Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics

Objective: The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries. Methods: A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0–18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information. Results: About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children. Conclusion: Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parent's education a national burn prevention program needs to be developed to combat the devastating child injury, burn

The Horizon of Unintentional Injuries among Children in Low-Income Setting: An Overview from Bangladesh Health and Injury Survey

Introduction. The paper aims to explore the magnitude and distribution of unintentional injuries among Bangladeshi children (<18 years). Methodology. A cross sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising of 351 651 children of under 18 years. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. Results. There were 351651 children in the study, of which 5577 had one or more injuries in the past one year. Drowning and falls was the leading cause of injury mortality and morbidity in children over 1 year of age respectively. Incidence of unintentional injuries was significantly higher among boys (95% CI = −2157.8) than girls (95% CI = 968.7 − 1085.8) while rural children were the most vulnerable group. Home and its premises was the most common place for the injury incidence. Conclusion. The result of the study could be an insight to the policy makers to develop realistic and effective strategies to address the issue

Consequences of childhood burn: Findings from the largest community-based injury survey in Bangladesh

In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10– 14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be $462. In this study it was found that more than 61$50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority

Improving household surveys and use of data to address health inequities in three Asian cities: protocol for the Surveys for Urban Equity (SUE) mixed methods and feasibility study

Introduction: As rapid urbanisation transforms the sociodemographic structures within cities, standard survey methods, which have remained unchanged for many years, under-represent the urban poorest. This leads to an overly positive picture of urban health, distorting appropriate allocation of resources between rural and urban and within urban areas. Here, we present a protocol for our study which (i) tests novel methods to improve representation of urban populations in household surveys and measure mental health and injuries, (ii) explores urban poverty and compares measures of poverty and ‘slumness’ and (iii) works with city authorities to understand, and potentially improve, utilisation of data on urban health for planning more equitable services. Methods and analysis: We will conduct household surveys in Kathmandu, Hanoi and Dhaka to test novel methods: (i) gridded population sampling; (ii) enumeration using open-access online maps and (iii) one-stage versus two-stage cluster sampling. We will test reliability of an observational tool to categorise neighbourhoods as slum areas. Within the survey, we will assess the appropriateness of a short set of questions to measure depression and injuries. Questionnaire data will also be used to compare asset-based, consumption-based and income-based measures of poverty. Participatory methods will identify perceptions of wealth in two communities in each city. The analysis will combine quantitative and qualitative findings to recommend appropriate measures of poverty in urban areas. We will conduct qualitative interviews and establish communities of practice with government staff in each city on use of data for planning. Framework approach will be used to analyse qualitative data allowing comparison across city settings. Ethics and dissemination: Ethical approvals have been granted by ethics committees from the UK, Nepal, Bangladesh and Vietnam. Findings will be disseminated through conference papers, peer-reviewed open access articles and workshops with policy-makers and survey experts in Kathmandu, Hanoi and Dhaka

Pattern of childhood burn injuries and their management outcome at Bugando Medical Centre in Northwestern Tanzania

Burn injuries constitute a major public health problem and are the leading cause of childhood morbidity and mortality worldwide. There is paucity of published data on childhood burn injuries in Tanzania, particularly the study area. This study was conducted to describe the pattern of childhood burn injuries in our local setting and to evaluate their management outcome. A cross sectional study was conducted at Bugando Medical Centre (in Northwestern Tanzania) over a 3-year period from January 2008 to December 2010. Data was collected using a pre-tested coded questionnaire and statistical analyses performed using SPSS software version 15.0. A total of 342 burned children were studied. Males were mainly affected. Children aged = 2 were the majority accounting for 45.9% of cases. Intentional burn injuries due to child abuse were reported in 2.9% of cases. Scald was the most common type of burns (56.1%). The trunk was the most commonly involved body region (57.3%). Majority of patients (48.0%) sustained superficial burns. Eight (2.3%) patients were HIV positive. Most patients (89.8%) presented to the hospital later than 24 h. The rate of burn wound infection on admission and on 10th day were 32.4% and 39.8% respectively.Staphylococcus aureus were more common on admission wound swabs, with Pseudomonas aeruginosa becoming more evident after 10th day. MRSA was detected in 19.2% of Staphylococcus aureus. Conservative treatment was performed in 87.1% of cases. Surgical treatment mainly skin grafting (65.9%) was performed in 44 (12.9%) of patients. The overall average of the length of hospital stay (LOS) was 22.12 ± 16.62 days. Mortality rate was 11.7%. Using multivariate logistic regression analysis; age of the patient, type of burn, delayed presentation, clothing ignition, %TBSA and severity of burn were found to be significantly associated with LOS (P < 0.001), whereas mortality rate was found to be independently and significantly related to the age of the patient, type of burn, HIV positive with stigmata of AIDS, CD4 count, inhalation injury, %TBSA and severity of burn (P < 0.001). Childhood burn injuries still remain a menace in our environment with virtually unacceptable high morbidity and mortality. There is need for critical appraisal of the preventive measures and management principles currently being practiced

Consequences of non-fatal electrical injury: Findings of community-based national survey in Bangladesh

