The Boys Left Behind: Where Public Policy has Failed to Prevent Child Labour in Bangladesh

Poor boys have been left behind by public policy efforts to expand school access in Bangladesh – the same policies which have succeeded in attracting girls to school. This article draws on original research to explore the failure to tackle the exclusion of poor boys from school, arguing that paid work has become more attractive in a context in which education is of poor quality and there are no social sanctions against child labour. Recently there has been a shift of policy attention towards poor boys, amidst concerns about security, militancy and Islamic education. Given steady economic growth, poor boys may not necessarily inherit deeper poverty, but in the absence of state or social sanctions against child labour, they are likely to inherit a position at the lower end of the social scale

A cluster-randomized, placebo-controlled, maternal vitamin a or beta-carotene supplementation trial in bangladesh: design and methods

<p>Abstract</p> <p>Background</p> <p>We present the design, methods and population characteristics of a large community trial that assessed the efficacy of a weekly supplement containing vitamin A or beta-carotene, at recommended dietary levels, in reducing maternal mortality from early gestation through 12 weeks postpartum. We identify challenges faced and report solutions in implementing an intervention trial under low-resource, rural conditions, including the importance of population choice in promoting generalizability, maintaining rigorous data quality control to reduce inter- and intra- worker variation, and optimizing efficiencies in information and resources flow from and to the field.</p> <p>Methods</p> <p>This trial was a double-masked, cluster-randomized, dual intervention, placebo-controlled trial in a contiguous rural area of ~435 sq km with a population of ~650,000 in Gaibandha and Rangpur Districts of Northwestern Bangladesh. Approximately 120,000 married women of reproductive age underwent 5-weekly home surveillance, of whom ~60,000 were detected as pregnant, enrolled into the trial and gave birth to ~44,000 live-born infants. Upon enrollment, at ~ 9 weeks' gestation, pregnant women received a weekly oral supplement containing vitamin A (7000 ug retinol equivalents (RE)), beta-carotene (42 mg, or ~7000 ug RE) or a placebo through 12 weeks postpartum, according to prior randomized allocation of their cluster of residence. Systems described include enlistment and 5-weekly home surveillance for pregnancy based on menstrual history and urine testing, weekly supervised supplementation, periodic risk factor interviews, maternal and infant vital outcome monitoring, birth defect surveillance and clinical/biochemical substudies.</p> <p>Results</p> <p>The primary outcome was pregnancy-related mortality assessed for 3 months following parturition. Secondary outcomes included fetal loss due to miscarriage or stillbirth, infant mortality under three months of age, maternal obstetric and infectious morbidity, infant infectious morbidity, maternal and infant micronutrient status, fetal and infant growth and prematurity, external birth defects and postnatal infant growth to 3 months of age.</p> <p>Conclusion</p> <p>Aspects of study site selection and its "resonance" with national and rural qualities of Bangladesh, the trial's design, methods and allocation group comparability achieved by randomization, field procedures and innovative approaches to solving challenges in trial conduct are described and discussed. This trial is registered with <url>http://Clinicaltrials.gov</url> as protocol NCT00198822.</p

The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution

<p>Abstract</p> <p>Background</p> <p>Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007.</p> <p>Methods</p> <p>The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward.</p> <p>Results</p> <p>HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers.</p> <p>Conclusions</p> <p>Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.</p

Integrated assessment of social and environmental sustainability dynamics in the Ganges-Brahmaputra-Meghna delta, Bangladesh

Deltas provide diverse ecosystem services and benefits for their populations. At the same time, deltas are also recognised as one of the most vulnerable coastal environments, with a range of drivers operating at multiple scales, from global climate change and sea-level rise to deltaic-scale subsidence and land cover change. These drivers threaten these ecosystem services, which often provide livelihoods for the poorest communities in these regions. The imperative to maintain ecosystem services presents a development challenge: how to develop deltaic areas in ways that are sustainable and benefit all residents including the most vulnerable. Here we present an integrated framework to analyse changing ecosystem services in deltas and the implications for human well-being, focussing in particular on the provisioning ecosystem services of agriculture, inland and offshore capture fisheries, aquaculture and mangroves that directly support livelihoods. The framework is applied to the world’s most populated delta, the Ganges-Brahmaputra-Meghna Delta within Bangladesh. The framework adopts a systemic perspective to represent the principal biophysical and socio-ecological components and their interaction. A range of methods are integrated within a quantitative framework, including biophysical and socio-economic modelling and analyses of governance through scenario development. The approach is iterative, with learning both within the project team and with national policy-making stakeholders. The analysis is used to explore physical and social outcomes for the delta under different scenarios and policy choices. We consider how the approach is transferable to other deltas and potentially other coastal areas

Projecting marine fish production and catch potential in Bangladesh in the 21st century under long-term environmental change and management scenarios

The fisheries sector is crucial to the Bangladeshi economy and wellbeing, accounting for 4.4% of national Gross Domestic Product (GDP) and 22.8% of agriculture sector production, and supplying ca.60% of the national animal protein intake. Fish is vital to the 16 million Bangladeshis living near the coast, a number that has doubled since the 1980s. Here we develop and apply tools to project the long term productive capacity of Bangladesh marine fisheries under climate and fisheries management scenarios, based on downscaling a global climate model, using associated river flow and nutrient loading estimates, projecting high resolution changes in physical and biochemical ocean properties, and eventually projecting fish production and catch potential under different fishing mortality targets. We place particular interest on Hilsa shad (Tenualosa ilisha), which accounts for ca.11% of total catches, and Bombay duck (Harpadon nehereus), a low price fish that is the second highest catch in Bangladesh and is highly consumed by low income communities. It is concluded that the impacts of climate change, under greenhouse emissions scenario A1B, are likely to reduce the potential fish production in the Bangladesh Exclusive Economic Zone (EEZ) by less than 10%. However, these impacts are larger for the two target species. Under sustainable management practices we expect Hilsa shad catches to show a minor decline in potential catch by 2030 but a significant (25%) decline by 2060. However, if overexploitation is allowed catches are projected to fall much further, by almost 95% by 2060, compared to the Business as Usual scenario for the start of the 21st century. For Bombay duck, potential catches by 2060 under sustainable scenarios will produce a decline of less than 20% compared to current catches. The results demonstrate that management can mitigate or exacerbate the effects of climate change on ecosystem productivity