A Multidimensional Approach to Measure Poverty in Rural Bangladesh

Poverty is increasingly being understood as a multidimensional phenomenon. Other than income-consumption, which has been extensively studied in the past, health, education, shelter, and social involvement are among the most important dimensions of poverty. The present study attempts to develop a simple tool to measure poverty in its multidimensionality where it views poverty as an inadequate fulfillment of basic needs, such as food, clothing, shelter, health, education, and social involvement. The scale score ranges between 72 and 24 and is constructed in such a way that the score increases with increasing level of poverty. Using various techniques, the study evaluates the poverty-measurement tool and provides evidence for its reliability and validity by administering it in various areas of rural Bangladesh. The reliability coefficients, such as test-retest coefficient (0.85) and Cronbach's alpha (0.80) of the tool, were satisfactorily high. Based on the socioeconomic status defined by the participatory rural appraisal (PRA) exercise, the level of poverty identified by the scale was 33% in Chakaria, 26% in Matlab, and 32% in other rural areas of the country. The validity of these results was tested against some traditional methods of identifying the poor, and the association of the scores with that of the traditional indicators, such as ownership of land and occupation, asset index (r=0.72), and the wealth ranking obtained from the PRA exercise, was consistent. A statistically significant inverse relationship of the poverty scores with the socioeconomic status was observed in all cases. The scale also allowed the absolute level of poverty to be measured, and in the present study, the highest percentage of absolute poor was found in terms of health (44.2% in Chakaria, 36.4% in Matlab, and 39.1% in other rural areas), followed by social exclusion (35.7% in Chakaria, 28.5% in Matlab, and 22.3% in other rural areas), clothing (6.2% in Chakaria, 8.3% in Matlab, and 20% in other rural areas), education (14.7% in Chakaria, 8% in Matlab, and 16.8% in other rural areas), food (7.8% in Chakaria, 2.9% in Matlab and 3% in other rural areas), and shelter (0.8% in Chakaria, 1.4% in Matlab, and 3.7% in other rural areas). This instrument will also prove itself invaluable in assessing the individual effects of poverty-alleviation programmes or policies on all these different dimensions

Are 'Village Doctors' in Bangladesh a curse or a blessing?

<p>Abstract</p> <p>Background</p> <p>Bangladesh is one of the health workforce crisis countries in the world. In the face of an acute shortage of trained professionals, ensuring healthcare for a population of 150 million remains a major challenge for the nation. To understand the issues related to shortage of health workforce and healthcare provision, this paper investigates the role of various healthcare providers in provision of health services in Chakaria, a remote rural area in Bangladesh.</p> <p>Methods</p> <p>Data were collected through a survey carried out during February 2007 among 1,000 randomly selected households from 8 unions of Chakaria <it>Upazila</it>. Information on health-seeking behaviour was collected from 1 randomly chosen member of a household from those who fell sick during 14 days preceding the survey.</p> <p>Results</p> <p>Around 44% of the villagers suffered from an illness during 14 days preceding the survey and of them 47% sought treatment for their ailment. 65% patients consulted Village Doctors and for 67% patients Village Doctors were the first line of care. Consultation with MBBS doctors was low at 14%. Given the morbidity level observed during the survey it was calculated that 250 physicians would be needed in Chakaria if the patients were to be attended by a qualified physician.</p> <p>Conclusions</p> <p>With the current shortage of physicians and level of production in the country it was asserted that it is very unlikely for Bangladesh to have adequate number of physicians in the near future. Thus, making use of existing healthcare providers, such as Village Doctors, could be considered a realistic option in dealing with the prevailing crisis.</p

Role of risk attitude in the decisions to enroll in micro health insurance plans in a low-income country

