Risk Factor Survey in 2010, 99% of the survey population revealed at least one NCD risk factor and ~29% showed >3 risk factors .Social transition, rapid urbanization and unhealthy dietary habit are the major stimulating reasons behind high prevalence of non-communicable diseases in Bangladesh remarkably in under-privileged communities such as rural inhabitants, urban slum dwellers.[11][12][11][13]

Diabetes

Diabetes, one of four priority non-communicable diseases targeted by world leaders has become a major health problem globally (415 million adults with diabetes in 2015 and by 2040 that number will increase to 642 million). More than two third of diabetic adults (75%) are from low and middle income countries due to demographic changes, cultural transition and population ageing. Among dominant identified risk factor of burden of diseases in South Asian countries, diabetes is placed in seventh position. Bangladesh is placed in top tenth position (7.1 million) among countries with highest number of diabetes adults in the world. Therefore, co-jointly with India and Sri Lanka, Bangladesh constitutes 99.0% of the adult with high blood sugar in the South Asian region. Previous studies show that prevalence of diabetes is increasing significantly in the rural population of Bangladesh. It is also observed that females have higher prevalence of diabetes than male both in rural and urban areas. Lacks of self-care, unhealthy dietary habit, and poor employment rate are the considerable factors behind that higher prevalence of diabetes among females. However, compared to Western nations, the pattern of diabetes begins with the onset at a younger age, and the major diabetic population is non-obese. Such clinical differences, limited access to health care, increase life expectancy, ongoing urbanization and poor awareness among population increase the prevalence and risk of diabetes in Bangladesh [14][15][16] [17][18][19][20][21][22][23]

The prevalence of Diabetic retinopathy in Bangladesh is about one third of the total diabetic population (nearly 1.85 million) .These recent estimates are higher like western Countries and similar to Asian Malays living in Singapore. Sharp economic transition, urbanization, technology based modern life style, tight diabetes control guidelines and unwillingness to receive health care are thought to be the risk factors of diabetic retinopathy in Bangladesh.Unfortunately to attain that emerging health problem, the current capacity in the country to diagnose and treat diabetic retinopathy is very limited to a few centers. Till this year (2016), as per record of National Eye Care under HPNSDP (Health Population Nutrition Sector Development Program), 10,000 people with Diabetic Retinopathy have received services from Secondary and tertiary Hospitals where the screening programs have been established.[24][25][26]

Environmental sanitation

The most difficult problem to tackle in this country is perhaps the environmental sanitation problem which is multi-faceted and multi-factorial. The twin problems of environmental sanitation are lack of safe drinking water in many areas of the country and preventive methods of excreta disposal.

  • Indiscriminate defecation resulting in filth and water born disease like diarrhea, dysentery, enteric fever, hepatitis, hook worm infestations.
  • Poor rural housing with no arrangement for proper ventilation, lighting etc.
  • Poor sanitation of public eating and market places.
  • Inadequate drainage, disposal of refuse and animal waste.
  • Absence of adequate MCH care services.
  • Absence and/ or adequate health education to the rural areas.
  • Absence and/or inadequate communications and transport facilities for workers of the public health.

Malnutrition

Bangladesh suffers from some of the most severe malnutrition problems. The present per capita intake is only 1850 kilo calorie which is by any standard, much below required need. Malnutrition results from the convergence of poverty, inequitable food distribution, disease, illiteracy, rapid population growth and environmental risks, compounded by cultural and social inequities. Severe undernutrition exists mainly among families of landless agricultural labourers and farmers with small holding.

Specific nutritional problems in the country are—

  1. Protein–energy malnutrition (PEM): The chief cause of it is insufficient food intake.
  2. Nutritional anaemia: The most frequent cause is iron deficiency and less frequently follate and vitamin B12 deficiency.
  3. Xerophthalmia: The chief cause is nutritional

deficiency of Vit-A.

  1. Iodine Deficiency Disorders: Goiter and other iodine deficiency disorders.
  2. Others: Lethyrism, endemic fluorosis etc.

