Showing papers by "Marufa Sultana published in 2018"
TL;DR: CBHI scheme increases the utilization of MTP among informal workers as well as the implementation and scale-up of CBHI schemes have the potential to address this challenge of universal health coverage.
Abstract: We aimed to estimate the impact of a Community-Based Health Insurance (CBHI) scheme on utilization of healthcare from medically trained providers (MTP) by informal workers. A quasi-experimental study was conducted where insured households were included in the intervention group and uninsured households in comparison group. In total 1,292 (646 insured and 646 uninsured) households were surveyed from Chandpur district comprising urban and rural areas after 1 year period of CBHI introduction. Matching of the characteristics of insured and uninsured groups was performed using a propensity score matching approach to minimize the observed baseline differences among the groups. Multilevel logistic regression model, with adjustment for individual and household characteristics was used for estimating association between healthcare utilization from the MTP and insurance enrolment. The utilization of healthcare from MTP was significantly higher in the insured group (50.7%) compared to the uninsured group (39.4%). The regression analysis demonstrated that the CBHI beneficiaries were 2.111 (95% CI: 1.458–3.079) times more likely to utilize healthcare from MTP.CBHI scheme increases the utilization of MTP among informal workers. Ensuring such healthcare for these workers and their dependents is a challenge in many low and middle income countries. The implementation and scale-up of CBHI schemes have the potential to address this challenge of universal health coverage.
58 citations
TL;DR: Disparities exist among urban and rural areas regarding stunting among the children younger than 5 in Bangladesh, which need to be reduced, and public health policies and interventions need to consider the risk factors in urban and Rural areas separately.
Abstract: Background:Despite improvements in the reduction of child stunting rates over the last decade, poor nutritional status still remains a public health concern in Bangladesh, where young children are
43 citations
02 Jul 2018
TL;DR: Other than education and income, several other factors including mass -media, place of residence, working status, and geographical variations were significantly associated with recommended ANC.
Abstract: Introduction:Utilization of recommended antenatal care (ANC) throughout the pregnancy period is a proven healthy behavior in reducing maternal mortalities and morbidities. The objective of this study is to identify the demand side factors that are associated with the recommended utilization of ANC services among adolescents and adult women in Bangladesh.Method:This study utilized cross-sectional data from latest Bangladesh Demographic and Health Survey 2014. Data of a total of 4626 adolescents and adult women were analyzed. Bivariate and multivariate analyses were performed for identifying the significant determining factors associated with the ANC services utilization.Results:Approximately, 32% adult and 30% adolescent women utilized the recommended ANC care. The higher educated adolescents and adult women were 8.08 times (P < .001) and 2.98 times (P < .001) more likely to receive 4 or more ANC, respectively, compared to uneducated women. The richest quintile showed higher tendency to utilize optimum ANC...
40 citations
TL;DR: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh that will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.
Abstract: Immunization has become one of the major contributors to public health globally as it prevents communicable disease, particularly in children. The objective of this study was to estimate the extent of timely immunization coverage and to investigate the determinants of incomplete and untimely vaccination. Methods: The study used data from the latest Bangladesh Demographic Health Survey (BDHS) 2014. A total sample of 1631 children aged 12–23 months who had an Expanded Program on Immunization (EPI) card and immunization history were analyzed. Multivariable logistic regression models were used to determine the significant influencing factors on untimely vaccination (BCG, pentavalent vaccine/OPV, and measles) and incomplete vaccination. The results were presented in terms of adjusted odds ratio (AOR) with a 95% confidence interval and a significance level p < 0.05. Results: The proportions of children who received timely vaccinations were 24% for BCG, 46% for pentavalent 3, and 53% for measles, whereas 76%, 51%, and 36% children failed to receive the BCG, pentavalent 3, and measles vaccines, respectively, in a timely manner. The proportion of early vaccination was 3% for pentavalent 3 and 12% for measles. Several significant influencing factors including age, maternal education and working status, awareness of community clinics, socioeconomic status, and geographic variation significantly contributed to untimely and incomplete vaccination of children in Bangladesh. Conclusions: The study identified some key determinants of untimely and incomplete childhood vaccinations in the context of Bangladesh. The findings will contribute to the improvement of age-specific vaccination and support policy makers in taking the necessary control strategies with respect to delayed and early vaccination in Bangladesh.
