![Life expectancy development in Bangladesh](https://upload.wikimedia.org/wikipedia/commons/8/82/Life_expectancy_development_in_Bangladesh.svg)
Bangladesh is one of the most populous countries in the world, as well as having one of the fastest growing economies in the world.) Consequently, Bangladesh faces challenges and opportunities in regards to public health.
The Human Rights Measurement Initiative finds that Bangladesh is fulfilling 89.3% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Bangladesh achieves 95.0% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 94.2% of what is expected based on the nation's level of income. Bangladesh falls into the "bad" category when evaluating the right to reproductive health because the nation is fulfilling only 78.8% of what the nation is expected to achieve based on the resources (income) it has available.
Health infrastructure
To ensure equitable healthcare for every resident in Bangladesh, an extensive network of health services has been established. Infrastructure of healthcare facilities can be divided into three levels: medical universities, medical college hospitals, and specialty hospitals exist at the tertiary level. District hospitals, maternal and child welfare centers are considered to be on the secondary level.
Upazila
An ''upazila'' ( bn, উপজেলা, upôzela, lit=sub-district pronounced: ), formerly called ''thana'', is an administrative region in Bangladesh, functioning as a sub-unit of a district. It can be seen as an analogous to a county or a ...
health complexes, union health & family welfare centers, and community clinics (lowest-level healthcare facilities) are the primary level healthcare providers. Various
NGO
A non-governmental organization (NGO) or non-governmental organisation (see spelling differences) is an organization that generally is formed independent from government. They are typically nonprofit entities, and many of them are active in h ...
s and private institutions also contribute to this intricate network.
The total expenditure on healthcare as a percentage of Bangladesh's GDP was 2.48% in 2019.
In the parliamentary budget of 2017–18, the budget that was set for the health sector was 16 thousand 203 crore 36 lakhs taka.
There are 3 hospital beds per 10,000 people. The general government expenditure on healthcare as a percentage of total government expenditure was 7.9% as of 2009. Citizens pay most of their health care bills as the out-of-pocket expenditures as a percentage of private expenditure on health: 96.5%.
The doctor to population ratio is 1:2,000
and the nurse to population ratio is 1:5,000
Hospitals
Medical schools
Health status
Demographics
* Population – 168. million
* Rural population – 70%
* Population density – (population/km2) 1,070/km2
* People below poverty line – 60%
* Population doubling rate – 25–30 years
* GDP (current US$)(billions) – 300
Health indicators
* 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 a large population, Bangladesh faces a large burden of disease:
* Non-communicable diseases: diabetes, cardiovascular disease, hypertension, stroke, chronic respiratory disease, cancer
* Communicable diseases: tuberculosis,
HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
,
tetanus
Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
, malaria, measles, rubella, leprosy
Malnutrition and environmental sanitation problems add to this burden.
Communicable disease
Historically, communicable diseases formed the 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.
An expanded immunization program against nine major diseases (TB, tetanus, diphtheria, whooping cough, polio, hepatitis B, Haemophilus influenza type B, measles, rubella) was undertaken for implementation.
Tuberculosis
''Background:''
Tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
is one of the most dangerous chronic infectious diseases in Bangladesh. It is the major public health problem in this country. Mycobacterium tuberculosis is a commonly responsible organism of tuberculosis. It is an airborne disease that spreads through the coughing of an infected person. This disease is more prone to slum dwellers living in unhygienic conditions. Tuberculosis mainly infects the lungs (''pulmonary tuberculosis'') with the symptoms of persistent cough, evening fever with sweating, chest pain, weakness, weight loss,
hemoptysis
Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, a ...
, etc. But it can also infect the other parts of the body (''extrapulmonary tuberculosis'') like the brain, kidneys and bones. In most cases patients infected with tuberculosis have other concomitant infections. HIV is more common to them.
![Female Patient Number According To Age](https://upload.wikimedia.org/wikipedia/commons/9/99/Female_Patient_Number_According_To_Age.jpg)
''Present TB status of Bangladesh:'' According to the WHO, 'Global TB Report 2017' total population was 165 million, Bangladesh is one of the world's 30 high TB burden countries and near about 59170 people died due to tuberculosis. The total estimated number of TB patients was 364000, among them male patients were recorded at 236000, and female patients was 128000. In 2017 the total case was notified 244201. The total new and relapse case was 242639. People are mainly suffering from pulmonary TB; it was 81% (''197800 patients'') of notified cases.
Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis.
TB with HIV patient: Still now, HIV is considered as the most deadly infectious disease all over the world. It suppresses the immune system of the body. So any kind of infection can be incubated into the body, HIV infected person can be easily infected by mycobacterium tuberculosis, it is
HIV-TB co infection. In 2017, the estimated number of the patient with HIV positive status tuberculosis was 540. Patient with HIV positive status (''new and relapse case'') notified was 89, out of 540 HIV positive patients. Among 89 patient 84 patients took
anti-retroviral therapy
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multiple ...
