Spatial and temporal dynamics of multidimensional well-being, livelihoods and ecosystem services in coastal Bangladesh.

Published onlineJournal ArticlePopulations in resource dependent economies gain well-being from the natural environment, in highly spatially and temporally variable patterns. To collect information on this, we designed and implemented a 1586-household quantitative survey in the southwest coastal zone of Bangladesh. Data were collected on material, subjective and health dimensions of well-being in the context of natural resource use, particularly agriculture, aquaculture, mangroves and fisheries. The questionnaire included questions on factors that mediate poverty outcomes: mobility and remittances; loans and micro-credit; environmental perceptions; shocks; and women's empowerment. The data are stratified by social-ecological system to take into account spatial dynamics and the survey was repeated with the same respondents three times within a year to incorporate seasonal dynamics. The dataset includes blood pressure measurements and height and weight of men, women and children. In addition, the household listing includes basic data on livelihoods and income for approximately 10,000 households. The dataset facilitates interdisciplinary research on spatial and temporal dynamics of well-being in the context of natural resource dependence in low income countries.The authors gratefully acknowledge the residents of Khulna and Barisal who gave up many hours of their time to be interviewed on multiple occasions. We are indebted to their generosity and patience. In addition we would like to acknowledge the important contribution of Tauhida Nasrin and colleagues at Associates for Community and Population Research and the team of enumerators who ensured the smooth implementation of the survey; Masfiqus Salehin and Rezaur Rahman at Bangladesh University of Engineering and Technology, Munir Ahmed at Technological Assistance for Rural Advancement and Hamidul Huq at University of Liberal Arts Bangladesh for their assistance in defining the social-ecological systems; Mahin Al Nahian for his assistance in implementing the survey; Rakin Muhtadee Shihab for completing the final translation of the questionnaire to Bengali; Munir Ahmed, Abir Ahammad Talukdar and Ali Mohammad Rezaie for assistance with qualitative fieldwork and pretesting; Abul Kashem Mohammad Hasan at the Center for Environmental and Geographic Information Services and Muhammad Zahirul Haq at icddr,b for the GIS work. The survey was part of the project Assessing Health, Livelihoods, Ecosystem Services And Poverty Alleviation In Populous Deltas (Espa Deltas; Grant No. NE/J000892/1), part of the Ecosystem Services for Poverty Alleviation (ESPA) programme. The ESPA programme is funded by the Department for International Development, the Economic and Social Research Council and the Natural Environment Research Council. Helen Adams had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis

Multi-dimensional well-being associated with economic dependence on ecosystem services in deltaic social-ecological systems of Bangladesh

This is the final version. Available on open access from Springer via the DOI in this recordWhile the benefits humans gain from ecosystem functions and processes are critical in natural resource-dependent societies with persistent poverty, ecosystem services as a pathway out of poverty remain an elusive goal, contingent on the ecosystem and mediated by social processes. Here, we investigate three emerging dimensions of the ecosystem service-poverty relationship: economic contribution of provisioning ecosystem services to the household livelihood mix, social-ecological systems producing different bundles of ecosystem services and material wealth versus reported life satisfaction. We analyse these relationships in Bangladesh, using data from a bespoke 1586-household survey, stratified by seven social-ecological systems in the delta coastal region. We create poverty lines to ensure comparability with traditional poverty measures that overlook environmental factors and subjective measurements of well-being. We find that any contribution of ecosystem service-based income to the livelihood mix decreases the likelihood of the incidence of poverty, and of individuals reporting dissatisfaction. We find no relationship between the incidence of material poverty and the specific social-ecological systems, from agriculture to fishery-dominated systems. However, the probability of the household head being dissatisfied was significantly associated with social-ecological system. Individuals living in areas dominated by export-oriented shrimp aquaculture reported lower levels of life satisfaction as an element of their perceived well-being. These results highlight the need for social policy on poverty that accounts for the diversity of outcomes across social-ecological systems, including subjective as well as material dimensions of well-being. National poverty reduction that degrades ecosystem services can have negative implications for the subjective well-being of local populations.Natural Environment Research Council (NERC)Economic and Social Research Council (ESRC)Department for International Developmen

Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites.