40 citations
TL;DR: The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.
Abstract: Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness. This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics. The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile. Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.
39 citations
TL;DR: The overall satisfaction level towards health services is quite favorable, but satisfaction scores can still be improved, which could contribute towards developing and designing the healthcare services packages of community-based health scheme.
Abstract: Background: Community-based health insurance is recognized as a promising tool for health system improvement for low-income people that improves the health status of enrolees and enhances productivity and labor supply. The experience and opinion of the clients who utilized health services through the insurance scheme are important for improving healthcare services, shaping health policies and providing feedback on the quality, availability, and responsiveness of healthcare services. However, studies focusing on clients’ satisfaction provided by the health insurance scheme are still limited globally. Objective: To address this knowledge gap, this current study attempted to measure the degree of clients’ satisfaction towards healthcare services and insurance scheme, based on their experience of health care which will serve the future reference point to implement potential quality improvement initiatives of community-based health insurance program. Methods: A cross-sectional household survey was conducted within the catchment area of a community-based health insurance pilot program named Labor Association for Social Protection (LASP) during April–June 2014 to compare the evaluation of healthcare services provided by LASP scheme. In the descriptive analyses, the characteristics of the study participants were presented regarding frequency and the percentages with 95% confidence interval. Spearman correlation analysis was conducted between the satisfaction score of each indicator and overall satisfaction score; multivariate linear regression analysis was used to identify the factors associated with overall health scheme satisfaction. Results: The overall satisfaction mean score was 4.17 ± 0.04 (95% CI: 4.08–4.26) out of 5.00. The most satisfied domains were related to the diagnostic services (4.46 ± 0.98), explanation about the prescribed medicine (4.23 ± 0.81), the surrounding environment of healthcare facility (4.21 ± 0.70) and the behavior of health personnel toward clients (4.18 ± 0.73). Conclusions: Our study observed that the overall satisfaction level towards health services is quite favorable, but satisfaction scores can still be improved. These findings could contribute towards developing and designing the healthcare services packages of community-based health scheme which is in line with the health care financing strategy of Bangladesh as well as the recommendation of the World Health Organization for developing social health insurance as part of path to Universal Health Coverage.
23 citations
TL;DR: Adolescent maternal healthcare utilization was associated with a number of factors including low socio-economic status, limited reproductive knowledge, and geographical region, which would be beneficial for introducing need-based adolescent maternal health programmes.
19 citations
TL;DR: Assessment of the cost-effectiveness of introducing universal childhood rotavirus vaccination with the newly developed ROTAVAC vaccine in national Expanded Programme of Immunization in Bangladesh finds it appears as highly cost-effective and would offer substantial future benefits for the young population if vaccinated today.
Abstract: Diarrhea is one of the world's leading killers of children, and globally, rotavirus is the most common cause of severe diarrhea among under 5 children. In Bangladesh, rotavirus kills nearly 6,000 under 5 children in each year. To reduce the burden of childhood rotavirus diseases, universal rotavirus vaccination is recommended by World Health Organization. The objective of this study is to assess the cost-effectiveness of introducing universal childhood rotavirus vaccination with the newly developed ROTAVAC vaccine in national Expanded Programme of Immunization in Bangladesh. We developed a decision model to examine the potential impact of vaccination in Bangladesh and to examine the effect if the vaccination is applied in the nationwide immunization program schedule. Introduction of childhood universal rotavirus vaccination in Bangladesh scenario appears as highly cost-effective and would offer substantial future benefits for the young population if vaccinated today. The cost per DALY averted of introducing the rotavirus vaccine compared with status quo is approximately US$ 740.27 and US$ 728.67 per DALY averted from the health system and societal perspective respectively which is "very cost-effective" using GDP threshold level according to World Health Organization definition. The results of this analysis seek to contribute to an evidence-based recommendation about the introduction of universal rotavirus vaccination in national Expanded Programme of Immunization (EPI) in Bangladesh.
17 citations
TL;DR: A concurrent process documentation using mixed-method approaches is conducted to identify implementation-related challenges in implementation of the Shasthyo Surokhsha Karmasuchi health protection scheme in Bangladesh and to estimate the project costs.
