Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh demographic and health survey 2014 data

BACKGROUND:Caesarean section (CS) has been on the rise worldwide and Bangladesh is no exception. In Bangladesh, the CS rate, which includes both institutional and community-based deliveries, has increased from about 3% in 2000 to about 24% in 2014. This study examines the association of reported complications around delivery and socio-demographic, healthcare and spatial characteristics of mothers with CS, using data from the latest Bangladesh Demographic and Health Survey (BDHS). METHODS:The study is based on data from the 2014 BDHS. BDHS is a nationally representative survey which is conducted periodically and 2014 is the latest of the BDHS conducted. Data collected from 4,627 mothers who gave birth in health care institutions in three years preceding the survey were used in this study. RESULTS:Average age of the mothers was 24.6 years, while their average years of schooling were 3.2. Factors like mother being older, obese, residing in urban areas, first birth, maternal perception of large newborn size, husband being a professional, had higher number of antenatal care (ANC) visits, seeking ANC from private providers, and delivering in a private facility were statistically associated with higher rates of CS. CONCLUSIONS:Bangladesh health system urgently needs policy guideline with monitoring of clinical indications of CS deliveries to avoid unnecessary CS. Strict adherence to this guideline, along with enhance knowledge on the unsafe nature of the unnecessary CS can achieve increased institutional normal delivery in future; otherwise, an emergency procedure may end up being a lucrative practice

A Preliminary Survey of the Fruit Flies (Diptera: Tephritidae: Dacinae) of Bangladesh

Thirteen species of Bactrocera and one species of Dacus were collected during field surveys in Bangladesh, including eight new country records, for a total of fifteen species confirmed to occur in the country. Color variation in Bangladesh B. dorsalis is similar to that observed in B. invadens in Africa and Sri Lanka

Seasonal Abundance of Economically Important Fruit Flies (Diptera: Tephritidae: Dacinae) in Bangladesh, in Relation to Abiotic Factors and Host Plants

Fruit fly monitoring traps baited with male lures (cue lure, methyl eugenol, zingerone) were maintained for two years (Nov 2016–Oct 2018) at ten sites (reduced to three on year two), in village-style subsistence agriculture envi- ronments, at the Atomic Energy Research Establishment campus, Savar, Dhaka, Bangladesh. A total of 15 species and 135,034 flies were collected, dominated by polyphagous fruit pest Bactrocera dorsalis (58.0% of all trapped flies), cu- curbit pests Zeugodacus cucurbitae (23.6%) and Z. tau (13.5%), and non-pest B. rubigina (3.6%). Three other pest species, collected in much smaller numbers, were polyphagous fruit pests B. zonata and B. correcta and cucurbit pest Dacus longicornis. Data was used to document the seasonal abundance of the above- mentioned species, in relation to host fruit availability and abiotic factors. Seasonal abundance of B. dorsalis, with peaks during wet summer months, was positively correlated with rainfall (r=0.70), temperature (r=0.66) and host availability (r=0.72). Seasonal trends in captures of B. zonata and B. rubigina were similar to those of B. dorsalis. Captures of Z. cucurbitae peaked in March 2017, early in the rainy season, and May 2018, in the middle of the rainy summer season, with no clear correlation with rainfall, humidity, or host availability. Captures of the two other cucurbit pests were inversely related to rainfall, with abundance peaks during the dry winter months. Data on seasonal abundance of these species will be utilized in formulating an area-wide pest management strategy in the agro-ecological system under consideration

Additions to the Fruit Fly Fauna (Diptera: Tephritidae: Dacinae) of Bangladesh, with a Key to the Species

Five species of Bactrocera are reported to occur in Bangladesh for the first time. The species previously recorded as B. nigrofemoralis is actually B. nigrifacia. An illustrated key to the nineteen species known to occur in the country, plus B. nigrofemoralis, is provided

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh

BackgroundDespite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children’s Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization.MethodTwo surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index.ResultsMean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370).ConclusionsOverall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups. Maternal health programs, if properly designed and implemented, can improve access, partially overcoming the negative effects of socioeconomic disparities