BACKGROUND: Mortality from external causes, of all kinds, is an important component of overall mortality on a global basis. However, these deaths, like others in Africa and Asia, are often not counted or documented on an individual basis. Overviews of the state of external cause mortality in Africa and Asia are therefore based on uncertain information. The INDEPTH Network maintains longitudinal surveillance, including cause of death, at population sites across Africa and Asia, which offers important opportunities to document external cause mortality at the population level across a range of settings. OBJECTIVE: To describe patterns of mortality from external causes at INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories. DESIGN: All deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 5,884 deaths due to external causes were documented over 11,828,253 person-years. Approximately one-quarter of those deaths were to children younger than 15 years. Causes of death were dominated by childhood drowning in Bangladesh, and by transport-related deaths and intentional injuries elsewhere. Detailed mortality rates are presented by cause of death, age group, and sex. CONCLUSIONS: The patterns of external cause mortality found here generally corresponded with expectations and other sources of information, but they fill some important gaps in population-based mortality data. They provide an important source of information to inform potentially preventive intervention designs

Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites.

BACKGROUND: Malaria continues to be a major cause of infectious disease mortality in tropical regions. However, deaths from malaria are most often not individually documented, and as a result overall understanding of malaria epidemiology is inadequate. INDEPTH Network members maintain population surveillance in Health and Demographic Surveillance System sites across Africa and Asia, in which individual deaths are followed up with verbal autopsies. OBJECTIVE: To present patterns of malaria mortality determined by verbal autopsy from INDEPTH sites across Africa and Asia, comparing these findings with other relevant information on malaria in the same regions. DESIGN: From a database covering 111,910 deaths over 12,204,043 person-years in 22 sites, in which verbal autopsy data were handled according to the WHO 2012 standard and processed using the InterVA-4 model, over 6,000 deaths were attributed to malaria. The overall period covered was 1992-2012, but two-thirds of the observations related to 2006-2012. These deaths were analysed by site, time period, age group and sex to investigate epidemiological differences in malaria mortality. RESULTS: Rates of malaria mortality varied by 1:10,000 across the sites, with generally low rates in Asia (one site recording no malaria deaths over 0.5 million person-years) and some of the highest rates in West Africa (Nouna, Burkina Faso: 2.47 per 1,000 person-years). Childhood malaria mortality rates were strongly correlated with Malaria Atlas Project estimates of Plasmodium falciparum parasite rates for the same locations. Adult malaria mortality rates, while lower than corresponding childhood rates, were strongly correlated with childhood rates at the site level. CONCLUSIONS: The wide variations observed in malaria mortality, which were nevertheless consistent with various other estimates, suggest that population-based registration of deaths using verbal autopsy is a useful approach to understanding the details of malaria epidemiology

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites.

BACKGROUND: Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. OBJECTIVE: To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15-64 years) and older (65+ years) NCD mortality. DESIGN: All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. RESULTS: A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15-64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. CONCLUSIONS: These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work

Does health intervention improve socioeconomic inequalities of neonatal, infant and child mortality? Evidence from Matlab, Bangladesh

<p>Abstract</p> <p>Background</p> <p>Although there are wide variations in mortality between developed and developing countries, socioeconomic inequalities in health exist in both the societies. The study examined socioeconomic inequalities of neonatal, infant and child mortality using data from the Matlab Health and Demographic Surveillance System of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).</p> <p>Methods</p> <p>Four birth cohorts (1983–85, 1988–90, 1993–95, 1998–00) were followed for five years for death and out-migration in two adjacent areas (ICDDR,B-service and government-service) with similar socioeconomic but differ health services. Based on asset quintiles, inequality was measured through both poor-rich ratio and concentration index.</p> <p>Results</p> <p>The study found that the socioeconomic inequalities of neonatal, infant and under-five mortality increased over time in both the ICDDR,B-service and government-service areas but it declined substantially for 1–4 years in the ICDDR,B- service area.</p> <p>Conclusion</p> <p>The study concluded that usual health intervention programs (non-targeted) do not reduce poor-rich gap, rather the gap increases initially but might decrease in long run if the program is very intensive.</p

Accounts of severe acute obstetric complications in Rural Bangladesh

<p>Abstract</p> <p>Background</p> <p>As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh.</p> <p>Methods</p> <p>Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model.</p> <p>Results</p> <p>Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors.</p> <p>Conclusions</p> <p>Strategies to increase timely and appropriate care seeking for severe obstetric complications may consider targeting of non-certified providers for strengthening of referral linkages between patients and certified facility-based providers. Future research may characterize the treatments and appropriateness of emergency care provided by ubiquitous village doctors and other non-certified treatment providers in rural South Asian settings. In addition, future studies may explore the use of mobile phones in decreasing delays to certified medical care during obstetric emergencies.</p