Abstract: Rapidly increasing healthcare costs and the growing burden of non-communicable diseases have increased the out-of-pocket (OOP) spending (63.3% of total health expenditure) in Bangladesh. This increasing OOP spending for healthcare has catastrophic economic impact on households. To reduce this burden, the Health Economics Unit (HEU) of the Ministry of Health and Family Welfare has developed the Shasthyo Surokhsha Karmasuchi (SSK) health protection scheme for the below-poverty line (BPL) population. The key actors in the scheme are HEU, contracted scheme operator and hospital. Under this scheme, each enrolled household is provided 50,000 BDT (620 USD) coverage per year for healthcare services against a government financed premium of 1000 BDT (12 USD). This initiative faces some challenges e.g., delays in scheme activities, registering the targeted population, low utilization of services, lack of motivation of the providers, and management related difficulties. It is also important to estimate the financial requirement for nationwide scale-up of this project. We aim to identify these implementation-related challenges and provide feedback to the project personnel. This is a concurrent process documentation using mixed-method approaches. It will be conducted in the rural Kalihati Upazila where the SSK is being implemented. To validate the BPL population selection process, we will estimate the positive predictive value. A community survey will be conducted to assess the knowledge of the card holders about SSK services. From the SSK information management system, numbers of different services utilized by the card holders will be retrieved. Key-informant interviews with personnel from three key actors will be conducted to understand the barriers in the implementation of the project as per plan and gather their suggestions. To estimate the project costs, all inputs to be used will be identified, quantified and valued. The nationwide scale-up cost of the project will be estimated by applying economic modeling. SSK is the first ever government initiated health protection scheme in Bangladesh. The study findings will enable decision makers to gain a better understanding of the key challenges in implementation of such scheme and provide feedback towards the successful implementation of the program.
13 citations
TL;DR: The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheals prevention programme.
Abstract: Introduction: Diarrheal diseases are a global public health problem and one of the leading causes of mortality, morbidity and economic loss. The objective of the study is to estimate the economic cost of caregivers and cost distribution per diarrheal episodes in Bangladesh. Methods: This was a cross-sectional hospital-based study conducted in public hospitals in Bangladesh. A total of 801 diarrheal patients were randomly selected and interviewed during January to December 2015. Simple descriptive statistics including frequencies, percentage, mean with 95% CI and median are presented. Results: The overall average cost of caregivers was BDT 2243 (US$ 28.58) while only BDT 259 (US$ 3.29) was spent as out of pocket payments. Caregivers mostly spent money (US$ 1.63) for food, lodging, utility bills, and other lump sum costs followed by the transportation costs (US$ 1.57). The caregivers spent more (US$ 44.45) when they accompanied the patients who were admitted in inpatients care and almost 3.6 times higher than for out-patients care (US$ 12.42). Conclusions: The study delivers an empirical evidence to the health-care programmers and policy makers about the economic cost of caregivers during diarrheal treatment care, which should be accounted for in designing future diarrheal prevention programme.
7 citations
TL;DR: The study showed that there was a huge variation of OOP, which was dependent on the facility and socioeconomic demographic status of the households, and policy efforts need to focus on lowest wealth quintiles to avoid economic burdens during child delivery-related activities.
Abstract: Objectives The objective of this study is to capture the relevant out-of-pocket (OOP) costs, coping mechanisms, and associated factors that are related to child delivery in Bangladesh through the use of nationwide household level data Data and methods The study was conducted using a secondary data source of the latest Bangladesh Demographic and Health Survey 2014 A cross-sectional survey was performed for 6 months, from June to November 2014, where closed-ended questions regarding child delivery-related expenditure were included Log linear regression and descriptive analysis methods were used to analyze these data Results Analysis indicated that the average self-reported OOP payment per child delivery was US$ 7923 (SD ±12805) The highest OOP was observed for C-section (US$ 24989, SD ±15354), followed by institutional normal delivery (US$ 6162, SD ±7528) The average cost per normal home delivery was US$ 1589 (SD ±2584) The richest quintile spent significantly more than the poorest quintile regarding C-section (US$ 281 vs US$ 204), normal delivery at an institution (US$ 80 vs US$ 65), and even normal delivery at home (US$ 22 vs US$ 13) Conclusions The study showed that there was a huge variation of OOP, which was dependent on the facility and socioeconomic demographic status of the households As such, policy efforts need to focus on lowest wealth quintiles to avoid economic burdens during child delivery-related activities, and therefore, financial risk protection should be provided Social health insurance might be an option for financing during child delivery, which is in line with the core objective of the Healthcare Financing Strategy of Bangladesh, which is to achieve universal health coverage
TL;DR: Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes.
