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SummaryThe effects of selected socioeconomic factors on basic competencies of children in Bangladesh were studied using primary data on 2520 children from all over the country. The residence of the child, years of schooling, parental... more
SummaryThe effects of selected socioeconomic factors on basic competencies of children in Bangladesh were studied using primary data on 2520 children from all over the country. The residence of the child, years of schooling, parental education and economic status of the household were found to be important determinants of basic competencies of children.
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This article explores the relationship between selected socio-economic factors and health knowledge of children in Bangladesh. Data was generated from a representative sample survey of 2520 children aged 11–12 y and resident throughout... more
This article explores the relationship between selected socio-economic factors and health knowledge of children in Bangladesh. Data was generated from a representative sample survey of 2520 children aged 11–12 y and resident throughout the country. A total of six health knowledge items, all of which are very relevant to Bangladesh, were assessed in this study. Both bivariate and multivariate analysis
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This chapter focuses on how local health teams can use epidemiology to help plan for health priorities and identify high-risk groups and to tackle inequalities. Using a systems approach epidemiology can help to strengthen primary health... more
This chapter focuses on how local health teams can use epidemiology to help plan for health priorities and identify high-risk groups and to tackle inequalities. Using a systems approach epidemiology can help to strengthen primary health care and improve the delivery of district health services and programmes. These need to be delivered so people have high levels of access to high-quality services and programmes that also achieve high levels of population coverage.
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Routine health information and surveillance systems collect and report information from the peripheral health facilities to the local district headquarters. Data are collected and recorded when people visit health facilities and later... more
Routine health information and surveillance systems collect and report information from the peripheral health facilities to the local district headquarters. Data are collected and recorded when people visit health facilities and later analysed and communicated to the Ministry of Health and other organizations. Data can also be collected using qualitative methods and surveys. District staff should know how to analyse and produce reliable local information. The Ministry of Health or national statistics bureau is usually responsible for collating this information for the whole country. A check list for reporting local health information is included.
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Sharing and dissemination of health information needs careful planning to inform both the public and local health staff, local government departments, and the Ministry of Health, as well as other health-related sectors like agriculture,... more
Sharing and dissemination of health information needs careful planning to inform both the public and local health staff, local government departments, and the Ministry of Health, as well as other health-related sectors like agriculture, education, water, and environment, and non-governmental health organizations. Local radio and social media are very important for active communications between district teams, health workers, and the wider public. Policy briefs can be used to disseminated and circulate health news, reports and plans. The importance of making power-point presentations and presenting written reports and papers is emphasised.
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This chapter covers understanding communicable diseases, main modes of transmission and causes of different outbreaks, and the definition of an epidemic and pandemic. Different kinds of outbreaks and their investigation and control are... more
This chapter covers understanding communicable diseases, main modes of transmission and causes of different outbreaks, and the definition of an epidemic and pandemic. Different kinds of outbreaks and their investigation and control are described. Person-to-person or propagated transmission, such as with SARS and Covid-19, can rapidly lead to an epidemic when on average one case leads to more than one new case. This is the reproductive rate or R value. It is important both to investigate and control local epidemics at the same time. Understanding and controlling major epidemics and pandemics are more complicated tasks and usually require specialist expertise. A district outbreak/epidemic checklist is provided.
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Ethical practice is important for all health workers in public, non-government, and private health services that aim to strengthen primary health care. Four general principles are important: respect for the right of individuals to... more
Ethical practice is important for all health workers in public, non-government, and private health services that aim to strengthen primary health care. Four general principles are important: respect for the right of individuals to practice informed choices (autonomy), a fair distribution of benefits and risks (justice), benefits that should far outweigh risks (beneficence), and do no harm or injury (non-maleficence). Local health teams should use these principles together with national guidelines to organise a fair and just approach to district health planning, data collection, and local research studies.
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Monitoring involves continuous observation to see if plans are on track and evaluation determines the effectiveness of planned health interventions delivered by the health services and programmes. The systems approach uses indicators to... more
Monitoring involves continuous observation to see if plans are on track and evaluation determines the effectiveness of planned health interventions delivered by the health services and programmes. The systems approach uses indicators to measure delivery, access, quality, and coverage of services and programmes and their impact on health status indicators. Efficacy measures the impact of interventions in individual people. Measuring effectiveness in whole communities utilizes quasi-experimental population-based study designs with community controls. The importance of ethical principles and monitoring equity in health planning is presented and emphasised.