.
''Drug resistance:'' When micro-organism of TB causes resistance to
isoniazid
Isoniazid, also known as isonicotinic acid hydrazide (INH), is an antibiotic used for the treatment of tuberculosis. For active tuberculosis it is often used together with rifampicin, pyrazinamide, and either streptomycin or ethambutol. For la ...
or/and
rifampicin the most effective drugs of TB. If the organism causes resistance against both of the drugs then it is called
multi-drug-resistant tuberculosis
Multidrug-resistant tuberculosis (MDR-TB) is a form of tuberculosis (TB) infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medications (drugs): isoniazid and rifampin. Some ...
(''MDR-TB''). In 2017 the estimated number of MDR was 8400, among them 5800 cases was notified and 944 patients were confirmed by laboratory test and 920 patients started immediate treatment. If any patient develops resistance against isoniazid/rifampicin and one of the 2nd line antibiotic
fluoroquinolones
A quinolone antibiotic is a member of a large group of broad-spectrum bacteriocidals that share a bicyclic core structure related to the substance 4-quinolone. They are used in human and veterinary medicine to treat bacterial infections, as we ...
(''i.e. amikacin, kanamycin, or capreomycin''), it's called
extreme drug resistance tuberculosis (''XDR-TB''). In 2017, 6 patients were confirmed XDR-TB by laboratory diagnosis and all of them started treatment instantly. As 31 December 2017, countrywide a total 6420 MDR-TB patients were enrolled for treatment including 920. Among 920 patients, 425 patients were in 24 month regimen and 495 patients were 9 months regimen
''Bangladesh combats with TB:'' Under Mycrobacterial Disease Control (MBDC) Unit of the Director-General Health Service (DGHS), National Tuberculosis Control Program (NTP) is working with a goal to eliminate tuberculosis from Bangladesh. The NTP adopted DOTS (
directly observed treatment, short-course) strategy during the fourth Population and Health Plan (1992-1998) and implemented it at field level in November 1993. This strategy reduced TB cases significantly. The program achieved 70% new smear-positive case reduction in 2006 and treated 85% of them since 2003. This program has successfully treated 95% of bacteriologically confirmed new pulmonary cases registered in 2016.
Table-1: Bangladesh Indicator in Line with End TB Strategy
In 2015 the TB case was noted 225/ per 100000 patient and the Government of Bangladesh has taken the target of reduction of TB New cases 10/ per 100000 patients by 2035 that will be around 1650 cases.
Non-communicable diseases of Bangladesh
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.
Diabetes
Diabetes, one of four priority non-communicable diseases targeted by world leaders has become a major health problem globally
(537 million adults with diabetes in 2021 and projected to increase to 642 million by 2040).
High fasting plasma glucose ranks seventh among risk factors for disease in South Asia. Bangladesh has the eighth highest population of people with diabetes, at 13.1 million.
Studies have shown that the prevalence of diabetes is increasing moderately to significantly in the rural population of Bangladesh.
However, compared to Western nations, the major diabetic population is non-obese.
Eye disease related to diabetes (diabetic retinopathy)
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.
Musculoskeletal Disorders (MSDs)
Musculoskeletal disorder
Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g., ...
s (MSDs) are a combination of
inflammatory and
degenerative conditions that influence the muscles, tendons, ligaments, joints or peripheral nerves, normally leading to aches, pains or discomfort. These are the most usual cause of severe long-term
pain,
physical disability
A physical disability is a limitation on a person's physical functioning, mobility, dexterity or stamina. Other physical disabilities include impairments which limit other facets of daily living, such as respiratory disorders, blindness, epileps ...
and premature deaths. MSDs are one of the most
prevalent occupational diseases liable for work limitation and
absenteeism
Absenteeism is a habitual pattern of absence from a duty or obligation without good reason. Generally, absenteeism is unplanned absences. Absenteeism has been viewed as an indicator of poor individual performance, as well as a breach of an implic ...
. Besides, these diseases can manifest as
acute
Acute may refer to:
Science and technology
* Acute angle
** Acute triangle
** Acute, a leaf shape in the glossary of leaf morphology
* Acute (medicine), a disease that it is of short duration and of recent onset.
** Acute toxicity, the adverse eff ...
or
chronic problems and can be incapacitating for their patients leading to huge costs for health systems particularly for chronic. pain.