Child malnutrition in Bangladesh is amongst the highest in the world. Two-thirds of the children under the age of five are under-nourished and about 60% of children under age six,are stunted.[27] As of 1985, more than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric intake level.[28] Malnutrition is passed on through generations as malnourished mothers give birth to malnourished children. About one-third of babies in Bangladesh are born with low birth weight, increasing infant mortality rate, and an increased risk of diabetes and heart aliments in adulthood.[29] One neonate dies in Bangladesh every three to four minutes; 120 000 neonates die every year.[30]

The World Bank estimates that Bangladesh is ranked 1st in the world of the number of children suffering from malnutrition.[31][30] In Bangladesh, 26% of the population are undernourished[32] and 46% of the children suffers from moderate to severe underweight problem.[33] 43% of children under 5 years old are stunted. One in five preschool age children are vitamin A deficient and one in two are anaemic.[34] Women also suffer most from malnutrition. To provide their family with food they pass on quality food which are essential for their nutrition.[35]

Causes of malnutrition

Most terrain of Bangladesh is low-lying and is prone to flooding. A large population of the country lives in areas that are at risk of experiencing extreme annual flooding that brings large destruction to the crops.[36] Every year, 20% to 30% of Bangladesh is flooded.[37] Floods threaten food security and their effects on agricultural production cause food shortage.[38]

The health and sanitation environment also affects malnutrition. Inadequacies in water supply, hygiene and sanitation have direct impacts on infectious diseases, such as malaria, parasitic diseases, and schistosomiasis. People are exposed to both water scarcity and poor water quality. Groundwater is often found to contain high arsenic concentration.[39] Sanitation coverage in rural areas was only 35% in 1995.[40]

Almost one in three people in Bangladesh defecates in the open among the poorest families. Only 32% of the latrines in rural areas attain the international standards for a sanitary latrine. People are exposed to feces in their environment daily.[41] The immune system falls and the disease processes exacerbate loss of nutrients, which worsens malnutrition.[42] The diseases also contribute through the loss of appetite, lowered absorption of vitamins and nutrients, and loss of nutrients through diarrhoea or vomiting.[43]

Unemployment and job problems also lead to malnutrition in Bangladesh. In 2010, the unemployment rate was 5.1%.[44] People do not have working facilities all year round and they are unable to afford the minimum cost of a nutritious diet due to the unsteady income.[45]

Effects of malnutrition in Bangladesh

Health effects

Undernourished mothers often give birth to infants who will have difficulty with development,pertaining to health problems such as wasting, stunting, underweight, anaemia, night blindness and iodine deficiency.[31] As a result, Bangladesh has a high child mortality rate and is ranked 57 in the under-5 mortality rank.[46]

Economic effects

As 40% of the population in Bangladesh are children,[47] malnutrition and its health effects among children can potentially lead to a lower educational attainment rate. Only 50% of an age group of children in Bangladesh managed to enroll into secondary school education.[46] This would result in a low-skilled and low productivity workforce which would affect the economic growth rate of Bangladesh with only 3% GDP growth in 2009.[46]

Efforts to combat malnutrition

Many programmes and efforts have been implemented to solve the problem of malnutrition in Bangladesh. UNICEF together with the government of Bangladesh and many other NGOs such as Helen Keller International, focus on improving the nutritional access of the population throughout their life-cycle from infants to the child-bearing mother.[31] The impacts of the intervention are significant. Night blindness has reduced from 3.76% to 0.04% and iodine deficiency among school-aged children has decreased from 42.5% to 33.8%.[31]

Maternal and child health

One in eight women receive delivery care from medically trained providers and fewer than half of all pregnant women in Bangladesh seek ante-natal care. Inequity in maternity care is significantly reduced by ensuring the accessibility of heath services.[48] The 2010 maternal mortality rate per 100,000 births for Bangladesh is 340.[49] This is compared with 338.3 in 2008 and 724.4 in 1990. . In Bangladesh the number of midwives per 1,000 live births is 8 and the lifetime risk of death for pregnant women 1 in 110.[49]

