Cost of Diabetes care in the Out-patient Department of A Tertiary Care Hospital in Bangladesh

ABSTRACT Background and Aims: Global distribution, determinants, and financial aspects of type 2 diabetes mellitus from data in developed countries depict it as a major health problem increasing at an alarming rate. But to the best of my knowledge, a comprehensive study regarding cost burden in developing countries is almost non-existent though it is a similar menace. The present study aimed to investigate and determine the cost of care among patients with diabetes, in the BIRDEM Hospital, the central institute of the Diabetic Association of Bangladesh (DAB), providing diabetes care to a large no of diabetic patients in one centre of the world (total number of registered patients are 0.29 million up to end of 2005). Materials and Methods: Three hundred uncomplicated diabetes patients registered within two years attending the Out-Patient Department (OPD) were interviewed with a preset questionnaire including scrutinizing guide book records regarding the direct cost (cost of medical advice, investigations, medical treatment), indirect cost [travel cost, cost of productivity loss, and cost of accompanying person(s)] along with an in-depth interview was collected through August-December 2005. A comparison was made between patients undergoing three different treatment modalities (Insulin, oral hypoglycemic agents and lifestyle management). An in-depth interview of the subjects was taken to know the effects of diabetes in life, the value of money they spend for diabetes and responses regarding future. Results: All T2DM patients in the OPD are taken care of by 78 OPD physicians, 5 Nutrition Officers, 12 social welfare Officers, 6 Health education officers, 128 Health Assistants, and 101 Technicians. Services provided to the patients include medical care, biochemical investigations, nutrition and health education, social welfare support in applicable cases. The total number of visit events in 2004-2005 was 0.04 million. The average cost per patient came to US$142 (US$ 88 to patient and US$ 54 to provider). The difference in mean cost of patients with different management groups was found significant (p = 0.000). Lifestyle management is cost sparing to other treatment modalities, and Insulin is costlier to other two. The in-depth interview provided supplementary support to the least cost model. Conclusion: Findings showed that i) cost of diabetes care is huge even at a reasonable BIRDEM rate ii) cost of treatment with insulin is high and lifestyle management is effective. The study provides a background for policy researchers to advanced studies on economic evaluation. Providing diabetes care to the population is a challenging task particularly in developing countries like Bangladesh. The huge burden despite comprehensive care is only the tip of iceberg and needs resource mobilization and careful health planning. Key words: Cost; Type 2 diabetes mellitus; Banglades

Perspectiva queer de feminismos diaspóricos y decoloniales: sobre, contra y más allá de las fronteras