=Risk Factors
=
The causes of MSDs can be exposure to work-related or
ergonomic
Human factors and ergonomics (commonly referred to as human factors) is the application of psychological and physiological principles to the engineering and design of products, processes, and systems. Four primary goals of human factors learnin ...
risk factors
In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
and individual related risk factors. Repeated manual labor, lifting heavy loads, prolonged static work, overexertion, vibration, or working in an awkward
posture
Posture or posturing may refer to:
Medicine
* Human position
** Abnormal posturing, in neurotrauma
** Spinal posture
** List of human positions
* Posturography Posturography is the technique used to quantify postural control in upright stance in ...
usually leads work related MSDs. Extended working hours and uncomfortable postures were significantly associated with the risk of MSDs and workers who work for conventional working hours (8 hrs per day) were less prone to develop MSDs. Among Ready Made Garments workers
lower back and upper back are the most affected area due to prolonged work and wrong posture. Moreover, work breaks, working under pressure or with deadlines, poor job design, job insecurity, and lack of social support from colleagues and supervisors are directly related to stress, and that stress can appear in increased
muscle tension
In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state.O’Sullivan, S. B. (2007). ...
and other stress-related differences to the body, making workers more vulnerable to developing MSDs. Workers often work for extended hours in awkward position can also suffer MSDs. Age, gender, health and lifestyle are the individual risk factors that are responsible for the higher risk of MSDs and other
chronic conditions
A chronic condition is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the course of the disease lasts for more than three mo ...
.
=Common Musculoskeletal disorders
=
![Musculatal_disorders_in_Bangladesh](https://upload.wikimedia.org/wikipedia/commons/3/35/Musculatal_disorders_in_Bangladesh.png)
Person's
skills
A skill is the learned ability to act with determined results with good execution often within a given amount of time, energy, or both. Skills can often be divided into domain-general and domain-specific skills. For example, in the domain of w ...
and functions are affected by Musculoskeletal disorders and therefore influence their
activities of daily life. Back and neck pain,
osteoarthritis
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone which affects 1 in 7 adults in the United States. It is believed to be the fourth leading cause of disability in the w ...
,
rheumatoid arthritis
Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are invol ...
and
fractures
Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...
are the most disabling conditions. Moreover, these are often correlated with major non-communicable
co-morbidities
In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary c ...
(ischemic heart disease, stroke, cancer and chronic respiratory disease) and they jointly increase disabilities and deaths.
The most prevalent MSDs in Bangladesh is low back pain (18.6%). Rapid urbanization, transition to
sedentary
Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like soci ...
work, weight gain; domestic and professional activities in banding posture may be responsible for the higher prevalence of low back pain in Bangladesh. The second commonest MSDs are knee osteoarthritis (7.3%) and it is related to more knee usage during occupational and household chores in Bangladesh. Besides these soft tissue injuries and
rheumatism can be the third commonest disorders (3.8%)
Among the female readymade garment workers in Bangladesh, the prevalence of lower back pain (41%) was the most leading accompanied by pain in the knees(33%) and neck pain (28%).
=Prevention
=
Musculoskeletal disorders are mostly preventable and
prevention
Prevention may refer to:
Health and medicine
* Preventive healthcare, measures to prevent diseases or injuries rather than curing them or treating their symptoms
General safety
* Crime prevention, the attempt to reduce deter crime and crim ...
is the best treatment. Therefore, understanding what these disorders are and the risk factors that contribute to their development is very fundamental. Furthermore, developing an effective and efficient prevention
strategy requires, risk assessment process and implementation of technical, organizational, and person-oriented measures.
Mental health
According to WHO, "mental health is a state of well-being in which the individual realizes his or her own abilities, can
cope with the normal stresses of life, can work productively and fruitfully, and is able to make a
contribution to his or her community."
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
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
,
dysentery
Dysentery (UK pronunciation: , US: ), historically known as the bloody flux, is a type of gastroenteritis that results in bloody diarrhea. Other symptoms may include fever, abdominal pain, and a feeling of incomplete defecation. Complications ...
,
enteric fever
Typhoid fever, also known as typhoid, is a disease caused by '' Salmonella'' serotype Typhi bacteria. Symptoms vary from mild to severe, and usually begin six to 30 days after exposure. Often there is a gradual onset of a high fever over several ...
,
hepatitis
Hepatitis is inflammation of the liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes ( jaundice), poor appetite, vomiting, tiredness, abdominal ...
,
hook worm infestations.
* Poor rural housing with no arrangement for proper
ventilation
Ventilation may refer to:
* Ventilation (physiology), the movement of air between the environment and the lungs via inhalation and exhalation
** Mechanical ventilation, in medicine, using artificial methods to assist breathing
*** Ventilator, a m ...
, 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
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
problems. The present per capita intake is only 1850 kilocalorie which is by any standard, much below the 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 a
smallholding
A smallholding or smallholder is a small farm operating under a small-scale agriculture model. Definitions vary widely for what constitutes a smallholder or small-scale farm, including factors such as size, food production technique or technology ...
.