Background: Lack of financial resources is a major barrier for access to health care for the poor. A financing system favoring the poor would include prepayment for health care through taxes or insurance with contributions tied to a person’s ability to pay rather than to use of services. Micro health insurance (MHI) was specifically designed for the poor, priced within low-income households’ ability to pay, and to improve access to health care. MHI can play a significant role in promoting the recent Universal Health Care (UHC) initiatives in Bangladesh by providing the foundation on which Governments can promote UHC initiatives. The main weaknesses of micro health insurance schemes are low enrollment and the low level of revenue, which threatens viability of insurance provision. Studies have reported risk attitude as a significant determinant of demand for micro health insurance (30-32, 34-36). A key policy interest is to identify the determinants of demand, emphasizing risk attitude, for micro health insurance programs. Objective: The first aim was to measure risk attitude of the rural people in Bangladesh. The second aim was to estimate the role of risk attitude as a determinant of demand for micro health insurance in Bangladesh. Method: A pilot experiment and a cross sectional survey were undertaken in Chakaria, a rural sub district in Bangladesh, from September, 2015 to June 2016. A micro insurance program, Amader Shasthya, launched in four unions of Chakaria in 2012, offered two options: a basic package which covered outpatient care, and an inpatient package which covered hospitalization costs at a local private clinic. This offered the opportunity to measure risk attitude for both large losses with a small probability (inpatient costs) and smaller losses with higher probabilities (outpatient costs). The sample for the study was drawn using a stratified random sampling design from households surveyed in the Chakaria Health and Demographic Surveillance System (CHDSS). The households were stratified into three groups by enrollment status; i.e. enrolled in the two types of insurance schemes offered and the third not enrolled in either of the schemes. In the pilot experiment, a small sample of 90 randomly selected heads of households, 30 from each enrollment status, were invited to come to a central location at a particular time and date. Risk attitudes of 84 rural respondents were obtained using Dohmen and colleagues’ general and health risk scales and Tanaka, Camerer and Nguyen’s (TCN) paid lottery experiment. The cross sectional study sample included 625 randomly selected heads of households, which included 200 individuals from each of the two insurance groups and 225 households from the non-enrolled group. Risk attitudes of 579 respondents were determined using the simple general and health risk scales developed by Dohmen and colleague. Results: The mean estimated values for risk aversion parameter (σ) and probability weighting function (α) were .57 and .60 respectively. The estimated average value of λ was 4.29 following Tanaka and colleagues’ method. The estimated average value of λ was 6.5 using Liu’s method. From Dohmen’s scale 53% of the respondents were risk averse. Respondents, on average, identified themselves as 6.96 on a scale of 1-11. Both Dohmen’s scale and Tanaka and colleague’s method were valid measures of risk attitude however, Dohmen’s scale was easier to understand and administer and was the preferred measure of risk attitude for the larger cross sectional field survey. From the cross sectional survey risk attitude measured with Dohmen’s general risk scale was not significant at the 5% alpha level (p=.06). The relationship between enrollment and risk aversion was negative for the inpatient package, but positive for the basic package. Trust in the insurer and the insurance product (p\u3c.001) and distance to the nearest facility (p=.048) were significant predictors of micro health insurance demand. A reversal in the direction of effect for the inpatient and basic packages was observed. This can be explained by contextual factors concerning the ‘riskiness’ of the insurance itself. Conclusion: The majority of the rural sample from Chakaria was risk averse with a high level of loss aversion. The risk behavior of the rural population followed Prospect Theory of choice under uncertainty. Both risk attitude measures were valid measures, but Dohmen’s scale was easier to comprehend and use. Trust in the insurer and the insurance schemes and distance to the nearest facility included in the insurance scheme were the only factors significant in the cross sectional analysis of demand for micro insurance. (Abstract shortened by ProQuest.)

Antioxidant activity and Brine Shrimp Lethality Bioassay of the Ethanolic and water Extracts of Fruits and Leaves of Olea Europaea

Background: Cell oxidation can lead to the onset and development of a wide range of diseases like diabetes, cancer, rheumatoid arthritis, neurodegenerative diseases and many more. Antioxidants are substances which can scavenge free radicals and help to decrease the incidence of oxidative stress induced damage. A vast of medicinal plants available in nature has the antioxidant and anticancer properties and recently a great deal of effort are being to find out effective natural antioxidant for the prevention and treatment of free radical mediated disorders. Objective: The purpose of this study was to identify the antioxidant and cytotoxic potential of Olea europaea. Results: Crude ethanolic and water extracts of leaves and fruits of the plant were prepared and evaluated for antioxidant and cytotoxic potential. All the investigated extracts showed antioxidant and cytotoxic potential. Ethanolic extracts of the fruits was found to possess highest antioxidant activity on the basis of DPPH scavenging assay, total antioxidant capacity assay, total phenolic content assay, total flavonoid content assay. However, in nitric oxide scavenging capacity assay ethanolic extracts of the leaves was found to be most effective among the tested extracts. Total alkaloid contents and total tannin contents of the plant extracts were also determined. In brine shrimp lethality bioassay, ethanolic extracts of leaves showed the most potent cytotoxic action with LC50 value of 3.335 µg/ml followed by ethanolic extracts of fruits where standard cytotoxic agent vincristine used as positive control. Conclusion: In this study both fruits and leaves parts showed moderate antioxidant potential. All the extracts possess substantial quantity of phenol, flavonoid, tannins and alkaloid content and initial phytochemical screening also confirmed the presence of the compounds which might be responsible for their activity

Functional Ultra‐High Molecular Weight Polyethylene Composites for Ligament Reconstructions and Their Targeted Applications in the Restoration of the Anterior Cruciate Ligament