In this queering decolonial feminist co(w)riting we bring to text a plural voice making of the philosophies and dark wisdoms emergent when queer decolonial feminist diasporic migrant/refugee (non)subjects speak in their/our own terms. We speak from the pluralities of the exteriority of (non)being and t)race of the “hieroglyphics of the flesh” (Spillers, 1987) as the attempted destruction of the racialized (M)other through blanqueamiento as onto-epistemological project of anti-life in nation-state/governance formation and (re)production. We bring to text the markings of the violating onto-epistemological intimacies of the frontier in the interstices of our everyday subjectification as/to flesh.  We thus centre the impossibilities of belonging, homecoming and sanctuary within the logics and (ir)rationalities of the modern/colonial heteropatriarchal capitalist state and its violent (re)production of our dispossession and exile. Yet we cannot stay in this place for this leaves us bereft reducing us to violation and re-thinigification, spoken as merely this violation. Instead and beyond, we move towards an affirmative presence of exteriority. Here we commit to an epistemological-political praxis in-relation to speak our poetics of that which escapes. We (w)rite as relationality, word and being-knowing as metaphor, myth, onto-epistemological materiality the re-membering of the plurally sided survivance and dark wisdoms (Hill Collins, 1991) of the impurity of our queer racialized and feminised lineages. We poetically travel and dance with our own plural and complex lineages beyond their banishment and negation inherent to many renditions of queer migrations and homecoming and making of homeplace (Wilderson, 2013; Bolaki, 2011; Motta, 2013, 2014, 2017, 2018, 2022c; Lorde, 1982). We also move in, against and beyond the concept of solidarity (Ponce, 2015; Fellner and Nossem, 2018) as means of embodying relationalities across plurality and difference from exteriority and between those of us inhabiting the borderlands of (non)being as queer racialized and feminised migrants and refugees. We thus articulate a kinship (m)otherwise weaved through and as the erotic in which we poeticise (non)being and the pluralities of home as/and world-making (Gonzalez et al., 2023). We build on the shoulders of queer kin who queer reading and(w)riting through embodied and located modes of producing text in a form that is both a radical relation and radical refusal (Cannon, 2018). We poetizar la vida through an erotic and dignifying poetics of meaning-making as world-creating, against and beyond the frontiers of reason, right, (political)subjectivity, desire, intimacy and love of (settler)coloniality. Our (w)riting then is a form of queer decolonial feminist resistances and survivance. Our texts are not mere representations but enfleshed cosmopolitics of subjects-in-relation who disrupt and burlarse of the codifications and containments of the frontier and its thingi-fication as it attempts to assimilate and annihilate our poli and trans being-knowing in and as the world. We do this for us, and our struggles and yearnings for plural in relation homeplace and sanctuary. In our case, that is Suman and I, queer poetry is our shared tongue of the poetics of this, our, erotic medicine-making methodology. This allows us to touch our tears and prepares us to fight against the onto-epistemological war declared against us again and again, day after day. Our queer diasporic feminist decolonising art sharpens our weapons of self-care and sovereignties (m)otherwise. Queer poetry and poetics implores us to take the time to listen to each other and to together decipher the indecipherable. This assists in collective pluridiverse self/other healing and/as homecoming. For us, poetry is a poetics that has the potential to bring into being both a speaking truth to power, in joyful defiance, and a form of poetizando la vida so that we might birth into be-ing becoming multiple world-making futurities.En este (esc)rito colectivo, feminista, decolonial y queer, llevamos al texto una voz plural que hace emerger las filosofías y las sabidurías oscuras cuando los (no-)sujetos migrantes o refugiados diaspóricos, feministas, decoloniales y queer pueden expresarse en sus/nuestros propios términos. Nos pronunciamos desde las pluralidades de la exterioridad del (no-)ser. Posicionamos la imposibilidad de pertenecer, de regresar a casa y de encontrar refugio en el centro de las lógicas e (ir)racionalidades del estado capitalista heteropatriarcal contemporáneo/colonial y su violenta (re)producción de nuestro expolio y exilio. Poetizamos la vida mediante una poesía erótica y dignificante, sobre la creación semántica como confección del mundo, desafiando y trascendiendo las fronteras de la razón, del derecho, de la subjetividad (política), del deseo, la intimidad y el amor del colonialismo (invasivo). Nuestro ritual de escritura es, pues, una forma de resistencia y supervivencia queer, decolonial y feminista. Nuestros textos no son meras representaciones, sino la encarnación de una cosmopolítica sobre sujetos interrelacionados, que trastocan y se burlan de las codificaciones y las contenciones de la frontera y su cosificación al tratar de asimilar y aniquilar nuestro conocer-ser diverso y trans, tanto en el mundo como siendo parte de él. Lo hacemos por nosotros, por nuestras luchas y anhelos a favor de un pluralismo en relación con el hogar y el refugio. Invitamos a que observéis a los abajocomunes queers de los manglares, en comunión erótica, partiendo de las pluralidades de nuestro (no-)ser, en el cual poder crear relaciones alternas, que sean productoras de amor

Economic Evaluation of a Pre-Hospital Protocol for Patients with Suspected Acute Stroke

Background: In regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA. Aim: To describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC) in regional New South Wales, Australia. Materials and methods: The PAST protocol was evaluated using a prospective and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention), patient data were collected prospectively at the PSC. Control patients included two groups (i) patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, (ii) patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs) averted in the intervention period compared to the control period. Results: The intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42-31.2, p < 0.05) and the majority of the associated costs were incurred during acute care and rehabilitation. Overall, the intervention was associated with an estimated net avoidance of 93.3 DALYs. The estimated average cost per DALY averted per patient in the intervention group compared to the control group was $10,921. Conclusion: Based on our simulation modeling, the pre-hospital triage intervention was a potentially cost-effective strategy for improving access to tPA therapy for patients with ischemic stroke in regional Australia

Knowledge, attitude and practice regarding hospital delivery among rural married women in northern Bangladesh

Various programs for safe motherhood aiming to reduce maternal and neonatal mortality are undertaken by public sectors as well as the NGOs. This descriptive cross-sectional study was conducted on the married women in their reproductive age (15-40y) belonging to 211 households of Shitlai village of Kahalu Thana of Bogra district in Bangladesh from January to April 2007. Using a semi-structured questionnaire, data were collected by door-to-door visits and through face-to-face interviews with the respondents. Considering the knowledge on safe motherhood and safe delivery, majority of the respondents (98.6%) mentioned that every pregnant mother should receive antenatal care, and 97.6% said that pregnancy is a period of risk. Regarding safety, 96.2% mentioned hospital delivery as safe, while 80.6% mentioned home delivery as a risk. Among the respondents, 70.1% said that ANC is important, 29.9% was found to be informed of child birth complications, 16.1% knew the duration of pregnancy, 8.1% knew the danger signs of pregnancy, 4.7% about emergency obstetric care (EOC), 4.3% about expected date of delivery (EDD), 2.4% about safe motherhood and 28.4% about the access of health facilities in the village. Among the respondents, 85.3% showed a positive attitude towards hospital delivery while 14.7% had a negative attitude. Study also showed that majority of the respondents (66.8%) had delivered at home, and only one-fourth of the respondents delivered their index child in a hospital. Thus the study recommends to improve the knowledge, economic status, to change the decision making process through the launching of different activities with appropriate health programmes. Ibrahim Med. Coll. J. 2009; 3(1): 17-2