Specific nutritional problems in the country are:
#
Protein–energy malnutrition
Protein–energy malnutrition (PEM), sometimes called protein-energy undernutrition (PEU), is a form of malnutrition that is defined as a range of conditions arising from coincident lack of dietary protein and/or energy (calories) in varying propo ...
(PEM): The chief cause of it is insufficient food intake.
#
Nutritional anaemia: The most frequent cause is iron deficiency and less frequently follate and vitamin B12 deficiency.
#
Xerophthalmia
Xerophthalmia (from Ancient Greek "xērós" (ξηρός) meaning "dry" and "ophthalmos" (οφθαλμός) meaning "eye") is a medical condition in which the eye fails to produce tears. It may be caused by vitamin A deficiency, which is someti ...
: The chief cause is nutritional deficiency of Vit-A.
#
Iodine Deficiency Disorders:
Goiter
A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
and other
iodine deficiency
Iodine deficiency is a lack of the trace element iodine, an essential nutrient in the diet. It may result in metabolic problems such as goiter, sometimes as an endemic goiter as well as congenital iodine deficiency syndrome due to untreated cong ...
disorders.
# Others:
Lathyrism, 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. As of 1985, more than 45 percent of rural families and 76 percent of urban families were below the acceptable caloric intake level. 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 ailments in adulthood. One neonate dies in Bangladesh every three to four minutes; 120 000 neonates die every year.
The
World Bank
The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Inte ...
estimates that Bangladesh is ranked 1st in the world of the number of children suffering from malnutrition.
In Bangladesh, 26% of the population are undernourished and 46% of the children suffers from moderate to severe underweight problem. 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. Women also suffer most from malnutrition. To provide their family with food they pass on quality food which are essential for their nutrition.
=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. Every year, 20% to 30% of Bangladesh is flooded. Floods threaten food security and their effects on agricultural production cause food shortage.
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
Water scarcity (closely related to water stress or water crisis) is the lack of fresh water resources to meet the standard water demand. There are two types of water scarcity: physical or economic water scarcity. Physical water scarcity is whe ...
and poor water quality. Groundwater is often found to contain high arsenic concentration. Sanitation coverage in rural areas was only 35% in 1995.
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. The immune system falls and the disease processes exacerbate loss of nutrients, which worsens malnutrition.
The diseases also contribute through the loss of appetite, lowered absorption of vitamins and nutrients, and loss of nutrients through diarrhoea or vomiting.
Unemployment and job problems also lead to malnutrition in Bangladesh. In 2010, the unemployment rate was 5.1%. 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.
=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.
As a result, Bangladesh has a high child mortality rate and is ranked 57 in the under-5 mortality rank.
=Economic effects
=
As 40% of the population in Bangladesh are children, 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.
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.
=Efforts to combat malnutrition
=
Many programmes and efforts have been implemented to solve the problem of malnutrition in Bangladesh.
UNICEF
UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing humanitarian and developmental aid to ...
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.
The impacts of the intervention are significant. Night blindness has reduced from 3.76% to 0.04% and
iodine deficiency
Iodine deficiency is a lack of the trace element iodine, an essential nutrient in the diet. It may result in metabolic problems such as goiter, sometimes as an endemic goiter as well as congenital iodine deficiency syndrome due to untreated cong ...
among school-aged children has decreased from 42.5% to 33.8%.
Maternal and child health status in Bangladesh
Maternal
]
A mother is the female parent of a child. A woman may be considered a mother by virtue of having given birth, by raising a child who may or may not be her biological offspring, or by supplying her ovum for fertilisation in the case of gestat ...
and child health is an important issue in a country like
Bangladesh
Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...
.
Bangladesh is one of the developing countries who signed onto achieving the
Sustainable Development Goals (SDGs). In the new target of SDGs the issue of maternal and child health is fitting under goal number three. Over the last two decades, national health policy and strategies progressed with significant achievements. Still now Bangladesh is aiming to reduce maternal and child mortality through its renovation process.
=Maternal health
=
The
MDG
The Millennium Development Goals (MDGs) were eight international development goals for the year 2015 that had been established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millenniu ...
Goal five target was to reduce the
maternal mortality rate
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to p ...
(MMR) from 574 to 143 deaths per 100,000 live births by 2015 in Bangladesh. There has been a significant downfall in the MMR rates; however, the trajectory is not enough to meet the targets.
The maternal mortality rate (MMR) per 100,000 live births was estimated at 385 globally and 563 in Bangladesh in 1990. In 2015, MMR was 176 per 100,00 live births in Bangladesh and 216 globally. However, the number of deaths of women while
pregnant or within 42 days of termination of the pregnancy in Bangladesh were 21,000 in 1990 which reduced dramatically and reached at 5,500 in 2015.