Comparative study to access coagulation abnormalities in breast cancer

Background: Coagulation abnormalities such as thrombosis and disseminated intravascular coagulation (DIC) are the major factors that play a major role in breast cancer. In this study, coagulation abnormalities were assessed in breast cancer patients to help the clinician in early detection of DIC and management of patients at different stages of breast cancer.Methods: 75 patients were enrolled in the study, 50 were from case group (breast cancer patients) and 25 were selected as control group subjects used to compare the results. All of these subjects undergone, General Hematological analysis i.e. differential leukocyte count hemoglobin, platelets count and total leukocyte count were performed on each of the samples collected from the subjects and Specific Hematological analysis i.e. Activated Partial Thromboplastin Time (APTT), Fibrinogen Assay, Prothrombin Time (PT), D-Dimer Detection and Fibrin Degradation Products (FDPs).Results: PT was found to be comparable in patients with breast cancer when compared with controls. Difference between control group (II) and subjects with breast cancer (I) was non-significant, fibrinogen level was found to be significantly increased (p < 0.01) in patients with different stages of breast cancer when compared with controls. FDPs were found to be significantly increased (p< 0.01) in patients of breast cancer when compared with control group. These increased levels of FDPs may be due to enhanced fibrinolysis. D-Dimers were also found to be significantly increased (p < 0.01) in patients with breast cancer when compared with controls.Conclusion: Patients with breast cancer were associated with compensated DIC state including normal PT and APTT level but increased fibrinogen and platelets count as compared to the controls. Detection of D-Dimers offers a differential analysis over other laboratory tests for DIC

Ever-increasing Caesarean section and its economic burden in Bangladesh

BackgroundCesarean Section (CS) delivery has been increasing rapidly worldwide and Bangladesh is no exception. In Bangladesh, the CS rate has increased from about 3% in 2000 to about 24% in 2014. This study examines trend in CS in Bangladesh over the last fifteen years and implications of this increasing CS rates on health care expenditures.MethodsBirth data from Bangladesh Demographic and Health Survey (BDHS) for the years 2000-2014 have been used for the trend analysis and 2010 Bangladesh Maternal Mortality Survey (BMMS) data were used for estimating health care expenditure associated with CS.ResultsAlthough the share of institutional deliveries increased four times over the years 2000 to 2014, the CS deliveries increased eightfold. In 2000, only 33% of institutional deliveries were conducted through CS and the rate increased to 63% in 2014. Average medical care expenditure for a CS delivery in Bangladesh was about BDT 22,085 (USD 276) in 2010 while the cost of a normal delivery was BDT 3,565 (USD 45). Health care expenditure due to CS deliveries accounted for about 66.5% of total expenditure on all deliveries in Bangladesh in 2010. About 10.3% of Total Health Expenditure (THE) in 2010 was due to delivery costs, while CS costs contribute to 6.9% of THE and rapid increase in CS deliveries will mean that delivering babies will represent even a higher proportion of THE in the future despite declining crude birth rate.ConclusionHigh CS delivery rate and the negative health outcomes associated with the procedure on mothers and child births incur huge economic burden on the families. This is creating inappropriate allocation of scarce resources in the poor economy like Bangladesh. Therefore it is important to control this unnecessary CS practices by the health providers by introducing litigation and special guidelines in the health policy

Estimating Catastrophic Costs due to Pulmonary Tuberculosis in Bangladesh

To eliminate TB from the country by the year 2030, the Bangladesh National Tuberculosis (TB) Program is providing free treatment to the TB patients since 1993. However, the patients are still to make Out-of-their Pocket (OOP) payment, particularly before their enrollment Directly Observed Treatment Short-course (DOTS). This places a significant economic burden on poor-households. We, therefore, aimed to estimate the Catastrophic Health Expenditure (CHE) due to TB as well as understand associated difficulties faced by the families when a productive family member age (15–55) suffers from TB. The majority of the OOP expenditures occur before enrolling in. We conducted a cross-sectional study using multistage sampling in the areas of Bangladesh where Building Resources Across Communities (BRAC) provided TB treatment during June 2016. In total, 900 new TB patients, aged 15–55 years, were randomly selected from a list collected from BRAC program. CHE was defined as the OOP payments that exceeded 10% of total consumption expenditure of the family and 40% of total non-food expenditure/capacity-to-pay. Regular and Bayesian simulation techniques with 10,000 replications of re-sampling with replacement were used to examine robustness of the study findings. We also used linear regression and logit model to identify the drivers of OOP payments and CHE, respectively. The average total cost-of-illness per patient was 124 US$, of which 68% was indirect cost. The average CHE was 4.3% of the total consumption and 3.1% of non-food expenditure among the surveyed households. The poorest quintile of the households experienced higher CHE than their richest counterpart, 5% vs. 1%. Multiple regression model showed that the risk of CHE increased among male patients with smear-negative TB and delayed enrolling in the DOTS. Findings suggested that specific groups are more vulnerable to CHE who needs to be brought under innovative safety-net schemes