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Health data become useful information after analysis. It is important to communicate health plans and findings on services and programmes to district and ministry staff, as well as to other health related sectors and other local... more
Health data become useful information after analysis. It is important to communicate health plans and findings on services and programmes to district and ministry staff, as well as to other health related sectors and other local organizations. Popular methods for presenting and communicating health information include tables, figures, graphs, histograms, bar charts, pie charts, scatter diagrams, and maps. Details for constructing and presenting these are explained. Mobile phones and photographs are useful to record and send health information. The importance of displaying and publicising local health information and achievements is stressed.
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This study assesses the effect of a customised Maternal Neonatal and Child Survival (MNCS) intervention in the rural areas of Bangladesh. This study attempts to estimate the lifetime fertility rate and the proportion of live births ≥3,... more
This study assesses the effect of a customised Maternal Neonatal and Child Survival (MNCS) intervention in the rural areas of Bangladesh. This study attempts to estimate the lifetime fertility rate and the proportion of live births ≥3, and the age-specific lifetime fertility patterns among the women of reproductive age. This quasi-experimental study used impact evaluation data from the MNCS intervention in 2013 and compared these with the baseline data collected in 2008. We used a multi-stage, cluster random sampling technique to include 6,000 and 4,800 women in 2008 and 2013, respectively. The respondents were either mothers who had alive/deceased infants or the mothers whose pregnancy was terminated or who had living children of 12–59 months without pregnancy outcomes in the preceding year of the surveys. Based on the mean difference of live births from baseline to endline year for each intervention union, and then we compared these two areas (intervention and control unions). Ove...
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Observational health studies look for associations between exposures and possible subsequent health outcomes. To test hypotheses, case-control studies look backward in time to earlier exposures while cohort studies observe exposed and... more
Observational health studies look for associations between exposures and possible subsequent health outcomes. To test hypotheses, case-control studies look backward in time to earlier exposures while cohort studies observe exposed and non-exposed groups forward in time to record outcome incidence data. Both designs test hypotheses for associations while cohorts can also identify causality. Interventions are best tested using randomized controlled trials for efficacy and community trials for effectiveness. These studies utilize complicated methods and require specialist expertise.
We focus on the importance of using epidemiological concepts and skills needed to investigate, plan and deliver primary health care services and to strengthen district level public health programmes. We illustrate these with examples from... more
We focus on the importance of using epidemiological concepts and skills needed to investigate, plan and deliver primary health care services and to strengthen district level public health programmes. We illustrate these with examples from LMICs and for a hypothetical district population of 200,000 people.
Research Interests: Epidemiology and Medicine
Data only becomes useful information when it has been analysed and the information has been processed, analysed, and interpreted. Small datasets of 100 or less subjects can be analysed quickly by hand. Data analysis starts with one-,... more
Data only becomes useful information when it has been analysed and the information has been processed, analysed, and interpreted. Small datasets of 100 or less subjects can be analysed quickly by hand. Data analysis starts with one-, two-, and three-way tables with the analysed data then summarized as percentages, proportions, range, averages, median, and standard deviation. Correlation measures associations between two variables and multiple variables may need to be analysed using regression techniques. Age and sex standardization is usually needed when comparing survey or reported data from two or more different populations. Analysis using computer programmes, such as EpiInfo, is useful for surveys.
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Epidemiological health information is vital for planning and managing health services. This chapter examines importance of different diseases, local health surveillance systems and availability of data and how to use it. Information is... more
Epidemiological health information is vital for planning and managing health services. This chapter examines importance of different diseases, local health surveillance systems and availability of data and how to use it. Information is reviewed for typical patterns of morbidity, mortality, and burden of disease. Local epidemiological data are useful to estimate expected numbers of cases, geographical access to health facilities, quality of services, and the coverage achieved for different programmes. Importance of understanding seasonality on health data and indicators of inequalities is explained. A local health information checklist is given.
