Health system impact of COVID-19 on urban slum population of Bangladesh: a mixed-method rapid assessment study

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Design Setting and participants A cross-sectional survey among 476 households was conducted during October–December 2020 in five selected urban slums of Dhaka North, Dhaka South and Gazipur City Corporation. In-depth interviews with purposively selected 22 slum dwellers and key informant interviews with 16 local healthcare providers and four policymakers and technical experts were also conducted. Outcome measures Percentage of people suffering from general illness, percentage of people suffering from chronic illness, percentage of people seeking healthcare, percentage of people seeking maternal care, health system challenges resulting from COVID-19. Results About 12% of members suffered from general illness and 25% reported chronic illness. Over 80% sought healthcare and the majority sought care from informal healthcare providers. 39% of the recently delivered women sought healthcare in 3 months preceding the survey. An overall reduction in healthcare use was reported during the lockdown period compared with prepandemic time. Mismanagement and inefficient use of resources were reported as challenges of health financing during the pandemic. Health information sharing was inadequate at the urban slums, resulting from the lack of community and stakeholder engagement (51% received COVID-19-related information, 49% of respondents knew about the national hotline number for COVID-19 treatment). Shortage of human resources for health was reported to be acute during the pandemic, resulting from the shortage of specialist doctors and uneven distribution of health workforce. COVID-19 test was inadequate due to the lack of adequate test facilities and stigma associated with COVID-19. Lack of strong leadership and stakeholder engagement was seen as the barriers to effective pandemic management. Conclusion The findings of the current study are expected to support the government in tailoring interventions and allocating resources more efficiently and timely during a pandemic.https://doi.org/10.1136/bmjopen-2021-05740212pubpub

Challenges of promoting physical activity among school children in urban Bangladesh: A qualitative inquiry.

INTRODUCTION:Physical activity (PA) confers a multitude of health benefits. Unfortunately, Bangladeshi school children get little PA. The current study assessed the barriers to promoting PA from the perspectives of school authorities and parents in urban Bangladesh. MATERIALS AND METHODS:This study was conducted between January-June 2018 in Dhaka city. Fourteen schools were sampled to represent different school types. We used qualitative methods: 14 key Informant interviews (teachers), six focus group discussions (parents), and 14 observations of school environments. Thematic analysis was performed. RESULTS:PA was not prioritized at most schools for two primary reasons: 1) there was a general lack of understanding of the importance of PA; and 2) physical education classes did not contribute to grades. Little time and resources were allotted for physical education classes because little priority was given to PA by school authorities. Outside school, lack of adequate safe open spaces undermined access to PA. Further, there were social barriers to PA including lack of parental support due to concerns about tiredness and injury and the perception that PA was detrimental to academic achievement. Many parents chose screen-based activities for children over PA. CONCLUSION:Despite policies that mandate PA, PA lost out to school and parental priorities for academic achievement. Parental concerns about tiredness, injury and safe spaces impeded children's access to PA outside of school. Steps should be taken to enforce existing policies that mandate effective PA for school children, and parents and teachers should be educated about the need for and benefits of PA

Qualitative exploration of the impact of COVID-19 on the food environment of urban informal settlements of Dhaka, Bangladesh

Objective Our study explored the impact of the COVID-19 pandemic on the food environment from the perspective of the urban poor and food vendors.Design This was a qualitative study conducted during September 2020 and February 2021.Setting The study was carried out in two purposively selected informal settlements of Dhaka City, Bangladesh.Participants We conducted 21 in-depth interviews with residents of informal settlements and 10 key informant interviews with food vendors and food aid workers.Result The availability of staple foods was not disrupted during the pandemic but some perishables foods became more expensive due to supply chain disruptions and increased transportation costs. Limited market hours affected market access and mobility restrictions adversely affected local vendors. Cart vendors selling perishables incurred business losses they could ill afford. Demand for food reduced as employment disruption lead to reduced purchasing power and, therefore, reduction of quantity, quality and desirability of foods purchased. Respondents reported skipping meals and going hungry. The aid received was considered inadequate to meet needs.Conclusion The food environment of the urban poor was disrupted from both supply and demand sides and the organisational response (both government and non-government) was severely inadequate. The social safety net needs to be extended and redesigned to ensure food security and health for the urban working poor in the future

The willingness to receive sexually transmitted infection services from public healthcare facilities among key populations at risk for human immunodeficiency virus infection in Bangladesh: A qualitative study.

BACKGROUND:In Bangladesh, community-based and peer-led prevention interventions for human immunodeficiency virus infection are provided to key populations (KPs) by drop-in centers (DICs), which are primarily supported by external donors. This intervention approach was adopted because public healthcare facilities were reportedly insensitive to the needs and culture of KPs, particularly with regard to the provision of sexually transmitted infection (STI) services. Nonetheless, in the absence of external funding, STI services need to be integrated into public healthcare systems. METHODS:A qualitative study was conducted in 2017 to understand the willingness of KPs to uptake the STI services of public healthcare facilities. Data were collected based on 34 in-depth interviews, 11 focus group discussions, and 9 key informant interviews. The social-ecological theoretical framework was used to analyze the data thematically and contextually. RESULTS:Most participants were either resistant or reluctant to uptake STI services from public healthcare facilities because of their previous firsthand experiences (e.g., disrespectful and judgmental attitudes and behaviors), perceived discrimination, anticipatory fear, and a lack of privacy. Very few participants who had visited these facilities to receive STI services were motivated to revisit them. Nevertheless, they emphasized their comfort in DICs over public healthcare facilities. Thus, it appears that KPs can be situated along a care-seeking continuum (i.e., resistance to complete willingness). Unless policymakers understand the context and reasons that underlie their movement along this continuum, it would be difficult to encourage KPs to access STI services from public healthcare facilities. CONCLUSION:KPs' willingness to uptake the STI services of public healthcare facilities depends not only on individual and community experiences but also on the nexus between socio-structural factors and health inequalities. Community mobilization and training about the needs and culture of KPs for healthcare professionals are essential. Therefore, addressal of a wide range of structural factors is required to motivate KPs into seeking STI services from public healthcare facilities