The selection of biomaterials as biomedical implants is a significant challenge. Ultra‐high molecular weight polyethylene (UHMWPE) and composites of such kind have been extensively used in medical implants, notably in the bearings of the hip, knee, and other joint prostheses, owing to its biocompatibility and high wear resistance. For the Anterior Cruciate Ligament (ACL) graft, synthetic UHMWPE is an ideal candidate due to its biocompatibility and extremely high tensile strength. However, significant problems are observed in UHMWPE based implants, such as wear debris and oxidative degradation. To resolve the issue of wear and to enhance the life of UHMWPE as an implant, in recent years, this field has witnessed numerous innovative methodologies such as biofunctionalization or high temperature melting of UHMWPE to enhance its toughness and strength. The surface functionalization/modification/treatment of UHMWPE is very challenging as it requires optimizing many variables, such as surface tension and wettability, active functional groups on the surface, irradiation, and protein immobilization to successfully improve the mechanical properties of UHMWPE and reduce or eliminate the wear or osteolysis of the UHMWPE implant. Despite these difficulties, several surface roughening, functionalization, and irradiation processing technologies have been developed and applied in the recent past. The basic research and direct industrial applications of such material improvement technology are very significant, as evidenced by the significant number of published papers and patents. However, the available literature on research methodology and techniques related to material property enhancement and protection from wear of UHMWPE is disseminated, and there is a lack of a comprehensive source for the research community to access information on the subject matter. Here we provide an overview of recent developments and core challenges in the surface modification/functionalization/irradiation of UHMWPE and apply these findings to the case study of UHMWPE for ACL repair

Evaluation of bioactivities of methanol and petroleum ether extracts of Cassia renigera seed

Abstract Background To investigate in vitro antioxidant, brine shrimp lethality bioassay, antimicrobial, anthelmintic activities and in vivo peripheral analgesic activity of methanol and petroleum ether extracts of Cassia renigera seed. Methods Phytochemical screening of the crude extracts was carried out. Antioxidant activity was determined using seven different methods. Brine shrimp lethality bioassay and anthelmintic activities were done using nauplii of Artemia salina and adult earthworm (Pheretima posthuma), respectively. The antimicrobial potential was investigated against three Gram-positive and three Gram-negative bacteria. Acetic acid induced writhing test was performed to evaluate peripheral analgesic activity. Results Both methanol and petroleum ether extracts showed the presence of flavonoids, saponins, and tannins. While alkaloids, glycosides, and steroids were only found in the methanolic extract. Methanolic extract showed more potent 1,1- diphenyl-2-picrylhydrazyl (DPPH), nitric oxide scavenging capacity, cupric reducing and reducing power capacity than petroleum ether extract. While petroleum ether extract showed better results in total phenol and total antioxidant activities. In brine shrimp lethality bioassay methanolic and petroleum ether extracts showed the LC50 value of 74.44 and 121.49 μg/mL, respectively. In overall antimicrobial study methanolic extract showed better activity than petroleum ether extract. Methanolic extract of 50 mg/mL showed maximum anthelmintic activity comparable to the standard (Piperazine Citrate, 10 mg/mL). Both 500 mg/kg and 1000 mg/kg body weight dose of the methanolic extract exhibited significant 39.64% and 58.73% writhing inhibition (푃< 0.05) in test animals, consecutively. Conclusions In a nutshell, the results suggested that the seed can be used as a potential source for the aforesaid bioactivities

Protective role of leaf extract against carbofuran-induced hematological and hepatic toxicities

The aim of the present study was to evaluate the protective effect of leaf methanol extract (SCL) against carbofuran (CF)-induced hepatotoxicity in Sprague-Dawley rats, along with the identification and quantification of polyphenolic composition by high-performance liquid chromatography (HPLC). Results revealed the presence of alkaloids, tannins, and flavonoids in SCL. Similarly, HPLC analysis suggests that SCL contains some known important antioxidants, such as rutin, benzoic acid, and salicylic acid that could be responsible for the hepatoprotective activity of the extract. In CF-exposed rats, significant hematological alterations along with histological changes were marked by the presence of necrosis, congestion, and inflammation. CF-intoxication also showed an increase in lipid peroxidation and decrease in cellular antioxidant enzymes (e.g., superoxide dismutase, catalase, and glutathione peroxidase) levels in rats compared with the control group. Furthermore, coadministration of SCL significantly ameliorated the abnormalities and improved the cellular arrangement in experimental animals. SCL also reversed the alteration of hematological and biochemical parameters and brought them back to normal levels as compared to the control group. In conclusion, may be one of the best sources of natural antioxidant compounds that can be used in the treatment of oxidative stress and stress-related diseases and disorders