See also

References

  1. ↑ Shah, Jahangir (18 April 2011). দারিদ্র্য কমেছে, আয় বেড়েছে [Reduced poverty, increased income]. Prothom Alo (in Bengali). Archived from the original on 20 April 2011. Retrieved 18 April 2011.
  2. ↑ "Health Bulletin 2015". Management Information System, Directorate General of Health Services, Mohakhali, Dhaka 1212, Bangladesh. December 2015.
  3. ↑ Nargis, M. "Scaling-up Innovations, Community Clinic in Bangladesh". Additional Secretary & Project Director, Revitalization of Community Health Care Initiatives in Bangladesh (RCHCIB), MoHFW.
  4. 1 2 "Global Health Observatory Data Repository". WHO. Retrieved 14 February 2012.
  5. ↑ "The allocation has increased in the health sector". jugantor. Retrieved 16 March 2018.
  6. ↑ "Hospital Beds (Per 10,000 Population), 2005–2011". The Henry J. Kaiser Family Foundation. Archived from the original on 11 April 2013. Retrieved 14 February 2012.
  7. 1 2 Syed Masud Ahmed; Md Awlad Hossain; Ahmed Mushtaque Raja Chowdhury & Abbas Uddin Bhuiya (2011), "The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution", Human Resources for Health, 9 (3), doi:10.1186/1478-4491-9-3
  8. ↑ National Institute of Population Research and Training Ministry of Health and Family Welfare Dhaka, Bangladesh. "BANGLADESH DEMOGRAPHIC AND HEALTH SURVEY 2014" (PDF). dhsprogram.com. Retrieved 9 September 2017.
  9. ↑ "Country Profile". World Bank. Retrieved 9 September 2017.
  10. ↑ "Indicators". World Bank. Retrieved 9 September 2017.
  11. 1 2 3 4 Hossain, Shah Monir. Non-Communicable Diseases (NCDs) in Bangladesh, An overview. Former Director General of Health Services Ministry of Health and Family Welfare Senior Consultant, PPC, MOHFW Senior Advisor, Eminence. Retrieved 9 September 2017.
  12. ↑ "21. Non-communicable Diseases (NCDs) in Bangladesh". icddr,b. Evidence to Policy Series Brief No.2. May 2010.
  13. ↑ Omran, AR (9 November 2005). ". The Epidemiologic Transition: A Theory of the Epidemiology of Population Change". The Milbank Quarterly. 83(4):: 731–757. doi:10.1111/j.1468-0009.2005.00398.x.
  14. ↑ 13. Global report on diabetes, 1. Diabetes Mellitus – epidemiology. 2. Diabetes Mellitus – prevention and control. 3. Diabetes, Gestational. 4. Chronic Disease. 5. Public Health. I. World Health Organization. ISBN 978 92 4 156525 7.
  15. ↑ IDF Diabetes Atlas,. Brussels,: International Diabetes Federation.
  16. ↑ Hussain, A (2007). "Type 2 diabetes and impaired fasting blood glucose in rural Bangladesh: a population based study". European Journal of Public Health. 17 (3): 291–6. doi:10.1093/eurpub/ckl235.
  17. ↑ Rahim, AM (June 2002). "Diabetes in Bangladesh: Prevalence and determinant [Thesis]. Master of Philosophy in International Community Health".
  18. ↑ Lim, SS (December 2012). "A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380: 380(9859):2224–60. doi:10.1016/S0140-6736(12)61766-8.
  19. ↑ Rahim, MA (August 2007). "Rising prevalence of type 2 diabetes in rural Bangladesh: A population based study". Diabetes Res Clin Pract. 77 (2): 300–5. doi:10.1016/j.diabres.2006.11.010.
  20. ↑ Hussain, A (July 2005). "Type 2 diabetes in rural and urban population: diverse prevalence and associated risk factors in Bangladesh". Diabet. Med.: 22(7):931–6.
  21. ↑ Sayeed, MA (2003). "Diabetes and impaired fasting glycemia in a rural population of Bangladesh". Diabetes Care: 26: 1034–9. doi:10.2337/diacare.26.4.1034.