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The definitions given in this chapter are valid for this publication but different definitions may be used in other contexts. They are based mainly on A Dictionary of Epidemiology (6th edn), edited for the International Epidemiological... more
The definitions given in this chapter are valid for this publication but different definitions may be used in other contexts. They are based mainly on A Dictionary of Epidemiology (6th edn), edited for the International Epidemiological Association by Miquel Porta and published by Oxford University Press (2014).
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Organizing investigations and surveys can be complicated and they require careful planning. Hand-held portable devices and mobile phones are commonly used today. All questionnaires require careful design, preparation, and piloting. Survey... more
Organizing investigations and surveys can be complicated and they require careful planning. Hand-held portable devices and mobile phones are commonly used today. All questionnaires require careful design, preparation, and piloting. Survey objectives can be reviewed if they are too ambitious and survey design may require changes, such as a reduction in sample size, omission of particular questions, or fewer clinical and laboratory procedures. A pilot trial is essential to test all the methods, fieldwork plans and logistic support. A full survey check list is provided.
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Surveys are used to collect data on the population distribution and frequency of health behaviours and use of services, health risks and diseases, as well as for the monitoring the implementation of health interventions, services, and... more
Surveys are used to collect data on the population distribution and frequency of health behaviours and use of services, health risks and diseases, as well as for the monitoring the implementation of health interventions, services, and programmes. Cross-sectional surveys collect prevalence data and longitudinal surveys collect mainly incidence information. Surveys can provide more accurate data than is available from local health information or surveillance systems. Survey methods are explained, such as on objectives, choice of variables, and sampling. Before undertaking surveys, local teams are advised to seek specialist advice and support.
This chapter reviews population measurements and the demographic and epidemiological transitions and how these may change over time. Knowledge of the population age and sex structure and distribution are essential to estimate those people... more
This chapter reviews population measurements and the demographic and epidemiological transitions and how these may change over time. Knowledge of the population age and sex structure and distribution are essential to estimate those people at most risk and for estimating population access to services and programmes. Sources of population information are presented and factors highlighted for the quality of population data. Definitions of demographic rates and life expectancy, population growth, census procedures, death certification, and demographic surveillance are all outlined.
Research Interests: Demography and Population
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This chapter introduces the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) and the central role of epidemiological concepts, knowledge, and skills in planning, management, and evaluation of district health... more
This chapter introduces the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) and the central role of epidemiological concepts, knowledge, and skills in planning, management, and evaluation of district health systems in support of primary health care. It focuses on interventions to improve the health status of whole populations and shows how epidemiology is essential to support local decision-making for improvements in the population’s health. Health planning is outlined using a systems approach for high-priority health services and public health programmes delivered by district health services and programmes. The differences between interventions for clinical medicine and public health are explained. The systems approach to district planning are also explained.
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Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important... more
Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status def...
Research Interests: Demography, Nutrition and Dietetics, Poverty, Health, Bangladesh, and 14 moreMedicine, Social Class, Ownership, Humans, Food supply, Female, Poverty Measurement and Monitoring, Male, Educational Status, Reproducibility of Results, Sensitivity and Specificity, Socioeconomic Factors, Rural Population, and Interviews as topic
Research Interests: Poverty, Forecasting, International Cooperation, Public Health, Health Services Research, and 15 moreBangladesh, Medical Geography, Humans, Organizations, Female, Male, Health Status, Lancet, Health Expenditures, Psychology of Power, Health Services Administration, cultural characteristics, Delivery of Health Care, Gross Domestic Product, and Medical and Health Sciences
Research Interests: Demography, Nutrition and Dietetics, Mental Health, Quality of life, Developing Countries, and 15 moreHealth, Bangladesh, Humans, Developing Country, Female, Male, Gender Difference, Key words, Health Status, General Health, Questionnaires, Assessment Tool, Health Outcome, health status indicators, and Family Characteristics
This paper investigates the impact of non-formal primary education programme of BRAC on women's autonomy and socialisation. The study was conducted in 87 villages in Manikganj district of central Bangladesh. The data were collected in... more
This paper investigates the impact of non-formal primary education programme of BRAC on women's autonomy and socialisation. The study was conducted in 87 villages in Manikganj district of central Bangladesh. The data were collected in 1995 through a sample survey of 744 married women belonging to the following three categories: i. BRAC school graduates who completed full three years of education; ii. formal school students who completed third grade and discontinued; and iii. women with no schooling. Woman's autonomy was measured by the extent by which she exercised her rights in five different areas of family life, viz. i. decision making power on contraception, ii. schooling of children, iii. buying right of essential items, iv. provision of free expression of opinion in front of her husband, and v. husband's acceptance of such right for her wife. Socialisation is measured by woman's autonomy, adaptability in the family and the extent of her interaction with the sur...