![Birth Attended Rate](https://upload.wikimedia.org/wikipedia/commons/8/81/Birth_Attended_Rate.jpg)
The reduction in maternal mortality is attributed to multiple factors. The factors like improved assess and utilization of health facilities, improvements in female education and per capita income helped to achieve the goal.
Fertility
Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertili ...
reduction have also contributed to reduce MMR by lowering the number of high risk, high parity births. However, the
antenatal care (ANC) coverage has been increased between 1990 and 2014. The proportion of women receiving at least one antenatal visit rose from 28% in 1990 to 64% in 2014 from a medically trained provider.
In 2014, the population of women aged 15–49 who received postnatal care within 2 days after giving birth was 36%, antenatal coverage for at least four visits was 31%, proportion of births attended by skilled health personnel was 42%,
caesarean section was 23%, proportion of women age 20–24 years old who gave birth before 18 years was 36%, number of women age 15–49 years with a live birth delivery in a health facility was 37% and births who had their first postnatal check-up within the first two days after birth was 31% in Bangladesh.
The major causes of
Maternal Mortality
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...
are -
postpartum haemorrhage (31%),
Eclampsia
Eclampsia is the onset of seizures (convulsions) in a woman with pre-eclampsia. Pre-eclampsia is one of the hypertensive disorders of pregnancy that presents with three main features: new onset of high blood pressure, large amounts of protein in ...
/pre-eclampsia (20%), delayed &
obstructed labour
Obstructed labour, also known as labour dystocia, is the baby not exiting the pelvis because it is physically block during childbirth although the uterus contracts normally. Complications for the baby include not getting enough oxygen which may ...
(7%),
Abortion
Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pre ...
(1%), other direct cause (5%) and indirect cause (35%). In Bangladesh prevalence of undernourishment among adolescent girls and pregnant women is very high, and one-third of such women have low BMI and
anemia
Anemia or anaemia (British English) is a blood disorder in which the blood has a reduced ability to carry oxygen due to a lower than normal number of red blood cells, or a reduction in the amount of hemoglobin. When anemia comes on slowly, t ...
. In urban area, anemia and
Vitamin A deficiency
Vitamin A deficiency (VAD) or hypovitaminosis A is a lack of vitamin A in blood and tissues. It is common in poorer countries, especially among children and women of reproductive age, but is rarely seen in more developed countries. Nyctalopia (ni ...
was found to be prevalent among most of the pregnant mothers.
=Child health
=
![Child mortality rate in Bangladesh](https://upload.wikimedia.org/wikipedia/commons/2/22/Child_mortality_rate_in_Bangladesh.png)
To achieve the MDG-4 target, Bangladesh has experienced a significant reduction of
child mortality over the past decades. But under 5 mortality must be reduced to achieve the SDG Goal three target. Neonatal mortality is a puissant part of overall child mortality.
Neonatal
An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...
mortality rate of Bangladesh fell gradually from 1990 to 2015.
In 1990, per 1000 live births under five mortality rate and
infant mortality rate
Infant mortality is the death of young children under the age of 1. This death toll is measured by the infant mortality rate (IMR), which is the probability of deaths of children under one year of age per 1000 live births. The under-five morta ...
was 93 and 64 globally but in Bangladesh it was higher than the global average. In 2017, global under five mortality rate and infant mortality rate was 39 and 29 per 1000 live births respectively and in Bangladesh this rate was lower than the world average.
![Trends of stuntind, wasting, underweight in bangladesh](https://upload.wikimedia.org/wikipedia/commons/4/47/Trends_of_stuntind%2C_wasting%2C_underweight_in_bangladesh.jpg)
In 1990, the number of under-5 deaths, infant deaths, and neonatal deaths were 532193.00, 368085.00 and 240316.00 and in 2017 the number reduced and reached at 99608.00, 82240.00 and 56341.00 respectively.
The major causes of under-5 child mortality were
preterm birth
Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is between 2 ...
18%,
intrapartum 13.8%,
pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...
13.5%,
sepsis
Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
11%,
congenital 9.1%,
injury 7.9%,
diarrhoea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
7.1%,
measles 1.9% and other 15.9%.
A study on risk factors of infant mortality, using data from the 2014 Bangladesh Demographic and Health Survey, showed that the risk of mortality in Bangladesh is 1.5 times higher for smaller babies. Infant mortality in Bangladesh is also lower for the urban population as well as for higher economic classes (which have greater access to health services).
In Bangladesh, just over half of all children were anemic in 2011. A number of interventions have taken to address this issue, including the distribution of iron supplements and deworming tablets every 6 months till 5 years of age. However, children age 6–59 months receive Vitamin-A capsules twice a year. Between 2004 and 2014 the prevalence of children who are stunted, and underweight declined 29% and 23% respectively. But the prevalence of wasting showed very little change during this period.