This study was designed to document the consequences of electrical injury in Bangladesh. A community based cross-sectional survey was conducted from January to December 2003. Nationally representative data were collected from 171,366 rural and urban households, comprising a total of 819,429 population. Face-to-face interview was chosen as a data collection method. The overall rate of electrical injury was 73.7 per 100,000 population-year. The rate of permanent disability due to electrical injury in Bangladesh was 0.366 per 100,000 population-year. Among the total 604 non-fatal electrical injuries in the survey, 282 (46.7%) had suffered from temporary disabilities for different durations. A total of 172 students were injured from electrical injury and among them 139 (80.8%) missed school for different durations due to their illness. Mean duration of absence from school was 9.72 days (SD 10.98), ranging from 1 to 45 days. Among the working people average duration of work loss was 10.56 days (SD 14.98), ranging from 1 to 90 days. About 39% of the total patients with electrical injury were contributors to their family income. For each family the expenditure for each seriously injured patient due to electrical injury was USD 271. Electrical Injury is a major cause of morbidity in Bangladesh. It is responsible for significant loss of school days and work days and creating serious health and economic hardship for the inflicted families. A nationwide prevention program needs to be developed to address this problem

Epidemiology and Outcomes of Burn Injuries at a Tertiary Burn Care Center in Bangladesh

Globally, burns are among some of the most devastating injuries and account for more than 265,000 deaths worldwide. In Bangladesh alone, nearly 3000 people die annually from burn-related injuries. This study was conducted at the National Institute of Burn and Plastic Surgery in Dhaka, Bangladesh in June of 2016. Data included conducting surveys of hospitalized burn patients (N=66) and a chart review of deceased burn patients (N=88). In addition to reporting on the demographic profile of patients, information was also obtained on clinical measures during hospitalization. For non-fatal burns, high risk groups included young adult males (early 30s) of lower socioeconomic status. Among children, the most vulnerable group was found to be children less than eight years old. The most common non-fatal types of burn injuries were flame (35%), electrical (31%) and scald (24%). Discharged patients had an average hospital stay of around 30days with half of all patients requiring surgical intervention, thus indicating the severity of those cases and the need for resource-intensive care. Among the discharged patient population, factors significantly associated with a longer duration of hospital stay included severity of injury, not having received prior treatment before admission and whether or not patients required surgery during hospitalization. Among the mortality cases, the high-risk groups also included young adult males and children of around eight years of age. The average total body surface area (TBSA) sustained in these cases was 46.4%, with 65% of deaths attributable to complications from flame burns. These findings highlight the frequency and severity of burn injuries, identify vulnerable population groups and list common causes of burns in this large developing country of 160 million people. Furthermore, these findings may be applicable to the epidemiology and outcome of burns in similar low and middle income countries

Social Inclusion and Sustainable Development: Findings from Seven African and Asian Contexts

Social inequities have widened divisions between diverse population groups. Inequity is associated with social exclusion, structural and physical violence and reduced development, which in turn are linked to civil unrest, conflict and adverse health and social outcomes. Public services are key institutions through which social inequities are created and maintained, but evidence on viable interventions to reduce institutional exclusion is limited for low- and middle-income (LMIC) contexts. We identify common drivers of institutional exclusion across diverse populations in LMICs and inclusion strategies that could potentially work across populations, public service sectors and country contexts. Seven studies engaged with over 385 key stakeholders in healthcare, education and local government settings in Bangladesh, Kazakhstan, Kenya, Myanmar, Nepal, Nigeria and Vietnam. Participatory research, in-depth interviews, policy reviews and multi-stakeholder workshops focused on a range of disadvantaged groups. A multi-sector partnership co-produced recommendations at each site. Findings were synthesised to identify common themes and a framework for social inclusion across disadvantaged populations. The invisibility of disadvantaged communities in public service planning and delivery processes helped maintain their exclusion from opportunities and resources. A spectrum of neglect, restrictions and discriminatory practice reflected structural violence linked to poor life chances, illness, physical abuse and death. Key recommendations include the representation of disadvantaged groups in service staffing and decision-making and the transformation of public service policy and practice to develop inclusive, targeted, collaborative and accountable systems

Initial community response to a childhood drowning prevention programme in a rural setting in Bangladesh

Objectives To describe the development, community acceptability, feasibility, and sustainability of a pilot drowning prevention intervention for rural children, 1-4 years old, in Bangladesh. Methods A prevention package was formulated and piloted in four rural communities of Bangladesh for 3 months. Focus group discussions and in-depth interviews were organised with stakeholders to elicit community acceptability, feasibility, and sustainability of the proposed interventions. Results Increased supervision of children, raising awareness on water safety, and educating the community on first response skills were the three core aspects identified through workshops to include in the intervention package. During development of interventions emphasis was given to finding low-cost local resources. To increase child supervision, creation of drowning-safe homes and establishment of community cre`ches were identified. To create heightened water safety, formation of village committees and conduction of courtyard and social autopsy meetings with communities were considered. The community actively participated and considered that these interventions would be useful for prevention of child drowning. There was also an increasing demand for some of these interventions. Conclusion Use of low-cost local resources, community participation, and increasing demand of the interventions indicated that the package was acceptable, feasible, and sustainable to the community. To determine the effectiveness of the package demands implementation on a larger sampl

Assessing service availability and readiness to manage cervical cancer in Bangladesh

Background: The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. Methods: An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. Results: There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. Conclusion: The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.