Rumours and social stigma as barriers to the prevention of coronavirus disease (COVID-19) : what solutions to consider?

Globally, multiple factors have elevated the risk and contributed to the fast spread of COVID-19. Alongside this, unsolicited rumours and social stigma are believed to be two possible barriers to the effective prevention of the disease. Despite measures taken, rumours and social stigma related to COVID-19 tend to increase globally. Several studies document that rumours and social stigma may fuel the risk and rapid spread of COVID-19. However, how these rumours and social stigma act as barriers to the prevention of the COVID-19 outbreak remain unclear. This article aims to discuss how rumours and social stigma can undermine the preventive and clinical efforts to fight against the spread of COVID-19 and suggest potential policy implications for addressing rumours and social stigma and optimising preventive efforts. A narrative review of secondary sources of data, including published studies, grey literature and authentic press reports was conducted. The analysis indicates that unverified rumours associated with COVID-19 may weaken people’s preparedness for a new infectious disease by driving them to wrong treatment and preventing them from adhering to evidence-based medical suggestions and treatment. Findings also suggest that social stigma may reduce healthcare workers’ agency and self-respect to provide support, treatment and care for those with COVID-19. Social stigma may also constrain participation in screening, testing, quarantine, isolation, and treatment of the disease. This article offers six potential policy pathways and emphasises the national and international coordination of all stakeholders for addressing rumours and social stigma associated with COVID-19

eHealth and mHealth initiatives in Bangladesh: A scoping study

BACKGROUND: The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential. METHODS: This scoping study applies a combination of research tools to explore 26 eHealth and mHealth initiatives in Bangladesh. A screening matrix was developed by modifying the framework of Arksey & O’Malley, further complemented by case study and SWOT analysis to identify common traits among the selected interventions. The WHO health system building blocks approach was then used for thematic analysis of these traits. RESULTS: Findings suggest that most eHealth and mHealth initiatives have proliferated within the private sector, using mobile phones. The most common initiatives include tele-consultation, prescription and referral. While a minority of projects have a monitoring and evaluation framework, less than a quarter have undertaken evaluation. Most of the initiatives use a health management information system (HMIS) to monitor implementation. However, these do not provide for effective sharing of information and interconnectedness among the various actors. There are extremely few individuals with eHealth training in Bangladesh and there is a strong demand for capacity building and experience sharing, especially for implementation and policy making. There is also a lack of research evidence on how to design interventions to meet the needs of the population and on potential benefits. CONCLUSION: This study concludes that Bangladesh needs considerable preparation and planning to sustain eHealth and mHealth initiatives successfully. Additional formative and operational research is essential to explore the true potential of the technology. Frameworks for regulation in regards to eHealth governance should be the aim of future research on the integration of eHealth and mHealth into the Bangladesh health system.DFI

Sedentary behaviour and theory- and evidence-informed intervention features to reduce occupational sitting time in Bangladesh : A mixed-methods study

Research on sedentary behaviour, a cardiovascular disease (CVD) risk factor, focuses predominantly on developed countries with little undertaken in low-and-middle-income countries (LMIC). The aim of this thesis is to measure sedentary behaviour in desk-based workers and to develop a concept of a theory-based behaviour change intervention to reduce prolonged occupational sitting time (OST) in Bangladesh. Using a mixed-methods approach, findings from three primary studies were collated. The first study was a cross-sectional survey (n=360 participants) conducted in three workplaces. Regression analyses were used to examine the association of individual level factors with total sedentary time and OST. In the second study, a scoping review (n=43) on workplace health promotion (WHP) interventions for CVD in LMICs was conducted to inform the research, then a descriptive qualitative study was employed to understand the socioecological factors of implementing WHP programs. The third study utilised qualitative methods to identify factors influencing breaking up prolonged OST. Finally, intervention features were developed applying the Behaviour Change Wheel framework. We found total sedentary time to be 9.6 hours/day (SD±2.35) of which half occurred in workplaces. Significant differences in OST were found by sex, income, worksite, and sitting break pattern. All participants showed enthusiasm for the idea of WHP, but the complexities of implementation were poorly understood. Limited awareness of the health consequences of prolonged sitting, work type, productivity concerns, and perceived negative judgement by others were reported as barriers to interrupting prolonged OST. Findings suggest that multiple levels of behaviour (intrapersonal, inter-personal, organisational and societal) must be addressed in designing interventions for OST. Twenty-five behaviour change techniques were identified and translated for delivery through a mobile phone application. The research found that sedentary behaviour is high among desk-based workers in Bangladesh. Given Bangladesh’s rapid urbanisation and growing burden of CVD, more research is required into its risk factors for behaviour change. By identifying opportunities for reducing OST in Bangladesh, this thesis contributes to public health evidence and proposes a potential intervention for LMICs. The recommendations offered will strengthen policy and programs to initiate WHP to tackle the increasing burden of CVD in Bangladesh and similar settings