=Maternal and child health care delivery system
=
In the
health
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
system of Bangladesh, maternal and
Child Health
Pediatric nursing is part of the nursing profession, specifically revolving around the care of neonates and children up to adolescence. The word, ''pediatrics'', comes from the Greek words 'paedia' (child) and 'iatrike' (physician). 'Paediatrics' i ...
(MCH) services have been given highest priority. At the society level, MCH services are provided by the Family Welfare Assistants and
Health Assistants. A Family Welfare Visitor (FWV) along with a Sub‑Assistant Community Medical Officer or
Medical Assistants are responsible for providing the services, at the union level. At Upazila level, Medical officer provides MCH services in Upazila Health Complex. The activities of the Maternal and Child Health unit along with other maternal health care services are overseen by Upazila Health and Family Planning Officer in the Upazila Health Complex. The district hospitals provide maternal services through an outpatient consultation center and a labor ward.
However, to provide MCH services private sector is playing supplementary and often competitive role in health sector with public one. NGOs also have a significant role providing primary, reproductive and family planning services.
[
]
=Development of maternal and child health policy
=
In following decades, Bangladesh government's policy
Policy is a deliberate system of guidelines to guide decisions and achieve rational outcomes. A policy is a statement of intent and is implemented as a procedure or protocol. Policies are generally adopted by a governance body within an orga ...
concentrated on reduction of population growth; policy perceived that a consistent maternal and child health based family planning programme would help to achieve development goals. The Health and Population Sector Strategy (HPSS) was developed in 1997. The following seven strategies were included in the HPSP (MOHFW, 1998): 1) Focus on Emergency Obstetric Care for reducing maternal mortality, 2) Provision of Essential Obstetric Care/Basic maternity care services for promotion of "good practices" including early detection and appropriate referral of complications 3) Addressing the needs of women through a woman friendly hospital initiative 4) Communication for behaver change and development 5) Involvement of professional bodies 6) Stakeholder participation 7) Promotion of innovation. This policy document is theoretical framework of what is necessary and expected for improvement of maternal health situation in national level and It includes maternal services such as emergency obstetric care, antenatal care, skilled attendance, postnatal
The postpartum (or postnatal) period begins after childbirth and is typically considered to end within 6 weeks as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state. The terms puerperium, puerperal perio ...
care, neonatal care and family planning.[
]
Occupational health
Occupational health
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wor ...
deals with all aspects of health and safety
Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wo ...
in the workplace and has a strong focus on primary prevention of hazards
A hazard is a potential source of harm. Substances, events, or circumstances can constitute hazards when their nature would allow them, even just theoretically, to cause damage to health, life, property, or any other interest of value. The probabi ...
.
=Health problems of female workers in RMG sector
=
Bangladesh has emerged as a key player in RMG (Ready Made Garment
Ready-made garments are mass production, mass-produced finished textile products of the clothing industry. Ready-made are garments that can be bought off of store racks or online, and are ready to wear. They are not custom tailoring, tailored acco ...
) sector since 1978. Textiles and clothing account for about 85% of total export earnings of Bangladesh. Before the starting of RMG sector, woman's participation in the formal economy has been low compared to man but in late 1980s after orienting this sector, the scenario has dramatically changed and now 80 percent of the total employment in RMG sector is occupied by female worker. But the health of this 'women-driven sector' is neglected.
=Reproductive health problem of workers
=
Bangladesh has made significant progress in reducing maternal mortality
Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pre ...
. However, the work environment of RMG has the potential to create health problems, particularly for vulnerable groups such as pregnant women. This paper explores perceptions of health problems during pregnancy
Pregnancy is the time during which one or more offspring develops (gestation, gestates) inside a woman, woman's uterus (womb). A multiple birth, multiple pregnancy involves more than one offspring, such as with twins.
Pregnancy usually occur ...
of factory workers, in this important industry in Bangladesh. Female workers reported that participation in paid work created an opportunity for them to earn money but pregnancy and the nature of the job, including being pressured to meet the production quota
A production quota is a goal for the production of a good. It is typically set by a government or an organization, and can be applied to an individual worker, firm, industry or country. Quotas can be set high to encourage production, or can be u ...
, pressure to leave the job because of their pregnancy and withholding of maternity benefits, cause stress, anxiety and may contribute to hypertensive disorders of pregnancy. This was confirmed by factory doctors who suggested that developing hypertensive disorders during pregnancy was influenced by the nature of work and stress
Stress may refer to:
Science and medicine
* Stress (biology), an organism's response to a stressor such as an environmental condition
* Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...
. The employers seemed focused on profit and meeting quotas and the health of pregnant workers appeared to be a lower priority.
