Impact of contraceptive counselling training among counsellors participating in the FIGO postpartum intrauterine device initiative in Bangladesh.

OBJECTIVE: To evaluate the impact of structured training given to dedicated family planning counsellors on postpartum intrauterine device (PPIUD) services across six tertiary hospitals in Bangladesh. METHODS: Family planning counsellors underwent structured training on postpartum family planning, PPIUD in particular, over a four-day period. Impact of training was evaluated by comparing PPIUD counselling rates, consent rates, insertion rates, and removal rates five months before and five months after the training, using data from women delivering in the participating facilities. RESULTS: A total of 27 622 women were included in this analysis: 11 263 (40.8%) before the training intervention and 16 359 (59.2%) after it. There was an increase in the proportion of women who were counselled (from 75.3% to 83.8%, P<0.001), and a small decrease in the proportion of women agreeing to have a PPIUD inserted following counselling (13.7% vs 12.9%, P=0.03). Overall insertion rate was similar before and after training (9.5% vs 9.8%, P=0.42), while removal rate reduced from 2.8% to 1.8% (P=0.41). CONCLUSION: Structured training had no impact on overall PPIUD insertion rate. However, it did impact numbers of women receiving counselling, perceived quality of the counselling received, and overall removal rates

Bangladesh Health Service Delivery: Innovative NGO and Private Sector Partnerships

The recent health service delivery achievements in Bangladesh have been attributed, in part, to partnerships between the government and non?state actors and the early and rapid adoption of innovations. Through the analysis of two case studies, this article examines the factors contributing to successful partnerships for health market innovations in Bangladesh and the extent to which these innovations can contribute to market systems changes that benefit the poor. The first case examines an innovation which aims to address maternal and child health issues by creating access to information on prenatal and post?natal care through mobile phones. The other case illustrates how Bangladesh's leading NGO partnered with one of the largest pharmaceutical companies in Bangladesh to develop a model for rural distribution of a micronutrient food supplement, ‘sprinkles’, to tackle the problem of micronutrient deficiency in young children

Agriculture and Nutrition in Bangladesh: Mapping Evidence to Pathways

Background: Although much work has been done on the theoretical links between agriculture and nutrition, there is limited understanding of the evidence from observational and experimental research studies on the impacts of agriculture programs on nutrition outcomes. Objective: To assess the emphasis of the literature on different agriculture–nutrition pathways in Bangladesh. Methods: Twenty databases and Web sites were searched, yielding more than 2400 resources that were pared down through an iterative, eliminative process to 60 articles. These articles were then rated for quality and mapped to 1 of the 6 agriculture–nutrition pathways. Results: The body of evidence reveals gaps in knowledge in all of the pathways, but especially in the areas of agriculture as a source of livelihoods, and women’s role as intermediaries between agriculture and good nutrition and health within their household. Conclusion: More research is needed on the links between agriculture and nutrition in country-specific settings, particularly as regards the role of women. Nutrition-related outcomes, such as dietary diversity and women’s empowerment, need to be measured more explicitly when evaluating the impact of agricultural production systems and development initiatives.Department for International Development (DFID)UKAI

Integrating a diabetes and hypertension case management package within primary health care: a mixed methods feasibility study in Bangladesh

Background: Almost three quarters of non-communicable disease (NCD) deaths, and 82% of premature NCD deaths, occur in low- and middle-income countries. Bangladesh has an estimated 7 million hypertensives and 10 million diabetics, and primary care is struggling to respond. Our aim was to develop and support implementation of a diabetes and hypertension case management package, and assess its appropriateness, feasibility and acceptability in two NCD clinics within two primary-care centres in Bangladesh. Methods: We used a convergent mixed methods design. We first assessed the level of appropriate hypertension and cardiovascular disease patient management, based on a composite outcome indicator using data from patients’ treatment cards. Appropriate management was primarily informed by International Diabetes Federation (IDF) and World Health Organisation (WHO) guidelines. We then performed qualitative in-depth interviews with doctors and patients to explain these quantitative findings and to understand the challenges to achieving appropriate patient management in the NCD clinics. Results: Eighty-one newly diagnosed patients were recruited. Over 3 months, 53.1% (95% CI 42.3% to 63.6%) of patients were appropriately managed. We found incomplete diagnosis (especially missing hypertension diagnosis alongside diabetes) and non-provision of follow-up appointments were the main causes of the relatively low level of appropriate management. We conducted interviews with 11 patients and 8 health professionals and found a shortage of human resources, reporting materials, available drugs and diagnostic equipment. This undermined patients’ willingness to attend clinics and doctors’ willingness to offer follow-ups. Hands-on skill-building training was valuable in increasing doctors’ competence for appropriate management, but was seen as a novel training method and faced constraints to implementation. Conclusions: A clinical guide, skill-based training and recording package can be implemented in routine primary care and can lead to appropriate management of around half of diabetic and hypertensive patients in a low-income country. However, considerable health systems challenges must be addressed before more patients can be managed appropriately