Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$27.39 [95$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods

The Meaning of “Hygiene” and Its Linked Practices in a Low-Income Urban Community in Bangladesh

Improving hygiene practices is considered to be the single most cost-effective means of reducing the global health burden of infectious diseases. Hygiene promotion and disease prevention interventions often portray and promote “hygiene” from a biomedical perspective, which may not be optimally effective for achieving their goal of changing people’s behaviors. This study aimed to educe the meaning of hygiene for the residents of a low-income community in Bangladesh and how that meaning shapes their personal hygiene practices. We conducted this study in the Tongi township in Dhaka, Bangladesh, from September 2014 to June 2016. The research team purposively selected 24 households. The team conducted day-long observations using the participant observation approach and in-depth interviews with specific members of the 24 households. The concept of “hygiene” had two separate meanings to the study participants: cleanliness and holiness. The participants reported that cleanliness was required to remove odors, grease, hot spices and dirt. The motivation for cleanliness was to feel fresh, avoid heavy feelings, feel light and feel comfortable. To maintain the holiness of the body, bathing and ablution needed to be performed following particular religious rules/rituals. The motivation of holiness was derived from their accountability to God. The participants also reported that the cleansing processes and methods for the body and the home for cleanliness reasons were also different from those for holiness reasons. The notion of “hygiene” was multidimensional for the residents of the low-income urban community in Bangladesh. Our study participants did not explicitly conceptualize a notion of hygiene that was based on the germ theory of diseases but rather a notion that was based on individual physical comfort and cultural belief systems. Future studies on the prevention of hygiene-related diseases should combine and link the biomedical aspect to religious and cultural rituals to promote improved hygiene practices

Measuring Water Quantity Used for Personal and Domestic Hygiene and Determinants of Water Use in a Low-Income Urban Community

There is a paucity of recent research on direct water quantity measurement for personal and domestic hygiene. We aimed to measure the water quantity used for personal and domestic hygiene and to explore the reasons and determinants for variation of water usage. We conducted this study from September 2014 to June 2016 in a low-income urban community in Dhaka. In 12 households, the team conducted a day-long bimonthly ethnographic observation for one year to measure the volume of water used per activity per person. They conducted 28 in-depth interviews to explore the reasons for changes of water usage. Participants used a median of 75 L (61–100) of water per capita per day (LCPD) and of this 75 LCPD they used a median of 39 LCPD (26–58) for personal hygiene. Women used less water than men. Individual and social norms, beliefs, and weather determinants determined personal hygiene. Water availability determined domestic hygiene (e.g., washing dishes, toilets and bathrooms). This study helps to elucidate a range of determinants of water usage of the participants from the participants’ perspective. The quantity of water used for domestic and personal hygiene and its relationship to fecal-oral transmitted disease can be explored in future research