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Qualitative methods can provide quick insights and information that can help to improve delivery, access, quality and coverage of health services and programmes. These methods ask questions and make observations that can complement... more
Qualitative methods can provide quick insights and information that can help to improve delivery, access, quality and coverage of health services and programmes. These methods ask questions and make observations that can complement quantitative information from routine information systems, health surveys, and quantitative studies. These quick methods help to understand people’s beliefs and why they make use and do not make use of local health services and programmes. The main methods include record reviews, observations, exit interviews, key informant interviews, focus groups, and rural appraisal. Importance of triangulation is explained.
Non-governmental organizations (NGOs) working in developing countries are chiefly a post-World War II phenomenon. Though they have made important contributions to health and development among impoverished people throughout the world, the... more
Non-governmental organizations (NGOs) working in developing countries are chiefly a post-World War II phenomenon. Though they have made important contributions to health and development among impoverished people throughout the world, the documentation of these contributions has been limited. Even though BRAC and the Jamkhed Comprehensive Rural Health Project (CRHP) are but two of 9.7 million NGOs registered around the world, they are unique. Established in 1972 in Bangladesh, BRAC is now the largest NGO in the world in terms of population served—now reaching 130 million people in 11 different countries. Its programs are multi-sectoral but focus on empowering women and improving the health of mothers and children. Through its unique scheme of generating income through its own social enterprises, BRAC is able to cover 85% of its $1 billion budget from self-generated funds. This innovative approach to funding has enabled BRAC to grow and to sustain that growth as its social enterprises...
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This paper is concerned with how poor populations can obtain access to trusted, competent knowledge and services in increasingly pluralistic health systems where unregulated markets for health knowledge and services dominate. The term... more
This paper is concerned with how poor populations can obtain access to trusted, competent knowledge and services in increasingly pluralistic health systems where unregulated markets for health knowledge and services dominate. The term “unregulated” here derives from the literature on the development of markets in low income countries and refers to the lack of state enforcement of formal laws and
Research Interests: Sociology, Anthropology, Community Development, Developing Countries, Public Health, and 15 moreHuman Resource, Bangladesh, Knowledge, Community Health Workers, Humans, Program Development, Developing Country, Social Medicine, Health System, Service provision, Low Income Countries, Environment, Health knowledge, Delivery of Health Care, and Community health services
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During the last decade, growth monitoring has been promoted us an important intervention for child survival, but questions have been raised about its electiveness and feasibility in less-developed countries. A growth-monitoring programme... more
During the last decade, growth monitoring has been promoted us an important intervention for child survival, but questions have been raised about its electiveness and feasibility in less-developed countries. A growth-monitoring programme was carried out by the Bangladesh Rural Advancement Committee for over four years, covering about 20,000 children under two years of age. The programme was equally accessible to all socioeconomic groups and both sexes. Children were weighed monthly in village centres, and their mothers were given health and nutrition education. A recent evaluation found modest coverage (43 %) of the target children. Accuracy in determining ages of the target children was reasonably good, with more than 90% within 30 days of actual age. Eighty-seven per cent of the Salter round scales used gave accurate results, compared with only 17% of the Salter cylinder scales. Local volunteers, mostly women, participated in growth-monitoring sessions by weighing, recording, and ...
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The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate... more
The contributions that community-based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health-related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence. An Expert Panel convened to guide the review of the effectiveness of community-based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review's findings and made recommendations. The review consisted of an analysis of 661 unique re...