  22. ↑ Sayeed, MA (1997). "Effect of socioeconomic risk factors on the difference in prevalence of diabetes between rural and urban population of Bangladesh". Diabetes Care. 20: 551-5. doi:10.2337/diacare.20.4.551.
  23. ↑ Sayeed, MA (1997). "Prevalence of diabetes in a suburban population of Bangladesh". Diabetes Res Clin Pract. 34: 149-55.
  24. ↑ Nag, KD (October–December 2015). "Diabetic retinopathy at presentation to screening service in Bangladesh". Bangladesh Ophthalmic Journal. 01 (04): 26–29.
  25. ↑ Wong, TY (March 2006). "Diabetic retinopathy in a multi-ethnic cohort in the United States". American Journal of Ophthalmology. 141 (3): 446–455. doi:10.1016/j.ajo.2005.08.063. PMC 2246042.
  26. ↑ Wong, TY (November 2008). "Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study". Ophthalmology. 115 (11): 1869–75. doi:10.1016/j.ophtha.2008.05.014.
  27. ↑ "Bangladesh Healthcare Crisis". BBC News. 28 February 2000. Retrieved 14 February 2012.
  28. ↑ Heitzman, James; Worden, Robert, eds. (1989). "Health". Bangladesh: A Country Study. Washington, D.C.: Federal Research Division, Library of Congress. p. 90.
  29. ↑ "Fighting Malnutrition in Bangladesh". World Bank in Bangladesh. Archived from the original on 1 December 2008. Retrieved 14 February 2012.
  30. 1 2 "Children and women suffer severe malnutrition". IRIN. 19 November 2008. Retrieved 14 February 2012.
  31. 1 2 3 4 "Child and Maternal Nutrition in Bangladesh" (PDF). UNICEF.
  32. ↑ "The state of food insecurity in the food 2011" (PDF). FAO.
  33. ↑ "The State of the World's Children 2011" (PDF). UNICEF.
  34. ↑ "High Malnutrition in Bangladesh prevents children from becoming "Tigers"". Global Alliance for Improved Nutrition. Archived from the original on 15 September 2014.
  35. ↑ Rizvi, Najma (22 March 2013). "Enduring misery". D+C Development and Cooperation. Federal Ministry of Economic Cooperation and Development.
  36. ↑ "Rural poverty in Bangladesh". Rural Poverty Portal. International Fund for Agricultural Development.
  37. ↑ "Bangladesh: Priorities for Agriculture and Rural Development". World Bank. Archived from the original on 18 May 2008.
  38. ↑ "Poverty Profile People's Republic of Bangladesh Executive Summary" (PDF). Japan International Cooperation Agency. Japan Bank for International Cooperation. October 2007.
  39. ↑ "Bangladesh's Water Crisis". Water.org.
  40. ↑ "A participatory approach to sanitation: experience of Bangladeshi NGOs" (PDF).
  41. ↑ "Rural Sanitation, Hygiene and Water Supply" (PDF). UNICEF.
  42. ↑ "C. Nutrition and Infectious Disease Control". Supplement to SCN News No. 7 (Mid-1991). United Nations. Archived from the original on 17 August 2011.
  43. ↑ "Underlying Causes of Malnutrition". Mother and Child Nutrition. The Mother and Child Health and Education Trust.
  44. ↑ "Unemployment Problem in Bangladesh". academia.edu.
  45. ↑ "Nutrition Program".
  46. 1 2 3 "Bangladesh – Statistics". UNICEF.
  47. ↑ "Bangladesh, Effects of the Financial Crisis on Vulnerable Households" (PDF). WFP.
  48. ↑ Rahman, M. H.; Mosley, W. H.; Ahmed, S.; Akhter, H. H. (January 2008). "Does Service Accessibility Reduce Socio-Economic Differentials in Maternity Care Seeking? Evidence From Rural Bangladesh". Journal of Biosocial Science. Cambridge University Press. 40 (1): 19–33. doi:10.1017/S0021932007002258.
  49. 1 2 "The State of the World's Midwifery" (PDF). United Nations Population Fund. 2011. Retrieved 2 August 2016.
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