The women reported that they do not visit the factory doctor for an ante-natal check-up when they first suspect that they are pregnant because they feel they need to hide their pregnancy from their supervisors. For example, they needs to meet a production quota of one hundred pieces per hour. If they lag behind the quota due to their pregnancy, their supervisors will encourage them to leave the job. They will also not be assigned to do overtime to earn extra money. They only go to the factory clinic for a check-up during pregnancy when their pregnancy becomes visible. They also do not go to the private clinics because of the cost.
=Healthcare for the workers
=
* BGMEA () recognizes the fundamental rights
Fundamental rights are a group of rights that have been recognized by a high degree of protection from encroachment. These rights are specifically identified in a constitution, or have been found under due process of law. The United Nations' Susta ...
of the workers, particularly access to healthcare facilities. On this spirit BGMEA runs 12 Health Centers for the garment workers and their families, provide pre – medical services and medicines
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy ( pharmacotherapy) is an important part of the medical field and re ...
at free of cost. •
* Besides, it run awareness program on HIV/ AIDS, tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
, reproductive health
Sexual and reproductive health (SRH) is a field of research, healthcare, and social activism that explores the health of an individual's reproductive system and sexual wellbeing during all stages of their life.
The term can also be further de ...
and the use of contraceptive devices.
* In addition to this, BGMEA runs a full-fledged hospital for workers in Chittagong.
* Another hospital for workers is under construction at Mirpur in Dhaka
Dhaka ( or ; bn, ঢাকা, Ḍhākā, ), formerly known as Dacca, is the capital and largest city of Bangladesh, as well as the world's largest Bengali-speaking city. It is the eighth largest and sixth most densely populated city i ...
.
* Lastly, every garment factory must have to ensure to place a health clinic with full-time doctor and nurse/medical assistance with following facilities and give proper training about health and sanitation specially to pregnant workers to minimize the health issues.
Doctor's room:
* Sickness Analysis
* Medical Issue Register
* Treatment Register
* Medicine Stock Register
* First Aid Training register
* Accident / injury Register
* Maternity Follow up file
* Medical Consolation Graph
* Maintain first aid kit
Substance abuse in Bangladesh
The use of illegal drugs or the use of prescription or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts. Different types of social, physical, emotional, and job-related problems can arise from substance abuse. This has become a matter of headache in recent years with overuse of substances like tobacco, alcohol, yaba along with some other prescribed drugs like sedatives or drugs used for anxiety disorders.
= Risk factors and Protective factors-
=
Risk factors can influence drug abuse in several ways. The more risks a child is exposed to, the more likely the child will abuse drugs. Some risk factors may be more powerful than others at certain stages in development, such as peer pressure during the teenage years; just as some protective factors, such as a strong parent-child bond, can have a greater impact on reducing risks during the early years. An important goal of prevention is to change the balance between risk and protective factors so that protective factors outweigh risk factors.
Table 1- Risk Factors and Protective Factors of Substance Abuse.
= Prevalence of alcohol and Drug use disorders-
=
Table 2- Prevalence of Alcohol and Drug use disorders.
= Tobacco
=
Approximately 126,000 deaths accounting for 13.5% of deaths were caused by tobacco from any cause in Bangladesh in 2018. Nearly 1.5 million adults were suffering from diseases attributable to tobacco use and due to exposure to secondhand smoke around 61,000 children were suffering from diseases. The direct healthcare costs attributable to tobacco use amounted to BDT 83.9 billion annually and the annual productivity loss, due to morbidity and premature mortality from tobacco-related diseases, was estimated to be BDT 221.7 billion. Thus, the total annual economic cost amounted to BDT 305.6 billion ($3.61 billion) which is equivalent to 1.4% of the GDP of Bangladesh in 2017–18.
Health hazards of tobacco use
Smoking increases the risk of
* cancer,
* heart disease,
* stroke,
* lung diseases,
* diabetes,
* chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis,
* tuberculosis,
* certain eye diseases and
* problems of the immune system, including rheumatoid arthritis.
= Alcohol
=
In Bangladesh, an alcoholic beverage is defined as any liquor with an alcohol content of ≥0.5%. These alcoholic beverages include beer (5% alcohol in volume), wine (12% alcohol in volume), spirits (40% alcohol in volume) and locally made alcoholic beverages (variable alcohol content). Locally produced alcoholic beverages are made from sorghum, maize, millet, rice, cider, fruit wine or fortified wine (''tari'', ''bangle mod'', ''haria'', ''choani'', ''do chuani'', ''mohua'', etc.).
Though alcohol use is low in Bangladesh, those who use alcohol frequently binge drink, which is a public health concern. The use is prevalent among men, younger age groups, labourers, salaried government and nongovernment employees and businessmen, current smokers and those with a minimal educational background. Harmful use of alcohol is increasingly becoming a national concern as very few people with alcohol problems seek de-addiction treatment in Bangladesh.