Original Article KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING HOSPITAL DELIVERY AMONG RURAL MARRIED WOMEN IN NORTHERN

Various programs for safe motherhood aiming to reduce maternal and neonatal mortality are undertaken by public sectors as well as the NGOs. This descriptive cross-sectional study was conducted on the married women in their reproductive age (15-40y) belonging to 211 households of Shitlai village of Kahalu Thana of Bogra district in Bangladesh from January to April 2007. Using a semi-structured questionnaire, data were collected by door-to-door visits and through face-to-face interviews with the respondents. Considering the knowledge on safe motherhood and safe delivery, majority of the respondents (98.6%) mentioned that every pregnant mother should receive antenatal care, and 97.6 % said that pregnancy is a period of risk. Regarding safety, 96.2 % mentioned hospital delivery as safe, while 80.6 % mentioned home delivery as a risk. Among the respondents, 70.1 % said that ANC is important, 29.9 % was found to be informed of child birth complications, 16.1 % knew the duration of pregnancy, 8.1 % knew the danger signs of pregnancy, 4.7 % about emergency obstetric care (EOC), 4.3 % about expected date of delivery (EDD), 2.4 % about safe motherhood and 28.4 % about the access of health facilities in the village. Among the respondents, 85.3 % showed a positive attitude towards hospital delivery while 14.7 % had a negative attitude. Study also showed that majority of the respondents (66.8%) had delivered at home, and only onefourth of the respondents delivered their index child in a hospital. Thus the study recommends to improve the knowledge, economic status, to change the decision making process through the launching of different activities with appropriate health programmes

Lead Exposure and Intellectual Function: Findings from Primary School Children in Bangladesh

Backgrounds: About 120 million people around the world are overexposed to lead which is neurotoxic and 99 percent of the most severely affected children are in the developing world including Bangladesh. Methods and Materials: The present cross-sectional ecological study was carried out to explore the impact of lead poisoning on the intelligence level among 84 primary school children of a school of Bangladesh, aged between 8 and 14 years from September 2010 through January 2011. The research instrument was an interviewer questionnaire, questionnaire for IQ test and assessment of blood lead level (inductively-coupled plasma mass spectrometry with collision/reaction cells) of the study subjects after obtaining permission from their parents and the school authority. Results: Data were cross-checked and frequency distribution and association using chi-square test was accomplished. Background information depicted majority (69.1%) of the children aged10-11 years (mean = 10.25 ±1.177 yrs), female (51.2%), parents having primary level of education or below (73.8% in case of father and 77.4% in mother) and from lower socioeconomics (78.6% earned BDT 10,000 or below per month). Among all, majority (56%) were found to be moron, 27.4% in borderline, while 8.3% were imbecile with the same proportion with normal level. By their blood lead level. Majority (70.2%) had blood lead level up to 10 microgram/dl and the rest (29.8%) had more than 10 microgram/dl. Though no statistically significant association was found between IQ level of the children and their blood lead level (p&gt;0.05), the health problems found among the respondents as abdominal pain (53.57%), impatience (14.29%), nausea (10.71%) and all other problems (loss of concentration to study, ear problem, anorexia and loss of weight) amounting for 21.43% are suggestive of chronic lead poisoning. Conclusion:Further studies in large scale with larger samples including comparative studies of inter-industrial areas have been strongly recommended. DOI: http://dx.doi.org/10.3329/bjms.v11i4.12599 Bangladesh Journal of Medical Science Vol. 11 No. 04 Oct’12  </jats:p

Economic Evaluation of a Pre-Hospital Protocol for Patients with Suspected Acute Stroke

BackgroundIn regional and rural Australia, patients experiencing ischemic stroke do not have equitable access to an intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA.AimTo describe the potential cost-effectiveness of the pre-hospital acute stroke triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a primary stroke center (PSC) in regional New South Wales, Australia.Materials and methodsThe PAST protocol was evaluated using a prospective and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention), patient data were collected prospectively at the PSC. Control patients included two groups (i) patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, (ii) patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs) averted in the intervention period compared to the control period.ResultsThe intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42–31.2, p &lt; 0.05) and the majority of the associated costs were incurred during acute care and rehabilitation. Overall, the intervention was associated with an estimated net avoidance of 93.3 DALYs. The estimated average cost per DALY averted per patient in the intervention group compared to the control group was $10,921.ConclusionBased on our simulation modeling, the pre-hospital triage intervention was a potentially cost-effective strategy for improving access to tPA therapy for patients with ischemic stroke in regional Australia