Abstract: Community-based Health Insurance (CBHI) schemes are recommended for providing financial risk protection to low-income informal workers in Bangladesh We assessed the problem of adverse selection in a pilot CBHI scheme in this context In total, 1292 (646 insured and 646 uninsured) respondents were surveyed using the Bengali version of the EuroQuol-5 dimensions (EQ-5D) questionnaire for assessing their health status The EQ-5D scores were estimated using available regional tariffs Multiple logistic regression was applied for predicting the association between health status and CBHI scheme enrolment A higher number of insured reported problems in mobility (73%; p = 0002); self-care (71%; p = 0000) and pain and discomfort (77%; p = 0005) than uninsured The average EQ-5D score was significantly lower among the insured (0704) compared to the uninsured (0749) The regression analysis showed that those who had a problem in mobility (m 125–217); self-care (OR = 229; 95% CI: 162–325) and pain and discomfort (OR = 143; 95% CI: 113–181) were more likely to join the scheme Individuals with higher EQ-5D scores (OR = 046; 95% CI: 031–069) were less likely to enroll in the scheme Given that adverse selection was evident in the pilot CBHI scheme, there should be consideration of this problem when planning scale-up of these kind of schemes
01 Jan 2018
TL;DR: House characteristics like unsafe water, unhygienic toilet and household belonging to urban community were significantly associated with OOP payments, while other significant factors were household income, age, sex, informal healthcare.
Abstract: Like many low- and middle income countries, out-of-pocket payment (OOPP) is the most common healthcare financing mechanism in Bangladesh. Higher and unpredictable health payments can expose households to substantial financial risk along with, at their most extreme, can result in economic impoverishment. Health policy-makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. This study intends to examine the factors that are mostly influencing out-of-pocket payments healthcare in Bangladesh. A total of 10,705 populations who spent for receiving any type of healthcare services were analyzed from Bangladesh Household Income and Expenditure Survey data, 2010. We used a multiple regression model for the determinants of OOPP using Ordinary Least Square (OLS) considering socio-economic, demographic, social financial security as well as health-related indicators. Adjusted findings showed that, household characteristics like unsafe water, unhygienic toilet and household belonging to urban community were significantly associated with OOP payments. The other significant factors were household income, age, sex, informal healthcare. Finding can help for the decision-makers by stating OOPP determinants, discussing the mechanism causing them and thus making them into account to adapt OOP relevant regulations which highlights the emphasis to develop financial protection mechanisms in Bangladesh. Government should consider enhancing resources of healthcare policy. Parallel to government, spending other prudent and sustainable risk-pooling mechanism can help reducing intensity of OOP payments.
01 Jan 2018
TL;DR: A number of determinants that have a direct influence on the prevalence of low birth weight are identified and strategies should be taken to improve the overall maternal health status, and thus to reduce further adverse health sequence progression.
Abstract: Low birth weight (LBW) is a major public health concern especially in developing countries which frequently is related to child morbidity and mortality. This study aimed to identify key determinants that influence the prevalence of LBW babies in 10 selected developing countries. We conducted a secondary data analyses from the recent Demography and Health Surveys (DHS) in 10 selected developing countries. Only numerical type of birth weight data were considered for the analyses. We performed multivariate logistic regression analysis to present the unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI). We find that the overall prevalence of LBW in the study countries was 15.9% with a range of 9.0–35.1%. Results of the study demonstrated that maternal age of 35–49 years (OR = 1.66, 95% CI: 0.45–1.96), antenatal care (OR = 1.75; 95% CI: 1.08–2.82), illiteracy (OR = 1.54;0.39–1.74), later conception (OR = 1.88; 95% CI: 1.40–2.53), underweight (OR = 1.59; 95% CI: 1.21–2.09) and wealth status (OR = 1.15, 95% CI: 0.93–1.41) were significantly associated with prevalence of low birth weight. This study identified a number of determinants that have a direct influence on the prevalence of low birth weight. Strategies should be taken to improve the overall maternal health status, and thus to reduce further adverse health sequence progression. Efforts on community-based intervention programs will likely reduce the occurrence of LBW infants.