Alcohol use disorders
* Injuries including motor vehicle crashes, falls, drownings, and burns
* Violence (homicide, suicide, sexual assault, and intimate partner violence)
* Alcohol poisoning
* Risky sexual behaviors such as unprotected sex or sex with multiple partners which may result in unintended pregnancy or sexually transmitted diseases
* Miscarriage and stillbirth or fetal abnormality.
* High blood pressure, heart disease, stroke, liver disease
* Learning and memory problem along with social problems
* Alcohol dependence etc.
= Other drugs
=
The main groups of illicit drugs used in international statistics are opioids, cocaine, amphetamines and cannabis. However, there is a range of other illicit drugs included in international drug control treaties. Deaths from drug use are of two types:
– direct deaths which result from illicit drug overdoses.
– indirect deaths resulting from illicit drug use acting as a risk factor for the development of various diseases and injury.
Table 3- Deaths due to Illicit Drug Abuse.
Physical and Mental effects due to drug addiction
* Death
* Weakened immune system, increasing the risk of illness and infection
* Heart conditions ranging from abnormal heart rates to heart attacks and collapsed veins and blood vessel infections from injected drugs
* Nausea, abdominal pain, changes in appetite and weight loss
* Liver damage or liver failure
* Seizures, stroke, mental confusion and brain damage
* Lung disease
* Problems with memory, attention and decision-making
* Behavioral problems including paranoia, aggressiveness, hallucination, addiction, impulsiveness, loss of self-control etc.
Legislation
Previously Bangladesh had no adequate and enabling law to handle the condition created by drug abuse and the related issues.The Government of the People's Republic of Bangladesh enacted the Narcotics Control Act in 1990 annulling all the colonial laws with a view to encountering drug problem true to the aspiration of the society.
Neglected tropical diseases of Bangladesh
There is a huge burden of the neglected tropical diseases (NTDs) in Bangladesh, particularly for Kala-azar; Lymphatic Filariasis
Filariasis is a parasitic disease caused by an infection with roundworms of the Filarioidea type. These are spread by blood-feeding insects such as black flies and mosquitoes. They belong to the group of diseases called helminthiases.
These ...
, Dengue
Dengue fever is a mosquito-borne tropical disease caused by the dengue virus. Symptoms typically begin three to fourteen days after infection. These may include a high fever, headache, vomiting, muscle and joint pains, and a characteristic ...
and Chikungunya
Chikungunya is an infection caused by the ''Chikungunya virus'' (CHIKV). Symptoms include fever and joint pains. These typically occur two to twelve days after exposure. Other symptoms may include headache, muscle pain, joint swelling, and a ra ...
.
Chikungunya
Chikungunya
Chikungunya is an infection caused by the ''Chikungunya virus'' (CHIKV). Symptoms include fever and joint pains. These typically occur two to twelve days after exposure. Other symptoms may include headache, muscle pain, joint swelling, and a ra ...
is one of the neglected tropical diseases of Bangladesh. It is a viral disease which is transmitted to humans by infected mosquitoes – including ''Aedes aegypti
''Aedes aegypti'', the yellow fever mosquito, is a mosquito that can spread dengue fever, chikungunya, Zika fever, Mayaro and yellow fever viruses, and other disease agents. The mosquito can be recognized by black and white markings on its le ...
'' and ''Aedes albopictus
''Aedes albopictus'' (''Stegomyia albopicta''), from the mosquito (Culicidae) family, also known as the (Asian) tiger mosquito or forest mosquito, is a mosquito native to the tropical and subtropical areas of Southeast Asia. In the past few cen ...
'', which is present in Bangladesh. It is an RNA virus that belongs to the alphavirus
''Alphavirus'' is a genus of RNA viruses, the sole genus in the ''Togaviridae'' family. Alphaviruses belong to group IV of the Baltimore classification of viruses, with a positive-sense, single-stranded RNA genome. There are 32 alphaviruses ...
genus of the family Togaviridae This category is for articles about virus families (or redirects to such articles). There should be no subcategories.
families
Families (biology) ...
. It was first described during an outbreak in southern Tanzania
Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands ...
in 1952. Since then, CHIKV has been reported to cause several large-scale outbreaks in Africa
Africa is the world's second-largest and second-most populous continent, after Asia in both cases. At about 30.3 million km2 (11.7 million square miles) including adjacent islands, it covers 6% of Earth's total surface area ...
, India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
, Southeast Asia
Southeast Asia, also spelled South East Asia and South-East Asia, and also known as Southeastern Asia, South-eastern Asia or SEA, is the geographical south-eastern region of Asia, consisting of the regions that are situated south of mainlan ...
, Western Pacific and Americas. In the South-East Asia region, Chikungunya virus is maintained in the human population by a human-mosquito-human transmission cycle that differs from the