Making information and communications technologies (ICTs) work for health: protocol for a mixed-methods study exploring processes for institutionalising geo-referenced health information systems to strengthen maternal neonatal and child health (MNCH) service planning, referral and oversight in urban Bangladesh

Introduction Disparities in health outcomes and access to maternal neonatal and child health (MNCH) are apparent among urban poor compared with national, rural or urban averages. A fundamental first step in addressing inequities in MNCH services is knowing what services exist in urban areas, where these are located, who provides them and who uses them. This study aims to institutionalise the Urban Health Atlas (UHA)—a novel information and communications technology (ICT) tool—to strengthen health service delivery and oversight and generate critical evidence to inform health policy and planning in urban Bangladesh.Methods and analysis This mixed-method implementation research will be conducted in four purposively selected urban sites representing larger and smaller cities. Research activities will include an assessment of information needs and task review analysis of information users, stakeholder mapping and cost estimation. To document stakeholder perceptions and experiences, key informant interviews and in-depth interviews will be conducted along with desk reviews to understand MNCH planning and referral decisions. The UHA will be refined to increase responsiveness to user needs and capacities, and hands-on training will be provided to health managers. Cost estimation will be conducted to assess the financial implications of UHA uptake and scale-up. Systematic documentation of the implementation process will be undertaken. Policy decision-making and ICT health policy process flowcharts will be prepared using desk reviews and qualitative interviews. Thematic analysis of qualitative data will involve both emergent and a priori coding guided by WHO PATH toolkit and Policy Engagement Framework. Stakeholder analysis will apply standard techniques and measurement scales. Descriptive analysis of quantitative data and cost estimation analysis will also be performed.Ethics and dissemination The study has been approved by the Institutional Review Board of icddr,b (# PR-16057). Study findings will be disseminated through national and international workshops, conferences, policy briefs and peer-reviewed publications

Improving quality of care for maternal and newborn health: a pre-post evaluation of the Safe Childbirth Checklist at a hospital in Bangladesh.

BackgroundBangladesh has achieved major gains in maternal and newborn survival, facility childbirth and skilled birth attendance between 1991 and 2010, but excess maternal mortality persists. High-quality maternal health care is necessary to address this burden. Implementation of WHO Safe Childbirth Checklist (SCC), whose items address the major causes of maternal deaths, is hypothesized to improve adherence of providers to essential childbirth practices.MethodThe SCC was adapted for the local context through expert consultation meetings, creating a total of 27 checklist items. This study was a pre-post evaluation of SCC implementation. Data were collected over 8 months at Magura District Hospital. We analysed 468 direct observations of birth (main analysis using 310 complete observations and sensitivity analysis with the additional 158 incomplete observations) from admission to discharge. The primary outcome of interest was the number of essential childbirth practices performed before compared to after SCC implementation. The change was assessed using adjusted Poisson regression models accounting for clustering by nurse-midwives.ResultAfter checklist introduction, significant improvements were observed: on average, around 70% more of these safe childbirth practices were performed in the follow-up period compared to baseline (from 11 to 19 out of 27 practices). Substantial increases were seen in communication between nurse-midwives and mothers (counselling), and in management of complications (including rational use of medicines). In multivariable models that included characteristics of the mothers and of the nurse-midwives, the rate of delivering the essential childbirth practices was 1.71 times greater in the follow-up compared to baseline (95% CI 1.61-1.81).ConclusionImplementation of SCC has the potential to improve essential childbirth practice in resource-poor settings like Bangladesh. This study emphasizes the need for health system strengthening in order to achieve the full advantages of SCC implementation

Healthcare seeking for chronic illness among adult slum dwellers in Bangladesh: A descriptive cross-sectional study in two urban settings.

IntroductionAccompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country's goal of Universal Health Coverage by 2030.MethodsThis descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed.ResultsSignificant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet.ConclusionsStudy results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost

Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh.

Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city's slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh's policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas